HomeMy WebLinkAboutHAMANN ADDN #1 BLK 1 LT 6Hamann
Block 1
Lot 6
#050-611-26
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
N, ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME — C? f�7 �•Y'l.�o %., t--l✓�'l��" Y"�'i.L /lr
PHONE
�`!S /5
❑ UPGRADE
MAILINGA DRESS +
LEGAL DESCRIPTION
L[ -t- C;, % Cy�lnJ ave 31 �GL�°� C�vb J ze %
LOCATWN
NO. OF BEDROOMS
Uy
DISTANCE TO:
Well /'(7� t
Absorption area
,%
Dwelling -
PERMIT N
Manufacturer �"1�
Materi %
No. of corn p3�tmants
'd
wQ
I.-
W
Liq. capacity in gallo
/G ns J d
IF HOMEMADE:
Inside length
Width
Liquid depth
JV`Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
2 z F
Manufacturer
Material
Liquid capacity in gallons
O
w=
DISTANCE TO:
Well r
��93�
Foundation
10L Ar
Nearest lot line /
/
PERMIT NO. t<1
'Il -e? r_Y'I '7%�
' J LL z
z W
—¢
No. of lines
%
Length of each line ✓
464)
Total length of lines
Trench width
, 6; inches
Distance between lines
� F-
Top of the to finish grade /
Material beneath the
Total effective absorption area
0
�
� j cg inches
3 11
Length
Width
Depth
PERMIT NO.
w
a
ii,-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Wa
W
w
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
3
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
Y . Arp ry
SOIL TEST RATING
d E�rm =StJ¢
INSTALLER
Hap" n17
REMARKS MUSrN
$ "r .;
AIR
enF
*;
.49TH
............. .....A An
o
2225-E
QP✓ JUNE 25, 1971.•`M,id�®
�,\O
N®L
APPROVED IATE LEGAL
)91 t Aim r� y y, AO&A
72-013 (Rev. 3/78)
Jr
Department f Health and Environment? Protection
825 J Street, Anchorage, AK. x-49501
264-4720 ��'
Permit 3Ui�c/ # # HANDWRITTEN PERMIT # # #
WELL D/OR ON-SITE SEWER PERMIT
Applicant: /i4/ ,l�.C/l� 1`.�1/�2� %��Nl�iling Address:
Location: Phone Number:
Legal Description: c�! � a&l 949,411
1 ._. Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: _4,__Seepage Bed Holding Tank:
Maximum Number of Bedrooms: _73_ Soil Rating(sq.ft/br) J.�-)
The Required Size of the Soil Absorption System Is:'
DEPTH LENGTH L _ GRAVEL DEPTH WIDTH -1492�
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# # TWO(Z) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection.and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
# # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is rem deled to include more that[3 bedrooms.
Signed :r--�� �:� Issued by :
Applicant
Date:
SWP/024(1/81)
Y I K SOILS LOG
MUNICIPALITY OF ANCHORAGE J
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
U TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Aze1O7-.7/'f7C4n � 6"'t�/" DATE PERFORMED:
LEGAL DESCRIPTION: L
SLOPE SITE PLAN
DEPTH
(FEET) GJ,C!AwiG
1 55'nc( r /.fir c.✓C /
C2
3
l'
5
7
I
8 j
9
10 4--
12
M■■■
MENM
MEMM
■1100
MEMS
■EME
■FMMM
M■■■
■MEN
OMEN
■E■■
M■■■■■■■E■
Date
Gross
Time
Net
Time
■■■MEMO■■■
Net
Drop
EMMENEEMEN
MI■■E■EM■'EM
011MM■■E■iME
NIEREMENEEN
■1■EME
OMMENERSEE
\■IM■
EMENEEMENIM
E■EMME■■■■
EM■■■■■EM■
■EM■■■M■■■
WAS GROUND WATER - S
ENCOUNTERED? �`� L
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
20 PERCOLATION RATE / � O (Vi[ -1. OA (minutes/inch)
J - TEST RUN BETWEEN FT AND FT
COMMENTS
• r 5Y�
PERFORMED BY: G' 40526"' -"4 CERTIFIED BY: 'ys DATE:
72-008 (6/79)
M -W DRILLING, Inc.
P.O. Box 10.378 • 10300 Old Seward Highway
(907) 349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner DAVV) 1(21. / .Tf+il FORWRIP Use of We11Ikn
Location (address of: Township, Range, Section, if known; or distance main road
Trac 0 Bloc%- 1_ '.[ract A l,:.l n<Au1r Sdbd7Y.d_Si( -i
Size of casing 6, Depth of Hole l) -feet Cased to 70 feet
Static water level 10 ft. (&W%) (below) land surface. Finish of well (check one) open end ( XX ) ;
Screen ( ); Perforated (
Describe screen or perforation 1`km
Well pumping test at .5+ gallons per flYMR') (minute) for --i hours with 100% €t
of drawdown from static level.
Date of completion SeotenDbox; 23, 1983
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
aming sti(:4up
Organics , wet
Silty gravel
Soft Bedrock
iGdrocyk, CI j
Bedrock, syru l w7ater sem)s in snoraffc frect111;<�s
3 —CONTRACTOR
TO
2
2
TO
6
TO
TO
9
1.9
TO
J !10
140
TO
2>0
TO-
OTOTOTOTOTO
TO-
TO-
TO-
TO-
TO-
TO
-TO
TO
TO
aming sti(:4up
Organics , wet
Silty gravel
Soft Bedrock
iGdrocyk, CI j
Bedrock, syru l w7ater sem)s in snoraffc frect111;<�s
3 —CONTRACTOR
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
/07- 6 d l' -11 1,/ g m 2 a V1 S//) Se�f7',' o �i A
Location (address or directions)
(b) Applicants Name Qvi'c� (�(i,J Uhf , aai161P. Forre:�i t Tblephone KY!f�-6<96?41
Applicants Address L'ver RL Eayle PLeNtAi'i `TL 77
(c) Applicant is (check one) Lending Institution ; Owner/builder
Buyer r_1 ; Other f::::l (explain);
(d) Lending Institution Ala5ka M1 alc-ca I PceL, k Telephone 33�5-7`70
Address _&kj SC>11 czuc� 'L ifl Vi e- S0±2
(e) Peal Estate Co. & Agent
Address
Telephone
2. Type of Residence
Single -Family � Multi -Family Other (describe)
Number of Bedrooms
3. Water Supply
Individual Well Community Public
Note: If ccmwnity well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrooms specified in this HAA (YIN) Xe5
4. Sewage Disposal
Onsite Public Community Holding Tank
Is the wastewater disposal system adequate fcr the number of bedrooms (Y/N) yes
[Page 1 of 21
2-15-84
5. Encineering Firm Providing Inspections, Tuts, Data and information
„I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in
effect on the date of this inspection. Ex,�eyt os 17oled ov, cheek 5-13-54,
.fin-Pov"JMbN based oh il'sQecfiiOhi well /oj teri;c sy5rem fQrAf,i-c1"d o)5PecTRm Peoor
Signed�� _�1 �. Date �3 -1 3-
Nam
>"Name of Firm L T E a l, e (F ULci Telephone
Address /5-� E-0 o ,2,')ev Rd, rC.'q16RIuerAK
10111 "04
Date
(ENGINEER SEAL)
6. DHEP Approval
Approved for --:2- bedrocm
Approved F:::l Disapproved f:::l conditional
• -�"''�' ��®fin
Date
The Municipality of Anchorage Departrent of Health and Environzental Protection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedrooms and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
(page 2 of 2.1
2-15-84
,9y AA e I/t-u.,l CK,
MUNICIPALITY OF ANCHORAGE (MOA) (j
HEALTH AUTHORITY APPROVAL (HAA) G I A R D
CHECKLIST - FEBRUARY 1984 VuG% i; 61VIN
B. SEPTIC/HOLDING TANK DATA
Date Installed 9 /`d - Size /00 O No. of Compartments P.
Standpipes (Y/N) ke5 Air -tight Caps 11 _) '25 _ Foundation Cleanout /N) o
Depression over Tank (Y/N) jun Date Last Pumped %/ZA
Pumping/Mairtenance Contract on File (Y/N) % for
Holding Tank High -Water Alarm (Y/N) A1,1A Temporary holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply 4b11 /00 t To Building Foundation J %
To Property Line 3,3- To Disposal Field $'
To Stream, Pond, Lake, or Major Drainage
To Water Main/Service Line 3L To 9e
Course WA p --
Comments < %ati o"I 41 gaselMyVI l .
>1l.e� G' 0. Al
_ [Page 1 of 21 2-15,84
+101103102Nd WiN3'NNMIAN3
A. WELL DATA
Q HilVIH 40 *id](]
3JVd0HaNV d0 1dilVdDlNnVq
Well Classification �r�ya�E'. If A, B. or,
C. D.E.C. Approved(Y/N)
7-25- S:3 Yield I !2 �
Well Log Present (Y/N) /'es Date Completed 7th
Total Depth '� ✓ Cased to 2 g
of
DepGrouting
Static Water l:svel /Q' Pump Set At
2 70 r
Casing Height Above Ground /b"
Sanitary Seal on Casing ( 2Lw
Electrical Wiring in Conduit (Y/N) y -es
Depression Around Wellhead (Y/N)
Separation Distances from Wells
To Septic/Holding Tank on Lot /�iC} ��- _
It
% On Adjoining Lots /00�
To Nearest Edge of Absorption Field on Lot JJ L % On Adjoining Lots 100'f
To Nearest Public Sevnr Lire ///A
To Nearest Public Sewer
Cleanout/Manhole IVIA To Nearest Sewer Service Lire on Lot /00 't
Water Sample Collected By Jaraey 1, Thole %
Date
Water Sample Test Results 20 s5eel
I Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 9 /`d - Size /00 O No. of Compartments P.
Standpipes (Y/N) ke5 Air -tight Caps 11 _) '25 _ Foundation Cleanout /N) o
Depression over Tank (Y/N) jun Date Last Pumped %/ZA
Pumping/Mairtenance Contract on File (Y/N) % for
Holding Tank High -Water Alarm (Y/N) A1,1A Temporary holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply 4b11 /00 t To Building Foundation J %
To Property Line 3,3- To Disposal Field $'
To Stream, Pond, Lake, or Major Drainage
To Water Main/Service Line 3L To 9e
Course WA p --
Comments < %ati o"I 41 gaselMyVI l .
>1l.e� G' 0. Al
_ [Page 1 of 21 2-15,84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata1 J O �'%2��1� Type of System Design
Date Installed ( - Length of Field G(�
Width of Field 4 C0 " Depth of Field %` to 21,
Gravel Bed Thickness ,300
Square Feet of Absorption Area #65 -PT 2 Standpipes Present (Y/N) Yew
Depression over Field (Y/N) /%/O Date of Last Adequacy Test /VonP Y� '
Results of Last Adequacy 'Ibst LLA
Separation Distance from Absorption Field:
To Water -Supply Well ) / 3 To Property Line
To Building Foundation a To Existing or Abandoned System on
Lot A4 fl e- ; On Adjoining Lots JOc) `f -
To Water Main/Service Line 17401 To Cutbank(if present) IVA
To Stream/Pond/Lake/or Major, Drainage Course �11A _
i
To Driveway, Parking Area, or Vehicle Storage Area /O
Comments
D. LIFT STATION
Date Installed 4 z Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Check
Permitted Bedroom Rating Against HAA Request **
I certify
that I have checked,
verified, or conformed to all
MOA HAA Guidelines in effect
on the date of this inspection.
Signed___«�c�fz
Company
�-
J
Date 3 13 �
MOA No. S/`6 z1-,0061
'`�''�p.•' •••.¢9 a
: • = s••:• w
•=._� . k
KB1/d5/s
[Page 2 of 21
2-15-84
4
HAMANN CONSTRUCTION CO., INC.
P.O. Box 617
Eagle River, Alaska 99577
MUNICIPALITY OF ANCHORAGE
Oct. 6 , 1983 DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 1 s
Cory Willis
Municipality of Anchorage RECEIVED
Pouch 6-650
Anchorage, Alaska
Dear Mr. Willis:
Referring to your letter dated October 3, 1983. The subject
septic installations for Lot 6, Block 1, Hamann Subdivision ##1, and
Lot 8, Block 18, Northwood Phase #4. The above lots were installed
with a berm over the septic drainfield, thus raising the finished
grade to a point 12 feet above the existing grade at the time of
the soils log for lot 6, Hamann Subdivision; and 1 foot above the
existing grade at time of soils log for Lot 8, Northwood Phase ##4.
This effectively raises the level of the trench and drainfield to
accepted Municipal limits.
If there is any further question, please contact my engineer,
Tobben Spurkland, who has been in contact with your office on this
matter.
Sincerely,
r`i la ,!
��
Robert J Amann
t,
Hamann Construction Go,, Inc.
DGS (_g,�
�o,t
SNL"4YI3i; i' a r 13u3
`t{uiitii�1T1 construction
Y . c {lox 617
ac31:>> i<ivc.r r tip 3957
1,ot 3sf;�i��trz 1a,Tdi.,1C7t'1
I'O �5 131c3c. �.; p riE�C#_.1 ✓,) C9 z ilia.�<-: F
tli:, 7.Tl�'c7�.f. 'LJL,C)ta0isiat'i7}lAy:.7��..��a-..i �
t!�r tl7e ak Svc: c�YY_61i e iVjstal l .,jtjk
n L^ £3 kY f."� �tiY :reach to beabove beorock
60epr. t.JcAri the 30110 test allowa.
�• -•-�.`d,t.'si:ie call
1i You iIGIV, iiiY V11""'ClI'.r ju -2stions i-
�y�Ltf'Y-�.�.4iiif
')9!301
Jiiicerely/
Cory VA.L11S, iia :3c
jict.illcj .S'XO eL & F3 i1 i
8 9
6 10 j pyE a°
Municipality of
a
On -Site Water and Wastewater gr �\ w
(907)343-7904 a SEP g 2�;5 n s
CERTIFICATE OF ON-SITE SYS S APPROV
.!Z 01 6 8 t, 9 5
Parcel I.D. 050-611-26 Expiration Date:
1. GENERAL INFORMATION
Complete legal description HAMANN BLOCK 1, LOT 6
Location (site address) 24525 COLEMAN CIRCLE, EAGLE RIVER, AK 99577
Current Property owner(s) DAVID WICK Day phone
Mailing address
Real Estate Agent
PO BOX 771066 EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class _ Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
ncucived Ivy: Date:
COSA to be released to the engineer, unless otherwis e d by the engineer.
COSA Fee $ :52L'o
Date of Payment `Y L/u l%
675
Receipt Number 67310-D
COSA# Q, IN61503
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal 010M99M 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 andlor 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 ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 9/9/15
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen OFA
encroachments, deficiencies or discrepancies exist. �� Z,4, ,
4 q
, f,
*`4ATII y
6. DSD SIGNATURE
System #1 Approved for a
System #2 Approved for
Disapproved.
Conditional approval for
P KEtiNETHr�1. DO -W
bedrooms. ! � ;,
bedrooms. 1 \
ssloi;N,
bedrooms, with the following stipulations:
WASTEWATER
Ry: Original Certificate Date:
The Munic alitof orage 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. _.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA We sheet_141 0_12.d.
If more than 1 septic system Is on the tot:
COSA Checklist # of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: HAMANN BLOCK 1, LOT 6 Parcel ID: 050.611.26
A. WELL DATA
Well type PRVT
Date completed 9/23/1983
Total depth 280 ft.
If A, B, or C provide PWSID # _
Sanitary seal (Y/N) Y
Well Log (YM)
Wires properly protected (Y/N) Y
Cased to 26 ft. (INTO BEDROCK) Casing height (above ground) 18+ in.
FROM WELL LOG
Date of test 9123/1983
Static water level 10 ft.
Well production 0.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 0.109 mg/L
Arsenic: ND ug/L Date of sample: 8/19115
B. SEPTIC/HOLDING TANK DATA
AT INSPECTION
1/30/14
86 ft.
0.4 9.p -m.
Collected by: ARCTERRA
Tank Type/Material SEPTIC I STEEL Date installed 9/1911983
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y (INSIDE FOUNDATION) Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping B /B -1S Pumper JRs
C. ABSORPTION FIELD DATA
Date installed 9/1911983 Soil rating (g.p.d./ftZ or felbdrm) 0.45 System type SHALLOW TRENCH
Length 60 ft. Width 5 ft. Gravel below pipe 2.5 ft.
Total depth 5 ft. (Measured 917/15) Eff. absorption area 468 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 917/2015 Results (Pass/Fail) PASS
For 2 bedrooms
Fluid depth in absorption field before test 14 in. (BELOW INVERT) Water added 525 gal. New depth 4 in. (BELOW INV.)
Elapsed Time: 1320 min. Final fluid depth 11 in. (BELOW INVERT) Absorption rate >= 367 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at —in.'
Datum
Size in gallons
"Pump off" level at _ in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tankAift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 751+
Sewer /septic service line 254
Animal containment areas 504
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas 100'+
Absorption field 5'+
Water main 10'+ Water service line 104 Surface water 1001+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 104 Building foundation 10'+ Water main 10'+
Water Service line 104 Surface water 100'+ Driveway, parking/vehicle storage 104
Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 100'+
F. COMMENTS
Septic system operating in the upper portion of the effective depth.
G. ENGINEER'S CERTIFICATION
l 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. �! OF AL�cS`
Engineer's Printed Name KENNEIH M. DUFFUS
Date 9/9/2015 t * 9 TH
COSA canary sheet_2-5-15.doc` Kf
fA ENNETH ll[: E
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ei.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 151503
During a recent COSA on-site inspection and test of the potable water
supply well on Block 1, Lot 6 of Hamann subdivision, the well's
productivity was determined to be 0.4 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 2 -bedroom
residence is 0.2 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
0
A56UILT
"-Wen ,..M.....
3' zt- ` ma:.
SGS
SGS Ref.#
1154653001
Client Name
ArcTerra Engineering and Surveying
Project Name/#
Hamann B1, L6
Client Sample ID
Haman B1, L6
Matrix
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
08/28/2015 11:12
08/19/2015 12:15
08/20/2015 9:10
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
LOQ
Units
Method Container ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
08/21/15 08/24/15
EAB
Waters Department
Total Nitrate/Nitrite-N
0.109
0.100
mg/L
SM21 450ONO3-F
B
(<10)
08/25/15
SLC
Microbiology Laboratory
E. Coli
Negative
1
100mL"
SM21 9223B
A
08/20/15
MEV
Total Coliform
Negative
1
100mL
SM21 9223B
A
08/20/15
MEV
_SGS
Brent Western
ArcTerra Engineering and Surveying
20441 Ptarmigan Blvd
Eagle River, AK 99577
Laboratory Analysis Report
Work Order: 1154653 Forest Taylor
Hamann B1, L6 20 5.48.28
Client: ArcTerra Engineering and Surveying V s V`7.� l
Report Date: August 28, 2015
Enclosed are the analytical results associated with the above work order. All results are intended to be used in their entirety and SGS is not responsible for
use of less than the complete report. If you have any questions regarding this report, or if we can be of any other assistance, please contact your SGS
Project Manager at 907-562-2343. This document is issued by the Company under its General Conditions of Service accessible at
<http://www.sgs.com/en/Terms-and-Conditions.aspx>. Attention is drawn to the limitation of liability, indemnification and jurisdiction issues defined
therein. Any holder of this document is advised that information contained hereon reflects the Company's findings at the time of its intervention only and
within the limits of Client's instructions, if any. The Company's sole responsibility is to its Client and this document does not exonerate parties to a
transaction from exercising all their rights and obligations under the transaction documents. Any unauthorized alteration, forgery or falsification of the
content or appearance of this document is unlawful and offenders may be prosecuted to the fullest extent of the law.
SGS maintains a formal Quality Assurance/Quality Control (QA/QC) program. A copy of our Quality Assurance Plan (QAP), which outlines this
program, is available at your request. The laboratory certification numbers are AK00971 (DW Chemistry & Microbiology) & UST -005 (CS) for ADEC
and 2944.01 for DOD ELAP/ISO 17025 (RCRA methods: 10208, 1311, 3010A, 305013, 3520C, 3550C, 503013, 5035A, 6020A, 7470A, 7471 B, 8015C,
8021 B, 8082A, 82608, 8270D, 8270D -SIM, 90400, 9045D, 9056A, 9060A, AK 101 and AKIO2/103). Except as specifically noted, all statements and
data in this report are in conformance to the provisions set forth by the SGS QAP and, when applicable, other regulatory authorities.
The following descriptors or qualifiers may be found in your report:
`
The analyte has exceeded allowable regulatory or control limits.
!
Surrogate out of control limits.
B
Indicates the analyte is found in a blank associated with the sample.
CCV/CVA/CVB
Continuing Calibration Verification
CCCV/CVC/CVCA/CVCB
Closing Continuing Calibration Verification
CL
Control Limit
D
The analyte concentration is the result of a dilution.
DF
Dilution Factor
DL
Detection Limit (i.e., maximum method detection limit)
E
The analyte result is above the calibrated range.
F
Indicates value that is greater than or equal to the DL
GT
Greater Than
ICV
Initial Calibration Verification
J
The quantitation is an estimation.
JL
The analyte was positively identified, but the quantitation is a low estimation.
LCS(D)
Laboratory Control Spike (Duplicate)
LOD
Limit of Detection (i.e., 1/2 of the LOQ)
LOQ
Limit of Quantitation (i.e, reporting or practical quantitation limit)
LT
Less Than
M
A matrix effect was present.
MB
Method Blank
MS(D)
Matrix Spike (Duplicate)
ND
Indicates the analyte is not detected.
Q
QC parameter out of acceptance range.
R
Rejected
RPD
Relative Percent Difference
U
Indicates the analyte was analyzed for but not detected.
Note: Sample summaries which include
a result for "Total Solids" have already been adjusted for moisture content.
All DRO/RRO analyses are integrated per SOP.
SGS North Am eric a lnc. !En vronmemaM
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