HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 1 LT 3Mountain Park
Estates
Block 1
Lot 3
#017-061-39
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.et.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: PID Number. D l7 —0bl— 3 q
Name
f lye 0004,IXWastewater
System: ❑ New Upgrade
Address
13 0-O C
ABSORPTION FIELD
Phone Number of Bedroom .�
L.
Deep Trench O Shatlow Trench 0 Bed t3 Mound 0 Other:
LEGAL DESCRIPTION
Soil Rating
/, 2
Total Depth from original grade.
10
, nrtt
F,.
BIddK. lot. Subdivision:
Depth to pipe bottom from original grade
Grave] depth beneath pipe.
r 2 T -be
Ft.
7 Ft
Townsh.p Range Section.
Fill added above ongoal grade:
Gravel length.
O
/-0 Ft,
Ft.
Well: ❑ New ❑ Upgrade
Gravel width:
2
Number of Imes:
/
Distance between lines
Ft.
Ft
ClasmsWbon (Private. A. B. Ct
Total Depth:
Cased to:
Total absorption area _
Pipe Malarial.
—50
FI
Flt
I� — 1 b 3
Driller `
/
Date Drilled:
Stacie Watar levet
Installer s
Date Installed 2
FL
YielOPump
Set at:
Casing Above Ground:
TANK
GPA1
F,.
FL
SEPARATION DISTANCES
Cl Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
PublicrPrivate
Manufacturer. `
Capacity
From
Tank
Field
Station
Tank
Sewer Line
/ I �V
Gal
Wee
��
Material: _j
T
Number of Compartments
T7
Surface Water
N�o
LIFT STATION
Sue.
Let LineN
LS"�'
Gal.
Gal.
"
1In.
'Pump on' Nuel at
-Pump otr level at.
Wgn water warm at
FoundaFoundation/�
I Is
611
m
m
Cunain Oran
I O
Pump Make I Model
Electrical Inspections performed by
Rema•ks
BENCH MARK
Location are Descriplwn:
Tao; i V" S tAiN
w ,J, Assumed E,eva,on
to
NVViL
1`1 W(4or Icso Ft
Engineer's Stamp
Inspections performed by: !. s Dates: let
.2nd yi�—V3
•f; o t':. :; _. .n%I is
Development Servic s Deplartment Approval
Reviewed and approved by: ll/. Date: Y'•z 0
IRn 1200).
I
I
I
I I
I 1
vasw RW US
CONNECTED TO CRIB
A
I MARK I
STANDARD nW(C .- C I
1 I 40 FT LONG f D
FT DEV
1 I 7 SEW ROCK UTECTAT �- Well I
I —
I s=5tx B
I c
I I
DOW 1250 CA CONCRETE TANK
j
I s*m M. TOP 8' IM BANK
I I AC X5
BC 37.5
AD 38.5
RD Il
1 I
At 37
I I BE 72
AF 87 -- --
I BF !06 _
_ ,IC -"7 80 87
�aaaa��
RN 7.1
1 0 ' 49th ........
2
IREN SPURKLAND
No. CE -2225 ' t;, ( I
♦ I
rte♦♦
� I
�
I
I 'I ,1 " -�- Well I
1 R5 0 25 s0 75 ion 125 150 KWH
TTOM
SCALE, 1' = 50 FT. ,' orHou-q+
AssWM W. 100.00
0 B N SPURKLAND P.E. MOUNTAIN PARK EST. /I BK I LOT 3 SEPTIC SYSTEM AS BUILT
203 W 15TH. AVENUE 13300 CRESTVIEW DRIVE DATE.- APRIL 21, 2003
ANCH. AK. 99501 SHEET • 2/3 GRID: 2938
907 279-3916 G/LES AIcDONALO
PERMIT # SW030048 PID R 017-061-39 HPE01032.DVG
I
1
I
0
Silt
718 Wi
ZO ft of Septic Rock
Effective
O .,
t
O 4 1250 gal Sept/c tank o
COMCREV
CONcAW CRE m �,
a
A 3
Standard Trench:
2' Wide
40' Long
10' Deep
7.0' Sewer rock
3' Cover
Monitor
rleA, ,,,,+�
NO SCALE
1250 gal, septic tank
eoncnh
t2
BENCH MART. DOITOM SONG
NW CORNER OF HOUSE
ASVA D RrV IMM P7
TOBBEN SPURKLAND P.E. f OT A. BK1, MOUNTAIN PARK ESTATE , SEPTIC SYSTEM SCHEMATIC
203 W15th Ave GILES MCDONALD APRlL21, 2003
Anchorage Ak 99501 DATE 1JXO fin, DRff SHEETS J/3 GRID, 2938
PEW SWOJ0048 PARCEL ID f 017-061-39 MPE01033.DWG
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030048
['Legal Description: MOUNTAIN PARK ESTATES BILK
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Giles McDonald
Owner Address: 13300 CRESTVIEW DR
ANCHORAGE. AK 99516-3118
Date Issued: Mar 17, 2003
Expiration Date: Mar 16, 2004
Parcel ID: 017-061-39
1 LT 3
Site Address: 013300 CRESTVIEW DR
Lot Size: 62400 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[1 Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
• Date: 7Z,03
Municipality of Anchorage
''ea ep.
• Development Services Department
Building Safety Division _.
On -Site Water and Wastewater Program ; *,
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 1)1%_ O19f' — 311 Permit Number SW 036048
Property owners) C/ L t S ill' D 0 A L l� Day phone
Mailing address (1) ) -73 3 a -o C 0 t= ST ✓r g: w
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) leo R IL 1 H o ON i I N P 2 !1 S i
Legal description (Section, Township & Range)
Lot Size L2.-1- r2r) -Acres/ q. t. - Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only.
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
[
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner. or authorized
Permit Fees: * Q-0
� — Waiver Fees:
Date of Payment:. / //�Ub 3 Date of Payment:
Receipt Number:' 2) a'3 I Receipt Number:
(Rev. 12100)
T.SFURKLAND P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 3 BLOCK 1 MOUNTAIN PARK ESTATE #1
13300 CRESTVIEW DRIVE
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
Anchorage, Alaska 99519-6650
March 5, 2003
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is
subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil
logs and percolation tests of applicable test holes are also enclosed. The septic system design is
based on the following:
No Ground Water or Impervious Layer to 16 ft.
Use Standard Trench
Soil Rating. From Test Hole 03/04/03
2.5 min/in = 1.2 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 15011.2 = 125 sq.ft.
Total area required: 125 x 3 = 375 sqft
Testhole depth 16 feet
Bottom Rock At 10 feet
Top Rock At 3 feet
Rock Depth 7 feet
Minimum Trench Length 375 / 14 = 27 ft.
Use 40 ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 40 FT
TOTAL WIDTH
2 FT
TOTAL DEPTH
10 FT
ROCK DEPTH
7 FT
COVER
3 FT
SEPTIC TANK
1250 GAL EXISTING CONCRETE TANK
CHECK BAFFLES INSTALL DOUBLE CLEAN OUTS
The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent
lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
203
:••.49th �•• ;'�
UBRN SPURKLAND
NO, CC -2225 ,
so 0
50 iov 100 FT. 150
SCALL, r- _ av lew
MOUNTAIN PARK AST {1 BK 1 LOT 3
13300 CRES7WrW DR1VE
G1LES 144444clO0NALD
PID # 017-/ht_on
aerllc SYSTEM OESlGN"—
DATE.• FEB. 14 2003
SHEEZ• 1/3 GRID: 2938
MPE01031.DWG
Dasi NO RING CR1a
ICONNECT TO CRIB \ --:.:'.y r• ; i,
NEW TRENCH �,.•t"
— 3 `- I
I s=5fx 30 I
STANDARD TRENCH: I
I I �o FT LONG
FT DUP
I I 7 SEW ROCK EFFECTIVE -�- Nell I
I I
I
I EXlSW 1250 CAL CONCRETE TANK I
I I
I I TOW 8' IBCA BANK 1
1
I I
I
I
I
I I
I I
SCALEr I' = 50 FT.
4th
TOBBE
2 No I
••�f\� X
TOBB£N SPURKLAND P.E.SEPTIC SYSTEM DESIGN
�4fOUNTAIN PARK EST. ,/1 BX 1 LOT 3
203 W 15TH. AVENUE DATE: MARCH 5 2003
ANCH. AK. 99501 13300 CR£STV/fW DRIVE
NC279-3916 GILES McDONALO SHEET.• 2/3 R10: 294
1907) PERMIT # SVO3OOOXX PID # 017-061-39 HPE01032.DVG
Standard Trench,
silt
7.0 rt or
Effective
2'
Wide
40'
Long
10'
Deep
7.0'
Sewer rock
3'
Cover
do
O
O
0 1250 gal Septic tank
C
a
C,
V
ti
3
Q
V
3
t2
,.0 %)LOn«
ITOBBEN SPURKLAND P.E.I OT 3, BK1, MOUNTAIN PARK ESTATE I SEPTIC SYSTEM SCHEMATIC
An W15th Ave GILES McDONALD DATEi MARCH 5, 2003
Anchorage Ak 99501 IMM CR£STWW DRIVE SHEET, 3/3 GRID, 2938
P£RMIT / SW0300XX PARCEL ID / 017-061-39 MPE01033.DWG
Municipality of Anchorage1roo'IENGi ER'S•!W'#,I
i
Development Services Department
Building Safety Division i L j
•»•M�.•...
0 On -Site Water and Wastewater Program
47CO South Bragaw SLPc
�..�. •••«r•M••• •• /
P.O. Box 196650 Anchorage, AK 99519-6650 /
• To ben Spvrkla� • eu/
vr,�w.ci.anchorace.ak.us �/ � ,� � �
(907) 343-7904 lfi . 10 Is &V
��E P 090 1515 GWr'
AV
Soils Log - Percolation Test 16%�
C �o
Performed For: (tom �l�l/L t, Pd ✓�� Date Performed:_ 3�jl�D 3
Legal Description: ��� 3 g Y i'4ov H L ., � Township, Range, Section:
SICoe Site Plan
Depot
(Feet)
2
- - o 6tE'i
4-
5-
6-
7-
8-
C'.
-5-
6 -B -G. tz _.
10-
12-
13-
14-
15-
0-
12-13-14-15- C-
16 `^
n-
1 E-
19-
20-
COMMENTS
r3o 9-1�
uoi1,
v:AS CROUND WATER
Date
ENCCl117TERE07
Net Time
Depth to Water
S
IF YES. ATYJHATDEPTH?
0
Depth to Water Atter
p
Monitoring?
G' Tr. — E
Date:
//! D'
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
rr_V
2�SOAi�
4Y/t
— —0
:s✓
E],/t-
I
3
10lJ�(1K
3/`%
T +i
y`�
60
I to
I S%>.Ll
' -I
to•.n u
1 10
I 5 3��
3' y
q Z
I
I to
P -o
I
5
h*3�1y
FERCCLATtOnPATECz _(M. testce) FERC HCLE CIALIETER �•
TESTF.UNSEWIEBN_15 FT AND_FT
PERFORMED BY: F_' S 1 T_ s CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE kND I IUN SCIPAL GUIDELINES IN EFFECT ON TH..!S DATE. DATE: _3& D
G NTER ANCHORAGE AREA BORC 'H
i
HEALTH DEPARTMENT N? 144
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
7�/SLG f MAILING
NAME
ADDRESS
LOCATION -C;;92
SEPTIC TANK:
AL
-
% PH0NEt
/ NUMBER OF /
DISTANCE FROM WELL MATERIAL �C�/(�l�'c�"%.�- COMPARTMENTS
�f LIQUID
LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
i
NUMBER OF PITS/ OUTSIDE DIAMETER —OR WIDTH 2� / LENGTH DEPTH_,
LINING MATERIALDISTANCE FROM WELL BUILDING FOUNDATIONS ,
NEAREST LOT LINE /�U TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) d1z" SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM V
NUMBER O INES
ABSQKPTION AREA
TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
FOUNDATION NEAREST LOT LINE OF LINES
STANCE BETWEEN LINES
A* T. LENGTH OF EAC INE
t(1 I
TRENCH WIDTH
IN. TOTAL EFFECTIVE
OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:DISTANCE FROM / WATER '
TYPEz%7al;:; , DEPTH X43 BUILDING FOUNDATION. SAMPLENEAREST
r NEAREST SEPTIC / SEEPAGE / L� OTHER--
LOT LINE �� SEWER LINE TANK �i SYSTEM, CESSPOOL , SOURCES_
DIAGRAM OF SYSTEM
DISTANCES:
DATE C ' ���`/ APPROVED�-
T' urAITu euTNnmTY
GAAB-HD-2 GREATEZ.
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
-)ROUGH
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No. Z'
NAME OF APPLICANT �D E L12.5 MAILING ADDRESS 6M ,6DC 3 %,% PHONE NO��—�
RESIDENCE ADDRESS LOCATION OF INSTALLATION 66!F CSE AiPMelef4Z
LEGAL DESCRIPTION Q�i, 1 \. o`er 'S '�J\A \'- "
APPLICATION TO INSTALL: SEPTIC TANK P"' SEEPAGE PIT ," , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY 2�S/QS/ _C f7 ^ J /3 C/2 4 Oda
FINANCED THROUGH s TO BE INSTALLED BY ('4�4,PE4 ?SXZZ=f'�/S2,S
PERCOLATION TEST RESULTS Aad pLV- j&FORo0M ANTICIPATED DATE OF COMPLETION 149
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS �< <� �� �� PERMIT TO INSTALL A e— ✓ >f�'��Z
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE _TYP 7(0 SEEPAGE AREA �TYPE �U
DIAGRAM OF SYSTE
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE 1 ' / " 7 42' APPLICANTS SIGNATURE
OVUM ANCHO"" " y ""
HEALTO
ANCHORA =i ALA KA "501-
performed
501.
6/�.,O-O-Utl�vtl
T'eriarmed for r _ � � ....�...._,....x„...._.,�...w
Le Ra 7. D4 at:'f.'7..� J4: :' J - ....m .,....,..,..n..
Ills Farm RePOrts a!
[De1 1 t
tg( tAe se Clr'v�'�hls Gvere.
pN(i' i�•C l' e/� res eii 1s u h
d er0e0CeCy�°
3 Grh
M W J4
3e6
6m
6
C, uJ
7 '
hn w n . -:krt 6:
Was
Ground
'dater
En count _.
:On
:?.
i es t At
.. ,:<i^"
.�%F `. s, t...d>........ ,...a....�•..�...,-,.....»..a....W.
Date qros� Me Mer e
T�et Drop
--
10577750M Rate i i.� ,.,r,.,...
"" Cir iJ.I) t F �.(1 ,.•..:.+.....m,..n.«.,.w -
FT t .:.J u � ne Y ] �. r77 1i=^i pr, ! !"nave i �..._.:......, �.,,....:.,�..,....,.r.,�... "' �( �
if'C,' r). i.Y"� e o.�.,...<�.., }.....,«....m...a.,....«. /�{ r �j lye G-�,,,�,•.e,Gl� _�� �'/h
C�,�, °i r ''_�_. L....r �G'.�,.ua,...+...�,.15+.�...4.�.":c.,�.2.t'�..«.��,,...�....�....•..+,. ""."w`�_.__.....a......,o..,......+.....e
�.,.«...,..�,�.�,,,,,..eo.�...,•e.......�.,.a....,Pwvr�,...rw,+.w.4,�.....w..,«�...�....ou....«..m.�....e..,._...+�.�.�.,..w.�.�,.,...+•......m.a^.,.
...�,�,�.�...�...��....w.�.�.�._,�.,..,,... �
SEP3()1970
1970
0
TeK Performed 13y; C�„„,�,•,,,,,_„�,..,.,�.
�S
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St. :" `T
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING'
Parcel I.D. O I `l _ Ob/—•3Q HAA #-AA- 3D 1101
Expiration Date: - %- 2_2 -0 3
1. GENERAL INFORMATION
Complete legal L07 -27j, kl 'o u aT Art N �AY1Kd
Locaton (site addressor directions) 1^ S1
13 3es-o C (�-em i 1/ 1 >r
Current Property owner(s) 1 4 s P C Do K dd ' Day phone
. 1�
Mailing address '
Lending agency'" Day phone
Mailing address
Real Estate Agent S PR� O Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2, NUMBER OF BIL
EDROOMS:
3. TYPE OF WATER SUPPLY:�/
TYPE OF WASTEWATER DISPOSAL:
Individual Well
M
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
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 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 seat 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 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 _ t _ S 1 t1 YZ-V—L- 64-,,I Y) 1�• Phone al q — 'Sc} l E,
Address tai /,t5 -P, 210 3
Engineer's Printed Name S VYV, Date '
Ablebe
10g
�. .«....... ... ,
5. DSD SIGNATURE z, '• , :W "'••»«� \
Approved for bedrooms.
Disapproved. t1oFo� ofES
Conditional approval for bedrooms, with the following ns:
i
; m:
Additional Comments • � - WATER AND
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory .
Maintenance Agreements
Supplemental Engineer's Report
Other
By:_ (% i Original Certificate Date: 3
(R". ovoz)
Muni cipalityr of Anchorage
Development Services Department *• `°
Building Safety Division •
Onsite Water & Wastewater Program . $ " "'
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.encharage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LOT 3 13V! ( WV Ni AI IJ PAA?,V- Parcel ID: 017-ote/- 3 q
A. WELL DATA ` t
Well type F- If A B, or C provide PWSID #N/Hr Well Log (YIN) tit
Date completed 1170 Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth 2o_3,_ft. Cased to _ fL Casing height (above ground) T`� in.
FROM WELL LOG AT INSPECTION
Date of test N -t o
Static water level
Well production
ft. R Y 7 ft.
g.p.m. 4V g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate D _ZAP mg./l. Other bacteria N L colonies/100 ml.
Arsenic: mg./1. Date of sample: Z-110 3 Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material ,�'�F�� Date installed If 70
Tank sizegal. Number of Compartments Cleanouts (Y/N) y
Foundation cleanout (Y/N) Depression over tank (YIN) _tj High water alarm (Y/N) 1�
Date of puj*pping %+ Pumper A f
C. ABSORPTION FIELD DATA
Date installed i441 -e3 Soil rating (g.p.d./fe or ftz/bdrm) --L,2 System type / Q tZNC�
Length fL Width ft. Gravel below pipe 7 ft.
Total depth 1 jZ ft. Eff. absorption area ff_k.Pft Monitoring tube `�_ Depression over field
Date of adequacy test N/A Results (Pass/Fail) T_ For -$— bedrooms
Fluid depth in absorption field before test L/in. Water added ✓gal. , New depth 1,/ in.
Elapsed Time: _✓min. Final fluid depth Win. Absorption rate >= ✓ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) ^ If yes, give date
D. UFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
Size in
gallon Manh ccess (Y/N)
level at _ in. igh water alarm level at
tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot S6
Absorption field on lot 145 -
Public
I' 5Public sewer main N/A
Sewer /septic service line .50 -f
On adjacent lots >! /V -u
On adjacent lots �t 10-0
Public sewer manhole/cleanoutL-AL-Al/
Holding tank N /A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10 Property line %- D Absorption field 6 D
Water main N�/a Water service line S^0 Surface water D
Wells on adjacent lots > Iy 0
in.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line $ o Building foundation 87 Water main M/A
Water Service line 0-0 4 Surface water 1
�4 Driveway, parking/vehicle storage O -0
Curtain drain r: V Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 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..
Engineer's Printed Name S t> u Y- V. 4 H X
Date Z Z d 3
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HAA Fee $ 37a Waiver Fee $ _
Date of Payment yl z/ Date of Payment
Receipt Number 30 i Receipt Number,
(Rev. 1 Z/0 t )
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SURVEY CERTIFICATION.�rrT►r1<1rr,+
Prepared by
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Robert E. Johns, -Jr. & Assoc.
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ANCHORAGE, ALASKA 99501
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Roc. Lot S.F.
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SGS Ref.# 1031915001
Client Name Tobben Spurkland P.E.
Project Name/# 3/1 MPE
Client Sample 1D 3/1 MPE
Matrix Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Datc/Pime 04/14/2003 9:57
Collected Date/Time 04/09/2003 16:00
Received Date/Time 04/10/2003 11:37
Technical Director ,fStephp C 'de
ReleasedYl
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Waters Department
Nitrate -N 0.208
Nitrite -N 0.200 U
Microbiology Laboratory
Total Coliform 1 OD, No Coli
0.200 mg/L EPA 300.0
0.200 mg/L EPA 300.0 (<=1)
col/100mL SM189222B (<=1)
04/10/03 JS
04/10/03 JS
04/10/03 KAP
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