No preview available
HomeMy WebLinkAboutTHOMSON LT 3Thomson Lot 3 #067-041-03 V ty i \ MUNICIPALITY OF ANCHORAGE +rrl DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE&SIJEW Y' OUI ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION hCM�fr LOCATION NO. OF BEDROOMS fz a) 4d .41 DISTANCE TO: Weil Absorption area / Dwelling PERM I NO. to Y �3 % O V E 2 Manufacturer Material No. of compartments N f 2 S1;ff L Liq, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth U �- 1 d Y DISTANCE TO: Well Dwelling PERMIT NO. —iaz Oz F Manufacturer Material Liquid capacity in gallons Q = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO.B�QO W J u. = Total length of lines OWL Trench width O No, of lines Length of each line Distance between lines F.2 W Inches H Top of the to finish Material beneath the Ic grade Total effective absorption area o inches W I7 Length O� Width U7 Depth 3� PERMIT NO.A2o 33a 66 ipType of crib Crib diameter Crib depth Total effective absorption area H DISTANCE TO: Well Building foundation r Nearest lot line -f Or J IC1aA Depth D%%i��ll�e�r Distance to lot line - PER^IT NO. J W �W[F/tDcU G W 3 DISTANCE TO: Buildingfoundation Sewer line 3/ Septic tank Absorption area(s) OTHER 1�t21 PIPE MATERIALS wo -30 SOIL TEST RATING 10 / S INSTALLER �} REMARKS E sr ,ULVA, Bfa,30'x3o 6"Ga.aurl e.o oo =.I,* Tr f i 'F- 61 j2 - 1 d 3 APPROVED DATE LEGAL 72-0131Rev. 3/78) Cl L% M L.1 t -a I C I�F1 L_ I T Y n F Fi t -d C N�+F? F=J G E DEPARTMENT HEALTH AND ENVIRONMENTAL ..<OTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 '• 264-4720 0t-1-5=' I TE SEFtIEFZ F'EF<t'1 I T PERMIT NO. C 820330 ) APPLICANT RICHARD LEGG LOCATION MILE F EAGLE RIVER ROAD LEGAL LOT 3 THOMPSON SUB LOT SIZE I E /D: F94-41 I� 44000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/ER)= 145 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CHEF=`TH= 4 LEt-41:3TH= L:2: GfRn v'EL C-EF='TH= v a THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION {IN F -. .. THE TREtaCH W I vTH I FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL I,� N HE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RELA-RU I FREC� SsEF}TIC TAt4F-' ".:-3:2-!E:= 1�� �� GFiLL4td5~ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY 4JELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE 4JELL WILL SERVE. --- TWO C a' ] I t47 F�ECT I Ot4�- AF?E Ft_EnU I REE> --- E:ADIFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SE14ER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•EF_M I T EXF=" I F_ESs [?ECEMBEF<: Z --::Lr 1E4:0 I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THANQQ ¢10 3�%�/�s�G���� SIGPJED:--------- --- GG ---------------- ,,l✓ AP LICA PICHRP A P'?L I CA P_ i ISSUED BY _ _ -------__ O & E ENUiNEERING & DEVELGr HENT CO. •,� Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellla 694-2774 SOIL LOG 688-2280 Performed for. Name: M2 ^�' //►� R-~ ��I— S Tel. No. &?C/- 1/400/ Mailing Address: `�.� /�� 2/7 Legal Description: Lor 3 r NOMPSt�nI �u,60, Depth (test) Soil Characteristics 0 5 6 SM- 6,I.-r� 6A,vp 1tw,T r1 8 6,e Adt� o . / 6a1C. 4CFs . 9- 10 10 — Nc PClet `.� 11 — �MvnL ur �r[rIJ 12 13 _ 14 _ 15- 16 Ground Water Encountered: Yes No If yes, what depth PLOT PLAN PERC.TEST A•r w0 1. 9� :%9r tla. A:SF[ .•` , .i Proposed Installation: Seepage Pit _ Drain Field / �; yeo •. Comments: ©uhlr � t✓, S. -l4 'S —7-47Qcrr �n/ FcPA:�k�P / L/1 1 A SL� Shit_. -6 //.Lp Q„O i(/o7- 4b -1 -ma iAJ / c_ i CST ON// - �Al aL`i [-'S Performed by: Date: $ �Q` RL� a VA -A J. Lit pO�t� Q �1V Trr.tfirh Drilling lExig by DOC Co, tlna SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 OWNER OF LAND �J/G k' /E CC ADDRESS RO '10A 1091 FR LEGAL DESCRIPTION 4 3 7 No-++ rz) ti DATE • Started �''� Ended a PERMIT NUMBER KIND OF FORMATION: From Ft. to a Ft. n dFQ �UiC�E� From Ft. to--'2—Ft. C� /�7� t -z(f ✓fL From !_Ft.toFt. S,a,VO �Pa4✓� From Ft. to _ Ft. CL From I / Ft. to 4F Ft.- C(4 r EC.CY✓EG From—'JE—Ft. to � S Ft. T/ E H T St9" FromK f Ft. to1v__'LFt. h! u E C t r17t From /0el Ft. to / / 3 Ft. 4 !A✓c < From Ft. to Ft. i From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Ft 4 From From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT GALS. PER [IR /d 0 0 KIND OF CASING Is "S"'Ot7 From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. From Ft. From Ft. to Ft. From Ft. From Ft. to Ft DRILLER'SNAME I�•/Lcl- — r•1 u r -a I C: I F• F1 L_ I -r ke C+ F- H r -a += "Ci F: Ft C� E DEPARTMENT HEALTH AND ENVIRONMENTAL ~.)TECTIOt " 625 'L STREET. ANCHORAGE, AK. • - 264-472N 1•IELL-_ FsEF_M I -T- PERMIT PERMIT N0. C 820284 APPLICANT R. LEGG-VALLEY DR.T'tJRLL C FO BOX 1091 E. R. LOCATION MI E E. R. P.D LEGAL L_ THOMPSON LOT SIZE 44000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SENAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUELIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MININUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF:r•1 I T E: :F• I F E'= LNECEr`1E:EF, = 1: J_ �4E:ns I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTR! t TNF CVSTPM Tra urrrnc•nararc LITTU rU= rnr.= SIGNED:_csiT y�y}}- _________ ______ __ AFPLICAIJR.11l_a�-t+ALLEY DRYWALL CONST IN IS=ilECr E:Y_=f ��e�y ----------DATES��/.L4V4. 0 cl >� V�f Q,a,,y�. #- 1(�s a Vl g L Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Si t Anchorage, AK 6650 0�40r www.muni.org/onrg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. I1CP-tX1�y5 COSA# 0ieoq} iR 1. GENERAL INFORMATION Expiration Date: /01 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THOMSON SUBDMSION: LOT 3 7134 CLEMENS CIRCLE • EAGLE RIVER, AK 99577 ALFRED TRAWICK Day phone 694-5772 7134 CLEMENS CIRCLE • EAGLE RIVER, AK 99577 Day phone �i[:I:Id�Zd�:II�:7i7�iI� : : ►� :. Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. 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 ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 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 seat 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 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 Finn 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 rbf lI,o L 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 & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the 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 of 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. 5. DSD SIGNATURE U/ Approved for bedrooms. Disapproved. Conditional approval for Attachments: / COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the fllowing stipulation .' •,�qC �_ •- \III LI\L"'� f0 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: Original Certificate Date: o z c IRti 11I S1 .,. Municipality of Anchorage Development Services Department Building Safety Division OnSros Water & Wastewater Program 4700 Bragaw, Street P.O. Boa 196650 Anchorage, AK 99519 -WW www,muni.arglormits (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: THOMSON SUBDIVISION; LOT 3 Parcel ID: 067-ti(L p7 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDN N/A Date completed 4/1982 Sanitary seal (Y/N) YES Total depth 113 ft. Cased to 113 ft, FROM WELL LOG Date of test 4/1982 Static water level 40 ft. Well production 20 g,p,m, WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Nitrate 1.21 mgJL. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 10/4/2006 44 ft. 5.2 g.p.m. Other bacteria _0 colonies/100 ml. Arsenic: N_ ugA. Date of sample: 9/27/2006 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA •INSIOE CRAWL SPACE Tank TypelMaterial SEPTIC/STEEL Date installed 6/1982 Tank size 1250 gW. Number of Compartments E Foundation deanout (Y/N) "YES Depression over tank (YM) NO Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 10/11/2006 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA PSELOW ExisnNo Data installed 6/1982 Soil rating (g.p.d./Ww4j!�rnD 145 System type BED Length 30 ft. Width 30 ft. Gravel below pipe 0.5 ft, Total depth •4.5 ft. Eft. absorption area 900 fe Monitoring tube YES Depression over field NO Date of adequacy test 10/4/2006 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth In absorption field before test DRY/DRY in. Water added 757 gal, New depth j. -lin. Elapsed Time: 249 min. Final fluid depth DRY DRY in, Absorption rete >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - D. UFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons "Pump otr High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A 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, parldng/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspecUms and i':: .. ..'>< .... review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this .. , . • . • ................ date. ey as S.- Engineer's Printed Name JEFFREY A. GARNESS Z79 3 •%� '•�4 /r 1.7�'•��q� Data • Op�of•ss1°nd COSAFee Sq"; O.C)C) Date of Payment 11) �t I 10 Receipt Number 6L 7 (Rev. 71/05) P urn 3�30�0� Waiver Fee $ Date of Payment Receipt Number I WTACIFIC 3-31- 0 :12i44PN : P`T 1.1c. JL.GC:,•.�yl•M.�•r�lRDI M'1[,1't 1l.Ml I11LG l.T M H1 Aak .._ ,i __, • i �. „'i J111, '1 r..-rl.111 `r ,)' 01' ..'• , r••. r.j• 41' p,ll l i•1•1•1 •1 j• 4�.}� •I�11i �1�`!!I ':�••':•.• .. \ y�� �� �cr pr/VI a„p y_f •r •"•L�iW �'•'•!'1 �i••,•-r :,..ri :•t. 1 ' 1/^I r• �X 14 t r9 Yr' 17� 1" / . . I ,�• i 11:: ♦iu OGrx ,-s "'`..' ;:to CIi<'r•�, ,';:Jr:;'.,r:j t,.rt tar/ l't �•1 j••r • • , , • ••ijt+ IM".F 1.t lyr'.; /'•.: ]iM,•�S►'.+i .' 1 • . 9� •' • I , •r: l.' �.••I•[yYL7nN�l•�C)••J..U•'/.i!i�1� �A. 338 3246:: 2/ •�a f�• j •/9 ♦•rl. �". ,.• }. '•.. ', •: •' r .':. ••1 �1 j•ll ��r �•fi r� •I •��_• .y'JI t••'7 •�.'„tt• •♦1 •• ;.,,.•• ••...;'•'.:.'� rj'•I•�i h rnl � i.•,•1� .t• �! �` J;''�ft �It ,�.., ��ti •••�•'• i';• + • • I' ; ; r�r1' �jw •Z 1.f J•I F< 1 �j r .1'Cll%IN• �'��,'•• jn i �! rr 1 1 1� 1', 1'';•' •' • is ••: ••; � � �•.`y � j(.it ;.� j%"♦ jt r r7 .:'•1"i••, r• r•�� �1�.: .:'• .•ll •j,1: 1V%i� r ;••. I(4 rI rjr L�11 ,L• �' � //, 1,.• `�.' � .7 "•" • ti 7 . . 1� 1I I� ./ la,, •N 1i•%Fr�,ii'I1i�1 . 4•�t�:•:"•: •'I.• ,•1.4.1' ;•,,,rl,;•) I5Q 41!r r �.�'':'. ter, •r'1 t• • ••J :�•, ; • •/• •, �Iw,, ,�'�, �1 1'r,14 . 111 1, , , •' •.• .. •,♦1 '•.. • • I' . 0. to : +•, \r 4 r .ilrt •/.J �i• % :'. . H111^• •• • 'i i,.•.i� :. \,' ', , • I •, :••, •f.' r �•/.l7' l�, rr. .,1, `I n�/,•♦ �i• u:� 4..j •,1";: i'r•• �1, �:•��11••���•,, •P q'I Y� } l • J r•/����� i w( !j •� X1.1 •'.r ;,r . j.•, • ',•, • o.I f. ••i• r .�•'• Iy f. `. n1 �• of ���}i,,�''.1:'I'••1'• .�,�r/I'•, 7�Ji, rr• � q•, ••'.''••%li •�qj ••1JJ..�IL�•��`1 14A. If of rrr (. � ' • % .'r j 7 � 1' • i 1 i f •; j fr' • �• 11 J t. 1''„�y/�' }. 1 ��jy i.'• f L1: ••1 li'•. r. •+. l.•, bi ♦�', ly' tl• •r; K. �''. S�• �iI •. /.•',ti ., � , �: i i.•'I��i1f•�i,•�Jd,t� i'1'. !' . '' •' - 114"Ity CtftUY that [ have 4too;; ;ri:y•'1i•. 1'•': 1inPartS;t ✓� •:.:r.;J:•••; .y..: : ' "'.:Kia 11•,. ; .. �.i n •/ ./�� 2. '! •�'}� % 4•. 9"A .r. r�\ia' loopr /;••• r �• r taenU NtwtaC 1••PaWI art wfLjhu! N� p 9 po>J'ttroa ant + .► • C d• 1• K/ •,•"' ` nal pr4rtlD or tRl nan On irlt Dro►arV jot rQ:acint th /' . U• that n0 ImMp+nmroM on pop N' 11 +t AUac l The r 1'U:Mj •b_:.'.••�'1 rt1' . •.. • anewrh on the DtemNt)) `n oaC.uen rnd•{�at titin srC w :��1 ••\ M 1••I .' •' �, ra4dwalllr LPdrw"%LUIan 11nat sr M" -i lalbl :� J • •1� ' ': 4410 tt/up4ttl utnDt u Inelattd Amen:•. , a rw`mpntt �ccc.....•i: al rStla ijIWT, �IYh1 • •0 h 'I. �i••' l'�h•'�. >!I,hrJ�urA:��44'�''�J •.. Iht. v-':"�'•1-�'V '/ :4 t(�`••ir:�160.7.s ti u'.�. 1'It•Yr•} !.••+"t• •• .'•1' •"•nC11=rlf!O'JOHM - -' %, er• "ti i i♦: r.' !'.F I r4aUlt Lofta.J Ll »Ya jMp. wI ••\1 '.'_/�•�',..1 �i r•' ..J,'":. 1' 1'w 1�0 r LNOW 41t•llidailV4r /FI►ilta+I+ t r4•y"1�•j'� •i�1�Y` j • ' ._=..'t. .��,�,�,}� hhan0-t0G)le t.711�•. •rl•. ,liir}::f• •�!)i/sillj'�J�%I�i�l�{jh►i.(�'it.:'�.1...., •.'i'.:%'. •'y�..• l•r.l•tijrly�` i'R�'•!.w!:r•.• ••,:• ,ljl•JJ a )Ik 1'J. i 71!••' Yl�i.,l �' 1 -j .I-/-r•••:ii�l�i'•h �'..r.l r..f•.•:1.1'. ��!Ii�J'isiti•1•p.4.)•I�.Liu:/.rjLZ��•i��(.� . :/ •.:'.1 1''L� 1.' 'f: ' • :. I:• •rl:' •4:rr; r. •. • ♦ • t:.T'ti -SCSI$ -- SGS Ref.N 1065839001 Client Name Gamess Engineering Group, Ltd. Project Name/N Thomson SD Lot 3 Client Sample ID Thomson SD Lot 3 Matrix Drinking Water Sample Remarks: All Dates/Times arc Alaska Standard Time Printed Date?ime 10/052006 15:35 Collected Date/Time 09282006 7:58 Received Dale/Time 09282006 9:50 Technical Director Stephen C. Ede ParameterAllowable Results PQL Units Method Container ID Limits Prep Analysis Date Date Inst Ne tals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 0929/06 10/03106 WAW Waters Department Nitrate -N 1.21 0.100 mg/L EPA 353.2 D (<10) 0929/06 ALR Microbiolow Laboratory Total Colirorm 0 col/100mL SN1209222B A (<)) 0928/06 TLF MUNICIPALITY OF ANCHORAGE AQL • DEPARTMENT OF HEALTH b HUMAN SERVICES Division of Environmental Services On -Site Services Section UDDER P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 067-041-03 HAA # VAQ01-Inn31 1. GENERAL INFORMATION Complete legal description Thomson Lot 3 Location (site address or directions) NHN Clemons Circle, Eagle River Propertyowner r7frM r Mimi Trawirk Dayphone r+(M-5777 Mailing address HC 83 Box 1791, Eagle River, Ak 99577 Lending agency National Bank of Alaska/Shirlene We118ay phone 257-3418 Mailing address P.O. Box 196127, Anchorage, AK 99519-9974 Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 %� 3. TYPE OF WATER SUPPLY: Individual well X Community well _ Public water — NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer _ NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72425 J%e.. 1191) imnl MOs 621 S. STATEMENT OF INSPECTION BY ENGINEER k. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my 1 investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I Iurtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineers signature Date 6. DHHS SIGNATURE Approved for - bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. n-025(FW.1AI) 6• k MOA621 ' Municipality of Anchorage lak Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 71401450A/ (4l 3 Parcel I.D. 069 _ 01-/1 ^ 0-3 A. Well Data Well type O,P/vH%E If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) YC S Date completed MeZ Driller SOL L /LU414 Total depth //71 Cased to //3 Casing height 3 / Sanitary seal (Y/N) yes Wires properly protected (YM)y C WATER SAMPLE RESULTS: ' Coliform -P_ Nitrate rZ% N61` 't^ Otherbacteria 7" Date of sample: S- S- 9y Collected by: �i1/Es/NLr�/1 B. SEPTICM"NG TANK DATA Date installed M18'7- Tank size ZZ 50 Compartments 2 6 Cleanouts (YM) YC 5 Foundation cleanout (Y/N) YES I_.r,) Depression (Y/N) NO High water alarm (Y/N) All " Alarm tested (Y/N) ,V/ <? Date of pumping 49/09/93 Pumper 5olylli9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I / / Well(s) on lot /// On adjacent lots 1"1190 Foundation / 8 To property line 5 5 Absorption field /% Water twin/service line 7' /D Surface water/drainage /1//9 72-026 (M)• Fwt CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION Date of test 05J0S 9y 70 Static water level 1/01 1 n Well flow 7 C c g,p,m, �. 9 g.p•m� M -' o o Pump levels UN kNOIJA/ m a' o Zfifi Z_ SEPARATION DISTANCES FROM WELL TO: m r SepticAug6ng tank on lot / / ; On adjacent lots _ _ _ 1WO Absorption field on lot i / Z/ ; On adjacent lots 4lby / Public sewer main i//ii Public sewer manhole/cleanout N�/} Sewer service line f FSS Petroleum tank //Owr WATER SAMPLE RESULTS: ' Coliform -P_ Nitrate rZ% N61` 't^ Otherbacteria 7" Date of sample: S- S- 9y Collected by: �i1/Es/NLr�/1 B. SEPTICM"NG TANK DATA Date installed M18'7- Tank size ZZ 50 Compartments 2 6 Cleanouts (YM) YC 5 Foundation cleanout (Y/N) YES I_.r,) Depression (Y/N) NO High water alarm (Y/N) All " Alarm tested (Y/N) ,V/ <? Date of pumping 49/09/93 Pumper 5olylli9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I / / Well(s) on lot /// On adjacent lots 1"1190 Foundation / 8 To property line 5 5 Absorption field /% Water twin/service line 7' /D Surface water/drainage /1//9 72-026 (M)• Fwt CONTINUED ON BACK PAGE ATION / Il n Date Installed Size in gallons— Vent (YIN) allonsVent(YIN) High water alarm level 'Pump on' Meets MOA electrical codes (YIN) SEPARATION DISTANCE FROM LIFT STATION TO: Manhole/Access (YM) "Pump off" Level at tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA a Date Installed 0G/ gZ Soil rating (GPD/Ft?) Al S Sty, tS2 System type 4T CQ Length 30 Width 30 Gravel thickness (17Totaldepth 3 Total absorption area 94000 Cleanout present (Y/N) YG 5 Depression over field (Y/N) 1VQ Date of adequacy test 05,25/2y Results (pass/fail) /'SSS for 1i Bedrooms Water level in absorption field before test 7 After test 5. 5 Peroxide treatment (past 12 months) (Y/N) N/l7 If yes, give date N10 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots */00 Property line #3J To building foundation 3 9 / To existing or abandoned system on lot N�0 On adjacent lots t 30 / Cutbank 1414 Water maW service line Surface water /y// 9 Driveway, parking/vehicle storage area �d / Curtain drain NOMI /��Of1�Eit/T E. ENGINEER'S CERTIFICATION I certify that I have checked verified, or conformed to all MOA and HAA guidelines in eHe Lbrt4l�e`tlat Wjhis inspection. v41 •, �- Signature_ Engineers Name 1-00 5 607-6)U, PE Date a HAA Fee $ 3019 Waiver Fee $ Date of Payment 5'—/0- A Date of Payment Receipt Number Int? Receipt Number 72-026 (=)• Back 0 j 057L (f [ • r l-loui; h. -:vera � b CE."726 ^ ' • Qn 05/16/94 10:47 CT&E RlVIRU9lENIt1_ LAU btNUIl -5 - W1 b74 .1dw r". b= we Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT CfQEReC.f 943075-1 ClimtSauylc� 1110MSONIAT3 Dtatri: WATER Cheat NsaLe PADA NWA ENC.& MOUNt3 WORK Order 79109 UrdeedDy rnwADatc OWN 009:23 Aro. Pro}ectNmne CullectedDete 03MY94 ®10:45 hN. >'rojectf RecdvedWe 05/05M @15:30 bra. PW91D UA Tecfntleal Ulccctor STPP1112J C.lDE �i�� RL elm"dBy:. 4C. "�"�. � SatnpleRanarks: SAMPLE COLLEUIWDY:t=H QC Allowable EKL And Paramcicr Rmlta Qud Unite Method Limho Date We Inst Nitrate N 0.49 mg/L EPA 35311300.0 10 051004 WE �� --- • Smitpeddlnvina:tionsAbove ILIA - Above •• Sce9otopleRcm+adceAbove liA—NotMdyxod U-L'ndetecicat.Reportedvalw1sthe practical gnofifiodionlialL LT.:Le T11n D- Smonduy d dation. (Tr- (lrmfer1hmt k 5833 8 Sheat Anchorage. AK 89619.1600—Tel:1!0l) 682.2343 Fax: 1907) 561-5301 —_ ENVIRONMENTALFACILITIES IN ALASKA.COLORADO, FLORIDA. ILLIHot$,mAnYLAND. NEWJERSEY. OHIO. UTAH. WEST VIROINIA - A czl-7 _.vim Time APPLI( NT FILLS OUT UPPER HAI ONLY Time Prop9Ny C'4ner Richard II./Patricia Legg Phone Post Office Box 1091 Eagle River 99577 694-9711 Mailing Address Zip Code c dC Q Buyer Alfred/Mitzi Trawick Date Date 1779 Morning Tide Anchorage Date Address Zip Code Lending Institution Alaska Bank of Commerce - Eagle River,Branch Phone Inspector Post Office Box 1185 99577 695-2021 Address Zip Code Inspector Realty Co. d Agent Helga Larson, % Commonwealth Area, Inc. Phone Post Office Box 249 Eagle River 99577 694-9555 Address 21p Code Legal Description Lot 3 Thomson Subdivision Street Location Clemens Circle Type of Residence k,'y,Single Family four ( ) DISAPPROVED ❑ Multiple Family No. of Bedrooms ( ) CONDITIONAL APPROVAL' ❑ Other Water Supply kjgndivIdual St a. ATTACH WELL LOG. A well log Is required for all wells drilled since June 1915. ❑ Community - For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility Solis Rating Date Sewer Installed Well To Absorption Area Sewer Disposal XZ Individual Q o'`, b3 3d Li—m5) 6 -i L1-.rf oa Year Individual Installed: 1982 — la 1� ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. - A czl-7 _.vim Time Time Time Time c dC Q Dale Date Date Date Inspector Inspector Inspector Inspector Field Notes: (q) APPROVED BEDROOMS -'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: , cb Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received U — la 1� Well to Tank ( Septic Tank Size 1 3� rroa CM -v LL)LU 1a-1L1-U('uJs november 13, 1932 Richard H./Patricia Legg Post Office Box 1091 Eagle River, AK 99577 Subject: Lot 3 Thomson Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: ° well log submitted to this office for our files and r review. ° The top of the well casing should be scaled so that it is water tight. ° Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. ° The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist RP226/p/EH