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ALLEN LT 2
Allen Lot 2 #015-271-55 MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 43<1 PHONE z = �� 4 NEW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION 4 LOCATION NO. OF BEDROOMS UY DISTA& TO: Well / /0l) Absorption area .2 f Dwelling S / PERMIT NO. E o20 H Z aQ W I,_ Manufacturer C Material No. of compartments y Liq. capacity in allons ��0 G� IF HOMEMADE: Inside length Width -- Liquid depth G Y J u Z DISTANCE TO: WellDwelling PERMIT NO. O < Manufacturer Material Liquid capacity in gallons O Lu= DISTANCE TO: Well /0 Foundation / Nearest lot line -r/C) PERMIT O. J LL Z Z W No. of lines 1 Length of each line C/' Total length of lines Slct" Trench width ,3C inches Distance between lines QkxTop of tile to finish grade Material beneath tile S i nches� Total effective ab so ption area ) W Length Width Depth PERMIT NO. Ql— CLs W Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line _jClas J Q q 1c Depth Drlrller �i Distance/to lot line PERMIT NO. f/ W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER I PIPE MATERIALS SOIL TEST RATING C INSTALLER�I f� C j REMARKS Z I APPROVE/D DATE LEGAL OX �/P 72-013 (Rev. 3/78) U U roi k-1�����������_][-��� DEPARTMENT HEALTH AND ENVIRONMENTAL 70TECTION 825 '� STREET. ANCHORAGE, AK 99�01 ' ~ . 264-4720 1=1 141 ED, KEN 01 1 '1 IEEE. 1.4 E� F-*.-" F:,EE�R PERMIT NO. ( 820356 APPLICANT AMC INC. P.O. BOX 4-2882 LOCATION CHNGE AVE ^�r- LEGHL LOT 2 ALLEN SUB LOT SIZE 41000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH (~� /�cls MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 146 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS /..rn THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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 GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) 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. �il.4 cl �a I r4 ', F" Eo C2 1- 1 CA f-4 F-0 FQ K FQ EO C -A 01 1 F."E:-- I:,,- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE HYHILHBLE TO INSURE PROPER INSTALLATION. F="k=7KJsll-T- [D*�EwCVlE7blE3lE7FR �772L, AL 00 iY:02 I CERTIFY THAT 1: I HM 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 THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. �3 SIGNED __ `- -- -'- --------------'- - ArPL. CH.�MC ��� -� ^ 1 SSUED `0�19_ T /�--' __ �� -"t Y_t- wT r'"t k17 DEPARTMy"T OF HEALTH AND ENV I RONME ~ IL PROTECTION 8`a 'L' STREET, ANCHORAGE, AK. 99501 254-4720 jump 44ELL FArJE'■ CA14— 3I TE t-�JEF_> P'EFzrl I 'PERMIT NO. ( 820356 APPLICANT AMC INC:. P.O. BOX 4-2862 445-581= LOCATION CANGE AVE LEGAL LOT 2 ALLEN SUE: LOT SIZE 41000 SQUARE FEE? TYPE OF SOIL ABSORPTION SYSTEM I5: TRENCH MAXIMUM NUMBER OF BEDROOMS = .x'-41 SOIL RATING CSD FT/8R)= 146 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: coEP TH= ss t- F= r -i ci TH= =+ lC F? E>FEE PTH= f THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN 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 CIN FEET). F -;P EiC�tt_t I FZ EC} S~FEE F�T I 41= TI=t t4K- c I Z'E= - C3 KL.L_CAt4SS 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. --- TF.4C-10 < - > I to F=E: IC --V I f_ -l" 4--- t=1R:E FZE:G t t I FZFEE G• -- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. j MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 206 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANi_E FROM A PRIVATE WELL TO A PRIVATE SEWER.LINE IS 25 FEET ANC., TO A COMMUNITY SEWER LINE I5 75 FEET. WELL LOGE. ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. j OTHER REQUIREMENTS MAY APPLY. SPECIFICTATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'E.FZM I T F=�-;F• I Fz:-*E'=. L:)-EGFEE ME�FEE F;;: :373a ::L*_::;w: f:> i I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS: AS SET i FIRTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. i SIGNED II f i ISSUED i K _ Inc. DATE.r r Com. � Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 Phone (907) 278-1551 (Telecopier (907) 272-5742) October 12, 1977 W.O. #D9985 Grid #2634 Mr. George Allen 6209 Chevigney Drive Anchorage, AK 99502 Subject: Subsurface Investigation for proposed Allen Subdivision Dear Mr. Allen: The following is a follow-up of our April 15, 1977 report for the proposed Allen Subdivision. That investigation consisted of two test holes and two percolation tests. As. noted in that report, the percolation rates obtained in the earlier investigation were considerably slower than usually observed for similar soils. At that time we noted that the rates may be excessively conservative and recommended addi- tional percolation tests. This report covers the following: a. An additional test hole was drilled to check the con- tinuity of soils. b. The percolation test on holes #1 and #2 were rerun. i Included in this transmittal is: Vicinity Map Figure 1 Test Hole Location Sketch Figure 2 Test Hole Log Table A Explanatory Information Sheets 1-3 Previous Report Appendix A The investigation for the latest phase of exploration was conducted July 27 and 28, 1977. One 17' deep test hole was drilled using a solid stem auger. Samples were taken at each change in soil type. The drilling rig is owned and operated by Denali. Drilling, Inc. Drilling was supervised and the test holes loq-ged by Mr. David Tobey, technician with Alaska Testlab. Table A is a log of a test hole reflecting visual observations and classifications. Based on the additional test hole, subsurface conditions appear similar to that: encountered in the other two holes. Predominant unified classification was GP with GW, SP, GM, and SM soils also encoun tercel. Mr. George Allen October 12, 1977 Page 2 When the percolation tests were rerun, the method as recommended by the Municipality of Anchorage Department of Public Health and Environmental Protection was used. For the second trial, results were as follows: Test Hole #1 - 4.7 minutes/inch Test Hole #2 - 11.4 minutes/inch The logs of test holes #1 and #2 are included in the previous report (Appendix A). No free water was observed in any of the holes at the time of drilling. We trust the results clarifies the subsurface conditions for this project. If there are any questions or if we can be of further assistance, please do not hesitate to contact us. Very truly yours, ALASKA TESTLAB Mark Hanse RMH:rb Enclosures AP OVE rry R e 4, -- Melvin R. Nichol, No. 4113.E ` Fav .To -Z46 N . 589°58'50"E 32995 9 • tON_ 00 Cd T`p O ocwoA 49,496 f. N 89°5850W O� , 25 299.93 00GO OO O 2 8 49,493sf.T. H. A2.959H2 o s 40 �, • ASV N89 58 50 30 1— — -- — — — — '" 299.91 N O O 8 I z a 3 2 1 49,499sf. tO Ernn4 6'50"W9 J� to F,, f.T^ Z 14�Q3 TH I 7 30 — — — — — "- -- -- -- to 329.87 1!2 th AVE. 50,E 1319.49 c0ll• so A -1.4 _ I t S / EFh(ER !VlDED S t/D D Test Hole #A Depth in Feet From To 0.0' - 0.4' 0.4' - 2.0' R Table A WO #D9985 Logged By: D. Tobey Date: 7-27-77 Soil Description Organics and wood. F-4, tan Gravelly Silt, ML, with roots, medium density. 2.0' - 3.0' NFS, brown Gravelly Sand, SP, coarse grained, with roots, damp, high density, subrounded particles to 1". 3.0' - 6.0' NFS, brown Sand Gravel, GP, contains roots, medium to high density, subrounded particles to 6". 6.0' - 7.2' NFS, grey Sand, SP, medium and fine grained, damp, dense. 7.2' - 9.0' NFS, brown Sandy Gravel, GP, many cobbles, damp, dense. %.0 - 10.0' F-2, brown Silty Sand, SA4�fine grained, damp, dense. 10.0' - 11.0' ZIFS, brown Sandy Gravel, GP, gap graded, con- tains medium and fine sand, damp, dense. 11.0' - 11.7' F-1, brown Silty Sandy Gravel, GM, damp. 11.7' - 12,7' NFS/F-2, layered Silty Sand, SM and Gravelly Sand, SP. 12.7' - 17.0' NFS, brown Gravelly Sand, SP, few cobbles and boulders, damp, dense, subrounded parti-cles. Bottom of Test Hole: Frost Line: Free Water Level: Sample Depth 1 2.0' 2 3.0' 3 3.8 (Continued) 17.0' None Observed None Observed Type of Blows/6" M% Sam '1e 9.7 G 2.8 G 1.0 G Dry Strength Group Unified N A SM N C GW N C GP Test Hole #A .0.N W.O. #9985 Sample Depth Blows 6" m% Type of Sample Dry Strength GroupUnified 4 4.8' 1.6 G N N C C GP GP 5 6.0' 2.9 5.9 G G N B SP 6 7 7.2' 9.01 3.0 G N C D GP SP -SM 8 9.5' 13.9 G N N E Sw 9 11.0' 2.6 2.3 G G N F GP -GM 10 11 11.5' 12.5' 5.9 G SP N D -SM 12 17.0' 3.0 G E GW Remarks: 1. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. 2. Dry Strength, N=None, L=Low, M --Medium, H=High. 3. - Group refers to similar material, this study only. 4. General Information, see Sheet 1. 5. Frost and Textural Classification, see Sheet 2. 6. Unified Classification, see Sheet 3. Test Hole Log -- Description Guide The soil descriptions shown on the logs are the best estimate of the soil's characteristics at the time of field examination and +s such do not achieve the precision of a laboratory testutg procedure. if the log includes soils samples, those samples receive All independent textural classification in the laboratory to verify the field examination. The logs often include the following items: De th Interval - usually shown to 0.1 foot, within that zone no signi tc+rat change in soil type was observed through drill action, direct observation or sampling. Frost Classification — NFS, Fl, F2, F3, F4, see "Soil Classification Chart" Texture of Soil — An engineering classification of the soils by particle sized proportion, see "Soil Classification Chart", note the proportions are approximate and modifications to the soil group due to stratification, inclusions and changes in properties are included. Moisture Content — this is a qualitative measure: dr�r, na or little apparent surface moisture, damp, moisture forms portion of color, less than plastic limit, wet, no free water, often soft, if cohesive soil, saturated, free water may be squeezed out, if a free draining soil: i sent at natural muisrure content, if a non -plastic silt or fine sand. (The moisture content is further definedby reference to PI, LW, NP, M% or dilatency.) Density — refers to more -or -less non -cohesive soils, such as sand gravel mixtures with or without a fine fraction, derived from drilling action and/or sample data; usually described as: very loose, loose, medium dense, very dense. General intent is to portray earthwork characteristics. Stiffness — refers to more -or -less cohesive soils and fine grained silts of tie clay silt groups. Derived from drill action and/or sample data. Very soft, soft, stiff, very stiff and hard are commonly used terms. Particle size — The largest particle recovered by the split spoon is 1-3/8", Shelby tube 3", auger flights (minute -man) 2" Auger flights (B-50 hollow stem) 6"-8". Larger particles are described indirectly by action of the drilling and are referred to as cobbles, .3" to 8", or boulders 8"t. Therefore when reviewing the gradation sheets, if any, the description oft the hole log must be considered for an indication of larger particles. Unified Soil Classification -- This is a two letter code. See Unified Classification sheet for further definition. In some cases AASHO and/or FAA soil classifications may be shown as well as the unified. Atterberg Limits - useful for fine grained and other plastic soils. PI; natural moisture content believed to be less than plastic limit PI+; natural moisture content believed to bc. between plastic and liquid Emits Lw+; natural moisture content believed to be greater than liquid limit NP; non -plastic, useful as a modifying description of some silty materials. Dilateric — is the, ability of nater to migrate to the surface of a saturated or nearly saiuratcd soil sample when vibrated or jolted — used as an aul to determine if a f -,C grained soil is a slightly or nor,-p{+sdc silt or a valcaw.t .sh, Rock flour -- finely ground soil that is not plastic but otherwise appears SIM r to a clayey silt. Organic Content -- usually described as Peat, PT, sometimes includes discrete parttc es such as wood, coal, etc. as a modifier to an inorganic soil. Quantity described as; trace, or an estimate of volume, or, in case of all organic, — as Peat. This may include tundra, muskeg and hog material. Muck — a modifier used to describe very soft, semi -organic deposits usually occuring below a peat deposit. Amorphus peat — organic particles nearly or fully disintegrated. Fibrous Peat — organic particles more -or -less intact. Bottom of Testhole — includes last sample interval. Frost Line — seasonal frost depth as described by drilling action andlor same es at the time of drilling. Frozen Ground — other than frost line, described by samples, usually includes description of ice content, often will include modified Unified Classification for frozen soils — th-s is a special case related to permafrost studies. Free Water Level — The free water level noted during drilling. This is not necessarily the static water table at the time of drilling or at other seasons. Static water table determination in other than very permeable soils requires observation wells or piezometer installations, used only in special cases. Blow 6" — The number of blows of a 140 weight free failing 30" to advance a 2" split spoon 6"; the number of blows for a 12" advance is, by definition, the standard penetration. „4% — natural moisture content of the soil sample, usually not per?ormed on clean sands or gravels below the water table. Tv e of_Saam�le - $p, refers to 2" split spoon driven into the soil by 140 pound weight, a disturbed sample, .a, thin wail tube, "Shelby" used to obtain undisturbed samples of fine grained soil, "grab" disturbed sample from auger flights or wall of trench, cut sample, undisturbed sample from wall of trench. Dry Strength — a useful indicator of a soil's clayey fraction, N=None, L=Low, M -Medium, H=High Group — The samples are placed into apparently similar groups based on color and texture +rid ate arbitrarily assigned a group letter. Further disturbed tests including Atterbetg Limits, grain size, moisture -density relationship, etc. may he performed on the group and are assumed it, reflect the general d:strubed characteristics of the soils assigned to tt;c group. This is an impoitant phase of the soil analysis and is used to standardize the various qualitative determinations and to reduce the number of quantttarit•e tests necessary to describe the soil mass. Rj SOIL CLASSIFICATION CHART �s Q C? do o, s k, a' A. �o m ' 10% GRAVEL oho OQ" c�1 0j v vo CLAYEY CL, / OR SILT h o SILTY \ o � � s n o � \00 s � O � O ,pc' so F2 � � o (El' CLAYEY R o i OR O Y SILTY o�• 0 10 20 30 40 50 60 70 80 90 100 GRAVEL (f#4 SCREEN) % BY WEIGHT NONFROST SUSCEPTIBLE SOILS ARE INORGANIC SOILS CONTAINING LESS THAN 3% FINER THAN 0.02 rnrtl. GROUPS OF FROST -SUSCEPTIBLE SOILS: F1 GRAVELt..Y SOILS CONTAINING BETWEEN 3 AND 20% FINER THEN 0.02 mm. F2 SANDY 5011.5 CONTAINING BETWEEN 3 AND 15''i) FINER THAN 0.02 mm. F3 a. GRAVELLY SOILS CONTAINING MORE THAN 2W"6 FINER THAN 0.02 mm. AND SANDY SOILS (EXCEPT FINE SILTY, SANDS) CONTAINING MORE THAN 15°'o FINER THAN 0.02 mrn. b. CLAYS WITH PLASTICITY INDEXES OF: MORE THAN 12. EXCEPT VARVED CLAYS. F4 a. ALL SILTS INCLUDING SANDY SILTS. b. FINE SILTY SANDS CONTAINING MORE THAN 15% FINER THAN 0.02 mm. C. LEAN CLAYS W!TH PLASTICITY INDL'XES OF LESS THAN 12. d. VARVED CLAYS. o a 8 =»TTTi c " o ° Ei E� J ° � o _ _ Et a as � �I I '•� I<c q' <V E3 - j tl ryngwas Imp 1n xn natnnbatsxn .minyaup ;.ZI n, ?15 � �o « S o JS'WS':Y)'WD �,Zlnryt uoy� v dS'Mti'AJ'MJ `>.S u"I—.1 spin Awpfrd ::nsopo) se pas)m-1, - :p- P-1.xam. (ax,s an.ae OOi off ceyt ,allows u:v,=n,t sauy 10 Anua—d uo 8u,puad 34 d :+ mrs uleii wnq pun pu,r 1.ur,810 saenuoe,aa,an I' ouvynuap, play aap,m—s-sum:ar+l ayt twin l" m anma ans —A nsn E 3f 9 uIf c �•E c n E•� '. >•» 8 �� �c Dom'- _ Etc" c o _ C w W L uir I I 6. 4. IE E y J E o f J a Z s < 3 =— 3 _. Z. y 1 - ' ° Z i 1' ,.1 lo,an J 2 y w,l 1ni a l uu ,�., attull ly S t l+ I„SII �yn,a,ddel 3 vv8 not , I 'pun ural,) I smut ,.«spurt 'J'; ntnaa 04 ur41 —1 uryt N . r j-.,�ba _ umq pmb;l f uwy p,nby I p n .,y ar , ..c a .y, 7i•l, lm i ..+JI = sAga pur slpl sArla pur s,l,y _. ,,,,<. •nn ans ,unix y r,7 rip ,iii:,•, ...n ,.rpt „tl• u, c'S ilry M.4, -:1111a., ,, I•• Ilry —1, a,uW d •• r„ purti SF� _ �_L__._ ;..t: pa;ru ut aly,u al ,,,+N natlr, ayt snug %1 wa,•: uui'uN a4 Li ... • Z';;uryt wo r 10 nry,'-k4 s.+prw a, le, , p y uryt —Wsp. t w3 pauuj—, _4 e-�- ti a c:) o vc, aid k�\ tPc �Cv� 0 = 9- ��- COD_s� IV 710` �,o STATE OF ALASKA RETURN TO: 'Division of Geological and C — Yslcal Surveys (DGGS) DEPARTMENT OF NATURAL RESOURCES 3001 Porcupine Drive (Tela e: 277-6615) _ Anchorage, Alaska 99501 " W A T E R W E L L R E C O R D Vern's Drilling, U.S.G.S. Local lio. Grilling Company Name Drilling Permit No. Please complete either la, lb, o;r Ic. A.D.L. No. is LOCATION OF WELL F i Ia. Borough Suv ivision _ Lot Block 11b. Fraction 5 Lit'rt,r�o.': Township Range Meridian H N/S E/W lc. Distance and Direction from Road Intersections 3, OWNER OF WELL: Sam Fe j e s Address:Beacharof Const Street Address and Area of Well Location 2. WELL LOG Feet Below 4• WELL DEPTH: (completed) Surface Elevation Date of Surface 2 25 ft. Co©pJgj n Material Type Top Bottom O� p G s and & gravel 5. []Cable tool ®Rotary ❑ Oriven ❑ Dug hard cemented gravel 65 88 ❑Auger ❑Jetted E] Bored E] Other: silty sanCO3 C9 1 140 d gray silt 1 0 1 6. USE: r❑ Domestic ❑ Public Supply Industry ❑ gra silt with rave 1 1 0 1 ❑ Irrigation ❑ Recharge ❑ Commercial l 2' cobbles 18 1 ❑Test Well ❑Other; cemented gravel seepage 1 1 225 7, CASING: ❑ Threaded []Qelded aou 3 gpmat 20 O U d e r s 2 1 6 in. to 22 9 ft. Depth Weight ibs/f t. in. to ft. Depth 8. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9. STATIC WATER LEVEL: 1 ft. ❑ Above Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pumping r- 9•p•m- ft. after hrs. pumping 9•p•m- 11. WELL HEAD COMPLETION: ❑ In Approved Pit ❑ Pitless Adapter inches above grade 12. GROUTING: Well Grouted: ❑ Yes ❑ No Material: []Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9•P Type: ❑ Submersible ❑ Reciprocating ❑ Jet ❑ Other: 14. REMARKS: Perforated 213' — 2241 Water Temperature: 15, WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Vern's Drilling & Ent AA 3327 Registered Business Name Contract License NumTer Address: 1 eJ,141 AV] 011 a l.• 9 0112-i DUX I -JIDU AIL"11rt r-1116" , HK ;„:;2 =�1y6 Signed: Date: Authorized Representative Form 02-WWR Copy Distribution: WHITE - State DGGS, PINK - Driller, CANARY - Customer Municipality of Anchorage Development Services Department j . Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. 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. HAAff � 1. GENERAL INFORMATION Expiration Date: _ I I f ( to Complete legal description ALLEN SUBDIVISION: LOT 2. Location (site address or directions) '11050 CANGE STREET • ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SHAWN do CHARLOTTE BRADY Dayphone 561-0550 11050 CANGE STREET + ANCHORAGE. AK 99516 Day phone BLAKE BUTLER W/ REMAX PROPERTIES Day phone 110 WEST 38TH AVENUE * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 257-0152 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation data shown below, 1 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. 1 further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells an septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the syste These conditions are outside the control of the evaluator of the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use ofthis report by any ocher person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Attachments: / HAA Checklist ✓ Septic System Advisory Well Flow Advisory bedrooms, with the 337-6179 Date 0 -1 oy WMAM 121• d��t \�YtOFffgNrC i 9QPM.••......, yo'•, t tations: '•,'Py m ON-SITE n WASTEWATER �� Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 10 11 t (R", 12101) Municipality of Anchorage R� • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6050 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ALLEN SUBDIVISION: LOT 2, Parcel ID: 015-271-55 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/1982 Sanitary seal (Y/N) YES Total depth 225 ft. Cased to 225 H. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 33 in. FROM WELL LOG AT INSPECTION Date of lest 8/1982 10/8/2005 Static water level 184 ft. 189 ft. Well production 7 g.p.m. 6.1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 oolonies/100 ml. Nitrate 0.1 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: VAAR Collected by: GEG, LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10/14/1982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/26/2005 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA •sdxow onsnrrc GWE Date installed 10/14/1982 Soil rating OEr ft'/bdrm) 146 System type TRENCH _ Length 44 ft. Width 3 ft. Gravel below pipe "5 ft. _ Total depth 015.4 ft. Eff. absorption area 440 ft' Monitoring tube YES Depression over held NO Date of adequacy test 10/6/2005 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 53 in. Water added _M gal. New depth 69 in. Elapsed Time: 251 min. Final fluid depth 57.5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — "PER S&S ENG. MONITORING TUBE EXTENDS 8.5' BELOW DISTRIBUTION PIPE. D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property rt line 101+ Building foundation 109+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and t! 1T► review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS VON 1 Date l4 1'1 /W Of4 • •t R 04ih°p�ar� HAA Fee $ Ll gc1 Waiver Fee $ _ Date of Payment 1U" 7 -Ori Date of Payment Receipt Number Receipt Number, (Rev. 12'01) O- C -UO; /:OOAM; GS ReEN 1052915001 Ilent Name Gamess Engineering Group, Ltd. 'reject Name/# Various dent Sample ID Allen S/D; Lot 2 latrix Drinking Water ample Remarks: ;907 5615301 All Dates/Times are Alaska Standard Time Printed Datel lme 06/01/2005 15:57 Collected Date/Time 05252005 15:35 Received DateMme 05262005 10:48 Technical Director Stephen C. Ede 0 2/ 9 Allowable Prep Analysis srametcr Results PQL Units Method ContaineriD Limits Date Date bit etals Department Hardness as CaCO3 823 5.00 mg/L SM -10 2340B D 0527/05 05/31/05 SCL rivate Individual Analysis . Aluminum 20.0U 20.0 ug/L. EP200.8 D 0527/05 05/31/05 SCL Antimony 1.00 U 1.00 ug/L EP260.8 D (<-6) 0527/05 05/31/05 SCL Arsenic 5.00 U 5.00 ug/L EP200.8 D (<-50) 0527/05 05/31/05 SCL Barium 4.09 3.00 ug/L EP200.8 D (<-2000) 0527/05 05/31/05 SCL Cadmium 0.500 U 0.500 ug/L EP200.8 D (a-5) 0527/05 05/31/05 SCL Calcium 21500 500 ug/L EP200.8 D 0527/05 05/31/05 SCL Chromium 1.00 U 1.00 ug/L EP200.8 D (<-100) 0527/0505131105 SCL Copper 18.0 1.00 .ug/L EP200.8 D. (<-1300) 0527/05 05/31/05 SCL Iron 250 U 250 uVL EP200.8 D (<-300) 0527/05 05131/05 SCL Lead 0.454 0200 ug/L EP200.8 D. (<-15) 0527/05 05/31105 SCL Magnesium 6930 50.0 ug/L EP200.8 D 0527105 05/31105 SCL Manganese 69.1 • 1.00 ug/L EP200.8 D (<-50) 0527/05 05/31105 SCL Chloride 1.17 0.100 mg/L EPA 300.0 B (<-250) 0527105 JJB Phosphorus 200 U 200 ug/L EP200.8 D 0527/05 05/31105 SCL Fluoride 0.100 1.1 0.100 mg/L EPA 300.0 B (42) 0527105 JJB Potassium 1070 500 ug/L EP200.8 D 0527/05 05/31/05 SCL Nitrate -N 0.100 1.1 0.100 mg/L EPA 300.0 B (<-10) 0527/05 JIB Selenium 5.00 U 5.00 uWL EP200.8 D (<-50) 0527105 05/31105 SCL Nitrite -N 0.100 U 0.100 mg/L EPA 300.0 B (<-1) 0527/05 JJB Sodium 3950 500 ug/L EP200.8 D (<-250000) 0527/05 05/31/05 SCL Silicon 4850 200 ug/L EP200.8 D 0527/05 05/31/05 SCL Silver I.00U 1.00 ug/L EP200.8 D (<-100) 0527/05 05/31/05 SCL Thallium 1.00U 1.00 ug/L EP200.8 D (<-2). 0527/05 05/31/05 SCL Sulfate 6.02 0.100 mg/L EPA 300.0 B (<-250) 0527/05 JIB 1� 6- 2-0b; 7:66AM; CS Ret# 1052915001 ;cent Name Garness Engineering Group, Ltd. 'rojectNsme/# Various Ment Sample M Allen SID; Lot 2 42triz Drinking Water ;807 6616301 All Dateslrimes are Alaska Standard Time Printed Date/time 06/01/2005 15:57 Collected Date rime 05/25/2005 15:35 Received Date/Time 05/26/2005 10:48 Technical Director Stephen C Ede • 3/ 8 arameter Results PQL Units btethod ContainerM Allowable Limits Prep Analysis Due Date !nit -rivate Individual Analysis Zinc 137 5.00 u8/L EP200.8 D (<-5000) 05/27/05 05/3I/6s SCL Total Dissolved Solids 110 10.0 mr/L SM20 2540C C (<-500) 05/26/05 KP Nickel 2.000 2.00 ug/L EP200.8 D (o-100) 05177/05 05/31/05 SCL HCO3 Alkalinity 97.0 10.0 mg/L SM20 2320E C 05/26/05 PLW CO3 Alkalinity 10.0 U 10.0 mg/L SM20 2320E C 05/26/05 PLW OH Alkalinity 10.0 U 10.0 mg/L SM20 2320E C 05/205 PLW Conductivity 190 1.00 umhoslem SM20 251OB C 05/26/05 KP PH 7.80 0.100 PH wits EPA 150.1 C (6.5-8.5) 05/26/05 KP Alkalinity 97.0 10.0 mg/L SM20 23208 C OS/26105 PLW Total Coliform 0 . coVIODmL SM20 92228 A (a.p 05176105 TLF 4 133UM 3ONYJ b M Z'd XHj 13rNR SHI dH WHiZ:Oi SOOZ 9Z new 10'S91 M.COi0.0 N su .enc = ----- ------- 7/�S3 '] i Y Al ------ Z'd XHj 13rNR SHI dH WHiZ:Oi SOOZ 9Z new Municipality of Anchorage Development Services Department ' • Building Safety Division .. .. OnS to Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-66501 S S www.ci.anchorage.ak.us^ `( j (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. ()15-2:11-55 HAA# ()5M_:v4 1. GENERAL INFORMATION Expiration Date: 9—:z— 0S Complete legal description ALLEN SUBDIVISION: LOT 2. Location (site address or directions) 11050 CANGE STREET • ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SHAWN do CHARLOTTE BRADY Day phone 561-0550 11050 CANGE STREET • ANCHORAGE, AK 99516 BLAKE BUTLER w/ REMAX PROPERTIES Day phone Day phone 257-0152 110 WEST 38TH AVENUE • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of tille (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates maybe reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the onsite 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit oflhe owner listed above. Any reliance upon or use of this report by any otherperson or party Is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Approved for —.-� bedrooms. Phone 337-6179 Date b17- o Disapproved. Conditional approval for bedrooms, with the following stipulations: `ltttt I((Of(Flffffrrrri/ �',y--=84E SITE Sao WATER AND t PROGRAM Attachments: HAA Checklist Maintenance Agreements JJl'/Jl��yl/J1i1N1S\\ Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: nx4N / 4!ZZ- Original Certificate Date: Con 2-05 4��rff or tRw. 1zoIr Municipality of Anchorage Development Services Department Building Safety Division On-Sse Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 095198850 www.d.anchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ALLEN SUBDIVISION: LOT 2, Parcel ID: 015-271-55 A. WELL DATA 'TEST DATA FROM S&S ENGINEERING Wed type SATE If A, B. or C provide PWSID# N/A Well Log (YM) YES Data completed 8/1982 Sanitary seal (YIN) YES Wires property protected (YIN) YES Total depth 225 ft. Cased to 225 ft. FROM WELL LOG Data of test 8/1982 Static water levet 184 ft. Wed production 7 9 -p.m - WATER SAMPLE RESULTS: ColKorrn 0 coloniesl100 ml. Nitnste 0_mgJL. Casing height (above ground) 12+ in. AT INSPECTION *6/5/2003 183 ft. 6.4 g.p.m. Other bacteria _0 coloniesl100 ml. Arsenic: N/A mg./L. Date of sample: 5/25/2005 Collected by: GEG. LtD. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date instatled 10/14/1982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (YM) N/A Date of pumping 5/26/2005 Pumper MCOONALDS PUMPING C. ABSORPTION FIELD DATA Date krstaded 10/14/1982 Sod rating (g.p.d-1ft'orq!5jE0 146 System type TRENCH Length 44 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 015.4 ft. Eft. absorption area 440 ft' Monitoring tube YES Depression over field NO 006/26/2003 Date of adequacy test "6/5/2003 59 5/Results (PasstFed) PAS600/ For 3 bedroloms 73 Fluid depth in absorption field before test DKY in. S8/ Water added 458 gal. New depth 6? in. 1246/ Elapsed Time: 79 min. Final fluid depth 58.5 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date — 64 INCHES OF WATER IN MONITORING TUBE ON 5/25/2005. *PER S&S ENG. MONITORING TUBE EXTENDS 8.5' BELOW DISTRIBUTION PIPE. CO AT BEGINNING OF TRENCH REMAINED DRY THROUGHOUT TEST. CO INSTALLED. **TEST DATA FROM S&S ENG. D. LIFT STATION Date installed 'Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfiift station on lot 100'+ Absorption field on lot t 00'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots t 00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and a ! ! ' r* review of Municipal records that the above systems are in """' .. ""' conformance with MOA HAA guidelines in effect on this date. ......ess:'... ..J eyG Engineer's Printed Name JEFFREY A GARNESSCE-7 sr •�1�. ar'�� Date(Jor �• ooro Endo^d' HAA Fee $ u '!\nom Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Data of Payment Receipt Number 6- 2-05: 7:56AM: :907 6615301 O 2/ 9 0 CS Ref.# 1052915001 71ent Name Gamcss Engineering Group, Ltd. •roJect Name/# Various Tient Sample ID Allen SID; Lot 2 latrls Drinking Water ample Remarks: All Dates/Times are Alaska Standard Time Printed Daterrlme 06/012005 15:57 Coneeted Date/rime 05252005 15:35 Received Datc/rlme 05262005 10:48 Technical Director Stephen C. Ede Allowable Prep Analysis unneta Results PQL Units Method Container ID Limits Date Date Init etals Department Hardness as CaCO3 82.3 5.00 mg/L SM20 2340B D 0527/05 05/31/05 SCL rivate Individual Analvais Aluminum 20.0 U 20.0 ug/L EP200.8 D 0527/05 05/31/05 SCL Antimony 1.00 U 1.00 ug/L EP200.8 D - (<-6) 0527/05 05/31/05 SCL Arsenic 5.00 U 5.00 ug/L EP200.8 D (<-50) 0527/05 05/31/05 SCL Barium 4.09 3.00 ug/L EP200.8 D (<-2000) 0527/05 05/31/05 SCL Cadmimn 0.5000 0.500 ug/L EP200.8 D (<-5) 0527/05 05/31/05 SCL Calcium 21500 S00 ug/L EP200.8 D 0527/05 05/31/05 SCL Chromium 1.000 1.00 ug/L EP200.8 D (<-100) 0527/05 05/31/05 SCL Copper 18.0 1.00 .ug/L EP200.8 D. (<-1300) 0527/0505/31/05 SCL Iron 250U 250 ug/L EP200.8 D (<-300) 0527/05 05/31/05 SCL Lead 0.454 0.200 ug/L EP200.8 D (<-15) 0527/05 05/31/05 SCL Magnesium 6930 50.0 ug/L EP200.8 D 0527/05 05/31/05 SCL Manganese 69.1 1.00 ug/L EP200.8 D (450) 0527/05 05/31/05 SCL Chloride 1.17 0.100 mg/L EPA 300.0 B (4250) 0527/05 1JB Phosphorus 2000 200 ug/L EP200.8 D 0527/05 05/31105 SCL Fluoride 0.100 1.1 0.100 mg/L EPA 300.0 B (42) 0527105 JJB Potassium 1070 500 ug/L EP200.8 D 0527105 05/31/05 SCL Nitrate -N 0.1001 0.100 mg/L EPA 300.0 B (<-10) 0527/05 JIB Selenium 5.00 U 5.00 ug/L EP200.8 D (<-50) 0527/05 05/31/05 SCL Nitrite -N 0.100 U 0.100 mg/L EPA 300.0 B (<-1) 0527105 JIB Sodium 3950 500 ug/L EP200.8 D (4250000) 0527/05 05/31105 SCL Silicon 4850 200 ug/L EP200.8 D 0527105 05/31/05 SCL Silver 1.00U 1.00 ug/L EP200.8 D (<-100) 0527/05 05/31/05 SCL Thallium 1.00U 1.00 ug/L EP200.8 D (42). 0527/05 05/31/05 SCI, Sulfate 6.02 0.100 mg/L EPA 300.0 B (<-250) 0527105 JIB 6— 2-05; 7:56AM; ;907 6615301 N 3/ 9 :CS Ref.# 1052915001 ;tient Namc Garncss Engineering Group, Ltd. 'roject Nnme/M Various Ment Sample ID Allen SID; Lot 2 42tria Drinking Water All Dat sfrimes are Alaska Standard Time Printed Date/Tlme 06/012005 15:57 Collected Date rime 05252005 15:35 Received Date/Time 05262005 10:48 Technical Director Stephen C. Ede Allowable Prep Analysis &==ter Results PQL Units Medved Container M Limits Date Data Init 'rivate Individual Analvaia Zinc Total Dissolved Solids Nickel IIC03 Alkalinity CO3 Alkalinity OH Alkalinity Conductivity pH Alkalinity Total Coliform 137 5.00 ug/L EP200.8 D (<-5000) 05/27105 05/31/05 SCL 1t0 10.0 mg/L SM202540C C (<-500) 05/26/05 KP 2.000 2.00 ug/L EP200.8 D (o— 100) 05/27105 05/31/05 SCL 97.0 10.0 mg/L SM202320B C 05/26/05 PLW IO.OU 10.0 mg/L S%I202320B C 05/26/05 PLW 10.0 U 10.0 mg/L Sh120 2320B C 05/26/05 PLW 190 1.00 umhos/cm SM202510B C 05/26/05 KP 7.80 0.100 pH units EPA ISO.( C (6.5-8.5) 0526105 KP 97.0 10.0 mg/L SM20 23208 C 05/26/05 PLW 0 coVI00mL SM209222B A (o—l) 0526/05 TIF May 26 2005 10:21RM HP LASERJET FRX r, � i T N 0�0!'a6•�'�3A7' ICY T. 4k Mr. 0 C 6 N 0 4� a F CANOE STREET P•2 s � � nr c� N o w 166.07. 0 C 6 N 0 4� a F CANOE STREET P•2 Municipality of Anchorage 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE F=AMILY DWELLING Parcell.D. (91S --a7/-5-3- 1. GENERAL INFORMATION HAA m____� V z,SJ3 Expiration Date: _J 0 - / L4 - O 3 Complete legal description T,nt,?y Allen Snhrli vi c; on Location (site address or directions) ,1 n1 nig Zt reet- Current Property owner(s) Sam Fe jes Day phone 349-4040 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 111394 Anchorage. Ak. 99516 Day phone Day phone Unless othe wise requested, HAA will behold by DSD for pickup. 7W4. 4Zr _71,Y163 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' -TYPE OF WASTEWATER DISPOSAL: Individual Well ] Individual On-site [Xj 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 seal affixed hereto and as of the validation date shown below, 1 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. S & S ENGINEERING Namo of Firm 17034 Eagle River Loop Road No. -204 Fitune G q y,; 0 7 y Address Eagle River, Alaska Engineer's Printed Name Pc0gt11-7-- C- CJW4,J Date 6l 9 to 3 OF .N. 5. DSD SIGNATURE % c' ROBERT C 1 `Q � .�ti• C�-8801 f��•, Approved for bedrooms.•.f..J..f.:._..y..(....... . Disapproved. <iw�,�,,..-►r- Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: _ HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 'w• �D'�/ Original Certificate Date: 7- %Y- (i3 (Rev. CIM2) Municipality of Anchorage ' Development Services Department J Building Safety Division On -Site Water & Wastewater Program 5 47Q0 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITi APPROVAL CHECKLIST Legal Description: t- a T- oZ 14 L L iL N SID Parcel ID: A. WELL DATA Well type &ELV474 If A, B, or C provide PWSID # _ Date completed g�� L Sanitary seat &N) YEJ' Total depth aS ft. Cased to 210f ft. FROM WELL LOG Date of test 515 -2 - Static 15-Z Static water level ft. Well production i 9 -P.M. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate 0•)93 mg./I. Arsen' mg.A. Date of sample: -13.1.3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material S EP TI c. / 5'7—COL Tank size O.00 gal. Number of Compartments '2 Weil Log ON) YkJ Wires properly protectedON) yE J' Casing height (above ground) 3'Y4- in. AT INSPECTION CIS -103 I V 3 ft. Other bacteria colonies/100 ml. Collected by: j & 4 ENGiNEER1NG 17034 Eagle River Loop Road No. 20.: ?agle River, Alaska 99577 Date installed )o /1y/ R 2 Cleanouts 0/N) Yi s Foundation cleanout (@N) Yt) Depression over tank (Y& NO High water alarm (Y/6) '' Date of pumping slab o3 Pumper A+ Nomd. 54rvoci1 C. ABSORPTION FIELD DATA Date installed 1 D/1'1 /g- Soil rating (g.p.d./ft2 o ftZ/bdrm) � y G Length 11 ft, Width Systemtype_ 7-BEwC14 Gravel below pipe -S ft. Total depth I (P ft. area q4 0 ft' Monitoringt Je YE S Depression oir field No 16 Date of adequacy test (0Mlbnjtion 0 3Results as Fail) fP�1ss For 3 beddAorps 40il /} �e0 6 , )„ -it- Fluid depth in r2 s�o�ption field before test � my , [c „ Water added ySS'gal. New depth S d in. Elapsed Time: 19 min. Final fluid depths ro>ifin. Absorption rate >= S/SO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N 0 N t K No w A.' If yes, give date — MOwLrl2o� c Tvd L wrc.-n i , o AT HCG 01F T2E. c N /iE�•+As.�nA PRji THh'Ov4Hcvi TES'i; C CO JVS -' 4,- X'o D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump otr level at Datum E. SEPARATION DISTANCES tested Manhole/Access water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot / O o 4- On adjacent lots Absorption field on lot 'f - Public sewer main K 1A r Sewer /septic service line a S- —4 /O0 On adjacent lots /00 �-f- Public sewer manhole/cleanout lv/'A Holding tank /4 in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3 0't- Property line Absorption field S Water main N �/9 Water service line 10 Surface water /00 f _ Wells on adjacent lots /0O /�- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line a 0 -t Building foundation 'Y 0 Water main N 114 Water Service line /0'f Surface water /00 } Driveway, parking/vehicle storage b Curtain drain N O &* Wells on adjacent lots /00 F. COMMENTS �� d j G. ENGINEER'S CERTIFICATION C) 1 certify that I have determined through field in and f.` "' ' ` Arc review of Municipal records that the above systems are in ;, r' k conformance with MOA HAA guidelines in effect on this date. v ' "^..... ...^v....� ROBERT C. COWAN C ar•Q r C COwAN j+off�4 CE - $801 Engineer's Printed Name • o Date 3 '�Oi�.3,'���,`..+' HAA Fee S 4 Waiver Fee $ b t /0 ? Date of Payment Date of Payment Receipt Number 3 G'7 Y L Receipt Number (Rev. 12101) 6- 5-03; 2:45PM; ;907 5615301 u 2/ 3 oG$ SGS Ref.# 1033058001 All Dates/fimes are Alaska Standard Time Client Name S & S Engineering Printed Datefflme 06/03/2003 15:10 Project Name/# Lot 2. Allen SO Collected Date/time 05/30/2003 11:00 Client Sample ID Lot 2, Allen S/D Received Date/time 05/30/2003 13:10 Matrix Drinking Water Technical Director Stephen e Released B f� Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 0.103 0.100 mg/L EPA300.0 (<=10) 05/30/03 JS Microbiology Laboratory Total Coliform 1 OB, No Coli col/100ml. SM18 92228 (<=1) 05/30/03 KAP Y to Is i=iia2 Ih �• N L; � ss�naSO3f 1 a S a „ter mss„9000N Bill Y IV ' N Municipality of Anchorage Development Services Department •°` 8�,� �. 3 • '� o Building Safety Division = On -Site Water and Wastewater Program a V 4700 South Bragaw St s c r r ., P.O. Box 196650 Anchorage, AK 99519-6650 i? A d www.ci.anchorage.ak.us y v d (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Bob Cowan i Legal description: Allen Subdivision Lot 2 s r = The attached paperwork has been reviewed and Is being returned for the following reasons: ? 2 3 ❑ Original signature or stamp missing on a ❑ Calculation error in design. 3 ❑ Additional soils information needed. ❑ Water monitoring results inadequate. �� ❑ Discrepancy in information submitted. Y ❑ Topographic information missing or inadequate. ® Incomplete; missing Tank is under drive. Incomplete; missing Need new adeq. test �% '� ❑ Additional adequacy test information needed. o ❑ Water sample unacceptable. ti v 4 ❑ Measured/proposed distances/dimensions missing. 2 r ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. kk'ty❑ Well log required. r ; _ ❑ Omission in narrative. *4Z ❑ Insufficient fill over tank or field. ❑ Other. Name of reviewer: Jeff Date: 6-12-03 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Time APPLI; ' NT FILLS OUT UPPER HAI" ONLY Property Owner -CG} [G�ul�{ Phone 4/0o 4a Mailing Address k �to 3 �.�,vy Zip Code Date Buyer A Y✓1 FC J'c 5 -SA a{/2I, WA Gi Vit/ Date Address Ate,/,{/ l Zip Code Inspector Lending Institution lea �� ,.L) ��E ��JL[�' X(Z Phone -;75 s/ 741 Address Zip Code Realty Co. & Agent ENVIRJi�;.,cP .;,.._ , ,J-EUION Phone Address Zip Code 1983 Legal Description f f Street Location RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Type of Residence ( ) CONDITIONAL APP OYAL- 7XIngle Family ❑ Multiple Family No. of Bedrooms El Other Soils Rating Water Su ,ply dividual Well To Absorption Area l is GWell Log Received ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community Well to Tank / For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer D' osal ndividual Year Individual Installed: y. ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time 1 Date Date Date Date Inspector Inspector Inspector Inspector MUNICI ALITY OF ANCHORAGE Field Notes: ENVIRJi�;.,cP .;,.._ , ,J-EUION 1983 RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APP OYAL- DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area l is GWell Log Received Septic Tank Size ®-1 o Well to Tank / 72-023 (3182)