HomeMy WebLinkAboutTANAINA HILLS LT 7Tanaina Hi ll
Lot 7
#011-05! -08
Municipality of Anchorage Page
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: .-~'~ c[
N.~: T~O~ ~ Wastewater System: D New ~U~r~
Address: ~0~
Phone: ~_ ~ ~ I.o.o,~.~,oo~ ~ Deep~ ~ Shallow Trench D Bed ~ M~ Other
Numbero ' es: Oist~nce~tweenlines:
WELL: ~XtD%I~w ~ Upgra~ Graw, width: ~ Ft. ~ Ft.
SEPARATION DISTANCES ~Septi. ~ Holding ~ S.T.E,P.
TO Septic A~sorption Let Holding .ubllc/Private ~anufacturer: ~ ~ Capacityin gallons:
From Tank Field Station Tsnk fewer Lines
Foundation
Drain
Remarks: ~[~c~ ~000 ~c~ BENCH MARK
Location and Description:
Department of Health and Human Se~ices approval til~;t., c.E.....,'~
Reviewed and approved by:
72-013 (Rev. 9191) MOA 25
PERMIT# SW980015
AS BUILT DRAWING
REVISED 5/7/98
SEPTIC TANK LOCATION IS REFERENCCD FROM
THE SOUTHEAST HOUSE CORNERS AS SHOWN
P.I.D.# 0011-051-08
/ NEW RO00 GALLDN
SEPTIC TANK
PUST TANK DDUBLE CLEANDUTS
(D~LES)
(O~LED
N,T,S,
SEPTIC UPGRAI]E: AS-BUILT LBT 7, TANAINA HILLS S/I]
PREPAREI] FOR: fiR, TED SHDHL
PREPAREI] BY' ALASKA WATER & WASTEWATER
REVISEI] 5/7/9~/:'~'' ~ DRAWN~ WILLIAMS SCALE~ 1' = 30'
PAGE 1 OF 1 u
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 (UPGRADE) PERMIT
PERMIT NUMBER:SW980015
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:SHOHL THEODORE
OWNER ADDRESS:6034 TANAINA DR
ANCHORAGE, ALASKA 99502
DATE ISSUED: 2/17/98
EXPIRATION DATE: 2/17/99
PARCEL ID:01105108
LEGAL DESCRIPTION:
TANAINA HILLS LT
LOT SIZE: 107158 (SQ. FT.)
NUMBER OF BEDROOMS: 6 THIS PERMIT: 6
THIS PERMIT IS FOR THE CONSTRUCTION OF:
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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS } (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
SEPTIC TANK REPLACEMENT' LIlT 7, TANAINA HILLS S/D,
PREPARED FOR ~ A+ HOME SERVICES
PREPARED DY, ALASKA WATER & WASTEWATER,
lATE, 1/18/98 ] DRAWNt WILLIAMS ISCALE'
1' : 100'
SEPTIC TANK REPLACEMENTI LOT 7, TANAINA HILLS S/I),
:PREPARE]) FF1R ~ A+ HUME SERVICES
PREPAREI] BYI ALASKA WATER & WASTEWATER,
DATE, 1/18/g8 I DRA~/N, ~/ILLIAMS ISCALE,
40'
,v1UNICIPALITY OF ANCHORAGE
DEPARTMEN'F OF HEALTH & ENVlRONIVIENTAL PROTECTION
ENVIRONMENI'AL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WEI. L INSPECTION REPORT
NAME PIPFONE [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Liq. in gallons Absorption area [
I- 2 Manufacturer Material
DISTANCE TO: ~ ~ Dwelling
DISTANCE TO: I ~ t~) !
lines / Length of e~h~ne
, of tile to finish grade
Foundati~ ~ !
Total I e, gtl~c~f_~les
Material beneath tile
Material
N ear e~W~t~n ~
Trench wi th
PERMIT NO.
N,A
No. of ~,r~l.p~me n t s
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance between lines
Total effective absorption area
Length Width Depth PERMIT NO.
Type 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 ~sso~tiption area(s)
DISTANCE
TO:
OTHER
PE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
72.013 (Rev. 3/78)
FI:iFIl_ I NO.
f I L.I
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THE L.ENGTI"I DIMEN.C:;ION IS 'T'NE LENGTH ,:::IN FICE':f') Of: TH[~ TREZN£::H I:IR
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,: :,I..IB.JE..I '['O F,f?r',:;[Fr TIFII'.~
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i',IIN):HUI,'I DIS'TFINC:E: E:ETHEEN FI I.,~EL.L FIND Fti'.~'t' ON--.,SITfE '.E:EI4FIOE DI~i:F:'OSFII... S'./E;'I'EP'I 1S
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CF]"H[:[R I;~'.E{:!UI[;:E:I'dI~.:i'.~T!B MFI"r' AF'F'L."/. SPE:C]:[:'ICI=IT]:ON% FIND COf',If:F[RI.JC:T:[Oi",I
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FORTH E:'t' TI'tIE HIJNICIPFIL. IT't' OF' F~I",ICHOf~F~C~[£.
~'.: ]: I.,.IZL.I_ :I[I"]STFIL. L THE ?/:'ST[EH
LER1 ].F ~ I"HFI'F
]: FIM FFli"t:~L:[FI[~ b.I]:TH THE RE.~.I3]:E.E.i'IEi'.~[:,
[] SOILS LOG
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorago, Alaska 99502 276-222'~
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
[] PERCOLATION
TEST
4
7-
8-
9-
8LOPE
SITE PLAN
10-
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED7 ',\.,! [)
IF YES, AT WHAT
DEPTH?
L
O
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
COMMENTS
DATE;
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS
FOR
APPROVAL
A SINGUP:' "FAHILY DWELLING
Parcel I.D. 01105108
1. GENERAL INFORMATION
COSA# d~~-'~--'''/¢ I lq 7
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TANAINA HILLS LOT 7
6054 TANAINA DRIVE *ANCHORAGE, AK 99502
MARK & HEATHER HANLEY Day phone
6054 TANAINA DRIVE *ANCHORAGE, AK 99502
Day phone
227-2718
FIDELITY INSPECTION & CONSULTING SERVICES Day phone 800-525-4677
626 dACKSONVILLE ROAD *WARMINSTER, PA 18974
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 6
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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my sea/affixed hereto and as of the validation date shown below, f verify that my
investigation, based on procedures outlined in the Certificate of Qn-Site Systems 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 Anchorage files and from my investigation and inspection, the"
on-site water supply and/or 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 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 authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
!J Approved for ~
Disapproved.
Conditional approval for
bedrooms.'
%. ,.,. ..,,',,., PROGRAM ..,.
bedrooms, with the fllowing stipulations: ...~/.~.~/.,., oo ..... o, ~.~.~
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Maintenance Agreements
Supplemental Engineer's Report'
Other
Original Certificate Date: ~- ~-//O
Municipality of Anchorage
Development Se ices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEMS ,PPROVAL CHECKLIST
Legal Description: TANAINA HILLS LOT 7
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date c,~mpleted PRE 1965 Sanitary seal (Y/N) YES
Total depth 170+ ft. Cased to *40'+ ft.
FROM WELL LOG
Date of test I NO WELL LOG J
Static water level jJft.
Well production g.p.m,
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: 8.13 ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 2000 gal. Number of Compartments 2
Foundation cleanout (Y/N)**YES Depression over tank (Y/N) NO.
Date of pumping 9/14/09 Pumper
C. ABSORPTION FIELD-DATA ,pBELOW EXISTING GRADEI
Date inStalled'. 1978 ? Soil rating (g.p.d./ft2~..125
Length 63 ft. Width 2+ ft.
Total depth '12 ' ft. Eft. absorption area 75.6 ft2 Monitoring tube YES
Date of adequacy test ,. 7/23/2010 Results (Pass/Fail) PASS
Fluid depth in absOrption field before test DRY. in. Water added 940 gal,
Elapsed Time:, 120 min. Final fluid depth 24
Any rejuvenation treatment (past 12 mo.) (Y/N & type)'
Parcel ID: 01 105108
*ASSUMED BASED ON SURROUNDING WELL LOGS. SEE ATTACHED.
Well Log (Y/N)
Wires properly protected
NO
Casing height (above ground) 12+ in.
AT INSPECTION
7/23/2010
167 ft.
3.5 g.p.m.
Nitrate ND mg./L. Other bacteria. 0 colonies/100 mi.
Date of sample: 7/25/2010 Collected by: GEG Ltd.
**NO C/O @ FOUNDATION. DOUBLE C/O'S @ TANK INLET
Date installed 3/3/98
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
A+ HOME SERVICES
in. Absorption rate >=
NONE KNOWN
System type TRENCH
Gravel below pipe 6 ft.
Depression over field NO
For 6 bedrooms
New depth..34 in.
900+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed
· "Pump on" level at
.Size in g~llons ~
in. Pump off' leve_.~. High water alarm level at
in.
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPA ~RATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic .tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
100'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO,:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water. 100'+
Property line 10'+ Building foundation. 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
COMMENTS
Water main N/A
Driveway, parking/vehicle storage 10'+
G. ENGINEER'S CERTIFICATION
I certify thatl,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
COCA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Name Garness Engineering Gro~.-~~Z:~ Printed Date/Time 07/2912010 8:53
Project Name/# ~ 7anmna kl~~ Collected Date/Time 07/23/2010 15:20
Client Sample ID Tanaina Hills Lot 7 Received Date/Time 07/23/2010 15:44
Matrix Drinking Water Technical Director Stel~hen C2 Erie
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date lnit
Metals by ICP/MS
Arsenic 8.13 5.00 ug/L EP200.8 C (<10) 07/27/10 07/28/10 KDC
Waters Department
TotalNitrate/Nitrite-N 0.445 0.100 mg/L SM20 4500NO3-F B (<10) 07/23/10 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 07/23/10 DLC
Total Coliform Negative 1 100mL SM20 9223B A 07/23/I0 DLC
Project Name/# Lot 7 Tanaina Hills
Client Sample ID Lot 7 Tanaina Hills
Matrix Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
06/29/2010 17:25
06/25/2010 14:20
06/25/2010 14:47
Stephen C. Erie
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container 1D Limits Date Date Init
Metals by ICP/MS
Arsenic 5.56 5.00 ug/L EP200.8 C (<10) 06/27/10 06/29/10 KDC
Waters Department
TotalNitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<I0) 06/27/10 AYC
Microbiolog~ Laboratory
E. Coli Negative I 100mL SM20 9223B A 06/25/10 DLC
Total Coliform Negative I 100mL SM20 9223B A 06/25/10 DLC
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
6034 Tanaina
Ahchorage
Well camera ran down to 45'. No perforations in casing noted.
Brian R. Wille
Aarow Pump & Well Service LLC
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Municipality of Anchorage
DeVelopment Services Department
Building Safety Division
On-Site Water and 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
Parcel I.D. O II -ORI- 0~:~
1.
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Current Property owner(s).
Mailing address
Lending agency
Mailing address
Real Estate Agent V--~.-~-~',
Mailing Address
2. NUMBEROF BEDROOMS:
Expiration Date: J-~- /~ -
Day phone
C L~,~ ~-~ ~ll~Day phone
I
Unless otherwise requested, HAA will be held by DSD for pickup.
TYPE OF WATER SUPPLY:
Individual Well'
Individual Water Storage
Community Class
Public Water System
Well
[]
[]
[]
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 sample results. (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 Anchorage tiles and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and 'State codes, ordinances,
and regulations in effect at the time of installation.
NameofFirm ~:~L)t2.~L-At,~:~ ~.~,,l~tl~lE-~.lP,..-\t,4F,.-n Phone Z'Tq-'DqIG
Address ~ ~1~ ~
Engineefs Printed Name ~o~ ~g~-~
Date
DSD SIGNATURE
L~ Appmved for (~'
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev, 0t~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Eragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.cLanchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type ['~
Date completed p,{z ~'~
Total depth ..1~, ~' '~ft.
ifa, B, or C provide PWSID #
Sanitary seal (Y/N)- '~/
Caaed to
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ¢ colonies/100 mi.
Arsenic: I~ mg./I,
B. SEPTICIHOLDING TANK DATA
g.p.m.
Nitrate ~'~ ~:~ mg./l.
Date of sample:
Tank Type/Material
Tank size ~gal. Number of Compartments _~_
Foundation cleanout (Y/N) ~ Depression over tank
Date of pumping ~'/t~' ~o~ Pumper
ABSORPTION FIELD DATA
Parcel ID:.
Well Log (Y/N)
Wires properly protected (Y/N).
Casing height (above ground)
AT INSPECTI ON
.. '°bloc
~- -~-. g.p.m.
Other bacteria ~ colonies/190 mi.
Collected by:
Date installed
Cleanouts (Y/N)
High water alarm (Y/N) .
Date installed /-~'~ Soil rating (g.p.d./ft~ or f¢/bdrm) I~.~
Length ~,.:~ ft. Width ~.- ft.
Total depth /~1,. ft. Eft. absorption area _~ft~ Monitoring tube .
Date of adequacy test I¢)-~ -O ~ Results (Pass/Fail). "~
Fluid depth in absorption field before test .. ~:~ in. Water added ~:~/~ gal.
Elapsed Time: ~. Final ~]uid depth ~ in. Absorption rate >=
System type ... I/t~,na~
Gravel below pipe ~:~ ft.
Depression over field ~
For ~, bedrooms
New depth~ in.
q ~:~) g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) .., J'~
If yes, give date
D. LIFT STATION /
/
Date installed
on" leve/ in.
"Pump
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallon~/
"PumP cT.vel at
Cycles t~'sted
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
in.
High water alu level at
Meets alarm1"& circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field
Surface water
in,
Building foundation .~L_~ Property line
Water main t'4/,A- Water service line
Wells on adjacent lots IO'~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~O Building foundation ~,~,
Water Service line I~;' ~ Surface water o
Curtain drain t~l I c~ Wells on adjacent lots
F. COMMENTS
Water main i.-t/,~
Driveway. parking/vehicle storage
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 Printed Name "~/o ~o e.
Date I, Z.- - ~--'7- ~
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date cf Payment
Receipt Number
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Sample Remarks:
1048053001
Tobben Spurkland P.E.
Tanaina Hills Lt 7
Tanaina Hills Lt 7
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 12/22/2004 10:29
Collected Date/Time 12/15/2004 8:10
Received Date/Time 12/15/2004 11:43
Technical Director stjpJ~n C. Ede
P~etar
PQL
Units Method
Allowable Prep Analysis
Container ID
Limits Date Date Init
Waters Department
NiU'ate-N
O. IOOU
0.100
mg/L EPA 300.0
B (<=10) 12/16/04 BJA
Microbiology Laboratory
Total Coliform 0 col/100mL SM20 9222B A (<--1) 12/15/04 DKC
20o~m
I
Z
m