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Home My WebLink AboutHARNESS LT 2 MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [] NEW ~ I MAILING ADDRESS LOCATION NO. OF~ROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: ~ I ~ ~ Z Manufacturer Material No. of compartments I nside ICngt~ Width Liqu id depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons Well ~ DISTANCE TO: / /~ .~ Foun~at~, Nearest tot Hne PE~lTNO..Distance No. of ,iney :Length of¢c~ne Total lengt~ines Trench~ between lines --/~ inches ~ Material beneath ti?~ *oral area ken,th ~Mth Depth ~[BMIT ~0. ~ ~ ~ype of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER I PIPE MATERIALS SOIL TEST RATING INSTAbLER 0~ 72-013 (Rev. 3/: PERMIT NO. I'-IL.IF~ :I. F: 1' F"F-IL I T'-r" OF F-II'-.~ C:i .IOF:FIF~E [:,EPARTMENT Or~HEFILTH FIN[:, ENVIRONMENTFIL P'~'iTECTION 825 "L STREET., RNCHORAGE., AK. L~L~.=_,u, 264-47'2~-1'~ CJF.~--S I TE SF"I4EF." F"EF:f.t Z T ( 800494 ) RF'PLICRNT LOCRTION LEGAL T. SPURI<LRND HRWKINS LANE SEC 20 TZ2N 8t55 CRANBERRM 24~-5302 i~0680 SQUARE FEET TMPE OF SOIL RBSORPTION SMSTEM IS: DRRINFIELD MFI,':'-,'IMUH NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [:.EF"-Fk1=c~.~- LEF~ISTH=: e]~ I3~:R'..."EL C. EPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THE TF:EIqC:t4 kiI[:.T~4 IS 5. ~30~3 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE RND THE BBTTOM OF THE EklCAVATION (IN FEET). RE[:, SEPT I C: TF~F~F.: S I ZE= 12 5F-! ,]RLLi]F4S PERMIT RPPLICRNT HFS THE RESPONSIBILITM TO INFORM THIS DEPRRTMENT DURING THE INSTRLLFITION INSPECTIONS OF ANM WELLS ADJACENT TO THIS PROPERTM RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SER',,,'E ........ T~40 ( 2 ) I F,tSF'EE:T I E~'4S F4F.'E E." EC4. IJ I Bi~O::.'FILLING OF ANM SMSTEM WITHOUT FINRL INSPECTION RND RPPROVAL BM THIS DEPRRTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RN? ON-SITE SEWAGE DISPOSAL SMSTEM IS tE~Z~ FEET FOR R PRI?RTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TMPE OF PUBLIC WELL. MINIMUM DISTRNCE FRBM R PRI'¢ATE WELL TO R PRI'¢RTE SEWER LINE IS 25 FEET AND TO R COMMUNITM SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAM RPPLM. SPECIFICRTIONS RND CONSTRUCTION DIAGRRMS F4RE R',;I'~ILFIBLE TO INSURE PROPER IN'-]TRLLATION. F"EF:F11 T E::-=:F' I RES [:,EC:EI'-IE:EF' 2:1., ::iL:-r~.. 8~-3 I CERTIFM THRT t: I RM FAMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BM THE MUNICIPRLITM OF ANCHORRGE. 2: I WILL INSTRLL THE SMSTEM IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTFIND., THFIT THE ON-SITE SEWER SMSTEM MRM ,REQUIRE ENLARGEMENT IF THE :ESIDENCE IS ~.EMCIDELED 'rD I~LIDE MORE THAN 4 E:E[:,ROOMS. 1]~. T. SPURKL. RND PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 ~0 ~2 14 17 18 2O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST ySOILS LOG [] PERCOLATION TEST DATE PERFORMED: (~/~ ~/°~ (~ SITE PLAN ~ oT'T'O ~ WAS GROUND WATER ENCOUNTERED? DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) __ FT COMMENTS PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79) 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address '~{~L~v-~? ~-~,v-~.s_~ Day phone I'~ ~ L~ /2-/-~ Day phone Day phone7 ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: individual on-site ~ Holding tank Community on-site Public sewer 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 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/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 is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm i'--'~/~ ~'~/''/ ~/~ <k L~'- ~9 ''~' ~--' Phone Address ,~ o Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~//'~ 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. Em ployees 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-O25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. Legal Description: A. WELL DATA Well type "[~ ~ :~ If A, B, or C, attach ADEC letter. Log present (Y/N) I~'"~ Date completed Total depth ~ Cased to ~ ~; Sanitary seal (Y/N) /%.~ ADEC water system number Driller Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIP, oNMENTAL SERVICES DIVISION JUN .- 5 1992 g.R"E. CEIVED 51 SEPARATION DISTANCES FROM WELL TO: Septic/hekt~ tank on lot Absorption field on lot ~ I q Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots PuDlic sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform / ~ Date of sample: ~' ~', B, SEPTIC/HOLDING TANK DATA Date installed ~' ~' ~. Cleanouts (Y/N) ~/' High water alarm (Y/N) Date of pumping ~,1~ ~ Other bacteria Nitrate ! ~ ~ Collected by: Tank size J ,,q.. 50 Compartments ~ Foundation cleanout (Y/N) /v' .... Depression (Y/N) /'~ ~h/,~ Alarm tested (Y/N) N/'/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Ic, c~ To property line ~/¢ Surface water/drainage 0n adjacent lots .)')/on Foundation Absorption field ///'7/ Water main/service line 72-026 (Rev. 7/91) Front ;: :";'t ~'i . C, ONTINUED: oN BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length f~t;~ Width Total absorption area Depression ow.~r field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~ --~ Gravel thickness I ~ Cleanouts present (Y/N) Date of adequacy test for System type />, Total depth 7 bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ! / ~/ To building foundation On adjacent lots_ ~ Surface water P'~I Curtain drain I.".~ l On adjacent lots '~ ,:~ (-~ Property line To existing or abandoned system on lot Cutbank P"/~ pt ~- 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. HAA Fee $ ['7 Date of Payment Receipt N u m ber ~__~ '-~61~ 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street ' Anchorage, Alaska 99518 Drinking W~ter Analysis Report for Total Coliform Bacteda TO BE COMPLETED BY WATER SUPPLIER Name Phone No. Marling Address Mo. Day SAMPLE TYPE: ~Routine / [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE No. LOCATION Year Treated Water Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: "'~atisfactory [] Unsatisfactory [] Sample too ~ong in transit: sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail, Time Received t "~ ~) 0 Analytical Method: Membrane Filter * No. of colonies/100 mi. [~st Lab Ref. No. Result* READ INSTRUCTIONS Membrane Filter: Direct Count Verification: LSB BEFORE -. Fecal Coliform Confirmation - COLLECTING sAMPLE ."~ FlnalMembraneFllte--rR'esu'~ ~, ~,' ' ' Reported By TNTC = Too Numl OB = Other Bacte REHAINDER Ti] FOLLOW BACTERIOLOGICAL WATER ANALYSIS RECORD (~ Coliform/100 mi BGB Date p.m. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE ~ 54184 Chemlab Ref,$ 92,2410 Sample ~ 1 ~4at~ix: WATER Client Sample iD PWSID Collected Received Presazved with PARCEL 33 SEC 20 T12N GA : ~Y 29 92 6 16:00 MAY 29 92 ~ 17:00 : AS REQUIRED Client Name :TOBBEN SPURKLAND. P.E. Client Acct :TOBBENM BP¢ : PO# ;NONE RECEIVED Req~ ; Ordered By :TOBBEN Analysis Completed : JUN i 92 Labozatoz¥ Supezvisqr :, STEPHEN C. EDE ? / : Sand Rapor~ to: 1)TOBBEN SPIRKL~ND, P.E. 2) Parameter Results Units Method Allowable Lin~ts N!TRATE-N ND(O.iO) ~,~/1 EPA 353.2 10 Sample ROUTINE SMILE COLLECTED BY: T.S. NO TAG FOR THIS SA~LE Remazks: 1 Tests Pe~fozmed See Special Instructions Above UA~Unavailable ND~ None Detected *' See Sample Remarks Above NA= Not Analyzed LT%ess Than. GT~Gzeater Than ~SGS Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 ~-~'~l L~.--;~) ~':~:~ Application Date (a) Legal Description (include lot, block, subdivision, section, t Location (address or directions) (b) Applicant N~me_~¢l~ ~¢~t.Z~ Telephone: Home Applicant Address / ~,>~4 / W~I ~S (c) Applicant is (check one): Lending Institution ~; Owner/builder ~uyer ~; Other ~ (explain); (d) (e) Lending Institution ~' ~ ~ Address Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family I~Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well I~¢¢Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ¢. SEWAG__E ~POSAL Onsite V Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 {11/84) Page 1 of 2 Name of Firm Address ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA rA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this H~alth Authority Approval 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 flies '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. Engineer's Seal ' 2¢-~'_~¢/~ ~ bedrooms dC d¢~/~'(~-- - Approved for /~ - by _/~ ., ~ Approved ~__~' Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authori.[y Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: WELL DATA Well classification ~2'~(~''1 ~V//4'~J"~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed '-~ Yield Total Depth .'~. "'J~ ~Cased to ' ..-~_ '~ Static Water Level .~ o~, ~' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: TO Septic/Holding Tank on Lot Depth of Grouting'~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /V/z~ Cleanout/Manhole Water Sample Collected by ; On Adjoining Lots //~O '/''' ;On Adjoining Lots .~0,'/~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results "~/~,¢"f'~ ~',lj2-(~"r~;~ ~' Comments ~ ~4~) f~-r~ ~/.~ _~_, ~ H TIC/HOLDING TANK DATA Date nsta,ed Size /Z-5-O o* Compa ments Standpipes (Y/N) y Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) j~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~,/,~ ; for Holding Tank High-Water Alarm (Y/N) N/'/~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well TO Property Line ~...~ To Water Main/Service Line Course /~//./~" ! Comments '-~ TO Building Foundation ~' To Disposal Field / .~ / To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Daie installed "~' Width of Field Square Feet of Absorption Area '"~ Depression over Field (Y/N) Type of System Design Length of Field Depth of Field _ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Results of t.ast Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~) To Building Foundation .~" / Lot ,/~J//~ To Water Main/Service Line /~/I To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '.,~. ~O To Property Line To Existing or Abandoned System on ; On Adjoining Lots /~ '7/" To Cutbank (if present) ~///¢~ DJmensions Manhole/Access (Y/N) L_ "Pump Off" Le~el~ ~-'~-~y/ High Water Alarm Level at N) __ Tested for ~ cl~ Ouring AOequacy Test. Meets MOA Electrical Codes (Y/N) .~'~- Comments .~ ** Check ~ ~d~oom/~ Rating Against HAA Request ** I certify th~t/¢~ , c~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed//~'///~ ¢~~ Date Date of Payment J D - ~--~¢ ~, ('''.. '" ~/: :~,, Amount: $ ~ %~ ¢ ~(:¢'r., ,' ': '~ ' '"'. Engineer's Seal 72-026 (11/84) ~ ~ ~OF D. LIFT STATION Size in Gallons ~'"""~-~ "Pump On" Level at . / DATE RECEIVED · ~" ~"~ INsPEcTION APPOINTMENTS ~)-~__ T~O~~~~ TIME TIME TIME DATE DATE DATE INSPECTORINSPE C I NSPECTO~_ MUN/~IPALITY OF ANCHORAGE MUNICIPAUT¥ OF ANCHORAGE ;: TION 825 L Street - Anchorage, Alaska 99501 ENVI RONMENTAL SANITATION DIVISION /-\ L~ ~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~/~I~-A~I[IJr~[ D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER I PHONE John A. and Paf.~v R. SadlerJ (208) 382-4779 MAILING ADDRESS P.O. Box 732 Cascade, Idaho 83611 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Philip D. and Rosetta A. Hamlin 248-4710 MAILING ADDRESS 2314 Roosevelt Apt. 2 Anchorage, Alaska 99503 3. LENDING INSTITUTION I PHONE First National Bank of AnchoraqeI 265-3818 MAILING ADDRESS 201 West 36th Avenue Anchora§e~ Alaska 99503 4. REALTOR/AGENT I PHONE Franklin D. HollowayI 272-7331 MAI LING ADDRESS 1601 Crescent Drive Anchorage~ Alaska 99504 5. LEGAL DESCRIPTION SW~, NE~, Section 20, T12N, STREET LOCATION NHN Hawkins Lane R3W, Parcell 33, Seward Meridian 6. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four [~ Two [] Five [] Three [] Six [] Other ?, WATER SUPPLY [~ INDIVIDUAL* 96~ [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY 1972-73 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. · THIS SIDE FOR OFFICIAL USE ONLY , 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY ' ~ [] ONE [] THREE [] FIVE [~ OTHER [] MULTIPL. E FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY I~] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER C-ISeptic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES--' WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area t-o nearest Lot Line 5. COMME NT,~; [~PAPPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# [] PRIVATE WATER SYSTEM Name Phone No. Mailing Address City State Zip Code MO. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE NO. LOCATION . I s I ) [] Treated Water [] Untreated Water Time Collected I I Collected By TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: ~ Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Membrane Filter * No. of colonies/lO0 mi. Lab Ref. No. Result* I/5~.771 ~ J CFI I i-VI I I BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filler: Direct Count Collformll00ml BEFORE _ _ COLLECTING SAMPLE Verification: LTB BGB Final Membrane Filter~esults /'~.~'/ Repoded By _ ~ Date Time: Coilformll00ml p.m. TNTC = Too Numberous To Count OB = Other Bacteria CHEMICAL & GlboLOGICAL LABORATORIES oF ALASKA, INC. TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CEN~'ER 274-3364 5633 B Street ' Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name / Phone No, Mailing Address City . State _ Zip Code Mo. Day Year SAMPLE TYPE: -~ [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sam 3le. Date Received Time Received Analytical Method: [] Fermentation Tube - [] Membrane Filter Lab Ref. No. Result* Analyst I .I-T-] I I *No ol co]omes/100 mi. or go. of Positive portions 06-1220 (b) Rev. 1978 BACTERIOLOGICAl. WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Data Collecte¢l Source Lab, No, Presumptive 10mi 10mi 10mi 10mi 10mi 1.0mi 0.Zml 48 HOurs Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 10mi Tubas Positive/Total ZOml Portions Membrane Filter: Direct Count - Collform/Z00ml Verification= LTB . ' RGB Final Membrane Filter Results Collform/lO0ml Reporteel By Date Time; a,m, 'John A./Patsy R. Sadler August 19, 1980 Page Two (6) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. Please notify this department for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: First National Bank of Anchorage Momtgage Loan Department Post Office Box 4-2090 99509 Franklin D. Hollcway 1601 Crescent Drive 99504 Tobben Spurl land P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Hr. ]~ank H~al~oway Target Res.lt~ Inc. 1021 W 25th Anchorage, Alaska 99503 ::~-1~ ,, ~i~11,' ,,'. Sept. 3 ,1980 INVOICE Upgrade of Sewer System Parcel 33, Sec.20, TI2N,R3W ................... $ 167~.00 ~ script ion. Soil Test .................... ~ 225.00 System Installat ion ........... 6d4~O.OO Total ........................ $ 167~.00 ..... August 19, 1980 John A./Patsy R. Sadler Post Office Box 732 Cascade, Id~aho 83611 // ~ ~.~. 825 "C" STREET -~ '" ~11 ANCHORAGE, ALASKA 99501/.Lbt~0 ~ ....~ :V ~ (907) 264-4111 ~ [)EPAf~TMFN[ O~ IlEAl IH AND ENVI[~ONMENFALPROTECTION /7,' '/1// Subject: T12N R3W Section ~0 Parcel 33 NW¼ NE¼ Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. (2) Expose the well for our inspection to determine proper construction, also to insure the minimum distance requirements are met between your well and sewer. (3) Locate and expose the standpipes to the leaching area for distance requirements. .~ (4)/The septic tank pumped with a receipt submitted to /this department. The total number of gallons pumped ~/ need to be cn the receipt to verify the size of the ~k~tank. This will need to be verified by a registered engineer prior to submittal. (5) Locate sewer system and well on the neighboring lot. This is to insure that the minimum distance requirements are met. water AbSorbed (Gallons) ~ 'Clock 10 FIELD PUHPIHG TEST /-~ : l DATA SHEET :/ ': : .,LOCATIQ~I OF WEL~ (Legal Description}: WELL'DEPTH:. FT. CASING: DATE DRILLJlIG COHPLETED: 'STATIC WATER LEVEL (Top of Casing): I Elapsed Time Sincel Pumping'Started/ Stopped, Hin. 15 ) . 25 DATE OF TEST:__/ ~ ~ 5~0I 3q,5 FT DRILLER: FT SCREE;I: 35 4O 45 50 55 60 ( 1 hour ) I ~-/, 9o l J20 (2 hours) ~-~,.//._~.~ 15o t~ZTS 180 (3 hours)l 240 (4 hours) ~, ~,~ J RECOVERY 10 15 ~0 50 60 (1 hour) lEO ('d nours Drawdown/ Recovery Pumping Rate, GPI4 I Start Remarks CORWIN & ASSOCI£ ;S, INC. 4790 Business Park Blvd. Building D, Suite 1 ANCHORAGE, ALASKA 99503 SHEET NO. OF CALCULATED BY ~~ DATE CHECKED BY DATE SCALE