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HomeMy WebLinkAboutT15N R1W SEC 8 LT 89T15N, R1W, Section 8 Lot 89 #051-151-01 Municipality of Anchorage Page 1 of 3 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 Permit Number: SW980314 PIDNumber: 051 -1 51 -01 Name: Claude Mongeau Wastewater System: ~:~ New [] Upgrade Address:p.O. BOX 671006 Chugiak, AK 995(i7 ABSORPTION FIELD INc. of Bedrooms: Phone: 688-9538 Three (3) D Deep Trench D Shallow Trench ~:Z~DBed DMound r~Other LEGAL DESCRIPTION SoilRating: .7 GPD/Sq. Ft. Total Depth fr~rn, originalgrade: Lot: BLM Lot 8~I°ck; Subdivision: 3epthtopipeboltomfromodginalgrade:2. 5 ' Ft. Graveldepth benea~th pipe. 5 Ft. Ft. 4 5 ' Ft. Number of lines: IDistance ~tweenlines: WELL: [] New [] Upgrade Gravelwidth: 1 5 ' Ft. 3I 5 Ft. ClaSSification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe materlal: Existing Ft. Ft. 675 SO. Ft ASTM D3034 PVC Driller: Date Drilled: StaticWater Level: Installer: Dateinstalled: Ft. Hamilton Exc. 8/27,28/98 SEPARATION DISTANCES :~ Septic [] Holding [] S.T.E.P. TO Septic Absorption Lift Holdir~g PublicJPdvat( ~lanufacturer: Capacityln gallons: From Tank Field Station Tank Sewer Lines , Anchorage Tank 1 , 000 Wel~ >100 ' > 100 N/A N/A N/A Material: NumberofCompartments: Steel Two Surtace >100' >100' N/A N/A N/A LIFT STATION - N/A Water Lot >5' >10' N/A N/A N/A Size in gallons: I Manufacturer: Line I >5' >10' N/A N/A N/A "Pump on" level at: I "Pump off" level at: I High water alarm at: Foundation Curtain None ~oted Dn Lot Pump Make & Model I Electricallnspections performed by: Drain I Remarks: 2' Sand Liner Placed Beneath BENCH MARK Bed. Material From Approved Wasilla L°cati°nandDescripti°n:Nail in Birch Tree North Source. Side of House. Assumed Elevation: 1 99,0 Ft. ' ENGINEER'S SEAL Inspections performed by: Ve'~ech Dates:lst 8/27/98 2nd 8/28/98 ~ Department of Health and Human Services approval 72~)13 (Rev. 9/91) MOA 25 Municipality of Anchorage Page 2 of 3 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 Permit Number SW980314 PID No. 051-151-01 s2122 M6~31 c7142 M8 57 C9 50 B 21 .5 25.8 43.9 51 .9 44.8 36.7 50' BLM Easement TH2 C7 /AlternateTH1 Site / M6 A ~ 2~Three C~ 11 Bedroom '~ Home~ B Existing well Existing Garage Z PLAN AS-BUILT SCALE 1" = 50' Municipality of Anchorage Page 3 of 3 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 Permit Number SW980314 PID No. 051-151-01 BLM LOT 89, ELEV= 106.1 ~ ~ ELEV= 106.3 c/o-I S/V1 S/V2 c/o-4 c/O-5 M/T-7 M/T-9 PROFILE AS-BUILT ~/T-~P. HORIZONTAL SCALE 1" = 10' ~ c/o-~P. ~ ELEV= 106.3' NO VERTICAL SCALE TOP DF FILL ~'+ COVER FILTER FABRIC ~ i __ ELEV= lO0.3~F--; ~ ~" a "z 18' 3/4'-I.5" Septic Rock ELEV= 99.~ 8'+ Sond Liner BOTTON THfl~ BOTTBN TH~i , ~, ~'+ No Impermeob[e L~yer  ELEV= S/V-t CAPPED SEPTIC 6LEANOUT CBMPARTMENT-I 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 PERIVIIT Upgrade Date Issued: Aug 20, 1998 Expiration Date: Aug 20, 1999 Permit Number: SW9803'14 Legal Description: T15N R1W SEC 8 LT 89 Design Engineer: Anderson Engineering Owner Name: Claude Mongeau Owner Address: PO BOX 671006 Chugiak, AK 99567-1006 Parcel ID: 051-151-01 Site Address: 020332 UPPER BOWERY LN Lot Size: 108900 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 ( 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. August 8, 1998 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: BLM Lot 89, Section 8, T15N, R1W, S.M. Septic System Design Impacts to Adjacent Properties Dear ©nsite Services Engineer: The owner of BLM Lot 89 intends to construct a three bedroom home on the lot. We therefore request a permit to place a new septic system to serve the new house. A mobile home is currently on the lot using a septic system which is near failure. A well is also on the lot and will remain in service for the new house. The attached site plan and backup documentation identify the size and location of the new septic system designed to serve the house. It also shows the location of the existing well and the neighboring well and their respective 100' protective radii. Two testholes were placed on the lot at the locations shown. Poorly graded gravel was found under the organic material. This material percolated at a rate faster than 1 minute per inch. The majority of the materialpasses the No. 4 seive so a 2' sand filter is required to slow the percolation of the effluent into the underlying strata. No groundwater was encountered nor was any measured during the monitoring period. We are therefore proposing to construct a 15' wide X 45' long bed system with a 2' sand filter layer. Distribution piping will be placed at 2.5' below the existing ground surface. The total depth of the system will be 5' below the existing ground surface. The surface of the lot is fairly flat in the area of the new absorption trench with a slight 1%slope from east to west. The existing system on the lot will be abandoned in accordance with procedures mandated by ADEC. BLM Lot 89 August 8, 1998 Page Two If the system is constructed as designed 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. 3. The system, if constructed as designed, will have no adverse 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 NOTE: 50' BLM Easement Driveway / I 'i~0~0' Gallon 15' W%de X' 45.'.~,~1 Septic Tank Long ~bs or ption~,'~"~ Bed/ Existing Well No conflicts with wells or septic systems in the area. Wells within 200' of the new system are shown. Existing Garage SITE PLAN SCALE 1" = 50' HOUS~ l, O00 SYSTEM PLAN SCALE 1" = 10' "~ ~:' BLM LOT 89, SECTION 8 T15N, RIW, S.M. DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Shallow Bed System Perc. Rate: LT 1 Min./Inch 1,000 Gallon Septic Tank Application Rate: .7 GPD/SF 2' Sand Filter 3 Bedrooms X 150 GPD = 450 Gallons Per Day 450 GPD/.7 GPD/SF /15 LF Width = 42.8 LF Total Length of Bed Therefore: Construct a Shallow Bed System 15' Wide X 45' Long. Distribution Piping to be Placed at 2.5' Below Ground Surface. A 2' Sand Filter Layer Must Be Placed Below the Bed From 3' to 5' Below the Ground Surface. ~ Backfill Geotextile FabriC 2' Coarse Sand Filter (See Specification) Drainfield Rock NOTE: SHALLOW BED SECTION (NO SCALE) Grade Area to Drain Away. Muni~ipallty of Anchorage DEPARTMENT OF HEALTH '& HUMAN SERVICES 82.5 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: Claude Mongeau LEGAL DESCRIPTION:iBLM Lot 89 OL 1 4 5 6 ? 8 9- 10- 11 12 13 14 15 16- 17- 18- GP GP with Sand WAS GROUND WATER ENCOUNTERED? IF YE~,AT WHAT DEPTH? Townshil3, Range, Section: T15N,R1W', Section 8 SLOPE SITE PLAN NO S~;e Sil~e Plan E D~mW~A~ None ~z 8/8/98 Reading Dam O~ Ne~ Depth ~o Ne~ Time Time Wate~ Dro~ · 2O PERCOLATION RATE < 1 {minutesqn¢ll) PERC HOLE DIAMETER 8 m, TEST RUN EE~WEF. N 3 FT AND 4 Fi' COMMENTS P~'~f%]~on Rate FaRter Than 1 Minute Der Inch. 2' Sand Filter ACCORDANCE. WiTH ALL STATE AND MUNICIPAL GUIDELINES IN 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED ,=OR: Claude Monqeau LEGAL DEECRIPTION:BLM Lot 89 DATE PERF~ Townsl~ip, Range, Section: T1 5N,R1W ,'x~§~e~.on 8 1 2 3 4- 5- 6- 7 8 9 10 I1 12- 13- 14- 15- 16- 17 18 19 . 20 COMMENTS OL GP GP with Sand WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN NO IF YES, AT WHAT DEPTH? De~ to Waa,r ~ M~i=ino? None _Oa~ 8/8/98 I N S,~.e Si e PliLn Reading Date Gro~ Net Depth to Net Time Time Wa'let Drol~ PERCOLATION RATE < 1 (mlnute~/mch) PERC HOLE DIAMETER 8" TEST RUN BETWEEN 3 . FT AND 4 FT P~rco]~tion Rate Faster Than 1 Minute per Inch. 2' Sand Filter PERFORMED 72.-(X)8 (Rev. 4/85) IN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: BLM LOT 89 - SECTION 8, T15N, R1W, S.M. GENERAL: The scope of this project includes the procurement and construction of a new 1,000 gallon septic tank. It also includes the construction of a new 15' wide X 45' long absorption bed at the location shown on the site plan. The distribution piping must be placed at 2.5' below the original ground surface. A 2' sand filter layer must be placed beneath the bed to slow the percolation of the effluent into the strata below. Total depth of the bed will be 5' from the original ground surface. Grade finished surface to drain away from trench. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be underground utility locates system and verification of responsible for obtaining all and for the layout of the septic the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown. BLM Lot 89 August 8, 1998 Page Two A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: The drainfield shall be constructed to the dimensions shown on the design. The bottom of the bed shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. BLM Lot 89 August 8, 1998 Page Three Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). BLM Lot89 August 8, 1998 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 ~-ZZ- OWNER OF LAND __~ 4. ~ J.O ~z /~/'/ ADDRESS ?: ~ :~:7/D°6 LEGAL DESCRI~ION < C~_ ~ ¢_ ~ ~/ DATE-Started / / / ~:-/ c ~ Ended PE~IT NUMBER DEl'TH OF WELL ~'~ G :" STATIC LEVEL OF WATER FT. DRAW DOWN FT. C;at.S. PER Ha 35'" KIND OF CASING d7> t.- / KIND OF FORMATION: From /) Ft. to~~ From ~ Ft. to_- From_~. Ft. to From__ Ft. to_ Ft. From '7. Ft, to--/ ~ _FL From_(~. Ft. to_ From __ Ft. to_ _ From ,~..~' Ft. to_~, ~ From __Ft. to___ From f! ;? __Ft. to_.'~ :3'0 From_ _Ft. to_- From ,FL to-- From Ft. to_- From _Ft. to-- From Ft. to___ From_ Ft. to__ - From-- Ft. to_ _Ft.~r~, ,-~X, .,ti , i< From- · - ~ /L~,~ Fr( ~ . Ft.~r~ ;'7~ ~ Ft. .~'~0 /~'~ ~ From~ ~o :~ '~ From Ft. tT.~ ~g~o~O From Ft, Ft, t..~r~'_~ ~ac. ,<- .Ft. .Ft. Ft. Fl._ Et.. From From From From· From From__ From__ From-- · Ft, to___ Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. h)--Ft Ft. to __Ft._ __Ft. to__Ft. Ft. to_ Ft.~ Ft. to__ Ft. Ft. to~{rtl 4 Ft. to Ft. Ft. to Ft~ DRILLER'S NAME ) // " :' POL,,~I I 6 650 AN(]HORAGE, Al ASK/\ 99502-0650 (907) 264-4 I11 DEPARTMENT OF ItEALTH AND ENVIRONMENTAL PROTECTION Permit ti: 840415 January 31, 1985 TO: Permit Applicant SUBJECT: T15N R1W Section 8 Lot 89 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. if a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 DEPFIRTHEiqT OF HERLTH AND ENVIRONHEN'FRL FRLTEI_.UI-' "] '-' 'IuN- ..... L STREET., RNC:HI3RFIGE., AK 99501 264-4720 F'F'RFII T N ] ' DRTE I__LIED. £~1'",1--'-S :[ TE ,_,4041._ 04, ,.,,4 HF F L I _.Mi'.IT HIE. E, R [~ ,:,.:,: CONTRRT PHONE: C:LRUDE HONGERU P.O. BOX 67'1006 CFILIGIRK, RK 9956? 74.5-5054 LEI3RL [.E:LRIF. LOT 'SIZE: SUBDIVISIIDN: N2R LOT: 89 -,ECTION. 8 'rOWNSHIP: tEN RFINGE: 1W o 5R "'-- FT. aR R_.RE:,.. ~. k~&L . F''"'-'~ E, LuL. f .... N,.."R I CERTIFY THRT: i. I RM FRMiLIRR WITH TFIE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MLINICIPRLITY OF RNCHORRGE (MOR) RND THE ~TRTE OF RLRSKR. 2. I NILL INSTRL. L THE SYSTEM IN RCCORDRNCE NITH RLL MOR CODES RND REGULRTIONS., RND IN COMPLtRNCE WITH THE DESIGN CRITERIR OF THIS PERM'.IT. ~, I WILL RDHERE TO RL.L MOB RND STRTE OF RLRSKR REQUIREMENTS FOR THE SET BRCI< DISTFINCES FROM RNY EXISTING WELL.. I,..IRSTEI,.IRTER DISPOSRL SYSTEM OR PUBLIC ,SEWERRGE S'T'STEH OW THIS OR~[:,JRCENT OR NERRE:Y LOT. S I GNED ~ ,/ /~ ~ [. ~,~,-. RPF'L I CRNT: ~ CLRL,ID~_ MONGERU MUNICIPALITY OF ANCHORAGE lie ':h and Environmental Prot~ ion Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4'720 SEP11C TANK: IHOM V',,'[ [I ['~*"C '~.f~ r,.,1/xr.~,.9[ ,",(TURER (~l,-~,-,-,._~, MA'IIT[UAL ............... COMPARTMENTS_.?_~____ ,¢~blLM [E/4£;IH . _INSI[)E WI{)III.. _ t_tQUl[} DEPI'H ...... LIOUID CAPA£1'F¥ /?,J[_~_GALLON$. '}tt.[ [;)l~Allq FIEL_O: TOTAL LENGTH DI!,I,.[I( E r NOM ',^,'Et_l_~\6''U ?EY~,.FOUNDATION ........ NEAREST LOt LINE ........ OF' LINE t~ of Lines !)I'-,Tr~NC:[ HE1WEEN LINES ..... 1RENCIt WII3TH_~- IN, TOTAL EFFE£TIVE !iIiEPAG[ PI'I: Log Crib Rings Crib Size: DIAME'I IOT;,.L EIFEETIVE iJiJlt ~JIH,, (-'t q 3A Orl , N[ARFS/ t_or LINE .......... APSORPTION ARFA (WAr, I_ A lEA) ............ SQ, FT, lass: Depth: )]1 Distance To: Lot Line t. dg: Sewer Line: i pe Materials: ~jf_F~z~ of gedrooms: ~staller: ~ ~marks: i I I GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 ' 'C ' ' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE Pit DRAIN FIELD COMPLETION DATE ANTICIPATED NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEEPAGE PIT SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO SIVER. LAKE, STREAM. , SEEPAGE PIT ALSO CONS]DER AREA WELLS. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET iNTO UND]STUR]~ED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAge PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYBTE~ GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 08..E Russell Oyster 694-2774 Soils If Foundations Perfo~ed for: GEO. :CHNI CAL 8- DEVEL Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 S_.0IL L0~. Name:_ Mail in!l Address: PMENT CO. Earl Ellis 688-2280 Land Development Legal Descrtptton:iX~m'r ~z~ _.Z;~c~.,~, ? /~,/, ~:,lV¢ /,,,,vl, De~th (fe, etJ. Soll Characteristics ,?/z£ . 13 15 16 GrouRd Water Encountered: Yes_.L./._. No .......If yes, what depth._/..~L./. PropOsed Installation: Seepage Pit Drain Field~.~_. Comments: Date:~ O. September 27, 1999 Municipality of Anchorage Department of Health and Human Sen/ices 825 "L" Street Anchorage, AK 99502-0260 Attention: Jeff Poet Subject: BLM Lot 89, Section 8, T15N, R1W Certificate of Health Authority Approval Water System Construction Dear Jeff: On Sunday, September 26, 1999, I inspected the water system located on the subject lot to determine whether it was constructed in conformance with the Municipal Ordinance and the Uniform Plumbing Code. The system is composed of a Burch 14' Long x 7' Wide X 2' Deep containment bladder with a capacity of 1,340 Gallons. This capacity meets the ordinance requirement for homes up to and including three bedrooms without a well. His water system therefore meets the requirements of the ordinance and still includes some production from the well. The bladder is currently filled by the well, but is equipped with an easily accessible 10" diameter flexible fill sleeve on top for filling from an outside source if it becomes necessary. The bladder is located in the crawlspace or unfinished basement of the house and is accessible through a standard sized door. Water from the bladder passes to the X-Trol pressure tank through a transfer pump. It then is transported through the interior piping of the house. All piping is soft drawn copper and no lead flux was used. All work was completed by a licensed plumber and appears to be in conformance with standard practices for installations of this type. In summary, it appears the water system was installed in compliance with the Municipal Ordinance and all codes regulating such installations. We therefore request a Certificate of Health Authority Approval be issued for the water system and septic system on BLM Lot 89. Please let me know if you have any questions. Sincerely, Michael E. Anderson P.E. September 22, 1999 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0260 Attention: Jeff Poet R.EC£IVF D umci a~ity ot A ~cnorage M ' P .... man Services Dept, Health ~- Subject: BLM Lot 89, Section 8, T15N, R1W Certificate of Health Authority'Approval Dear Jeff: The owner of BLM Lot 89 has recently constructed a three bedroom home on the lot. Up until this time he has lived in a mobile home on the property. Water was produced from the well drilled in 1987. He also intends to supply his new home with water from the we] Unfortunately, the well delivers less than the 450 gallons per day to supply a three bedroom home. He has therefore installed a storage bladder in the crawl space of the new home. The bladder has a capacity of 1,140 gallons. This capacity meets the ordinance requirement for homes up to and including three bedrooms without a well. His water system therefore meets the requirements of the ordinance and still includes some productibn from the well. The bladder is equipped with a 10" diameter flexible fill sleeve on top for easy access.should filling from an outside source become necessary. A copy of the manufacturer's data concerning the bladder is included for your review. We hereby request a Certificate of Health Authority Approval be issued for the water system and septic system on BLM Lot 89. Please let me know if you have any questions. Sincerely, Michael E. Anderson, P.E. Attachments 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 ¢07) 343-4744 ON-SITE WATER SUPPLY PERMIT Upgrade Date Issued: Sep 29, 1999 Expiration Date: Sep 28, 2000 Permit Number: SW990362 Legal Description: T15N RIW SEC 8 LT 89 Design Engineer: 0014 Anderson Engineering Owner Name: Claude Mongeau Owner Address: PO BOX 671006 Chugiak, AK 99567-1006 Parcel ID: 051-151-01 Site Address: 020332 UPPER BOWERY LN Lot Size: 108900 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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. DATE: TO: FROM: SUBJECT: MEMORANDUM September 27, 1999 Jeff Poet Mike Anderson, P.E. 7~ ~J~ Lot 89, Section 8, T15N, R1W Certificate of Health Authority Approval RECEIVED SEP 27 1999 Muf~icipali[y ol A,:',cr~orage Dept. Health & Human Services Attached is a certification of the water system constructed on the subject lot. I have also included an application to construct the water system and paid the $120.00 fee. It is my understanding the Certificate of Health Authority Approval can now be issued for this lot. Please let me know if additional information is required. Attachment Copy: Claude Mongeau Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 _x/,' CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O51-1 51-O1 Expiration Date: ~ - i / - U Section 8, T15N, RIW, S.M. Chugiak, Alaska 99567 GENERAL INFORMATION Complete legal description BLM Lot 89, Location (site address) 20322 Upper Bowery f.ane Current Property owner(s) Claude Mongeau Day phone 688-9538 Mailing address PO Box 671002 Chugiak, Alaska 99567 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Brooke Stiltner RE/MAX of Eagle River Day phone 244-6742 11525 01d Glenn Hwy Eagle River, AK 99577 Unless otherwise requested, COSA' will be held by DSD for pickup. NUMBER OF BEDROOMS: " .3 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 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 publ!c water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/Or wastewater disposal system iS(are) in compliance with all apPlicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pinard Engineering Address PO Box 871347 Wasiiia, Alaska 99687 Engineer's Printed Name Paul E. Pinard, P.E. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. Phone (907)357-36/+7 Date bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic AdvisOry Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 3-11 (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Section 8, T15N,RIW, S.M. ParcellD: 051-151-01 IfA, B, or C provide PWSID #__ Sanitary seal (Y/N) Y Cased to 1 3.2 5ft. FROM WELL LOG 6/1 5/87 9 ft. 0.4 g.p.m. Nitrate 10.5 mg/L Legal Description: BLM Lot 89 ~ A. WELL DATA Well type Private Date completed 6/1 5/87 Total depth 200 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: ND ug/L date of sample: 1 2/3/1 0 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. Foundation cleanout (Y/N) Y Date of pumping 6/14/10 C. ABSORPTION FIELD DATA Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 1 8+ AT INSPECTION 12/3/10 24 ft. 0.5 in. g.p.m.(1.2gpm for Other bacteria 0 colonies/100 mL Collected by: Pinard Engineering Numberof.Compartments 2 Depression over tank (Y/N) N High water alarm (Y/N) Pumper Sanitary Pumpers system) Date installed 8/27/98 Cleanouts (Y/.N) Y NA Date installed 8/28/98 Soil rating (g.p.d./ft2~rXf~._~ $. 7 Length 45 ft. Width 1 5 ft. Total depth 5.5ft. Eft. absorption area675 ft2 Monitoring tube Y Date of adequacy test 1 2/3 & &_/1 0 Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 in. Water added 510gal. Elapsed Time:l/+1 Ch3in. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type Seepage Bed Gravel below pipe O. 5 ft. Depression over field N For 3 bedrooms New depth 0 in. in. Absorption rate >= 450+ g.p.d. None Known If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at ~ in. "Pump off' level at ~ in. High water alarm level at in, Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SePtic tank/lift station on lot Absorption field on lot 1 O0 ' + Public sewer main NAt. 100'+ On adjacent lots 100 ' + On adjacent lots 100 ' + Public sewer manhole/cleanout NA Sewer/septic service line Animal containment areas 25'+ 100'+ Holding tank NA Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ' + Property line 5 ' Water main 10 ' + water service line Absorption field 5 ' + Surface water 100' + 'Wells on adjacent lots100 ' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 ' + Water Service line 10 ' + Curtain drain None noted Building foundation 10 ' + Surface water 100 ' + Wells on adjacent lots 100' + Water main 10' + Driveway, parking/vehicle storage 20 ' -I- COMMENTS in DW sample exceeds the Nitrate level ENGINEER'S CERTIFICATION I ce~i~ that lhave *te~ined through field inspections and review of Municipal records th.t the above systems are conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard, ~ P.E. COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1106386001 Client Name Pinard Engineering Printed Date/rime 12/10/2010 9:58 Project NamW# Lot 89 S 8 T15N R1W Collected Bate/rime 12/01/2010 16:15 Client Sample ID Lot 89 S 8 T15N R1W Received Date/Time 12/01/2010 17:20 Matrix Drinking Water Technical Director Stephen C. Ede Saml~le Remarks: Allowable' Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init ~.s b~ xcv/y~s Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/03/10 12/08/10 NRB Waters Department Total Nitrate/Nitrite-N 10.5 * 0.100 mg/L SM20 4500NO3-F B (<I0) 12/02/10 AYC Microbiolo~ Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 12/02/10 DLC Negative I 100mL SM20 9223B A 12/02/10 DLC (907) 631-0536 Fax Bill To: Brooke 8tiltner Remax 11525 Old Glenn Hwy Eagle River, AK 99577 RE: 20322 Upper Bowery Invoice 02/14/11 2117 I Due on mceip~l Item .. Descriptioa' .. .Quantity Rate . .Amount Labor 1140 gallon bladder tan k with liqu led level control 2,100.00 2,100.00 install. Fill pipe and tie into existing jet pamp, Removed existing softener and disabled well pump. PER BID Out Of Ama Not within Wasilla city limits 0.00 % 0,00 Sales Tax We charge 18~ per annum on all past due balances. Thank you for your business. Total. $2,1 ARCTIC PUMP & WELL INC. Jim S~ll~.~ PO Box 770197 Eagle Ri¥¢r, ^K 99577 (907) 688-2510 (907) 258-25 I0 (907) 745-2510 apw(~gci.net On Site Services 2-11-11 R.E. T15N R1W S8 L89 Well conversion The well on this property has been converted to an agricultural well. The well has been sealed fi.om the bottom up to -25' with bentonite Hole Plug and the pump is disconnected fi.om the pit les adapter - severing the connection to the house. The water for irrigation will now be discharged at the top of the agricultural well for non potable use. This work was performed at the request of the property owner. Jim Sullivan Arctic Pump & Well, Inc. Page 1 of l PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST LOCATION: Lot 89, Section 8, T15N, RlW, S.M. DRILLER: Sullivan Water Wells DATE WELL COMPLETED: 6/15/87 WELL DEPTH: 200' JOB NUMBER: 10-318 DATE OF TEST: 12/3 & 12/4/10 FIELD STAFF: PJ Pinard STATIC WATER LEVEL (top of casing): 24' Elapsed Static Flow Cumulative Time Time Water Rate Gallons Remarks (Minutes) Level (~lpm) Pumped 11:30 AM - 24' 3.3 - Start Test - Meter 371550 11:45 15 45' 3.3 50 371600 12:00 PM 30 71' 3.3 100 371650 12:15 45 97' 3.3 150 371700 12:30 60 115' 2.0 200 371750 12:45 75 136' 0.7 230 371780 1:00 90 138' 0.0 240 371790 1:15 105 138' 0.7 240 371790 1:30 120 138' 0.0 250 371800 1:45 135 138' 0.7 250 371800 2:00 150 138' 0.7 260 371810 2:15 165 138' 0.0 270 371820 2:30 180 139' 0.5 270 371820 3:30 PM 240 138' - 300 Stop Flow to allow well to 371850 refill storage bladder/tank 10:15 AM 1325 24' 4.7 - Resume Flow next morning 371860 11:00 1410 117' 510 Stop Test 372070 RECOVERY All well protection features are adequate. Well began refilling storage tank after flow was stopped at 3:30 PM on 12/3. Static level at 10:15 AM on 12/4 (18 hrs & 45 rain after stopping test flow the previous afternoon) showed a complete recovery to the starting level. Average Flow Rate: 1.2 gpm Comments: DURING THIS TEST, THE WATER SUPPLY SYSTEM WAS CAPABLE OF PRODUCING 4.7 GPM FOR A LIMITED TIME. THIS TEST DOES NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Reviewed by: Paul Pinard ~{:Z~;~~ Date: 12/10110 PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST-FIRST ATTEMPT LOCATION: Lot 89, Section 8, T15N, RlW. S.M. APPLICANT: Claude Mongeau PO Box 671002 Chugiak, Alaska 99567 SEPTIC TANK TYPE/SIZE: Steelll000 Gallons, per MOA Records ABSORPTION SYSTEM: Seepage Bed, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAL/BR = 450 Gallons JOB NUMBER: 10-318 DATE OF TEST: 12/3 & 12/4/10 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.1' SLUDGE: Minimal NEEDSTO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No TEST DATA Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments Rate Volume Tank AM (GPM) (GALs) (GALs) Liquid Level A Level Monitor A SAS Monitor /~ SAS * Tube 1' Level Tube 2* Level 11:30 3.3 4.0' - 0.0' 0.0' - Start Flow - Meter 371550 12:00 3.3 100 100 4.1' 0.1' 0.0' 0.0' 0.0' 0.0' 371650 12:30 1.3 100 200 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 371750 1:00 0.3 40 240 4.1' 0.0' 0.0' 0.0' 0.0' 0.0' 371790 1:30 0.4 10 250 4.0' -0.1' 0.0' 0.0' 0.0' 0.0' 371800 3:30 - 50 300 4.0' 0.0' 0.0' 0.0' 0.0' 0.0' Stop Flow 371850 (allow recovery to 12/4 AM) 10:15 4.7 - 4.0' - 0.0' - 0.0' - Resume Flow 371860 11:00 - 210 510 4.1' 0.1' 0.0' 0.0' 0.0' 0.0' Stop Test - 372070 RECOVERY Date Time ST MT SAS MT *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: System appears to be operating satisfactorily. There was no measurable liquid in the SAS MT prior to or at any time during the test. Test was conducted in two periods within 24 hours during which the test volume (510 gallons) was added. This was necessary due io limited flow available from the water supply system. It should be noted that additional flow was contributed during this period since the residence was occupied. Reviewed by: Paul Pinard Date: 12/10110 FEB-25-2011 16:46 From: To:190734~7997 Page:3/4 Z FEB-25-2011 16:46 From: To:19073437997 Page:2/4 Z/2$/ll Attn: Brooke Stiltner RE/MAX of Eagle River, Inc. 11525 Old Glenn Highway Eagle River, AK 99577 RE: 20322 Upper Bowery, Birchwood To Whom It May Concern: The water system installed at 20322 Upper Bowery, Birchwood Alaska was installed according to the current code with approved pipe, fittings and components, Thank You, Michael La Fay Meadow Lakes Supply Company Plumbing & Heating LLC. 1651 W. Parks Hwy. Wasilla, Alaska 99654 907-373~2746 ph 970-631-0536 fx ~_ike @ mea~_o_wl.a kess ~u_p.p_ly .corn SOA Plumbing Journeymans Lic # 118939 Mechanical Admin Lic # 831 AK Contractors Lic # 33978 FEB-SS-SOl1 16:46 From: To: 19073437997 Page: 4/4 Convenient to .Fill, Dr~n Quality t Vz' gate valve is mounted on $' PVC extension pipe for easy drain/rig. Big 10" diameter flexible sleeve on Wp makes tank simple W fill. Compact, Easy to Store Even the largest Kolaps-A-Tank can be folded up and stored an 18" x 18" X 18" carton. SPEC CATIONS Model No. Approximate Size Gals, Liters FDA 50.MT 40" x 50" x 12" ( 102cm x 127cm x 30cm) 73 276 ApproX. Shipping' Lbs. ,11 .. 5 FDA 73MT 80" x 73" x 16" (203cm x 185cm x 4tcm) 275 1040 23 FDA 98MT 65" x 98" x 18" (165cm x 249cm x 46cm) 525 1987 33 ..... FDA 6t~0MT 6' x 10' x 2' (1.83m x 3.05m x .6lin) 800 302,8 42 FDA 712MT 7~x 12' x 2' (2,13m x 3.66m x ,61m) 1140 4315 58 26. FDA 714.MT 7' x 14' x 2' (2.13m x 4.27m X .61m) I340 5072 64 29 FDA-approved models meet Food and Drng Administration 21CFR121.2514 of subpart F of the.,~ood Addit'~e Regulation, making it safe for drinking water used for human consumption.. . -,.. il'om covered wagons to turk .ey saddles,.. Burch Manufacturing has been making quality ~e~tfle products for agriculture, indusO-y, and more for almost 100 years. If a product you need can be made of canvas or v/nyl coated nylon -- chances are we can sew it., heat seal it, or silt<screen it. Send us your specifications and well be happy to provide you wi{h a free estimate.:" Sales and Service: 'kI ASBUILT ~EWARD & ASSOCIATES LAND SURVEYING 694-082q I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND ~AT NO ENriCHMENTS EXIST ~CE~ AS INDICA~D. IT IS THE RES~NSIBILITY OF THE ~N~ TO D~ERMINE THE EXISTENCE OF ANY E~EMENTS, COVENANTS~ OR RESTRICTIONS WHICH DO NOT ~PEAR ~ THE RE~D~ ~BDI- VISION P~T. UNDER NO CIRCUMSTANCES S~ ~Y DATA H~EON BE USED FOR CONS'TRU~ION OF FENCE LIN~ OR FOR EST~LISHING ~ND- ARY LINES. SCALD /., DATE~ GRID" ,~*~-o~/.~- 7 FB-' ' UWN; PO Box E~ Rtver, AK 99577 (907) 9~i7344982i Roma× of Eagle River 525 Old Glenn Highway Eagle River. AK 99577 (907) 694~4200 Service Agreement Number; 032930 Order Date: 0g-Mar-2011 Sel¥ioe Date: tO-Mar-2011 Technician: Dan Net 30 Tax %: 0 Lynette Job CoTnment~: 20209 Chapel Drive Chugiak, AK 99567 (907) 694~4200 greatlar~d Drive joked &,Pumped Tank - L ~ good iB/F 2 X s *NEED D~ WING~ Additional Location Comments Cedar sided home - has barn on property t Gal. Actuak ~ Hose Length: Double Tank: Pump System: Baffles In,et: Baffles Outlet: 81 Service Type Qty Price ~ch Tax? Extension Actual Septi~ Sew 15K I $210.00 No $2.10.00 Estimated Cllatges: $210,00 ~O. O0 $0.~ ~210.O0 Actual Cha~ge~: Al[er 30 Day~ a~Jr~t v4ti' be turned over t~ COLLECTIONS° ~0.00 FO~ NSF Chec~ RebJmed~ 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 Parcel I.D. # 1. GENERAL INFO RMATION Corn plete legal description CERTIFICATE OF HEALTH AUTHORITY A'PPROVAL FOR A S NGLE FAUILY DWELUN 051 -1 51 -01 HAA # BLM Lot 89f Section 8, T15N, R1W Location (site address or directions) Property owner Clabde -Monqeau Day phone 688-9538 Mailing address P.O. Box 671006 Chugiak, AK 99567 Lending agency Mailin. g address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Three (3) XXX 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 XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide Written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev. 1/91) Front MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewa~er disppsal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK Engineefs signature ~ ~ ~ Phone 99524 522-7773 Date 9/23/99 DHHS SIGNATURE L.~ A?proved for ~T'/¢/~F--F- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. --There Pre ~s pr~n~. T~ ~ ~,,g?~ ~h~ p~n~ ~ng ~ performed to insure the wells continued suitability. Current nitrate More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Addition~ Comments The Municipality 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 satisfy certain federal and state requirements. Employees of DHHS 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 engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division SIP 2 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 · Dept Health & Human ~ervmes Health Authority Approval Checklist Legal Description: BLM Lot A. WELL DATA Well type Private Log present (Y/N) Y Total depth 200 ' Sanitary seal (Y/N) 89, Section 8, T15N, ParcellD.: 051-151-01 RIW . If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level 9 ' Well production .42 WATER SAMPLE RESULTS:. ColifOrm 0 Date of sample: ..~ .; 8/25/99 B. SEPTIC/HOLDING TANK DATA Date installed 8/27/98 Tank size Foundation cleanout (Y/N). Y Date of Pumping New C. ADSORPTION FIELD DATA Date installed 8/28/98 Length 45 ' .Width Effective absorption area 675 Date completed Cased to 13.25' Bedrock Y FROM WELL LOG 6/15/87 Nitrate 6/15/87 Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 2I Y g.p.m, g.p.m. 9.73 mg/L Other bacteria Collected by: Tim Kimbrough I , 000 Number of Compartments 2 Cleanouts (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Pumper Construction Soil rating (g.p.d./ft2 or ft2/bdrm) .7 15 ' Gravel thickness below pipe SF Monitoring Tube present (Y/N) Y Date of adequacy test New Const. Results (Pass/Fail) Pas s Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (y/N) 72-026 (Rev. 3/96)* System type Bed · 5 ' Total depth 9 ' Depression over field (y/N) __ For Three Immediately after Absorption rate = N If yes, give date gal. water added (in.): q.p.d. bedrooms D, LIFT STATION - None on Lot Date installed Manhole/Access (WN) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons F. "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots > 1 N 0 ' On adjacent lots > 1 0 0 ' Septic/holding tank on lot > 1 0 0 ' Absorption field on lot > 1 0 0 ' Public sewer main N/A Sewer/septic service line > 2 5 ' Public sewer manhole/cleanout Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ' Property line ;, .5 ' Water main/service line > 1 0 ' Sudace water/drainage > 1 0 0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 1 0 ' Building foundation > 1 0 ' Surface water > 1 0 0 ' Cu~aindrain None Noted on I, of. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal · in conformance with MOA HAA guidelines in effect on this date, Signature ~c~t-O.L Engineer's Name NJ ~h~l ~ An~er_~en, P.E. Date 9/22/99 HAA Fee $ Date of Payment Receipt Number "Pump off" level at* 72-026 (Rev, 3/96)* N/A Absorption field. > 5 ' Wells on adjacent lots > 1 0 0 ' Water main/service line > 1 0 ' Driveway, parking/vehicle storage area > 2 0 ' Wells on adjacent lots > 1 0 0 ' Waiver Fee $ __. Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot ~ p uc~ivity was dete_mined to be .~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is , ~/2 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 ncn-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Apprcva!. · AUG-31-~g 08:41 FROIA-CTE ENVIRONMENTAL ~ .~-t~m~. CT&E Environmen,a, Serv,ce~ Inc. ~815301 T-428 P.OZ/03 F-~89 CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordexed By lrWSI~ 994488001 Andc'v~n Engineering Mongeau Job No. Ki[c~e.~ Faucet Drinking WaIer Sample Remarks: Client pos Printed Date/Time 08/30/99 16:29 Collected Date/Time 08/25/99 12:55 Received Date/Time 08/25/99 14:20 Technical Direc-~r: Stephen C. F. de Released ~ ~ 1 oS/~OO ML. NO 9.73 0.5oo $fl15 9222B 08/25199 KAP EPA 300.0 10 max 0B/25/99 0~/25/99 SCL Received Time Aus.31, 7:42AM , ^UG-31-gg 08:42 FEO~CTE ENVIRONPENTAL 5615301 T~4Z8 P.03/05 F-589 zTF. CT&E Environmental Services Inc. ~eld For Con(irmatk}n Laborato~/Division r. ar~a~ar.~r~ ,,~a-.~a~e',~'a-a.:ar~',~a'a,4 200 W- Peter Dr~vo Drin¼ng Water Analysis Report for Total Coliform Bacteria A.~hor~,.. AK 99sls.~6os Tel (907) 562-2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING S.4MFLEFax (~O7) 561-5301 ~ TO BE COMPLETED BY LABOKATOKY MUST BE COMPLETED BY WATEP. SUPPLIES PUBLIC WATER SYSTEM I.D. jjfi~'k._PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be: Sans factory Unsaasf~Ctory m Sample over 30 hours old. rcsutm may be unreliable Sample [oo long m ~ansR, sample should [o indicate ~diable result. Please new san,pie wa ~ectal dehve~ marl- Date ~eived Anal~i~l Meth~: ~mbrane ~ MMO-MUG SAMPLE DATE- [~ [~ ~ Month Day Year SAMPLE TYPE. )~ Routine ~ Treated Water 13 Repeat Sample {for rou[ine sample ' [3 Untreated Water with lab ref. no, ) Cl Special Purpose Time Collected Collected By .... 00 ml. Result~ Analyst Sent to A,D.E.C- Anch Fbks Jun [] Faxra Client notified of unsatisfactory results: SAMPLE LOCATION BACTERIOLOGICAL WATER ANALYSIS ~CO~ MMO-MUG Re,alt: Tuta{ Coliform E. Coil Verification' gl'8 ~( BGB ~ .COLIFIRM 'c,.rc~ Col!;orm/100 mi Time ~7~0 hr~ Received Time-Aug.31=7:42AM~