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HomeMy WebLinkAboutBOB WELLS BLK 1 LT 4Bob Wells Lot 4 Block I #067-042-04 Municipality of Anchorage P~ee DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report '~: ~ ~ ~y Waslewater System: ~New ~ Upgrade Township: ~ Range: J Section: Fill added~,~above original grade:~l. Gravel length: ~ Fl, ~O FL Classificatio~ (Privale, A,B,C): Total Depth: Cased To: ~EPARATION DISTANCES ~s~c u Holding ~ S.T.E.P. From Tank Field Slation Tank Sewer Lines ~ ~ % Wmer ',00~ [~0'+ ~ LIFT STATION Line 6~' ~J Size in ga'°ns:I Remarks: 7&~ ct¢ R$~z~,~eO ~o~,~¢ BENCH MARK Inspections performed by: s: ls Department of Health and Human Services approval 72-013 (Rev. 9/9D MOA 25 PERMIT NO. SW990422 PAGE 2 OF 3 Municip. ~ti~ oF Anchoroee DE?ARTHENT OF HEA~TH AND HUPfAN SERVICES ENVIRONHENTAL SERVICES DIVISION P J], ]}ox 196650 ®Anchorage, Alaska 99519-6650 ®Telephone: 343 4744 ON=SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 1, BOB WELLS S/D P.I.D, NO. 067-042-04 (ISTING 3 BDRM 1000 GALLON POLYETHYLENE SEPTIC TANK DBL1 & BBL2 DV (DIVERTER VALVE) ST1 MT2 ~T1 SCALE: 1" = 40' 'x 'x % %, C. COWAN ~ x. x. CE -8801 PERMIT NO. SW990422 PAGE 3 OF 3 ~uniciDo, U~ o¢ /~nck/oPo, Qe DEPARTMENT OF HEAETH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 ~anchoraBe,A[aska 99519-6650~Te~ephone: 343-4744 ON-SiTE ~AST~ATER DISPOSAL SYSTEM AND/OR ~ELL iNSPECTION REPORT LSGAL LOT 4, BLOCK 1, BOB WELLS S/D P.I.D. NO. 067--042--04 --FINAL GRADE ~__~7.4' 93.2' NEW 1000 GAL. POLY. TANK 93.0' FINAL GRADE CO1 =84.0' /-C02=81.5' c CO1 =79.2' 02=79.2' N.T.S. WATER FOUND 66.0' B.O.H. A B FCO 5.5' 19.5' ST1 11.0' 28.5' ST2 14.5' 30.5' DBL1 18.0' 33.0' DBL2 19.0' 34.0' DV 46.5' 58.0' C01 80.0' 96.0' MT1 83.5' 100.0' C02 109.5' 129.5' MT2 106.0' 126.0' C03 64,0' 74.0' MTl=72.1'/ MT2=72.O' NO 1" = 100' SITE PLAN DESIGN ~0 1" i 40' SITE PLAN DETAIL ~ , ,C~'¢ ,, ~ ~,. ,.,,%,, ~o ~ ." I,; /~ / --_ / 100' WELL RADIUS I 10-15% ~ , < m ~ ~ ~ / / N~/ ~zo~j / ~~ ~ ~~ / / oo ~X' /~ ................................................. z Om ~TmN -~. -~ ........................................... ~° Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: .~O~' ~.~/~-(// LEGAL DESCRIPTION: '~4; ~ '/~ 1 2. 3 4 5 6 7 9 10 11 12 13- 14--- 15- 16 17 18 19- 20- COMMENTS ~:~.'¢~ ~g)/c~.Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ ~L DEPTH? p E Dolllh to Water Altor/q/}d Monitoring? ~1~-~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~,'~V II///¢~) PERCOLATION RATE /~ ' (minutes/inch) PERC HOLE DIAMETER TES'I' RUN BETWEEN ~"~- FT AND ~' FT ACC ~ ~e River, Alaska ~95~ ...... o DANCE WITH ALL ~ATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-008 (Rev. 4/~) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 30, 1999 Expiration Date: Nov 29, 2000 Permit Number: SW990422 Legal Description: BOB WELLS BLK 1 LT 4 Design Engineer: 0003 S & S Engineering Owner Name: Doug Gray Owner Address: 11411 Old Glenn Hwy, EAGLE RIVER, AK 99577- Parcel ID: 067-042-04 Site Address: 026066 LOG CABIN CIR Lot Size: 55527 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [~ SepticTank ~-] Holding Tank [~ Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: "),/~ 7-,~ ~--r-/~ Date: Issued By: Date: //- 7~ --~' 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 /.¢ON E I .~'NEW NAME Manufacture~~ ,' g~ons IF HOMEMADE: Inside length M a nD~ fSaTc tAuNr eCrE T O: We ~.4~f/~t~ Dwelling Width NO. OFBEDROOMS~_~ ~artments Z Liquid depth PERMIT NO. Material Liquid capacity in gallons DISTANCE TO: No. of line~ Top ~e't~ f.~sh Length Type of crib Width Crib diamete Well DISTANCE TO: :rib depth Building fOundation inches inches ~ICE TO: Building foundation Sewer line OTHER PERMIT NO. area Total effective absorption area Nearest lot line Distance to lot line PERMIT NO, Septic tank Absorption area(s) PIPE MATERIALS soil TEST.ATI INSTALLERs,~ REMARK~ ~ '2y13 (Rev. 3~78) [:,E!:::'F1F.:'TMENT HEFILTH FI. ND EN',/I ROf',ff'tEi'.~,TFIL. ,;::OTECT I CLN 825 '" L '" STREET., FII'.,ICHOF..',RGE, FIK. '995E~i 264-,::1.?;F'0 ,:..:~ II"-~ ...... :..E~.; ][: 'T E: ]:=-'-; E I1.....il E_- F: F' EE IFil: l"'! ][ ,.'.' ',::20622 ::, ,? FIF:'F::'L. ICFtNT[:,OUG GRFIY 4058 F'IFIND CT FIf..!C!--t t_ 0 E: FI T I 0 t'.,I L E ::iFIL. L4 B:I..,~ HEI,,.LS (_ ¢o~b~ I,...OT S I ZE TYPE OF SOIL. FtBSORF'TION SYSTEM IS: TRENCH MFIXIMUM NUMBEF: OF BE[:,ROOMS = ;:_:.". 4 :,~: - [.~LE :1.7 4]:5E, E~. S~])UFIRE FEE:T SO I L F.'.FtT I NG (Sg! FT,-"BR > = :1..50 THE REQL,IIRE[:, SIZE OF THE SOIL FtBSOF.'.PTION SYSTEM IS: 'T'HE I...EI'qGTH [:, I MENS I ON IS 'T'HE LENGTH < IN FEEl"::, OF ]"HE TRENCH OR DRRINFIEL. D. THE [:,EPTH OF' R 'TRENCH OR PIT IS ]'HE D ISTFtNCE BET.WEE:N THE SURFRC.'E OF 'THE GF;.:OLIND RND ]"HE BOTTOM OF' THE E::'::C:RV.FITION ,::IN FEET). THERE iS=.; NO SET HIDTH FOF.: TRENCHES. ]"HE GRFI',,,'EL. DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL 8ETI4EEN THE OI,.rTFFtLL. PIPE RN[:, ]"HE BOTTOM OF THE: E',,.'-iCR',,,'Ft'T'ION ,::IN FEET). PERMIT FIF'F'L. ICFINT HRS THE RES;PONSIBIL I"I"Y TO INFORM 'T'HIS DEPFIRTMEN'T' [:,LIR!I'.,IG THE If.,ISTFIL/.JR]~ION INSPECTIONS OF RN"r' HELLS RDJRC:ENT TO "ri-liS PROPEF..:TY Bf.,ID ]"lac 1'41...Ir,'tBER OF." RESIB, ENCES THRT THE HELL .WILL SER',,,'E. ................ 'T #-,-~ C, ,:.'. ;2::: :::, ][ I"-,1'_-}::; F' E: E:: Ir' :[ cIl'-.l"'_:~; taFt:E: F~:E ,::.~b~ 2[ BFtC. KF'IL. LING OF' RN'.-r' SYSTEM HITHOUT FINFtL iNSPECTION RN[:, RPPROYRL BY THIS E:,EF'FIRTMENT t.4IL[.. BE .SLIBCECT TO PROSECUTION. MINIMLIM [:,ISTFINC:E BETI.,.IEEN R HELL RN[:, ANY ON-SITE SEI. qRGE [:,ISF'OSFIL SY~.::';TEM IS :1. OO FEET FOR FI PR IVFITE I,.IEL. L OR :250 TO 200 FEET FF.'.OM R PUBLIC HEL. L DEPENDING UPON THE T"r'F'E OF PUBLIC t,.IELL.. MINIMUM [."ISTFff4CE FROM Ft PRI'¢RTE: HELL TO R F'F.:I',,,'RTE SEI.qE:R LINE IS 25 FEET RN[:' TO FI COM. MUNITY SEHER LINE IS 7'F'[ FEET. OTHER REQU I REMENTS MFI"r' RPF'L.Y. SPEC:I F I CRT I ON"--'] RN[:' CONSTRUCT I ON [:,I FIGRFIMS FIRE F!',,,'FIIL. FtBL. E TO INSURE PROPER INS'T'FtLLFtTION. i CEF.'.T I F'"r' THR"F ::1..: i RI"1 F'FIHILIRR WI]"H 'THE F.:E6.!UIREMENTS FOR ON-SITE ::;EHERS FIND .HELLS FIS SE:]" FORTH BY THE MLINIE:IPFIL. ITY OF FINCHORFtGE. ;:.2: i HILL IN:.'.::;TFIL. L THE SYSTEM IN FICC:OR[:'FtNCE P~ITH THE CEE)ES. 3: I UNDERL-'.;TRN[:, THFIT THE ON-:::;ITE SEWER SYS.,TEM MFIY RE6~UIF.:E ENLFIF.:GEMENT IF' THE RESIDENCE IS REMO[:'E:LED TO INCLUDE MORE THFIN ]: BEDROOMS. Y4. 0 SOILS LOG ~---~:-~- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORm, ED FOR: b("0t/t d- · I L \ SITE PLAN 10 11 12 14 17 N~. 2O COMMENTS PERFORMED BY: ~,,..~., ~m~ ~J~I~A~ ' '~ 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop (minutes/inch) PERCOLATION RATE ,~//f'/J~ .~T/J TEST RUN BETWEEN AND -- FT CERTIFIED _ _ DATE: Petit ~ MUNItIPALITY OF ANCHORAGE Department ~' Health and Environmenta3 ~rotection 825 ~ Street, Anchorage, AK. 79501 264-4720 ~ ~ ~ HANDWRITTEN PERMIT ~ ~ ~ WELL AND/OR ON SiT~ SEWER PERMIT Location: Legal Description: T~e of Soil ~sorption System I.s: Trench: Maximum N~ber of Bedrooms: Mailing Address: Phone Number: Seepage Bed: ...... Holding Tank: Soil Rating (sq.ft/br) The Required Size of the Soil Absorption System Is: ' DEPTH "'"'-'~'"' LENGTH ........ GRAVEL DEPTH " ..... WIDTH , .... , ..... Th~ 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 = ........ --"'~'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 ~1~ 1 9 S 2 * * * 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) I understand that the on-site sewer system may require enlargement if the residence/~s remodeled S igne~ Ap'p 1 ~can~ to include more that 3 bedrooms. Date: SWP/024 (i/si) by DOC Co. dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION /: ,,:'~':-/< / ':~ ~:' / DATE - Started ~ / //' Ended PERMIT NUMBER DEPT. OF WF~LL / "3 ? STATIC LEVEL OF WATER FT, C/~:tC4 ~z-.~RAW DOWN FT. '7/'/ ) /,/? ~' GALS. PER HR KIND OF CASING KIND OF FORMATION: 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 :~, ,,'~i Ft. to / .) ,Ft. From. 7 ) .... Ft. to ,~ ,v Ft. From [ ,',:: Ft. to i Ft. ~-' From ?' /,}> Ft. to ' '-:' Ft. From ' :' Ft. to,/<g ., .. ) 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__ From Ft. to Ft. From__Ft. to__ From~Ft. to Ft. From Ft. to From Ft. to Ft From__Ft. to MISCL. INFORMATION: DRILLER'S NAME UMC PAUTY of ANCHORAGE Development Services Department _ -' Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 067-042-04 1. GENERAL INFORMATION Complete legal description BOB WELLS BLOCK 1, LOT 4 Expiration Date: 1(9-2--l-21 Location (site address) 26066 LOG CABIN CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) DONN & JULIA BENNICE Mailing address Real estate agent Day phone 26066 LOG CABIN CIRCLE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _67_50 Waiver Fee $ Date of Payment 7 2 1 Date of Payment Receipt Number Receipt Number COSA # 0.5G21 1333 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/15/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the tt\\\\\l system and maintenance. The operational life of all well and septic systems are subject to r'��i1 these various and dynamic characteristics and are outside the control of the evaluator of the Pi . well and septic system. Therefore, any estimate of how long a system will function satisfactory /��g�.. • • • for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & FWCTH S ' * • , , , , ,•;* r 6. DSD SIGNATURE r • ' • Curtis Huffman j System #1 Approved for bedrooms � c� CE 128991 System #2 Approved for bedrooms l�iF�PROFESSIONP� Disapproved Conditional approval for /bedrooms, with the following stipulations: r I ev' cc/ /-h ► I'`v T n I�[�c F7� V IF t"� i g lu 1/1 ON -RITE_ 'Y WATER AND m� WAZTT _v, R z� PRnrE A A SER\1� Original Certificate Date: - Z 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 Legal Description: BOB WELLS BLOCK 1, LOT 4 Parcel ID: 067-042-04 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) Date drilled 7/21/1982 Total depth 149 ft Cased to 40+ ft (PER MOA DOCS). ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/18/2021 Static water level at beginning of test 30 ft. Well production at time of test 5+ gpm Comments B. TANK DATA Age of tank(s) 21 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank 40" ® Standpipes/foundation cleanout per record drawing Date of pumping 5/18/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/31/2000 ® ALL standpipes present per record drawing Total measured depth from grade 11.7 ft (max) Measured depth to pipe invert from grade 4.6 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.41 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWD% Collected bye - Date of Sample 5/18/2021 - C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/18/2021 Results M Pass For 3 bedrooms Fluid depth prior to test 47 in Water added 450 gal New depth 63 in Elapsed time 1350 min ® Code -required soil cover over field Final fluid depth 45 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date NE Comments/Deficiencies: 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 if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if -ft Manure/Animal Excreta Storage > 100' Building Foundation > 10' 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 *5+ ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: 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 —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes ' if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER CODE AT TIME OF INSTALL. G. ENGINEER'S CERTIFICATION l 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. �. ���� •.!v •Z..,.: ..... �. Curtis Huffman ' .• �� �'F�,%•. CE 128991 .•�e4`4A. 6125/2921 ���l�a° OfESSONP��cm LOT 3 BASIS OF BEARING LOG N90°00'00"E 210.00' (R&M) CABIN 83.2 CIRCLE GRAVEL 50.0' D/W EXISTING " WELL HOUSE A 26.0' k WALK o DECK r a 24.0' 0 0 e Q (J7 00 00 Cd0 �- eco et 00 ® N 0 C Crl e SEPTIC :::j Lfl W ® ® o VENT r (typ) M 0 crnn N -A N OCA °-� LOT 4 1 ow o BLOCK 1 ` -� z v / \ \ oy \ 581.08 16 ,E I / \ \ (S80-58, 32"E S80°5g,32„E 267.89' ANCHORAGE RECORDING DISTRICT, ALASKA 268.20' R AS -BUILT OF: BOB WELLS SURD LOT 5 LOT 4 BLOCK 1 PLAT 79-32 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a ©F' A ��� vDLANbRjr� physical survey of this property as shown on this drawing and that the �� . • `4�� CSL ��O Sj� �� improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should �. 4TH any information on this drawing be used for construction of fences, '�� structures; improvements, or for establishing boundary lines. � ....... • � • � r� � � . J � . � r v o r EXCLUSION NOTES: It is the owners responsibility to determine �' ' ' ' ' ' ' ' ' \...... c� the existence of any easements, covenants, or restrictions which s '.JOHN L. SCHULLER: ' o0 do not appear on the recorded subdivision plat. LS -10408 ,,,i, ;, •' J" ® 1831 Talkeetna Street WORK ORDER NUMBER: Darc scntF E-MAIL- P -1 - i 4j a 6190 Anchorage, Alaska 99508 JULY 24, 2021 1"=40' schullerIIvk.net A 21-111 �V' BY: CHECKED BY CRUD NUMBER' BDDK/PacE: ro f essiono\ � W (907) 227-1455 office JLS SWo363 210234 (907) 274-4992 fax '~' -~!"~ MUNICIPALITY'OF'i DEPARTMENT OF HEALTH AND ENVIR~NMENTALPRO DIVISION O! 'INSPECTI ~*"~:.!: OF ON-SITE SEWER~AND ~ ~. !:~264-4720 21, ~GENERAL INFORMATION i i. ~ :'~ ,~ "'?'i :" ~' · include lot block, Location (address or 'directions) '':! ';'i..'. Mil~ I, '.Eagl~ River Road ' "~ "'""~ 279-5508 (b) Applicant Name Docc~la6 R. .... G~a~ Telephone: Home 694-52~2 '"::~' '~ Business~'~:~:'~: Applicant Address SR 1790, Ea~l~ Riu~ Ro~d, Ea~l~ ~v~, Ala6k~ 99577~ (c) Applicant is (check one):.Lending Institution D; Owner/builder ~; Buyer D; Other ~ (e~plain); ~'t'~' :' (d) ?:~': Lending i~t?[ion~,~: c~~ .............. ,~ ............ ~ -~ ........ ' ...... ~ (e) Real Estate Company and Agent EOA~/A~ZA~A~A3 · Address Telephone (f) . ~{~C[he HAA to the following address: S ~: S Enginee)ting SRB 196X Eagle River, Alaska 995~7 HOlding Tank l . ' ..Onsite I-'1111; 'Comm ntyr''l i~' Note: If community well system, mUst have.written .con!!.r~ation,.!rom the State Departme~! 9f E.,~,n.?!,r~nment~! Co,ns~rvation ';"'..: i 5. ENGINEERING FIRM PROVIDI, INSPECTIONS, TESTS, FILE SEARCH, D [ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/c r wastewater dis posal system is 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 .~ i'il ~ ~ wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on ~'the date bf ~this inspection, .!.~ !;,. : ' Name of Fi~'m ~ ,e.. '¢ ~'k~k~'~'~.,~.~ Telephone Address ' ' Date ..... JUL.,- lUUb DHEP APPROVAL Approved for '~'~'~--~ _~..~bedrooms by Approved '~ Disapproved Terms of Conditional Approval Conditional ~CAUTION The MUncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or 'analyze data, before'a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional eng neer s work. -:,, WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) I~UNICIPAUTY OF ANkH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTi(~/~IECKLIST- FEBRUARY 1984 264-4720 · !~..i ~_ 0 ~ ~ Legal Description: ~ff' RECEIVED Well Classification Well Log Present (~N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~/N) Separation Distances from Well: To Septic/Heidmg Tank on Lot /---~'~' If A, B, C, D.E.C, Approved (Y/N) Date Completed '7-?---~. - B1.'' Yield Cased to ~AF~ ! . Depth of Grouting ..~...~, r Pump Set At I~ /.~D ' Sanitary Seal on Casing ~N) Depression Around Wellhead (Y/l~ ; On Adjoining Lots To Nearest Eage of Absorption Field or.~ 1~ [!~::>~Jr ; On Adjoining Lots To Nearest Public Sewer Line i To Nearest Public Sewer Cleanout/Manhole ~ JP To Nearest Sewer Service Line on Lot & Water Sample Collected by ~ Water Sample Test Results Comments ~J~.4.. ',,J I ~ I' '7.~ ~- ~::~ ~,t~'~''¢=~z~,',-~& ;Date [e-?pO-~:)~, / B. SEPTIC/H4~'DIR~ TANK DATA "7 .'-ID- Date Installed Standpipes (~VN) Depression over Tank (Y~) Pumping/Maintenance Contract on File {Y/N~/~ Holding Tank High-Water Alarm (Y/N) Se paration Distances from Septic/l=t~l~lm~ Tank: To Water-Supply Well / ~ P /,~, Size ~/ ~::~O No. of Compartments Air-tight Caps~N) Foundation Cleanout (Y/~) / Date Last Pumped · for ' Temporary Holding Tank Permit [Y/N) To Building Foundation ~ / To Property Line To Water Main/Service Line Course ~ /= /'~ To Disposal Field /G /'~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed r~ - Width of Field Square Feet of Absorption Area /3/',-~'''~ Depression over Field (Y,~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /,~-~ /~ To Building Foundation Lot P/ta To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~'~' Depth of Field Gravel Becl Thickness Standpipes Present ~)N) Date of Last Adequacy Test To Property Line /~ /-~ To Existing or Abandoned System on · On Adjoining Lots ! To Cutbank (if pr/esent) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) /~ump Off" Level at vent (Y/N) /L~ /T Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t~ ~t, I J3 a_v.e.c_h_e_c ked, verified, or conformed l~(~,a!l'~ QA aad HAA gUidelines in effect on the date of this inspection. & ~NGINEERING " Signed .~R~ ~Y6X Date C°mpa~llL~LF' RiVE~, AK 99577 MOA No. Date of Payment ~ ~~ ~ ~"'~-'/~"~" ~' Amount: $ ~ ~ O Page 2 of 2 72-026 (11/84) · APPLIE ~I'T FILLs OUT UPPER HAL ONLY Buyer Address Zip Code Lending Institution .~ - Phone Realty Co. & A~nt Phone Address ~0~ ~ Zip Code Street Locatlm Type of Rest~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ ~ Other Water Supply ~ ~ ~- Individual ~ ~ ~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community ~ p~F~ ~ ~ ~ ~ ~, P ~ For wells ~llled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector I~CIP,~ .OF ~ICHORAGE Field Notes: ~ ~~./~~ ENVIROHM~;~A~ ~,O ECTION ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CONDITIONAL APPROVAL* _ . o~, ~ /0 ~/~~'/ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ -- ~ Well to Tank Septic T~k Size O 72-023 (3182) t ROBERT C. COWAN, P.E. November 1 O, 1999 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVAL8 SEWER & WATER MAIN EX'rE~IONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORIS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL tEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE W/k~ TEWAT ER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 1, Bob Wells Subdivision It is requested that you issue a permit to upgrade a septic system to serve the three bedroom dwelling on the referenced property. One test hole was excavated and a percolation test was performed on 11/1/99. The approximate location of the test hole is located on the attached site plan. Ground water was monitored and after seven days the hole was dry as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage pattems by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1" = 100' SITE PLAN DESIGN i '/ ~ \, , I m / / ' ' ' ~ o / ,/ / / o / / ~/ / I ~ ~_ / I~ ~ i >~/' I N ~ ~: I' ............................................................................................... o~ ~5 ~_~= Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (EN GI.N~.~.~S SEAL) Township, Range, Section: '~XX<~~ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? s IF YES, AT WHAT ~ L O DEPTH? p E Depth to Water Alter/~t~I [qq Monitorino? Date: J I Gross Net Depth to Net Reading Date Time Time Water Drop ~o ~,~ five" PERCOLATION RATE /0 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'~"- ET AND 6 ET COMMENTS Elide River, Alaska 99577 /"' t,'/ - ' '-' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 30, 1999 Expiration Date: Nov 29, 2000 Permit Number: SW990422 Legal Description: BOB WELLS BLK 1 LT 4 Design Engineer: 0003 S & S Engineering Owner Name: Doug Gray Owner Address: 11411 Old Glenn Hwy, EAGLE RIVER, AK 99577- Parcel ID: 067-042-04 Site Address: 026066 LOG CABIN CIR Lot Size: 55527 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Apchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. ROADDES[GN SOIL TEST ONSITE November 10, 1999 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 1, Bob Wells Subdivision It is requested that you issue a permit to upgrade a septic system to serve the three bedroom dwelling on the referenced property. One test hole was excavated and a percolation test was performed on 11/1/99. The approximate location of the test hole is located on the attached site plan. Ground water was monitored and after seven days the hole was dry as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 067-042-04 1. GENERAL INFORMATION Complete legal description Lot 4; Expiration Date: Block 1; Bob Wells S/D Location (site address or directions) 11411 Old Glenn l{wy, Eagle River, AK 99577 Current Property owner(s) Doug Gray Day phone 694-5282 Mailing address 11411 Old Glenn Hwy, Eagle River, AK 99577 Lending agency Mailing address Day phone Real Estate Agent Kathy Geracci Day phone 694-91 25 MailingAddressll411 01d Glenn Hwy, Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 3 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates ot 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 less than 30 days old. 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. 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 Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and/or wastewater disposal system is 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 in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S&S Engineering Phone 694-2979 Address 17034 North Eagle River Loop, Ste. 204, Eagle River, AK 99577 Engineer's Printed Name Robert Cowan Date 6-13-00 '/,' ENG NEER S" ',, ' . '. ;.- ~1,~?.,',., CE - 8801 .,!,-"'-' ,~:' ': 't~ bedrooms, with the following stipulati6~.~<~2_2~ DHHS SIGNATURE /~ Approved for "~ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: ~ -/Z7Z - 0 o Reissue Date: 75 025 (Re,,' 01'001" Division of Eevironme,,n,t,a, I Services On-Site Services Sec, tion 825 L Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.¢i.anchorage.ak.us (907) 343-4744 Legal Description: A. WELL DATA Well type ~r ;w.]L# If A, B, or C provide PWSID # Date completed 7'~,.~1- ¢o~ Sanitary seal "~5; Total depth 1/-"/'~' ft Cased to '~" ft HEALTH AUTHORITY APPROVAL CHECKLIST FROM WELL LOG Date of test ~ t Static water level "~1 ft Well production ~, --~' g.p.m WATER SAMPLE RESULTS: Coliform '0 colonies/100 mi Date of samp,e: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~-'~2ff'; g'/ Date installed ~/~/~ .nksize ~ gal Cleanouts Y~5 Foundation cleanout ate o, pumpin,_ -- Nitrate 1- ~ b/ mg/I Collected by: Parcel I.D.: Well Log Wires properly protected Casing height (above ground) ~ ~ t- in. AT INSPECTION Ho 5 g.p.m Other bacteria O colonies/100 mi Number of Compartments '~ Depression over tank J~.)~ High water alarm Pumper -- C. ABSORPTION FIELD DATA Date installed ~/~ J/O0 Soil rating ~r ft2/bdrm) Length L/~ ft Width '~t~C,,~fl Gravel below pipe ~ ft Total depth ~ ft Effective absorption area ¢ I ~ ft2 Monitoring tube ~¢.5 Date of adequacy test A,I//~-,/0¢co Results (Pass/Fail) / Fluid depth in absorption field before test~ed__ Elapsed Time: __~......~1 fluid depth in Any rejuvenati,~ (past 12 mo.) (Y/N & type) 72-026 (Rev. 01/00)* O. ~ System type 'T-/'¢n 4 ]q __ Depression over field ~,~0 For --~ . bedrooms gal. New depth in. Absorption rate >= __ g.p.d. If yes, give date __ LIFT STATION ~ Date installed Size in gallons __ "Pump on" level at _ i~~-el ~'~ Dat~'~~ Cycles tested in M an h ole/A(;;c.e~s& ..... ~ High water alarm level at in Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on Jot Absorption field on lot Public sewer main //~ Sewer/septic service line On adjacent lots /O0"f'- On adjacent lots l O0' 4- Public sewer m/~h~/cleanout JU/i~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main //~/~ · Drainage Property line ~ ~ Water service line Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Propertyline ¢/' Building foundation -7 Water Service line JO"/- Surface water )O0~- Curtain drain /~o/4~ ~//,~/,~r~ Wells on adjacent lots Absorption field Surface water Water main Driveway, parking/vehicle storage F. COMMENTS 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 Date (¢//3, HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00}* Parcel I.D. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 067-042-04 GENERAL INFORMATION Complete legal description Lo t 4, Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Expiration Date: Block 1, Bob Wells S/D Doug Gray Day phone Day phone Real Estate Agent Great Land Realty/Kathy Geraci Day phone 694-9125 Mailing Address ll411 Old Glenn Hwy., Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 3 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72 025 IRev 01,'00)' ,<LCEIVED Municipality of Anchorage 09 ~000 DEPARTMENT OF HEALTH & HUMAN SERVICES MAR Env ronmental Services Division MUNICIPALITY OF ANCHO 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)'~-N4~S~Rv~cEs o~ Health Authority Approval Checklist LegalDescription: ~.o'7-* ~-/ ~L.o©~ I ~0,8 ~.c~.~ '~'//0 ParcelI.D.: O~' '7 -O~-/*~.O~ A. WELL DATA Well type Log present(~/N) Total depth Sanitary seal Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed '7/ ~! '/' ~' ~- .... Cased to z../0 '¢' Casing height (above ground) Wires properly protected ~/N) ¥ ~' £ FROM WELL LOG ~)~/~- AT INSPECTION Static water level ~' ) ~ (~ Well production <;;;z. S~ g.p.m. "/' ~ g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate ,/. _7 ~ Other bacteria Date of sample: 3 / ~'/o 0 Collected by: S & $ ENSlNEERIN6 17034 Eagle River Loop Road Ne, 204 B. SEPTIC/HOLDING TANK DATA (' T~ "~'/- ~'~'/~c'a'""~'° ~ Eagle River, Alaske99577 Dateinstailed ?/,~'l%"z- Tanksize ?<)oo Number of Compartments _ ~Z- Cleanouts(~/N) ¥CJ*- Foundation cleanout (Y(~) ~'"~',¢ ~,,.4,~ Depression (Y,(~) .,v O High water alarm (Y . )v 0 Dateof Pumping )0/2,,/tiff Pumper *~-/*~ ~s C. ABSORPTION FIELD DATA (' /-o f:J6 ~76.¢t4,~,o ) Date installed '-'1/IO/ ~ ~- Soilrating (gpd/ff~o~ )5"0 Systemtype Length ' ¢t ,t'- Width ,g- Gravel thickness below pipe Total depth Effective absorption area '~/¢-o ¢-~ Monitoring Tube present (Y/N) Depression over field (Y/N) __ Date of adequacy test I°/l~[~c) Results (Pass~ ~4'C.-''~ For -~' bedrooms Fluid depth in absorption field before test (in.); ,,'l ~ '/'//~ Immediately after 31 ~ gal. water added (in.):_ Fluid depth "~ ! (ins) Minutes later: ) 0 ~ Absorption rate = ~ ':/~-o g.p.d. Peroxide treatment (past 12 months) (Y/N) ,~"~ ~c,.,,.~ if yes, give date