HomeMy WebLinkAboutWALTER G PIPPEL #2 BLK 11 LT 4Walter G.
P IPP el #2
Block I I
Lot 4
#050-124-40
Municipality of Anchorage
• Development Services Department
Building Safety Division ==
On -Site Water 6 Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 "
www.ci.anchorage.ak.us (907) 343.7904
On -Site Wastewater Disposal System and/or Well Inspection Report Page 1 or 3
Permit Number. SW050272 PID Number050-124-40
Natne:
RICHARD JONES Wastewater System: ❑ New ■ Upgrade
Arial
P.O. BOX 771981 a EAGLE RIVER, AK. 99577 ABSORPTION FIELD
Phone' No. of Sodroome:
(808) 334-0033 3 0 Deep Trench O Shallow Tmmh a tied O Mound ■ other*
LEGAL DESCRIPTION q4.5'
ei«k: Lof: e85 wo/sa rt 11 q SubdNl.bn awtn req U.tb a th n a. pY M pasty tkaeth ..eWALTER G. PIPPEL2 7,5' Township: Range: section: n 61 eN A rt
WELL: ❑ New ❑ Upgrade
UNK
T.td M.arsl4e;Z
UNK
bwtesr:
UNK
1 � —
►e. e.et.ti
UNK
a.te t"wee.a
•1968
CPU
1 R
n
TANK
SEPARATION
To Septic Ab tion
rrom Tank
DISTANCES
LNt Fiotdkq /Pr�rst.
Station Tonle s..« ty...
■septic 1Hokang 1S.T.CP. 10 Other
M°"r.d....: c•e••b ti 9e —
ANCHORAGE TANK 1000
Well
100'+
1006+
—
—
25'+�
STEELS
w �iijvbiwn1c
2
Surface water
too'+
100'+
—
—
—
LIFT STATION
Lot Une
5'+
10'+
—
_
_
°i ~ e°b `
M..s.oe.en
Foundation
5'+
10'+
_
_
_
'" t"`i •h t^'o� rt et.m et
Curtain Drain
unrur
runtyI
^'" Mote a
m,e..O... sw1..,.e w
Remarks: *SYSTEM INSTALLED PRIOR'T0. i,BENCH MARK
FORMATION OF ANCHORAGE BOROUGH. .w�'"
FRONT DOOR THRESHOLD
SOIL RATING AND GRAVEL/TOTAL DEPTH BASED '
OFF FIELD MEASUREMENTS TAKEN ON "" id o..
02.76 n
7/18/2005 AND 7/27/2005. e,a actrs
WELL ON LOT ABANDONED PER MOA ORDINANCE.G_ t� • .. Cir Vin.
Inspections performed by: GEG, Ltd.
Dates: 1st 8/17/2005 *, •„
2nd 8/17/2005
3rd 8/17/2005 A •,
Development Services Department Approval
RIs. IZMI) d and approved by: ��� / W �M�Date: -�'O Ott\
...... A. ........ ..
Ca ss:
WO50 AS -BUILT DRAWING P050-124-40 ID `
A I B
DBLI
34.53
56.19
DBL2
35.56
56.66
STI
37.34
57.28
ST2
42.60
59.55
DBL3
45.93
61.74
DBL4
46.97
62.07
AIT
62.33
1 72.27
y
y.
NOTE: THE WATER LINE
RUNS ALONG THE SOUTH
PROPERTY UNE BEHIND THE
y.)
p� \
\
\
^by. LOT 17. BLOCK 17: 2
WAITER 0. PIPPEL S/D f
3
NpRTy c` \
<F
XF
NEW 1000ALLON SEPTIC
TANK /
TH/+ /
IsnNc
CR1B /
•• �BL4
/ BL3 /
Bl2 /
BU
/
M
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS .
=1 L x NWA � ,O, • MCMAWL M w, . n QVW, 1T • But eooa»,n« • �w..,.. �.
PREPARED FOR PHONE NUMBER PAGE NUMBER: .. ...... ..........
RICHARD JONES (808) 334-0033 2 OF 2 QO p f rey C mess.
LECAL DESCRIPTION:
DRAWN BY: Q ° ' CE -7 �a
WALTER G. PIPPEL SUBDIVISION #2; LOT 4, BLOCK 11, R.A.L �� eee''y� �Fogo
TYPE OF WORK: DAB 22 2005
AS—BUILT FOR SEPTIC SYSTEM UPGRADE
fC^.1[SL.bP
POUrrNUMBER AS -BUILT DRAWING P 50 124-
SW040
SW050272
TOP OF TANK AT
INLET - 91.90-
INVERT
1.90•
INVERT OF BUNG
AT INLET - 9128
ELEVATION OF
FINAL GRADE
98.48-98.54
n
U
NEW 1000 GALLON
SEPTIC TANK
IN FROM
M OF TEST I
FOUND ON 7
O 80.02
ST2
F9LLL GRADE
- 98.45
OF
OF
TOP OF TANK AT
OUTLET - 91.90
BUNG AT
91.04
GARNESS ENGINEERING GROUP, Ltd. /p * 4`9t
CONSULTANTS & GENERAL CONTRACTORS �..... • • • • • • •
m, L sioas su4 an[ tm . ,ww.uG ,t weor • p (07)1*�-sm . M (07)�• SIG war,
PREPARED FOR PHONE NUMBER: PAGE NUMBER: ......•• ..... •••
RICHARD JONES (808) 334-0033 3 OF 2 p '• ey ess:
LEGAL DESCRIPTION: DRAWN BY: OQ�sp. CE -795 �`�
WALTER G. PIPPEL SUBDIVISION #2: LOT 4, BLOCK 11, R.A.L.�p s Z74i�ogo�'
TYPE OF WORK DATE: �OOdP�ossslol",
PROFILE AS—BUILT FOR SEPTIC SYSTEM UPGRADE 8/22/2005 DOOp�
(R«.01M)
GARNESS
ENGINEERING
GROUP, Ltd.
y*
9
el A
. , m
...... .. ... .... .............
SOIL
LOG — PERCOLATION TEST
LEGAL
DESCRIPTION:
LOT 11
BLOCK 4• WALTER G. PIPPEL S D 12
9 ey ness.-
PERFORMED FOR:
RICHARD JONES DATE: 7 Y7 Y005
°o CE -79.53/
'••
DEPTH
T77.
../Z.'.1.4:
E
d Oro
(feet)
TEST HOLE # 1
f es$1004
1
..4x
GW -GM
(DISTURBED)
SOIL CLASSIFICATIONS
GW =__= ORG
3
ax
r w, it GP ML
1>x
GM CIL-
4
GC OL 3 BMREOM
\\\`
¢�
°..�• SWUTTTTT
MH
TH
5
�.r_
o-ir
•. ••.t SP CH
SM � : OH
6Q'
tx
SC
I
t
7;a
DEPTH TO DATE
GROUNDWATER
8
+. r'
DRY 7 27 2005 \ N
\
9
GW -GM
DRY 8/1/2005 -
oxx
-Q .x
-o-x
12
4 x
�,r'
13
~s,r�
14
o -x
'o-tx
15
.,.,r.
-o-.x
16
..Qi�t
17
6
18-
B.O.H.
PERCOLATION RATE — (MIN./INCH) PERC. HOLE DIA. — (INCHES)
19
19
TEST RUN BETWEEN — FT. AND
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO
SOILS
LOGGED
BY: JODY MAUS PERCOLATION TEST PERFORMED BY:
N/A
COMMENTS:
BY GEG, Ltd.
I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERF RMED IN ACCORDANCE
PERFORMED
WITH ALL STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 8 L
�
w:d 11 AM
■ i
AAROW PUMP & WER SERVICE, LLC
PO. Box 110496
..,346- ap5 o F y 511
(90
Office' 1907::3x6-9355 •Fax (907) 333.8976
Palmer: (907) "41.9077 • Eagle River: (907) 622- T35.
C.., f.1!•tER
a�
rlr. •f �. �J r
7Qa9
JOB SI•IE
�51 f1 5t, b. )
J
t•J''�DtTE
t�
W=De"n
:HLORiNATEO
POMP Dieu'
SALESPERSON
-
1 DESCRIPTION
Vc
a A
LABOR
HOURS ) RATE
AMOUNT
TOTAL MATERIAL
I
TOTAL LABOR
1
A')QK ORDERED BY
DATE COMP.
�TOTTAL
_
PAY THIS AMOUNT
7 G
",lank You
SIGNATURE
(I HArer•YAckO0W16dnR'na SHligthoom Cmple+.n' w the Above Described Work.)
TERMS ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGG AT RATE OF 1 5% PER MONTH WILL SE CHARGED ON OVERDUE ACCOUNTS.
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO50272
Legal Description: WALTER G PIPPEL #2 BLK 11 LT 4
Design Engineer: 0855 Garness Engineering Group, LTD
Owner Name: RICHARD JONES
Owner Address: PO BOX 771981
EAGLE RIVER. AK 99577-1981
Date Issued: Aug 09, 2005
Expiration Date: Aug 09, 2006
Parcel ID: 050-124-40
Site Address: 016958 EAGLE RIVER LPN
Lot Size: 16478 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q 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.
5. The following special provisions.
Abandoned well near west property line must be permanently decommisioned before installation of tank.
Received By:
Date: S%// -OS
Issued By: = �( Date:
Municipality of Anchorage
Development Services Department1
i Building Safety Division
On -Site Water & Wastewater Program • ' . "
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.sk.us
(907) 343.7904 � r
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D`50 i,�Ll -4U Permit Number D Z ?z
Property owner(s) RICHARD JONES
Day phone (808)
334-0033
Mailing address (1) P.O. BOX 771981 • A , R
R. AK.
Fita�i m7address (2) _1 b 55? M . CA(-, Le TiV PX
LcxD ( Zip Code 99567
Legal description (Lot, Block & Sub'd.) LOT 4. B 0
K 11. wA TCR r. PIPPEL SUBDIVISION
02
Legal description (Section, Township & Range) —N/A
Lot Size Acre
Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only 0
Well Only
❑
Sewer and Well ❑
Water Storage
❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Not Tub ❑
Jacuzzi
❑
Swimming Pool ❑
Water Softening Unit
❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made fora
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
Permit Fees:
Date of Payment: g ���
Receipt Number: 190' ' Iq
Waiver Fees -
Date of Payment:
Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS ��-=�
August 4, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Tank Permit for Lot 4, Block 11, Walter G. Pippel Subdivision #2,
To whom it may concern:
On July 18, 2005 we performed a site visit on the referenced property to assess the water and sewer
systems. Prior to our site visit, we found no documentation in regards to the water and sewer system. The
house was built in 1968, prior to formation of the borough. Based upon a visual assessment of the
standpipes for the septic system, we believed there was a septic tank followed by a seepage pit. Per the
MOA memo regarding undocumented septic system, the septic system is only required to pass an
adequacy test and a test hole be excavated to confirm the system does not encroach upon groundwater or
bedrock. Per the request of the buyer of the referenced property we performed a septic system adequacy
test on a seepage pit that serves the residence. Based upon septic test, the seepage pit absorbed 1160
gallons in a 24 hour period. On July 27, 2005, we had a test hole excavated 6+ feet below the seepage pit
and confirmed that the system does not encroach upon groundwater or bedrock (see attached log).
Because there was no foundation cleanout, we installed double cleanouts prior to what was believed to be
the septic tank. During the installation, the standpipe believed to be the cleanout for the septic tank was
found to be a broken cleanout pipe. The line was then cameraed by Chugach Sewer & Drain and no septic
tank was found. Per the request of the owner, we are proposing that a new 1000 gallon septic tank be
installed prior to the seepage pit. This design was discussed with Dan Roth, the head of your department,
to confirm that this request was acceptable. There is an abandoned well near the west property line and it
is unclear if the well is on the referenced property or the property next to it (Lot 5, Block 11; Walter G.
Pippcl S/D #2). Prior to the installation of the septic tank, the well will be decommisioned and
permanently abandoned per MOA requirements. Per the owner, the property is served by a community
well located on Lot 3, Block 7, Walter G. Pippcl S/D #2. After the installation is complete, documentation
of the septtnk and a partial documentation of the seepage pit will be submitted to your department. I
am unawarqcf any adverse impacts this installation would have on adjacent wells or septic systems. if
you have a�rfy fluestions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.)
6901 Debarr Road, Suite 2B • Anchorage, AK 99504
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessenginecring.com
O te, cK tt:
\ / WALTERtar C. PIPPeLoEL S/D
(NO CONCERN)
\
/ V / WALTER C. PIPPEL 5
'/0 /2 /
(NO CONCERN) /
LOT 15, BLOCK 11;
/ALTER G. PIPPEL S/D /2
o \
(NO CONCERN)
\
LOTOCK 10.
C. PI/O
bACANO
ED
�EX
SEYSTEM \
PRC
SYSTEM
TMI�-
EXISITINC
1 3 BEDROOM
HOUSE \
ti 1 ABANDON / /
^��' .R �G•�,�Qi1 / LOT 3. BLOCK 11:
WALTER C. PIPPEL S/0 /2
�•, 3?'(�p��r�Y� `h / (SERVED BY CLASS 'C' WELL)
L,LA��S/'Y�
LOT 1, BLOCK 11;
WALTER C. PIPPEL S/D /2
(SEINED BY CUSS 'C- WELL)
11 101. zl
q. ecp -1.0Q I LOT 12. BLOCK 8; ,�`O' '`bC.• ,
g. ��`� ���0• Ni WALTER C. PIPPEL ADDtv`�Q �•�`�
GARNESSCONSULTANTS & ENGINEER GENERALNG4CTOR GROUP, Ltd. ;�:' 4
PREPARED FOR: PHONE NUMBER: I PACE NUMBER: ~MR 07;
RICHARD JONES 1 808-334-0033 1 OF 1 1 R.A.L.
LECA. DESCRIPTION:
WALTER G. PIPPEL SUBDIVISION
OF WORK:
SITE PLAN
purr. DIM)
LOT 4. BLOCK 11
;HOWN ARE SERVED BY
LETTER THAT PERTAINS TO THIS DESIGN -
CLASS "Co WELL ON
TO
CONTACT � PPRROCEEEpOF DIjNEG, ��
LOT 3, BLACK 7;
WITH THIS INSTALLATION. THE ENGINEER,
LTER G. PIPPEL S/O J2
WELL DRILLER, CONTRACTOR AND
11
PROPERTY OWNER AGREE THAT THEY
PER OWNER
HAVE READ THESE SPEOFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
DRAWN BY:
R.A.
\ N
NoRTN
FR 400,,
EXISTING SEEPAGE
PrT - PASSED
ADEQUACY TEST Or
7/Ta/zoos
/THJ
�•INSTALLED /
• DOUBLE
CU ANDUT /
mo
{Ti.
q�ANOLR
A /
ON /NK
GARNESS ENGINEERING GROUP, Ltd.
p�';?•
4 ;
CONSULTANTS & OENERAL CONTRACTORS
SNI L ROW RRA ]NR W1 • ANOOVOL Mt $ ] • PI X 00*Wr179 • Na • 7.410 w
11
0
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
RICHARD JONES (808) 344-033 2 Of 2
DRAWN BY:
R.A.
__-
Q m
•• r• .. .....• ..........
e y Ga nese:
LEGA. DESCRIPTION:DATE:
WALTER G. PIPPEL SUBDIVISION #2; LOT 4, BLOCK 11,
8/4/2005
4��
CE 7 �•`
$�LrOs��oog
TYPE OF WORK:
c
profe911100 DQO4p�
DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE AND
DOCUMENTATION
aww.OIM5)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 11, eLoc
PERFORMED FOR: RICHARD JONES
(feet
Q" GW -GM
aux (DISTURBED)
3
4
5
6
7
9—P:;o,'4'IDIIGW-GM
10
11
12
13
14
15
16
17
TEST HOLE 1
•
DATE
i cl•L
7/27/2005
DRY
8/11/2005
1191
MOO
IIIIIIII
yM1y�C.YyYy
'��fZ�i
�/!yB
•
DEPTH TO
GROUNDWATER
DATE
DRY
7/27/2005
DRY
8/11/2005
EXISMNG
3 8MR00
19 B.o.H. PERCOLATION RATE _ (MIN./INCH) PERC. HOLE DIA. — (INCHES)
TEST RUN BETWEEN FT. AND FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: N/A
PERFORMED BY CEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEWORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:--awcIr
Municipality of Anchorage_,:>,
�t Development Services Department
j Building Safety Division ..
On -Site Water 8 Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. D�'"7U HAA# p5&q j
1. GENERAL INFORMATION Expiration Date: Cl — V, in
Complete legal description WALTER
G PIPPEL
SUBDIVISION
02: LOT 4. BLOCK 11,
Community Class�_Well
0
Public Water System
Location (site address or directions)
16958 NORTH
EAGLE RIVER
LOOP ROAD • EAGLE RIVER, AK. 99577
Current Property owner(s) RICHARD JONES Day phone (808)334-0033
Mailing address P.O. BOX 16958 • EAGLE RIVER, AK. 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class�_Well
0
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
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 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 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 engineers
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 forthis application,
shows that the on-site watersupply 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 g 12-216
Engineers 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 lost, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lest
results do not guarantee future performance orthe 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 aulhorized nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
--L Approved for _R bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
`J : ON-SITE
WASTEWATER
PROGRAM
Attachments: '�O ••
HAA Checklist _� Maintenance Agreements ��JJJJ/D • • • cti�
Septic System Advisory Supplemental Engineers Report
Well Flow Advisory Other
By: ate/ --' ft!!� 19-Qf T Original Certificate Date: _ - - 0 J
(Rev. 13101(
F"
Development Services Department
Building Safety Division
I On-Ske Water & Wastewater Program • "
4700 South Bragaw SL
P.O. Box 1 W650 Anchorage, AK 99519-6650
k www.d.anchorage akus
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:WALTER G. PIPPEL SUBDIVISION #2: LOT 4, BLOCK 11, Parcel ID:
A. WELL DATA
Well type COMM If A, B, or C provide PWSID#
Date completed Sanitary seal
Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate
Well Log
properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
Date of sample: Collected by:
ft.
g.p.m.
ml.
B. SEPTIC/HOLDING TANK DATA 'INSTALLED DOUBLE CLEANOUTS BEFORE TANK.
Tank Type/Material STEEL Date Installed 8/17/2005
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (YM) 'YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date installed "t9sa Soil rating (g.p.d./ft'or®85 System type CRIB/CESSPOOL
Length ••N/A ft. Width **N/A ft. Gravel below pipe "4.25 ft.
Total depth •12' ft. Eft. absorption ama•'N Aft' Monitoring tube YES Depression over field NO
Date of adequacy test 7/18/2005 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption field before test 20 in. Water added 1160gal. New depth 35 in.
Elapsed Time: 893 min. Final fluid depth 20 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
"UNDOCUMENTED SYSTEM, INSTALLED PRIOR TO THE FORMATION OF THE ANCHORAGE BOROUGH. SOIL
RATING AND GRAVEL/TOTAL DEPTH OFF FIELD MEASUREMENTS TAKEN ON 7/18/2005 AND 7/27/2005.
D. LIFT STATION
Date Installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAifi station on lot
Absorption field on lot
Public sewer main
line
COMMUNITY WELL
On adjacent
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 50+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+/100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkingtvehicle storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+/100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and * I4 71L �*
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
ass.:...
Engineer's Printed Name JEFFREY A GARNESS CE -7955
Date V31 2;AWT
HAA Fee $ y
Date of Payment) 4�
Receipt Number 73� `
(aw. 12ro»
Waiver Fee $
Date of Payment
Receipt Number
FROM AK FAMILYHES CLINIC PHONE NO. 6962273 Aug. 30 2005 09:52AM P2
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It surveyed the oUotying �eacnbed
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.. /lficltora�ia .Recotdktg pr cthni'Alaaka: a.d %hat die'-i¢tprpvr
q0 �� �Q� menti slCuated theteonlie Within the property lines'
and r-6
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overlap or:ttxioach on the property IyinS ady''cent.thereto; that
/ ro iatpeatteatents on•property.IyinR adnt eherem e4rcroach'
? r C��l�.i!P°••;sj 1� on the'ptemixc in question and'tla! fhete are roadways;
.^ 4j ► • y ti>tion. lines of other Visible easements'on'said property
:j:' y'i` f .ejs is .'twceptk� ptds;ated.hemom'. .
y t Dated at Eagk-River; Al"
t G✓ rr this 2q ��• day o! D r :G r 19 F
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li9Da:R3ohnon.�;ylr ROBFJiTC.)OHNSON..fr�
e •W'1 (10, aw ✓ SCALE: Regi+teied Land.Surteyor No. IS
1•• - 3o r. ,. Box.77•0456.Eagle River, Alaska 99577
t . Phone. 6942513