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HomeMy WebLinkAboutT15N R1W SEC 3 N2SE4NE4SW4 PTNTI§N, R1W, Section 3 $E4, NE4, $W4 PTN #051-063-16 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report · Permit Number: SW000092 PID Number:_ 051 -063-1 6 .a.,e: Wastewater System: 1~'(New [] Upgrade MM&M' Contracting. ,ddr~: ABSORPTION FIELD P.O. Box 670495 ChUgiak, AK 99567 688-1236 ~hree ~ ~pTrench ~ShallowTrench ~B~ UMound ~Other lotal ~e~th from orioiaal LEGAL DESCRIPTION soi..~.~:.6 ~Sq. ~. ' ' J J Fijl added a~ve original grade: Gravel length: Township:' ~ange: 1 W. '.J ~ion: . 3 .5 ' 43 Ft. 1 5N F~- · ' WELL: ~ New'. ~ Upgrade ' Gravel.,Ch: 3 '- 1' Private.. Unk. Ft >40 Ft. ' 774 So.~t. ASTM D3034 PVC Drillec : ... ' , DateDriUed; ' S~¢cWaterLeve~ Installe~ 7/21-24/00 . Unknown ~ Unk... 69 m_ MM&M Conbra~ing Dateinstalled: ' ..SEPARATION DISTANCES' .- ~ Septic - ~ Holding O S.T.~P. . From Tahk F(eld ~ · Stolon Tank ~werLin~ Anchora Tank. .1 ¢ 000 ' '100' ' 100' N/'A N/A >25' Materi~h Num~rof~mpa.~n~' Steel · TWO . ' TS/ T N/A Sudace >100~ >100' N/A N'/A N/A LIF A ION - Lot ' > 5' :> 10 ' N/A N/A N/A' Size in gallons: JManufamure~ . . Cu~ainDrain None . . . . ' ...- ' . . ' ' · · · Remarks: 2" Insulation Over Tank ' : BENCH MARK · and Absorption Trenc'h. . L~fion~dDe~dption: . . .J · Back Deck Top Surface ~' '- ~'~ . .. _l · · - ' ~l~'b~m~' ~ z~ . . · .' ,' · · ' :' .. ' ' 100.0 ~ ~ ~10 ~, r {nspe6tJonspedo~ed by: M~n D~t.:.ls' ?<21 < ~~ Deoa.ment of Health and Human Se~,ces approval .. %:,~¢~ 4.>;4~ Reviewed and approved by: ~. Date:~ =q ¢0 Permit No. SW000092 PID No. 051-063-16 Page 2 of 3 A B Sl 12.0 47.9 S2 16.4 42.1 C3 21.3 36.7 C4 59.0 14.3 M1 59.5 15.3 PLAN AS-BUILT SCALE1"=40' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES . ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 ~ 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Page 3 of 3 Permit Number SW000092 PID No. 051-063~16 99.1 99.3 /~,000 Ga. 96.7 / pep. Tan 96.6 2" Insul. Drain Field Rock 96.4 87.4 81 .0 43' PROFILE AS-BUILT 1" = 10' ROM : COUNTRY REALTY PHONE NO. : 90?6881238 ~ug. 21 2000 01:1?PM P1 PH: 688-2510 ARCTIC PUMP & WELL P_ O_ Box 197 EAGLE RIVER, AK, 99577 FAX: 688-2543 AuguA 15,2000 Mr. Mike Anderson Anderson Engineering P. O. Box 240773 Anchorage, Ak. 99524 Re: Well Casing This letter is to advise that the well easing on 21709 Old Glenn Highway is in excess of 40' deep. Legal Description as follows: That portion of thc SW ¼ of Section 3, T15N, Alaska, described as follows: Commencing at the center ¼ corner of said Section3: thence South along the north-south ~A section line a distance of 591.8 feet to its intersection with the northwesterly fight of way llne of the Old Glenn Highway; thence southwesterly along said right o't'vcay line a distance ol~ 324.8 I'eet to the True Point of Beginning: thence S 89 55' W a distance of 371.8 feet; hhence S 00 07' E a d~stance of 135 feet; thence N 89 55' E a distance of 274.3 feet to a [xfint on the Northwesterly tight of way o£ the Old Glenn Highway; thence northeasterly along said right of way line a distance of 166.5 feet to the True Point of Beginning. Sincerely} Received Time Aug.21. 12:52PM 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 (9O7) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: May 08, 2000 Expiration Date: May 08, 2001 Permit Number: SW000092 Legal Description: T15N R1W SEC 3 N2SE4NE4SW4 PTN Design Engineer: 00'14 Anderson Engineering Owner Name: MM & M Contracting Owner Address: PO Box 670495 Chugiak, AK 99567- Parcel ID: 051-063-16 Site Address: 021709 OLD GLENN HWY Lot Size: 43560 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 subsudace 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: ~ /-~--~]~-'~) Date: May 4, 2000 Municipality of Anchomge Departmentof Health and Human Services 825"L"St~et Anchorage, AK 99502-0650 Subject: Tract C, Eklutna Heights Subdivision Septic System Design and PermitApplication Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Tract C, Eklutna Heights Subdivision intends to construct a three bedroom home on the lot. We are hereby requesting a permit be ssued to construct a new well and septic system to serve the house proposed for the lot. The attached Site Plan and backup documentation show the location and configuration of the new septic system and the location of the well. The 100' protective radius for the well is' also shown. Two testholes were recently placed on the lot to find an acceptable location for the new septic system. Both holes revealed silty sand with some gravel which percolated 30 minutes per inch. No. groundwater was noted during the excavation and none developed during the ensuing monitoring period. We have therefore designed a deep trench absorption system with 7' of gravel beneath the distribution lateral. The lateral will be placed at 4' below the ground surface and the total depth of the trench will be 11' beloW existing ground. The bottom of the trench will be more than 6' above any impermeable soil layer. The lot surface slopes gently from north to south at between 1% and 2%. The absorption trench will be placed with the slope of the property in conformance with Municipal Cequirements.' The lot is fairly, deep in length and the protective well radius will be almost entirely contained on the lot and the adjacent road right of ways. Placement of the new system in the location shown on the lot will similarly have no effect on wells or septic systems on adjacent lots. If the system is constructed in accordance with our design the following statements apply: The system; if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. Tract C, Eklutna Heights Subdivision May 4, 2000 Page Two The system, if constructed as designed, will have no a~lverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will 'have no adverse impact on drainage patterns in the area The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments / / ° 2 / L~NNIE 589'52'50"W 283.27 Circle 3D ~ .~_7_ _ J 30 / \ / / / / / / '-- ~o~.2o Circ{~ / / (70-?0)(6~--10) AREA MAP // / ,// SCALE 1" = 100' / / / /. / / / / / / ./ / // IS4.00 / NOTE: No Confl or Septic the Area. /, cts With Wells systems in SCALE: TH1 Alternate Site ~I2 52 ~ ~. 1.1.1 ~ ,ooo ~ '~ Septic T Bedroom I Proposed Well SITE PLAN SCALE '1" = 40' Lonq X 3' Wide ' Effective Depth:: orption Trench [lon ~nk TRACT C, EKLUTNA HEIGHTS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Deep Trench System Perc. Rate: 30 Min./Inch 1,000 Gallon Septic Tank Application Rate: .6 GPD/SF 7' Drainfield Rock 3 Bedrooms X 150 GPD / .6 GPD/SF = 750 SF of Absorption Area 750 SF/14 SF/ LF of Trench = 53.6 LF Trench Length Therefore: Construct a Deep Absorption Trench System With One Lateral 55' in Length with 7' of Drainfield Bock Beneath the Distribution Pipe. Below the Original Ground Surface. to Distribution Pipe in Trench Placed at 4' Total Depth to be 11' From Original Ground Surface. Provide a Minimum of 3' ol Cover. Mound Over Trench .5' 720' Backfill '// /- Geotextile ~ , Fabric .-4" PVC Holes Down --------Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Provide 3' Cover Over Trench and 4' Over Tank or Insu ate. Maintain 10' Separation From Lot Line. Maintain 10' Separation From Water Service Line. Maintain 100' Separation From All Wells Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: MM&M Contractin9 Legal Description: Tract C. Eklutna Heights Subdivision 3 4 5 OG/OL SM Silty Sand TESTHOLE NO. 1 SLOPE North South Was Groundwater Encountered? No If Yes, What Depth? Depth to Water After Monitoring None Date: 5~4~00 Date Performed: SITE PLAN See Site Plan S L __ 1% -2% 0 12 13 14 Bottom of Hole 15 17 18 Reading Date Gross Net Depth To Net Time Time Water Drop 1 4/25/00 2:00 11.5" 2 2:30 30 12.5" 1" 3 2:31 11.5" 4 3:01 30 12.5" 1" 5 3:02 11.5" 6 3:32 30 12.5" 1" I 21 Perc. Rate: 30 Min./Inch Perc. Hole Diameter: 8" Test Run Between 6 Ft. and 7 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Mike Anderson. I, Michael E. Andersop Certify That This Test Was Performed tn Accordance With All State and Municipal Guidelines In Effect On This Date: 5/4/00 Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: MM&M Contracting Legal Description: Tract C. EMutna Heights Subdivision OG/OL SM Silty Sand with Gravel SLOPE North Date Performed: SITEc. PLAN See Site Plan 9 10 11 12 13 14 15 16 17 18 Bottom of Hole South Was GrourMwater Encountered? No S If Yes, What Depth? L Depth to Water O After Monitoring None P Date; 5~4~00 E Reading Date Gross Net Depth To Net Time Time Water Drop 1 4/25/00 2:10 3.5" 2 2:40 30 4.5" 1" 3 2:41 3" 4 3:11 30 4" 1" 5 3:12 3" 6 3:42 30 4" 1" 21 Perc. Rate: 30 Min./Inch Perc. Hole Diameter: 8" Test Run Between 8 Ft. and 9 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Performed By: Mike Anderson. I, ' I E. Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 5/4/00 Municipality of Anchorage M OR On -Site Water and Wastewater Program z (907) 343-7904 CERTIFICATE -OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-063-16 1. GENERAL INFORMATION. Expiration Date: Complete legal description T15NR1 W SEC 3 N2SE4NE4SW4_ Location (site address) 21708 Old Glenn Highway, Eagle River Current Property owner(s) David & Alicia Matthews Day phone. 907-854-5486 Mailing address Real Estate Agent 21708 Old Glenn Highway, Eagle River 2. TYPE OF DWELLING: ® Single Family.(w/wo ADU) ❑ Duplex • ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Waiver Fee $ Date of Payment Receipt Number d% 3 g5 G Receipt Number COSA # ©S C Z D 1 SLJ 1 1 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 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AIC 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 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 ArcTerra guarantee that no unseen Aw- OF encroachments, deficiencies or discrepancies exist. , _V A carr- %C 6. DSD SIGNATURE i System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stiputoat ul(wi lt JJ�jJ `C�1, - �V) MENT111���111 Original Certificate Date: 10-13-;2,020 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 Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory Arsenic Advisory Other 'Gt.w� Axe 0 ve ' Legal Description: T15NR1W SEC3 N2SE4NE4SW4 IParcel ID: 051-063-16 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.4 gpm Date drilled UNK Water storage tank volume NA gallons Total depth UNK ft Well disinfected for coliform test? ❑ Yes No Cased to >404 ft N Coliform bacteria is Negative 1.48 Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) Wires are properly protected Arsenic ug/L Arsenic less than MRL (ND) Casing height (above ground) 20 in. Collected by ArcTerra Consulting , Date of flow test for COSA 9/23/20 Date of Sample 9123/10 Static water level at beginning of test 72 ft. Comments Per previous COSA B. TANK DATA Age of tank(s) 20 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 4 7 Standpipes/foundation cleanout per record drawing Date of pumping 9/10/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 11/11/16 ALL standpipes present per record drawing Total measured depth from grade 16.6 (max) Measured depth to pipe invert from grade 7.6 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/23/20 Results ❑Q Pass For 3 bedrooms Fluid depth prior to test 18 in Water added 450 gal New depth 27 in Elapsed time 60 min Final fluid depth 18 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES ® Yes if No ft Surface Water > 100' From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes Septic Tank/Lift Station on Lot > 100' ft Wells on Adjacent Lots: 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 septic tank is under driveway comment below Animal Containment > 50' ® Yes if No ft ® Yes if. No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet > -0 0 In --0 Z'R w :5-:3 0 cr m (Dg cp Er > CD 0 C, CD n 0 bi CD 'n, cv Ln ,=' R 3 LO.00 S c)n �;.0 h w n 0 - = - c - > wPr 11 M CD '0 cn ;:r l< M* 0 T CD ;3 , CL = r m z CA T r =r =r oso 4 z �l 0 E� P- m CD cis cr (, 5" a7 0 OIQ 0 p < c 2 9i CD 0 cr cr w n 0 ul (A rri > rri CD Z @ Z7 C/) z z ;0 rm 6 m r -n CD CL b. Z ro IVC�a m Z 08 z 8 :; c) CL U * =3 — pca Z bo r frl 0 C) ;0 > 25' o > 0S- ri) ;0 0 t2 L70 Irl?, CO C, rTl 0 < A I X m m CA L-4 Co 0 rn MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT � � � 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank advisory Certificate of On -Site Systems Approval #OSC 201541 Subdivision: T15N R1W Sec 3 N2SE4NE4SW4 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Municipality of Anchorage Dopartmont of Hoalth and Human $orvi¢os 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. 051 -063-16 1. GENERAL INFORMATION Complete legal description Expiration Date: T15N R1W SEC 3 N2SE4NE4SW4 ?TN Location (site addressordirections) old Glenn Highway & Lennie Circle Current Property owner(s) MM&M Contracting Day phone 630-1236 Mailing address P.O. Box 670495 Chugiak, AK 99567 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone 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 Three 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 Certificates 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 properties served b~ 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 Municipaiit'., of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I 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 Anderson Engineering Address p (b Row 24077q An~h~r~g~ AK Engineer's Printed Name Michael E, Anderson, P.E. DHHS SIGNATURE ~ Approved for Phone 522-7773 Date 8/21 /00 ': .... --% :~ ,~ ~ ' STAMP -- ' ,C ct.. L. .... bedrooms. ' : '; ;;;';' '' ' :' ... Disapproved. : ' .- ;...x ,, .,,,:....~':. ---' Conditional approval for bedrooms, with the followin~stipule/ti06}. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Expiration Date: Original Certificate Date: Reissue Date: -' 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.ancho rage.ak.us (907) 343-4744 Legal Description: A. WELL DATA Well type Private Date completed __ Total depth .__ HEALTH AUTHORITY APPROVAL CHECKLIST T15N R1W SEC 3 N2SE4NE4SW4 PTN If A, B, or C provide PWSID # __ Sanitary seal Yes ft Cased to >40' ft FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 8 / 1 8 / 00 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel ft g.p.m Date installed Cleanouts ¥ Date of pumping C. ABSORPTION FIELD DATA Date installed 7/24/00 Length 43 ft Width Nitrate · 734 mg/I Collected by: MEA Parcel I.D.: 051-063-16 Well Log No Wires properly protected Yes Casing height (above ground) 24 in. AT INSPECTION 7/5/2000 69' ~ 2.3 g.p.m Other bacteria 0 colonies/100 mi 7/21/00 Tank size 1,000 gal Number of Compartments 2 Foundation cleanout ¥ Depression over tank N High water alarm New Construction Pumper N/A System type Deep Trench Soil rating (g.p.d./ft2 or ft2/bdrm) .6 3 ft Gravel below pipe 9 Total depth 1 2 ft Effective absorption area 774 ft2 Monitoring tube Y Depression over field Date of adequacy test New Results (Pass/Fail) ConstructionFor bedrooms N Fluid depth in absorption field before test __ in Water added__ Elapsed Time:, min Final fluid depth in Any rejuvenation treatment (past 12 mo.) (Y/N & type) gal. New depth in. Absorption rate >= __ g.p.d. .If yes, give date __ 72-026 (Rev. 01/00)' LIFT STATION N/A Date installed "Pump on" level at in Datum E. SEPARATION DISTANCES F. Size in gallons "Pump off" level at __ Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot > 100 ' Absorption field on lot > 100 ' Public sewer main Sewer/septic service line > 25 in Manhole/Access High water alarm level at in Meets alarm & circuit requirements On adjacent lots > 100 On adjacent lots > 100 ' Public sewer manhole/cleanout N/A Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation > 5 ' Property line > 5 ' Water main N/A Water service line > 10 ' Drainage > 100 ' Wells on adjacent lots > 100 ' Absorption field > 5 ' Surface water > 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 ' _ Building foundation > 10 ' Water Service line > 10 ' Surface water > 100 ' Curtain drain None Noted Wells on adjacent lots > 100 ' COMMENTS Water main N/A Driveway, parking/vehicle storage > 20 ' G. ENGINEER'S CERTIFICATION I cedify 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 Michael E. Anderson, Date 8/22/00 PoE. HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 {Rev. 01t00)'