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Home My WebLink AboutSUE TAWN ESTATE #2 BLK 1 LT 10Sue Tawn Estates #2 Block 1 Lot 10 #051-501-34 M Ul1GIPALITY Or ANCHORAGE Development Services Department °- On -Site Water & Wastewater Section ,AT Phone: 907-343-7904 Fax: 907-343-7997 [PUMP hstaflafim Log. Well Drilling Kermit Number: Date of Issue: Parcel Identification Number: Legal Description Block Lot 5 tAe, 1 avert ESfi. 2, (3 1k l 1-t to Pump Installation Date: Property Own r am & Address: Pump Intake Depth Below Top of Well Casing:� feet Pump Manufacturer's Name: Pump Model: 5% Pump Size: hp Pitless Adapter Burial Depth: I �5_ feet Pitless Adapter Manufacturer's blame: r Lam. Pitless Adapter Installer: Well Disinfected Upon Co pletion? a' Yes ❑ No Method of Disinfection: M11C,,k Comments: Pump Installer Pial Company: Mailing Address: City: ANCHORAGE WELL & PUMP SERVICE 7640 King Street Anchorage, AK 99518 PH: (907) 243-0740 - State: dip; Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION ~ Z ~ ,anufacturer~ ~~~ ,ateri~ ~ ~ ~ Inside length Width Liquid depth Liq. capacity in gallons ? 0 ~ ~ IF HOMEMADE: Well Dwelling PERMIT NO, ~ ~ ~ NO. of lines Length o~e ~ ~p of tile to finish grade ~ I Material beneath tile ~ ~ ti inches OTHER PIPE MATERIALS , SOILTESTRATING / ~ ~ I0 0 ]NSTAELER I~ ~j '~ I 3 (Rev. 3/78) r ... .~... '~ ;,'..' t, .' -' '- -.' 17 ."- - L '. ~,.~~"~ - .. ' .... .'. ',~'.~".:" ' .. ' I': ....? 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":'- . ~.,-.~4 '~... ~. iI~ i :.i'.,,:k,4 ':a-..'.4 '.i · ! ii. : ~.: ID ~ I~ ._: ' [[':' ~ < [ .iI I ' .~...m _, .-':. ,,.,/~ .,.,???........ ....,......., .,. ,.,..,, .,....., ....., .... ,,.:. i__ ' ~_ .Z _c; ~_ .~.1~ .i~ '.'i... ~ ~ " '~ ~ ~.1 ~ '~0 O~ O0,O~O~..n~n~ 0 ' 0 O' O' '0''0 '0 I ~,' .. L,~' ~l"! ' :':'.:': " . · : · n~ F4' I I I/O · ~-,' nC. ~C ~: n~'. ~c ~ I"' 1'"14.... ! · . ,:, .~ ,. ~. · ... o ..<. ~.,=, ,:,1~ '; ,:.:.... /I~-.: i, .':'. ' ~-:.. . "'~' , ': ' ' ' . " .." ~'~0~ .'&~_..i~:' " ':. '-.....,'.. ,. · '~.. ~.~ . . . .. ; - ~'~ PERMIT NO, RFF'LI_.RNT DRNIEL L-:. HUTTI_INEN i:[34 [:,RVIS =,T. RNCHORRGE LBF:RTII]N LtE~ E,± _.-,LIE TRHN ESTRTES RD[:, ~f~ LE2HL L~LE~ B1 SUE TRHN E=,THTE=, RD[) ~2 LOT SIZE .... 81._, SL~!URRE FEET ,- ~ ,-, c' ' TRENCH TVPE OF ~CIL RBSORF'TION =,¢_,FEM IS: NR:.",IMUM NUrlE, EF, OF BEDF.'.OOMS = ~.~ _,uZL RRTZNG (Si3.. FT. BR..- ~.- ~,,c ' I~: :,u_L RB'~ORPTION :,~_,TEM THE REwIJIRE[ SIZE OF THE ,--T THE LENGTH DIMENz, ION I:, THE LENGTH (IN FEET) OF THE TRENBH OR [:,RRINFIELD. THE DEPTH CIF R TREN_.H OR PIT IS THE DISTRNCE BETNEEN THE 5LIRFRCE OF THE GROUND RND THE BBTTOM OF THE EXCRVRTZON (ZN FEET). THERE ZS NO SET HZDTH FOR TRENL. HE_,. MZNZ - DEPTH OF aEHCEL BETNEEN THE OLtTFRLL PZPE THE GRRVEL DEPTH ~=, THE HIIM RND THE BOTTOM OF THE EHCRVRTZON ([N FEET). PERMIT RFPLI_.RNT HRS THE RESPONSIBILITS' TO INFORM THI_, DEPRRTMENT DURING THE . PROPERT~ RND THE INSTRLLRTION INSPECTIONS OF RNS' HELLS RD.TRCENT TO THIS ' '" NLIMBER OF RESIDENC:ES THRT THE HELL NILL SERVE. .... i- ,~' '~ - .. BRbF..FILLINa OF RNV :~_TEM HITHOUT FINRL IN:,PEbTIuN RND RPPROVRL B'¢ THIS ,- , 'n' F'I I DEPRRTMENT NILL BE :,LIBJECT TO PE_$E_._TION. .. ,- ,-~ ') ~ , ~- ,-,,,~ - ,- MINIHUM DI:,TRNCE BETNEEN R HELL RND RN~ ON-:,ITE ~EHHmE ~00 FEET FOR R PRIVRTE NELL IDR ~SEl TO 2~ FEET FROM R PUBLIC: NELL DEF'ENDING UPON THE TS'PE OF FUBLI_. HELL MINIMUH DI~TRNC:E FROM R PRIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RN[:' TO R BOHMUNIT'¢ SEHER LINE IS ~, ._ FEET. HELL LOb_, RRE REQUIRED RND MI_I~T E:E RETIIRNED TO THE E:,EF'RRTMENT HITHIN ~,0 E:,RN'S OF THE NELL COMPLETION. OTHER REQLIIREMEHT$ MR'¢ RPPLV. 5PECIFIC:RTION$ RND CONSTRUCTION DIRGRRM5 RRE RVRILRBLE TO IN_,URE PROPER IN~TRLLRTION. I _.ERTIFT THRT 'q '-'='~"Fc:'"~ RND NELL=,'- H=,-'- SET ±: I RM FFIMILIFIR HITH THE RE6!_IREMENTS FOR OH--ITE -- ......... FnRTH BV THE MLINIC:IPRLITS' OF RNCHORRGE. 2.: I HILL INSTRLL THE SVSTEM IN RCCOR[:,RNCE HITH THE I_.ODE_,. 3- T IIN['ER'=:TBN[~ THRT THE ON-SITE SEHER SVSTEM MF;V REQUIRE ENLRRGEMEi~'~T Il:' THE RESIC, ENCE REMUDELED TO INbLUO MOF..E THRN --. E, ECRuOM_. I S"%UE[:, B"r ...... DRTE .... %/4. 0 · , GREATER AI~CIIOk/~GE AIWA DORt)Ur , ~.~-~{}epartment of D vi ronmen [al Qu~-~. 3330 "C" Street Anchorage, Alaska 99503 SOlI,S 1,o(i - PI.;ll. OI,ATION 'I'EST Legal Deocription: %.l~tS ~. lC& [~. lids form ~eports:-- ~-ii~-~6~] -~--- ' .... Percolation test 3 *%o 12- Was ground water eecountered? If yes, at wi~at depth? Reading Date Gross Time Percolation rate -Proposed installa~'~h?---~-6~-ge Pit Drain Field Depth of Inlet ............... · Depth to bottom of pit or trench COI,I~IENI'S: Net Time Depth to Water Net DroD Perfomled By:~_Z~C_._~_~_C~¢~L~.___.~Certified By:. Date._ ............ EQ-040 (6/74) /,90 c • ' BG •, c P Municipality of Anchorage °� moi" On-Site Water and Wastewater Program (907) 343-7904 e'erIT�i CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-501-34 Expiration Date: Oc* 13 ) a 01 1 1. GENERAL INFORMATION Complete legal description SUE TAWN ESTATE#2 BLOCK 1, LOT 10 Location (site address) 19127 MELISSA LANE, CHUGIAK,AK 99567 Current Property owner(s) JAMES&REBECCA MONTGOMERY Day phone Mailing address 19127 MELISSA LANE, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: C Date: 7 - /3 /7 COSA to be released to the engineer, unless othe quested by the engineer. COSA Fee $ Gj?"(v — Waiver Fee $ Date of Payment U l apt (I'l Date of Payment Receipt Number 651(46). b Receipt Number COSA# O''JC),1 1-L' Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date S 6/23/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING.CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments,deficiencies or discrepancies exist. O1' A, �, Air 6. DSD SIGNATURE / System #1 Approved for 3 bedrooms. �F KENNETH Ni 'r :G � System #2 Approved for bedrooms. ' r� 7116 : � Disapproved. \ ��F'ESIOr�� ► Conditional approval for bedrooms, with the following stipulations: 1 G 1.1c _t S 6-:ri(/'S. , r� --(9:642 S iLI Pc� ,,.(, Or Aiv• C .70 ON-SITE �c, WpfERAND In WASTFVVATER C '— PROGRAM By: i x,11` ekk Ca7r,tztv , To Eck LL~4,�t Original Certificate Date: 3 O 1 �' '7 13/101 F The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only . upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc 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: SUE TAWN ESTATE#2 BLOCK 1, LOT 10 Parcel ID. 051.501.34 A. WELL DATA Well type PRVT If A, B. or C provide PWSID # Well Log (Y/N) N Date completed Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth ft. Cased to _ ft. Casing height (above ground) 24+ _in. FROM WELL LOG AT INSPECTION Date of test 6/22/2017 Static water level •• ft. 203 ft. Well production -• g.p.m. 2 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/1 00 mL Nitrate 1. 61 mg/L Arsenic: 1l/ ug/L Date of sample: 6/22117 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 512811981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 6/21/17 Pumper ONE STOP • vcr,'{icc 7-/v17 d14-. C. ABSORPTION FIELD DATA Date installed 5/28/1981 Soil rating (g.p.d./ft2 o i2/bdr 125 System type DEEP TRENCH Length 35 ft. Width," '-✓ ft. Gravel below pipe 6 ft. Total depth 10 ft. (Measured 6122117) Eff. absorption area F' Monitoring tube Y Depression over field N Date of adequacy test 6/22/17_ Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 465 gal. New depth 17 in. Elapsed Time: 1200 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date _ D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ _ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+___.__ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ _ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 0' Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS Appears that the septic tank and field is partially and fully under driveway(2013 MOA approved COSA stated otherwise). 4'+cover over field and tank with no known frost issues. Septic tank levels appeared to be at acceptable. 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. \ � �� OF Aj4c�, Engineer's Printed Name KENNETH M.DUFFUS c� * 7 � Date 612312017— ,� 4 9 TH Nistiq COSA canary sheet_2-6-15.doc + y r:rN�� ` 2., Ktan7 t 16 ty4r' AO �u • Municipality of Anchorage On -Site Water and Wastewater Program .: (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-501-34 Expiration Date: ,✓ l - 1. GENERAL INFORMATION *? Complete legal description Sue TaWn Est. Block 1, Lot 10 Location (site address) 19127 Melissa Ln. Current Property owner(s) Joseph Caperton Mailing address Real Estate Agent PO Box 671131 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Fx I Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ n..tin.. Ini..r__ 0. _._ _, Public vvalcl oyaLcui f—I U o„t.it,, c,....,... ruvu. .�cvvci r1 u WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ G 'lo Date of Payment �B 1 �) h2) (�s� Receipt Number Oda 0\vPv COSA # 05 14 3? Date: n a Waiver Fee $ Date of Payment Receipt Number Waiver 4 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Phone (907),272-8218 Date 8/1/13 6. DSD SIGNATURE System #1 Approved for bedrooms Steven k �onnone System #2 Approved for_ bedrooms CE 814g „q f Disapproved l�APOFESS�.4" Conditional approval for bedrooms, with the following stipulations: By: 1 � Original Certificate Date: 3 The Municzalit o � nchorage 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f - c If more than 1 septic system is on the lot: COSA Checklist # i of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist -wd- Legal Description: Sue Tawn Est. Block 1, Lot 10 A. WELL DATA Well type Private Date completed _ Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to ft. FROM WELL LOG ft. Parcel ID: 051-501-34 Well Log (Y/N) NO Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 7/31/13 195 ft. 9.p -m. 1.8 9 -P.M. WATER SAMPLE RESULTS: Coliform ��colonies/100 mL Nitrate r• ? mg/L Arsenic A6>-- ug/L Date of sample: ��3113 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Y N Date installed 5/28/81 Cleanouts(Y/N) Y Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water alarm (Y/N) N Date of pumping V1 A3 Pumper —J-1zS Pty. 'e i .-.+► C. ABSORPTION FIELD DATA Date installed 5/28/81 Soil rating (g.p.d.tft2 or ff/bdrm) 125 SF/BR System type Deep Trench Length 35 ft. Width 30 ft. Gravel below pipe 6 ft. Total depth 12.1 ft. Eff. absorption area 375 fe Monitoring tube Y Depression over field N Date of adequacy test 7/3/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 13 in. Elapsed Time: 130 min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in. Size in gallons "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS / ) / el 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 Steven R. Pannone Date 8/1/13 COSA brown sheet -1 0-10-1 2AGG Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ Q/ in. %A 1p L�15.gs° A R=50.00" La13.' \ R=20.00o0' Lot 10 57,815 s.t. 1� 1 900" PROTEC WELL RADIUS2 STORY. i ` t RESIDENCE P � SEPTIC CLEANCUTS D.6, f / 49.4' !! !! / 10:0' x 20.0° ! 90.2' x 12.2' SH IENdT0 10' UTTI 1Y EASEMENT !f ! N 89"59 27 188.82' ! ! ! !� Lot t1 ME PLOT PLAN AS BUILT % SCALE 1' 50' GRID NW 1160 Project No. 13123bl Lang & Associates, inc 11500 Daryl Avenue. Anchorage, Alaska 99515-3049 Registered Land Surveyors ($ 9Da) 22—sags Phone Y 9Da) 22-4625 rax�'� kenAlongsurvey.com / jonothanOlangsurvey.00m v % ,,,....,., 45� I hereby certify that I have surveyed the following described properly; A- K 4 � Lot 10, Black 1, SUE TAWN ESTATES SUBM ADDN No. 2 (Plot No. 76-268) E? Ancharaga Recording DI Fiat, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that jI no Improvements an the property lying adjacent thereta encroach on the surveyed � �F ,A., r � R premises and that there are no roadways, transmission lines or other visible Q10 KER G i AfjG easements on said property except as Indicated hereon. Q x� Dated this the a Day of x 'UAa , of Anchorage. Alaska 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 plat. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE FOR Parcel I.D. 051-501-34 1. GENERAL INFORMATION Complete legal description LOT Location (site address or directions) Cu~ent Property owner(s) Mailing add~-e~s Lehding agency Mailing address Real E§tate Ag6nt Mailing address 10, BLOCK 19127 · DqN Hu'r~UNEN P.O. BOX 874105 OF HEALTH AUTHORITY APPROVAL A SINGLE FAMILY DWELLING Expiration Date: ~o -' ~r'-_ 1; SUE~AWN ESTATES SUBDIVISION ~2 MELISSA ~NE * CHUGIAK~ ~, Day phone 376-2975 · W~IL~ AK. 99687 Day phone JOE FISCHER W/ RE-MAX 'PI~OPERTIES Dayphone 696-0214 16600 CENTERFIELD DRIVE * EAGLE RIVER, AK. 99577 Unless otherwise requested, HAA will be held by DSD for pic. kup. 2. NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual Well · Individual Water Storage [~] Community 'Class Well D · Public Water SyStem E] TYPE OF WASTEWATER DISPOSAL: Individual On-site · Individual Holding tank E] Community On-site [~] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority · Approval (HAA) based only ~Jpon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska, Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples, (Certificates may be reissued for~a period of up to one year with valid water samples,) Certificates are valid for one year for properties served by Class A or B wells or a public water system, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · MUnicipality of AnCh°rage Develo ment SerwceS D partrne . : .: Budding Safety D~ws~on On-Site Water & Wastewater program.: . ':.i·. 4700SouthBragawStJ . : P,O, Box 196650 Anchorage, AK g9519-6650 - :~! ' wWW.ci.anchorage.ak.us · '~ "(907) 343-7904 ; :i '"i HEALTH A'UTHoRITY 'AppR0V I."!'CHE KE'iST Well production - 1 {:EST)' ! ,'adm .:;: i :i .. ~ 209 ' ,.~'r' ' ~ ~ ~ ~ ', [ ~ ~ . ~ .... ';' · ' ' " ': ' ' .... ; i' ir?' ......'..' , '. i,' ' : , : ~' ~,' : , h.r, ',l'i:i.:~, = '' t' CohformI.,. 0 colonies/100 mi. ;; Nitrate. 1;23 mo'/L, t' ~ ~ I~Other bacteria A · ' NA ' ' " ' ', ' ' rsemc:'.L: / rog.IL , . ? Date of sample: 2/11~2004 :..Collected by' SEPT C/HOLmNG TANK DATA : '-,'. : g: .:,, :' TankType/Material ' - ;: STEEL- ; '!. ~ : ~ .~ i:,?t~::: Date ir stall~d "I I~. " ~: . ':', . ',. ) ' · . ..... ,; ~ , ~. Tank'sizG_lO00 'gal. '/.: Number of'Co'paYments ~ 21~;. :~; Cleahcut~:~/N) '~ ; . . - ' ' ~ h ~ " ' ,' ,, , Foundabon cleanout ~/N) ~YES - Depression,over tank ~h, rater ala~ al D,~scdption: LOT '10, BLOCK 1 SUE TAWN ESTATES ;S~'D.#2 ! Parcel ID: 051-501 A. WELL DATA . ': ' ' .:!~ :,' , : j ;i1",', ' . .W.e:ll typ.',e PI~IVATE .'' ' r ; .~ IfA, B, OrC )rovide:pWslD#: N/A'"=i'=~'"; ';." ": 'Well=Log(Y/N)--~' I:. . YES Date ~mpleted .11/11/1981 Sanita~seal (Y/N) YES .; il i' ;.: :'Wires properly protected ~/N) YES ';:'1 '.1 , . ~ ' ~': '.' :' ~ ~:" ~ ': ~'': '. '' Totaldepth .426 ~. . ..' ;Casedto 40+ ff. '' ..~,.~~ ; ~ Casing height (above ground) 24+ ', I ~[, , , ','. ~' ,' ' ' ~ ' .,. ,~' FROM WELL, LOG ,.. : . .. ~: .,~ ~" ~.AT'INSPECTION .Dateo~test, .. . 11/11/~981~. ,. :.~'~',~ ' .'"~!,,;~....~,:~';'~::. ': 2/1~1/~004. . .... ... . ~ , . i= '~ j'?.- . [ 97- g.p.m. in. 0 colonies/100 mi. GEG, LTD. 5/25/1981 , YES uateofpumping' '. /29/2004 ,, Pumper , :", , SANITARY. PUMPERS C. ABSORPTION FIELD DATA ' , ' '; -I"BELOW EXSTING GRADE :J!.'i:. i ' i: l;i, '' . ,'~ . :t , .,' . ~ 'i~: -~,' I~. ; ':" ~i'~,l,:i;:!~..! ':~ I:' 1! ' Dat,e ~nst,alled s/28/1981 Soi~ rating (g.p~d./ft'or~'/bdrm')il 25 ~.:i! i;'::.. ;. :'S~/~t~n tyPe DEEP TRENCH "t ' ~, ' ' ,' ' , h ' ~ ':' "1 i , ~ ~:~.:,~' ~,I ' '1 i~'' :, : ' ' ,i, ':. ........ . ; ;"~ ' ,, ::-;T'" .....~"~""' '" , I ,I .', . ..... =,. ' ,, 1. ! i .,',,,1 ..... I ,, Total depth .9.92 . ft. Eft. absorption area !!420 fi' Monitdrirm'tt~lde = YES t Denression nv4~r f"i~ld NO ! J '! ' · .' ' ::, ':;' ti, , 'Ir: 't [,"' !,';J ':,'~: ," J .... " ' ' ' ¢; i, ~' ' ' ,'1;' ;,~I, ];~ '' ' , :: I,: , - D,.a,.t~e of, a, rdequacy test 2/11/2004, , . ; , ,,Results (Pass/Fa, d) I PASS " ' . For 2 bedrooms . i,., ~' . ..... ii :. r, .... '",~ll, !:,.f. ]'.:'.', :.:J:,.li .. . Flu],d dep!h in absorption field before test, ,57 i; in.' ' Wate'r'added 1258g&1., '; ' ;' New depth *'54in ·ila"se T° 20 o ;, ;..,, ~ u- . **'21 , I;!i, ! ~ till i,~1 :' .,i J,, iI- , p d ,,~me: 'mm. : . Fmalfluiddepth, in.,,;j , ,, :i:,AbsorPtio~i'ate>= .. 500+ gpd Any rejuvenation treatment (past 12 bo.) (Y'/N,& type) ~ONE,r, KNOWN~ I ', illf ye~, give date ' - :J ~,J' . '' ~, **TO!,TOP ,OE DISTRIBUTION [12NE, i ,,J! ~i,,' ,i' i! ,' [' : ***LOWER 'ti:lAN WHEN THE TEST: WAS 'S'i',~TED': ~;' : ,:' ti ': . - I, : , ,: , ,~; ,ii .: : ~ , :' I ' . ":, , ' [ , i , , ' ~' =: , ~' ' ' ., ; ,;' ~ . ' ',I , ! I i:~' ' "' = ! ' ' :i ' ' '' . ' ! ~ ;' ":' : ' ~ :t ' ' ' ', ' ', ' ;i: ',,:, ,:' , ; ,I,:: :t ' L;,':ii, ' , ~i ,~¢ ' :' - 2--16--04; 7:13PM; ;907 5615301 # 2/ 3 ,GS Ref.# .~lient Name .~roject Named# .'llent Sample ID ~Iatrix 1040726001 AK Water.& Wastewater Consultants Inc. Sue Tawn Est//2 Lot 10, Blk 1 Drinking Water ample Remark: All Dates/Times are Alaska Standard Time Printed Date/Time 02/16/2004 15:46 Colle~ed Date/Time 02/11/2004 11:20 Received Date/Time 02/11/2004 15:45 Results PQL Unit~ Method Allowable Prep Analysis Container ID Hmita Date Date Init taters Department Nib'ate-N H crobiology. Laboratory Total Coliform 1.23 0.I00 mg/L EPA300.0 col/lOOmL SMI8 9222B B . (<=lO) ^ (.<=1) 02/11/04 02/11/04 JJB KC T0:~8~846 - 11~-96' R - ,f~.O0' · I ~.4~' R- 20.00' Oo,// / / / ,/ I I I I / / / TWO STORY RESIDENCE .: DRIVE,,~.:: LOT 10 UTLITY F..~EMENT $ 89'59'2:7'E LOTII I LOTI F'UEL TM~IK LOT4 [,] PLOT PLAN. ' ASBUILT _~X... SCALE I' - 50' GRID Mi/ 1160 Prhi,,.~4, Mn 04.-007' PLOT PLAN..___ ASBUILT ~ SCALE I' . 50' _Long & Associotes. in~- eRID ~v~l~ Prelect No. o~-oo? 11500 Daryl Avenue, Anchoroge Alaska 99515 Reglsfered Land Su~v'e o~s' (907)522-6476 Phone Y (907) 522-4625 Fax '