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GINAMI HILLS LT 3B
G inami Hills Lot 3B #015-461-49 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211101 PID Number: 015-461-49 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New FN Upgrade Name NATHANIEL SMITH ABSORPTION FIELD WEST/EAST ❑ Deep Trench I Wide Trench ❑ Bed ❑ Mound Site Address 12020 GINAMI STREET *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 801-560-8306 3 0.6 GPD/SF 8' MAX Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG Ft. Gravel depth beneath pipe 4.01/4.02 Ft. Subdivision Block Lot GINAMI HILLS; LOT 3B Fill added above original grade SEE DWG Ft. Gravel length 40/40 Ft. Township Range Section Gravel width 5/5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 800 Ft 2 2 '+ 8 Ft. Well 1001+ 100'+ - _ 25'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCHORAGE TANK 1000 Gal. Surface Water 100'+ 100'+ - _ Material Number of compartments Lot Line 5'+ 10'+ - - NA HDPE 2 Foundation 10'••1- 10'+ _ _ LIFT STATION Manufacturer Capacity Remarks OLD SEPTIC TANK DECOMMISSIONED PER UPC Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer A+ HOME SERVICES Drainfield D3034 CO/MTD3034 Inspector GEG BENCH MARK (Assumed elevation) 100.00 ft Inspection 15` 5/11/21 5/12/21 Location and description 2nd OF MANHOLE 3rd 5/12/21 4-16/13/21 ITOP ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's tamp oo�o O Conditional Approval: Date7. � 0 o: ............................... Septic System ffrey G ness,- OQ Approved--.--- w ' Date CE-7 53 q"- Note: this approval does not include well permit requirements. aECC884Op�000��o trcev UOiutn a/ PERMIT NUMBER: PARCEL ID NUMBER: OSP211101 RECORD DRAWING 015-461-49 I A 1 B C DBL1 22.7 35.6 DBL2 23.6 35.8 "1 25.1 35.4 STI 29.4 37.1 DBL3 30.9 37.3 DBL4 31.9 37.6 FD 32.6 37.8 FS 72.4 58.9 C01 - 56.2 75.8 MT1 54.7 74.4 CO2 60.8 71.9 MT2 62.5 73.9 CO3 72.6 91.8 MT3 73.9 93.1 C04 88.5 102.2 MT4 86.7 100.3 NEW 1000 GALLON HDPE GREER TANK WITH DOUBLE CLEANOUTS BEFORE AND AFTER / z wl w �I uI M / �HIw cvi FD o NEW DRAINFIELDS S / NI FS I G� I I I I I I I I I I I . I . I I MT 03 C T1 O� EXISTING 3 BEDROOM HOUSE I I I 1 C I 1 �Rp`O\JS I MTC 4 MT2 2 �- - - - - - - - - - - - - - - - - - - - - - - - - - - - - v -- - - - - - - - - - - - - - -I 10' TELECOMM. 8 ELECT. EASEMENT GINAMI HILLS; LOT 2B \ 9 DOH ROAD, SUITE 101•A ENGINEERING H=�SALES-CONSULTiNG 37oiE.ru(907)337-6179 : u . NCHORAGE. AK 99507 -PHONE • FA%(907) 336J246 •WEBSITE: w+ a messenameem PREPARED FOR: NATHAN CLAUDIA SMITH LEGAL DESCRIPTION: GINAMI HILLS; LOT 3B TYPE OF WORK: � SEPTIC SYSTEM RECORD DRAWINGS PHONE NUMBER: 801-560-8306 PAGE NUMBER: 2OF3 DRAWN BY: D.J.G. DATE: 5/24/2021 OF.. e�® Jeff,ey A. Garner"s CE-79 /jj3 AV'Aw LICENSE '4®®®��S®gyp®® �® #AECC884 / PERMIT NUMBER: OSP211101 PARCEL ID NUMBER: 015-461-49 TOP OF MH = 100.00 FINAL GRADE = 99.4 ST2 F i r-2" HIGH DENSITY INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 97.05 -\ I I I I / r TOP OF TANK AT OUTLET = 97.05 NEW 1000 GALLON \ INVERT OF BUNG AT INLET= 96.35 H. D.P.E. GREER SEPTIC TANK RATED FOR 10' BURIAL ORIGINAL GRADE AT EAST HIGHEST POINT = 96.50 TCO -FINAL GRADE = 97.1-97.4 ORIGINAL GRADE AT T.H. 7 ' FILTER FABRIC HIGHEST POINT = 94.19 INVERT OF BUNG AT OUTLET = 95.20 WEST FINAL GRADE = 94.1-95.0 T.H. TER FABRIC T T 4.02' INVERT OF PIPE = 92.52 4.01'W5 - INVERT OF PIPE = 90.20 I5' BOTTOM OF TRENCH = 88.50 BOTTOM OF TRENCH = 86.19 RELATIVE ELEVATION OF BOTTOM OF T.H. = 80.19 RELATIVE ELEVATION OF BOTTOM OF T.H. = 82.50 aro I M. I VUVK KVAU, aUl It l Vl . ANUt1VKAGt. AK 99007' FHUNt (907) 337.6179 • FAX (907) 338.3246 • WEBSITE: www.gamessengineedng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: NATHANIEL SMITH 801-560-8306 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: GINAMI HILLS; LOT 3B D.J.G. TYPE OF WORK: DATE: �,_ SEPTIC SYSTEM PROFILE RECORD DRAWING 5/21/21 OF ®°+® � .............t , ... .....:..... ® m ®0 �,l .,Jeflrre . Gar, ess W Aw g-793 �• =gym ®+ pROFESSNY, MUNICIPALITY OF ANCHORAGE [n -Site Water & Wastewater Program POBox 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 httpmmww.mum.org/onsite On -Site Wastewater Disposal System Permit Pe,mitNuruber: OSP211101 Effective Date: 4/14/2021 Work Type: Septic Upgrade Expiration Date: 4/14/2022 Tax Code Number: 01546149000 Site Legal Address: G|NAK4/HILLS LT 38 G:2741 Site Mailing Address: 12O2OQ/N&M|ST, Anchorage Owner: SMITH NATHANIEL L&OALU0Ap Lot Size |n8qFt: 108312 Design Engineer: GARNES8ENGINEERING GROUP LTD Total Bedrooms: 3 This permit kafor the construction of: M Disposal Field RI Septic Tank [] Holding Tank [] Privy 11 Private Well [] Water Storage All construction shall beinaccordance with: 1. The attached approved design. 2. All requirements specified inAnchorage Municipal code Chapters 1565 and1565 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) -. The wastewater ,~_~ ..,~.~~...'..^.~..~.~°.g the installation.""The engineer w/ao /wu/y the Development Services Department per AMC 15.GG.Provide notification bycalling (QU7)343-78O4(2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Special Provisions: Slopes in the area of the proposed drainfields and within 100 ft down -gradient shall be confirmed prior to construction of the drainfields to verify slopes less than 45% (drainfield design meets steep slope provisions ofthe node). If slopes are 45%orgreater, achange order orwaiver request shall besubmitted N for Onsite review and approval. Slopes shall benoted onthe final record drawings. Received By: Issued By: _ f -cu- S Date: YO yl/�—/ IRA"UMICIPAL11TY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section =`� Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-461-49 Property owner(s) NATHAN AND CLAUDIA SMITH Mailing address 12020 GINAMI STREET *ANCHORAGE, AK Site address Legal description (Sub'd., Block & Lot) GINAMI HILLS; LOT 313 Legal description (Township, Range & Section) Lot Size Day phone 801-560-8306 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank Upgrade, (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 5 9 S Date of Payment: _ �/?/.2 00 Receipt Number: D 5 °I r7 G Permit No. 05P 2 (1 1 O 1 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211101, Rebecca Carroll, 04/14/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211101, Rebecca Carroll, 04/14/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211101, Rebecca Carroll, 04/14/21 LOT 13 \ S89'059'30"E 630.53 EASEMENTS 8 . THER THAN4 SHOWNTHOSE RECORDED PLAT ARE NOT SHOVM HEREON. AS -BUILT W11 CORNERS SET71"HIS DATE .s, fh Municipality of Anchorage Page I o _2 1 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: :5L, t"1 4>250 PID Number: 4 is I - q l Name: Wastewater System: ;I New ❑ Upgrade Address: ABSORPTION FIELD 53o 1 UJrjJOFi.ou1ER AP t. 1� ►Ic�4 • /acK ggSo'I Phone: oo-( No. of Bedrooms: 3 Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0.(0 original Total Depth from i®igrade: GPD/S . Ft. Lot: Block:Subdivision: Otu. Depth to pipe bottom from original grade: Gravel depth beneath pipe '7 39 --- Glao.wtt S 2.5Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: S t 1 0.5, Ft. Ft. Gravel width: Number of lines: Distance between lines: WELL: New ❑Upgrade 3 Ft I Ft, Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: —7105 Pipe material: I4wre r,• 0 5 Ft. 'go Ft. So. Ft. As?a1 0-3o F.S b Driller: LPt✓k, p1QILLIKir Datil Drilled, b7a 0797 Static water Level: / q FL Installer: OwNL12 Date Installed: Yield: I Casing Height Above Ground: TANK 3 GPM U k Ft. a Ft. SEPARATION DISTANCES IS Septic ❑Holding ❑S.T.E.P. To Septic Absorpllon Lift Holding Public/Private Manufacturer: 69'Er:2 Capacity in gallons: f Oo O From Tank Field Station Tank Sewer Lines Well .____ _ 25 f- Material: 5-reeL_ Number of Compartments: 2 101, loll --- --- —' LIFT STATION WateSurface r look too' {- Lot 1,1. '15 14„ - — ._--, Size in gallons: Manufacturer: Line 2Q "Pump on" level at: "Pump oft" level High water alarm at: Foundation 191> i II curtain ` �o rz Know Pump Make & Mo ectrical Inspections performed by: Drain Remarks: rLo w 01 ul a/L2 (/ZoJ ^ ST94,L#4 BENCH MARK M/O lootN% D/� /alrfi26gUT/os.J Location and Description: 'r rat s' To of GAQ.AGE SL Ala 0 Assumed Elevation: lOo. o Ft ENGINEER'S SEAL OF r` AV - -19 • ' ' a -i Dates: 1St -7/ l ' 1 �':' y.- -� ...._�.°.. -.. e s e e�Rllleenlr�r• Inspections performed by: it i . 17034 Eagle River Loop Road, N0.2" 2nd 2 97 / '°= "" "' "mss"� "•"° Eagle River, Alaska 99577 3*4 k 1O %IS T C y ROBERT C. COWAN �4VGC Department of Healt .and Human Services approval Depa c� -asoi �N Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW970050 PAGE 2 OF 2 \ MunicipaUt of Anchora e DEPARTMENT OF V�C��TH AND HUKAN SCWCES \ ENVIRONMENTAL SERVICES DWS SOON P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Tele hone: 343-4744 ®N -&TE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION (REPORT LEGAL LOT 3B. GINAMI HILLS SUBDIVISION P.I.D. No. 015-461-49 A B C FCO 5.5' 25.5' - ST1 21.5' 32.5' - ST2 27.5' 35.0' - DBL1 30.5' 36.0' - DBL2 33.5' 36.0' - I FD 40.0 14.5 34.0 I C01 25.5' 26.5' - -PT 1 25.0 26.5 - I CO2 61.0 31.0 36.0 MT2 61.5' 31.5' NEW 1000 GAL. ] SEPTIC TANK o a z I >w E NEW TRENCH09 ST2 o o i w OBL2 I E- co CO I I FCO A I I F Q ALT. SITE l i 3 NFK, i o F I TH/1 e tio�S,pM WELL TH#2/ /� ATT2 CO2 I -------------------------- - - - - - - --------------- --------------10' 10' UTILITY EASEMENT STI S FINAL GRADE Col MTl COl CO2 = 98.9; = 98.8 SCALE 1" = 40' 99.8' INSULATION MT 02 ENGIN.��; MP OF AL t4, INSULATION ,��ss ✓i,`Q� ,,.•� "" •••., 'Q3s 98.6' NEW 1000 GAL col = 95.9; CO2 = 95.9 SR r�� 4 ' SEPTIC 98.4' j" ' N.. r .........«.s.... 0 TANK y sf� ROBERT C. COWAN MT2 88 5' CE - 8801 +0, �sj/e. = • NO WATER FOUND 4 82.5' B.O.H. Yrom . HLr1rvC LK1LL >U( ------- LOCATION --•---- STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOCATION OF WELL so VON SUBDIv5s N �ipgml �rlis LOT BLOCK SECTION OTRS SECTION TOWNSHIP RANOE MERIDIAN CIN OE OS OW LOCATION/SKETCH: WELL OWNER:1 n DEPTHS MEASURED FROM:Ocasing top Oground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: t% ft // fP r -s % BOREHOLE DATA; Depth Depth of casin it Material Type and Color From Tp DEPTH TO STATIC WATER LEVEL: & ft bolow -'top of casing D ground surface Date; /. /r r l K7 a METHOD OF DRILLING; A air rotary O cable tool �j O Other USE OF WELL: JES-domestic ❑ irrigation © monitor O public Supply © other Jr r CASING -STIC -UP: 2— ft. Diem: in. toW ft Casing type: in, t0 ft / F _ WELL INTAKE OPENING TYPE: O open end O Screened CA )k1 perforated ), open holo Depths of openings: to 7-%57_ ft l � _73 r•\` �%��tjr SCREEN TYPE: Diam:_ in. r(�`-(.wxi 5z? i Slot/Mesh Size: Length; ft ,. l GRAVEL PACK TYPE: Volume used: Depth to top; GROUT TYPE, tSW 7t Depth: from ft t0 ft R DEVELOPMENT METHOD: l % Duration: PUMPINq LEVEL AND YIELD: r _ ft after '.-. hrs pumping _gpm PUMP INTAKE DEPTH: ft Horsepowar: WELL DISINFECTED UPON COMPLETION? QB YES ❑ NO CONTRACTORINFORM ON: REMARKS: - A A Rog)'qerF Business Name •PLEASE MAIL WHITE COPY OF LOG TO: �� DNR/DIVISION OF MINING & WATER MGMT Ignature of horize espres latheatb e 3601 C St, Suite 600 Anchorage, Alk 99503-5935 Ph(907)762-2538,Fax(907)562-1364 L SOLS HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN Date: 7/ -7lg7 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 4 REFERENCE: 1-07" 3 (3 6,LNAMI kILL, 5 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 RECEIVED JUL 10 1997 itY of Anchorage Municipal Dept. Health &Human Services sin The septic in pections for �he referenced property were performed on `7 /1 / g 7 and l 17 Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the Foa. laroi-I 1As&,L: S�ooq to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 A40/f c. ur 7 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970050 DATE ISSUED: 4/04/97 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 4/04/98 OWNER NAME:LARRY REITER OWNER ADDRESS:5301 WINDFLOWER APT. 99507 ANCHORAGE, AK 99507 PARCEL ID:01546149 LEGAL DESCRIPTION: GINAMI HILLS LT 3B LOT SIZE: 108312 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER -MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: ►s�� (4o�owi DATE: / 4 /A 7 DATE: L-6 ,Y i I -'sl Ci d TtP2 (gD7)k7� 3007 C9o)7,62.675s- 1 OPO ,,()50D /�LL.— TY/55 6VurPVkU� ter 766 � O ea cs 2/k N (Ilv 515Prc(— S�S � —t D'� is �`� S �C''�2 $ (5 4 Y IMS -5 . V L S& March 6, 1997 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 j FAX(907)694-1211 RECEIVED MUNICIPALITY OF ANCHORAGE APR 4 19S HEALTHAU�HORITY Department of Health and Human Services APPROVALS P.O. Box 196650 MunicipalltyofAnchorage Anchorage, AK. 99519 Dept. Health & Human Services REFERENCE: Lot 3b, Ginami Hills Subdivision SEWER&WATER MAIN EXTENSIONS Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on SEWER&WATER the referenced property. _ INSPECTION Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. ENGINEERING STUDIES AND REPORTS At the time of excavation no water was encountered. the monitoring tubes within the test holes have been checked and found to be dry. WELLINSPECTION This property has enough area for a future septic upgrade &FLOWTESr which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the SITEPLANS installation of the proposed septic system. If you require additional information, please contact us. ROAD DESIGN Sincerely, '/j,'yA so ILTEST Robert C. Cowan, P.E. RCC/mg Enclosure PERCOLATION TEST FG£ - STRUCTURAL&), ,t'' �(£lt _n:p,tj �. uc T,'.0-•• MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 60' mZ�� pzC �c y Vvmi�m<C ZC G9C'gtiT I I O rl ml--rlyW ZZ�vif— Sm �� I Oma ODcm p A AZ VI K<VI2 _Owo jmm - SITE -PLAN z -25' ACCESS EASMENT- -. ----------------------------- ;v 0 . t m n pOTI£z O 70 or 0 Z cr .,O zm m U) 0 ti Nvm,K. �'n rri to 7070 pA mm0K 0 m0 vo Nn o n AA—zi G7 Ox yl ZO Own zm l[�id mrll Z� N O Q O r, G7 Zo n (n p �z"oma 0 I 0� O"� �L I !/AKA mm I .O O DESIGN 10' ELECTRIC EASEMENT -25' ACCESS EASMENT- -. ----------------------------- ;v 0 . mr 70 or 0 Z cr .,O D U) 0 ti [arte rri to ® 7l d 0 T � m0 L�j w00-rlm n r m H',tlMy -+ o D O (1� 0 x ('2 O ZO NO WELLS D WITHI 200'+ n I ►` ` r F_ 9lz 1 hll o O Z i hl r- ;v 0 . mr r� or czimrrl 0m D 6) 'tn y /sP_ F 0 70 °""1 :Ea Z ® 7l @� rn II � m0 L�j w00-rlm OOe�e? x• r m H',tlMy I o ,W (1� 0 x I zKan O Q O r, G7 n (n p �z"oma m 0� O"� �L m . !/AKA mm �a .O O ozQA ��tzq gmMK Tzm � O z ymo W I Zom I � I O A N +�m� a rb -------------- -----------------1---------- 10' TELE.COMM. & ELECT. EASEMENT ; �t XCff- F_ O W D ;v ki. . mr r� or czimrrl 0m D 6) 'tn N -,I -P 00 I F 0 70 °""1 :Ea Z ® 7l @� rn II m0 L�j w00-rlm II o II � I o ,W F_ O W D CIr W -I O N O t . ------- -P fl1 or czimrrl 0m D 6) 'tn N -,I -P 00 I F 0 70 °""1 :Ea Z r @� rn II m0 L�j w00-rlm II o II � I o ,W (1� 0 x I < m O Q O r, G7 n (n p �L m . �a m jo ;r r v 0 CIr W -I O N O t . 00 0 m 0 czimrrl C � vv � I o ,W �d I Ism .1- S'' ® Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ' T : 825 "L" Street, Anchorage, Alaska 99502-0650..,�; SOILS LOG - PERCOLATION TEST if�. 9 ROBERT C. COWAN c� •4 CE - 8801 <� PERFORMED FOR:Et?E2 DATE PERFORMED: V e LEGAL DESCRIPTION: LC 6INAMI H%Lt-55/*Township, Range, Section: SLOPE SITE PLAN 2 Date M L — SILT ItJ7C SANp i .iY[' Depth to Water Net Drop P+sE S G N1 M 1X D w LT FF i 3, .o:3 •1 ': i ANO sANa 4 l.,b,• GM SILTY slit-+�� Ci'(2AJ>rL.. 5 6-" o • .., Io; o•. — ORAVGLLQf SAWO u'.6.. (�? n 18 19 GFA—S`kL.V 541401 WAS GROUND WATER Nd r,RAJEtw- W1 ENCOUNTERED? UP S C�8Q1i�s IF YES, AT WHAT — 0 -ro 4 DEPTH? P E Depth to Water Atter Monitoring? 'PQ Date: 3'ab-�(GL' 'B.C).AA , Reading Date Gross Time me Depth to Water Net Drop P+sE S A1, `PER:o0 rNet t3:lo � � S'p Il $ � • 1� ., 20 I 20 uPERCOLATION RATE moi" (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS I ESi �oc EXC.A�/4T� BY--rwwa o �XG. PERFORMED BYS & S ENGINEERING r/, G��J� CERTIFY THAT THIS TEST WAS PERFORMED IN ] 7034 Engle Iver oop jab b ACCORDANCEa��(�iii�da9Yt3asisal9®&I�iPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) f Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LAQRY —9, a I ram_ — DATE P LEGAL DESCRIPTION: LOT SS I G (t,/.AHI PILLS54;, Township, Range, Se ction: SLOPE 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 M L — slt-T, r- tN'5 SA" C) H%xiEt> wtr,4 60A*Jtg� 6"vrL_ Alr40 SAWD S.0'+i - sw'04 SNNCA� c_.,q�A,,46-L "kxvect) vit-r" 5IL111 S&aC- L-wr4SES swTy SA00V 6,9_Ak4CL W/CoSeLIEI, T-blia" � I "f ........... ROBERT C. COWAN C�c - 8801 i I i3f - q V RMEbl,,- SITE PLAN WAS GROUND WATER ENCOUNTERED? L 01. t__T_ IF YES, AT WHAT 0 DEPTH? P E Depth to Water After TO Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop �t, *-Pemit-c j;t.'35P.VA. I S 1;6.415 10 104100 151/1 4 va" 12151 it to Ibb .516 it 06, $11' 'F/S ItIS �2 it 20 t__] - It PERCOLATION RATE 20 (minutes/inch) PERC HOLE DIAMETER _k�t TEST RUN BETWEEN 15,57 FT AND FT COMMENTS __r 14 EFXii. 0 Oti) rNUJI'JrrKINV PERFORMED BY: 17034 Eagle River Loop Road No. 2n, I 4t::�4� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIFA*IJPjYX"0%8RU7AL GUIDELINES IN EFFECT ON THIS DATE. DATE: '3, j ;L C 72-008 (Rev. 4/85) HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&S ng ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 3b, Ginami Hills Subdivision March 6, 1997 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVE APR 4 1997 Municipality of Anchoraeo Dept. Health & Human Services 1. The scope of this project includes the installation of a 1000 gallon septic tank and a leachfield trench to serve the proposed three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. C TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 3b, Ginami Hills Subdivision March 6, 1997 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 3b, Ginami Hills Subdivision March 6, 1997 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation 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: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page Four Lot 3b, Ginami Hills Subdivision March 6, 1997 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on --site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 3b, Ginami Hills Subdivision March 6, 1997 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality ®f .Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval _ Parcel I. D.015-461-49 1. GENERAL INFORMATION: Complete legal description GINAMI HILLS; LOT 3 Location (site address) 12020 GINAMI STREET *ANCHO Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Expiration Date: 2 �t phone � f3 0 i — 5to— 6 Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE .OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ NO Waiver Fee $ Date of Payment �� z7 / 2- Date of Payment Receipt Number Receipt Number COSA# TSC 2 ( I Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE ? _X_ System #1 Approved for J bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fol ....... . • er ��ess: CE 7951.3 #AECC884 TY 0 •�,�� q 8174 do 4g�SgNo o,. Rom. Tin m� J J Original Certificate Date: S-Zcl y 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 Nitrate Advisory �X0 Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: GINAMI HILLS; LOT 3B If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/20/97 Total depth 205 ft Cased to 80 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA .3/24/21 Static water level at beginning of test 40.3 ft Comments B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIGMON Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade 8.9 ft (max) Measured depth to pipe invert from grade 3.9 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 NIA gallons Comments/Deficiencies: COSA Checklist yellow sheet of Parcel ID: 015-461-49 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ON No Al Coliform bacteria is Negative Nitrate 7.83 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 3/24/21 C. LIFT STATION ❑ Required maintenance com Age of lift station vaeg Lift station materia Commen Adequacy test date N/A Results ❑Q Pass For 3 bedrooms Fluid depth prior to test - in Water added - gal New depth in Elapsed time - min Final fluid depth in Absorption rate - gpd Any rejuvenation treatment (past,12 months) If yes, enter date - E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) 0 Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' 7 Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' 0 Yes Animal Containment > 50' M✓ Yes if No ❑✓ Yes if No ft . F71 Yes if No ft If septic tank is under driveway Manure/Animal Excreta Storage > 100' W Community Sewer Main > 75' ❑✓ Yes if No ft M Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No. Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100'[]✓ Yes if No _ Water Main > 10' 0 Yes if No ft Community Wells > 200' [✓ Yes if No _ Water Service Line > 10' F71 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'M✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓1 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' F-71 Yes if No ft F. ENGINEER'S COMMENTS W *THE DECK SUPPORT APPEARS TO ENCOROACH UPON THE OLD TRENCH G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 ft ft ft ft ft ft ft ft ft ft MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT � 907-343-7904 On -Site water and wastewater Section L Fax: 343-7997 www.muni.org/onsite Nitrate Advisor, Certificate of On -Site Systems Approval # OSC 211267 Subdivision: Ginami Hills Bot 3B A water sample revealed a nitrate concentration of 7.83 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 5- ����,� � � � �Ma�fing Address ��� OBox 196�50�'��Anc�iorage, Alaska 99514`6650 *'�nrww'mun��org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Al� h Mailing Address P O Bax 196650 * Anchorage, ask9519 665 a 90 *www muni org • G 4 8_O ., I r ate' Municipality unici a it ofnchora a =_=__ On-Site Water and Wastewater Progra rk,� 9�O (907) 343-7904 ` I. >> SA ETV 0. Certificate of On-Site Systems .. 'royal 7201? Parcel I.D. 015-461-49 Expirati.' i‘: -: c.: '� 1— 17 • 8L 991 1. GENERAL INFORMATION: Complete legal description Ginami Hills; Lot 3B Location (site address) 12020 Ginami Street Current Property owner(s) Heather Ryan Day phone Mailing address 12020 Ginami Street Real Estate Agent Marianne Hamilton Day phone 317-5756 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual IZ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer LI WaiverNariance request for: Distance: ----- -- Received by: Date: 311//q— COSA (Ifflq—COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5210 Waiver Fee $ Date of Payment Z1/211/1- Date of Payment Receipt Number 0993/4 Receipt Number COSA# O5U-(155 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`iter supply and/or wastewater disposal system is (are) safe, functional and adequate for the number o 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Y7/l-f— �Q�000po�4 In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system oOF A in accordance with the guidelines and regulations established by the Municipality of Anchorage and a�� .. •... 40� industry practices. The reported results describe the condition of the system/s on the date/s of the 0 P • evaluation. Separation distances were measured to readily identifiable features. Hidden defects or , th\ •• V encroachments may exist that were not identified during the evaluation. The operational life of all wells � � TH � • �� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ' ..... ••• . 17 groundwater levels (that may fluctuate during the year), quality of construction (materials and 4VA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and /. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the # -f r- • A. orn:ss;' system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of d�0 _79 the well or septic system. GEG makes no representation whether an alternative well or septic system 09. •• . ,fT • e4 can be installed on the property in the event either of the current systems fail to perform adequately in P, 17 -' the future. The content of this report is for the sole benefit of the person/party that retained GEG to 11\Pa P ; r o f e s son° Q perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 9 bedrooms System #2 Approved for bedrooms .toix\YCY OF4 Disapproved �U ON-SITE Conditional approval for bedrooms, with the following � �l�v� rn m WASTEWATER z : PHOGRAM nr � , r-D\nC'Fc, By: - G Iry E-" 6Original Certificate Date: I _1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. • 1 7. ATTACHMENTS: . COSA ChecklistNitrate Advisory ." •. X Septic System Advisory � Arsenic Advisory -t. Well Flow Advisory Other COSA blue sheet_1 o-1 o-12.doc • If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Ginami Hills; Lot 3B Parcel ID: 015-461-49 A. WELL DATA Well type Private If A. B, or C provide PWSID# N/A Well Log (Y/N) Yes Date completed 6/20/1997 Sanitary seal (Y/N) Yes Wires properly protected (YIN) Yes Total depth 205 ft. Cased to S0 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 6/20/1997 4/3/2017 Static water level 44 ft. 39.1 ft. Well production 3 g.p.m. 6.7+ g.p.m. WATER SAMPLE RESULTS: Water samples were pulled pre filtration. Coliform 0 colonies/100 ml. Nitrate 6.76 mg./L. Collected by: GEG. Ltd. Arsenic: ND<5 ug./L. Date of sample: 3/24/2017 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/1-10/15/1997 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) N/A Date of pumping 1-17-1 i f 1 4 Pumper t\--)Q/ 11 oft CI C. ABSORPTION FIELD DATA *Below Existing Grade at MT Date installed7/1-10/15/1997 Soil rating 6p.d./f3'orft`/bdrm) 0.6 System type Deep Trench Length 51 ft. Width 3.0 ft. Gravel below pipe 7.5 ft. Total depth *10.4+ ft. Eff. absorption area 765 ft` Monitoring tube Yes Depression over field NO Date of adequacy test ***4/4/2017 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test**43 in. Water added 1,965 gal. New depth **87 in. Elapsed Time: 1,260 min. Final fluid depth **63 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date — **South monitoring tube was the only standpipe available during test. Elevation shots were taken on the monitoring tube using the previous engineer's benchmark (top of garage slab), and were within three inches. ***A 2,030 gallon pre—soak was performed on 4/3/2017. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off" level at '• wa er alarm level at in. B- •• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 + On adjacent lots *100'+ (With Caveat) Absorption field on lot 100'+ On adjacent lots *100'+ (With Caveat) Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain __ None Known Wells on adjacent lots 100'+ F. COMMENTS *Could not locate septic system on lot to south (Ginami Hills; Lot 28), "No Tresspassing" signs throughout property. oo�opp0 G. ENGINEER'S CERTIFICATION o�7•OF q CNN ��•' • T. I certify that I have determined through field inspections and Q 4 , ,� review of Municipal records that the above systems are in Q' "' ;4 Q conformance with MOA COSA guidelines in effect on this date. Q ••, e -y A. Garness.� 4 Engineer's Printed Name JEFFREY A. GARNESS Q(] CE-795 opt J 04s�er ''•�,Z���•��o,`cPO� Date `�'f?4'I-� OQ p 4:C:=:17 7 0 4eC tofessiO'4� �04000o�d #AECC844 (Rev. 11/05) • Municipality of Anchorage *' t Development Services Department t, l_ P P K. Building Safety Division 5• ETV On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 171155 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 3B of Ginami Hills subdivision. This inspection revealed a nitrate concentration of 6.76 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. a Woodboume Subd. 8454D o LOT 13 \ LOT 14 I I S89°59'30"E 630.53 `I w � I I /I 1_ o I _ o f1 - �{- No w /oi / / S89°59'30"E 326.57 $ I W z , } I _® m in IN / / ui 10'TELECOMM. & ELECT. EASEMENT-" I 6 w 24.0 — — 76 / / 30 0 z E / F- I- C7 R c1) I1 ' / w w I- W / 2 2 N- w w w w o _ o CO ¢� 1.6ti rn w ¢ w W L, 2.0 OH o Metal fen 1 co .- N \ 0 F- w w M �o 4 b 1 ioes o n° a c LOT 3B t i o 0 o LOT 3A of . 0 rn co D Z ) \ w w ww q� 0 / nx a 30/ 400 es' C• /f�� onc.block wall .lit • Sh I HOUSE DETAIL Septic vent= ' • �,��� � SCALE: 1' = 20' - 195.• `3��.oJyO .�� •57 0 I ill% Well I See house detail I at right I L_ _ ao AS-BUILT NO CORNERS SET THIS DATE 1p' TELECOMM. & ELECT. EASEMENT { I I _ ! •%•"v4.1, t I hereby certify that I have performed a Mortgagee's inspection N89°57'53"W 303.01 �Q�<<.'• ' • • • •Az. :9`S �� GINAMk of the I HILLg described BDIV SUBDIVISION 38. Of*' 49th �c *,0 Anchorage Recording District,Alaska,and that the LOT 2B /. •.::.. .•:.: / improvements situated thereon are within the property lines .• • and do not overlap or encroach on the property lying ` - ► / adjacent thereto,that no improvements on the property lying '�, Fred Wol otka ! adjacent thereto encroach on the premises in question and 0/ .u�•• 3255 - 5that there are no roadways,transmission lines or other 0 S'FPE:a •• • • ••• y::: visible easements on said property except as indicated ,o�,,� . . . ��C hereon. it II -. .ssiotua- ...". Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN 1%%X`.% this 4th day of APRIL ,2017. THOSE SHOWN ON THE RECORDED SCALE: 1"= 50' FRED WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON. S&S, FB 17-3, pg B Engineers and Surveyors BE (907-246-1666) • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-461-49 Expiration Date: %� r 1. GENERAL INFORMATION Complete legal description Glnaml HIIIS Lot 313 Location (site address) 12020 Ginami Hills Dr, Anchorage AK 99516 Current Property owner(s) Larry Reiter Day phone 348-2553 Mailing address Same Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx I Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiveriVariance request for: Received by: I a ' ;�n.+ dJ�,� d�v��,y" Date: COSA to be releasem-tdthe ehg beer, unless otherwise requested by the engineer. COSA Fee $ —I % — Waiver Fee $ Date of Payment 1 1 ;L Ll `f (► I Date of Payment C Receipt Number i 0 q� �Receipt Number COSA # 0J C `22''j� 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 SPURKLAND ENGINEERING Address 203 W. 15TH AVE. STE. 202A, ANCHORAGE, AK Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE __�e_/ System #1 Approved for "; bedrooms System #2 Approved for _ bedrooms Disapproved Phone 279-3916 Date 7/22/13 Conditional approval for bedrooms, with the following By: o Original Certificate Date: 9—q-13 They nici i of orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represen tions given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f .- .. If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Ginami Hills Lot 3B A. WELL DATA Well type Private Date completed 6/20197 Total depth 205 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 80 ft. FROM WELL LOG 6/20/97 3 WATER SAMPLE RESULTS ft. Parcel ID: 015-461-49 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 7/12/13 31 6.9 g.p.m. _ Coliform NEG colonies/100 mL Nitrate 6.5 mg/L Arsenic ND ug/L Date of sample: 7/12/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 & 4gal. Number of Compartments Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 7/30/12 Pumper Northland Pumping ft. g.p.m. Collected by: Anson Moxness Date installed 712/97 Cleanouts (Y/N) Y High water alarm (Y/N) n/a C. ABSORPTION FIELD DATA Date installed 7/2/97 Soil rating (g.p.d./fe or ftz/bdrm) 0.6 System type Trench Length 51 ft. Width 3 ft. Gravel below pipe 7.5 ft. Total depth 10-10.tft. Eff. absorption area 765 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7112/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 70 in. Water added 450 gal. New depth 78.5 in. Elapsed Time: 300 min. Final fluid depth 75 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N/A D. LIFT STATION Date installed "Pump on" level at Datum -- Size in gallons _ in. "Pump ofr level at= E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested - Septic tank/lift station on lot 101' Absorption field on lot 103' Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access(Y/N) -- in. in. High water alarm level at - Meets alarm & circuit requirements? _ On adjacent lots 100'+ On adjacent lots 100'+ in. Public sewer manhole/cleanout N/A Holding tank 100'+ Manure/animal excrete storage areas'59,1V,;i, 100 r (, § SEPTIC/HOLDING TANK ON LOT TO: Building foundation 19' Property line 75' Water main 10'+ Water service line 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 20' Building foundation 11' Water Service line 10,+ Curtain drain N.O. F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water 100'+ Wells on adjacent lots 100'+ 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. Engineer's Printed Name Date COSA brown sheet 10-10-12.doc Absorption field 5 Surface water 100'+ Water main 10'+ Driveway, parking/vehicle storage 25' a�qs�� ®A,•. 9 •S PURKLAND.i 0 Ilk Municipality of Anchorage Community Development Department ° Development Services 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 Nitrate Advisory Certificate of On -Site Systems Approval # 131358 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 3B of Ginami hills subdivision. This inspection revealed a nitrate concentration of 6.5 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. z 0 w O N 00001'00"W 329.91 (R) d 00000'08"W 330.07' (M) T 19—FT.—ELECTRIC EASEMENT S 00009'32"W 305.07 (R) 0 vG m W o 25 FT. ACCESS EASEMENT —\ O —r ------------------------------------------- I 1 I o c. I I 1 I I 1 1 I _ 1 � - v N O i 0' 0 m l ml ly o � cmm -> 1n W I I I N m0) N el E! ROOFED ARzi 4 0 a m O A mo m � aBsti n /q� O W I N W LF 3 m CO I y 1 0 w 10 FT. TELE.COMM.8 ELECT. EASEMENT _. ,rip 1 N 00'03'14'E 305.03' lMJ S 00009'32"W 305.07 (R) 0 vG m W o O o c. z w O GINAMI ST. W nl(D (0 IO 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 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmWW4 Eable Ri", Loop Road No. 204 54SENGINEERING 6' oiy - ag7,1 Phone Address Eagle River,. Alaska 99577 Engineer's signature Date 01/ 9 g .ask OF At Ae 40 In rtczy ,� •;-� fit. .,..,.,f �9 ROB CE - 8801*` 6. DHHS SIGNATURE tili F9Fp 44 ' % 5 - o .b —a— Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date CAUTION The Municipality of Anchorage Department of Health and Human Services ."TIS) issues Health Authority Approval Certificatesbased only upon the representations given in paragraph 65 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 DHHSdo 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. 72-025 (Rev. 1/91)- Back MOA 921 - - - - Municipality of Anchorage JAN 199 DEPARTMENT OF HEALTH & HUMAN SERVICES EA oe* Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343- 4�V IV Health Authority Approval Checklist Legal Description: Lo -r 3(j , G iAArAt W,L,s --'> /10 Parcel I.D.: 61,5- - 461 - A. WELL DATA Well type &N JNTc If A, B, or C, attach ADEC letter. ADEC/ water system number Log present &N) Y 9- 5 Date completed b / a 0 / �1 i N/A Total depth 0 S Cased to Casing height (above ground) Sanitary seal &N) v 6-i Wires properly protected (Y)N) _ Date of test Static water level Well production FROM WELL LOG (,/a()/ 1 7 WATER SAMPLE RESULTS: Coliform J r .L4 14 3 g.p.m. Nitrate 4.9 AT INSPECTION i N� YJ Other bacteria f� Y 6 Y 0 Date of sample: f / L / 01 Collected by: 5 & S ENGINEERING 17034 Eagle RivGr Loop Road, No. 20.4 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed '7 z ah Tank size 1600 Number of Compartments 2_ Cleanouts (,YEN) YES Foundation cleanout ft Yr=5 Depression (Y/l4) tJa High water alarm (Y/d-T) N o Date of Pumping I er.is Pumper C. ABSORPTION FIELD DATA Date installed Length 51 Width Effective absorption area Date of adequacy test -Soil rating 6EOori) O • 6 System type _RFge4 3 Gravel thickness below pipe -7• S Total depth 10 -Io-5 -it < 0 Al IJ e- Lj Monitoring Tube present (ybN) 7 E Depression over field (YA v Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after= gal. water added (in.): Fluid depth — (ins) Minutes later: —" Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot lot' Absorption field on lot Public sewer main Sewer /septic service line t,l Ik b31 2S Size in gallons at* On adjacent lots On adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station t4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 19 Property line 7S . k Absorption Water main/service line )01+ Surface water/drainage lob' -t- Wells on adjacent lots fool SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '201 k Building foundation I I Water main/service line I ° Surface water I a + Driveway, parking/vehicle storage area — Curtain drain � / k Wells on adjacent lots 100 �'+ F. ENGINEER'S CERTIFICATION l certify that l have determined thru field inspections and review of Municipal in conformance wit77O H A guidelines in effect on this date. Signature Gs�'zi_ Engineer's Namez2? Date I ' -11 `1 HAA Fee $ 300,00 Date of Payment 119 a Receipt Number 0 S3 9 3 6 29 3 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number �ti RU�(:RT C: COWAN c �� are ALCTU Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample W Matrix Ordered By PWSID Sampled By: Bob C. Parameter Nitrate -N 980080001 S & S Engineering Lot 3B Ginemi Hills S/D Lot 313 Gineini Hills S/D Drinking Water Waters Department Analyses Total Coliform Client PO# Printed Date/Time 01/12/98 13:11 Collected bate/Time 01/06/98 20:00 Received Date/Time 01/07/98 13:45 Technical Director: Stephen C. Ede Released By Allowable Prep Results Pal units Method Limits Date 4.50 0 0.700 mg/L EPA 300.0 10 max Col/100mL SM18 92225 Analysis Date Init 01/07/98 GCP 07/07/98 TMW