HomeMy WebLinkAboutSTONEHILL BLK 1 LT 3Stonehl"ll
Lot 3
#060-342-03
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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SULLIVAN NATER WELLS
P.O. BOX 670472, CHUGIAK, ALASKA 99667 • TELEPHONE6R6.7750
OWNER OF LAND Af 4t.E < DEPTH OF WELL
ADDRESS !T C T 3 7S' /hI& Q l0 R STATIC LEVEL OF WATER FT. 41
LEGAL DESCRIPTION L ; 'SLC 1 DRAW DOWN FT.
DATE • Surted Ended ' q/qZ GALS. PER HR
PERMIT NUMBER KIND Of CASING 5 -
KIND OF FORMATION:
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MISCL. IN F OR.NIATION:
3 q 13 N 7'0 ry [ (0 A) 6
DRILLERS NAME
na+n t'rY1S 69ZZ899 T8:08 6E6T/T01T0
M U IJ 1 C I P A L I T Y O F A N C H O R A G E
Department of Health & Human Services
025 L Street, Anchorage, Alaska 99501 343-4720
ON-SITE SEWER & SEPTIC TANK & WELL PERMIT
Permit Number: 900206 land a&s
Date Issued: 09/10/90 Engineer Designed
Owner Name: PETE MILLET:
Owner Address: HC 05 9375 HIGHLAND
EAGLE RIVER, A<: 99577
2url � oa�-9(
SSS end.
Day Phone:
694-4351
WLLL: Log must be submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion.
THIS SYSTEM MUST BE INSTALLED AS SHOWN ON THE ENGINEER'S DESIGN
DATED 9/5/90. A COPY OF THE WELL LOG MUST PE FURNISHED DHHS
WITHIN AXI DAYS AFTER THE EWLL IS COMPLETED. NOTIFY DHHS BEFORE
ALL INSPECTIONS. THIS PERMIT IS FOR A 3 BEDROOM SINGLE FAMILY
RESIDENCE ONLY, AND EXPIRES ON 12/31/90.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
_. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms. 1
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will require on additional permit.
S . :
gned:
towner
Issued D�
DATE:
DATE:
Porcel Id:
050-062-03
Lot Legal:
Subdivision:
SIONEHILL
Lot: 3 Block:
1
Section: 19
Township: 14N Range:
1W
Lot Size
50975 (sq.ft.
or acres)
Max
Dedrooms:
This Permit:
3 Total
Capacity:
3
SEPTIC
tank
TAMP::: Minimum
must have
total septic
at least
tank:
capacity:
1,000 gallons. Each septic
feet
requires
2 compartments.
insulation
Depth to
top of septic tank(s) < 4.0
over
tank(s).
WLLL: Log must be submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion.
THIS SYSTEM MUST BE INSTALLED AS SHOWN ON THE ENGINEER'S DESIGN
DATED 9/5/90. A COPY OF THE WELL LOG MUST PE FURNISHED DHHS
WITHIN AXI DAYS AFTER THE EWLL IS COMPLETED. NOTIFY DHHS BEFORE
ALL INSPECTIONS. THIS PERMIT IS FOR A 3 BEDROOM SINGLE FAMILY
RESIDENCE ONLY, AND EXPIRES ON 12/31/90.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
_. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms. 1
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will require on additional permit.
S . :
gned:
towner
Issued D�
DATE:
DATE:
�PND.
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:_�rT1=T2G•O
1 DATE
LEGAL DESCRIPTION:�T 3 STa m IA • .. SI Township Range Section:
Din SLOPE
�� Dt2rawvy►GS
1
0 'r
2
0
J
3 0
4
0, y.
5 v
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8
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10 WAS GROUND WATER
• a ENCOUNTERED? O
11 01
G gM ���prf�`� IF YES, AT WHAT L
12 ` � / ��0,1.10 DEPTH? F
a /o• E
13 T30H Depth
Water A Dalt
14
15
16
17
18
19
20
S & S ENGINEERING
COMMENTS 17Il34 Eagle River La
SITE
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN �.G�T AND FT
34 Ee91e River
PERFORMEDIF}A $77
Eagte Rive CERTIFY THAT THATESTWAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDE II S FECT ON THIS DATE. DATE J 0
72-008 (Rev. 4ia5)
Municipality of Anchdtage
Development Services Department a
Building Safety Division
On -Site Water and Wastewater Program $ A E T Y
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLINGc } oto
Parcel I.D. 060-342-03 COSA# bscw �
Expiration Date:
1. G,;A
0E L )NFORMATION
gomlpilete legal description Lot 3, Bk 1, Stonehill Subdivision
"l gQatjon„(site address) 19922E Stonehill Dr Eagle River, Alaska 99577
Current Property owner(s) Air; source (foreclosure) Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
2002 Summit Blvd #600 Atlanta GA 30346
Day phone
Ruthann Baker Day phone ( 907) 301-4888
Real Estate Brokers of Alaska
3300 c Bt #200• Anchorage Alaska 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPP(Y:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ;-
M
Individual On-site
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 On -Site Systems
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 On -Site 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 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 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 Pi narA engineering Phone ( 907) 357-3647
Address PO Box 871347 Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard, P.E. Di
5. DSD SIGNATURE
Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments: "I'll
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By; Original Certificate Date:
(Rev. I M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 3, Bk 1 , Stonehill Subdivision Parcel ID: 060-342-03
A. WELL DATA
Well type Pvt If A, B, or C provide PWS ID #-
Datecompleted 9/90 Sanitary seal (YIN) Yes
Total depth 164 ft. Cased to 39 ft.
FROM WELL LOG
Date of test 9190
Static water level 46 ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS
Coliform 0 colonies/100 mL Nitrate 1 .97 mg/L
Arsenic: ND ug/L date of sample: 12/7/11
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Seotic/Steel
Tank size 1 000 gal.. Number of Compartments 2
Well Log (Y/N) Yes
Wires properly protected (Y/N) Yes
Casing height (above ground) 12+ in.
AT INSPECTION
12/9/11
49.7 ft.
g.p.m.
Collected by: Pinard Engineering
Date installed 10/22/90
Cleanouts (YM)
Yes
Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) No
Date of pumping See Comments Pumper
C. ABSORPTION FIELD DATA
Date installed 10 22 190 Soil rating (g*xbft?3mft2/bdrm) 15 0 System type Trench
Length 64 ft. Width
ft. Gravel below pipe 3. 5 ft.
Total depth 6 ft. Elf. absorption area 450ft2 Monitoring tube Yes Depression over field No
Date of adequacy test 12/9/11 Results(Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 2%. New depth 0 in.
Elapsed Time:225 min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NnnP xnnwn If yes, give date
D. LIFT STATION NA
Date installed Size in gallons
"Pump on" level at _ in. "Pump off" level at_ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
100'+
100'+
Sewer /septic service line 25'+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
100'+
100'+
Public sewer manhole/cleanout NA
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 10'+ Absorption field 5'
Water main NA Water service line 101+ Surface water 100'+
Wells on adjacent lots 10 0 ' +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main NA
WaterServiceM 10'+ Surface water 100'+ Driveway, parking/vehiclestorage 5'
Curtain drain None Known Wells on adjacent lots 100'+
in.
F. COMMENTS This is a foreclosed property; septic system has not been in
use for several months. SAS was soaked w/2000+ gal,��i� 2 days prior
to test. Septic tank was checkedj found to - II
not
G. ENGINEER'S CERTIFICATION needed. �?'�Q'••• n•••.•�t�
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 Paul E. Pinard, P.E.
Date 12/20/11
COSA Fee $ 410 ,OD
Date of Payment 17-1* l(
Receipt Number 11A 7101
(Rev. 4/10)
Waiver Fee $
Date of Payment_
Receipt Number
SGS Re£#
1115878001
Client Name
Pinard Engineering
Printed Date/Time
12/20/2011 15:58
Project Name/4
3-1 Stone Hill
Collected Date/Time
12/07/2011 14:40
Client Sample ID
3-1 Stone Hill
Received Date/Time
12/07/2011 16:58
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks!
E. Coli
Negative I
100mL SM209223B A
12/08/11 DLC
Total Coliform
Negative I
Allowable
Prep Analysis
Parameter
Results LOQ -
Units
Method Container ID
Limits
Date Date snit
Metals by ICP/MS
Arsenic
ND 5.00
ug/L
EP200.8 C
(<10)
12/12/11 12/13/11 NRB
Waters Department
Total Nitrate/Nitrite-N
1.97 0.100
mg/L
SM20450ONO3-F B
(<10)
12/12/11 AYC
Microbiology Laboratory
E. Coli
Negative I
100mL SM209223B A
12/08/11 DLC
Total Coliform
Negative I
I00mL SM20 9223B A
12/08/11 DLC
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 3, Block 1, Stonehill Subdivision
APPLICANT: Eric Marcellus
19868 Stonehill Drive
Eagle River, Alaska 99577
SEPTIC TANK TYPE/SIZE: Steel/1000 Gallons, per MOA Records
ABSORPTION SYSTEM: Trench, per MOA Records
DAILY FLOW:
3 BEDROOMS x 150 GAL/BR = 450 Gallons
TEST DATA
JOB NUMBER: 11-381
DATE OF TEST: 12/9/11
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.0' SLUDGE: 0.0'
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes No XX
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soil Absorption System
Comments
pM
(GPM)
(GALS)
(GALS)
Liquid Level
A Level
Monitor
Tube 1'
4 SAS
Level
Monitor
Tube 2'
A SAS
Level
3: 55
5.3
-
-
4.0'
0.0'
-
Start Flow - Meter 228800
3:30
5.3
80
80
4.1'
0.1'
0.0'
0.0'
288880
4:00
5.3
160
240
4.1'
0.0'
0.0'
0.0'
289040
4:30
5.3
160
400
4.1'
0.0'
0.0'
0.0'
289200
5:00
5.3
160
560
4.1'
0.0'
0.0'
0.0'
289360
5:30
5.3
160
720
4.1'
0.0'
0.0'
0.0'
289520
6:00
5.3
160
880
4.1'
0.0'
0.0'
0.0'
289680
6:30
3.3
160
1040
4.1'
0.0'
0.0'
0.0'
289840
7:00
-
160
1200
4.1'
0.0'
0.0'
0.0'
Stop Test - 290000
RECOVERY
'ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: System appears to be operating satisfactorily. There was no measurable liquid in the SAS MT
prior to or at any time during the test. The absorption field was soaked for two days prior to
testing the system.
Reviewed by: Paul Pinard fe
Date: 12/12/11
LOCATION: Lot 3, Block 1, Stonehill Subdivision
DRILLER: Sullivan Water Wells
DATE WELL COMPLETED: 911990
WELL DEPTH: 164'
STATIC WATER LEVEL (top of casing): 49.7'
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
WELL FLOW TEST
JOB NUMBER: 11-361
DATE OF TEST: 1219/11
FIELD STAFF: PJ Pinard
Time
Elapsed
Time
(Minutes)
Static
Water
Level
Flow
Rate
(pm)
Cumulative
Gallons
Pumped
Remarks
3:00 PM
----
49.7'
5.3
---
Start Test - Meter 288720
3:15
15
53.3'
5.3
80
288800
3:30
30
53.3'
5.3
160
288880
3:45
45
53.3'
5.3
240
288960
4:00
60
53.3'
5.3
320
289040
4:15
75
53.3'
5.3
400
289120
4:30
90
53.3'
5.3
480
289200
4:45
105
53.3'
5.3
560
289280
5:00
120
53.3'
5.3
640
289360
5:15
135
53.3'
5.3
720
289440
5:30
150
53.3'
5.3
800
289520
5:45
165
53.3'
5.3
880
289600
6:00
180
53.4'
5.3
960
289680
6:15
195
53.3'
5.3
1040
289760
6:30
210
53.3'
5.3
1120
289840
6:45
225
53.3'
5.3
1200
289920
7:00
240
53.3'
-
1280
Stop Test - 290000
RECOVERY
7:10 PM 10 49.7'
All well protection features are adequate.
Average Flow Rate: 5.3 gpm
Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 5.3 GPM. THIS TEST DOES NOT CONSTITUTE A Reviewed by: Paul Pinard
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM fa
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Date: 12112/11
Municipality of Anchorage
Development Services Department
/ Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onsite
(907)343-7904
Parcell.D.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
060-342-03
COSA # 0(ob Z IT
Expiration Date: C1 - G — O G
1. GENERAL INFORMATION 'jtDCk
Complete legal description Lot 3; Stonehill Subdivision
Location (site address) 19922 Stonehill Dr.
Current Propertyowner(s) Joe Daugherty Day phone 622-4668
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA 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:
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
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 Onsite 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 On -Site 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 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 engineers work.
Individual On-site
❑
Individual Holding Tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
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 Onsite 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 On -Site 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 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 engineers 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 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.
NameofFirm S & S Engineering
Phone694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Po Lia e i C Cot -141- Date S /?/ /Q 6
5. DSD SIGNATURE "sv '- ! - '.....
Sl ` ROBERT C COWAN �Q
✓ Approved for 3 bedrooms. ce-asot
Disapproved.
Conditional approval for bedrooms, with the following stipulat)or��^
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: a al Original Certificate Date:
(Rev. H05)
Municipality of Anchorage •.,
Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsde
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: [T 3 f G1a)K)1 fktt s1b Parcel ID: 060 -312- 03
A. WELL DATA ` I
Well typal VRT1- If A. B, or C provide PWSID # = Well Loga) 't
Date completed _0Sanitary seal) 7c5 Wires properly protected�l)
Total depth ft. Cased to � 3 ft. iuro 9 cderx Casing height (above ground) 1 Z t in.
FROM WELL LOG AT INSPECTION
Date of test 111111b 'SI
Static water level q bt �i (ot ft. ft.
Well production 20.9 2_ g.p.m. 5e 9 p -m•
WATER SAMPLE RESULTS:
Coliform O colonies/100 mL Nitrate 3eb mg/L Other bacteria colonies/100 mL
Arsenic: 0 mg/l Date of sample: �D(, Collected by: �J`7 5 !G06/rt7l!c�' /t7(a
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Sr'P-11G ( S-M£c, Date installed
Tank size /DP.O gal. Number of Compartments Z CleanoutsdQiN)
>✓ g
Foundation cleanouO/N) 'YgS Depression over tank (X ►t2e High water alarm (Yo POO
Dateofpumping lf? lO OS Pumper SAIU(t VVWiJf 001PIE1RS
C. ABSORPTION FIELD DATA
Date installed W ZZ qb Soil rating (g.p.d./ft' or 21M ISO System type T H
�f� 1
Length �A ft. Width oZc+s ft. Gravel below pipe 3o S ft.
r
Total depth ft. Eff. absorption area !L�ftr Monitoring tube V rS Depression over field No
Date of adequacy test 1514RLC�y Resufts(!as ail)?A,95 Forbedrooms
Fluid depth in absorption field before test � in. Water added gal. New depth in.
Elapsed Time: 40 min. Final fluid depth D4a in. Absorption rate >= (45,0f- g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y& type) Ido If yes, give date =
D. LIFT STATION
Date installed Size in gallons
'Pump on" level at in. o P level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot Ile 6 -
r
Absorption field on lot I' S +
Public sewer main
Sewer/septic service line ZZ 15 r4-
Animal containment areas 50 +
(Y/N)
High water alarm level at
Meets alarm & circuit requirements?
m
On adjacent lots (cO 4 -
On adjacent lots I oo /+
Public sewer manhole/cleanout
Holding tank R
Manure/animal excrete storage areas IOo
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r
Building foundation 5t f Property line /0 Absorption field S /
Water main A) Water service line IL �►- Surface water 100
Wells on adjacent kris 00 I +-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
L
Property line Ib I +- Building foundation 181
Water main tift
)
Water Service line 10 Surface water /46 '�- Driveway, parkingNehide storage S t
Curtain drain N O&* ICA)6") Wells on adjacent kris 1 c' It
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and ..
review of Municipal records that the above systems are in M »•:.••.:�;
conformance with MOA COSH guidelines in efleot on this date.�;
Engineers Printed Name _►C J l3 ri it : C.� WAS �(� <5;'. iC t t J l : r
Date �3 / A C
'y1
o J
COSA Fee $ # Li 3 0 .
Date of Payment 6 If /-0
Receipt Number I D rT -2-
(Rev. I IMS)
Waiver Fee $
Date of Payment
Receipt Number
in.
FM
SGS ReEN
Client Name
Project Name/N
Client Sample ID
Matrix
Sample Remarks:
1062535001
S R S Engineering
Lot 3 Stonchill SD
Lot 3 Stonchill SD
Drinking Watcr
All Dates rimes are Alaska Standard Time
Printed Date rime
05/30/2006 12:20
Collected Date/rime
05/18/2006 19:00
Received Daterrime
05/19/2006 17:00
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results POL Units Method Conminer ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (o- 10) 0523/06 05/24/06 Nil
Waters Department
Nitrate -N 3.00 0.100
Microbiology Laboratory
Total Coliform 0
mg/L. EPA 353.2 D (<-10) 0520/06 ALR
col/100mL SM209222D A (<-1) 05/19/06 TLF
Municipality of Anchorage
I • �1 Development Services Department I30dirg
Safeb/ Didion ,.,:On -Site Waterand 4Vaste:vatcr Program "
4700 South Qragav: St.
P.O. Box 196650 Anchorage, AK 93519-6650
vrvrv.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORI.IY APPROVAL
FOR A SINGLE FAMILY DLVELLING
Parcell.D. HAA#_ y1�03co3G.
Expiration Date: _ y�zz_
1. GENERAL INFORMATION
Complete legal description S I oN ' j} I _ S
Location (site address or directions) S i o t l l L L
_ i•
Current Property'owner(s) Day phone
Mailing'address 1�0.8mX 773152
Lending agency
Day phone
Mailing address
Real Estate Agent I rccc�ta � rri� i/i s a
✓q Day phone
_,..
Mailing Address
Unfess otherwise requesled, NAA will be held by DSD forpickgo.
2.NUMBER OF"
BEDROOMS:
3.''TYPE OF WATER SUPPLY: .TYPE OF WASTEWATER DISPOSAL:
-
Individual Well Q Individual On-site f,
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 Health Authority
Approval (HAA), based only upon'the'representations given in paragraph 4 by an rindependent professional civil
engineer registered, in the State of Alaska.'.Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) �forproperties served by a single-family.on-site wastewater disposal and/or water -
supply sisterti. 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 samp!e results. (Certificates maybe. reissued for a period, of, up to one. year with valid water samples.)
Certificates are".valid-for one year:for propertie 6 erved'by•Class;A or B.wellsor a'public water'system. The
Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
n
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 informaticn 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 _ ohbe✓l S�ur�c'1�iK Phone
Address off• 0 3 W// 1
Engineer's Printed Name L n%�i S'pvik It Date ��%3/°L
. ... CO' e-
ERS M
S. DSD SIGNATURE tCip o,: •cc2225 e
Approved for 3 bedrooms ,
Disapproved.
"Conditional approvat for 'bedrooms, with the following stipulations:
OFgw'%
�y0 ,
WA7Eiv 517E e _ —
RANn
7EWA� TER
Additional Comments PRnrDA R.
Attachments:
HAA Checklist_ X Mainfenanca Agreements
Septic System Advisory, Supplemental,Englneer's Report
Well Flow AdvisoryOther
r
7777
By: t .-Or qinal Certificate Date:. 1?, e
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program :
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I_ T 3 S"rytA = 1+1 LL Parcel ID: 410003 cam
A. WELL DATA-$is6�.•$by�L .�3
Well type _E% If A, B, or C provide PWSID # __IA Well Log (Y/N) Y
Date completed IQ 90 Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) 15 in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level Jib tk3 ft
Well production g.p.m. 3
5 �y g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 13
�g mg p. Other bacteria NO0olonies/100 ml.
Arsenic: ✓ mg.A. Date of sample: t 01,b t. Collected by: _
B. SEPTIC/HOLDING TANK DATA
C
Tank Type/Material SC-p�! Date installed _ t 012 qfl
Tank size 106-0 gal. Number of Compartments Cieanouts (Y/N) _ X
Foundation cleanout (YM) Depression over tank (Y/N) J�L- High water alarm (YIN) 14_
Data of pumping �7/i S Pumper
C. ABSORPTION FIELD DATA
Date installed n>/z=. O Soil rating ( fe/bdrrn) /5p System type t4ex
Length ip A/ _ ft. Width _ 72, r> R Gravel below pipe 3.5 ft.
Total depth —&- ft Eft. absorption area _yQr49fe Monitoring tube
Date of adequacy test - "gloje 7 Results (Pass/Fail) r
Fluid depth in absorption field before test A in. �
Elapsed Time: W/ min. Final fluid depth ✓ in,
Water added_ JaMgal.
Depression over field N
For L bedrooms
New depth in.
Absorption rate >= 66W g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date i'. -I
D. LIFT STATION
Date installed Size in
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
(YIN)
ofr level at _jcr High water alarm level at in.
tested / Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot (b
Absorption field on lot ) 5
Public sewer main NSA
Sewer /septic service line j I,
On adjacent lots 7 106
On adjacent lots �2 /a -C,
Public sewer manhole/cleanout N/Q
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 Property line > 1-0_ Absorption field rJ
Water main
N/A Water service line O tt Surface water N 1 D
Wells on adjacent lots 1 /C<O
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation 1_ Water main N�A
Water Service line % J o Surface water —.tk—) Driveway, parkinglvehicle srorage �r
Curtain drain 1-410 Wells on adjacent lots > /40-0
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through held inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. (J
Engineer's Printed Name a b em I v r kla K K
Date 1 e /X-bJV t -
HAA Fee $
Date of Payment
Receipt Number 3O 91 Z
(Rev. 17mt)
Waiver Fee $ _
Date of Payment
Receipt Number
k,
N
L. CUE Environmental SorvlceC Inc.
C7 SERef.x
102025900:
Client Name
Tobben Spurkland P.E
Project Name'M
LI. B3 Stone lli:i
Client Samp!e ID
Ll, B3 Stone Hill
Matrix
Drinking Water
PWSID
0
:4p1 6$1!30:
All Dates/rlmes Are Alaska Standard Time
PrintedDatelrlme 01!16/2003 8.44
Collected Dawflitie 01/10/2003 16:00
Received Date.rrime 01/10/2003 16:37
Technical Director Stepp/�/ea C. Ede
Releaaed S ky rY,4 --
a4mpic rtanarct.
EP 300.0 - 77he M—trix spike failed for Nimte anal Nitrate individually, but passes for Total Nttrate+Nitrite.
Pe:YSelR ttK 114
-- POL Ilritt Meth'd
Alluvz e P*ev Analysis
Limiu Ikte Deie Init
Watere Department
Total lira:e/Nimte 139 1.00 m9/1. EPA U0.0
MierobiolOgy Laboratory
TotalCeidorm C eol/100tn1, SM:89222B
OI/IVO 3S
0!/10'03 KAP
Nov 27 02 04t57p Eva Lokcn
•� f'O•/��iY/GG
907 669 6476 p,l
.✓�O�.fl ;rs�� JC6 od '
' e
o
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I
:+ o, NI
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o.:
dr
A ..•i . 9r
*01fjr
ASBUILT
I HEREBY CERTIFY .THAT I HAVE SURVEYED THE
xD &
SCALE, se'aaRD
FOLLOWING DESCRIBED PROPERTY:
AND THAT NJ FNvFiyNTS
DATES
EXIST E7CCc_PT AS
INDICATED. IT IS THE RESPONS!B;LITY OF THE
14-10:55-.1-:
OWNER TO DETERMINE THCE OF EArM NTS, COVENANTS,
GRID:
ORlSTENRESTRICTIONSY
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT, UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR
FB
16"�li
CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN:
e•OF At
��a,a� a a
C�.'•. 'S-6918 < .
h A�p'rsMx.�'.�'''.`
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