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HomeMy WebLinkAboutT12N R3W SEC 23 PARCEL 21COnsite File #015-232-20 A ®fta m,� tnev uoluu 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 Of 2 ON-SITE WASTEWATER INSPECTION REPORT OCT 2 8 2020 Permit Number: OSP201326 PID Number: 015-232-20 Dwelling: ®❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name David & Marianne Kurtz ABSORPTION FIELD ❑Deep Trench ❑Wide Trench El Bed ound Site Address 5901 Tappers Trail Rd ❑ Other Phone Number of Bedrooms Soil Rating Total depth f original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot 21 C Fill added above original grad16 Ft. Gravel length Ft. Township Range Section 12N 3W 23 Gravel width Ft. Beds: Number of Lines Distance between lines FL SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total a orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ ZS r TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments I f Lot Line 5'+ I NA HDPE 2 Foundation 10'+ I LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 A+ Home Services Drainfield CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 717.0 it Inspection V, 9/2/2020 9/2/2020 Location and description 3'd 10/1/2020 2nd 4"' BOTTOM STEP (see site plan) ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF A�, s� 4 -H��� .. r� '5;even R. Pannone m CE 8149 <w Septic System Approved Date 11131.20-90 Note: this approval does not include well permit requirements. tnev uoluu 10) N Cm) O� _ � C E �u nm -0-1m .Z7 -p_1o0 LO m0O oc 0 c�z Z m Z (n M ; o z ::E :�E zrn m m D O z m 0 N rri A r -� 0 z n cm U) 0o a m -n NOTES: RECORD DRAWING V z-oC) 07 D M iJ N O �0UZ O m U D CT, o� '0 O m a m N Ln �n D / om \\ \ mLn � I \ m s -r-- 0 / s c > / / o i I 0 ca -�� o o ' �z mo \F�l / / OD xz cn / n 00 1 I Z mN 0cf) ON—. � U1 m \ / m\ Ic� \ / 0 \ \ mu D \ \` U1 W C(O I\ \, \ N � Un No Z /I \ \ W c0 0 CJ N 0) V PANNONE ENG SVC LLC (C.I. 10$$) "`111, REVISIONS DATE PHONE (907)X7458200 EFAX (907)ER, AK 39745-8201 .... AC9SF9h REV 1: 10/30/20 SO10E27/2020 T12N R3W S23 PARCEL 21C DRAWN ACP DAVID KURTZ & MARIANNE WAADE—KU 5901 TRAPPERS TRAIL RD SITE PLAN ANCHORAGE, AK 99516 :...:... .. _ ...............s ' Steven R. P-- annoneCE-814 CE-8149 P.1'D. NO 015-232-20 OSP201326 SHEET2 OF 2 O _= Q D O — y Q y 3 3 a> O s .m. 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I s a V)-0 C fl y T W a-3 p W p C I t W > 4 s W W 0 07 y W C 0 p 0 r -� �3 0 mJ-� a W 0 a, W m m K —a y ca a 0 :3 a Qm y -► 0 Mol O W w CD .a C! d O 000;o 3vv0 Q am Cn Ln to C ' c (a W Of 3�- A I. yK N V t C n to CD 3 'O � a f ® s xa a sa O W v rt to Svp � o �. 0 f o,U) z' 0� cn Ln 0 Z O O c Z D A Al M 2 -T9 M O "0 Z 0 ( Cn O) W M r: rN. 14F fix f# r- 0 O ., MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite Permit Number: OSP201326 Effective Date: Work Type: SepticTank Upgrade Expiration Date: Tax Code Number: 01523220000 Site Legal Address: T12N R3W SEC 23 PARCEL 21C G:2738 Site Mailing Address: 5901 TRAPPERS TRAIL RD, Anchorage Owner: WAADE-KURTZ MARIANN & Lot Size in Sq Ft: Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 8/21/2020 8/2112021 108702 11 Disposal Field Ef Septic Tank E1 Holding Tank 171 Privy 171 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By, Date: Issued By:_Z�1 C6 Date: -19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201326, Rebecca Carroll, 08/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201326, Rebecca Carroll, 08/21/20 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP191452 Work Type: Well Initial Tax Code Number: 01523220000 Site Legal Address: TI 2N R3W SEC 23 PARCEL 21C G:2738 Site Mailing Address: 5901 TRAPPERS TRAIL RD, Anchorage Owner: WAADE-KURTZ MARIANN & Design Engineer: This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: c�111CnT �. a J 1.)epai•tzaztizt 10/7/2019 10/6/2020 108702 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: To close out this permit, please submit the following: 1) Well log 2) Pump install log 3) Water sample results for total coliform, nitrates and arsenic 4) Decommissioning log for existing well if it is not to remain in service. Received By: Date: Issued By: �Q1L�ri1! Date: I I I In MUNICIPALITY OF ANCHORAGE Development Services Department Alies Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. #) /S- `3 Property owner(s) �%, r� P �uv /r,.�cr�V�ll Day phone Mailing address Site address .S yo / lVryry4,d2 P'e' Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) 7/�2 Al K �A-� -S'� 7 t C Lot Size /o Ss770z Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption. Field ❑ Initial) Single Family (SF) IKI (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (p) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 9 r Mater Storage ❑ THIJ APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner of auth d agent) Permit/Rush Fees: 3(,o� Waiver Fees: Date of Payment: 101-%M9 Date of Payment: Receipt Number: Receipt Number: p Inj No. d519 Ig Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 0= v Omz¢> - - 0 0 O 0 =3 S sv O s3 S?>O 7 . o. „3�oss O S r 0 0-0 50 40 ? �aoS40 uoo�oro I'ao ® 3 0. 0 0 0- W � -'o o n �c a= O o 0 O a rt It ®�o0aovp W+ v®OupZS �O'D O 3 O n 30 N s =0 O 0 0 0.:~:H O S0 O n 0 0 p Y+� O N O a' I 3OZ0 0,o 7 O 0. = ;a 00 O *to 0W� �06 —,°�O= 0�s M �—O O. O0 O�oASm� 03 % —0 =0 0.w +o OSa SO =040 �S O �O. S O OO p +3 m 0 ® O 0 7 0 0=rl0 �X I ov2 e >> szs CL � �°oo0 a CL -10 a (6 o I y C rt O W 7C 0 o•OS0r+> CL � -► 0 O Ss O 0 0 7 M O rt0. O C Z S �3 0 rt o ®o0 O > SO a �o O I Q ® D N o W Lo p• 0. " a D U) Q 0e CD i U) C ® �o U) 0 0 a N C 5 — W1/1.—> d 004040— 0 O V V C S ®vv G D O7CA N ®a N1Na0 N I > v O.,C N V g CA C p ul of 0 Ql �3-n A 0Ts o ° > > 3 0 24 s m � ®p3 ••• � ••''900 '° ®®tee m• po 0 o•N�z:,OO � OR (j, X. I= D ml ® 0 w 0 Z. z �v -1 m i0� Mm mZ D m m v OD w� my �M c� m Z �m Z1 N r. 2 m O 0 O m v m r N O m m v C N PD O OD O PM 0 N J w r- 0 F -- r 0 S. L4 O_ P• 97 s �f Y V' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~m~ DISTANCES //~'/~//,/[..'/ [/~'"',~'/,,~' ~--Z FRO~ SEPTIC ABSORPTION WECL Permit No. ~' SEPTIC ~ HOLDING (~ ~ ~ ~' ~ TYPE OF SYSTEM J~ ~ ~1 ~k //= ; ~TRENCH ~ BED ~ W. DRAIN ~OTHER y~ odgJnal grade ~.~ FT /~i~ FT l ;~ Number of Ii.es 3Fk Pipe materielJ ~ ~ ~X/~'F{~d- WELLS' / O ~ /.- PRIVATE ~ /2 OTHER (Identifvi ' ~ · ~ ~ ScaW ' Inspections P e by: / ~:~ 'U~' A~: : t . ,==,~ ce ify Lhat this inspe~ion was pedormed according Io all ~ 72o013 (3/85) F'erm.~.t;. NLmlber :~ Date Issued: Ala~k~ 99"3()1 .;:. I...:, 4.? ..... '"'7~''~ Owner. Name: KURTZ KAl I ~..K,.. 'FRAIl .... ,A~,~I ..... AK 995 16 Day Fib orle. :]!;45-044 F.'aPcel 'l:.::l~I ' ";'"""~" '" © ~ .~on,, Lot: ,~1[., Block'.' '-- Lot I..egal ." ot.,bd ' : ~' ' .... ' Sec t ii, on ~,:;,",";r...,"I-owFIsh :i. p ~ ']. ''~,:.N f,.a.," 'lg~:'~ ....." .... ',,.~ Lot c:.~ .... ,.: ,'2.5A (sq.f't .... or act'es) [ I~,~) Max B~:cJrc~om~ 'l'h~s F'~.H't~l:i.t~ zt. Total CZ:apac:i'Ly~ 4 SEP'I"]C 'T'ANK: Minimum to'Lal septic: tank capacity: ].,250 gallons. fca:et, reqt.~J, pes inst.t].atior~ over' tank (s),, ONE ADDITIONAL. SO]:L.S t_OG MUST BE SUBMI]-FED WITH AS-BUIL..T' TO A M ]:NI MUM DEP'II'H :16,, 5 F:'EiZ'f': INFOI::~M D.I"I.FI.Si, PRIOR TO J.S"I & 2. ND INSF'EC]'I[]NS BY IS. NGINEER~, IF AF'T'ER [}F'F;'J:CE I"tOUF~S~ CALJ... E~4:3"-'4.681 AND L. EAVE A MESSAGE. CONSTRL;CT F:'ER ENGINEERS ATTACH!:ED AF:'PRC~VED DESIGN. THIS F:'ERMIT EXF:'IREES :[2/3:1./89 AND VALID F;'[IR A SINGLE FAMII-Y I"IOME., Each septic t. ank (~) < 4,. I CERT I F'Y 1,, I am 3. S i !:~ n ec::l: (C)wner) ]:1; fami 1J. ap wl~'Lh 'Lhe requirements for on-c~ite sewers and we]. ls as set f'or'Lh by the Mun:~cipa].ity of Anchorage (MC)A) and the S'Late of A].asl.::a. I will :i. nstall 'Lhe system in accordarlce witln ali. MOA codes and regu:l, at ion~ alqd J. rl compliarice with 'Lhe design criter':i.a of t. lnis 13ermit. I w:L1], adhere ~:.l::~ a].l HOA and State of Alaska requir'emerrLs for the s~t back se~ef'a~;;j~a system on 'Lhis or' al']y ad.jac::er'lt of near'by lot. I under, stand 'Lhat 'Lh~ ; permi'L is valid for a max:i, tm. tm of 4 bedrooms. I ........ ~h(e c:apacJ.'Ly of the total cCys'Lem is 4 bedrooms and any erilar-gemen .equiPe an add:L'Lional permit. DAT'E R'T Z SCALE T Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAI~ SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: DESCRiPTiON: ~ ~' ~:L~ ~--[ ~ LEGAL 1 2 3 4 5 6 8 10 13 14~ 15 Township, Range, Section:-l~U2~t.~ SLOPE WAS GROUND WATER ENCOUNTERED? SIT~ PLAN IF YES, AT WHAT DEPTH? Depth to Waler ADer MonDorin§? '~ ~"~ Date: 17 18 19 20 PERCOLATION RATE TEST RUN BETWEEN~ '~--~/FT AND ~ FT PERFORMED BY: ' .... · ~_~--'~- CERTIFY THAT THIS TEST WAS PERFORMED N 17034 Eagle Rtver Loop Road No 2 Eagle River, AlasKa ~,y~5'5' ACCORDANCE WI,H ALL STATE AN D MUNICIPAL GUID~,,~JJ~Y'EFFECT ON THIS DATE-DATE: Gross Net Depth to Net Reading Date Time Time Water Drop MUNICIPALITY OF ANCHORAGE Development Services Department Y ...Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 01523220 1. GENERAL INFORMATION Expiration Date::� — 7 — �Z-© 2— ( Complete legal description T1 2N R3W SEC23 PARCEL 21 C Location (site address) 5901 TRAPPER'S TRAIL RD Current property owner(s) DAVID KURTZ Mailing address 5901 TRAPPER'S TRAIL RD 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 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $.. �.b I �1 Waiver Fee $ Date of Payment Z '3 rZ O Date of Payment Receipt Number. d G 2706 Receipt Number COSA # OS CQ 0 1 b 5 —I 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 MCA 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for _�_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907) 745-8200 Date r7 l 1 f z� � N y :14. H Ponnor.e CL 8149 .4�� bedrooms, with the following stI tions: `���t,(tt((((((((� TY O Al m--4 0' ERq r) - m o OGF TFR 11 4 'o � FRVICv--'5 V o", rZ + Y w�- Original Certificate Date:.../?-- 7-2 02-1 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 Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: T12N R3W S23 Parcel 21C If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA 0_1 Well log is filed with Onsite (or attached) Date drilled °"5l0t9 Total depth 386 ft Cased to 246 ft 0 Sanitary seal is functioning correctly [01 Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA NA Static water level at beginning of test 225 ft. Comments B. TANK DATA Age of tank(s) 9f212020 years Tank type/material HDPE Measured operating fluid level in septic tank NA ®❑ Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 6/1/89 0 ALL standpipes present per record drawing Total measured depth from grade 15.9 ft (max) Measured depth to pipe invert from grade 3.25 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field 0 System presoaked (Required if vacant for greater than 30 days prior to date of test) 1200 Gallons introduced gallons Comments/Deficiencies: Dralnfield system is soar used. COSA Checklist yellow sheet Parcel ID: 015-232-20 Structure served by this system 1 Well production at time of test 2.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑✓ Yes ❑ No R Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 10.6 ug/L ❑ Arsenic less than MRL (ND) Collected by PES Date of Sample a ao C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 81312020 Results ❑ Pass For 4 bedrooms Fluid depth prior to test 84/2 in Water added 600 gal New depth 84/4 in Elapsed time 10 min Final fluid depth 84/2 in Absorption rate >600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date me E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' 7✓ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25'✓� Yes if No Absorption Field on Lot? 100' ❑✓ Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ED Yes if No ✓Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft[Z] Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft . Surface Water > 100' ft ft ft ft ft 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No. Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft if absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots.- ots:Water WaterMain > 10' ✓0 Yes if No ft Private Wells > 100' n✓ Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Drainfield system is 50% used. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Steven .p. PannoneE 8,14 - WVI-0 2101v- COSA Checklist yellow sheet ft ft ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC201654 Subdivision: T12N R3W Sec 23 Parcel 21C 907-343-7904 Fax: 343-7997 A water sample revealed an arsenic concentration of 10.6 micrograms per liter (ug/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MaUirig Address P O Bax 196650 *Anchorage, Alaska 99519 6650 *www mum org 07/25/2020 01:03 907-345-0202 ALPINE DRILLING PAGE 01/02 MUNICIPALITY ANCHORAGE p. DEVELOPMENT SERVICES DEPARTMENT U -Mr 907-343-7904 On -Site Water and Wastewater Section � � "; ,� Fax: 343-7997 www,muni.org/onsite w Subdivision Mock Lot T_12,_R3UJ Sectio>'t___5 Lot g/C On-site Water & Wastewater Section certified contractor perform ft the well decommissioning: Name: David Signature, 9`�j Harper Company: ,Alpine Drilling & Enterprises 11 Well decommissioning date if"y - Method of decommissloning: AMC 15,55,060L1 a, b. c. Location: Use the space below to provide a drawing of the property showing the following Items: North arrow Decommissioned well location a Location of other water wells on the property Two separate swing -tie distances for each well shown an the dratf Note: The swing -tie distances shall be measured from either perm n structures or the p arty comers. 0 GADevelopment: ervic6e\BLJi1 ing Safety\On Site W,iter and Wastewater\Forms\Client FormsWeil Decommisioning l �i t {� l: E Com' �7 i F i l i i ��� {•Y, e� i.. � �#i 1 q '-� 'r` Vi �i, i r [._ l�,3 � Permit plumber: #SW 191452 Date of Issue: 10-7-19 Parcel Identification Number: 01523220000 Date Started: 10-12-19 Date Completed: 10-15-19 Is well located at approved permit location? x Yes ❑ No Legal Description: T 12N R3W Sec23 Parcel 21 C Property Owner Name & Address: David Kurtz 5901 Trappers Trail Rd Anchoraae. Alaska Q..5113 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling x air rotary ❑ cable tool Casing type: steel stick zip 0 2 Wall Thickness:.250 inches organics t& silt silt} cobbley gravel 2 3 3 36 Diameter: 6 inches Depth: 246 feet Diner Type: Diameter: inches Depth: feet gravelly silt 36 51 Casing stickup above ground: 2 feet Static water level (frorn ground level): 225 feet silt 51 86 gravelly silt 86 112 Pumping level: 380 feet after silty gravel silt 112 167 167 180 ? hours pumping 2_5 gpm Recovery Rate: 2_5 gpm Method of Testis an li t gravelly silt 180 217 Well Intake Opening Type: cobbly gravel 217 224 ❑ Open End x Open Hole gravelly silt bedrock 224 242 242 386 ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granldtls Volume: 2 bgs Depth: Start 0 feet Stopped ? feet Pump; Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes ❑ No .�..,.,,� WATER Q MTY ETESTING Corm -- "� CoI/100mL tS fa � C —1 ° ug�L Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling t& Entefprises PO Box 110496 Anchorage AK 99511 zvelopment Services Department Building Safety Division L On -Site Water & /astewater Program �� s U o � 4700 Elmore Street r ° P.O. Box 196650 < Mark Begich Anchorage, AK 99519-6650 s ., F E}r� Mayor mm.muni.org/onsite (907)343-7904 Pun Instailaflon Log Well Drilling Permit Number: Date of Issue: - - Parcel Identification Number: - - Legal Description Block Lot Property Owner Name & Address: - p 9--r . Pump Installation Date: 10 - Z.? - Pump Intake Depth Below Top of Well Casing: 6 6 feet Pump Manufacturer's Name ( �-njy\c) Pump Model: C4 D`7 Pump Size � a%'�{ lip Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: 6263-X &r Pitless Adapter Installer: N\o_.�-k Well Disinfected Upon Co Tletion? W Yes 0 No Method of Disinfection: ; i ci`S Comments: Pump Installer Name: i,2E Company: t-" C_ €t -f •G Q t !c' �3 z� Mailing Address: 330 ff ! , ' Aye City: ,cn ;c State: /firh Zip: ? Attention: The pump installer shall provide a pump installation log to DSD within 30 days of pump installation.