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Home My WebLink AboutT15N R1W SEC 4 LT 37AT15N R1W SEC 4 Lot 37A #051 -072-60 Mark Sagich Mayor (Development Services bepartrnent Building Safety Division On -Site Water & 'Wastewater Program 4700 Bragaw Street P.O. Bax 196850 Ancharage, AK 99519-6650 www muni.arTinnsite (907) 343-7904 Pump Installation Log Date of Issue: Well Drilling Permit Number: 371_ parcel Identification Number:_ O 0.5 o-ia-(0° Legal Description /9--)‘) din/ Scc 7A Pro erty Owner Name & Address: CO acne/fig a/33a C&7 "y pump Installation Date: // t /D pump Intake Depth Below Tap of Wet Casing: 160 feet Pump Manufacturer's Name: $SRK£1W •pump Model: B7P400. 405:23/ Pump Size 9s. hp Pitless Adapter Burial Depth: �% feet Pitless Adapter Manufacturer's Name: Jn/17wc:574- pitless Adapter Installer: R74 Weil Disinfected Upon Compietian'gYes ] No Method Off Disinie�,c��j/j/ppn: Comments: Attention: The pump installer shall provide a. pump installation log to the DSD within 30 days of pump installation_ ALASKA WATER & WASTEWATER April 24, 2002 CONSULTANTS, INC. "':,a°m,�. mcipality of Anchorage Department of Development Services On -Site Services Section P.O. Box 196650 50 State of Alaska Department of Environmental Conservation 555 Cordova Street Anchorage, Alaska 99501 Subject: for Private Well & Septic System To whom it may concern: The subject lot has a 4 bedroom duplex house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: 37A, T15N, 121W, Section 4. A. WELL: The static water level on 4/16/02 was 152' BTC. Water was pumped from the well at a rate of 5.4 gpm for a total of 10 minutes (54 gallons). This had no effect on the water level. The water was then pumped at a rate of 5.5 gpm for a total of 120 minutes (666 gallons) with no drawdown on the water level. In short, the well will continuously produce about 5.5 gallons per minute. Based upon this data it was determined that the capacity of the well exceeds the Municipal and State requirements for a 4 bedroom house (.42 gallons per minute). B. SEPTIC SYSTEM: A -new septic system was installed on 4/8-10/02. See the attached as - built documentation. C: WATER SAMPLE RESULTS: Water samples were taken on 4/16/02 and the results were found satisfactory and meet State requirements. If you h vye any4 jtions, please contact us at 337-6179. Pres Games , .E., M.S. 6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com ALASKA WATER & WASTEWATER e m CONSULTANTS, INC. On -Site Wastewater Disposal System and/or Well Inspection Report Page 1 of 3 Nome: DON McKENZIE Wastewater System: 0 New • Upgrode Address: 21332 OBERG ROAD * CHUGIAK, AK 99567 ABSORPTION FIELD Phone: (907) 242-1689 No. of Bedrooms: 4 0 Deep Trench 0 Shallow Trench ■ Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: 0.8 CPD/Sch FL Total Depth from original grade: 3.5 DEEP MAX n. Block: Lot: 37A Subdivision: Depth to pipe bottom from original grade: 1.98-2.98 Ft. Gravel depth beneath pipe: 0.52 Township: 15 Range: 1 Section: 4 WELL: 0 New 0 Upgrade Total De Cased To: Ft. Driller. Tleld: Date Drilled: Pump Set At GPM Ft Ft Static Water Level: Ft. Caving H Ight Above Ground: FL Fill added above original grade: 3.0-4.0 Gravel width: 15 Total abserption arca: Ft. 750 so. rt Installer. CCC CONSTRUCTION Gravel length: Number of lines: 3 50 rt. Distance between lines: 5.0 Pipe material: D 3034/ F-810 Date installed: 4/8-10/2002 TANK SEPARATION DISTANCES ■ Septic 0 Holding ❑ S.T.E.P. 0 Other To From Septic Tank Absorption Field Uft Station Holding Tank Public/Private Sewer Lines Manufacturer. "PREMIER PLASTIC" Capacity In gallons: 1300 Well 100'+ 100.+ 25'+ Material: PLASTIC Number of comportments: 2 Surface Water 100'+ 100'l - LIFT STATION Lot Line 5'+ 10,+ Size in gallons: Manufacturer Foundation 5'+ 10'+ 'Pump on level at 'Pump off' . ot• High water alarm at: Curtain Drain NONE KNOWN Pump Make del: Electrical Inspections performed by: Remarks: —EXISTING SEPTIC TANK ABANDONED BENCH MARK PER UPC. Location and Description: BOTTOM OF BASEMENT DOOR THRESHOLD Assumed Elevation: 106.05 Fc inspections performed by: AkWWC, INC. Dates: 1st 4/8/2002 2nd 4/10/2002 3rd 4/10/2002 ENGINEER'S SEAL NA i, �yohp I. 0 'i Garnessr' 5 7953 P`,•/ d,o NEW DRAINF1ELD 20' BLM ROAD RESERVATION \obi 009 \006 8 TO 10 TET TALL CUTBANK C ( NEW 1300 GALLON "PREMIER PLASTIC' SEPTIC TANK / / / / / DBL1 78.02 53.77 DBL2 77.67 53.62 ST1 71.31 57.86 ST2 71.39 59.21 DBL3 73.02 63.10 DBL4 73.68 63.91 MT1 117.03 117.95 C01 118.56 119.27 CO2 122.87 123.81 CO3 128.02. 129.26 MT2 127.48 128.95 MT3 153.67 146.37 C04 152.38 145.28 C05 147.83 140.591 C06 144.32 136.41 MT4 143.74 135.44 ALASKA WATER & WASTEWATER 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 ' PHONE (907)337-6179 • FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: DON McKENZIE (907) 242-1689 LEGAL DESCRIPTION: LOT 37A; SECTION 4, T15N, R1W, EXISTING WELL DATE: 4/24/2002 DRAWN BY: C.J.G. SCALE: 1" = 40' PAGE NUMBER: 2 OF 3 TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 79 . 1! Qd'DrofesB1o'.c ' 040000�`� AS BUILT DRAWING TOP OF TANK AT INLET = 101.96 FINAL GRADE = 106.53 (AVG.) TOP OF TANK AT OUTLET = 101.98 INVERT OF BUNG AT INLET = 100.92 NEW 1300 GALLON "PREMIER PLASTIC" SEPTIC TANK INVERT OF BUNG AT OUTLET = 100.66 FINAL GRADE = 98.58-98.64 ORIGINAL GRADE MT CO C = 95.67-96.67 3.5 FE DEEP MAXIMUM CO MT BOTTOM OF BED = 93.17 (AVG.) 15 FEET WIDE INVERT OF DISTRIBUTION UNE = 93.69 (AVG.) ALASKA WATER & WASTEWATER .. CONSULTANTS, INC.�m�,,, 6901 DEBARR ROAD, SUITE 26 • ANCHORAGE, AK 99504 • PHONE (907)337-6179 • FAX (907)330-3246 PREPARED FOR: DON McKENZIE LEGAL DESCRIPTION: LOT 37A; SECTION 4, T15N, R1W, DATE: 4/24/2002 DRAWN BY: C.J.G. SCALE: 1"=40' PHONE NUMBER: PAGE NUMBER: (907) 242-1689 3 OF 3 TYPE OF WORK: PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 0g mow. STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOCUMENTATION OF CONSTRUCTION 18 AAC 72.035(d) allows conventional onsite wastewater treatment and disposal systems that serve a single family home, a duplex or a small commercial facility to be installed without prior plan approval by the Department, if the system is installed by a certified installer or under the direction of a registered engineer. Approved Homeowners may install conventional onsite systems serving their own home or duplex, provided they meet certain requirements. For those systems installed under 72.035(d), this form must be completed and submitted to the Department within 90 days of completing construction. In addition to this form, other information must be submitted as identified below. Additional submission requirements for all installations: I. A copy of the asbuilt survey (if available); 2. A well log (if available); 3. Testhole log and percolation test results if a percolation test is required because of soil type; 4. Sand liner material approval if a sand liner was installed. Additional submittal requirements for Certified Installers: 1. Minimum of four photographs of the installation in accordance with page 3 of the Installer's Manual. Additional submittal requirements for Approved Homeowners: I. Minimum of four photographs of the installation in accordance with Page 3 of the Installer's Manual. Record of a soil classification from a soil testing lab or a letter from a registered engineer who rated the receiving soil. Copy of letter from ADEC confirming that the installer has attended the required Department training. Additional submittal requirements for systems with construction observation by an engineer. I. Record drawings in accordance with 18 AAC 72.010(c)(1). 2. The Documentation of Construction Form must be sealed and signed by the observing engineer. This construction documentation form with the applicable attachments should be submitted to the nearest local office of the Department of Environmental Conservation at the address listed below. Notification lines shown below are for certified installers use to notify ADEC of a planned installation. Juneau 410 Willoughby Avenue Juneau, Alaska 99803 907-465-5150 Kenai 35390 K -Beach Road Soldotna, Alaska 99669 907-262-5210 Notification Line 907-262-5210 Ext 252 Ketchikan 540 Water Street Ketchikan, Alaska 99901 907-225-6200 Mat -Su Valley P.O. Box 871064 Wasilla, Alaska 99687 907-376-5038 Notification Line 907-376-5139 Fairbanks 610 University Avenue Fairbanks, Alaska 99709 907-451-2360 Notification Line 907-451-2184 Anchorage 555 Cordova Anchorage, Alaska 99501 907-269-7500 Notification Line 907-269-7517 apter 72, Wastewater Treatment and Disposal Regulations, the Installer's Manual and this form may be found on the department's Home Page at http://www.state/ak.us/local/akpages/ENV.CONSERV/home.htm Form revised 4/99 s on ou e d by a Cernf ed Installer. Profemonal Engineer. DEC staaj. or Ownerl$wiUer 2. A I pu4NIc a r systems mutt receive ADEC plan approval prior to construction. See 18 AAC 80 State ofAlaska Drinking Water R/qulallortsfor specific requirements. ' STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOCUMENTATION OF CONSTRUCTION Date Received I. GENERAL INFORMATION Legal Description of the Location Ltd-37Art5D11 R IW f SGS}t�n`1( Submitted by: (Check one) Certified Installer Approved Homeowner Registered Engineer • A Installer Name: / E tly C 4 cc C :'. A t- r J v%c r $ ‘✓' ' GLC ions4-fvc4-;o. 41°.zl•e.✓• c( 4rts,i+-„is 'Fnc. Onsite Wastewater System Serves: 0 Single Family. Number of Bedrooms 0' Duplex. Number of Bedrooms 0 Small Commercial Facility With Design Flow of less than 500 Mailing Address 1 (,q0 ( Da.be rr R04 sot 4c- 16 ' 1 Li Estimated GPD. 1 {i'nC�.oro\ Pk 10.50`i Ii. WATER SUPPLY SYSTEM (SECTION II IS OPTIONAL) Source of Water Well (Drilled ❑ Roof and Containment (Check all or Driven) Catchment Tank that Apply) (Identify) Type Ft `P'� of Water Supply System Private 04 plc* Public (Serves more that one family) Treatment of Water (Check all that Apply) Chlorination Mineral Removal • Surface ra None • • Filtration • El Other (ldetal& • Holding • ❑ Other: Well Dau Is the height of the well casing more the 12' above the ground? Yes ■ NO Is a sanitary seal or well cap installed on the well casing? tM Yes 0 No Is drainage directed away from or around the casing within a radius of 10 feet of the well casing? [4 Yes ■ No Is well wire enclosed in conduit? iii Yes ■ No Dat Drilled Vrrtow/. tk. Depth of Well (feet) 15L4 Static Water Level (Feet) 1$21 Yield Of available) 5,S Pump Rate Of available) 5_5` Separation Distance from the Well Casing to each of the Foliowing Sources of Contamination: Septic/Holding Tank on Lot l00It Feet Sewer Lines on Lot 1 Z -I-5 Feet Absorption Area on Lot 160' f Fi Closest Septic/Holding Taink on Adjacent Lot 1 0 0 3 Feet Closest Sewer Lines on Rd'acent Lot l 00'4- - Feet Closest Edge of an Absorption Area on Adjacent Lot: l 00 + Fr Indicate separation distance from toxic materials including fuel tanks, paints, lubricants and other petroleum based materials, pesticides, fungicides or herbicides to well casing: On Lot i % Oe t Feet On Adjacent Lot tee 14 Fe Water Sample Taken by: (Name) A ( li err. L . Sampler is: MEngineer .•• l] :a.'I 4 -7 Government Official Address / c !1 n p U 1� 1 Oc,1,t Re, -,01 5...,;4,ie . Arc-1tuf'.5'c/ MC etc se, , Water Sample Results: / ' f . Attach Copy IX Satisfactory - Date q/1647.- 0 U < • . -i,13° Comments/Recommendations: ............. . n: s/O ,rO, mesa; r. °_ E-7953 ta��e, i erns I ow' / 1 rtifv t t ve i f rmat on and that nr vided in Section IV is correct: ::: Typed/Printed Name e A /'1' isle-SS/cL Titlepate`�7. ,� / s on ou e d by a Cernf ed Installer. Profemonal Engineer. DEC staaj. or Ownerl$wiUer 2. A I pu4NIc a r systems mutt receive ADEC plan approval prior to construction. See 18 AAC 80 State ofAlaska Drinking Water R/qulallortsfor specific requirements. Ill. WASTEWATER DISPOSAL Type of Wastewater System: Legal Description: I" f 0 37A • Tis r ll R `' r/ S i Iv V' GG tGr\ t et Septic Tank with Conventional Soil Absorption System 0 Package Treatment Plant (requires engineered design) Holding Tank: Material Type: Size in Gallons: Manufacturer: LJ Other - Specify Type 0 Alternate Onsite (requires engineered design) 0 Small Commercial System[ (<500 GPD) With Estimated Daily Wastewater Flow of: Criteria Used to Estimate Daily Wastewater Quantity: Gallons Per Day (GPD) .imum Ground Cover Over: Septic Tank: -I 4 Absorption Area: Cleanout Pipes/Caps Installed:Yt oundation Cleanout: ---c" Septic Tank Yea (`$ VrEl/.ri Certified Installer Installation Notification Date: ■ NEW SYSTEM 15K REPAIR TO EXISTING SYSTEM Nameoflnstaller: CCC CcASr\--roGilt' b1 Date Installed: 9/`a-Io/0-7-_ System Installed: 0 By a Registered Engineer ❑ By Approved Homeowner (attach copy of approval letter) ist With Inspection by a Registered Engineer Number • By a Certified Installer/Installer obut 4�_ Septic Tank: Material: Manufacturer: Size (Gallons): Number of Compartments: fiercfccf 13CD 2 Type of Soil Absorption System: 0 Deep Trench 0 Shallow Trench 0 Mound 0 Other, Specify OF A qS N��. rc arness/t E-7953;• ' • Seepage Pit K Bed Soil Type: 6 e / S P Soil Rating: 0. g 6PO�Sr.Ft Dimensions/Size of Absorption Area: rst ...or4k b) 50` f Grading/Size of Distribution Rock: Y2_11 — 16U ..0o��ni Thickness/Depth of Distribution Rock: O-si o4_e Lct.ve. Percolation Test Results, Attach Copy of Report: HAq Minutes per Inch Sq. Ft. per Bedroom PercolationTest Performed by: percolation test results must be sealed/signed by a registered engineer .imum Ground Cover Over: Septic Tank: -I 4 Absorption Area: Cleanout Pipes/Caps Installed:Yt oundation Cleanout: ---c" Septic Tank Yea (`$ Monitor Tubes: t � List Separation Distances From Septic Tank or Absorption Area, Whichever is Closest, to Al Public Drinking Water Sources Within 200 feet: -2-co1 • Private Drinking Water Nearby: Sources Within 100 feet: )Ue 1.1" Nearest Water Bodies (see 18 AAC 72.020(b)): lac 4- Lot Line: 10'^)- Separation Distance from Onlot Sewer Lines to: Public Drinking Water Sources: } DD 14 Private Sources: L>-} 1 Separation Distance From Bottom of Distribution Rock to: Groundwater Table: 9 ^t- Bedrock: % I+ Separation Distance from Absorption Area to Slope exceeding 25%: SDI •i' Comments/Recommendations + obut 4�_ / lc LIcaAe.okS C F -C. " ee\ck till-. .1ns�•`pti<a Peiwc•e- \ (0 (...-\,,,r,_ ev.J\ 4kc. cp.-4,;(_:-11,,\ k, *�' .. .Q.r•� r. ,- ' Ne. OF A qS N��. rc arness/t E-7953;• ' I cefy , .ve information, and that .rovided in Section IV, is correct:wv Sign to ,es Typed/Printed Name Title, Reg./Cert No., Inst. No. ' t':' SiE 211-' JL 507: • mr, n : e stg a Certified Installer. Professional Engineer. DEC staff or Approved Homeowner. if engineering seal bears printed name. ber. and is signed. those blocks need not be completed for engineered submittals. CC .r Registered Professional Engineer • IV. DIAGRAM OF SYSTEM(S) INSTRUCTIONS FOR DIAGRAM I. In a plan view, locate and identify each of the following: a) Well b) AMI Structures e) Surface Water 0 Sources of contamination h) Closest well on adjacent property j) Closest edge of an absorption field on adjacent property 2. Show distances between the well and each of the sources of contamination listed in 1. 3. Show distances between water bodies and each part of the onsite system listed in 1. 4. In a cross section view of the soil absorption area, identify each component and show the depth (thickness) of the following: a) Soil Cover b) Absorption Material c) Water Table d) Bedrock e) Discharge pipes c) Septic Tank d) Soil Absorption System g) Property Line (Include dimensions) i) Closest septic tank on an adjacent property k) All cleanouts and monitor tubes t) Insulation �1 ++ e1 c c c -J\ r,/\\fJ �� S ALASKA WATER & WASTEWATER r. CONSULTANTS, INC. April 24, 2002 mcipality of Anchorage Department of Development Services On -Site Services Section P.O. Box 196650 • • 650 State of Alaska Department of Environmental Conservation 555 Cordova Street Anchorage, Alaska 99501 Subject: for Private Well & Septic System of 37A, T15N, R1W, Section 4. To whom it may concern: The subject lot has a 4 bedroom duplex house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 4/16/02 was 152' BTC. Water was pumped from the well at a rate of 5.4 gpm for a total of 10 minutes (54 gallons). This had no effect on the water level. The water was then pumped at a rate of 5.5 gpm for a total of 120 minutes (666 gallons) with no drawdown on the water level. In short, the well will continuously produce about 5.5 gallons per minute. Based upon this data it was determined that the capacity of the well exceeds the Municipal and State requirements for a 4 bedroom house (.42 gallons per minute). B. SEPTIC SYSTEM: A -new septic system was installed on 4/8-10/02. See the attached as - built documentation. C: WATER SAMPLE RESULTS: Water samples were taken on 4/16/02 and the results were found satisfactory and meet State requirements. If you h. vg any jtions, please contact us at 337-6179. Presfd Games , .E., M.S. l 6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com • l � ALASKA WATER & WASTEWATER ----------, -- =.;...m CONSULTANTS, INC.-„nsm-,n^^-.,.-,^.*. "m` On -Site Wastewater Disposal System and/or Well Inspection Report Page 1 of 3 Nome: DON McKENZIE Wastewater System: • New ■ Upgrade Address:FIELD 21332 OBERG ROAD * CHUGIAK, AK 99567 ABSORPTION Phone: No. of Bedrooms: (907) 242-1689 4 0 Deep Trench 0 Shallow Trench • Bed 0 Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0.8 GPD/Sts. Ft. Total Depth from orlglnol grade: 3.5 DEEP MAX Ft. Block: Lot: Subdivision: — 37A — Depth to pips bottom from originol grade: 1.98-2.98 Ft. Grovel depth beneath pipe: 0.52 pt, Township: 15 Range: , Section: 4 Fill added above original grade: 3.0-4.0 Ft. Gravel length: 50 rt. WELL: ❑ New ■ Upgrade Gravel width: 15 Ft. Number of lines: 3 Distance between lines: 5.0 FL Cloesifcaeon (Private. A,B,C): Total De• • Ft Cased To: FL Total obsorpaon area: 750 so. Ft. Pipe material: D 3034/ F-810 Driller. Date Drilled: Static Water Level: R. Inetaller. CCC CONSTRUCTION Date Installed: 4/8-10/2002 raid: GPM Pump Set AN Ft Casing Height Above Ground: Ft TANK SEPARATION DISTANCES ■Septic ❑Holding 0 S.T.E.P. ❑Other To From Septic Tank Absorption Field Litt Station Holding Tank Public/Private Sewer Lines Manufacturer. "PREMIER PLASTIC” Capacity in gallons: 1300 Well 100'+ 100'+ — — 25'+ Material: PLASTIC Number of comportments: 2 Surfoce Water 1001+ 1001+ - - - LIFT STATION Lot Line 51+ 10'+ - - - Size In gallons: Manufacturer. Foundation 5'+ 10'+ - - - 'Pump orC level a 'Pump off. . . at High water alarm at: Curtain Drain Pump Make odel: D ctricol Inspections performed by: NONE KNOWN Remarks: —EXISTING SEPTIC TANK ABANDONED BENCH MARK PER UPC. Location and Description: BOTTOM OF BASEMENT DOOR THRESHOLD Assumed Elevation: 106.05 Ft ''''' j * j '/Q Iref'--y 009 4��4ed ENGINEER'S oma; 4$ �4P ,37 11 CE 4rof 400.� SEAL 00�,w I 1. Gar -7953 essionp .16 '.� Q °Op0 0 ness;' • ..' 4:1-01 ac" Inspections performed by: AkWWC, INC. Dates: 1st 4/8/2002 2nd 4/10/2002 3rd 4/10/2002 AS -BUILT DRAWING A NEW DRAINF1ELD 20' BLM ROAD RESERVATION ---- o, 1 \CO 1 1 is 8 TO 10 "EET TALL CUTBANK NEW 1300 GALLON *PREMIER PLASTIC' SEPTIC TANK 0 Q 0 0 LLJ CO 0 B DBL1 78.02 53.77 DBL2 77.67 53.62 ST1 71.31 57.86 ST2 71.39 59.21 DBL3 73.02 63.10 DBL4 73.68 63.91 MT1 117.03 117.95 C01 118.56 119.27 CO2 122.87 123.81 CO3 128.02 129.26 MT2 127.48 128.95 MT3 153.67 146.37 C04 152.36 145.28 C05 147.83 140.59 CO6 144.32 136.41 MT4 143.74 135.44 / EXISTING WELL rpt. ALASKA WATER & 6901 DEBARR ROAD. SUITE 28 • ANCHORAGE. AK 99501. PREPARED FOR: DON McKENZIE WASTEWATER • PHONE (907)337-6179 • FAX (907)338-3246 PHONE NUMBER: (907) 242-1689 DATE: 4/24/2002 DRAWN BY: C.J.G. SCALE: 1" = 40' PAGE NUMBER: 2 OF 3 LEGAL DESCRIPTION: LOT 37A; SECTION 4, T15N, R1W, TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE koro fesslo'o�o 000��q� AS -BUILT DRAWING r FINAL GRADE = 106.53 (AVG.) i TOP OF TANK ATTOP TOP OF TANK AT INLET = 101.96 OUTLET = 101.98 INVERT OF BUNG AT INLET = 100.92 NEW 1300 GALLON "PREMIER PLASTIC" SEPTIC TANK FINAL GRADE = 98.58 98.64 INVERT OF BUNG AT OUTLET = 100.66 ORIGINAL GRADE MT CO CO CO MT = 95.67-96.67 3.5 DEEP MAXIMUM BOTTOM OF BED = 93.17 (AVG.) 15 FEET WIDE INVERT OF DISTRIBUTION UNE = 93.69 (AVG.) ALASKA WATER & WASTEWATER CONSULTANTS, INC 6901 DEDARR ROAD. SUITE 2B' ANCHORAGE, AK 99504 • PHONE (907)337-6179' FAX (907)336-3246 PREPARED FOR: PHONE NUMBER: DON McKENZIE (907) 242-1689 LEGAL DESCRIPTION: LOT 37A; SECTION 4, T15N, R1W, DATE: 4/24/2002 DRAWN BY: C.J.G. SCALE: 1" = 40' PAGE NUMBER: 3 OF 3 TYPE OF WORK: PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE :37• o VA G. ne$ 0 7953 O • �dProfessiol\O (Form revised 4/99 STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOCUMENTATION OF CONSTRUCTION 18 AAC 72.035(d) allows conventional onsite wastewater treatment and disposal systems that serve a single family home, a duplex or a small commercial facility to be installed without prior plan approval by the Department, if the system is installed by a certified installer or under the direction of a registered engineer. Approved Homeowners may install conventional onsite systems serving their own home or duplex, provided they meet certain requirements. For those systems installed under 72.035(d), this form must be completed and submitted to the Department within 90 days of completing construction. In addition to this form, other information must be submitted as identified below. Additional submission requirements for all installations: 1. A copy of the asbuilt survey (if available); 2. A well log (if available); 3. Testhole log and percolation test results if a percolation test is required because of soil type; 4. Sand liner material approval if a sand liner was installed. Additional submittal requirements for Certified Installers: 1. Minimum of four photographs of the installation in accordance with page 3 of the Installer's Manual. Additional submittal requirements for Approved Homeowners: Minimum of four photographs of the installation in accordance with Page 3 of the Installer's Manual. Record of a soil classification from a soil testing lab or a letter from a registered engineer who rated the receiving soil. Copy of letter from ADEC confirming that the installer has attended the required Department training. Additional submittal requirements for systems with construction observation by an engineer. 1. Record drawings in accordance with 18 AAC 72.010(c)(1). 2. The Documentation of Construction Form must be sealed and signed by the observing engineer. This construction documentation form with the applicable attachments should be submitted to the nearest local office of the Department of Environmental Conservation at the address listed below. Notification lines shown below are for certified installers use to notify ADEC of a planned installation. Juneau 410 Willoughby Avenue Juneau, Alaska 99803 907-465-5150 Kenai 35390 K -Beach Road Soldotna, Alaska 99669 907-262-5210 Notification Line 907-262-5210 Ext 252 Ketchikan 540 Water Street Ketchikan, Alaska 99901 907-225-6200 Mat -Su Valley P.O. Box 871064 Wasilla, Alaska 99687 907-376-5038 Notification Line 907-376-5139 Fairbanks 610 University Avenue Fairbanks, Alaska 99709 907-451-2360 Notification Line 907-451-2184 Anchorage 555 Cordova Anchorage, Alaska 99501 907-269-7500 Notification Line 907-269-7517 apter 72, Wastewater Treatment and Disposal Regulations, the Installers Manual and this form may be found on the iepartment's Home Page at http://www.state/ak.us/local/akpages/ENV.CONSERV/home.htm Date Received STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOCUMENTATION OF CONSTRUCTION 1. GENERAL INFORMATION Legal Description of the Location ' i L_ -+37A;T1S011 R1Wf Scc)r;.,r.4, Submitted by: (Check one) •Certified Installer Approved Homeowner Registered Engineer Installer Name: 1=n”`.4.cer.` PtkSI" kJ-8<r t , �/ ,54e..r'A r 4....s.. 4,ecks 'PAC. t—' LC4 S 4r vc s t.,,,..■ Onsite Wastewater System Serves: Single Family. Number of Bedrooms Mailing Address.11) 6 lO ( Oc_b c,rr R c' a s . A4c 16 [< Duplex. Number of Bedrooms 14 0 Small Commercial Facility With Estimated Design Flow of less than 500 GPD. PS AC-kofn.)C1 {}k 410. SOLI II. WATER SUPPLY SYSTEM (SECTION II 1S OPTIONAL) Source of Water and Containment (Check all that Apply) eg.Well (Drilled or Driven) • Surface (Identify) Roof Catchment Type of Water Supply System Private 0491.0‘ 0 Public (Serves more that one family) Treatment of Water (Check all that Apply) X None ❑ Chlorination a Filtration 0 Mineral Removal III Other: 0 0 Holding Tank ❑ Other (Idents) 11 eeoo Well Data Is the height of the well casing more the I2' above the ground? Cy Yes • No Is a sanitary seal or well cap installed on the well casing? [Xi Yes • No Is drainage directed away from or around the casing within a radius of 10 feet of the well casing? toYes 0 No Is well wire enclosed in conduit? WI Yes ❑ No Date Drilled VAV-11064- A. Depth of Well (feet) 1SL. 4 Static Water Level (Feet) jszt Yield (If available) 5.S Pump Rate (If available) 5^S Separation Distance from the Well Casing to each of the Foliowing Sources of Contamination: Septic/Holding Tank on Lot 100It Feet Sewer Lines on Lot 7-5' + Feet Absorption Area on Lot 16eI 4- Fe Closest Septic/Holling Tank on Adjacent Lot IVO 4. Feet Closest Sewer Lines on adjacent Lot 100 "1" Feet Closest Edge of an Absorption Area on Adjacent Lot: 100 I + Fee Indicate separation distance from toxic materials including fuel tanks, paints, lubricants and other petroleum based materials, pesticides, fungicides or herbicides to well casing: On Lot i 1 OC •{- Feet On Adjacent Lot jet '4 Fee Water Sample Taken by: (Name) AK W W ,' ,y^ Ti 1 NS L , Sampler is: Engineer .OF `b Bay 1.1 7 Government Official Address 6 j L01 ( OAU (( �o.al $ie'tc Z>%�j V�C1e: 5.z/Ak Nei St' Water Sample Results: :` i IP •.;F Attach Copy Satisfactory - Date y/IG/a2 0 U ,fa=tal 0.;'•'^ '•,T Comments/Recommendations: •^ • F9., if .* G mourn' O. 1 E-7953: r PROFFSSIONI.' 1 • ifv t +t t .. rive i r format on and that nr vided in Section IV is correct: Si nature , Typed/Printed Name j f Prtg t Title St T—, lQk.ee/t•✓e. / 14C- _ Date }�^ ...da �.. ^.0 �.. .. r•^..:c..r ,^....a..^ a.re ..G.....-..If.....^. ncr ..•.?... /f.....o./R•.aA.^ 2. Ar!'pu4liicwa)er systems must receive ADEC plan approval prior to construction. See 18 AAC 80 State of Alaska Drinking Water RIgula ions for specific requirements.