Loading...
HomeMy WebLinkAboutOVERLOOK ESTATES BLK 3 LT 572-013 72-013 (1/91) MOA 25 Anchorage Page of '- Municipality of DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report `l7- "/4// PID Number 5C1z(k— Lf1-k\-..1 Permit Number: Name: �C.✓ G /G //L7"-r't-e-,.,-Cr Wastewater System: 1 New ❑ Upgrade Address: / iris 77/k.2 z .4r ,e,..,�- ..4 -it" 5:r-7? ABSORPTION FIELD Phone: 65v-ars No. of Bedrooms: Deep Trench ElShallow Trench 0 Bed ❑ Mound 0 Other LEGAL DESCRIPTION Soil Rating: �, a GPD/Sq. Ft. Total Depth from original grade: Lot: Block: - Subdivision: S 3 (�v F-,- /< u kr fr t Depth to pipe bottomtt�from original grade: L i t _ Ft. Gravel depth beneath pipe 1 Ft. Township: - / se/ N Range: / E-..--)cf Section: 3- Fill added above original grade: 1 - Ft. Gravel length: t 3 Ft. WELL: New ❑Upgrade Gravel depth: w'�r� 3 Ft. Number of lines: ) Distance between lines: N/I> Ft. Classification (Private, A,B,C): 12VIVb1z Total Depth: 110 Ft. Cased To: //D Ft. Total absorption area: 5 -GI/ SQ. Ft. Pipe material: 1\-1-Y13C)3A i S\0 Driller: 50t -I--1 VA11 Dat Dr.11ed: 6/9 I Static Water Level: 82 Ft. Installer: G -e.,) Date installed: i4 _sv01 1 Yield: ;;; tdy ; /y S GPM Purnp Set at: 1-1M<KC�LA)0 Ft. Casing Height Above Ground: 2 Ft. TANK o� SEPARATION DISTANCES tR(Septic 0 Holding 0 S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Fabtic/Private Sewer Lines Manufacturer: Adc.No ',z TLt.K-- Capacity in gallons: I2—o Well tDiA 107.6 Nip, ulN 6s Material: ---T.‘;-11_. Number of Compartments: Z Surfac Watee Wilk N% NIa N/A t/a LIFT STATION ,,,/4 Lot 4 -I, -/t 35.2 NA% N% + J 0 Size in gallons: Manufacturer: Foundation Z I ' I 22 . �/A �/ "Pump on" level at: "Pump off" level at: High water alarm al: Curtain Drain N /� / r I/A IV N IA f //j !V /1 / �/A Pump Make & Model Elec rical Inspections performed by: Remarks: iN,,.k-vJwiG=t-e, BENCH MARK Location and Description: TOP O Ir W E -L .., Assumed Elevation: I SCO , GY> Ft. ENGINEER'S SEAL ^ h Jw i 1 . �AY 'n1 ry s by: e_ --• -`-• Dates: lst Iii k50c11 h7 7:- Q --% ' .G> Inspections performed • . 2nd IC. •)u d gl . F,,!' _.--.., rr Department of Healt d Hu : vices approv I b G ° ?,'._—Date• €SI , t,,, rli° F,_r.9f0 Reviewed and approved .,,,-,.q.',.._.:,-‘ 72-013 72-013 (1/91) MOA 25 Permit No. y/_ o/y/ Page / of -- " 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: /074- S eiy 3 3 ve,r/ D `f s PID No • LOT 2 3L❑CK 3 218.55' S 81° 38' 89" c LOT! 3 BLOCK 3 Y4cANT 197,31' 1250 GAL SEPTIC TANK LUT 6 i W BLOCK 3 LOT 6 BLOCK 1 } 36' LEACH FIEID TRENCH PROPOSED REPLACEMENT LEACH FIELD (U 0 0 0 TOP OF CUT BANK VANTAGE AVENUE S 89° 49' 57 i E ELEVATIONS 2' INSULATION BOARD OVER LANK BSN L1 •DIEO FILL=1' es+' ORIGIIIAL ! Fi ccvARIO LEVELtc It 84.4•1 NO WATER TABLE lm 6VLLL v ASSUIEb Rry • lonan En GalqwwEAL OF T • 6AB1 - �A, FIR NOT 10 SCALE 0 .?1,1 L ' GT o o:.r.s A. iutera o Cc" -673.6 m • • '�•� %, o 4p D BYGLCr \�WY 9� O FES�1'A)�•1 72-013 A (2/91) MOA 25 `� -7/74 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910141 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:EAGLE VENTURES OWNER ADDRESS:P.O. BOX 771822 ANCHORAGE, ALASKA 99577 PARCEL ID:06804121 LEGAL DESCRIPTION: OVERLOOK ESTATES BLK 3 LT 5 LOT SIZE: 43531 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/07/91 EXPIRATION DATE: 6/07/92 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: , OirLO,,7 ,4_,(y. i0 -GC DATE: /0 JA 1 DATE: 7-?/ 9/ /2100IV Louis Butera, P.E. Registered Civil Engineer June 5, 1991 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 5, Block 3, Overlook Estates Dear Mr. Smith, RECEIVED JUN 6 1991 Dept. . u,-ccipaiiiy o Anchorage Ve t. Health & Human Services The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance from lot lines. 3. Reserve space is adequate, homes are existing on each side. adequate, ground water is not a problem. 4. Drainage will not be effected by septic system. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. • P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 Soils are very EAGLE RIVER ENGINEERING SERVICES P. 0. Box 773294 EAGLE P„oVER, ALSKA ne 694-5195 99577 JOB T• SHEET NO. CALCULATED BY CHECKED BY SCALE G/f OF 7 DATE 9/%t DATE 'myna' Ti71a fid r. Mha 01/11. PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: L ,) t NI SOILS LOG ® PERCOLATION TEST DATE PERFORMED: Sa Y/5 /g//r 3 Uve r /o o <r 6 7' i4 f 2 3- 4- 5- 6- 7- 8- 9- 10- 11 - •e 13- 14- 15 • • U• -CC .,icfy 6vuve,/ lea .ye 01e•e-A jit• /� y 16- 17- 18- 19- 20 - COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? N° IF YES, AT WHAT DEPTH? ry,�—, Tired 7d43t E SITE PLAN n N t/Y Elf --4 77, o' s1` I./A NTH o -E Co, ,•.- .S Reading Date Gross Time Net Time Depth to Water Net Drop SGA G( S/J6/' f / / ,_., 5 ., 3: SFr 6•s-6,,,.;, '_„ C 3; ie 7-16 �.a 7' '/,c' G ” S " 3 . sL '. P.-.3 - arc PERCOLATION RATE /"2 (minutes/inch) TEST RUN BETWEEN 3 FT AND ' FT PERFORMED BY: .S 72-008 (6/79) CERTIFIED BY: DATE: 62/,?// fEXISTING SEPTIC SYSTEM LOT 2 BLOCK 3 LOT 3 BLOCK 3 LOT 4 BLOCK 3 LOT 5 BLOCK 3 VACANT 197.31' PROPOSED VEIL LOT 6 BLOCK 3 LOT 6 BLOCK 1 0 0 VANTAGE AVENUE ti S 89' 49' 57' E P w a 0 L+ H 50' SLOPE SETBACK as.00' PROPOSED 1250 GAL SEPTIC TANK EXISTING STRUCTURE%' gt1.1 EXISTING SEPTIC TAM( AND FIELD PROPOSED LEACH FIELD PROPOSED REPLACEMENT LEACH FIELD LOT 7 BLOCK 3 TOP OF CUT BANK LOT 1 BLOCK 4 LOT 2 BLOCK 4 NO KNOWN CURTAIN DRAINS A/o STArnmf ort sasrne wATf.e SEPTIC SITE PLAN 3 OVERLOOK ESTATES LEGAL: LOT 5, BLOCK OWNER: EAGLE VENTURES CONTRACTOR: N/A 91-0581 DATE: 05/31/911 SCALE 1" JOB 100' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK, 99577 (907) 694-5195 FAX: (907) 694-3297 - Gf .: P [a 92,0©0.00000 Ci a 65 4 Louis A. `;uteri g )�J®UC_[-6736 66,x Dan b . 60 ‘..,"Ro C0ARp :Ess\'; SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 5 BLOCK 3, Overlook Estates A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. S. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 9' at any point. 4. The trench gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the trench is to be fmish graded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 9' GRAVEL DEPTH = 7" TRENCH LENGTH = 36' TRENCH WIDTH = 3' SOIL RATING = 1.2 GPD/FT2 BEDROOM CAPACITY' '4 SEPTIC TANK SIZE = 1,250 ABSORPTION AREA = 500 SQ.FT. Twenty-four (24) hours required for all inspections. e, =ae aooa_n7ec_..Coe _..ec A. ifirb�: �rillin 6y DOC Co. dba SULLIVAN - WATER WELL P.O. BOX 670272, CHUGIAK, ALASKA 99567 •. TELEPHONE 688.2759 OWNER OF LAND F4GL E u Tf U4 S Q ADDRESS P6 6oit 77 /rad. �' r'`� DEPTH OF WELL'<'''�t)i STATIC LEVEL OF WATER FT. Qct LEGAL DESCRIPTIONAr5. 054.4 3 (o t}rr d ( DRAW DOWN FT. DATE - Started Ended PERMIT NUMBER GALS. PER HR 37:9a KIND OF CASING 6 -P0 KIND OF FORMATION:, From 0 Ft. to(22 Ft. C4,ir/t/c KA JP From Ft to Ft Y From Ft. to 44 Ft. ) UF4 66INIE/Q From Ft to Ft. From i' Ft to (!-1 / Ft 514 1 / S" NAA 6e/Ne. C From Ft. to Ft. From Ft. to Ft 0,-,/ C A 11434. tz $ From Ft to Ft r // From 6 / Ft. to 7 7 Ft. ` J di00 6X4t%ti =- 14 From Ft to Ft �. From Ft. to Ft i �ta t3 (34. t - _S From Ft. to Ft. From_ `1 7 Ft. to /tet 0 Ft. ?714 6 P41J i ' Co e3'-' J- From Ft. to Ft: From b Ft to f i5- Ft.�dq'�3 p��4`t= C- From Ft. to Ft. From Ft to Ft. i.)/4 fn From Ft. to Ft. / 0 5' Ft. to / /o Ft S 4ii€) 646 40 -4- '` From Ft. to Ft. From 00117—C-:"... � } From Ft. to Ft. r../`� 011 (` L:. From Ft to Ft i From Ft, to _ ;__Ft ` From - . : Ft'to- .. . .: Ft. r• From Ft. to Ft. From Ft to Ft. From Ft to Et. From Ft to Ft From Ft. to FC, . From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft to Ft. From Ft to Ft MISCL. INFORMATION: DRILLER'S NAME Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL p Expiration Date: I, --2?_ Parcel I.D. 068-041-21 1. GENERAL INFORMATION Complete legal description Overlook Estates Block 3 Lot 5 Location (site address) 6127 Maonaview Dr Current Property owner(s) Fuller Day phone 694-8234 Mailing address Same Real Estate Agent Owner Day phone 694-0234 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: 4 COSA to be released to the engineer, unless otherwise requested by the engineer. Date: i/22//C COSA Fee $ 5;26 66 Date: Date of Payment G -/ (/—/6 Date of Payment Receipt Number CAO- \ \) Receipt Number COSA # OCC/6/2- 22 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6(1,4/2016 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditional approval for By: bedrooms. bedrooms. S1nvon w.'Eno ✓.i625C bedrooms, with the following stipulatTonV.- k 1CHOp . ,. O�-(2- �f ezoiNFN-v S� Original Certificate Date: 9 —2--E2-1 6 The Municipality of Anchorage Devlopment 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. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet_91-12.doc X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot COSA Checklist # of Structure servedby,this system Certificate of On -Site Systems Approval Checklist Legal Description: OV g'L.00k. t Sr4rf_.r 8 3 L 5 Parcel ID:0080"1/ Zi A. WELL DATA Well type P / If A, B, or C provide PWSID # Well Log (Y/N) Date completed.... C/ /7/ Sanitary seal (Y/N) Wires properly protected (Y/N) 1 Total depth //0 ft. Cased to I/O ft. I Casing height (above ground) Z if in. FROM WELL LOG AT INSPECTION Date of test. 0 0979/fP//g Static water level P2 ft. %f S ft, Well production 5 g.p.m. g.p.m. WATER SAMPLE RFSULTS: Coliform © colonies/100 mL Nitrate Nd mg/L Arsenic A//) ug/L Date of sample: $(2?//6 Collected by: Nor eh B. SEPTIC/HOLDING. TANK DATA TankType/Material r fe__ ___ Tank size /250 gal. Number of Compartments 2. Foundationtleanout (Y/N) Date of pumping C. ABSORPTION FIELD DATA Depression over tank (Y/N) A/ Pumper Date installed 6//0/ Cleanouts (Y/N) High water alarm (Y/N) Ai Date installed ��/0/ Soil rating (g.p.d./ft2 .rft2/bdrm) /..2 . System type %E/JC/i4 Length .36 ft. • Width ft. Gravel below pipe 7 ft. Total�depth v - ft. Eff. absorption area 504 ft2 Monitoring tube Depression over field A/ Date of adequacy test •• CAPfro- : /� Results (Pass/Fail) P ! For / bedrooms Fluid depth in absorption field'liefore test Q in. Water added COO gal. New depth Z in. Elapsed Time: .2G min'. ` Final fluid depth 0 in. Absorption rate >= COQ' f g.p.d. Any rejuvenation t'eetmeot (past 12 mo.) (Y/N & type) AM If yes, give date D. LIFT STATION ,A/A Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in "Pump off' level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /00 i t-- Absorption field on lot Public sewer main /00 '1- /0014- r Sewer /septic service line Z S 14- Animal containment areae .5o 4- •SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 et Property line / 6 1'f" On adjacent lots /0 0 " On adjacent lots /0 0 '* in. Public sewer manhole/cleanout • Holding tank. /00'y' /00 Cc- Manure/animal excrete storage areas /BO if Absorption fieldr Jr & Water main /Q Water service line /0 Surface water /00`� Wells on adjacent lots /00 r1'" ABSORPTION FIELD ON LOT TO: Property line /0 '* Building foundation /0'1- Water main. /air Water Setvioe:tine , /0 Cr Surface water e/D'f•�O`�- ` DS.riveway,.parking/uehicle storage 0 1,4 50 f" Wells on adjacent lots /00 ''r Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rePiew of Municipal records that the above systems are iii conformance with MOA COSA guidelines in effect on this date. Engineer's PrintedriName J ..77.6"(/' e//! Date 6//4/ /6 / COSA yellow sheet_2-6-15.doc w@,�•m1®9g��d oF..;•4.51101 • •.• . a• w.+ : r•• Steven W. Eng :CC 4481; _� ��'ROFEt t-•• • 9 MUNICIPALITY OF 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. # 068 041 21 HAA # q ir1I.1 .((D 1. GENERAL INFORMATION Complete legal description Overlook Estates, Lot 5 Block 3 T14N R1W Sec.25 Location (site address or directions) NHN Overlook Drive, Eagle River Property owner Eagle Ventures Day phone 694-2529 Mailing address P O. Box 771822, Eagle River. AK 99577 Lending agency N/A Day phone Mailing address Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 x 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 x NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 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 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. Name of Firm Eagle River Engineering Services Phone 694-5195 P.O. Box 773294, Eagle River, AK 99577 Address Engineer's signature 6. DHHS SIGNATURE Approved for 7 bedrooms. Disapproved. Date 7//'5/7j ®s. OF 1.41, a``t3 �° aoae *6,0 4p�F4 4u �{� .°ate a'as i.t •13- sg�OF-A 39 e o,. e°o.N��. x.97" �A aeeeza°aaa.oc�� A -yJ"S cam. Fas•x".Id's •et, 1T `.• Lcuis A. Butera 01 4 �4. % ° CE -6736 a ? ci Conditional approval for bedrooms, with the following stipulations: Additional Comments By b2Qef/ Date 1 2.0-?/ CAUTION 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: DymOdK EST., LOTS, 15Ve 3 774N 21w sec. 25 A. WELL DATA' Well type RelOWL. Log present (Y/N) Y65 Total depth 1101 If A, B, or C, attach ADEC letter. Date completed Cased to 1/0 Sanitary seal (Y/N) Yes FROM WELL LOG Date of test 0(D/o9/91 Static water level 2-' Well flow 5 Pump level UNKNOW// Parcel I D 0(.? 04/ 2/ ADEC water system number M/i4 0109/ Driller. 5ULL/I/AA/ Casing height Wires properly protected (Y/N) gpm Ys AT INSPECTION Ill /A .✓l�k g )3 7c.1 - u) /08' /v/4 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /07'4 j ; On adjacent lots Absorption field on lot 101, ; On adjacent lots f" /00 Public sewer main NSA rn ...a as corri n r Public sewer service line 8'z WATER SAMPLE RESULTS: Coliform Date of sample: 091/1/9/ B. SEPTIC/HOLDING TANK DATA Date installed 61,04/91 Cleanouts (Y/N) YG 5 Nitrate Public sewer manhole/cleanout N/A 3,-"A. Petroleum tank Collected by Tank size /, 250 Foundation cleanout (Y/N) High water alarm (Y/N) VA' Date of pumping iV//4 — Nati Other bacteria Compartments 2 %e5 Depression (Y/N) n/(1 Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /0 2..4 To property line 41.'7 Surface water/drainage 72-026 (Rev.3/91) Front MOA 21 On adjacent lots Absorption field N/A t /00 9/ Foundation 21.I Water main/service line N/A CONTINUED ON BACK PAGE C. LIFT STATION MUNICIPALITY OF ANCHORAGE Date installed Manufacturer eNVIRO►a(MENTALSERVICESDIVISIOIN Size in gallons Manhole/Access (Y/N) SEP 1 6 1991 Vent (Y/N) "Pump on" level at "Pump off" level at C High water alarm level Cycles ed R ECC ! V E D Meets MOA electrical codes (Y/N) 4//� • SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot B. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed 06/J0/9/ Soil rating 1. 2. 6,DD/F'r z System type D' 1,eVC4/ Length .3L1) i Width 31 Gravel thickness 7' Total depth 9 y Total absorption area _5_0_4_0_ Cleanouts present (Y/N) YE 5 Depression over field (Y/N) NO Date of adequacy test N/A — NEGt/ Results (pass/fail) PASS ' Peroxide treatment (past 12 months) (Y/N) N/A for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot JO/. /, / On adjacent lots f 4 bedrooms If yes, give date /v/4 Property line 35.2 To building foundation 22.4 To existing or abandoned system on lot N/4 On adjacent lots S� Cutbank / Water main/service line N/A Surface water Curtain drain A//A N/A E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Bs' 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date % - SEP 16 '91 10:03 NTL -ANCHORAGE 907 274-9645 P.1/2 NORTHERN TESTING LABORATORIES, INC 3330 INDUSTRIAL AVENUE 2505 FAIRBANKS STREET Eagle River Engineering P.O. Box 773294 Nagle River AK 99577 Attn: Louis !Altera Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A113897 Overlook Est 5/3 Water Method Parameter FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99903 r (907)456-3116 • FAX 456-3125 (907) 277-8378 • FAX 274.9645 Units Report Date: Date Arrived: Date Sampled: Time sampled: Collected By: 09/16/91 09/11/91 09/11/91 1100 LM Definitions MDL = Method Detection Limit B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Result Flag MDL Analyzed EPA 300.0 Nitrate -N Reported By: William : Buchan Anchorage Operations Manager mg/1 0.3 0.1 09/12/91 NORTHERN, TESTING LABORATORIES, INC. (907) 277-5375 • FAX 274.9645 (907) 456.3116 • FAX 4593125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT • ❑ PUBLIC WATER SYSTEM I.D. # rikf PRIVATE WATER SYSTEM NAME 11111.11 /Z. £N /N • sits, Pa. 430x 11329 At- Mailing t Meiling Addreee +yJ City �G� r Stets SAMPLE DATE 09 // 9 Phone M. Day Year 9577 roepc 6744-3zS ire 6944- J9•.5 Purchase Order No, SAMPLE TYPE: kfRoutine O Special Purpose o Check Sample (for original contaminated mple with lab reference no. ®sa mple No Location 1 Pala /11014 53 Time Connoted 2 3 4 5 6 7 8 0 Treated Water XUntreated Water. Collected by Laboratory Ref. No, L. H. AA 10‘45//A- 9 a$ vA• 9 10 Signature of Representative CHARGE • KA LABORAT01RL USE 0NL ' :' FAEPAID TRANSMITTAL SPECIAL INSTRUCTIONS 1___ MAIL ` NOLO FOR V PICKUP TO BE COMPLETED BY LABORATORY Received at: I'Anch. ❑ Fbks. Date Received Pg. /1 •• 9' Time Received 6.30 Next Sample Due COMMENTS: SATISFACTORY UNSATISFACTORY RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT R OB TNTC Direct Verification flnel Count L.5g eGe R _int• f Total ollfor - • lots es per/0 mis. Date Time Gt,9F,-19'2.2 L06 39bI JOHDNLi-11N t'O:OT t6. 91 d3S