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HomeMy WebLinkAboutT12N R2W SEC 30 BLM LT 4 W300' OF N440' OF S690'T12N R2W Sec 30 BLM Lot 4 W300' of N440' of 5690' 021-021-07 Apr OC- 21 04:23p Anchorage Well & Pump Set 0724'30742 p.1 Development Services Departmem Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Well. Dritring Permit Number- Date of Issue: Parcel Identification Number: Ul- 01-07 Legal Description Block Lot Property el Owner Name &: Address: Tfpft �'20 Sec SO ,8L/Y) LI IJ360,g 1 qqo, or S(, Pump Installation Pump Intake Depth Below Top a'Well Casing. �5c) teet Pump Manufacturer's Name: Pump Model: /Pump Skze: _ 2-7 hp Pittess Adapter Burial Depth: I j _ feet Pitless AdapterManufacturer's Name: yl'*(/LGz�-h Pitless Adapter Installer. Well Disinfected Upon Co letion? 7/yes 0 No Method of Disinfection - Comments: Pump Installer Name: - ANCHORAGE WELL & PUMP SERVICE 7640 King Street Company: Anchorage, AK 595IS PH: (907,1 243-0740 Mailing Address - City: State: Atlention., The pump installer shah priwide a pump insla';lation log to On-site within 30 days ofpump bastallation. Municipality of Anchorage Page —I of -P DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: 0 zi a 2 to 7 Name Iia leen "we E Neirun Pa G Wastewater System: ❑ New [I Upgrade Address o ¢ox 91977 1}ne,4 Ikk 995-09 ABSORPTION FIELD LOAtsrfrN6 Phone 3Y6 - 2667 No of Bedrooms y n Deep Trench 9 Shallow Trench (Deed ❑ Mound ❑ Other LEGAL DESCRIPTION $od Rating Total Depth from original grade GPD'Sq Ft l...t- Bio... Subdivision s w by s w Yr Pfii (700' K jvoO ) Depth to pipe bottom from original grade- Gravel depth beneath pipe Ft FI Township. Range Section Fel added above original grade. Gravel length: IZN 2w 3o FI ft WELL: EnrSr0 New ❑ Upgrade Grrw,,l weld, Number or hoes' Oalance between lines fl FI Clabs, iCahon (Pham c. A.8 l ulal Uuplh C.ISUd I u I uLd absogllwi, dims Pipe maluual FI FI $O Ft Driller Dale Drilled Stal,t Waley Lea.rl /� Inslallci' C>.r•./� Re/oCo1TWi) Dale mslallvd fl CHuctcS QhGI:IFO@ 9130/92 Yield Pump See at Casing elinghl Aziow GWum1 TANK GPM FI FI SEPARATION DISTANCES '�C Suplc )Holding ❑S.T.E.P. To Septic Abwrpliou Lilt HomingemmrPnwl. ManWaeluwr. Capacity in gallons: From Tanis Feld station Tani, Seer L.nex IJAChorQ e_ 7-een1C 1 ZS0 Well1 8O Material. S reel Number o1 Compartments s Surface Water ta' Z LIFT STATION Lot No' Size in gallons'. Manufacturer. Line 'A Foundation 6 L X 'I'unip Or,' level at. "Puny elf 4level at Molt watur alarm at. Curtain NONe°ump Make d Model Electrical lnspecbons performed by: Drain $549N Remarks: Se 'c fink refocale.( fo BENCH MARK builc(rn rernorlal ro ecf• Location and Description.accornoctRIr- 7 -op of concrete stir Per Dian (3ollu 'f woe Ofc&Y fu rno..e near Sr- corner of bulla(rn unk n eilrtf'ris 1992 ermrf Se fie Assumed Elevation: fOU•o0 , fcrnk Ild all lftw wauic I;A" rnr"(*feu( w./ -A 2 n ENGINFyI&MEAL youTA L ri rc.� •rrtulaf•fun � ��';•••••••• ly��/, Ar JV Cl TH Inspections performed by: E14f e Tich Svc Dates:lst 9r?0192°.........•,"' ' ""'••" %%J./ 2nd -•'f.... .. a; TH_ODORE F. MOORE •• Department of Health a H trim Servic approval ` 2 V•: • CE -354 ��•d Reviewed and approved by: Date: ° L_ pate: " u,i Mir. Y,YiI MVM 15 Permit No. S W 9 2 00 S6 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report , 7-12 N, R 21U Legal Description: SW1 iY S I PfA (7cn' XV0o') L Y Sec 301 PID No.: 02/02107 WELL SWING T/ES non can A" Con 'a" r 0 0 u S.% C 1z' 12.5' O��J tt 1 S..T.2 .O, IV' 17' CXIsrINF OAP, N FI EI. BY TIUEEC E St's ,yG " - 4SR � ren C.O. (ft. n elL0CATG 0 I 25 6n c SC•rrlc TeN& PIAN 1111 C -W 1.1 = 6o' .0. &Z Io0' is' I -1 — II C2" rnluln flon .0. Ft I FINISH GRAON c�r 975' Oatle t, Inv. 93.89' R ELOCA TE 0 .L..✓ 9Y.10 1250 6•AAcoN SE;e7U TAN- yo' rFG.Ev, view vC--?T SCALE III= 61 40" 22.010 A (Rn 9/91) MOA 25 m ........................ IHCODWE F. MOOR2 00.. .....• '•Eos; Fr%eztit:�ao� Municipality of Anchorage Page I 0f:7== DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: OZ 1 bZ 164 Nem Wastewater System: ❑ New upgrade Add`°"4*-1-(o a ABSORPTION FIELD Pho : ' 1 DZ No. of eear 3: p Deep Trench ❑ Shallow Trench—Qt9ed ❑ Mound ❑ Other LEGAL DESCRIPTION soil Rating: Total Depth from original grade, O• GPD/Sq FI .Leede: iebdnrainrn I W , 4c-- ,/ Depth to Pipet HOM from anginal grade'. �.�� �. � Ft Gravel depth beneath pipe t/Z FI. Township:1 Range: Section: 3D Fill added above original grade: Gravel length: F�7 o'-3' Ft hE1 5N6Er ZolF WELL: ❑ New ❑ Upgrade G Number dr linea: Dlatanu De wem li. FI (/O F1 Clasmhcaoon (Private, A,e,CI: Total Depth: Caaed To: Total absorption area: Pipe materia . t() 1 FI. Ft. t O!j SO Ft. �y v94•'Pt/ Driller. Dale Drilled: Static Water Laval: Installer. Date nst led: Ft. X;iCQ ;al yield:Pump Sal at: Caaing Height Above Ground. TAN K GPM Ft. FI. SEPARATION DISTANCES Aeptic ❑Holding ❑S.T.E.P. To Septic Absorption Lin HoWlnp PubliefPnivalo Manufacturer:I ,N'V•In([�/•1�� Capacit� in a11Ona' FFrom Tank Field station Tank Seer Lmaa w Well 20%' t it�,o If �74- !�— Material: Number of Companments: Surface Ib�'-i — -- LIFT STATION , Lot ( J �- Size In gall Manufacturer: Line ' i Foundation 1 J I 1 J ,� "Pump on' level at: "Pump o I at: High water alarm at: CurtainPump Make 6 Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: G c Assumed Elevation: I e EN `,%F�;4J DEAL • re GlGI � `� Inspections performed by:54s �tes:ls ,�•'•' 2nd "" ••• ROC l 1 SHAFER I Department of Hea and H 4n Services approval `e "fF f., No. Is Reviewed by:dl ,•.;��.� �C$FOpROFESSIONA+� and approved Vate:S'\\��•a�+a.. 72-013 (1v91( MOA 25 Permit No. -!�7Q �20o Page 2 Of Z Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:?iZ0,1220 5bG 30,`�y�1i�1 �4T'1rIL r � X21 X21 i Col GOT- toot IV vi r�tti S•T. - J 41w�92 85' � GDI IS' �`- �2 ?h 2los �— —Q C� 30t 21 c r+r yh5 Ifi; NGa.I 1?ldC.�1�4 c' va Tari 40 72-013 A (291) MOA 25 , pr• e ti Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR LEGAL DESCRIPTION:'C /w% SWI �EPTM E&Ti 4:7� 1 2 .o. QIP �/�7PJL Til 3- 4 4- 5 5- aa���at�R-��a•a® 6- `stn 7- 7$ (GINI 8- iO 9 A Al k L til s Jf n DATE 7, Range, Section: �a �Wt f 9jp SLOPE SITE PLAN 10 /0 1 WAS GROUND WATER ENCOUNTERED? ✓ 11 — 'T� S • �{/D• IF YES. AT WHAT L V l D DEPTH? 12 P E Depth to Water All r r Galt Afu&2- 14 15 16 17 18 19 20 COMMENTS q i., t♦ i.°14'LalJ t••f'CG: ' J. aAFER : i4 k L til s Jf n DATE 7, Range, Section: �a �Wt f 9jp SLOPE SITE PLAN 10 /0 1 WAS GROUND WATER ENCOUNTERED? ✓ 11 — 'T� S • �{/D• IF YES. AT WHAT L V l D DEPTH? 12 P E Depth to Water All r r Galt Afu&2- 14 15 16 17 18 19 20 COMMENTS PERCOLATION RATE.1- 0 (mmute&m6h) PERC HOLE DIAMETER (409 TEST RUN BETWEEN J5 FT AND & FT PERFORMED BY: 17034 Eagle River Loop Road No. 1204 CER7)FY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska 99577 ��/ ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON HIS DATE. DATE: / 72-0081Rev. 4;85) aa���at�R-��a•a® `stn rRYMM MA U a M�� o�r�����E���a• PERCOLATION RATE.1- 0 (mmute&m6h) PERC HOLE DIAMETER (409 TEST RUN BETWEEN J5 FT AND & FT PERFORMED BY: 17034 Eagle River Loop Road No. 1204 CER7)FY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska 99577 ��/ ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON HIS DATE. DATE: / 72-0081Rev. 4;85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE L-IPm DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 c ANCHORAGE, ALASKA 99519-6650 Sco S LL�GI L�. ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT SIU U PERMIT NUMBER:SW920056 DATE ISSUED: 4/16/92 S o S DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 4/16/93 OWNER NAME:PROCTOR STEPHEN 0 & OWNER ADDRESS:PO BOX 91476 ANCHORAGE, AK 99509 PARCEL ID:02102107 LEGAL DESCRIPTION: T12N R2W SEC 30 SW4SW4 PTN (30 0 X 400) LOT SIZE: 131750 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (1BAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE• ` v DATE HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PIANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN AptiY. 7, 1992 Municipality o6 Anchotage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stteet P.O. Box 196650 Anchotage, ACasha 99519-6650 REFERENCE: SW 44, SW ., TTN (300x 400), Sec. 30, T12N, R3W, S.M. ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694 FAX 694.1211 Reque,6t you .issue a petm.it to upgtade the aepti.c system aetv.ing the 4e6erenced ptopetty. An adequacy teat tecentty pet6o4med bot Heatth Authot.ity Apptovat purposes bound the aystem to be in a state of jaitute. A soitz teat was pet6otmed and a dea.ign developed bot the ex.iat-ing 3 bedroom house. However, the buyers o6 the ptopetty may incteaae the capacity o6 the house to 4 bedrooms .in the jutaAe. Thete6ore, they wiah the ayatem to be approved jot a 4 bedroom house. We have designed an upgrade jot 4 bedtooma, however, pr.iot to construction we wiU need to pet6otm a second teat ho Ce in the area proposed jot an attetnate 4 bedroom site. Once the soits ate ve,%i6.ied to be awitabte bot a 4 bedroom attetnate a.%te, conattucti.on o6 the ptopoaed system w.itt commence. We do not anticipate any advetae eb6ect on neighbot.ing ptopettEes by the .instaUati-on o6 the proposed upgtade. 16 you %equ,ire additionat .in6otmatton jot your tev.iew, pCease contact ua. S.incetety, ROGER J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 m I- _ en, OHO A00C� u LO::o o�O �ciRl 0 0 I UPGRADE s --qtr I 2 0 - _/�,vclv✓a�-E_�./'9/�•--- �,�// w/.�s __dam%-�-�.--d.�•//Z4;--z".1�,��.�� - d�'i/�Sd--li-v�'��Z— .GHSiN�—�E1✓/..E�Za� _ - - ---- -------- --- --- - ----.f ti- Sd3- 567-y°59------------ - - 03/04i1992 1310 FROM NUGENT-MASONRY TO 19076941211 P.01 May 2, 1992 TO WHOM IT MAY CONCERN: This letter is being written to certify that 1, Lamond Collier, formerly owned the land that Mr. Proctor currently has in Anchorage, Alaska, located S.W. one-quarter, S.W. one-quarter, (300' X 400'), T 12 N, P. 2 W. During January, 1975, I, Lamond Collier, was present when the well was drilled. I can testify that the well casing installed extended more than 40' into the well. A copy of the well log is currently not available to me due to my present location, however, I testify that it does exist and the well casing was installed as stated above. Respectfully, Lamond Collier Rt. 2, Box 2747 Hermiston, Oregon 97838 Phone: (503) 567-4059 TOTAL P.es NAME LOCATION GRE' -ER ANCHORAGE AREA BOf"�UGH UNDepartmentof Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING C PHONE LEGAL DESCRIPTIONT�Z IV Raw 5QG.30Lt-q4- /Y 0 S` 1mj 144t- 110.g24q K/s civ SEPTIC TANK: DISTANCE//`` NUMBER OF FROM WEL�C0 t MANUFACTURER(2L6F 'P MATERIAL�l�'e1 COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY / z5a GALLONS. SEEPAGE PIT - NUMBER / NUMBER OF PITS ' DIAMETER OR WIDTH �, LENGTH :�_), DEPTH — a re" [ / Loo f LINING MATERIAL f P•� CRIB SIZE: DIAMETER _DEPTH C DISTANCE FROM: WELL r LINE ABSORPTION TOTAL EFFECTIVE 7.,(!�� BUILDING FOUNDATION 2O , NEAREST LOT LIN. ABSORPTIONAR(WALL AREA) SQ. FT. AREA ADDITIONAL ABSORPTION 45:47W45:47W `DS r0 5 r7 ZOO to Iqr" YtpIt/"t1 WELL: TYPE i daf CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL , OTHERSOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: d nZ 5 1r -on LOT SLOPE: �R-rEMARK,(S�: <TC?gell ND / /N Qt i rAc D( ��(1 PCI.O ri. LFII Aoasp W well hJi/I SQ✓ut d�1/y lhs)JF�v Form No. EO -031 i DEPTH DISTANCE FROM: NEAREST SEPTIC -aeof . SEEPAGE Z po'0+ SEWER LINE , TANK SYSTEM REMA DIAGRAM OF SYSTEM S 6d✓m zl s:�e /D c 2�r it DATE " APPROVE[ go4,fe GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 `� •.•../// SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SfZE OF FACILITY TO BE SERVED SEEPAGE [LING ADDRESS 60O FINANCED THROUGH �-•TO BE INSTALLED �[(By SOIL TEST RESULTS l' S - `� '' to /T' 700' Nr"' COMPLETION DATE ANTICIPATED PERMIT NO. PHONE FIELD OTHER PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD - %S /(�-}CZ( k✓(P -O SEEPAGE AREA SIZE TYPE SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELLTO SEPTIC TANvNK 1.049SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK. SEEPAGE PIT .LSCC I DRAIN FIELD /0000 TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A. .B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE' I - 4- APPLICANT'6 SIGNATURE J FORM NO. EO-OI4 Municipality of Anchorage d°£ On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcel I.D. 021-021-07 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: Expiration Date: 0- /`( - 1 a IRms 13688 CANYON ROAD ANCHORAGE, AK BRIAN LANCE Day phone 351-8353 13688 CANYON ROAD ANCHORAGE, AK JUDY ROSENBERG W/ PRUDENTIAL Day phone Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 762-5800 TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 11 qo(G Waiver Fee $ -3G� Date of Payment 1'_ _- Date of Payment Receipt Number © 3tt c(A Receipt Number COSA # �( , )�! q'A Waiver # 5. 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 ooOr o,( r H Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 OP , . • ^�4 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date J 113 Engineer's Comments in conducting this evalawon, GEG, LtD. attempted to provide a thorough, the in ADEC MOA p60r0� 0044 conscientious engineering analysis of system accordance with and & Regulations. The described the of the ooOr o,( r H DSD Guidelines reported results performance system under the conditions encountered at the time of the test, and separation OP , . • ^�4 distances measured to readily identifiable features. The operational life of all wells and that \ . \ J septic systems depend on the local soils condition, groundwaterlevels may fluctuate during the year, and the water usage of the family being served by the system. I-{ '• — O 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 ... ........ OQO ........ operational requirements of the ADEC or MOA DSD. The content of this report is for listed Any this report by any .•• f r A. a r ess,• the sole benefit of the owner above. reliance upon or use of other person or party is not authorized, nor will it confer any legal right whatsoever. o "3 Q4 s E 79 SS"// iG , cgQ 6. DSD SIGNATURE "V40p�000000 System #1 Approved for bedrooms. System #2 Approved for bedrooms. w����(tOF i 0 Disapproved. j � ON SITE t Conditional approval for bedrooms, with the following stipulations: Z WATER AND .o WASTENATER Original Certificate Date: a —/ 2 "l Thel nici,p�flty d/�&rage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist / Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 1NO) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: T1 2N, R2W, SEC 30, LOT 4, W300', N440', 5690' Parcel ID: 021-021-07 A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION. SEE 2008 REPORT. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed PRE -1975 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth *33 ft. Cased to *31 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test NO WELL LOG 2/6/13 Static water level ft. 22 ft. Well production g.p.m. 6.80 g.p.m. WATER SAMPLE RESULTS: Coliform et'�" colonies/100 ml. Nitrate r mg./L. Collected by: GEG. Ltd. Arsenic: "P ug./L. Date of sample: 8/1 /2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/30/92 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping _7� Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 4/22/92 Soil rating ( .p.d./ft r ft2/bdrm) 0_4 System type Length ** ft. Width ** M Gravel below pipe 0.5 ft. Total depth *5.83 ft. Eff. absorption area 1505 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 2/6/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test E in. Water added 1110 gal. New depth***E 5 in. Elapsed Time: 1020 min. Final fluid depth E in. Absorption rate >= 600+ g.p,d_ Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **SEE MOA INSPECTION REPORT. ***0.5 INCHES IN BED CLEANOUT THAT IS ADJACENT TO THE NORTH MT. SYSTEM WAS APPROXIMATELY 85% FULL AT THE BEGINNING OF THE ADEQUACY TEST. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High -water level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: L A G. Building foundation 5'+ Property line 5'+ Absorption field S 7 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 1 D'+ Buildingfoundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ASSUMED PER PREVIOUS INSPECTION REPORT. SOUTH MT IN BED DID NOT APPEAR TO BE FUNCTIONAL. G. ENGINEER'S CERTIFICATION 1 certify that / 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 JEFFREY A. GARNESS Date (Rev. 11105) Page 1 of 1 Poet, Jeff W. From: Rob Campbell [Rob@garnessengineering, com] Sent: Thursday, August 15, 2013 12:26 PM To: Poet, Jeff W. Cc: Jeff Garness Subject: T12N, R2W, SEC 30, BLM LT 4, W300' OF N440' OF S690'- COSA Hello Jeff, Jeff G. asked me to respond to your comment sheet on this COSA submittal. I ran the septic test completed on this property. To clarify, we used a cleanout and adjacent monitoring tube for the test. Prior to starting the test, no water was observed in the cleanout and there was 7" of standing water in the MT. At the end of the test (1110 gallons later), there was 8.5" of standing water in the MT, and .5" of water in the cleanout. 1020 minutes later, the liquid level had returned to 7" in the MT, and the cleanout was dry. It is reasonable to assume (based upon the liquid level in the cleanout), that there may be more than 6" of sewer rock under the lateral in this drainfield. In short, the system absorbed all 1110 gallons of water in less than 24 hours, and the water level returned to approximately 1" below the invert in the drainfield. An advisory letter seems more fitting for this property, opposed to a failure as the system observed all of the 1110 gallons, returning the water level to 1" below the invert. Please let me know if you have any questions. Thanks so much. Rob Campbell SuperintendentlEngineering Consultant Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Office: (907) 337-6179 Cell: (907) 317-9433 Fax: (907) 338-3246 http://www.garnessengineering.com/ 8/15/2013 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ak.us (907)343-7904 Septic System Advisory Certificate of On -Site Systems Approval # 131418 During a recent adequacy test on the septic system for Block , Lot BLM 4 W300' of N440' of 5690' of T12N R2W Sec 30 subdivision, 7 inches of standing water was observed in the absorption field. This indicates that approximately 85% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval Municipality of Anchorage • -tel Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw 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 DWELLING Parcel I.D. /'l)" /' DA/ COSA# t98L%)I pj 1. GENERAL INFORMATION Expiration Date: 7-17-08; Complete legal description T12N. R2W. SEC. 30, LOT 4. W300: N440: 5690 Location (site address) 13688 CANYON ROAD ' ANCHORAGE. AK 99511 Current Property owner(s) NELSON PAGE Day phone 440-7561 Mailing address Lending agency Mailing address Real Estate Agent Mailing address PO BOX 113188 " ANCHORAGE. AK 99511 Day phone BONNIE MEHNER w/PRUDENTIAL JACK WHITE Day phone 762-3108 3801 CENTERPOINT DR. $200 • ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site E 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 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 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 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 Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the fest, and separation distances measured to readilyldentiriable 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 parry is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIG' NATURE VSIe.,.,..,,,. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Date 3 i o t3 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other WASTEWATER PROGRAM By: 6, 4! _ " !N, Original Certificate Date: —17 — Q 00 (Rev IM) Municipality of Anchorage (• ;y_� Development Services Department � Building Safety Division On -Site Water & Wastewater Program e 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T1 2N, R2W, SEC. 30, LOT 4, W300; N440; S690 Parcel ID: iii / — D.,'k 1— O % A. WELL DATA 'PER INSPECTION REPORT 9/18/1974 'SEE ATTACHED LETTER Well type PRNATE If A. B, or C provide PWSIDN N/A Well Log (Y/N) NO Date completed ' Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 0*33 ft. Cased to "31 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 2/19/2008 G Static water level it. N 0 22 ft. Well production g.p.m. 6.94 g,p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 9.17 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: NO ug./L. Date of sample: 2/19/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/ANCHORAGE TANK Date Installed 9/30/1992 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 2/21/2008 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA eELow EXISTING GRADE Date installed 4/22/1992 Soil rating (g.p.cfdit=o t /bd 0_4 System type BED Length " ft. Width " ft. Gravel below pipe 0.5 ft, Total depth •5.58 ft. Eff. absorption area 1505 ft Monitoring tube YES Depression over field NO Date of adequacy test "'2/20/2008 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test? in.. Water added 649 gal. New depth 5 in. Elapsed Time: 940 min. Final fluid depth'1 in. Absorption rate >= 600+ g_p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **SEE MOA INSPECTION REPORT ***,PRE—SAOKED WITH 1180 GALLONS ON 2/19/2008 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump offlevel . High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main N/A Water service line ►10'+ Surface water 100'+ Wells on adjacent lots 100'+ *ASSUMED PER PREVIOUS INSPECTION REPORT 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, parking/vehicle storage "'0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS **SEE ATTACHED AERIAL PHOTO SHOWING DRIVEWAY GOING OVER G. ENGINEER'S CERTIFICATIONF� `;:� •(' I certify that I have determined through field inspections and t'n review of Municipal records that the above systems are in Q' /'t " conformance with MOA COSA guidelines in effect on this t� Y , ,, ,,,,,, date. 00... •.J t ssr Engineer's Printed Name JEFFREY A. GARNESS Q� •�f E—(951 ,FG Date LI It 6 106 DOr^.,d 4. I b• D�o 4 ez Pre P ... 10T` o COSA Fee S 30 Date of Payment 3 " — 0 OR Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division i Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Jeff Gamess Legal description: TUN Sectlon 30 Lot 4 W300 N440 S690 ❑Permit ®C.O.S.A. ❑Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: 1. Well is less than 40 feet deep of unperforated casing. 2. Absorption fields may not be located under a driveway or parking area. 3. M.T. is broken below grade. Name of reviewer: Poet Date: March 18, 2008 13✓la� _ 113 -3 35- 35"7 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK To: Municipality of Anchorage Regarding: 13688 Canyon, Anchorage, Ak 99516 We are in the process of purchasing this property; We are aware of the leach field, and that currently there is a driveway over top of it; We will not drive over it; We will plant flowers, grass or a garden. This will de done by July 15, 2008 /x�- ' ' Ellen W. Lance Notary State of Alaska 3rd Judicial District LEE ITA J 8 3N„'0U8001 h ori 'G �• OF P�P•'de=• 114IV) FrPfres: 5000—" Commission Expires 9-11-2008 SCS Ret# 1080658001 Client Name Garness Engineering Group, Ltd. Project Nsmc/N 13688 Canyon Road Client Sample ID 13688 Canyon Road Matrix Drinking Water PN'SID O Sample Remarks All Datc&Mmes are Alaska Standard Time Printed Datdl'ime 03/032008 9:25 Collected Date/Time 02/192008 14:25 ReceivedDatellime 02/192008 16:35 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug(L EP200.8 C (<10) 0225/08 0229/08 M11 Waters Department Total NitnteMitritc-N 2.17 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 mg/L SNU04500NO3-F D (<10) coVI00mL SM20 92220 eol/100mL SM2092220 coV100mL SM2092220 A (<200) A (<I) A (<I) 0227/08 LCP 02/19/08 SDP 02/19/08 SDP 02/19/08 SDP GARNLSS ENGINEERING GROUP, Ltd. - CONSULTANTS & GENERAL CONTRACTORS 1+ - _ March 4, 2008 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water R Wastewater Program 4700 Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well Justification, T12N, R2N, SECTION 30, LOT 4, NN'300, N440, 5690, Per Brian Wille with Aarow Pump and Well Services, the total depth of the well is 33 feet deep and is cased to 31 feet below grade. There is no existing log of the well to be found. The well was drilled approximately around 1994 when the house was built. The well has a 24 inch stick up above grade and has a sanitary seal. The water samples results show no arsenic detected, nitrate at 2.17, total coliform 0 and other bacteria 0. (See attached results) '.E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246 • Websitc: www.gamessenginccring.com .......... SCAI F 1" - 100' LEGEND Edge N Wwww wr a FND REBAR S W A09.1 IIII I � rl�l v I I oi� II -I v II I W I I Wall Vb . 3 Z O ZZ SatteRte Otah � I I I I a� for g I I I -cap •r I (WEST 300.0') N S 90 0000" W 299.1' I hereby certify that 1 have surveyed the following described property. That Portion of Government Lot -4, Section 30, T. 12 N., R. 2 W., Seward Meridian Alaska more particularyiy described as follows: Commencing at the Southwest comer of said Section 30, thence North 250 ft. to the True Point of Beginning, Thence; North 44o ft., Thence: East Mn rt_ �►,..,... South 440 West 300 ft., to the True Point of Be and that no encroachments exists except as indicated. It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or fbr establishing boundary or fence lines. Dated this 21st day of September, 1994. Dcugtos Groether, Registered Surveyor ASCG Incorporated 301 Aectic Slope Ave. Anchorage, Aloska 99518 V 110 �i Fro w. AQ raw Pump S Oe i% S1--ryie, e- n�13g GT trN,�ora�e,i i9AK• `7 ` 57 6 We II Cas�� 7`0 3/, 4i e1aw -to dr�ve 5ke9c, o fo f c .r 7*d 9ba=101 :WMU H£0:60 BOOZ-b-Mi■ O MUNICIPALITY ANCHORAGE • DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# QI-f" \-n-A -1 1. GENERAL INFORMATION IMMO-M M.: Complete legal description SW 44 ob SW . VrN 1300x 400); Lot 4; Sec. 30; TI 2N; R2W;S.M. Location (site address or directions) 13931 Canyon Road Anchortage, Aea6ka n I 6 r, Property owner -b BJ P4.0cto2 Day phone 345-1802 Mailing address Box 91476 Anchoaa9e Atka 99509 I Lending agency Day phone Mailing address Agent Nancy SeAgh-PofYock 2001 REALTY Day phone 276-2001 Address 2600 Denali. 0400 Anchotage, Ataeka 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State AOEC attest- t Ing to the legality and status of system.. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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. 72-0251R".1/91) Front MOA821 IZN VOW MMe (16/1'w) RPU -4iom sJaaui6ua Ieuo!ssalad ayl ul suo!ss!wo jo siowa j01 elq!suodsai lou si e6ejogouV to 41!led!o!unyq e141 •pansst st aleo!puao a ajolaq elep ezAleue jo suopoadsul lonpuoo lou op SHHO to saaAoldw3 •sivawailnbaj elels pue lejapal u!evao Alslles of japjo u! suo!lnl!lsu! 6u!pual j!ay1 pue sawoq io siesegoind of Asavnoo a se s!yl saop SHHO 0141 •e>Iselylo elels eyl u! pajais!6ai iaau!6ua leuo!sselad luepuadapul ue Aq enoge S ydoifted ul uanl6 suopluasaidai e14l uodn Aluo paseq saleo!1!lia0 IenaddV Aluoq;nV ylleaH sanssl (SHH(3) saofmoS uewnH pue yi!eaH to luawlieda0 e6ejogouV to Al!ledlo!unyq e141 G1eO — suolle!nd!ls 6ulmopol eyl yl!m 'swoojpaq N Y'. :,If" sluawwoO Iuoll!ppy e V sol Ienadde Ieuoll!puo11O •panaddes!O IV 'swoojpaq .. �- sol panaddV 3dfl.1VNJIS SHHO 9 03eO emleu6ls sjaaul6u3 LLS66 e�lsely',ta�ia •Ibq UOS *ON ptoa dool •eAla 01593 V90i L ssalppv _auoyd �Nlaaaulnu3 e 19 wJ!J to aweN •uo!loadsul slyi to elep ayl uo loalla ul suolleln6ai pue 'saoueulpjo* 'sapoo olelS pue Iedlolunyq Ile yl!m eouelldwoo ul sl walsAs Iesodslp jalemalsem jo/pue Alddns jalem oils-uo s14l'uolloadsul pue uo!le6ils9nu! Aw wojl pue sal!l o6eiogouV to Allledlolunyq 0141 woal paumigo uollewjolul ayl uo paseq 1e143Aluanj914lJnl I •ulajay paleolpul0inlorulslo adAl pue swoapaq to jagwnu eyl jol elenbape pue Ieuollounl'ales sl walsAs Iesodslp Jalemalsem Jo/pue Alddns jalem ells-uo mil leyl smogs uo!lealldde IenoiddV Ai!joyinV ylleaH slyl to uolle6llsanul Aw 1ey1 yuan I 'molaq umo14s elep uollep!Ien 014110 se pue olajay paxllle lues Aw Aq pallluao sV N33NION3 AS NOLLOUSNl dO LN3W31V.LS 'S 4 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal DescripiioYn: r SWrMrTfNC!ca4n� TIX0, RzW SEc Parcel I.D. A. WELL DATA Well type RIOPEE If A, B, or C, attach ADEC lettpy ADEC, water system number AYM Log present (Y/� Ivo Date completed TV NfG MIG Driller Total depth A Cased to i nF 40 -VCasing height y� 1, Sanitary seal O/N) yF5 Wires properly protected (?/N) o? FROM WELL L G AT INSPECTION rn g Date of test o Static water levet Well flow �`V I� g.p.m. S.0 m ,m^' v o Pump level SEPARATION DISTANCES FROM WELLTO:I/Jv�� Septic/holding tank on lot ri 00 r+ ;adjacent/00 rf On lots Absorption field on lot I �� rt ; On adjacent lots /00 'i - N/A Public 12A Public sewer main Public sewer manhole/cleanout Sewer service line 1 rJOr+ Petroleum tank a00 ri WATER SAMPLE RESULTS: Coliform Nitrate �•� � Other bacteria C) Date of sample:. �- - Collected by: S ` S CNG W F_CMN� B. SEPTIC/HOLDING TANK DATA Date Installed 4--a1-92. Tank size )a5O GAL Compartments 2 Cleanouts WN) Foundation cleanout QN) yES Depression (YO No High water alalm (Y/6) NIA Alarm tested (Y fi) NIA N Date of pum mg ' New TANIc ., NFw SYS - _ Pumper N /A SEPARATION DISTANCES FROM SEPTIC/fiG TANK TO: Well(s) on lot Ao0 • On adjacent lots I D� r* Foundation l t) 4 r Topropertyline �Sd Absorptionfield SS !; Watermain/service line 50 + Surface water/drainage l00 r+ 72.026 (Rev. 7191) From CONTINUED ON BACK PAGE C. LIFT STATION'' 11 nstailed LV I� Manufacturer Size in Vent(Y/N) High water alarm level Meets MOA electrical codes (Y/N) on" level at Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at _ Cycles tested water Date installed Soil rating -2y GPD ArSystem type QEO\ -)� ' SEE ZNS�ECTlon1 . "(LIT Pe 1 OF 2. i� Length 2 0 rWe ts�o Gravel thickness 6 Total depth Total absorption area 1505 SF Cleanouts present &N) YFS Depression over field (YX@ NG Date of adequ cy test NIA - NF -:w SvrrFxn Results (pass/fail) L/Ar /l)F_uw SX9_ for bedrooms Peroxide treatment (pasf 12 months) (Y/) IM6 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 150 + On adjacent lots- IOOr+ Propertyline //r To building foundation I I r� To existing or abandoned system on lot /0 r On adjacent lots 100 r+ Cutbank_ 1004- Water main/service line Surface water - I801t Driveway,g g parkin /vehicle storage area 1^�11 as i Curtain drain _UDNF Km& -N 1' &X 60 q,5; ' _y -3 E. ENGINEER'S CERTIFICATION /certify that I have checked, verified, or conformed to aft MOA and HAA guidelines In effect on the date of this Inspection. 5 9 5 ENGINEERING Signature Engineer's Name Ecplo Rlrcr, Alaska 99577 Date kZ / %D HAA Fee $ Waiver Fee: j Date of Payment SSg ZI — Date of Payment Receipt Number Receipt Number 72-M (A" LD1) Back MOA 21 RODERTA.SNAFER CIVIL ENGINEER C94 2979 DATE OF TEST: 2 - LOCATION 0FWELL (LepaIDescripIion):-SW AfF SW&7N470ox4o07,tolYr SEC204TON,RPW, S.M. WELLDEPTN: Af3,4 FT. CASING: yet FT. SCREEN: DATE DRILLING COMPLETED: U K STATIC WATER LEVEL (Top of Casing): 3 FT V/a-7f% SQMDCFc TAKEN DRILLER: Uy, DATE: 3/34 /`i 2- CLOCK TIME ELAPSED TIME SINCE PUMPINGSTARTED1 STOPPED,MIN. DEPTNTO WATER, FT. DRAWDOWNI RECOVERY PUMPING RATE,OPM REMARKS utoM 0 r (swl) 0 0 Starl t,CE OLEGP,FO :7t 1 -7,= - OW(FD- !.P G r)lITS(Oc 0 to a -I 7-S, &0 ASF gla - Ftnw orJ :MS 15 -&0 FVILL :5a 20 &0 25 30 Q :0 35 SU :10 40 :I 45 - O ao 50 55 -rl,0 60 (1 hour) 90 'S SO ;2 120 2nours) :o0 150 - S0 180(3nours) -S o 210'S S,0 240(4hours) RECOVERY 1 0 0 5 10 15 20 25 30 35 Comments: Wf �Ep S G,PM OUE2 A FbUljZ 1-4ou L -PEM6 > . .1 "w Is not Guaranteed Subsequent Variations Can necu. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALTSIS RESULTS Eot INVOICE ~ E3013 Chemlab Ref.J 92.1663 Sample # 1 Nat:ix: WATER FAX: (907) 561-5301 Client Sample ID PWSID Collected Received Preserved with SW 1/4, SW 1/4, T~N (300X400)L4 SEC 30 ' UA APR 21 92 0 15:45 hts. APR 21 92 @ 16:dO hts. AS REQUIRED Client Name :S & S ENGINEERING Client Acer :SNSENGP BP08 : Req~ : O~dered By :R. SNAEER POg :NONE RECEIVED Analysis Completed : APR 22 92 Laboratory Supervisor : ~ETEPHEN C. EDE Released By : ~,/~~)_ ~ Send Reports to: l)S & S ENGINEERING Parameter Results Units Method Allowable Limits NITRATE-N 1.2 mg/1 EPA 353.2 10 Sample ROUTINE SANPLE COLLECTED BY: J.W. Remarks: 1 Tests Performed See Special Instruction8 Above UA=Unavailable ND: None Detected '* See Sample Remazks Above UA= Not Analyzod LT=Less Than, GToGrsater Than Member of the SGS Group (Soc,6t{~ G6nOra,e de Surveillance)