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HomeMy WebLinkAboutLANGNES LT 4Langnes Lot 4 #016-151-55 JUL-15--2016 93:12P FROM: 70: 343.'997 R. 1/1 Municipality of Anchorage Community Development Department Onsite Water and Wastewater Program 4700 Elmore St. • P.O. Box f 95650 Archorage, AK 99519-6660 • httpJAwA t.munl.orWonsits • (907) 343-7904 Well Decommissioning Log Legal Address: Subdivision�fb Block Lot T R_ Section- Lot a (/U L 4101 5 (Awe 7 • On-afte Water & Wastewater AWam canified contractor performing the wall dsoommisslontng,- �^ Nares: d " Signature: p ^Y "� a -- Com a + �% L Walldsq:mmloalloning data %• r; `! it Method ofdecatnmisstoning: AMC 16.55.0601-1 a. ❑ b. ❑ C. Ldcatlon: Use the space below to Provide a drawing of the pnoparty showing the famirmng items • North anew Decommissioned well, + Other water wells do the property, • Two separate swing-tia distance for each well shown on the drawing. Note: The swingdie distances shall be Measured from either pormanent atncwms or the property comers, NW OP40'W JJARP s ; 2 �z 7111 9 IV L_u., I 1 �i o.•• . v. �1 AT v:wmnmuAiy r.+euampimnnuererapmmlT serwceswulloing setet}ncan sloe Watar ana wastewatenForntgoG lent FonnatWeli Dst:ammlatonhg totm.doc MUNICIPALITY OF ANCHORAGE DEPARTM, i OF HEALTH AND ENVIRONMEN L PROTECTION 825 L Street, AnchoraaR, Alaska 99501 264-4720 Date Received: February 15, 1978 41: Time i:3Q. #2: Time #3: Time _ Date ]� • �gy(_ Date Date Insp Pnaq� Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Bank B i l S t M Alaska Mutual Savings an 1.. Lending Institution Request: Alas��L ^Q Mailing Address: Post Office Box 1120 99510 Phone: 274-35611,),q6 2.. Property Owner: Wayne P. Love Mailing Address:Star Route A Boc 156T 3. 99507 Legal Description: Lot 4 Langnes Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Permit # Construction Phone: 276-4800/w Number of Bedrooms: Number of Bedrooms: 349-2909/h Individual Well. (x) Community/Public System nn ( d1 Depth of Well Well Log on File ( ) Bacteria). Analysis 6. Sewage Disposal System Permit # Septic Tank ;Size Absorption Area . On-site System ( ) ? Public Utility ( ) Installed Installer Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4 Langnes Subdivision Comments: Affadavit Attached: 1( Letter Attached: ( ) Approved: — Date: j Disapproved: Date: Department Worksheet: M-00P',O zcal : odo 11VW 10401AVNH3!NI UOi ION 11.61 '30V (opts ,oglo oag)—OHIAONd 3UVI13AOO 3'JNVHNSNI ON OOOE tua0d Sd ...................................(Poalnb091s oslxe ) AU3A1130 1V103dS 109 .. A1N0_33SS38.0_OV 01 UTAI-130 098 ' " Aluo aassalpPU 01 AmAll0 41!td 5391AU31 P9£ " paloAllap alagM pua oleo 'nlagn oy SNON$ Z 1113?3N P99 . ... Aluo oassalppe 01 AJaA110P 41!/A MUM ... _pWaAIIUP oleo Pue_moyM 01_SMOUS _1_—.. '_ ._ s33i UNGIA190 eod _s� IMS_IVtiuu,i0__ - 7009 dIZ ONV MIS "0'd 'ON (INV 13381S 31VU UO MMISOd 0.1 JOS (afejsod sn1d) ;sOF— -41VW MOA .>AH� )AN 0 �. MUNICIPALITY OF ANCHORAGE p�la'� DEPARTMENT OF HEALTH AND ENVIRUIJf✓tLN fAL PROTECTION Alaska 99501 825 L Street, Anchorage, 279-2511., ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1, Type of Inspection: VA FHA CONV xxx 2. Property Owner: Wayne P. Love Mailing Address;Star Route 85 -Bo 15FiI Anrhoraaa Day Phone:_ ^" 1�00 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: P.Q. Bok 1190, Ancboxao- Au Phone: 5. Name of P,caltor or Agent: Phone: Mailing Address: 6. Legal Description: Lo La 3rd house on left Location :NHN LanQns5 (Durr ( K1arr gd rur 7afh �7� ' _��'' es Court 7. Type of Facility to be Inspected: w r No. Bdrms. B, Watar Supply Type of Supply: Public Utilit If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72003(3176) ndividual xx Individual (on-site) Alaska Mutual Savings Bank 5th & F STREET P.O. BOX 1 120 ANCHORAGE, ALASKA 99510 MEMO - LETTER TO c' FGIIiZCC- � LL[f..G�'( ("4(-e-lv 4G�_zDATE SUBJECT.�(./...C-CC1Z-��Cs�-�. 'J •� ,.�<<l�+a„GL � ��Cg2•'-t�/ ��c,�.l �.� �>-�' z.��zts� �--��-c"t-4_c� ��r��(�_� -- GNED PHONE 907/274-3561 Almicipaliiy of Anchorage M(irk- Begich, M(iyor Buildhict Sarety Dix-ision P.O. I3ox 196650. 4700 Bragaw Strect Anchorage, Alaska 99519-6650 • (907) 343.8301 • Pax (907) 343-5200 10/16/2003 Michael N. Anderson, PE Anderson Construction & Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Subject: Waiver Request for Langnes Subdivision Lot 4 Waiver Request frWR030094 Parcel ID 4016-151-55 Dear Mr. Anderson: Your request for a waiver of the required 100 feet horizontal separation from the public sewer manhole to private well has been approved. The approved separation distance is 76.0 feet. This waiver approval also includes the private well to public sewer main of 52 feet. This waiver approval applies to the existing public sewer manhole to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, 4, / 7�a� Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department • '"' Building Safety Division On -Site Water and Wastewater Program _ 4700 Bragaw Street e " P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak.us (907) 343-7904 &jq (0 50w2730 Waiver Review Worksheet WR#: 030094 PID#:016-151-55 HAM Permit#: Date Received: 10/14/03 Legal Description: Lananes Lot 4 Engineer: Anderson Construction & Enaineerina 34.3 4640 Shoshoni Avenue Applicant: Clark Todd 7G FE ET Waiver Requested:.2*ieet waiver from Well to Public Sewer Manhole Criteria: SZ FEETtvAJvfi*FROM WILL TO PkINIC SEwEKJNwfA/ Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: - X_ Waiver is not Granted. List Conditions or Reasons for above: SEE %}%/ ii Date: 0 !6 Q3 By: PAA Name of Reviewer Rec#: 43099 Amount: $1000.00 Date Paid: 10/14/2003 W 141 vF-a EquFST� SuVD%vi S'/oA1 L 0 bvl4lvER R L=1PwESr Nu rs pER w12 03009¢ Wl4rvF/Q i?F_QUF57' dol¢ W14TF/Q LwFLL TO Pum -le SEwrle K14,vf1p4i=- AIVO :rFWF_R /M#4/N O1: 76 Ffer APO S2 FFET Rip-fpl-c rIvELY. —SOIL $ NNN SO/1-S TME S EL�EIQ M14IN /S 19ufPlEp 1N AIQE sIaNOY r W YW izi R Hl(t/I f►LT CvNrlovr. PERC 14147"ES AIQF_ /960 I- 30a.P../iA1 f h h h , 000 "=� Tills ro►L TYnlCiacLY T/CEATS s►5lorIc rlfAlc EPFLuENr 1►v 1QEL14T���L-Y vNa vv XPDXT VIf7-NAiC1r S CMfV ��r TkE PANA440LE HAf ENCR0 4CH&D 76 FEE rAUVA; y it cl? OVEA LD YEAi12S I..rTi( NO 140vEreSE %}FPELTS. T'MF SEIw6R LINE /� QuESTi6a /S DOM.N &Rp01gNT FROM TKE; LA,4TF►2 WELL RON 0A1 TKF &ROLudO SuR FAGS .4ND H YDR l4kL/L/g LL Y. —WEL-L VAT14 — riiF_ WI4TF,Q WELL IN Q%.cFST►anr DOGS NOT 1117vE1g WELL L06. /9VAILABLE NoWEVER Two 0774tie bvtsu L065 Lv6►QE Po Lc vQ im Me- /414E14. ri-wE Wft,L I-o(S IMOIC14TE rk 4T TK1r WELLf /9l¢F rYip IC14LLY 100 FEAT DEEP av►ra STAP►c w►}*rER LEvELS RNk6IwC- Pxvxt 20 Fse7- TO E30 FEET, MAD WEL►-t 4)CF- SNALLOaE►e FKoM T141' sOU rAl ivi7,tWF_ "it# Fgp- G-F7/N1r pEEI°E)e /ts IT" moves ry rkF Noxrq. Tl�ll_ S'E&,&A LIA16 If NoRr,{ OF Tice tvl4TB12 L --cu. /7 Eovcwoltcmef oiy Tmui jr /r, kYpu/guL'ooiir DOwN &R 4A oAo,7- OF Tier' L„w Tn5►t L4,rLI., wra 7-,,)C S14MloiF_S IAliala+rr NO 0*4c7L:lelA ANO mlrn*7-ES of. ?(o2 3G21tiy�! NITle/pT5S 1S A/F_GL1Cr/01-E. Qd W ►4 TF n T/4QG F_ Os70/0 �5"6ws)? MA/OV.'. jigs- -7t 0 ,FDr S. C. R. 0. )lo/NTS ~~~ SOIL So1Q8TioN W W W W W W zxz N N N hOU n ¢s 1s3;S+ /as) C4 a F/O .los�� �Tr � C4 PERMFIVILITY 1 � t C � WATE►Q TA&I-AS 6-R.9V1EN7- Rssit.4F cav siclev#17-1 v 0 % Nprelzv�vrq� s��A�e�r/o�v CO/uCL u s � oiv G-1Q14iv i w)v v r_tz 7.0 3.3 /.7 612)fAvV To Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 October 10, 2002 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Waiver Request for Lot 4 Langness Subd. To Whom it may concern: This is a request for a separation distance waiver of 24 feet from the public sewer manhole, (see plan view ). Some of the mitigating factors for justification of the waiver for the individual lot are as follows: 1. Low nitrate levels and zero coliform levels in the area, this was verified by SGS on October 3, 2003 see lab results with this letter 2. The original sewer line was install over 10 years ago up to station 31+27.45 with a clean out at grade level. This encroachment has persisted for more than 10 year without any wells being contaminated. The new sewer line starting at the clean out was installed in 2003 with a manhole per the plan. A well log has not been found but the current owner said it was installed in the mid 1970's. A DEC waiver should have been completed by the city during the design phase but I have not been able to find any record of it. 3. The neighboring well depths in the area arc 117 feet for lot 5 Langnes and 113 feet for Lot 3 Langncs Subdivision. The well on lot 4 should be about the same depth as the neighboring wells also. 4. The top of the well is sealed and elevated over 6 above the manhole. A new mechanically scaled manhole lid will also be installed to prevent leakage. The grades are very steep, over 10 percent in places, flowing away from the well. 5. Public water is available in the area for hookup to this residence if this well ever becomes contaminated. 6. Over time as the homes are resold the banks will require hook-up to public water. 7. A water sample for Lot 3 Langnes is also included with this submittal for a comparison. 8. Lot 4 & 5 Blake Subdivision, across the street, are served by public water and sewer now. From the above data it can be seen that the risk is minimal for contamination of the well in this area and the granting of this waiver, 24 feet, from the well to public manhole is requested.. If you have any question please call me at 345-3377 Sincerely �,/ Michael N. Anderson, P.E. I I ( EXISTING WELL III III I \! I I i r Z CONNECT f --, EXI C NECTION N A 30+00.00 12 v do SSMH-1, TYPE A - 1i1 t• III REMOVE E LLA�CCE EXIST G PAVEMENT. S AjIEM NTC r 2EPLACEMENi t. tT L ON SHE 1. THIS LOSS RVICED BY PUBLIC SEWERE AND- WATER I . S I—II THIS LOT SERVICED BY IW UC SEWERE AND WATER O II I I r li L -------- I En 0 _._ ... I I I ;I 2 5 - Ellen Avenue c. U� NORTON PARK SUBDIVISION Date 10-12-03 Sheet WAIVER REQUEST LAYOUT Drawn SMT Architecture . Engineering Checked ZWS Land SurwAng . Planning DON WAGNER USKH W.O. 769000 4(=5: EXISTINGWELL O ISTA. 31+27.45 122 REMOVE EXISTING C OUT I I F&I SSMH-2, TYPE A — � I I I REMOVE E LLA�CCE EXIST G PAVEMENT. S AjIEM NTC r 2EPLACEMENi t. tT L ON SHE 1. THIS LOSS RVICED BY PUBLIC SEWERE AND- WATER I . S I—II THIS LOT SERVICED BY IW UC SEWERE AND WATER O II I I r li L -------- I En 0 _._ ... I I I ;I 2 5 - Ellen Avenue c. U� NORTON PARK SUBDIVISION Date 10-12-03 Sheet WAIVER REQUEST LAYOUT Drawn SMT Architecture . Engineering Checked ZWS Land SurwAng . Planning DON WAGNER USKH W.O. 769000 . ,� �.,.:.. AY.r {fit -, •:I 1' � 1 •. �= ' IP..r 1 �;.,; p :1�' �,�1 ', Y,.Y� 1""•.rV J. il.^•; It li 11••J '.r": 1.. 1' �:.* }�'♦ Y. L ` a �'�...� •...•R:a Imo•' may. •. 1.` `•L n1 f J � p r S.r ,'I '�.•.i ly�,�'j �,•, J �1.i _ _.._... _....__...4 �.rY n LI al r .1, } I.1 IJ r. ',4 �'wy(7: .h nT '.c: r ,v '` 7 r,. :. ` rr } AFI fL' • 1' 1 ^`r � !'rel y 1 •1 �. r,,� +.,I a y �I 11 F ,� r Xt�. s..4 }' i I r � ti ti .a ♦ � , l (�� . l�� ;� .., J� r�. ',, i• s -1 1 1 © 1 1 4✓ 1 Y r 1 �� �/• a 1 Ilq•••••• 1 1 � L i• 1 Ir i!. n.. T � Y /1y 'r ,1 •,•1♦,.nll�� "' ML ' �,I_=I4L tib, � • f n I. rY ..a._ �4�y�J`.. «'�,��•� Cl yk" �✓�i 1,� L ._.. _ r Lfy; � ,if �l 1t� , • r '► '9. �. �. .•r • /I I 1• 1 1 1 r•' r e-..1 w.x« . ,i .r• y- � t ♦4 AJC .� �j � r '♦ IL ('.-,.i 1.::.' „'� � ' •: T,,' I l,q, f / L Vi ry• M1` M!'1 1 1 / rr .. ~t- � 9C f - �'�� ♦ J^• •!+� ra'•.,• ./tit,• y•'v ": �• "•� t f. ..t ' � •i, T�><'Ti -f1}'• •,I�,'E 1t14'��la ':w i • � { Y •A�.' T i"� F { J �•.� �`? � f/ I f`r..« .4' 't.y •:J v,� .`J � ✓� �«' i' �1 z `4„ �.\ r'.r: � � .,. nl ri ✓ 'sig � ... r JI t _♦ i. Vit.(.=.a ` , �rrr111 ��\� I� i` y^ .Y � , } • ,ray, +1 .�w.�.'.... . 10- 7-03; 2:29PM; SGS Ref.# 1036422002 Client Name Mike N. Anderson, P.E. ProjectNameH/ NA Client Sample ID Lot 4 Langness S/D Matrix Drinking Water ;907 5615301 All Dates/Times are Alaska Standard Time Printed Date/Time 10/07/2003 11:50 Collected Date/rime 10/03/2003 12:08 Received Date/Time 10/03/2003 1 :30 Technical Director --Stephen 0 3/ 5 PWSD) 0 Released 7d-�✓*" / Sample Remarks: /// Allowable pRp Analysis Parameter Qualifiers Results PQL Units Method Container M limits pate ate Itlit Waters Department Nitrate•N 0.362 0.100 mg/l. EPA 300.0 B<- ( 10) 10/03/03 JIB Microbiology Laboratory Total Coliform 0 cot/l00mL SMI89222B A (<-1) 10/03/03 DKC PLATER WLLL DRILLERS LOG Drilling Co. E ate$ Deilll/✓q_ Drillerp 11 �J/ Well Owner �J�� S J Jo'J / ei /Use DO NOT FILL IN USGS No. St3 ia--3- {`t(_ACA { Area )f Well Location (address of: Township, Range, $ Section (if known); distance from road: Size of Casing �Depth of Hole �Ll?/feet. Cased to� / feet. )f h/ L Static water level feet {above) (below) land surface. Finish of well (check one) Open end ( 41' Screen ( ): Perforated ( ). Describe screen or perforations: Well pumping test atV 6 gallons per (hr) (min) for na / Cl 9- feet of drawdown from static level. Remarks /�7 9 ; -- Date completed 1-/, / a' 7 y WELL LOG _ ___Depth in feet from Give details of formations penetrated, size of material, ground surface color, and hardness. Q to —Z 4 C to to _.•_._ � t06 � 6 �to esle, 25,T Py zG.8 to D-0 to r 33�to b -7V1 to to .o to to to S �N�e/��-/, 17����( �� r k 4 If 0 hiM n 10- 7-03: 2:29PM; SGS Ref.# 1036422001 Client Name Mike N. Anderson, P.E. ProlectName/# NA Client Sample ID Lot 3 Langness S/D Matrix Drinking Nater ;907 561$301 x 2/ 5 All Dates/rimes are Alaska Standard Time Printed Datefrime 10/07/2003 11:50 Collected Datefrime 10/03/2003 12:05 Received Datefrime 10/03/20 12:30 Technical DirectorjSte .Ede �Released Bv�� 7 Sample Remarks: Parameter Qualifiers ReResultsAllowable Prep Analysis PQL Units Method ContaincrlD Limits Date Date Init Waters Department Nitrato-N 0.807 0.100 mg/L EPA 300.0 Microbiology Laboratory Total Coliform 0 coV100mL SM l8 9222B B (<=10) A (<=1) 10/03/03 JJB 10/03/03 DKC Municipality of Anchorage On -Site Water & Wastewater Program - (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcel I. D. 016-151-55 Expiration Date: 1. GENERAL INFORMATION Complete legal description LANGNES; LOT 4 Location (site address) 240 LANGNES COURT *ANCHORAGE 99515 Current Property owner(s) TODD CLARK Day phone 227-9890 Mailing address Real Estate Agent 240 LANGNES COURT *ANCHORAGE 99515 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well M Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer Waiver/Variance request for n/O / — Distance : Received by Date: ' 2 COSA to be released to the engineer, unle lhemise requested by the engineer. COSA Fee $ �5G Date of Payment 1-2-41 ly C� 1a Receipt Number �164�1 COSA #c�5L1`�V.. Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 iype 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(aie) 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 JEFFREY A. GARNESS, P.E. Date Itht•JfLG Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the o0�00� 004 conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and o� Q F q o o............. 4 septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being by the O P S�LDOn served system. These conditions are outside the control of the evaluator of the system. Satisfactory testTH.'.�tr 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�Q any warranty or future estimate of how long the system will continue to meet the o operational requirements of the ADEC p MOA 0 G �-, ffr A. bar � q or . p DSDThe content of this report is for the sole benefit of the owner listed above. Any reliance s; O 9 .. upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. QO 9i EIr 79 3 Qe • f r/ , ..� , AO 6. DSD SIGNATURE M �w000� l-� System #1 Approved for bedrooms. ��llltlli System #2 Approved forbedrooms. OF Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE WATER AND WASTEWATER PROGRAM Original Certificate Date: The Mcf &iE itlor4?rchorage 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory IR- llmKl Nitrate Advisory Arsenic Advisory L� Other 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: LANGNES; LOT 4 A. WELL DATA Well type PRIVATE Date completed — Total depth — ft. *PER SURROUNDING WELL LOGS If A, B, or C provide PWSID# N/A Sanitary seal (Y/N) YES Cased to *40+ ft. FROM WELL LOG Date of test 00 Static water level ft. N Well production g.p,m. WATER SAMPLE RESULTS: Coliform a colonies/100 ml. Arsenic: JC', ug./L. B. SEPTIC/HOLDING TANK DATA Parcel ID: 016-151-55 Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 11118/2014 56 ft. 3.5+ g.p.m. NitrateN—� mg./L. Date of sample: 1 1 /18/ 014 AWWU Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (Y/N) _ Depr an Date of C. ABSORPTION FIELD DATA Date installed Pumper AWWU Soil rating (g.p.d./ft2or Obdrm)_ Length ft. Width ft. Total depth ft. Eff. absorption area ft2 Monitorinc Date of adequacy test Rea Fluid depth in absorption field befor st _ in. Elapsed Time: n. Final fluid depth treatment (past 12 mo.) (Y/N & type) Collected by: QFG I td. Date installed High water alarm (Y/N) System type Gravel b_eLoipe ft. Depression over field For bedrooms Water added _gal. New depth _in. in. Absorption rate >= g,p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manho!s/Access "Pump on" level at in. "Pump off" E. SEPARATION DISTANCES water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NSA On adjacent lots 100'+ Absorption field on lot N/A Public sewer main Sewer/septic service line UNK On adjacent lots Public sewer manhole/cleanout *76' Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: A Building foundation Property line Absorption field Water main Wells on adjacent lots Water service line Surface SEPARATION DISTANCE FROM ABSORPTION FIEL OT TO: Property line Buil oundatio 'n Water main Water service line Surface water Driveway, parking/vehicle storage Wells on adjacent lots F. COMMENTS *SEE G. ENGINEER'S CERTIFICATION I certify that I have determined through rough field inspections spections and * 4 T review of Munici al records that the above systems are in �' conformance with MOA COSA guidelines in effect on this date. ........ ................... Engineer's Printed Name JEFFREY A. GARNESS QQ� A. or ess. 9. E-795 a Date _ (i) P_do 0 (Rev. 11/05) Municipality of Anchorage PauE sL, Community Development Department ' Development Services Division a SA ETY On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 141622 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 4 of Langnes Subdivision. This inspection revealed an arsenic concentration of 10.8 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. LANGNES CCURT ---°--- - -- --' r r4 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PIAT. ARE NOT SHOWN HEREON.(UNLESS INDICK NOTE= ANY FENCELWES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY L SS -5;' OF O ...4 C.I � ..... , ......— ................ SHANE A. HOLT s LS -6914 �i ott�A� •t��� �"qa Baa laanai �� IRVEY (NO CORNERS SET THIS DATE = 20' 4, LANGNES SUR, RECORDING DISTRICT. ALASKA AND THAT IMPROVEMENTS SITUATED THEREON ARE ED AT ANCHORAGE, ALASKA THIS PTH OF MAY 4001 T LAM SURVEYING 8285,FR434E 3455513