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GLACIER VIEW HEIGHTS BLK A LT 4 REM
PpWr'CEL11-01510 sol HSS. AS Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650 •http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181202 PID Number: 050-501-12 ❑ New •Upgrade Name: ABSORPTION FIELD ELIZABETH MEGAN HODGE Address: ❑ Deep Trench ❑ Shallow Trench ❑ Bed P ound 23033 EAGLE RIVER ROAD, EAGLE RIVER,AK 99577 ❑Other Soil Rating. Total Depth from origin ...e. Phone: No.of Bedrooms: 253-576-7673 3 GPD/Sq.Ft. Ft. Depth to pipe invert from original grade: Grave .:pth beneath pipe LEGAL DESCRIPTION F Ft Subdivision: Block: Lot: Fill added above original grade: Gravel length: GLACIER VIEW HEIGHTS A 4 REM �'�s�\� Ft. Ft. Township: Range: Section: Gravel width Beds Number of lines. Distance between lines: ----.: Ft. Ft. SEPARATION DISTANCES Total absop area Number of benches. Dist.between benches: To Septic Absorption Lift Holding Public./Private From Tank Field Station Tank Sewer Linos SD.Ft. Ft. Well 100'+ I 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding 11 Other Manufacturer: Capacity. Surface Water 100'+ CD - Z ANCHORAGE TANK 1000 Gal. co Material. Number of compartments- Lot Line 5'+ w - N/A • STEEL 2 Foundation 10'+ 1 - - LIFT STATION Curtain Drain - NONE KNOWN Manufacturer: C •I Gal. Remarks: OLD SEPTIC TANK WAS DECOMMISSIONED PER "Pump on-level at 'Pump off'level at: High water alarm at UPC PER THE CONTRACTOR Pump Make&Mode' Electrical inspections performed by: PIPE MATERIAL House to tank EXISTING Tank to 03034 drainfield Installer DENALI EXCAVATING Drainfield EXISITING CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) Inspection 113.25 Ft Dates: 1st 7/23/2018 2nd - Location and Description 3rd - 4th - TOP OF GARAGE SLAB NEAR POINT"B" ENGINEER'S SEAL Community Development Department Approval �.•`..`„I._4 ... ........ , y....... Conditional approval: Date: ' 1, Ir • • c , y -ss ri IN C -7• �`"ir A. h1 _____------- --CeVr_4( Nr4z....**•.-7L 2,c 1 l 'k****<c :r Approved: Date: 7----)4:24L, LICEN��,IOFESS` •�• #AECC88 •II%swill. Inspection Report_1-1-t2.doc / PERMIT NUMBER: PARCEL ID NUMBER: ` OSP181202 RECORD DRAWING 050-501-12 • N. \ / \ N \ N \ \\ \ / � � ` \ \ \ / - _ _ GLACIER VIEW HEIGHTS; \ \ N �/ r - -. BLOCK A,LOT 10 REM \ \ GLACIER VIEW HEIGHTS; ` \ \ BLOCK A,LOT 5 REM /� N \ \ / N \ / N \ \ / N \ / \ N A B ` / \ N ST1 95.5 57.9 \ / \ N N. ST2 99.4 63.9 1 / / 70 \ DBL1 101.9 66.9 1 / / 0• \ DBL2 102.7 67.4 CO1 106.9 70.6 I / / 90' , \ / MT1 _106.3 71.5 I / / �F< i. �O \ / SUMP 79.9 82.6 I / / -v �GiS \ MT2 80.7 83.3 1 / / F',QG \ / / / / �4/), / 1 / EXISTING WELL I/ / I 1 1 / I INTEGRITY OF EXISTING // 1 i A 3 y OM FCO WAS CONFIRMED I \ \ / \ 1 1 E / N N // \ \ • • . ,� / N / \ \ / v \ \ • . / i � \ \ / • \ \ • •. •t / N \• •'- /// /NEW 1000 GALLON • \ _ __ // STEEL SEPTIC TANK •SCALE: SUMpN g7j 1._40' 472 S7? - - i \ DBL1&DBL2 GLACIER VIEW HEIGHTS; N \ 417j O7 BLOCK A,LOT 3 REM // N 4, EXISTING DRAINFIELD / / cN c,�,� N \ / // �0'9p N / N. \ / 44 A44. GARNESS ENGINEERING GROUP, Ltd ; 4', ,. ... -- CIVIL&ENVIRONMENTAL ENGINEERS, � I. _. i 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(907)338-3246'WEBSITE:www.garnossenginoeringcom •••• 'PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 : y • - ness : Z., MEGAN HODGE 253-576-7673 2 OF 3 11 -" '.. -79153 ,", PROJECT/LEGAL DESCRIPTION: DRAWN BY: +,<�.../1 0 9......<§)/ GLACIER VIEW HEIGHTS; BLOCK A, LOT 4 REM J.L.M. .�i 0/'RJJJJJJOFESS\�NP��. TYPE OF WORK: DATE: LICENSE 0I 11>♦"`�*44 RECORD DRAWING OF SEPTIC TANK DESIGN UPGRADE 7/24/2018 1tAECC884 C.. PERMIT NUMBER: RECORD DRAWING PARCEL ID NUMBER OSP 181202 050-501-12 FINAL GRADE = 98.42-99.95 ST1 ST2 2"OF INSULATION TOP OF TANK PER CONTRACTOR TOP OF TANK AT INLET=95.67 AT OUTLET=95.50 ■I 11 NEW 1000 GALLON INVERT OF BUNG SEPTIC TANK AT INLET=94.98 (RATED FOR INVERT OF BUNG 10' BURIAL) AT OUTLET= 94.73 NOTE: THE CONTRACTOR WAS SUPPOSED TO INSTALL A PLASTIC TANK; HOWEVER THE GRADE AT THE TIME OF THE INSTALLATION APPEARED THAT THE TANK WOULD HAVE OVER 5 FEET OF COVER ON THE UPHILL SIDE OF THE TANK. THE CONTRACTOR CHOOSE TO INSTALL A STEEL TANK DUE TO THIS FACT.AFTER FINAL GRADING, THE TANK WAS FOUND TO HAVE 4.28 FEET OF COVER ON UPHILL SIDE AND 2.92 FEET OF COVER ON DOWNHILL SIDE. ♦� .. 1444*• GARNESS ENGINEERING GROUP, Ltd - 47 9 .. . CIVIL&ENVIRONMENTAL ENGINEERS -: • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337-6179'FAX(907)338-3246'WEBSITE:www.gamess6 gineoring.corn •• • •• 'PREPARED FOR: PHONE NUMBER: PAGE NUMBER: r A. Gia tress MEGAN HODGE 253-576-7673 3 OF 3 ♦♦J,= . E-795 _� PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦♦ �� • L'� 1 ••`� GLACIER VIEW HEIGHTS; BLOCK A, LOT 4 REM J.L.M. • v., •Q'� ........ P� ♦♦ TYPE OF WORK: DATE: ,1� r OF`S`;" 4. RECORD DRAWING OF SEPTIC TANK DESIGN UPGRADE 7/25/2018 #AECC884 I ♦♦ MUNICIPALITY OF ANCHORAGE mens „ %N On-Site Water&Wastewater Program \c) PO Box 196650 4700 Elmore Road • Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite 1)cI,arttlit nt � 'CHORP' On-Site Wastewater Disposal System Permit Permit Number: OSP181202 Effective Date: 7/17/2018 Work Type: SepticTank Upgrade Expiration Date: 7/17/2019 Tax Code Number: 05050112000 Site Legal Address: GLACIER VIEW HEIGHTS BLK ALT 4 REM G:0159 Site Mailing Address: 23033 EAGLE RIVER RD, Eagle River Owner: HODGE MEGAN ELIZABETH & Lot Size in Sq Ft: 25398 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing • -0 Received By: V(/' Date: /1 Issued By: 7 L .c 4 ax Date: MY 8 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181046 COSA#: Permit#: OSP181202 PID#: 050-501-12 Legal Description: Glacier View Heights Block A Lot 4 REM Engineer: Garness Engineering Group Applicant: Megan Hodqe Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 90.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 7 i 7/1X Approved by: Niece C Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHO - A ' $ 910 RUSH •,tri JLJj / (A Community Development Department : Ph 1 :: 907-34 - 04 z Development Services ? 907- 343-799971 On-Site Water & Wastewater Program Mayor Dan Sullivan 6 y 9 5 On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 050-501-12 Property owner(s) MEGAN HODGE Day phone 253-576-7673 Mailing address 23033 EAGLE RIVER ROAD *EAGLE RIVER, AK 99577 Site address 23033 EAGLE RIVER ROAD*EAGLE RIVER. AK 99577 Legal description (Sub'd. Block & Lot) GLACIER VIEW HEIGHTS; BLOCK A. LOT 4 REM Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: qo WELL TO SEPTIC TANK Distance: ›?'FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP. Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 415 Waiver Fees: I (21 Date of Payment: D Date of Payment: Receipt Number: OaqnG-4 Receipt Number: D'3c2,C1 Permit No. 06191 t 11--OZ Waiver No. �Y 143(011(0 (Rev.01711) Quanics GARNESS ENGINEERING GROUP, LtdAdvanced Treats ENGINEERING SALES CONSULTING dealer July 17, 2018 (REVISED) Municipality of Anchorage Development Service Department On-Site Water&Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Glacier View Heights; Block A, Lot 4 REM To whom it may concern: The existing 3-bedroom home is served by a private well and septic system. Per the "Review Comments" by MOA onsite employee Tim Ecklund, the existing septic tank is in a state of failure and needs to be upgraded. We are proposing to install a new 1000-gallon HDPE septic tank (if cover allows) or steel tank if cover over tank exceeds 4 feet. As can be seen on the attached design drawings, the proposed tank is approximate 90 feet from the existing well. We are requesting that your department issue a variance from the required separation distance of 100 feet from well to tank down to 90 feet. Justifications for granting this waiver is as follows: • The proposed septic tank will be made of HDPE (if the tank can have less than or equal to 4 feet of cover), therefore it would be less prone to decay/leaking. However, if the tank will have more than 4 feet of cover than the tank will be steel. • The house is located between the well and the septic tank. In short. if effluent were to overflow from the tank it would not travel in a direct path to the well head. • The septic tank location is located off to the side of the driveway, if effluent were to overflow it would likely be noticed immediately and it is assumed immediate action would be taken to fix the issue. • The existing tank is approximately 93 feet from the existing well; we are only requesting a variance of 3 feet to the existing separation distance. • Water samples were pulled on 4/25/2018; the sample results are as follows: o Nitrate: 2.84 mg/L o Coliform: Negative o Arsenic: Non-Detectable We are unaware of any adverse impacts this installation and/or waivers would have on adjacent wells or septic systems. f pu have any questions, please contact us at 337-6179. Thank you for your assistance. Since ely, effre, ( rn-.. , P ., M.S. Presi 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com e N - �\ / \ / \ / -- \ / / 1 APP., \ 1 •XIMATE • \ I WELL RADI , / \ GLACIER VIEW HEIGHTS; GLACIER VIEW HkIGHTS; / — — . BLOCK A,LOT 6 REM BLOCK B,LOT 9I2EM - \ ASSUMED SAME\ 1 A WE��all 1 I \\\ '��-�`\ OWNER AS LOT IO; \ I IUIY 1 \ \ I / / \ / ` �---5_- / / \ / GLACIER VIS,W HEIGHTS; \ / PP'OXIMgTE 100' / 1 / BLOCK A,LST 5 REM i,, GLACIER 4 W HEIG.ITS; I WELL RgDIUS / I / \ / BLOCK B,L6T 10 REAL \ // 9.0 \\ / / / \ l Atop'. IMA 1�, 1 // ,, 0 \ \\ �/ / I WELL \ �_ \ / / , ` \ / 1 \ // 1 GLACIER VIEWTI61G1-ITS: - - / / BLOCK B,LOT 11 REM - / \ \\\ / \ / \N �/ \ / - \ GLACIER VIEW HEIGHTS; GLACIER VIEW HEIGHTS; ` /BLOCK A,LOT 3 REM BLOCK B,LOT 12 \\ --�� / \ / \ / \ \ / GLACIER VIEW HEIGHTS; / BLOCK A,I\OT 2 GLACIER VIEW HEIGHTS#4; / BLOCK 2,LOT 10 / .- -` \ 'PP'OXIMA7 � \ 100' / \ I IUS � / \ 1 / \ \ \ / / \ \ / b / \ \\ / / \ \\ / ApPROXIM 1 \ / ATE WELLRgDIUS0 I \\\� .- I 1 \ / S ALE: \\ GLACIER VIEW HEIGHTS#4; 1 =100' / BLOCK 2,LOT 11 ��-_ -`, 1 .*VOA\ 11, • .'P••..•,...... .�,,,..•�..1 444� ♦�1 GARNESS ENGINEERING GROUP, Ltd 4= '' r•....:... ... . ... 3701 E.TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507'PHONE(907)337-6179'FAX(907)338-3246'WEBSITE www gamessengineenng.com • . . • • • 0•�.: PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦C^ • = ' Gamess = MEGAN HODGE 253-576-7673 1 OF 2 ��J,' CE-7• • _� PROJECT/LEGAL DESCRIPTION: DRAWN BY: �� `��• 3 p•'�� � GLACIER VIEW HEIGHTS; BLOCK A, LOT 4 REM D.J.G. .4/� �''� •• ;�P:.•� TYPE OF WORK: DATE: LICENSE 4 1.1�,"���4 SEPTIC TANK UPGRADE 7/13/2018 #AECC884 y C \ G I GEG,Ltd.HAS A 8 PAGE SPECIFICATION , NOTE:THE CONTRACTOR SHALL HAVE THE EAST LOT LETTER THAT PERTAINS TO THIS DESIGN.TO OBTAIN A COPY OF THE LETTER CONTACT LINE,ALL PERTINENT WELL RADIIAND SURFACE WATER SETBACKS FLAGGED BYYA REGISTERED LAND / N GEG.BY PROCEEDING FORWARD 1MTH THIS SURVEYOR PRIOR TO CONSTRUCTION INSTALLATION,THE ENGINEER,WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE \ THAT THEY HAVE READ THESE \ SPECIFICATIONS AND AGREE TO ACCEPT THE \ TERMS AND CONDITIONS OUTLINED. — GLACIER VIEiALHEIGHTS;BLOCK B,LOT 10 4M \ / .----- — — \ \ \ \GLACIER VIEW HEIGHTS;BLOCK,L T4REM \ \ \ \ / 7 X \ \ 1 / // \\\ \ � \ 1 / \ \ I / / 90 \ \ I / / </1,q/` \ \ I I / �RRFO \ 1 / I �FSr 1 / I I W��`Rpp\US INTEGRITYEXISTING 3 NON-FUN O ONAL,CONF EXISTING TRACTOR 0 WILL RE CO TO pE CO -MED; ECEF / PppR(0101E BEDROOM HOME/ 1 1 / / �\ \ i / 1 , / i \ / /, / \ • / \ d ROPOSED 1000 GALLON DPE SEPTIC TANK(IF IT WILL \ \ • BE BURIED LESS THAN 4 FEET OF COVER)AND 1000 \ • ! GALLON STEEL TA IF CO R WILL BE OVER 4 FEET; 4 INSTALL DOUBLE LEANO S AFTER TANK �• 4 .: • APPROXIIyIATE LOCATION OF EXISTING SEPTIC T 0 BE gEC�OMMISSIONED PER UPC .4411‘rorr.• ,.. 1 7 • N )k % • i i APPROXIMATE LOCATION OF EXISTING TRENCH N 4 / ,N / / S ALE: •\. 0,90 / 1"=40' N •\ / ,\ \ / \ / .06.111M%Vi i GARNESS ENGINEERING GROUP, Ltd(11�`' 4'' '• �• '� ... .....•.... • ENGINEERING•SALES'CONSULTING - - - - --T; 0 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX(907)338-3246•WEBSITE:www.gemessengineerin9.com 0••.%) ,••• f,!!• mg PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 to ,y ey A. (iam. ss w• MEGAN HODGE 253-576-7673 2 OF 2 •• ,,* I C 795 a PROJECT/LEGAL DESCRIPTION: DRAWN BY: .� v N'•O a GLACIER VIEW HEIGHTS; BLOCK A, LOT 4 REM D.J.G. .1♦7••• ; 1P�..•� -OF WORK: DATE: LICENSE 40. ESS Ct\���• SEPTIC TANK DESIGN UPGRADE 7/17/18(REVISED) #AECC884 ����� J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE EW NAME-` J—, _� ❑ UPGRADE MAILINGADDR SS n,C� .� 1 LEGAL DESCRIPTION Lc�—" �� -- NO. BEDROOMS LOCATION Tr - L - v� ;MateZ_rLa_l Well j Absorptio are J � •- PERMI O. , /n� �J' DISTANCE TO: /a�J U y No. of compartments Manufacturer t , C,J wF- ! Inside.lengtLL— Width rn Li canacityin gallons � IF HOMEMADE: Liquid depth �� Well _ Dwelling PERMIT NO. D OY Z DISTANCE TO: Material Liquid capacity in gallons O?Q F Manufacturer M Well /# Foundati"I 1, f,. Nearest lot 0 / PERMtante ;= Lu V DISTANCE TO: P Length of e h li a lines 9 � Total len - of liges Trench wy h , �) Distance between b Z F p� F. No. of i Top of the to finish grade / inches Material beneath the %�,,� �/ inches Total effect v)tirib area � Length Width Depth PERMIT NO. w OCrib CL Type of crib diameter Crib depth Total effective absorption area a Lu - Well Building foundation Nearest lot line - O DISTANCE TO: Depth Driller Distance to lot line PERMIT NO.. J Class i Lu ui in o n do Sewer line Septic tank Absorption area � DI ANC T OTHER PIPE MATERIALSy� V SOIL TEST RATING n INSTALLER REMARKS dw s �P'C ''• ......�S+�h .49 ..9 i '.• lig. 1157•E ,J i APPROV Di,s$�"'aI DATE S � 7UAS nnr=n. 1�Lfa:E4A n � MUe .� I I V � 1_ I "i V ID F F-1 t-4 0 H k.+ F_ r=i � i FEE ���� ��,, //�� �� DEPARTMENT OF HEALTH AND EP'�':� I RONMENTAL PROTECTION 1a�� 825 L STREET., ANCHORAGE, AK ag5��1 264-4720 PERMIT NO: 840342. DATE ISSUED: 05/15/ 4 APPLICANT: TH0MAS J. LORD ADDRESS: P.O. i. BOX 8882 ANC•H� iRAGE: AK 99508 CONTACT PHONE: 271-5646 LEGAL DESC:R I P : SUBDIVISION: GLACIER VIEW HTS. LOT: 4 BLOCK:: A SECTION: 1E. TOWNSHIP: 14N RANGE: 1W LOT SIZE: 25500 { Q. FT. OR AO :RES ) MAX BEDROOMS: 3, LISTED BELOW ARE THE OPTION A AILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. - - .. F= F-1 I. H E-" F:" E-- L4 - C.r Fp n I r-4 DEPTH TO PIPE BOTTOM (FT. ? 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 5.0 0.5 3.5 TOTAL DEPTH (FT.) 9.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 19.0 5.0 13RAVEL LENGTH ;FT. :> 45.0 36.0 49.0 GRAVEL VOLUME- (CU. YDS.) 22.9 25• t: = 6. 2 TANK SIZE ( GALS) 1, 000.0 +: 1,000.0 :}: } 1,000.0 _OIL RATING (SID. FT. /BR) 150 150 150 ww TANK: MUST HAVE AT LEAST TWO COMPARTMENTS — — — — — — — — — — — I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWER= AND 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 MCRA CODES AND REGULATIONS, 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 BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER [DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF S BEDROOM'S. AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, - THEN ( 1) AN ELECTRICAL PERMIT AND INSPECTION M{ST BE OBTAINED: ( 2) AS—BU I LTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (f) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: S -�__�------------- - z ---- . APPLICANT: TISSUED BY —_-- DATE •---- SOILS LOG MUNICIPALITY OF ANCHORAGE +.� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: r1 C ) moi ( ?.L) DATE PERFORMED: �'�_ a — LEGAL DESCRIPTION: L7z 4 L—eor (r' I+rI2-%/ /Cilli S SLOPE SITE PLAN DEPTH (FEET) 17 13 jet: ('j�i6�� G1z 14 -1 ...` C)L-c 17 0'.4 , ,G/ ' i 2 , :0"�• S�1\j 3 / ., ... .a. A. 'Jhwfsr E 4 5 Ai 6 -` -� 7 d 8 9 10 WATER 11 1 WAS GROUND L/ �� f%r G,ZA. VEL- ENCOUNTERED? 12 c� IF YES, AT WHAT DEPTH? 13 jet: ('j�i6�� G1z 14 -1 ...` C)L-c 17 Date ' i Net Time Depth to Water a 18 ., ... .a. A. 'Jhwfsr E 9 19- Ai 20 20 L P E If Reading Date Gross Time Net Time Depth to Water Net Drop Ai PERCOLATION RATE a A (minutes/inch) TEST RUN BETWEEN T AND FT 72-008 (6/79) � �, t • 1 i t• 44'1All'TY OF ANCHORAGE C�EPT°NL'-i cCTION by A & L DRILLING COMPANY JAN `' two BOX 97, EAGLE RIVER, ALASKA 99577 - • TELEPHONE 694-2588 RECEIVED OWNER OF LAND r()''k) ADDRESS LEGAL DESCRIPTIO^' '/-- C9 DATE - Started by 17g Ended Ld `t Z-7 PERMIT NUMBER 1 KIND OF FORMATION: DEPTH OF WELL = i STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR S` KIND OF CASING 0 Ft. r�4 Ft. 006J -'ef3U t'%g!F°'j Froin -Ft. to Ft. From to �Ft. ��� �� (�F�dFZ From Ft. to Ft. From to_Ft. I p 1 Ft.%���� � `� From Ft. to Ft. From Ft. to From Ft. to (c Ft. �4 R !—L From Ft. to Ft. Fromj--0-4 Ft. toI / ? Ft. �1 G From Ft. to Ft i rFrom From I 1 el Ft. to l a J' Ft. //lies!!=t �i Gu Ft. to Ft. — From_ Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From—Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: From Ft. to Ft. From Ft. to Ft. noTT T V V'Q NAMF Demember 29, 1978 Thomas Lord Box 1.97 Eagle River, Alaska 99577 Subject: #780518 Lot 5 Block 2 Valley View Estates #780511 Lot 3 Bloch 2 Valley View 'terrace #780515 Lot 4 Block A Glacier View Heights A permit issued by this departLti€ nt for well and/or sewer system has expired. permits are issued calendar s as stated on thpermitt by authority oiff Municipalordinance. If you have drilled the well: a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 2614-4720. Sincerely# Les N. Buchholz, R.S. Senior Environmental Specialist LNB/ljw encs copy of permit .,, L•cr-nr.l l'iei'al �' nr..n�.�n rove:• c_iav a•.:i ni n_ie„i�.. c:..,_, .c _a a n;'21'U_` TREET: ANICH1DRAGE: Fik:.. 99` s UAFEE-1_.L_ F—'E=— T 'T- E- RM I T TE-RMIT NO. c ?;10515 _ICANT i ' 1 [-ID _1.97 EAGLE F:I'y'ER F,`-'d.I .,5. ATION GL JL . y NT_ S. --'f) viL.. L4 E:LK A GLACIER VIEW HT �.,` C> LOT I e -E c -i S•i;!1 IAF'.E. FEET :"MUM DISTANCE BETWEEN H WELL AND ANY OIN—SITE S•EblAGE DISPOSAL SYSTEtl I'S' FEET FUR A PRIVATE WELL: OR TO 200 FEET FF-.'OA PUBLIC WELL DEPENDING UPON THE r'r'F'E OF PUBLIC- l•!EL_L. L_ LOGS ARE REQUIRED AND HOST BE RETURNED TO THE DEPARTMENT WIT-IIt'd 30 -'HE WELL COMPLETION. I:iR REG -M I REHENTS MAY APPLY. SPECIFICATIONS AND r:Cr'd = TF:L IC:'r I C IN D T AI RAH_• ARE '.LABLE TO IP';S.URE PROPER INSTALLATION. 1. "T 1--- FE 6�- FT 1-1 n F-:—:7- F-' _- - A_ . -T ;ERTIFY THAT I AM FAHILIAR WITH THE REI=!UIF'EMEPaTS FOR ON—SITE SE4dEF:5 ANDWELL,—:AS SFT -f-1 BY THE MUNICIPALITY OF ANCHORAGE. WILL INSTALL THE S YSTEH IN ACCOi--:DAP,CE WITH THE CODE::. NE:D : ______-------------- APPLICANT THOMAS LOr—..D �UEC> � , f MUNICIPALITY OF ANCHORAGE 0/a Development Services Department S, Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-501-12 1. GENERAL INFORMATION Expiration Date:.2- — /Q `ZD z-?— Complete Z Complete legal description GLACIER VIEW HEIGHTS BLOCK A, LOT 4 REM Location (site address) 23033 EAGLE RIVER ROAD, EAGLE RIVER AK 99577 Current property owner(s) SHAWN & TIFFANY REED Day phone Mailing address Real estate agent 23033 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55D Waiver Fee $ Date of Payment IA-Ze'l Receipt Number 2 I ZOZI COSA # CS C 1� A (,p C{ � Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name _CURTIS HUFFMAN, PE Date 11/01/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the 11\\\\�\ system and maintenance. The operational life of all well and septic systems are subject to ,��OF Ak ���� these various and dynamic characteristics and are outside the control of the evaluator of the .; ;Rf well and septic system. Therefore, any estimate of how long a system will function satisfactory r�Q: • • • • • ;1 for current or future occupants or guarantee that no unseen encroachments, deficiencies or fig•• discrepancies exist can be given by First Water Consulting & % *� 9 TH FWr.5 .. ...... - 6. DSD SIGNATURE ••. •'•' "•" • • Curtis Huffman System #1 Approved for 3—bedrooms CE 128991�� System #2 Approved for bedrooms �l��F�PROFESS NP���� Disapproved Conditional approval for bedrooms, with the following stip l`l�tt���s:,rr WATER E �m PP �V ATER U M o; Jl SERVICES,���,�\ Original Certificate Date: – The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: GLACIER VIEW HEIGHTS, BLOCK A LOT 4 REM Parcel ID: 050-501-12 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 9/29/1978 Total depth 123 ft Cased to UNKNOWN ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 11/3/2021 Static water level at beginning of test 94 ft. Comments B. TANK DATA Age of tank(s) 3 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 48 ® Standpipes/foundation cleanout per record drawing Date of pumping 11/1/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/31/1984 ® ALL standpipes present per record drawing Total measured depth from grade 7_6 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4' OF THE 5' ED ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Structure served by this system _ Well production at time of test 4.7+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 1.57 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW'C; ` .,, S Date of Sample 11/1/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 11/1/2021 Results E Pass For 3 bedrooms Fluid depth prior to test 2 in Water added 600 gal New depth 15 in Elapsed time 35 min Final fluid depth 3 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date MI E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *90 ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ® Yes-- if No- ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation .> 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No _ft Wells on Adjacent Lots: Water Main> 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *EXISTING MOA WAIVER G. ENGINEER'S CERTIFICATION I 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. A10��1 g.• :9 . Y—" ....•.. lid if .... ....t...... • Curtis Huffman 0 ��� �°F�; •. CE 128991Aw AW .• @,`v�/� ll���PROEESSIOW .C` • • ao •` c" Municipality of Anchorage On-Site Water and Wastewater " Program .. 9 a.il (907) 343-7904 SA ETY Certificate of On-Site Systems Approval Parcel I.D. 050-501-12 Expiration Date: 1. GENERAL INFORMATION: Complete legal description GLACIER VIEW HEIGHTS; BLOCK A, LOT 4 REM Location (site address) 23033 Eagle River Road*Eagle River 99577 Current Property owner(s) Megan Hodge Day phone 253-576-7673 Mailing address Real Estate Agent Day phone 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 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: 6 " Date: /' COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 7/S1 ( Date of Payment Receipt Number © 7 39 7 t-7 Receipt Number COSA# as C / 13 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: 7 W u Q0000�0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system ,,,'="7 . OF A %4,%44 in accordance with the guidelines and regulations established by the Municipality of Anchorage and o ..• . • v O industry practices. The reported results describe the condition of the system/s on the date/s of the QO,P,•• /; /' 1 j evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o A ) encroachments may exist that were not identified during the evaluation. The operational life of all wells " ' 49 T .1 Uv and septic systems depend upon a variety of variables, including but not limited to, soil conditions, * *VD/ groundwater levels (that may fluctuate during the year), quality of construction (materials and O' , p ; D workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and,,....a: 1 1. are outside the control of GEG. Satisfactory test results do not guarantee future performance of the�'U Q •Jef,#rk‘y •. Go Hess: system/s;therefore, GEG makes no warranty(express or implied) regarding the future performance of V 13, :•.i•i / CE-7• • ,p� the well or septic system. GEG makes no representation whether an alternative well or septic system sf v. cs'0 can be installed on the property in the event either of the current systems fail to perform adequately in 0� �r ..1(-2*‘' f.(,°o the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4%e P o \. rofessi n o perform the evaluation. Reliance upon the information provided in this report by any other person or �DOO000�b party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for �Y, O� `�vLh°+.4' y pp bedrooms System #2 Approved for bedrooms - .5\I - �'� . Disapproved ON R PNS z Cr Conditional approval for bedrooms, with the following stip_ gekix �� PRS G0 /()1,,,BAIT C�0\,\C r- / By:-.."4"..."-a-, 71 �—�// Original Certificate Date: 7- -1-0 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 Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10•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: GLACIER VIEW HEIGHTS; BLOCK A, LOT 4 REM Parcel ID: 050-501-12 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/29/78 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 123 ft. Cased to UNK ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/29/78 4/24/18 Static water level 85 ft. 89.9 ft. Well production 10 g.p.m. 5.3+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate 2.84 mg./L. Collected by: GEG, Ltd. Arsenic: <5 ug./L. Date of sample: 4/25/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/23/2018 Tank size 1000 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 NEW Pumper - C. ABSORPTION FIELD DATA I'BELOW EXISTING GRADE AT MONITORING TUBE] Date installed 7/31/84 Soil rating (g.p.d./ft2o /bdr ) 150 System type DEEP TRENCH Length 45 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth *7.5+ ft. Eff. absorption area 450 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/24/18 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added 509 gal. New depth 14 in. Elapsed Time: 120 min. Final fluid depth 8 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.)(Y/N &type) NONE KNOWN If yes, give date - MONITORING TUBE ON WEST SIDE OF TRENCH APPEARS TO BE NON-FUNCTIONAL MONITORING TUBE ON EAST SIDE OF TRENCH ONLY EXTENDS 48 INCHES BELOW THE BOTTOM OF INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at .. wa er 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 .90, On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ 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 10'+ 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 *SEE WAIVER#OSV181046 G. ENGINEER'S CERTIFICATION •••- 'I • 1 certify that I have determined through field inspections and (1t1 }4 I. review of Municipal records that the above systems are in • 1 • conformance with MOA COSHuidelines in effect on this 'V• • ag date. g . ; ,►. A. Garn=,s:: Engineer's Printed ame JEFFREY A. GARNESS �• 1, ••• CE-79 �� Date 7s// •, 1)PROFESS\�lb!. LICENSE Ili%„`wig #AECC884 (Rev. 10/12/12) v �e Q�611w � i rad If 1131 / 13 =�� 1 ? it . ,1),,i, , i 41 - , ' z b' f/ —tea . spiv p � o ra, A 4/ • X11 a a a I o • -'.zs- /IA it .--- .- - ro _ 1 3 \.r... o sem _ : //WC • I i -.... -'zz ., frn x rf',.g 0 r 2,"-,4-; ')t'' •'.1/ •7 •7.1,7, ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE jamG' ' 4►••� vAllio FOLLOWING DESCRIBED PROPERTY: ' OF At t, �c,5�/iF'/-'7d—'//'l - 2 Gor S/,��if!� DATE: z r Q ' •:.S�. AND THAT NO ENCROACHMENTS EXIST EDCCEPT AS ,oiler - ,• � „r ter'► INDICATED. IT IS THE RESPONSIBILITY OF THE * ; OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: 0 EASEMENTS, COVENANTS, OR RESTRICTIONS SwiS'9 i. . e4,4'. , • : WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �j . Duane Mer Seward 0 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F& ��_sem 41 LS 1 a� , , ANY DATA HEREON BE USED FOR CONSTRUCTION t, "47.-..-'..�.> . 5..,.' AOF RY LNNES LINES, OR FOR ESTABLISHING BOUND- DRAWN��� �, '�� • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROV F JUN 19 2015 Parcel I.D. 050-501-12 Expiration Date: \ns\ `I`I 1. GENERAL INFORMATION Complete legal description GLACIER VIEW HEIGHTS BLOCK A LOT 4 R l: M Location (site address) 23033 EAGLE RIVER ROAD EAGLE RIVER, AK 99577 Current Property owner(s) DONALD & GERALYN PRICE Day phone Mailing address Real Estate Agent 23033 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 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: COSA to be released to the engineer, requested by the engineer. COSA Fee $ 526 Date of Payment [0L9 //S Receipt Number/i (3835D COSA# 15c1T/aq� Date: Waiver Fee $_ Date of Payment Receipt Number. 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 n,yy��ber of bedrooms and type of structure indicated herein. I further verify that based on the information �7btail tlWom the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/18/15 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen CF AZ\ encroachments, deficiencies or discrepancies exist. /P6� 4,,S' / r T , * 4gTtt+. 6. DSD SIGNATURE _ "�' System #1 Approved for bedrooms. , y� " " $ UT/ 8 1 System #2 Approved for bedrooms. a 1 ssro>v�' i Disapproved. Conditional approval for bedrooms, with the following stipulations: OF AND By: —_ - Original Certificate Date: G, - The Mdricipal Ay A e ge 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 far errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other . Cosa blw sheet_iaio-12.mc 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: GLACIER VIEW HEIGHTS BLOCK A, LOT 4 Parcel ID: 050.501.12 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed 9129178 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 123 ft. Cased to 40+ ft. Casing height (above ground) 36+ in. FROM WELL LOG AT INSPECTION Date of test 9/29/1978 6/1/2015 Static water level 85 ft. 87 ft. Well production 10 g.p.m. 4.3 9.p -m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 3.55 mg/L Arsenic: ND ug/L Date of sample: 6/1115 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC ISTEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 611/15 Pumper JRs C. ABSORPTION FIELD DATA Collected by: ARCTERRA Date installed 711984. Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 711984 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type DEEP TRENCH Length 45 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 9.9 ft. (Measured 611/15) Eff. absorption area 450 fe Monitoring tube Y Depression over field N Date of adequacy test 611115 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 29 in. Water added 520 gal. New depth 37 in. Elapsed Time: 1300 min. Final fluid depth 28 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off" level at —in. Cycles tested Septic tank/lift station on lot 93' (2003 Waiver) Absorption field on lot 1001+ Public sewer main 754 Sewer /septic service line 251+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout 1001+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 54 Property line 51+ _ Absorption field 51+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main 104 Water Service line 104 Surface water. 1001+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS New MT installed - original MT plugged. Field operating in top half of the effective depth G. ENGINEER'S CERTIFICATION I 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 KENNETH M. DUFFUS Date 6112115 COSA canary sheet 26-15.doc in. Municipality of Anchorage �0, Development Services Department Building Safety Division On -Site Water and Wastewater Program $ , (I 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CFRTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE F=AMILY DWELLING Parcel I.D. 050-501-12 HAA Expiration Date: -2- c� 1. GENERAL INFORMATION Complete legal description Location (site addressor directions) 23033 Eagle River RD Current Property owner(s) Tom Lord Day phone 694-9278 Mailing address Saine�.- The Municipality of Anchorage* Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority 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 engineers work. Day phone Lending agency Mailing address . Real Estate Agent Audrey Mason Day phone 694-4200 Mailing Address Unfess otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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 S & S Engineering Pl;one694-2979 Address _17034 N Eagle River RD Eagle River AK 99577 Engineer's Printed Name Robert C. Cowan Date --Li �3 1D 3 a �h. c�,t� 1W C2 jW 5. DSD SIGNATURE ROBERT C COWAr/ F ✓ �9� CE -8801 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ,G \\�`��:,,....,, pyo • •. J ON-SITE WATER AND WASTEWATER RAM—: Additional Comments •. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:_ t'/h#20.3 (Rev Ov02) 1---1 ---- Municipality of Anchorage Development Services Department Building Safety Division ii�l L on -.site water & wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK :1 99519-6650 VA"V.ci.anchorage.ak.us (907) 343-7904 HFALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1 KKA. &W' 167(Z't-t Ts Parcel ID: A. 'WELL DATA Well type //-le- if A, B, or C provide PWSID # Well tog (Y/N) Date completed Sanitary sea[ (YIN) Wires properly protected (YIN) Total depth ft. Cased tot. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test t Static water levelit. 0 ft.: Well production /0 9 -P.M. G.P.M. WATER SAMPLE RESULTS: Coliform 0 coionies' Nitrate 4-Lbmg./l. Other bacteria colonies/100 mi. 1100 ml. S & S ENGINEERING Arsenic: mg -A. Date of sampla:1S2!V 03 c'0IIect04P934EagkXkejjo9p_Rqa No204 E&9fe River, Alaska 99577 B. SEPTICIHOLDING TANK DATA V 84- Tank. Type/Material fg 97pr I 2� Date installed 1,; 4 ; i I I I Tank sizegal. Number of Compartments Cleariouis (Y/N) Pj Depression ove Found N) r tank (YIN) /J High water alarm (YIN) Foundation cleanout (YI Date of pumping 0 -2) Q3 Pumper C. ABSORPTION FIELD DATA Date installed Soil rating: (g.p.d./ft2 or I(g) LJL System type Length '. W 57 Gravel below pipe ft. tWidth Total depth 61#Dft. Eff. absorption area-40fe Monitoring tube Depression over field A/ Date of adequacy test Results (Pa For _bedrooms 10 1 -4 Fluid depth in absorption field before test -L in. Water adde; d! s�gal. New depthin. Elapsed Time: 6o min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Al If yes, give date D. LIFT STATION Date installed AJ I t' "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off"level at —in. Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift station on lot 1W1,_ On adjacent lots 100 rt - Absorption field on lot _- 100 r(L 4- On adjacent lots Ion ' f Public sewer main tj I'Ar Public sewer manhole/cleanout �4 A- Sc�r /septic service line ps '4 -Holding Holdin tank rl IF-AV SEPARATION DISTANCES FROM SEPTIC/1-161:0ING TANK ON LOT TO: Building foundation Property line" Absorption field S 4 - Water main/� fF Water service line / + Surface water Wells on adjacent lots /QQ /�- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / b 14- Building foundation Water main A/�,q 'fid �- Water Service line,i 4 /�_I;, Surface Water %{�>� t Driveway, parking/vehicle storage /0 T Curtain drain jlaAIC `fAJIJ l Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAAuidelines in effect on this date. Engineer's Printed Name A,3 4,'L7- C. C,0&_ -J4,.1 Date ROBERT C COWAN 1 tt<��: HAA Fee $ 3 7 S: Waiver Fee $ 4-6,00 Date of Payment lI / If 6-3 Date of Payment fJ / JJ /D 3 Receipt Number O `I / a g Receipt Number O y Yl d- � (Rev. 12101) 11/12/03 Alunicipahty of Anchorage Mark Begich, Mayor Building Safety Di-s7sion P.O. Box 196650 • 4700 Bragaw Street Anchorage, Alaska 99519-GG50 • (907) 343.8301• Fax (907) 343.800 littp://H,%%-w.mant.org Robert Cowan S&S Engineering 17034 North Eagle River hoop, Ste 204 Eagle River, Alaska 99577 Subject: Waiver Request for Glacier View Heights Block A Lot 4 Waiver Request #WR030105 Parcel ID #050-501-12 Dear Robert Cowan: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 93.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jri leer n -Site Water & Wastewater Program Municipality of Anchorage Off. B4 Development Services Department a.r Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 w%-w.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: 030105 PID#:05050112 HAM 030563 Permit#: Date Received: 11112/03 Legal Description: Glacier View Heights Block A Lot 4 Engineer: S&S Engineering 23033 Eagle River Road Applicant: Tom Lord Waiver Requested: 93 foot well to septic tank Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer ..■.............■.....■....■.................■..........■........■............. Rec#: 44128 Amount: $800 Date Paid: 11112/2003 1n/4/vEtz REQ vbsT Fox C 4CrEQ V/Faw s�o 8/a!L 6 6•or I � Wrri vEz Rt�qur5T NUMBER: wK 0301O5-- WR(VErR At QUEST FM O,%J•S/TE PA(UATE W&A- 'To rKE fkr5T/Nrj SEPT IG TslNk qj 1cF fT, NNN SEPT,c. TANG W W CooO THE SwS,(Eor �Eir�c (.-'15 Co-+STrnuc.•rEo iN SE' /9S(. PTIc O O woo � TRNjr5 4j .JE/Zal(7 Artc NoT R SOU2c.t cF CoA,JSTANT CovrA-*%tv4TIoov, tl V O A r A 711F To Po § ,rAPN7 of T/(F- Rt FE d&1 CED P?oPEAT y S l o,*5 i9 wI} y FAor+ rKE w«L Towond, 7't(E 5FPTic 7)wk. iWo SysTEi+. TH/s Wovltl P/tevexir 4Ny SoRrAcE EFn UEvT- FAOM F/owtIr6 Towhl?rl INFiti DR TA 77/(1s w6/-!. 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SEp�42Rr10N Lo^JC. lug lotJ � � RhNT hl/�l VE 1Z y. 8 4- QL, J \ ' q .51f G-1 2.•:t'Z 7-0Tnt Z0 -0k. =1 Sent By: REIMAX OF EAGLE RIVER, INC.; ASRUILT 9076960214; Oct -28.03 11:01; Page 2/2 11 6 I HEREBY CERTIFY.: -THAT I -HAVE SURVEYED THE SCALE'0. FOL DESCRIBED PROPERTY , 3� i DATE AS INDICATED. IT .IS THE RESPONSIBILITY OF :THE / �`��` OWNER TO DETMMINE-THE•EXISTENCE OF. -.ANY GRID, EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED .SU9D1- VISION PLAT. •UNDEltNO`CiRCUMSTANCE$* FB, .$WjLD ANY.DATA HEREOtN`.BE-USED:FOR CONSTRUCTION OFFENCE LINES,''OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN r w 6 I HEREBY CERTIFY.: -THAT I -HAVE SURVEYED THE SCALE'0. FOL DESCRIBED PROPERTY , 3� e-e.4ri01*10 vw--.t.ry- tsryB�rr.' AND THAT NO ENCFMtHMENf S EXIS'FEXCEPT DATE AS INDICATED. IT .IS THE RESPONSIBILITY OF :THE / �`��` OWNER TO DETMMINE-THE•EXISTENCE OF. -.ANY GRID, EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED .SU9D1- VISION PLAT. •UNDEltNO`CiRCUMSTANCE$* FB, .$WjLD ANY.DATA HEREOtN`.BE-USED:FOR CONSTRUCTION OFFENCE LINES,''OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN OF. At`%%� �j 044"o -M&A 3+wud ro LS - 6918 i 14v►w wy►w S&S November 3, 2003 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907) 6942979 FAX (907) 6941211 MUNICIPALITY OF ANCHORAGE � APPROVALS PoTM Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWER&WATER MAIN EXTENSpNS �' REFERENCE: Lot 4, Block A; Glacier View Heights Subdivision Request you grant the following waiver for the existing private well on the referenced property: SEWER & WATER INSPECTION Waiver the separation distance from the onsite private well to the existing septic tank to 93 feet. ENGINEERINGSTMIEs The mitigating factors involved which support the issuance of this waiver is as follows: AND REPORTS 1. The topography of the referenced property slopes away from the well towards the septic tank and system. This would prevent any surfacing effluent from flowing WELL INSPECTION toward the well. & FLOW TEST 2. Septic tanks are not generally considered a constant source of contamination and would not normally contribute contaminants to the surrounding soil. SITE PUNS 3. The well log (attached) for the referenced property shows a clay and gravel layer between 2 and 18 feet, and a hard pan layer between 18 and 101 feet. The hard pan ROAD DESIGN and clay/silt layers would form an impermeable layer to any vertically migrating effluent. The static water level for the subject well was measured at 90 feet in October 2003. SOIL TEST 4. Water samples taken from the well located on the referenced property on 10/20/03 indicate 1.02 mg/l for nitrate, 0 colonies/100 ml for fecal coliform and 0 colonies/100 ml other bacteria. Water samples taken for Lot 6; Block A; Glacier PERCOLATION View Heights S/D on 10/23/2003 show 0.10 mg/l for nitrate, 0 colonies/100 ml for TEST fecal coliform and 0 colonies/100 ml other bacteria 5. Adjacent properties' well logs are provided. Based on these well logs, the soils are STRUCTURAL& similar to the referenced property's well log. MOHANCAL INSPECTIONS 6. The hydraulic gradient appears to slope to the southwest, at approximately 17%. 7. Since this system's installation, the on-site well and supporting aquifer have ON SITEVVAIER suffered no ill effects and there is no reason to expect this situation to change. WASTE DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RNER LOOP • SUrrE 204 • EAGLE RIVER, ALASKA 99577 pA(�t z L. 4 4,'I.k A CL4u4.t V144, Hr5 It /i/o3 8. The onsite septic system did receive initial approval by the Municipality of Anchorage. The separation distance in this case is 93 feet. We believe that due to the topography of the lot, the position of the house between the well and septic system, and the absence of an accurate as -built survey, the separation distance was incorrectly assumed to be 100'+. Based on the provided information, we therefore recommend a waiver for the separation distance between the existing private well and the existing septic tank to 93 feet. We do not anticipate any adverse effects on the neighboring properties by the granting of this waiver. If you have any questions, please contact us at 694-2979. Sincerely, Yr& 2, z1 Robert C. Cowan, P.E. RCC/mjc mun istutr/waiva/mason 1 " = 40' WAIVER REQUEST SITE -PLAN SCALE zo �NO-11 ' O�opA �7 wow` j•i�o �•�((1/� nvo �O o / Z o w• Ol r / � o / cl �++ w LA-'^ :: '—(A AZ ^ / / AOXx p?OCO i lJ o i=� J 0n� / O m r> Z CO of t r' ^ Ter"t'Afirb BrUlixeg 40,E 17 �II �{ q{,T DOC Co. au+ WATER WELLS P.O. BOX 272. CHUGIAK, ALASKA 996ti7 a TELEPHONE 666.2750 OWNBROFLAND frNA•tQ��.f �^'�-! _ ADDRESS LEGAL DESC IPTIONL� 44A' DATE - Started Jay Ended-- !PE%Mff NUMBER ;rdND OF FORMATION: 'i'trert Ft. to Ft.—D11-'L 41 i Ft. co l5 Ft._ rig r . .JIM Ft. to Ft. C s of 7 ..... ' t. jj�� .t Ft. to Ft. :f0rit-0-aFt. to fO ? Ft._ ,i'GAl 'j . From Ft. to Ft.'-- itF��xn ; Ft. to rt. - tNm' -Ft. to Ft. ' o From Ft. to—Ft.- Ft. -Fran_ Ft. to ..From-..Ft. —Ft. - From ' Ft. to Ft. -- From' rt. to Ft. — I)rl'Tll 01: WELL— STATIC LUVEL OF WATER Ff. .4 �aaJ � �I1RA1Y I)01�N FT. GALS. PER HR — O -- KIND OF CASING _ 6FQn Froin --.---Ft. to Fl. From ---- rt. to_ rt. to -.__Ft. Frnm_,—Ft. to----Ft- From .. ........ --Ft. o__--.—_Ft. From..........--Fl. to.. ---.I From -----Ft- to —Fl, to.—.—Fl._ From ... ...... rt. tu..__....-.rt•. From__ -Ft. to Ft. From. Fl. to_ rt. From Ft. to Ft. From -----rt. to.--- Ft.-- rront_--FiNtd(WALITY E�m&RAOB DEPT. p1 PROTECf10i`l from .FLNWENT Froin ----rt. to—*Mr rp 9NB9- Frum__—..._.Pt, w ..... D �C1V E F� Ft. to Ft. _ rrum-----1't. to t.--------- -- . °Flom .r Ft. to Fl. From 395CIr.INFORMATION: (��ex�ifie� Brittiong I-xg by DOC Co, tlbs SULLIVAN WATER WELLS P.O. BOX 272, CHLIGIAK, ALASKA 80567 • TELEPHONE 688.2759 OWNER OF LAND C- f'( /'+ 113 1.511 4'n ��JI;'j • DEPTH OF WELL From ADDRESS S /V i. iJo r%i :3 7f C2 //cJ G ,1-F & STATIC LEVGLOFWATL•RFT. Ft. LEGAL DESCRIPTION /2 r 10 111 A- c) GLA r //!,C tJ /Cw✓ DATE • Started !Y 1161" Ended 116: `} PERMIT NUMBER KIND OF FORMATION: From O Ft. to Ft. 'ti r'tt"� lJd41067*A`'J Fromr,) Ft. t._121 Ft._ 64 �1v� From Ft. to Ft. "4'9 "9'l 4 X From. 01 Ft. t0_.:_Fl, s A•Ja !r'(,? Pf From Ft. to Ft. From els Ft. to__;33.Ft. Ka'•f-4et Illi 9- S/�.y r .fes c From.yFt. to�_Ft. a !-. 2 E From—el.3_Ft. to Ft. C ,i % / .c9✓CFe From Ft. to I t C, Ft, Sh( From! — Ft. to t3J_Ft. From US Ft. toI 15'71 -Ft. 13 "r" d'5 .1'T' sZ From Ft. to Ft. l-� R qo,- /_ From Ft. to OirFt.- J � vL C44 From � � S Ft. to lrt. From Ft. to Ft. /vATJrC From Ft. to Ft. From Ft. to Ft DRAW DOWN FT. GALS. PER HR - 40020 KIND OF CASING G a O <2 From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to —Ft. ,l From --Ft. to Ft Froin -rt. to Ft. From Ft. to Ft. From Ft. to Ft. Froin -Ft. to Ft. From Ft. to Ft. Froin—Fl. to—Ft. Froin Ft. to Ft. From Ft. to Ft. Froin Ft. to Ft." Froin I'L to Ft. From Ft. to Ft. From Ft. to FL MISCL. INFORMATION: • '0 F� t DRILLER'S NAME