HomeMy WebLinkAboutHALVERSON LT 10AHolver
#051-131-29
· Municipality of Anchorage Page j of '-~
i.' DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~---~0,.~ c:~'O'~c~c~ PIDNumber: O~ - ~(-~
N~e: ~ ~ALV~ Wastewater System: ~ New D Upgrade
Address: ~tH ~~o ~, ABSORPTION FIELD
Phone: ~--~lJ~ No. of Bedrooms~ ~ Deep Trench ~ Shallow Trench ~Bed DMound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION so~,,~: ~,8 ~/s,.~.~.5~' ~
Lot: /~ ~ Block: jJ Subdiv~ion: Depth to pip~ boHom from original grade: Gravel depth beneath pipe
Township: / Range:/ I Sec~ Fill addedo,~above~ origin~l~ ~grade: Ft. Gravel length: ~0 t Ft.
Number of lines: Distance ~een lin~:
WELL: ~t~i~ew ~ Upgrade S.~veSwi~th: ~5 Ft. ~ ~ Ft.
Clarification (~te, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: StaticWate[ Level: Installer: Date installedj
Pump Set at: Casing Height Above Ground:
Yield: ~'~ GPM ~ .,. I,o* ,t. TANK
SEPARATION DISTANCES ~s~ptic ~ Holding n S.T.E.P.
TO Septic Absorption Lift Holding =ublic/Private Manufacturer: ~ Capacityin gallons:
From Tank Field Station Tank Sewer Lines ~
Wel~ /OO ~ (0~ '+ N/A N~ ~,~ uateria,: STEEL Number of C~pa~ments:
Sudace
~ "~/A LIFT STATION
Water 100 t~ IOO'~
LOt Sizein gallons: M~
Line lO~ J0~
~ "Pump on" level at:~ water alarm at:
Foundation ~ JO ~
Remarks: ~ ~N~ ~ ~ BENCH MARK
Location and Description:
A~um~ Elevation:
E~~AL
~ O~ A~
,~. . ~ .~ ~-
" " ~' Dates: 1st ~=/~h~ ~.~ .~.'[..~b~~'""'" ~'' ~"
Heallh and Human So,ices approval ~%~+;t... C.E.
Depa~ment of .t:,e~.: .....
Reviewed and approved by:~~ · Date: ~7/~ ~
72-013 (Rev. 9/91) MOA 25
WELL
F.C,O 140,5
S1 125,5
S;2 119,0
MT1 109,5
MT2 124,0
CO1 185,5
C08 182,5
CD3 llB,O
COl TO MT1 = 34,6
CD2 TO MT1 = 34.0
C03 TD MT1 = 34,5
MT1 TO MT8 = 33,8
'A' 'B*
14,5 17/0
8%5 84,0
36.5 29.5
61,0 44,5
AS-BUIL T DWG
S:W970399 PID#~ 051-131-29
NEW BEll. 15 FEET
WIDE BY 40
LONG, 600 SQ, FT,
GALLDN
C' HOLE
SERVICE LINE WELL
ICATE9 DY THE
SEPTIC SYSTEN AS-BUILT: LOT 10 A, HALVERSDN S/D
49--
PREPARED FOR: PETE HALVERSDN
PREPARED BY: ALASKA WATER & WASTEWATER
DATE: 1817/97 DRAWN: GARNESS SCALE~ 1' = 30'
James P.
",. CE-g608
/----~ROUN~ ~V~R TANK = 105.6+
, i ~ ~ER = 4+ FEET
101,6 :
N ~ lO00 GALLON ~EPTIC
TANK. INLET INVERT =
lOMS. OUTLET INYERT = ) TD ~RAINFIEL~
100,85.
TANK 8ET LEVEL ~ITIN I
,05 FEET.
CH DIA, PVC LINE FROM
HOUSE. INVERT AT F.C.O = 108,97
%83 FOOT DROP FROM FOUNDTAION C/0
TO THE SEPTIC TANK.
I~ 15.0 , m
A, ~OTT~M OF ~E~ = 9%47 ORIGINAL GRA~E = 99,8 TO 101,3
B, INVERT BF ~RAINPIPE = 98,03
~, ~E~ LENGTH = 40' ANO ~I~TH = 15'
~, T8T~L A~gORPTION AREA = 600 gQ, FT,
E. NO ~E~ROCK VITHIN 6 FEET OF lEO ~OTTOM.
,~ ~dames P. ~lllams~ -
ALASKA WATER & WASTEWATER ~'~~~' · . '
DATE: ~/7/97 3WN: GAYNESS g CALE~ NTS
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970399
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:HALVERSON PETER F & DARLENE A
OWNER ADDRESS:20214 GREATLAND DRIVE
CHUGIAK, AK 99567
DATE ISSUED:il/18/97
EXPIRATION DATE:il/18/98
PARCEL ID:05113129
LEGAL DESCRIPTION:
HALVERSON LT 10A
LOT SIZE: 78239 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18A_AC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE:
DATE:
· ., All ]ka W ter & W tew ter
October 31, 1997
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
(907) 337-6179 N Fax (907) 338-3246
Consulting Engineers
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Septic System for Lot 10A, Halverson S/D.
To whom it may concern:
The subject property is currently undeveloped, except for an existing well, and a foundation. The
owner, Pete Halverson, is proposing to build a 3 bedroom home on the site, which will require
the installation of a septic system. Comments regarding the proposed system are summarized as
follows:
1. SOILS: Attached is a copy of the soils logs.
PRIMARY SITE: Test hole #3 is for the primary bed system. The accepting soil in this area is a
5 foot thick layer of GW, which perked faster than 1 minute per inch. Since the GW is underlain
with a 5 foot layer of GM, followed by ML, a sand filter should not be required. Seeping water
was encountered at a depth of 11 feet, however standing water was not encountered after
monitoring. We are proposing to limit the total depth of the bed to 3 feet.
RESERVE SITE: Test holes #1 & #2 are for the reserve trench system. The accepting soil layer
(GW) in these holes perked faster than 1 minute per inch, but was underlain by a tight/bonded
layer of GM to ML soil. The bottom of the reserve system should be 6 feet above this ML layer.
It is reconm~ended that the trench be excavated down to the GW soil, and then sand placed so as
to ensure a 6 foot separation to the ML soil. This will require a minimum sand layer of 2 feet. A
shallow 5 wide trench could then be constructed.
2. BED DESIGN:
a. Percolation Rate: <1 minutesfinch, with protective underlying soils.
b. Allowable Application Rate: .8 gallons/day/fi2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 562.5 fi2
f. Maximum total depth: 3 feet
g. Effective Depth: .5 feet
h. Reduction Factor = N/A
i. Width: 15 feet minimum
j Minimum Length: 40 feet
k Effective absorption area = 600 ft2
3. SURFACE WATERS: There are no surface waters within t00 feet of the proposed septic
system.
4. TOPOGRAPHY: Attached is a topography map which shows the contour of the subject lot.
The primary bed system is located at the toe of a steep slope, on a flat area. The reserve trench
site is located on a bench (at the toe of a slope). In each case, the system is located on a
generally flat area that is greater than 50 feet from any slopes that drop off greater than 25%. In
short, there are no slope concerns.
! am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for
your assistance. A
~ t~~~~Sincerely,
Jef ¢. ^l/Pl less, P.., M.S.
Pfi¢i tlk. J
j LOT 9, I~K 1, GREATLAND
j ~ ,; ~ ESTATES, PVT, t/ELL &
~ \ ~ J ~ SEPTIC SYSTEM PER
/ / ~ / ~.E NUCH GREATER THAN
~ ~ [ ~ FEET FRDM THE PRDPDSED LDT ~, BK J, SCIMITAR
~ ~ ~ ~ SEPTIO SYSTEMS. PVT, ~ELL AND SEPTI~ SYSTEM.
J /450 ~QUARE FEET, ~
LOT 10 B, HALVFRSBN
OF
PREPARED FDR~ PETER HALVER~N ~;~lA. Garnes~X
PREPARED BY~ ALASKA ~ATER ~ ~ASTE~ATER ,, ~ .... .'"
DATE~ 10/31/97 DRAWN, GARNESS SCALE, l' = lO0'
PROPOSED RESERVE TRENCH,
5 FEET WIDE AND 90 FEET LONG
WITH A 2 FOOT MIN, SAND FILTER,
EXCAVATE TD THE GW SOILS EN-
COUNTERED IN TH'S #1 & ~2, FILL
WITH SAND SD THAT THE MAX, DEPTH ~ ./~ ~ /TEST
HOLE
:it;::'
DF THE DRAINRDCK )tELDW THE ~ / ] /
ORIGINAL GRADE IS I FDDT. THE ~ / / ~
EFFECTIVE DRAINROCK DEPTH SHALL ~,/ / /
]~E 6 INCHES, A LIFT STATION WILL DE / /_/
REQUIRED TO USE THIS DRAINFIELD, / / '"
CANNOT OBTAIN GRAVITY FLOW FROM / /
TH~ HOUSE, --- // C
TEST HOLE ~1-~. / / ~ EXISTING FOUNDATION
~/ FOR 3 ]~EDRODM HOUSE
\'
/ / '~ FOUNDATION C/D-x ~\. ~:?,.: "¥.~\ \
, / / 4 INCH PVC SLOPED
EXISTING DRIVEWAY-N \'
GALLON SEPI~IG TANK
i:.:. '"..:
DDU]~LE
SEE ATTACHED CDPY DF M,D,A
TOPOGRAPHY MAP SHOWING THE
SLOPE CDNTDURS IN THE AREA.
BED IS 15 FE~T BY
40 FEET. 600\SQ,FT,
HOLE ~3
EXISTING WATER LINE. THE
CONTRACTOR SHALL ~E
RESPONSIDLE FOR LrlOAT- / ~-"'
lNG THE LINE AND EN~UR- /
ING A ~0 FDDT SEPARATION
TD THE DRAINFIELD /,-' :"':"~
/-.....
/z. ".'.3 ' -,/ .
! ... ~ ~ WELL
WELL & SEPTIO LOT 10 A, HALVERSDN S/D
PREPARED FDR~
PREPARED BY~
DATE~
PETE HALVERSON
ALASKA WATER & WASTEWATER
10/31/97 DRAWN~ GARNESS SCALE: 1' = 30'
CE-7955 ..'
NOTE, FUR LnCATIDN OF THE CLEAN-OUTS AND MONITORING TU]]ES, SEE THE 30 SCALE SITE PLAN. THE MATERIALS
AND CONSTRUCTION PRACTICES SHALL COMPLY WITH M,B.A, DEPT OF HEALTH AND HUMAN SERVICES GUIDELINES.
SOIL OVER DED SHALL BE GRADED
THAT SURFACE DRAINAGE DOES
NOT POND OVER THE 3ED.
FOOT MIN, COVER OVER TOP
OF DRAINPIPE. IF COVER IS LESS
THAN 3 FEET, PROVIDE 8 INCHES
OF BDARD INSULATION,
4 INCH DIA, PERFORATED PIPE
INSTALLED LEVEL. MAXIMUM VARIANCE
OF ,01 FEET FROM LEVEL,
6 INCHES DF DRAINRDCK
UNDER THE PIPE, AN~ 8
-INCHES OVER THE TOP DF
THE PIPE,
FILTER FABRIC OVER
DF DRAINRDCK
5,0
15,0
WELL & SEPTIC ~ LOT 10A, HALVERSON
PREPARED FDR~ PETE HALVERSDN
ALASKA WATER & WASTEWATER
DATE~ 10/31/97 I OWN: GARNESS
ISCALE~
NTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
OATEPERPO
Township, Ran§e, ,Section: l',J I~/~ -
SLOPE SITE PLAN
S
11 IF YES, AT WHAT ~ lA. oL
DEPTH? , P
12 . E
Oepth (o Waler After tj/A c~j/~..o/~
13 Monitoring? Date: .
Gross Net Depth to Net
Reading Date Time Time Water Drop
__
I
14
16-
17-
18-
19-
20-
PERCOLATION RATE '~ I (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '~' ~" FT AND ,~* 0 FT
COMMENTS' ~ /
ACGORDANOE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72~08 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,., ;::, : .. ;-~.
DATE
PERFOR ~/2~//~ ~'
~.o*"¢
Township. Range, Section:
14
15
COMMENTS ~ ~"'~
SLOPE
· SITE PLAN ".'
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~ pO
DEPTH?
. E
Deplh '° Water Alter I'J ~- .~/~
Monitoring? Date: ~'
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~--' · (minutes/inch) PERC HOLE DIAMETER :' ~3 /!
TEST RUN BETWEEN ~" ~' FT AND ,t¢¢.~,0 FT .
· ~\'i : Municipality of A.cho age
[~) i-~: DEPART,,MENT OF HEALTH & HUMAN SERVICES
/i::~:: :': : 825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: P~---'~'~--------
LEGAL;DESCRIPTION:
Township, Range, Section:
6
14
18
ACCORDANCE
72-008 (Rev. 4/85)
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
S/,~.TC~(~--i~O IF YES, ~T WHAT ~[~{~NOt~-~O~ I/ pO
0eplh 10 Wa,er
Gross Net Depth'~. ~ Net
Reading Date Time Time Water /iLL- Drop
PERCOLATION RATE ~' _ (minutes/inch) PERC HOLE DIAMETER [~ ~
TEST RUN BETWEEN O~'~L~" FTAND "~,O'FT ¢~Ut, Jl:~ J~ ~ glt~ }~.E,
'H ALL STAT; AND MUNICIPAL 6UI"ELIN~' EFF'E/T OR THIS BATE. DATE: /ol'o~h~
Parcel I.D. ' 051-131-29
Complete. legaldescfiption f,ot 10A,. Halverson Subdivision
Location (site address or directions) .20012 ChuRach Park Drive
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater progra .m
, .. 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-FAMI~'DWELLiNG '
Expiration Date:
Current Property owner(s)
· Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
- Un/ess ~thetwise requested, HAA wi//be hem by DSD forpickup.
2. NUMBER OF BEDROOMS: 3
Susan Hale
20012 Chugach Park Drive',
Day phone _6RR-7 7'1 6
Eagle River, AK'99577
Day phone.
Day phone
3. ' TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class~
Public Water System
Well
[]
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations 9ivan 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
ne,,',' 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 ere valid for one year for properties served by Class A or B wells or a public
water system. The Municipality ot AnchoraGe is not responsible for errors or omissions in the professicnal
engineer's work.
and regulations in effect at the time of installation. · S & S ENGINEERING'
Name of Firm 17034 Eagle River Loop Road No. 204
r. aglo K~ver, Alaska 99577
Address
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 invest/gAt[on,
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 end inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
Phone ~7 ~-3-r-)7~ .
Engineer's Printed Name_ Robert C. Cowan, P.E.
5. DSD SIGNATURE
Approved for _
Disapproved.
~ .. bedrooms.
Conditional approval for _ _
Additional Comments
bedrooms, with the following stipulations:
.~"~.' r~,_~l'r~ '-.~;,~
~ · "~nG~M ·
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ,~'//"/"0 I
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Oivision
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
LegafOescriptlen: It,.~'~%°/~- t,~?d..-d~...~,) Parcell.O.: ¢~'[" t~t-'~-=t
A. WELL DATA
Well type
Log present
Total depth
San /
If A, B, or C, attach ADEC letter. ADEC water system number
FROM WELL LOG
Date completed
Cased to ,-(o t ~ Casing h~lght (above ground)
wiras proper protected
AT INSPECTION
g.p.m. ~'o
Nitrate ~/,/-' Other bacteria
Collected by:
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
g.p.m.
B. SEPTIC/I-IOLDING TANK DATA
Date installed /~'3~7 Tanksize /~/P~> Number of Compartments ~.~ Cleanouts(~N) ~
Foundation cleanout (~N) ~ Deprassion (Y~) ~J High water alarm (Y/N) '~/~
Date of Pumping ~/'~-',~1 Pumper ..~-~., tO~,4/t4~ ,Sh
C. ABSORPTION RELD DATA
Fluid depth in absorption field before test (in.);
Fluid depth z~ (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y~I~ ~
Date installed ,/~'~°¢)7 Sollrating (g.p.d./fForft=/tx~rm) ~,~' Systemtype ~
Length /¥'o I Width /~" ~ Gravel thickness below ptbe ~. ~4, / Total depth (~ / ~
Effective absorpaon area ~,O~' ~ Monitoring Tube presenting) ~/ Depression over field (Y~J ~
Date of adequacy test ~--2-~t-'~) . Resu~al ) /'A~ For .,7 bedrooms
Immediately affer/,,..~ gal. water added (in.): ~
Absorption rate = 9",t'~ ~' .g.p.d.
If yes. give date /'/~
72-026 (Rev. 3/96)*
D. LIFT ~TATION
Date installed Size in gallons -
Manholo/Access (Y/N) ~off' level at*
High water alarm level at* ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 1 ~e. ~'~'
Absorption field on lot ~o~ t -¥
Public sewer main ~ I &'
Sewer/septic service line ~ t.~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~" I~' Property line ~o ~' Absorption field ~o I'~
Water main/service line ~ t~ Surface water/drainage I~o I*' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ) ~ I ~ BuiMIng foundation ~ o t. ~' Water main/service line
Surface water ~ ~ t + Driveway, parking/vehicle storage area
Curtain drain ~,J~- ~,~ ~ Wells on adjacent lots i~o Ur'
F.
HAA Fee $.
Date of Payment
Receipt Number
ENGINEER'S CERTIRCATION
I certify that I have determined thru field inspections and review of Municipal r~, ~._~.e systems are
in conformance wfth MO,~ .I-LAA guidelines in effect on this date.
Signature ~J~3~" ~ ~
/ . r_ cow*.
Date ~ --' / 0 · _ '~'~.._~.. CE-8801 .,.~"',~
Waiver Fee $
.r- / ~ / e / Date of Payment
0 o ¥o~7
Receipt Number
72-026 (Rev. 3/96)*
APR-30-OI I?:O0 FROM- T-162 P.02/03 F-238
,d~_.. CT&E Environmental ~wices Inc.
CI'&E ReL# 1012050001
Client l~ame S & S Englnecring
ProJe~ Namet~ LIOA Halvcnon S~
~ient Simple ID LIOA ~ve~on S~
Matdx D~g Wat~
O~e~ By
PWSID 0
Sample l~a~:
Client PO#
Printed Date/l'lme 04/30/2001 14:11
Collected Dale/Time 04/24/2001 13:$0
Received Date/Time 04/25/2001 9:50
Technical Director Stephen C. £de
Released B~ ~
Allowable P~'p Annl~i$
LLm~ts Da~ Dtte Init
4.20 0.500 mff/L EPA 300.0
10 ~ 04/25/01 SCL
~.c xob:1 o~.oc~' Labor&r. ory
Total Col~ form 0
0 col/100mL SMI8 9222B
04/25/01
il E R","' ! I::' ! Ill: ATE
OF:
A F' F:' F< O 1::' R I A T i (3 N
...... "' UNDJ.E]R A,~ .48~5 THE At..A,~'KA I,,IA'I'E]:~ U,!;'E AF;T
THE .':?TATEi (iii::' ,d...:-.~,.;LP~ .....
A?-!D 'i"HE RI'~Z;.LII..ATtON,S' ADOPTED UNDER IT, C~.RAN]'3' TO:
i::'ETER FAViI...L.E HAL. VE]:<.S'ON AND
I)ARI..ENE Pi HALVERYON
STAF;,' R'riE 2 BOX 4244
CHLIQIAK, AK, 99567
'r~ -::' i.< ill (;-I-.I T "!' !'1 i..i.'..;' E W A T E R I::' R O M T I'.1 El F' O L L O W I N {; $ ( ~ L I'~ C Ex:
' ""FI::' ' ' . ..........
A;. DRILt..ED WELL WITI-I A FKI..I,IF't DATE OF' i2,'i.~,,"i':;'r:v::
5:0(i).. ~i) I~,AL/DAY
FOR ,rlN(.~I...F..: ])W[EI...I..INC2. JAN (.)5 TI-IRU DEC ';:',
'i'Hii.i i..C i.~: :!'.. T ]i [i h! 'j'('J WIqlC:H THIS WA:I'ER RIi;.HT AF F I'Zi:Ci'AIN~¢
L. OT !(.;,, I-.'.,'I..OCK i, [;Rlii:AT LAND E:,?TA'I'E,'~:, UNIT NC), Ii, ACCORDINg;. 'TO PI...AT
NO., 72.-. i 'i (.,', Fil...I~:D :I:N Ti-.ll!i: ANC:HORA(;.E: t:;:I!iX:'.:ORDIN[;. D]:,".:...'TRICT, 3'A!D L. OT
L. OCAi"ii::D WI't'f-IIN NEi./4,~;'Wi/4 5'ECTION i,3, TOWN,?;'HIP J Y NORTI-I, RANC;.E 'i
bi[i:,?'. .?EWAF, tD kili.:RIDIAN.,
THE !...OCAT I C~N
W ]: T I-I i !',! T I..I E A B 0 V I/J:.-. D E 3'tl; R '1: B E I) I::' A R C E i... 01::' P R 0 I::' E Fi: T ¥.,
T Fi Iii: i ~ I'l N D I '1' I 0 N 3' T I.I A T ('. I. I I... t' T Ci "1' I-I 1,5.'.' A F' F' R 0 P R I A 1' I 0 N - I,, 1:. I::' 0 t..I N D I N A'I"!' A C H ....
MENT A.. ATTACHI:".:D HERETO AND MADE A t::'AF;tT HEREOF.,
!'l--I E bi A T Ii!: I;..' R :l: {;.i-.I T I ,'.,.': (;. R A ix!T 1:"..: D ,? U B ,J E C; T '¥' 0 T H Ii!: F'I..":: R"!' :1: i',! E: N T 3' T A T I..! T 0 F.' Y
~ , * '"' 93,
I::'RCrv'IS'ION,? 'l:i',,~ AS' 4,5 'i5 AND A.I.)MIN]:,?;'TI:;:ATIVli!: REC;ULATION:?
Jim Sullivan
688.2510
~,~ ARCTIC '~
(PUMP & WELL /
~ SUPPLY ~
NWWA CERTIFIED PUMP INSTALLER
NO 58
WELL RECOVERY TEST
Alaska
Distributor
P.O. Box 197
Eagle River, Alaska
ADDRESS:
LEGAL:
CASING DIAMETER
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