Loading...
HomeMy WebLinkAboutFISCHER BLK 3 LT 2AFischer Block 3 Lot 2A #015-292-45 Municipality of Anchorage Page t or s Development Services Department g On -She Water and Wastewater Program 4700 South Bragaw, Street P.O. Box 196650 Anchorage, AK 99519-6650 (907) 343-79N ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. WWO50092 PID Number 015-29245 CYcelia & Eygeny Gumennik Wastewater System: New LEGAL DESCRIPTION BbtA. La S.rdvlwl 3 2A To --w Rope sm. Well: New CWvt"n IPM1110. A, 0. CE Tar DaM C Private 100 FI. ' Dr. Dare. SI Al ine 8112105 YAW! R -m Sr r C—q 5 DPM Ft. SEPARATION DISTANCES From Tank Fiek1 Station I Tank wra, >100' >100' N/A N/A S.Iecewrr >100, >100' N/A N/A Laune >5' >10, N/A N/A Fes= >5' >10, N/A N/A CMtse,D. None Noted Fte r 1.2 DwM b PW r.t M Fischer 3 Fr w.a no.. apu 1-3 cr..r.mu. 5.9 b, di tl,aµal ria FL 520 FL I Red ABSORPTION FIELD 5' Wide Trench we 7 Ft. cr..r wFln tw..tn Fp. FI. 4 FL Wx Luptn FI. 52 FI. Ft. 1 • FL Pp� MWr W Fe ASTM 3034 PVC AI. NIWIe 5/17/2005 TANK ® Septic ❑ Holding ❑ S.T.E.P. ❑Other. ubIWJPrtvete sewerLine Anchorage Tank 1,250 >25' Steel Two (2) LIFT STATION — NONE ON LOT Finished Floor c.l InI in BENCH MARK Inspections performed by: MEA Dates: 11" 5/17/05 2. Department of He Ith and Human Services and pproval5117/05 Reviewed and approved by: Date: 100.0 FL Engineer's Stamp 49th *N MC14AEL E. ANDERSON in Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage. AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW050092 U PID No. 015-292.45 ru U S F N Vl s ti P, -,�,;: ry. 41/ ! 49th •�?'� r .............................. PROFILE AS -BUILT '.,'""luttcw+aeasuy �1��JJ'No. CE -4381 �,• Scale: 7-- 10' �jf,+a'lo-a?•''C +• �IU�'• m z° �= I I N CD N ,60'OtZ &ZZ,90.00 N ,04 d ---------------------------------- IMS3 3 8 '1 ,0 t a I d 2O_do I ONON00 00 tg NW1 C) i' P, N-.fO f < N 0 GO a) Y .f n nnoon to V)N U�U2 � C )n _O Z ED d O �!_ E LLI LI N- N Q� 6) °) o� ain N Z w o)a N a `v ¢a 00< O ��• a N C W W i. n.O£ _QUo O�LCO V b, ^ s 'roNQ y n N V/ N t Ji Q W r -W LD H I U �aN� N ca w 10 €�g 7 Z Lu � Q ;a I J U)C C�` O N O Vn O D J 5 Z a Q 17 ZS6'691 A1.9Y,ZO.00 N og IQ�ryO' I M i j U E _ '1S 2J3l0NIlN p 0 — M J M t� V) Eli N Of W 2 F— U O J li ALPINE DRILLING & ENTERPRISES Permit Number: t1SW050092 Date of Issue: 4-20-05 Parcel Identification Number: 015-292-45 Date Started: 8-11-05 Date Completed: 8-12-05 Is well located at approved permit location? ® Yes ❑ No Legal Description: Fischer Blk 3 Lt 2A property Owner Name & Address: Cycelia & Evgeny Gumennik 10333 Klingler St. Borehole Data: Soil Type, Thickness & Water Strata stick-up Depth (f) prom To 0 2 Method of Drilling ®Air rota ry ❑ cable tool Casing type. steel Wall Thickness:.250 inches silty cobbly gravel 2 15 Diameter: 6 inches Depth: 100 feet gravelly silt 15 63 LinerTypc: - silly water sand & gravel 63 67 Diameter: inches Depth: feet silt67 79 Casing stickup above ground: 2 feet Static water level (from ground level): 49 feet gravelly silt 79 100 Pumping level: 80 feet alter 2 hours pumping 5 gpm Recovery Rate: 5 gpm Method of Testing: gkM Well Intake Opening Type: ❑ Open find ❑ Open Mole ❑ Screened Start feet Stopped feet ® perforations Start 63 feet Stopped 66 feet Grout Type: bentonite rrnrrules Volume: ! Ur Depth: Start0 feet Stopped 7 feet II Pump: Intake Depth feet �I Pump size hn Brand Name IIWell Disinfected Upon Completion? ® Yes ❑ No II Dletltod of Disinfection: chlorine tahlelc Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of -completion and the property MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street J 1 Wql P.O. Box 196650, Anchorage, AK 99519-6650 I ����� (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Apr 20, 2005 Expiration Date: Apr 20, 2006 Permit Number: SWO50092 Parcel ID: 015-292-45 Legal DescriptioVFISCHER SUBDIVISION BLOCK 3 LOT 2A', Design Engineer: 0014 Anderson Engineering Site Address: 10333 KLINGLER STREET Owner Name: CYCELIA & EVGENY GUMENNIK Lot Size: 62740 SO. FT. Owner Address: 10333 KLINGLER STREET Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516 - This permit is for the construction of: Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well ❑ Water Storage 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: y_zo-o5' Issued By. I IYl' Date: so 0 r� 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.292.45 Permit Number SW Property owner(s) Cycelia and Evgeny Gumennik Day phone 564.2496 Mailing address (1) P.O. Box 243482 Anchoraoe AK 99524 Mailing address (2) 10333 Klingler Street Anchorage, AK 99516 Zip Code Legal description (Lot, Block & Sub'd.) _Lot 2A. Block 3. Fischer Subdivision Legal description (Section, Township & Range) Lot Size 62,740 SF Acresq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Four (4) 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. (Signature of property owner or authorized agent) Permit Feesf 41C = 50" `- -F .11 7S1 aivefr ees: Date of Payment: 4'16-05'_ Date of Payment: Receipt Number: C6.zZ7 Receipt Number: (Rev. 12100) 1 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 FAX April 18, 2005 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2A, Block 3, Fischer Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer. The owner of Lot 2A, Block 3, Fischer Subdivision intends to construct a new four- bedroom home on the property. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the home. No conflicts exist between the proposed well and septic system and the wells or septic systems on adjacent properties. The Site Plan and backup documentation identify the location and configuration of the proposed septic system and the alternate site. Existing drainage arrows and the current drainage pattern are also identified on the Site Plan. The drainage pattern will be maintained after development of the new system is complete. Test holes placed near the location of the new absorption trench and alternate site revealed well graded gravel with sand. The accepting soils were tested and found to have a percolation rate of between 1 and 5 minutes per inch. The average application rate for design purposes was set at 1.2 gallons per day per square foot. No groundwater was found during excavation and none was noted during the monitoring period. Our design includes the placement of a new 1,250 -gallon septic tank along with a new 50' long by 5' wide absorption trench with a 4' effective depth to collect and treat the sewage generated in the house. The bottom of the trench will be 7' below the ground surface. The distribution pipe will be 3' below the surface. A minimum of 3' of cover will be placed atop the bed and a minimum of 4' of cover will be placed atop the new septic tank. The ground surface on the lot slopes from east to west at grades approximating 2% to 5%. The new absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The new septic system will be constructed 100' from all wells and 100' from any surface water. It Lot 2A, Block 3, Fischer Subdivision April 18, 2005 Page Two will also be constructed a minimum of 10' from any water service in the area. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, wwG E Michael E. Anderson, P.E. Attachments !49th•. MICHAEL E. ANDERSON LOT 2B i Q 1 •. � r 1 1 ]fY I b' r SPRUCE rnmct,7 woo , �— CINCIL — � •v ry ...M 1 �.� _ 1 1 1 ~ Yr r. 1y •• 1 (7 H e r LOT 2A , 1 1 1 rws* lanl wtwu[ O E 41 49th•'. •• AREA - M A P ». 0�AtMICINCL E uDERSW i�j�� SCALE V 100• ��r i c = io 60'OLZ #,ZZ.90.00 N u ------------- -- 3 — — — --_—_______— 0 I n I z elO , .S N Y }a Z r I Q M �4 N tt �Ws N Q N sr n N M (/1 p �. n. S n � N LLJ a W N QN OI W U N to € F— W 2 F- 52 P �o 81 .t6'69l M.Sf.LO.00 N ! b 1.0 M c i s E; TT?"i •1S N3I0NIIN 1j1 •• i � .•:Ct: LOT 2A, BLOCK 3, FISCHER SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House 5' Wide Trench System Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area 500 SF/5 SF *.5 (Red. Factor) = 50 LF Trench Length THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Trench. Natural Backfill 2'6• 3' Cover Over Trench Geotextile Fabric 6• I U 4• Perforated t PVC (Holes Down) 4'0. 1 1 r'r Drainfield Rock 5' TYPICAL 5' WIDE TRENCH SECTION •..��� ..- (NO SCALE) • p'� ........... NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ; ....: „ 49th.„ Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. 0 d M , E. MM Minimum 10' Separation From Water Services. 0i No. a.x Minimum 100' Separation From Surface Water or Streams. V���.. `o®�aea®le 4' 4:6 OF .44 14t pr 4918f e Municipality of Anchorage i • �( Department of Health & Human Services o 0 •„ •UCHAEL !. ANDERSON v 825 L Street, Anchorage, AK 99502-0650 0 f•. GE -4381 SOILS LOG - PERCOLATION TEST 01 �e, '• V%8 ��•' ��.:� N1• ep � • Performed For. Paul Palmer Dale Performed:%%'L'L Legal Description: Lots 2A B Block 3 .,Fischer Suhdivision SLOPE 1 4 OG/PT Sandy 7 Well Graded Gravel 8 GW Was Groundwater Encountered? If Yes, What Depth? Depth to Water After Monitoring Date: 13�Bottom of Hole 14 15 16 17 18 See Site Plan No None 1/31/01 Reading Date Gross Time Net Time Depth To Water Net Drop 1 24 -Jan 10:50 2" 2 11:00 10 12" 10" 3 11:01 2" 4 11:11 10 12" 10- 5 11:12 2" 6 11:22 10 12" 10" Perc. Rate: 1 MinAnch Perc. Hole Diameter: 6" Test Run Between 5 FL and 6 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Tim Kimhroioh. I, Michael E_ Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 1/25/01 OF Ate It i*: 4918 Municipality of Anchorage 0"' " "" Department of Health & Human Services o -Wo" "' """ "" d I. MICHAEL C ANDERSON ti 825 L Street, Anchorage, AK 99502-0650 io s ; ` E - 4381 •: SOILS LOG - PERCOLATION TEST d �F, p•.,•f- �OS.•'�� o QFp •.....•• ` • Performed For: Paul Palmer®1IlpROFESSt0���►� Date Performed: ��1ltQ�X1F� Legal Description: Lots 2A ?B Block Fischer Snhdivicinn SLOPE RITE P1 Ant 1 I I OG/PT 2 Date Gross Time e 3 Net Drop 1 4 T THO NO. 5 2 11:05 6 12" 9.5" 7 11:06 Well Graded 2• Gravel 8 10 12" 10' 5 GW Was Groundwater 9 2" Encountered? No 6 11:27 If Yes, What Depth? 10 10" Depth to Water After Monitoring None 11 Date: 1131/01 13" Bottom of Hole 1 17 1 See Site Plan •Y Reading Date Gross Time Net Time Depth To Water Net Drop 1 24 -Jan 10:55 2.5" 2 11:05 10 12" 9.5" 3 11:06 2• 4 11:16 10 12" 10' 5 11:17 2" 6 11:27 10 12" 10" Perc. Rate: 1 MinAnch Perc. Hole Diameter. 6" Test Run Between 5.5 Ft. and 6.5 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Tim Kimbr�h I, Michael E Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 1/25/01 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2A, BLOCK 3, FISCHER SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,250 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 7' below the existing ground surface. A separation distance of 100' from any well and 100' between the septic tank and absorption trench and any surface water must also be maintained. A minimum of 3' of fill is required over the absorption trenches and 4' over the septic tank. In lieu of the required fill 2" of insulation and 2' of fill may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 2A, Block 3, Fischer April 18, 2005 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 1 00'away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. ... Lot 2A, Block 3, Fischer April 18, 2005 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. qht wai Municipality of Anchorage .` " Development Services Department <, �• �, Building Safety Division On -Site Water and Wastewater Program a 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. 015.292-5 HAA # D 5�O Cn5' o Expiration Date: _N�i,�tn 1. GENERAL INFORMATION Complete legal description Lot 2A, Block 3, Fischer Subdivision Location (site address or directions) 10333 Minaler Street Current Property owner(s) -C tcelia and Evaenv Gumennik Day phone 5642496 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10333 Minaler Street Anchoraae, AK 99516 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 Four 4 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ED ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522.7773 Address P 0. Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 12/2312005 5. DSD SIGNATURE ✓ Approved forbedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WAI LN ANu HAA Checklist X Maintenance Agreements Septic System AdvisorySupplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date_ r o (Rw. goo) Municipality of Anchorage Development Services Department =� Building Safety Division Onsite Water b Wastewater Program ' 4700 South Bragaw SL P.O. Box 198050 Anchorage, AK 99519.6650 www.d.anchorsge.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ lot 2A. Block 3. Fischer Subdivision Parcel ID: 015-M-45 A. WELL DATA Well We EdM If A, B, or C provide PWSID # _ Weil Log (YIN) Y Date completed 11111211M Sanitary seal (Y/N) I Wires properly protected (YIN) Y Total depth _1j LfL Cased to.jQLfL Casing height (above ground) _24 In. FROM WELL LOG AT INSPECTION Date of last 8012I2005 Stag water level 49 M fL Well production 5 g.p.m. 9— p.m-WATER SAMPLE RESULTS: Coliform -t—colonkWl00 ml. Nitrate -5.35 mg.A. Other bacteria —L colonies/100 mi. Date of sample: 12n9=5 Collected by: AH B. SEPTICIHOLDING TANK DATA Tank TypelMaterial—SeMWSteei Date installed 5n7I2005 Tank size 1.250 gal. Number of Compartments Z Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) jy High water alarm (Y/N) N Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Data Installed 51`11=5 Soo rating (g.p.dR or fe/bdrm)12 OPDISF System type S Wide Trench Length 52 R. Width 5.7 R Gravel below pipe _2 fL Total depth 1A fL Eft. absorption area Mfe Monitoring tube i Depression over field jy Date of adequacy test Results (PasslFeil) For _ bedrooms Fluid depth in absorption field before test _ In. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate x g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Sae In gallons 'Pump oft' level at _ In. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot >1W Absorption field on lot >1W Public sewer main NIA Manhole/Aocess (YIN) High water alarm level Meets alarm & circuit requiremerds7 On adjacent lots MW On adjacent lots MW Public sewer manhole/cteanout MIA Sewer /septic service line >2S Holding tank NIA SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >8 Property line ?I Absorption field >S Water main >17 Water service line >111' Surface water MW Wells on adjacent lots >IW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >Ilr Building foundation Air Water main Mir Water Service line >1g' Surface water >1W Driveway. paddrq vehide storage >S Curtain drain None Noted Wells on adjacent lots >IW 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 conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name _ Michael E. Anderson, RE Date 12M=5 NAA Fee S !�, 7 50 Waiver Fee $ Date of Payment ( 2 - 2 7 Date of Payment Receipt Number % 4 9 LL' ( Receipt Number (Rev. 12100) In. SOS ReLM 1060005001 Client Name Anderson Engineering Project Name/# Lot 2A ©lock 3 Fischer Client Sample ID Lot 2A Block 3 Fischer Matrix Drinking Watcr PWSID 0 Sample Remarks: All DatWrimes are Alaska Standard Time Printed Date rime 01/13/2006 5:04 Collected Date/rime 01/03/2006 10:20 Received Datelfime 01/03/2006 10:42 Technical Director Stephen C- Ede Puameter Results PQL Units Method Allo"Ne Container ID Limits Prep Date Analysis Date [nit Nitrat -N 3.35 0.100 mg/L LPA 3532 D (<-10) 01/04/06 JC Metals by ICP/M3 Arsenic 5.00 U 5.00 Microbiology Laboratory Total Coliform 12 00. No Coli ug/L EP200.9 C 01/05/06 01/11/06 SCL ceVl00mL SM209222B A (�1) 01/03/06 TLF JFYJ-13-2006 11:5W FROM: vl-I[-vD.lr.�l i St3SICUE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total -Coliform 6ecteda ROM Off"M TIONM ON ReVERM MIOE BOOM C&.LW WO SAMPLe L MUST RK COMPLETED BY WATER SUPPLIVA Q PUMUC WATER BYBTMM Me T r'PRNATE WATER BYM U I _ rl Moro ReAft rl e.•.a�w TO:67TT766 Paul DDI Dovl P.1 v cr s 200 W. POTTER DRIVE ANCHORA06, ALASKA M1.8 Yet 607.882.2313 Fne 007.MM14201 1060183 1111111 rT Bud R.rA• n -%m I.oV. TO 09-COMPLUMD BY LAYDPtATORY 1 @.8sivine: Dow: Temp: OBdvay Method: ReceNed By. 13Gwvkwv2Dlx.u.dd: ❑ RUMUMPLE RGQ" Mur be u rwwk aufvvnw Ph"R Por hrna.lmolom IrexIR •............................... .............. :........ .............. .......................................... ................................ B��Tblo0lat WeterAeMNlI� Rneend• MYy7UMa0pr{J/i//� //3(� Ae.lyftT� I _ f Amalydpl Method: I 0--membmms Mar B�nLbAD6G MMOMYO pwy RMMULTs: ANO PBK AN Tom comm. 0wr • E Cdl: _ Sort 10 Cant UNIRAWMMMULTMI Phoned O FOO DM Carat Ceknl.erfDOmL W Vuvke bre NO soda MMO•MUO(P/A) r Our • L C3 Un3adef.actory C"SeUMtsctory ialt.rr.>...wMew.. RapKtrtMd By "'�'� DMtxfflma: ;�L.EPL4a�Iny' O an - . fwr NnM.o1 Farm O IW 0007 1217102 1w.. V W1_Oroup0e41Pu61d�DOCUMI!Ni1FORLWapprwmWAR Form 121702.W • I. ! �, I j � � I I E i 2001-66 FISCHER SU DIV S10N r ; LOT. 2A, B 10C < i 62,740 S. I , S 89'56'45'E i 299.25' I Ico i y r ru vv ♦ y GLLCJ I I v M I i EAST 104TH AVENUE I AS—BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED! THE GASTALDI LAND PROPERTY DEPICTED ABOVE AND THAT NO SURVEYING, LLC ENCROACHMENTS EXIST EXCEPT AS INDICATED. JEFF NG, LDI, R.L.S. IT IS THE RESPONSIBILITY OF THE OWNER TO 4726 WEST 88TH AVENUE DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99502 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 2537 12/13/2005 ESTABLISHING BOUNDARY OR FENCE LINES. F.B. JOB N0. ANCHORAGE RECORDING DISTRICT, ALASKA 05-16 FS2A3 NOTE: NO CORNERS SET THIS DATE V1=40 ,&%♦UNN, OF �A4 i k•49IH •:•! . i fforya Gastald, . , J 1• o, e� AN '� •. LS -6091 : P • 410 prOJ°ssbna% voa i 69.7' �. RAVEL ORNE oe � I i 'SEPTIC SYSTEM 'I EXISTING I BUILDING • . •: j i •• I' Int i i I f I I i to f l I i + I I I I A-71 y r ru vv ♦ y GLLCJ I I v M I i EAST 104TH AVENUE I AS—BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED! THE GASTALDI LAND PROPERTY DEPICTED ABOVE AND THAT NO SURVEYING, LLC ENCROACHMENTS EXIST EXCEPT AS INDICATED. JEFF NG, LDI, R.L.S. IT IS THE RESPONSIBILITY OF THE OWNER TO 4726 WEST 88TH AVENUE DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99502 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 2537 12/13/2005 ESTABLISHING BOUNDARY OR FENCE LINES. F.B. JOB N0. ANCHORAGE RECORDING DISTRICT, ALASKA 05-16 FS2A3 NOTE: NO CORNERS SET THIS DATE V1=40 ,&%♦UNN, OF �A4 i k•49IH •:•! . i fforya Gastald, . , J 1• o, e� AN '� •. LS -6091 : P • 410 prOJ°ssbna% voa i