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HomeMy WebLinkAboutPETERS GATE BLK 1 LT 9',ESS~ BORE HOLE ONE level: .~ · Method b Wail intake 0~'enir~g I~ ,Screened; .. ; :.' b [Z~'PerfO, rations. Start ,;I.! ,, -- "* :' Grout ;!:" :'O;Pth:fr;3rn. O ', k, Pumplntake Depth: ; ~' · puml~size..:: :: . : Well Dis!nfected.Ul~0i~ C~., '~d 6f DiS!nfeCt'iOh: ~'~. Cornments~ ~' [':I i,-"' ',:':;6i,'.',.',: '~:' -~.'-t';;' ".:.:::",:.i: ,'! v t~, '--'.,'.' ,' , -',.,.::: .:.,.', . '.-., "' ~ - .' ::.'. -,. ~:~,., ).~ . :"~.. ..:,".,. , ....,....-. · .:-.: ~..~., ~ENTION: It is the responsibili~ of the prope~ o~e~'to'~SuS'mit a CopY of t~e well I~g'10 the Proper abt '0d ." unici of Anchorage: Depaament of Health &Human Se~iCes anglor Depadment Of'Environmental ConSe~ation' MatSu Boro Depa~ment of Environmental Conse~atiOn~. " "" ~'~ ? ';.: '.~.[::t ~ ..'--.~",, ',':;~:',.. :- ~.-: ::. '-',/ ,., .:',.~: ;-,.;; ..:,::,z 't "~': .',", :' ', :.:  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ///~c,~..~ PHONE I .J~N EW MAILING ADDRESS iLEGAL DESCRIPTION LOCATION NO. OF BEDROOMS~ ]Well I ~ Absorption area Dwelling I PERMIT NO. ~ ~ DISTANCE TO: ~ Manufacturer~~~ ~.~Yy ~ Ions ~ Width Liquid depth ,~ 1 ~ O~ IF HOMEMADE: ~~0: Well Dwelling PERMIT NO, r Material Liquid capacity in gallons Q Well I Foundation I N~arest lot line i PERMIT NO. ~ DISTANCE TO: ~ ~ ~ Z ~ ~ No. of lines / Length ~ ~ Top of tile to finish grade. Material beneath tile Q ~ w ~ Total effective absorption area ~ Length ~'Width Depth PERMITNO. ~ Type of c Crib diameter Crib depth Total effective absorption area  Well Building foundation Nearest lot line NCE TO:  Class_ . Depth Driller Distance to lot line PERMIT NO. ~ ~~ Building foundation Sewer line ~ Septic tank , Absorption area(s) OTHER PIPE MATERIALS P so, % INSTALLER ' REMARKS  DATE LEGAL 72-013 ~ev. 3/78) by DOC Co. dba SULLIVAN WATER WELLS P. o. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS ,~',~ LEGAL DESCRIPTION Zr~ 7' ~7 t,~z.A;' DATE- Started 7 . ,'; ,) 9/?'5' Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From O Ft. to / <'/' ,.Ft. From /~:~ ..Ft. to f ~ Ft. From / ,c~ Ft. to '7 d/ Ft: From 7.:~ ..Ft. to Ft. From _Ft. to ..Ft. From,~'() .Ft.t~ .~' ~ F From__Ft. to ,.Ft. From__Ft. to , Ft. From__Ft. to ,..Ft. From Ft, to ...Ft, From Ft. to Ft, From ,.Ft.~o--Ft, From. __.Ft. to__ From ___Ft. to Ft.__ From__Ft. to .... Ft. From.__Ft. to Ft. From Ft, to .Ft From From · From Ft. to__ From Ft. to From __Ft. to. From Ft. to. From Ft. to From .... FI. I'o From _.Ft. to~ From ..... Fl. to. From__Fl. From Ft. to From From Ft. to__Ft. .Ft, to ,Ft. Ft. to Ft. ,, .-Ft. to.~.Ft, Ft. to____Ft Ft. .Ft. ,,Ft.. Ft. FL _ Fi. -- .Fi Fi. Ft Ft.. Irt. 1o ............ Fi. Ft. to ..... Fl:. MISCL. INFORMATION: ! Permit MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmental ~rotection 825 __ Street, Anchorage, AK. o ~501 264-4720 * * * HANDWRITTEN PERMIT WELL AND/OR ON-SITE SEWER PERMIT ~K S'[gkm.~5//~? ~~. Mailing Address: Lot Size App 1 ic ant: Location: 7-{S-~3 ~/~3 ~a{! Phone Number: Legal Description: ~ ~ /~/~/ ~'h~s ~3~ Type of Soil Absorption System Is: Trench: u/ Drainfield: Seepage Bed: .. Holding Tank Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH ,/O" -~ W I DTH LENGTH .33 . GRAVEL DEPTH ~,~ ' I/ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /000 GALLONS * * 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. * * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) sewer system may require enlargement if include more that 3 bedrooms. Date: S igne~: I un~d_~rstan~ that the on-site the ~esids4~c~e is r~modeled to A SWP/024(1/81) SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ~/~ ~.~ ,.~ r .~/(Jf,.~ DATE PERFORMED: , LEGAL DESCRIPTION: ~o~ ~ ~:~ /~ ~?~'~ [~,1~..~-~ //i %1~: ~1'~ ~'~C~Z~ ' ' ' SLOfiE ' ' SITE PLAN 1 2 3 4 5 6 7 8 9 -'10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ./ S L ENCOUNTERED? ' O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time ~,?~,~ ~,~ll~r.. :Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: ~.~" ,~,~<")C/~?~-~-~ (minutes/inch) . FT AND . FT CERTIFIED BY: DATE: 72-008 (6/79) Decem0er 12, 19U3 Mr. George Strother Alaska Land Developlnent Services Star Route ~ox 32[)9 Krenik Building, Suite 201-A Wasill~, Alaska 99687 Subject: As-built for Lot 9, Block 1, Peters Gat~ Dear iqr. Strother: l?iease ~ill in the "liquid,, capacity in gallons" blank in the sep- 'tic tank portion of our inspection report form. You have indi- cated in the drawing] that there was a 1,000 gallon tank. Thank you ~or your assistance in this matter. Sincerely, CW67/ej/E1 Cory Willis, R.~' Actin9 Sewer & Water Program t~'ianager a, • 'ti Municipality of Anchorage °` On -Site Water and Wastewater Program (907) 343-7904 F E T y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-541-08 Expiration Date:. 1. GENERAL INFORMATION Complete legal description Peters Gate Block 1 Lot 9 Location (site address) 25005 Sierra Mesa Cir. Current Property owner(s) Christopher McKnight & Rebecca Brown Day phone Mailing address PO Box 671028 Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well M Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ Waiver/Variance request for: TYPE OF WASTEWATER DISPOSAL: Individual M Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_5 Waiver Fee $ Date of Payment a Date of Payment Receipt Number ©`{ 0 9 a G Receipt Number COSA #_ (G 2_/087 Waiver# Distance: 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, LNC. Phone 696-6111 Address 20441 PTARMIGAN: BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date -- -- _J - - 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 4r `\ \ occupants or can ArcTerra guarantee that no unseen o encroachments, deficiencies or discrepancies exist. , a �)I 49TH/� J* 6. DSD SIGNATURE ` ^ KENNET,e H M. v System #1 Approved for bedrooms. ` System #2 Approved for bedrooms. / .r 1 \ ry:rFssle' , i Disapproved. Conditional approval for bedrooms, with the following \tpb Vti'Sr�sOFA*O y(ii�� 94 tv��' �- C'' g __ WATER AND c5'� WASTL-VATER o; — J pM BY� �_ fir___`✓ Original Certificate Date: 3-2--Z-2z 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 Legal Description: Peters Gate Block 1 Lot 9 Parcel ID: 051-541-08 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Well production at time of test 3.8 gpm Date drilled 7/30/1983* Water storage tank volume gallons Total depth 85* ft Well disinfected for coliform test? ❑ Yes E No Cased to 63* ft 0 Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate mg/L Nitrate less than MRL (ND) Wires are properly protected Arsenic ug/L Arsenic less than MRL (ND) Casing height (above ground) 12 in. Collected by Arcterra Consulting Date of flow test for COSA 3/1/22 Date of Sample 3/1/22 Static water level at beginning of test 63 ft. Comments* 2 Well logs found in MOA docs, only 1 well found onsite. B. TANK DATA Age of tank(s) 14 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" 11 Standpipes/foundation cleanout per record drawing Date of pumping 7/6/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 11/7/!83 11 ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4.5 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet STATION ❑ Requl aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/1/22 Results ®Pass For 3 bedrooms Fluid depth prior to test 3 in Water added 462 gal New depth 3 in Elapsed time 10 min Final fluid depth 3 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10'__ ®Yes if No ft Community Wells > 200' -... ®Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No It Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet Parcel I.D. 651.541.08 GENERAL INFORMATION Complete legal description. Peters Gate Block 1, Lot 9 . · Location (site address or directions) 25005 Sierra Mesa Circle, Chugiak, AK 99567 current Property owner(s)~Linda Maxwell Mailing address POB 671693 Chugiak, AK 99567 Lending agency Municipality o.f 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' Expiration Date:. Day phone 230-5942 Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDRooMs: .3 Day phone 3.- TYPE OF WATER SUPPLY: Individual Well IndividUal Water Storage 'Community Class ~ Public Wa!er System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] IndMdual 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. 5 STATEMENT OF INsPEcTIoN BY ENGINEER As'certified by my seal affixed hereto and 'as of the validation date shown below, I ve'rify that my investigation, based on procedures outlined in the. Health Authority Approval Guidelines~ for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of Structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING, Inc.· Phone (907) 696-6111 Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 . Engineer's Printed Name Kenneth M. Duffus Date 6~28~04 .... 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 clay tested. The flow and absorption rates may change due to subsurface conditions that may not be observed frOm the surface, changes in land 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, KND can not give any estimate of how long a · system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approve! for bedrooms, with the following stipulations: ~. Attachments: HAA Checklist ' Septic System Advisory Well Flow Advisory X · . . . _..- Maintenance Agreements ' ~-~..'?~o,- ' .... -,~-'=,,~',"' Supplemental Engineer's Report ~~ · Other,, Original Certificate Date: ~,~ - ~ o - 0 ~ . Arse.~ c: NA . mg./I. Dateof samPl(~: 6118/04 - ;. Col ected'bv.: KND EnCrine~]i,,- : : Tank~,'!',ype/Material ' SEPTIC/STEEL Dat~ in§taile~ :Ii/?'//~5: :' Tank si:~le 1000 '~al ' :. ;!' . ii; : , , 'i : : ' i!:'~,,,' :. .' , ',. ~ ~ '~,~ ' , '. : Number of Compartments 2 :;! '. Cleanouts (Y/N) Y. ,,: ::. ~ ', . ~ - .' ..... ,, ~-oundation: ,;.clean°ut. (Y/N).. Y_..DepreSsi0n ...... over tank (WN) N High waier alarm (Y/N) ~ : ,,, ~, , ~ r'! ' .... . ' ' ' .: : ,: , ' · ~ i-- ' ' !. Date.of PumPing..6/17/2003... -;.!.:i · ~ pump~r.'SANITARY_, i '.:.:., i: f : . .: I..} C...ABSC)RPTIONFIELDDATA'i :. i :':"i !iI : '" ":/' i:' ;;': "':l::iI: Date,mstall~.d .11107183 . Soil rating (g.p.d./fl. or fl/bdrm) 125 .:: : ~ Syster~ tvoe TRENCH · "'*' I' ,. , , · ,, , . r ;,' ' ~ ' i ~ . : ~ : !* · · Length 35 ii! ' ,ff:'Width 4 ,! . fit Gr~v,:q h21nwn;n'~ '~'g' [~' ".' :[i[ , i ' r ' ' i ~ ~;''" :' --~ 'T.'.--' ~'~'' I'' ~'""''''--~'~ IL' ., Total [~epth.[9.5 ft. Eft. absorpt,on.area 385 ft Momtor, ng tube Y Depression 6~]er field N .... ~ Y _ , . ~. esu!ts (Pass/Fail). PASS ..~For3 bedrooms . , . , I , d ~ ' ;'~ ~ ' ';' ' ~ ', : ,' ~ !1:~[ ' , Fluid depth In absorpton field before .test 17.4 in: : Water added4so' al '.. ~'" Newd ' , ~ ~ . ', · , ~ ', ,z, , · , ' g · ' i .. epth 25.8 in. E . i. . , , ~ , I ~",."~ ..... ~"~ ,' '-:i! lapsed Time:40 min., ; .... Final fluid 'depth20.4 in ".': ' AbsorPtion rate >- 450' ' · ':'. ,;.. · · . ~ ' ~., '~"~'.' i" :":'· '.' t:i ' Any rejuvenation treatment (past 12 mo.) (Y/N:&'tYpe) N . i , :'" :': ': '.. f'.b,~n;~,~ ,~ ' ' ~ ' : ' i · ; ' :";': ' '" ' "i: " ";~:t ' , ' ! 'i ,i !i , ,: i ':' ; ' .. i '; ',: ; ' ' :, "~ ~ ' " ' :' " ':.. . .'. ,i'MUnicipalityiofAn'ch°rage,: , . .. ,,"Development SerVices Department : ' il., :~i Building Safety Division ,. .'~ '~' .' , ', On-Site Water &.Wastewater Program ' ';J " ' " [:i--~ ; , ' . i, :i[ 4700:South Bragaw St. : ~i , ~" 'i:I' - · P.O. Box :196650': Anchorage, AK 99519-6650 :"::i~'l .- ' ' ,: ' , , : i. ': .' , .;:! (907) 343-7904 ' ;' -' ":!:t' i -, :i', -' HEALTH AUTHORITY APPROVAL CHECKLIST ' , , : I I" : - : , 'i ' t ' I' ' ' ; ' . ~,', . L , :'Legal Description' Peter's GateB1, Lg~ ~' ~ ' ' ' I O~ '~ ' ' n ' ~1~ A. WELLDATA . ! .' ' !.' ' ::!.: , · ' ': '- · 1'} ' .' ' ' :~'} .... I ,',' :.:, , ," , , ~'~ ' - , ' , ' ' '!~'. ' ...... :,: ii ',;: .... ,-' ,, · :: ;,!" :,', ......... Well !ype.prlvate: ' .' If A, B, or C Provide PWSID # ', ' ,i .... Weli Date completed 2123/98 ' " Sanita,',, s~al ~V,,,,,,, ' .... ,.,. . :;. .. I .... : :' , ,~, . .t,,,',~,_._ . ; vwres proper,ly prmecmd (Y/N) Y Tot,!;dept!.200-ft... · ...'.::.: case),o'-2~.3 ff.. : ' Casing heigl~il(above ground, '24" 'i '.ii' .FROM WELL LOG. '~: ~ · ' : ' AT:INSPECTION '. : Dat:e~ of test ' ::.2123198 :.'i ..- = ;: . 6118104 i:[ Static Water level : :~ 85 63 '[:1 ~ ! · ' ' '' Welllprod~Jction ' ,! 30 i::;' '[ ;ilg:.p.m !:, ~--:,6 ~ g.p.m.1 .'.. ' wATER 'SXMPL. E, :"'~. ,: ,,," . RESULTS'. . , . ' ;'i"i!,,' , : .... t; '. : , ' :":f: "~:::: ' '~ '. 'F' *~:"~O'" '-'. "'":-"[ -;'.-..' ' .: Oohform. 0 colonies/100 roi. Nitrate ~ rog.fi.Other bacteria.. :' Colonies/100 mi.' Eo LIFT STATION Date installed "Pump on" level at in. Datum SEPARATION DISTANCES · Size in gallons' "Pump off" level at· . Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic~ tanl;Jlift station on 10t 100'+ Absorption field on lot 100'+ Public's(~wer main 75'+ Sewer/septic service line 25'+ Manhole/Access (Y/N) ,,. in. High 'water alarm level at Meets alarm & circuit requirements? in. sEpARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: on adjacent 10ts 100'+ on adjacent lots 100'+ Public sewer manhole/cleanout Holding tank 100'+ 100'+ Go Building foundation 5'+ Water main Wells on adjacent lots "100'+ Property line 5'+. Water service line 10'+ Absorption field 5'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water mair~ t0'+ Water Service line 10'+ , Surface water 100'+ Driveway, parking/vehicle storage Curtain drain 50;+ Wells on adjacent lots t00'+ COMMENTS 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 daie. Engineer's Printed Name Kenneth M. Duffus Date 612812004 t0'+ HAA Fee $430.00 Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date,of Payment Receipt Number 6--26--04. i · '~ = Laboratory Analysis Report $G$ Ret., 1043559001 Client Name lO,ID Engineering Project I~,'amd~ ]%t~'s Gate B I, L9 Client Sample ID Peter's Ga~ B l, L9 Sample Rcm=ks: All Date~Tim~ are Alaska Standard Time ' PrintM DatO't/me 06/28/2004 l 1~7 Collected Date~ime 06~8~004 12:00 RecdvM Dare.line ~/~ 8~0~ !5:33 Technical D;r ector - $tcp~C. ~de Rele~e~~~ EP $00.0 - Smnpl¢ was mn past hold time for nitrate due lo an imtn~.ent malfunction crypt a wcck~d. P~r ~ PQL Uni~ Me~ Con~lncr~ ,, Limits Date A0owabl= ~p ~al~is Wat~_--~ D~pa~:tment l?~tcrobiolog~ L~boratory Toul Coli£0nn 0.101 0.100 m~dL ~PA 300.0 B (<=1 O) 06;22/0a ceI/100mL $M20 9222B ^ (<=I) 06/]s/o4 · '." ...... '.. :.:'~v.'.:,l.:: Lcl~ratotyOivi~Tcn 20~We~tPoTcr0rivc. Aqcnotzge, AK99StS. 1E05 1(~7)S(~2-:2343 fiO07JS~1.53D1 vn~w.~'-'Bnvmnme~al.com I £0 39~?d SIN3~'~IS3ANI GN>{ ITI8969LOB 8£:~T ~80~/8g/90 Pr, Jerty 0~'~ ,er Mailing Address D~---~ Institution Address Realty CO. & Agent Address APPLI(. NT FILLS OUT UPPER HAl. ONLY Zip Code . Zip Code Phone Phone Legal Description Street Location Type of Residence [~"g I e Family [] Multiple Family [] Other Water S..~ply ~/fndividual [] Community [] Public Utility Sewer DiSposal [~..l~divid ual [] Public Utility  -ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). Year Individual Installed: ~ When Connected to Public lMility: [] Holding Tank Time Date NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. "- Time Time ~ -~ \, --"-'---------- Date Oat~ Date Inspector Inspector ( ~./~ 'APPROVED BEDROOMS ) DISAPPROVED ) CONDITIONAL APPROVAL' DATE ~- ~ ~ ~- '~ '~'' ~ Inspector Inspector CONDITIONS OF AP~ Rating 72.023 (3/82) Date Sewer Installed lWell To Absorption Area I {--"~ ""82 Well tO Tank ~e__ell Log Rece''vedas' Approval ~[or the indivi{lt~al sewe~ and ~ater 2aciiities /~~-r-~ view · noted discrepancie~.~ nave been c(>r~ec[e(/~. ~[ th~ere are f~t}ler questions, please call thi~ o~'~ic<~ ,~t Sincerely