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HomeMy WebLinkAboutPTARMIGAN ROOST BLK 3 LT 4p"Mmko OR ^r N" 3 Sep 06 22 06:35p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section �, Fax: 907-343-7997 Pomp Installation Log Well Drilling Permit Number: Parcel Identification Number: 020 042 $9 Date of Issue: - - Legal Description Block Lot Property Owner Name & Address: LOBANOVA YELENA (TOD) PTARMIGAN ROOST 3 4 16105 SANDPIPER DR ANCHORAGE, AK 99516 Pump Installation Date: 09 - 05 - 2022 Pump Intake Depth Below Top of Well Casing: 175 feet Pump Manufacturer's Name: A.Y. MCDONALD Pump Model: 24075V2 Pump Size: '75 hp Pitless Adapter Burial Depth: 15 feet Pitless Adapter Manufacturer's Name: MARTINSEN Pitless Adapter Installer: Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: PELLETS I Comments: Pump Installer Name: ANCHORAGE WELL &PUMP SERVICE Company: 7640 KING STREET ANCHORAGE, AK 99518 Mailing Address: _ 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 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 Page 1 of 1 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000209 PID Number: 020-042-89 Name` GENE & FLORENCE BRYNER Wastewater System: ■ New ❑ Upgrade Y pg Address: 16105 SANDPIPER DR. * ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-4168 4 ❑Deep Trench ■Shallow Trench []Bed ❑Mound 11 Other* LEGAL DESCRIPTION Soil Rating: 1.2 Total Depth from original grade: *10.5 GPD/Sq. Ft. Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 4 PTARMAGIN ROOST *6.5 Ft 4 FL Township Range: Section: Fill added above original grade: Gravel length: Gravel — — — Ft. Ft. WELL: ■ New [:1Upgrade Gravel width: 5 Number of lines: 1 Distance between lines: — Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To:(BmROGQ Total absorption area: Pipe material: PRIVATE 245 Ft 1 40 Ft. 500 so. Ft. **D 3034/ F-810 Driller. Date Drilled: Static Water Level: Installer. UNKNOWN Date installed: 7/10/2000 HEFTY DRILLING 9 7 24 FL Yield: Pump Set At: tOO? Height Above Ground: TANK 30 GPM UNKNOWN Ft. 2 FL SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. ■ Other* To Septic Absorption Lift Holding Public/Private Manufacturer. UNKNOWN Capacity in gallons: 1250 From Tank Field Station Tank Sewer Linea Well 100,+ 100 + — — 25•+ Material: STEEL ASSUMED Number of compartments: 2 Surface Water 100'+ 100'+ - - - LIFT STATION Lot Line 5'+ 10,+ — — — Size In gallons: Manufacturer. 'Pump an' level at: 'Pump off' at: High water alarm at Foundation 5�+ 10'+ — — — Pump Make el: Electrical Inspections performed by. Curtain Drain NONE KNOWN Remarks: *DEPTH BELOW EXISTING GRADE @ MT BENCH MARK Location and Description: **PIPE MATERIALS ARE ASSUMED BOTTOM OF SEPTIC TANK Assumed Elevation: 992.62 Ft. ENGINEER'S SEAL JAMES SIZEMORE 7/10/2000 Ins actions performed b Dates: 1 st©• P p Y�d• * ' ....I • • • • • • I • • • 0 2nd UNKNOWN D 3rd UNKNOWN..... .�....IY Jre O�4 ... ...... Garness:Q Development Services Department Approval 9i 1 s 953 Atf �} �,'z it 181,Q00`{ °'Pr ,moo G7 Reviewed and approved by: Q C��U Date: ofess� �� oo� (Rev. 12/01) GARNESS ENGINEERING GROUP, Ltd amen! CONSULTANTS & GENERAL CONTF2ACTORS: ru u mnnm; m June 3, 2004 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Ptarmigan Roost S/D; Lot 4, Block 3. 16105 Sandpiper Drive; Explanation of Inspection Report. To Whom It May Concern: Research completed at and with the Municipality of Anchorage (MOA) has concluded that the On -Site Wastewater Disposal System and/or Well Inspection Report for the well and septic currently serving the referenced property is not complete. James Sizemore & Associates received a permit on July 6, 2000 for a well and septic system. It is noted on the MOA's copy of this permit that an installation inspection was called in on July 10, 2000. Sometime after this (exact date unknown) pages two and three were submitted to the MOA for documentation. It is assumed page one has never been submitted. Based on the As -built profile and As -built plan submitted by James Sizemore & Associates, and information gathered by Gamess Engineering Group, Ltd. the attached Inspection Report should complete the documeanon of the well and septic system on the referenced lot. If you have any questions please c ac us at 337-6179. Thank you for your time. .E., 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com Jul 7. 2004) 9:29PM w^)arness Engineering Group. Ltd• (-Ax)1 4or d,b Plo•7968 P. 3/3) lVV .. Municipality of Anchorage ; V" Development Services Department 1 Building Safety owwon of ... OnSiw Water and Waatelrater Progrmn. 4700 $. Bragaw SL , P.O- 6=196650 Anchorrge. AK 99519.66$0 page of www.d_anchorrgeak.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Permit Number �` " O ^ PID Number. Na". % WastewaterSystem:ew ❑ Upgrade �7 ABSORPTION FIELD rr�' rbmM elBAraanr. oeW Tromn �Snelro.'hen6n Dow a N ❑ oVNm LEGAL DESCRIPTION Sol '°L"°eF"'�^ngmproee: 91odc� let• ��� �� aiew plmde: limn dm,m4 nDO.: 2ROlu o G'W.Fi.Well; New DUpgrade wmemn i:,d onance ee+aene e� ClMdeadl4n (p4vele,A&C- 5 Teld oeplrx 6.M Iw a. rdd QbWT nyd o;e, yds A- FL wnwc one DrieeY aWb4w1"Loa! FL F11 vxuOm,,,,II G �^ �r N �I6�' J/ 0916 I0e1604d: YInC PpFp Gn W: Ceenp nNpnl ADO+a agyi6 GPM Ft. FL TANK SEPARATION DISTANCES —Lift Septic ❑ Holding 0 S.T.E.P. Cl Other. Yo Septic A�orpden Hok1ing puldMNmat From Tank field Stettin Tank. Ste LIM -„way. l wn1rx”('`' D� ntnm.al: �� V' Nuneerar Gompam+"me: LIFT STATION Ld 4ne 1 N Jeb: rrenulanurm 1 'rwpen'l Vt 'Pun Ievl4 Niah.raleral&I a Cudan Drain //1 F9r6p W1ie64baN klee4id Mepnm"a parrerr��� 1emeMa BENCH MARK teasonaro oe.aroupn: 4? CIG e "vnron. O F1. rnglneefa $tamp 44 C4i el a,►IL3A♦6�w � ` Inspections performed by::To�Yj P� 5 �u Dates: 1s Y r0� ZIF 2n° r rJv Development ServiceS Department Approval JE lX Reviewed and approved by: Date: I9". 1_reel a JOneq F. -.MM p SW000209 AS BUILT PLAN FROM TO DIST A STCO1 278 B STCO1 96 B CO1 164 C col 64 5 B CO2 513 C CO2 33 D WELL 3j] E WELL 64 4 T H 1 �7 ip feet ) N 75' 26 Ie'N LOT 3 w / LOT 6 Ei Alt. Leach Field TH "?.� 0,p , p �- *1250~ tal ST 50' (4 Effective) leac Field JAMES SIZEMORE & ASSOCIATES CIVIL ENGINEERS & SURVEYORS SW000209 AS BUILT PROFILE w JAMES SIZEMORE & 1°✓Wew*°tib 4S4' I Pl TIa:;L3A 4 '� SOCIATES CIVIL ENGINEERS & SURVEYORS 3 s �T. LOCATION OF WELL iiEPTY DRILLING 3540 AKULA DRM AN,CHURAGE, AK 994IG (907) 345-0593 rw , (Plea-- complete either la. It, or le ) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological B Geophysical Surveys Drilling Permit No ca1000=J.� 9 to Borough Subdlvition Lol Block Ib 1/4gIts X—ef—ol_ol� to DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ah,m: Slner Addnn an At" fOWell Lee, go. Section No TownshlpNO Range E[3Meridian S❑ W❑ S OWNER OF WELLI 2 r1 L 'l y 11211-. i Add, p� i 2 WELL L00 Material Typo � Feet Below Sur/ace 4 WELL DEPTH (final) ��` I[fl. S DATE OF COMPLETION �q — �5 — ..oa To Top Bottom 6 ❑ Cobl• tool � Rclery ❑ Driven 0 Du / 0 ❑ Auger ❑Jetted' ❑ Bored ❑ Other I 7 USE aDemeetic, ❑ Publlc Supply ❑ Industry ❑ Irrigation 0 Recharge ❑ commerical ❑ Test Well C] Other ` L 8 CAS NGI ❑ Threaded � Welded diem =In to_ It Depth weight —lbs/fl - --, dram in to—_ It, Depth SfickuD fl 8, FINISH OF WELLt Typo ap" 1a ,f✓ Diameter, Siot/Meeh She, Length ' Sol between 11 and if -- Bat k filling gravel pock —'— 10 STATIC WATER LEVEL e') f ft S ❑ Above or ❑ Below land surface Date -- Equipment used, II PUMPING LEVEL below land surface and YIELD fl offer hrt pumping It p m It eller _hrs pumping p m _a 12 GROUTING Well Grouted �EaY-- ❑ o Material D Neat Comonl 0 Other P nc 17 PUMPS (If available) HP --�--_ Length of Drop Pipe ft capacity 0 D m ❑ Subm ❑ Jet ❑ Centrlfical ❑ Olhsr �—��--- 14 REMARKS ------- 16 WATER WELL CONTRACTOR'S CERTIFICATION G�� p n. 15 Wale, Temperature e 0 F ❑ C This ell we• d Ned .neer mY ).111d1cli.. and this •.purl l: buc In Ilv basl of y kn.wledg• and belief, -(fie �.�-LL in tSD�[7 Ha Islbrvd Bus ne,t Nom. Conlrocl Licents Number +au . ulhorl[1• Ila lbtbnlubvo '-'----__ _ 0. 1. A— LF.mO2-WW" __-_,—_-- T_—'Ft afuio DGGS, PINK -01111", CANARY-Cuslomer s, .. ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued Jul 06, 2000 Permit Number: SW000209 Legal Description PTARMIGAN ROOST BLK 3 LT 4 Design Engineer 0027 James Sizemore & Associates Owner Name Gene Bryner Owner Address PO Box 113023 Anchorage , AK 99511 - Expiration Date Jul 06, 2001 Parcel ID 020-042-89 Site Address 016105 SANDPIPER DR j Lot Size 34157 SQ FT Total Bedrooms 4 Permit Bedrooms 4 This permit is for the construction of ❑✓ 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 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 3 r Date Date — ' - O o MUNICIPALITY OF ANCHORAGE ` 711b�00 lU Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P O Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued Jul 06, 2000 Permit Number: SW000209 Legal Description PTARMIGAN ROOST BLK 3 LT 4 Design Engineer 0027 James Sizemore & Associates Owner Name Gene Bryner Owner Address PO Box 113023 Anchorage , AK 99511 - Expiration Date Jul 06, 2001 Parcel ID 020-042-89 Site Address 016105 SANDPIPER DR j Lot Size 34157 SQ FT Total Bedrooms 4 Permit Bedrooms 4 This permit is for the construction of ❑✓ 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 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 3 r Date Date — ' - O o a ' 6 � i e J Note:Wells on Lots 5. 6, & 3 are more than i 100 ft. from Lot Lines ad3osning this Lot. �J i i r a i s y 41 �O? �� , S O $y 1 � v v Prop d Well 9 yy i Q / �, ea D Q I Qy°4 LOT 6 1 C) P, .,�,y Alt. Leach Field a I a �= TH 2 a°•t I .b , CO ,-Prop sed 1250 � ) °' I Gal T \ TH Propos d 5' x 50' (4' Effective) leach Field �.•.::`tJ�'°ii LOT 3 vp LOT 41 BL. 3 PTARMIGAN ROOST SUBD , ° PROPOSED WELL & SEPTIC SYSTEM . t jot", fg' SITE PLAN '���.^•••.-•••''.a pRui,ESS\p -- JAMES SIZEMORE 9 ASSOCIATES L CIVIL ENGINEERS & SURVEYORS TEL. 907-345-1572 FAX-345-9669 DNN BY JPS CHND BY JS DATE JUNE 16, 2000 SCALE 1' — 60, +I i WASTEWATER DISPOSAL SYSTEM LOT 4, BL 3, PTARMIGAN ROOST SUBDIVISION 0 0 GENERAL 01 The scope of this project consists of installation of a 1250 gallon Septic Tank and a five foot wide by 50 foot long absorption trench containing 4 0 feet of sewer rock 01 Construction shall be as shown on the approved site plan and design drawings Deviations from the approved design drawings shall be coordinated and approved by the engineer conducting the inspections 0 3 All construction procedures and material used to construct the system shall comply with Municipal and State regulations 0 4 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading areas after the system is constructed and soil is compacted and mounded over the wide trench disposal field and the Septic Tank 0 SEPTIC TANJK� 1 1 The 1W Gallon septic tank shall have two compartments and shall comply with Municipality of Anchorage Requirements 12 The septic tank shall be set level and shall be bedded as necessary to prevent settling or shifting of the tank 13 All pipe connections to the septic tank shall be made with waterproof mechanical couplings A cleanout shall be installed upstream of the tank within 5 feet of the house foundation A double cleanout shall be installed downstream, within 5 feet of the septic tank 2 1 The soil absorption drainfield shall consist of a 5 ft wide by 10 ft deep by 50 foot long dramfield containing a total of 4 5 feet of sewer rock, 4 0 ft beneath the perforated drain pipe 2 2 The bottom of the excavated trench shall be level within +/- 2" And compacted or smeared surfaces shall be raked to allow for proper infiltration of effluent This includes both the sides and bottom of the trench 2 3 Sewer rock shall be 0 5 — 2 5", screened gravel with less than 3% passing the # 200 sieve 2 4 Cleanout pipes and monitor tubes shall be 4" diameter and ionstalled as shown on the plans The portion of the monitor tube extending through the sewer rock shall be perforated All monitor tubes and cleanout pipes shall have waterproof caps conforming to Municipality of Anchorage Specifications 3 0 ENGINEERING INSPECTIONS 3 1 A minimum of four engineering inspections will be required during construction of the system One after the septic tank is set prior to its backfill, one after excavation of the absorption trench prior to placement of sewer rock, one after placement of the sewer rock and the distribution piping, cleanouts and monitoring tubes are in place The final inspection shall be after filter fabric is placed, the trench and the final grading are complete 3 2 The contractor shall coordinate with the engineer at least 24 hours prior to start of construction If the contractor desires, a site visit with the engineer prior to start of construction can be arranged PROBABLE IMPACTS TO ADJACENT PROPERTIES A) WELLS The proposed wastewater disposal system is designed in accordance with current Municipal Wastewater Disposal Regulations The proposed system has the required 100 R separation distance from wells on adjacent lots and the proposed well on this lot Therefore there should be no adverse impact on wells from this new system B) WASTEWATER SYSTEMS The proposed system is designed in accordance with current Municipality of Anchorage regulations There should be no adverse impact to adjacent wastewater disposal systems C) RESERVED SPACE/SURFACE AND SUBSURFACE There is enough space on this lot to put in another replacement system and maintain the required protective distances between wells and disposal systems D) DRAINAGE The location of the disposal system will not interfere with any drainage The area disturbed during construction of the system will be graded to prevent ponding of water Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST loans, F a r? �� DATE PERFORME6 ... PERFORMED FOR ��V /r�J / Y' qtr, r LEGAL DESCRIPTION L`T R :� f" 1'c-Q✓7M1967f7"'Wn�p Range, Section ortp 2 2 5 s i r� y� sa7�Y Gia vel 3- 4- 5- 6- 7 45 6 8- 91011 9- 10- 11 12 13 14 ' 15 16 17 Sa rl G) / crI o vc v 4p) 6-©k b 1 eq G. -P 18 • E3v4' 191 1'P"5 20 COMMENTS WAS GROUND WATER , ,� ENCOUNTERED? �_ S IF YES, AT WHAT L O DEPTH? P E Depth to Water After Monitoring? CDatez SITE PLAN N Reading Date Gross Net Time Time Depth to Net Water Drop �m 4-17 : - ' a 3 17 ! CJ 1 t 1 12- 7—z� PERCOLATION RATE Z'� (minutes/inch) PERC HOLE DIAMETER 1 TEST RUN BETWEEN FT AND � � 5 FT PERFORMED BY - ) 4 XJ:54Y4 46'1' i L CERTIFY THATTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINEVIN EFFECT ON THIS DATE DATE 72-008 (Rev 4/85) r` s Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR GC -, )e' ar/ wr DATE PERFORM �A•i!r�"T ��` .� � //J Q �/� Mp..fa°a> LEGAL DESCRIPTION tZf33 Pforrn ��C�i/ / 1C(/ OWnShlp, Range, Section SLOPE SITE PLAN (FEET) 1 2' 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 6®f -!p WAS GROUND WATER ENCOUNTERED �'p G' IF YES, AT WHAT I( DEPTH? Depth to Water After 5 Monitoring? 7 Date PERCOLATION RATE ? s�p (mmutes/mCh) PERC HOLE DIAMETER 61 TEST RUN BETWEEN FT AND ii . 5 FT PERFORMED Bt� �e'" `✓�� / CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIeSINEFFECT ON THIS DATE DATE �/' L © O 72-008 (Rev 4/85) Municipality of Anchorage ' Development Services Department r Building Safety Division s, . 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. 020-042-89 HAA# O L4 1. GENERAL INFORMATION Expiration Date: / i7 (DA, 0 4 Complete legal description PTARMIGAN ROOST SUBDIVISION; LOT 4 BLOCK 3 Location (site address or directions) 16105 SANDPIPER DRIVE * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address GENE AND FLORENCE BRYNER Day phone 345-4168 Lending agency Day phone Mailing address Real Estate Agent THE RAMSEY TEAM W/ DYNAMIC PROPERTIES Day phone 261-7553 Mailing address 3111 C STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 samples. (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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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 ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analvsis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation . distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local 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 outside 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 therefore 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 authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for :_ bedrooms. Disapproved. Phone 337-6179 Date 2j. 4 Conditional approval for bedrooms, with the filowing stipulations: 0-1 j: • ON-SITE •• �Gi: �� • WATER AND WASTEWATER • PRnARAM Attachments: JJ''Ji! • • • ' ' • S"��`\, HAA Checklist Manitenance Agreements ��JJjOENTSEN\\ J)IJ Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By. ((/, U Original Certificate Date: �7 " 15 (Rev. 12101) 666- -in. High water alarm level at ted Meets alarm & circuit requirements? Leif records that the above systems are in rOA HAA guidelines in effect on this, date A Janie ' ff JEFFREY A." CARNEtt -r Fee $ rl"11_1�1111 _71�� of Payment ipt Number 60'+ . Gp ........ . orne 795 W" May 21 04 10:58a (A The Ramsey Team 907-261-7555 p.2 SANDPIPER DRIVE ---> �Lj ce Q 1230.00, L-90.02 (R) A•36.61' 5 sati�� /�z 41.'Ve 2i PN 8 v m cn y v Ail 175.6 F4 Oq� b 0 O I6.p• Ek)aTl NG HO �< _~ fuNpeR CONSE � �n vn �x � Dfck o 9n N / O p 24./' O o 60 � o�G /0. H 2/ D TIL/Ty' N 2/ 48 e F �9,NF , HT MM lg9Be (hl) ` o (R) vm �: y �Cv �o n ' oov_z r a m o 0 m ro �m n n� rP o' m m m o 0 \ 8 A z0 =� > > rn y o b Q^ p 0 — o � I0 I 8 ax N Rl o � m am m o p m �.gy 3 ] O p O O]N ] r N ] 4 < o _ C ] rpo �u7amo�-]o II z y N a m ] ° °a `;p�y�•o O y cu r ao. p .r o o m oo$�.o N 3 V W% N< N j] z p� 0p� m o a� ?o(ba I0 I 8 A W P S 19072430742 06/16/04 03:39pm P. 003 oOPMp........... .... ... ... ............. I Laboratory Analysis Report SGS Re" 1043290001 All Dates/Times nre ALisks Standard Time Client Name Anchorage Well & Pump Service Printed patelrime 06/16/2004 14:36 Project Name/# Byner Collected Date/Time 06/11/2004 14:45 Client Samplc ID Ryder Received DatelCime 06/11/2004 16:22 Matrix Drinking Water Technical Director Stephen C. Ede .� PWSID 0 Released By <, Sample Remarks: POL jJnity Allowable Pr Anil sis Parameter Results Method Container ID Limits Date Pow lnit Waters Department Nitrote-N 3.30 0.100 m&/j. EPA300.0 A (<=10) 06/11/04 1[B tj V` L-trx,� P o m P e;Q FO -L- -2- Q as S• AM CTP.0 Cnvirpnmen:nl Senicr.;t Inr..� labaraluly (lhY$an 200 Wear, Patter oliva, Anchorage, Ah 95$1(W 303 l(a07i $02-2343 11907) 361..5301 v %.q.mviramannm1.cnm ., mombor of tom SGS GMIP (90C100 NftAtO q 4n SI)NYIIInnen) 06-07-04 03:14PM FROM--CT&E ESI, SGS ENV SERVICES B SGS Ref.# 1043066001 Client Name Gamess Engineering Group, Ltd. Project Name/# Ptarmigan Roost S/D, L4, B3 Client Sample ID Ptarmigan Roost S/D, L4, B3 Matrix Drinking Water Sample Remarks: 9075615301 T-658 P.02/02 F-465 All Dates/Times are Alaska Standard Time Printed Date/Time 06/07/2004 8:54 Collected Date/Time 06/02/2004 11:00 Received Date/Time 06/03/20,94 12:75 Technical Mrector . Ede Released r/—:447 Parameter Results PQL Units Method Waters Department Nitrate -N 10.9 * 0.100 mg/L EPA 300.0 Container ID Allowable Prep Analysis t ;..,a. no.. n... snit A (<=10) 061D3/04 JJB 05-27-04 03:34PM FROM -CUE ESI, SGS ENV SERVICES SGS Ref.# 1042851001 Client Name Gamess Engineering Group, Ltd. Project Name/ft Ptarmigan Roost, B3, L4 Client Sample ID Ptarmigan Roost, B3, L4 Matrix Drinking Water Sample Remarks: 9075615301 T-540 P.02/03 F-265 All Dates/Times are Alaska Standard Time Printed Date/Time 05/27/2004 8:46 Collected Date/Time 05/24/2004 10:30 Received Date/Time 05/24/2004 12:20 Technical Director Step an an de Released'/ Parameter Results PQL Units Method Container ID Allowable Prep Analysis WE Date Date Waters Department Nitrate -N 12.9 * 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<=10) 0524/04 .i.18 CDVI00mL SM199222B A (<=1) 0524/04 DKC 05-27-04 03:34PM FROM-CT&E ESI, SGS ENV SERVICES 9075615301 SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria REAP INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM Ipa RIVATE WATER SYSTEM ] Send Results 0 Sand Involas Vbm3nNm ym.IcclnWlV Nam. cos, PINm NNroN . Fa. NumMr nnn.N~ 33'7--617 2 _ FatNNNar 3 2 Nglinp haprnn 30i To c C) atgn avcw. T-540 P.03/03 F-285 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax: 907-561-5301 � Lab �uun�n Q Sand Results []Sandinvales M Sy.am NFnWCgryaM NaM CmNO Nnln PINm NNroN . Fa. NumMr using w CNy SIW zlpca SAMPLE COLLECTION: SAMPLE TYPE: Dia: is re.l..nl.nq.p Tun nXlNn �J� bnn q..Tq. mMnbn. ® ❑ Routine ❑ Treated Water NwNa a.r Yap Tima: _,-30 IQ PM lawnml Q Repeat Sample G7 -Untreated Water Locaaon: _ < <i" (refer to lab no. 1 Collector. / ❑ Special Purpose PAM Nam. SI Tranapmted to Lab By: �/ '�0 Same as collector Qther P".4 Neow TO BE COMPLETED BY LABORATORY Sample Receiv Date: S' 2 r% i ❑ Semple oar so noun ad; ❑ RUSH SAMPLE Time: Results may W unrellable Tamp: AA(O ❑ 4e Nourwalm Phone P. Delivery Method: e,( For Ra to to Fax #: Received By: fTLGS Commema: ................................................................................................................ n.... ....................... Bacterlolopical Water Analysis Record: Sent mADEC: MMOdaUG(PIA) RESULTS:ANC FSK JUN Analyals aegan: 5jzq i g� lz5an I_ Total ColNotm: 10atoMma: AnalysC tiT>L Analytical Method: Membrane Filter MMO-MUG (PIA) Reported By: Siang urs %� E. Cale MEMBRANE FILTER RESULTS: Direct Count 0 Colonio.1100ML veff"tion: Tgne.egT tLTB' / BGS: FgNGnmm L EC: Sent to Client; Phoned ❑ Faxed ❑ Delomme: Spoke Wick ® Satisfactory ❑ Unsatisfactory Datemme: '=qI �)D(1 TNTC.,I.a N.m ..b CngN da •palm Bn.ml. Form # FW- 0053 12117/03