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HomeMy WebLinkAboutALDERWOOD PLACE LT 1Alderwood Place Lot 1 #050-281-65 -- --� WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or Ic.) A.D.L. No. lo. Borough Subdivision Lot Block Ib. '/.qtrs. Section No. Township No Range E[3 Meridian AnchAlderwood 1—Of —of —Of — S❑ WO Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Paul Miller Address: 129 Toakoama Eagle River Street Address and Area of Well Location Feet Below 2. WELL LOG Surface Material Type Top Bottom 4. WELL DEPTH: (final) 1�_ ft. 5. DATE OF COMPLETION �_ — �_•— _ O•cyr- Loam 6, 0 Coble tool ® Rotary C3 Driven C] Dug [] Auger C] Jetted ❑ Bored ❑ Other: 7. USE: © Domestic C] Public Supply [:] Industry O Irrigation 0 Recharge 0 Commerical Test well C] Other: Sandy Grairei 4 20 B 20 80 Sand -1 8 80 Sandy r1ravel 88 Q6 Sand Gravel. Water—ino d. CASING: E] Threaded ® Welded diam. 6 in. to 107 ft. Depth Weight 17 1be./ft. diam. in. to ft. Depth Stickup ft. Gr-Axei- wgit-r 100 1()7 9. FINISH OF WELL: Type: Open HOle Diameter: 61 Slot/Meth Size: Length: Set between ft. and ft. Backfilling Gravel pack DEPT. OF HEAI TW GE t:NVIRr)N&4ENTAL PROTE TIO)(J 10. STATIC WATER LEVEL: 80 }t. / y �-J Above or lBelow land surface Dote Equipment used:static Meter 11 . PUMPING LEVEL below land surface and YIELD 1011) ft. after _hrs. pumping 10 g.p.m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: E) Yes [N No Material: E] Neat Cement E] Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9..P. m. O Subm. E] JN E] Centrifical Other I4. REMARKS: IB. WATER WELL CONTRACTORS CERTIFICATION: I5. Water Temperature ° 0 F C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Bart Pill l ozk- Wel 1 Dr- 11 ing A-15478 Registered Business Name Contract License Number Address; P.O. Box 874272 Wasilla Ak G Signed: L2/.�7�'- Dale: /,4 — ,— uthorized Representative Form 02-WWR (II/81) Copy Distribution: WHITE - State OGGS, PINK -Driller, CANARY' Customer " "A.,"~^` ".~'A.o o -"W_ -^c a " A.," &-,;i 1i - i-, 'i it L:::.. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION --325 L STREET, ANCHORAGE, r~� 99501 264-4720 - �� C111NJ__1 I-VEY 5JE=L_1L_ F"F--:F;�.r1 11 - PERMIT NO: 850636 DATE ISSUED: 09/30/85 ��� ' APPLICANT:� c��"BODA,MILLER CONST ADDRESS: 129 TOAKOANA EAGLE RIVER, AK 99577 CONTACT PHONE: 694-9302 LEGAL DESCRIP: SUBDIVISION: ^e*Y:4\��v��c*��r`w04-OT: 1 BLOCK: NA SECTION: 12 TOWNSHIP: 14N RANGE: 2W LOT SIZE: .5A (SQ.FT. OR ACRES) I certify that: I. I am familiar with the requirements for on-site sewersand wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulation and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set bac distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. SIGNED APPLICANT S3vOBQPQ,MILLER CONST ISSUED BY "�--T--'-------��------------ DATE:,*����.' «� Q,� DATE: January 10, 1986 TO: Permit Applicant P.C. El OX 6650 +NCH0RAG-E, ALASKA 9950 t. 50 1907) 264-4111 DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit # 850636 Lot 1 Alderwood Place Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. 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(three part form) 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, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH %��- - ) f •r1,(�� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION (a) Legal D,scription (include lot, block, subdivision, sectio Lgcation (address or directions) Application Date township, range) (b) Applicant Name f Telephone: Home (y — 93� Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,; Buyer O ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and =ge1 Address Telephone (f) Mail t iS/SNij WVgffljftddress: SR B 196,X EAGLE RIVER, AK 99577 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well K Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite O Public Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIN.a INSPECTIONS, TESTS, FILE SEARCH, DA. A AND INFORMATION 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 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 inspectiog.& $ MGINEERING Name of Firm SR B I 96X Telephone Address E*GLE RIVER, AK 99S77 Date 6. DHEP APPROVAL ()y 1 Approved for bedrooms by Approved Disapprove Terms of Conditional Approval Condition CAUTION Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) fNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ti CHECKLIST - FEBRUARY 1984 \P 0* 1 ?VLO 264-4720 Nth'' n �\ 2 Legal Description: *J 1 a A. WELL DATA ``�� GL1 �V N � Well Classification 5 • r- G If A, B, C, D.E.C. Approved (Y/N) Well Log Present 69N) Date Completed f G��— Yield Total Depth 10'9'1 Cased to 101'r Depth of Grouting Static Water Level gLbi Pump Set At U •k - Casing Height Above Ground Sanitary Seal on Casing (&N) Electrical Wiring in Conduit (&N) Depression Around Wellhead (Y/6) Separation Distances from Well: To Septic/Holding Tank on Lot _1' ; On Adjoining Lots W To Nearest Edge of Absorption Field on Lot` ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by .S t.f'Z Date Water Sample Test Results Comments a" C_ saw" - B. SEPTIC/HOLDING TANK DATA Date Installed 1C7-?--8'5.kSize Standpipes (Y/N) Depression over Tank (Y/N) Air -tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ,for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments \AL Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments ���L-t C_ _`S& wv17t_ D. LIFT STATION Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M A a HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date Z-' Y i-- SR B 19 6X Company MOA No.R, AK 99577 -5: n Receipt No. o oe"I %12 � A` Date of Payment +�4�� ��� •*•��5'F, � er s'6 Amount: $ / � • 9 .......il..,j Page 2 of 2 72-026 (11/64) M1A.aw tis. 1404 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# I 1 :1 11 Anal sis shows this Water SAMPLE to be: E2/PRIVATE WATER SYSTEM Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: O � F&Tfl 8 �; Mo. Day Year SAMPLE TYPE: CT-1ioutine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 3 1 t 4 1 5 y (rV Satisfactory ❑ Unsatisfactory ❑ sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Li �l Time=Received S Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result* Analyst EF ED m BACTERIOLOGICAL WATER ANALYSIS RECORD i READ INSTRUCTIONS Membrane Filter. Direct Count Coilforml100ml BEFORE verification: LTB_ COLLECTING SAMPLE Final Membrane FI Reported By _42z TNTC = Too Numberous To Count OB = Other Bacteria BGB E 00ml Date Time: a.m. P.M. 3 C, Municipality of Anchorage 111;1= pGi $L • Development Services Department =Q Building Safety Division c On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-281-65 COSA# M649/25'9 Expiration Date: / 0 - -6--- 1. 6- 1. GENERAL INFORMATION Complete legal description Alderwood Place Lot 1 Location (site address) 10106 Lee Street, Eagle River, AK 99577 Current Property owner(s) SCHMID WILLIAM J SR Day phone 830-8387 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address same Day phone Sue Burnstin Day phone 830-8387 Dynamic Properties Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/2/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The Flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all subject to these various and dynamic characteristics and are outside the control of t evaluator of the well and septic system. 5. DSD SIGNATURE _ z Approved for _ bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other WATER AN By: Original Certificate Date: (Rev. 11/05) Municipality of Anchorage • ' ` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Alderwood Place Lot 1 Parcel ID: 050-281-65 A. WELL DATA– Public Water Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 10/7/85 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 107 ft. Cased to 107 ft. FROM WELL LOG Date of test 10/7/85 Static water level 80 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform Pass colonies/100mL Nitrate 1.49 mg/L Casing height (above ground) 18 in. AT INSPECTION 6121112 77 ft. Arsenic: 0.277 ug/l Date of sample: 5/31/12 Collected by: nr B. SEPTIC/HOLDING TANK DATA Ulm Tank Type/Material – Date installed -- Tank size = gal. Number of Compartments = Cleanouts (Y/N) = Foundation cleanout (YINY= Depression over tank (YIN) — High water alarm (Y/N) _Date of pumping ---- Pumper _---- C. ABSORPTION FIELD DATA- Public Sewer Date installed – Soil rating (g.p.d./ftp or ftz/bdrm) — System type = Length — ft. Width —ft. Gravel below pipe =ft. Total depth — ft. Eff. absorption area =fe Monitoring tube = Depression over field_ Date of adequacy test ----- Results (Pass/Fail) — For – bedrooms Fluid depth in absorption field before test --- in. Water added — gal: , New depth =in. Elapsed Time: = min. Final fluid depth = in. Absorption rate > Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1f yes, give date -_ D. LIFT STATION Date installed na Size in gallons na Manhole/Access (YIN) na "Pump on" level at na in. "Pump off' level at na in. High water alarm level at na in. Datum na Cycles tested na . Meets.alarm & circuit requirements? na E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100' + On adjacent lots 1001+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank na Animal containment areas 5('+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation— Property line_= Absorption field -- . 7777.. Water main — Water service line - Surface water - Wells on adjacent lots= SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation - Water main Water Service line --- Surface water - Driveway, parking/vehicle storage Curtain drain — Wells on adjacent lots F. COMMENTS '1. 5 - _. _. ....>. .. ..lit: ... _. _ ...77.7.7 G ENGINEER'S CERTIFICATION��*" >°"•�' I certify that f have determined through field inspections and ;�9Tta • ` rewew of Municipal records_ that �the abov& systems are. in gea. •.,.77.7••»7777•. °>' conformance with MOA COSA guidelines in effect on this date. ... m Engineer's Printed Name Steve End "�. Steven w. Eng d c. PE Date 7/2/2012. _ �� �A�C' •>. ..- .. --P COSA Fee $490.00 _ _. -_-- _ . -.Waiver Fee $ Date of Payment__�3/�a -- --- - -- Date of Payment - - - )Rece"`rii6-6er /^,,/�/� f3f3''Y to� _ Receipt Number (Rev. ij/453, - =$ G7 Dm3 D m v'z ZON mr Ozo Nom ii =z IN 2:c 0 O _MO mm moo Z�z OS D z m v N O m m • maHdgo�3� D�W m a ..mom D 05.-, C y'o oom ^.n OOof F a O�m O m -n mei �'°°3m�n my m ' = co Q w 3.mm mp�mD ED 7C a� C �Aivm ay O� Z m�- i C m� I'm �o_m_.� a a c c w •��' O -4o Z m m m S Z -M m N Qnv _�01 m � N u Si egg�� m m - n g's H m m �1p � ti w Unnamed STREET (Not Built) 8370K w W N00002'00"E 82.50 w 0 C 7 a w w; D 3 S 3 iu v 0 �C/) c CO m (D �U1 m C;) ca m N 0) W V W T n � � S F 0'ZZ 15' Elect. N00002'00"E 82.50 w LEE STREET 0 a 3 cn 00 01 m W co m (3)N W V 5.2 T 0 n atn _ r- 0 N Municipality of Anchorage ® Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 " L" Street Room 502 Ali 15 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. ak. us (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I. D. G S U- S'/' G S HAA# L!M(_T_C '� I Expiration Date: 1. GENERAL INFORMATION Complete legal description Zyr- ��L 7 Location (site address or directions) l'G106 -/��T_ Current Propertyowner(s)�OJ��i2Y)� ���t7G��(l,'i72P�?lylllryphone Mailing address 9,77 Lending agency Day phone Mailing address Real Estate Agent //7//GA LZ 17c-;V01-� Day phone Mailing Address/ _{,L 5-77Z Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: S 01/f_/oo 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Public Water System ❑ Community On-site ❑ Public Sewer �q The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates op- Health fHealth Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independen- professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served b} a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipalin of Anchorage is not responsible for errors or omissions in the professional engineer's work. -2-0251Rev. 01'OOP 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and /or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Name of Firm 11 V^ 9957 / Phone (O C�¢ - L_ 1/_�,-� Address Engineer's Printed Name��E' ?LIZ i 9� Date 3 W o e OF Pt's'• i' q ENGINEER�� •.., ��i . 6. DHHS SIGNATURE ` p r"YCBERT G CCWi;F: Approved for bedrooms. J ,t CF -8,-,01 >y —1� Disapproved. �' °"1 c•' Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ���p�/—�'- / �l� : P/ Original Certificate Date: r 8' Expiration Date: / G Reissue Date: 72-025 (Rev_ 01100)' Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services RE C E I VEE& On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us AUG 3 0 2000 (907)343-4744 MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHEdNVMNMENTAL SERVICES DIVISION Legal Description: tVT / i k-ot'rG eya' 'x-46& 5�AO Parcel I.D.: tOSo -afr/ -d.r A. WELL DATA Well type Pyr If A, B, or C provide PWSID # — Well Log C C� Date completed 4 Sanitary seal yc3 Wires properly protected Total depth 60 ft Cased to l O ft Casing height (above ground) l ,� in. FROM WELL LOG AT INSPECTION Date of test Static water level 'eo ft ft Well production 70 9 -p.m o g.p.m WATER SAMPLE RESULTS: ° D y Coliform 0 colonyes/100 cml Nitrate y /°! mg/I Other bacteria � colonies/100 ml �/� Q6 2r Date of sample: Collected by: g & s ENGINEERING B. SEPTIC/MOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank'Type/Material Date installed Tank size Cleanouts Foundation cleanout Date of pumping C. ABSORPTION FIELD DATA gal umber of Compartments Ion over tank High water alarm Pumper Date installed Soil rati f (g.p.d./ft2 or ft2/bdrm) System type Length ft Width ft Gravel below pipe ft Total depth/tion absorption area ft2 Monitoring tube Depression over field Date of adResults (Pass/Fail) For bedrooms Fluid depthd before test in Water added gal. New depth in. Elapsed TiFinal fluid depth in Absorption rate >= g.p.d. Any rejuvepast 12 mo.) (Y/N & type) If yes, give date 72-026 (Rev. 01/00)' D. LIFT STATION -7V Date installed ��� Size ingallons — "Pump on" level at in "Pump �ff-1everat in High water alarm level at —in Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot "l L4 On adjacent lots n/ Absorption field on lot /V Z A On adjacent lots N Public sewer main S Public sewer manhole/cleanout h Sewer /septic service line 2S /� Holding tank /V �/4- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1,0Z16t lG �1G21 y� Building foundation Property line Absorption field Water main Water service line Surface water Drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS e- OF IF :fir `l►r G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and (' review of Municipal records that the above systems are in wx� conformance with MOA HAA guidelines in effect on this date. g ,'••T 1 3T- ERT C COWAN i P Engineer's Printed Name T �_ Co�r9w "c,. ce -aao) +atkk ,!`. /oo S130100 a ;. ;:... '.',✓'u./ Date HAA Fee $ 3M, (9C) Date of Payment-?�-_o© Receipt Number 72-026 (Rev. 01/00)' Waiver Fee $ Date of Payment Receipt Number 09-06-00 09:24 FROM -CTE ENVIRONMENTAL 5615301 T-733 P.05/05 F-016 ME Environmental Services Inc. Laboratory Division 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria. Anchorage, AK 99519-1605 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tex (907) 562-2343 Fax: 1907)561-5301 Q PUBLIC WATER SYSTEM V.D. # )U" PRIVATE WATER SYSTEM )� Send Results S 5 (�JG-INL ❑ Sendfnvolce 2I n1 Waltt Sp'1 1:1111[/ umpvtl :lflle 94- Z9 na[lnmrc tone nm er ar um er w imA 1005249 city zipciadc ❑ Send Resufls C1 Send Invoice Co.,, N..c ontpctnm Mailing Ae City nWc Zip Code SAMPLE.bATE: Month SAMPLE TYPE: Ar Routine ❑ Repeat Sample (for routine sample with lab ref. no. ) q Special Purpose SAMPLE LOCATION Gl: ALGIC-W-rtw Comments: Ell FUM Day Year An sis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory. ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indic»te reliable results. Please send new sample via special del v: il. Date Received Time Received J� Analysis Began /V� 1-60 Analytical Method: vl Membrane Filter ❑ MMO-MUG q Treated Water ----2 Fbks Jun ❑ Untreated Water Fazed Time Collected 1l_ Collected By o Please Print Date: Time: Client notified of unsatisfactory results: ❑ I ❑ Phoned Spoke with Faxed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO•MUG Result: Total Coliform Membrane Filter. Direct Count 01) E Coll Colonies/I00 ml Verification: LTB BGB COLIFIRM TNTC= Tao Nwmervws Te Count Fecal Coliform Confirmation oa =Or*er Parnda Final Membrane Rep Collform/100 ml Reported B� ate Time d firs 'v BGB Member of the SGS Group ISociiit4 (39narale do Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA * Number of colonies/100 ml. l Lab -RPU No. Result* Analyst 1005249 -72 <V1 q Treated Water ----2 Fbks Jun ❑ Untreated Water Fazed Time Collected 1l_ Collected By o Please Print Date: Time: Client notified of unsatisfactory results: ❑ I ❑ Phoned Spoke with Faxed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO•MUG Result: Total Coliform Membrane Filter. Direct Count 01) E Coll Colonies/I00 ml Verification: LTB BGB COLIFIRM TNTC= Tao Nwmervws Te Count Fecal Coliform Confirmation oa =Or*er Parnda Final Membrane Rep Collform/100 ml Reported B� ate Time d firs 'v BGB Member of the SGS Group ISociiit4 (39narale do Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 09-06-00 09:24 FROM -CTE ENVIRONMENTAL 5615301 T-733 P.03/05 F-016 4 CT&E Environmental Services Inc. ,L��..m russssisvesr®sodse's� CT&E Ref.# 1005249002 Client Name S & S Engineering Prof eM Name!# N/A Client sample ID Ll Alderwood PI SID Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: Parameter Result$ Waters Department Nitrate -N 4.19 Microbiology Laboratory Total Coliform 0 I Client PON Printed Date/Time Collected Date/Time Received DateM= Technical Director, PQL Units Method 0.500 mg/L EPA 300.0 col/100mL SM18 9222B 09/05/2000 16:33 09101/2000 14:00 09/01/2000 14:50 Stephen C. Ede Allowable Prep Analysis Limits Date Date Init 10 coax 09/01/00 SCL 09/01/00 ,1DT