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HomeMy WebLinkAboutT12N R3W SEC 25 N2NW4NW4NE4NW4 MUNICIPALITY OF ANCHORAGE 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 PHONE [~NEW .'~ L~ C~ ~0dT{ ~] UPGRADE NAME LEGAL DESCRIPTION LOCATIO ~_ ~/~ I ~) (-~,~ ~:~-1~ ~ DISTANCE TO: ,/~ Absorption area~0 Dwelling~,~0~r Material ~ Manufacturer ~i/~ ~ J/~ Width ~ Ir Liq. capacity in gallons wellFI HOMEMADE: Inside length,~.. --.. Liquid depth DISTANCE TO: ~ Dwelling ~ PERMIT NO.~ Manufacturer ~ Liquid cap.~acity in gallons NMe~tr~rsi~ Iiot , i n e ~)...~ DISTANCE TO: I WeI~}C)'T' ,~N~ Length of each lin Top of tile to finish grade Width Foundation Total length of linAs >~ Material beneath tile ' Depth NO. OF BEDR~.~(1MS PERMIT N~:)7 (~ 0 G '~'~ No. of compartmen.~ PERMIT NO. "7 (~(~-')~>E'~'~ Distance between li~e~) Total effective absorp_t on area ,3,3 o PERMIT Type of crib ;rib diameter Crib depth -- Total effective absorption area Well Building foundation Nearest lot lije Building foundation Sewer line DISTANCE TO: PERM'T NO. qSo . ES {Absorption area,(s) Septic tank OTHER PIPE MATERIALS SOIL TEST RATING , REMARKS APPROV ~ , DATE LEGAL C:EF'Ftr4"~'HEI'.T -*' -"~-ILTH FIND EN'v'IRONf,IENTAL r~' "-%C:TZON /~ ~-7~ , FIF'F'LICFINT NORM BI;'.Z2;TOkl SRR BOX 3:90-V :¢44 (~:~¢'J. L. OCF~T ~ ON TURK%TURN LEGRL. "1 .... z,'-'-'=¢z.-, N~,. ~.f41,.11., 4N[.I&,- 4NEJJ). LOT _., I ~E E~ Sg!L.IFIRE FEET T'¢PE OF SOIL FIE:SORB].'IOH S'¢STEM IS: TRENCH MFIXIMIjH NUMBER OF BEDROOMS = 4 SOIL RRTING THE REQUIRED S)]ZE OF' THE SOIL I=~BSORPTIOt",I S'¢STEM IS: THE t..ENGTH DIHENSION IS THE LENGTH (IN FEET) OF ].'HE ]"RENCH OR DRFIINFIELD. THE DEPTH OF R TRENCH OR PIT IS ].'HE DISTRNCE E:ET/4EEN THE SI_IF,:F'RCE OF TFIE GROIJND RND THE E,'OTTOH OF THE EXCRVFFf'ION (IN FEE]''). THERE IS NO SET WIDTH FOR TRENCHES. THE EiRRVEL DEPTH IS THE HINIHUH DEPTH OF GRRVEL BETWEEN THE OUTFF~t..t_ PIPE RND THE BOTTOH OF' ]'PIE EXCRVRTION (IN F'EET). PEF,'MIT FIPF'LICFINT PtRS THE RE'=;F'ONSIS!LIT'¢ TO INFORM '['HIS DEPRRTi'qEI"II].' DLIRiNG ].'HE tNSTFILLRTICtN INSPEC:TIONS OF RN"r' NELI...S RDJRCENT TO THIS PROPERT"r' FIND THE NUHBER OF RESIDENCES TI'f FIT THE WELL I.,.IILL SERVE. BFIC:KFILI_ING OF FtN'¢ SVSTEM ]4ITHOUT F]:NRL. INSPECTION RND FIPPROVRL B'¢ ].'HIS [:'EPRRTMENT [,JILL BE SUBJECT TO PRO25ECUTtON. f'I](NIMUI"I DIC;TRNCE BETklEEN R 14ELL AND AN? ON-'SI].'E SENRGE DISPCISRL S"r'STEM I:5 :LO0 FEET FOR F~ F;RIVRTE NELL.~ OR 2t. f2E'~ TO 2CIC'~ FEET F~'CH R PUBLIC WELL DEPENDING IjF'ON ].'HE T'¢F'E OF F'UE:LIC NE:L[ .... ~-4ELL LOGS FIRE REQUIRE[:, RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 3:E~ OF THE NELL COHPLETtON. OTHER REQUIREMENTS M[:I"? RPPL"r'. SPECIFICRT]:ONS FIN[) CONSTRUCTIOH DIR(IIRRHS 8RE R","RIL~BLE TO INSURE F'ROPER INSTRLLRTION. I CERTIF'¢ TFIR'r ~.: I Ri',1 FRMIL. IRR WITH THE REQUIREMENTS FOR ON-SI].'E SEWERS FIND WELLS RS SET FORTFI 8'.r' ]"HE HUNtCIPRLIT"r' OF' RNCHORRGE. 2: I WILL INSTRLL THE S'~'STEH IN RCCOR[:'RNCE k!I'rH THE CODES. 2:: I UNDERSTRN[:, THRT THE ON-SITE SEI4ER S'¥'STEf,I f,lR'?' REg!UIRE ENI_.RRGEHENT IF' THE RESIDENCE IS REMODELED TO INCLUDE MORE ].'HRN 4 BEDROOMS. RPPLICRNT NORf,1 BR I E;TO.t4 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'~ SOILS LOG -- PERCOLATION TEST [] SOILS LOG TEST SLOPE Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ~,~ (minutes/inch) 72-008 (7/76) k G~fm~.ER ANCHORAGE AREA BOROUGH .~ - , Depalk ~nt of Environmental Quality 3330 "C" Street · ,: Anchorage, Alaska 99503 ~F~ ~ Performed for ~ ~,~ ~_ l~ ,~ ~-~ ~ Date performed Legal Description: -F~'~L~ '~ ~ ~c.~5- ~V,~~u,L) ?his form reports: Soils log ~ Percolation ~est Depth Feet ~fas ground water encountered? If yes, at what depth? ..... Reading Date Gross Time Net Time Depth to 1120 Net Drop mi nu ta j I, S,-8 I ~: LlOn. Pit ' ' D:,'ai n ,eld Depth to hotto~ of p'lt or trench DRILLING, INC. DRILLING LOG Use of WellD~n' Lecalion (address of: Township, Range, Section, if known; or distance main roacL . ',i;ize of casing~ ~;tatic water level_i~ 1,~ ft. Screen ( ); Perforated ( Describe screen or perforation-~ZrJ9 Well pumping test at___gallons per (hour) of drawdown from static level. Depth of Hole ~'~> _feet Cased to ~,3 feet (below) land surface~ Finish of ;vell (check one ). opm~ end (/J~ ); (minute) for_ hours with Date of completion WELL LOG Depth in feet from ~round surface Give details of formations penetrated, size of material color and hardness 5"ac c 3--CONTRACTOR Well Owner Location ~"~ ~;~flNICIPALITY OF / M-w DRILLING, [nc. / DEPT. OF ANkH?RAGE P.u. Box 4-]224 · I~10C IntorndtionaIAilport Ro~jVIRONMENL aZCTION {907) 274-4G1 ] ANCHORAGE, ALASKA 99509 FEB 8 N/iq Walt DRILLING LOG RECEIVED Use of Well Dom (address of: Township, Range, Section, if known; or distance main road '~/-~ ,N~',,-x.NeS;, Sec ~- 'fiL2N ! GW. Seward }lerid~an. ~qell Site No. 3 Size of casing 6 Depth of Hole_..'TqO __feet Cased to__ 20.~-4__feet Static water level i00 ft. (axblS¥~) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ). None Describe screen or perforation Well pumping test at ] gallons per (h'6ltl9 (minute) for :~ hours with ft. of drawdown from static level. ~WoJJ vi.e} I checked by recovery method--well was pumped dry, 1 .... '~Jttinc~ for recovery period, Date of completion27 Jul 79 then amount of wa%e? v,fi ich had come ~n was mCA- WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 Casing Stickup 2 _TO 2 TO 5 5 _TO 10 10 TO 16 ] 6 TO 750 TO TO TO TO. TO .TO_ TO TO ~TO _TO Silty Cobble (]ravel Sand Silty Gravel Gray Siltstone Argillite: water seaps in sporadic fractures from 400 to 750, calcite/quartz fissure filling ~{ 6..0 with apparent increase in water. No'to: no water encountered before 400 ' . 1--CUSTOMER Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Braaaw Street . P.O. Bo; 196650 ,,- Anchorage, AK 99519-6650 wvccc.muni.org/onsite (907) 343-7904 ~,/ "/ CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 017-422-05 1. GENERAL INFORMATION Expiration Date: ~- //¢-//'/ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T12N, RSW, SEC 25, N2 7800 UPPER HUFFMAN ROAD DAVID 7800 NW4 NW4 NE2 NW4 *ANCHORAGE, AK 99516 LUCHER Day phone 702-685-1157 UPPER HUFFMAN ROAD *ANCHORAGE, AK 99516 Day phone BOB BAER W/ DYNAMIC PROPERTIES Day phone 5111 "C" STREET *ANCHORAGE, AK 9950.3 727-6025 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site Wastewater disposal and/or water supply system. DaD also issues COSAs upon request to homeowners. Certificates of On-Site Systems 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 vafidation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guidelines for this application, shows that +.he 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 GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179 Address .3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 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 & 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 and 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 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 of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE J Approved for L~ Disapproved° Conditional approval for bedrooms. _ bedrooms, with the following stipulations~ "',, ~NT 5'; "' .' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) L/// Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report /u~/'"'~~~ Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T12N, R3W, SEC 25, N2 NW4 NW4 IWELL A. WELL DATA [WELL #2 *CASED TO BEDEOCK Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed Sanitary seal (Y/N) YES 130 *20 Total depth 750 .ft. Cased to *20.4 ff. NE2 NW4 **WELL #2 TESTED BY AAROW1 PUMP AND WELL· SERVICE J Parcel ID: 017-422-05 Well Log (y/N) YES YES Wires properly protected (Y/N) YES 12+ Casing height (above ground) 12+ in. FROM WELL LOG Date of test ~/~"/"¥0/2¥~'7'99 25 Static water level 100 .ft. 0.50 Well production 1.00 g.p.m. WATER SAMPLE RESULTS: 0 Coliform 0 colonies/100 mi. ND Arsenic: ND ug./L. AT INSPECTION *'3/10/2011 **56 *'0.51 ft. g.p.m. I WELL #2I WELL #5 0.337 0 Nitrate 4.85 mg./L. Other bacteria 0 colonies/100 mi. 3Z,V. 11 Date of sample: 3;/1;/1 1 Collected by: GE(:;, Ltd. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size. 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 1/18/11 Date installed 7/1978 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Pumper. ANCHORAGE CESSPOOL PUMPING ABSORPTION FIELD DATA Date installed. 7/1978 Length 95 ft. I'BELOW EXISTING GRADEI Soil rating (g.p.d./ft2o~ 250 System type DEEP TRENCH Width 3 .ft. Gravel below pipe 7 .ft. Total depth '13.04 ft. Eft. absorption area 1330 ft2 Monitoring tube YES Date of adequacy test 3/4/11 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 760 gal. Elapsed Time: 10 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Depression over field NO For 4 bedrooms New depth 2.5 in. 60O+ g.p.d. If yes, give date - D. LIFT STATION Date installed "Pump on" level at__ E. in. Size in gallons Manhole/Access (Y.~.~_) ~ "Pump off" level.ag~ High water alarm level at Cycles tested. Meets alarm & circuit requirements? SEPARATION DISTANCEs SEPARATION DISTANCES FRoM WELL ON LOT TO: 100'+ Septic tank/lift station .on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ in. On adjacent lots 100'+ On adjacent lots 100'+ PUblic sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK O~ LOT TO: Building foundation 5'+ Property line '5'+ Water main N/A Water service line. 10'+ Wells on adjacent lots 100'+ Absorption field Surface water, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 5'-I- 100'+ Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ COMMENTS Water main N,/A Driveway, parking/vehicle storage 10'+ 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. Engineer's Printed Name JEFFREY A. GARNESS Date ~?ll/,I COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) CtO -- oq '--t l 0% Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # 111072 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot of T12N R1W SECTION 25 N2 NW4 NW4 NE2 NW4 subdivision, the well's productivity was determined to be 0.51 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4-bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS Ref.# 1110696001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 03/08/2011 15:41 Project Name/# TI 2N R3W Sec25 N2NW4NW4 NE2NW4 Collected Date/Time 03/01/2011 10:50 Client Sample ID T12N R3W Sec25 N2NW4NW4 NE2NW4 Received Date/Time 03/01/2011 11:15 Matrix Drinking Water L~L{ ~c. -~ Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 110 5.00 mg/L SM20 2340B C 03/02/11 03/07/1 I NRB Waters Department Total Nitrate/Nitrite-N 4.85 0.100 mg/L SM20 4500NO3-F B 03/01/I I AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 03/01/1 I DLC Total Coliform Nec;ative 1 100mL SM20 9223B A 03/01/I 1 DLC Private Individual Analysis Alkalinity 113 10.0 mg/L SM20 2320B D Aluminum ND 20.0 ugFL E7200.8 C 03/02/1 Antimony ND 1.00 ug/L EP200.8 C (<6) 03/02/1 Arsenic ND 5.00 ug/L EP200.8 C (<10) 03/02/1 Barium ND 3.00 ug/L EP200.8 C (<2000) 03/02/1 Cadmium ND 0.500 ug/L EP200.8 C (<5) 03/02/1 Calcium 34800 500 ug/L EP200.8 C 03/02/1 Chloride 5.67 0.100 mg/L EPA 300.0 D (<250) 03/05/1 Chromium ND 2.00 ug/L EP200.8 C (<100) 03/02/I CO3 Alkalinity ND 10.0 mg/L SM20 2320B D Conductivity 308 1.00 umhos/cm SM20 2510B D Copper 14.9 1.00 ug/L EP200.8 C (<1300) 03/02/1 Fluoride 0.126 0.100 mgFL EPA 300.0 D (<2) 03/05/1 HCO3 Alkalinity 113 10.0 mg/L SM20 2320B D Iron ND 250 ug/L EP200.8 C (<300) 03/02/1 03/01/11 SDP 03/07/11 NRB 03/07/11 NRB 03/07/11 NRB 03/07/11 NRB 03/07/11 NRB 03/07/11 NRB 03/06/11 SDP 03/07/1 I NlRB 03/01/11 SDP 03/01/11 SDP 03/07/11 NRB 03/06/11 SDP 03/01/11 SDP 03/07/11 NRB SGS Reft# ll 10780001 Client Name Garness Engineering Group, Ltd Printed Date/Time 03/11/2011 11 :l 0 Pro.iect Name/# T12N R3W Sec 25 N2NW4 NW4 NE2 Collected Date/Time 03/04/201 l 14:15 Client Sample ID T12 R3W Sec25 N~NW4 NW4 NE2 Received Date/Time 03/04/2011 14:55 Matrix Drinking Water Technical Director Stephen C. Ede eWS~D 0 ~.¢. ~.~ ~:k 7__ Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date lnit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 03/08/11 03/10/11 SCL Waters Department Total Nitrate/Nitrite-N 0.337 0.100 mg/L SM20 4500NO3-F B (<10) 03/07/11 AYC Microbiology Laboratory Colony Count 0 cot/100mL SM20 9222B A (<200) 03/04/11 DLC Fecal Coliform 0 col/100mL SM20 9222B A (<1) 03/04/11 DLC Total Colilbrm 0 col/100mL SM20 9222B A (<1) 03/04/11 DLC " HUFFMAN ROAD 58' W 299.54 89' 58' W 299.54 RECERTIFICAT]ON BASED UPON ORIGINAL SURVEY OCT 5, i978 Ar2 ~74 NTf4 NE4 Nil4 S25 ?fz?~" R37/' SM ~ITUArED T.~EREON ARE ~IT~t.~ THE PROPERTY LINES AND DO NOT OVERLAP gR ENCROMC~ O~ THE PROPERTY LCI~V ADJACENT TIfERETO, T~4T NO fMPROVE~'ENTU ON THE PROPERT~ L~TNO 2DJACENr 7~IERET~ _~}IC~OACN ON THE PREMISES IN QUESTION AND THAT THERE ARE NO ROAD~AYS, TRANSMISSION LINES. OR OTHE~ VISIBLE EASEMENTS ON SAID PROPERTY EXCE~ AS SHO~'N HEREON. IT IS THE RESPONSIBILITY O~ THE OICA'ER TO DETERMINE TNE ~.VISTENCE OF A~' EASEMENTS, COVENANTS OR RESTRICTIONS ~HfCH mONeT APPEAR DATE~ ON THE RECORDED SUBDIVmIGN PLAT. UNDER NO CIRCUMSTANCES SCALE: SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ~' ASSOCIATES, INC. 510 W 41ST AVE, SUITE ANCHORAGE, At(~ 99502 TELE 907--562-6050 FAX 907-652-6040 MARCH 28, 1994 i" =50' Aarow Pump & Well Service LLC (907)346-9355 Flow Test Report T 12N,R3W,SEC.25,N2,NW4,NW4,NE4,NW4 Well #2 was tested on March 10, 2011. Static water level at beginning of test was 56. After 21 hour and 50 minutes of pumping we had a productions rate of.51 GPM. Although well #3 wasn't flow tested, it is the primary well the house uses everyday. Brian R. Wille Aarow Pump & Well Service LLC 0 © 0 0 0 0 0 0 0 0 0 0 0 ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (D 0 © © 0 0 0 0 0 © 0 0 .~ 0 0 Well Owner P,u, Box4-1224 o ]310C InternationaiAirpor~ Ro~JVRON~p~'~'- ,-'.u2CTION (907) 274-461J ' ' ..... ANCHORAGE, ALASKA 99509 FEB 8 DRILLING LOG ?q/ivi Walt Ha:skin?: RE.CEIL/ED U'se o£ Welt Dom Location (address of: Township, Range, Section, if known; or distance main road Sec ~-"?:L2N !..:~W Seward iV!critiC, No. 3 Size of casing Static water'leve] i00 ft. Screen ( ); Perforated ( Describe screen or perforation Well pumping test at_ )- gallons per of drawdown from static level. 6 Depth of Hole .... 750 feet Cased to__ 20.4 feet (below) land surface· Finish of well (check one) open end ( )o i q o n e Date of comp/etion~7 Jul. 79 Depth in feet from ×); (minute) for :a hours with *Well vie. J.d checked by recove?,:y method--well was pumped dry, /.eft ,~5_ttin9 for recovery period, then amount of ware:,- which had come ~n was mea- su. red. ground surface Give details of formations penetrated, size of material, color and hardness 0 .TO 2 _TO.__. 5 · TO 10.TO. 1 6__TO _TO .TO .......... TO .... --.TO ~_TO --___TO ----_TO, _TO __ --.TO. 5 16 75O Casing Sticku'p Si'! ty Co'bble (....avel Sand Silty Gravel Gray Siltstone ArgJ. 1].ite: water seaps in sporadic fractures from 400 to 750, calcite/quartz fissure filling ~ 650' with apparent increase in water. Note: no water encountered before 400 ' . ? 1 -- CUSTOMER Municipality of Anchorage Development Services Department Building Safely Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Maiiing address COSA# Expiretion Date: T12N, R3W, N2 NW4 NW4 NE2 NW4 ~/C,, ~ 5 7800 UPPER HUFFMAN ROAD * ANCHORAGE~ AK 99516 DASD LUCHER 7800 UPPER HUFFMAN ROAD Day phone 271-2086 * ANCHORACE~ AK 99516 Day phone Day phone, Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: · Individual Well ~ Individual Water Storage Community Class Well J~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site ~E] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 v~lidation 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 fime of installation. NameofFirm GARNESS ENCINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE. AK 99507 Engineer*s Printed Name JEFFREY A. GAYNESS, P.E~ Phone 337-6179 Engineer's Comments: In conducting Bis evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The repo~fed 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 and septic systems depend on the local soils condition, groundwater levels that may Euctuate 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 msults do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encreachments. GEG, Ltd. can themlore not provide any warranty or future estimate of how long the system will conbhue to meet tho operational roquiraments of the ADEC or MOA DSD. The content of this repo~ is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not autho/fzed, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for F Disapproved. Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms. bedrooms, ,,ith ,he sfipulati~ Maintenance Agreements Supplemental Engineers Repo~ Other , By: (Rev, 12,T)1) Original Certificate Date: SCS Ref.# Client .Name Project .Name/# Client Sample ID Matrix 107564 I001 Garncss Enginccring Group, Ltd. 7800 Upper I luffman 7800 Upper I luffman Drinking Water All Date~JTimes are Alaska Standard Time Printed Date/Time 10/31/2.007 8:10 Collected Date/Time 10/23/2007 9:02 Received Date/Time ~ 10/23/2007 9:50 Technical Director Stephen C. Ede PWSID 0 Sample Remarks: ...... · AIIo~ble Prep Analysis Parameter Results I~'QL Units Method Contatncr ID Limits Date Date Init Waters Department Total Nitrate/Nitrite.N 6.91 0. I00 mg/L SM204500NO3-F B (<10) 10/26/07 LCP Microbiolo~ Laboratory Total Colifi~rm 0 ¢ol/100mL SM20 9222B A (<1) 10/23/07 SDP Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T12N, R3W, SEC25; N2 NW4 NW4 NE2 NW4 7800 UPPER HUFFMAN ROAD * ANCHORAGE, AK 99516 DASD LUCHER Dayphone 271-2086 7800 UPPER HUFFMAN ROAD * ANCHORAGEI AK 99516 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OFWATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: · ~[~ Individual On-site Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 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 inforrnat/on 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 b'me 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. 6ARNESS, P.E. Engineer's Comments: In conducb'ng this evaluation, GEG, LtD. atlempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The repotled 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 lifo of all wells 'and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and tho 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, horde they guarantoe that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future esb'mate of how long the system will conb'nue 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 of this repe,'t by any other pereon or parly is not authorized, nor will it confer any legal tfght whatsoever. 5. DSD SIGNATURE JApproved for bedrooms. Disapproved· Conditional approval for _. bedrooms/with the fllowing stipulations: Phone 337-6179 Date . ~/15/o~- Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements 'Supplemental Engineer's Reort Other ,.~/~ Original Certificate Date:_~'~ - 0 7 Municipality of Anchorage Development Services Department Buikling Safety Division On-Site Water & Wasfewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519.6650 w-~w.muni.org/onsite (~07) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL CHECKLIST Lega~ Descdptton: T12N~ RaW, SECTION 25, N2, NW4, NWa,, NE4, NW4, Parcel ID: ~)~ 7' Date of test Static water level Well production WELL DATA Well type7/~'-'~- '27/1979If'A' B, or C provide PWSlD~ N/A Date completed 10/17/197~ Sanitary seal (Y/N)YES/YES Total depth 750/150 ff. Cased to 20.4/'~20it. ·TO BEDROCK FROM WELL LOG 7/2.7/1979/ lO/17/lS79 lOO/2`5 It. 1/0.50 g.p,m. Well Log (Y/N) YES Wires property protected (Y/N) YES/YES Casing height (above ground) 12+/12+ in. AT INSPECTION 6/6/2007 UNK 0.80 COMBINED WATER SAMPLE RESULTS: WELL ilI2/WELL Colifoml 0/0 colonies/100 nil. Arsenic: ND/ND ugJL. Nitrate 0,204/7.90 mgJL. Other bacteria 0/0 colonies/lO0 mi. GEG. Ltd,Z Date of~ampla: ,5/16/2007 6~ZB/2007 Collac*ed by: AAROW PUMP AND WELL Date installed Length Total depth B. SEPTIC/NOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping ,5/16/2007 C. ABSORPTION FIELD DATA ff. 2 Depression over lank (Y/N) NO Pumper Soil rating ~-~-'J~or flarodrm) 250 Width ;3 lt. Date installed 7/1978 Cleanouts (Y/N) YES High water alarm (Y/N) N/A McDONALD'S PUMPING It. Eft. absorption area 13.t0 fi= Monitodog tube YES Date of adequacy test 5/16/2007 Results (Pass/Fall) PASS Fluid depth in absorpUon field before test DRY in. Water added 646 gal. Elapsed Time: 25 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN System type DEEP TRENCH Gravel below pipe 7 ft. Depression over field NO For 4 bedrooms New depth 4 in. 600+ g.p.d. If yes, give date - D. UFT STATION Date installed .Size in gallons Manhole/Access (Y/N1 _.-----~ "Pump on" level at in. Pump off'~m~~~~~ ~ ~1 at ,in. Datum ~ .------ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift elation on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas, 50'+ 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/ctaanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation, 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Absorption field, 5'+ Surface water. 100'+ Water main N/A ,Driveway, parking/vehicle storage 10'+ 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. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ ~'~.~* Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $. Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 ww~v.ci.anchorage, ak.us (907) 343-7904 ~Vater Well Advisory, Health Authority Approval # 070320 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot ofT12N R3W Section 25 N2 NW4 NW4 NE4 NE4 subdivision, the well's productivity was determined to be .80 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4-bedroom residence is .41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory. Certificate of On-Site Systems Approval # 070320 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on T12N R3W Section 25 N2 NW4 NW4 NE4 NW4. This inspection revealed a nitrate concentration of 7.9 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS Rcf.# Client .Name Project .Name/# Client Sample ID Malriz 1072187001 Gm'ness Enginccring Group, Ltd. TI2N R3W Scc 25 TI2N R3W $¢¢ 25 Drinking Water Ail Date~./Time~ are Alaska Standard Time Printed Date~fime 06/04/2007 16:54 Collected Date/Time 05/16/2007 0:00 Recei~ ed Date/'Time 05/16/2007 15:54 Technical Director Stephen C. Edt PWSID 0 Samplc Remarks: Allov,~ble Prep Amalysis Parameter Results POL Units Mcthod Contsmer ID Limits Date Date Init Metals by ICP/MS Al'sonic ND 5.00 ug/L EP200.8 C (<10) 05/20/07 05/25/07 DSII Waters Department Toul Nitrate~ilrile-N 0.204 0.100 mg/L SM204500NO3-F B (<10) 05/29/07 JDS Microbioloc~ Laborator~ Total Coliform 0 col/100mL SM209222B A (<1) 05/16/07 DLC SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1072571001 Aarow Pump & Well Service 7800 Upper Huffman 7800 Upper Huffman Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 06/13/2007 16:23 Collected Date/Time 06/06/2007 13:30 Received Date/Time 06/06/2007 14:02 Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init )4et:als by :ZCP/MS Arscnic ND 5.00 ug/L EP200.8 C (<10) 06/07/07 06/12/07 TK Waters Department TotalNitratc/Nitrltc-N 7.90 0.100 mg/L SM204500NO3-F B (<10) 06/09/07 JDS M£crob£oloc, ry Labor&tot,Z T0talColiform 0 col/100mL SM209222B A ¢<1) 06/06/07 DLC , , , j !Oe~t. HDaltH&Huma~Se'vic~ d d d d d d d d 0 d d d 00000000~000 /~N~ClPALITY CF AF~CHORAG~ JUJ-W DRILLING, Inc.. P. u. Box ,1-122.1 (907) 27,1-461 ANCHORAGE, ALASKA 99509 FEB 8 1280 Well Owner M./M b;alt !!n4kin: DRILLING LOG RECEIVED ___Use of Well Dom Location (address of: 'lo~nslup, Range, Section, if known; or distance main road ~/:~ t'ZIon- qoe 25 '~ '),' ,'&..:, Size of casing 6 Static water level 1OO ft. (a'L~¥~') Screen ( ); Perforated ( Depth of IIole__ 7;;ri feet Cased to 2q, 4 feet (below) land surface. Finish of well (cheek one) ). (minute) for * hours with Describe screen or perforation Well pumping test at 1 gallons per of drawdown from static level. Date of completaon~7 .Jul open end ( X ); ft. *Well viel,I chockerl by recovery metboct--well was [)ttlrli)Ort dry, loft ';ittin9 for recovery period, ~'~OD ~/HOL1DL O~ V.'~('~' which had como ~n w~s moa- WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 .TO 2 Casino St icl<up 2 .TO 5 5 .TO 10 Sand IOTo 16 Silty Gravel 16 TO 750 ____.TO __.TO __ .TO __.TO 4 O0 ' . .TO .TO , frO .TO ~O ~O Silty Cobble Gravel Gray Siltmtone Argillite: water seaps in sporadic fractures from 400 to 750, calcite/ouartz fissure iiii~.l fillino ~ 650' with apparent increase in water. Note: no water encountered before I --CUSTOMER K~/le Maus From: Sent: To: Subject: Attachments: Brian Wille [aarowpumpandwellsvc@hotmail.com] Friday, August 10.2007 2:46 PM Kyle Maus 7800 UplHuffman 1072571.PDF ~ garage produces .25 GPH. Thanks, ~ Bdan Wille ~ Aarow Pump & Well Service LLC Subject: 1072571 Date: Wed, 13 ]un 2007 21:07:48 -0~00 From: Forest.Tavlor~sos.com To: aar0w~umpa ndwellsvc~hotmail.com Forest Taylor, Project Manager 5G$ Environmenl'el Services, Al~k,~ 200 W. Potter Drive Anchorage. AK 99518 p: 907-562°2343 ddh 907-550-3207 f: 907-561-5301 SGS sends analytical reports via the Intemet as Portable Document Format (PDF) flies. Reports in this format, with authenticated electronic signatures, are considered official reports. No hard copy reports will be sent either by fax or U.S. Postal Service unless otherwise requested. You may distribute your PDF files electronically or as printed hardcopies, as long as they are distributed in their entirety. Information In this email and any attachments is confidential and Intended solely for the use of the Individual(s) to whom it Is addressed or otherwise directed. Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the Company. Finally, the redpient should check this email and any attachments for the presence of viruses. The Company accepts no liability for any damage caused by any virus transmitted by this email. All SGS services are rendered in accordance with the applicable SGS conditions of service available on request and accessible at http:l/www.ses.com/terms and conditions.htm Messenger Caf~ -- open for fun 24/7. Hot games, cool activities served daily. Visit ngw, ~m~)~-15-2007 05:5.~ FROH: T0:~58~248 AS-BUILT SURVEY [ HUFFMAN ROAD N 89' 511' W 299.54 N 89' 58' W Z99.54 RECERTIFICATION BASED UPON ORIGINAL SURVEY O~ 5, 1978 N2 Ntf4 ~f'4 N~4 ~r4 S25 TI~* R31ff SM ~ ~ .. ~ ~ x~x u~x o~ FEnnU~r tr .1994 ,a~n r/t~r rNX tu~novx~E~s & ASSOCIATES, INC. · OYER~AP OR g~RO~CH ON ~IIE P~OPE~ ~r/A~ A~ACZ~ ~ll~. ANCIIORAGE, AK, 99503 ~6~. r~su/ss/o~ u~. on ortt~ v/s/~r ~s~u~s TELE 907-562-6050 ~ -~*' ~ ~ / ~.~T t~stu~s. ~rt~s o~ ~r~to~ ~t~ w~'r ~n DATE: MARCtl 23, 1994 ~~ S~ULD A~ DATA IIgREON ~ABLISHI~ BOUNDARY OR Pg~g LIN~ ~: AUG-I:~-L:'O0? 05:55A FR~4: A~g.ll. ZUUl II:~DAU TO: ~8~46 Garness tnEineertng lJrou~, Ltd, ,S-BUILT SURVEY RECERTIFIUA'rlOIq BASED UPON ORIGINAL SUP. V[%' OCT 5. 197D BLS ~: ASSOCIATES, INC. ~0 ~ 41ST AVE. SUITE ANCHORAGE, AIC. 0950'3 TELE 907-56Z-B050 FAX 007-653-0040 DAT~: {~iAP, CH ;~3, 1994 iCAhE: f'=50' DRILLING, INC. '/;ell Owner DRILLING LOG ,Use of Well ~)'~P~' Locatiou (address of: Township, Range, Section, If known; or distance main road. Size of casing '4tatic water level Screen ( ); Perforated ( Describe screen or perforation~/~ ',Veil pumping test at gallons per (hour) of drawdown Irom static level. Depth of llole ~ feet Cased (below) land surface. Finish of well ). :ck one) ope. n end (D~, ); Date of completion (minute) h ft. WELL LOG Depth in feet from /;round snrface Give details of formations penetrated o .TO L ,.TO 3t.~ :to _l~ TO. · L~/ TO'- TO. TO TO--- TO .TO ~__~O _ ,.TO ,TO hardness 3--CONTRACTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Sen/ices On-Site Sen/ices Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 017-422-05 HAA# HA940102 GENERAL INFORMATION Complete legal description N2 r NW4, SM. NW4, NE4~ NW4~ Sec. 25, T12Nr R3W, Location (site address or directions) 7800 Dpper Huffman Road Property owner Mailing address Lending agency Mailing address Agent Address Walter & Ardelle Haskins Dayphone" 345-5049 7800 Upper Huffman Road, Anchoraqe, Ak. 99516 NBA Attn: Mary Jo Pippen D~yphone 257-3094 Carol Pope ~-3o~ Day phone 2. NUMBER OFBEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: Individual well XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site xx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1191) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site Wat~.T supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Constructing Engineers 9601 Buddy Werner Drive Address __A.r~ ~m-~;~ ~-A~a~k a 99516 Engineer's signature :/~¢d~ C/lA ~ Phone 346-2000/694-9098 IIC83 Box 192A Myrtle Drive Eagle Rive~-, Ai~k~ 99577 .' " ' D ~- //- ~ ~/' DH,HS SIGNATURE Approved for Four (4) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not cosduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev, 1/91) Back MOA Parcel 1. MUNICIPAUTY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN S.E, RVICES Division'of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR'A SINGLE FAMILY DWELLING N 1/2 NW"i/~r NW 1/4, NR 1,/4~ ~w 1;/a~ GENERAL INFORMATION Complete legal description /'7' Location (site address or directions) :. Property owner Mailing address Lending agency Mailing address Agent Address ~alter & Ardelle Haskins Day phone 345-5~49 7Rrm r'i~',',-,,='," m~F~*~ Road, Anchor~_ge, A!=-sk=- 995!~ ~,/SA A~'* /~a¥~ '3~ ?~P'~'""Day phone ZS¥-"SOgcr Day phone Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: NOTE: ndividual well X Community well Public water tf community weft system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: x If community waStewater system, provide written confirmation from State ADEC attesting to the legality and 'statUs'of system. 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY. ENGINEER As certified by my seal affixed'heretO' and as of.the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms . and type of structure indicated herein, I further Verify that based on the information obtained from the Municipality of Anchorage files and from myjnves.ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in cqmpliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Cons±ruct;inq Engineer`s 9601 Buddy/ Werner Dr Address A n,- ¼ r~ n ~',¢1 Engin'eer's signature Phone 346-20R0/694-9098 FIC83 Box [92A Hyr`'tLe Dr' Eogie Pl~,e~. AK. 99577 DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for ¢ bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human ServiCes (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of AIaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · · ~ Municipality of Anchorage , ~) Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegaIDescription: N2, NW4, NW4, NE4, NW4, Sec. 25, T12N, R3W, SM A. Well Data parcel I.D. 017-422-05 Well type I nd. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) *Y Attached) Date completed 10-17-79 Driller Penn Jersey Total depth .].30 ' /? Cased to Bech:ock Casing height 2.4 ? Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) ¥ *Visually verified no perforations in casing. ~o &~ ~*/6 FROM WELL LOG AT INSPE~-~ON ,¢,u'~-z~ c,4-c¢,,36;, 10-17-79 2-17-94 ~ ~-~~ ~i Date of test Static water level 25 ' Well flow 0, 5 Pump level1 ] 3~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot +10 0' Absorption field on lot +10 0 ' Public sewer main + 2 0 0 ! Sewer service line + 50 ' g.p.m. 23' ~'~ ...0~ '- D, ~0 g.p.m. <~.o ~3o .; On adjacent lots .; On adjacent lots +100' +100' Public sewer manhole/cleanout +200 ' Petroleum tank + 100 ' WATER SAMPLE RESULTS: Coliform 0 Date of sample: 2-11-94 Nitrate 4.2 2 Other bacteria 0 Collected by: SO B. SEPTIC/HOLDING TANK DATA Date installed 7- 7 8 / Cleanouts (Y/N) y High water alarm (Y/N) NA Date of pumping :9-3_4- 9~ Tank size 1250 Foundation cleanout (Y/N) gal Compartments Y .Depression (Y/N) Alarm tested (Y/N) NA Pumper Isaac ' s N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Weif(s) on lot +10 0 To property line +10 Sudace water/drainage On adjacent lots +t0 0 ' Absorption field 10 ' +10 0 ' Foundation +20 ' Water main/service line +50 ' 72-026 (3/93)* Fret CONTINUED ON BACK PAGE Date installed ~ Manufacturer Size in gallons ~ Manhole/Access (Y/N) High water alarm level _ Meets MOA electrical codes (Y/N) SEPARAT~~STATION TO: ...~[p~3-10t- On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed 7- 7 R Length . 95 ' Width .3 ' Total absorption area 1330 Date of adequacy test 2-17-cJ 4 Water level in absorption field before test 30" Peroxide treatment (past 12 months) (Y/N) N Soil rating (GPD/FF) 250 Gravel thickness Cleanout present (Y/N) ¥ Results (pass/fail) Pass Systemtype (2) Trench 7' Total depth 12.O' .Depression over field (Y/N) N for Four f4~ Bedrooms After test 30" If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot + ] ¢i ¢~ ' To building foundation ' +30 ' On adjacent lots + 100 ' Sudace water +100 ' Curtain drain + 100 ' On adjacent lots + 100 ' Properly line +10 ' To existing or abandoned system on lot + 1 P fl ' Outbank +50 ' Water main/service line +25' Driveway, parking/vehicle storage area +5,0 ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on ti Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number__ 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number ~,nchorage Well / Pump Service 690i TanBIna Drive Anchorage, Aiask~ 99502 (907) 243-0740 FAX #: (907) 243-3239 FAX COVER SHEET To:. ~/~/.~ ~'&~, co./erg.:_._ Total Number of Pages (inc, luding cover sheet): IF YOU DO NOT RECEIVE ALt-' THE PAGES, PLEASE CALL BACK AS SOON AS POSSIBLE. Domestic and Industrial Pump Sales and Service Water Well Service, Water Treatment and Conditioning ANCHORAGE WELl. & PUMPS SERVICE 690! Tanair~a Drive ANCHORAGE, ALASKA 99502 (907) 243.0740 £. & ,4,¢soci tes, /nc. Engineering, S~rYeying, Planning June 8, 1994 RECEIVED Mro Robert W. Robinson On-Site Services Section Municipality of Anchorage Po O. Box 196650 Anchorage, Alaska 99519-6650 JUN 1 4 1994 Mumc~pahty of Anchorage Dept. Health & Human Services Subject: Final Health Authority A5proval N2, ~4, NW4, Nw. 4~ NW4, Sec° 25, T12N, R3W Dear Mr° Robinson: On May 12, 1994, Anchorage Well and Pumps Service was able to get a well rig in to service Well #2 (see attached copy of surveyed as- built) on the above property. Tt was found that the pump motor was inoperables therefore it was repaired. In addition, since the water had previously been slightly turbid, the well pump was relocated to 508 feet. During this investigation, the static water level was noted to be 34 feet° AWPS performed two recovery cycles on the well that days resulting in readings of 1o0 gopom, and 0..797 gopomo On May 19~ 1994, we performed three recovery cycles after first pumping out 692 gallons of standing water. As the testing progressed it was noted that the production fell off slightly; however, during the entire test period the recovery averaged 0°592 g.pom. Used an combination with Well #3, there is adequate water production so that the existing storage tank will no longer be necessary. This well has now been connected to a common pressure tank inside the garage; separate pressure settings will assure that when flow from Well #3 is inadequate~ Well #2 will automatically begin production. Each water line has a pre-pressure tank hose bib which Mro Robert Robinson Page 2 will allow separate water sampling in the future. Well #2 is sealed and wires are in conduit, has approximately a 6" stick-up, and is located on a slope which provides positive drainage. The well log is on file in your office° Water sample results are attached. Based on this information, we request that you now remove the Conditional status and the need for a storage tank, and grant a final Health Authority Approval for a four bedroom dwelling. We also wish to thank you for your assistance with this rather involved approval° Sincerely~ Chuck Landers Attach° \haskins A-S _- BUILT: _ SURVEY_ I HUFFMAN ROAD I N 89' 58' W 299.54 RECERTIFICNrlON BASED UPO~ ORIGINAL S~RV~Y OCT fi, N2 NE4 ~4 NE4 NE4 S25 TY~' R3W SM ~? ~ ~ lgAS MADE ON FEBRUARY 17 J9~4 ,~NO THAT THE IMPROVEME~5 & ASSOCIATES, INC. ~.: ~.. ~ ~, SITUATED THEREON ARE FITHIN THE PROPERTY LINES AND DO NOT 510 W 41ST AVE, SUITE THAT NO IMPROVEMENTS ON THE PROPERTY LYING ADJACENT THERET~ ~r~YS. rs~smssm~ tress, os o~sss wsmts ~SSMS~rS TELE 907-562-6050 ~ s~s~uzm's, co~rnAnrs os sssrmcrm~s ~rszcs so~'r ~e~x~ DATE: MARCH 23, 1994 h ~ ~[~ ~ [eO~ss~oS~t ~ ON PHS RECOR$ES SUBSlVlSlON PLAT. UNDER NO CIRCUMSTANCES iCALE: f' =50' ~~ SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR E~TABLISHING BOUNDARY OR FENCE LINES ~ID~ CT&F. Rcf.# CJient Sample MatrN Commercial Testing & Engineering Co, Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94,2417-1 , t-B.s~ s ~[,~, ~2:~8oo UPPE~. Hm:I,'I,~/,N riD. WATF, R Client No, me CoNSTP, UCTINr3 I.".N GINrE E~S WORK. Order 78660 Ordcr~;(l By CIIUCK I.ANDBP, oS PHniedDate 05/25/94 ~ I0:25 hrs. l'rojcutName collecteclDat¢ 05/19/94 (..~ 13:42 Iraq. Yroject# Rccej~ved ~te 05/20/94 ~./08:50 tu:s. FWSli) I)'A Tct~hn~eat I)im(~tot S'I~PHEN C. F, DE QC Allow~ble Ext, Anal l'aran',etcr Results Qtt~l Units Method Limits Date Date Init --~¥;C;~ ............................. DU¥ .... 5- ..... ;,;fi,- ........ -g.P~.TB?f/5~7o- ..... ~ ................... ~{T~T-~¥n~-- * S~ Spe¢it~l b~struotiono Above I. IA = t tavaihthle ** See 8ampD Remarks Above NA = NvlA~mJyzcd ,, U~U~t~tected, Kq)m~edvah~is hepract~cal qmntificatioMimlt. IX=~ss%an 5633 B Street, Anohorago, AK 99518-~600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WE~T VIRGINIA CT&E Ref.~ Client Sample ID :N2 NW4 NW4 NE4 ~4 SEC 25 Matrix :WATER Commercial Testing & Engineering Co. O/7- - of Environmental Laboratory Services ~~..~.e-~-.e-~-~-~'.~,.~.~-.~'~-~'~'~e'.a REPORT of ANALYSIS 5633 B Street :94.0657-1 Anchorage. AK 99518-1600 Tel: (907) 562-2343 7800 HUFFMAN* Fax: (907) 561-5301 Client Name :CONSTRUCTING ENGINEERS WORK Order :75770 Ordered By :LANDERS Printed Date :02/14/94 @ 15:35 hrs. Project Name : Collected Date :02/11/94 @ 08:00 hrs. Project~ : Received Date :02/11/94 @ 08:45 hrs. PWSID :UA Tecbnnical Director Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S. OSWALT. * HASKINS. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 4.22 mg/L EPA 353.2/300.0 10 02/14 LLH * See Special Instructions Above ** See Sample Remarks Above , U = Undetected, Reported value is the practical'quantification limit. ~ D Secondary dilution. o '~' SGS Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO. FLORIDA. ILLINOIS. MARYLAND. NEW JERSEY. OHIO. UTAH. WEST VIRGINIA d d d d d d d d d d d d © 0 0 0 0 0 0 0 ~ 0 0 0 ~ 0 obb) F. Burn t! ~ineering, L~nd Surveying, Environmental Surveying P.0 Box 230084. 99523-0084 - 510 ~ 41si Ay. Anchorage, AK 99503 March 10, 1994 Tele. (907)562-6050 Fax (907)56g-6040 Mr. Robert Robinson Civil Engineer Municipality of Anchorage On-Site Services P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: N2, NW4, NW4, NE2, NW4, Sec. 25, T12N, R3W, S.M. Health Authority Approval Dear Mr. Robinson: On March 8, 1994 we conducted an eight hour flow test on the well serving the above residence. The results showed that the well is producing 0.20 gpm (recovery) rather than 0.6 gpm as originally shown on ~ur submittal. We have physically verified no perforations in the casing to a depth of 23' (static water level); furthermore there is no water entering the casing above 23'. The total depth of the well is 130', which means that the well casing is holding approximately 158 gallons of water; in addition, the pressure tank currently in use ~s about 40 gallons. We recognize that the well production is inadequate to~:meet MOA minimums for sale approval. However, since this house is being refinanced rather than sold, we are requesting an approval based on the addition of a 200 gallon above ground storage vessel. The Haskins realize that for sale their well must produce additional water. We request that a Conditional Health Authority be issued s~nce their closing, originally scheduled for today, has been held off until March 15, 1994. Thank you for your consideration of this request. Sincerely, Charles Lander~'~.E. IJ : ~ubdivision was made 7~ and (hat.the ' rated thereon the prope~y lines 'a:~d'8o not overlap or oropeA~ lying adjacent thereto, .~he premisos in questic that the~no roadways, transmission lines or other v~ ~tson saic~r~ except as indicated hsreon,'~ ' ' ~ '~ .... ~horage, Alaska, t}~is ~_. d~, UC~NG ENGINEERS, INC. · ~ SRA Box ~, Anchorage, Alaska 99507 ~817 .-. , CONSTRUCTING ENGINEERS 9601 BUDDY WERNER DR, ANCHORAGE~ AK, 99516 HC83 BOX 192A MYRTLE DR, EAGLE RIVERt AK, 99577 346~2000 694-9098 WELL FLOW FIELD REPORT ? £o o o GPD MI~IMUM '" ABOVE GROUND TIM]~ CU~4ULAT IVE TIME FLOW RATE INI AUG CUMULATIVE FLOW RECOVERY R ECEI ED FEB 2 ~ 199 H~altli & H~mafl Se~vio~J d d d d d d d d d d d d ~ ' DEPT. OF ~EALTH & ~ ~ ~UNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street-Anchora.e, Alaska 99501 SEP 2 6 1978 ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS; Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, PHONE PROPERTY RESIDENT (If different from above) PHON~ 4, REALTOR/AGENT ~HON~ MAILING ADDRESS 6. TYPE OF RESIDENCE ~-~L~,¢~ O~¢~r~_ NUMBER OF BEDROOMS [] One [] Four "'~ SING LE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~-~ Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975, For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~--J. NDIVtDUAL/ON-SITE** **If individual/on-site, give installation date .,~/~P~z_~..~(~ ~'~ If system is over two (2) years old an adequacy tes;~ is required [] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS', 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or []Holding 'rank ~c~ Size: t ~,_%"1~ If Tank is homemade SOILS RATING TOTAL ABSORPTION AREA MATERIAl. 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Lille s. COMMENTS __ [/.~-" ~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL {latter must ac~any certificate) [i~.~ DISAPPROVED ~ ~'/~ LEGAL DESCRIPTION 72-010 (Rev. 3/78) 825 "L" STREET ANCHORAGE, ALASI<A 99501 (907) 264-,l'1/'1 August 7, 1979 M-W Drilling, Inc. Post Office Box 4-1224 Anchorage, Alaska 99509 Subject: Walter Haskins Property T12N R3W Section 25 N½ NW¼ NW¼ NE~ NW¼ Dear Sir: This department has received a complaint from the owner of the subject property. Apparently they have little or no water available to them, even after a ~hird well had been drilled. This office requires a well log on Therefore, you will need to submit and third wells that were drilled. each individual well drilled. a well log on the second Also, on the first well drilled, we received a carbon copy of the log. The gallons per minute or hour is smeared and can not be read. Please submit a well log or verification on the gallons produced. If there are any further questions, please conta~ct this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw