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HomeMy WebLinkAboutT12N R3W SEC 15 LT 49ET12N R3W Section 15 Lot 49E #015-052-46 Municipality of Anchorage page at J DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION W.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _ SWg303 60 -- PID Number:_ 0150 S Z` (l 2 MN e: n ��' � !1 c--�V Wastewater System: [4ew ❑ Upgrade Address: I ABSORPTION FIELD ---- Phone: No.. aedrooms: �� ❑ Deep Trench fg5 hallow Trench ❑ Bed El Mound C1 Other --- ----- Soil Facing: Total Depth from original grade: / !ScGPD/Sq. /%i /.a LEGAL DESCRIPTION_— Ft. -- Lot: v/ �C Stock:— Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3"—f E7 Ft. FI. Township: /2-N/ Range: 7 1 Section: 3 L, � /� Fill added above original grade: Ft. Gravel length: / Fl. —_� Number of lines: Distance between lines: Z Ft. WELL: New ❑ Upgrade Gravel width: e Ft. Classification (Private, A,S,C): Total Depth: �� t Cased To: Total absorption arga:: 3 Pipe material: /I)_$O_� r/VQfP Ft. Z,01 Ft. �— SQ. Ft. Driller: �LPlnt�r QM(,L4,j 6 Date Drilled' /0/1 93 Static Water Level: / FL Installer: Sttrroirc Date installed: Yield: Pump Set at:: Casing Height Above Ground: TANK Q ,eQ? GPM 7,V 0 Ft. --2 f FI. --- SEPARATION DISTANCESeptic ❑Holding ❑S.T.E.P. To Septic Absorption Litt Holding Public/Pole Manufacturer:Capacity in gallons: From Tank Field - Station Tank Sewer Lines Well %los" /76' // �-/^ 1Aitc5 Material syee/�—� Number of Compartments:— 12" Surface — / i/50 l 7/5-6 si STATION Water L0 t Line ,k� / s / / _LIFT — Size s: in gallonManufacturer: "Pump "Pu level at: High water alarm at: r J r_ on" level at: Foundation ��� -� -- Pump Make 8 h1 Electrical Inspections performed by: Curtain A/� N//,„ Drain r -min BENCH MARK Remarks_' Location and Description: _---- —r7r04L+ S�Q� Assumed Elevation: RL t�fl Dates: 1st �D 0 E- Inspections performed by: — of 2nd Department of Health and Human Services approval _> at �j at Reviewed and approved by: Permit No. SLJ Q30,3 PJB — Page. 2 — of —& Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4.744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: T-419 , %r/ZAJ /Z3 GJ S J 9 - IN _ In tit WI PID No.: D/SOSZ4��o I-c1T 49 i I 15 4f/K a G 5ts �� LL X099' KE -p of Permit No. - 5yi C13 0 3 80 Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND -HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-•6650 • Telephone: 343-4744 On. -Site Wastewater Disposal System and/or Well Inspection Report 0; STATA OF ALASKA �. DEPARTMENT OF NATURAL. RESOURCE?; DIVISION OF WATER OF WEL1. WATER WELL RECORD {st 11tlH GUF1tiIVlAIrON LOT MOCK st�pN p�T:t6 SECTION YDNMI91,1S RANDS IDIpN ,! i? 1 Cis C►W `IiDh1181fETCHa (� hurl. WELL OWNCR: ID I's -bsa / ' �wtillilY�wCuwtmtu'mww .rrt - /%..%%•L.Li,�. - M&A$UlYFYI Ff6MjboA9inp top Opround surface LL DEPTH: 0A7E'OF CD�1117WION' 01.9 OJ#Tpt w Oopth of hole: C7 /_ It s G 11Y08 osd Color Depth I Depth of Car:ind:r 9 /.. It /�Q , 4y �--VEL�.W. 1 [ •�1 From To . DEPTH TO STATIC WAYEA LE? _ft belowtop of ming iJ ground,#urleoe Data: /0 //%n� Mkl'HOD OF plitLLINC) ;F�* rotary L1 cable toPi :.•1.x'4 other USE OF WELD,; ',*darnestio C ,Irrloation, (a mon' 110 , i- putalic supply E) Dolor .9 a. Ca t I0CA$INGt STICK -U �e� /t, Olnm: in' Lc WELL INTAKE OPENING TYPE: 1J open enii Ci14. dnod ,I ! _ n porforoted Cl open holo /p 116 r'tiA r� I U__ > '•c Depths of Dponinps; »� N w:,• , , _ _ SCREEN TYPE: Dieln: Slot/Mash Sizo: M, Lonpth; GRAVEL PACK TYPE: V4Wnla URd:Depth to to f` GROUT TYPE: Volume: „, r _ r Depth: irom,� �� ft to ss»+ ft to ' i Mur llty of Ancho ge r r, . DE ktOPMANT AMETHOD , Duration.,, _ I;UMPING LEVEL AND YIELD; hra pumping pn1 PUMP INTAKE DEPTH; --ft Harsapowar WELL DISINFECTED UPON COMPLETION? CI YE$ „ NO MpgtQR INFORMATION:�J / REMARKS: us nnsseme r' wN •.-..,,.. ; r/ •, ; ,�' PLEASE MAIL WHITE COPY OF LO 0: 57t{f ufti of Au fiaflieti OR spro'sq l " `'�5jiu DNR/DIVISION OF WATER � F'.. a PO NOX 77211& EAGLE RIVER AK 99877.2'11 R 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:SW930380 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:CORP OF HOLY FAMILY CATHEDRAL OWNER ADDRESS:225 CORDOVA ST. ANCHORAGE, AIC 9950. PARCEL ID:01505246 LEGAL DESCRIPTION: T12N R3W SEC 15 LT 49E LOT SIZE: 8067 (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 13E IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 9/21/93 EXPIRATION DATE: 9/21/94 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 (16AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: Z �� _ ANDERSON ENGINEERING P.O. BOX 240 773 ANCHORAGE, ALASKA 99524 September 6, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AIC 99502-0650 Subject: Lot 49, NW1/4, S15, T12.N, R3W Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The topography of the subject lot as shown on the attached Site Plan is characterized by flat ground in the area of the proposed septic system. Soils encountered in the testhole revealed sandy soils at a depth of nearly 10' with no groundwater encountered. A shallow wide trench system should function adequately on this lot at a depth between 9' and 12-1/2' below ground level. The lot is only 115' wide restricting the area for the septic system and allowing for the 100' separation distance from the proposed and existing wells. The location shown on the site map provides the necessary separation distances. If the system is constructed in accordance with the attached design the following statements can be made: 2 3 4 The system, if constructed as designed, will have no adverse impact on the wells currently in use or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. designed, will have no adverse impact on ia'f-.fi�ue"a'u JOB CALCULATED BY 4�— DATE 41061'7 - CHECKED BY__ ' • MgA DATE 9/d /9,3 w'n r'rv.i -cu 4rrr M.I iMLli �. ie !.� W n ]illi }f MLr PqF r VL lo[I' M11}S6W LOT 49, 515,T12N,R3W m do d n y m° 48 tlQ -.v... ` O 80'ROyADV/A/ 6 PUBLIC UTILE TFMPOR, 01-KA0T o6n 50 T3 - 9A 3 9A I 49B 149C WEST SET $TO BRASS MON, MARKED "SW COR. 56 BLM POST- SW COR. LOT 56; 1 /256TH CO 0 INDICATES IRON PIPE SET. LEGAL DESCRIPTION 47 TURNAROIPID-TO tE REMOVE WHpl STREET IS CONTINUED ROADWAY N PUBLIC UTIL, ESMT AS PROVIDED IN PATEN! i0 10 POWER 8 TENS PHONE ESMT. SET SYD BRASS MON, MARKED°8E COR.LOT 490-872 LS -672LS" 0 CEA POWER LINE COMMENCINGAT THE SECTION CORNER COMMON TO SECTIONS 9, '0,15 9 16, T 12 N, R3W, S.M. THENCE SO009'& A DISTANCE OF82620 FEET, "Hc—NCE EAST A DISTANCE: OF 50.00 FEET TO THE TRUE POINT OF BEGINNING, THENCE N 0°05'W A DISTANCE OF 135.24 FEET, THENCE EAST A DISTANCE OF 260,13 FEET, THENCE SO°05'E A DISTANCE OF 135.24FEEET, THENCE WEST A DISTANCE OF 280.13 "EET TO THE TRUE POINT OF 9EGINNING, SAID TRACT CONTAINS 0.87 ACRES MORE OR LESS. C RTIFICA POst•ItTl HEREBYCERTIFY T C°. AVEYOR AND THA 'ADE BY ME OR t 1) pt' •ONUMENTS SH OWt NO ALL DIMENSIC _ y_ 55 NQTARY',cj ACK SUBSCRIBED AND SWORN T'0 E DAY OF L AC/. NOTARY POR—AL Municipality of Anchorage 4 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " t_" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: S n�� CLL /7fl WIGS— --DATE P LEGAL DESCRIPTION: Township, Range, Section: DEPTH SLOPE (FEET) � 2 3 5 oa&t6jc?AI �QW(11 leUe,, 4 Q °a v' �5 Q �� o s a �a„. „uc �c rp e�ooyreaeeaoo Mlchoel E. Anderson SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Reading Date Gross Tiime� 5 i Depth to Water Net Drop 6 .o M 8 .54o o Jo OD� OG i a � 1� 3' ter, r }/ 12 10 W/gf�Gl (04") G o a) I o II l]i 13 14 J, 15 16 17 0 � 6: W/Snr1.Er 6f Z', I I ('OPCs (to 6 8 18 ' ---- �N 19 "✓T 20 1 f N's'1' Q °a v' �5 Q �� o s a �a„. „uc �c rp e�ooyreaeeaoo Mlchoel E. Anderson SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Reading Date Gross Tiime� Net Time Depth to Water Net Drop 17.0 11.0,2 .54o o Jo OD� OG i a � 1� 3' 10 Cd G o — I o l]i L— I ?/ PERCOLATION RATE (minulee/Inch) PERO HOLE DIAMETER I/ TEST RUN BETWEEN FT AND 10 'P FT COMMENTS —jk?Lt �'I_”' 2YIL!iglnrT Mir iU I -- -- PERFORMED BY: --_ 1 2-�i �"= CERTIFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C -f -- 72-008 (Rev. 4/85) o � Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L." Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST £; 114 PERFORMED FOR:_ �N <•= l --_?I% rs DATE P LEGAL DESCRIPTION DEPTH �j'j— (PEET) I I l Y 2 h 3 S I I/ yJ/oGG gY3Vr� 10 .5�s JZonGs4 6 0' a 7 F. Net Drop F D u� 6 ' O O h o 10 11 lob iOC x 26 - _12 ,. 13 14 �l ?j 16 ,vf` �H WI076' e�-w lcw"� X w/6,1� Ede1V�C �'nrwb gredd 17 �4 16 -fir How; 19- 20 9 20 COMMENTS 1�a 616, Wath h0 Township, Flange, Section: SLOPE E. Anderson SITE PLAN WAS GROUND WATER - ENCOUNTERED? I� S IF YES, AT WHAT L O DEPTH? _ P E gepl9 to Water After © 9�. �y, y Monitoring? « (111C �— Reading Date Gross Time Not Time Depth to Water Net Drop v 9 D O O h o I A6 II. 8 .Kir lob iOC x 26 0 ?j }o p Ivw Iy n 1 6 0 - 10;1A PERCOLATION RATE TEST RUN BETWEEN --II (mmulea/mch) PERC HOLE DIAMETER I FT AND ��� FT PERFORMED BY. I .G�~�'t`"`""CER71FY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.. — �- Y%� —� 72-008 (Rev. 4/95) �!'i�� Municipality of Anchorage '�0 �h✓ DEPARTMENT OF HEALTH & HUMAN SERVICES s wa 825 " L." Street, Anchorage, Alaska 99502-0650 ° u SOILS LOG -- PERCOLATION TEST, ��, shichoel L Anderson o W PERFORMED FOR:_—JPIh.1G C.L. %!u✓�CS —_ DATE PE�1Ix`b`J LEGAL DESCRIPTION: Township, Flange, Section: r—ffs—wr—A7 SLOPE SITE PLAN 'o 3 . / .: ° �I 117 y//OCGPyIIOitg{ /VY I CILhG4 4 °jp n 5 I ° Y(• 6 9 10 WAS GROUND WATER ENCOUNTERED? 11 S IF YES, AT WHAT _/ OL _ u/ DEPTH? P ° 12 E — Depth to Water After �� 13 Monitorings 6 Date: •!-,j 14 -�(7T rIT 15 41 16 17 18 19 Reading Date Gross Time null Net me Tiw�5 Depth to Water ir<. Net Drop in. 1p9q911.. o _L110 ,3�n1 O 100 Tov C7. 14 ——IfL•'1.z �r� 20 l PERCOLATION RATEI' (mmutes/m--//ch)) ,—, TEST RUN BETWEEN Io �N FT AND 11 COMMENTS 1d HOLE DIAMETER " P"W PERFORMED BY: ---- I Yom` `-`�'-`= CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. — �q // %-r _�.. — 72-008 (Rev. 4/85) Az L-" VV 7 ,, rt,A l t e.-- e.. 1. k,e- � (C �I YU�"_�t_ ��!, ��_p . c_i/ tr/�., �i r: �a! P /!'1( s) u /-A / `�e-u-",..�ari�s b f 7!%.c....., .c�li:r�7s�� fir"/ f�'9fl' ,r:� 5'/rru�,.•c.� 'j ,bi ."'a'�tw /��9'J'I�l.w• �Ci _._/%UI��i!�' � WCJi,'�a�,G''�.,(/.y-!"�. l�yc?L /t-, u../S j�/!,7 a� ,y/ri � o �-` 11—Ae 1,�j !'A�✓..tvL� /Y' �/��O.S Ac' Parcel I.D. 015-052-46 Municipality of An( On -Site Water and Wastewater (907)343-7904 JUN 13 2016 3 age w \1689 5 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: q^ I � -( Complete legal description T12N R3W SECTION 15, LOT 49E Location (site address) 9411 Elmore *Anchorage 99507 Current Property owner(s) Steven & Tabatha Perry Day phone 301-0661 Mailing address Real Estate Agent Heather Damassiotis 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: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 830-6540 TYPE OF WASTEWATER DISPOSAL: Individual 19 Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver/Variance request for: N/A Distance: N/A Received by: 0�� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SZ (0• 60 Date of Payment G iy /0f Receipt Number by—Ro(1 COSA # 02/6/ZZ 6 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, 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. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Gayness In conducting this evaluation, GEG provided an engineering evaluation of the well andlor septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systemys on the datels of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systemys. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemys; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the personyparty who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, isnot authorized. In short, GEG disavows any legal duty to anyone other than the personyparty who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Date G A 3 1 bedrooms, with the following OF Altich0, QP s \Pd N a�D ttlyntio�,�S�F�`'i/\1�R zo: n� pRpGR�°� Original Certificate Date: t��lln �10 The Municipality of Anchorage Development 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc 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 R3W SECTION 15, LOT 49E Parcel ID: 015-052-46 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 10/7/93 Sanitary seal (Y/N) YES Total depth 201 ft. ICased to 201 ft. FROM WELL LOG Date of test 10/7/93 Static water level 145 ft, Well production 8.0 g.p;m. WATER SAMPLE -RESULTS: Coliform ND colonies/100 ml. Arsenic: NO ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 1.36 mg./L. Date of sample: 5/24/16 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 6/8/16 145 ft, 5.7+ g.p.m. Collected by: GFQ Ltd. Tank Type/Material SEPTIC/STEEL Date installed 10/19/93 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 8/3/15 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GR—AD—El. Date installed 10/19/93 Soil rating .p.d. 2or ft%drm) 0.45 System type SHALLOW DUAL TRENCH Length 134 (TOTAL) ft. Width 5 ft. Gravel below pipe 4 ft. Total depth * + ft. Eff. absorption area 1334 fe Monitoring tube YES Depression over field NO Date of adequacy test 6/8/16 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 26 in. Water added 1375gal. New depth 45 in. Elapsed Time: 120 min. Final fluid depth 39 in. Absorption rete z=. : 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date TESTED EAST TRENCH ONLY. MONITORING TUBE IN WEST TRENCH REMAINED DRY THROUGHOUT TEST. CLEANOUT ON NORTH SIDE OF EAST TRENCH & NORTH SIDE OF WEST TRENCH NOT LOCATED. D. LIFT STATION Date Installed Size in gallons Manhols/Ac cess (YM "Pump on" level at in. "Pump off" leve High water alarm level at in. Cycles tested Masts alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtit station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots ***100'+ (WITH CAVEAT) Public sewer main Sewer /septic service line 25'+ Public sewer manhole/deanout 100'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ 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 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **5'+ Building foundation 10'+ Water main 10'+ Water service lire 10'+ Surface water 100'+ Driveway, parkingivehicls storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certlfy that have determined through field Inspections and review of Mumlclpal rewde that the above systems are in conformance with MOA COSA guldellnes In effect on tllls date. Engineer's Printed Name JEFFREY A. GARNESS Date b/m3 & (Rev.11105) .Q£ r .y^z Z tom[ J t Q 1 O 4 xl u E CC M t w W 4 �t O CV LZ N�3 iF t� lJ � n n Jtv � MRE i � F z� 1 t E< 1 U a I .Q£ 4Iy fY °C Li x t t t I i 1 4 i ~ 4 cy a 1 • m� i 1 .�� ,fZ"Sit AL.D6SD:00 N � II o - r .y^z Z 0 ffitjp a 1 O 4 xl 4Iy fY °C Li x t t t I i 1 4 i ~ 4 cy a 1 • m� i 1 .�� ,fZ"Sit AL.D6SD:00 N � II o - r .y^z Z 0 ffitjp '3i 1 O 4 xl CC Ljj W 4 0 O r w ffitjp '3i 1 O 4 xl CC . m t MRE i z� 1 t E< 1 a I Municipality of Anchorage *AE Development Services Department Building Safety DivisionOn-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 �^,,�� Anchorage, AK 99519-6650 C� 'Fee, . www.muni.org/onsite W ; */13 (907)343-7904 Q POI CERTIFICATE OF ON-SITE SYSTEMS APPROVAL a55�i1`f FOR A SINGLE FAMILY DWELLING Parcel I.D. of S" 05'Z 16 1. GENERAL INFORMATION COSA # C_J .1 ()(0 Expiration Date: fro - (n 1 Complete legal description i- Y 9E Sic tS 7- N, R 3 O; 6-M. Location (site address) 9111 E l m O rr 13 as 04 Current Property owner(s) Zot," es E CeAZ f F�, o cR e e- Day phone 770 - 7710 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address gyil Ef,norie- Rat/9r lehe, V6 A&S 99307 Day phone t3o._4 k;ng Day phone 696 - SY6Y Unless otherwise requested, COSA will be held by DSD for pickup. Plewe a -i+, a: if enj,,7 e er' a/ny 1:1(ctt J{,n�hBr@�ei,nef w%+dn Cc7SA 2. NUMBER OF BEDROOMS:_ 1/, aevner. 3. TYPE OF WATER SUPPLY: Individual On-site Individual Well Individual Holding Tank Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ reaafy fir, P,etekoo 1/, aevner. TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 sample results. (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, f verify that my.investigation, based on procedures outlined in the Certificate of Onsite 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. Su rvt7 a r - 3 1} e n At0- Name of Firm Ff a Floe %eche) a ca.1 S e, -v c" Phone 3 vs"- 13 ss" Address 1 Y S ?a Cctio 6t n vc,a 1344 /)-n CAT /1-k 99,5-16 Engineer's Printed Name Theo e&;.e r= i"t� rC Date 'Z / 2-6/ ! 3 5. DSD SIGNATURE Approved for bedrooms. By: Disapproved. Conditional approval for bedrooms, with the following .Air a"M. F. tseoae &,. Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11105) Certificate Date: 3-6-/-3 Municipality of Anchorage �t��• 84, . • '� Development Services Department g "Q Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343=7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: l.af 419 E, Se c 1 T 17 /` y R 3 y S • /'r. Parcel ID: ®1 S - 052 A. WELL DATA Well type Pv k If A, B, or C provide PWSID # _ Well Log (YM) i Date completed _r [,719,3 Sanitary seal (Y/N)Wires property protected (YM) r Total depth 20 I ft. Cased to 20 t ft. Casing height (above ground) min. FROM WELL LOG AT INSPECTION Date of test 10/7 / 93 Z /I?-/ rg Static water level I K S ft. 137 ft• Well production g.p.m. 9 t = g.p.m. WATER SAMPLE RESULTS: Coliform Net? colonies/100 mL Nitrate 1.93 mg/L Collected by: FlQii- a,P %c1' Sic Arsenic: —<5' ug/1 date of sample: -!—/12. r3 B. SEPTICIHOLDING TANK DATA Tank Type/Material 5orA%r e- % -04-eel Date installed 10 / t 91 93 . Tank size 1250 gal. Number of Compartments Cleanouts (Y/N) `f Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) I✓ Date of pumping 2 /13 / 1.3 Pumper /1 rcvun cl th,2 C l aC Pu fn'e' C. ABSORPTION FIELD DATA Date installed 1a /r9l93 Soil rating (g.p.d-e orff/bdrm) 0.15', System type V- wry d2 ;"fi@IOe Length 13 rJ ft. Width 5 ft. �t2 Gravel below pipe 1.6 ft. Total depth 12S -ft. Eff. absorption areal_p'-Lft' Monitoring tube Y Depression over field A/ Date of adequacy test 2/12 -13ZW 13 Results (Pass/Fail) PASJ For _ bedrooms Fluid depth in absorption field before test 52 in. Water added-V6gal. New depth55'Sin. 9.� Elapsed Time: IQ77min. Final fluid depth52.1? in. Absorption rate >= G DO g•p•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO n2 k now n If yes, give date 0, R D. LIFT STATION -Nlon e, Date installed Size in gallons, "Pump on" level at —In. Datum "Pump off" level at Cycles tested ManholefAccess (YIN) _ in. High water alarm level Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot I bur On adjacent lots too ' Absorption field on lot 17,F On adjacent lots Public sewer main N. A > LOO') Public sewer manholeldeanout Sewer /septic service line I tS # Holding tank N • A. Animal containment areas hone (>/ev) Manurelanimal excrete storage areas Llano too j SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S Z r Property line Absorption field > S t Water main M. A. t> to'Water service line O > 10 ! Surface water > Wells on adjacent lots > [t30 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: WiFu. r'r{ Propertyline 5' aN nee Building foundation 67, Water main N.A.. > o' Water Service line > !p Surface water > / c-)C� ' Driveway, parkingIvehide storage O N. ends of Curtain drain t`lone Seen Wells on adjacent lots l-oo ' GL r-4 rn fie/t�� cx �e un mtei cam. ��� F. COMMENTS Clectnouf r a- M, enolr of O'ira#n fiPlo<s tae tun fel' eYnl�v of dr'itrd Agrarenf leearttcns e&pifomeol wd-h nmekel 10 {0. Per 2/1Z/3 G. ENGINEER'S CERTIFICATION trle[on w. �r�y t^rrev dla'JJ Meeni tw!/ u��rpee ,_lora tiY+y I certify that I 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. ' n-NOINEER - �iA&sk�t3 wax Ba�YYYYYMBoCa'!l� Englneer's.Printed Name -rA gr, "-IOre r )'r re— Date Z /26 / 13 COSA Fee $ H 90 2a Waiver Fee $ Date of Payment Receipt Number (Rev. 4110) Date of Payment Receipt Number sc aeY® Y•�oxe; Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us / (907)343-7904 G CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-052-46 HAA# /9 y oL O 0 6-7 1. GENERAL INFORMATION Expiration Date: r" 02 6 - 0 :2 - Complete legal description r T12N R3W SECTION 15 LOT 49E.' Location (site address or directions) 9411 ABBOTT LOOP ROAD * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MARK SHIMMEL Day phone 346-1804 9411 ABBOTT LOOP ROAD • ANCHORAGE. AK 99516 JANELLE PFLEIGER w/ REMAX PROPERTIES Day phone Day phone 2600 CORDOVA STREET * ANCHORGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 257-0156 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ 11757�t, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As cerfihed by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system !slate) 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 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 ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SURE 28 • ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for L� bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other .-.+n c G1 WATER AND • rnS BY ��^ �+� ��/ Original Certificate Date: 6 �� (R". 17101) Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water & Wastewater Program " 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 995196850 www.ci.anohorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T112N. R3W. SECTION 15, LOT 49E. Parcel ID: 015-052-46 A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N/A Date completed 10/7/93 Sanitary seal (Y/N) YES Total depth 201 ft. Cased to 201 ft. FROM WELL LOG Data of test 10/7/93 Static water level 145 ft. Well production 8.O — g -p.m - WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.05 mgJL, Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 1/28/2002 141 ft. 5.4 g.p.m. Otter bacteria 0 colonies/160 ml. Arsenic: N/A mgJL. Date of sample: 1/28/2002 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 10/18-19/93 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping 9/20/2001 Pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA Date installed 10/111-119/93 Soil rating .p.d r ft1bdrm) 0_45 System type TRENCH Length 134 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 13.1 ft. Eft. absorption area 1.334 fe Monitoring tube YES Depression over field NO Date of adequacy test 1/28/2002 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth In absorption field before test 0 k1. Water added 1095gal. New depth 15 in. Elapsed Time: 1260 min. Final fluid depth 7 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date – D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic Yankilift station on lot 100'+ Absorption field on lot t 00'+ Public sewer main N/A On adjacent lots too'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service Una 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIGHOLOING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ 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 '5'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER INSPECTION REPORT G. ENGINEER'S CERTIFICATION I ced fy that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineers Print%4 Na a JEFFREY A GARNESS Date TZ .7, HAA Fee $ `'75.00 Date of Payment a - as - o a Receipt Number bl Co 379 (Rev. UJOI) Waiver Fee $ Date of Payment Receipt Number JAN -31-02 11:46AM FROM -CUE ENVIRONMENTAL SRV CTBE Environmental Services Inc. CT&ERtt# 1020514001 Client Name AK Water & Wastewater Consultants Inc. Project NameM T12N.R3W.Sec 15 Lot 49E Client Sample ID Outside Hose Bib Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: 9075615301 T-012 P.01/03 F-378 Client POM Printed Date/f[me Collected Dstefrime Received Date/time Technical Director � Released BAY 01/31/2002 8:09 0112812002 14:55 01/2912002 13:30 Stephen C. Ede � io Allowable Prep Analysis P,nmeyo Results PQL Unto Meduxl Limits Date Date Init Waters Department Nitrate -N Microbiology Laboratory Total Coliform 1.05 0 0.200 mg/L EPA 300.0 (<10) 01/29102 JDT coV100mL SMIS9222B (<I) 01/29/02 SDII 0 2/252002 Municipality of Anchorage George P. Witerch, Mayor Department or Public Works Building Safety Di%ision P.O. Ik)e 106050 a 4700 S. Bmgaw Street Anchorage, Alaska 09510.6650 a (007) 343-&3301 It tt p://%%i% x .ci.anchotnge.ak.us Jeffrey Gamess Alaska Water and Wastewater Consultants, Inc. 6901 DeBarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for T12N, R3W, Section 15, Lot 49E Waiver Request #WR020008 Parcel ID #015-05246 HAA 020057 Dear Mr. Gamess: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line 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, hIlzlal Jeffrey W. Poet Civil Engineer On -Site Water & Wastewater Program ABBOTT LOOP ROAD 0 O p ` \ N 00'05'00"W 115.24' A T g D m o 9S rn +moip L/) I I zZ O I � T — mm� N ti co dco ; sz m in 0 (A f0 I I;QOD mzr 0 o? z wrnz o A� I Ime yy 1/ � v I I O m = c oz ;o C �v 1n Z. - m i ' s 0 O m0 Imp o mNe�=mm'o� �0 m A OnONZ n f I I. z om C Zm�mQz m� mz N A Z O-4O�y m Nm LnO 0D p I CC �'pp I;8 �fC 45.41 0 Z. 0 cm,yn m�0y Sm '1 41♦e'9 d I O w m r52 I i 4 I 2 10-/1 AyZjNN Ln O�l'IV y<�< CA b r I 110 Ce, ma 4s VI 2p mm= i yzyz ~-y101'1 Ox N Nc co I cA I D =00 1 mO0 C,63(l -C�N=C D p m m O4A m � Z O m m a Z� c.-.«� ••A 51.5'1 M m N� 00AV at • ♦ >E apqg��G 0: it ''o D � 0 �' �'•y I � gpx I // If I oIt I 1 � I I I 1 m A I m I1 1 I� I I O P I I \\ I \ 0 o I 10' T. & E. ESMT. (BK. 136. PC. 482) 0 z f ' N 00'05'00'W 135.24' m^ N y / Z N y m s � �I,Mol z r a 10 N A 0 ri IF r o m N 30' v o z A AICACA ;m 00 � z (v y .Z1 r ,ZI Z Z O C viz A I Z0N ,:t =1m Z m c 0 q r- 0 N m O V ' MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES a � 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. # 01 50 S 2 _ HAA #Q Cal -d (1L)Ji)_ 1. GENERAL INFORMATION Complete legal description -T— Z_,IQ 1Z'3 I J is. /S Lor 4q Z:: Location (site address or directions) Property owner _-Zn `rM I-1yY`run L nL ___ Day phone — — Mailing address Lending agency Mailing address. Agent _-- Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: —4-- 3. — 3. TYPE OF WATER SUPPLY: Individual well X 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 x — 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(Rev.1/91) front MOAB21 5. n M 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, supply and/or wastewater disposal system is in compliance with all Municipal ordinances, and regulations in effect on the date of this inspection. Name of Firm A -N 'i)cRSo/j LI'jGiiJ�Z`TLfn1U Phone Address the on-site water and State codes, - A I y- 9 9 S zq Engineer's signature r t V� Date f fq �94 �` yas; say r ' 1 :•. rJ "fir Sit Fi�_, DHHS SIGNATURE _Y Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 4UTlr '- fL�chaci E. Anderson ' 4351-C �•� bedrooms, with the following stipulations: Date /— 2 6— 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 (Rw.191) Beck MOA #21 a Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T�IZA R33W S I L,�_ Parcel I. D. _ 0PS. 0 5 1 A. Well Data Well type 1 l2) J1 TC If A, B, or C, attach ADEiC letter. ADEC water system number 7 Log present (Y/N) Y Date completed /O 9 S5 Driller _ AI-PW67 b21 L, L AA r r / Total depth 2-0 / Cased to Z"Casing height Z Sanitary seal (Y/N) Date of test Static water level FROM WELL LOG /0/-)3 / GI ' Wires properly protected (Y/N) Well flow • U g.p.m. Pump levell Z-0 0 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE: RESULTS: Coliform O Date of sample: lorGC= B. SEPTIC/HOLDING TANK DATA AT INSPECTION On adjacent lots Public sewer manhole/cleanout Petroleum tank MA I /lIILtzs Nitrate -36 Other bacteria 0 _Collected by: A h{ArnALA Date installed /U l� �� _Tanksize _Compartments_ l c�rJ Cleanouts (Y/N) y _Foundation cleanout (Y/N) Y Depression (Y/N) /V High water alarm (Y/N) 4 L4 Alarm tested (Y/N) 4A _ Date of pumping 44--1 i _Lni Sr'r2u CX/04 Pumper __ I\ SE=PARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot On adjacent lots r To property line _Absorption field _ Surface water/drainage >/SD / > /DD r Foundation 7 Water main/service line 72-026(3/93)'Front CONTINUED ON BACK PAGE 7 C � C) Z_ m rrtj i`� o cN% On adjacent lots -> r z On adjacent lots Public sewer manhole/cleanout Petroleum tank MA I /lIILtzs Nitrate -36 Other bacteria 0 _Collected by: A h{ArnALA Date installed /U l� �� _Tanksize _Compartments_ l c�rJ Cleanouts (Y/N) y _Foundation cleanout (Y/N) Y Depression (Y/N) /V High water alarm (Y/N) 4 L4 Alarm tested (Y/N) 4A _ Date of pumping 44--1 i _Lni Sr'r2u CX/04 Pumper __ I\ SE=PARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot On adjacent lots r To property line _Absorption field _ Surface water/drainage >/SD / > /DD r Foundation 7 Water main/service line 72-026(3/93)'Front CONTINUED ON BACK PAGE N/A tYEIFT�T�kT16N Date installed Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on” level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Plymil 76Ii D. ABSORPTION FIELD DATA "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed fi0//8"/9lg3 Soil rating (GPD/Ft2) Length /. y Width S Gravel thickness type Wla L� %/Lent U-1 Total depth /2. S / Total absorption area � 3 > V FrLCleanout present(Y/N) ~� Depression over field (Y/N) M Date of adequacy test N CW 6,J ^J S , Results (pass/fail) T_�SS for FOU A Bedrooms Water level in absorption field before test do^11b &After test /�10 J t� Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: To building foundation On adjacent lots_ Surface water Curtain drain /5 i On adjacent lots >/C)O/ Property line /,J /A To existing or abandoned system on lot r / ✓� Cutbank A10 ^J L Water main/service line > /00 7/SO ( E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area �(-- Z -r- Z„vim J�)\I� 1 certify that I have checked, verified, or conformed to all MOA and HAAguidelines in effect.on the dae'of (his inspection. Signature Engineer's Name MiC,4-1'AE-L_ 4-jo6tPJD l Date /[/9 by HAA Fee $ 70 ` Waiver Fee $ Date of Payment / — / R `? Receipt Number A4 rS ,�'% �? 13. 72-026 (3/93)' Back Date of Payment �_1 —?e Receipt Number S /Y oal 3) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 January 19, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 49E, T12N R3W Section 15 Lot Line Waiver Dear Onsite Services Engineer: The drainfield serving the subject lot was placed within 5' of the western lot line to provide sufficient room for a replacement septic system. The western lot line abuts a 100' Right of Way for Abbot Loop Road. Placement of the system at this location will have no adverse effect on wells or septic systems serving adjacent lots in the area. We hereby request a lot line waiver be issued allowing the drainfield to encroach within 5' of the western lot line. Sincerely, Michael E. Anderson, P.E. Commercial Testing & Engineering Co. Environmental Laboratory ServicesW®05®AW® 00 REPORT of ANALYSIS 5633 B Street Chemlab Ref.# :94.0234-1 Anchorage, AK 99518-1600 Client Sample ID :PRIVATE WELL WATER LOT 49 lel: (907) 562-2343 Fax: 1907)561-5301 Matrix :WATER Client Name :ANDERSON ENGINEERING ordered By Project Name Pro jectit PWSID :UA Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A.H. QC Parameter Results Qual Units --------------------------------------------------------- Nitrate--N0.389/L WORK Order :74978 Report Completed :01/18/94 Collected :01/14/94 @ 11:30 hrs. Received :01/14/94 @ 11:55 hrs. Technical Di.rector:STEPHEN C. EDE Released By : / ')% -24--/� Allowable Ext. Anal Method Limits Date Date Init EPA 353.2/300.0 10 01/17 LLH * 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 Iv� S1Gra Member of the SGS Group (SociM6 GAnArale de Surveillance) ENVIRONME=NTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY 3F ANCHORAGE COMMUNITY PLANNING AND DEVELOPMENT P.O. Box 196650 Anchorage, Alaska 99519.6650 PRELIMINARY PLAT APPLICATION A. Please fill in the information requested below. Print one letter or number per black. 1. Vacation Code 2. Tax Identification No. F1 3. Street Address OFFICE: USE REC'D BY: i 4. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). 5. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page. 6. Petitioner's Name (Last - First) 7. Petitioner's Representative M�-T-r7i{ Address `blrb WIa"ST S� _bylff"ur _ Address _ 1-6 lXbu,CtW SAL,`=C.;L(—L-� �-- City StateLt-&gym—� __ City State 'LL.hu--k Phone Zip_�q5b 1 Phone ri _ �d 5 �M 1<0 _ Zip �0t515 8. Petition Area Acreage 9, Proposed 10. Existing 11. Grid Number 12. Zone Number Lots Number Lots 0,1 Liu F4—] FM [E (I 13. Fee $ _ __ _ 14. Community Council _ B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it it conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee i< nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the pubdivision. I alsc understand that additional fees may be assessed if the Municipality's costs to process this application exceed the -i asic f I furthei understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting B d, Planning Cc mission or the Assembly due to administrative reasons. Date: y„�� � Signature 'Agents must provide written proof of authorization. 20-009 FIM JR<v. 91921 C. Please check or fill in the following: i. Comprehensive Plan — Land Use Classification V Residential Commercial Parks/Open Space Transportation Related L 2. Comprehensive Plan — Land Use Intensity Special Study 3. Environmental Factors (if any) a. Wetland 1. Developable 2. Conservation 3. Preservation IS (twt LS Marginal Land Commercial/Industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected Alpine/Slope Affected Industrial Special Study b. Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) Please indicate below if any of these events have occurred in the last five years on the property. Rezoning Case Number Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building /Land Use Permit For Army Corp of Engineers Permit E. Legal description for advertising. Lo -r 49 b) LoT q- Lo -r C,Lp-r 4-q tj, 7421 )I jz 3W Lo cpTc�� lypsr of Af�rT LnoF zawc> 0 Sn,-rL4 of LILLCS7otJ 4:z�T"c"T F. Checklist I/ 30 Copies of Plat Y, ._Reduced Copy of Plat (8'/2x 11) Certificate to Plat Aerial Photo Soils Report 4 Copies k Housing Stock Map k Landscaping Requirements Zoning Map I/ Fee Y, Drainage Plan Topo Map 3 Copies Soils Report 4 Copies k Pedestrian Walkways k Landscaping Requirements Waiver Water: ✓ Private Wells Community Well Public Utility Sewer: u/ Private Septic Community Sys. Public Utility 20 W9 BaCk IRBv. 9/921' ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 June 24, 1993 Spinell iIo.mes, Inc, 0 9210 Vanguard Drive Anchorage, AR 99518 Attention: Chuck Spinelli Subject: Lot 49 of. NW1/4S15T12NR3W Soils Exploration Testholes r On June 22, 1993, testholes were dug on bots 49A, 49B, 49C and 49D of the NW1/4S15T12NR3W for the purpose of determining whether an onsite septic system could be placed on the lot if the interior lot lines were vacated, The testholes were placed on existing Lot 49A and Lot 49B, The attached diagram illustrates the exact locations. Materials encountered in Testhole No, 1 ranged front, peat at ground level to 1' below, then silt to 5 1/2', gravel to 9-1/2' then silt to the boltoni. of the testhole at approximately 18' below the surface, A percolation. .test was run in the silt layer at 3-1/2' to 4-1/2' below the surface. After a presoaking period the rate was measured at 24 .minutes per inch. This rate is acceptable for an onsite system and would require 1,000 square feet of drainfield area for a trench type system. Tosthole No. 2 was excavated on existing Lot 49B and revealed soils similar to. Testhole No, 1. A percolation test was run in the silt layer at 9-1/22' to 10-1/2' below the ground surface. After a presoaking period the rate was measured at 20 minutes per inch. This rate is also acceptable for an onsite system and would also require 1,000 square feet of drainfield area. A third test.pit was dug on existing Lot 49A for the purpose of performing a percolation test in the dense gravel layer. After a presoaking period the Pout -It' brand fax transmittal momo 7671 Mol pages r From Co. �•�C.. (. ( Cay .q Dept. PhOtler—E Spi.nell Homes June 24, 1993 Page Two rate was measured at 49 minutes per inch, This rate is much slower than tests run in the silt layer and, although acceptable for an onsite system. would result in a much larger drainfield area requirement. In conclusion, Testholes No. 1 and No, 2 revealed soils acceptable for the construction of an onsite septic system if the interior lot lines on Lot 49 are vacated, No groundwater was encountered in the excavation and none is anticipated over the monitoring period. The monitor tubes must be checked, however, after seven days to verify that no groundwater is evident, Testhole Logs and Percolation Test results are attached for your use. Please advise if you need additional information or if you have any comments. Sincerely, n Michael El". Anderson, PR fx:'i yam? �:Ib "417 Aya���.d)e,J9eyr,+oo �Y��C00 mjchc.l C. Ardmis,)n % 4381•E _ OWmulnldpsllty of AnohorepoDEPARTMENT QF HEALTH & HUMAN S�RVICLS 825 "L" Street, Anchorage, Alaska 99502 -OW SOILS LOG Ww PEWCOLATION TEST �nec PERFORME'O.POR: //1°�h1.CL.L..• I9Mf".5, DATE PERM LEGAL DESCRIPTION:,(„ T_...- `�_ Township, Flange, Section; nl IAI 2 3 "r I11� pd/oIGGJIDng� 6w 11"It 4 ert, 7 ion e 8 10 12 13 14 15 16 17 18 19 20 �0 1W r1T 41 WAS GROUND WATER ENCOUNTERED7 — d IF YES, AT WHAT DEPTH? O P E Depth W Welty After 111841tnriap7 - 0+1a� ':5 f1 1 9J, o,t;7 Qt S, ,P o ■■ 1■ ItIEN Reading tete Grou - Time nit Net Tim „y, Dwth to Wate I Not - Drop 'a w DI = r'w 31 0 ■■ 0" 10,5 1 7 I o 7 0 D Z 0 ■■ 1■ ItIEN Reading tete Grou - Time nit Net Tim „y, Dwth to Wate I Not - Drop 'a w DI = r'w 31 0 9+1 0" 10,5 1 7 I o 7 0 D Z 0 PERCOLATION RATE (m,nuteG/mGh) d , HOLE DIAMETER COMMENTS ._..LF rI L_� .. .r` ,.,„,... ili�ikLll'-LEftw.`�.„ FERFORMrD EY: .,.,,.._,__�� .......,.,. I—..:C`S�F�tL._![�.�t (;.,.� jYb(-ryTTFY'PtIAT TH15 TEST 1WAS• PERFORMED IN ACCORDANCE WI71•t ALLSTATE AND MUNICIPAL GUIDELIN6E51N EFPEG'f ON THIS DATE DATE; 7?,000(Roy 4i06) • Municlpallty Of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 829 "L" Street, Anchorage,, Alas" 99602.0650 SOILS LOG •— PERCOLATION TEST PERFORMED FOR:,_,_,_ `F'�N E'c,L. Mc'sOATE PERF(Q(t /_ p M LEGAL DESCRIPTION: IP7' / e Township, Range, Section: NW /J ' DEPTH (FEET) 1 2 ' 3 �� �.�, v1/vcr, gr6�IG1 lot�y�s ZCAL y �I} '��Mrw/ou.W Irn6.s a 9 ra e 10- 11 0 11 Q; �e.11�iG 4 �)• , :tea gre�t� 16 17 1j04 is- 19 - 20 8 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH?- » B01411 to WAV mu Rending Data Gross Tlme Not Tirne Depth to Water Net Drop y �I} '��Mrw/ou.W Irn6.s a 9 ra e 10- 11 0 11 Q; �e.11�iG 4 �)• , :tea gre�t� 16 17 1j04 is- 19 - 20 8 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH?- » B01411 to WAV mu Rending Data Gross Tlme Not Tirne Depth to Water Net Drop 3' + I.4 lob r — 1 a h. tr' i n IL PERCOLATION RATE TEST RUN BETWEEN ynnomvincn) PERC HOLE DIAMETER ;T AND --V-FT I I t PERFORMED BY; ons Y THAT THIS TEST Wn PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:L�7� 72=008 (nov,4)E5) 0*hMunlcljpetlity of Anehorape DEPARTMENT OFF HEALTH & HUMAN SERVICES ,251'L" Street,,Anchorage, Alaaka 995112'0,50 i SOILS LOG PERCOLATION TEST PERFORMED FOR: IPJMCu.. M C. S _ DATE PER LEGAL OESCRI 3 SLOPE MnQTM� Vt ItV 1� d1 ;v p. .0i' 04 Vn<A�4Lx�0 U00 ooaVcon n:, ',p�; Michnul E• Anticrsun � L}! 1J�p. r�v'U�µ I Q'D,v}v.aw.1 7%! 5/5.7-/ eA./ 3 W SITE PLAN -—,�'• WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Ml 1� 5 ...r^ L p Depth to Water Aller MoNWIng? aa:. P E ME® is in Reeding pate �.8 Not Time 5 i a' 8 a, SLOPE MnQTM� Vt ItV 1� d1 ;v p. .0i' 04 Vn<A�4Lx�0 U00 ooaVcon n:, ',p�; Michnul E• Anticrsun � L}! 1J�p. r�v'U�µ I Q'D,v}v.aw.1 7%! 5/5.7-/ eA./ 3 W SITE PLAN -—,�'• WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Ml 1� 5 ...r^ L p Depth to Water Aller MoNWIng? aa:. P E ME® is in Reeding pate Gross Tlme Not Time Depth to Net — Wetu Drop A A b OD FOG :17 0 a9n., P y i tis o , p (r ?1 Ib w e PERCOLATION RATE t� (minulos7mcn) PERC HOLE DIAMETER I I TEJT RUN BETWEEN FT AND—101—FT - COMMENT$......I��l__.F.�I'.VYY2�.L.I,(,f.,, '/I/4W lel L,/.jf�_�A-- PERFORMED BY: ACCORDANCE WITH ALLSTATE AND MUNICIPAL CUIOF.LINCS IN EFFECT ON THIS DATE DATE. __._.._ .. �,L V/ P. „• ____ 72.000 (Rev. 4i05) li II JOB CHECKED BY--„_,__ - DAM__ P_ I _/ Vi ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 June 24, 1993 Spinell Homes, Inc. 9210 Vanguard Drive Anchorage, AK 99518 Attention: Chuck Spinelli cy� Subject: Lot 49 of NW1/4S15T12NR3W Soils Exploration Testholes Gentlemen: iCC- r-(V1: Spinell Homes June 24, 1993 Page Two rate was measured at 49 minutes per inch. This rate is much slower than tests run in the silt layer and, although acceptable for an onsite system would result in a much larger drainfield area requirement. In conclusion, Testholes No. I and No. 2 revealed soils acceptable for the construction of an onsite septic system if the interior lot lines on Lot 49 are vacated. No groundwater was encountered in the excavation and none is anticipated over the monitoring period. The monitor tubes must be checked, however, after seven days to verify that no groundwater is evident. Testhole Logs and Percolation Test results are attached for your use. Please advise if you need additional information or if you have any comments. Sincerely, �/ `- ate, G(lLGi(.�� Michael E. Anderson, P.E. ROCKFORD CORPORATION P.O. Box 111706 SHEETNO.__ — OF_ ANCHORAGE, ALASKA 99511 CALCULATED BV 104�— DATE_ (907) 3444551 FAX (907) 344.2130 CHECKED BY— — DATE_ SCALE ' L� _ _ ,� A P lv TN - �-� 4 t9L Mi h d F. vcf.rsorl T- T3f11 38 1 PRnuct 2N iIS". SA 2O' P,"' �Irc,O.'Nasi OlUL to OWPHOSE TOIL ME 1MKS M Municipality of Anchorage , DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 c`_--'� •,»- SOILS LOG — PERCOLATION TESTA PERFORMED FOR:_—S��n1 CLL_ /YiE'S V DATE P 9 LEGAL DESCRIPTION:__' 49 — Township, Range, Section: /\ a7swy� i,,.i SLOPE 1 — 2 3 5W 1.0 4 e• ;, 5 ec• 6 7'! n_nni, 6 9 10 11 12 13- 14- r�ir rIT 15- 16 5 16 �T 1 77 78 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? 'q _ IF: YES, AT WHAT DEPTH? Depth to Water Aller Monitoring) oNC Date:�S_ `t `(ENgJN� ER'S SEAL) t J)19F 0 E. Andnrson 1/4 s/S 'r SITE PLAN Reading Date Gross Time nL� Net Time qhs Depth to Water iA Net Drop(ID) _ Q✓' 0 S F� I ,59 o 1�� of 9 0l T 9`IS H 16 o I o IA R Iq,SG` n .31 0 31 o o ;rp +CiO o fog ,63. �3 o IO:O Io05 o — CI; P12RCOLATION RATE_�+�/// � minutes/inch) TEST RUN BETWEEN .mak FT AND 13L d HOLE DIAMETER PERFORMED BY:�T _ �'! /t. i,(2[X ° F—alP GLC RTTPY THAT THIP TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ 72-000 (Rev. 4/85) PERFORMED FOR LEGAL DESCRIPTI DEPTH (FEET) 1 ' r , 2 3 I cYL /'• ) ZonL4 5 , . 6 0' n 7 a. 8 0 10 12 ' 13 '.E 14 �.:. 16 fL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 15'` ` SOILS LOG -- PERCOLATION TEST;., r7ati s; sly/n19-1 L 4,,4 ES --- DA-r�1,�I�;F Z07- �� / Township, Range, Section: hJt tl 5M, 14 1/1 1rg'v l je'its" �prnPi Ljrbvfrl 17 Ij04 18- 19- 20- COMMENTS 9 20 COMMENTS �VY ILrtsaS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE L o --_ P E Depth to Water After ,', / Monitoring? 0'JL Dale: S& _ - q„ttNUINEER'5 SEAL) . I2 �7 asul.r: F�'I101 E`S SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop oILMa — — t�' 23 IS o 2• .ri G o 03 9br Ih � 13,06 II:B$ .51� Z 15 o Z.1. A3 n E .. •1 L PERCOLATION RATE TEST RUN BETWEEN It (minutes/inch) PERC HOLE DIAMETER I FT AND �FT PERFORMED BY: I Lr�`�`�-' ccg-CERTIFY THAT T IS PEST WAS PERFORMED IN ACCORDANCE WITH ALL. STATE AND MUNICIPAL. GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L'• Street, Anchorage, Alaska 99502-0650 SOILS LOG •— PERCOLATION TEST PERFORMED FOR: /5�7�1E1L _DATEA LEGAL DESCRIPTION: i 7" / Township, Range, Section: At SLOPE (FEET) 1 — 2/ vl/�Il 3 II I I 5 � F oGGNSlghrbl �rvgvG �`/YV IPr1UiF17 4 �e o� 6 7 8 91_n e' I M,61 10 Net Time Depth to Net Water Drop 11 , 12 13 14- 4 15 15- G�ora �ob to 16 16 ,3 e L' Gil 0 17 o Oy1 (vt6j to 18 19 20 COMMENTS WAS GROUND WATER I1I"�J" ENCOUNTERED? JI SOry hlI tIF YES, AT WHAT _/' p . �o DEPTH? P W/1 04(d (OGG) v E Depth to Water After Monitoring? W0n1F Date: J3 6 _ SEAL) 049 SITE PLAN W/iOAAC, I {G Reading Date Gross Time Net Time Depth to Net Water Drop G�ora �ob to o ,3 e L' Gil 10' Oy1 (vt6j to o PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER �— p I I I/ -EST RUN BETWEEN __/� FT AND 1� Z FT PERFORMED BY:—____—C1.IL__ I ! "�" �E�i(-TIFY THAT THISTEST WAS PERFORMED IN / ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C1 ` ?–e 72-008 (Rev. 4/85) lre, P.S I _ L `` ! I 1-310 1 I x 07,500 v v _ r i I I T¢ C o, LOT' t !rn IN ISO • h »000 I_.... -� 350 I ; 140 1�