Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutLAMPERT ESTATES BLK 1 LT 1Lampert Estates Block 1 Lot 1 #051- 102- 55 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES FROM SEPTIC TANK ABSORPTION FIELD WELL Address' %�'�•'� C3� [�:t �'/K �y< .�fi� ��SG 7 Phone(s) Permit Nc: No. of 8etlrooms WELL i f� E: i rrs C7� 3,,ftfD U i 3 G% LOT LINE 321 /e / /E LEGAL DESCRIPTION Lot Block Subdivision FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS 110 SEPTIC❑ HOLDING Kiri/'Ar - - -- - Manufacturer Capacity in gallons ,a0 Material No. of Compartments TYPE OF SYSTEM ql' j TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER �, r Depth to pipe bottom from Total depth from original grade original gradeV FT FT IL Fill added above original grade Gravel depth beneath pipe (� FT 3 FT r r r - q Gravel length Gravel width FT _ FT v ( : �� Total absorption area e� %D Distance between lines a, SQ FT FT Number of lines Soil rating Pipe material _s •5 SOFT 4.syl, -?,:)31/ I s Installer �,_ Dale Installed -I 7'p,v e 71 Se WELLS PRIVATE ❑ OTHER (Identifv) r/OD y Classification (A,B,C) Total Depth Cased to FT -:La 1 FT Installer Date Installed: 5e, /�/✓u ✓ �1�7�5 Wei l REMARKS: C ' r Sca e: ENGINfiERS FSAL Inspections Es91e Performed RRfoul by v cos [' f0 Dale: P. O. ®OA 773294 C �_ E291e River, AK 99577 'CSI}-1 F � 694-5195 I', u�!� . I peril yyIIhat this inspection was perlormed according to all Municipal and Stale guidelines in ellect Health Department Approval:' Date: 72-013 (3/85) MUNICIPALITY OF ANCHORAGE Departfnent of Health & Human Services 825 L StPgetAnchorage, Alaska 99501 343-`4720 ` ON^SITE SEWER PERMIT Permit Number: 880130 Upgrade Date Issued: 07/22/88 Engineer Designed Owner Name: ROBERT F. SCHOONMAKER Owner Address: PO BOX 670502 CHUGIAKv AK 99567 Parcel Id: 051-102~55 Lot Legal: Sub�iYision: LA 'ERT E.UBD Section: 4 Township: 15N Raoge: Lot Gize 20000 {t. or acres) Max B�d�oom�: This Permit� 3 Tot�l Capacity: Day Phone: LDtn 1 E'lizck: 1 1W SEPTIC TANK: Minimum tOtal septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments" Depth to tr:)p �f' septic tank(s) < 4"0 feet requires insulation over tank(s)" INFORM D"H"H.S, PRIOR TO 1ST & 2ND INSPECTIONS 8Y ENGINEER, IF AFTER OFFICE HOURS, CALL 343~4681 AND LEAVE A MESSAGE" CONSTRUCT ATTACHED APPR0VED DESIGN" THIS PL�RMIT EXPIRES THIS PGRMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY" I CERTIFY THAT: 1" I am f,amiliar with the requirements for ongite sewers and wells as set forth by the Municipality of Anchorage (MOA) -and the? Gtate of, Alaska. 2. I will iDstall the in accordance with all MOA c�d�s and r�gulations� and in co0pliance with the design (._� ritePia of this permit" 3^ I will adhere to all MOA and State of, Alaska rements for the set back distances fro0 any existing to (a *)astewater disposal system or public sewerag�� ystem on this or any adjacent Or nearby lot" 4" I understand that this permit is valid for a maXimum of 3 bedrooms" I also the capacity (:)f' the totZ.Al and any enlargement will requir� an additional permit" (Owner) ROBERT F, SCHOONMAKIE, R Issued By: DAT£: �� J.J ` ° �m�8�" �`\!�U» Jo ��-~'^' ��]��C>| \ [�� '^� \ ^ 1 � , . ` 00 So MUNICIPALITY OF ANCHOI::- I, -L rtAnchoragev Alaska 99501 343~4720 ON~SITE SEWER Permit Number: 880130 Upgrade Date Issued: 07/22/88 Engineer Designed Owner Name: (,:)+:: ENTERPRISES INC" Owner Address: 408 EAST FIREWEED LANE ANCHORAGE, AK 99503 Parcel Id: Lot Legal: Subdivisiono LAMPERT ESTATES SUBD Section: 4 TC")wnship: 15N Range: Lot Size 20000 (sq"ft. or acres) Max Bedrooms: This Permit: 3 Total C � p city: Day Phone: 688-9038 Lot: J. Block: 1 1W SEPTIC T8NKA Miniml'.1m tOtal septik c:apacity: 1�000 gallons" Each septic tank must have at least 2 co�partments. Depth to top of septic tank(s> < 4"0 feet requirc,.:s insulatiOn oveP tank(s)" INFORM D.H.H"S" PRIDR TO 1ST & 2ND INSPECTIONS BY ENGINEER, IF - 1 61B 4681 AND LEAVE A MESSAGE, CONSTRUCT PER ENGINEERS ATTACHED APPR0VED DESIGN. THIS PERMIT EXPIRES 12/31/88. THIS PERMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY. I CERTIFY THAT: 1. 1 ith the requiroments IoP on-site sewers and wel1s as set c) I, I by the Municipality of, Anchopagcx� (MOA) and the Sta-tte o[ Alaska, 2. I will install the system in acCordance with all MOA and regulations, �nd in c��pliancG with thdesigD criteria oIF thig p9P0it" 3" I will adhere to all MOA and State of, Alaska requiremeDts {or the set back distances [rom any existing tmgll, wagtewater disposal syste0 or public sewerago� system on thi5 or any adjacent or nearby lot. 4" I understand that this per0it is valid for a maxi0um of 3 bedrooms" I also understand that the capacity oI the total system is 3 bedrooms and any enlargement wi1l requir dditi al pPmit" Signed: DATE: .... .�.... (Owner) O^K ENTT�,RISES INC�� ~- ~v � Issued By: DATE: 71-11.12~J SPECIFICATIONS FOR ON --SITE SEPTIC SYSTEM LEGAL: LOT 1, BLOCK 1, LAMPERT EST DESIGN # 1 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation require- ments. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. S. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi --family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. $. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. BED 3. The bed is to follow the natural land contour to maintain uniforn total depth of the bed bottom. 2. The bottom of the bed shall be level, plus or minus 1.5 3. The total depth of the bed excavation is riot to exceed 9' at an point. 4. The sewer line is to be connected into the existing leach line tc allow effluent switching to the upgrade leachfield. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a deptl of 4' or equivalent is to be placed over the leachfield. 7. The area over the bed is to be finish graded to prevent ponding o• surface water runoff. S. The septic tank and leachfield must not be closer than 100' to an existing private well, 150' to any Class "C" well, or 200 feet to an, community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 9' GRAVEL DEPTH = 6" BED LENGTH =42' .BED WIDTH =24' Soil Rating =225 /f Bedroom Capacity = 3 Septic Tank Size = 1000 GAL. EXISTING i G t SPECIFICATIONS FOR ON -,SITE SEPTIC SYSTEM LEGAL: LOT 11 BLOCII 11 LAMPERT DESIGN #2 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All. materials and workmanship shall meet the Anchorage Department of Health and :hate Department Of Environmental. Conservation require- ments. 4. All soil tests are advisory -to the design and. are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi --family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. 7t is always recommended that a surveyor Locate the nearest lot :Line position and the location of any easements. B. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 9' at any point. 4. The sewer line is to be connected into the existing leach Line to allow effluent switching to the upgraded leachfield. 5. The trench gravel. is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a, depth of 4' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL, DEPTH = 9 GRAVEL DEPTH =3.5 TRENCH LENGTH =135' TRENCH WIDTH = 3' Soil Rating = 225 Bedroom Capacity = 3 Septic Tank Size = 1000 gal. Exist NOTE_ 3 Trenches to be run with total_ length of 135' as per plot plan. NQ CONFLI WELLS ELSIE ST, _ WELL AND SEPTIC SITE PLAN LEGAL L❑T 1, BLK a LAMPERT ESTATES 2111110l'ur13421% C❑NTRACT❑R1GARY ST❑NE EAGLE RIVER ENGINEERING SERVICES P❑ BX 773294 EAGLE RIVER, AK, 99577 X694-5195 EASEMENT - - EXISTING LEACH FIELD « «- NEW LEACH FIELD« CLEANOUT SCAM I' = 40' 0 SOILS LOG MUNICIPALITY OF ANCHORAGE +.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION C9� PERCOLATION TEST 625 L, Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:0 he r14-- �G%y or✓ rr+a LCvr DATE PERFORMED: _7�l/ / �-.v LEGAL DESCRIPTION: Go % y3�L(� �� w,r�@r �S%`, /SW /e / r.,✓ S el't F`DTH SLOPE SITE PLAN 1 2 3�4 8 ') t 9- 10- 11 10 11 12 13- 14 r t 15 r r Q/C err,9 "i c - / ote ro/ L (S r n) S�.Nri LJYOW� W/SV r�i 16 S Q er! 00 Depth to Water 0 .5"AGf MON r�uYp G/ P IF YES, AT WHATE 17 DEPTH? 18 V7.4 /u ,N 7 %e /O�y 20 - GC J��xa C. w,�_h o A„r /0 ,� 7 n �' COMMENTS WAS GROUND WATER S ENCOUNTERED? 00 Depth to Water 0 .5"AGf MON r�uYp G/ P IF YES, AT WHATE ��y s DEPTH? Reading Date Gross Time Net Time Depth to Water Not Drop .5"AGf 711z V7.4 /u ,N 7 %e /O�y /0 ,� 7 /• b/ ib PERCOLATION RATE_ a D (minutes/inch) TEST RUN BETWEEN % FT AND. FT PERFORMED BY: Eagle Rivir Engineering ServIce3 CERTIFIED BY: �� DATE: Ix 773294 E2910 Rlver, AK 99577 72-008 (6/79) 8ld•5195 4,P MUNICIPALITY OF ANCHORAGE DEPARTMENT 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 /� PP�HONE II NEW �0L ��`t'CU ❑UPGP,ADE b�t�� MAILING AD S LEGAL DESCRIPTION L l CAM,aew I- LOCATIONj( NO. OF BEDROOMS Well Absorption areau r Dwelling )� PERMIT N DISTANCE TO: r (7� — 4;L_ o U Y b aZ Manufacturer Mat l C No. of compartmey s y allons Liq. c TW3 IF HOMEMADE: Inside leng/ Wi dth Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Z F Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well "�'� -Foundation .� '�Q Nearest lot line .� ry PERMIT NO.-7907a3 -7 9O a w g Z _ G _ J LL Z No. of lines Length of each li a Total length of li e Trench width/^Distance between lines Z ? ` — —a f' I- Top of tile to finis grade Material beneath tile otal effective sore n area q ;14FRIMIT Lu Length rf Width Depth NO. f7 0, 4 F CL e Type of crib t Crib diameter Crib depth Total effective absorption area in Well Building foundation Nearest lot line DISTANCE TO: ' j Depth Driller Distance to lot line PERMIT NO. J (� w � DISTANCE TO: Building f u ation Sewer line Septic tank _ Absorption area(s) v OTHER PIPE MATERIALS q SOI L TEST RATI NG INSTALLER REMARKS s1/ — LEGAL b APPROVED DATE 72-013 (Rev. 3/78) U - 0 \ ) MUNICIPALITY Of- ANCHORAGE r () 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 9950.1 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT NAME '- '— :L -------__ PHONE NEW UPGRADE MAILING MAILIN'ODD, i,� c KJ —---------- LE_GAL DESCRIPTION --------------- -------- n- i=— ---�----------- LOCATION — _ A.._.� . NO. OF BEDROOMS V Y F -Z Well Absorption area DISTANCE TO: L -- — --- Manufacturer ---- Dwelling I _i - ----- -- PERMI'rN L� a a ! Materiel No. _ of compartments L"I c pacit in gallons --- X g Inside len t)1' IF HOMEMADE: f?� � r -------`-------- I lh irltL• - Liquid depth �� C7 Y Z Well T- DJs rANCE TO: _ Dwelling --- -- -- PERMIT NO. S N ------ Material -- -- ------ Liquid capacity in yallons - ® J= Well Foundation DISTANCE TO: / Nearest lot line PERMIT NO. - I u Z =• Z w f. No. of lines Length of each line Total length of lines �� - •. _ II / --- — -- ni-- ------ _i - Top of lite to finish grade fV, Material beneath tile. Trench width _ ' - inches --------'-------- - Distance between lines (.:... - — — lbtol r,}Icctive)t sorpti cc w Length Width Depth 1, inches �- n area PERMI IT N0. as H wa Type of crib 111 ------ Crib diameter Crib depth Total effective absorption area w w ------------ Building founclation DISTANCE TO: -VVcll------- Nearest lot line ---- .0 �� ,,� - � �-�""c`t;('�(. SIG Depth � Driller T Distance to lot )int, PERMIT NO. w -- � DISTANCE TO: Building f w1dation Sewer line __ Septic tank( r _ _ Absorption area (s) O T H E R PIPE MATERIALS c SOI I_ TEST RATING -- --�--tet. �_1------ --i--- -- — I INSTALLER --- �1 � I — -- -- — R r_ M A R KS n=n' — -—i-r- �_l-- r-- - - -- --- � 1• - - -- It- - I i 4C' APPROVED DATE _EE _GAL jr 72013 (Rev. 3/781 I - THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: 13M K 17, -f P-1 11.110 �FIT ��F I M. col 10 M 10 V fv� L. RJKW"! P-1� PERMIT HPPLI(nor MHS THE RUPONSIBlLITY TO INF0RM THIS DEPHRTMENT WAR lNG THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERYE ��, F^f ,� �� 11 BRCKFILLING OF RNY SYSTEM WITH0UT 1"I41L INSPECTION OND HPPROVRL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTRNCE BETWEEN H WELL 8ND HNY ON~SITE SFWHGE DISPOSHL S9STEM IS 100 FEET FOR H PRIVHTE WELLY OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MITI, SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS RRE HVHILHBLE TO IHSURE PROPER INSTHLLRTION. W Q Fly V1 1V "V K X Q I'L�� I CERTIFY THRT 1: I HM FFul ILIHR WITH THE REQUIREMENTS FOR ON-SITE SEHERS HND WELLS HS SET ISSUED BY_ -r TE_.��'~.�../-..�_ Steven A. Johnson NET TIME(Min.) NET DROP In. Soils Log Box 76 30 7.80 Percolation Test Chugiak, Alaska 99567 30 4.125 7-3 Phone: 688-3085 30 3.75 8.0 Performed for Charles Oliver _ Date 8/9/78 9.6 Legal Description Lot 1, Block 1, Lampert Estates Subdivision 30 2.875 Test Pit Location 1251 N and 45' , . of SW corner 0 0' -- 2' red brown silty sandy gravel w/organics GM (GM) 2.25 ft2/bdrm 2. 2' - 16' gray brown sandy gravel w/variable amounts of silt and cobbles to eight inches (GW -GM) 4 180 ft2/bd.rm GW- GM 12 14 16 z perc test from 6' to 8' no water table encountered Total depth this test 16 feet AVERAGE ABSORPTION AREA REQUIRED FROM SOILS LOG = 186 ft.2/bdrm. T NET TIME(Min.) NET DROP In. PERC RATE(Min/in) 8/9/78 30 7.80 4.3 30 4.125 7-3 30 3.75 8.0 65 6.75 9.6 30 3.125 9.6 30 2.875 0.4 Percolation rate 10.4 minutes/inch � Signed ��A� ]�� __ji r DEO/ HL IN ST�EET/ HNCHORHGE, HK99501 264~4720J. PERMIT N 102 ) HPPLICHNTFl I'A P�O. BX� 197 E�R694�2588 LOCRTION OLBERG RD C: 1711.... LT.1 BK1 LHMPERT ESTD. LOT SIZE 28000 SQUHREFEET MINIMUM DISTHN�� BETWEEN H WELL HND 8NY ON^SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL/ OR 1�0 TO 201.1FEl1 FROM A PU�L 1 C WEL� DEPENDI�� UPO� THE TYPE OF PU�LIC WELL WELL LOGAI'tiE 1: 1' F` 1:::lND MUST BE RETURPlED TO THE DEPHRTMENT WITHIN ]0 I,.'- A, OF THE WELL COMPLETION. OTHE� �EQU��MENTS MHY �PPLYSPECIFICHT�ONS HND CON�TRUCTION 1.) 1' HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION. �� q-IL�� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FClRTH BY THE MUNICIPHLITY OF HNCCl rHGE 2I HLL THE SYSTEM IN HCCORDH�CE WITH THE CODES ~~ .... .... ..... .. -�-�~-�~~ RPPLICHNT LEE SULLIVHN ~^' Trrttffirb l by , A & I, DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 OWNER OF LAND 1-7 i •,r C. -'A1 r :sI ADDRESS DEPTH OF WELL STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION / %> / %r' �," ': T DRAW DOWN FT. DATE - Started �� 7,i Ended GALS. PER HR i PERMIT NUMBER %+' I / r- KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From— Ft. to Pt. From Ft. to Ft. 1>izr'o r'i` t- From Ft. to Ft. From " Ft. to; Yi Ft. From Pt. to Ft. From Ft. toFt. 1 . 27t A_j �i— � � � j>s;',--_, Froin -Ft. to _Ft. From ! ' Ft. to ``r' Ft. 1J INiTj f '!:'-,rr"=r_ r. % r `F;onis '- —Ft. to Ft. From ,%'1 r" Ft. to -(-117t. t`t)t) om Ft to _Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin -Ft. to Ft. From Ft. to Ft. From Ft. to_ Ft. From Ft. to Ft. From Ft. to Ft. Froin—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 - L11� 1 P LITY Of ANCHORAGE i { MUNIc,IP4ITY OF ANCHORAGE DEPT. OF HEALTH & j 5. LEGAL DESCRIPTION �— - -_ -(f - -- - �� - - -- - Lr<. - er-t F,S 6 r.te__s ,r 67 )', - J-0 STREET LOCATION DEPARTMENT OF HEALTH & ENVIRONMENTAL PR_ OTECTIOWVIRONMENTAL N,OI ECTION SINGLE FAMILY 825 Estreat_ -Anchorage, Alaska 99501 - � MUL•rIPLE FAMILY NOV 8197$ 7. WATER SUPPLY �vn�«Q ENVIRONMENTAL ENGINEERING DIVISION ®INDIVIDUAL* 1„;�i� '-Ilr,;yATTACH WELL LOG. A well log is required for all wells drilled Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incompleterequestswill not be processed. Please allow ton (10) days for processing. - - - 1. -PROPERTY OWNER INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date u , o" S�.,(11 8 {ONE Wa e Cous ne-ex, j Z 13ui)cQe.tc by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING, CAN BE INITIATED. MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER -- PHONE �• _ob-4 11IcL 1SC oo rr2rxr� MAILING ADDRESS 3.- LENDING INSTITUTION ��C SV-6' —HONE MAILING ADDRESS 4. REALTOR/AGENT _ PHONE - -North S -cc' L exo 1;. pQt-HuV✓Ivne-1 - 9 y-3'7.00 . MAILING ADDRESS - '. 0 ' R ox 7 si E �41'S 191've-r , �K: 9-7 s � �7` 6 - 5. LEGAL DESCRIPTION �— - -_ -(f - -- - �� - - -- - Lr<. - er-t F,S 6 r.te__s ,r 67 )', - J-0 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One E] Four El Other Q Two ❑ Five MUL•rIPLE FAMILY Imo'- Three E] Six 7. WATER SUPPLY �vn�«Q Se ®INDIVIDUAL* 1„;�i� '-Ilr,;yATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY h L 4,411” Iry since June 1975. For wells drilled prior to that date, give well E] PUBLICUTILITY by , 4 DgSdepth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM oY e INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date u , o" S�.,(11 8 ❑ If system is over two (2) Years old an adequacy test is -required PUBLIC UTILITY - by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING, CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY - INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY 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 DATE INSTALLED �y b INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1 000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTU ER TOTAL ABSORPTION AREA MATERIAL Y 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR 3— BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE -/A BY (Title) LEGAL ESCRIPTION 72-010 (Rev. 3/78) • Municipality of Anchorage s ` On -Site Water and Wastewater Program (907) 343-7904 < < Parcel I.D. 051-102-55 Certificate of On -Site Systems Approval `4a 'a'2 >F A. R � � �015 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lampert Estates, Block 1, Lot 1 Location (site address) 22733 Friendship Lane Chugiak, AK 99567 Current Property owner(s) Christopher & Chantelle Van Wyhe Day phone Mailing address Real Estate Agent 22733 Friendship Lane Chugiak, AK 99567 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received by: Day phone TYPE OF WASTEWATER DISPOSAL: Individual it Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be relea4d to the)engoeer, unless otherwise requested by the engineer. COSA Fee $ �52 t'd — Date of Payment g1.3_115 Receipt Number5— COSA # O Date:/A. `3. IS Waiver Fee $ Date of Payment Receipt Number 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 Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE _�Z� System #1 Approved for System #2 Approved for Disapproved Conditional approval for 522-7773 Date dll�� OF so 49TH bedrooms el;MICH � C4 ANDERSON �� Ob bedrooms., _ bedrooms, with the following stipulations: Original Certificate 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 - ors 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 £' i u 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: Lampert, Block 1, Lot 1 Parcel ID, 051-102-55 A. WELL DATA Well type Private If A, B; or C provide PWSID # Well Log (YIN) Y Y Date completed 4/5/78 Sanitary seal (YIN)Y Wires properly protected (YIN) Total depth 202 ft. Cased to 202 ft. Casing height (above ground) >18 in. Date of test Static water level Well production. FROM WELL LOG 4/5/78 WATER SAMPLE RESULTS: 153 ft. 18 g.p.m. AT INSPECTION 3/10/15 158 fL 7.5 g:p.m. Coliform 0 colonies/100 mL Nitrate 1.77 mg/L Arsenic ND ug1L Date of sample: 3/13/15 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA TankType/Material Septic/Fiberglass Tank size 1,000 gal Number of Compartments 2 Date installed 8/78 Cleanouts (YIN) Y N Foundation cleanout (YM) _Y Depression over tank (Y/N) N High water alarm (YIN) Date of pumping 6 — iZ-N Pumper 71?—.% 110 M P1 ki Q C. ABSORPTION FIELD DATA Date installed 7/28/88 Soil rating (g.p.d./ftz or ftp/bdrm) 225 SF18oRM System type Trench Length 117 ft. Width 3 ft. Gravel below pipe 3 ft. Total depth 8.5 ft. Eff. absorption area 702 fe Monitoring tube Y Depression over Feld N Date of adequacy test 3/10/15 Results (Pass/Fail) Pass . For bedrooms Fluid depth in absorption field before test 0 in. Water added 1,320 gal. New depth 17 in. Elapsed Time: 1,440 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 No Add On Manhole - Gravity Flow to Absorption Trench. Date installed Size in gallons Manhole/Access (Y/N) "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 Absorption field on lot >1 00' On adjacent lots Public sewer main N/A Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO >100' > 100' Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas >100' Building foundation >51 Property line >5 Absorption Feld >51 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 Service line >10' Surfacewater >100' Curtain drain None Noted Wells ori adjacent lots >100' Water main N/A Driveway, parking/vehicle storage > 10' F. COMMENTS 46' Long x 7' Effective Depth Absorption Trench Constructed in 1878 is. Still in Service. Additional Absorption Trench System was Installed in 1988 and Overflows from Older Trench. Surveyor As Built on File Shows Septic Vents currently on Site.Several en are missingTrom Original Installation. System Previously Tested and Approved in 2011. G. ENGINEER'S CERTIFICATIONww`n�G,eeIt4 I certify that t have determined through field inspections and i \; ''" •�: Jf'�� P review of Municipal records that the above systems are in r conformance with MOA COSA guidelines in effect on this date. Michael E. Anderson, P.E. •• ••• i Engineer's Printed Name ...� ... *.MICHAEL 4/2/2015 E.ANDE.SON - A E. ANDERSON W a a' Date CE -4381 COSA brown sheet_10-10-12.doc 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 Parcel I.D. 051-102-55 1. GENERAL INFORMATION COSA# U5 C_ 11� � Expiration Date: / I - / o l Complete legal description Lot 1 , Block 1 , Lampert Estates Location (site address) 22733 Friendship Drive, Chugiak, Alaska 99567 Current Property owner(s) Mailing address Lending agency Mailing, address Real Estate Agent >: Lillian Schoonmaker Dayphone(907) 688-9038 22733 Friendship Drive, Chugiak, Alaska 99567 Day phone Jim Ewing @ RE/MAX of ER Dayphone(907) 229-9660 Mailing Address 11525 Old Glenn Highway, Eagle River, AK 99577 Unless btherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF.WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site FE Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 Pinard Engineering Phone (907)357-3647 Address PO Box 871347 Wasiiia, AK 99687 Engineer's Printed Name Paul E. Pinard, Sr, P.E. Date a;I QP efam A. P 5. DS, D SIGNATURE ®g h V Approved for bedrooms. 0 pp 4..� bedrooms. �� , Disapproved. Conditional approval for bedrooms, with the following stipulations: OF,� ;� oNs�TE '••,� WAT R AN4- WASTEWATER Am �4ENT SEVV�,�� Jll)1)`l, Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: - G�°�' t Original Certificate Date: (Rev. 11105) Municipality of Anchorage • �`` Development Services Department a {a Building Safety Division ` On -Site Water & Wastewater Program s" K'v 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 1 , Block 1 , Lampert Estates Parcel ID: 051-102-55 A. WELL DATA Well type Pvt Date completed -4L5/78 Total depth 202 ft. Date of test Static water level Well production If A, B, or C provide PWS ID # Sanitary seal (Y/N) Y Cased to 202 ft. FROM WELL LOG /.15.17R 153 ft. WATER SAMPLE RESULTS: W 9.p -m. Coliform 0_colonies/100 mL Nitrate 1 .35 mg/L Arsenic: ND ug/L date of sample: 7/20/11 B. SEPTIC/HOLDING TANK DATA Tank Type/MaienaPlt�''i�erglass Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 7.12 / 1_»___1 158.8 ft. 5.3 9.p -m. Collected by: Pinard En gin r i n g Date installed 8/78 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NA Date of pumping 7/27/11 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 28 8 Soil rating (gqxivr ft2/bdrm) 225 System type Sh i i ow Tran ob Length 117 ft. Width 3 ft. Gravel below pipe 3 ft. Total depth8_ft. Eff. absorption area702 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/25111 Results (Pass/Fail) Pass For_3 bedrooms Fluid depth in absorption field before test 1 in. Water added 640 gal. New depth 1 in. Elapsed Time:120 min. Final fluid depth 1 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (Y/N) "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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lots 1001+ Absorption field on lot 1001+ On adjacent lots 1001+ Public sewer main NA Public sewer manhole/cleanout NA Sewer /septic service line 251+ Holding tank NA Animal containment areas 1001+ Manure/animal excrete storage areas 100' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' + Property line 5' + Absorption field 51+ Water main NA' Water service line 101+ Surface water 100'+ Wells on adjacent lots 100' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 51+ Building foundation 10' + Water main 10' + Water Service line 10' + Surface water 1001+ Driveway, parking/vehicle storage 25' + Curtain drain NA Wells on adjacent Iots100' + F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and h ' review of Municipal records that the above systems are in • o:. conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard, Sr. P. E. Date 8/4/11 V COSA Fee $ Date of Payment Receipt Number (Rev. 4/10) Waiver Fee $ Date of Payment Receipt Number o AS -BUILT I hereby certify that I have surveyed the following x described property '0 s` I r a ��+, r U L ,,. Anchorage Recording Precinct, Alaska, and that the �� OF Al �� improvements situated thereon are within the property 'i 0".0800e,, � �I 47 lines and do not overlap or encroach on the property �*t �p /�. I � r' ( lying adjacent thereto, that no improvements on prop- ssj a `9 �r J erty lying adjacent Thereto encroach on the premises in 9th -7-1 I question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. ssig�ab7+ems-�sba�ascwsae.�"�.� /''�'�w' Dated at Eagle River, Alaska a Hebert C. 0hnson �y o� NO 880.5 a � t� this _ -Z — day of M/R_.!" d>ROBERT C. JOHNSON �daP°��"8000'0 . SCALE: Registered Land Surveyor No: 88b=LS �s��i�r?��ve��'�r�r "' — 3 d Box 456, Eagle River, Alaska Phone 694-2543 SGS Ref.# 1113267001 Client Name Pinard Engineering Project Name/# Lot 1, Bk 1, Lampter Client Sample ID Lot 1, Bk 1, Lampert Matrix Drinking Water PW SID 0 Printed Date/Time 08/04/2011 11:40 Collected Date/Time 07/20/2011 11:40 Received Datefrime 07/20/2011 13:50 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 ug/L EP200.8 C (<10) 07/21/11 07/25/11 NRB Waters Department Total Nitrate/Nitrite-N 1.35 0.100 mg/L SM20 4500NO3-F B (<10) 07/21/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 07/20/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 07/20/11 DLC �■� nj2- 011 17:05 FROM:JR'S SEPTIC PUMPING 9073449821 •TRs Pumping -C PO Dox 773415 Bagle Rivcr, AK 99577 (907)694-6454 tilling. Information.. Lillian Schoonmaker Job Description: 1000g Po BOX 670502 P.O. Number: Chugiak, AK 99567-0502 (907) 688.9038 Job Site Information_„ ... Jim - Remax 22733 Friendship Lane Chuglak, AK 99567 (907) 688-9038 Terms: Net 30 Salesrop: Karlia Map gook: TO:6960214 Service Agreement Number: 033942 Order Date: 26 -Jul -2011 Service Date: 27 -Jul -2011 Technician: Dan Tax W 0 Job Type: Repeat Map Grid: 28 Cross streets: Oberg Road Job Comments: L• st Sery 12/12/2006" tank levels. ok back Flushed 1 time clean outs & leach field ok Additional Location Comments: Diagram:. S:tD1aAr0ma1987a4.bm Park on Oberg Rd and please "be Friendship careful of lawn", try not to park on it Task - back in dw, not into yard. Wood -natural home w/ Vs.Pipes 0 back FYI Obcrgitd Park on Ober; Service Typo Qty Price Each Tax? Septic Sery 1000K 1 $195.00 No 1000g Gallons Planned: 1000 P. 1/1 Gal. Actual: Hose Length: 1 ©ouble Tank: n Pump System: [V7J Baffles Inlet. ❑ Baffles Outlet: ❑ ��„` Extenclon Actual $195.00 NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charges. $195.00 $0.00 $0.00 $195.00 Actual Charges: Customer agreec to tho torma and conditions shown. THIS IS A BINDING AGREEMENT. n TI 1 Customer Representative et 114 L -) , 1, Accepted by JRs Pumping Or+le Accepted For your added convenience we accept; Dlcover, Visa and Maslen Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. $30.00 For NSF Chocku Returned. PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 1, Block 1, Lampert Estates APPLICANT: Lillian Schoonmaker 22733 Friendship Lane Chugiak, Alaska 99567 SEPTIC TANK TYPE/SIZE: Fiberglass/1000 Gallons, per MOA Records ABSORPTION SYSTEM: Shallow Trenches, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAUBR = 450 Gallons TEST DATA JOB NUMBER: 11-216 DATE OF TEST: 7/25/11 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments AM (GPM) (GALs) (GALs) Liquid Level A Level Monitor Tube 1" A SAS Level Monitor Tube 2" 0 SAS Level 11:10 5.3 - - 4.0' - 0.1' - 0.1' - Start Flow - Meter 139720 11:25 5.3 80 80 4.1' 0.1' 0.1' 0.0' 0.1' 0.0' 139800 11:40 5.3 80 160 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' 139880 11:55 5.3 80 240 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' 139960 12:10 5.3 80 320 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' 140040 12:25 5.3 80 400 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' 140120 12:40 5.3 80 480 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' 140200 12:55 5.3 80 560 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' 140280 1:10 - 80 640 4.1' 0.0' 0.1' 0.0' 0.1' 0.0' Stop Test - 140360 RECOVERY Date Time SAS MT1 SAS MT2 `ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: System appears to be operating satisfactorily. There was 0.1' of measurable liquid in the SAS MTs prior to beginning the test. With the addition of 640 gallons to the system (significantly more than the design daily flow), the levels remained constant (no change) throughout the test. Reviewed by: Paul Pinard Date: 7/31/11 LOCATION: Lot 1, Block 1, Lampert Estates DRILLER: A & L Drilling Company DATE WELL COMPLETED: 4/5/78 WELL DEPTH: 202' STATIC WATER LEVEL (top of casing): 158.8' PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST JOB NUMBER: 11-216 DATE OF TEST: 7/25/11 FIELD STAFF: PJ Pinard Time Elapsed Time Minutes Static Water Levelm Flow Rate Cumulative Gallons Pumped i 10:10 AM ---- 158.8' 5.3 --- Start Test - Meter 139720 10:25 15 161.1' 5.3 80 139800 LOCATION: Lot 1, Block 1, Lampert Estates DRILLER: A & L Drilling Company DATE WELL COMPLETED: 4/5/78 WELL DEPTH: 202' STATIC WATER LEVEL (top of casing): 158.8' PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST JOB NUMBER: 11-216 DATE OF TEST: 7/25/11 FIELD STAFF: PJ Pinard Time Elapsed Time Minutes Static Water Levelm Flow Rate Cumulative Gallons Pumped Remarks 10:10 AM ---- 158.8' 5.3 --- Start Test - Meter 139720 10:25 15 161.1' 5.3 80 139800 10:40 30 161.1' 5.3 160 139880 10:55 45 161.1' 5.3 240 139960 11:10 60 161.1' 5.3 320 140040 11:25 75 161.2' 5.3 400 140120 11:40 90 161.1' 5.3 480 140200 11:55 105 161.1' 5.3 560 140280 12:10 PM 120 161.1' 5.3 640 140360 12:25 135 161.1' 5.3 720 140440 12:40 150 161.1' 5.3 800 140520 12:55 165 161.2' 5.3 880 140600 1:10 180 161.2' 5.3 960 140680 1:25 195 161.1' 5.3 1040 140760 1:40 210 161.1' 5.3 1120 140840 1:55 225 161.1' 5.3 1200 140920 2:10 240 161.1' - 1280 Stop Test 141000 RECOVERY 3:15 5 158.8' All well protection features are adequate. Average Flow Rate: 5.3 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF PRODUCING 5.3 GPM. THIS TEST DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. I Reviewed by: Paul Pinard Date: 8/1/11