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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 8 LT 5kyway Park Estates Block 8 Lot 5 #019-201-06 :<~ ~Y201~ Rainona St. 99515' DRILLED ............ OUT TO THE DEPTH OF 6t) feet. : DRILLED AT THE RATE OF $23.00 PER FOOT. Claus -of, -Rampart ~ material with 65% clay. gravel with30%'clay. Steel casing seated to 60 'ft'.-:'- 4u "~: ---~ .'. Drill:Lng Works. ~' ,_-..._,~-, .... '~ i-, ~-f._ 49 - 58' A fine wet sand. 58 - 60~ A good water bearing gravel. One hour of gumpin6 showea the quality of water vooe very L'ooa. :~ e .... l.L~ ..... lO Total stand of water off Total cost of is /o ieeto off bottom.. drilling is $23.00 per ft. x 60 feet: $1,380.00 CHECK PAYAFILE TO RAMPART 'DRILLING WORKS FOR THE SUM THANK YOU VERY MUCH. ~ . ~. ~ : : : :: ;: , BERNIE CLAUS O~ RA~r ~i~-~S ~ER~i~E CHAROEOF 1~% pER MONTH WILL BE AB~;ESSED ON PAST DUE ACCOUNT~. ' 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 WELL SYSTEM PERMIT PERMIT NUMBER:SW920254 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:TOVREA HUBERT D & BLYTHE OWNER ADDRESS:4161 TAHOE DR ANCHORAGE, AK 99519 DATE ISSUED: 9/01/92 EXPIRATION DATE: 9/01/93 PARCEL ID:01906112 LEGAL ]DESCRIPTION: SKYWAY PARK ESTATES BLK 8 LT 5 SEC 25 T12N R4W SM LOT SIZE: 67518 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: _ Municipality of AnChorage Development Services Depsrtment Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O, Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAIVllLY DWELLING O Parcel I.D. 019-201-06 1. GENERAL INFORMATION Expiration Date: I/-/7-// Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing, address SKYWAY PARK ESTATES S/D; BLOCK 8~ LOT 5 1240 SHORE DRIVE * ANCHORAGE, AK * 99502 WASEEM BUTT & KELLY CONRIGHT Day phone 5541 SKYLINE BLVD * RENO, NV * 89509 C/O AGENT Day phone BARBARA BOWDEN W/ PRUDENTIAL JACK WHITE Day pho.ne 562-3500 5801 CENTERPOINT DR, #200 * ANCHORAGE, AK * 99505 Unless otherwfse requested, COSA will be held by DSD for pickup. 2~ NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class__Well [] Community On-site [] Public Water System [] Public Sewer · The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ~. STATE.f~ENT OF iNSPECTiON BY ENGINEER. ~,,,,xeu ,,~i~to and of'~ ' ~ :'~-"~- u~Le show:'7u~uvv, I v~rlfy u,o~ my As certified by' my seal .... " .... as ,t~ investigation, based on procedures outlined in the Certificate of On-Site Systems Approval GuMeiines for this application, sho~¢~ that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for t,he number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained Lmm the Municipa#ty of Anchorage files a,'~d [~om my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all appficable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179 Address 5701 E. TUDOR ROAD,. SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time 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, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control 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. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The 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 party is not aut,horized, nor will it confer any legal right whatsoever. DSD SIGNATURE 'iJApproved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisow (Rev. 11/05) Arsenic Advisor'/ Maintenance Agreements Supplemental Engineer's Report tJtner Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 EImore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SKYWAY PARK ESTATES S/D; BLOCK 8, LOT 5 Parcel ID: 019-201-06 WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/8/1992 Sanitary seal (Y/N) YES Total depth 60 ft. Cased to 60 ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) YES YES 12+ in. Date of test FROM WELL LOG 10/8/1992 AT INSPECTION 8/8/2Oll Static water level 44 ft. 50 ft. Well production 10 g.p.m. 4.7+ g.p.m. WATER SA~E RESULTS: Coliform colonies/100 mi. / Arsenic: ~:[) ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate ~ mg./L. Collected by: GEG, Ltd. Date of sample: 8/5/201 1 PUBLIC SEWERI Tank Type/Material Tank size __ gal. Foundation cleanout (Y/N)_ Date installed Number of Compartments __ Cleanouts (Y/N) Depression over tank (Y/N) ~ High water alarm~JN~ Pumper Soil rating (g.p.d./ft2or ft2/bd em type Width J ft. Gravel below pipe ft. Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth ft. Eft. a~a~ ft~ Monitoring tube Date of adequacy test~ Results (Pass/Fail) Fluid depth in absor~tiO~eld before test ~ in. Water added Ela~: ___ min. Final fluid depth_ in. ArC) rejuvenation treatment (past' 12 mo.) (Y/N & type) gal. Absorption rate >= If yes, give date Depression over field__ For__bedrooms New depth in. g.p.d. D. LIFT STATION Date installed "Pump on" level at Size in gallons Manhole/Access~ ~ in. "Pump off" leveLa~. High water alarm level at, in. ~ ~ Cycles tested E. SEPARATION DISTANCES Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: N/A Septic tank/lift station on lot Absorption field on !ot N/A Public sewer main ~ Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas 100'+ 100'+ 75'+/100'+ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field PUBLIC SEWERI Water main Water service line. Surface water Wells on adjacent Iot~ SEPARATION DISTANCE FROM ABSOR~LOT TO: Property line ~~oundation__ Water main m drain Wells on adjacent lots. Driveway, parking/vehicle storage F. 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1113648001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 08/10/201 ! 14:56 Project Name/# 1240 Shore Dr. Collected Date/Time 08/05/2011 11:50 Client Sample ID 1240 Shore Dr. Received Date/Time 08/05/2011 12:30 Matrix Drinking Water Technical Director Stel~hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/08/11 08/09/11 NRB Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM204500NO3-F B (<10) 08/05/11 AYC Microbiology Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 08/05/11 DLC Negative 1 100mL SM20 9223B A 08/05/11 DLC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parce~ kD. 019-' ;2. O.~ - O '1. GENERAL INFORMATION Expiration Date: O,.q,, o Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SKYWAY PARK ESTATES; LOT 5, BLOCK 8, 1240 SHORE DRIVE HUGH TOVREA & BLZTHE STENMARK BONNIE MEHNER JACK WHITE 5201 Day phone 522-9799 Day phone Day phone 565-5500 "C" STREET #200 *ANCH, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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 Anchot'age files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal and State codes, ordinances, and regulations in effect at the time of instaflation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date .357-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time 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, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control 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. AKWWC, Inc. can therefore not provide any warranty orfuture estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The 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 party is not authorized, nor will it confer any legal right whatsoever. o DSD SIGNATURE 'L/'// Approved for -~ Disapproved. Conditional approval for __ Attach ments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms. bedrooms, with the fllowing stipulations: ~ WATER AND ~ - WASTEWATER ' ~ % PROO~M ? ~ ~ ~ '. .~ ~.~ %%;.. ..... Manitenance Agreements 222~j1)) ) ) ~ ) ~ ~ ~ :~ Supplemental Engineer's Read Other (Rev. 12/01) Original Certificate Date: D..:.'LIFT STATION - · ,.::' '"~? ,"*~;.~.,',' ,; ;., ..... .' ~ , ... · 4 :': '; . · · Pump. off' k, el'at.. '- m..: ,. :...,... .H~gh. water alarm level at :i~Date installed SEPARATION DISTANCES FROM:WELL 'ON LOT TO: Septic tank/lift station on 10t N/A' Oh' ~ja'cb~{':l~t~ Public sewer main 75'+ .PubliC.~bwer.. manflOle/clean0ut ,..,..,..1-00 .+~-~ Se~'/septic se'NiC~,lihe' .... 25:'+ .": '...' .... "HoIdi'n~:tank':! -. - N~A .:SEPARATI'0N DIS~A;NC'ES:FROM,SEPTIC/HOLDING/q;ANK::©NfLOT~.'ITO: '.,~.U:"~".L:I ~'!":;:,~.-'~ W;:~'R Buildiqg foi~ndatieh-...': ........ · .. :... 'Property line : ~ ,':~:~.: ;,~,':AbSorption field · ' -;... Water main .: .... Water Service"lin~ ...... ,;Sur~ace~water .Wells on..~dj~cont SEPARATION.DISTANCE ~FRO.MABSORPTION. FI'ELD ~N LOT'..TO::'?' Prope~ty-.line -' Water service, line .. C~rt~in"drai,... Buildihg foundation . .. V~'ater. main :: .,-. '...: ,.'.-":" Surfade water D~ ivewaY;-;;pa~king/veh Cle':st~m'~e __ · "Wells on adja~'ent,,:l~t~. :" .COM'M.~N:T,S:': -- . ~' .. .... - ' ENGINEER;$"CERTIFICATION ..................... ~ ~ ".'"" "~'~'.~fl',' ~ ~ '" ' '~ '..':9~"~- ':" ' ' "' ":":"'- .: '~'.,:'~..:"~ '.: ~'." ~'-;~ .... '.'~ :,~;!~:'~'"" Engineer,s Print.e~/Na~e dEFFR~: A..' GARNESS ~: ;. '" 3E~7953" -:' &~ - D~te of,Payme'nt ,1~' t ~"-: 0~',,~ ..... ':' :',":~"-' :':':',:,~::"Date.'orP~ymeat.. ' ...... "' '. - -, ,. Rev 1~01)':'F.'' :, ( .......... .. . ....... · . ,. :.'.'.:~ ;: ~:~... .. ~:'~ ~t~.- CT&E Environmental Sewices inc. CT&E Ref.# Client Name Project Name~ Client Sample ID Matrix 10288292001 AK Water & Wastewater Consultants Inc. Skyway Park Est L5; Bi] Skyway Park Est LS; B88 Drinking Water PWSID 0 Sample Remarks: Results PQL Units Method All Dates/Times are Alaska Stand~rd Time Printed Date;l'ime 12/09/2002 16:44 Collected Date/Time 12/06/2002 14:30 Received Date/Time 12/06/2002 16:32 Allowable Prep Analysis Limits Date Date Init Waters Department Nitrate-N Microb£ology Laboratory Total Coliform 0.302 0.200 mg/L EPA 300.0 (<=10) 12/06/02 col/l OOmL SMI8 9222B JS (<=1) 12/06/02 Ir. AP P-632 SKYWAY PARK ESTATES SUBDIVISION LOT 5, BLOCK 8 ,1,55 AC, (PER PLAT) LEGEND: ~'"'~~'o~ FOUND 5/8". RE~ WEH ~ S~ 5/8" RE~ WEH C~ ~AMPED ' ~ ~~ - "LS- 6091" / 4 I!__ ~1/'~1 LOT 5 EXISTING BUILDING ~°~-~'3 SCALE: 1"=20' ~'"'"- AS-BU IL T I HEREBY CERTIFY' THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RCSPONSIBILIIY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEUE~, ANCHORAGE, AtJ~SKA 99502 COVENANTS OR RESTRICTIONS WHICH O0 NOT APPEAR ON THE RECORDED SUBD~StON PLAT. · UNDER NO CIRCUMSTANCES SHOULD ANY DATA DATE* HEREON BE USED FOR CONSTRUCTION OR FOR 12/16/2002 ESTABUSHINO BOUNDARY OR FENCE UNES. ANCHORAOE RECORDING DISTRICT, AI~S~ JOB NO. SPE58 NOTE: NO CORNERS SET-TH!S DATE. 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 HEAL.TH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) /,~, ~.~0 ~_~']~10~-_~_ U_~./~.f'~Y ~- Property owner Mailing address Lending agency Mailing addressL~_~' /~d~j¢ · . /' · ~ / - . Day phone 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, 4. 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) Front MOA #21 STATEMFNT OF INSPECTION BY ENGINEFR 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/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 inves!i_gation 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 Address Engineer's signature Phone ,,.HS Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 th is 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.  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Otq~ LegalDescription: L5 0~ ~'}L~l~,~ ~;~,Y Parcell. D. O~(~1~ A. WELL DATA Well type Log present (Y/N) Total depth ~' Sanitary seal (Y/N) Cased to. Casing height Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Datecompleted 0c-~ ~1-c)9v'' __ Driller~'~pe¢-~'~'~-~ Z' Y wires properly protected (Y/N) FROM WELL LOG AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL 'FO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ~"-/' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~ I CO WATER SAMPLE RESULTi~) Coliform , Date of sample: ~'-~ ~-93 Nitrate _ ~' ¢/~ ~-~ Other bacteria ¢ Collected by: _~.*-~"'~¢'~'~ ~'~' ,,~¢_~¢~z' B. SEPTIC/HOLDING TANK DATA Date installed Tank size Cleanouts (Y/N) Foundation cleano~'¢~~) High water alarm (Y/N) __, \ ( ,¢ Alarm tested (Y/N) Date of pumping ,/'~'~ t~ ~:~' Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK T~,,E~. Well(s) on lot On adjacent lots To property line Absorption fiel,,d~' Surface water/drainage Compartments Depression (Y/N) Foundatiu. Water main/service I~ ~e 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed % Size in gallons '~ Vent (Y/N) "Pump on" level a'l'~t High water alarm level ~,~ J"/~-Oycles tested Meets MOA electrical codes (Y/N) _ ~. SEPARATION DISTANCE FROM LIFT STATION TO: ~ Well on lot ~ On adjacent lots '~rface water Manufacturer Manhole/Access (Y/N) "Pump off" level at D. ABSORPTION FIELD DATA Date installed Length Total absorption area Depression:over field (Y/N) Results (pass/fail) Soil rating System type. Widl~ Gravel thickness Total depth Cleanouts present (Y/N) Date of aOequacy test for ~,~/ Peroxide treatment (past 12 months) (Y/N) ~(~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIEL~/ Well on lot .On adjacent lots ~ ~'~ Property line To building foundation __ To existing or~a~doned%'~ system on lot %. Wat~a~n/service line On adjacent lots Cutbank Surface water Driveway, parking/vehicle st~area Curtain drain bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines te of this inspection. Signature Engineer's Name Date HAA Fee $ /7~)zcF~ Date of Payment (-¢ .---Z-~"-?,~ Receipt Number ¢%.~,Z.¢,~ ~, ¢¢~/ 72-026 (Rev, 3/91) Sack MOA 21 Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-4§6-3116 2.505 FAIRBANKS ST. ANCHORAGE, ALASKA 99503 907-277-8378 Dns~ructin¢ Engineers 9601 Buddy Werner Drive Anchorage AK 99516 Attn: C. Landers Report Date: 06/24/93 Date Arrived: 06/21/93 Date Sampled: 06/19/93 Time Sampled: 1500 Collected By: CAL Our Lab #: A124229 Location/Project: Skyway Your Sample ID: L5 B8 Sample Matrix: Water Comments: Lab * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Date Date Number Method Parameter Units ................. Result * MDL Prepared Analyzed A124229 EPA 353,3 Nitrate-N mg/L <MDL 0.1 06/22/93 Reported ]3y: Susan C. Tifental Microbiology Supervisor NOF1THERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 450-3~ 16 · FAX 450-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFOtL~ BACTERIA Constructing Engineers 9601 Buddy Werner Drive Anchorage AK 99516 Public Water System I.D.# Date Received: Date Analyzed: Date Reported: Next Sample Due: 06/21/93 Time Received: 11:15 06/21/93 Time Analyzed: 13:30 06/24/93 Time Reported: 10:07 Collected by: CL Sample Type: Routine Untreated Method of Analysis: Men~rame Filtration Comments: S = 0 = POS = ND = TNTC = CG = HSM = SA = Old = Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent: Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old Por Analysis Resample Required No Test * # Colonies/100 ml ~* # Colonies/mi Sample Sample Total* Fecal* Other* HPC*~ Location Dats Time Lab# Coliform Coliform Bacteria Result Comments 1 L5B8 Skyway Park Est, 06/19/93 15:00 AA2101A 0 NT 0 NT S Hugh/Blythe Torrez C.Tifental Microbiology Supervisor