HomeMy WebLinkAboutDEARY LT 19A
Deary
Lot 19A
#007-094-80
30planb drilling Co.
SOX 1713. STAR ROUTE
SPENARD. ALASKA
�� SUBSURFACE EXPLORATION
1. LOCATION PROJECT. Al DPA eH HOLE NO
2. TYPE OF EXPLORATION/.
CONTRACT NO NUMBE
3. SURFACE ELEVATION WEATHf
l '
DEPTH -BEGIN 6HIFTIrl DEPTH -END SHIFT '77 DEPTH DRILLED
A. PERMAFROST ENCOOUUNTf RED: FROM TO
S. WATER LEVEI DATER SHIFT n- !q
S• TIME DISTRIBUTION HOURS SUMMARY COLUMN
DRILLER FISHING DRILLING
REPAIRS PULL CASING
HELPER STANDBY MOVING
7. GASOLINE -
S. OIL
SUPPLIES AND REPAIRS (ITEMIZE)
S. CASING LOG
S. SOILS LOG
TOTAL
NO. LENGTH LENGTH
SAMPLE DEPTHSTYPE
NO. FROM TO SAMPLE I MATERIALS AND REMARKS
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DRILL E INSPECTOR
09c-10-2001 04:00po Fren-
T-500 P-002/002 F-006
NORTHERN
TESTING LABORATORIES, INC.
33301NDUS'n1AL AVENUE
FAIRBANKS. ALASKA 99701 1907145&1116 -FAX 4S6 -312S
$751 SI.VEnADO WAV: UMT N
ANCNOAAGE. ALASKA 99519 19071349 -1000 -FAX 3041016
POUCH 140043
PRUDNOE SAV. ALASKA 99734 (90716'.9 -2145 -FAX 6592146
P.T.S.
912 E. 15th Ave, Suite 102
Anchorage, AK 99501
Arm: D. Karez
Phone: (907) 561-6266
Fax: (907)563-3813
NTL Lab#:
A300294
Client Sample ID:
Deary Well
Location/Project:
Dewy Well
COC 9:
30539
Sample Matrix:
Water
Comments:
Report Date:
12/7/01
Date Arrived:
12/4/01
Date Sampled
12/4/01
Time Sampled:
13:50
Collected By:
DK
Flag DeCmitioW
MRL = Method Repotting Limit
MCL -Maximum Contaminant Level
B - Below Regulatory Minimum
H - Above Regulatory Maximum
M - Matrix Interference
- Best Available Estimate
U - Less Than Detection Limit
D — Lost To Dilution
-- - — Prep Prep Analysis Analysis
Parameter Result Units Fla[ MRL MCL Method Date :Method Date
SM 4500 NO3E
Nitrate -14
Reported By: Wendy Mitchell
Anchorage Laboratory Manager
0.23 MWL 0.10 10 12/5/01 SM 4500 1215101
NO3E
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 007-094 T "
1. GENERAL INFORMATION
Complete legal description DEARY LOT 19A
Location (site address) 3627 CAMPBELL AIRSTRIP RD
Current Property owner(s) RUTH DEARY
Mailing address
Real Estate Agent
DAVID WINDSOR
Expiration Date: ` —
Day phone
Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex URMITTA
❑ Multiple Dwellings (Single Family and/or Duplex) 9 L
3. NUMBER OF BEDROOMS: 1
JUL z 9 2094
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Dnbl'r � ,l , C Item
n
, I
PwF,yljr• Se�uor
r�X
Waiver/Variance request for: NONE Distance:
Received by: 4 - �-, `Z _ C-- Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ �yta P Waiver Fee $
Date of Payment 7I aP)lIq CL Date of Payment
Receipt Number ��o/� vt Receipt Number
COSA # CKDCrit{I �� to Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
Phone 279-3916
Date 7/28/14,
cE•aF'AL�1sj�1
• 'slI .:..j
System #1 Approved for bedrooms �� LARS E. SPLlRKLAND:O-,C e-1
System #2 Approved for bedrooms j v3 1 9100
Disapproved
Conditional approval for bedrooms, with the following stipulaYI�t�s��
By: dfd. Original Certificate Date:
The M cip ity o nC orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 7 , ..
If more than 1 septic system is on the lot:
COSA Checklist # 1 Of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: DEARY LOT 19A
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #-
Date completed LINK Sanitary seal (Y/N) Y
Total depth 93+ ft. Cased to >40 ft
FROM WELL LOG
Date of test
Static water level ft.
Well production _ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG Monies/100 mL Nitrate ND mg/L
Arsenic 14.4 ug/L Date of sample: 7/15/14
B. SEPTIC/HOLDING TANK DATA
Parcel ID: 007-094-0 g10
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
7/28/14
70
4.3
ft.
Collected by: ANSON MOXNESS
Tank Type/Material Date installed
Tank size gal. Number of Compartments_ Cleanouts (Y/N)
Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm (YIN)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ftz or ftz/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. M. absorption area ftz Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
in. 'Pump off" level at
Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot NA
Absorption field on lot NA
Public sewer main 75'+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line Building foundation _
Water Service line Surface water
Curtain drain Wells on adjacent lots
F. COMMENTS
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots NA
On adjacent lots NA
Public sewer manhole/cleanout 1004
Holding tank NA
Manure/animal excrete storage areas100 +
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKLAND
Date 7/28/14
COSA brown sheet 10-10-12.doc
Absorption field
Surface water
Water main
Driveway, parking/vehicle storage
rlil
Municipality of Anchorage s
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.mani.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 141366
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
19A of Deary Subdivision. This inspection revealed an arsenic concentration
of 14.4 micrograms per liter (ug/L) for the property's well water sample.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Information on arsenic is
available from the On -Site Water and Wastewater Program website
(www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Svstemc Approval,