HomeMy WebLinkAboutPARKSIDE BLK 1 LT 2Parkside
Block 1
Lot 2
#050 - 591 - 02
Municipality of Anchorage
6,...—r--,
;� i_i Development Services Department
J.,
Building Safety Division
A
On-Site Water and Wastewater Program, 4700 S. Bragaw St. �/
P.O. Box 196650 Anchorage, AK 99519-6650 Page
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. 8 7d_/ te PID Number: a TO— S q/ — az.
of
Name: Ls RYi/'/lt [j/ESAN7'
Wastewater System: D New p3 Upgrade
Address:
/567 i1?yzrr 6R/vr , 144*-6'i Rru.
ABSORPTION FIELD (AtEtn1)
Phone. 4,...?‘/.....
` ���� ^Numbe of Bedroq�s:
3
reel, Trench p Shallow Trench O Bed O Mound CI Other
Soill
LEGAL DESCRIPTION
Rating:
GPD/Ftz
Total Depth from original grade:
/ 4 Ft.
BloatLot Subdivision:
I2 R4Rtc S14E
Depth to pipe bottom from original grade:
5" Ft.
Gravel depth beneath pipe:
C — 1 Ft
Township: Range: Section:
Fill added above original grade:
TO i..tvFL Ft.
Gravel Length
-CZ Ft.
Well: ❑ New ❑ UpgradeGravetwmn
.3 Ft.
Number of lines:
/
I Distance between lines:
Ft
Classification (Private, A. B, C):
Total Depen:
Ft.
Cased to
Ft.
Total absorption area: p
a Ftz
Pipe Material:
% ti C.-
Driller.
Dale Drilled:
static Water Level:
Ft.
Installer.
An/e ER. Son/
Date Installed:
FAG.`P )
Yield:
GPM
Pump Set at:
Ft.
Casing Height Above Ground:
FL
TANK 4��a
SEPARATION DISTANCES
1A Septic El Holding ■ S.T.E.P. ■ Other,
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
�ublicJPrivate
Sewer Line
Ma ifaaurer. q /�
( T t rjd�
Capeaty
/ a CO Gal.
Well
Not*
/ga't-
N/II
,v///
/4e0'4'.
Material:
S7"EE(,
Number of Compartments:
Z
Surface water
/oars-
/oa'.rr-
^PR-
N/fi
LIFT STATION ////,¢
Lot Line
p/�/
Ove
3O"
•41/4
a
'V/'7
Size:
Gal.
Manufacturer.
Foundation
5 '
r
75
of/r¢
JJ/,
'Pump on' level at
in.
'Pump ofr level at:
In.
High water arm laat
in
Curtain Drain
N/n
Alp
Af/rt
Aim
Pump Make & Model
Electrical Inspegions performed by
Remarks:
° °"
A/SPe'coo/sr /Zf.°o2r"
BENCH MARK77/i-r
GVAS C- i PLif-TEA , 4FTeli- ea,‘rIrnteho
Location and Deaaiption:
v
l/-:-/1 r(/cA-r'/,, f L J4-j- .Jt'/AAB)/
Assumed Elevation:
FL
/)R/Vf fG' Qe.:54-� £ cc t/,47 / ' To
RA-/NF154-.4 771-/C/A C . S'.4sr)PA1�� •t:PS- .."14-54.0 'f<••--.;.^YZ,�
Engineer's Stamp
,
Inspections performed by: __S-7"--t/(5.. ,S.t. C Dates: 1't .6/0/63
rl .,, t . 1 ...: rrt
eh ?/°3';
2nd
Development Services Department Approval
Reviewed and approved by: Date:
,, r- e _, ..
'
(RN. tubo)
-.r C ''��IJ
...
�`'\, .-...rter✓'
NorthRim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694.7026
907.830-4186
June 18, 2003
Jeff Poet
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Parkside Subdivision, Lot 2, Block 1, Eagle River
Dear Jeff,
Please review the Health Authority Approval information. The absorption field upgrade
from the fall of 1987 never had an inspection report completed. Under your direction and
in coordination with your office I conducted the following tests on the absorption system
to determine if it was constructed properly:
1. An excavation was made 5 feet in depth into the top of the deep trench. Samples were
taken by driving a steel pipe. At a depth of 5 to 6 feet the cover material changed to a
clean drain rock. Some samples of the drain rock were obtained.
2. Steel rebar was driven into the trench. The rebar drove easily below 10 feet, indicating
the presence of drain rock.
3. Surface measurements of the system indicated conformance with the design drawing
and calculations.
4. The monitoring tube was over 15' in depth at the end of the trench and the cleanout at
the beginning of the trench was 5' in depth.
These measurements along with the excellent test performance of the system indicate a
septic system that was constructed properly. Water sample results and the survey as -built
will be brought in for your ,revie r.
Sincerely,
NorthRim Engineering
Steven W. En , PH
Enclosures
Municipality
of
Anchorage
January 8, 1988
P.O. B0196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
RNY AR f Tom Fink,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Bryan Biesanz
1561 Myrtle Drive
Eagle River, Alaska 99577
Subject: Lot 2 Block 1 Parkside
Permit #870198, Ta
050-591-02
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
Permits are issued on a calendar year basis by authority of
Municipal Ordinance. A new permit must be obtained from this
Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system, the original as -built inspection report (three-part
form) must be sent to this office for review and approval, and
for documentation.
Effective January 1, 1988, a new fee schedule is in effect.
When re -applying for a new permit, the new fees are; $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00 for
a combined sewer and well permit.
If there are any further questions, please call this office at
343-4744.
Sincerely,
Robert W. R..inson
Program Manager
On-site Services
RWR/ljw
enc: Copy of Permit
M LI P.1 I C I P A L
Department of Health & Human SETViESS
825 L Street, Anchorage, Alaska 99501 343-4720
0M -SITE SEWER PERMIT
Permit Muller: 870198 Upgrade
Date Issued; 08/04/87
Owner Mame: BRYAN 1.1ESAM2
[WET Address: 1561 MYRTLE DR:
EAGLE RIVER, 1K 99577
Day Phone:
T
Parcel Id: 050-591-02
Lot Legal; Subdivision: PARKSIDE Lot: 2 Block; 1
Section; 15 Township; 14N Range: IN
Lot SiZe 118500 isq,ft, or atres)
Max Bedrooms; This Permit: 3 Total Capacity: 3
SEWER SYSTEMSiisted below are the options available to yiiit in dESiCalifig your
sewer system, Choose the option that best fits your site,
TRENCH BED W, ---0 RAIN
Depth to Pipe Botteo (ft): 4,0 40 40
Gravel Depth (ft):• 8.0 0,5 • 3:5
Total Depth- (ft): 12,0 4.5 7:5
Gravel Width (ft): 2,5 24,0 5:0
Gravel Length (ft): 54:0 ** 47:0 930 **
Gravel Voluoe (cubic yds): 42:5 41.8 68:8
Soil Rating Used (sg ft/bre): 287 250 287
** Gravel length >50 feet requires multiple soils tests:
** Gravel length >75 feet requires multiple runs (not ox ceedino 75 ft each):
SEPIIC TANK: Minimum total septi: tank capacity: 11000 gallons: Each septic
tank must have at least 2 cempartments- Depth to top of septic tank (1 < 4:0
Ft requires insulation over taek(s),
LIFT STATION: if a lift station is installed, a high water lass must be
_un,cLted to the residence:
I ERTFTT:CIYHA
1. 1 8P familiar with the requireoents tel on-sie sewers and wells as set
forth by the Nnicipality 02 Anchorage (MOA) and the state of Alaska:
2, I will install the sysleo in accordance with all MOA codes and regulations,
sed in compliaece with the design LliLt:Tid of this permit:
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system Or public
syetem on this or any adjacent or nearby lot,
4, 1 understaed that this permit is valid for a oaximuo of 3 bedrooms,
also understand that the capacity of the total system is 3 bedrePos and
aev enlargement will require an additional permit.
DATE: eiti
(Oweer) BRYAN BI
issued By: DATE;
f) F
A N C HnR ARE
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PRINTED ON NO. 1000H CLEARPRINT
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: VYI4101 314Z11° '2.
LEGAL DESCRIPTION: L Z S k 1 t3rks'i4e
DEPTH
(FEET)
2-
3-
4-
5-
6-
7 -
8-
9-
10-
11 -
12-
13-
14-
15-
16-
17-
18-
19-
20 -
9Y?„ d
'OILJEEf S6'
:ox c;Jo tag
HO. 7742-E
Jusw 2'2, 196a
Township, Range, Section: 51S "r 14tJ R 1y✓
SLOPE
l.ovc�
PJ
WAS GROUND WATER
ENCOUNTERED? N®
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? •
s
L
0
P
E
Date -
1 -13 -87
SITE PLAN
T
N
z
O'
laueel
�1T
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
—
1-8-87
pre. so -4'444
+ta.# ‘43\
44
i
1-4-61
0
0
41 Vs
Z
.,
30m,;,..
30,",ft
5 A
1„
3
It
i
101%4%
6114
i t6(.0
4.e
VIIr
1!4
2 `,,
5
i,3
kr
1 kr
?Y
21/2 ..
6
t,
4 We
l hr
VA`"
2 t/h'
PERCOLATION RATE
30 ,y (minutes/inch)).t
/ PERC HOLE DIAMETER 8
TEST RUN BETWEEN 3 4 FT AND 4 1** FT
Z. �►1 x t rM ! b@jr w.
COMMENTS )44:,, se t i vai-1
PERFORMED BY. CO+VS4YUCANhoi(VI iice, 1K I CCl. .49,1,.a.
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE -
72 -008 (Rev. 4/85)
t Orr
MUNICIPALITY OF ANCHORAGE
DEPAR'rMF.NT OF HEALTH & ENVIRONMENTAL- PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL_ SYSTEM AND/OR WELL INSPECTION REPORT
NAME
a), UJ41 km.
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Uy
as
wF
rn
-JO'Z
1?I--
w
ah
o. Er.
w
w
J
J
w
Ja 2 / Pe4,C/<' Sic%
DISTANCE TO: wall
Manufacturer
G2E€2.
Liq. capacity in gallons
MOO
DISTANCE TO:
Manufacturer
DISTANCE TO:
No. of lines /
IF HOMEMADE:
Well
Well
Length of each line
Top of tile to finish grade
r Z•
Length l Width
Type of crib Crib diameter
DISTANCE TO:
Well
CIark/6141e Depth L!)Y1
DISTANCE TO: Building foundation
GLS ✓GuN
PIPE MATERIALS
b303et
SOIL TEST RATING
1_0 CI
INSTALLER
5 c
OTHER
PHONE
33S-6-69'71
Lin
❑ UPGRADE
Absorption are / /
IInside length
Dwelling
Dwelling /
4
Material
le-gSZ..
Width
NO. OF BEDROOMS
3
PERMIT NO.
c& 2(555/
No. of compartments
Liquid depth
PERMIT NO.
Material
Foundatio ` i
Total length of lines
Material bene tile
Depth
Nearest lot line
- /SU/
Trench width
inches
Crib depth
inches
Building foundation
Liquid capacity in gallons
PERMIT NO.
8a0s's/
Distance between lines
Total effective absorption area
‘376-
u
!PERMIT NO.
Total effective absorption area
Nearest lot line
Driller
Sewer line
REMARKS
1 o C62.9c f- -C,,a ,q d Fr7nti 2Q
_-sof,
s1 nd p;4eal/epi !9_ Jd //d.
(i p /2c t g '4trCy r' G
APPROVED
1 • W.dt../ep,OferVi
72-013 (Rev. 3/78)
DATE
,'"d/D2
DiAce;oo�lot� line
ai
Septic tank /
J PERMIT NO.Bo i
a
Absorption area(s)ea
tketIE
ry
I'
e
LEGAL
Trr.ifithEng�xt��trt
by
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND
DEPTH OF WELL
ADDRESS STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
DATE - Started ' -• Ended 1 ' GALS. PER HR
PERMIT NUMBER '
KIND OF CASING
LEGAL DESCRIPTION • -w - .f 4,:;'4;`
KIND OF FORMATION:
From Ft. to Ft. Cr)'' :
From
..,,,., r
Ft. to Ft.
From Ft to c:) i Ft �_ r< s. r f '.C'
From Ft to Ft.
From •` r i Ft to i Ft
From
• ` Ft. to Ft.
From Ft to 1 • ( Ft 4',,l''';,1 ;.:" F ` A",----) From Ft. to
Ft
From Ft. to Ft.
,e , I:, t i; ."
From Ft to Ft
From . . C._ Ft. to J `'' %. Ft.
f "i-,;,6".,;-: From Ft to Ft.
From_ Ft. to Ft.
From Ft to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft. - - From
Ft. to Ft.
From Ft to Ft. - From
Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft. From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft. From
Ft to Ft
MISCL. INFORMATION:
DRILLER'S NAME
DERAK|RENT rr
825
\-/
EtibNIK»
PERMIT Na (
APPLICANT BILL WALKER
LOCATION
LEGAL L2B1 PARK SIDE
HEALTH AND ENVIRONMENTAL ����—^��
~�|E�TION
STREET: ANCHORHGE. HK. .01
264-4720
PO BOX 998 E. R. 99577
}
][�
]]8~5694
LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
108
����EEP". �EEF-,...1.-- ED;
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
/HE DEPTH OF A TRENCH OR PIT IS THE DISTHNnE BETWEEN THE SURFACE OF THE .
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET)
THERE IS NO SET WIDTH FOR TRENCHES. .
|HE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
g T P-44 11‹ r.i.�I 2f F17= �������Ah=„,
PERMITHPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
Ims/ALLM/1UN INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE
1-14 > g77:. ni.1HO IFALF?[Ez E=97.:Dirti :TAR g=f>
BMCKFILLING OF ANY SYSTEM NITHOU! FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSHL SYSTEM IS
100 FEET :EOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
urVNTHF TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
!O A COMMUNITY SEWER LINE IS 75 FEET
WELL |OGSRREREQUIRED AND MUST BE R�TURNE[) TO THE DEPARTMENT WITHIN 30 DAYS
vr THE WELL COMPLE.|IOI
OTHER REQUIREMENTS MAY HPP|Y. SPECIFICATIONS AND CONSTRUCTION DIHGRHM5 ARE
AVAILABLE TO INSURE PROPER INSTHLLHTION.
��ERM I "in a IR IFRIEE.:SE: DoFT.C31EFME3E,EFT,:f
I CERTIFY THAT
1:IRMFAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET
EuR/HBy/HE MUNICIPALITY OF RNCHORHGE
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES
]�SIUNDERSTHND THAT THE ON~SITF SEWERSYSTEM MAY REQUIRE ENLARGEMENT IF THE
RE 1DEN[F IS REMODELED TO INCLUDE MORE MAN ] BEDROOMS.
SIGNED'~ ~��
*
, ' � � , � ,'
-SSUED BY ' i'(.'|� ( /q
^�^~+_��~~��_` HTE
r. //
Y4.0
v
^811.=11 V~
PERMIT NO, ( 780]26
• AAP ICHNT N
LOCATION CAROL DRIVE
LEGHL L2 B1 PHRKSIDE SUBD
264~4720
P.O. BOX 3204 ANCHORAGE 99510 272 4376
TYPE OF SOIL HBSORB|ION SYSTFM IS� !RENCH
LOT SIZE 111357 SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS - ] SOIL RATING (SQ FT/BR)~ 100
THE REQUIRED SIZE OF THE SOI| HBSORPTION SYSTEM IS:
ED, ET r— -T1 11-- rgr: r 1 V E.. LE �IPA ;2.1,2!
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN 1 -ELT).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHYF| BETWEEN THE OUTFALL PIPE
.AND THE BOTTOM OF THE EXCAVATION (IN FEET).
K���~���
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE
� �
rH! H17r. Y ..)1N 11 1- Pc.n: EL LD.
BACKFILLING OF ANY SYSTEM WITHOUT FINH. INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIOM
MINIMUM DISTHNCF BETWEEN H WELL AND ANY ON SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WFL/ OR
150 TO 200 FEET FROM H PUB| IC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPHRTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUC|ION DIAGRAMS ARE
HVHILHB/E TO INSURE PROPER INSTRLLHTION.
E��
I CERTIFY THAT
I HM FAMILIAR WITH 'HE REQUIREMEN!S FOR ON—SITE SEWERS HND WELLS HS SE|
FORTH BY THE MUNICIPALITY OF HNCHORHGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE NITH THE CODES.
]: I UNDERSTAND THAT THE ON SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS
'PFIYIrU [U INCLUDE MORE THAN ] BEDROOMS.
-HTTY SLOHN
EN GI N EE RS
GEOLOGISTS
PLANNERS
SURVEYORS
67&IVI CONSULTANTS, INC. 5029 CORDOVA • BOX 6087 • ANCHORAGE ALASKA 99502 • PH 907.279-0483 0 TLX. 090-25360
May 16, 1978
R&M No. 851116
Patty Sloan
2419 Sprucewood
Anchorage, Alaska 99504
Subject: Soil Investigation for Sanitary Sewer System, Lot 2, Block 1,
Parkside Subdivision, Eagle River, Alaska
Dear Ms. Sloan:
At your request of May 11, 1978, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the subject
lot. The investigation complied with those procedures required by the Muni-
cipality of Anchorage Department of Health and Environmental Protection.
This investigation, which was accomplished on May 12, 1978, consisted of a
test hole drilled to a depth of 20 feet below the existing ground surface.
The test hole was sited according to your verbal instructions and its loca-
tion is shown in attached Drawing A-01. Drilling was accomplished with a
rotary drill rig using continuous flight solid -stem auger with an outside
diameter of 6 inches. A sample was taken at the depths shown on the soils
log in Drawing A-01. The sample will be held in storage at our lab for
approximately six months. In addition, all material brought to the surface
by the augers was continuously monitored by an experienced engineering
geologist.
The topography at the drilling site is generally steeply -sloping to the
South. At the time of the investigation a pad had been constructed for the
proposed house by cutting and filling on the steep slope. The fill was 6
feet deep at the point drilled and is approximately 15 feet deep on the
downhill edge of the pad.
The soils encountered in the bore hole are shown in the test hole log in
Drawing A-01. This log displays specific conditions encountered at the test
location. However, subsurface conditions may vary in other parts of the lot
without any apparent surficial evidence of the change. Groundwater was not
encountered. Bedrock was not encountered. At the time the hole was drilled
seasonal frost was not present and permafrost was not encountered.
A percolation test was performed within the bore hole at the depth shown in
the attached Table 1. All depths were measured from the top of the hole.
The data in Table 1 show average infiltration from the depths indicated to
the bottom of the hole. The measured percolation rate was 2.0 minutes per
inch.
ANCHORAGE
FAIRBANKS JUNEAU
VALDEZ WAST LLA
May 16, 1978
Ms. Patty Sloan
Page -2-
We appreciated this opportunity to be of service to you. Please contact us
if you have ary questions concerning this letter or if we can be of addi-
tional service.
Very truly yours,
R&MCONSULTANTS,
INC.
0.106:6€ 1,Az/10,-0-)
Gary A. Smith
Senior Geologist
JMB:GAS/kah
Jim McCaslin Brown, Ph.D.
Head, Earth Science Department
TIME
TABLE 1
PERCOLATION TEST
Patty Sloan
R&M No. 851116
ELAPSED
TIME
FEET
DROP
IN FEET
3:04 0 3.60
3:05 0
3.75 .15
3:06 2
3.90 .15
3:07 3
4.05 .15
3:08 4
3:09 5 4.10 .05
4.20 .10
3:10 6
3:11 6 4.25 .05
4.30 .05
3:12 8
4.35 .05
3:13 9
3:14 10 4.40 .05
4:19 15 4.45 .05
4.55 .10
4:24 20
3:29 25 4.70 .15
3:34 30 4.80 .10
3:44 40 4.90 10
3:54 50 5.20 .30
5.
4:04 60 .35
6.10 .55
30" in 60 Minutes
2.0 Minutes per Inch
1�Y
BORING NUMBER 1 Date Completed: 5-12-78
I
LL
2
0
5
10
15
20
Z
m
2
Ja
00
ooj
d
�0•
;off
DO
;Qo b.
20
OW
fa
0ON
SOIL DESCRIPTION
FILL - SANDY GRAVEL WITH SOME SILT,
OCCASIONAL COBBLES (GM)
Gray -brown, angular to
subangular
6' Bottom of Fill
NATURAL GROUND SANDY .GRAVEL AS. ABOVE
(GM) No organics, easier drilling
SANDY GRAVEL WITH SOME SILT
OCCASIONAL COBBLES (GM)
Gray -brown, angular to subangular
No Water Table Encountered
20'TD
YDWN. tj,i
C KD. ,
1(48
DATE.
5-15-78
SCALE.
`
N/A
J
R&M CONSULTANTS, INC.
ENGINEERS GEOLOGISTS PLANNERS SURVEYORS
SOILS LOG
LOCATION SKETCH
No Scale
N
NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE
NOT BEEN MEASURED BY SURVEYING METHODS.
EXPLANATION
r UNFROZEN GROUND
ORGANIC MATERIAL
—i?p..
_
--V?
-5-740'
_.4,p4':V
_4p7.4
}P
•p4
Zi
-8.-
n•b
pb"
LittleA.B. Visible Ice 0=I0' VX
'—/CE DESCRIPTION
SAMPLE NUMBER
IiSs,72,571%,85.9pcf
L DRY DENS/TY
L WATER CONTENT
BLOWS/FOOT
SAMPLER TYPE
-i W.D. WATER TABLE
—E—APPROX.
-J4
v
STRATA CHANGE
BEDROCK
"FROZEN
GROUND
TYPICAL SOILS
WD. -WHILE DRILLING
LOG I A.B.-AFTER BORING
Ss /4" SPLIT SPOON WITH /40 LB HAMMER
Sz /.4"SPL/T SPOON WITH 340 LB. HAMMER
Sh 2.5" SPL/T SPOON WITH 340 LB HAMMER
Sp 25" SPLIT SPOON, PUSHED
A AUGER SAMPLE
Ts SHELBY TU3E
Tin MODIFIED SHELBY TUBE
Bs BULK SAMPLE
SAMPLER TYPE SYMBOLS
ti.•+
tiv+
ORGANIC •-oo
MATERIAL "eo0 GRAVEL
,
COBBLES 8
CLAY
f
Ir_.4
BOULDERS
V/ SILT
771/I
BEDROCK
SAND /CE, MASSIVE
SOIL SYMBOLS 1
e
LOT 2, BLOCK 1
PARKS IDE.SUBDIVISION
EAGLE RIVER, ALASKA
E B.
GRID.
PROJ.NO. 851116
DwajnA-01
APPLa ANT FILLS OUT UPPER H/_ F.ONLY
Property Owner WJW Conttructjon, Inc. ,
Mailing Address P. 0. Box 998, Eagle River, AI{ zipcode 99577
Phone
694-5726
Buyer Bryan Biesanz
Address Nox 1 Twenty Grand Rd. Ea"e River zip Code qq,-�
Lending Institution First National Bank of Anchorage, ATTN: Dawn
Address Eagle River, AK ZipCode ggS77
Phone
6q4-7103
Realty Co. & Agent Commonwealth AREA, Inc., Myrna Johnston
Address Box 249, Eagle River, AK zip Code 99577
Phone
694-9555
Legal Description Lot 2, Block 1 Parkside Subd.
Street Location NHN Carol Drive
Type of Residence
XX Single Family 7
❑ Multiple Family No. of Bedrooms
Inspector
❑ Other
Water Supply
XX Individual
❑ Community
.❑ Public Utility
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal
Individual
❑ Public Utility
❑ Holding Tank
Year Individual Installed. 198 2
When Connected to Public Utility.
071983
r, ,raga"
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time -
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
r ur..
JUN
„
071983
r, ,raga"
( '<APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONA APPROVAL'
DATE
'CONDITIONS OF APPROV�,4..r.. _ ).
iii rx ' `" `"
r.i i.i.;;I:i!?:;, rl�i2::itgfl"
BY: . d . / . 0 1 ,'
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Well to Tank
Septic Tank Size
APPLI( NT FILLS
OUT UPPER HAI , ONLY
Property Owner`
U.� , 'j . Lk) CO 0 S r. -
Mailing Address 1 c) CDOR 61,1 f //,,...:: _ ^�
E---446-- i t✓ :7. 4 K Zip Code q y )
Phone
Buyer ( /
lir 4 n it S (,-.-.?,/ t.-_- c c, i 7/s4, -7-A---1
Address J S (r; S Soil t-/7 ,,,,,,`
-. / I !(,[JC/t- 4' Zip Code
i
Date
Lending Institution �C-; /U /-3�) J_ /�,�� 4
Address 1der.; ��
-- /( /( r!iI'7"" f"a.,,
Zip Code'/ 9 -- 7
Phone
Realty Co. & AgentPhone
Mor✓I'SoAl `� 6 iSfc,
Address M1 -.Air -7,
)
Zip Code
Inspecto
Legal Description 8 ( J
Street Location Dr /6' ,. < f) _
t . (/v
//` //
( APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL
DATE 3 --p/ 'x%73
Type of Residence
ftSingle Family
❑ Multiple Family No. of Bedrooms
O Other .
Water Supply
ni Individual q aO.L3 /
Community
El Public Utility nv ) 0-), cs-n.
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal ___.
pl Individual 1 L0 -.n -c3
0 Public Utility
0 Holding Tank Xan,6
Year Individual Installed. /X'
When Connected to Public Utility.
Well To Absorption Area %if 0
Well to Tank / -O
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
TPrime
` 0
Date
Date
Date
�� _n0
Date
Inspector
Inspector
Inspector
Inspecto
Field Notes: MUNICIPALITY OF ANCHORAGE
/42, to e7 ,/S DFnT C' I -' !.7:! ,^,
O ; e ENVIRJiJ,.. i..?..:..i!. :.TION
51 ,/ DLL
RECEIVED
( APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL
DATE 3 --p/ 'x%73
APPROVAL'
'CONDITIONS OF APPROVAL
BY* �.1.�-fi�--
Soils Rating
72.02313/821
Date Sewer Installed
.. '5 ::1, 4 s'•-
Well To Absorption Area %if 0
Well to Tank / -O
Well Log Received
Septic Tank Size ,/ D_ c-.)
Z-1-u i Luis
February 17, 1983
W.J.W. Const
P.O. Box 998
Eagle River, AK 99577
Subject: Lot 2 Block 1 Parkside Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
0
0
A well loci submitted to this office for our files and
review.
The eater analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
The depression over the sewer system will need to be filled
so that surface {water drains away from the sewer system.
Locate the sump stand pipes to the sewer system. May have
been snow covered.
Please notify this Department for. a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Jim Roberts
Associate Environmental Specialist
JR97/p/EU1
cgiEs
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 05O—S7I- O�
1. GENERAL INFORMATION //� /
Complete legal description Jac.kS. S 1 de.. -tel ,
Location (site address) 023 3 aC Ciao ler
COSA #
Oda l b4
Expiration Date: 1 - / 6 - 0 8
/o -k / Ldf-..7
wwg-
Current Property owner(s) PNORLM Fe-NI/WC-1H,- y Day phone
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent C rndm lir /cnn Day phone
Mailing Address P6/4 .4)( 0 -n &i to Jf,vev
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: -3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
6Pz/-'4'7?
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑ Individual Holding Tank
❑ Community On-site
❑ Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the 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 Alo dIt 2,0-1 Frtq . Phone 612/— %Oc2cP
Address R(') ROX 7707.2 Li
Engineer's Printed Name Sr vF f,t16
5. DSD SIGNATURE
V Approved for 2 bedrooms.
Disapproved.
Conditional approval for
By:
Date C//O/08
.^F OF AL'`iS $
0,5.r...* '••••.• f 4.
4
el
d`•••...el
ICJS
' i• Steven W. Eng Lei
tIJ1% FE 6::6 • `to.
�F,4.
•'• .o• iy
•.esemt.. ibFEV:0:14rr
bedrooms, with the following stipulations:
Il'fir rngr
,1<<tstY OFN''�.,�
P C«�
2. ••• �=
•
•
`�: WATER AND m=
: WAbIEWA ItN : _
PROGRAM
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(R•r. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: C -OF
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Perk Cite Sii , 8lack_ f, / ,, -2 Parcel ID:0 Sd—S9'boa
A. WELL DATA
Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) V
Date completed Oa Sanitary seal (Y/N) V Wires properly protected (Y/N) Y
Total depth /40 ft. Cased to a % ft. Casing height (above ground) 1.3 in.
FROM WELL LOG AT INSPECTION
Date of test de2, __...d/v&)_
Static water level 6O ft. G_ ft.
Well production 6 g,psn.
'7..S g.p.m.
WATER SAMPLE RESULTS: 4 q
Coliform 0 colonies/100 mL Nitrate 44 ! (mg/L Other bacteria 0 colonies/100 mL
��
Arsenic: -2. 12 r�gll Date of sample:5�OP Collected by. /dos f>! E.., N. -..q
B. SEPTICMOLDING TANK DATA \1
Tank Type/Material.TE€L t C Date Installed lilit12
Tank size /000 gal. Number of Compartments _ Q. Cleanouts (WN) y
Foundation cleanout (Y/N) Depression
Depression over tank (Y/N) /f High water alarm (Y/N) /4
Date of pumping 7P-5/ OS Pumper J7.11
C. ABSORPTION FIELD DATA �7
Date installed Soil rating (g.p.d./(t2 or ft2/bdrm)a (/ System type 1) Pe» .1ronc_4
Length ft. Width p _3 ft. a - 7 ft.
Total depth / y ft. Eff. absorption area 0 .�Oft2 Monitoring tube Depression over field /V/,
Date of adequacy test,c-bgieff Results (Pass/Fail) MSS For bedrooms
Fluid depth in absorption field before test /r in. Water added 5-00gal.
Elapsed Time: CO min. Final fluid depth /8' in.
Any rejuvenation treatment (past 12 mo.) (WN & type) UNr
Gravel below pipe
New depth 22 in.
Absorption rate >= 4/SO g.p.d.
If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on- lev at In. -Pump off level
Datum Cycles te -d
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM ON LOT TO:
Septic tank lift station on lot /go., t
Absorption field on lot ACC'
i4-
Public sewer main
N/t
Sewer /septic service line /2/0 /-`-
Animal containment areas /00 if
Manhole/Access /N)
in. High water rm level at
Meets nn & circuit requirements?
On adjacent lots / 00/t
On adjacent lots MO /1 -
in.
Public sewer manhole/cleanout
Holding tank /VA
Manure/animal excrete storage areas / 00'#
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
S'
NM
Property line Qd_f Absorption field 70 /
Water service line 271011- Surface water / 004 -
Wells
0<1
Wells on adjacent lots /GO /d'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line -?Clr+ Building foundation /
Water main
Water Service line /64 "?
Curtain drain NIA
F. COMMENTS
Surface water lad f
Wells on adjacent lots /50
/VP
Driveway. parking/vehicle storage
so
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field Inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines In effect on this date.
Engineer's Printed Name ST e✓E E.UC
Date CA070 if
•„......,.•.;;
”` •*. 'd,^Ra
r'r. , •
t' ;P;•.
J„
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
0/, 1/4g
160.90/
Waiver Fee $
Date of Payment
Receipt Number
ANALYTICA
GROUP
Northrim Eng
Attn: Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
Fax: 907-694-7026
Analytica International, Inc.
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 5/30/2008
Receipt Date: 5/19/2008
Sample Date: 5/19/2008
Sample Time: 12:00:OOPM
Collected 13y: SE
Flag Definitions:
Client Sample ID: MRL = Method Reporting Limit
Sampling Location: Parkside BI L2 MCL = Maximum Contaminant Limit
Client Project: Northrim Eng B =Present also in Method Blank
Sample Matrix: Aqueous 11= Exceeds Regulatory Limit
COC #: M = Matrix Interference
pWS#: .1= Estimated Value
Residual Chlorine: D = Lost to Dilution
Comments: "= RL higher than MCL; target not detected
INC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Labfl: A0805108 -02A
Analysis Method
Parameter Result Units Fla s MRL Prep Prep Analysis
1 INCL Method Date Date Analyst
92228 (Aqueous) - Membrane Filtration MF Test was conducted by: Analytica -Anchorage
Bacteria, Other <MRL CFU/IOOmL 1.0
5/19/2008 5/19/2008 PL
Total Coliform <MRL CFU/I00mL 1.0
5/19/2008 5/19/2008 PL
Lab#: A0805108-0213
Analysis Method
ParameterResult Units Flags MRL Prep Prep Analysis
g MCL Method Date Date Analyst
4500-NO3E (Aqueous) -Nitrate Test was conducted by: Analytica - Anchorage
Nitrate as N 4.99 mg/L 1.3 /0 5/20/2008 5/20/2008 JQ
Lab#: A0805108 -02C
Analysis Method
Parameter Result Units Flags MRL
200.8/200.8 (Aqueous) - Family Well Water
Arsenic 2.12 ug/L 0.15
Re ted a P r rs
Laboratory Project Manager
Page 2 of 2
Prep Prep Analysis
MCL Method Date Date Analyst
Test was conducted by: Analytica - Thornton
10 200.8 5/27/2008 5272008 GY
uopq
pspioo. •441.10 Josddo40U o o M suo a uo • 4Did IJUI Pgno
P 4 l4 1044• yuousAoo ywwssos
Aso Jo sous4Jxs 144 •ujuus4sp o4 J•UMO •44 Jo kulgPuodsu s44 •I u
miaow •sboiogouy Jo *coot flNns 30 ADO —.Tr •44 •I44 P•400
•uo0J04 p.4Dojpul so 4dsoxs icedoid P1os uo •4U•w••o0 •19RH 41440 J0 SOUR
Uopgwsuou4 •sLo*poo ou uo S1044 4044 pUD sn;wud p•Aomnu 044 U0 40D020U1
°}a44 40000Jpo eu}AJ d}isdad sy{ uo opioulimoickul ou 4044 004t1.44 4U•DDIp0
Si.dad 04i 04uo 4000.ous Jou op puo ssujJ Lpsdoid 044 o144JM •lb Uous44
ps40n4Js. S4u•wsno dw1 •44 404; Pu0 rn soJy •0J4•ia eunuoDsa •E0to4Duy
�a-v7—ND 1ST ntcearirEt4s�-J12dt � 1,0 oneari• 2"1"�+'f
OJ pdd99 os•p ouj*o fo& 043 ps,tSNns •/w4 1 4044 4J1p•o hqu•4 1
xod Sz9y—ZZs (Lo6) rook:uns puo1 pele1si6ea
euoyd St/1—ZZ; L06)1
S1S66 D)1aDly 'e8oiot ouy 'onueny IluDO oosi i **Ug 'Co}Dj3OSCy BUD'j
s' o -'go oN 4oelad oo ans 01N9 ,a5:,1 31Y3S 'r 11I(18Sy — NY1d 101d
• Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.050- 59(- az
1.
GENERAL INFORMATION
Complete legal description P%RKS 06 S/\ , Lor .2, £'Lock
Location (site address or directions) /Se/ "MYRTLE bei✓f_
Current Property owner(s) 'RYt t 4'ieJ'4,v= Day phone 6?i'- 7Cz3
HAA # 027D a1
S�
Expiration Date: / 1- 7 - 0 '3
Mailing address /SG f itt yrz.nr S . Fid c F ems dL.
Lending agency Day phone
Mailing address
Real Estate Agent EV4 Lc fceAv PA )i) erdf/Q''- V7srADay phone 6cP 9 -64076
Mailing Address /6‘3.5 Cent 4,e/(16;
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: •
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
CL r2n/c,.. ti
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑ Individual Holding tank
❑ Community On-site
❑ Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. 1 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 /VQ,eTi°f�Pi4 4 rFi16inr 4P/At 6' Phone 4,a- 7 o z
Address / 7237 544-4 //4i0-Cr,?a-L 1 r'fC)-
Engineer's Printed Name /EAR'
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Date 6-/,./J'/ 03
rF
*co. -
0. `•'x; �1
i '• , ; EI'•GiHEER'S .+
.' C:•,:; V/._.
r.c::S .,,`�"
. . ..r
bedrooms, with the following stipulations:
Additional Comments
<it\'Y OFAtV(
tej
_
Jr: ON-SITE .0
: WATFR AND : rt
WASTEWATER :
•. PROGRAM
J O ••
J
NO -
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
ey.‘,14/lir/. i°6e/r.
(Rev. 01102)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: Fj - 7 - 03
• 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
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: MR/CS/46 sof) / LA! z, BLOC c.. / Parcel ID: Q SC ^ S9 / ^ O 2-
A. WELL DATA
Well type P , If A, B, or C provide PWSID # ` Well Log (YIN)
Date completed ide2 Sanitary seal (YIN) y Wires properly protected (YIN)
Total depth / 6/0 ft. Cased to 4/ ft. Casing height (above ground) /-3 in.
FROM WELL LOG AT INSPECTION
Date of test a!f'Z 6741/0.3
Static water level ft. ! P ft.
Well production 6 g.p.m. 7, 5
WATER SAMPLE RESULTS:
Coliform Q colonies/100 mi.
Arsenic: — mg./I. Date of sample: G3 Collected by: C
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S re 'EL CR fe- Date Installed 6f PZ
'TOG
g.p.m.
Nitrate 7.O 3-mg./I. Other bacteria _ colonies/100 ml.
Tank size /40O gal. Number of Compartments ? Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Depression over tank (Y/N) A' High water alarm (Y/N) ti'//j
Pumper (
Date of pumping 973/0
C. ABSORPTIONFIELDDATA
Date installed cAita./P 7 Soil rating (qpitairrYW or ft2/bdrm) Z ((7 System type PC,P 7 En(C 14
Length .r.Z ft. Width 3 ft. Gravel below pipe I- ? ft.
Total depth /41 , ft.*" Eff. absorption area •:? 30 ft2 Monitoring tube �f Depression over field /f
Date of adequacy test 41L f/0,3 Results (Pass/Fail) 11:4->s/ For 3 bedrooms
Fluid depth in absorption field before test/? in. Water added 4t5Vgal. New depth /g in.
Elapsed Time: 70 min. Final fluid depth / 5 in. Absorption rate >= l./.5-0 ' g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) 4 If yes, give date
D. UFT STATION /�f �/11
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in. "Pump off" level at ___ in. High water alarm level at
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /110 '4-- On adjacent Tots /o O f'"
Absorption field on lot / S 0 r 't"
On adjacent lots /40rf
in.
Public sewer main Ar/4 Public sewer manhole/cleanout AO/
Sewer /septic service line /41 Q `'' Holding tank /`//A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
14.
Building foundation S r Property line a a
Water main /V/'`"
Water service line 1/o''`
Absorption field
70
Surface water /00 4. -
Wells on adjacent Tots /OG r*
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Zine 3o Building foundation 75' Water main rst74
Water Service line /60 '1 -
Surface water
/oo`#,
Curtain drain A/%R Wells on adjacent lots /a 0'4"
F. COMMENTS
Driveway, parking/vehicle storage
50'-
x'71"—\
c,^J i•i1
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 HAA guidelines in effect on this date.
Engineer's Printed Name `5 TEV !: rJ E
Date (<//cP/Q�
: cy
HAA Fee $ 3' S Waiver Fee $
Date of Payment
Receipt Number
Date of Payment
ts )101 03
/
Receipt Number Cb
(Rev. 12/01)
C7-16-03 13:28PM FPCu-C7LE EVVIRONiENTAL SPS'
SGS Kef.tt
Client Name
Project Name/*
Client Sample ID
Matrix
PWSID
1034093C01
NnrtF-Rim Engineering
Parkside L 2, 61
Parkside Water Tap
Drinking Water
0
9075615301 7-4(C F.02/03 F-910
All Data/Times are Alaska Standard Time
Printed Date/Time 07115/2003 10.01
Collected Daie/Ti nte 0710912003 17:15
Received Date/Time 07/10.'2001 9 20
Technical Director Step1ja C. Cele
Released 8y
Sample Remarks:
EP 300.0 - Detectable amount of nitrate in the calibration bank; the concentration of this analyte in the sample us 10X greaser.
Parameter
Haters Department
Nine -N
Qua;iiters Results
2.05
0
t't.c rcb101ogy Laboratory
Total Cohtorrn
PQt.
Allowabk pnp Analysis
U:riu Methal Con:ainer10 limits M;e hate Inn
0.100 mg/t. EPA3G0.0 B (<-10) 07/11'03 JJD
col/100m1. 5M18922211 A (<-1) 07/I0.01 1S
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