HomeMy WebLinkAboutMOUNTAIN MANOR BLK 2 LT 11Mountain
Manor
Block 2
Lot I I
#050-671-12
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201181 PID Number: 050-671-12
Dwelling: 011 Single Family (SF) F� with ADU El Duplex (D) F-1 Two Single Family Project: El New FIC Upgrade
Name
JOSHINGRAM
A RPTION FIELD
F-1 De Trench 1771 Wide Trench F-I B d ound
Ze
Site Address
11824 INSPIRATION DRIVE, EAGLE RIVER, AK 99577
Other
Phone
Number of Bedrooms
Soil Rating
Total depth f -.1. original grade
720-891-0377
4
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from origi
]EXISTING
jel depth beneath pipe
Ft.
Subdivision Block Lot
MOUNTAIN MANOR 2 11
Fill added above or,!;?! Ft.IG !7�Z Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dis en lines
Ft.
SEPARATION DISTANCES
Toll
Septic Absorption
Holding
Sewer
T rption area
Number of trenches
Dist. between
From
Tank Field
Lift Station
Line
Ft2
Well
1100,+ EXISTING
2b _r
TANK 9 Septic E] S.T.E.P. 171 Holding 0 Other
Manufacturer
GREERTANK
Capacity
1250 Gal.
Surface Water
*70'4- EXISTING
NA
Material
HDPE PLASTIC
Number of compartments
2
Lot Line
51+ EXISTING
**10'+
OT��TION
Foundation
EXISTING
Manufacturer Ca
Gal.
Remarks *WAIVER GRANTED (OSV201026)
**NEW TANK IS 5+ FEET FROM ANY EXISTING DECK SUPPORT
:Al!a:rm�location; �:*IEle'ctn ailed by
PIPE MATERIAL House to tank D3034 (NE Tank to D3034 (NEW)
W) drainfield
Installer
DEAN CONSTRUCTION
Drainfield EXISTING CO/MTD3034 (NEW)
Inspector JODY MAUS, GEG CONSULTANT
BENCH MARK (Assumed elevation) 100.00 ft
Inspection 1�1 6/25/2020
Location and description
2nd
dates:
BOTTOM OF SIDING BY FCO
d
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's �tamp
Conditional Approval: Date
41 D
Septic System
Approved &UM Date
Note: this approval does not include well permit requirements.
#AECC884 ro fe""00
UHovu5/u2/lu; .
PERMIT NUMBER: RECORD DRAWING PARCEL NUMBER:
OSP201181 050-6711 -12
MOUNTAIN MANOR;
BLOCK 2, LOT IOA
T\
fQ
NSR
EXISTING FCO i
WITH HIGH
LEVEL ALARM /
NOTE: OLD SEPTIC TANK
WAS COMPLETELY
REMOVED AND DISPOSED :.(• �O/�,S //
OFFSITE PER CONTRACTOR
NEW 1250 GREER HDPE `^ /
2 -COMPARTMENT
SEPTIC TANK y t�+,Sr WEST
i
y00Qoyc i _ ) WELL
INSTALLED ti, G`sF L _ _
DOUBLE ry \ 1 GRAVEL.."
CLEANOUTS
(DBL1 & DBI -2) �� ` I " DRIVEWAY.."
EXISTING
DRAINFIELD \\ CEO f
\ j
FCO 5.5 1 20.7 \ j
70' WAIVER GRANTED TO ANY PORTION MH 20.1 22.4 \
OF SEPTIC SYSTEM. (WAIVER # OSV201026) STI 24.5 26.2 \\ i
DBL1 26.3 27.9 \
DBI -2 26.8 28.5
C01 30.6 17.7r�-
0O2 56.4 33.1
MT1 1 56.6 33.5
APPROXIMATE LOCATION OF / O�
OPEN CHANNEL WITH SURFACE
WATER. BELIEVED TO BE SEASONAL. /
(STILL FLOWING/PONDED ON 6/25/2020)
/ N
r
j rr
ROADS END CIRCLE SALE:
„1„= ao'
Ltd
ENGINEERING SALES CONSULTING ,
3701 E TUDOR ROAD, SUITE 101 `ANCHORAGE, AK 99507 ” PHONE (907) 337-6179' FAX (907) 33&3246. WEBSITE: www.gammengineedng.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOSH INGRAM 720-891-0377 2 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
MOUNTAIN MANOR SID; BLOCK 2, LOT 11 J.L.M.
TYPE OF WORK: DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE 6/26/2020
PERMIT NUMBER: RECORD DRAWING PARCEL NUMBER:
OS P201181 050-6711 -12
TOP OF MH LID = 99.71
TOP OF TANK @
INLET = 93.68—
INVERT OF BUNG
@ INLET = 92.94
FINAL GRADE
= 98.89-98.55
►IST.
NEW 1250 GALLON
GREER HDPE
SEPTIC TANK
STI
GARNESS ENGINEERING GROUP, Ltd
ENGINEERING SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX(907) 336-3246' WEBSITE: w .gamessengineering.corn
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JOSH INGRAM 720-891-0377 3 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
MOUNTAIN MANOR S/D; BLOCK 2, LOT 11 J.L.M.
TYPE OF WORK: DATE:
� RECORD DRAWING OF SEPTIC TANK UPGRADE 6/26/2020
TOP OF TANK @
OUTLET = 93.61
INVERT OF BUNG
@ OUTLET = 92.82
Oft
..... ..... ........... ...................
,®
®f �':,• r .•..A. Ga ness..' 4u19
f® E- .1 Zai
AV
40
'•; pROFess��`P:
LICENSE ,,t1IlkIs �
#AECC884 J
TnWhom It May Concern:
Precision Decks, LLC was hired tuevaluate the main structural support beam for the rear deck located at
11824 Inspiration Dr. The beam was determined to be out of compliance with the Municipality of
Anchorage requirements for the span that existed. The inspection showed a Hem Fir #2 416 beam
spanning adistance of21feet with nointermediate vertical supports.
On July 2 nd , 2020 Precision Decks installed a 10" sono tube at a depth of 48 inches between the two
posts with an outdoor treated lumber 46 vertical post, attached to the beam with Simpson hardware
BC46Zandfastenedvyitheight1.2S^exteriorrutedposhivep|acementnaUs. . The placement ofthe
sono tube was 7 feet from the east side support, shortening the largest span to less than 14 feet,
allowing the beam tosupport acalculated load of50lbs per sqft.
Precision Decks noted that the septic engineer requested no footings within a 7.5 foot radius of the new
existing man -hole cover. The new sono tube was installed a distance of 9 feet from the cover and
therefore should clearly be in compliance with the septic engineers request as well as the Municipality
ofAnchorage's local minimum code requirements.
Please feel free to contact Precision Decks with any further questions or concerns at (907)521-2126,
m
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,lfwww.muni.org/onsite
Permit Number: OSP201181
Work Type: SepticTank Upgrade
Tax Code Number: 05067112000
Site Legal Address: MOUNTAIN MANOR BLK 2 LT 11 G:0254
Site Mailing Address: 11824 INSPIRATION DR, Eagle River
Owner: INGRAM JOSHUA N & LINDSEY A
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
�t11�nC
off. � Sn
Department
6/19/2020
6/19/2021
57934
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Received B _ Date:
Issued By: Date: d
CI
Municipality ®f Anchorage
P.O. Box 196650 e 4700 Elmore Road
Anchorage. Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
Department
x x x x VARIANCE/WAIVED. REVIEW x x x x
Waiver#: OSV201026
PID#: 050-671-12
COSA#:OSC201241 Permit#:OSP201181
Legal Description: Mountain Manor Block 2 Lot 11
Engineer: Garness Engineering Group
Applicant: Josh & LindseV Ingram
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field and septic tank to the surface water has been approved. The approved separation
distance is 70.0 feet. See engineer's waiver request for justifications.
This waiver approval applies to the existing absorption field and proposed septic tank only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
.............................................................................. 1
Waiver is Granted: X Waiver is not Granted:
Date: C�l� l Ci ��i Approved by:
Name of Reviewer
*** VARIAN C E/WAIVER REVIEW ****
UNICIPAILITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
.-
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 050-671-12
Property owner(s) JOSH & LINDSEY INGRAM Day phone 720-891-0377
Mailing address 11824 INSPIRATION DRIVE, EAGLE RIVER, AK 99577
Site address 11824 INSPIRATION DRIVE, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) MOUNTAIN MANOR S/D; BLOCK 2, LOT 11
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF) Q
(w/wo ADU)
Septic Tank 0 Upgrade 0
Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
NEW SEPTIC TANK TO SURFACE WATER (ALREADY REQUESTED WITH COSA) Distance: 70'
I certify that the above information is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: ��`J I ($--15 Waiver Fees:
Date of Payment: ( a l okQ aD Date of Payment:
Receipt Number: ()non 6 Receipt Number:
Permit No. 65 8201 <? I Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201181, Rebecca Carroll, 06/19/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201181, Rebecca Carroll, 06/19/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSC201241, Rebecca Carroll, 06/19/20
Page 2 of 2
this surface water may be seasonal or intermittent. At the request of GEG, Tim Eklund performed
a site visit on 6/4/20 to assess the situation. He determined that a surface water waiver was going
to be required.
We are requesting a 70 -foot (horizontal distance) waiver be granted for any portion of this septic
system to the standing surface water. If the drainfield were to overflow, the daylighting wastewater
would flow at least 80 feet along the ground surface, down a heavily vegetated slope, before
reaching the surface water. To justify the waiver, a float was installed in the foundation cleanout
that will activate an audible alarm in the residence if the liquid level in the septic or drainfield is
more than 6 inches above the pipe invert elevation at the foundation cleanout. This will ensure
the liquid level in the septic system will never get high enough to overflow any of the cleanout
pipes and migrate towards the surface water without homeowner "notification". See the attached
information and photos regarding the "alarm system".
Drainfield to a Slope Greater than 25 Percent
We did note the end of the sump for the drainfield is approximately 10 feet from a slope that is
greater than 25 percent. We walked the area below the drainfield and did not find any indication
of daylighting effluent. In short, it appears there is no concern with this existing condition. The
system was installed prior to 1986 and we do not believe the code at that time required a
separation distance to a slope greater than 25%.
Deck Pile to Septic Tank:
During our 2019 inspections we noted that there was a deck support with a pier block near or
partially over the existing septic tank (see attached photo). The deck was constructed by a
contractor retained by the current property owners. The property owner conveyed to us that the
subject support was not necessary for structural integrity, so they had it removed. Attached is a
recent photo with the deck support no longer present. GEG did not direct removal of the support
or perform a structural evaluation regarding the deck and/or the necessity of the support that was
removed.
This concludes our findings. If you have any questions, please contact us at 337-6179
M
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com
Thank
June 2, 2020
Mr. Jody Maus
Garness Engineering Group Ltd
3701 E Tudor Rd # 101
Anchorage, AK 99507
Dear Mr. Maus,
I am writing regarding the small amount of surface water observed during your trips to
our property in May. To the best of our knowledge and recollection, this water is
seasonal and only present during spring break-up when melting snow flows down the
hill from Mount Baldy.
Sincerely,
Joshua Ingram Lindsey Ingram
Home Owners
11824 Inspiration Dr,
Eagle River, AK 99577
6a 5TD
INS
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x 4 . C 5:3
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pal
as `, o ,EP's OCC
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1Fift B'E�u
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W GRAVEL
th
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14 , '* 3 e
14-1
EASEMENTS
ROADS
END
CIRCLE
s AS BUILT SCALE i � 5�' ilk Project No.
11500 Daryl Avenue, Ancheara—3049
6 . (907) 522-6476 Phone
522-4625
aei rye kens langsas F
jortath
I hereby certify that I have surveyed the
LOT 11, BLOCK 2, MOUNTAIN MANOR SUBDIVIS 3) 49LH*'
Anchorage Recording District, Alaska, and th d therson are
va
within the ra lines and do not � ISI 1°i� �I�I �0�',°'�'' �� ��i
� pr>Mspe eta, thatI�
no Improvements ars the prcpert, hereto encroach are
premises and that there or transrrslsslcan lines or rather vl lts
easements on sold pr s Indicoted hereon.
.d AT&T '" —," 8_;,46 -AM 98°!°
I
I V I I Cl kOV.
MAUS >
Alarm is in and works. Set
just above crown of pipe.
N
Wn
0)
DECK-
cly
Lot 10 Lu
SEPTIC
PIPES
60
0
C
no
14
`,� - -��
101V
�b 6
3.0' CANT 4 01i)/t
RETAINING WALL
-WELL
l$�l 7S0 1.0' COVERED DECK
ABOVE wl 4.0'06.0'
'DECK BELOW
jatC !-WELL
GRAVEL.-
2.0' X24DRIVEWAY
)
CANT
.0.
12.2'x3l.4'q
CARPORT ,�t4S
Q
Lot 11
57,934 s.f.
~Loi
100 10' DRAINAGE
EASEMENTS
ROADS END CIRCLE
PLOT PLAN AS BUILT _�_ SCALE 1" = 50 GRID NW 254 Project No. 20%276 A1_
A 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang &r Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax
1=1 () F
Professional Land Surveyors ken 0longsurvey.com X I
Jonathan Otangsurvey.com A
I hereby certify that I have surveyed the following described property:
-'* 49TH* -,.-y
LOT 11, BLOCK 2, MOUNTAIN MANOR SUBDIVISION (Plot No. 77-23)
..
-I- -1i .........
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
W
I
no Improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible G. LANIG)
easements on sold property except as indicated hereon.
LS -5202.
Dated this the Day of of Anchorage, Alaska ......... 110
,
It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
MUNICIPALITY OF ANCHORAGE * M071 W" --v Ot.t
Hey h and Environmental Prote on �EL�o.Jn
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 2.24, 225
INSPECTION EPORT ON-SITE SEWAGE DISPOSAL. SYSTEM
a(� >
NAMC. __M''nnnll``ING AUDRF55
d,./
LOC A"TION- -._. ____ _._d0/L .GnL_ uL �cltlhrlorJ__��
SEPTIC TANK:
DISTANCE ¢ NU BER OF r�
FROM WELL. __.__ M A N I J I ACTURE�xj5.L._� _-_ TE ILIAL _�% _. MPARTMENTSs ._-
INSIDE. LENGTH_._._.' __-_ INSIDE WID111 _ LICIUID DFPI I _.."• LIQUID CAPACITY-,. __- ,ALLN�1
-ib
O
\ 250 A -S �2 R�c-,TPts
-_ �ob.Q
T�k-� rIRAIN FIFLCJ: � P6R-mi; �'�\�q\Z'1
%-7 TOTAL LENGTH
DISTANCE FROM WELL 1ofl /._FOUNDATION /_�_. _-.m ARE cT LOT LINE_�� �._. _--OF LINE
DISTANCE BETWELr- LINES _-. �17_.__-1RFNCH WIDTL; IN. TOTAL EFFECT i`/1
ABSORPTION nHLA .._d �v _ _-.. SO. (T. L CNGTH OF EACt I L INF_
- IAPI 101- I ILTL R
H
DEPT: TOP OF TILL TO FINISII GRADE _. _ _ MATERInI_ HINEATIi TILE 6_0__.IN. ABOVE TILE
SEEPAGE PIT:
DIAMETER _-.--OR WIDTH __ LL:NGIH__, DEPTH
Log Crib Rings/,:RIB SIZE: UTAME.I[ 11 ____ULPIH_-__-DISTANCE FROM: WELLe____.�___.
101 AL EFFECTIVE
BUILDING FOUNDATION______ NEAREST LOT L INE - ALSORPTION ARIA (WALL AREA) SQ. I T.
----_ . _-- -- -- -_ _---- - - -rte_ - � , _
Well
Class
Depth: � � f�0udlY�cR.'f'
0 II
Well Distance To: Lot Line j 1 I
Bldg: Sewer Line:
Pipe M
p �._
Pi aterials_: NI I
�
# of Bedrooms: i ++
Installer.—
Remarks :-
-
I
i I j I I
- I
I;
;
1)AIL nPPRovFD
0 Ft E GEO'. CHNI CAL Ft DEVEL -IMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 6BB-2280
Soils Er Foundations Land Development
Performed for: Name: s1".S`- Tel. No. t%`f=
Mailing Address:
Legal Description: Z&7-11,
Depth (feet) Soil Characteristics
0
1
2
3
4
5
6
7
8 �� t7Ai4f ,✓ r%'✓11�/.:r�'?t r .S r_ C eS
9.
10
11�
15
16
Ground Water Encountered: Yes_. _ No ��4� If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by /�� V� ,E�� Date:
UGHL ,.ry.U.
SGS SW Id.. J Ysg9
1.33�1P
tj "uciny . elktns of water pow how.wt .L_s1.`.. f�
INVOKE Set Oump CQ1
WIWN DRILLING - 7
INVOICE N7
SR SOX 6M, ROOARp RD.
PAU40k ALASKA "60 8 p YOUR P. O. NUM_ e&R
TEWHONR 7454071 TERMS
Lwi-L—BIk 2,_Sub LLdOf1t] WELL LOG"i far"° SALESMAN
n
_ ✓Jflrt l�. cJi to .... / c oi_.. e� <7��i
DEPT CASIN FORMATION
DEPTH
IN
I CABIN
146
166
167
Set
PLEASE PAY FROM THIS INVOICE �j 7 7'
L_.-�-ie!cl yn.0 9-S-Q�- 7✓�
Ycl ., wP IS m;c 1�Vs2.
_— ASSw.•��n9 L5 }ol w>;i� �: Usa. '.._...._ ...
FORMATION ' R7
266
241
261
267
266
268
274
276
276
1,7-06 • 06 vv tont
/hg <2
I nuze nvl �,c'.n l:e At,l
j� _ I
CABIN I FORMATION
� eG
• Municipality of Anchorage =
On -Site Water and Wastewater Program
(907) 343-7904 5 E T r
Certificate of On -Site Systems Approval
Parcel I.D. 050-671-12
1. GENERAL INFORMATION:
Expiration Date: cd el alo'�'o
Complete legal description MOUNTAIN MANOR S/D• BLOCK 2 LOT 11
Location (site address) 11824 INSPIRATION DRIVE, EAGLE RIVER, AK 99577
Current Property owner(s) JOSH & LINDSEY INGRAM Day phone 1-720-891-0377
Mailing address 11824 INSPIRATION DRIVE EAGLE RIVER AK 99577
Real Estate Agent KYRA DREHER W/ KELLER WILLIAMS Day phone 865-6500
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4-
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:,
V
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55b— 412-0
Date of Payment (4 /it) i �® �
Receipt Number o&aq C�
COSA # C .261RLl
Date:
I
: -70
Waiver Fee $ q&O — &7, • AD
Date of Payment 12U 26
Receipt Number -
Waiver #
umberWaiver#
COVID-j9
i DISCOUNT AppLII_Q-A
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.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness C
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
•/ System #1 Approved for q bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
#AECC884
OcF (444f,,r
Z`' ON-SITE o -
with the f1lowi+ s�t�kCA : o-
with
o
PROvthHtvl
By: Original Certificate Date: 7 0200
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
Septic System Advisory
Well Flow Advisory
COSA blue sheet 10-10-12.doc
Nitrate Advisory
Arsenic Advisory
Other
COSA
Checklist
Legal Description: MOUNTAIN MANOR; BLOCK 2LOT 11
Parcel ID: 050-671-12
If more than 1septic system onlot: CU8AChecklist # 1 of 1 Structure served bythis system 1
A. WELL DATA I EAST WELL/ WEST WELLI
110-1 Well is filed with Onsite (or attached) Well production edtime oftest
Date drilled Water storage tank volume `,vv gallons
Total depth Well disinfected for coliform test? E] Yes F011 No
Cased to ��Coliform bacteria ioNegative
IRE Sanitary seal is functioning correctly Nitrate -819/100mg/L [l Nitrate less than MRL (ND)
��wires are properly protected Arsenic FOR BOTH ug/L FE-1Arsenic less than MRL(ND)
Casing height (above ground) 18~n8+ in. Collected by GEG.LT[l'
Date offlow test for COSA Date ofSample 5/26/20Stotinwater|eve|etbeginningofteot
Comments *PER SULLIVAN WATER WELL INSPECTION. SEE ATTACHED REPORT. —ESTIMATED TANK SIZE BASED UPON o/wswomwoopTANK.
GEG, LTD. DID NOT EVALUATE THE WATER STORAGE SYSTEM. ***PER GEG FLOW TEST.
B. TANK DATA T STATIONT STATION
Age oftank(s) NEW
years [l Require aintenance
Tenkb/po/mebahm| *opEof sAge of lift station
Measured operating fluid level inseptic tank NEVV
Lift station materia
F01Standpipes/foundation o|aonoutpernsuovddnywing Commen
Oahe of pumping NEW
Q. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 03/77
��ALL standpipes present per record drawing
Total measured depth from grade 9-75*(nax
Measured depth topipe invert from grade 5J5*
FlN/A — pressurized field
FlMonitor tubes gohobottom ofeffective. |fnot, state
depth into effective *4LFEET
5115/19�e������___
RoouUo R]Paoo For 4 bedrooms
Fluid depth prior hotest �» in
New depth 0 in
Elapsed time 0 min
��Code-required soil cover over field Final fluid depth u in
171System presoaked . Absorption rate 800+ gpd
(Required ifvacant for greater than 3Odays prior hm Any rejuvenation treatment (past 13months) NONE
date oftest) ��—
Gallons introduced gaUona |fyee.on�erdate
Comments/Deficiencies: *EFFECTIVE DEPTH ON 1977 INSPECTION REPORT SHOWS 5 FEEET (60") OF EFFECTIVE
*MONITORING TUBE IN DRAINFIEDL FOUND TO BE DRY ON 5126/2020.
COSA Checklist yellow sheet
��
E SEPARATION DISTANCES
From Private Well onLot to: (Please enter distances if less than required mif community well)
Septic Tank/Lift Station onLot >1OU'
Yes
if No
Community Sewer Manhole/Cleanout >1OO'
r.11 Yes
ifNo#
Property Line >5'
MYea
ifNoft
Neighboring Tank >1OO' ��Yeo
ifNoft
Surface Water >1DU' El Yes if No **70+ ft
Private Sewer/Septic Line >�25'E]Yes
ifNoft
Absorption Field onLot >1UU' MYea
ifNoft
Private Wells >1OO'
Holding Tank >1OU' R] Yes
ifNoft
Neighboring Absorption Fields >1OO'
ifNoft
Animal Containment >5O' El Yes
ifNnft
Yes
ifNuft
ifNoft
\fseptic tank iaunder driveway comment below
/certify that / have determined through field inspections
Manure/Animal Excreta Storage >10O'
Community Sewer Main >7S' Yes
ifNoft
��Yeo
ifNoft
From Septic/Holding Tank mnLot to: (Please enter distances if less than required)
Building Foundations >1O'
Yes
if No
+ ft
Surface VVaber>1OO'
Yes ifNo*7D+ft
Property Line >5'
Yee
ifNoft
Community Wells >28O'
Wells onAdjacent Lots:
Surface Water >1DU' El Yes if No **70+ ft
Absorption Field >5'
Yes
ifNoft
Private Wells >1OO'
Yea ifNnft
Water Main >10'
Yeo
ifNoft
Community Wells >2UO'
Yea ifNoft
Water Service Line >1O'
Yes
ifNoft
\fseptic tank iaunder driveway comment below
From Absorption Field onLot to: (Please enter distances if less than required)
Building Foundation >1O' ED Yes ifNnft
Ifabsorption field isunder driveway comment below
Property Line >1O' G/1 Yes ifNnft
Wells onAdjacent Lots:
Water Main >1O' [Z] Yes ifNoft
Private Wells >1DO'
Yeo ifNoft
Water Service Line >1O' MV Yes ifNoft
Community Wells >28O'
Yeo ifNoft
Surface Water >1DU' El Yes if No **70+ ft
F. ENGINEER'S COMMENTS
*10'+ TO HOUSE FOUNDATION AND 5'f TO PILES FOR DECK.
^*MSV201026
G. ENGINEER'S CERTIFICATION
/certify that / have determined through field inspections
and review
ofMunicipal records that the above systems are /nconformance
with
MOA COS4guidelines /neffect onthis date.
SOGxChecklist yellow sheet
o«scouo*
11
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Nitrate Advisory
Certificate of On‐Site Systems Approval # OSC201241
Subdivision: Mountain Manor, Block: 2, Lot: 11
A water sample revealed a nitrate concentration of 8.2 & 10.0 milligrams per liter
(mg/L). 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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a medi a with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
SGS Ref.#
1202110002
Client Name
Garness Engineering Group, Ltd (GEG)
Printed Date/Time
06/03/2020 16:59
Project Mame/#
MOUNTAIN MANOR BLOCK 2, LOT 11
Collected Date/Time
05/26/2020 11:23
Client Sample IOD
WEST WELL
Received Date/Time
05/26/2020 13:22
Matrix
Drinking Water
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
Arsenic
ND
5.00
ueL
EP200.8
B
(<10)
06/01/20 06/03/20
ACF
Waters Department
'Total Nitrate/Nitrite-N
10.0
0.400
mg/L
SM21 450ONO3-F
C
(<10)
06/02/20 EWW
Microbiology Laboratory
E. Coli
Negative
1
100mL
SM21 9223B
A
05/26/20
MA
Total Coliform
Negative
1
100mL
SN121 9223B
A
05/26/20
M.A
SGS
SGS Ref.#
1202110001
Client Name
Garness Engineering Group, Ltd (GEG)
Project Name/h!
MOUNTAIN MANOR BLOCK 2, LOT 1 I
Client Sample ID
EAST WELL
Matrix
Drinking Water
Printed Date/Time
Collected Date/Time
Received Dateffirne
Technical Director
06/03/2020 16:59
05/26/2020 11:17
05/26/2020 13:22
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container 1D Limits Date Date lnit
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 B (<10) 06/01/20 06/03/20 ACF
Waters Departutent
Total Nitrate/Nitrite-N 8.19 0.200 mg/L SM21 450ONO3-F C (<10) 06/02/20 EWW
Microbiology Laboratory
E. Coli Negative I 100mL SM21 9223B A 05/26/20 M.A
Total Coliform Negative 1 100mL SM21 9223B A 05/26/20 M.A
Carroll, Rebecca M.
From:
Jody Maus <Jody@garnessengineering.com>
Sent:
Tuesday, July 7, 2020 5:15 PM
To:
Carroll, Rebecca M.
Cc:
Jeff Garness
Subject:
Mountain Manor wells
Becca,
Based upon my site visit to take the most recent water sample, both wells were active and being used to supply water to the
house.
Sincerely,
Jody Maus
Garness Engineering Group, LTD
907-223-0555
Sent from my Whone
1
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-671-12 Expiration Date:
1. GENERAL INFORMATION
Complete legal description MOUNTAIN MANOR S/D BLOCK 2 LOT 11
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
11824 INSPIRATION DRIVE, EAGLE RIVER, AK, 99577
MICHAEL LUPRO & MARCIA BRAD Day phone
11824 INSPIRATION DRIVE EAGLE RIVER, AK, 99577
SHAWN RABBIT W/ KELLER WILLIAMS Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
227-7687
441-2500
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
W aiver/Variance request for:
r
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 4�
Date of Payment /*�
Receipt Number
��S �>
COSA # C2,
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance: —
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the 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.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, GEG, UD. 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 cm chfron, 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
6. DSD SIGNATURE
System #1 Approved for H bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Phone
337-6179
Date ill%
Original Certificate Date:
C —73531
Pr o fessio�o�
(of ANCti�,,��i/
ON-SITE ��
WATER AidD
WASTEWATER rot
The V nlcipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rov 1 Vnfi1
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: MOUNTAIN MANOR; BLOCK 2, LOT 11 Parcel ID: 050-671-12
A. WELL DATA *PER SULLIVAN WATER WELLS INSPECTION. SEE ATTACHED. EAST WELL WEST WELL
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed UNK/ 7/25/80 Sanitary seal (Y/N)YES YES
*BEDROCK/
Total depth*105+ 377 ft. Cased to *BEDROCK ft.
FROM WELL LOG
Date of test NO WELL LOG/7/25/80
Static water level UNK/UNK ft.
Well production UNK/1.33 g.p,m,
WATER SAMPLE RESULTS:
Coliform 0/0 colonies/100 ml.
Arsenic: ND NDug./L.
B. SEPTIC/HOLDING TANK DATA
Well Log (YIN) NO/YES
Wires properly protected (Y/N) YES YES
Casing height (above ground) 12+/12+ in.
AT INSPECTION
**10/25/13
12/13 ft,
1.78/5.54 g.p.m.
**WELL TESTS PERFORMED BY SULLIVAN WATER WELLS
5.87/
Nitrate 6.11 mg./L. Collected by: SULLIVAN WATER WELLS
Date of sample: 10/25/13
Tank Type/Material SEPTIC/FIBERGLASS Date installed 8/3/77
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 10/10/2013 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 8/3/77 Soil rating (g.p.d./ft2or /bdrm 85 System type TRENCH
Length 35 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth *8.00 ft. Eff. absorption area 350 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10/29/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 604 gal. New depth 0 in.
Elapsed Time: E min. Final fluid depth 0 in. Absorption rate >= 600+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date —
D. LIFT STATION
Date installed -
"Pump on" level at in.
Size in gallons - Manhole/Access (Y/N
"Pump off" level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E°: SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+/100'+
Absorption field on lot 100'+/100'+
Public sewer main N/A
On adjacent lots 100'+/100'+
On adjacent lots 100'+/100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25 +/25 + Holding tank N/A
Animal containment areas 50'+/50'+ Manure/animal excrete storage areas 100'+/100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l 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 i �7.�/14-
(Rev. 11/05)
Municipality of Anchorage
Community Development Department <a
a.:
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC131604
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 11 of
Mountain Manor subdivision. This inspection revealed a nitrate
concentration of 5.87/6.11 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 -
Sits Systems Approval.
YET C. JG p.omn
no's
,,
i
AS -BUILT
I hereby certify that I have surveyed the following described
property: F, .
x
Anchorage Recording Precinct, Alaska, and that the unprove
menta situated thereon are within the pro art lines and do
overlap or encroach on the property 1 docent thereto. encroach
no improvements on property ymg 1
on the premises m question and that there are no roadways,
I hansmissmn lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska n i
j this 3.:= day of —O ' HNSON
l� ROBERT c. JOHNSON
SCALE: Regrstered Land Surveyor No. NG -LS
Box 77-0456, Eagle River, Alaska 99577
Phone (907) 694-LM3
ULLIVAN MATER WELLS
"` 0'r P.O. Box 670269, Chugiak, Ait 99567 907-688-2759
TO: Lindsey Ingram
11824 Inspiration Drive
Eagle River, AK 99577
TERMS:
PHONE
720-233-4242
DATE OF ORDER
11-25-13
ORDER TAKEN BY
CUSTOMER ORDER NO.
❑ DAY WORK ❑ CONTRACT ❑ EXTRA
JOB NAME/NUMBER
JOB LOCATION
11824 Inspiration Dr.
JOB PHONE
STARTING DATE
11-25-13
CITY. DESCRIPTION OF WORK
PRICE
AMOUNT
2 Camera wells
Close Well: L vo i
15' of casing
15' to 17' borehole is smooth
17' to 65' borehole is rough and fractured
18' to 20' water seeping
20' to 30' water seeping increases
103' water spraying in
105' water spraying in
Far Well: �, s
20' of casing
21' to 22' water pouring in
21' to 100' borehole is rough and fractured
Unable to determine where water is coming from below
22' due to
cascading water.
Thank you,
Cole Sullivan
DAIE
1125-13
COMPLETED:
WORK ORDERED BY: \� '
SIGNATURE
I HEREBY ACKNOWLEDGE THE SATrSEACTORY COMPLETION Oc-ME ABOVE DESCRIBED WORK.
p DO - CO dba
`' , ULL[UANVWATER QUELLS
O,rP.O. Box 670269, Chugiak, AK 99567 907-688-2759
TO: Lindsay Ingram
PHONE
720-233-4242
DATE OF ORDER
10/25/2013
ORDER TAKEN BY CUSTOMER ORDER N0.
0 DAY WORK 0 CONTRACT 0 EXTRA
JOB NAME/NUMBER
JOB LOCATION --
-117814, nspi ration Drive ar well- farthest from house„L_,,.: j
JOB PHONE STARTING DATE
TERMS:
WORK ORDERED BY:
SIGNATURE
_nrvvavLtuvt I ntM l ISFACTORY COMPLETION OF THE ABOVE DESCRIBED WORK.
p DOC DO dba
OLE
' ULLIVAN WATER WELLS
P.O. Box 676269, Chugsak, AK 99567 907-988-2759
TO: Lindsay Ingram
TERMS:��✓ i
WORK ORDERED BY:
SIGNATURE
I HEREBY ACKNOWLEDGE THE SATISFACTORY COIVPLETION OF THE ABOVE DESCRIBED WORK,
Sewer and drain
Anchorage: (90h 575-9915
SGS Ref.#
1135505001
Client Name
Sullivan Water Wells
Project Name/#
11824 Inspiration Dr. Eagle R
Client Sample ID
11824 Inspiration Dr. Eagle R
Matrix
Drinking Water
Microbiology Laboratory
CDE
Sample Remarks: /
Parameter
Results LOQ
Metals by ICP/MS
11/06/2013 11:00
Arsenic
ND 5.00
Waters Department
Stephen C. Ede
Total N itrate/Nin ite-N
5.87 0.100
Microbiology Laboratory
CDE
E. Coli
Negative I
Total Coliform
Negative I
Printed Date/Time
11/14/2013 14:56
Collected Date/Time
11/06/2013 11:00
Received Date/Time
11/06/2013 14:38
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date [nit
ug/L
EP200.8
C
(<10)
11/08/13 11/12/13
HKS
mg/L
SM21450ONO3-F
B
(<10)
11/12/13
CDE
100mL SM219223B A
I00mL SM219223B A
11/06/13 SDP
11/06/13 SDP
SCS Ref.#
1135504001
Client Name
Sullivan Water Wells
Project Name/#
11824 Inspiration Dr. Eagle R
Client Sample ID
11824 Inspiration Dr. Eagle R
Matrix
Drinking Water
11/12/13
CDE
Sample Remarks:
Printed Date/Time
11/14/2013 14:55
Collected Date/Time
11/06/2013 10:30
Received Date/Time
11/06/2013 14:38
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00
Waters Department
"Total Nitrate/Nitrite-N 6.11 0.100
Microbiology Laboratory
E. Coli Negative 1
Total Coliform Negative 1
ug/L
EP200.8
C
(<10)
11/08/13 11/12/13
HKS
mg/1-
SM21450ONO3-F
B
(<10)
11/12/13
CDE
100mL SM219223B A
100mL SM219223B A
11/06/13 SDP
11/06/13 SDP
N
S. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
DATE
DATE
DATE
1
Im
[:1 One F-1Four❑ Other
(
INSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI DEPT. OF 1i`J i l i'<
825 L Street - Anchorage, Alaska 99501 ENVIRONiME L .'- i. _: i `CTION
•
ENVIRONMENTAL SANITATION DIVISION MAR T u 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEIRFBQEt f D
DIRECTIONS; Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 00) days for processing.
1. PROPERyYOWNER
PHONE-
X INDIVIDUAL/ON-SITE**
MAILING, j�ADDRESS
Oie4`i 61
PROPERTY RESIDENT (If differentfrom above) PHONE
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
)2119
2. BUYER PHONE
C
MAILING ADDRESS ? 7 r
e4p G;
3. LENDING INSTIT TION PHONE
Lew
MAILIN DDRESSSS
..
4. REACTOR/AG NT
411
PHONE
MAILING ADDRES /
N
S. LEGAL DESCRIPTION
cv,
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
[:1 One F-1Four❑ Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
J Three ❑ 'Six
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.)
B. SEWAGE DISPOSAL SYSTEM
X INDIVIDUAL/ON-SITE**
I�l`1 1 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) #
1. _ .1.% ty nr_
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY'
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑Septic^T�acnk or ❑ Holding Tank
Sizer Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
4.. DISTANCES
WELL TO:
MATERIAL
Septic/Holding Tank
Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
&—APPROVED FOR �_ BEDROOMS
❑ CONDITIONAL APPROVAL (letter must as
❑ DISAPPROVED
DATE BY
19_nin (Rev. 6/79)
ficate)
