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HomeMy WebLinkAboutT12N R3W SEC 35 PARCEL 29T12N, R3W, Section 35 Parcel 29 #017-092-17 e Municipality of Anchorage Department of Health and Human Services ( Division of Environmental Services On-Site Services Section 825"L" Street Recto 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343.4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~L,,,3 c[, c{ O H' O~,~ PID Number: Na.,.: ',["t ~ .~ '~-o~..e ¢" Wastewater System: [] New [~Upgrade ~ ~, '~o~ 'Sed"'~ 9 '7~J" o ABSORPTION FIELD LEGAL DESCRIPTION /,~-- Well .~ New ~ Upgrade ~0 SEPARATION DISTANCES ~smic ~ Holding ~ S.T.E.P. ~ Other: ~ T° I Septi~ Absorption LiR HoldingTan Publie/Privat[S~r Line Su.,~Wa,r /OOt~ /OOt,~ ~ / LIFT STATION ~o~,~o~ ~0~+ i~i ~. ,~ .... , / "'~'~' ~1 ~ L~ ~c ~¢ 6 ~ /o¢ BENCH MARK inspections pedo~ed by:. ~,¢¢e¢ (~ ~ .,' ¢ ~,d Dates: 1~' I//~/~ ? Depadment of Health and Human Se~ices approval ¢~.. c[-9~69 Permit No. $W990408 Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Aleske 99519-6650 Telephone: 34.3-4744 On-Site Westeweter Disposel System end/or Well Inspection Report Legal Description: T12N R3W SEC .35 PARCEL 29 PID No.: 017-092-17 / T,L~T HOLE Jjl- EXISTINO MARK GALLON TANK C01 TC01 TC02 C02 C03 DIVIDER MT COZ. C05 / (~RND, PIPE 19~/1~7.s' 19~.~,' 192.8'1 125~j j 32.75'J93.4' J J J ~-~-7'/14u J g2.B' I I t-~5:5' I I,~.~' J91.o' IO8.8'1 I59'. I . 07' 91.Y 187.9'1 1~5~' I'ms' I 178.7'1 I Imo' . p78'. 79' 75.25' I1~0.~'1~' i 17~.~' 7~.2' TWO STORY FR/LU E HOUSE I ASBUIL! SCALE: 1"=80' MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box '196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 05, 1999 Expiration Date: Nov 04, 2000 Permit Number: SW990408 Legal Description: T12N R3W SEC 35 PARCEL 29 Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Jim Stover Owner Address: PO BOX 387 ANCHORAGE , AK 99510-0000 Parcel ID: 017-092-17 Site Address: Lot Size: 132000 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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 ( 18AA072 ) 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: Issued By: Date: Michael N. Anderson, P.E. 4640 Shoshoni Avenue Anchorage, Alaska 99516 Ph 345-3377 Fax 345-1391 Date October 29, 1999 Municipality of Anchorage Department of Health and Human Services On-site Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: NW Comer, NE ¼, NW ¼, NW ¼, Section 35 T12N, R3W, Seward Meridian To Whom it may concern://, This--is a request for a four bedroom septic upgrade. The so~f.~og .showed the existing material was loose sandy gravel material in the top 6 feet (perc rate ~ff minutes per inch), then changing to tight silts from 6 feet to 10 feet (pete rate 90 minutes per inch), then changing back to sandy gravel from 10 feet to the bottom of the hole at 18 feet. Some water was observed in small pockets but did not become measurable in the monitoring tube after 7days. The old failed system is a bed setting in the top 6 feet of sandy gravel. The old soil logs show a water table in the tight silts but no measurable water was found during the test hole excavation. The test hole was completed during August just before the major rainstorms started and no water was ever~ found in the monitoring tube. ~ ~J- ~'~ ~// hk ~ r~;,,, T~,~ ~,~1¢oI~ ~,~, lo/,~L, {~ [ [ The new system will be a deep trench that is excavated through the ML layer for extended life of the system. The application rate of 0.8 gallons per day per square foot will require a trench length of 63 feet with 6 feet effective depth. The tight ML layer perced at 90 minutes per inch and therefore will not be counted in the new system design. The slope on the lot is to the north east at approximately 4 pement see plan. This new system will not impact future wastewater and well development on the adjoining lots. The existing systems on the surrounding lots appear to be performing adequately. Please feel free to call with any questions concerning this system at 345-3377. Michael N. Anderson, P.E. SEWER VENTS RABBIT CREEK GREEN BELT EAST 350.00 ,, ........................ ...... 100' WELL RADIUS ADdACENT--/~ EXISTING 100' WELL RADIUS HOUSE WEST 350.00 STOVER DESIGN CRITERIA: 4 BDRM : 600 GPD SOILS : 0,§ GPD/SQ, FT, 600/0,B = 750 SQ, Fr. REQ'D TRENCH: 11,0' DEEP 6' EFFECTIVE 2.0' WIDE 6,.3' LONG -1'~OR _18'L~JGM SEPTIC DESIGN PREPARED FOR JiM STOVER NW CORNER, NE 1/4, NW t/4, NW 1/4, SECTION55 TOWNSHIP 12 NORTH, RANGE 3W, SEWARD MERIDIAN PREPARED BY MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI AVENUE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=80' OCTOBER 29, 1999 MOUND OVER GRADE ~FILTER FABRIC --DRAIN ROCK ', TH#1 /'F II 'x DIVERTER VALVE~ / ~ ', , / / II I I ~,, , ~ X I / ~ II // ~EXISTING BED ,. J., .- ............ / '~ ~.-' NEW 1250 / / ---I~ GXLLO~ TANK WELL RADIUS SEPTIC DESIGN PREPARED FOR JIM STOVER NW CORNER, NE 1/4, NW 1/4, NW 1/4, SECTION 55, TOWNSHIP 12N, RANGE 3 WES% SEWARD MERIDIAN PREPARED BY MICHAEL N. ANDERSON, P.E. 4640 $HO~HONI AVENUE (907) 3~5-3377 / FAX (~07) SCALE: 1"=50' OCTOBER 29, 1999 Municipality of Auchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: OATEPERFORMED: 2 3 ~, ~./t 4 5 6 T-ti3 ~ F ~L 9 10. 11 13- 14- 15- 16 17 2O Township, Range, SEction: SLOPE WAS GROUND WATER ~ O ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Oeplh to Wal,r kl~er Monitoring? ,~/t~,~/~C~ Da~~//~, '~'~ SITE PLAN Gross Net Oepth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~,,~ ' // (m~nutes,qncn) PERC HOLE DIAMETER TEST RUN BETWEEN / '/L'~FT AND ~ FT 3OMMENTS 72-008 (Rev. 4/851 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION; 5- 7- 8- 9- 11 12 13 14 15 16 17 19 20 3OMMENTB DATE PERFORME[ Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN IF YES, AT WHAT DEPTH? Oeplll Io Water After Monflormo? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ~,t (m~nutes/~nchl PERC HOLE DIAMETER TEST RUN BETWEEN ~1~ FT AND ~7 FT ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev, 4/85) CERTIFY THAT THiS TEST WAS PERFORMED IN DATE: 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 /~UPGRADE NAME MAILING ADDRESS LEGAL DESCRIPTION Well DISTANCE TO: Manufacturer Liq. capacity in gallons IF HOMEMAD bsorptioKrea Dwelling ~ legth~ Material Insid~ Width NO. OF BEDROOMS,.~ PERMIT NO, ~,.i.~¢~i' No. of compartments Well Liquid depth Dwelling PERMIT NO. DISTANCE TO: Manufacturer Liquid capacity in gallons DISTANCE TO: IWell ~ Len ~ o ch line Top of tile to finish grade ~ Width Length Type of crib Foundation Material Trench width Crib diameter Well DISTANCE TO: Class Depth Building foundation DISTANCE TO; Total length.Df lines / 5 'z-~- PERMIT NO, ~05--~ Distance between lines Material beneath tile ~ inches Depth ' NO. /./ ,. ;~:/ Fetal effective absorption area Crib depth Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER APPROVED 72-013 (Rev. 3/78) DATE LEGAL DEPARTMENT DF HEALTH AN)-") EIqVIRONMENTAL F'F~OTECTIOIq 8'~5 L. STREET, ANCHEIRAGE~ AK 9'750 264-4720 PERMIT NO: DATE I SSLIED: APPL I [',ANT: ADDRESS: CONTACT PNONE: I...EGAL DFSCRIP: LOT SIZE: MAX BI,-TDR 0 OM S ,', JAMES STOVER P 0 BOX 100387 ANCHORAGE.~ AK 263-4001 SUBDIVISIGN: NA 3A (SQ. FT. I_isted below are the options available to you itl des:Lgnin~ your =~[..ptz*.. system. Choose '[he optioI] that best ¢its your site. DEP"rH TO F'ZPE BOl"'l'OM (FT.) 4.0 3.5, ,~..~ GRAVEL DEPTH (FT.) G.5 :1,. TOTAL DEPTH (FT.) 4.5~ 5.0 GR~VEL WIDTH (FT.) ].9.0 5.0 GRAVEL LENGTH (F'T.) 36.0 71~ 0 GRAVE[- VOLLIME (CU. YDS. ) TANK 8I ZE (GAL..S) 1 ~, 000.0 '~'~ 1 ~ 000,, 0 '~'~' SOIL RATING (SQ.F'r./~1:~) ~- DEP'TH TO PIPE BOTTOM < 4,,0 FT. MAY RE[,]UII::d~.: A LIFT STATIGIq ~ ]"ANK VILJST HAVE AT I_EA.~T TWO COMF'ARTME:J'4TS I certit'y '[hat: 1. I am ~amiliar with the requirements For (:)n-site sewers and welIs a~ set forth by the MunicipaIity of Anchorage (MOA) and the State (:)[ Alasl::a. =..~> I wilI install the system J.n accordance wi'Lb all MOA codes and r~gu:l, ations~ and itl compliance with the design criteria at' this permit,, 3. I wilI adhere to ali MOA and State of Alaska requirements Jar the set back c:listarlces from any existing well, wastewa{er disposal system c)r public sewerage system on '[his er any adjacent or nearby lot,, 4. I understand that this permit is valid ~op a maximum o~ 3 bedrooms arid any enlargement will require an add:[tional permit. IF;' A L. IFT STATION IS IIqS]'ALLI~<D IN AN AREA CGgEIRE:D BY HCA BLJII.DING CODES, THEIq (1) AN E~LJ:.(~]I~I[.,AL PERMIT AND ].N~FI:.C]ION MUS]' BE (]BTAINED~ (;~) AB-BUILTS WILL.. N[)T BE AFH~[I]E~D WITHOUT AN ELECTRICAL INSF'ECTI[]N REPORT; AND (3) TI-IE I:]L..EC]'R~CAL. WORK MUST BE DONE BY A L. ICENSED ELEC'T'RICiAN. APPLICANT: J~ STOVER 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 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6~ 7- 8 9 10 11 12 13 14 15- SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date DATE PERFORMED:, SiTE PLAN Gross Time S~,St Net Time /( Depth to Net Water Drop , ~'~ 72-008 [6/79) GF"~,TER ANCHORAGE AREA BOROW ",H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 N.o 525 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS w- LOCATION /~/(? j':'' ~q'.,'/~'~C L~ '7(- /~/.//' LEGAL DESCRIPTION SEPTIC TANK: ~/~/~/ t /~ /? NUMBER OF DISTANCE FROM WELl MATERIAL 5' ~ COMRARTMENTS I/N SID/jI DTH LIQUID CAPACITY I~) .~.6~-~,~ f GALLONS. iNSIDE LENGTH. '~'~'~? ~'' L' ~// ~'~> PHONE LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / LINING MATERIAl ~ O CC' ~' NEAREST LOT LINE ~L OUTSIDE DIAMETER. OR WIDTH DISTANCE FROM WELL /J/S!-- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH ~'~ ~ DEPTH , BUILDING FOUNDATION ~ 6 (' s,::,. FT. TILE DRAIN FIELD: DISTANC~M WELL , FOUNDATION , NEAREST LOT LINE TOTAL LENGIH , OF LINES --~---'~/q~T A L EFF ECTIV~ ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE WELL: TY~E (J: ,//*/~'1 DEPTH /:/~': ' NEAREST SEPTIC LOT LINE ., SEWER LINE . TANK DEPTH OF FILTER MATERIAL BENEATH TILE DISTANCE FROM ~ ., ,BUILDING FOUNDATION. ' ' SEEPAOE , SYSTEM IN, ABOVE TILE WATER SAMPLE. , NEAREST OTHER , CESSPOOl , SOURCES DISTANCES: DIAGRAM OF SYSTEM APPROVED ,-/,/ - DATE / '" "' "'" ~ "IEALTH AUTHORITY 'Certified We~[ Deptlx of well......~.~?.~3.~.~. ..................................................................... ' Size oi caslng......~....~J(k~..,kI. .................................................................................... 'i.'....:~ ....... ~, , ,-:-, 'Distance t~ wa~er.....~.~.~...e...~ ....................................................................................... ~:..' ': ..... q.l.l. IZota~ ' :;'~ Distance to water while pumping ............... , ....................................................... a ra~e 0,.......:.. :.. ~ L~. - -..,-:L:.::.,..~a~o~,~o~.:~our. :: ?.0 25 70 7~ '95. :~':. :: : ,,: ..: ,., I certify, the above true and correct. : - :..'- . '...' : ~'/:;;' ' ~. /' ;TZ~gNI,C.~PALTY OF : ' ~. ' '~ : ":="~'"~'"""~:"~":'"'": ...........; .................................. ~"LTH ;,:: ' Driller DEPT, or ~c~ & FOSS D~ILLING ~ 1~36 INCRA PH. 279-2849 ~ : ANCHORAGE, ALASKA 99501 ' We advise Yo~ ~o at~ach ~his certificate to your deed. GREATE[ X. NCHORAGE AREA )ROUGH Case 327 Eagle St. Anchorage, Alaska 99501 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ../~1~,~:~ ~?- ,5/~/~,,~. MAILING ADDRESS ~/ ,'./ .~/~6,z~.,,. PHONE NO,? ~- --' R ESID ENCE AD D R ESS ,Y/D~;. ~Yz~ ' LO CATI 0 N 0 F INSTAL LATI 0 N~~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS z- , SEEPAGE PIT -- ,DRAIN FIELD ,OTHER TO BE INSTALLED BY. ANTICIPATED DATE OF COMPLETION ,.;~t~'.~<'~ BELOW TO BE FILLED OUT fly HEALTH DEPARTMENT THIS IS TO SERVE AS .~'/d,¢.~;/~ , PERMIT TO INSTALL A --?' £-c'-~- -~/://://- .AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE ,/~:~;~,';' TYPE ~;:.-z'..~:/- SEEPAGE AREA' DIAGRAM OF SYSTEM I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordhmnce No. 28-68 and that the above described system is in accordance with said code, DATE APPLICANTS SIGNATURE k' r p-, ..... ', :,,/as G~ound :,'later Peadlng Date Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 Re. 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. 0{: g- - oq.'Z.-~' HAA# :,/~'~'~"~24~~ 1. GENERAL INFORMATION Complete legal description Expiration Date: Location (site address or directions) Current Property owner(s) Mailing address P-~-~. Lending agency Day phone Day phone Mailing address 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 Well ¥ 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 propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Cedificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Appreval 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 verity 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_ Address ~ ~0 Engineer's Printed Name ~ bedrooms. /.-, ~ ~:~ ~', Conditional approval for ~ bedrooms, with the following stipulati"~'~,-'~'~ The weZZ ~o~ ~Zs p~ope[t~ mee~s e~st~n8 S~ate a~a Hu~Lc~ga~ Codas. Zt Zs sus~ested tha~ pe~odLc ~es~Ln8 be DHHS SIGNATURE Approved for Disapproved. Note: There are nitrates present. performed to insure the wells continued suitability. Current nitrate concentration is 5.09 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available ~rom the un-site bervices rrogram, DHHS, 343-4744. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other 5/// ~' Expiration Date: '~'- ~ ~?- 0 b Original Certificate Date: Reissue Date: "- Municipality of Anchorage "(I ¢EIVIED Department of Health and Human Services Division of Environmental Services JU J 272000 On-Site Se~ices Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-665~UNlCi~ALiT~ O~ ANCHU~AG~ ~.ci.anchorage.ak.us 'wlP~NMENT~ SERVICES DIVISr (907) 343-4744 Legal Description: HEALTH AUTHORITY APPROVAL CHECKLIST T 1'2.~,l 1~.3~,O 0&C~4~c~'~'~5'-i~ree(~-¢[ ParcelI.D.: __ A. WELL DATA Well type ~0th.'v~J'-~ Date completed t, cl ~'0 Total depth [ ct 0 ft Cased to FROM WELL LOG Well Log Wires properly protected Y Casing height (above ground) '~. in. If A, B, or C provide PWSID # Sanitary seal Date of test Static water level / ft Well production / g.p.m WATER SAMPLE RESULTS: Coliform ¢ colonies/100 mi Date of sample: /- B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed I1/~, Cleanouts ~' Foundation cleanout Date of pumping t',[ AT INSPECTION C0,~ c{' g.p.m Nitrate ~ mg/I . Other bacteria Collected by: /,¢(/k~ ¢¢'. colonies/100 mi gal Number of Compartments Depression over tank f~ High water alarm Pumper c. A.SORPT'O. ,,ELD DATA Date installed 'l/bf~ Soil rating (g.p.d./ft2 or ft2/bdrm)¢,~=~ System type Length ~ ¢( ft Width ?----' ft Gravel below pipe Total depth 1 (, .¢.ft Effective absorption area~' fF Monitoring tube Date of adequacy test ~u,3 Results (Pass/Fail) ~,~,~ For ~ bedrooms Fluid depth in absorption field before test ~ in Water added~'" Elapsed Time: ,~ rain Final fluid depth ,,~ in . Any rejuvenation treatment (past 12 mo.) (Y/N & type) gal. New depthJ in. Absorption rate >= ~ g.p.d. If yes, give date J 72 026 (Rev. 01/00)* D. LIFT STATION Date installed Size in gallons ~~.-__~ '- ''Pump on" level at ~ inHigh water alarm level at in D~ Cycles tested Meets alarm & cirCuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tar~/IJ, f, CCa.t-i~ on lot /~O ~ '¢ On adjacent lo. ts Absorption field on lot /~,,c~ f ¢. On adjacent lots Public sewer main ~' //¢ Public sewer manhole/cleanout Sewer/septic service line t~,-~~'+' Holding tank _ SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOT TO: Building foundation ¢ O Water main i'''f' Drainage /~ ~, Property line % Water service line Wells on adjacent lots Absorption field _ Surface water SEPARATION DISTANCE FRO~ ABSORPTION FIELD ON LOT TO: Property line Io ! '¢ Building foundation Water Service line /o ¢ (..,L Surface water /o O h Curtain drain /k/,,~. Wells on adjacent lots COMMENTS Water main /v',~ Driveway, parking/vehicle storage 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 Pl~.,'rcv~,c(/~(-~d ~-~r~'d Date HAA Fee $ Date of Payment Receipt Number Waiver: Fee $ Date of Payment )Receipt Number 72-026 (Rev. 01/00)* MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. 000 2 ~ ~ During a recent Health Authority ADprovat on-site inspection and test of the potable water supply well on Block -- of ~-/~,/~2 ~//~,~Subdivision, the well's productivity was determined to be ~0~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is 0.~ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be recuired. This advisory must be attached to all copies Of the subject Health Authority Approval. 06-27-00 09:09 FEO)~-CTE ENVIRONMENTAL 5615301 T'§25 P.03/04 F'835  EnvironmenTal Servicers Itlr'. CT&E Client Name Project Name~ Clien~ Sample ID Matr~ Ordered By Pw§ID 100318800! Mik; N. And~so~ P.E. 14020 Smver 12N 3W Seclion 35 Parco] 20 Drmld~g Wa~r 0 5.09 Pri~td Dam/Time Collected l~te/Time Rt~ejved lY~l~.ffimc Technical Director Released By O.SOO ~'L EPA~flD.O (<10) 06/26/2000 16:I8 06/20/2000 12:30 06/20/2000 13:05 Stephen C. Ede 06/20/00 SCL OG-ZT-O0 09:09 FROM-gTE EN¥1RON~flTAL 5615301 T-625 P.04/04 F-635 CT&E Environmental Services Inc. 200 W PotTer Drive Drinking Water A~alysis Report for Total Colifot--, Bac~a ~"~, """a"~a°" Tel: l~7} 562-23~ ............. TO B~ CO~LE~D BY LAflO~TORY MUST BE C0~L~D 8Y wA~R SUPPleR tq FUBLIC WATER SYSTEM I,D. ~ pRIVAT£ WATER sYSTEM Rq~eat Sample (foe roudrm sample with lab rtl'. no-. ) Special PurpOse SAMPLE [] Treat~l Water Q UnTreated Water Time Cblleet~l CoUa~xed By, dy~ shows this Wa[er SAMPL£ to be: S~ ov~ 30 hou~ ol~ r~[~ nat ~ ov~ 48 ~d~ old ~ e~a~on ~MUG Numh~ ofcoloni~lGO mi. lOO llaa BACTERIOLOGICAL WATER ANALYSIS RECORO © . Colsnlt~lO0 mi BGB COLWIHM Coliform;TOo mi I~~ M.mbar ~f ,he S~l$ Group ISOCiele C~lnl~rale la~ ~"me'ffnnce) ENVIRONMENTAL FACiLiTiES IN ALASKA, C,~F~RNIA, FLORIDA ILLINOIS, MARyLAnD. MICHr.IfiAN, Mis,~Oiafll. NEW 41;Rq~Y, OHIO. wEeT vIRGINIA