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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 22a(Y\P%Y\ 1 � � JXrws\z, �w \a ftm�j 4mj) %AA Municipality of Anchorage Page of - DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S uJ g 1 v 1'53 PID Number: 0 5S 1 rot 7 1 '?- Name: Name: EQc�t.� Vr��iTU�.I;S Wastewater System: New ❑ Upgrade Address: t'o -1--11622 ��'�� ��d�.� �K ABSORPTION FIELD Phone: — Z S Z 694 No. of Bedrooms: 15 ,tet ❑ Deep Trench ❑ Shallow Trench ,LY Bed 11Mound ❑ Other LEGAL DESCRIPTION Soil Rating: ^,15 Total Dep»>2151rom 2151 GPD/Sq.Ft, Lot: Block: Subdivision: Lot: 2 2 Depth to pipe bottom from original grade: Gravel depth beneath ipe 01 5P �A t"I p 22,1 Ft. Ft. Township: `157 Range: N Section: Fill added above original grade: Gravel length: X77. —- 3 Sr S I Ft. 1Ft. WELL: Ex`'''�S ❑ New ❑ Upgrade Graveklepth' WIw-rA Number of lines: Distance �eenlines: ZA FL Classification (Private,EA,B,C): T V -i VA Total Depth: 1g0 Ft. Cased To: 16© Ft. Total absorption area: IQD so. Ft. Pipe material: AST 1`1 3032Driller: WIL.I- rls DasSa Drilled: 7116�� Static Water Level: 1P2.2 Ft. Installer: oh/e.- Date Installed: _gq �1J�Y 91 Yield: / �j, "J Pump Set at: LI <J VI4 W }� Casing Height Above Ground: 2 �% f� TANK CO. GPM Ft. i Ft. SEPARATION DISTANCES p septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Litt Holding Public/Private Manufacturer: AR(_woe_b f_ TAtJ Capacity in gallons: todQ From Tank Field Station Tank Sewer Lines Well loo.S C25•f�:, O/N Nf A 76.2 Material: Number of Compartments: 2 Surface��A Water N/A N A N%A N LIFT STATION Lot L}�' 23Z N/a N 42.3 Size in gallons: Manu er. Line Q Foundation 2, 1q v N i N t 1 I`1 "Pump on" level at: "Pump off' leve High water alarm at: Curtain itr A N L I/� N . t N/A Pump Make 6 Model Electrical Inspections performed by: Drain Int N A N A Remarks: 3— 1 to (2" BENCHMARK Location and Description: E L -L... GbSI iJ Assumed Elevation: DO. � ENGINEER'S SEAL Inspections performed by: Dates: 1st 22 �UL`i 2nd vel Department of Healt d Huma rvices ap76A/ ' Reviewed and approved by. �✓ Date: 72-013(1/91) MOA 25 PermltNo."5UJ 21142153 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L-01 ZZ, 5k -y— -4 T501� � %, P I D N o.: e2 N;5'1 4;5 7--e--' 17- TH ' 'F F I lot 6 LEAC"jFIELD LEA'" TH L 110- 1000 GAL. .40.9, OT 23 "TV L ELECT EASEMENT (NOT TO SCALE) TANK FIELD 98.0 72-013 A (2/91) MOA 25 WELL FILL ADDED SINAL LIND IEL @ IOD V TANK ----------- '\�CALE: 1' = 50 <XI, / TEST HOLE MONITOR T 0 SEWER CLE WELL PROPOSED EASEMENT _TDP _ V - 100,00, @ 91.3 PAGE C1 OF 1 MUNICIPALITY OF ANCHORAGE L ISL) DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 n m ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910153 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:EAGLE VENTURES OWNER ADDRESS:P.O. BOX 771822 EAGLE RIVER, AK. 99577 PARCEL ID:05182212 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 22 LOT SIZE: 40960 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 _)"Qq -%l DATE ISSUED: 6/14/91 EXPIRATION DATE: 6/14/92 e __/ E2�L. THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / 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: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. RECEIVED BY: DATE : ('0AZ& ISSUED BY: JOWN &-1 m-+ DATE: �1I?/21 TVA E��81'B"TBUS &))VT (M Louis Butera, P.E. Registered Civil Engineer June 5, 1991 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 22, Block 4, Sampson Estates Dear Mr. Smith, RECEIVED JUN C, 1991 Municipality of Anchorage Dept. Heaitn & Human Services The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, homes are existing on each side. Soils are very adequate. Wells are located so that large septic replacement areas are available. 4. Drainage will not be effected by septic installation. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 \ EXISTING WELL \ EXISTING SEPTIC \ \ SYSTEM LOT 21 \ N 84° 34' 30' E \\ 1 135.41' \ N LOT 22 \\ N \ \ 1 1 1 11 \ PROPOSED REPLACEMENT \ LEACH FIELD \ \ TH 2 ® 1 1 1 \ \ 1 SJ \ \ -� 3].5' EXISTING LEACH 1 1 PROPOSED 24'x \\ ✓6� (Y \ FIELD1 LEACH flELO V� \ 16,1 e1s.h \ d Z TH 1 N 1• � di \ �\0/L \ w \ w � \ SYSTEM EXISTING SEPTIC \ 9 3 �\aOv oe / e� IS / LOT 23 /�'/ ,C) EXISTING WELL / S 10' TELE 6 / V ELECT / z EXISTING WELL EASEMENT / /— — — — — ® - TEST HOLE • - MONITOR TUBE o - SEWER CLEANOUT WELL NO KNOWN_CLRjA V-DRA NS H+Mi+TT - PROPOSED LEACHEIELD — — - EASEMENT SEPTIC SITE LEGAL: LOT 22, BLOCK 4 OWNER: EAGLE VENTURES CONTRACTOR: N/A JOB # 91 —063 DATE: 06, P LA N SAMPSON ESTATES 05/91 SCALE 1" = 50' EAGLE RIVER ENGINEERING P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907 SERVICES 694-3297 T V p��'��ccc.'c-.::uo�aocc aseu,n �r e� try r gf'Ro - b5 U` SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 22, BLOCK 4, Sampson Estates A. GENERAL 1. The well and septic plan are 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 and State Department of Environmental Conservation 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 or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation 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. : 0 1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed 2.5' at deepest point referencing ground elevation at test hole #1. 4. The bed gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 7. 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 = 2.5' GRAVEL DEPTH = 6" BED LENGTH = 37.5' BED WIDTH = 24' SOIL RATING = 0.5 GPD/FT2 BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,000 GALLONS Note: 2" insulation (35 PSI strength) over flow lines and tank. Minimum 3' soil over bed mounded or insulate. Twenty-four (24) hours required for all inspections. -- IIUI rr i" i'r SOILS LOG / — MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: FGa %G /�� /� it '-tfJ DATE PERFORMED: LEGAL DESCRIPTION:_ 1u f , /�/� �/ S4 rryW f e l �J,7+ ?/S'n/ 'm I ty Sec T" 1 1',FJEOTII I SLOPE SITE PLAN 1 _ o Cry -c P) 2 s/•r/r f.ir 3 G r+, 31415 13- Date Gross Time 14- Depth to Water Net Drop S�q f/sr y, 15 A, -In ve 16 17 e� 18 19- 20 COMMENTS WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? 8• B AFXi Reading Date Gross Time Net Time Depth to Water Net Drop S�q f/sr y, A, PERCOLATION RATE -7-1-- / • F (minutes/inch) 0.,p TEST RUN BETWEEN 3 FT AND y FT PERFORMED BY: Eagle River Engineering Services CERTIFIED BY: DATE: G 5 / P. 0. Box 773794 Ea918 River, Al( 99577 72-006 (6/79) 694-5195 SOILS LOG MUNICIPALITY OF ANCHORAGE t� s ar DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION `A PERCOLATION TEST .� 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: � 6V _If y C�'�T�� I DATE PERFORMED: ��547F/ LEGAL DESCRIPTION: SMps�^ F�* %/T/✓ ')ei.-t) 're -C 3 %/-l-)- VDEPTHl SLOPE SITE PLAN 1 ' 2- 3 3 p d < O 4- 5 6- 7 7 O l 8- 9 9 10 0 �D 11 6 12 13 7--w -C V, / 14- 15- 16- 17 415 17 r Louis A. "atem v. J' CE -8730 18- 19- 20- COMMENTS 8 19 20 COMMENTS EMEM NEME EEE EEIEE EEINE WERE MOWN EEMM MEMO EE■M EEEE ■EMM 60 WAS GROUND WATER _ S ENCOUNTERED? % r L O IF YES, AT WHAT 7 dayl DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop S- aAPf FT AND 3 FT PERCOLATION RATE 1 -:t,, 3 (minutes/inch) - 0r 6&'0 At 1 TEST RUN BETWEEN FT AND 3 FT Eagle (liver Engineering Services PERFORMED BY: P-9 Be'- 773?9d CERTIFIED BY: Eagle River, /1K 99577 694-5195 72-008 (6/79) DATE: f EAGLE RIVER ENGINEERING SERVICES P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB Zo7- --,,z SHEET NO. / OF / CALCULATED BY L DATE CHECKED BY DATE SCALE PROCIILT 241 Mes Inc. C'dw Mau U1411. Pout-, 16-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840705 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 22 Block 4 Sampson Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 . ^ . . 0-1 U 11"11 -1 C-, 1 F-- gff4 L- -r'V C3 F=- �11%�u C- 0-1 C3 IF< U3 Fl=— ,^ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 - 264~4720 113 E3 1��� ����������| ��I � � � ` PERMIT NO: 84()705 ` DATE ISSUED: 08/20/84 APPLICANT: SKAGGS CONSTRUCTION ADDRESS: P.O. BOX 670690 CHQGIAK, AK 99567 CONTACT PHONE 688~2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON LOT., 22 BLOCK. 4 SECTION: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: ` 40960 (SQ.FT. OR ACRES) MAX BEDROOMS,- 3 ` Listed below are the options available to you in designing your septic System. Choose the option that best fits your site. � DEPTH TO PIPE BOTTOM (FT.> GRAVEL DEPTH (FT. TOTAL DEPTH (FT. GRAVEL WIDTH (FT -- GRAVEL LENGTH LENGTH (FT. ) -^« 1 3�� TANK SIZE (GALS)- &900 FRC- ' SOIL RATING (S(2.F. T /DR) ^ ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the require nts for on-site sewers and wells as -set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with allMOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to allMOA and State o{ Alaska requirements for the set back distances from any existing well, wastewater disposal system. 01" public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for 'a maxin`um of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS--BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED � DATE: ^ APPLICANT SKA � ISSUED BY DATE: ` r~ X SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST y / PERFORMED FOR:///�e�j% DATE PERFORMED: LEGAL DESCRIPTION: 1& ZZ, !f dt( jsjm 7 SLOPE SITE PLAN 1! 1 ail I I I 12 3- 4- 5- 6- 7 8 9 10- 11 12 13- 14- 15- 16 3141516 17 18 19- 20-1 COMMENTS PERFORMED BY: 72-008 (6/79) Sir 1zC5rJvw , �g3e aaaa f# 3ac� 4r asa4::�sceaays vSceaswa;- Bruce S. Cc -:'11. hlo.C�-"S3 WAS GROUND WATERS ENCOUNTERED? /ML O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN �qD WA ,5 �nd 65' CERTIFIED BY' FT AND (minutes/inch) FT 1 ✓ ! /'mac DATE: 7- l44- 0 C Y co ® Q Q J J ® a U, mn� ® w C/) LU "0; I�. 4 � 7 l U O ; 44 o aJ 3 v j 44 O O O O O O O O O O O O F+ H F F F F E F F;F4 F O j d 0 O O O O O O O O O O O O +) rx x x cG cd C4 W w x 9 x w w w w w w w w. w w w ro S4 s4 3 i4 ra "J Q N a C? D; rt r•i t~ b rd O, flE s6 S.c E zF cc7 L1 -R c7F r -I Q rd 2f r 5 0 o w w w w w w w w w u l w 4-) G u ro koi c i o r> aZ t`; ca r -r ri O o O o o o o 0 o 0 0 0 0 z F F F H H F H F F F F F ra w w w w w w ri: w w w' w d� O O o 0 o o o 0 0 0 0 o z 6G cG g c4 a a a g c4 w w w w w w w w w w w w ri U rn fl} flu)• 4 4.1 u; W a u a� 44 ) O w ,-4 F+ w P: Q: oh JJ; v): Nj w F c3 q o; w . coi a O O >} v w z 3 q x a F � a, v �. v u U "0; I�. 4 � 7 l U O ; 44 o aJ 3 v j 44 O O O O O O O O O O O O F+ H F F F F E F F;F4 F O j d 0 O O O O O O O O O O O O +) rx x x cG cd C4 W w x 9 x w w w w w w w w. w w w ro S4 s4 3 i4 ra "J Q N a C? D; rt r•i t~ b rd O, flE s6 S.c E zF cc7 L1 -R c7F r -I Q rd 2f r 5 0 o w w w w w w w w w u l w 4-) G u ro koi c i o r> aZ t`; ca r -r ri O o O o o o o 0 o 0 0 0 0 z F F F H H F H F F F F F ra w w w w w w ri: w w w' w d� O O o 0 o o o 0 0 0 0 o z 6G cG g c4 a a a g c4 w w w w w w w w w w w w ri U rn flu)• 4 W a a� ) u • 00: N d! li coi 3 S a, �. N i.i D N Cl . � A z rq � W d w O 'C4 w I I 3 A w O "0; I�. 4 � 7 l U O ; 44 o aJ 3 v j 44 O O O O O O O O O O O O F+ H F F F F E F F;F4 F O j d 0 O O O O O O O O O O O O +) rx x x cG cd C4 W w x 9 x w w w w w w w w. w w w ro S4 s4 3 i4 ra "J Q N a C? D; rt r•i t~ b rd O, flE s6 S.c E zF cc7 L1 -R c7F r -I Q rd 2f r 5 0 o w w w w w w w w w u l w 4-) G u ro koi c i o r> aZ t`; ca r -r ri O o O o o o o 0 o 0 0 0 0 z F F F H H F H F F F F F ra w w w w w w ri: w w w' w d� O O o 0 o o o 0 0 0 0 o z 6G cG g c4 a a a g c4 w w w w w w w w w w w w ri U rn P MUNICIPALITY OF ANCHORAGE�� • '� DEPARTMENT OF HEALTH & HUMAN SERVICES}i 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 1. D. # (7)�) \ _ �� - t a HAA # 1. GENERAL INFORMATION Complete legal description Sampson Estates, Lot 22 Block 4 T15N R1W Sec.3 Location (site address or directions) 23847 Goliath Drive Property owner Eagle ventures Day phone 694-2529 Mailing address P.O. Box 771822, Eagle River, AK 99577 Lending agency N/A Day phone Mailing address Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well x 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 x 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(Rov.1/91) 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 Fagle River Fnaineering Services Phone 694-5195 Address P.O. Box 773294, Eagle -`River, AK 99577 Engineer's signature �� Date g�/7z �Z 6. DHHS SIGNATURE %C— Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 UITir bedrooms, with the following stipulations: Date r The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 5 /MPSON E57.37C-S 10T tZ &.k'4 Parcel I.D. 05/8 2Z/Z A. WELL DATA Well type P4Og12.5 If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) Date completed 01 -&hg Driller J4Y Total depth /90 Cased to / ?0 Casing height 2' h J Sanitary seal (Y/N) YG`5 Wires properly protected (Y/N) Y4� Date of test Static water level Well flow Pump level FROM WELL LOG _ h _y/Fli n / � /Z (65 r) g.p.m. 0IV,L/V06J1q SEPARATION DISTANCES FROM WELL TO: AT INSPECTION (BS PEk' Sts�/6/N/i+l� D3�L0&191 Impa-T 0310(009/ 16g, 7 MWNICIPALUTY OF ANCHORAGE ENVI GNMENTAL SERVICES DIVISION Gm.1 q 1991 UNK/yoGvN RECEIVED Septic/holding tank on lot /001 J ; On adjacent lots Absorption field on lot 1 25. 8 A ; On adjacent lots Public sewer main N/A Public sewer service line WATER SAMPLE RESULTS: Coliform -® N/A -y- loo J Public sewer manhole/cleanout N%A Nitrate /,S �s/4 5 Petroleum tank f / O0 Other bacteria -8 Date of sample:�`9 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size 00 67/34 Compartments Cleanouts (Y/N) GS Z Foundation cleanout (Y/N) Y65 5 Depression (Y/N) High water alarm (Y/N) Na Alarm tested (Y/N) N�A Date of pumping nl,5W SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: J Well(s) on lot /00.5 On adjacent lots -� /00, Foundation To property line A5. 1P / Absorption field /9.7 J Water main/service line Surface water/drainage NIA 72-026 (Rev. 3/91)Front MOA 21 - CONTINUED ON BACK PAGE STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at les tested Surface water . Date installed 1) 919/ Soil ratingJi J (%O1 F7 Z System type Length 39. 5 Width 2�4 Gravel thickness / Total depth Total absorption area glia FT 7 Cleanouts present (Y/N) YDS Depression over field (Y/N) /UU Date of adequacy test N Results (pass/fail) ��sISS for 5 bedrooms Peroxide treatment (past 12 months) (Y/N) ND If yes, give date N�� SEPARATION DISTANCE FROM ABSORPTION FIELD TO: � � s Well on lot 126. On adjacent lots f 11019 Property line 2 3• L To building foundation � 9. F J To existing or abandoned system on lot eY414 On adjacent lots �- 30 , Cutbank NLA Water main/service line f )5 ! Surface water ,bJJA Driveway, parking/vehicle storage area f 12 S l Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect. ,on. the date of this inspection. Signature Engineer's Name Date �I U U v % Waiver Fee: $ HAA Fee $ / Date of Payment $-19 ` 5/ Date of Payment Receipt Number C�,_x 9 78 � ff ZG Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99519 TELEPHONE (907) 562.2343 FAX: (907) 501.5301 ANALYSIS REPORT 1Y SAMPLE for NORRotderl 37279 Date Report Printed: AUG 16 91 1 16:47 Client Sample ID:LAE REI IAA9002A SAMPSON 22/4 Client Naas :EAGLE RIPER ENGINEERING PMSID :UA Client Acct :EAGLERP Collected ►UG 13 91 1 16:46 his. BPO IR PO I« NONE RECEIVED Received AUG 14 91 1 14:10 hie. Raq It Preserved with :AS REQUIRED Ordered ly :LOU 1111641 Analysis Completed :AUG 16 91 Send Reports to: Laboratory Supe Ti or : EPNEN C. EDL 1)EAGLE RIVER ENGINEERING Released By o vvrr sa o.u• .r.w......rr..............................................r..........rw.uvu.v u.w..0 v..w.www r...w•o.. vw.r• Chemleb Ref 1: 914131 Lab Sapl ID: 3 Matrix: NATER Allowable Parameter Tested Result Units Method Limits ----------------------------- ---------` NITRATE -N 1./ ag/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED 11: G.K. Remarks: .............................. w........... ................. I......o.......... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " Sao Sample Remarks Above Nk- Not Analyzed LT -Loss Than, GT -Greater Then %)uS8 Member of the SGS Group (SW616 GAn6rale do Surveillance) 1661 P.2 JUL 15 '91 15:16 RE/h1AX� -EAGLE RIVR 17034 Eagle River Loop Road ROBERT A. $RAPER Eagle River, Alaska 99577 CIVILENGINEER 884.2878 DATE OF TEBT: -�—�- LOCATION OFWELL (Legal Deeoriptlon): WELLDEPTN:� MINN leC> FT. ~ j SCREEN: DATE DRILLING COMPLETED: 77L'' DRILLER: V A" ` 1►�L- 1 /�f-'1s 1 (�7 � �.V .DALE: FT. . STATIC WATER LEVEL (Top of Caslnp): --41p- LOCK ELAPSED TIME SINCE DEPTH TO CLOCK WATER,FT. TIME I STOPPED, MIN. n I I t021 7— M 10 45 50 55 fi0O hour) 90 120^, •12h 150 190 (3 hour 210 2400 (4 hq RECOVERY 0 RECOVERY I I RATE, GPM PUMPINO REMARKS 1:57-;1 Comments: , I o� � y. � q 0G ; � �• 3 1`� Fraw la not Guaranteed � � �-1 r�Vk � � Subsequent Variations Can occur.