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Home My WebLink AboutSCIMITAR #1 BLK 2 LT 8cirniarIt Block 2 Lot 8 #051-132-16 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: .51X/ 03Paa0 PID Number: O — Ito ne KQIS Lu n Wastewater System: E] New Q'Upgrade ddre a P D 30 7 v q�' ABSORPTION FIELD arc, -e Number of Bedrooms' ❑ Deep Trench ❑ $hallow Trench Bed ❑ Mound ❑ Othe, LEGAL DESCRIPTION Soil Rating: 0,45 Total Depth from original grade GPDrFIr Btcck Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 1' d f �C 5 FI. O. s Tc:vasmp anger Section: " Fill added above aiginal grade: Gravel Length: FI. r" Well: ❑New ❑ Upgrade Gravel width p Number of lines: y Distance belveen'•-es 1 FI t. dSS:I= or. !pnva e. A. e. Cp Total Depth: Cased to: Total absorption area: Pipe Gv Fts 10 303 biter jr • Data Dtllted: Static Waler Level. Installer: Dale Installed 1l '�9/0"b g'�t FI to I Y.ed / v Pump Set al: Casing Haight Above Ground: TANK GPM F1. F1, SEPARATION DISTANCES L'7 Septic ❑ Holding ❑ S.T.E.P. ❑ other: To From Septic Tank Absorption Field Lift Station Holding Tank Public]Private Sewer Line Manufacturer11 A.N c -i4 i pt' v._ capacity 11100 Get (q 1(v 0 t"f/!a NIA i t, J Material: ST Number of Concae,:s 5-apebVater N b LIFT STATION Lp: line V -O 1 v t O � Size: Gal. Manufacturer 'Pump on' level at 'Pump off level at a•. Ron water ala:mIn da w In Cl Drain V h• Pump Make & Model Eleddcai inspectigA performed by 1 BENCH MARK ,'C�/ Location and Desaiplion, 1 ], I S JALYJ (/1/✓W �/i/O'V I' — Uv. Y- f d el '. A$S,ned Eeve;. c- "!T e :491 — Inspections performed by: Dates: ial ., 2nd i q 8� }. • - sai ae� Development Services D art t rova p p pp ®mss T ben SpurAiand a 1 anti c�aaas �- �� lE � �°• Reviewed and approved by: Date:14 ell I --�-- -- G 10 FT 1 STANDARD BED 1 20 X 30 EXIS RELD 4 -FT TOTAL DEP TN I K f 40 17 10 FT M/N. 1 1 I I I 1 ;EPUCL71 1 GAL SEPo#C I 1 I 1 � I 1 � I 1 I r�nnlrm,� PS 0 50 75 IOD 125 150 ,........l.:... ...... I SCA _ TO N SPLRKLAND f... NO. 2225•.AVe Ar Ar GARAGE TLooR SUB ASSUMED f[EYAT/ON 100.00 fT TOBBEN SPURKLAND P.E. LOT B BLOCK 2 SCIMITAR 7SEPT/c SYSTEM AS BUILT 209073 W K. 279-3916 TH. AVENUE11 KRIS KUDYBA DATE: JULY 22, 2003 (NCH. AK. 99501 24414 WHALEY AVE.SHEET' � 2 3 GRID: NW1161 PERMIT # SW030220 PID # 015-132-16 SC102082.DWG D 3 rix G AD 3d5 80 5BE 34 CE 61Bf 111 Ci 118 BD 145 3w11J,"N 1Ye11 !34CH 143 BK 119 CK 121 PS 0 50 75 IOD 125 150 ,........l.:... ...... I SCA _ TO N SPLRKLAND f... NO. 2225•.AVe Ar Ar GARAGE TLooR SUB ASSUMED f[EYAT/ON 100.00 fT TOBBEN SPURKLAND P.E. LOT B BLOCK 2 SCIMITAR 7SEPT/c SYSTEM AS BUILT 209073 W K. 279-3916 TH. AVENUE11 KRIS KUDYBA DATE: JULY 22, 2003 (NCH. AK. 99501 24414 WHALEY AVE.SHEET' � 2 3 GRID: NW1161 PERMIT # SW030220 PID # 015-132-16 SC102082.DWG STANDARD BED 20 FT X 30 FT CLEANOUTS AND MONITOR 3 Ft. of Cover /-- Topsoil 6" Sewer Rock — 4" Distibution Pipe SILT iSIRIBNAON PIPE 9G WPE-� Gy 1000 GAL SEPW TANK F `pO ti 9 MONITOR Bit .� _� 5 BUILT LU3 1000 gal tank GROUND WATER 77.3 6/18/03 BENCH MARK: GARAGE FLOOR SLAB 10B9EN SPUNKLAND RE. LOT 8 BLOCK 2 SCIMITAR I SEPTIC SYSTEM SCHEMATIC 203 W 157H. AVENUE11 KRIS KUDYBA DATE: JULY 12, 2003 ia�i�i ��l0_9 In 24414 WHALEY AVE. SHEET 313 GRID. NW1261 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Permit Number: SW030220 Legal Description ,: y Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Kris Kudyba Owner Address: PO BOX 670895 CHUGIAK , AK 99567-0895 Upgrade Date Issued: Jun 25, 2003 Expiration Date: Jun 24, 2004 Parcel ID: 051-132-16 Site Address: 024414 W HALEY AVE Lot Size: 54729 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: �� — Municipality of Anchorage •;' Development Services Department Building Safety Division =. _ On -Site Water and Wastewater Program SA ETY 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage:ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING OSI Parcel I.D. '9 • - 132.- I L2 Permit Number SW 3D 220 Property owner(s) V_Z\ S K U D'1 RSA- Day phone Mailing address (1) ?A q A19 ddress (2) �A %.4p Zip Code Legal description (Lot, Block & Sub'd.) L oT �3, 1� k 2, 5 C,1 1 TAYL� Legal description (Section, Township & Range) Lot Size S� I ZGAcre Sq.Ft Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Well Only. ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ L\q Z I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: yea= Date of Payment: &/1, /b3 Receipt Number:Yi (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: T.SFURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 8 BLOCK 2 SCIMITAR #1 S/D KRIS KUDUBA Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 June 19, 2003 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following: Ground Water at 9.5 ft June 18, 2003. Use Standard Bed Soil Rating. From Testhole 06/10/03 2 min/in = 0.8 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/ 0.8 = 187.5 sq.ft. Total area required: 187.5 x 3 = 562.5 sgft Groundwater at 9.5 Bottom Rock At $fes ` Top Rock At 4.5 feet Rock Depth 0.5 feet SYSTEM CONFIGURATION STANDARD BED TOTAL LENGTH 30 FT TOTAL WIDTH 20EX -2 TOTAL DEPTH PP ROCK DEPTH 0.5 FT COVER 4 FT SEPTIC TANK 1000 GAL '12.r C�3 The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. -F -(- - - -1 TR 6 well WHALEY AVE a �ff DW I 15 1 1 1 1 1 � � i 1 I z I Q I V III .. . •��p"............. I / I 1 I I ■ ` 49th ■ r �....... ... ................... ...:.....� � / i................................... r / TOB N �\ _ �, •., No. CE - ................ E - 50 0 50 � - 150 £'v / SCALE.E, 1 ' - 100 F7 I MUM 3YUKKLAKU Y.L. I I LOT 8 BLOCK 2 SCIMITAR SID I I SEPUC SYSTEM DESIGN I 203 W 15TH. AVENUE KRIS KUDYB4 DA TE. JUNE 9, 2003 ANCH. AK. 99501 24414 WHALEY AVE. SHEET.• 1 3 Lvml �zv-.;vis � GR/D: NW1261 PERMIT #SW030XXX PIB # 015-132-16 SCIO2081IB616 25 0 10 Fr MN. STANDARD firO 7 30 -4T TOM DEP 40 FT 10 FT MN. -Y- Well m ------- ---- lUbrffi:N aFUNKLAND P.L. I I LOT 8 BLOCK 2 SCIMITAR SID SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE (NCH. AK. 99501 KRIS KUDYS4 DATE. JUNE 20, 2003 (907) 279-3916 24414 WHALEY AVE. SHEET.• 213 GROW1261 PERMIT #SV030XXX PIP # 015-132-16 SCI02082BV6 1I I1 REP" 1000 6AIISEAW 11 1 III lUbrffi:N aFUNKLAND P.L. I I LOT 8 BLOCK 2 SCIMITAR SID SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE (NCH. AK. 99501 KRIS KUDYS4 DATE. JUNE 20, 2003 (907) 279-3916 24414 WHALEY AVE. SHEET.• 213 GROW1261 PERMIT #SV030XXX PIP # 015-132-16 SCI02082BV6 STANDARD BED 20 FT X 30 FT CLEANOUTS AND MONITOR 3 Ft. of Cover /-- Topsoil 6" Sewer Rock 4" Distibution SILT �F ll :Ilif:�;7/9l]a �G W _� Gy 1000 CAL SEPAC TANK Oma` 140 ti 9 <�F MONITOR m 1000 gal tank BENCH MARK.• GARAGE FLOOR SLAB 11UrrerN )FUKKIANU r t. I I LOT 8 HLOCK 2 $CIMl7AR 1 I I SEPTIC SYSTEM SCHEMATIC I 203 W 157H. AVENUE KRIS KUDYBA DATE: JUNE 19, 2003 9o��J ��la_9 901 24414 WHALEY AVE. SHEET.• 3/3 GRID. NW1261 SC102083 DWG Municipality of Anchorage Development Services Department Building Safely Division On -Site Water and Wastewaler Program 4700 South B agaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 wwcr ci anchorage.ak.0 0s*s (907)343-7904 Soils Log - Percolation Test Performed For: J. f-{e��[� Dale Performed: eID--D� Legal Description: LD l Y 13k 2_ GCI M I-V Township, Range, Section: COM. !ENITS WAS C-P.OUND WATER V E>ICCUNTE _-D? t s IF YES. AT WHAT DEPTH? I%o Depth to Water After I12, p Monitoring. _ E Dale: l0 18%d 3 Reading Depth Gross Time Net Time (Feet) Net D Cp V ,I _ L -OA 0.A f 2 l / D�hRNICS 3- / o 5, 4-1-1 Cly -ave 4- a a a � e � 6- / t 7- , sr1�.1 4 SM COM. !ENITS WAS C-P.OUND WATER V E>ICCUNTE _-D? t s IF YES. AT WHAT DEPTH? I%o Depth to Water After I12, p Monitoring. _ E Dale: l0 18%d 3 Reading Dale Gross Time Net Time Depth to Wale; Net D Cp I. II I 7'1 x 5 1 PERCOLATION PATE y( (r.,oul¢ssncl) FERC HOLE CIP-METER (Q " TEST RUNSETMEEN _FT AND S Fr PERFOPZMEO BY. 11-S1 !. 5 CE:RTIF`(THAT THIS TEST �`;=6 OFRFOR',AED IN ACCORDANCE VAT ALL STATE AND P,tUNI Cl PAL GUIDELINES IN EFFECT ON THS DATE OATS l!Q 1 03 Municipality of Anchorage Page 1 of Z 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: PID Number: Name:- IcHnet�„s43-” Wastewater System: ❑New Upgrade Address: F" c0. Sox 67005ZCrdu(i/%,e .�k 913Z? ABSORPTION FIELD Phone: (z,05–,3/i4(„ No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ❑ Bed 1KMound ❑ Other LEGAL DESCRIPTION Soil Rating: 0'8 Total Depth from original grade: 2.5 r GPD/Sq. Ft. Lot: Block: Subdivision* � Depth to pipe bottom from original grade: Gravel depth beneath pipe t YYI / M/Z— 2. � Ft. � ' J Ft. Township: r5� Range: r vv Section: - t o Fill added above original grade: Gravel length: 2� ..7 Ft. Ft. WELL: ❑ Upgrade Gravel width,s Number of lines: Distancebetween lines: Lsr/� 5 O' Ft. Ft. Classification (Private, A,B,C): 61`_1.5 "/)'� fwd!?/U>17i> Total Depth: '0. Ft. Cased To: 4-0 '4- Ft. Total absorption area: - (037 SG. Ft.'1'pJG Pipe material: 3303 Driller: �u Lu J AJ Date Drilled: Static Water Level: 49 Ft. Installer: 6kCE-- 581DG� L_ C,,*KT L4 Date install d: $ j0 Z, ,i 3/ %L Yield: S% LP Pump Set at: Casing Height Above Ground: TANK r GPM Ft. Z Ft. SEPARATION DISTANCES Septi c7�ts77�190 Holding ❑ S.T.E.P- To Septic Absorption Litt Holding Public/Private Manufacturer: - Capacity in gallons: From Tank -- F,eld---Station -Tank-- Sewer Lines .--�/i!.aS+Y - - /ooh --- M&Well __ Material: S—C—L Number of Compartments: Z Surface Water lnb /00 -- — — LIFT STATION Lot Line 52 6Z Size in gallons: Manufacturer: 14bN6— Foundation"Pump 33 IS on" level at: 'Pump off' level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain Remarks: Z`/%gu11�j—/oti! ,L, v,5,12- BENCH MARK /OSE ru tkrs 15 a votes �7tl�c� Location and Description: Gq 6 craz 5�^6 C11. 414"l K I✓bot- - 5,W, CO3KXV1C_ G'44,ottisrig. ,,e Assumed Elevation: Ft �Q [7d ENGINEER'S SEAL ,�aa^i +•`�• i w. x'08 l p'�t2s A Inspections performed by: Dates: 1st^L � 3oq2 e ?9 --Go,N __ N= 2nd 3/A? Z Department of Healt and Human Services approval E' a David R. Dayton 4- ,of �`��% Na.229s•E Reviewed and approved by: Date: 6 -17- ?2 Q. pRr...."N�s�'� D VFr ESSt� 72-013 (Rev. 9191) MOA 25 Permit No. SyAJ q2 0 / ob Page Z of Z Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: �� g bQ, 2 ' G5 YIL <��' PID No.: I A-3 3e •z 3 - 3 SS. 2�' (-� cs T FJ__I_ 27.$� � N �A C-1 L2,Co C1.) 8 ®✓ r - �~st Lev /Yr" '^ Z• i i uf4' 60 G.O. mn ren C.O. 72-013 A (Rev. 9/91) MOA 25 IJ ZS.L JFf�+3t Qaa2 r ROBERT SHAFER, P.E. ROGER SHAFER, P.E. a CIVILL LN(aIN I_I_i 1:. A ra ' (907) 694-2979 1i A FAX 694-1211 Aptit 2, 1992 HEALTH AUTHORITY APPROVALS Dattene Nicotayson RE/MAX OF EAGLE RIVER 16600 Center6.ietd DAi-ve SEWER&WATER Suite 201 MAIN EXTENSIONS Eagle Riven, Ataska 99577 REFERENCE: Lot 8; Btock 2; Scimitars Subdivision 01; SEWER&WATER At yowc requiest a we.0 stow te6t waa en ormed and water sam tes were INSPECTION taken on the to ereneed p p 6 property. The bacten.i.a and nitnate anaeys.i,a sampte wene satis6actory (copies attached). The weU was �ound to produce 3.6 gaUon6 pen minute (GPM) with a 77 6t. drawdown (report REPPORTSORTS Eqattached). This stow nate is not guaranteed to remain constant, AND R ENGINEERING STUDIES .6ub6e uent van.cations can occut. Ae6o, an adequacy test wa6 pen6ormed on .the septic system aenv.ing .the neSenenced property. The septic tank was pumped on Manch 24, 1992. On Manch 25, 1992 water was added to the teaeh6.ieed white measurements & FLOOWWTEST WELL INSPECTION wene taken 6rom the monitoring tube. From the data neee.ived, we bound the existng teaehiietd ab6anbs appnax.imatety 110 gattou os water a day. This .i6 not adequate bon any bedrooms. To bn.ing this three bedaoom house .into eompPiance with Munieipati-ty o6 Anchorage (MDA) SITE PLANS requ.irement6 the septic system w.itt need to be upgraded. The 6.inst step required .is to have a soiZ6 test per6ormed .in the Qocation a6 the proposed upgrade. This soiZ6 test wile require a seven day water monitoring period. The upgrade can then be designed and a permit to upgrade the system obtained Gram the MOA, Department o6 Heaeth 9 Human ROAD DESIGN Services (DHHS). Once the permit .i6 obtained the system may be .i-nstaUed and .inspected by a registered Pro6e66.ionae Engineer. 16 we may be o6 6urther service, please contact u6. SOILTEST S.ineerety, PERCOLATION TEST ROGER J. SHAF , P.E. RLS/gm STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920108 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:FIELDHOUSE MICHAEL P OWNER ADDRESS:P.O. BOX 670032 CHUGIAK ALASKA, 99567 DATE ISSUED: 5/27/92 EXPIRATION DATE: 5/27/93 PARCEL ID:05113216 LEGAL DESCRIPTION: SCIMITAR #1 BLK 2 LT 8 LOT SIZE: 54729 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS UPGRADE BED SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN DATED 05/20/92. THE TOTAL DEPTH OF THE BED MUST NOT EXCEED 2.0 FEET SO AS TO ~,M~INTAIN THE REQUIRED FOUR FEET OF ~EPARATION FROM THE GROUNDWATER TABLE. /~ .~ ~ // /~ RECEIVED BY: .~i - DATE: DATE: D. R. DAYTON, P.E., R.L.S. HC 78 Box 1026 Chugiak, Alaska 99567 19071 ffaffiMi 696-2417 May 20,1992 DESIGN NARRATIVE Lot 8, Block 2, Scimitar Subd. #2 This project is to up -grade the absorbtion system to replace a failed deep trench system. The deep trench is not functioning propertly due due a high ground water table. The test holes show adequate soils, and depth to water great enough to allow an absorbtion bed. The lots are large in this area and therefore required separation distances are not a problem. The lot is well drained from Southeast to Northwest at a slope of approximately 8%. The proposed system will have no measurable impact on existing or fuyure wells on adjacent properties. There will be no impact on reserve space/surface or subsurface or on drainage. aDu' David R. Dayton e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMEDFOR:_{{�//C[;�ELL�ie%OUCj� DATE LEGAL DESCRIPTION: I -or -a &t�K 2-5tim,yinge tTownship, Range, Section: DEPTH - SLOPE (FEET) 5/�.7Y_ SA-�rO r--7--r--T-1 r- 1 1 2 3 4 5 6 7 8 9 10 11- 12 13 13•a — 14 15 16 17 - 18. 19 20- COMMENTS 0- COMMENTS SILTY 69AUM WAS GROUND WATER y� ENCOUNTERED? Ww rss2 S 9 P�C'T'°"1 "'t ri:,C• IF YES, AT WHAT1 OL DEPTH? I i G e P E Depth to Water AftercS Monitoring?! Date: SITE Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: 2 '� T�'V I �� ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L ~-'~'~--i~ t,¢ [~'~,..~ IFYES, ATWHAT ~ O 12 DEPTH? __Z, p E 13 Deplh l0 Water Alter ~onitoring7 SITE PLAN 14. 15 16 17 18 19 2O COMMENTS Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE _¢,r~ (mmutes/,nch) PERC HOLE DIAMETER ~-~ TEST RUN BETWEEN ~ FT AND ~' FT PERFORMED BY: '"~' ~2' ~'~'~¥'~ I . CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C,/~,'~ ~- 72-008 (Rev. 4/85) D~z;d Fi. (;wlor, P.E. MC 78 Box 10",~ Chugiak, Alaska 99567 ,. David R; Dayton Pi'E. HO 78.Bex ,3026 :.ChU giak(,Ata,~ka:99567 ~/~- 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 [~UPGRADE MAILING ADDRESS ~---~__~ EGAL DESCRIPTION LOCATION ~---~.~r-~'~ Well ~ z I Manufacturer ~ I DISTANCE TO: ~ = ~ DISTANCE TO: ~ ~ ~ I No. of lines ~ Length of each line ~ ' Top of tile to finis~ grade Absorption area NO. OFBEDROOMS PERMIT NO. No, of compartments Inside length Liquid depth Dwelling PERMIT NO. Material Neares~ot line %::::~ ¢~.~ ! Trench width ', ~;;' inches Length Type of crib DISTANCE TO: Foundation Total engt~ ofl nes Material beneath tile -Liquid capacity in gallons PERMIT NO, ~'2~.~,~-~ ~ Distance between lines Width Depth PERMIT NO. Total effective aL2Aorption area Crib diameter Crib depth Well Building foundation Class Depth Driller PERMIT NO, Building foundation Sewer line Absorption area(s) DISTANCE TO: I-Total effective absorption area Nearest lot line Distance to lot line Septic tank OTHER PIPE MATERIALS SOIL TEST RATING I NSTA L LE R.~-~ -~-~RKS APPROVED DATE LEGAL lq'TV .... :, .:, [ F:.I I ]: :~i; ' TYPI:!! CIF S 3 3: l,. I:::lli'~:!E;Cfl':i:[!?,T T r'ff.,I ............ " i~,'II::;IX:I:t','II..IP1 I'.,II..IH[31~!:I:;?. O1::: 13E!:I)I:;':iOCIHS = 2; '1'1-..1ii: t:;?. E (;:! t. .I :t: I:;i:[EK:, Si; 3: ?IE OF TI...II}F SCI Z[ I... 1:::II3SCi[~'.P'F ]: (:iiI.,t 'i!;YS'TEH 3: :~i;; THE: I...E'iiN(]iTH [):l: t"lE:l'.,l!:i; :1: O1'.,I :1: S 'THE I_.IEhI(3'I"H ,:: 3: t",! F:'EIET ::, OF 'THE 'T'l:;i:l:~J'.~!(:::l.q Cfi;i: 13, t~?.1:::t :[ I",ff:' :!: !i!:l....D. THE Ii:;,!~ii:l::'"l"l'"l Cfi;;' FI TFiiEI",IC:H OF, ii P'[T ):'.!i!; "I'I'IE I) :[ '.E;TFINI::::[!i: [31i!iFI,.ll(:lii:I",l THE :!~il...tl:;?.'~::'l:::l(]:!:!i: i:iF: THE (~iF?.OI..II.,ID I:::llq[:, TI'IE !?,CFI"TC~HO1:::' THE: E!XC:F:I',,,'t:IT:[(')I",t (:[l.,I I:::[~(E'I"). 3'l...lt!i:l:;i:lE ]:S.'; I'.,11:::{ SET I.,.13'I)TH F:'OF: TI;?.E:I",IC;HES. THE 13f,;:1:::I',,,'t:i;:1.... DEPTH ]: S TIlE t'l ]: N ]: h'll..IH [;,lii!:l:"['l'"l OF:' Gl';i:l::~',,,'lii!:L.. BETI41]ii:I!'::I",I "!'l'lf~: Ol. ITl:::f::ll..!. F:' :1: l:::'!'i!: FIN[) THE [!!',OT"I'(:)i~'I O1::: THE EXC:F:I',,,'I:::IT i[ C~t'.,I ( ]: t'.,I I:'t:EET ). 08-EGE Russell Oyster 694-2774 Soils ~ Foundations Performed for: Legal Description: L aT ~. Depth (f,eet) ,-ECHNICAL 8 DEVL .OPMENT CO. Box 90, Davis SI., Eagl~ R~w , Alask~ 99577 6942774 m 688 2280 SOIL LOG Name: ~-T~--,~ ~ Mail tng Address Sol) Ch)rqFteristtc) Earl Ellis 688-2280 Land Developn'~nt 15_ Ground Water Encountered: Yes __ No ~ If yes, what depth__ Proposed Installation: Seepage Pit Drain Field Comments: Perfor~med by:_ Date:. t y `2 ji sx r Taffirb 40th n }J AUN CF ANCH RAGE :..:' by 'ADEPT. _ ENViRONn�.ENTAL P; :� DOC Co. dba SULLIVAN WATER WELLS ctinAY 5 `�` P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 GD[(EIV E® . j� OWNER OF LAND 2 / eE f / EG Q t7co l-I f c DEPTH OF WELL �p / ADDRESS STATIC LEVEL OF WATER FT. 9 ! LEGAL DESCRIPTIOrQ g <K c� S Ci , r DRAW DOWN FT. DATF. - Started Tt 9 Ended of LO r GALS. PER HR `y P,gRMIT NUMBER 79 o d 6 ? KIND OF CASING o KIND OF,*ORMATION: From Ft. to___3_Ft. 0 `'��= Id J.4'o O= "j From Ft. to - Ft. From—Ftto o Ff. C < 04 i Qk1 / From—Ft. to Ft. FromC , Ft. to 3, I Ft. 5�' J d� �G From Ft. to Ft. From Ft. to 4,) Ft. d4 U if CL g From Ft. to Ft From_I*LL�Ft. to Ft. �4,4i '- From Ft. to Ft From ~fib Ft. to—T I" Ft. T/ 61-y �,,e-#-1�From Ft. to Ft. From Ft. Eo Ft. Sf G�GR % �Ai ✓Q f`i a From Ft. to Ft. From Ft:'to Ft. w�� `� R r'=' n From - Ft. to Ft. From�Ft.:to_1�Ft 13��% PJ From Ft. to Ft. From _a S Ft. to i�Ft. 1260 IeO C. /C 66YC t J T o Ft. to Ft. From Ft. to p Ft �6 �P From Ft. to Ft. From) �ZFt. to- S4 Ft. /3/. 104 K From Ft. to Ft. From Ft. to—& _Y' Ft. % �' O � r� < K !ie�i -%-v o M ' Ft. td, . � FC r ' L-4 From Ft. to. Ft. a From Ft. to Ft. From / �'� Ft. to �o o Ft. �1 4Q n </C From Ft. to Ft. From Ft. to Ft. From Ft. to - Ft. Front` Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME P Ei]I:;~:J"I ]] T ::1F::' I::'1 .. ;11 C: FII",I 'l'r ... O C: F;I'T' ]11 O1",1 _. [!i[ (i!i I:;:11 .. '1 ];t',1]; P'IL.tI'I D )7 STf::II',tC:E [d~Ii.T'f'I'.IEEi",I I::1 HE'.I...I... f::lbt[:' f::ll",l"d OI",I"S _T. 'Fli; SI:!!;t.'IFI(;;iEi; !) ;I; i!!i;l::'Oi!::l::ll~ S"?'.:YI'I:ii]I"I ]'. ;!ii; I..OO I::'liil;tliJT F:'OI:;?. I:::1 F'I:;?,.iT'v'I::ITE f.'.IIEI..L~; I..t'!iO TO ;~i:OO F:'Eli(T F:'I:~:CIH I:::! F:'I. Jf31.,. ]; (;;: HEL,L DEF'ii;I",I[:';[I",I(3 UF:'Oi",I "1"1'"11~!~ 'l*"r'l::'lii7 CJI::' I~:'I..IE~I....;i;C; I.'11'!~I...I '.IEI..I.. I...O(3S I:::II:;?.E I;.'.IE(i;!IJ];FiiIb~D FII",ID i"IL.I':'i;T I?,1~ii f;?.~iUI't.,II:~'.?',If!LD TO 'T'I'IE DE!JF:'I:::II:;':rTI'lli~]I",IT I.'.I]iTHII",I ;;~1::' 'l'Ftl~i~ l'.ll:i~i.,L.. C:Ol"lf:'L. lii;T ;t; O1",1. ~FI"I"IEF?. lq:l~!!lZLll,.,I ;[ I:;?,I?:;VII'~:7t",IT'.E; I"ll::l"l" F:IF:'PI..."?. '.!i!;F:'EC: ~ F' ;!J C:F:IT ]1] ObIS I:::!1",1[) C:(7It",I?'FF;?.L.IC:T :'I'v'FI]iI..F:It?,I..[~. 'T'CI il;l",lii~;I..If;i'.i~] F:'t;i:CIl:;:'l~!~fg'. ]I'.,I~i];'FI:SlI...I...I:;:IT]jCII',,I. !; C:I:~;f~'.T ii; I:::"t' 'I'HFIT L: ]i FIH F:'I::;II',I];I..];I:::II:;i: Hi[TH THE; I;;?.l~ii]~:!L.I;(l~'.lEl'"lEl",lT'."ii; FC~I:;?. OI',,I....S]]TIiil Sl:i;I.,.ll~i:;?.'.!!; F:It'.,I1)HELl. ?i; t::r:'!; '.!ii;l~!?l' :'O~'.TI'I El"? THE 1,11...11',4 it] C; ;[ F'I:::IL. i[ '1"~,' OF I:~ll',,IC:l'"lOl:;~'.l:~l(;iiE. ;!l: :1: H :[ I.,.I.. ;1: I'.,l~i?t"l:::ll._L.. Tt"IE: '.!!i;"r'STE:H :1:I",1 F:II:::I::::Ii) I~;?rf)I:;iJ'.~C.'.[::i I.,.I ]: '1"1~1 Tl-.-Ilii: !!: ....... ..................................................... f;:li'::'f::'L.. ;Ii C:I-;II",IT l..f~E~. ;:~;I..ILJ... ]i; 'v'FIi",t / 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. i — 3 a -- i to HAA (r Expiration Date: O - 30 -03 1. GENERAL INFORMATION Complete legal description 1-0AfiA� 3V 91 SC t 1 i t TA rL�� Location (site address or directions) a 4 4 1 N ti,N A L_ E. Y A V t= Current Property owner(s) KRIS IL U D`1 3A- Day phone Mailing address P. n.3ax 67o8q5, 6HZ4/AV_ Lending agency Day phone Mailing address Real Estate Agent J/_ Y14 `I 6 612ACj , Day phone Io 1 Mailing Address GA"j LAA 4/ 1rr,/// :tj O Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:' Individual Well [f Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 15 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 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 r o bio err 9 p o vV_ t Address P-03 Ie- 15 L-4 M Aa 2� Engineer's Printed Name i o 66 ,i rocs -V_ 1 air J, 5. DSD SIGNATURE V10<4 Approved for 3 bedrooms. Phone a 79-34/b Date It -Z, /0 3 F, 1 iw SperktcRd c91aas Disapproved."!l� pRtt ESsto�'"e-- Conditional approval for bedrooms, with the following stipulations: Additional Comments The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.83 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: �.Z fa Original Certificate Date: 7— 3 O O 3 (Rev. 01/02) Municipality of Anchorage �E ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LD 1 8! h3V- 2 SC i M 1T A tZ Parcel ID: 0/5- /3;2- 16 A. WELL DATA Well type 1z If A, B, or C provide PWSID # _!t/A Date completed _ Sanitary seal (YIN) y Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Q ci' ft. Well production ?), ir0 g.p.m. Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) _ in. AT INSPECTION °i ft. HIM WATER SAMPLE RESULTS: ,\ Coliform+mg.11. colonies/100 ml. Nitrate �u mg./l. / Other bacteria I i Y colonies/100/ml. Arsenic: Date of sample: 7/t /83 Collected by: f� S�� v rkAeA n ✓ B. SEPTIC/HOLDING TANK DATA Tank TypelMaterialSz 40- / S i'_rj Date installed �0 3 Tank size 1000 gal. Number of Compartmentsa2 Cleanouts (YIN) Foundation cleanout (YIN) Depression over tank (YIN) I` High water alarm (YIN) Date of pumping N1A Pumper C. ABSORPTION FIELD DATA Date installed 1/0,1 Sail rating (g.p.d./ft2 orft2/bdrm) O.3 System type Length --2,0 ft. Width `'Lo ft. Gravel below pipe 0.5 ft. Total depth 3 ft. Eff. absorption area boli ft Monitoring tube Depression over field r�t Date of adequacy test N/Ok Results (Pass/Fail) U For ✓ bedrooms Fluid depth in absorption field before test fn. Water added � gal. New depth "in. Elapsed Time: ✓ min. Final fluid depth V in. Absorption rate >= ✓ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) /✓ If yes, give date '� D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallon "Pump o level at Cy es tested SEPARATION DISTANCES FROM WELL ON LOT TO: (Y/N) High water alarm level at Meets alar & circuit requirements? Septic tank/lift station on lot Igo On adjacent lots ) cc -4 Absorption field on lot (tail On adjacent lots !ao f Public sewer main "A Public sewer manhole/cleanout NIA Sewer /septic service line toff Holding tank NIA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 3 y Property line o2O Absorption field 13 8 Water main N/P11 Water service line SO t Surface water 1-1 Iv Wells on adjacent lots )! ) uo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line i D + Building foundation k t B Water main N�i't Water Service line I" + Surface water N 10 Driveway, parking/vehicle storage Io O Curtain drain 1%410 Wells on adjacent lots t(1D 4 F. COMMENTS G. ENGINEER'S CERTIFICATION 37y'�� Date of Payment 7/ u I0 3 I certify that I have determined through field inspections and r, , review of Municipal records that the above systems are in conformance with MOA NAA guidelines in effect on this date. Q x 5pvYV ID , �.n; Engineer's Printed Name tobk-eK ja.tx GG✓o /i Date HAA Fee $ 37y'�� Date of Payment 7/ u I0 3 Receipt Number Jis5�1 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number in. FROM :Great Land Realty FAX NO. :6943 -093 - if At, at Jul. 28 2003 09:16AM P2/2 TT �AAV hW'. rd Cr 4e tfiemm 00t 91, no im is 04 4 on jbft ocerlm #h1kofed NIX hn,go oL V ti 44 A -TT-TT TT �AAV hW'. rd Cr 4e tfiemm 00t 91, no im is 04 4 on jbft ocerlm #h1kofed NIX hn,go oL V MUNICIPALITY ANCHORAGE • T DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services 44 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. # _ l3 to L- 1. GENERAL INFORMATION Complete legal description HAA # y�yL` �.I �� I�Lctc � 7�C,mi�7J.�' S✓�O Location (site address or directions) v Property ownerWitgAAC-- P I—'c�or+o�sa Daly phone 6-3/silo Mailing address P. 0, gayx /„7 00 43 Z C1+��G rye - �9�b7 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA x21 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 p,,,, Q �P `'Ta J P. b, Phone -,2 Y1,7 Address ri c- 7 8 0' 02 c� A4Ji _ x- ,iSb7 Engineer's signature Date % �- 6. DHHS SIGNATURE XApproved for 3 Disapproved. Conditional approval for bedrooms. David k Dayton NO. 2295-E bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing_ State and Municipal Codes. There are nitrates present. It is qnqqPczi-,,e9 +h + n ppriodd i -est' nq he p=fo d to i ri sure th I continued suitability. Nitrate concentration is 6.0 mg/l. EPA IWARVIN.t�l1��- �' Date i�- 11 ITIr1 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#21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L� T- 8 i�)Lor_K- 'Z Parcel I.D. A. WELL DATA Well type P211)1, a� If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 1 Date completed 312` Z TV Driller Total depth 700 Cased to 40', Casing height Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test A €- 7 z s10 s 17' g9 Static water level c Well flow Za S g.p.m. �• o r '7 z Pump level t� SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 4' ; On adjacent lots j oo fl 1 �- Absorption field on lot %�3 ; On adjacent lots 1 C)o Public sewer main `�� N Public sewer manhole/cleanout Alb N3 Public sewer service line A/O ^ Petroleum tank Al.' a a n/e%J WATER SAMPLE RESULTS: Coliform 0- "Al-) Nitrate 4,Ll37k-/9.2 Other bacteria Date of sample: 0w/4 Collected by: B. SEPTIC/IITANK DATA Date installed -114 -2 19-0 Tank size I (D OCD, Compartments Cleanouts (Y/N) V Foundation cleanout (Y/N) Z Depression (Y/N) High water alarm (Y/N)/�+ Alarm tested (Y/N) ';LL'9 //Z`!/ y Date of pumping 2, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IqLp 0 n adj acent I ots /00 �_ Foundation 3 A.l To property line Absorption fieldT° Watermain/service line 7S— Surface water/drainage 72-026 (Re. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION 1114 Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at "Pump off' level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Date installed /�'I/%� Soil rating O, "dA, Length ?_ (�° Total absorption area Width Z4,5 Gravel thickness Depression over field (Y/N) Results (pass/fail) Poi Peroxide treatment (Past 12 months) (Y/N) Surface water System type F -3G O C� Total depth Cleanouts present (Y/N) Date of adequacy test A�iJ &V for If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / � 3 On adjacent lots 1001- Property line 6�Z To building foundation ( 5" 6"' To existing or abandoned system on lot 4_5 On adjacent lots Al, / & Cutbank /{/07�1(5 Water main/service line V,,u Surface water l 049 t Driveway, parking/vehicle storage area Zo / Curtain drain /V1 ^ L k1111 E. ENGINEER'S CERTIFICATION bedrooms l certify that l have checked, verified, or conformed to all MOR and HAA guidelines in effect on the date of this inspection. Signature �.• �.; "•. Engineer's Name D/�2,0 Qsk?7-0,J �L �4" .... Date %% �tvo Z�u....+•w•s..r.•s•..,�i Yn� � David R. Dayton I.:tn. •. NO. 2205E HAA Fee $ Z:Z2 , cD Date of Payment 4-4-2L Receipt Number E237-118 ��{ 11 72-028 (Rev. 3/91) Beek MOA 21 Waiver Fee: $ Date of Payment Receipt Number 17034 Eagle River Loop Road PROJECT: ~"~.,~ C--- LOCATION OF WELL(Legal Description): WELL DEPTH: '~Oc:. ~ FT. CASING: CATE DRILLING COMPLETED; STATIC WATER LEVEL (Top of Casing): RODEfir A. SI-IAI: Ell Eagle River. Alaska 99577 ** WELL FLOW TEST DATA SHEET ** CIVIL ENGINEER 694-2979 ~ FT, SCREEN: DRILLER:, ~ ',..3 ¥.,k.~ \ FT, DATE:, ,'~ CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWN/ PUMPING TIME PUMPING STARTED/ STOPPED, MIN. WATER. FT. RECOVERY RATE, GPM REMARKS 15 20 25 30 35 40 45 50 55 90 ~ ',~ 120 (2 hours) ~q ~ ' q ~ ' ~, 5 180 (3 hours) %',~¢ 240(4 hours) ~ ~' ? ~' 3,~ ~ REC~ERY ' t 0 0 5 10 15 20 25 30 35 Comments: '"¢~¢'.4.A._. ~¢-~¢,¢~¢~.% '~,(,.~ (~,~t2P''',- Flow is not Ouaranfee~ Su~3seciuent VaHatlon$ Can Oc~r. CHEMICAL & GEOLOGICAL IJA~ORATORY A DIVISION OF COMMERCIAL TE3TING & ENGINEERING CO, TELEPHONE (~O?) ~-2343 An~ago, Ala~k~ ~B18 Drinking Water Analysis Repor~ for Total Coliform Bacteria TO BE COMPLETED ElY WATER SUPPLIER ~/~.PRIYATE WATER SYSTEM Mo, Day SAMPLE TYPE: _J;_~loutlne [] Cheek Sample (for routine sample with lab ref. no. r-i Treated Waist ~ glllreatsd Water sAMPLE *Hme No. LEGATION O~lle~t~ By /~-~ / I A.O.E.C.~ TO BE COMPLETFO BY LABORATORY Analysis shoWS 1rtl0 Water SAMPLE Io be: .'-Setl~fa~ery [] Une~tl~la~o~ D ~ample too ~ng in transit; sample shou~ not ~ over 30 hour~ old at examination to Ind~ate reliable reau~. Please new sample via a~dal delNe~ m~il. Date Remlv~ Time Rioe~ ~. Afl.~l Wthod: L_ J BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filler: mr~ Om,at VerlflGptloa; LBB BBB BEFORE Foo81 Coliform Conflrmstlon COLLECTING 8AMPLE FIn;IMembrermFlller Itemulll , ,,~ .. TNTC = Too Numerous~o P-~'~- - .......... OB = Other Baoterla p~,RT REttAINOER T~ FOLLO'd EOc:J BT, O 00000000000000000000 0000000000000'0000000 ~.r~ Ooflform/t I~ rnl ColllormllO0 mi J.~: 9T, qO-90-SGG CHEMICAL & GEOLOGICAL LAB, ORATORY A DIVISION OF COMMERCIAL TESTINU & ENI3IN ~i,RINi3 00. ___ r~33 B STREI-'T ANCHORAGE, ALASKA 99518 TELEPHONE (0~7) r~12.2349 tAX: (907) r~l.O30t AIIi~LTC. i$ kg.$1~LTB for IIIVOlC[ ! 5~34I~ I)DAVlD DAYTOn, NIY~ATE-~ ~,0 ~g/l SPA 353.2 ,,,/\~ c ,,,, ag,) [)ept, Iq~alth ..... Services ~n~le ~09~2~ ~AIiPLE COLLECTED BY~ D,R. DAYYON. .zOd 8t, O ........ oooooooooooooooooooo oooooooooooooooooooo"~'~';~[ ~o-9o-~66 CHEMICAL & GEOLOGICAL 1MBORATORY A DIVISION OF COMMERCIAL TESTING f ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ~NA~.~,~ ?,~3~:L1S f~r .},VOIC~ # 52078 Client Sample ID : LB B2 SCIMITAR PWSID : UA Collected : ~AR 20 92 @ 13:45 hrs. Received : MAR 20 92 Preeerved with : AS REQUIRED Cllont Name :S & S ENGINEERING Client hcct ;SNSENGP BPOE : ~eqt : Ordered By :R.J.S. :NONE RECEIV£L, Analysis Completed : ~[R 23 92 Laboratory Supervisor : STEPHEN C. EDE Released By ; Send Reports to: I)S & S ENGINEERING Parameter . Results Unl%s Method Allowable NITRATZ-N .t.$ ,.~/1 EPA 353.2 Sample ROUTIltE SAMPLE COLLECTED BY: RJS. Remarks: I Te~ts Performed See gpr:¢~o.'r. [n;~tr.:ct~ ;-,:; ',~ove UA-Unavailable ND- None Detected "S~,e ~ ~r~s Member of ~he SGS Group (Soci~t¢ G~n~rale de Surveillance) · CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Slreet Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [23~'PRIVATE WATER SYSTEM Year SAMP[.E DATE: ~ ~-~'-[ Mo. Day SAMPLE TYPE: _./~ouline [] Check Sample (for routine sample with lab ref. no. [:] Special Purpose [] Treated Water [] Untreated Water SAMPLE No. LOCATION , I Ucc~ 41 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: '-~ Satisfactory [] Unsatislactory [] 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. Date Received Time Received Analytical Method: Membrane Filter · No. of colonies/lO0 mi. Time .Collected Collecled By Result" Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READINSTRUCTIONS BEFORE COLLECTING SAMP' - TNTC = Too Numerou: OB = Other Bacteria Membrane Filter: Direct Count Verification: LSB BGB Fecal Coliform Confirmation Final Membrane Filter Results ,/~ . ~..ART O~JE OF T 'e: ~ rO FOLL 0 Coliforrn/lO0 mi Coliform/100 mi -'~ .~l,Cl ~ p.m.