HomeMy WebLinkAboutSTONEBECK TR 2BEvans
Tract 2
#051-202-03
U*—
Municipality of AnchorageL;_611
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.enchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL
INSPECTION REPORT
Permit Number: SW030145
PID Number: OS1- 0 -0
Name:
CMM - Robert Camoo
Wastewater System: ® New ❑ Upgrade
Address:
PO Box 774n I
A� ABSORPTION FIELD
PhonQ:
Number of Bedrooms:
-
0Deep Trench ■ Shalow Trench O Bed O Mound 0 Other.
LEGAL DESCRIPTION
Soil Rating: Total Depth from original grade:
1.2 GPDfFts 5 Ft.
Block: Lot: Subdivision: Depth b pig g
Tract 2 IrDe bosom from mal rade: Gravel depth beneath pipe:
Township: Range:
Evans 2.97 Ft. 2.03 FL
Section:
FYI added aboveinal rade:
� g Gravel Length:
1.94-4.01 Ft. 54
Well: ® New ❑ Upgrade
Ft.
Gravelwah: Number of Anes: Distance between hnes:
Classification (Private, A. B. C): Total Depth:
5.0 Ft. 1 NA FL
Cased to: Total absorption area: Pipe Material.
Priv. 2
Ff. 7 Ff 385 Ft' D3034 & F810
Driller: Date Drilled:
Sullivan 14 2
Static Warp Level: Installer. Date Installed:
CMM
Yield: Pump Set at
Ft 7/11/03
Casing Height Above Ground:
1.1 GPM unknown Ft.
2 Ff TANK
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑Other:
To Septic Absorption Lifl
From Tank Field Station
Noldmg Public/Private
Tank Sewer Line
mariuldctuter. paury.
Premier Plastics,
Ltd 1300 Get.
well
100'+
100'+
NA
NA
25'+
Material'
H.D.P.E.
Number of Comp. mauls:
2
Surface Wafer
100'+
100'+
NA
NA
LIFT STATION
Lot one
5'+
10'+
NA
NA
"e'
ane ac rer.
Gal.
Foundation
5'+
10'+
NA
NA
'Pump ori level at
'Pump off level at. High water alarm at.
Cunt Drain
NA
*50'+
NA
NA
H.
Pump Make d Model
h N.
Electrical Inspecbona performed by:
Remarks:
*none known
BENCH MARK
Location and D"-,.,.
Bottom of siding
Assumed Elevation:
100 FL
Engineers Stamp
.i.
% ..q$*.gs�,0
Inspections performed by: KND Fn9me_nnq,
--I=Dates: 15t 7/1 1 / 0U
* • 199E a �r
ne
. gg io dg. ..edge gddd.• .. g 0
Development Services
2 7-- 1 n
Department Approval 3'� Igo4�o3
..g« ..........
/
�c : :� ��
Reviewed and approved b y:
/ �j�e� Date: - 0-r7
I s •g Ce 71
fI�F9 of.,�••
INC. I+nru
d�.•• �Ve
JJiFppR #soe.•NP�,��
\�`OFESS0�'4-
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030145
EVANS SURD. TRACT 2 PID#051-202-03
ERES TH
K
COf
dpd
A -C= 75'
B -C= 41'W 1
A -D= 83' a
B -D= 48'
A -E=102'
IB -E=681 1300 GA
A -F=160' SEPTIC
B -F=110' ;r TANK
E7QSTim 1.700
GAL SEFMC TAMC
mi
wmw
94.11 FINAL GRADE
r .Ta rAws�
SCALE. V = 50'
•II 8918 : .:�....8918 ...
'SEWER ROCK
344'
SCALE, NTS 79.15 ,a
PREPARED FOR:
ROBERT CAYWOOD
P.O. BOX 774042
EAGLE RIVER, AK. 99577-4042
(907) 694-8758
FIELD BOOKS CDwPUMM.
BDUNDARIi DRANK:
VeG _
STucwc DHEO(ED: KMD
ASOMT. DATE: 11 14 03
Dw• rxE: CRiD: N W1060
AGAR rxE 02060.DWG doe Na. 02060
9
vw¢L
w
1"dV 4W ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
KINYD ENGINEERING
20441 PTARMIGAN BLVD. *?4 L
EAGLE RIVER, AK 99577-8736 r •••.«"•' $f" ""
. ..... ....... .. ....
T/ Ke C _
�•, CE
SOILS PERCOLATION TEST f t4#'09.0 SI'000 �Me
Performed for: CMM ,VIROFE
�O\was+`
Date Performed: 7/ ] 1 /03
Project: Evans Tract 2 TEST HOLE # 03-1
Depth
ORG— red/brown overburden
w/ organics
GP/SP —brown /gray, sandy
gravel, coarse sand
and density
increasing w/ depth
SP — Mod. dense sand
GP/sp — Dense sandy gravel
MATERIAL CONSISTENT
17- W/ EKES TH
18-
19-
20 -
"FOR
ACHED SITE PLAN
OLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? NA Date? 7/18/03
Reading
Date
Gross
Time
Net
Time
Dept to
Water
Net
Drop
1
7/11/03
1:00
-
6"
_
2
1:05
5 min
dr
6"
3
1:06
-
6"
_
4
1:11
5 min
dr
6"
5
1:12
-
6"
_
6
1:17
5 min
d
6"
7
1:18
-
6"
_
8
1:23
5 min
d
6"
9
'
1:24
-
6"
_
10
1:29
5 min
d
6"
11
1:30
-
6"
_
12
1:35
5 min
d
6"
'
Water I
Added
Percolation Rate < I (min/in) Perc Hole Diameter 6"
Test Run Between 3 _ feet and 4 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
NOV-18-03 09:43 AM CMM GENERAL CONTRACTORS 696 8758
' P.01
Cerlif teb Ort"Ifing ineyDOC i
ba
SULLIVAN WATER WELLS
RO, BOX 870272, CHUGIAK, ALASKA 99587 • TELEPHONE 6a8.2750 i
OWNER OF LAND: __� / �► /' ,tC _ BORE HOLE DATA !
ADDRESS: DEPTH f
From To
LEGAL DESCRIPTION: "j'
DATE: Uy !�40eddl'0OCrN I
• •:
PERMIT NUMBER: Date of Issue +� _�`�1'�td { C�x� ✓�{L I
• f�.
TAX IDENTIFICATION NUMBER: �1.D�. U •'? C7 ��` «�� "� '� �'�`��
Is well located at ap6roved permit location? (t-*rCJ No
Method of Drilling:,,`j¢ �.-%j
�,� �'E7r rotary U cable tool �P
Depth of well: - 3 „2
Casing Type J 7.4-' c, Wall Thickness ' 5 V inches �,�� VA aC x / ,y�0 . J �}
Diameter / inches, depth 7�_ feet C ��
Liner Type: P't) b A�l t� ,COGS%. lie 1 K1
Casing Stickup Able Ground: feet J
Stdtic Water LeveL•_I�_
feet
Recover Rate:1- � L_gpm
Method of Testing: L1I�
Well Intake Opening Type: 0 open end 4eptrnhole -�. --fes-i C' �' 011w 4 �_
0 Screened; Slam feet Stoppe$ _ fget r•. • L
U Perforations Skart feet Sto I ' !
Grout Type: = •� 7 ^� volume ,pig_ ; F t
Depth: from feet, to -� u�� feet ~
Well Disinfected Upon Completion? 6-ye"s' 0 No i
Method of 0isinfeCti�n: CNL �.t...,�:.
5^ J sl/s'• •� • I
i
Comments:
Driller's Name —12r.A.A
ATTENTION: It is tlie'responsibility of the property owner to submit a Copy of the well log to the proper authority. Municipa:lty
of Anchorage: Deparitment of Health & Human Services and/or Department of Environmental Conservation, Matsu BprOU h:
Department of Envirrnmental Conservation.
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
Initial
Permit Number: SW030145
Legal Description:' EVANS TR 2
Design Engineer: 0070 KND Engineering
Owner Name: CMM - Robert Caywood
Owner Address: PO Box 774042
Eagle River, AK 99577-4042
1 ) t-1—' = 3o a')
Date Issued: May 21, 2003
Expiration Date: May 20, 2004
Parcel ID: 051-202-03
Site Address:
Lot Size: 1742400 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify 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:
Issued By:
Date:
Date:. 2/ O
- Municipality of Anchorage
+'
Development Services Department
�� ��'•
t P P
Building Safety Division
On -Site Water and Wastewater Program i164 5bl"
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-202.03 Permit Number SW 030 / 4S
Property owner(s) CMM - Robert Caywood Day phone 694.8758
Mailing address (1) PO Box 774042 Eagle River, AK 99577.4042
SITE
address (2) / 8340 /10q# r -/#V RDAD Zip Code 2M %
Legal description (Lot, Block & Sub'd.) Evans Tract 2
Legal description (Section, Township & Range)
Lot Size 40 Acre q.Ft Number of Bedrooms 3
x,742400
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 ❑
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.
of property owner or authorized agent)
Permit Fees: 4V00
Date of Payment: S /Y d
Receipt Number: 0 3.5- 4/ZS (�
(Rev.12/00) Y�
Waiver Fees:
Date of Payment:
Receipt Number:
KND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
May 14, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer permit — Evans Tract 2
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On May 5,1995 EKES dug one testhole for the proposed system. The results of this
test are attached. The general slope of this lot is from east to west at various grades of
approximately 2-25+%.
We have designed our system utilizing the existing testhole that was excavated for the
proposed 3 -bedroom house. The lot is served by an individual well, located on the
northeastern portion of the lot. We propose to install one 5' wide shallow trench.
Water was not encountered during the excavation or monitoring'. No groundwater
was monitored on 05/12/03.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111 /FAX 696-8111.
Respectfully submitted,
MID Engineering, Inc.
Kenneth M. Duffus, P.E.
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
DESIGN DETAILS
3 BDRM X 150 GPD = 450 GPD
450 GPD/1.2 GPD PER SO. FT. (0.4 MIN/IN.)= 375 SO. FT
(375/5'(W)) X .7(RF) (2.0' GRAVEL) = 52.5 FT. TRENCH
USE 1 TRENCH - 53 (L) X 5' (W) X 2.0'(D)
Total depth of system Is 5.0' from original grade.
Total depth of gravel below distribution pipe Is 2.0' .
NOTES,
1. CONTRACTOR & ENGINEER TO VERIFY INTEGRITY OF SEPTIC TANK AND
REPLACE AS REQUIRED. INSULATE TANK IF <4' COVER.
NO PUBLIC WELLS WITHIN too, Or 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
PROPOSED SYSTEM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
NO PRIVATE WELLS EXCEPT
SONO TE 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
NO PROPOSED SYSTEM SYSTEMS
c�N 2W Or MIN. 3' COVER IF REQUIRED.
PROPOSED WELL EXCEPT AS NOTED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
F95*22MON AN m.
ROBERT CAYWOOD
P.O. BOX 774042
EAGLE RIVER, AK. 99577-4042
(907) 694-8758
BOUNDARY:
STMND:
ASKXT:
Dn¢ IDE:
ACAD "LE' 0206
DRAWN: vE3G.
p1ECKM KMD
DATE: 5 /13/
°t° NW106
JOB No.: 02060
Scale) 1'= 100'
PAGE 1 OF 2
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
I
WASTEWATER DISP❑SAL SYSTEM DETAILS
EVANS SUBD, TRACT 2
—------------------------------
H "E
25%+
R--3
OF A
Af
449 MW
S• /
`1 CE -711
,25%+
TH BY E
,2-8%
— m•
f
M
O
w
w-2-80/6
�
Y
(n
W
d
W
V)
o
w
Ln
o
w
V)
MT
0
a
1
a
r c0
PROPOSED 1000
GAL TANK
PREPARED F❑Ri
ROBERT CAYWOOD
P.O. BOX 774042
EAGLE RIVER, AK. 99577-4042
(907) 694-8758
FIELD BOOKS coupulm.
BOUNDARH DRAWM
BTAMC: CHE" KMD
ASSMT. DAM 03
Dwm Mr: NW1060
A0AD 'N -L* 02060.DWG ''DB "a 02060
Scales 1'= 40'
PAGE 2 OF 2
M.11 LW ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11
11
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED
o
r:•���� tip• y� 4
+ � Louis A. du:^ra � � �►•
DATE PERFORMED:
ci a
LEGAL DESCRIPTION: /I4Fli4Nt Township, Range, Section: Tjs I✓
S
SLOPE .R �w ec Jr
{ SITE PLAN
Oc¢ n.•. t t
3
a -4".
Monitoring? dr
Date 5 �8 St
Reading Date
Gross
4-
Time
Si FIr C/c/ice � ._
51 5
=
r4.ee, F.a✓�/
Q
Gres - /o G'.fC
6
v
7
�o
8
,
`
•�'
.1
SAND w�6 ca✓G.
GK
'e .Ole ..rt
10
11
Gl
(G to)
2
12-
o
13
13-
14
14
15-
16-
17-
18-
19-
20-
COMMENTS
51s17181920COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Na
Depth to Water After
a -4".
Monitoring? dr
Date 5 �8 St
Reading Date
Gross
Time
Si FIr C/c/ice � ._
S
L
0
P
E
a
Net Depth to Net
Time Water Drop
a -4".
y'- 7-
Ron
loom
Now
a
Net Depth to Net
Time Water Drop
PERCOLATIONRATE • �2� (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN Gf FT AND S FT
PERFORMED BY: E/ee'r
I r-�-�ri�" CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. -
72 -008 (Rev. 4/85)
a -4".
y'- 7-
PERCOLATIONRATE • �2� (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN Gf FT AND S FT
PERFORMED BY: E/ee'r
I r-�-�ri�" CERTIFY 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 .
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. 051-202-0'_3 HAA # 0V_7,_)1Q
Expiration Date: - O — nL f.
1. GENERAL INFORMATION
Complete legal
Location (site
Current Propertyowner(s) CMM - Rnhprr C2M)nti Day phone _694-f37SR
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
_PO Box 774042 Eagle River. AK 99577
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY.
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank El
Community On-site El
Public Sewer D
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, 1 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 KND FNGINFFRING, Inc. Phone (q07) 696-6111
• • 3i1
Engineer's Printed NaDate 11/17/2003
Engineer's Comments:
'(F;;.+M••••�qS�
This investigation was completed in compliance with
The assessment of they'<Q.�
.�1
.- 4•.:q 1#,
ADEC and MOA regulations.'
condition of the well and septic applies only to the
The flow absorption
JO !4000 ••• /
conditions as of the day tested. and
$0 to 4446... .644•
rates may change due to subsurface conditions that
the changes in
•4444 4444'
may not be observed from surface,
land use, local soil characteristics, groundwater levels
; Ko M. f
00.ce 71
that may fluctuate during the year and the water usage
that
of the family being served by the system. The operational
�TF9 6••
F ••• P_
,`%\ROFESSa
life of all well and septic systems are subject to these
various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system.
Therefore, KND can not give any estimate of how long a
system function or
OF•CiyO
cupantslor can KND guaranteerthat not unseen
`�`QQ�•.
encroachments, deficiencies or discrepancies exist.
�� V .•
• 'Py
J=. ON-SITE G�
s. DSD SIGNATURE
��• WATER AND
_ z Approved for 3 bedrooms.
WASTEWATER
:• PROGRAM
Disapproved.
Conditional approval for bedrooms,
with the following stipulatioJrikVi�0rr CS;\`��\\`
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: IAJ. Original Certificate Date: 1 I _ a 0' 0-3
Municipality of Anchorage
Development Services Department .:.
Building Safety Division
- On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
jwww.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: EVANS TRACT 2Parcel ID: 051-202-03
A. WELL DATA
Well type'-' rivat If A, B, or C provide PWSID #
Well Log (Y/N) Y
Date completed 9/14/02 Sanitary seal (Y/N)-Y_ Wires propedy(protected (Y/N)Y_,_
i I!
Total depth''' 320 ft. Cased to 78 1. Casing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test! 9/14/02
Static water level
85 ft, ft.
Well production 9 -p -m g.p.m.
WATER SAMPLE RESULTS:
Coliform � 0' ; colonies/100 ml.Nitrate 3.U7 mg./LOther bacteria
! , �0 colonie's/100 ml.
Arsenic:' NA' mg./I. Date of sample:_? 1 /04/2003 Collected by: KND Engin Tina
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _ SEPTIC/HDPE Date installed 7/1 1 /03
Tank size
_13S00_ gal.
Number,of Compartments Z Cleanouts (Y/N)Y
Foundation cleanout (Y/N) Y_Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping _NA - NEW TANK Pumper
iii';
C. ABSORPTION FIELD DATA
Date installed !7/11/03 Soil rating (g p,d,/ft2 or ftZ/bdrm)1.8 System type TRENCH
Length 94' ft. Width _S ft. Gravel below pipe _2.0 ft.
Total depth S ft. Eff. absorption area 385 ft2 Monitoring tube Y Depression over field N1
Date of adequacy test_ NA - NEW Sy
EM Results (Pass/Fail) PASS For
3— bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth 1 P h in.
Elapsed Time: ' min. Final fluid depth in. Absorption rate >_
iI g"p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
1,
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in.High water alarm level at
in.
Datum 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 10 0' +
Absorption field on lot 100'+ On adjacent lots 1 00'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line 5' ++ Absorption fields' +
Water main 10'+ Water service line 1 0' + Surface water 10 0 +
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 1 0'+ Water main 10'+
Water Service line 10'+ Surface water 10 0' + Driveway, parking/vehicle storage 11 0'+
Curtain drain 50'+ Wells on adjacent lots 100'+-
F.
0'+F. COMMENTS
Aw 1tj
G. ENGINEER'S CERTIFICATION
WN1, OFA 8
�,&•.......��gs,DOi
I certify that I have determined through field inspections and p •• f •.
review of Municipal records that the above systems are in O * : e} L '
conformance with MOA HAA guidelines in effect on this date. ••• •••••• •••• i0.0
Engineer's Printed Name jsenn * M, Duffus I ;61 e CE 711.
•:fir
Date 11/17/2003 ,I��9Fpp••.....••'P�Fa�
,
HAA Fee $375.00 Waiver Fee $
Date of Payment 111I1$IU3 Date of Payment
Receipt Number L� L�'_� Receipt Number
T
(Rev. 12101)
Y,
N
E -;err' i3zn t
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NOfFNCR6A HMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE: bh'WARD
& ASSOCIATES LAND SURVEYING 694-0I
i'- ZOO
erwww
DATE:
i �� OF At R+
GRID:
* :.4n
FB
Duane Mark Sward A
LS -6918 x
DRAWN]
11-12-03: 5:36PM;
SGS Ref.#
1037199001
Client Name
KND Engineering
Project Name/#
Evans Tract 2
Client Sample ID
Evans Tract 2
A[atriz
Drinking Water
bamplc Remarks:
:907 5615301
All Dates/Pimes are Alaska Standard Time
Printed Datelrime 11/11!1003 12:19
Collected Date/Time 11/04/2003 13:45
Received Date/Time 11/05/2003 10:55
Technical Directqx. Stepbe . Ede
Released By (;;?
0 2/ 3
Parameter ResultsAllowable
PQL Units Method
ContaincrlD Prep
Limits nate
Analysis
Date Init
Waters Department
Nitrate -N 3.07
0.100 mg/L EPA 300.0
I3 (<-10)
1I/05/03 JJB
Microbiology Laboratory
Total Coliform 0
eoV100mL SM18 9222D
A
11/05/03 DKC
11-12-03; S:36PM;
..- „ :807 6616307 3/ `
ME Environmental Services Inc. G�
L Laboratory Division
Drinking Water Analysis Report for Total Colifon
READ 1NSTRUCTIONS ON REVERSESME BEFORE COLLBCTINt
MUST BE COMPLETED BY WATER SUPPLIER
o PUBLIC WATER SYSTEM I.D. N ®m
PRIVATE WATER SYSTEM
' Send Results O Send Invoke
JGyD �,ub/�k��C/NL, ANG $trw-T
l✓EtTL,
40 - 37? /
00-1793
rto.2oyYi I �Vwl rj
9:74TUM
�qGc� llircx� ,¢�
99577
r+r
w Code
O SendRewW 0 Send Invoke
k—PytZ. Camst I
p
SAMPLE DATE: M/7
Month
SAMPLE TYPE:
Routine
o Repeat Sample (for routine sample
with lab ref, no. )
a Special Purpose
SAMPLE LOCATION
EY,4Ns- rrAc7- z
Comments:
E0 m
Day Year
a Treated Water
Untreated Water
Time Collected
Collected By
fol RAW
rkm Price
200 W. Potter Drive
n Bacteria Artchoraoe• AK 99518-1605
.SAMPLE Tel; (9071562.2343
Fax: 907 561.5301
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
fit. Satisfactory
O Unsatisfactory
C3 Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be over3lVhours old at examination
to indicate reliable results. Please send .
new sample via special delivery mail.
Date Received L 1;�b3
Time Received lr>:j��_
Analysis Began f3�
Analytical Me(Wd- tlt. Membrane Filter
O MMO-MUG -
'1 ml.
1037199 IA7 Result* Analyst
ntto A.D.LC. Aneh Fbks Jun ❑
Faxed
Date: Time:
Client notified of unsatisfactory results:
❑ ❑
Phased Spoke with Faxed
Date Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Rank: Total Coliform ' Q Coll
Membrane FlIter• Direct Count 7 Colonies/101 ml
Verlficatloo: LTB BGB COLIFIRM tvrc-A. d.•1n..r r. Gant
Fecal Coliform Confirmation oa •ouwsanra
Final Membrane Filter Results -& Coliform/100 ml
Reported By Date 0 Time WO hn
WGIM Member of the SGS Group (Soeidtti GMNrals de Survaillance)
cuv10n1Uucu7a feta MFS IN ALASKA_:UF�jNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
ua: =
I if II Ili I'