HomeMy WebLinkAboutWENTWORTH BLK 1 LT 24Wentworth
lock I
Lot 24
008-023
-33
(907) 243-7893
KEN JOHNSON
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
3163 LINDEN DRIVE
ANCHORAGE. ALASKA 99~02
Hank Korpi
United Construction
Lot 24 Blk. I Wentworth Sub,
~mohorage, Alaska
0 ft. to 13 ft.
13 ft. to 38 ft.
38 ft. tO 48 ft.
48 ft. to 50 ft.
MUNICIPALITY OF ANCHORAGE
DE~T. OF HEALTH &
ENVIRO~?AENTA[ PROTECTIO~
RECEIVED
Course gravel and b~own silt
Course gravel and grey silt
Same but weeps water
Clean medium gravel and cour~se sand
Water bearing
Test bailed ! hr. at I~'GPM..
Drawdown to 38 ft.
Good recovery
Static water-'level 12 ft.
Claean and clair
Set permanant pump at 4~ ft.
P~mped for I hr. and took water sample
r'
. ��$ 18970 ,7 Et
•� � Municipality of Anchora�e� _
On-Site Water and Wastewater Program -
(907) 343-7904 a OCT 0 9 2017
CERTIFICATE OF ON—SITE SYSTEMS A4 OVAL
o Lc5>
Parcel I.D. 008-023-33 Expiration Date: f"17 !g
1. GENERAL INFORMATION
Complete legal description WENTWORTH BLOCK 1, LOT 24
Location (site address) 3251 EAST 41ST AVENUE, ANCHORAGE, AK 99508
Current Property owner(s) JORDAN & KATHERINE VAN DUINE Day phone
Mailing address PO BOX 1949, VALDEZ, AK 99686
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual ❑
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer
Public Water System ❑
WaiverNariance request for: Distance:
Received by: /40:4 ,(� Date: /0/ 7
COSA to be released to the engineer,unless of, f/requested by the engineer,
COSA Fee $ 57-to " Waiver Fee $
Date of Payment l o/io/i - Date of Payment
Receipt Number (f , $.1 Receipt Number
COSA# CJ CJ?I � Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 10/5/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS (ENGINEERING, SURVEYING,
CONTRACTORS, ETC... ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments:This
investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well'and septic
applies only to the conditions as of the day tested.The flow and absorption rates may change due to subsurface conditions that.may not be
observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and
dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any
estimate of how long a system will function satisfactory for current or future occupants or can ArcTer -.4.-74"-‘4►\,
encroachments,deficiencies or discrepancies exist. OF AZ4
z 4 9 T11
6. DSD SIGNATURE Ir % -1<
System #1 Approved for 3 bedrooms.
KENNETH M.
System#2 Approved for bedrooms. ' c<`%,? G •\w��
reo
Disapproved. 11, t'
\`'116:411
Conditional approval for bedrooms, with the following stipulations:
OF Aivr.4'.,
:=c,Q
— z aN_SITE pr
s \NATER p,�1D
WINSTEWP3- o
PROGRAM
By: L.—/ =%%/lam- Original Certificate Date: U r 7
�,7
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 sheer 10-1O-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: WENTWORTH BLOCK 1, LOT 24 Parcel ID: 008-023-33
A. WELL DATA
Well type PRVT If A. B, or C provide PWSID# Well Log (YIN) Y
Date completed 10/13/1980 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 50 ft Cased to 49 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 10/13/80 9-25-2017
Static water level 12 ft. 14 ft.
Well production 14 g.p.m. 4.7+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L Date of sample: 9/25/2017 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed _ Soil rating (g.p.d./ft2 or ft2/bdrm) System type _
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) _ For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
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 NA - ivvt}" On adjacent lots NA ' /CO‘t-
Absorption field on lot NA - /CV," On adjacent lots NA 'l.00►.—
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank NA '! c.10'r
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line Building foundation Water main
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
Air
.frOF' AI�() 1
G. ENGINEER'S CERTIFICATION / • 7*
t certify that I have determined through field inspections and review of -401 t„,
Municipal records that the above systems are in conformance with MOA # KENNE:1711111111171.,
COSA guidelines in effect on this date. 1 % 71 8 +0.
Engineer's Printed Name KENNETH M. DUFFUS
`_*'•16 4°-
Date 1010512017
COSA canary sheet_2-6-15.doc
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 008-023-33
1. GENERAL INFORMATION
Complete legal description WENTWORTH BLOCK 1 LOT 24
Location (site address) 3251 E 41s:r AVE, ANCHORAGE, AK 99508
Current Property owner(s) ROBERT [AMES Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless o!herwise,requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
COSA # O' i .... -
ExPiration Date: // - / ! -/[
3251 E 41sT AVE, ANCHORAGE, AK 99508
Day phone
Day phone
TYPE OF wATER:SU~'LY:
Individual Well ," []
Individual Water StOrage []
Community Class ' Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen ~
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
~¢""~ Approved for ~._3 bedrooms.
Disapproved.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 08/08/2011
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. Th e
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 duetO 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
Conditional approval for
bedrooms, with the following stipul~t~ff~i:t.,.
~; WATER AND
~ ; · ; -
. WASTEWATER .
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
(Rev. 11/05)
Original Certificate Date:
Length __ ft. Width __
EFT. absorption area__
Date of adequacy test
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE Of ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: WENI3,VORTH BLOCK ~LOT 24
A. WELL DATA
Well type PRtYATE If A, B, or C provide PWSID # .~
Date completed I0f13/80
Total depth 50 ft. Cased to ~
FROM WELL LOG
Date of test . 10/13/80
Static water level 12 ft.
Well production 14 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100mL Nitrate ND mg/L
Arsenic: 6.36 mg/I Date of sample: 7/29/2011
B. SEPTIC/HOLDING TANK DATA- PUBUC SEWER
Tank Type/Material N/A Date installed __
Number of Compartments __ Cleanouts (Y/N)
High water alarm (Y/N) __Date of pumping
C. ABSORPTION FIELD DATA--N/A
Date installed __ Soil rating (g.p.d./ft2 or ft2/bdrm) __
ft. Gravel below pipe
ft2 Monitoring tube
Sanitary seal (Y/N) ___
49 ft.
Parcel ID: 008-023-33
Well Log (Y/N)Y
Wires properly protected (Y/N) Y
Casing height (above ground) 16 in.
AT INSPECTION
7/29/2011
24 ft.
6.8+ g.p.m.
Collected by:' ArcTerra
Tank size ~ gal.
Foundation cleanout (Y/N) __ Depression over tank (Y/N) _
Pumper__
Fluid depth in absorption field before test__ in. Water added gal.
Elapsed Time: __ min. Final fluid depth __ in. Absorption rate >= __
Any rejuvenation treatment (past 12 mo.) (Y/N & type) __
System type
ft. Total depth __ ft.
Depression over field
Results (Pass/Fail)~ For.
New depth __
g.p.d.
If yes, give date
bedrooms
in.
LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
"Pump off" level at
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NIA
Absorption field on lot N/A
Public sewer main 10~'+
- SeWer/septic service line 25'+
Animal'.cO~tainment areas ...5~+
in.
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots N/A
Public sewer manhole/cleanout 100'+
Holding-tank 18~'+
Manure/afiimat excrete storage'areas ..
SEPARATION DISTANCES FROM SEPTIC/HOLDI NG TANK ON LOT TO: - NIA
Building foundation N/A Property line NIA .Absorption field +
Water main Water service line Surface water
Wells on adjacent lots
Water Service line
Curtain drain
F. COMMENTS
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation ~ Water main
Surface water Driveway, parking/vehicle storage
Wells on adjacent lots
G. ENGINEER'S CERTIFICATION
revie, w of Mun!c..ip. al records that the above systems are
conformance w/th MOA COSA guidelines in effect on this date.
Engineers Printed Name KENNETH M. DUFFUS
Date 08/08/11
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev, 11/05)
Waiver Fee $
Date of Payment
Receipt Number
NOTES
T~E AREA DF ~OT e4 GL~ ~, ~ENT~ORTH GUa~ZVZGZON. HO CO~ERG FROM
~E OflXG2HA~ ~AT WERE RECO~O.
2. ~ TITLE ~EAR~ ~ PE~DR~O FOR TH[~ e~RVEY,
~. NO LOT COR~RG ~E~ 5~ DUflZN8 T~XS g~VEY.
0R28 TNAC 6~GN~TUflE.
B. t~TE ~ F~LO~;; EN~OAC~EflT9; T~ NO~ ANg CHAZN CXN~ PENCE ON
EAST ANO T~ ~OUTH. THE AS~LT OR~ FROH LeT ~ ~NTO LOT 2~.
EXCEPT AS 5HDHN.
SGS Reft# 1113473001
Client Name ArcTerra Eng. i~eering and Surveying Printed Date/Time
Project Name/# Wentworth B~L24 08/03/2011 11:28
Collected Date/Time 07/29/2011 12:30
Client Sample ID Wentworth B~gL2~ Received Date/Time 07/29/2011 13:00
Matrix Drinking Wat~ ct~ ,,_ Technical Director Stel~hen C. Erie
PWSID 0
Saml>le Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Hardness as CaCO3 247 5.00 mg/L SM20 2340B C 08/01/I1 08/02/11 NRB
Waters Department
Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B
08/02/11 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 07/29/11 SDP
Total Coliform Negative 1 100mL SM20 9223B A 07/29/11 SDP
Private Individual Analysis
Alkalinity 194 10.0 mg/L SM20 2320B D 07/29/11 NRR
Aluminum ND 20.0 ug/L EP200.8 C 08/01/11 08/02/11 NRB
Antimony ND 1.00 ug/L EP200.8 C (<6) 08/01/11 08/02/11 NRB
Arsenic 6.36 5.00 ug/L EP200.8 C (<10) 08/01/11 08/02/11 NRB
Barium 14.6 3.00 ug/L EP200.8 C (<2000) 08/01/11 08/02/11 NRB
Cadmium ND 0.500 ug/L EP200.8 C (<5) 08/01/11 08/02/11 NRB
Calcium 67200 500 ug/L EP200.8 C 08/01/11 08/02/11 NRB
Chloride 31.9 0.100 mg/L EPA 300.0 E (<250) 08/01/11 08/02/11 SDP
Chromium ND 2.00 ug/L EP200.8 C (<100) 08/01/11 08/02/11 NRB
CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 07/29/I 1 NRR
Conductivity 515 1.00 umhos/cm SM20 2510B D 07/29/11 NRR
Copper 1.49 1.00 ug/L EP200.8 C (<1300) 08/01/11 08/02/11 NRB
Fluoride ND 0.100 mg/L EPA 300.0 E (<2) 08/01/11 08/02/11 SDP
HCO3 Alkalinity 194 10.0 mg/L SM20 2320B D 07/29/11 NRR
Parcet I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. BOx 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
' APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Location (site address or directions)
Property owner ~-'ec~,x ,N~.(,.z~ ('~l~,~b,~ .~,.. Dayphone ~-7z~e~-°~
Mailing aadress
Lendingagency Al'~'r~'o Ho,,~e /-ro,-/~?'¢' Dayphone
Mailing address_
Agent L'~o (/~_,z/~ ~.~< /'¢o_¢~ Day phone
Address ~d"~'.5' De.o(; £/,~ £.j,/~ /~/ ~¢~o~-~j~, ~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
individual well
Community well
Pu 9lic water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community On-site
Publ ~c sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5." STATEMENT OF INspECTION'By ENGINEER ~ .
As certified 'by my seal affixe~ 'herei~'~nd ~s of th; Validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
· and/or wastewater disposal System is Safe, funCti0nal 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 Anchora§~ ~iles and f~om ,my investigation and inspection, the on-site water
supply and/or wasteWatsr dispo~ai syTstem is in' Compliance with all Municipal and State codes,
ordinances, and regulations.in effect on the date of this inspection.. :,
NameofFirm ~'~//~i~ 7-~4~;¢'~f -C~-,,;c~ Phone
Address /¥¢-~o"~c&~~ ~ ~~ ~ ~-/~
Engineer's signature ~~ ~ ~ Date
DHHS SIGNATURE
~ Approved for ~T'-/~-~-(~bedrooms.
Disapproved. 'r ' r
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By;
The Mu~icipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to sati~fy, certain federal and state requirements, Employees of DH HS 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 ~ngineer's work.
72-025(Rev, I/91) Back MOA~21
Municipality of Anchorage ~ E
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Se~ices Division
825"L" Street, Room 502 · Anchorage, Alaska 9950~ · (907) 343-4744
Health Authority Approval Checklist
LcgalDescription: Lo~ g¥/ e/k'g/ ~/en~-~,o~-H~ PareclI.D.:L~L'7~-0&,~
A. WELL DATA
Well type F~/?
Log present (Y/Iq)
Total depth
Sanitary seal (Y/lq)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed t o / /.5 I t~o
Cased to ~ ? ' - {5'~/q" Casing height (above ground)
FROM WELL LOG
Wires properly protected
Date of test
Static water level
Well production
AT INSPECTION
?1~0
ig.p.m. 3'. ~ + g.p.m.
WATER SAMPLE RESULTS:
Coliform Oral {too m~[,,
Date ofsample: ~ { ~ o [
B, SEPTIC/HOLDING TANK DATA
Nitrate < t~'. I rn~? /.~ Other bacteria t'/o~g ~pa/','t'~
Et'Eh:/9 ? Collected by: F[,~c~¢-~ 7-ec-~ ~'~c
Date installed Tank size
Number of Compartments __
Foundation cleanout (Y/N)
Depression (Y/Iq)
High water alarm (YfN)
Date of PUmping
C. ABSORFFION FtELD DATA
Date installed
Pumper
Soil rating (g.p,d./ft2 or ft2/bdrm)
System type
Length Width
Gravel thickness below pipe
Total depth
Effective absorption area
Monitoring Tube present(Y/N) Depression over field (Ytqq) __
Date of adequacy test
Results (Pass/Fall) For bedrooms
Fluid depth in absorption field before test (in.);
Immediately after gal. water added (in.):
Fluid depth
(ins.) Minutes later:
Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N)
ffyes, give date
D. LIler STATION t
Date installed Size in gallons
Manhole/Access (Y/N) "Pump on" level at*
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tamk on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
"Pump off" level at*
; On adjacent lots /~. A.
; On adjacent lots ~. ,4.
Pablic sewer manhole/cleanout ~ / E ~
Lift station ~..4.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: h-'. ~9
Building foundation
Properly line
Absorption field
Surface water/drainage
Wells on adjacent lots
Water main/service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Line
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
I crt#fy that I have determined thru field inspections and review of Municipal records thi¥,the ab ov. e systems
in conformance with MOA IPtA guidelines in effect on this date. ;9"~ ~*..:"~:':, [;, ';
Building foundation
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
E~hgifie ~ering Seal Here.
Engineer's Name ~7~,~eoc~or~ [z.
HAA Fee $
Date of Payment '~/-~/~fi' '~
Receipt Number ,,~ ~ ~
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
REALTY
March 3, 1997
2605 Denali, Suite 101
Anchorage, Alaska 99503-2749
(907) 277-4770
(907) 277-4720 Fax
Department of Health and Human Services
Division of Environmental Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519-6650
Dear Sir;
I would very, very much appreciate if you could "rush" the issuance of this certificate. Due
to a mistake made by the laboratory, the completion of these tests are one week late.
Upon their ftrst negative report we treated and flush the well as you can see, to learn, just
after we had started the process, that they had given us the wrong report. The Buyers are
soon going to be out of a place to live, as they gave notice at their rental place. Please,
please, can you give us your final approval sometimes this week; we would, for ever, be
thallkful.
In advance thank you, as I am sure that you will do your utmost to help us.
Sincerely,
Colette La Rose
7 Star Realty
277-4779 office or 244-6827 mobil
83/03/97
12:45 CT&E ESI ANCHORAGE -~ 9075451555 NO. 183
Environmental Services Inc.
Laboratory Divi':ion
Drinking Water Analysis Report for Total Coliform Bacteria =oow. ~o,,,r o,~w
- Anchorage, AK 99518-1605
fiE.qD Ih'$TRUCTIO:Y3 0;¥ REFERSE SIDE BEFORE COLLECTI:~'G SAMPLE Tel; (907) 562-2343
lUST BE COMPLETED BY WATER SUPPLIEP~"
SA~IPLE TYPE:
~,Rout/ne
Repeat 5Ample C;or routine sample
~witb lab ref. no. ~, O~O)
Special Purpose
Time
SA~IFLE LOCATION Colleeteg
Cax: (9071 $$1-$301
TO Og COMPLETED BY LABORATORY
Ana ys{s shows ~his Water ~.Aa, IPLE to be:
· ~ Sad$ factory
O UnsatisfaetoD'
D Sample over 30 hour~ old, results may
5ampl~ [o0 long, in [ransit; ~ampl~ ~h~uld
not be o~et 4S hours old at examination
I0 indicate tellable results. Please scad
.A nalysi~ Began
Analytical 3,{etho'"d'?,-~i;-v Membran~ Filter
~ MMO-MUO
· Numbero£¢olonies/lOOmL
Result" Analyst
97.0943
0 Untreal~1%valet- '-- --
Collected- Ctienl notified of unsafisraeto~ results:
BACTE~OLOGICAL WATER ANALYSIS ~CO~
~IalO,3.1L'G Result: Total Coliform,
Verillenfion: LTB BOB
E, Coil
Colonle$/100 mi
COLIFIRM
Fecal Coliform Confirmat;on
D
~,~S Member of the $G$ Grouo (Societe G~netale de Surveillance)
CT&E Environmental Services Inc.
CT&E Ref.~.
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
970800001
Flattop Technical Srv.
L24 BI Wentworth S/D
3251 E. 41st Ave.
Drinking Water
Client PO#
Printed Date/Time 02/25/97 10:59
Collected Date/Time 02/20/97 12:45
Received Date/Time 02/20/97 13:30
Technical Director: Stephen C. Ede
Released By
Sample Remarks:
Sample collected by: T.F. Moore
gitrate-N
Total Coliform
Results PQL Units
0.100 U 0.100 mg/L
11 OB W/TOTAL&FECAL COLI
Allowable Prep Analysis
Method Limits Date Date Init
SM18 4500-NO3F 10 max
SM18 9222B
02/20/97 EMB
02/21/97 RAM
APPLIC NT FILLS OUT UPPER HAL.,ONLY
F}operty owner , ~/L~J~,'.iy!'U~ ~:~' /(~){</';I Phone
Mailing Addre~ 'Y; ~ ~<.~ ~ lJ Zip Code
Address Zip Code
- · Phone
Lending Institution ~ rI f ~ ~){" '~/~
Phone
~ Single Family
~ individual ~/'> ~ A~ACH WELL LOG. A well Icg is required for all wells drilled since Jun~ 1975.
'~ Community X~:' For.wells drilled prior to that date, give well depth (attach Icg if available)..
~ Public Utility
Sewer Oisposal Year Individual Installed~
~ Individual / When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE iNITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
:,~,,~,~~ ........ ~
EECEIVED
(~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
C D IONA APPROVAL*
DATE ~
Soils Rating Date ~wer Installed Well TO Absorption Area Well Log Received
Well to Tsnk Septic T~ Size
~,?t~F~i~IC.~L ,~ ~/~j,~CJ(J/t~ ~udt~.~8/tl 0i%~5 ~'7 ALASKA, INC.
TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
'~. - 5633 B Street
Drinking'W~ter Analysis Report for Total Coliferm Bacteria
TO BE COMPLETED ~BY WATER SUPPLIER'
WATER SYSTEM:
I.D. NO.
Water System Name rd"W"/X'{A) Phone NO.
~ailin§ Address
State Zip Code
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO.
LOCATION
L..,..I
Time Collected
Coltected By
COMPLETED BY LABORATORY
Jina~ys s shows this Water SAMPLE [o be:
..[~atisf actory
[] Unsatisfactory
[] San* pm too long in transit; samole should
~ot De over 48 ~ours old at examination
~b 3dicate reliable 'esults. Please send
new sample.
D~[te Received
Ti~e Received
Analytical Method:
[] Fermentation Tube
[]/-Membrane Filter
~ab Ref. No. Result*
I r-I-I
i [T'I
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
Date ColleCt ea S~our ce.
Lab. NO.
Presumptive 10mi 10mi 10mi 10mi l~ml 1.0mi 0,1mi
24 Hours
48 Hours
Confirm&torY
Time. . ~'~ (')~' a.m.