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HomeMy WebLinkAboutPATTY LT 128APatty Lot 128A #051-144-51 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: ~, ~A/ ¢4, ~.'7~ PiD Number: ¢9'5/-/~¢~7/~'~/ _ Name: Wastewater System: ~ New ~ Upgrade ABSORPTION FIELD Phone: INo. of B~oms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: Lot: Block: Subdiv~ion: Depth to pipe bo~om from original grade; Gravel depth beneath pipe Township: /5~IRange: / ~ Section: ~ Fill added above original grade: Gravel length:  ~ Number of lines: WELL: Q New~x ~/~ Upgrade Gravelwidth: ~ TANK SEPARATION DISTANCES ~s~pt~o a Holding ~ S.T.E¢- Sudace w~t~, ~/90~ ~- ~ ~/2 LIFT STATION Cu~ain Drain Remarks: ~/V~¢3/O~ V~LF~ /~Z~I~ BENCH MARK Location and Oescription: I Assumed Elevation: Inspections po~ormed by: Datos: 1st ~__ 2nd Reviewed and approved by' ~ Date /. . 72-013 (Rev. 9/91) MOA 25 Permit No. SW960270 Page 2 of 2 Municipolity of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchoroge, Alaska 99519-6650 · I-elephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PATTY LOT 128A PID No.: 0§7144-51 N 89°50'30, E 150,00 ~ - DIVERSION VALVE [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT -,:F - WELL EASEMENT NEW LEACHFIELD ~- OLD LS,',CH~IELD SCALE 1"=50' SWING TIES A-D = 18.6' C-D = 18.2' A-E = 39.0' B-E = t7.3' 2 sTORY HOUSE LOT 128A ELEVATIBN2 (NOT TO SCALE) 9/5/96 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 NUMBER:SW960270 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:DAVIS GREGORY M & DIANNA OWNER ADDRESS:PO BOX 670352 CHUGIAK, AK 99567 (UPGRADE) DATE ISSUED: 8/28/96 EXPIRATION DATE: 8/28/97 PARCEL ID:05114451 LEGAL DESCRIPTION: PATTY LT 128A LOT SIZE: 45091 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD 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 Eagle I iver Engineering Louis Butera, P.E. P.O. Box 773294, Eagle I~iver, iLK 99577-3295 Services (907) 694-5195 tel (907) 694-3297 fax August 21, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Patty Lot 128A Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1996\96-070^-N^R.DOC SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Patty Lot 128A 08/21/96 GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. SEPTIC TANK 1. The existing septic tank shall be retained with a diversion valve and cleanouts added. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 12' at any point. 4. The sewer line shall tie into the existing trench with a Bull-Run type diversion valve. 5. The effluent line within the trench shall be laid level within 0.03'. 6. The trench gravel is to be covered with typar fabric material. 7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 8. The area over the trench is to be finish graded to prevent ponding of surface water ranoff. 9. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 12' GRAVEL DEPTH = 9' under pipe, 2" over pipe TRENCH LENGTH = 42' TRENCH WIDTH = 3' SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 3 Twenty-four (24) hours notice required for all inspections. 996~96-070a-spc.doc /~ l{]~LL8 +100' 150,00 o, ~o, 150.00 S 89'57'30' W a TEST HOLE ~R[~ ~V~ o SEWER CL~NOU~ ~ WELL -- -- - ~SE~ENT NO SURFACE WATE~ PROPOSED L~CHFIELD NO KNOWN CURTAIN DRAINS I- ~XISTING L~CHFIELD LEGAL: PATW LOT 128A ~WNER: DAVIS ~. Jo~ ~e-oTo /~r~: s/~/~eI ~ EAGLE RJTER ENGINEERING SERVICES ~ P.O. Box 77~4 ~ ~c;~ ~, ~x. ~sT7 'q?~o '". .... '"~ ~ x (~07) ~4-S~S FAX: (~07) EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No,: 96-070 Calculated By: LB Date: 8/16/96 Legal: PATTY LOT 128A Single Family 3 Bedroom Dwelling TEST HOLE Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 28.2 minutes per inch Wastewater application rate = 0.6 gallons per day per square foot Required absorption area = 750 square feet Trench width ON) = 3 feet Gravel depth (D) = 9 feet Required length = Required absorption area / 2 / D Required length = 750 / 2 Required length = 4-2 feet Total Excavation Depth = 12.0 feet / 9 SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 9B-070 LEGAL DESCRIPTION: PATTY LOT 128A NUMBER OF BEDROOMS: 3 WATER USE PER BEDROOM: 150 PERCOLATION RATE: 28.2 DEPTH TO GROUNDWATER: 18 DEPTH TO IMPERMEABLE LAYER: 18 ANTICIPATED DEPTH OF COVER: 3 MOUND OR BED SYSTEM CALCULATED BY: LB WASTEWATER APPLICATION RATI=_: ABSORPTION AREA REQUIREMENT: MINIMUM BED LENGTH 12 FEET WIDE BED 15 FEETWlDE BED TRENCH SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH GALLONS MINUTES PER INCH FEET FEET USABLE SOIL STRATA FEET TOTAL USABLE DEPTH: USABLE SOIL STRATA DEPTH: 0.45 GAL/SQ.FT 1000 SQ.FT 12 9 83 FEET 67 FEET 0.6 GAL/SQ.FT 750 SQ.FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) ENGTH (FT) DEPTH (FT) ENGTH (FT) 1 131 4 94 2 105 4.5 83 2.5 95 5 75 3 88 5,5 68 3.5 81 6 63 4 75 7 54 8 47 9 42 DESIGN SPECIFICS FIELD SYSTEM: D GRAVEL DEPTH: 9 TRENCH OR BED WIDTH: 3 LENGTH: 42 TOTAL EXCAVATION DEPTH: i2.0 FEET (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH} FEET FEET FEET PERFORMED FOR: LEGAL DESCRIPTION: 2 4- 5 8 9 10 11 12 13 14 15 16 17 18-- 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: /.~7- ,/,~,~ Township, Range, Section: ~'OPS OIL N/TH ,SO,He- d~P SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth lo Waler Af~er,.o£.~' Monitoring? Reading Date Gross Net Depth to Net Time Time Water Drop / v' 12. rl. IE ¢'.¢' ~ ~ I; I~ 30 ~/~ ~ Ol/U'/ I ~i/~" ~ /: t 5 ~ ~//~' ~ ~ I;~ ~o 75 ~//~ / 0//~" 5 - I :4~ ?~ ~l/u, ~ . ~', lq .~o ~ ~//~' / ,//~" PERCOLATION RATE ~ ~ tmmutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN ~¢~ FT AND '~ FT PERFORMED BY: .//~/,/V/ I E ~ ~ ,~ ~'~-,'~- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~.~,'~-£Z¢ --~- 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPAR'rMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L." Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION ~St"PTIC Material ~ HOLDING TYPE OF SYSTFM ~}~TRENCH BED [~ W. DRAIN [] OTHER Distance be[ween lines ~J/A FT WELLS .,~--~PRIVATE [] OTHER ildentifvi FT DISTANCES SEPTIC ABSORPTION TANK FIELD WELL ;WELL V'~.,..-"// t. LOI LIN! REMARKS: Inspections Performed by: 72 013 (3/85) D,':.vLc~? :i: ~:+~,~l~cJ ~, CI~?/2! :1/t':~i:~ l I',IST{M.I. I::'I:':R I[:i:lqE~ :1: N[ii:I'L'F;:Ei ~',YI'I ~:'~C'.I~IZ]:) DES I [;'1',1 ,, 'l"ld I C;I:::i < I J i: Y I ['1(.'~'1 ~::~ ]. (~(:;) LI It, t'. I"f ,~ E. ]:. h (2 (::: a [:) ~':~ (::: :i. [. 'V o { '[t. h c., [. E)I.. ¢..t ] El ',/~i; '[. E~ Ill :i. ~[i ::S I::) (.? CI I" c)(3 [~t!~; ~ r'[ cI ~:~n'y ~',:,vl:l v,~:i :i. ] ['c.~f::lt.(:i ~% an add ~.'I; J C)I'IF~], p<ar' m:i.!:.. SCALE Municipality of Anchorage DEPARTMENT OF NEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 8- 9- Reading Date Gross Net Depth to Net Time Time Water Drop 14- 19 20 t,.o ,-, / PERCOLATION RATE \ ~' (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ ET AND__~ . FT 17034 Eagle E[ver L~p Eoa~ No. 2~ ~/ ~ PERFORMED B~ag~a~, Alaska 99577 ~(~/~ CERTIFY THAT., IS TE AS PERFORMED IN ACCORDANCE WITH ALL S~ATE AND MUNICIPAL GU~DELINE~FFECT ON THiS DATE. DATE: 72-000 (Rev. 4/85) 10 - WAS GROUND WATER ENCOUNTERED? 11 IF YES, AT WHAT DEPTH? E Depth l0 Water Alter 13- Monitoring? '~'~'~'~ l)ate: --j DATE PERFORMED: ~[- ~""~ ~ ~)~,..~ ~¢//F)Township, Range. Section: ~""~ _~ ¢.~t~ ,~---.~¢:~, ¢:~ SLOPE SITE PI~AN SCALE  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF I-IEALTH & ENVIRONMEN'rAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Streot- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT ~IUNGADDRESS ~ ~c~,~,o~ 'T~-rr7 ~Y~ /~ r /~ ~ ~, LOCATION ~o. o~ ~c ~s ,-~ Manufacturer Materla~,~ No. of compart~s ~ Liq capacity in gal,o~~ " __. / 000 IF HOMEMADE; ~ ~ Well Found~{i Nearest lot I~ / PERMITNO, No. of lines Length of~ I,no Total IonS~ ~ I)nos Trench~ Distance ~ -- ~ [ inches ~ ~lass ~ ...~_ Depth Driller Distance to lot llne PERMITNO. OTHER / 72-013 (Rev. 3/78) by SULLIVAN WATER WELLS P. o, BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 ,DDRESS _[-;'o 1." .,/. /,., ':, / ~;' ~-. ,EGAL DESCRIPTION Z' /,~ .5; /4 ? .... ,ATE-Started 5///'.'?/ ';:. - Ended_ ,?//{/~c.. .? 'ERMIT NUMBER / DEPTH OF WELL STATIC LEVEL OF WATER FT, _..~) DRAW DOWN FT. GAt,S. PEB. HR KIND OF CASING ~IND OF FORMATION: rom (1 Ft. to- -) _Ft. rom -'! Ft. to_ / 3"',, _Ft, ; '7' Ft. to_''? ,_Ft. rom '~/'~ Ft. to--Ft. rom Ft. to- -Ft. rom "l ,,? Ft. to rom .... Ft. to_ _Ft. rom <,.~', .Ft. to_ '~* c~ _Ft .... rom ~-'i~< _Fi. to (, [ Ft~ rom ;,/ Ft. to 70 _Ft. rom 7 o Ft. to.__Ft, :rom -- Ft. to__.Ft. 'rom Ft. to Fi, __ rom Ft. to_ _Ft. rom Ft. to Ft. 'rom___Ft. to , FI.. 'rom Ft. to_ _Ft. From From Ft. From ..... Ft, Fr(nn _. ~ Ft. From ..... Ft. From ......... Ft. From .... Ft. From Ft. From Ft. From ....... From Ft. From_~Ft. From .... Ft. From Ft. From~_~Ft. From Ft. Ft. to Ft. to_ __Ft.. to_ ~ Ft to .... Ft ......... to .... Ft. to .... Ft. to ..... Ft. to .... Ft.. to ...... Ft. to .... Ft. to____.Ft. to .... Ft to Ft to ...... Ft to__ Ft. ___ to ...... Ft. to __Ft. DRILLER'S NAME ",'~ Permit ~ Applicant: Location: MUNICIPALITY OF ANCHORAGE Department 'f Health and Environmenta~ Pr'otection- 825 ~ Street, Anchorage, AK. 9501 ~O~~ * * HANDWRITTEN PERMIT * ~ * /',~ ~O d~ Mailing Address: Z4~F~ Phone Nu~er: G, 9 ~'-- ~ 7 / I Legal Description: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Beds Lot Size: ~ Holding Tank: Maximum Number of Bedrooms: .__~__ soil Rating(sq.ft/br) ~-~ ~ ~7,~~ ~' The Requ~red~f the Soil Absorpti~ystem Is: t~ ~ , The length dimension is the length(in feet) of tre~C~ or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ] ~Or__P GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if tha 3 bedroo . thel/C'residence'~ .~-~ ~/ f ?~f/~/'"'~'is. remodeled. _ .:~ to./~_ _...~include moreissued by: Signe~: 2~ .'~ i Applicant '~ ~ SWP/024 (1/81) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 2~4-4720 SOILS LOG - PERCOLATION TEST TEST LEGAL DESCRIPTION; DEPTH SLOPE / SITE PLAN 10 11 12 13 14 15 16 17 18 .19 2O /'~' x., ENCOUNTERED? IF YES, AT WHAT DEPTH? P E Gross Net Depth to Net Reading Date Time Time Water Drop ¢. -t-/~ '?;'~ ~o ~ '1~" Z " Russell L. O?~oi' t iRCOLATION RATE ,/ ~ /~/~L//~ (minutes/inch) No. 428~.E TEST RUN ~]ETWEEN Z! ~ FT AND ~ FT SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl_ PROTECTION 826 L, Street, Anchora~]e, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SLOPE [] PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date 'Time Time Water Drop PERCOLATION RATE (minutes/inch) /{,. / _/ Z~,)TES/T RUN BETWEF~ ,- F~ AND ~ ( , [ , ~ - v~ ~' ~'~ ~' ~'~"~"~:~:':~,," L~ .~..~, ,~." ~vz ,,"111 //~'/Z/~/~ 72-008 [6/79) F f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIvlslon of Environmental Services On-Site Services Sectio~ P.O. Box 196650 Anchorage, Alaska 99519-6650 ' (9071 343-4744 ' ' CERTIFICATE OF HEALTH AUTHORITY ' · . , . APPROVAL'FOR A SINGLE FAMILLY DWELLING Parcel I,D. #_ 051-144-51 HAA #. DOg I OW 1. GENERAL INFORMATION Complete legal description PA'I-IY SUBDIVISION: ' LOT 128A Location (site address or directions) 21717 TARIKA AVENUE. CHUGIAK. AK Property owner ,.JEFF KOONT7 .' ' "' ' ' ' Day phone Mailing ad~res~ C/O RdMAX. PROPERTIES. A~CHORAGE Al<. 9950.'~ Lending agency Dayphone ' ' · Mailing address · ' Agent btARILYN .MOORE./REMAX PROPERTIES Dayphone.(~nT) 976-9761 Address 2600 CORDOVA STREET. ANCHORAGE AK, 99505 Unless otherwise requested, HAA will be held for pi~k~ip, 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Community well Public water ". NOTE: If community woll system, provide Wn'tten confitmation from State ADEC attest~- lng to the legality and status of system. - ~'~. ' TYPE OF WASTEWATER DISPOSAL: Individual On:Site xxx Holding Tank Community on-site Public sewer . NOTE: if commun!ty wastewater system, provide wdtten confirmation from State ADEC lng te the legality and status of'system. 72.-025 (Rev, 1/91) Front MOA ~1 Computer Versien 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-sita water supply and/or wastawater dsposal system is safe, funct ona and adequate fo~; the number of bedrooms and type of structure Indicated herein. I further ve ,rify that based on the information obtained from the Municipality ~f Anchorage files and from my Investigatio 'the on-site water su'pply and/or wastawater disposal system is in comoli ordinances, and regulations in effect on the date of this inspection. N~ Address 6901 DI Engineer's Sig~ 337-6179 1. In conducting analysis of the system/n accor~ansa with ADEC and MOA DHH8 Guidelines & Regufatiosa. The reporfed ' ' results described the ~efformse~;e of the syststn und~ the conditions e~countsrod, at the ~.rne of the the test, and separation distances measured to'readily Idontiflabte features. The operational life of all wells and septic systems depend on the ~ sells condition, ground water levels that rn&/.fluctuate du#ng the year, and the water usage df the family being served by the system. These bcodl~lqns are outside the control of the evelsator of the s~,,~aan All systems eventually fall and satisfactory test resutis do not guarantee futura per[ormance of the system, ~or do they gsarantee that there are no ~ encroacbrnen~s. AWWC,, the. can therefore not provfde any warranty for future per[ormansa nor give any estimate of how long the systsrn v~ll continue to meet the operational requirements of the,4DEC or MOA DHH$. The content of this rolx~rt Is for the sole benefit of the owner listed above. Any rotiansa upon or use of this rep,~ct by any othor porson or parly te not authorlzed, ~or wlll ft confer any legal dght whaIsoever. 2. Alaska Water and Westswatsr Conse/tsnts, Inc. shall be paid $400,00 at, or prior to, dosing for the engineering servfce$ provided. : . . .~ . 6. DHHS SIGNATURE ,/..-? Approved for -~ -' bedrooms ' ' Disapproved :,/jC°nditi°nal. approval, for 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-O25 (Rev. 1191) Back MOA//21 Computer Vorsfon Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Legal Description: A. WELL DATA Health Authority Approval Checklist PATTY SUBDIVISION; LOT 128A Parcel I;D.: 051-144-51 Ifa, B, crC, attach ADEC letter. ADEC water system number N/A 4./85 .Casing height (above ground) 12"+ Wires properly protected (Y/N). YES Well Type PRIVATE Log present (Y/N) YES Date completed Total depth 70' Cased to 70' Sanitary seal (Y/N) YES FROM WELL LOG AT INSPECTION Date of test 4/85 8/13/99 Static water level 25' 30' Well production 1.67 g.p.m. 0.75 ~, ~ /7~/./_ Other bacteria Collected by: A.W.W.C., INC. 1000 . Number of Compartments 2 Cleanouts (Y/N) YES Depression (Y/N)__ NO _ High water alarm (Y/N) N/A _Pumper JR's PUMPING _Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 Gravel thickness below pipe g.p.rn, Effective absorption area 774 SQ. FT._ Monitoring Tube present (Y/N) YES-- Depression over field (Y/N) NG Date of adequacy test_ 7/17/99 Results (Pass/Fail) PASS For 3 . Bedrooms Fluid depth in absorption field before tast (in,); _ 25" __ Immediately after 1500 gal. water added (in.): 86" Fluid depth 67" .(ins) Minutes later: 310 Absorption rate =. 450+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yea, give date 72-028 (Rev. 3/98)* Computer Vemlon WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: "'~//,~-/~O El. SEPTIC/HOLDING TANK DATA Date installed 4 1..~_,/83 Tank size Foundation cleanout (Y/N) Date of Pumping _ 7/,30/99 C. ABSORPTION FIELD DATA Date installed 9/5/96 Length. 43' Width System type TRENCH 9' Total depth. 12' - YES D. LIFT STATION ~ Date installed, Manhole/Access (Y/N) ~evel at* "Pump o~' level at* High wa~ *Datum ...Cyol~sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ On adjacent lots 100'+ 100'+ On adjacent lots 100'+ N/A Public sewer manhole/cleanout N/A 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5% Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation Absorption field Wells on adjacent lots Surface water 100'+ Curtain drain F. ENGINEER'S CERTI~ I certify thatJxh~ of Munlcip~ reco~d#tI Signature t"'-"~/j/~/~! Engineer's Nam ' Date ~ NC IE KNOWN ~AT/~# ~eld inspections and review ~Tiin~ tl b~ th~ ~ l~b( ~ systems are in conformance on this date. JEFFREY A, GARNESS 5'+ 100'+ 10'+ Water main/service line 10'+ Driveway, parking/vehicle storage area 10'+ Wells on adjacent lots 100'+ A, 6orness.' g HAA Fee ~ ~-~'~ 5o Receipt Number "~ 5'~ 5~; ~_~ ~ __ 72~26 (Rev. 3/96)* Computer Vemlon Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. O0~/0~ During a recent Health Authority Approval on-site inspection and test of t]!e potable water supply well on Lot ~.~ ~ ~ Slock - of Subdivision, the well's productivity was determined to be 0.7~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is O, ~/ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised ~.~ the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and lawns and gardens may be required. This advisory must be attached to all copies of the subject Health .... ho=zty Approval. Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE ,,~ DEPARTMENT OF HEALTH & HUMAN SERVICFS Division of Environmental Services on:sit'e Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTFI Au'r'HORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-144-51 HAA# GENERAL INFORMATION Complete legal description Patty Lot 128A Location (site address or directions) 21717 Tarika Property owner Mailing address Lending agency Mailing address Agent Address Gregory & Diana Davis P.O. Box 670352, Chl.~iak, AK 99567 Alaska Hcme Mortgage/Jean Brunner P.O. Box 196850, Anchorage, AK Day phone 688-6401 Day phone 563-3033 99519 Re/Ha× ./ Joe VJsher Day phone 276-2761 2600 Cordova Street Ste 300, Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMEIER OF BEDROOMS: 3 N TYPE OF WATER SUPPLY: NOTE: Individual well x Community well Public water If oommunify well system, provide written confirmation from State ADEC attest-~ lng to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site x 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) Fronl 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 rny 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 ty'pe 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. Name of Firm Eagle River Engineering Services Address P.O. Box 773294, Eagle River, AK Engineer's signature ~ Phone 694-5195 99577 DHHS SIGNATURE --/~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 'he Munic y of Anchorage Department of Health and Human Services (bHHS) issues Health Authority Approval iL. ~'icates 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) Back MOA~¢21 MUNICIPALITY OF ANCHOP, A~I~ I]NVIItONMI~NTAL .SERVIO/$ DIVISION Municipality of Anchorage SE[) 2 $ 3996 DEPARTMENT OF HEALTH & HUMAN SERVICE~.. _ .. , Environmental Services Division ' < J~ (,- E J V E D 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (Y/N) ~/~"~ Total depth ~t9 / Sanitary seal cf, qq) Health Authority Approval Checklist L/97'/~7 8/')~ Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to _ 7t9 ' Casing height (above ground) Y~5 Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION .~, YT,'q4~'/6--- Other bacteria Collected by: ~ 1~ _ ~ /t9/9/) Number of Compartments Depression (Y/N) ,AftP Date of test Static water level Well production /' WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: B. SEPTKJ ./HC~'~,t:ffqG TANK DATA Date installed ()~//~'~ Tank size Foundation cleanout (Y/N) __ DateofPumping t~¢/~¢/2~ Pumper g.p.m. ~-~ Cleanouts fi/N) . High water alam~ (y/N) _ - If yes, give date Fluid depth in absorption field before test (in.); Fluid depth ~- .(ins.) Minutes later: ~ Peroxide trealment (past 12 months) (YfN) ~- Absorption rate = _ *'- g.p.d. C. ABSORPTION FIELD DATA Date installed Dq/~/.,¢, Soil raring ~ ..2,. ,_ ~), ~ '7~./VE (g.p.d./fi o~n mmm) Systemtype __ Length. ~ ~ t Width Gravel tldckness below pipe ~ Total depth f ~ Effective absorption 77¥ ¢¢ area Monitoring Tube present(y/N) ~ . Depression over field (Y/N) /ia, Date of adequacy test ~/gSpO Results (Pass/Fail) P..4 55' _ For _3 bedrooms hnmexliately after, gal. water added (in.): O. STATION Date installed Manhole/Access (Y/N) ~level at* "Pump off?' level High wa~ *Datum ~ted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hot~ tank on lot //~ ! ; On adjacent lots Absorption field on lot / t90 ~ .; On adjacent lots Public sewer main A//.4 Public sewer manhole/cleanout S~wr/septic service line / tgO ~ Lilt station SEPARATION DISTANCES FROM SEPTIC/I-}GLDING TANK ON LOT TO: Building fom~dation / t~ / Properly line ~ <~ ! Absorption field Water maga/service line 2-tZO / Surfacewater/drainage ~"/{-.)0 / Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water -p /OtD / Curtain drain F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inxpections and review in conformance with MOA It/IA guidelines in effect on this date, Signature Engineer's Name .L~OO15 ,/~ UT'E~-,,4~ ~ ~ · Property Line /~) / Water mai."Jservice line Driveway, parking/vehicle storage area Wells on adjacent lots ~fi/tgO / HAA Fee $ r_'9)~'D Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 DSS: haa.wk.doc MUNiCiPALITY Oi~ ANCHORAGE :4 E M © R A N D U M V'ATER WELL ADVISORY HEALTH AUTHORITY APPROVAL During a recent Health Authority Approval on-site inspection and_~',~'~':'~ ~f~ the~otab'-e~ water supply well on Lot I~,~'~ ~" Block ~ of /~A~ ' Subdivision, the productivity was determined to be c.Z 5- gallons per m~nute. The minimum well ~ '~ p~du~=_v~ required by this Department (AMC 15.55) for a ~ bedroom residence is ~', ~/ gallons per minuke. A=~no~.~_~''' ~m -one subject well currently exc~e~s~ ~' =nzs minimum~e~u~_~me==~, .............. ~=z par~ies concerned are advised _nan the production capacity oz Erie v~=z= may fluctuate. Restriction non ................ uses such as washing ears and watering lawns an-~ gardens may be required. This advisory must be attached to all copies Health Authority Approval. of the subject -? 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. # (~\- \.L~,L~.-~\ NAA# 1. GENERAL INFORMATION Complete legal description Lot 128A; Pc~y Subdivision; Location (site address or directions) 21717 Tarika Property owner Mailing address Lending agency Mailing address. Brian & Gl¢nda Gerri~v ¢1717 T~Jba: ehugia~.: A~. 99577 Day phone 688-1578 Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Agent Sha*_on ~f~!&r'h ~F,//JAX' []F ~A¢I F RIVEP Day phone Address Unless otherwise requested, HAA will be held for pickup. 3 NOTE: Individual well XX 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: XX 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. 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/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 Address S & S ENGINEERING Eagle Rivel', A aske, 9957~ Engineer's signature Phone ~2 ¢~¢~-Z~',~ Date ~'~¢,/ /' / SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for 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 DH HS 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. 72~)25 (Rev. 1/91) Back MOA ~Y21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~--~,'¢ \"/-.~,A Parcel I.D. A. WELL DATA Well type ~ If A. B. or C. attach ADEC letter. Log presentd~/N) '~ Date completed Total depth '7 ~' '~" Cased to '~' '~" Casing height '---' Sanitary seal ~/N) ~ Wires properly protected (~/N) FROM WELL LOG AT INSPECTION ADEC water system number ~/~ ~' ~ ~' Driller ~o~.~, ~/~-~J ~J~¢~ ~_u~ Date of test ~- -. ~,~ ' Static water I~vel %¢ ¢, I' ", t,~ -'"' Well flow dV-.L ~, g.p.m. g.p.... Pump level' bt~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~, %'7~.' ; On adjacent lots Absorption field on lot t ~' ' ; On adjacent lots ~c>c~ ~'~ Public sewer main ~J,~' Public sewer manhole/cleanout Public sewer service line ~/~' Petroleum tank WATER SAMPLE RESULTS: Coliform ~) /1~o.,,~¢, Nitrate Date of sample: ~ ' ~'~'~/ 5-;, / ,~/~,/.~, Collected by: Other bacteria ,,,',/~ ,.J E B. SEPTIC/HOLDING TANK DATA Date installed ~}' Cleanouts t~N) High water alarm Date of pumping Tank size / oo 4) Compartments ~-- Foundation cleanout (~N) ~ Depression (Y~ Alarm tested ¢¢--/4~ '"J/~,- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I¢' ?--* To property line t~ Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line lC, i--'- 72-0?6 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIF'r STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (YJ.N.P:~'_'~. V~,,T1'~on lot On adjacent lots Manhole/Access (Y/N) ------~ycles tested Surface water D, ABSORPTION FIELD DATA Date installed ~1' -. ~ ~ Length ~"L' ~, ~. Width ~ ,~" Total absorption area ~ ~ ~. ¢ Soil rating ~c~ ¢/~,~- System type Gravelthickness '7 ~ ¢ Cleanouts present ¢~/N) Depression over field (Y,~ ~ Results ~;~)¢fail) /~¢-< Peroxide treatment (past 12 months) (Y~ Date of adequacy test for ~.-~) 7'~q ~. ~-~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot I~'~ To building foundation ~"~' On adjacent lots '~o¢'' Surface water 'J c~ Curtain drain ~/~ E. ENGINEER'S CERTIFICATION On adjacent lots I~o'~'' Propertyline ~- To existing or abandoned system on lot 'J Cutbank ~J I~' Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 'i70'~ ~ g.~lo River Loop Road No, 204 Signature HAA Fee $ Date of Payment Receipt Number 1'70, Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91 ) Back MOA 21 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. Ct ~(~.~ \ 1. GENERAL INFORMATION (Must be completed prior to s'bbmittal) .: ~: - (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner '~C'~GS¢'¢ .~l~ (c) Lending Institution Telephone: (home) Telephone Business Mailing Address (d) Real Estate Company and Agent "~---~J~ ~,~::;¢~1%"~ Address 1D,D. ~,.~,.¢ ~,'¢2'~ ~ ~ ~ ~ ~ ~ i Telephone ~ ~'~ (e) Mail the HAA to the following address: (or check here~if hold for pick up.) List contact person and day phone number.below: $ & S ENGINEERING 17034 Earle Ricer L~op React'Ne. Eagle ff. lver, Alaska ~J'577 2. TYPE OF RESIDENCE Single-Family¢5~- Number of bedrooms 3. WATER SUPPLY Individual Well¢ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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 IRev. 7/88) Page 1 of 2 ~ ,to ~ ebBd '~ldO/~ s,Jeeulbue leUOlSSe,todd eq~, u! SUO!SS!LUO JO sdodJe dOJ elq!suodsed leu s! ebBJOqOUv,tO/il!lBd!o!u nlAI gq1 'pensB! s! e~Bo!j!lJeo B eJojeq elBp eZ/IlBUB dO suo!~oedsu! ~onpuoo leu op SHHQ jo see/ioldLUq 'siuetued!nbed eiB~s pub IBdepe~ u!BiJeo/lieges ol~epJo u! suo!~nlBsu! bu!puel ~!eq~ pub SeLUOq JO sdeeBqoJnd o~ /isa~,,~ooo BBB B!LI~ seep 9HHQ eqj. 'B~ISBI¥ ,to alB1S aq; u! pe~elB!ee~ deeu!ieue iBuo!ssejo~d ~uepuedepu! ue/iq e^oqB g qdBd§B~ed u! ua^lb suoRe~,uese~de~ eql uodn/ilUO pesBq peu;eiJ!de3 IB^o~dd¥/i~!doq~n¥ q),lBeH s@nss! (gHHC]) sea!^~es UBLUnH pUB queeH jo ~uetm, JBdec] ebB~oqouv jo/i~!lBd!a!unlM eqj. 9'~ sT uoT~ezquemuo2 · e~e=~TN rX~TITqe~Tns penu~uo2 sII@~ eq~ eznsuI ~% ,p~mzo~x.ed @q B~!~s@~ m!po!ze~ ~q~ pe~s~BBns s! ~! '=~A~o~ '~Uesezd ss~p~BTu ~ ~q~ 'sspoD I~dIoTun~ IB^odddvlB~oB!puoo,tos~Jei 8861 auoqdele.L ~Nh~I~ONiDN,q 5 ~' ~ e~BC] sBedpp¥ 'uoBoedsu[ s!ql ,to e~Bp gq] uo ~,oejje u! sUO!lBInee~ pub 'seouBulpJo 'sepoe pub IBdlo!unlAi lib q~!~ eouellduJoo u! 9! Lug]s/is IBsods!p ~elB~AelsB~ do/puB /ilddns ~e]B~ e~!s-uo eq~ 'uoBoedBu! pub uop, BIB!~sa^u! /iuJ uuodj pug Sel!j eeedoqou¥ jo /i]!lBd!o!unlM sql, tao~j pau!B~qo UOBBLUdOJU! eq~ uo pesBq )Bq]/i,t!de^ deqpnj I 'u!edaq pe]Bo!pu! edn~onJ]s jo ed/il pub suJoodpeq ,tO JequJnu sql, doJ elBnbepB puB' IBUOp, ounJ . 'e,tBs B! tuals/is lesodslp Je~BMelSBM do/puB AlddnB de;IBM el!s-uo eH1 ~,Bqi SMOHS leAoJddv X~!Joqin¥ qllBeH s! ql JO uo!oBe!iSeAU!/iuJ F~Lli/iJp@A I 'MOleq UMOqS eiBp uo!lep!lB^ eq~ ,to sB pug oleJeq pexBjB lees/itu/iq peBBJe3 sv NOIJ.~I~IBO-tNI aNY YJ.'va 'NObl¥~l$ ~'114 'S.L$~IJ. '$NOIJ. O~dSNI 9NICIIAOI-Id INI:II=I DNI~t~INIDN~t ,)MUNICIPALITY OF ANCHORAGE (MOA) o[-lealth Authority Approval (HAA) ,r,5o?'N ~,(~ECKLIST - FEBRUARY 1984 Well Cla*s f ~t on ~ ~..~ ~ ~ If A, ~, C, D.~.C. Approve~ (Y/~) Well Log Presen~N) ~ Date Completed ~/~ Yield Total Depth""/ol/~''~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit4~N) Depth of Grouting -- Pump Set At ~-'Z.-' ~ \3-"~ '~ Sanitary Seal on CasingS/N) '~ '~ Depression Around Wellhead (Y/~) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot [,'~¢'"' ' ~; On Adjoining Lots To Nearest Edge of Absorption Field.on ~-ot]~ ~ ~ ~ ; On Adjoining Lots \.~ TO Nearest Public Sewer Line --/r- To Nearest Public Sewer Cleanout/Manhole I To Nearest Sewer Service Line on Lot Water Sample Collected by ~'~.~ ~lh3~c~PF2-~/"-~C';Uate ~'7.~ Water Sample Test Results ~----~,,~'~'3'~~ - ~. ,~ Comments ~t...,c~ ~'~:::¢~1" ~~~ ~--"/..~'¢~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~¢t(b.--~"~ Size Standpipesd~N) '~/ Air-tight Caps./N) Depression over Tank (Y¢_.~) /-~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments "7/ Foundation Cleanout (Y~ ate Last Pumped' ~-'?-~- F~/~::~ ;for JCl/"/' Temporary Holding Tank Permit :(Y/N).. /'~/~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ,.:... ,. I '~Z'~2~'t To Building Foundation \ '(~ I To Disposal Field ~ To Water-Supply Well To Property Line \ ,;:::, 14_ To Water Main/Service Line \~::, t..~ To Stream, Pond, Lake or Major Drainage Course t 72-026 (Rev. 7/88) F¢ont Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorp, tion Strata --4 ~ , ,,~¢¢-"'- Type of System Design Datelnstalled _ "~/~% ~, ~I/E~¢~ Length of Field '~'2~1 ,/~/"~ Width of Field ~ ~" Depth of Field "71///[¢ Gravel Bed Thickness Square Feet of Absortion Area ~"~?--~'¢~ "~-~I¢.d.~ Statndpipes Present~C:~N) Depression over Field (Y/~ ~.~ Date of Last Adequacy 'rest ~;~--~.--'~ - Results of Last Adequacy Test '~./:~'~ I ~¢--~ ~ ~'~-¢~.r~"T'¢~ ~(~_~,¢.~;2,_~-.~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well I '¢)~ ~ To Property Line [.~ '~,,4~ To Existing or Abandoned System on To Building Foundation Lot ~-~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ; On Adjoining Lots ,-~po \~::~ U~ To Cutback (if present) Date Installed Dimensions Size i1~~ "Pump On" Level High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect~J; inspection. $& S ENGINEERING Signed 17034 Eagle River Loep Road Ne. 204 F-egle River, Alaska ~957'! Company Receipt No. Date of Payment Amount: $ 72-028 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ))ore l{~po~t Printed: ~P I 88 (! J3;39 Client Sal,lple ID:Li281~ ?ATfY Collooted AU(; 26 85 0 Received AUG 30 ~8 8 14:30 Client Met : $)I~ENGP P,O.~ tIONg REC'9 Req ~ O~de~ed By Analysis Co).pteted :AUG 31 88 Send ~epozts to: Cbelalab Roi ~: 2~21 Lab $}npl ID: 6 ~at~lx: Allowable Polerl,oto~ ~o~tod geoult/Untts ~ethod Li)~its }lI?Rh~E-}l 8.6 ~,~O/1 EPA 353.2 2an:plo ROUTIItE SM,i?LE I Te~ts Pozfo:l.od 8~0 Special Instzuction~ Above UA~Unavallable liD- }lone Detected '~ Soo Sa~:ple ~o]m~k~ Above CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska, 99518 Drinking Water Analysis Report for Total Coliforrh Bacteria TO BE COMBLETED BY WATER SUPPLIER [] PUBL,O WATER SYSTEM ,,",, I I I [ I I I '"F~:C,~RIVATE WATER SYSTEM Name S & S ENGINEERING 17034-Ea §I e-I~k,e~'-L~e~p4~, c, a d No720~ Marling ~f~SRiver, Alaska 9t577 ~ Phone No. City SAMPLE DATE: State Zip Code MO. Day Year SAMPLE TYPF: ~/Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water [] Untreated Water SAMPLE ? NO. .: LOCATION 2 I 3 I 4 I 5 I Time 'i Collected Collected! By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE.COMPLETED BY LABORATORY Analysi~ shows this Water SAMPLE to be: ,~Sati~factory ! [] Unsatisfactory [] Sample too long in transit; sample should no[be over 30 hours old at examination to I~dicate. reliable results. Please send new sample via special delivery mail. Date Received o¢ '..~ '~¢-9 [eceived / ~"""""""""~ Time ? Analy Ical Method: Membrane Filter * No,. Lab Ref. No. I " J I J q! colonies/lO0 mi. Result* Analyst . -~.~,. BACTERIOLOGICAL WATER~A,NALYSIS RECORD Membrane Filter; Direct Count (~) ! CoJlform/lOOml Verification; LTB BGB. ~eportcd By ~ Date Time: TNTC = Too Numberous To Count Coilforml'lOOml OB = Other Bacteria APPLI¢ NT FILLS OUT UPPER HA[ ONLY .4~ , ,l: . /i Street Locati~ , Date Date Cate Inspector Inspector Inspector Inspector Field Notes: ( ~'~"APPROVED BEDROOMS ~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ~ JUN 2 7 1983 Envirenmem~l Protection" Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received