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HomeMy WebLinkAboutSUNSET HILLS WEST BLK 3 LT 4ASunset Hills West Block 3 Lot 4A #018-204-34 JUN --2-2016 08:04F FROM: TO:3437997 P.111 Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 985194650 • trttp:/ANww.rnuni.org/onsits • (907) 343.7804 Well Decommissioning Log Ott' Zoe 3y Legal Address: Subdivision �t..:"td- �7�5 �/e 4f Biock - Lot �t► A T R-- SecfiOqLot Vi DIr ---�On-site Water $ Wastewater Pregram cortNied mntractorperforming the well decommissioning: Nama: �i 9lgneture: Company.; iX i i li',AD Wed aecdmmestonsg date ' // _ method of dacommissioning: AMC 45.55.0601.1 a.0 b.FI C. Locator: Use the specs below to provide a drewtrg of Me property showtng the iwowing Items; • Norm anew • Decommissioned well, • Other water wage on the property, Two separate ewtng-tis dfatances for each well shown on the drawing, Nate: The swfng-iia diislanow shag be measured from aither permanent structures or the property tbmam Ta r V D Dr, s r WIUCIMMUmty taevmopmannt.aevntopment setwceawunding 98taty Un 5116 water and WastowatanFonns%GNent Fdmts\Wag DaoommislwUn fomt.doo -a 9 ;0 7 Municipality of Anchorage° hb 2A ,,,Or Water & Wastewater Program q� (907) 343-7904 '' 6b Ju� 'SD1� i CER FIC OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 018-204 z�g j -1 Expiration Date: 1. GENERAL INFORMATION Complete legal description SUNSET HILLS WEST; LOT 4A, BLOCK 3 Location (site address) 14290 JARVI DRIVE *ANCHORAGE, AK Current Property owner(s) KENTON & PRISCILLA WOHL Day phone Mailing address 14290 JARVI DRIVE *ANCHORAGE. AK Real Estate Agent MICHELLE NELSON Day phone 240-0570 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ WaiverNariance request for. iN H Distance:= Received by: COSA to be released to the otherwise requested by the engineer. Date: _(n COSA Fee $ 3-q 16b Waiver Fee $ Date of Payment (0 Date of Payment Receipt Number CM!1�92;5 G Receipt Number COSA # c6c l (P �a Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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. 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 provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the MunfeipaffyofAnchomge and mdushypracfices. The reported results describe the condition of the systeMs on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identiled during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, sail conditions, groundamerlevals (that may ducfvate during the year), quality of consfructmn (materials and workmanship), and the waterusage ofthe family utilizing the systemis. These conditions can vary, andare outside the coniml of GEG. Satisfactory test msufts do not guarantee future performance ofthe systerNs: lherefore, GEG makes no warranty (express orimplied) regarding the future performance of the well orseptic system. GEG makes no representation whetheran aftemative well orsepfic system can be insfalledon the property in the eventeftherof the current systems fail. The contentof this report is forthe sole benefit of the persoNparty who retained GEG. Reliance upon the information provided In thisreportby anyotherpemon orparty, including but not limited to subsequent propertypumhasers, is not authorized. In short, GEG disavows anylegal duly to anyone other than the person partywho paid for this report. 6. DSD SIGNATURE M System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the Phone 337-6179 Date 2 L, /b stipulations: ear Original Certificate Date: 6o 4 L The Municipality or Anchorage 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:\Q 1"l' OF -4 COSA Checklist Nitrate AdvisoryV 5n Septic System Advisory Arsenic Advisory ON -SIT Well Flow Advisory (Rev. 10112/12) Other WATER AND 1 rrWASTE VVA I ER z c3PROGRAM to A Q\ F`Vr SF.R\J\c�� 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: SUNSET HILLS WEST; BLOCK 3, LOT 4A Parcel ID: 018-204-18 A. WELL DATA PUBLIC PER HEFTY DRILLING, ABANDONED WELL WAS DECOMMISSIONED TO CODE ON 6/2/2016 (SEE ATTACHED WELL DECOMMISSIONING LOG) Well type If A, B, or C provide PWSID# _ Well Log (Y/N) Date completed Sanitary seal (YIN)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (abo round) in. FROM WELL LOG AT IN CTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESU . Coliform colonies/100 ml. Nitrate mg./L. Collected by: ic: ug./L. Date of sample: B. SEPTICIHOLDING TANK DATA *PER ONE STOP SERVICES ON 6/20/2016. FCO IS LOCATED INSIDE HOUSE IN BATHROOM AND WOULD BE ABLE TO BE USED FOR MAINLINE CLEANING (SEE ATTACHED RECEIPT) Tank Type/Material SEPTIC/STEEL Date installed 1968 Tank size 1500 gal. Number of Compartments UNK 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 5/18/2016 Pumper. A+ HOME SERVICES, INC .at C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 1968 Soil rating (g.p.d./ft2or ft2/bdrm) UNK System type TRENCH Length 30 ft. Width UNK ft. Gravel below pipe 6 ft. L Total depth Eff. absorption area UNK ft2 Monitoring tube YES Depression over field NO Date of adequacy test 6/8/2016 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 59.5 in. Water added 1071 gal. New depth 76.5 in. Elapsed Time:, 120 min, Final fluid depth 70.5 in. Absorption rate >= 750+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN ° if yes, give date — NO MOA RECORDS OF SEPTIC INSTALLATION OR INSPECTIONS. ALL INFORMATION WAS TAKEN FROM TOBEN SPURKLAND P.E. 1993 HAA REPORT. DURING INSTALLATION OF NEW CO & MT AT END OF TRENCH, IT WAS DISCOVERED THAT PERFORATIONS IN THE LATERAL FACE UP. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump oft" level at in. High water alar level Datum Cycles tested Meets alarm & req E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/ rvice line containment areas On adjacent On adjacent lots Public sewer manhole/cleanout Holding tank Manure/anlrratl excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water --LOC -+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parldng/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *SEPTIC TANK IS LOCATED UNDER STEPS OF DECK. PORTION OF LOW LYING DECK IS OVER THE SEPTIC TANK. G. ENGINEER'S CERTIFICATION I cert/!y that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines In effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 0"t1k (Rev.11/05) gECe, 86f Lot 4B 09 0 F \b\bA-. & R Sg 27 X10' T&E Easement oodfence gage \ Lot 1 -cane ret. wall \ ply '3 Cray- V deck 'Zopced by _—,) CEG Lot 4A \ 8.0x4.3 shed 2 0` `0 \\ : '; Lot 2 \� septic vents \ wood ret, walls \ >\\\ Lot 3 syr 10' T&E Fasement \ •� N89°49'54"E 208.47 UNSUBDIVIDED OF 49th '9 00 O �c Fred Walatka. ON s 3255 - 5 ���ea • • , , .tea �' SCALE: 1"= 50' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 16-2 pg. 3637 AS -BUILT NO CORNERS SET THIS DATE I have 2681 Inspection Anchorage Recording Precinct, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach on tFfe props ng -- -- adjacent thereto, that no hnprovements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated. at Anchorage, Alaska. - this 23rd day of�M y .2016 - FRED WALATKA & ASSOCIATES CH(907-248-1666) Engineers and Surveyors Bill To Re/Max Dynamic Properties Attn: Michelle Nelson 3350 Midtown Place Anchorage, AK 99503 Item I Quantity Job Address: Description Anchorage, AK 99515 Camera 1 Camera'd sewer line from clean out beside toilet, out around 65 -feet to septic tank. Line does not have an outside cleanout. The cleanout next to the toilet can function for the FCO for mainline cleaning. Thank you for your business. Phone # Fax # Web Site 907-338-5563 907-338-5564 w .onestopservicesak.net Total Invoice Date Invoice # 6/20/2016 9626 P.O. No. Rate Amount 300.00 300.00 $300.00 $0.00 Balance Due $300.00 Municipality of Anchorage Community Development Departrnent Onsite Water and Wastewater Prngram 4700 Elmore SL • P.O. Sox 196650 Anchorage. AK 99519-8650 • http:7/www.muni:orgtonsite • (907) 343-7904 Well Decommissioning Log Legal Addrew Subdivision Sk.*,Y4- 41715 40"t Brock A lot yA T . R Section Lot MOMO LJslVi pa site Water f Wastewater Program carglfed contractor performing Ups well dsmmenisslonhV: Name: ')t p , Y 'V�� _ i �gnaaoa: compam: N, Qfi{�ittSil E. Well decwrpmrssiming date ' %4? Meumd of demmmissiordw AMC 15.55.0601-1 a. ❑ b. ❑ 0. Loceffo Use the space below to provkis a drawing of th pmpedy Wmwkg the ming items; • Nam arrow Oemnsrdssiarred wag. Of ler water wells on the property. Two separate swingdie distances nor each well afavm on the drawing, Nota: The swing-tedistancas shall be measured from either pemnanent structures or Via property Corners. �aiVi Vr, ,t �f s r j aD _ GACOM runity UmloprywanDevelMount SerWeesl ffdkrg 5~ 0n Site Water and WastewaWFarm VXant ForrnskWeg ©emmmisiarinD fam.doc MUNICIPALITY ANCHORAGE DEPARTMENT OF HEALTH &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 I.D. # ac� –192 1. GENERAL INFORMATION HAA# 4A 930763 Complete legal description Lo1, Lt. ZIP 3 SoL`4S_4=� [- I"s 1X/t;5[ Location (site address or directions) 14 o'Ll0 ` AgV I 1' 2. � Property owner —�H �c �t 44o-4 Day phone V /) , rn IN Mailing address Lending agency Mailing address. Agent Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: �L- 3. TYPE: OF WATER SUPPLY: Individual well Community well _— Public water — Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 72-025(Rm 1/91) From MOA 421 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Yolo%ek�' 5taur�GjAPhone Address Engineer's signature P9 DHHS SIGNATURE Approved for C7�c_ bedrooms. Disapproved. Conditional approval for Additional Comments `yylq_-_,� bedrooms, with the following stipulations: UITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA R21 Municipality of Anchorage Department of Health and Human Services it HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:_ K> :- fa2C�Pl /� 111 91T A. Well Data Well type _?, If A, B, or C, attach ADEC letter. ADEC water system number NIA Log present (Y/N) N Date completed 19(PC,2 Driller OVI 6 "(Pw-w Total depth 11-1 Cased to 11`7 __Casing height IH Sanitary seal (Y/N) Date of test Static water level Well flow Pump levels Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE 1A , IG o 9 ?) F.NVIRONMENTAI. SERVICES DIVISION to �> 2 , 1993 t" g.p.m. I1d gRL (..,FI�! FD SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1,30 ' ; On adjacent lots _ i 10-0 Absorption field on lot 1 `i 0 t ; On adjacent lots 10 ri Public sewer main 1d /A Public sewer manhole/cleanout- Nle Sewer service line i _Petroleum tank N 10 _ WATER SAMPLE RESULTS: Coliform_ 1 Nitrate _ r��(C�, Other bacteria _ Date of sample: I rl L. 9 'r Collected by: I a Ei B. SEPTIC/HOLDING TANK DATA Date installed Tank size / 5 6�0 Compartments 1) V1 6 V10 L t,tl Cleanouts (Y/N) f Foundation cleanout (Y/N) N Depression (Y/N) 1\1 High water alarm (Y/N) VA Alarm tested (Y/N) N/A Date of pumping let 19 9 3 _Pumper Atc-4 S� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1 34>,y_ On adjacent lots Foundation 17 To property line ) I D Absorption fielder Water main/service line %6D Surface water/drainage 1J 1 Ca 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at rer Manhole/Access (Y/N) "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on D. ABSORPTION FIELD DATA Date installed I I On adjacent lots Surface water Soil rating (GPD/Ft2) Length JD Width 0 hIla on,A" Gravel thickness System type I Ire." c,(n Total depth Total absorption area Cleanout present (Y/N) y Depression over field (Y/N) N Date of adequacy test f `6 to /<N� Results (pass/fail) 1f for Bedrooms Water level in absorption field before test 5 `r` e G O After test F, Y £ (.10 Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date Well on lot / 6 .p f On adjacent lots >% MUNICIPALITY OF CRA • '• DEPARTMENT OF HEALTHTH & 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 1. D. B OI6g- AO ^ I g 1. GENERAL INFORMATION HAA !# W",n_)RS__ Kf-48 Complete legal description _Lo - _4 SUN t=SA}L4S U'JEs i Location (site address or directions) 1t 12RD Q�/t Pt2 t VL Property owner Day phone Mailing address --2e50V,– -# vo u -1 Lending agency_til r� /� Day phone Mailing add Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well — Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site _ Holding tank Community on-site _ Public sewer y NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Re, 1/91) Front MOA 021 5. STATEMENT OF INSPECTION 13Y ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 11 Name of Firm 10 bel 10 ?F _Phone Address Engineer's signature M 6. QHHS SIGNATURE X Approved for 6u-� ll bedrooms. Disapproved. Conditional approval for Additional Comments Date _I, /21 1 bedrooms, with the following stipulations: Date r-2 -9'20 CAUTION L �� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72.-025 (Rev. 1/91) Back MOA N21 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality o+ Anchorage December 21, 199 Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage, Alaska 99501. Subject; HAA for Lot 4, Block 3 Sunset Hills West Gentlemen We are submitting an HAA for Lot 4 Block 3 Sunset Hills West, 14290 Jarvi Drive, Parcel I.D 018-204-18. This property was developed in 1968. The health department: does not have any record of the well or septic system, except for an HAA dated 9/24/60. This HAA indicates that the well is 110 feet deep, and that the septic_ tank has a capacity of 1500 gal. The type of absorption field was not was not noted, no soil informa- tion was listed. This system was tested and inspected on December 16, 1993. The system absorbed 500 gallons in one hour. There was no evidence of surcharging or surfacing of waste water. This property is locat- ed adjacent- to the railroad., next to the tidal bluff. Ground water is not present within tens of -Feet of the bottom of the system. This lot is approximately I acre in size, basically level with few restrictions on reserve area. The Sunset Hills West area is currently petitioning AWWA for a LID, with balloting scheduled within the next 30 days. Eased on the above information we request that an HAA be issued for this property. Yours Tobbe Spurkland P. i LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: -R- ... E3 t= lJ F=e P _:� L a' -'e iV L) F= - E_. _ 203 NEST 15YH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM ADEQUACY TEST Lot 4 Block 3 Sunset Hills West 14290 Jarvi Drive Single f=amily, Private, On Site Bedrooms FROM MUNICIPAL RECORDS: TANK: 1500. ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: INSTALLATION DATE: WAIVERS GRANTED: DATE OF LAST PUMPING: Anch. Cess Pool DATE OF TEST: December 16, 1993 No Records Sq. Ft. 1968 December 17, 1993 TEST PROCEDURE: System was inspected and measured. Tank was found 7.5 feet: deep and with a liquid level of 54 inches. Two standpipes were found. One was 9 feet deep and with a liquid depth of 35 inches. The other was 9.3 feet deep and with 60 inches of liquid. 500 gallons of clean water was added to the second cleanout while the while the water levels in the tank and the first cleanout were monitored. The water- level in the tank did not change, while the level in the cleanout 4 inches. Within one hour the water- leved dropped to the pretest level. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, 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 this septic system- We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. All septic systems ultimately fail. Some systems last 15-20 years, others fail after less than 5 years. -T - SF'uFR1<LAIMID Fs .. IE= .. 2.03 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Fax (907)-276-6013 RESIDENTIAL WELL INSPECTION LEGAL: Lot 4 Block 3 Sunset Hills West LOCATION: 14290 Jarvi Drive OWNER: John McKinnon TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: No INSTALLATION REQUIREMENTS MET:Yes WAIVERS GRANTED: None WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: DATE OF INSPECTION: Gallons per Minute 5 Gallons per Minute December 16.. 1993 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 56 feet below top of casing. At a pumping rate of 5 gallons per minute the water level stabi- lizes at 105 feet after 60 minutes of pumping. A total of 500 gallons were pumped in a time period of 90 minutes. The well recovered to 83 feet in ten minutes. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on December 21, 1993 E.Coli 0. Total Nitrogen .65 mg/1.. Max. allowable Total Nitrogen 10 mg/1. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS I -JE=LL WILL PRO IJC_F_ MORE THAN _3. GAL=LONS_ PER MINUTE FIR MORE .FHAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. RL COMMERCIAL TE'S'TING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Siete repo REPORT of ANALYSIS 5633 s STREET Chem.lab Ref . # :93.6'747--t ANCHORAGE, AK 99518 Client Sample ID :POTABLE/L 4, BK 3 SUNSET HILLS WEST TEL: (907) 5622343 (907) 5615301 Matrix :WATERFAX: Client Name :TOBDEN SPURKLAND, P.E. WORK Order :'14216 Ordered By :TOBBEN SPURKLAND Report Completed :12/21/93 Project Name Collected :12/16/93 @ hrs. Project# Received :12/16/93 @ 15:30 hrs. PWSID :UA Technical Director -STEPHEN C. EDE Released By Sample Remarks: SAMPLE COLLECTED BY: T.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate --N 0.65 mg/L EPA 353.2/300.0 10 12/.17 CMR * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than `mo) SCIS Member of the SGS Group (Soci6t6 G60rale de Surveillance) ENVIRONMENTAL- SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA Ali REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER. FACILITIES (Fill out in Triplicate) "I.Name of person requesting approv 2. Name of property owner _ 3. Legal descripti.on_ v/��� 4. Number, of bedrooms in house 5. Water Analysis: a. Bacterial_ b. Detergent^. B. Well data: a. Type—�!a� b. Depth"_ ZZ ( f C. Casing Size_ d. Distance from well to closest existing* or proposed: l.. .fewer. line 2. Septic tank �e 3. Seepage Area Z%Q L , 4. Cesspool' 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. _. 7. Sewage disposal system. auv, a. Age of system b. Septic tank capacity in gal.lons_�L _ c. Name of septic tank manufacturer - 1. If "home made" show diagram on reverse side of this form. d: Disposal. field or seepage pit size and type _ _ - 1, Distance to property line to house foundation_ ___2 1. e, Percolation, Test results f-. Percolation Test performed by n_ Use the reverse ,side of this form to show diagram, Diagram should include i;he foll.owing information: property lines'•well location, house location, is tank location, disposal. area location, location of percolation test, a,,d direction of ground slope. 9. The lnfor¢mtion on this form is true and correct to the best of my knowledge. 0 Si1:,nature of Applicant DateSigned TO -$E FILLED OUT BY HEALTH MPARVIENT PERSONNEL XIIIhe above described sanitary facilities are hereby approved, subject to the .011owlnP COnd!if'S nnc. — - - - �^s' Conditions: M The above described sanitary facilities are disapproved for the following reasons: Sign ure o£ Affle•�.a. Date � :T— Approval is valid for one year following the date of approval. CPJ:cw FHA Form 2573 U. S. DEPARTME14T OF HOUSING . URBAN DEVELOPMENT FEDERAL AUTHORITYHEALTH • INDIVIDUAL PART I1. --TO BE BY F14A INSURING OFFICE ..EE ERIAL NO. MORTGAGOR OR SPONSOR PROPERTY ADDRESS SUBDIVISION NAME R BLOCK N& TOTAL NUMB9 i BASEMENT r_V1 New installation Can affic or other area be made Into LIVING UNITS &ED additional bedroome? (if Yes, ho� tnariyf) El Yes [id No ■ Yes EnNo rwXyllill-w"lit liftPublic system ElCommunity, system E�] Individual• ■ SIWAGE Public■ISPOSAL BYt •• • • ® ■ • • Y Y, I r � .:■ . r..S ■ ■u ■ ■■ o■r i .i ....■ ■ so . on N ■■ ■ no ■ on on :::::5:::.:: ■ ■ ■ :■ ■■ : CS ■ :■ ■■ :rr ■:■ .S Sa ■ ro S rr rrrrrr ...■■■■■or . ■■■■■■ No IN now ■r r■■ ■■ ■■■�■ on :r'1■'i ■.■....Niro ■. ... ■■ .........■ ■■ ...... rr :rs ■■ ■■■ ■■ ■r■ ■rrr .■ ■■■ soli ■■ ■■N:■■ ::::_: ..■■ . ■■ ■■■ r■iru■ rrrrr■ ■■■u■■ ..■■■r MINN C■■ ■ ■ on0 in rr rr rr .■ ... on .■ .. on r■:.■ ■..sono■ no No ■ ■ ■■ ■■:■i : ■ ■e sr ii 'i'ii ii ■■ ..... .r rN r. ■. urs: on ■■ ■r : ■■ ■■ N■ ■ ■■ so on no ■ rr ON ■■ ■■ on on ■ ■■ No ss■ :: ■■�is■ ■■ _ _::�:n O::::::::::� ■ u■ ON ■■ rrr■ ON ■■ ■■ N■ ■■ rr or ■r rr no ■■�rr ■r■■ no ON ■. ■.■. ■■■■■:■...■.�:: ■o=■■s■.:■.. or no r■ union rr ■.:■■. ■ S�■■■■ ori ::iris ::•■.■ .■. r....:.■■ ...N.■ r�.r■uu ■ ■■■■ ■■■ ■ rrr r■■ ■ ■ ■:■ r.■ ■■■ ■■■_■■ rrr ■ iBoom rr■ ■ . on ■■ ■ ■ rso ■ ■■ rr ■■ ■■ ■■ ■. ■ r ■u ■ o:.■..■�:. rr rr r■ ..... ■■...■ :■.■...:■ Nor ■■■■■ ■'■■■ ■ ■r■ ■o■■■ rrrro .■■S... .■■ .... ....::..: .■■S....■ rr■�rr ■■ ■■ ■■■■■ o.■oo ■■■r■ rrrr■ .■ . ■:.■ :■■■■ .... ■ ■ ■ r:■:■ ■rr r ■■ : .■:.::■ ■■... ■o rr ■■ ON ■■ ■■_■■ ■ ■: rr r■ ■■ ■ �.E�....o■�■n ■ or : ■■ ::::C:J N ■■ ■■ rr ■ ■ rrrr rr rrr o .. : ■. ■■ ■■■ ■r ■r■ ■'_ ■■ ■ ■r�■r■ rr r ■..SS ■r ■ . ■■li■:■� ■■■■■ ■■■■■■ ■NUNr■ rrrrrr ME me ■■■N■■ No no ■■. s ■re ■■ ■■r ■■ ■ ■ ro olio ■■:■■ ■. ■..■. :.. ■. r.. N. ON Emli rr ■r r r rrrrrrrrr 0 ME Now ■r:0C Mammon ACSHOUSE meo■ ■u■■■r ■■ No on rousse ■■ ■■ no no e■■■■r ■r ■■:■r�i■n ■■■■■■ ■■ ■■ ■r rr ■r■ ■■�■■�l■rr�■E ■■■:r■�■■ no r� rr rr rrrrr ■■.iCS..=..:■■..r=sr on ...■ .■■.■r ■■:..... .■ .■■..r...■. on .... �1■i■ .■■ rr�i■■�i�i"N Nrne ■■ ■■ i ■ ■■■■■ ■ ■ ■■ ■■■ ■1 .r� : N■■ rr rr rr rr rrr ■■ ■ one r■ ■e■won ■.. ■r ■■■ ■■ ■.:■r ■ ■■■ ■■ ■■■■■ �■ ■■■ :S 5:�:0= _ :�� r... ■ ■■ ■■ru ■■ ■■ ■r ■■■■■■■■sir■ rr o■ we No ■■ 11 No rr ■■■■■.■.■ r..■ no IN ■... ■r ■■...N rr ■o rr rrrr am 00 r a .:.. .■ . rr:■ ■■■r ■■■■ ■neu■■■r r rr r r .. . .r... . ■rrr��: ■ ■■ ■■■■ on ■■ rr Oman No Nino .. ■■■■■■■ ■■ ■■ ■ ::=C:=: ■r ■■ ■ ■ ■ ■ ■:■:■Nr ser r r ■:S ■ line . ■ ro■■�■■ N■1�■.�: ■■ rr ■ ■ .. .. ... WAN I Nam PART .• USE OF F14A OFFICE TO Till CHIEF UNI DERWRITER: have reviewed the foregoingpertinent AcceptableIndividual water -supply system be considered Ej Acceptable E] Not AcceptableSewage disposal be considered E] ..•- DATE SIGNATURE ■CHIEF ARCHITECT DEPUTY■ 'EALTH AUTHORITY APPROVAL FNA Form 9977 INDIVIDUAL \ 111111 SUPPLY AND SEWAGE DISPOSAL 4 ,TEM R., JW, 1958