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Home My WebLink AboutT12N R3W SEC 33 LT 154T1 3W e c ion 33 154 018-281 -18 Municipality of AnchOrage · Development Services DePartment Building Safety Division . ...' On-Site Water & wasteWater program, 4700 SoUth Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ~ ~ www.cl.anchorage.ak.us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW010452 PID Number:. 01 8--281 --1 8 Name:KATHY JELLICH WastewaterSystem: [] New [] Upgrade Address: 14951 SNOWSHOE LANE * ANCHORAGE, AK 99516 ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907~ 257-0156 4 i'1 Deep Trench · Shallow Trench rq Bed nblound nother LEGAL DESCRIPTION 2, ,~.; 1.2 o./~. FLI ,~, o.~ ,~. ~,~, o~.; 7.25 - 8.0 Lot: Block: Subdivision: Oepth to plpe boftom from original grade: Omval de~ t)e~e(~th pti)e: 154 - - 5.25 - 4.0 FL 4.0 Township: 12N Range: 5W Section: 55 Fill added obow edglnal gnxle: Grovel length: FL SEE DWG. FL 50 WELL: [] New [] Upgrad 5 FL 1 - Clo#lflcet.on (P/lvofe, A.B.C): ~..~*'~'~C ~' ~='"" C(~ed To: Tala, abeorl~n or11(3: I~pe hi. rial: .. ,~ FL FL 500 s~. FL D 3034/ F-810 FL A+ HOME SERVICES 11/12-19/01 o,. FL FL TANK SEPARATION DISTANCES . s.ptic D Holdlng · S.T.F-P. =Other To Septic Absorption Uft Holding ~ubllc/PrtvoteMonufac~ur~n. Cepaclt7 In gal~ne: Tcnk Field Station Tank s,,.r u~,, ANCHORAGE TANK '1500 From Mofe~oh Number of cx~mp~brm,~. Well 100'+ 100'+ 100'+ -- 25'+ STEEL 2 Surfaoe Water 100'+ 100'+ 100'+ - - LIFT STATION ~ in galloM: ~ Manufoctumn Lot Une 5'+ 10'+ 5'+ -- - 1500IANCHORAGE TANK//ORENCO SYSTEMS 'Pump em' lewl at: I'Pump oft' leval of: IHlgh ~qter elmtn et: Foundation 5'+ 10'+ 5'+ - - 42" 42" 46" Pump 1~3ke a, Model: ~ IMpeciJona performed ~ Curtain Drain N(~NF' KNOW~I ' ~20 OSI 05 HHF M.O.A. Remarks: THE EXISTING SEPTIC SYSTEM BENCH MARK Loc~en .nd D#c~pt~n: WAS COMPLETELY ABANDONED. TOP OF' MANHOLE · SEPTIC TANK IS A DEEP BURIAL RATED TANK. Inspections performed by: AWWC, INC. Dates: 1st 11/12/2001 ~.:'_:.~...~ j[ . .j /. . . :[: .... :....~ 3rd 11/19/2001 v~~v...~ ef[/-(~[ A. '~am~ss.-' Department of "ealtl~'apdd-/'-~,.,;/~. 7'/~/,,,~H'u~a~l .S. ej;vi~s approval///-2. ~-0/ (~1~¢~?o;.,~: ~,~,~,'~ and approved by:-, Dete,: R~viewed PERMIT NUMBER: AS ~ BUILT D RAWIN G PARCEL ID NUMBER: SW010452 : 018-281-18 /--NEW 1500 OALLON / S.T.E.P. TANK ~'~_? -'~.>.. ~ '.~ ~..~. , ~ ~ I ;3 BEDROOM ~ ,/ _' · .~L / xx / DBL1 11'5 25'4 - ~, DB~ 12.1 2~.7 - i~~1 13.2 22.4 - ST~ ~7.~ ~.~ _ ~ MH 18.6 15.2 - MT1 - 13.3 19.9 / MT2 - 61.3 63.0 / / ~ (P~D fOR S~DY ~0~) %~ / ~-, ~ ~/2S/ZO01 ~ OF .......................... c.j.o. ~."[ ' ~'.;~ ~SI~ WATER & ~STE~TER ,~ ~:, ~ ~ ~ ..~, ~ CONSULTANTS, INC.--- - , 69Ol DEBAR RO~, SUITE ~ e ~CHO~GE, ~ 995~ · ~0~ (907~37~179 e F~ (g07~8~2~6 1 KATHY JELLICH (907) 257-01~6 2 LOT 154; T12N, RSW, SECTION 55, ~ ............ AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ~ ~": AS- BUILT DBAWING SW010452 018-281-18 1'0F 0~ ~ ~ ~ .1~ ~~ N~W I¢00 ~FON ~ / 1~.25-101.27 OR~ ~E~ H / F PIPE ~~ - ~2 (~.) ~~ 0.2~ HO~ 0 2~' +/- I 5' ' B~ OF ~ENCH - 92.82 (A~.) . .,, 1/27/2001 ' C.J.G. ~I~ WATER & WASTEWATER ~, .......... ~. ~o,so~,,~, ,,~. .. ,.~.s. ~-..,.,... = ~.~ .... ..... K~THY J[LUCH (907) 257-0~S ~ OF ~ ~E OF WORK: PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 11/21/2001 13:02 FAX 9078686770 __A+ Home Services, Inc. ~.001 ..-' ..MUNICIPALITY OF ANCItORA~E -BUILDING'SAFE .T~ DIVIStON 4700 SOUTH BtL~GAW STREET, .~4NCHORAGE, ALASKA · INSPEtYlION$: Voice: (907) .~43-8.~00 Far.: (907) ~49-7777 INFORMATION: (907.t 343-3211 NAME: ED ELECT· AODRE$$: 14931 $~,IOW. SI.*!O,E:LA.NE .P. HONE #1: ~,z:tumux, va~e: 01-9471 DA g~Ei ~ 272-4591 PHONE#~2: LO~: 154 BLOCItL' ' 6YfM~EA'/~?' CAL'L~ B-4 ~O'BDIt. 9SION: SECTION · 717'£ OF )'~., No non-compliance obsdwtd. Elect6'cal Final [] Con'cctions c.~,~'gJfl as explained bcknv. [] Do not conceal ~r~il re-inspected. [] Will rc. cx~mtfie nt next inspection. [] NPL,~ [] C.O. approved. CO.M~,IENT~" _ ...y_ ',. P,, '_eLns~aion? [] [] Sitetoffsitc dreimgc la/not ~ing comrolicd. [] Inst~II/corrcct silt fc~c:s. [] ~c~ aUachcd dctatlcd notca/instruations. [] Take action now. Report given to: [] Sto~mwatn'ttc.m~nt h~lcmmted.' [] Instatttcorrcct strew I~les. [] ~ best .nnmgen~nt practices on sitednccded. ' [] Failure to comply may result in fmcs. F'] Rcinspcctionwill berm& on: 1..~] ~direct flow. Con~any: WHEN CORRECTION, g ARE. MADE, PLEA~E CAI. L FOR L%~PECTION DO NOT RE~IO I"E .THIS NfflI'CE. 3631 Nov-28-O1 !..5:58 CT&E An. chorage/Micro 907 561-5301 i P.02 CT&E Enwronmental Sew~ces inc. Laboratory Division 200 W. Pot~er Drive Drinldng Water Analysis Report £or Total Coliform Bacteria A.cho,.ge. ^K SSS~ Tel: (907) 562-2343 V VERSE SIDE BEFORE COLLECTING SAMP£F Fax: {907) 561-5301 READ INSTRUCTIONS O, RE ~ TO BE COMPLE {3 MUST se COMPLETED SY WA~ SUPP'E~ pun,.~C WATEa SYSTEM '.O. # et'l i lit PRIVATE WATER SYSTEM dysis shows this Water SAMPLE to1 ALASKA WATER & WASTEWATER -- Si ~ Cmd~ {3 Se~,t. Retult~ ~ Send ln)~ice SAMPLE DATE: SAMPLE TYPE: ,~ Routine 0 Repeat Sample (for routine sample with lab ref. no. ) Month Day Year Treated Water Untreated Water Satisfactory {3 Unutisfacmry D Sample over 30 hours old, results be unreliable D Stn~le too long in transit; s~mpl.( not be over~l~ours old at examr to indicate reliable results. Please new sample via special d~livgry m ,~/~/~ ~ ', Date Received Time Received Analysis Began \\/~'~ Analytical Method: 1-1605 e: my should ;end ill. Membtane i: it~: .......... MMO-MUG ............. * Number of colonies/lO0 mi. Result* 101B09~ [~ nch Fbks Jm tAnalyst Data: Time: Client notified ot'~..~ rest r-i Faxtd o Special Purpose Time Collected N Celleded By SAMPLE LOCATIO ' m Phoned , Spoke with ~-~ - ~.- ~,~' . '--~ I '" BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total CelffaFm ~ Membrane Filter: Direct Count ~ Colonies/100 mi T. YTC . Verification: LTB BGB COLIFIRM Fecal Cotfform Confirmation Final Membrane FAlter Results O Cotiform/100 mi Comments: d~~ Member of the SOS Group (Soci~t0 Gkd~oi~ de Surwiilaflce) ~NVU~ONMFNTAt J:ACILIT~'£5 IN AUi~SK)~ CALlf-ONNIA, FI. OAID~ ILLJNOIS. MAAYLAND. IdlCHtCU~, MISSOURI. NEW VIRGINIA MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water & Wa'stewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 26, 2001 Expiration Date: Oct 26, 2002 Permit Number: SW010452 Legal Description: iT,12N'R3W SEC 33 LT 154 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: John E. Day Owner Address: 14931 SNOWSHOE LN ANCHORAGE, AK 99516-3969 Parcel ID: 018-281-18 Site Address: 014931 SNOWSHOE LN Lot Size: 108900 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: r~ Disposal Field [~] Septic Tank [] Holding Tank [--~ Privy [-~ Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing, 5. The following special provisions. Submit well log or verify existing well meets muni standards prior to construction of wastewater disposal system. Received By: /~~ //~ Date: Issued By: Date: Municipality of Anchorage Development Services Department Building Safeiy Division on-site water & wasteWater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAHILY DWELLING 018-281 - 18 Permit Number ~I/L/O ! 0 LJL ~'~. Propertyowner(s) ,JOHN E, DAY C/O RICK JARVIS Dayphone 257-0136 Mailing address (1) REMAX PROPERTIES Mailing address (2) 2600 CORDOVA. ANCHORAGE. ALASKA Zip Code 99503 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) LotSize /tO~"I ~00 Acres/Sq.Ft. T12N. RSW. SEC, 33. LOT 154- Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only I-"1 Well Only Sewer and Well [--I Water Storage r-I Sewer Upgrade · THIS PROPERTY CONTAINS: Hot Tub Swimming Pool [-'] Water Softening Unit r-'l Therapy Pool r-I i certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Permit Fees: Date of Payment: Receipt Number:. Waiver Fees; Date of Payment: Receipt Number:. ALASIG WATER & WASTEWATER "" CONSULTANTS, INC. October 23, 2001 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650, Anchorage, Alaska 99519-6650 Reft Proposed Septic System Upgrade for T12N, R3W, SEC 33, Lot 154 To whom it may concern: The existing three bedroom house is served by a private well and septic system. The existing undocumented septic system is in a state of failure and needs to be upgraded. A test hole was excavated in the area of the proposed septic System upgrade. The septic system will be designed around the 30 foot radius of this test hole. Because the buyers of the house want the septic system to be adequate for 4 bedrooms, we are proposing that a 1500 gallon S.T.E.P. tank and a 5-wide trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an 2 application rate of 1.2 gallons/day/ft should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft c. Number of Bedrooms: 3 (designed for 4) d. Design Flow: 600+ gallons per day2 e. Minimum Absorption Area: 500 ft f. Total Depth: 7.0 feet (max.) g. Effective Depth: 4.0 feet h. Width: 5.0 feet i. Minimum Length: 50 feet long j Effective absorption area = 500 ft k. Reduction Factor: 0.5 3. SURFACE WATERS: There is no surface water within 100 feet of the proposed septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: The topography of the lot in the area of the proposed Upgrade is generally flat. There is a slope of about 20% running from north to south beginning approximately 20 feet south of the proposed trench. In short, there are no sloPe concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact our office at 337-6179. Thank you for your assistance, a~'l jeffr_~y j~.,G~me~.~~/1., M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log. and a 7page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com I ' ' , I LOT I I I I ,,, ~ ~ ~ SNOWSHOE .~LLS ~ ~ ~ I I I I , I I I I I LOT 137 T12N, R3W, SEC 33 , I I I I I LOT 2 LOT 1 I I ~ SNOWSHOE HII.~ I I WELLMAN I I z°',. ~-"=--..; / 1-~LT~N~ srrE tOT ~SS 031 ./.~. ~ ;¥',:,._,/~,..~ [ T12N, R3W, SEC LOT 153B i ' ';; Fa.TS D(~ST~NO I'HRE:E:.---~'"'~[ '.,"L~ BEDROOM HOUSE ~ '~,,,,,.7'"~ ~__ .....'~..... /~"~ / ~ ;/F -:/------J \ ~ , t ~ \ X ~'~PROpOSED SEPTIC ! \ / % (SEE DESIGN, PAGE E. 150 AVENUE ' ~X (pi. Al-rED FOR SH~NDY ROAD) xx~. I LOT 170 T12N, R3W, SEC ,33 .C'11 LOT 1 MERRYlaAN LOT 169 T12N, R3W, SEC 33 I~ I I I I DATE: ~~'? :'~ ~'~ DRAWN10/23/2001m,:~,~:~,"X~:... AI.A_SICk WATER & WASTEWATER s~ ~,~ CONSULTANTS, lNG. ,, KATHY JELLICH 257-0156 1 OF 2 LOT 154; T12N, R3W, SEC. 33, ~[ o~ WORK: : SITE P~N~ FOR SEPTIC SYSTEM UPGRADE INOTES: EXCAVATOR IS TO HAVE THE WELL RADII FLAGGED / BY a REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTIONI / NOTE: THE SEPTIC SYSTEM IS SIZED FOR A 4- BEDROOM RESIDENCE, THE -~.- .~'"'"-~ REQUIREMENTS FOR 3 BEDROOMS IS ~ ~ A 1250 GALLON S.T,E.P, TANK AND A ~ WITH 4 FEET OF' EFFECTIVE. ;,. .. ; -,,'-,,. '~"~ '" · ' ' '' "h ,~.EXlSTING UNDOCUMENTED "~ ' "~ ' ' , I\ SEI:q'IC SYS3EM ~PROPOSED DRNNFIELD UPGRADE. \ a . . a · I ! \ TO BE ABANDONED / I~CAVATE A TRENCH 3'HAT IS 7.0 ~ '. ' : ,,~ I / X PER THE UPC / FEE3' DEEP MAXIMUM, BY 5.0 FEL~ ~ - · I J ,,) / WIDE. BY 50 FEEl' LONG. ADD 4.0 INSTALL FOUN. OATI?N \' ': ~ ~T:I:~ /' __...~,~_~O,F'. C..,~L~:~,W,,~,~F-~x.,S ,,L:'~., ~ '.,,,,,._...~.4,,~ ~ , / PVC WiTH 1/4 INCH DIAMETER HOLES '~,X \ ~"'--J/'c~./_---~l~r ~" SPACED EVERY 20 INCHES ON ~~ ~' '/"~s~-z'' .... /"------3 CENTER (30 HOLES TOTAL). .,,. / ~Is~No ~ ~,'---- Z-_-,~.__., / '""'- / 3 .".9,R2.°~ --'1/ "~. _ ~ / '~' '-~ ~ , / ~ -' ~.~s~sn~ . :/.. / / ,/ --' / / S.T.E.P. TANK. DEEP \ BURIAL TANK MAY BE ,ED,,,ED. \ I I / \ / \ / \ \ k (PLAITED FOR SHANDY ROAD) ',~ / ,, ~ DRAWN BY: ' ~ ' J.W.M. ~.;:~ 1 ~,,,' '.:."'~_~0, ALASICA WATER!& WASTEWATER '~'~~"'i~:"~J.~..<~.~...t::l '"'~~!~ ~ ' ..... CONSULTANTS. lNG. i .... In __ 40~ · ~~ k~ .... 6901 DEBARR ROADt SUITE ZB · ANCHORAGEt AK 9950& · PHONE (907)337,.6179 · FAX (907)358-.3Z&6 KATHY JELLIOH 257-0136 2_. OF' 2. ,ff~) LOT 1541 T12N, RSW, SEC. 33, ~B;,e,',, %..\ 'I,J ~'-/'e~ /3/. ....... o~~ °' ~ ~r.,~ ~:~'~ ~' TYPE OF WORK: "~'~' cress1, DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE ALASK& WATER & WASTEWATER ,SOIL LO6- PERGO.TION TEST, ~.~~:. ~OAL DESCRIP~ON: T12N. R3W, SEC 35. LOT 154 ~ -~_ [IcE~'7955 .? PERFORMED FOR: ~A~ OF JOHN DAY DA~: 10/10/2001 ~64j'-...~ ...' =~=~: TEST HOLE 1 ' 1--/~HIII~ OM/ML .SOI~ C~SSIFIOATIONS ~.~ ' ~I~NO 4 __ ~ O~(e' ~l G C OL HOUSE TH~I .<.;:.~o"~ DEPTH TO I :,..;..z~o% ~ GROUNDWATER I ~ . .~eoo,~ DRY 10/18/01I k / ::,~, ~o% ( [ ~"=~oo' 1 10~ .~.. . ~)~-~o% ( · -:.ooo, CLOCK NET TIME WATER LEVEL NET DROP >~9~ DATE EEADING '>~3 % ~ TIME (MINUTES) READING (INCHES) :,~.-;~.o ~ V~IA~ONS OF 12--;4~'~°%"~ SW AND GW 15 -- ~Eeoo [ ~.oo~ ~ r'- ~.0~. 18-- 19-- PERCO~TION ~TE <1 (HIN./INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN 6.5 FT. AND 7.0 FT. 20 COHHENTS: PERCO~TION ~ PERFORMED BY JOE ~RCH~ PERFORMED BY A~S~ WATER · WA~ATER I, JEFFR~ A. GARNESS, CERTI~ T~m THIS WA~. ~--PER~ORMED IN ACCORDANCE WI~ ALL ~ATE AND MUNICIPAL GUIDELINES IN EF~CT ON ~IS DATE: DEPTH TO DATE GROUNDWATER DRY 1 O/10/01 DRY 10/18/01 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 018-281-18 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING' Expiration Date: C~ _ ~ ,.. (~ L~ Complete legal description T12N, Location (site address or directions) Current .Property owner(s) BRIAN Mailing address 14931 Lending agency Mailing address. Real Estate Agent KAEA Mailing address R3W, SECTION 33; LOT 154 14931 SNOWSHOE LANE * ANCHORAGE, AK 99516 & SHEYLA' CLUB~ Day phone 245-0226 SNOWSHOE LANE * ANCHORAGE, AK 99516 Day phone ~ICDONALD W/ COLDWELL BANKER FORTUNE Day phone 2525 C STREET * ANCHORAGE, AK * 99503 265-9140 Unlessotherwiserequeste~ HAAwillbeheldbyDSD ~rp~k~. 2. NUMBER OFBEDROOMS: 4 TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I Individual On-site Individual Water Storage [~ Individual Holding tank [--~ community Class Well ['-] Community On-site Publ!c water system [-] Public Sewer The Municipality of Anchorage Development Services Department (DSDi Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska; Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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 less than 30 days old, (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. e o STATEMENT OF INSPECTION BY ENGINEER ·. As certified by my seal affixed hereto and as of the validation daie shown below, I 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 GARNESS ENGINEERIN0 GROUP, Ltd. Address .3701 .E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 357-6179 Date Engineer's Comments: -- · In conduCt/ng this evaluation, GEG; Ltd. attempted to provide a thorough,' conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system underthe Conditions encountered at the time .of the test, and separation distances measured to readily identifiable features. The operational life of all wells and sepEc systems depend on theio~.al soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. . These conditions are dutside the control of the evaluator of the system. Satisfactory test results dO not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therafora not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorfzed, nor will it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for Disapproved. bedro0ms~ ' ' · Conditional approval for bedrooms, with the fllowing stipulations: "~ WATER AND ~ml .~ ~ WABTEWATER : . Attachments: · HAA Checklist Septic System Advisory . Well Flow Advisory -'-. '. PROGRAM : : Manitenance Agr&ements . ~//,-;:,.,~ ~ o~-, ,.,~ SuPplementai Engineer's Re°rt "))**)) Other original'Certificate Date: ~ -- g - l0 /7~ (Rev. 12/01) Legal Description: .t A.' WELL. DATA . W;il tY;e PRIVATE Date completed MUnicipality of Anchorage Development Services Department ' : .BtJilding S~fety Division . ' i ii · .: .On-Site water & Wastewater Program · ~ :'!:ii ' 4700 Sou{h Bragaw St.. ' i ii , P.O. Box 196650 Anchorage, AK 99519-6650 ~ i. www'ci'anch°rage'ak'us ~(907) 343-7904 HEflLT. H AUTHORIT' APPROVAL' CHECI I IST LOT '154; T12N, R3W, SECTION 33 Pa col ID: IfA, B, or C provide PWSID# N/A:: · 'Well Log (Y/N) 1974 B: Sanitary seal (y/N) YES ' Wires proPer'l~; j3rotected Total dE Dat~ Static pth' 220 ,ft. test ~vater level Cased to~ 220 FROM WELL LoG 1974 87 ¸ Well p'roduction " I WATER SAMPLE RESULTS: .3.5 Date of sample: 5/14/2004 018-281-18 (Y/N) Casing height (above ground) AT INSPECTION . 5/1~4J/2004 · .. 121 2.0+ Other bacteria __ YES YES 12+ in. 'ft. g.p.m. New depth 2/3.5in. 6OO+ g.p.d. ,es, give date - · ate >= :] ' J NONE KNOWN '! Any: reluv]enation treatment (past 12 mo3.(Y/N & type) :~ i I .... ~ ':' ~ *";DOUBLE...C/O AT:.TAN~i~,INLET. sEp'I;IClHOLDING TANK DATA .... !; .... .;![ . :'," J :1 . '~ ':" !'' il/12-19/2001 Ta~k ~Type/Matenal STEEL/S.T,E!P, Date installed ~ iil' i15oo . , : . lanK ~size gal. Number of,Compartments 2 clea'no~t~'(Y/N) -YES Foundation cleanout (Y/N) **NO DepresSion over tank (Y/N) NO High W~tef alarm ~/N) YES ., per' Date pu:mping N~ 5[~7[° ~ HO~ :~r~ ABSORPTION FIELD DATA ~BE~OW ~l~N~ ~Dgl ': · ,;~ . ~ Date in~talled ~1/12-19/2ool Soil rating ~r fl~/bdrm} .1.2 . ; ~yste~ ~ype~: SHALLOW. TRENCH L h .: 50 fl. Width : 5 'fl' . :~ .. ~:~i~. ..... i~d~ T~ pth 7,5-8.5 fl. Eft. absorption area 500 fi= Monit0ringtube' YE~ Depression overfield NO Date~ofadequa~test 5/14/2004 . ~ Results (PasslFal), PASS, ~ .For 4 bedrooms .... : · ,~ '~ i Fluid dbpth in absorption field before test,{DRY in; ~ Wa~er addeo ,g~ El~e~ Time: 1370 min. Final fluid depth' DRY. in. Absorption ;~ il 0 Coliform 0 c~31onies/100 mi. coloniesl100 mi. Arsenic: N/A mg~lL. Collected; y: GEG,. Ltd. D. LIFT STATION Date installed 11/12/'01 .;'P~mp on" level at 42 in. Datum BO'FrOM OF TANK E. SEPARATION DISTANCES size in gallons · ' 1500 "Pure p off" level at 42, in. Cycles tested ,3 Manhole/Access (Y/N) . YES High water alarm level at 46 in. MeetSalarm & circuit requirements?. YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station' on lot 100'+ :Absorption field on lot 100'+ - . _ Public sewer main N/A 25'+ SeWer/septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ..... Building foundation - 5'+ Absorption field Water main · N/'A .,Surface water. 100'+ Wells on adjacent lots On adjaCent lots 1 oo'+ On 'adjacent lots 100'+ Public sewer manhole/cleanout N/'A Property line ' 5%. . Water service line · 10'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:'. N/'A water service line , ?.i:,~ Curtain drain NONE F.I cOMMENTs. 1 oo'+ ProPerty line lO'+ ' -water main N/'A. 10'+ Driveway, parking/vehicle storage 10'+ ,Building foundation 10'+ Surface water 100'+ · Wells on adjacent lots 100'+ KNOWN ENGINEER'S CERTIFICATION ;:,-; II ~.-- ' - ' I ce~/fy that I have determined through field mspecbons and :review o'f ~unicipal records that the above systems are in conformance w~th MOA HAA guidelines m effect on th/s date. .', .' Enqineer'sPrinLed Name JEFFREY A. GARNESS ' : - H/~ I~ee $ .... Date of Payment Receipt Number (Re~.:12/00) !~ : . : ': Waiver Fee $ Date of Pay~nent Receipt Number 907-276-442~ 10/~8/01 11~17A P.O04 Locaticm (ad~eee o~: ~bip~ ~nge; ~eection, if ~o~; or dia~ce ~in r~d ~/~'~/~.:~l _~ ~f:, , : . Size or easing. 1. .... ~'.De~th or h~_~-~0 feet ~ved tR, .O.~A tee~ ' (check one) ~en end ('~ Screen ( ~; Perforated ( ). ~e~cribe ~creen nr ~erfo~tione , , , ~ /.~,~. _fe~ d~o~ from ~tatlc level Bemarke Depth in feet from ~round surface color, and h~r~lnees. to to r ,)(f A. /i/'~C, 6L7' tO 05-18-04 03:41P~ FRO~CT&E ESI, SGS E~V SERVICES g075615301 T-38B P.02/03 F-048 SGS EeL# Client Name Project Name/# Client Sample ID Matrix 1042638001 Gamesa Engineering Group, Ltd. TI2N, R3W Sec 33 L154 T12N, R3W Sec 33 L154 Drinking Water Sample Remarks: All Datea/Times are Alaska Standard Time Printed Date/Time 05/18/2004 11:34 Collected Date/Time 05/14/2004 ]5:35 Received Date/Time 05/14/2004 16:15 Pi~.~mctcr PQL Units Method Allowable Prep Analysis Container ID Limils Date Date Init Waters Department Nitralc-N O.lOO U 0.100 mg/L EPA 300.0 B (<=10} o$/! 5/o4 lIB ' Microbiology Laboratory 'l'oml Coliform col/lOOmL SMI8 9222B A (<=1) 05114104 DKC 05-18-04 03:41PU FROI~-CT&E ESI, SCS ENV SERVICES §075615301 T-386 P.03/03 F-048 ~/iSL S~SiCT&E ENVIRONMENTAL SERvicEs Drinking Water Analysis Report for Total Coliform Bacteria READ IN.~TRUCI'IONS ON REVERSE SIDE ~EFORE COLLECTING SAMPLE .MUST BE COMPLETED BY WATER SUPP?ER · 200 W. P~TTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax;. 9137.561-5301 1 042638~-//~ I~,'T'F- WAI~3~ 8YSl'T~ SAMPLE COLLECTION; · SAMPLE TYPE: ~" ' .~ ~ ~ ~ ~~!. _. O Repeat Sample' .... :~r "~-'~ : _. ~. ~.~,~ , ~SpeclalPu~oBe CoII~ ~ ' ~ bb nV: me as mli~or ~c_~ TO BE COMPLIED BY ~BO~TORY Sample ~ecelvlnR[ ~te: .. [] Tr~atod.Wntm' r'lj Untreated Water RHu~ may be RUSH SAMP. LE [] 4a Hour vw~er Phone #: I~elivery -------.-.. Received B~': c~mment~:' ............... . .............. · ........ . ....... : ..... ": ................ ' ........... : ..... ' .............. ";;:~: ..... ':':'"'"T' ]BacterioloRtcalWaterAnalY~lsRecord~ U.O~3tPIAiRI~SULT~' ' I' ~ FaK JUN I ' [~: , I To~ C~: - ' ' Faxed Fon, nWFW-O053 12/17/03 .. .] // ASBUILT E,~'t~/Altl) & ASSOCIATE. S /-J~'PD SU~V]gt'lh'(; 69&-OR2O I HEREBY CERTIFY THAT ! HAVE SURVEYED ' FOLLOWING DESCRIBED PROPERTY= ~N~ ~ D~ERMINE T~ EXISTEN~ OF ANY E~MENTS, COVENANT~ OR RESTRICTIONS WH]~ DO NOT ~R ~ THE RE~ ~BDI VISION PL&T. UND~ NO CIRCUMSTANCES ~Y D&TA H~EON BE US~ FOR ~NSTRU~IO~ ~ FENCE LIN~, OR FOE E~LISHING ARY LINES. DATEs . GRID: FB:' D~WN, iunicipality of AnchOrage Development serVices Department Building Safer'./Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-281-18 1. GENERAL INFORMATION Expiration Date: ~- ~'''' Z? -- O Z Complete legal description Location (site address or directions) Current prOperty Owner(s) ~ Mailing address 14931 Lending agency Mailing address Real Estate Agent Mailing address 14931 KATHY JELLICH i~:'J'12N, 'R3W,'SECTION 33; LOT 154:: .- SNOWSHOE LANE * ANCHORAGE, AK 9~516 Day pho'hi~ ;257-0136 SNOWSHOE LANE * ANCHORAGE~ AK 99516 RICK JARVIS w/ REMAX Day phone 2600 CORDOVA STREET * ANCHORAGE, AK 99503 346-3719 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER oF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage Community Class Well Public Water System r-I TYPE OF WASTEWATER DISPOSAL: Individual On-site ~;~ Individual Holding tank r--I Community On-site D Public Sewer D The Munlcipality of Anchorage Development Services Department (DSD) ISsues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health AuthodtyApprOval are required for the transfer of title (except between spouses) for propedies 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for propedies 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. Note: Alaska Water and Wastewater Consultants,/nc. shall be paid $2857.50 at, or prior to closing for the engineering services provided. 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 ouflined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(am) safe, functional and adequate fo/' the nUmber of ~edrO oms and type of structum' 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 Suppty. and/°~' wastewater disposal system is(am) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm- ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address' 6901 DEBARR ROAD, SUITE 2B * 'ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. (~ARNESS, P.E. Date . entsi'- ' "' .Englne'~}r's Comm' : ' *"* ' * In conducb'ng this eva/ua§On, AWWC, /nc. aitempted lo provide a ~horough, C°nscient~ous eng[ne&rin~ analysis of the system in accomlance with ADEC and MOA DSD Guidelines & Regu/a~ons. The reporied results desc~fbed the perk~rmance of the · system underthe conditions encountered at the time of the test, and separation distances measured to readily Idengfiab/e features. The opera§one/life of all wells and septic systems depend on the local soils condiEon, groundwater levels that may. fluctuate during the year, and the water usage of the farni/y being sen(ed by the system. These conditions are outs/de the control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, /nc. can therefore not provide any warranty or future estimate of how long the system w~/! continue to meet the operaEona/ requirements oft he ADEC or MOA DSD. The confent of this report is for the so/e benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor wf/I it confer any legal right whatsoever. 357-6179 5. DSD SIGNATURE - ,/~ Approved for Z~ bedrooms. Disapproved. Conditional approval for ~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: (Rev, 12/00) ,= :i: De ' ,,' ~'.i ' ? : "i ' ~ 4700 SouthBmgaw~t. , : ', ~i ::i ' , ~' ,. . l:[[i '1~ ':'. ', : ~,.O~B0xlg6650Anchomge, AK 99519-6650 :, ,: ~}!,i ~i: i ,;":," ' . , . ; , : ;: · , ~: : www.ci.anchomge.ak, us , :. ~,- ,; ~,, , . :: l' ..... . !' .;I ~ ": . ~ , '' (907) 343-7904 ' ~., .j II i;~ . : .' .' ., ; - . '. ~ . ' , ' i ' ' ' ' '; ' / t ' "' " : ~ I',~ ~ ~ .... , HEALTH AU.THORI'I Y. APPROVAL L.,MI-UI'S, LI~;I. F,, '.~!: .LeglaiDesl~iOtion:''__ -~- , '. LOT i541 T12N,,'R3W, ,SECTION 33 . ~' P~IID: :' 018-281-18' " ~ ' r :'A' WELD""!' ~DATAH"' .., ...... , ',i ..... :,! ,:, .... ':. . . ,,, ,r~ ~, ,~'. · " ~Il I"l' I ' ' ' ' ' It ' : i ; ' . ' , , F' ' ' ', :', Welltype ;PRrVA'rE:. IfA, B. orCpmvidePWSID¢/: N/A :.' ', · Well Log (y/N) ,, YES , ;" . : ' Date,~mpletad _ ' 1974. , Sanitary seal (Y/N) .YES ~, , Wires properly protected (Y/N) YES , · - i i '. , i:.li-'~'li:' .,',"r : ' :i: i~' ' ' i' ",:' i ' ! i'' I=!I-i', '' TotaldePth-220 ff. .. ',, Cased to;_:22.0 _ff.: .... Casinghelght(abovegmund)__l_2+.-;.in.' ~' ~ ~I.I~, t I ~', ..... , ...... / , 'r ' ' r' ' ' . · [ ' " ~ , · ' : I :I, ': : ' ' · , !. ,' '. I I ', H :' FROM WELL LOG . ': :AT INSPECTION ::!i '.. ' . ',~ ~t: ~' ,' ,i' i; . i ; , ', _ ' · · D~Jt;JOf~t ' 7/i8/19'94 : ' ', il/27~/20'0i" ' static Water level W~)II production' Date 'of sample: 87. 3.5: g.p.m. WATER SAMPLE RESULTS: :;i~ ' ..: ...... i.~ Col ii coionles/lO0 mi. ;' NitrateID;5'' mg./Li 11/26/2'00i r.l. Collected by: O~er ':~ 'Ii i~ AWWC; lINC. g.p.m. ,l',,t~ ']; ': i,: .... '~ Date of pumping ' · NEW ' i Pu~nper, . ' - '*~t" I-I ' C. ABSO~ON FIELD'DATA ], 'i:: ~*BELOW FINAL ORADE:I Da{b inst~lled 11//12-19/2001 Soft rating (~.p.d./l~or fl ~d~) 1.2 Colonies/lO0 mi. ' RFPTIC/HOLDING TANK DATA .... ,. ~ ;: , . DOUBLE C/O AT TANK: INLET. .: ' r Tal~k',~rYpii/Matedal :' :.' STEEL/S.T.E.p.: ,, '. "' ' ' r r Data.installed :,' 11/12-19/2001 Tank"size11500 'gal. - '~Number of Compartments 2. ; Cleanouts(y/N)__;. YES . .. ;'~' I : ' :' " ' ~ :' ~ ' ~ " · t ; I', j ,, - ' '~ ;1 ' : i '. · i - . ',', t~,t .:, , , ' Fo d .ti H c eanout (Y/N)**NO Deprasslo, Over tank .0. · High i'a arm 'rES }e SHALLC~w ,TRENCH Tota epthe, som on e/e, 'SOO Uo...',Nte ng tube 'rES ' '.Depra io over. NO Date of adequacy test; NEW ,;. Results (Pass/Fall) - ~For 4' 'bedrOoms Elapsed Time: - rain, ':- Final fluid depth - in, : ~ Absorption rate >= - g.p,d, · , - If yes, give date' - j' j- .',~ . . - y rejuv,enaaon ~eatrnem (past 12 mo.) ,(Y~ & type) i : 4 i.' ':'': "' LIFT STATION Date installed 11//12//01 Size in gallons 1500 "pump on' level at 42 in. "Pump off' level at 42 'in. Datum BO'I-rOM OF TANK Cycles teSted NEW SEPARATION DISTANCES =. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift stafloh on iot 100'+ Absorption field on lot 100'+ Public sewei- maih N//A Sewer/Septic service line 25'+ Manhole/Access (Y/N) YES High water alurm level at 46 Meets alarm & circuit requirements? YES in. On adjacent lots 100'+ 'On adjacent lots 100'+ Public seWer manhole/cieanout Holding tank N//A N/A SEPARATION DISTANCEs FROM SEPTIC/HOLDING TANK ON LOT TO: Building found;~fion 5'+ ' 'Property line 5'+ . AbsorPtion field 5'+ Water main N//A . ~Water Service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ .. sEPARATION DISTANCE FROM ABsoRPTIbN FIELD oN LOT TO: Property line 10'+ . Building foUndafloh.' 10'+ water main N//A. Water service line 10'+ Surface Water 100'+ Driveway, :Parldn'g/Vehicle storage ~ 10'+ Curtain drain NONE KNOWN ~WellS on adjacent I~ts '"t 00'+ F.. :COMMENTS G. ENGINEER'S C~=RTiFICATION I certify that I have determihed through field inspections and -'-"review of Municipal records that file above systems are in conformance with MOA HAA guidelines in effect on 'fflis date. - .Engine~r's.Print. ed Name JEFFREY A. GARNESS Date of Payment Receipt Number .; (~. 1~) Waiver Fee $ "Date of Paym6'nt Receipt Number NOV-29-OI 09:08AM FROM-CT&E ENVIRON~NTAL SRV 9075615301 T-557 P.01/02 F-399 CT&E Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage. AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref. #: 1018092001 Client PO#: n/a Client Name: AK Water & Wastewater Cons. Printed Date/Time: 11/29/01 09:00 Project Name: rl/a Collected Date/Time: 11/26/01 14:45 Client Sample ID: Lot154 Sec33 T12N R3W Received Date/Time: 11127101 12:10 Matrix: Drinking Water Technical Director: Stephen Ede PWSID nla Sample Remarks: Released Parameter Results PQL Units Allowable Prep Analysis Method Limits Date Date Init Total Coliform (MF) 0 col/100 mi SM9222B 11/27101 Nitrate 0.5 U 0.5 mg/L EPA 300 10.0 11/27101 KAP SCL NOV-29-01 09:08AIA FROg-CT&E ENVIRONI,~NTAL SRV g075615301 T-557 P.OZ/02 F-399 J~t~ CT&E Environmental Services Inc. ~"~ Laboratory DivA.lan 200 W. Porter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage. AK e~eli18o1606 Tel: 1~7} 562-2343 ~ /N~C~]O~ O,V ~E $1~E ~EFO~ CO~L~ING ~AMP~F Fax: {907} 561-5301 TO BE COMPL~:r~D BY LABO~TORY MUST BE COMPLETED WA-lEK SUPPLIER PUBLIC WATER SYSTEM I.D. # I lllJl~ PRIVATE WATER SYSTEM 13 Se~*f Re~lts Mar. th Day SAMPLE TYPE: Routine a Repeat Sample (for routine sample with lab rte. no. ) 13 Special Purpose Treated Water Untreated Water Time Collected Collected By ~:~lysis shows this Water SAMPLE to be: Sadsfacto~ Unsatisfactory Sample over 30 hours old, results re. ay be unreliable S~mple too long in tTansit: sampl.e ah. auld nm be over~ll}hours old at exammanon to indicate reliable results, Please send new sample via special d/olive/fy m~ii. Date Received SAMPLE LOCATION 101BOS2 Time i~ceived Analysis Began \\/~-~ Analy~scal Method: r~Membrane Filet; ....... ' D _ MMO-MUG - ..... * Numb~ ofcnlonic~100 mi. Result* Analyst ach Fb~ Jun Faz~ DAte:., Ti~: - Client notified of~ result: ~ Spoke wllh -- Ph~d BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Collfor~ btembrane Filter:. Dirz~ Count Verification: LTB Fecal Coliform Confirmation Final Membrane Filter Results BGB Colonles/i 00 mi COLIFIRM Collform/I O0 mi l xlo\. Ted A~mdw-f ri, t'*~e, Comments: I d~~ ldoml2e, at the SOS Group ISoc,Ot6 Generab ~e Su~millaflcel --- VI~3JNIA ENVIRONMENTAL FA~I CAUFORNIA. FLOP~DA. ILUNO , MARYLAND, MICHIGAN. MISSOURI. NEW JERSEY. OHIO. Wt;ET Rick Ja~vis 807-27~-4428 10/08/01 ll:I?A P.002 (907) 243~282 FAX:(907) 2434852 KEN JOHNSON DRILLING CO. WATER WELL DRILLING PUMP SALES AND SERVICE 44 Years Alaska Drilling Ta~ I.D. # 92-0068950 LOT BLK SUBD. KEN JOHNSON ~3 L, ND~. D.,vE ANC~OR*GE~.?~ ZIP ' //' ...- CONTROLS ~'~- -'--~'--' "~/T,--.'~=,_ -- - PURP INTAKE-DEP'~H-'-"-- - D~"OP PIPE SIZE TANK SIZE ~ TYPE FILTERS s TYPE '----' ELL--'"DA'TA-~.-GA&I.NG SIZE.(~' DEPTH VATER LEVEL Il'LESS:TYPE ,," ' DEPTH WELL-SEAL " .............. ,/~' 2.'~, ~ ~ ~..~ ~.z "r--- REMARKS: GPM DD KEN JOHNSON CWD/Pi NWWA CERTIFIED Rl?'k J~pvi~ 807-27G-4429 10/08/01 ll:lTA P.OIZI3 ~F8 I-- o o ~ m ,[ Ri~-k Ja~is ~?-Z?~-442~ 10/08/01 11~17A P,~0¢ ~lze of easin~ ~n , , ,Depth of hole~fect ~ased to~..o.f)r~ feet ' (check one) ~n'~nd ('~' Screen ( ~; Perfomte~ ( ). De~cribe screen er perforations .... Well pumping test at ~. gallons per (hour)LmA~ute)'for ._~,~._hours with ~feet cf &r~down from static level Remarks .~roun~ surface colort and hardness. C" to ~,~__ ,,., ,,'.-,,'~ '/i~.(",.. - 1( · ~ , '.: , ' ~ , U ~ ' ., ~to to to to to Rick Jab-vis ~7o278o¢¢Zg 10/08/01 11:17A P,I;~ and the ~les and regula~ons prom~gated the~der, hereby grants to ..~.~)~..~.~...~)~..~.~. .................... tho right to the ~ of ............. ~.~...g.~[!.~...~.~r..~.~V .................... ~rom th~ public ~ka for th~ p~o~o~ of .......... d~.~.~.[$..~!~ ..................................................................................................... The location of the water source totwM~:the'.w~t~r ~ght herel~.g~anted shall appertain is...~.~.l].~ .... '~,~.: '~'..~ ',' "'" · ,' ~:,~ .~..:'~. ,..' r;-j.~,. · ~]x in ~o~ ~5~ Soc. ........................................................... ·. "~ ~......,~:.~-...~ tJ~ '~"z. · f' .~., ~,~ ~..~ ...... ""'~'~'"'"'"';~ ~'"'"~'. .e..'~ .~' ~ '~' ~:~,, .. ,.,~ 'f,.~.~j .;~-~'"i ............................................................ ..... ,. :~[~' ' '~' ', 9 :'~,'.;"~'~: . .. . . .': ~ ~ ~ ,.;'.-. ' '....%,'; . '.~'~..f~t~'~ -v, 'If.... .., ... .~..,, l...?,.i. [ .~ ..:.:~,..~ l'..la.2,~,~;'~' ~d the fight tO said wa~r.ahall~.~appuktenan~,.to..ihat.,~l~';f~gCt of real property describ~ as · ' ~ ".'~'~;' -i.-'- ' '. · '" "· · "P~ ':'f";' ~:~'~' ia]iowa: '-; ~' :i. 't..>~ .'.. · . '" ",..a . ,7.'~-.. . : .. .~a" :.~;~.....'., · ~. ~ ~'.,-.'~, .c..';-~' ~" ~. '...;?{J~-;l'...'. ,~ .... 7: ,~Bk' :: .' · ~;.;~:'~Y,'~i.~, ~'f'.; ~' ':'-~7.' ~;.:.' '~: .. · , ~. ,'r~:~i.~-"~c.l~'-%'..:,~i-r.-~:-..-. ~ .... ~yg~' '.~ · '-., ..,? .~', ~.~"'. I.. "- .:i.'.~ ;, ,- .~' '"~'~..' ';~' ..:~2:'.[l 'm.;..' M, · ~.':'... ~.." ?. ¢~<" .¥~:it:;~: ~' , ,~' 7 "F", ~" ~; .,' ~:'~' ~ .'"'"'; '?':~' '~:' ~?'~'?'?~"~'~f:'/.:" .... ~'";'":;~'~;" ' '. ~f:,:'f".~ ' ,' ~.:' ,~.'".' '"~..'. " 1 · .['. · .. t,¥'~ 9.":.'.,. ' ':: ':'~'.'~ .' .' ·: .... ~:..~.~.:.,: · . .~ .., · .../~.. . ..' .1:: ~.~. ., . .:'. . .~ · . · . ~.~. ~,,,. ,~,. ,. . ....... ~riori~ of appropriation ~i~. ............... ~!~12~..}.[~...?.[! ........................................ .~ ....... :;:..~, ........................ ...... ~ ~a~r a~ to..~OJ~:; th~' ~aid ~aterrtght with the "~:'1'~: "*:'... appurtenances ~ereof ~to ~d ... their heks and a~l~ iorever, subject to the p~v~lons of A. S. t6.15.140-160.t~. ' ~n ~fSllm0,~ ~rfof ~e S~te of Alaska h~ ca~ed thee presents to be executed by ~e Director al the Div~ion of ~n~ p~su~t to ~ S. 16.15, ~s amended, this ....... ~.~.~. ........................................................... day of ............. ~1.~ ............................................ A.D. 19...~1 .... State Record uf Water Right Certificates