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HAMPTON HILLS BLK 1 LT 3
Hampton Hills Block 1 Lot 3 #015-134-42 Municipality of Anchorage Page ( of 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 Permit Number: -Swg4 00�3 I PID Number: Name: �o Wastewater System: L( New ❑ Upgrade Address: _ lCESZ �Li� DilZ, A A _( Phone: _ No. of Bedrooms: 2 -43i6 LEGAL DESCRIPTION Lot: Block: Subdivision: RAM P'MNKJ H I Township: Range: Section: WELL: New ❑ Upgrade Classification (Private. A,B,C): Total Depth: Cas di Ft. 144 iPe-( Ai_ Ft. Driller: ALPiN i�j2iLUNG Dale Drilled: Sialic Water Level: 5(ro(�t�j 65 Ft. Yield: Pump Se^t�at: Casing Height Above Ground: 2- i I •� GPM 12.61 Ft. F:L SEPARATION DISTANCES To Septic Absorption LIII LST J Tank Field Station NIA NlA THoldIngPub1lc/Priv8tFrom well- IIZ 132_ Surface N/A �/�} water MJA OJAr Lot 70 6® LineFoundation EMA QJA UJA 12 �� IWI/A Q CurtainP/,4 0/AA Drain Remarks: �UJFLe_ OU LST ` 1SLl" I /W -,I 04::' P(zo t 15 2� ro> f+ -5;,eP-)C_ � WEELl . Lc rr 4 A-V_ I �po-)tZil IS 2-2.y ft F2oM -5ffP-nc_ Sys tom! . ABSORPTION FIELD Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other Soil Rating: Total Depth Iromorginal grade: O GPD/Se. Ft. �� ' + — Depth to pipe bottom Irom original grade: Gravel depth beneath pipe A Ft. Fill added above original grade: Gravel length: 1JOQE Ft. 6_0 -(7+ Ft. Gravel width: �f Number of lines: Distance between lines: 2 < -S Ft. ill 10 Fl. Total absorption area: Pipe material: g!0 SD. Ft f:: r• Installer: Date installed: A �CcAvht11.>c, J14► 7 g lgcfA TANK Septic ❑ Holding ❑ S.T.E.P. Manufacturer: Capacity in gallons: AmcHop. A45�f. -rA4)K I 'I 2;D0 GAL. Material: Number of Compartments: COA17ED 2 LIFT STATION p/q Size in gallons: Manulacturer: "Pump on" level at: "Pump ol(" level at: I High water alarm at: Pump Make d Model I Electrical Inspections performed by: BENCFI MARK Location and Description cco6aff-ra PAD Cu r�;110E OF Mn�� Dx)oR, AT NF- 60PY vF-?, OF Houma Assumed Elevation: rN�IG� u��// IOv-co _ ENGIRMkrhWL Inspections perforrned by: � T- 6�_ bates: 1st 6 7 2nd 6 Department of Health,an Human vices approval Reviewed and approved by: Date-�O/°/ n -1 me„ 0.01% MnA 95 Permit No. -%J-74 002 i Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES of 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: kAA/jP-j-r_Q 1,110 `S, Lc -,;-r :-;;., I— PID No.: :5 W I N3 CN -n;—= 1) KrA. A-126142"�426-1 34 Lc>" A-2 ........ .. .1 ...... .. 6.73 .......... I A-4 57 lroto A-5- CqL-7" MON rT.04Q(r-' 2- ............. ...... .......... ........ Ar4 S-7 6 3 7. 10_7 71"" A -S q51 6 -C C:-10 12'4 1 it G-16 C 12. 24-10 C --t3 7- 1 C -A 28)- 311 1& V) - J/ VALVE - 72-013 A (1193) - - 0 I:EA-4 2- 201 I Permit No. 5;W ':�7q oo? 1 Page Z of Z 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: NJ&A+M'j 1'I « S., d� 2; GLV— I _ PID No.: 0/6-13-442- 72-013 /6-13-442- 72-013 A (1193) WELL SYSTEM DATA SHEET 106sz> Owner of WellQT �_ GF�L.!l(�i"i-�- ALISC41 L- SA,tT'M ELIC C(L Drilling Company AL_PIN a CQtU- 1JG P DAV C 1.1 VaP , Pump setter AL_IPIIJa C1I1i�-L.I Qa Inspector V -Liz -7 F, P.0. Make of Pump C --t 2u ria P�b<s's Model or Type 10 507 e 12- Size 1Size '�q HP Volts 2.30 Phase Serial No. of Motor Date Pump Warrantee Begins Drop Pipe(s) 5!QC-Le- Material G--,ALVAJI ZGD _ Serial No U IJV�ow>J Cycle 60 GYCc-EL SINGLt= P(�IA�E Pitless Adaptor Brand and Type ��Atic-F_ D MAS/ 2-0. IG6t4 Diameter I Length 12G 'Pt• Electrical Work and Controls 136/ IZ-3 WE�L_L W!+2E=_ 131x' IZ-3 U F W 1(Le . N 01--F= : !2eD * sLAc-K. W 1 R-irS AR -f-- H cn : Comments wF-t.t_ ! 7 --me 14 b Pt Tn'r`T WAS 'Te-9A-hQA'T'F_SJ AP;I 2 16- wrh AXQ AN F ---Z P(,WPUJG T�ff-s-r WAS PrFIR�eZ Ar I I.� 9p�, . TYl+S TEs -r WAS 11EP-MINAn-F-b A7" 98 milk w Mi A -RaTAL 20 -P!- OF 0Y1Aw0owJJ, Toe CAST P"010(5. 4_AS-r� 4 HoutZ:S 4vb P-F-Su-7,.� W A -fDTAL- OY2Awdow,-� oi= 22,2'9 -Pt. 1N4:-: We -la- TD rr)N- c- LeveL. io oNLy _% AAlIJlxTE=$. OVA Q,CCO CALL -00G 04= WA -T WAS P(,VMPC~_I] F-gCwI 1bIE= LUEO- ON 61S* CSM Date Si SOF, ........... A t Kurt Z. EgelWer i `^O'xJ .� CE - 7635 +4444\,o PROFESSIONP���� AQUIFER TEST FIELD DATA SHEET T AT -ZF rVI 106 Project No . 5 W 131 © 031 Project Name_ LI{� /SM n1 i Well No. Location of Well HLOP120 {MILLS PLoGI< I � LOT 3 AMCWI>QAC,(zI AK Depth of Well IqI ft. Length of Casing Ida ft. Top of Casing to Static 0AVI0 Date Drilling Completed_51ol9q D ill.er NhP-P�Date Tested t J}olua CV-ILZ-,1y_ ) Pc�,�+.mac,. >eEEcovSa>-/ � +elapsed time 'depth 1drawdown11 relapsed time 'depth drawdown clockisince pumping water 1@11_5gpm 11clock1since pumping water i@-gpm time szarz/stop iLum CIL ��,<« �J, I _ 08 11 TOC ��q recovery, 5.o IS=oaf 1 TOC 78.5 recover 14.5_ 2 8.0 2 t-�-3 -74.5 Id.S 18=11 3 X0.0 6.0 4 .75 11.75 4 161=13 5 �- 13.0 1 1 1$=t�1 5 1 6 14.01 6 65.0 1.-0 7 15.0 18.15 7 64 0.0 8 S 15.7 8 9 $O 16.0 9 WIG 10 $0.5 16.5 10 � 11 �-�. 0 11 t� 12 gl 5 I-1.5 12 15 Fi 2 r 18.0 15 -� t 11:28 20 20 25 83.5 19.5 25 I -.N 30 ti 0.0 30 40 B 20.5 40 50 8q.5 2a.5 50 $: ag 60 8-1.7 20.-75 60 --1 80 8~ z1.0 80 10o gs zl.o 100 16:28 140 5 a ZI.S 140 180 (3HRS)' 22-o 180 (3HRS) 17:08�� t IS=o2 . 240 (4HRS) I-p6.2,G1 22,25 ,1 240 (4HRS) l j �1�4® A/ 1�.•�.'SJ� A`,9i0�1 ...........Ma.�'aly •_••_• ....... Kurt Z. Eger fer0. CEJ '.ti CE -7635 xz 1p +�\►�-�3FESS10NP�a� I IT N m 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:SW940031 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:EGELHOFER KURT Z OWNER ADDRESS:3406 OREGON DRIVE #1 ANCHORAGE, ALASKA 99517 PARCEL ID:01513442 LEGAL DESCRIPTION: HAMPTON HILLS BLK LOT SIZE: 65039 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 1 LT 3 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: 2/18/94 EXPIRATION DATE: 2/18/95 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 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: / THE TOTAL DEPTH O E TRENCH OT XCEED 10.0 FEET. RECEIVED BY:,°'7� lb DATE: ISSUED BY. , fI, �'`i��� — DATE: U /G Kurt Z. Egelhofer Alison L. Smith 3406 Oregon Dr. Anchorage, AK 99517 February 7, 1994 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99519-6650 Subject: On -Site Sewer / Weil Permit Application Hampton Hills Subdivision, Lot 3, Block 1 Dear Sir: Enclosed is a permit application for on-site sewer and well for our property located at the corner of Upper O'Malley Road and Elies Drive. Also enclosed are the soils log and percolation test for two test holes that were excavated last fall, and two sets of drawings including the Site Plan (Sheet 1) and the Septic System Details (Sheet 2). 1 plan to hire one of the municipality's approved excavators to install the on-site sewer system, I plan to hire a well driller to drill the well and I plan to log the well myself. I am a registered Civil Engineer in Alaska and i design water and sewer systems in rural villages of the state. There are two lots adjacent to our property that are potentially affected by our proposed on-site sewer system. Lot 2 to the west is on the other side of a ridge that parallels our common property line. 'The well on Lot 2 is located on the south side of the lot near Upper O'Malley Road and the septic system is located on the north side of the property. Lot 4 is located to the north of our property and is situated at a slightly lower elevation. The well on Lot 4 is located near the northwest corner of the lot and is on the opposite side of the ridge that parallels the west boundary of our lot. The on-site sewer system on Lot 4 is located more than 150 feet north of our proposed sewer system. In conclusion, our proposed well and on-site sewer system will not have any negative impacts on either of the lots adjacent to our property. The topography physically separates our proposed on-site sewer system from the wells located on Lots 2 and 4. Furthermore, separation distances are more than adequate to prevent well contamination or drainfield flooding. If you have questions or comments, please call me at 273-4316. Sincerely, Kurt Z. Egelhofer, P.E. G Alis L. Smith Municipality of Anchorage J" ,i �1.o.oy, uq • ce�rc a000e �uoi' . DEPARTMENT OF HEALTH &HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650.;:i,•=• SOILS LOG — PERCOLATION TEST 44V���s `°KurCE ge3hjfer • F a PERFORMED FOR: V =+`-1= L'}��--•- `� 'j' �5AA IT"1 DATE PERF( RMED: <'•y �/� lit�ily..l_.'�J �'l ll_1��� 5f -7=P- 30 t tG// 3 LEGAL DESCRIPTION: vi' -` , F,?--✓-�`- ( Township, Range, Section: SLOPE SITE PLAN 6 'a .�.. p N Oct P e - P" -- -!I + WAS GROUND WATER k lO 10 DEPT I: SAIvi Ltj ENCOUNTERED? Depth to Water :v Q. S 11 x 'o RJ41f_I L IF YES, AT WHAT -- 0 DEPTH? P 12 , - lAl_ I.. E JD=P3 lo:9S C� n n,- r r1 j Do to Water Aher !JD 3 -G1'. C' `�IGT� CGF�(3ieS Mani ? �Ir '—Date 1016W' r, 4-0: r ; t,.�, �AmL 6 (ti�i?l IV[.) cc;(-�'13CL_`.� 8 9 r' > 6 'a .�.. p N Oct P e - P" -- -!I + WAS GROUND WATER k lO 10 Date I: SAIvi Ltj ENCOUNTERED? Depth to Water :v Q. S 11 x 'o RJ41f_I L IF YES, AT WHAT -- 0 DEPTH? P 12 � - lAl_ I.. E JD=P3 lo:9S C� n n,- r r1 j Do to Water Aher !JD 13 y t' ��j�" (xSOa !l) Mani ? �Ir '—Date 1016W' r 6 'a .�.. p N Oct P e - P" -- -!I + WAS GROUND WATER k lO 10 Date I: SAIvi Ltj ENCOUNTERED? Depth to Water :v Q. S 11 x 'o RJ41f_I L IF YES, AT WHAT -- 0 DEPTH? P 12 � - lAl_ I.. E JD=P3 lo:9S C� n n,- r r1 j Do to Water Aher !JD 13 y t' ��j�" (xSOa !l) Mani ? �Ir '—Date 1016W' .v °,Ci• 14 U i 15nr,�� VERY 16 j Cr- Fs) it NG+ -.t° 17 18��1�� %^ i 19 d� I` Reading Date Gross Time Net Time Depth to Water Net Drop 61= 33 Atit CS S In ,?4t. j J's/>!r f 3-4 h (r u I, JD=P3 lo:9S 4omttt 66 MIA 6 3�or W1 20 PERCOLATION RATE �-`(minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN �' FT AND FT COMMENTS IUG> iV PERFORMED BY: z -_`% '' CERT IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — -- 72-008 (Rev. 4185) ••` . e� jY to :. .. Municipality of Anchorage � 1�=.• 49th 4 DEPARTMENT OF HEALTH & HUMAN SERVICES V (� �..... 825 "L" Street, Anchorage, Alaska 99502-0650 Y. eua.•u n- _ SOILS LOG PERCOLATION TEST Vsi �','o I(Urf 7. Egclhofer" t' 4i C --7635 7 • V ..r PERFORMED FOR: V-• /C� 'L-IiI.%-I-i-'. -- A. '!211 IT4) DATE PERFORMED:�I LEGAL DESCRIPTION: r-' I "�; C���--I� I Township, Range, Section: � I q6? `' oOEPTH7 SLOPE SITE PLAN 1 n•�� C '. 1LLJ Depth to Water 2 n, G>, 3 IO=� i o M,t) 3" 4 i I� II=CJI 2-L,h,Q 5 I�i/ ,O . '3011It.0 n 6 0 - u 11 . -- 7 If LAI IQ �i i s 7 r ( 75—/ 8 _4 9 •. 4.l .. 10 6o 4,fllJ Y�' 3� u 11 n 12 fJ 13 . e) a "< 14-0 W D - 0 15- t5. 16- - T) 2i\Ci= _ =moi L:1 L f) 0--L,E a T7) v'r J �/ktil Ply �a�� ,o,� WAS GROUND WATER .S ENCOUNTERED? J 50/111E fi f`' T OF 17 - I-ta tr 18 - 19 -1 1 t A�- 22- IF YES, AT WHAT .A DEPTH? Depth to Water After. 00 Monitoring? w'� Date: tU S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop :Z IO=� i o M,t) 3" N i I� II=CJI 2-L,h,Q Ali I�i/ =1'7 '3011It.0 5 ( IVa" r u 11 . -- 7 If LAI IQ ° -Y4 i s (� r ( 75—/ Eat-' 411Q '11112Y -7 n 0 --4-7 6o 4,fllJ Y�' 3� u 20 20 -� �.W PERCOLATION RATE {�' � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN �% FT AND FT COMMENTS .NO VUAT E= - VjA—'; !: lyf-co ll 1'Fp t�H� jh)f6ZI -f (,T-- PERFORMED ,T-- PERFORMED BY: `�Y�_ - v - I KYJ-1 _ F-�-`O'f�ffNGERTIFY THAT THIS TEST WAS PERFORMED IN .0 . ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:' ; 72-008 (Rev. 4/85) 21 -r r- Kokd--'`ds AT 4,c+ C3' I. FV -QM 00-51 bt1l�Y=�s uJ�ri� t YZ�aItJt� Jc RG7 '�` ( -�� F rbp- PE-kccX.A:cto�) t},A-T : APPLICA-nw..a r...A-ri-:2- f§?>-5o"too v_'..Gaui�f� fc.��a _N E7 1)tti44f3 /5CJ 0i'iY 3P41 / .fir w� c�« 7}t = �� o�ZA I �P�e . t=,ACq u5:Et 4- 2 '5D ( i ,kr T 51 TE PLAN 6& .HOF6K / 6MIYH K65IP6NG6 l -Of 5, 0t OGK I HAMPfON HILI -5 5000 ANGHOKA66AI-A6KA HM- 274-b�57 - WY,- 275-4716 GID N0. 95010" rvl COP Cf3 a' 0" TiUpN "UQ, me �x x NCSN- D-YP 15ul"ING fOUNOAf ION 'V OY S r T -WA O Ik 0. m0 p a Yz • Zm > AZ Z(II U I m � Z O PICK >\ O 01 > zX rA 1 6 Z C > Z p �N- p C�fli YS O > > 'I SEPTIG 5Y5TEM OEtAILS Y O ^ \ 6 61,NOFER / SM I fN UO I PONGE ' I v LO1 31 01-OGK I NAMPfON M CLS 6U60 ANGNORA6E1 ALASKA HM' 271-6]57 - WK• 273-1316 010110. 9301661 tooW ....1 c%i Oo N \ m y �C \ (I �N- p C�fli YS > > >O (I i Z OP >AC 0 No O to '� C31 Y '-'o°>> O •Omz to N c< x Z>O m m 0 Z APZr Z - YPC O ;FO Z70� i> _ >A> o" Z O � yon m;- zpr < • >c c In _< mz � TA I V n'o" I I I I I I I I I II � I .1 II II II II II II II II p II II II II 11 '. .Oi II b IIA Iln Iln Iln 1 a II o II o II o Ila' I N I Ila II> II>I, >oomi>°m'-' I Ilm `n"TT.�znon > I < II < I < II p< Yimo�i.Y.•>' II n I A II n II n X Z. 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I < II z 1 z 11 z 11Z n II II II 11 N>>rNA'V, II m v I m v m v m o c,zzzc II m Nm -c' I o I o 10c 11 m O O mTmoum•i II °' 1 I m2Nc_mc-w' AY;ocN'z' II 11 I ;n T 11 I II m T 11 I 11 zzxo=cP' > mixt ooinom> 11 II IIS—A m II o—`I II (~—A m II x—'11 o /11 p • I p �im+nmm 1 Z o s m z Y + .>1 I z II II z II zo � - m p ii � II m II II ry II II r x IIY; 11Y; 111; 11 1; p II p�{I. �__`� _.. �__.`• o m ilmZ Y Oz 11m- o IIO1 1m02 - 1 IiOo Oz m- 1100 N I i I i i i U o 0 I I P �I 0^I P m^I P NI �^I P 11 H 1-f r uU 1+ a• 10' 0" 10' 0" a 10' 0" a•- 'I SEPTIG 5Y5TEM OEtAILS Y O ^ \ 6 61,NOFER / SM I fN UO I PONGE ' I v LO1 31 01-OGK I NAMPfON M CLS 6U60 ANGNORA6E1 ALASKA HM' 271-6]57 - WK• 273-1316 010110. 9301661 tooW ....1 c%i \ ��� �,-• \ Two ' �, fOCe ROgQ ��\\\\`so 1 w i ------------ I N ' I O� / p i .I 51 T6 PLAN E&EI.NO W / 6MIfN KE610ENGE Lof 3, b"GK 1 NAMPf ON HI "0 6UbO ANGNOKA6E ALASKA HM, 274-8157 - WK, 273-916 0v0 N0. 05010H II II II II II ii II II IIv N4 pz II II II II II II II II II„ II II II II II II II II IIa -m » II II II II II II II II IIa p> T< IIA Ilo IIA Ilo ro IIA Ilo Am � C) a 5-0" A Vi MAN Ilm Ilm E911 ' Z °I II° Ilp Ilp VAS S < m II< T m >_ (l m y 'y Ary xlo- o z > > -tr mo y Z Iln -z>- DCNNO r -OT • iT0 --Nti I I m II tiP>S S Ol'm I I S II II I l m II II 1p T-1 I l m II II sm-n mTmm N T � - II II II o�z TAOCI o N T T II II II -m s C i II pr -�pc- m>Nz II IIom II II J4 p -1 n m ZE SEPfIG 5Y51'6M PEfAIl.5 \ I t4f 3, bFER / SM I fN RE5I LENGE \v\ Hor 3, BHocK CD NNGHOKA NII -A1, 5U60 HMI 271-61 AI-- Wr, Nh1. 271-8/57 - WK• 273-9316 090 NO. 9301am "rj rT"1 Go �s Cf a Lf_) GU I LAI NG /OUNOAr I ON II II II II II ii II II IIv II II II II II II II II II„ II II II II II II II II IIa II II II II II II II II IIa IIA Il o" IIA Ilo IIA Ilo IIA Ilo II> Ilm Ilm Ilm Ilm II° II° Ilp Ilp II< T Ila Ilo Ilo IIA II ro Iln I I m II o o I I S II II I l m II II o I l m II II II II II II N T � - II II II II II II o N T T II II II II pr II II II IIom II II II o z II II II I o _ z II II Q m II II II II > > II II II II II II II II > > II II II o II Ileo Ileo II Ileo Ilcc m Ilm_ II�� 0Z pp Ilap pA Ilor I I SII SII - Oil - OOIP' lir} H� I I Kurt Z. Egelhofer Alison L. Smith 3406 Oregon Dr. Anchorage, AK 99517 July 8, 1994 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Well Information -- 10650 Elies Drive Hampton Hills Subdivision, Lot 3, Block 1 Permit Number: SW940031 Dear Sir: As promised in my May 19 letter to your office, I am enclosing a packet of information concerning the new well installed on my property. Enclosed is a copy of the Well Permit, Well Log, Well System Data Sheet, Aquifer Test Field Data Sheet, Aquifer Test Results, Well Pump Performance Data, Coliform Bacteria Test Results and Primary Inorganic Test Results. As you can see from the enclosed information, this is an excellent well. The well was tested for 4 hours at 11.5 gallons per minute; total drawdown was 22.25 feet and full recovery occurred after only 7 minutes. The capacity of the well is calculated to be 14,850 gallons per day. I pumped over 5,000 gallons of water from the well during the pumping test on June 8. As for quality, the water tastes very good; iron exceeds the secondary standard of 0.3 mg/I but I cannot taste any iron in the water. The nitrate level in the water is 6.1 mg/I, which is below the MCL of 10 mg/I. I will probably monitor nitrate levels on an annual basis. No other primary inorganics were detected in the water sample. If you have any questions or comments please call me at my work number, 273-4316. Sincerely, v Kurt Z. Egelhofer, P.E. cc: Alpine Drilling WELL SYSTEM DATA SHEET l O6� Owner of Well 11 -MR -7E GF�L!•(L7 � �kt_ISof�l L. s/w rm �Ll =� Cry Drilling Company ALPIINE CCZIL! ING DAV!C 4tAc2.P "'S� Pump setter Al -PIN= p1CJ IAC I IJP Inspector P.E. Make of Pump C� (Zbl IJO Fcb. SS Model or Type size 3/i � 10507 -12 Uri Serial No. U t. 4wowo Volts _ 23o Cycle GO GyCL Phase Serial No. of Motor SINCL.E_ PRASS Date Pump Warrantee Begins 20, Icg4 Drop Pipe(s) SIIJCLfE Diameter Material C-ALVAeQ12F� _ Pitless Adaptor Brand and Type Length 12.6 ipt. Electrical Work and Controls 1 :��� !"2-3 W,t=L.L WliZf+ I?oO' 12_3 U �• W I PLG . N o1-r-� : 12 GIS *• e LA CK.. W I P-eS A9.re N oT•. Comments r�115 IS AWC_ LLf-TwGLL! rlj� OY2I4-LF_R Dt1/GLOWi�Z 1114E WALL- Ar u�ow, A�vD PfEpop-)-TtD I -4o Pt o!= o>e"wa0R-kQ AFT-IE.R 7 Un/.r[>G TUB' In. In)A�, "f' 5"'1---PfnMPF� iwi-nA[1_�/ A -r '7 c1om 6W7 AFT'E3Q IS mnn DI= PUMPING WA -s ONL,/ 6 cj i= c)rAWOdwlJ. -Me -IT--S7 WAS A� IS v4ns Au0 AA-\CMIEZ P�MPIQC1 TFS"T WAS PEEP -fl 2A eZ A -r I I.S 9pv., . iN IS TE- Si WA— I NA -1'12p AT* R'R m rm W fiM1 A IMAL 20 -Pt Of= C;Y2AWQ0VJQ. -Me- LAST (BUMPING " eG7 4 OWOZ'S AvD IN A TOTAL_ 0Y2lw0ow" C>P 22.25 Vt. THE WP_LL_ �oVC�2�11 -rD 5'T7 c- i-euaL_ tQ owLy 7 Mill U"rj=5. OVA Q,COO CAL4-OKNS 04�" WACT9EP WAS P" Pel:� fW-:W1 TNG u.LED- OK) 4/sl cm Date signee(�O' Aqa vdAV £f P S Kurt Z. Egelh6fer r �� pgslCE -7635 PROFESS AQUIFER TEST FIELD DATA SHEET 7ES-T- --7;r E'> (:E N-S-ynn 1 D 6-!S�v Project No. 5wlg400B1 _ Project Name Well No. SIE G _ Location of Well AMP"TOIJ {-TILLS RLOC.IL I) LOT 3 AMCWC)QAC-�1-:, AK Depth of Well (41 ft. Length of CasingJ43 ft. Top of Casing to Static_ IJ DAVIa Date Drilling Completed 5110 44 Dfiller IA-P-PE9 Date Tested I4q4?'i t�F}LPIIJ� G(z �� �—l2EECov� relapsed time depth drawdownrI relapsed time !depth drawdown clock isince pumpingiwater I@11`Sgpm lclockisince pumpingiwater 1@_gpm time start/stop from or time start/stop from or ITOC !recover II I ITOC Irecovery 14=0s 1 69 5.0 18=moi 1 78.5 14.5 2 3 7Z 8.0 X74.5 10.5 fig=l1 2 3 -70.0 - 6.0 4 -76.75 II. -715 _ 4___ 14:13 5 -7-7 13.0 _ _ 5 6 -7g 1 14.0 6 I.0 7 '7 Of 15.0 8 79.5 15.5 8 1 9 $O 16.0 IE:.t 9 _ 14:18 10 $o.5 (%•O 10—�- 11 11 SI _ 12-81.a 175 12 f` 15 82. 115.0 15 =28 2093 I`I.0 20 25 _i— 83.5 25 _ 14=38 i 30 534 7.0.0 30 40 84.5 20,5 40 50 Bq.S 20.5 50 5: C79 60 34A5 20.75 60 80 '35- 21.0 80 100 $S ZI.o 100 16.28 140 --l— '35.6 21. s 140 �I-7�os 180(3 RS) � 2 2. 0 180 MRS 1 la:nra I Af)fAS..TD0 2� �yII 279G 7An(AHRR1 . OF o �p�,•............. !q Ota ,4911, 40Q -A Kurt I Egeftfer i �2 CE -7635 ooa��1%, PROFESSIONP�m��� r, O N L9 CA U N Q lJ 00 � N N I� i7 NMd-1MV-A (I FLOW RANGE 5to14GPM PUMP OUTLET 11/4" NPT 2-7 PERFORMANCE CURVES DIMENSIONS AND WEIGHTS MODELNO. HP LENGTH (INCHES) WIDTH (INCHES) APPROX. UNIT SHIPPING WT. (LBS.) 10503.6 1/3 215/8 3'5/16 26 t OS05-9 '/2 245/8 3 15/16 29 10507-12 3/4 275/a 375/ie 32 10510-15 1 30'/2 315/1(1 34 lOS15-21 1'/2 377/a 315/16 44 10520-27 2 42 315/16 49 10530-34 3 547/a 315/1a 83 Specifications are subject to change without notice. 0� SELECTION CHARTS FLOW RANGE PUMP OUTLET (Ratings are in GALLONS PER HOU R—GPH) 5 to 14 GPM 11/4" NPT PUMPMODEL HP PSI DEPTH TO PUMPING WATER LEVEL (LIFT) IN FEET I 20 40 60 80; 100 120 140 160 180 200 220 240 260 280 300 340 400 460 520 600 700 800 900 1000 1100 0 856 811 766 665 564 398 233 20 840 790 741 636 532 315 lOS03-6 '/3 30 790 706 621 501 40 712 606 500 50 588 447 60 464 232 _ Shut -of PSI: 64 55 47 38 29 1 21 112 3 0 847 802 746 685 626 568 499 393 207 20 835 785 727 667 608 549 472 347 122 IOS05.9 '/2 30 828 777 718 658 600 538 457 320 73 40 768 708 649 590 528 440 290 50 699 639 581 516 422 258 60 630 572 504 403 223 Shut -of PSI: 100 92 W 74 66 57 48 40 31 23 14 5 _ 0 057 1 828 1 791 1 748 703 658 1614 1 570 521 457 362 20 849 817 778 734 689 1 644 601 556 503 1 432 323 155 10507.12 3/4 30 845 812 77 727 682637 594 549 494 418 302 121 40 840 806 765 72 675 631 587 541 484 403 279 85 50 800 758 713 669 624 580 533 1 473 387 254 60 751 706 661 617 573 525 462T370 228 Shut -ON PSI: 137 129 120 111 103 94 85 77 68 59 51 42 33 25 16 0 843 816 785 750 714 678 1 643 608 573 489 226 20 935 807 774 739 703 667 632 598 1 562 522 472 312 10SUM 5 1 30 831 802 769 734 698 662 62792 556 515 463 393 153 40 851 827 797 764 728 692 656 621 587 550 508 454 380 276 50 840 823 792 758 723 686 651 616 581 544 500 444 366 256 99 60 818 787 753 717 681 645 611 576 538 493 434 352 235 Shul-oN PSI: 174 165 157 148 139 131 122 113 105 96 87 79 70 61 53 35 10 0 1_ 853 836 1 817 1 795 772 747 721 669 1594 511 375 20 848 831 811 788 764 1 739 713 687 661 611 1533 415 176 1OS15.21 1'/2 30 845 828 807 784 760 709 683 657 632 583 495 344 40 843 825 604 781 756 731 679 653 628 604 552 449 248 50 840 822 800 777 752 727 701 5 !64 650 625 600 575 519 389 120 60 854 837 818 797 773 748 723 697 671 621 596 571 544 478 308 Shut -of PSI: 237 229 220 211 203 194 185 177 168 151 142 133 125 107 81 55 29 0 1 847 834 819 1 803 1 766 1707 647 589 500 284 20 B44 830 814 797 779 760 1 720 1660 602 541 425 1 87 10520.27 2 30 842 827 812 795 776 757 737 1 697 1638 580 514 373 40 852 839 825 809 792 773 754 734 714 674 615 556 483 309 50 850 837 823 807 789 770 751 731 711 691 651 593 228 60 848 835 820 804 786 767 748 728 708 688 668 629 570 all 126 Shut-oll PSI: 285 276 268 259 250 242 233 224 216 207 198 181 155 68 25 0 841 808 769 1 725 1 667 596 519 399 20 847 838 816 778 736 691 1 634 562 472 309 10530.37 3 30 846 836 826 802 762 719 675 617 545 444 252 40 845 835 824 813 787 746 702 658 601 525 411 185 50 843 833 822 811 798 772 729 685 641 585 504 372 105 60 842 832 821 809 796 783 756 712 668 625 568 481 326 Shut-oN PSI: 362 354 345 336 328 319 302 276 250 224 189 146 103 59 0 826 790 751 711 1 655 577 471 289 20 833 822 799 761 720 679 620 534 400 159 _ lOS30.34 3 30 832 820 809 784 745 704 662 602 509 357 79 40 _ 840 830 819 807 795 770 730 688 646 583 481 308 50 839 828 817 805 793 781 755 714 672 629 563 449 250 60 826 815 803 791 779 766 739 698 656 611 541 413 184 Shut-olt PSI: 332 324 315 306 298 269 272 246 220 194 159 116 73 29 J h r'T i o -?pm 12-8 B 5• S •d — <0 Municipality 4of Anchorage r7 V• On-Site Water and Wastewater Program - All i (907) 343-7904 JUN 074 s - Er, ti It. Certificate of On-Site Systems Approvt i ,.�^c„ Parcel I.D. 015-134-42 Expiration Date: 1 - 1. GENERAL INFORMATION Complete legal description Hampton Hills Block 1 Lot 3 Location (site address) 10650 Elies Drive Current Property owner(s) Case, Daniel & Tschappat, Jennifer Day phone Mailing address 10650 Elies Drive Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b ,�� /��t. f'r A/` i Date: __6043/7_, COSA to be released to the engineer, unless otherwise requested by th, gineer. COSA Fee $ 52k Waiver Fee $ Date of Payment (0171(?" Date of Payment Receipt Number 61=6 Receipt Number COSA# Q.5CJ `t2 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. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations The reported results describe 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 soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control,of the evaluator of this system, All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 6/6/2017 '_�63P. .,1�- 14 6. DSD SIGNATURE "" x.;040. System #1 Approved for (I bedrooms ' 'Steven 12.•F Pannone;" System #2 Approved for bedrooms �r i9�;,. CE-8149 'e Disapproved +'k\, DFE55l��� I. Conditional approval for bedrooms, with the following stipulations: • In i/iqRAS� C ) S7- -1., PROP.RAts c�, . 0. n.. ^��. • -�,iii`ti--^. By: ,� w,., (....-- Original Certificate Date: 6 --J 2_, -/ 7 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 X Nitrate Advisory' ' X Septic System Advisory Arsenic`Advisory Well Flow Advisory Other ' f •' COSA blue sheet_c • • b If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Hampton Hills Block 1 Lot 3 Parcel ID: 015-134-42 A. WELL DATA Well type Private If A. B. or C provide PWSID# Well Log (YIN) Y Date completed 5/10/1994 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 144 ft. Cased to 141 ft Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 5/10/1994 5/23/2017 Static water level 65 ft. 85 ft. Well production 9 g.p.m. 6'3 g.p.m. WATER SAMPLE RESULTS. Coliform NEG colonies/100 mL Nitrate 7'35 mg/L Arsenic ND ug/L Date of sample: 5/24/2017 Collected by- PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Coated Date installed 6/7-8/1994 Tank size 15002 Number of Compartments 2 •Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/17/2017 Pumper Northland Pumping Service C. ABSORPTION FIELD DATA Date installed 6/7-8/1994 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Deep Trench Length 50/50 ft Width 2-2'5/2-2.5 ft. Gravel below pipe 4.3-4.8/4.3-4.8 ft Total depth 11 -3 ft. Eff. absorption area 800 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/23/2017 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in Water added 640 gal New depth DRY in. Elapsed Time: 120 'min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm& circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ 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+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 1 0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION .,.&.-• Ace, kh I certify that I have determined through field inspections and �Aill _ •i review of Municipal records that the above systems are in *• :L V_ '�►' *�Y conformance with MOA COSA guidelines in effect on this date. ••• ` •ie` Engineer's Printed Name Steven Pannone 0 ': }even W.•;annone.• •Of 6/6/2017 41:-.. DateCE-8149 • 'i COSA canary sheet_2-6-15 doc • • Municipality of Anchorage •` r r Development Services Department Building Safety Division s 4F ,, On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 171228 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 3 of Hamption Hills subdivision. This inspection revealed a nitrate concentration of 7.35 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. • Municipality of Anchorage On -Site Water and Wastewater Program r (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-134-42 Expiration Date: _ 7' _13 1. GENERAL INFORMATION Complete legal description Hampton Hills, Block 1, Lot 3 Location (site address) 10650 Elies Drive Current Property owner(s) Kurt Egelhofer & Alison Smith Day phone Mailing address 10650 Elies Drive Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual I] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance Received by: � l I I/" bffAv Date: & ; -7do / 3 COSA to be released to the a gi er, unless otherwise requested by the engineer. COSA Fee $ !0 Waiver Fee $ Date of Payment (,O laqI(3 c Date of Payment Receipt Number 056; 3G Receipt Number COSA# 0,5C�31al a 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE _System #1 Approved for 4_1 bedrooms System #2 Approved for bedrooms Disapproved Date 6/6/13 Conditional approval for bedrooms, with the following stipulations: By: �0riginal Certificate Date: 6 -,_-Z 7—Z The lcipa�i ,,I� o/�ra a Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represe - ti6rr�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: t COSA Checklist X Nitrate Advisory R „ Septic System Advisory Arsenic Advisory Well Flow Advisory COSA blue sheet r - '., c Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Hampton Hills, Block 1, Lot 3 Parcel ID: 015-134-42 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 5/10/94 Sanitary seal (Y/N) Y Total depth 141 ft. Cased to 143 ft. FROM WELL LOG Date of test 6/8/94 Static water level 64 Well production 11.5 WATER SAMPLE RESULTS: ft. ColiformA e_.Ltcolonies/100 mL Nitrate • 5O mg/L Arsenic O7. j I ) u /L Date of sample: 9 P /I $ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Coated Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Date of pumping 8/3/12 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 33 in. AT INSPECTION 6/4/13 63 5.3+ ft. [!1120 Collected by: P l5 J Date installed 6/7-8/94 Cleanouts (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N _ Pumper Northland Pumping Services C. ABSORPTION FIELD DATA Date installed 617-8/94 Soil rating (g.p.d./ftz or ftz/bdrm) 0.8 GPD/SF System type Deep Trench Length 50 150 ft. Width 2-2.5 12-2.5 ft. Gravel below pipe 4.3-4.814.3-4.a ft Total depth 11 * 3 ft. Eff. absorption area 800 ftz Monitoring tube Y Depression over field N Date of adequacy test 6/4/13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 654 gal. New depth 0 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at Cycles tested _ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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. Engineer's Printed Name Steven R. Pannone Date 6/6/13 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. Municipality of Anchorage Community Development Department ° p Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 131272 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 3 of Hanpton Hills subdivision. This inspection revealed a nitrate concentration of 6.5 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. PLAT NO, 73-26 HAMPTON HILLS SUBDIVISION LOT 3 BLOCK 1 SoRvEyma, uc 40T A. QAVAtM RL.S. M40HOPAGE A00MING NSM= MASKA NOTE, NO CORNERS SET TRIS DAM BUILDING DETAIL $CPAY-. J,,.w LEGEND MMOXOMIM PW MAI NO 74—A ()i} t1Eib DINOa81kN P4R PIA R0. ib -3$ mrmurw olmetimoN If" $URTr MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section `� v P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# 015-11-qZ-OGbIC) HAA#_'`r.r�w.,..�1- UM0 x.14 -I M41 I XOL13 GY flork i Complete legal description {-UkAAP1v>'j I4IC-Ls _ LUT Fs P5LW_ Location (site address or directions) _ 106 EL) E!S OyZ- Property owner_ ILl,1y2`I- ) =C (j(p _ Day phone 7_73-431 Mailing address 34 06 c�?� o.� Off , AUG.Id t= AV-`gR97 Lending agency _ 40(CDER NMOt2-_DC—AC- Day phone .561 -02 -HD Mailing address_ 101 W.0ST 3Q-5_OQ i:?>CQ _% AIJ04DpJ�1--_ AIC gq•S1c�' Agent GN�1`-'�p�� 6�9-ADLE_y j Day phone Address _ Unless otherwise requested, HAA will be ,held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State AOIFIr 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 MOA #21 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 ��� �f/ Tt;�J�l4 Phone Address �8©� :�D'r✓i=Ry �2 f��l�f°�6�c ��SO� Engineer's signature ���—��- Y Date �� S Al. 1k I.!!• 4!lYYs✓�05 4YPOtlP 0!!!A • • .50. •.S fiOP Y :P. f ; BERN M J. C-IJW 0 fW*w l ..� No. U 5B9'i ;,i4" 6. DHHS SIGNATURE 7`-'' Approved for T bedrooms. By. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State nnd Municipal Codes There are nitrates present It is suggested that a periodic testing be performed to insure the wells continued s -=ability- Nii-rate—eeno-entration—i-s F,i ,,,T/1 EPA maximum concentration is 10.0. mg/1. Additional Comments E 4t1TIC 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-M(Rw.1/91) Back MOA821 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:_NA/tidMK) HILJ,-s `vi -3 Parcel I.D. Olt i3A-42—C.c- 10 t3LiC I A. Well Data Well type 9Vz1VA1�F_ If A, B, or C, attach ADEC letter. ADEC water system number PSA Log present (Y/N) Date completed /l&V 1( 1gq-1 Driller O/\Vi> HA% 1°EP,. Total depth 14q Cased to iA I F+ Casing height 2— �} Sanitary seal (Y/N) y E—z'-s Wires properly protected (Y/N) yew Date of test � FROM I'�ELL LOG AT INSPECTION F'V'yi� ��Fti1/Tro Static water levels I��� �G4� i �iaI y�l� `SFS rq�sF�i�sctio�v P4 % 0i�7 Well flow 11b �_p� g.p.m. 11.E n�v, g. �' 99Q py Pump levell _ 12.6 P4 (2-(m •(}- ��f®� SEPARATION DISTANCES FROM WELL TO: 6� Septic/holding tank on lot 1l ; On adjacent lots 1530 ._��•3T Absorption field on lot 132— !31 ; On adjacent lots ( � (> -F4 C_A`� Public sewer main NOfl1f--- IK) V ICIIQ� L_01 Public sewer manhole/cleanout N00F_ IQ VICOJ i-hV_ Sewer service line 1 QUF_ IQ V i 0 N I" (y Petroleum tank NJC)Q ✓ IQ V I Gi N 1n WATER SAMPLE RESULTS: Coliform p / top vH I Nitrate /L Other bacteria 1JJIJ� Date of sample: c'C6,`llI Collected by: 1LUlZ7 EEC; F_-4_11 C> FiH-P� B. SEPTIC/HOLDING TANK DATA Date installed Tank size o, ( Compartments __1+57-_V:_> j Cleanouts (Y/N) Foundation cleanout (Y/N) `!E`er Depression (Y/N) j�lo High water alarm (Y/N) W0 Alarm tested (Y/N) W0 /N)A Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 24.0 {4CWG'ciT Well(s) on lot I _On adjacent lots 2_2_ic> ±, Not�i'K Foundation I Z To property line ZAbsorption field IZ -�—+ Water main/service line 40 "Pt Surface water/drainage 1\)0tJE I M V) Ci N 1'1y 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed _ Size in gallons_ Vent (Y/N) NJA _ N0L)f-::' High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water _ Date installed QF_ -7, 1"704 Soil rating (GPD/Ftz)0-49 90001/-Fi, System type htJr�"nc- V(F"E Length 6U f+ 6 4 Width Sig �-t Gravel thickness 4-� -�+ Total depth �6 - `f a Total absorption area `500 .14z Cleanout present (Y/N) N Depression over field (Y/N) NO Date of adequacy test -6111 1'14 Results (pass/fail) e/1j-S for 1� Bedrooms Water level in absorption field before test ® ftJCl I✓=S After test O 1 iC dr•( > Peroxide treatment (past 12 months) (Y/N) Q0 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots iIS_h &XAV4) Property linejt To building foundation To existing or abandoned system on lot U%la On adjacent lots 1 (57 -t Cutbank QDWE tQ vtc(l;'N Water main/service line 65 Pt Surface water NtiUE W V) CI tJ „y Driveway, parking/vehicle storage area 2® -PA Curtain drain NONE W E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in•effd_d00Akgate of this inspection. t; Signature Engineer's Name Date HAA Fee $ Date of Payment Waiver Fee $ Date of Payment Receipt Number q`�) / Receipt Number 72-026 (3/93)' Back 05 0 o 3 0 / Wed -L-. LOT 2 P Locr- I 5Fp71c LoT 4 6Lxk I �n L 07 S g Lock I -SIC �-- olvea.TF-a VAI -U r ZQU� N o U St � � SC-Pr1c TAMIL vi ry Q� 144 Pt DEEP SAA \ Q, IIt= 5O' sit �c�tv is«� LOT 3, SLDCk I SEPTIC SYS -mm AS- eWL-T SEP. IS) IR�%4 OFA4 ht a� ° e • e • aay !� 0 ( s yv�l Dan eo al c•aa�••� � �. t 1��1.S ��i%)a COMMERCIAL TESTING & ENGINEERING CO. V I C =, S Dril EL"iin cr 7. -no - To�-' i -To:,. �'E-0 -EFO?.-7 COLI SyDpi LD. 340 Cy2,E,,fC-;.k_) De -AU DYZA4',E Ai Qqt7) -7 OF qEk---lV 0- ax -a— Mozzh Day - eaz- S (.or routine -,Y;rh lab no. , LP L E L 0 Ck TII 0 N (N &-j- Y9 EZL4 I SVJ 54 oc) RA-MPTt:i,j HILJ-S, T;Me Collected (� t2 2 L -DT 3 CoHecred BY V-Lmr 0 EE 3 -- -- -- Date Rz--c;-,-ed A . - 'y=15 3e22r'JJM 0 9 1994 Lab T2s. No. 4 ul 6flY 6;f ta Clie-- cotf,-ied c,, 21 Phoned BACTERIOLOGICAL'WATER --k-N-A-LYSIS RECORD _G Result: To:z! CC!; -, Co Ni_ a.._ Filte7: Direc- BG3 t COL-' —C c ti i 0 0 1 7:3 ,Lt6�CE 1908 CT&E Ref # Client Sample ID Matrix Client Name Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ®•'evvv.�®+vvvvvvvvvvvv�►.gym®vv.�®®®vv®v,.. LABORATORY ANALYSIS REPORT 94.2820-1 HAMPTON HILLS BLKI LOT 3 WELL PERMIT WATER EGELHOFER, KURT UA WORK Order 79223 -------------------- Est. Date Printed Date 06/23/94 @ 10:20 his. Collected Date 06/08/94 @ 12:26 hrs. Received Date 06/08/94 @ 16:00 lus. Technical Director STEPHEN C. EDE Released Sample Remarks: Parameter SAMPLE COLLECTED BY: KURTEGELHOFER. *#SW940031. CYANIDE SAMPLE WAS NOT PRESERVED PRIORTO ANALYSIS. IRON EXCEEDS THE RECOMMENDED DRINKING WATER LIMIT OF 0.3 MG/L. QC Allowable Results Qual Units Method Limits --------------------------- -------------------- Est. Date Anal Date Init Inorganic Contaminants 18AAC 80.070 n/a Antimony 0.0050 U mg/L EPA 204.2 0.006 06/15/94 06/17/94 KGF Arsenic 0.0050 U mg/L EPA 206.2/206.3 0.05 06/14/94 06/16/94 KAW Barium 0.025 U mg/L EPA200.7 2 06/10/94 06/15/94 KAW Beryllium 0.00025 U mg/L EPA 210.2 0.004 06/15/94 06/22/94 KAW Cadmium 0.0005 U mg/L EPA 213.2 0.005 06/15/94 06/20/94 BMW Chromium 0.0050 U mg/L EPA 218.2 0.1 06/15/94 06/17/94 BMW Cyanide 0.0050 U mg/L EPA 335.3 0.2 06/15/94 06/15/94 DJS Fluoride 0.05 U mg/L SM14413E 4.0 06/16/94 CMR Mercury 0.0002 U mg/L EPA 245.1/245.2 0.002 06/10/94 06/10/94 AFK Nickel 0.025 U mg/L EPA200.7 0.1 06/10/94 06/15/94 KAW Nitrate -N 6.1 mg/L EPA 353.2/300.0 10 06/10/94 DJS Nitrite -N 0.10 U mg/L EPA 353.2/300.0 1 06/10/94 DJS Nitrate and Nitrite 6.1 mg/L EPA 353.2/300.0 10 06/10/94 DJS Selenium 0.005 U mg/L EPA 270.2/270.3 0.05 06/14/94 06/17/94 KGF Thallium 0.005 U mg/L EPA 279.2 0.002 06/15/94 06/17/94 KGF Iron 0.34 mg/L EPA 200.7 ICP 06/10/94 06/15/94 KAW Manganese 0.025 U mg/L EPA 200.7 ICP 0.05 06/10/94 06/15/94 KAW * See Special Instructions Above UA - Unavailable ** See Sample Remarks Above NA=NotAnatyzed U =Undetected, Reported value is the practical quantification limit. LT= Less Than D = Secondary dilution. GI' = Greater Than 5633 B Street, Anchorage, AK 99518-1600 - Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL BOROUGH SUBDIVISION LOTEOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN ❑N ❑E ❑S ❑W LOCATION/SKETCH: WELL OWNER: I Z��LI -t I {/C) b!.�t.E}ZA DEPTHS MEASURED FROM:❑casing top ❑ground surface — r WELL DEPTH:DATE OF COMPLETION Depth of hole:,ft BOREHOLE DATA: Depth Depth of casing: /l,// ft l t i 1,94 - ,94 - Material Material Type and Color From To _= a DEPTH TO STATIC WATER LEVEL: ft below b top of casing ❑ ground surface Date: — METHOD OF DRILLING: 'El air rotary ❑ cable tool ❑other -- % L USE OF WELL: .Z domestic ❑ irrigation ❑ monitor d=cv� (-✓t� ❑ public supply ❑ other 99 CASING STICK-UP: ft. Diam: 6 in. to/U/ft Casing type: ��Zir� �a in. to / (-/ ft f�� WELL INTAKE OPENING TYPE: El open end El screened /3q ❑ perforated /® open hole 1 yy Depths of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: _ Depth: from ft to ft e DEVELOPMENT METHOD} �C�t v Lj, Duration: Munic'{��llt Dept. ea n Service s PUMPING LEVEL AND YIELD: 1416 ft after �_ hrs pumping % gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? 'EJ YES ❑ NO CONTRACTOR INFORMMATION:_ Registt rod Business NaCe Signature of Authorized Respresen tive Date REMARKS: PLEASE MAIL WHITE COPY OF LOG.TO: DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116