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Home My WebLink AboutVIRGINIA RUDE LT B2Virginia Rud Lot B2 #050-531-31 Municipality of Anchorage .'::, ... Development Sea/ices Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page [ of 3 www.cl,anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. ~) ~ ~,~' PID Number. 050-5~1-'~ "'"": P~¥LLI..t' ~. C.~,/~T~,,~ WastewaterSystem: [] New [] Upgrade '~"": ~.O. 8e x '7751 ~ I ,, ~.4~c¢ /~,,,4%,~.- ABSORPTION FIELD LEGAL DESCRIPTION B- ;;t v,.~,.,~ ~ ~/e. '~ ,,. Well: [] New [] Upgrade e,.,~ ~. ~' Ft. t, ' ' Ft y~ld: GPM Pump ~ ~ Ft. FL TANK SEPARATION DISTANCES ~tseptic I-I Holding [] S.T.E.P. [] Othe~ Tank FieldStationTank Sever IJ~e ,..r ~.~.r t'. ~./" ¢1.~' oo'+ LIFTSTAT,O. ,... ~o'6,'_ /XX'~"-'~~,~-'-",_ "'~': BENCH MARK 170~ E~Ie River Loop R~d, No. ~ 1st ~-~O-oo ~--: ' ~*' DevelopmentSe~ices Depa~ment~pproval ~,~ Ct.88oi /~ ,eviewe~ ~nU ~,~ov~ ~ / ~~te: ~ -V' O/ . .,,.: ........... .. -_ ~ ' e£R.~T t~O SW000565 eAC£ 2 O~ .3 D ........ M u n~i£ ip. g_.t i t:. y...o. F' .A.n_c h.q .r' ~ g .e. bl~Al~/IVll:N/ C)h HI:AL/H AND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION P.D. Box 196650 eAnchor~ge, Alosk~ 99519-6650 e Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L£CAL LOT B-2, VIRGINIA RUDE S/D P.I.D. NO. 050-551-51 EKLUND AVENUE 10' TELECOM & ELECTRIC EASEMENT 15' TELECOM A ELECTRIC EASEMENT P£RM1T NO SW000565 PAGE DEPARTMENT OF HEA~_TH AND HUIVIAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.B. Box 196650 mAnchor~ge, Ato. sko, 99519-C650eTelephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT B-2, VIRGINIA RUDE S/D P.LD. NO. 050-531-31 ST1 ST2 /-94.3' .IL I1/ FINALG~~N ............................... SULATION 89'2'J %- 88.9' FINAL C01=93.3' C02=92.4' b~_~J ~ Co1=88.1' ] co2=88.4' MTl=81.7'-~ · NO WATER FOUND 75.2' B.O.H. A B FCO 3.0' 21.5' ST1 45.0' 46.5' ST2 48.0' 48.0' DBL1 50.5' 50,0' BBL2 51.5' 50.5' 601 64.5' 65.5' MT1 77.0' 76.0' C02 85.0' 84.0' From : RLPINE DRILL 90? 345 02~2 Hat. 20.2001 10::~1 PN POI cl.,~ I~.' Department of Health and Human Services 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 R~ck Mystrom hRptlNvww c~ anchorage ek ut MAyor I'ermi! Number: #SW 990f f2.Redo for wronq placement of ot~qinal well see Io~1 dated 6-5-99 Date of Issue: 5.= 27.9g .P~zrc~J Jdcutificatio= Number.* ~50-53~-31 i~te ~rte~.: ~ Dele Completed: 5-6-00 Is weli located at approved p~mil Iocalion? [~ Ya [] No Legal lk~:rlpfloa~ · Viroln'~-~-~e ]~ B2 Properly Owner Name & Addre~. Phylis Cadet P. O. .Box..77312f EaSe R:,vc;,4~, g~577 Borehole Data: Depth (fi) S~il 'l~ypc, 'l'hi&nc~s & Water Strata From To slick-up 0 2 silty gravel w/ cobbles 2 30 gravelly silt 30 40 silty sandy gravel 40 40 63 sandy silt 63 .67 silty sandy gravel 67 130 '154 bedrock 154 156 large fracture to bedrock surface imbeddedd with silty gravel and water 1.gpm 156 158 bedrock 158 204 [] cable io~l' Method of Drilling [] ~fir rotary Casing type: ~[eef Wall ThiCkness: .025 inches Dhmeter: 6 inches Depth: 157 feet Liner Type: Diameter: inche.~ Depth: feet Casing stickup above ground: 2 feel Static water level (fi*onlground level): 164.. feet Pumping level:, 204 feet after _2 hot,rs pumph~g _~ gpm Recovery'Rate: I gpm Method of Testing: air lift Well lnlake ()penhtR Type: [] Open'End ~ Open tlole ' [] Scream 'Start feet Sto~ed ' feast [] Perforations Starl foot Stopped fee~ Gruut T~pe: ~¢nton~te # 8 Volume: I b~?s Depth: Start 0 feet Stopped = feet Pump: Intake Depth feet Pump size hp Brand Name Well Disln fe~exl Upon Completion? [] Ye~ [] No Method ofDIslnfeetlon: clorfne tablols Comments: MUNICIPALITY OF ANCHORA GE Department of Health and Human Sen/ices On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEVVATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Sep 11, 2000 Expiration Date: Sep 11,2001 Permlt Number: SW000365 Legal Description: VIRGINIA RUDE LT B2 Design Engineer: 0003 S & S Engineering Owner Name: Phyllis A Carter Owner Address: PO Box 773121 Eagle River, AK 99577- Parcel ID: 050-531-31 Site Address: 030324 EKLUND AVE Lot Size: 42614 SQ. FT. Total Bedrooms: 2 Permit Bedrooms: 2 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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 ( 18AACS0 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. Received By: Issued By: Date: MUNICIPALITY OF ANCHORA GE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box f96650, A~chorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Renewal Date Issued; May 27, 1999 Expiration Date: May 26, 2000 Permit Number: SW990112 Legal Description: VIRGINIA RUDE LT B2 Design Engineer:. 0003 S & S Engineering Owner Name: Phyllis A Carter Owner Address: PO BOX 773121 EAGLE RIVER, AK 99577-3121 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank Parcel ID: 050-531-31 Site Address: 030324 EKLUND AVE · ot Total Bedrooms:/?,,, Permit Bedrooms:/,/,/ [] Pdvy [] Private Well [] Water Storage Ail 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apdl 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. Date: PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960024 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CARTER PHYLLIS A OWNER ADDRESS:P.O. BOX 773121 EAGLE RIVER, AK. 99577 DATE ISSUED: 2/23/96 EXPIRATION DATE: 2/23/97 PARCEL ID:05053131 LEGAL DESCRIPTION: '~IRGINIA RUDE LT B2 LOT SIZE: 42614 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (18AAC80). 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: DATE: DATE: ROBERTC. COWAN, RE. ROBERTA. SHAFER. RE. February 6, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot B-2, Virginia Rude Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced proper~¥. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk MUNICIPALii¥ O~ AI~CH~kAGc i[N~iRONMENTAI. SERVICES DIVISION Enclosure FEB 07 1996 RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577 LEGAL LOT B-2, VIRGINIA DRAWN J.L.M. J CKD. R.C.C. ~~e~ 6~E},~,~ DESIGN CRITERIA: SOILS = 1.2 GPD~SO.FT. 600/12 = 500 SQ.FT. REQ'D. TRENCH DESIGN: 10' DEEP J 6.5' EFFECTIVE 2.5' WIDE 59' LONG RUDE SUBDIVISION J DATE2_6_96 ISHT. LOT 2 EKLUND AVENUE 1 OF1 STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SITE PLAN ARE AS SHOWN ON AN AS-BUILT SURVEY DRAWN BY: WILLIAM D. FLEMING -- IT IS THE RESPONSIBILTY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTY LINES PRIOR TO COl ',UCTION. PROPOSED 1250 GAL. SEPTIC LOT B-2 PROPOSED TRENCH~ LOT 2 PORTIONS OF SYSTEM LESS THAN 3.5' OF 'OVER REQUIRE INSULATION. 10' TELECOM. ELECTRIC & UTILITY EASEMENT CONTRACTOR IS REQUIRED TO OBTAIN UTIUTY LOCATES PRIOR TO ANY EXCAVATION WORK. LOT 1 PROP. WELL AND SHEDS TO BE REMOVED CLIENT N PERFORMED FOR: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED. ~.-~,~...c~, . LEGAL DESCRIPTION: ~ ~)~']-' ~/IK-L,, ~-~,&- ~Fe. Township, Range, Section: SLOPE SITE PLAN I 2 WAS GROUND WATER ~o ENCOUNTERED? IF YES. AT WHAT ~1 SL DEPTH? ~. pC E 5 7- 8- 9- ----~ I 0 - 11- 12 13 14 15 16 17 18 lg- 20- I N $ ~ '-.4e,.~-r r-p Gross Net DePth to Net Reading Date Time Time Water Drop "~ ~-,~'...~ ,-I '/-- t 4%' PERCOLATION RATE '~',~" (m~nute~mch) PERC HOLE DIAMETER TEST RUN EETWEEN' FT AND FT COMMENTS S & S ENGINEERING 2 ~t04~)~'%° ~)[~ PERFORMED BY: 17034 Eagle KIYer Loop Koed No. ACCORDANCE WiTH AGG~T~r~blqKJ:iI~I41LId(I~UIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THiS TEST WAS PERFORMED IN ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE= Lot B-2, Virginia Rude Subdivision February 6, 1996 GENERALt 1. me e The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the proposed four bedroom house located on the referenced property. ~- Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with .any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INST~T,?.~TIONt A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. e The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP * sUn'E 204 ,, EAGLE RIVER. ALASKA 99577 Page Two Lot B-2, Virginia Rude Subdivision February 6, 1996 e ® Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INST~.~TION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. 0 Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a mlnimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 0 Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot B-2, Virginia Rude Subdivision February 6, 1996 Se Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS~ Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. e The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). e A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the 4200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot B-2, Virginia Rude Subdivision February 6, 1996 INSPECTIONS~ Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: must The first inspection . be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. e The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot B-2, Virginia Rude Subdivision February 6, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage Department of Health and Human Services Division of Environmental Services ' On-Site Services Section 825 'L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. cLanchorage.ak.us (907) 343-4744 CERTIFICATE OF HI~ALTH AUTHORITYAPPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-531-31 1. GENERAL INFORMATION Complete legal description Lot 1~-2, Location (site address or directions) Expiration Date: Virginia Rude Subdivision 30324 Eklund Avenue Current Property owner(s) Phyllis Carter Dayphone 694-1313 Mailing address PO Box 773121, EaRle River, AK 99577 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer [] D [] D The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners, Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old, Certificates are valid for one year for properties sen/ed 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, 72.025 {Rev. 01~001' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING 17034 Eagte Eiver Loop I~oa(J No. 204 Name of Firm Address Engineer's Printed Name DHHS SIGNATURE I.-'" Approved for ~ bedrooms. Disapproved. Conditional approval for __ Phone // Robert C. Cowan, P.E. Date G-~ .. .. %~ ~ ~ ON-SITE ~ ~ ~' ~' ~: WATERAND : m~ ~""~'~'~'~'" ~"'"'~"'"~ bedrooms, with the fo~lowing stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: '~-/-7z'- ~ / Original Certificate Date: Reissue Date: 75.025 (Rev. 01,~0)' Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage, ak.us (907) 343-4744 Legal Description: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST We~ type '~ Date completed ~._~1 Total depth ~ ft Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal Cased to FROM WELL LOG It / g.p.m WATER SAMPLE RESULTS: Coliform O colonies/100 mi Date of sample: 3/.3 3//o I Nitrate 0.$- mg/I Collected by: D. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ Date installed ~gal Cleanouts ~z_Foundation clsanout ~/~-~; Date of pumping '~/~" Parcel I,D.: SZ)-53/-5 I Well Log Wires properly protected Casing height (above ground) I~ in. AT INSPECTION Other bacteria o colonies/100 mi Depression over tank /~/'~ Pumper. ~ Number of Compartments ~ High water alarm ~.__.~___~t- / C. ABSORPTION RE~.D D~TA, Date installed ~ Soilrating~orft2/tx:lrm)~/o~-- Systomtype Length ~7 tt Width ~. ~' ft Gravel below pipe ~/o. ~' It Total depth ~fl Effective absorption aree~{~ fi2 Monitoring tube ~'~ Depression over field Date of adequacy test Results (Pass/Fail) For ~" bedrooms gal. New depth in. Absorption rate >= g.p.d. If yes, give date Fluid depth in absorption field before test in Water added Elapsed Time: min Final fluid depth in ...Any rejuvenation treatment (past 12 mo.) (YIN & type). 72-02~ (Rev. 01/00)' UFT STATION Date installed ) ~ .~'~ze in gallons "Pump on" level at ~ in "Pump off" level at Datum J Cycles tested SEPARATION DISTANCES in Manhole/Access High water alarm level at in Meets alarm & cimuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tan~ on lot /~'~ /'-/--- Absorption field on lot On adjacent lots On adjacent lots Public sewer main /v ./',~ Public sewer manhole/cleanout .Sector/septic service line /~- ~ / '~- Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ '~- Water main /"//~ Drainage ~,//,~ ' Properly line ~' ~F- Absorption field Water service line /~) ~' Surface water Wells on adjacent lots /.~.~ ~-- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / C) ~- Building foundation /~ ~ Water main Water Service line /Q '~' Surface water /~ ~ Curtain drain ~ Wells on adjacent lots Driveway, parking/vehicle storage 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 HAA guidelines in effect on this date. Engineer's Printed Name Date HAA Fee $ ~,~ 0 O. "o Date of Payment '~/~.,~/a / Receipt Number o~ ;~ ~o 3. Waiver Fee $ Date of Payment Receipt Number 7~.o~ (Rev. 0~,~o)' MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. ~'~ During a recent Health Authority Approval on-site inspect%on and test of the potable water supply well on Lot · .'_.%. ~__ Subdivision, the well's Block --__ of Vi~;~._- .: productivity was ~termlned to be o~ gallgns per m~.ute. The minimum well productivity required by this Department '(~C 15.55) for a ~ bedroom residence is , ~.~ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies ~f the subject Health Authority Apprcval. 15:15 FRO~CTE ENVI RONI~NTAL ,~1"~__..' Envlmnmmlml Ser'vtce'~ In{l, 561530T T-896 P.02/01 F-751 CT&E Ref.# Cl|~t Name ProJet~ NIm~ Client Sample ID Ordered Sample 1011457001 S & S Engineering LB 2; Virginia Rude S/D LB 2; Virginia Rude S/D Dri_n_Idng WATer 0 Units M~hod Client PO# Printed Datte/TIme Collet~ed Date/Time Rt~ehed Dste~Ime Technleil Dlreclor Released By 03/28/2001 8:55 03F23/2001 9:30 03F23/2001 17:05 Stephtn C, Ede .~llowable prep AnAlysis Limits D,te D~ Init Nitr~t~-N 0.500 U 0.500 Ing/L EPA 300.0 10 rm~x 03/23a11 SCL Nicrobiology LaBoratory ToM Coliform 0 coVl 0Oral SMI8 9222B 03/23/01 FIODEII ! C. COW^ti, P.E. Itel'TEl11 A. SI IAFEfl. CMENT: WELL RECOVERY TEST DATA CIVIL EtlGI/IEEItS {9o?) 694-2979 FAX (907) 694-1211 TEST DATE, ~=,/~ :~ / O ' ' TESTED wELL ~P111: ~ ~ ~ WELL ~RILLER: CASING DEPTIh ~O ~ DATE DRILLED: TEST pRoc_EI:)Un~ ~.lsc DATA; $) Draw water down Io pump. Casing Ilel0hl: 2) Shut pump oll 15-60 Inht. Sanitary Seal? .record lime Wires lo Condull? -leco~d meier leading Grading 3) ~tlrn ~unt~ on. Urawdown. ~tlltt~ 4) Sh,,I pump oil Samples Taken? -tecmd meier leadln0 CMcnlale gM.hnlm recovery. TEST DATA'.. START TIME: STATIC WATER LEVEL: TR(AL II PUMP II TIME II METER II orr I ~ ~ W I~ ~ ~,~.~ I o~ /0~ ~ OFF /0 ~ 1~4~5.4 O. 2 oN I ! O~ " " OFF 3 ON OFF OFF 4 ON OFF OFF 5 O~ OFF RESULTS; WELL CURRENTLY PRODUCES: 4:/-I~ FLOW RATE HOT CUARANTEED-SU~TSEQUENT VARIAIlOtJS CMl OCCUR. 17O34 HOI'III I EAGI E rffv[ll i oep · St/IfF 204 · EAGI.E HIVEI1.