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HomeMy WebLinkAboutSPRING FOREST BLK 2 LT 7ASpring Forest Lot 7A Block 2 #015-321-30 Municipality of Anchorage Page ,/' ,of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,~'~..,/ ~'?__..- o~_,5"'¢.¢, PIDNumber: E:~/..S"...~cO-./,.E, 4..~ _ Name: . ~ ..~,,'~"/~/,,v'~¢' /~'3~'~'~-7-/ Z.-%~-..~ Wastewater System: DHOw D Upgrade Address: /¢~/,~. ~¢,,.x ~,¢,¢/-/7,/..cc..¢'¢'_<"~' ABSORPTION FIELD PT"~ '= I NO, of Bedrooms: / z~'~) ,,~/L/y ._~oC:2'~2(.2 y BPC~epTrench EJ Shallow Trench rlBed E3Moun8 [3Other_ Total Depth from original grade', LEGAL DESCRIPTION S°il"ati'g:~. ~ ~p/s,~.Ft. /¢.,¢ Lot: ~ Block: ~ Subdivision: Depth Io pipe bottom from original grads: Gravel de~th beneath pipe Township:/~ ~ {Range: X ~ ISoction: /~ FilladOod~bovooriginalgrado;o Fl, Gravollength: -,,,..~.O WELL: ~/~ D New D Upgrade Graveldepth: Numbor of lines: Dislancebetweenlines: /~, o ~,, / Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~,. ~. 2~ s~.~,. /~r~ ~F/o Driller: Date Drillod: Static Water Level: Installer: Yield: ~ Pump Set at: Casing HoigM Above Ground: TAN K SEPARATION DISTANCES ~eptic D Holding D S.T.E.P. To ' Septic Absorption Lil[ Holding Public/PrivateManufacturer: Capacity in gallons: Material: Number of Compartments; Surface ~ ~ w~t~ --~ LIFT STATION Lot Size in gallons: Manufacturer: ' "Pump off'; level at: Foundation. ~. ~ I/~"~ ~ ~ ~ "Pump on" level at:, High waler alarm at: CurtainDrain ~ ~ ~ ~ ~ Pump Make & Model Electrical Inspections perlormed by: Remarks: ~~¢., /¢~j¢/~ ~ BENCH MARK / Location and Description~ / /' ~ Assumed Elevation'. ENGINEER'S ~EAI. Inspections performed by: ~ ~ ~ Dates: lst~¢~ ~ ~2.,' ~ Department of Hea~ and.Human Services approval ~,~.¢~ ~, ---NO' ~-~ ~/<W..¢'~ 72-013 ~/91) MOA 25 Permit No, On-Site Wastewaf. er Disposal System SW 92 0256 2 2 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVIOES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ·Anchoroge, Alosko 99519-6650 · Telephone .343-4744 and/or Well Inspectlon Report LOT 7A, BLOCK 2, SPRING FOREST SUBDIVISION 01532130 L. egal Description'. ~ PID No,:  : :/ ~ ~- ~ . . - PROPERTY LtNE' : :'~ .... 7 :/ ' % : ...... \ ....... i .................... ~..~ ..... .I:..~..-\ ~.~ .... i ...... .~ ........... ~ ........ ~ 3~ ~DE ~ENCH ~ ~ ~ : ~ ~ .................. ............ .............. ,; ..... : ..... PROP~R~ DNE ~ ~ 2" HI P~YS~R~NE -~ TRENCH ,11 I ' m~p ~ ~' ~A~ '~ EL: '89:5t .......... ~BE PLAN -- EL. 80.5 1"=50' I1~ EL. 72,8 (BOTTOM EL, OF TEST HOLE) .................... · ..... PROFILE ....... _~ ......... . .................... : .................... NTS TABLE OF REFERENCE DISTANCES POINT DISTANCE TO INVERT REMARKS A B .................. ' .................... " 1 7,9 2 / 49.o I 5 I 57.3 I 70.9 4. ~ 61.4- I 74.5 5 I 68.7 I 8o.a 6 I 128.7 1164.7 7 J 151.2 J168.7 ELEVA'IION 105.13 FDN. CO 101.85 ST CO 101,62 ST CO CO CO 89,51 CO MONIT, TUB 89,51 CO PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920256 DESIGN ENGINEER:BRUST AND ASSOCIATES OWNER NAME:SPRING FOREST INC OWNER ADDRESS:P.O.BOX 90467 ANCHORAGE, AK 99509 DATE ISSUED: 9/01/92 EXPIRATION DATE: 9/01/93 PARCEL ID:01532130 LEGAL DESCRIPTION: SPRING FOREST BLK 2 LT 7A LOT SIZE: 90455 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS SEPTIC SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN DATED 8/19/92. EXTREME CAUTION MUST BE EXERCIZED WHILE INSTALLING THE PERFORATED PIPE TEN FEET BELOW GROUND LEVEL IF THE TRENCH SIDEWALLS ARE NOT SHORED OR SLOPED TO PREVENT SIDEWALL CAVING. RECEIVED BY: BRUST & ASSOCIATES Engineers. Planners - Surveyors 1610 Dimond Drive Anchorage, Alaska 99507 (907) 562.7878 August 21, 1992 Municipality of Anchorage Department of Health and Human Services On-site Services 825 "L" Street Anchorage, Alaska RE: Lot 7A, Block 2, Spring Forest Subd. This letter and attachments is to accompany a permit application for an on- site waste disposal system at Lot 7A, Block 2, Spring Forest Subdivision. The following are attached. 1. Drawing of proposed on-site system. 2. Soils logs and percolation test results. 3. Trench design calculations. 4. Compliance letter from ADEC on Spring Forest public water supply. Applicable portion of plat for Spring Forest Subdivision. A previous plat, before Lot 7 and 8 were combined into Lot 7A, is shown with contour lines. 6. Mechanical analysis of SW soil layer. This subdivision is served by a Class A well which is not within 200' of the proposed on-site system. Development of the adjacent properties will not be adversely impacted by construction of the proposed system as these properties are already developed and distances to adjacent features are in compliance with applicable requirements. The closest feature that could be affected is the existing water line, which is 16' from the closest point of the proposed original system, and which must be crossed by the proposed sewer. Slopes on this portion of the lot are moderate. Drainage is to the north. When the SW soil layer was perked it was noted that the perk rate was less than 1 minute per inch, therefore only one reading was taken. However, subsequent examination of the soil and a mechanical analysis disclosed that the characteristics of the SW soil were similar to the filtration materials specified in AO 90-48(S-1), Section 15.65.060. Actually, the D10 size is finer and the soil less uniform than specified in the ordinanceS- It would be incongruous to remove the SW layer and replace it with a layer of possibly more permeabl~ material. It is felt that using this material in the design will allow the design to function in compliance with the intent of the ordinance. There are several mitigating factors which were considered. First, this subdivision obtains its water from a distant public supply. Second, no ground water was encountered in the test hole, which was dug to 26.5', nor was any moist soil noted. Third, the large size of the lot (2.08 acres) was considered to be a plus factor. DHHS Page 2 August 21, 1992 Both the replacement and the original system trenches fitted within the 30' radius circle around the test hole. It is recommended that a permit for the on-site system be issued. Sincerely, Stanley Brust, P.E. cc: Spring Forest, Inc. E c~ SP PIPE ~ ~o ~.~' ° ~_ ~_2,0' ~ENCH CROSS SEC~ON I"=10' 1"=100' NOTES: 1, TRENCH IS 37,5' LONG FOR A 4 BEDROOM DWELLNO, ~A~ 2. SEPTIC TANK CAPACITY IS 1250 GALLONS, ~ .2~ .~' 3. ALL MATERIALS TO CONFORM TO MOA REQUIREMENTS. x'~'X~'~'' .... ,,~;e~ 4. FINAL ELEVATIONS TO BE SET IN THE FIELD. ~,,, 5. SEWER LINE SHALL BE DUCTILE IRON WITHIN 10' OF ~ ~ .~ WATER LINE, AND BE NO LESS THAN 18" ABOVE OR ~ ~ 49~h ~ % ~ BELOW. SEWER LINE JOINTS MUST BE AT LEAST ~"""""~ .................... ~ ............ ~""""~ 9' FROM WATER MAIN, ~ STANLEY ~RUS~ BRUST & ASSOCIATES CHECKED BY; S,B. SEPTIC SYSTEM LAYOUT ~A~: 8/~ ~/92 EN Gl N EER S- PLAN N ERS- SU R~YOR S SCALE; AS NOrD 1610 DIMOND DRIVE (907)562-7878 LOT 7A, BLOCK 2 ANCHORAGE, ALASKA 99507 SPRING FOREST SUBDIVISION dOB NUMBER; 92-13 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEG*' DESCR,PT,ON: 1 2 3 4 5 6 7 8 9 1o 11 12 13 14 15 16 17 18 19 2O COMMENTS ..... " /0|~ . ' .~ ~ Township, ~an§e, Section: '~/'* SLOPE SITE FLAN ~ ' WAS GROUND WATER ENCOUNTERED? L IF YES, ATWHAT O DEPTH? p E IYioniloring? Date: ~ Gross Net Depth ~ ¢ i~ Net Reading Date Time ,,,¢/L~ Time Water Drop / pl .lcz. RATE /~' ~ (mmules/,nch) PERC HOLE DIAMETER TEST RUN BETWEEN /~__ FTAND /¢'~ ~ ,.-~-~, ~b ~" / PERFORMED BY: .~¢'- ~'$"t~.~7' I ,~, ~,-~')'¢~* b'..(~'" CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE-DATE: ~--~)/4~ 72-008 (Rev. 4/85) Municipality gl Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTIQN: ¢-2 '¢-6 5/44 ¢. ..... 9.': Township, Range, SITE CLAN COMMENTS WAS GROUND WATER ~/~ ENCOUNTERED? S L IF YES, ATWHAT O DEPTH? Pi Oopth Io Waler Alle~r/ Monitoring? /L/dF1 .~ Gross Net Depth ~o- O' i/~ Net Reading Date Timo Time Water Drop PERCOLATION RATE (f~' ~(' immures/tach) PERC HOLE DIAMETER TEST RUN BETWEEN /7 FTAND //'~ FT PERFORMED BY: ,~-~, ,~',~'/~ ~ 'T i ,.~' X"?/~?'/ ¢ ~ CERTIFY TRA] THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC1 ON ~HIS DA 72-008 (Rev, 4/85) JOB NCl, BY DATE CHKD - ', ~ ~ ~ ','-~ ......... ~ ~,~- ~ ~ ~-~- ~ ~ i ,, .... -~ b 'r - i ', ~ · ~ · · :. ~ -~ ~ · ~u~ i. ~ ~ ~-~.-~ .... "-~ .... ' ....... I ...... ~ .............. ~ ......................... ~ .~... ~1 ..... ~ ............. ...... 1 ......... ! ...... j , ,, - I ..... ! ...... ..................... ~ ......... ~ ..... . ; ..... [ ..... i ............ 1 ....... ~...;- ~ , ........... ~ .... 1 ...... f ............. ~' -I -~ · ~ ..... ~ '~ ~ .... ~ ............ t · , ~ I I ~ ~ t ', , ' ' .... ; ...... ~ ....... .... ~"', ............. ~ ............. ~ .... ~ .... ~ ~ ' ~ ' '~ ~ '~'"~ ........ b I ....... ~ '~ ' ~, ~ ~ ...... i ~ , ..... ~ ..... ~ .... I ~ ..... ~ .-[ . . : -. ~ ~ ~ ~. i .... ~, - ~ · ~ .... ~ ~ ~ --~ ~.~.,,~'- .....,~-,.,-~,~-~.. · ; :J i ~ ' .' ,i t' J ~ j j AN~HORA~ E, IAL&SK5 97 ,507, _BASIS OF BEARING N 89° 59' 51" E ( 85-7 526.28( 8:5*7 & MEAS) 14 R :50,00 T:34.30 L,% CHD. BRO., N 78o00' '0 0 20' Utility Eosmt. eo'...,.// 0 "~ TREE /' / ~. ~oJ x,~ e,,. ~.., CHI CH CASE 300.00 REC.& H~LD ~ lO' TELEPHONE '~ ' EASEMENT S.F. Ac. 50~8! 1.16 '1 \37,525 X~862 Ac.,.,, I $,F 6 53, 15 1.2: 3 130 S.F. 0 33 Ac. \ 5 48 219.97' 4 43,730 $.F. I. 004 AC. 5 ,/ .2 2.0 Ac. 43,121 0.990 o0 ,~0 9 43 001 S.F. ~- /I D44'Ac. ~ / © 347 S.F. ALASKA T E S T L A [] Elivision of [:)OWL, Incorporated AUG 1992 BRUST & ASSOCIATES 1610 DIMOND DRIVE ANCHORAGE~ AK 99507 ATTEN: STAN BRUST PROJECT CLIENT SUBJECT SPRING FOREST SUBDiV1}i;iON SPRING FOREST INC. MATERIALS ANALYSIS SAMPLE DATE: 14 AUG 1992 GENTLEMEN: TRANSMITTED HEREWITH ARE ?HE F, ESUbTS Oli' SIE\!E ANALYSIS PERFORMED IN OUR LABORATORY ON THE SUBJ~.:C,T THE METHOD USED WAS ESSENTIALLY iN ACCORDANCE WITH THE FOLLOWING: ASTM C'-]36 (AASHTO T-27), "SIEVE AHALYSIS OF FINE AND COARSF. AGGREGATES", ASTM Cl17 (AASHTO T-ii) "MATERIALS FINER THAN NO. 200 SIEVE IN MINERAL AGGREGATES BY WASHING", AND ASTM HETHOI) !}422 (AASHTO T-88) "PARTICLE SIZE ANALYSIS OF SOILS". THE GRADATIONS MAY BE FOUND ON SHEET ]. OF 3 ATTACHED HEREIN. I[.' THERE ARE ANY (.~UEST[ONS IJ~! TIiiS REGARD, PLEASE CONTACT OUR OFFICE. VERY TRULY YOURS, ALASKA TESTLAB TECHNICAL DIRECTOR CC: SPRING FOREST, INC. ./ 4040 B STREET e ANCHORAGE ~ ALASKA ' 9950~-5999 ' 907/56~-2000 A Divisian of nC)WL~ MECHANICAL GRAIN SIZE ANALYSIS SHEET i OF 2 FOR SAMPLE: 718 ........................................ WORKORDER NO. A25341 ,JOB NO, PROJECT: SPRING FOREST SUBDiVISiON I,OCATION: S?RING FOREST SUBDIVISION [,0%' 7A, BLK 2 SUBMITTED BY CLIENT DATE RECEIVED: 14 AUG J. 99[] DATE '?ES'rED: :[4 AUG 1992 FROST CLASS: NULL(CORP) NULL(MUNI) UNIFIED: SW-SM DESC: WELL GRADED SAND WITH SILT SAMPLE TAKEN WAS 3199% OF RECOMMENDED MINIMUM SAMPLE WT. OF 200GMS COEFFICIENT OF UNIFORMITY = 5.3 COEFFICIENT C~ CURVATURE = 1,3 PERCENT SIEVE PASSING 3 INCH 100 2 INCH 100 1 2./2 INCH 100 ]. INCH 100 3/4 INCH 1/2 INCH 3/8 iNCH 100 NO 4 97 NO 10 89 NO 20 64 NO 40 32 NO 60 17 NO 100 10 NO 2OO 6 4040 B STREET e ANCHORAGE e ALASKA ' 9950G-5999 * 907/56E-2000 Percent Finer by Weight 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shcwn below= I ~.dfy that n,y investigation, based on procedures outlined in the Health Authority A;:proval Guidelines for this applica~cn, sncws, that the site water supply and/or wastewater disposal system l~.(are) safe, functional and 3dequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the infommtian obtained frcm the Municipali,'y of Anchorage. flies and from my investJgaSon and inspe~ion, the on-site v,~ter supply and/ur wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 5 & s ENGINEERING liUJ,4 F..a§le F.l,,;, Lo'~ Read Address =~aqle Rive;', Alaska 99577 Engineer's Printed Name ~3~ r~o;. 7' (~. DSD S~NATURE ~ Ap;3roved for ~ Disapproved. Conditional approval for Phone 6'c~~~'~ "7 ? bedrooms. bedrooms, with the fcllcwing stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's R6pert Other __. Odginal Certificate Date: I O - ~.. 0.2-_ Municipality of Anchorage Development Services Department Butldlng 6afety Division On-Site Water & Wastew!a_ tar Program 4700 South Bmgaw St ~ P.O. Box lg6650 Anchorage, AK g9519-86S0 vnw,,.cLanchorage.ak.ue HEALTH AUTHORITY APPROVAL CHECKLIST Legal Oesc~lpflon: A. WELL DATA Well lype ~ IfA, B, or G provide PW~ID # ;~ I ]'~& ~ Well Log ~/N) -------- completed Sanltery eesl (Y/N) Wires properly p. ~~) Date Total deplh ,. , [ Cased to It. ~(above ground) - in. Sta~¢water level Well pn3duction / g.p.m, g.p.m. Co~, f colonies/100 mi. Nitrate mgJI. Other bacteria colonies/Il30 mi. ~~ mg~1'' Date of .ample: . Collected by: Oat~'in~lled~; $ollratino~or~/bdrm) O-E)q 8ystemtype 'TR¢,vc-- Length ~/<~ It. Width 3 ft. Gravel below pipe ff ft.. Toteldeptfl ~I lt. Eff. absoq~tlanares'/3Oftj Monltorlngtube ~'Ls' Depres$1on over field Wo Date~fadaquacytest ~/~'"//0~- Resulte'"~[Fall) eAU For /'/ bedrooms Fluid depth in absoq~tion field before test} / II/'in. Water edded7$/ gal. New depth~ '~n. EiapsedTime: GO min. Final fluid depth l' h /' in. AJ~oi13tlonmte >= ~(PO g.p.d. AnyreJuvenafiontrestment(pest12rno.)(Y/N&type) ~o,v¢ K'~v~ Ifyee, glvedate ~ O~ installed c~anow~) High water alarm (Y~ B. SEPTIC/HOmING TANK DATA Tilnk.~l~t~.$ O gal Nu~r~~n~ ~ Oam~pl~q/a~e~ Pum~r D~ ~ C, A~SO~ON ~ DATA D. UFT STATION Date lestelled 'Pump on" level at __in. Datum ~.- E. SEPARATION DISTANCES Size in gallons 'Pump off' lewl =t Cycles tested (~ ,~,,~ ~ ~', ~.- y SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N~ / High water alarm level at in. Meets alam~ & circuit requirements? Se~c tank/lilt station on lot On adjacent lots Absorption field on lot Public sewer main Se~r/septic s~,wt~ line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3 "/ / Property line 5"/ Water main 10/'~ Water sewice line /o Wells on adjacent lots ~' O0 Absorption field 3"0 ¥'- Surface water ! Oo ~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: prOperty line '"/t Building foundalton Water Sewice line /o ~' SurMce water Curtain drain/d~,v~.. ~c~'ew~ Wells on adjacent lots Water main / oo'Y- Fo COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Pdnted Name ~0~'~7- C. C~A~/ Date / o HAA Fee $ .~ 7,~. "~ Date of Payment / o / ~- ~.//o -=- Receipt Number o '~- '/ ~ ¥ =/ /~ (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number N BASIS o~ I0' UTIL, & TELECOM. ESMT, 243.12' t 243.54~ (REC) / Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Sox 196650 Anchorage, Alaska 99519-6650 (9O7) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-321-30 1. GENERAL INFORMATION Completelegaldescription SPRING FOREST S./D: LOT 7A, BLOCK 2 Location (site address or directions) 6o21 WEST TREE DRIVE Property owner Mailing address Lending agency Mailing address JEFF HI'FI-SON/MARY PACHECO 6021 WEST TREE DRIVE. ANCHORAGE AK Day phone Day phone Agent TERESA BELL PR~ENTIAL JACK WHITE Day phone (907) 441-2952 Address 5201 O STREE-r SUITE 200. ANCHORAGE AK. 99505 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of systern. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide wfitten confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91 ) Front MOA fY21 Computer Version Note: Alaska, Water and Wastewater Consultants, Inc. shall be paid $1100.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As cadified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I fudher vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municip'~l and State codes, ordinances, and regulations in effect on the date ofth,s,nspect,on. Name of Firm ALASKA W~TER &,~AS'I~EWA~ER CONSULTANTS, INC. Phone (907) 337-6179 / IIIII/ VII/ Address 6901 DEBARP,/ROAD,/S¢~/E2B' ANCHORAGE, ALASKA 99504 , / Engineer's Signature ( _~,/-~/,,"//~~ .--. ~ Date '~'/z~,/o~ In conducting this evaluation, AWWC, lng. ~tte/~pted to provide a thorough, conscientious engineering Jnalysis of the system in accordance with ADEC and MOA DHHS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the lime of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water ,~.,~.~_~..%.%~,, / usage of the famlly being served bythe syetem. Thase conditions are outside the eentrel of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. '" ...... .. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. Tho content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or pady is not authorized, bedrooms nor will it confer any legal right whatsoever. 6, DHHS SIGNATURE ~ Approved for L.~ Disapproved Conditional approval for -7955 bedrooms, with the following stipulations: Additional Comments {/L,/, ~::;:~ Date Z./- /LO-OO The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cedificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Sack MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L' Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: SPRING FOREST S/D; LOT 7A, BLOCK 2 Parcel I.D.: 015-321-30 A. WELL DATA Well Type CLASS "A" If A, B, or C, attach ADEC letter. ADEC water system number 213564 Log present (Y/N) Date completed ~ Total depth Cased to ~ Casing height (above ground) ~ Wires proPerly protected (Y/N) Date of'test Static water level Well production FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: Coliform Nitrate _~_~_--~-- Collected by: ena B. SEPTIC/HOLDING TANK DATA Date installed 9/23/92 Tank size Foundation cleanout (y/N) YES Date of Pumping 3/31/2000 125o Number of Compartments 2 Cleanouts (Y/N) Depression (Y/N) NO High water alarm (y/N) N/A PumperA+ HOME SERVICES YES C. ABSORPTION FIELD DATA Date installed 9/25/92 Length /A~3/ ~' Width Soil rating (g.p.d./ft2 or fl2/bdrm) 0.89 3' Gravel thickness below pipe System type TRENCH 9' Total depth 22' Effective absorption area Date of adequacy test 4/3/2000 Results (Pass/Fail) PASS For Fluid depth in absorption field before test (in.); DRY Immediately after 1271 Fluid depth DRY (ins) Minutes later: 1125 Absorption rate = 720 SQ FT Monitoring Tube present (Y/N) YES Depression over field (y/N). NO 4 Bedrooms gal. water added (in.): 5,5 6OO+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date 72-026 (Rev. 3FJ6) ComputerVersion D. LIFT STATION ' ~' Date installed_ - ~ ..... Manhole/Access (Y/N) ~lat* "Pump off" level at* High wa~ *Datum __ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~ Septic/holding tank on lot O~ts Absorption field on lot ~ / On adjacent lots Public sewer main Public sewer manhofe/cleanout  Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field Water main/service line 10'+ Surface water/drainage, 100'+ Wells on adjacent lots SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Surface water 100% Driveway, parking/vehicle storage area Curtain drain NONE KNOWN E. ,.EER'S I certify that I~avo (~et~rr~r~hr~field inspections and review of Municipal ~co~ t~t~e ~ve~systems am in confo~ance Signature EngineeCs Name[ dEFF . Date 5'+ 200'+ Water main/service line 10'+ 10'+ Wells on adjacent lots 200'+ '(~.'~. ',., ~E-7953 ..' ~ Date of Payment Receipt Number ,~'~/~ (~P(0r'~' 72-026 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number .~ I~UNICIPALITY OF ANCHORAGE 2-~ DEPARTMENI' OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) ~-O0~j (.¢-~r.L%~'T.c'cL~_. ~)~",~' ..p ,y _ . . ,. yp M~i~ih'g address ~t~,~%. :'Qf} ¢~[~C~ [,~¢ Lending ~agency- = Day phone Mad~ng.address~ · ~, ,~ .¢, : ,; .... Agent J~[,7~/.. ~rl~e_t~(,, ~ff/)~ ~-~)W~["~i Unless otherwise requested, HAA will be held for pickup. NUIVlBER OF BEDROOIVI8: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: 'Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA#21 STATEMENT OF INSPECTION BY ENGINEER, As certified by my seal affixed t~ereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I fur[her verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm'~::~A Address ~'~-- (~,~c~'¢- Engineeds signatur~~-'~~':'~ Date. DHHS SIGNATURE ^pprovedfor Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-~25 (Rev. 1/91) Back MOA¢~21 Legal Description: A. WELL DATA Well type /~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage i{,.,oIE CE~IV 1998 E ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANCHORAGE Health Authority Approval Checklist qNVIRONMENTAL SERVICES D V S O~ , J If A, B, or C, attach ADEC letter. ADEC water system number C~ / ~ 5(0 q _ Date completed Cased to Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ ~ '~'- Date of sample: -~z -l"~ g.p.m, g.p.m. Nitrate * J ~ Other bacteria Collected by: ~- [~--'~, B~___p_~HOLDING.TANK DATA Dat~i~stalled ?/(~./? ~ Tank size /c~-~_.) ~t~umber of Compa~ments Foundation cleanout (Y/N) ~ Depression (Y/N) High water alarm (Y/N) Date of PumPing IO/~? Pumper C, ABSORPTION FIELD DATA Date installed Length z'"z c::' Width Soil rating (g.p.d./ft2 or ft2/bdrm) 4~:~, ~ ~ Gravel thickness below pipe _ Cleanouts (Y/N)-~ System type bc~p-F~a% Total depth Effective absorption area -';'?¢~C) Monitoring Tube present (Y/N). ( Depression over field (Y/N) .4./ /ttl ? (Pass/Fa,) <q~k ,s.~ bedrooms Date of adequacy test Results For Fluid depth in absorption field before test (in.); 22~ Immediately after ~'~ gal, water added (in.): ~' Absorption rate = ~'~ _g.p.d. Fluid depth ~" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) '------=~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size i?~...~ Manhole/Access (Y/N) ~t* High w~ *Datum ~tested "Pump off" level at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On ad'a_~M~ On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM ~HOLDING TANK ON LOTTO: Foundation i~_:~2)~r~ c~' Properly line ..~ Il 0 ~ , Absorption field Water main/service line ,~'¢ ~ Surface water/drainage /cc)T- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation /2~1 '-~ Water main/service line Driveway, parking/vehicle storage area WeIIs on adjacent lots / ~ ~' ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rec~stems are in conformance with MOA HAA guidelines in effect on this date. Signatur~~_.-~~~ En neers Name '~~~--~,,~AJ/,JO~¢-~'''~ ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3~96)* Waiver Fee $ Date of Payment Receipt Number 90'?S61530! P.01/01 ChemLab Ref, #: 98.3621 Client Name: Pennons Eng, 8vt, Project Name: LTA B2 8prlnQ Forest $/D Client 8aml31e ID: Outside Hose Bib Matrix: Drinking Water PW$1D n/e Sample Renlarks: Ciient PO#; Printed Date/Time; Collected Date/Time: Received Date/Time: Technical Director: I~lea..~d By 7/~0/~8 10:00 7/13/~8 1t;30 7/13/~8 11:45 8tephan Ede Parameter Results F'QL Unite Method Total Coliform (MF) 0 col/100 mi SMg222B Nitrate 0.1 U 0,1 mgtL EPA 300 Allowable Prep Analysis Limits Date Date Init 10,0 7/13t@8 TMW 7/14/g8 RMV TOTAL P,OI Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, Alaska 99514 (907) 272~8218 Legal: Owner: Residence: SEPTIC SYSTEM ADEQUACY TEST Lot 7A, Block 2 Spring Forest S.D Mr. John Slade & Ms Carol Singleton-Slade 6021 West Tree Drive, Aucborage, AK 99516 Septic System: Tank Size: 1250 gallons. Absmption System Type: Deep Trench (fi'om Municipal records) Absorption System Size: 40x9x3 Absorption Area: 720 Installation Date: 9/23/92 Soil Rating: 188 sffbr Date of Pumping: 7/10/98 By: A+ Home Services Date of Test: 7/11/98 'rest Procedure: Systelu was inspected visually and measnred. Tank was :found with 4 feet of cover. Liquid depth was measured to be 5 inches. The draiu field was found to have 12 feet of cover and a total depth of 25 feet. There was 3 iucbes of liquid measm'ed in the trench monitor tube. Water was added from the house at a rate of 7.9 gallons per minute (GPM) The water levels in the tank and drain-field monitor tubes were monitored. A total of 600 gallons of water was added. During the test, the liquid level rose 5 inches in the field. No rise was noted in the tank. The infiltration rate was monitored for 24 hours. During this period, a total of 600 gallons were absorbed. By the observations made, this system has an absorption rate 600 + gallons per day at the time of the test. This house is served by a Class A water system. The water fi'om the outside hose spigot flowed at 7.9 gpm. We contacted the Alaska Department of Environmental Conservation (ADEC) concerning the adequacy and quality of this ;yell. They stated that this well is in conformance with 18AAC70, Drinking Water Regulations. We conducted a water quality investigation from the hose spigot. There was no bacteria noted and less that I mg/l of nitrates, which meet the drinking water standards. TESTS RESULTS: This system meets tie code and operational requirements of the Municipality of Auchorage and ADEC. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the systmn under the couditions encountered at fl~e time of fl~e test, and separation distances measured to readily identifiable features. The operatioual life of all wells and septic systems depend on the local soil condition, ground water levels that tnay fluctuate duriug tim year, and the water usage of the fmnily being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactm~ test results do not guarantee fi~tum performance of the syste~n, nor do they guarantee that there are no hidden defects or encroachments. We can therefore uot give any estimate of how long the syste~n will coutinue to meet the operational requirements of the Municipality and State. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O \~'- -- ~-( - -~ C::) 1, GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) (o~- I Property owner Mailing address Day phone ~{~-'~'7 Lending agency Mailing address Agent Address Day phone Day phone "TDZ- '~/)0 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well X Public water NOTE: If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of tills Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system isflin compliance with all Municipal and State codes, ordinances, and regulations in effect on the~ate of this inspection. Name of Firm ,A'~'~'~[~. ~ /I. Engineer's signature (__.,~ Phone ~37-~/? ~' Date ~/'~ ~-/~ bedrooms. 6. DHHS SIGNATURE './~ Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments II!1 The Municipality of Anchorage Department of Health'and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The D H HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~Y21 ~UN~C~^Urr O~ ~NC~o~e~ mv~ot~mr,~ ~wc~ D~W~o~ Municipality of Anchorage ~G 2 6 ]996 ~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: bet "7'/~,,~ ~1~?.~ ~'.,¢--I,,~ Parcel I.D.: 0 c.~- 3~_~1 -50 A. WELL DATA Well type ~o~-4. If A, B, or C, attach ADEC letter. ADEC water system number Total depth '"'~_ Cased to Casing height (ab~round) Sanitary seal (Y/N) '"'-~_ Wires pr~t~e~y protected (Y/N) F:RO ' L LOG INSPECTION Date of test ~'t~,,~ Static water level Well production / g.p.m.~ g.p.m. cWcAI iTf:rRmSA~" Nitrate Da e ot~f sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~/2,2,/~ ~.. Tank size / 2~._~"O Number of Compartments ~-' Cleanouts (Y/N). Foundation cleanout (Y/N) _ y Depression (Y/N) .~C) High water alarm (Y/N) Date of Pumping B/:z~"/c)~ .Pumper~ ~c4) ,~1¢~c,,,,',,'~-~ ~¢' C. ABSORPTION FIELD DATA Date installed ~/2-3/c/z Soil rating (g.p,d./fF or ft2/bdrm) "~ System type Length '¢~rO Width ~ / ~ ! Gravel thickness below pipe Total depth "~ Z / _ Effective absorption area -7 7~O Monitoring Tube present (Y/N) ~ Depression over field (Y/N) Date of adequacy test ~/~/~ Results (Pass/Fail) ~OA'-3 -,(' For ,~L bedrooms Fluid depth in absorption field before test (in.)',_ ~' Immediately after~C;O., gal. water added (in.): Fluid depth I ~ (in.s) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Absorption rate = If yes, give date ~/~ _g.p.d. Date installed ~ Size in Manhole/Access (Y/N) ~__"Pump off"level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main t,J Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station i',J SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / Foundation '~" ~ Property line --'~ / '~ Absorption field ~'~ / Water main/service line ~ / Surface water/drainage '> J oo Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line "7 t / .~ Building foundation [ '~'. L7 / ~ - ~ Water main/service line Surface water ;~ ~ ~20 ~ Driveway, parking/vehicle storage area / Curtain drain ~ ~ Wells on adjacent lots ENGINEER'S CERTIFICATION ~ /I) I ce~i~ that I hav~eter~i~d th~u fie~spections and review of Municipal in conforman~th~AA'~n* in effect on this date. Signature Engineer's N~m~~ ~"~~~ HAA Fee $. Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment 'Receipt Number Bonn -i ~ M~I'~ 'n~a Y' 76~,, - :L EISEI :. - US91:00(~TI'~4C:E$ PRL'YA~L OV~ r.~2,AUH~, REPR~X~UOIlI~I UAY O;ALI~: I~R~$ IN ~P,7,A.LL PLOT P~N~ ~, LOT SUR~ GON~UC~ON, TD ~R)~ PRO O~ I~HO ~'~ .....I .~ ~. ~z'~,, Robert E. Johns,: .dr. · A~,S,~; ;;' Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~.~ -,~ .~) ¢.~/.~¢~¢.~ ,:... ,.: :,, ,; , NAA # GENERAL INFORMATION ' ' Complete legaldescription -~)~7~ /~y /~O~/J'~' ¢ · Location (site add'ress or directions) Property owner ~.-/_~./,,.~¢ /z_%¢.¢.:~"..~/~-~o6 Day phone Mailing address / Lending agency Day phone / /,.> / Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my'investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone ---~'~' ~ "',~¢-'¢¢JoP7 Address BRUCT & .... ~'^t=o ENGINEERS - PLANNERS - SURVEYORS 1610 DIMOND DRIVE AN OHO RAG E~/~.~AS KA 99bU! Engineer's signature ..~/~ A .~..~ ~'~ DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms, Date bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1t91) Back MOA #21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -~¢;/'~,~-//Y~- r~¢'/~D~- ~/-~//~¢¢Parcel I.D. A. WELL DATA Well type Log present (Y/N) ~-' Total depth ----- Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION FROM WELL LOG Date of test Static water level Well flow Pump level ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g,p.n~iT~ ~o WATER SAMPLE RESULTS: Coliform Date of sample: B~JHOLDING TANK DATA Date installed Cleanouts (Y/N) __ N it rate Collected by: Tank size/, Foundation cleanout (Y/N) ~ High water alarm (Y/N) /~/~ Alarm tested (Y/N) Date of pumping //?~¢ ¢~'~ .-~' ~ ~¢¢'~ Pumper ~ ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _~'"~ On adjacent lots TO property line ~-~'~: d) Absorption field Surface water/drainage /'~"/Z¢¢ Other bacteria Compartments Depression (Y/N) /~ Foundation '~ (°'~¢ ¢¢r~ / Water main/service line ,-~ ~' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ,~'~./~' '- Length Z/' (..)" Width ~-~ / Total absorption area Depression over field (Y/N) /'l/' Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for if yes, give date ~. (¢¢¢ ~)'~¢~,~'System type ZPZF'Z'~'/'~ -~-/-Z~:/¢ c/L/ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot .,d/o >-2~- On adjacent lots ///'/~ Property line To building foundation On adjacent lots /'~-~ Surface water Curtain drain To existing or abandoned system on lot Cutbank ,/'~/~ Water main/service line. Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S i g n at u r e,.....__..~ ~ Engineer's Name Date HAAFee$ /'7~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRIC-r' OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 April 12, 1993 (907) 349-7755 Brust and Associates SUBJECT: Lot 7A, Block 2, Spring Forest Subdivision Class "A" Public Water System, PWSlD #213564 Dear Sirs: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 12, 1993. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on January 28, 1991. This does meet the provisions of 18 AAC 80.200(a). The last Radioactive Contaminants Sample results were submitted to the Department on July 27, 1988. The analytical results of previous water samples for Radioactive Contaminants were satisfactory. The owner/operator is currently collecting samples to remain in compliance with State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 16, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do riot hesitate to contact this office at 349-7755. Sincerely, . ,, Keven K Kleweno, P.E. District Engineer Enclosure