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SHELL #2 LT 8
Shell #2 Lot 8 #015-112-21 72-013 (RevV3/78) 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 PHONfE YC] NEW /V J V I'S J EIUPGRADE MAI LING ADDRESS lor,3,6 LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area Dwelling / PERMIT NO. f„ 0 () J N Z Manufacturer rr- Material No, of compartments LUN ` / , , Js f - e<.. Liq. capacity gallons IF HOMEMADE: Inside length Width Liquid depth b�Qin DISTANCE TO: Well Dwelling PERMIT NO. 0z< Manufacturer Material Liquid capacity in gallons O J 4 DISTANCE TO: Well Foundation Nearest I t line Fd' PER�p(11T NO. J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines F- Z w '� Z cl ` t) `� f-/� - inches •�, r HTop the to finish Material beneath the Total of grade �'i' n effective absorption area S. ✓ ,SC /// /,!�I c, //. inches ('" /r r07 f7 '5' Length Width Depth PERMIT N0. Lu (7 41- Type of crib Crib diameter Crib depth Total effective absorption area CL UJ N Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS.- SOIL TEST RATING / a' rf IC 0 P • Q HE LTH o & GE INSTALLER fJ/ 6 f r /1 D ,tl/� J -V - f 4Or CTI N REMARKS - Ij G m„ 41 I �t 1 v P •I �A sl t;._n It a�:aar evn aaunnvrsoe o nn NB4n° o �J (r )ems e' G^ I A - Cory 1 Mellott L� i? A_ °�° CE 5.144 V �C osa a9 on�T � qy APPROVED DATE LEGAL 72-013 (RevV3/78) PERMIT NO� VwU��X IC-:: JE. F "', pr -ll IL -1: T, `-d " V-4 --jI CII IF;;?. YF::11 IC.]�i EE DEPHRTMENT OF HEHLTH FIND, ENVIRONMENTHL PROTECTION 825 L STREET/ RNCHORHGE, HK 99501 264~4720 840092 0]/28/84 HPPLICHNTRON DAVIS HDDRESS� SRH 17]]H, 106]0 WHIMBREL DRIVE HN��OR�8E/ RK 995�l6 CONTHCT PHONE� ]46~10]7 LEGflL U.E!�]; C: ["IPSUBDIVISION: -SMELL #2 LOT� 8 SECTI��� 15 TOWNSHIP� �2� RHNGE� ]W LOT SIEHCRES) MHX BEDR.00Pei S ] BLOCK: YAFI LISTED BELOW RR� THE OPTIOHBLE TO IPA DESJGNIP--IG �OUR S�PTIC SYSTEMC1 .1O0 'S'; H: THE OPTIOY.-I THfT BEST FIT(,IUR ITE I ... .... ..... �..... ������ 0-l'�H-49 TO V 11 11.3i LiE, U."j,������� DEPTH TCj G(TTTOM (FT. ) 6.0 6.5 60 GRHVEL DEPTH (FT. ) 5. 5 2.0 ~/ TOTHL DEPTH (FT ) 11�0 7� 8.0 GRHVEL W��TH (FT ) 2� 19.0 5.0 G�HV�L VJ. 1/ 00C1. 0 ** �/�000 �* 1/000. @ �* �O�L RHTING (SQ�T/B�) 145 1�0 1�Ci ** THNK MUST HHVE HT LEHST TWO COMP�RT�ENTS I CE.,:RTIFY THHT� 1. I HM FHMILIHR WITH THE REQUIREMENTS FUR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUQICIPHLITY OF HNCHORHGE (MOH) FjklD TTIE HLHSKH 2I,WILL INSTRI L THE TEM IN HCCORDHNCE WITH HLL MOH CCIE, ES HNE) REGULHTI{jN�, HND IN COMPLIHNCE WITH THE DESIGN CRITERIH OF THIS PERMIT. �1: I. -Ill 1. FIG'HURE TO f"—L. MOH HND STHTE OF' FEQUIREMENTS.; F�� T1E S�T BHCK DISTHNCES FROM HNYEXI�T�NG WELL/ WHSTEWHTER C.: SEWE�RGE SYSTEM ON THI!-." 1.)R HNY OR HE-,:HRBY LOT T I UNDERSTHND THHT THIS PERMIT IS VALID FOR H MHXIMUM OF ] BE0ROOMS HPAD HNY WILL REQUIRE HN HDDITIONHL IQRMIT� IF F! LIFT STRTION IS ED IN HN HREH COVERED GY MOH BUILDIN� CODES, THEN (1) HN ELECTRICHL PERMIT HND INSPECTIUN MUST BE OBTHINED/ (2) HS�BUILTS WILL NOT BE HPPROYED WITHOUT HN E1 ECTRIC8L INSPECTION REPORT/ HND (]) THE ELECT�ICHL WORK MUSTBE DONE BY H LIC�NSED ELECTRICIRN �~~~~............ _~—... ... ..... �PPL�C8�T� RON DHV0� ISSUED BY DRTE� �� �-cz G ' SOILS LOG C MUNICIPALITY OF ANCHORAGE J `1 b (' ��, ❑ m DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /1 ON DAV% ,� DATE PERFORMED: LEGAL DESCRIPTION: L Al1.[.. ''fie �z J-6 6 5 T 12 1v & � W DEPTH SLOPE SITE PLAN (FEET) 1 2 3 4 5 6 , / 7 8 9 10 ---11 ' 12 13 14 15 L a& G ^A sw �izs7 WAS GROUND WATER / L ENCOUNTERED? O r/7„ er SA P E l IF YES, AT WHAT DEPTH? COMMENTS rt! li' Reading Date 'elf , c Net Time Depth to Water Net Drop 16 n k r1 17 ' S C+ COMMENTS rt! li' Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) _— FT PERFORMED BY: -4/LCERTIFIEDBY: G /'tomV' DATE: r 2Z -7j 72-008 (6/79) U ki X oil 1: 0 00 n x i1 E., E F-Tj FR* fl, I E 11.4T F I F- I-If-FlUld 9950::L EH: R-11 FEE F,-,.:! 11-,, IE_- 0.„_A JE 'T F"FBITT 'T A 1 11 B 1. 9 - - 6 7,`� 2. Fi P F, L. C: A NT FRC)hl Ci:3 0 1. ... ORE RD (1-1. 1 LE (", A I S F I E L L !:.",IZE S(-.!UAF;:E FTEET T II 'I - L, 52,,ISITH C: 14 MAXIMUM P-11-111P.E.ER C)f" BE,.T)FRC)fDr,,IS = SCIJI_. RATThIC.-i FT/E:R). 150 fl � s- - R 17 -YSTEH 15 I -IE FTEG!L1 1: FREC, _'-.;T'ZF-E OF:' 'I I- IF. SU I L. -'T I CAI FEE., IF', - IF H-11 lj_ -:JlL.— EE H ..,A 1(:-lu -T... 11, 1 E TIdE LEENCATI Ic..; THE L.E11CATI FEET) (Dr- THE CIF.-.' THE". CIE17"TH F) CiR PIT P-.': 'TFIE BEE"I"I.,JEEhl -1111HE S1_1F!F'AC:E OF' 'FI..IE F11,1C, TFIE: BOTT01-1 (')F'YfIE �:Jhl FEET). FFIERE L5 Fd C1 -';E T' 1-111.)IH F'Of,". 'FRUICHES. THE.: G-EP'Tld IS THE IN DEPTH OF GF..'.FiVEL. 13FTWEEI'l THEE OU'FF:T1L.I PI PE FIND THE Bi.)TTOM OF THE [.:::..-',C.:F1'-,-'ATI CAI (IS! MET). E . F:7,-" -q- ::E -I- 1"f PnA 1 2 - - P -EE, f, U. _._ : � - -- - --.L. U`ii fl L... L_ k - ^ 0 '—' :c„ APF"LAC:FINT 1-117'r.5 TFIE rci INFORM THIS DEPARTMENT DURING ITE 11'ISPECTIM-P.S. OF" AklY FII_ ..)TK-:EEI,..FY -FO WIS FAMPERTY AND -"FIE" OF" RESP IE,.fE--I,,IC:ES3 TFIFIT THE-: kIIE"LL. WILL !7.; E I?,V FE. A I M no Q: 1. 1: 07:" 11.-�,E. C*7�"._ " f- 1: hill II,A,.,*E7-,: JFA IFR F.*i,---. IFR EH" U Dr P'. I[,*-":: ...... OF' 1.11-FI.-IOL.FF F."11,09L. INSPEWIC014 At -.ID 1:1PPRi.DVAL. E; Y TI -II=; i.I:u..I EF: S:.1_.1E:._TIEC:T TC., F" F! E C: I.YfI ID 1,4. BE"TWEE.'hi A WEL.L. ANY OPUSITE 'SENAGE D PSP :15 F1. dEI., .AOR !.-.50 TO *�'._*i.'-,5Qi F'EET FRON F1 F"LIE;L.TC: WEL.1 Gf F.E P FE hl E., I I, -.I (-'.i -FEE-T F'C.iR Fi P k*J FiTEE I UP()I,.,I THE CIF' PUBLIC: kIEL.L., I ell 1,11, I'l I IN F'ROFI F1 F`,RP,,,'F1TE WEI. L. TO F-1 PRII,,IATE LJJ-,IE PS 25 Fr.-`.IEET Flt..ID T',:'.', F1 0:11"11'ell INIT'r' IS "FJ FEEET. t.-IF.EL.L. I.-CIC"is FIR.F.: REi:...!UIF'.T--:D BE "I"Ci THE I-ITTFID-1 JF' TFIE: C 01- IPL.E: TI CAI. ()THER R[...,'*,C.IL.JT.RF-:I-IE:Y.,I"I'S PIAY FiFfl. Y. F`11'4) C: C,hV5 T F! U C.: "T.T. Cil' -,I D1F1GF.`.F1HS F1F,`.E F11 I ... FIBI. "I -Ci F1 TI CI F'*"FE:F.P,111 1 ....A-' IF."" 1 E" EE L. ii 7 1: 1: FIN F-MILIFIR MIT THE FREE Q U I I-RE I'l ffllf) WELL.kE; F*ORTFI E:',,.' I TY OF' Fi I,..I I:..: 1 -1 Ci R F1 E. 1: " F:.. T. WILT IFITTIALL ThE SYRFEN fI'-.I 1,11 -1 -Id 11 -RE. 7, I L.Ikl G, [.,E F! 5, "1, f, -,i E.M.RRUPIENT IF' TIRE: F,'-FF11("FE 1: E,.1::1"D IP.1CL.UE1 ., FE I - I () R 1.7. TI -1 F1 N :..: E." E I.) F,.' ".., C) I ............ ... f.-1 P P LJ CiA NT Ru T. az� ..... .. ...... .... �41.. X?�� ....... ... ...- KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE (907) 243-2282 30 YEARS ALASKA DRILLING KEN JOHNSON RON DAVIS 10623 WHIMBREL ANCHORAGE, ALASKA 99516 Re= Water Well pump & installation. STATEMENT 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 JULY 7, 1985 iwNcrt Air, Y/ v� ImKrapm,\Q;e DOPT. OF IHIENLTHI & Ei`ifYMONMENTA'L 'PROTECTION !,1 N � 41986` RECE VED One 3/4 HP. Submersible pump Mod. 7B Cat. # SG72 & control box. New.... $ 350.00 199 ft. one inch galv. drop pipe safe 258-70 218 ft. 12/3 submersible pump cable loge 91.56 one one in. in line check valve 16.50 two hrs. Setting pump & testing well 130.00 Tank testing & misc. old Reda pump .. 50.00 BALANCE,.... sisal $ 896.76 U F � TEST PUMP DATA STATIC 'NATER LEVEL // 195 ft 4 in. ( TOC ) Well depth 218 ft ( TOC ) Test pump set at 213 ft. Permenant pump setting at 216 ft. TIME GPM 1330 9+ 1335 9+ 134.0 9+ 1345 . . . 1350 5 1355 5+ Stop pump DD (water level ) 201 210 213 212 212 Remarks Dirty Dirty Clearing Pump broke suction Clear Clear recovers at 5 GPM Pump performance at 213 ft setting 30 # 7.5 GPM 50 # 4.5 GPM Shut off pressure 70 # Municipality of Anchorage°< On -Site Water & Wastewater Program (907)343-7904 — CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-112-21 Expiration Date: 11 —,2 7'G 1. GENERAL INFORMATION Complete legal description SHELL S/D #2; LOT 8 Location (site address) 10706 WHIMBRELL DRIVE, ANCHORAGE, AK, 99507 Current Property owner(s) ASHLEY DUNBAR Day phone 541-639-6956 Mailing address 10706 WHIMBRELL DRIVE, ANCHORAGE, AK, 99507 Real Estate Agent TERI PISA W/ JACK WHITE Day phone 244-9900 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Waivere/ariance request for: 3 Received by: Z� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ Date of Payment Receipt Number COSA # mo Waiver Fee $ Date of Payment Receipt Number Waiver # Distance. TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ Received by: Z� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ Date of Payment Receipt Number COSA # mo Waiver Fee $ Date of Payment Receipt Number Waiver # Distance. 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time ofthe test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD, can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content or this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date tJ,Jy,I` ..... ••.. f yA. Garn - .�� •; y!�1t 3 y �'ROFESS��NPi•�• bedrooms, with the following stipulations: I's AN4 VVKf-ER AND r ROGRAM By:Original Certificate Date: 9 — .2 -7r, The Municipality o chorage Do, �emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10112112) If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SHELL SUBDIVISION #2; LOT 8 Parcel ID: 015-112-21 A. WELL DATA *WELL DEPTH AND CASING DEPTH STATED PER 11/19/1997 PUMP INSTALL DOCUMENTATION (KEN JOHNSON DRILLING CO.) Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 3/1984 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 278 ft. Cased to *40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 4/6/2013 Static water leveluNPJ P��g�� ft. 173 ft. Well production g.p.m. *2.13+ g.p.m. WATER SAMPLE RESULTS: *NOTE: FLOW RATE RESTRICTED BY SEDIMENT FILTER. Coliform ___0 colonies/100 ml. Nitrate' 4-mg./L. Collected by: GEG. Ltd. Arsenic: NO ug./L. Date of sample: 8/14/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed - Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) 7/1984 YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping � 6 �"O / �umper46 4 1401hin S C i, b ] 'C t -S C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/1984 Soil rating (g.p.d./Wor bdrm 150 System type TRENCH Length 60 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth *11.2 ft. Eff. absorption area 600 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/6/2013 Results (Pass/Fail) PASS For E bedrooms Fluid depth in absorption field before test DRY in. Water added 690 gal. New depth DRY in. Elapsed Time: = min. Final fluid depth DRY in. Absorption rate >= 450+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date NOTE: DRAINFIELD WAS CHECKED ON 8/14/2014 AND FOUND TO BE DRY. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line 25'+ Holding tank *101' Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots **95' F. COMMENTS *FROM EDGE OF WELL TO EDGE OF PIPE ON LOT 7. **PER EXISTING WAIVER.[ SuF_r.r,# Z, L G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS /P Date t -LZI'f (Rev. 11/05) Municipality of Anchorage r_ On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-112-21 Expiration Date: 3 1. GENERAL INFORMATION Complete legal description SHELL S/D #2; LOT 8 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 10706 WHIMBRELL STREET ANCHORAGE, AK, 9950 CLOVER SIMON & ORVILLE SMITH Day phone - 10706 WHIMBRELL STREET, ANCHORAGE, AK, 99507 240-7449 ELIZABETH HOOPER W/ PRUDENTIAL Day phone _ 227-6794 2. TYPE OF DWELLING: N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS:�__Tal 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: �� ' Date: T— COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $-- Date =Date of Payment Receipt Number COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 tANCyQ'Q/�/,� Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Disapproved. Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: /F V In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the 000�Op0�4 system under the conditions encountered at the time of the test, and separation distances to identifiable features. The life o! OF X740 measured readily operational of all wells and septic systems depend on the local soils condition, groundwater levels that may p0�C�. •"' .; D Q'. • • 7 S.f-OQQ fluctuate during the year, and the water usage of the family being served by the system.' * 4 T * Q These conditions are outside the control of the evaluator of the system. Satisfactory test % results do not guarantee future performance of the system, nor do they guarantee that I there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet thef ' "' ..... " g operational requirements of the ADEC or MOA DSD. The content of this report is for s es; G the sole benefit of the owner listed above. Any reliance upon or use of this report by any Q y, E— 7 53 .•'` 4` other person or party is not authorized, nor will it confer any legal right whatsoever. QQ�n e✓%� �t3 r , E�w 6. DSD SIGNATURE System #1 Approved for "vUv bedrooms. tANCyQ'Q/�/,� System #2 Approved for bedrooms. OF Disapproved. Conditional approval for bedrooms, with the following stipulation: wRjf;R i W ASS J� \NNSTE RAtJI c /F V Original Certificate Date: Thl,,Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SHELL SUBDIVISION #2; LOT 8 parcel ID: 015-112-21 A. WELL DATA *WELL DEPTH AND CASING DEPTH STATED PER 11/19/1997 PUMP INSTALL DOCUMENTATION (KEN JOHNSON DRILLING CO.) Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed 3/1984 Sanitary seal (Y/N) YES Total depth 218 ft. Cased to *40+ ft_ R907 Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 4/6/2013 Static water level �NPJp��3g�� ft. 173 ft, Well production g.p.m. *2.13+ — 9 -p.m -WATER SAMPLE RESULTS: *NOTE: FLOW RATE RESTRICTED BY SEDIMENT FILTER. Coliform 'er� colonies/100 ml. Nitrate & 2Nmg./L. Collected by: GEG. Ltd. Arsenic: Np ug./L. Date of sample: 4/5/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping if h & b Pumper 'Ja rJ 't-% SSE WEJ2- � ODAiN C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/1984 Soil rating (g.p.d./ftbr /bdrrn 150 System type TRENCH Length 60 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth *11.2 ft. Eff. absorption area 630 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/6/2013 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 690 gal. New depth DRY in. Elapsed Time: = min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump of" E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100 + On adjacent lots *101' Public sewer main N/A Public sewer manhole/cleanout Sewer/septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots **95' F. COMMENTS *FROM EDGE OF WELL TO EDGE OF PIPE ON LOT 7. **PER EXISTING WAIVERtCVA. � J* 7-1 LL*) G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date Lf 116 ba (Rev. 11/05) Municipality of Anchorage • '� Community Development Department Development Services Division Sn Ei Y On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC131130 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 8 of Shell #2 subdivision. This inspection revealed a nitrate concentration of 6.24 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. -- WHOM 9 L•00L ,f it \TRM\ \ ( § ! " �3 l� ^ �w \0-00L 6te0�O N m e @ , (\( \§) ; _ ' /\§ \® le r tj ){ y§ MW . \)a; � -"- �§��[ q§}\ E § \)§§ \ ) § ,,Zr ( §/EE § § \ ,,,...., § _@® !§ §)§} \\( :i. r; ) H § §3\S Jcati Mw�i 9 /tz z �04; Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. %ii5'll2'�/ COSA# 000453 1. GENERAL INFORMATION Expiration Date: 12— Complete 2— Complete legal description SHELL SUBDIVISION #2: LOT 8, Location (site address) 10706 WHIMBREL DRIVE • ANCHORAGE. AK 99507 Current Property owners) Mailing address Lending agency Mailing address RON do MARY LOU DAVIS Day phone 10706 WHIMBREL DRIVE • ANCHORAGE. AK 99507 Day phone 346-1037 Real Estate Agent MATT DIMMICK w/ KELLER WILLIAMS Day phone 865-6521 Mailing address 101 WEST BENSON BLVD. #200 • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of iteSystems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage riles and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date IV o4 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. Those conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the solo bonefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ? bedrooms. Disapproved. Conditional approval for Attachments: rOSALhecklist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the flloWng stipulations: Maintenance Agreements Supplemental Engineer's Reort Other ON-SITE � WWgqSSTR •. PRS. By. Original Certificate Date: Municipality of Anchorage ' Development Services Department ; Building Safety Division . Onsite Water 6 Wastewater Program 470D Bragaw Street P.O. Baa 198650 Anchorage, AK 9951968511 www.muni.oryonske (907) 343-79114 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SHELL SUBDIVISION N2; LOT 8. Parcel ID: D I.! 112-2.1 A. WELL DATA "SEE ATTACHED INFO. Wall type RWATE If A, B. or C provide PWSID# N/A Well Log (YM) *NO Date completed 3/1984 Sanitary seal (Y/N) YES Wires property protected (YM) YES Total depth 218 ft. Cased to 218 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/28/2006 Static water level ft. 184 ft. Well production N g.p.m. 3.12 g.p.m. WATER SAMPLE RESULTS: Coliform _.P_1 colonies/100 ml. Nkrete 4) b mg./L. Other bacteria colonies/100 mi. Arsenic: NO ug./L. Date of sample: 8/23/2006 Collected by: GEG. Ltd. B. SEPTICIHOLDING TANK DATA Tank TypeJMaterial STEEL Date installed 7/1984 Tank size 1250 gal. Number of Compartments E Clesnouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 8/23/2006 Pumper DENALI PUMPING C. ABSORPTION FIELD DATA Date Installed 7/1984 Soil rating (g.p.ddft'or� 150 System type TRENCH Length 60 ft. Width 3 ft. Gravel below pipe 5.0 ft. Total depth 010.75 ft. Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/28/2006 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 480 gal. New depth DRY in. Elapsed Tame: U min. Final fluid depth DRY In. Absorption rate >= 450+ g.p.d. Arty rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes. give date — D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. "Pump off" E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAl t station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent k)ts *101 Public sewer manhole/deanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 100+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 0095' F. COMMENTS *FROM EDGE OF WELL TO EDGE OF PIPE ON LOT 7. **SEE ATTACHED WAIVER PACKAGE. G. ENGINEER'S CERTIFICATION I car* that I have determined through field ftpecbons and review of Municipal records that the above systems are in conformance with MOA COSH guideAnes in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date l- 14 /0 j6 COSA Fee S `ii)� Date of Payment 47J, `" Receipt Number 9 1 q5p (Rev. I lim) Waiver Fee E Date of Payment Receipt Number GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS September 5, 2006 Municipality of Anchorage Department of Health R. Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request for Shell Subdivision #2; Lot 8, The existing 3 bedroom house is served by a private well and septic system. During a site -visit to perform the work for a COSA it was noted that the well on Lot 4, Shell 42 was 95 feet from the septic on Lot 8, Shell #2. The septic system on the referenced property was installed on 4/8/1986 and the well on Lot 4, was drilled on 12/23/2004. We request you grant a 95 feet separation distance waiver from the drainfield on the referenced property to the well on Lot 4. The following items are justification for the waivers: The lots are generally flat in the area. There is a road between the well and the drainfield. If the septic system was to overflow it would have to cross the road before it reached the well. The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration wastewater should the tank begin to leak. As can be seen on the attached well logs, the aquifer is relatively deep, with over 200 feet of silt, sand, and clay soils that have served to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels to be 0.581 mg/L, other bacteria to be 4, and no coliform detected. Based upon the aforementioned facts, it appears that there is minimal risk associated with the granting of the requested 95 feet separation distance waiver. Since the septic system that serves the referenced property was installed prior to the drilling of the well on Lot 4, it is our understanding that the property owner of Lot 4, Shell Subdivision is responsible for the waiver fees. We also request that your department issue a Certificate of Onsite Systems Approval. If you have anAuestions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamessenginecring.com ,-- — — SHELL S/D #2: LOT 9. [SEPTIC \ ARE / SHELL T7. /2: I I I 100• WELL RADIUS GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS Ml C nDa11 by fort 101 • AHCHOF E M MSo1 . Fgrt (101)117�1» y FM . W . ww,srn..r..yr�Msrn PREPARED FOR: PHONE NUMBER: PACE NUMBER: RON DAVIS 1 346-1037 1 1 OF 1 LEGAL DESCRIPTION: SHELL SUBDIVISION #2; LOT 8. TYPE OF WORK: SITE PLAN FOR WAIVER PACKAGE C.J.G. m a n: SHELLLT :D /2. I AN US= .h. is 'mss::• dy W � 1. Tt ! •: 1 :. •.• ...t:. :.v ..• y •: / SHELL T7. /2: I I I 100• WELL RADIUS GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS Ml C nDa11 by fort 101 • AHCHOF E M MSo1 . Fgrt (101)117�1» y FM . W . ww,srn..r..yr�Msrn PREPARED FOR: PHONE NUMBER: PACE NUMBER: RON DAVIS 1 346-1037 1 1 OF 1 LEGAL DESCRIPTION: SHELL SUBDIVISION #2; LOT 8. TYPE OF WORK: SITE PLAN FOR WAIVER PACKAGE C.J.G. m a n: SHELLLT :D /2. I AN US= SCS ReLN 1065189001 Client Name Garness Engineering Group, Ltd. Project Name/N Lot 4 Shell I Client Sample ID Lot 4 Shell 1 Matrix Drinking Water Sample Remarks: All DatesMenes are Alaska Standard Time Printed Date/time 09/12/2006 13:28 Collected Date/time 09/052006 10:38 Received Date/time 09/052006 11:21 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Mcdad Container ID Limits Date Date Init Waters Department Nitrate -N 0.581 0.100 Microbiology Laboratory Total Coliform 4 OD, No Coli mg/L EPA 353.2 D (<10) 09/06/06 ALR coUl00mL S%1209222D A (<I) 09/05/06 TLF SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE tOLLECTING SAMPLE -DUST BE COMPLETED BY WATER sUPPLIER ❑ PUBLIC WATER SYSTEM IDD ,FFRIVATEW TER SYSTEM .[�SoM Rosuaa Send ltvdu SAMPLE COLLECTION:hW W1'e-'' LOR /iri 7 - Date: /J n A 200 W. POTTER DRIVE ANCHORAGE, hkSKA 99519 Tel: 907-562-2343. `! `.' " . Fax 907.561-53Q1 ishftf . 1065189A" .. J [j Send Resuhs ',[]r twoke .r sy. er..Cawrrr Mao. Ww. Gbr11,..Cr MrW raDIV su�. �•. SAMPLE TYPE: /• -' '�-t ROutlno Treated Water PMWdse..I Repeat Sample ;KUntreatddWater -(referlo lab no. 1 Special Purpose Tranapenid to Lab By.' ,[ (SSMO DS CDIII)CtOr Other. a«. TO BE COMPLETED BY LABORATORY Sampla Receiving: Date: SampIgover30 ha ro O t. . ❑ . RUSH SAMPLE Tone: Delivery Meq Received Comments: Resuas mayba uneaable Phone #: Fax#: ..............................................................................:.............................................................. Vaeterloloeieal Wator Analvsla Record: ISOMIOADM MM"UG(WA) RESULTS: ANC' FSK AM Analysts Sepan; 9/fIjc /5f� Total Collorm: . DaWTIme: . Analyst: E. Col: . • Sento pent ... . Anaytipal Mallod: MEMBRANE FILTER RESULTS: Phonad C] FaxedO Olrod Count CdaJaW00mL Dawrene• Membrane Filter w n stlo,r No spoke with: h: (P/A) Twde LTB eoe• Satisfactory r...... { EUnsatisfactory nge.*«Il.s�n«I.t:.w Reported By: �-0 Datemme: �j �. ,t7 C / 4 = c,e oe .ewra..wds - SiY^.I+e F...... a FW.M51 49$47 11 06/17/2006 10:55 907-348-8931 FAjL OM 24SA 62 KEN JOHNSON DRILLING CO. WATER WALL DR& WO PUMP SALES AND SM" u Yww AlsoM Dftog KEN JOHNSON �7O 511 c�L v 21E3 LINDEN Di O ANCYORAOE. ALASKA 99522 PAGE 06 NoAjo, va 4#FA., -_r TA: H DATE aunmr3Y6-/O37 TANK SIZE i TYPEz4-0-74 FILTERS t TYPE _ �7PITLEDATA: CASIN6USIZtW1"""d5):WATER LEVEL S TIME: ON SITE OFF SITE REMARKS: KEN JOHNSON CWD/Pl NWWA CERTIFIED FROM : ALPINE DRILLING FAX N0. ; 907 345 0202 Se P. 17 2004 10:26AM P2 Municipality of Anchorage Department of Health and Human Services AAk 825 *V Street P.O.. Box 196650 Anchorage, Alaska 995198650 Rick Maayoorr o./AMyh w.ctanehoWeAxV% Permlt Number #SW 047 Dste of Issue: 1-1 1� Parcel Identification Number: 0151U-23 2- 4 Date Started: � Date Completed -.8-10-04 Is well located at approved permit location? pg yesNo Legal Description: Shell # 2 Lot 6 Property OwnerName & Address: Spinnel/ NomeS 1900 Aforthem Lights Blvd. Ste 201 Borehole Data: Depth (ft) Sol Tyye, Thickness & Water Strap From To stick-up _ 0 .. 2 Sift 2 12 gravelly snt 12 34 silt cobblygravel 34 68 cobbly9mvel 68 89 silty sand 89 112 silty oobblygravel 112 156 silt 156 180 gravelly silt 180 183 silly cobbly gravel w/bldrs 183 230 gravelly sandy silt 230 254 Silt 254 267 vratersand & gravel .267 269 �1 TZ - V 2 4R^ 714 5 7 Method of Drilling ® air rotary ❑ cable tool LD g type: 0eel hiclmess:.250 inches ter. ¢ inches Depth: 269 feet Type.- Diameter ype: ter inches Depth: stickup above ground: Z f water level (from ground le el): 221 feet ing level: 267 feet after pumping 2.Q gpm ery Rate: ZQ gpm d of Testing: In r Itake opening Type: ® Open End ' ❑ Open Hole ❑ Screened Startfeet Stopped feet ❑ Perforations Startfeet Stopped feet Grout Type: bentonite # 8 Volume: j Depth: StartQ fect Stopped n feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® yes [] No Method of Disinfection: Chlorine tablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the propeny Municipality of Anchorage Department of Health and Human Services 825 /L' Street P.O. Box 196650 Anchorage. Alaska 9951M650 tscfr Mysown hflplh w a.anchorage sk.us Mayor Permit Number. NSW 40341 Date of Issue: 0811M Parcel Identification Plumber: 015-112-14 Date Started: 12-01=04 Date i7ompkted: 12=23-04 Is wilf located at approved perm t locaiio670 Yes ❑ No UPI Description: Lot 4. Shelf Sub. #2 Property Owner Name & Address: Malt Methews 2804 Northern Lights 'Borehok-Dala: 'Depth (ft) Method of Drilling'[D air rotary t3 cable toot Soil Type. Thickness & Water Strata From To Casinglype: st el Stick-up 0 2 Wali Thickness:,M inches silt 2 5 Diameter. 4 inches Depth: M feet grevellysr7t 5 29 IlnerType: s,7rycobblygravel Y9 65 Diameter: Inches Depth: feet Casing sliekup above ground: 2 feet eobbygravel 65 96 sillysand 96 115. Static water level (from ground level): feet Pumping level: 89 feetntter sr7tycabblygravel 115 159 hours pumping 20 gpm sr7t 159 185 Recovery Rate: n gpm gnmffys3l 185 191 Method of Testing: jLrfi cobbygravel w/btdr3 191 220 Well IntakeOpeniogType: gravelly sandy sM 220 260 ® Opcn End ❑ Open Hole silt 260 265 ❑ Screened Start feet Stopped feet ❑ Perforations Stat feet Stopped feet sr7y walersand &gravel 265 272 Grout Type: bentonite it R Volume: j silt 272 285 Depth: StartQ feet Stopped.? feet watersand&gravel 286 289 pump: Intake Depth feet Well Disinfected Upon Completion? ® Yes 0 No Q 14 Method of Disinfection: chlorine tablets !J/W" Comments: Well Driller: Alolne Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property . �.... ...1. ..../� J.N/.../ .26 .....R J. .. 1. /.. /. ./ . n... .!//.. Hl I /I...... I... '... ..1K'. !n 1.....f ...../.�'.. ALPINE DRILLING FAX N0. : 907 345 0202 Sep. 17 2004 10:2SAt1 P1 Municipality of Anchorage Department of Health and Human Services P.O. Box 19665 825 V Street 0 Anchorage, Alaska 99519-6650 Ma Rick ayoryor htprJA~.d.anrh orage.ak.w Permit Number. *SW 030471 Data of Issue: 11.10- Identification Parcel Identition Number: 015-112-22 .. Date Startod:'8=10-04 Date Completed:13- is well locoed ai approved permit • location? :Yes ❑ No Legal Description: Shell # 2 Lot 7 Property Owner Name & Address: Spinnell Homes 1900 Northam Lights Blvd. Ste 201 Borehole Data: Soil Type, ThIcimess d: Water Santa stick-up Depth (ft) From To 0 . 2 Method of Drilling ® air rotary ❑cable tool Casing type: cf egl Wall Thickness:. 250 inches silt 2 15 Diameter: § inches Depth: M feet gravelly slit 15 '35 Liner Type: silt cobbly gravel Cobb vel N � silty send silty cobbly gravel silt • 61dr 35 70 92 111 160 173 70 92 111 160 173 178 Diameter: inches. .. Depth: Cuing stickup above ground: Static water level (from ground evel): Meet Pumping level: 275 feet after Z hours Pumping 8 gpm Recovery Rate: 8 gpm Method of Testing:!g rlff gravelly silt 178 180 Well late" Opening Type: silty cobbly gravel w&drs 180 227 ® Open End ❑ Open Hole gravelly sandy at Silt silty watersand & gravel 227 251 251 272 ❑ Screened Start—feet. Stopped feet 0 Perforations Stan feat Stopped feet berr Grout Type: nrofre # A Volume: j Depth: Start Q feet Stopped 2Q feet Pump: Iotake Depth feet Well Disinfected Upon Completion? ® Yes ❑ No Method of DisWcctfo4:.6hr0rina tahlahq Comments: Well Driller. Alpine Drilling & EnterprLses PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a ivell log to the property owner within 30 days of completion and the property ...V.�.a J.tN.. .L.N ... i 1. ....P 1.. �. J.. !\.e •I�q .,.� � tg.u.. P..J.....4\�. /q l..0 .t.. -..4�6. FROM : ALASKA WATER & WASTEWATER r %.S O 1w LN; W N �1 I PHONE NO. : 9073383246 Aug. 31 1999 12:04PM P2 4= b 81 !w i9 .Imam ao on I~ # \ w & row ;k', . a � \ � y � \�. \ u f�� /|� ) �w: /..y.� . } . . .. •.. R9 . to # ! E ;\v . | �E §e|i SH `§§§g§31 |f k §§ ||come|2 co . xe(| �■§�`- �|i| R9 . to # ! E ;\v . ;. a § m ƒ [ § | N DOD 7'13 o w ,00,s }]�\ 1�211MW Ty, . to E . a § | N DOD 7'13 o w ,00,s }]�\ 1�211MW Ty, SGS RcO Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1064914001 Gamess Engineering Group, Ltd. Lt 8 Shell #2 10706 Wimbrcl Dr Lt 8 Shell #2 10706 Wimbrcl Dr Drinking Watcr All DatesMmes arc Alaska Standard Time Printed Date/rime 08/302006 13:23 Collected Date fime 08232006 8:57 Received DateMme 08232006 11:23 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units MCdkd Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0824/06 0825/06 M11 Waters Department Nitrate -N 4.16 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 353.2 D (<IO) 0823/06 ALR cul/IOOmL SM209222B A (<I) 0823/06 TLF F }+ If MUNICIPALITY OF'.ANCHORAGE r, DEPARTMENT OF HEAL TH- AND. ENVIRONMENTAL PROTECTION , f t�!'' DIVISION OF ENVIRONMENTAL HEALTH'J� ,Px� t• +''sr til 'y hj' CERTIFICATE OF, INSPECTION,FOR,HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY IL 264-4720 x` u, tP ;�lf III, a' 9 , [ ,. ff:„ s Q + 13 Application Date t t t. ,' i?f r ,1 '� t ,1, GENERAL INFORMATION ' a Legal Description include, lot, block, subdivision, section, township,range). Is v1 Location (address or directions) (b) 'Applicant Name /�' ON (JA V LS p ��/6�LU3 `7 ' 'Business 3 �lv -/0 3 Tele hone Home I _ [ n Applicant Address (% (0 3 d C[J // h E't �12 , �( %7 mce/ i A licant is ,`l� ' B (explain); (c) , pp' (check one): Lending institution ❑ , Owner/build_er uyer ❑ ;Other ❑ (d) Lending Instrtution Telephone a Address (e) "; Real Estate Company and Agent:' I , r.; ,'• `Address - r - Telephone (f)! MailI. the to the following address - I i. 1 r j tit i ' "I MUNICIPALITY. OF ANCHORAGE.;, t x+ ,a r DEPT , OF HEALTH. & t 21'I`TYPE OF RESIDENCE FNVIRONMkNTAL PROTECTION fys�'1 / x, f = jl - ) a Smgle,Family10 `,Multi Family ❑ OthEller„ �+ £' e l�w_r•y a� �'t,YY i,rl ` tbir ' 2 'Y ki�`�i� t I140 905 M1 - PI Number of Bedrooms $ `, cr t .+ , I ` t_,�� , ' _ trht.3 t1n'r,{,� y + Y - AM1 s__I I r li I r ,S +. n L ro r x e i �' r i �^ 1 rr It _ , y f ,¢ 1p,,1� j -:l rrt, a '! r' r[ S! I• !# ,IJ, 4 1 a'ff tiff+t a5f ,`� �' r } j kv 4 f y,' i I� d Fi/ kt { '� /�/'�'� 1C r'1 fjFf� I �_.f tt '<-'4iil'+ S,- x�t' "R �VY �V•Dr y n FEE - t{ r, s c't{y Y ti ,F l i,� 9PI i ' = j ! x3, roti s t x,ri 1 .y,; y+, ay.; I , - r t 9 i' t r t '3,r'WATER SUPPLY y, T a ; id{!� P+r l r,�.p �"=�°I�} } frt• x{1:� �',, t, � f y"'1I dly{dual Well Community ❑ r, Public ❑,'-" s o + ''ii"1B d %,¢fizNote'If community well system, must have written confirmation from,the State Department of Environmental Conservation , ` + f ' ' attesting to the legality and status.,. )' } 7 e pt "! 7 t 4 a, e y { rr' Y �f I'. , 5 r r ,t I .1-- slI.0 w,FF q r ri ' 1P, ' t1 Fr < 4,c rrr .r,ff PFM1t �trl4 i irk -.r fl a5ye��V ,h al,' 1 ,�-,. r'd�r2%J Qr A4 M r _j , f k{ �j�'( --rr �I+-�i_.t . dryh I l R ,ty t a, 1-i fY s } 1 11 41 it - i "!3I,A SEWAGE DISPOSAL + f,l t r: fL a ' ' ',r ' fi'tetS'+�rY r t^F'F� 1 »)1 t 6 !I 1}.4 r j 'FEE! 1.11 r �VU M1r '1 r.= 'Onsite of?ublicti❑ kCommumty 0�1 Holdlng.Tank D"7 'a ` r Y ;a`3vf �` °t. r r , !. y,, i r .� >+. tk'.;)- ti Nate' If comrrfumty well system, must have written confirmation fromtheState Department of Environmental Conservation F, atteshngrto the legality andstatus "4 '�t�''; 1rt i t I r +iq11,`+L l•13jS r; ,l; ,..r i,& _'tri t r ,, it ( i 'J 1!t :_, I i. rtl! - r1 �Y,1 '., b't(i ,J z s�...,IT, 025111/04) Page.1 of 2 nr ez 5. - ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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. JJ Name of Firm &14 A- /`� L L.Q 1 Telephone I Address. 30-k%Oy /� U` OX T 7 o Z. Date i • c i.l ,fes • ° 1 rxr ;"an c� ra, 1 �z) (;u waJY4n neN�.a%s..�rar w�upp.o,,,,. oaoo.. �i i e..'e/.�' o.yS,nee.a ......... •..... !1j 'i { i • L �) rJ� Gary J. PA_�Ilott s Y• QpggCr'J, e� - CC 5.144 %'0 R� 6. DHEP APPROVAL C� i Approved for bedrooms by ate . l Approved Disapproved Conditional Terms of Conditional Approval 1 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) ,issues Health Authority Approval certificates based solely upon the representations given,.in paragraph 5 above by an independent professional J engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or l analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: iw W ANCHORAGE A. WELL DATA dNVI ONmBNTAI,BPkOTECTION Well Classificationr�, /�«� 7Le. If A, B, C, D.E.C. Approved (Y/N) �C�1QAF Well Log Present (Y/N) /" Date Completed w4 rc.l� / Y d� Yi d ^` Total Depth Cased to Z �� Depth of Grouting _�� -- -- Static Water Level / ��-� Pump Set At 2.16 Casing Height Above Ground Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot -1-106 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �` l40 ; On Adjoining Lots -j4 /G1d /dd To Nearest Public Sewer line Neel To Nearest Public Sewer Cleanout/Manhole N' /4, To Nearest Sewer Service Line on Lot `L �U Water Sample Collected by r+az ; Date / '—ek Water Sample Test Resultsel'z ' Comments G��- i��`�� ©',�, %K,57 X - B. SEPTIC/HOLDING TANK DATA Date Installed 7-9-// Size 12 5'4 No. of Compartments — 2 Standpipes (Y/N) y — Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) /V _ Date Last Pumped OVA Pumping/Maintenance Contract on File (Y/N) N/1 ; for Holding Tank High -Water Alarm (Y/N) �L/A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: 1 To Water -Supply Well to (?/-d- To Building Foundation —sem To Property Line /0� 'k" To Disposal Field is � To Water Main/Service Line SO 4To Stream, Pond, Lake, or Major Drainage Course /V i Comments �e.'AJ/G IA- S/'=a<< Page 1 of 2�� `lfr3� 72-026(11/e4) f/ C. ABSORPTION FIELD DATA IRJidiCIFALITY GF ANCH�. AGE KEPT. GF HEALTH & CN'dIRONMENTAL PROTECTION �t3 Soils Rating in Absorption Strata T tUCAI J 9f� m Date Installed Design n 7--` /�, Length of Field / Width of Field Gravel Bed Thickness ri Square Feet of Absorption Area Ci (� C�j f% Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test IV 6 Results of Last Adequacy Test Al A Separation Distance from Absorption Field: To Water -Supply Well /06/ 4- To Property Line I To Building Foundation ✓� �� To Existing or Abandoned System on Lot AZ 4 ; On Adjoining Lots _� o / �, To Water Main/Service Line rd �2�' To Cutbank (if present) �" d To Stream/Pond/Lake/or Major Drainage Course // To Driveway, Parking Area, or Vehicle Storage Area /a 0 /a" Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed - - G �r_' Date /Z 2 0 ,s S Company OA/V Vfl-1-07 MOA No. 2O Receipt No, 2(;� J� Date of Payment /2 �� Amount: $ o Page 2 of 2 72-026 (11/84) �(Tyrfde7`3.6ea1 cV r1�' ' t .•ax a a:ocvw �°�'1 ¢. 26 oa. z� 2z �. o 715. 1 / 1 ZZ �IZEVERSE� Ati! /G4E6 AC- 5PC-/T) 2.1285 1S• 9. 4 4 O'f9 (93- 2q$) a-23-83 ;5.112 42c43 (f1.: -258)q /if32 20152/ 5-4-73 4•/8-73 III -13 7hru 19 11-26.70 '/S-//4- 34 -/'17ru39 /1-13-9a O'MFILLEV FAD. �4 Ad;o,ning i'nge !io. Adjoining 7nx Booz No. 1 O 6 c0 t-- 89601 -001 .001 .001 O>1 O �0 M � N N s N ici �01- co to I L GOI .001 ctti OI ..`OI _ O. li" 002 O 6 c0 t-- 89601 -001 .001 .001 O>1 O �0 M � N N s N ici to 2_ Q J cm 1i