HomeMy WebLinkAboutELMORE BLK 2 LT 10Onsite File Elmore Block 2 Lot 10 #018-171-15 1983 absorption field can only be tested for up to a 3-bedroom COSA approval. lfRCv VJ/VG/ 10) Municipality of Anchorageflu . On -Site Water and Wastewater Section • (907) 343-7904 Page'�1f ON-SITE WASTEWATER INSPECTION REPOR NOV 16 220 Permit Number: OSP201177 PID Number: 018-171-15 Dwelling: RE Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑Q Upgrade Name ERNEST EDLUND ABSORPTION FIELD El Deep Trench FM Wide Trench ❑Bed Mound ❑ Site Address 4901 SHOSHONI AVE, ANCHORAGE AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 0.8 GPD/,,:;F JTotal 5.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 2.0 Ft. Subdivision Block Lot ELMORE 2 10 Fill added above original grade 0.0 Ft. Gravel length 106 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field f Tank Line 750 Ftz 2 6.0 Ft. Well 100'+ 1001+ I n/a n/a E TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ n/a n/a Material Number of compartments Lot Line 10'+ I 10'+' n/a n/a NA Plastic 2 Foundation 10'+ 10'+ n/a n/a LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield A+ HOME SERVICES Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCHMARK (Assumed elevation) 100 fl Inspectioim 20200720 20200721 Location and description 3`d Znd 4'h HOUSE TRIM ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ;�� OF AC 'Ak co Stever R. Pannone � �. CE 8_14 Septic System Approved Date Note: this approval does not include well permit requirements. lfRCv VJ/VG/ 10) Engineer: Legal Description Parcel ID: Permit: Report Type: Municipality Of Anchorage On -Site Water and Wastewater Program P.O. Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Review Comments PANNONE ENGINEERING SERVICES EPLANS ELMORE BLK 2 LT 10 01817115000 OSP201177 Septic As Built Review i�el7drtmellt 1/7/2021 Completed By: R.Carroll The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: 1. Trenches were installed perpendicular to the slope contours. Please submit waiver request and provide a profile drawing to demonstrate max depth was not exceeded and effective area was completely within perked soil layer. oto O Please label what I assume to be insulation over the septic tank in the profile drawing. ©,(,- -,-c' The bottom of test hole elevation on the profile elevation indicates a 26 ft deep test hole, please confirm AP A percolation test was required of the test hole. Please submit percolation test data. Response Comment #1: The subject lot and surrounding lots are flat in the area of the drain fields. The trenches i vere field fit to match actual slopes in the area which are south to north at <5%. The total depth of the fields did not vary more than 1 inch across the entire length of both fields. No waiver is required. o� N m C) o_ po z a7 E o Z7 ' C, no m v 'g: cX-novmi< o2> � D >O)O C Zc) 2-i E C�> c 0 O O W r- p Z (n Zm Z� m rTi o X rr- rmn Dr n Em N� F, p 0 0 K n K n K n K n rn o o -+ K -P -P W W N N -. -. U) < O N= Oma CD CD Cn Cn (0 cD -P -P -P W W (A N -! J� -i U) W p --1 Cb 6) N -• O V y CD rD N -.+ v Cn 0) 1 W N -P O t3) O C3) CS) W W U) U) N N W W W GW W rn� m co O O) Cn 9) O Cn -P W O CD (n N N N CO _. M W CT -P CT o � -iNIC �U) D�)D U) mo C6 O�Tm Z.nnc-OmF;uz' KI D�Q r� D{� I DcDrnSW W m-< _1x> �OU)M -< m� �mO�oz�m��Z x rn .. p D _ n m o z �) O D oOn000UN�D ox Ulrnzo Co r�o� orn-<D o )yam -nn Co rX�" o -r) r.,.) -o U) S 0 !T1 rnz>. o - Omm .. _ J(A � Ti Ul N d O N m Cn - O (A p !r" T1 c/) 0 �\ DECK a I > I I z / �, m I I O / m r - n - 1 I rO 0 n I to I / \ f J QI �Z CO to / n 1 II` I M-� Iz �� 3 Iii • n 1 mm I I I o r, o I I I I I nc"no o I o 1 1 l pbD �vz mo \ l m m r 3 < / ! o \ • =/ ( I cn z / \ -i / \ zm o 1 I I I� \ ww fw (\\ I NOTES: PANNONE ENG SVC LLC (C.I. 1088) REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALLIER, AK 99645 OF11 /3/2020 PHONE (907) 745--8200 FAX (907 745-8201 �� REV 1: 1/8/2021 SCALE ELMORE B2 10 •••• •. •• ••••••. P.I.D. NO DRAWN ACP ERNEST EDLUND "even onnome 018-171-15 8149 PERMIT NO. 4901 SHOSHONI AVE osP2o1177 SITE PLAN ANCHORAGE, AK 99516 SHEET 2 OF 3 _0 �\ Oma Z� om it ' rr�p O O n / M -` w -i U) ` D rn(� mTI INo < m m n _ _ o N — - Z �0� ocn N v rn� m co no ZD n 0=1 �m ! I�j o u ' v o � ti >n 8 \ \� m_ n<� 0 Z \ _>. � 1 ! g m rn" \mZ DECK a I > I I z / �, m I I O / m r - n - 1 I rO 0 n I to I / \ f J QI �Z CO to / n 1 II` I M-� Iz �� 3 Iii • n 1 mm I I I o r, o I I I I I nc"no o I o 1 1 l pbD �vz mo \ l m m r 3 < / ! o \ • =/ ( I cn z / \ -i / \ zm o 1 I I I� \ ww fw (\\ I NOTES: PANNONE ENG SVC LLC (C.I. 1088) REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALLIER, AK 99645 OF11 /3/2020 PHONE (907) 745--8200 FAX (907 745-8201 �� REV 1: 1/8/2021 SCALE ELMORE B2 10 •••• •. •• ••••••. P.I.D. NO DRAWN ACP ERNEST EDLUND "even onnome 018-171-15 8149 PERMIT NO. 4901 SHOSHONI AVE osP2o1177 SITE PLAN ANCHORAGE, AK 99516 SHEET 2 OF 3 READING SOILS LOG — PERCOLATION TEST TEST HOLE 1 WATER t.EVEI READING NET DROP RATE (MPI) SLOPE �/zo/zo 1 OR ORGANICS a.000' 2 2 3 7.000" 3.000' 4 z 4.000` 5 SAND & w SP/SM GRAVEL 6.950" SEE SITE PLAN 6 5 7 w w to 8 6.891" 2.891" 9 10 11 12 13 SLOPE 14 SEE SITE PLAN WAS GROUND WATER 15 ENCOUNTERED? N 16 IF YES, AT WHAT BOH DEPTH? N/A DATE PERFORMED: 7/20/2020 DEPTH TO WATER AFTER MONITORING? DRY DATE: 7/27/2020 SOIL TEST RESULTS /ANALYSIS • PERCOLATION RATE 10.4 (min/inch) (Hydrologic Soils Group: HSG A) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 3 FT AND 4 FT. COMMENTS: Test hole excavated by A+ HOME SERVICES PERFORMED BY: Pannone Engineering Services. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC LLC (C.1. 9088) P.O. BOX 1807 PALMER, AK 9645 PHONE (907 745-8200 FAX (907) 745-8201 ""` i, _ '�E DF. A4,jS,, _=y�P. " s�'y REVISIONS DATE 1/8/2020 RECORD DRAWING SCALE ELMORE B2 L10 ERNEST EDLUND 4901 SHOSHONI AVE - - ... .... - ; i� Steven R. Pannone = CE -8149 NTS P.I.D. NO 018-171-15 DRAWN PERMIT N0. osP2o1177 SOIL LOG ANCHORAGE, AK 99516;`- SHEET ....... 3 OF 3 READING GATE NET TIME WATER t.EVEI READING NET DROP RATE (MPI) i �/zo/zo -- a.000' 2 30 MIN 7.000" 3.000' 10 3 4.000` 4 30 MIN 6.950" 2.950' 10.2 5 4.000" 6 30 MIN 6.891" 2.891" 70.4 0 IS 0 cl� 444 "a z z Co X� LLI ca V) is < cc a - 0 :1- 00 z Lli U' U LC i'x crxto C) m 0 z 0) C)" '—j jr V) z u z -i 35 n LT SO - "a IQ 70 SOO' 07 00 E C) —4 178.71 0 0 25,6 0 Q0 03 GO ul z ot 3: (A ol Qil cc CgL cc w 4", 4,17 CL µZ— 75 5 0 �E x �k' '0 o W 0 bL 41'8 —:F < a2z C :5-� e M0oE ;�- - r ;.1 w c 0 > 1 '00 cr � I 11 -" Q, 0 olO -t z Co X� rp ca V) is < cc a - 0 :1- 00 z %- 03 - CN , U' U LC i'x crxto z < m 0 z 0) C)" IQ 70 SOO' 07 00 E C) —4 178.71 0 0 25,6 0 Q0 03 GO ul z ot 3: (A ol Qil cc CgL cc w 4", 4,17 CL µZ— 75 5 0 �E x �k' '0 o W 0 bL 41'8 —:F < a2z C :5-� e M0oE ;�- - r ;.1 w c 0 > 1 '00 cr � I 11 -" Q, 0 olO t� -t z Co rp ca V) is < cc a - 0 :1- 00 z %- 03 - CN , U' U LC i'x crxto z < m 0 0) t� z I rp 0 L > 4, LC i'x crxto m 0 '—j V) z u z -i GO n LT Wit Ld 0 4 z z' 00 w CO < 3: Z z 0 L > 4, LC i'x crxto ui V) z u z -i GO n LT Wit Ld 0 4 z z' 00 < 0 L > 4, LC i'x crxto GO n LT Ld 00 < 3: - -1 C) < 2 0 T V) L) OC Co z < 0 1 CO 0— MUNICIPALITY OFANCHORAGE On -Site Woter& Wastewater Program pOBox 1S865o 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone- (907) 343-7904 Fax: (907) 343-7997 Permit Number: OSP201177 Work Type: Septic Upgrade Tax Code Number: 01817115000 Site Legal Address: ELK8QREBLK 2 L 10 G:3036 Site Mailing Address: 4901 SHOGHON|AVE, Anchorage Owner: EOLUNDERNESTG Design Engineer: PANN[}NEENGINEERING SERVICES This permit |nfor the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 6/23/2020 612312021 2 Disposal Field ERT Septic Tank [] Holding Tank 11 Privy [] Private Well 0Water Storage All construction shall bainaccordance with: 1, The attached approved design. 2. All requirements specified inAnchorage Municipal d Chapters 1555 and15S5 and the State Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations ) 3. The wastewater code requires inspections during the installation. The engineer shall notifythe Development Services Department per AMC 15,G5.Provide notification bycalling (887)343'79O4( 4. From D�ober15huApril 15, esubou�acesoil abeorpUon system under construction duh�gfreezing weather shall baeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Special Provisions: A test hole is required prior to construction of the drainfield to confirm percolation rate and separations to groundwater and an impermeable /ayoc If results require a design change, construction shall stop pending On-site review and approval ofachange order. Construction can proceed otyour own risk prior to 7 -day groundwaterreading. Please submit results with the inspection report (or change order, if required). Received B� Issued By: 4 MUNICIPALITY F Community Development Department Development Services Division On -Site Water & Wastewater Pro ram Phone: 907-343-7904 Fax: 907-343-7997 g :I ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-171-15 Property owner(s) Ernest Edlund Mailing address P.O. Box 111683, Anchorage, AK 99511 Site address 4901 Shoshoni Avenue Day phone Legal description (Sub'd., Block & Lot) Elmore, Block 2, Lot 10 f. Legal description (Township, Range & Section) Lot Size 23,590 Sq. Ft. Number of Bedrooms 4 APPLICATION 1S FOR: APPLICATION IS AN: TY f E OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo AD U) Septic Tank 0 Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ i (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5Q57 - L1 L{(o•ZS Waiver Fees: Date of Payment: Receipt Number: DZDtE(106a Permit No. 61; P ZD W39 Permit App_- : • : '_.,:c Date of Payment: Receipt Number: Waiver No. I. COV ID -19 : ' 257k DISCOUNT APPLIED .I R I' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201177, Rebecca Carroll, 06/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201177, Rebecca Carroll, 06/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201177, Rebecca Carroll, 06/23/20  ('~ MUNIClPAUTY OF ANCHORAGE /'~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION " ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchora~. Alaska 99~1 Telephone 2~720 ~ "~ ON~ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME kADDlican~Name:, A~ond, Inc. ~PHONE LEGAL DESCRIPTION I · /,~ lmore Subdivision No. of compartments IOOO IF HOME.DE: ~O ~ Well Dwelling PERMIT NO. DISTANCE TO: Foundat on Nearest I~ ~e -- No. of li~es ~ ~;nches OTHER SOIL TEST RATING INSTALLER I I 72~13 tRey. 3/78) Lt,'%~'~ec~` ~py ~¢x/(.e'%~, ALASKA ENVIRONI~[NTAL" ~NTROL SERVIC ~INC. ~.~.o, ~ / o~ / 1220 West 25~ Avenue Suite B · ~CHORAGE. ~SKA 99503 27~1~1 27~17 . CHECKED BY DATE ~CALE : '~;' ~ * L*? .... .... ~ ..... i ~ * ' 7' '~ '":"-~ ' ~ ~ ¢/¢. ..: , ' ' ~ 73~/: ..... i ' ' .-~--4 - 4 ...... ~--.-; · ; --,~ ...... __A ...... ,~' ..... I ~ ., ....... ¢/ . -.t .... % "1 .................... , T'-' "! '-' -t -~,, -'"1, ....... ...........! ,' "t :' .... ~' *-~y-' .............................................................. ¢~ ~,~.' f .......... , , ~ I , ~ I_ _J __[ _ _ j I _MUNICIPALITY OF ANCHORAGE,, . Department.~. Health and Environmenta~?rotectzon 825 ~ Street, Anchorage, AK. ~9501 264-4720 ' ~ # * HANDWRITTEN PERMIT # # * Permit ~~ WEEk AND~ON-SITE SEWER PERMIT Applicant: ~ Mailing Address:~~ Phone Number ~.~/_~ Location: Legal Description: L 7' t~ [ ~ot Size: ~ ~ Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bedt /----~'Holding Tank: Maximum Number of Bedrooms: .% Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH ~--( LENGTH ~"V /9 . GRAVEL DEPTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ' ' REOUIRED SEPTIC~ TANK SIZE = ,/~9 GALLONS * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' ' ~ TWO(2) INSPECTIONS ARE REQUIRED # * # Backfilling of any system without final inspection.and approval by this departmen' will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee' for a private well or 150 to 200 feet from a public well'depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. ' ' ' PERMIT EXPIRES DECEMBER 31, 1 9 8 3 ' ' ' I certify that: '(1) I am familiar with the requirements for on-site sewers and wells as (2) (3) S igne~: set forth by ','luq. a~, :he~.~unicipality of Anchorage. ~'~he system in accordance wxth codes. :J3at the on-site sewer system may require enlargement if is remodeled to include more~ha~//bedrooms. . Issued by: Date: ~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 I Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMEDEOR: ~'~[. ~'~T~TIE' ~/~, ~47'~v~- I~'~L~[~r-'~ OATEPERFORMED: I~''"~)°~)~L" LEGAL DESCRIPTION: ~/'" ~ Ot~ ~' O~. 3 m 4- 5- 6- 7 8 9 10 11 12 13 14- 15. 16- 17- 18- 19- 20- SLOPE SITE WAS GROUND WATER ~C) ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time. Water Drop H'aC) i .t. . ~4::~ 11; 3 ~ 1.0'6 ~,~ '~ '~): ~3 ~ , J.~ U~O ~ '.O~ I ,~ PERdiTION ~ATE T~ST~eE~E~ ~-~ ~T*~O ~'~,F~ .// PERFORMED BY: ~).J'v~- ,~J'/~. CERTIFIED BY: 72-008 (6/79) Box 1369, STAR ROL"rE A A.%'CHORAGE, ALASKA 99~02 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF ,"?._~. CC PER FOOT. PROPERTY OWNER LOCATION OF WELL SIT~ DRILLER WELL LOG: COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILL!I~G~ "~ WRITE'CHECK PAYABLE TO RAMP~AR~'-~RILLING WORKS FOR THE SUM OF,~'-°~°'q, OA , THANK YOU VERY MUCH. j DATF · BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF I~'a% PER MONTH WILL BE ASSESSED ON PA J ~-~ ....... -,:. ............ ~ ..... -. ..... MUNICIPALITY OFANCHORAGE ~:-;~;=.~*.-",.::. ~, z, ~= ~ ~*,"'.:~' ~'~*~* ,,-"*::*,-,,*,,~ '?,-~.~ CERTIF CATE OF HEALTH AUTHORiW ~, ; -: ~=.~ ...... - *. ................ ? APPROVAL FOR A ................................... ,.~ .......... SINGLE FAMILY .......... Complete legal descrmtlon -- to;~. lO, ,.E~ock ,~, E.f.~o~e~$u.~c~u.z~.~n, dir~tlo )'- "' .... ..'..:. 5. .. L'STATEMENT. OF INSPECTION_ BY .: *; *':**- :,,._ .~*E: .'~. :_::, .m,;,,,~ ho,,~ and as of the validation date shown below, I verity that my . ....... ~ investigation o,f this Health".a,'~thortt~' APpmval~.apl~ll~.fl.~n'*sh°ws*tt{~'~'~**0fl:site water supply · and type of strUcture.indicated herein. I further verify that based on me m~ormauon oomme~ ' ;'.i'{ ~h~ MuniciPality of Anchorage filesand f~om'l~Y'in~-9ati°n and!nspec}j0n'~tte.°n'sitewater .... ::' ~.:~.!!~uP..Ply'~..~0r wastewate~ itispo~l system Is in ,comp?ance With all Municipal and State codes, . ."_' ~: ~c~l,l{a~ _'.~.'_ :'and reg-~iat ons'in effect on ~h~*~Jaie of'th~i?l~*tto~-}i'.-.~ ';-.' -~.'-* :.-i' .'*: ' . X'~':':: ::.".,~ '" :" '~'; S&S~I~m~*NG ""' .'- -:..-:* ' -- ~,none '~ · ~ · _ . ......, ...... ,., ........... '" "~: ':-~'-'Er~,~i~e~r's s anature: ' '-/',-rr,--~ ~.~ ............... ......· : ; :'?.?* '.:~_.~;a~.~'_;~.~..;;~--..'..'~'~'''* **.--.,.--*.~-..--~.-~,','*,~-;~¥':~:*'?-m'"~'-"l[7~,:~c;'cow~ /Z*r.~" ..... '-* , , :. ?-~- ,..--DHH$-$1GNATUR£ ............... : ~- .... ~ · , .. . · .. ",,~ !'}-.,'~ ~'-'. '-- ~'~;"~ ."~,.D roM~d.- · ... -.-...;: . .....; - v --.: : ..... ,--~ :-'.. , . .,--. ~. :. --; .... *."- · £. '; "",' ;' ~' ~-~'~ ;-?.*.~ ', · ,'9" ,-..~..-, ~ ~:. ~,, -.=-~-;- ;.-,;..- -:.- ~-:;vt :i'.,-:.-'.~ ?;":;'9:.' ';"i, ...... :;..u;: ..~..-.; ~..~. ,u.~.;.., -l/' ......... ........ ~ ~ , ~< :-/./ --:,.:~c.~;~,-~ ......,... r~-.,/**~>'~// t/- */ ~ .. ...... . ................ ..: .., ....... .... '~.;-;, .-' ........... -:.-_.-.,:. * .z_ ,--?-'~*-."~;;".,.,.,, the me~msentatlons gwen.lnj · ~, ·., sndlt~irlendlnG nstitutionsinorder~S~ ; ' ~ ,"" ~a.~ I~m~-flons or analyze ~ata ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage. Alaska 99501· (907) 343-4744 Health Authority Approval Checklist A. WELL DATA Well type/a/'. '~. Log present fi/N) Total depth Sanim~ ~1 Date of test Static water level Well production ~..//'/~' g.p.m. Ifa, B, or C, attach ADEC letter. ADEC water system number Date complcteit / c~.~ Cased to / .~, O ' Casing height (above ground) Wires properly protected fi/N) FROM WELL LOG AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: B~"~"~IOLDING TANK DATA 0 · {; '7 Other bacteria 0 Collected bi,': $ & S ENGINEERING 11034 F..agle River Loop Rosd No. 204 Eagle Rivm', Alaska 99577 Ce Dateinstal[~ ~'-Z~-~g Tanksizc ~ ae'~_q.,/.NumberofCompartments ~.. Cleanouts(Y/N). Foufi~tib~ cleanout fi/N) Y Depression fi/N) /L./ High v,'ater al'arm LDate~fPumPing 9-//- ~_C" Pumper ~ ABsoRFTION FIELD DATA Date iastalled ~/'~.-?' ' ~ ~" Length C/',~ / Width $oilrating (g.p.d./~tZo~/OO" Systemtypc ,ff"" Gravel thickness below pipe. 2 ' Total depth ~: Effcctive absorption area ~(7:/'/ MonitoringTubopresent(Y/lq) Y Depressionoverfleld(Y/N) Date of adequacy test 9 -//- 53"- Results (Pass/Fail) ~,,1',.c For -~ bedrooms Fluid depth in absorption field before test (in.); E57 Immediately after 7/! gal. water added (in.): Fluiddcpth ~ O Minutcs later: ~7.,,. '>"(m.)' Absurpuonrate = q'.f-~ "~ g.p.d. Peroxide treatment (past 12 months) fi/N) ~1,/" ' " If yes. give date Manhole/Access (Y/N). / .~'7~/~m./'~ ~ 'Pump on" level at* High water alarm level at* --.... SEPARATION DISTANCES ~Pump off" level at* Absorption field on lot Public sewer main Sev,'cr/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding lank on lot 75r '¥- ; On adjacent lots ; On adjacent lots Public server manhole/cleanout Lift slation SEPARATION DISTANCES FROM~e~'~'C~OLDING TANK ON LOTTO: Foundation ,/~ /," Property line /gy a.,t. Absorption field Water main/service line 4tO" ," Surface water/drainage /~o ',~ Wells on adjacent lots /O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water /,0 o ~K--. Cumin dmifi Driveway, parking/vehicle storage area Wells on adjacent lots /0 ~9 ENGINEER'S CERTIFICATION e~ I certify that I have determined thruJ;eM inspectlo,.ns and review ~fMunicipal r e in conforman~~ gui~s i'n effect on this date. Signature ~ O-'. 64' t,,..,----- ..,d-..~."~ Da,e / ,rs- [I," .' ..' tt,at $ 300.00 Date of Payment O~- Iq- e}.~, Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Div;~ion .... " ,s.,70.= Laboratory Analysis Report #ATBR 20OW. Potter Drive. Aflchorega, AK 99618.1~,06 -- Tel: (gOT} 682.2343 Fax (~07} 581-5301 .... .. APPLIC"~NT FILLS OUT UPPER HA~'~ ONLY Type ol Resi~nce ~ Holding Tank NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Time ~ Date Date Date Date Inspector Insp~:tor Inspector Insp~tor Field Notes: ~t~ ~UNICIPALI~ OF AN~O~GE ~ DEPT. OF HEALTH JUL 2 5 .RECEIVED -~VED BEDR~MS *CONDITIONS OF APPROVAL ( ) DISAP~OVED ~lls Rating Date ~wer Insl~ll~ Well To ~sorption Area Well Log ~ - ~ ~ ~ Well to Tank Septic T~k Size [ July 27, 1983 Almond, Inc. P. O. Box 11-2247 Anchorage, AK 99511 SubJectl Lot 10, Block 2, Elmore Approval for the individual sewer and water facilities cannot be granted until the following items have been completedz ~q~r well log submitted to this office for our files and eview. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist RP26/eJ/E2