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RUSS HARMON LT 125A
Russ Harmon Lot I #051 - 144- 55 Municipality of Anchorage Development Services Department Buildin§ Safety Division On-Site Water and Wastewater Pro§mm 4700 Flmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-144-55 GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: "'~/¢~ ~// / RUSS HARMON SUBD VISION, LOTS 125 A 21714 KAREN LANE; CHUGIAK, AK 99567 Current Property owner(s) MA'Iq-HEW & MELANIE WARNICK Mailing address P.o. Box 671471, CHUGIAK, AK. 99567 Day phone 907-360-4611 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 Day phone TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] 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 On-Site Systems Approval (COSA) based enly upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska_ Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (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. Address P.O. BOX 2749 PALMER, AK. 99645 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 flies 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 ALASKA RIM ENGINEERING, INC. Phone 907-745-0222 Engineer's Printed Name CHARLES A. LEET, P. E. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well FI0w Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:__~/~ ~ ~_~ / / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Russ Harmon Subdivision; Lot 125 A A. WELL DATA Well type _PRIVATE Date completed 82/01 Total depth U-K-/300ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 .colonies/100 mL Parcel ID: 051-144-55 (Note: 500 gallon water storage in garage.) IfA, B, or C provide PWSID # N/A Well Log (Y/N) YES Sanitary seal (Y/N) YES Wires properly protected (Y/N) Y~ES Cased to 40+/41 ft. Casing height (above ground) 12/24 FROM WELL LOG AT INSPECTION ~1982/8-8-01 4/14/11 U.K./66 ft. 27.8 / 78.3 ft. U.K./0.15 g.p.m. 3.0 g.p.m. Nitrate 3.45 mg/L Arsenic: o ug/L date of sample:4/6/11 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 4250 gak Number of Compartments_2 Foundation cleanout (Y/N) YE_____S Date of pumping 4/13/11 ABSORPTION FIELD DATA Date installed 1982 Length 136 ft. Depression over tank (Y/N) NO__0_- Pumper JRs PUMPING ( * SYSTEM C~ZLRGED Soil rating (g.p.d./ft2 or ft2/bdrm) 280 Width 3 Collected by: ALASKA RIM ENG., INC Date installed 1 982 Cleanouts (Y/N) YES High water alarm (Y/N) N/A WITH HAUL WATER FROM JRs) System ~pe TRENCH Total depth _5-9 ft. Eft. absorption area. !360 ft2 Monitoring tube YES Date of adequacy test 4/13/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0____ in. Water added *650 gal. Elapsed Time: 1380 min. Final fluid depth 0 in. iR. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Gravel below pipe 5 ft.. Depression over field NO, For 4 bedrooms New depth_32 in. Absorption rate >= >600 g.p.d. If yes, give date D. LIFT STATION Date installed N/A "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ in. Animal containment areas 75'+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots 100'+ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field 5'+ Surface water 100'+ 100'+ Public sewermanhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots .100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 0 Water Service line 10'+ Curtain drain NONE OBSERVED COMMENTS Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ I certify that I have determ/ned through field inspections and review of Mun/cipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's P,r?ed Name Charles A. Leet, P.E. in. COSAFee $ $A90 Date of Payment Receipt Number (Rev. 4/10) (RUSH) = $7_84 Waiver Fee $ Date of Payment Receipt Number ~ d~ 0 ~ 0 0 uJ 0 ~ 0 n ~ o o o z 0 0 n n 0 -mo o> 0 0 0 ZZ Z t'- C E = E I~_ 0 .~ > i° i.I. · 2.2. .~ f- r~ ._ ._~ ID > q>o~ ~ o · ~ ~.g o t- {- f.... SGS Ref.# 1111287001 Client Name Mat-Su Test Lab, LLC Printed Date/Time 04/20/2011 10:51 Project Name/# MSTL Collected Date/Time 04/06/2011 0:00 Client Sample ID ARI 130 ARE11-00091 Received Date/Time 04/07/2011 13:00 Matrix Drinking Water Technical Director Stel}hen C. Ede Saml~le Remarks: 2540C - Total Dissolved Solids - Sample analyzed outside of hold time due to lab error. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 128 5.00 mg/L SM20 2340B B 04/08/11 04/11/11 NRB Waters Department Total Nitmte/Nitrite-N 3.45 0.100 mg/L SM20 4500NO3-F A 04/12/11 AYC Private Individual Analysis Alkalinity 126 10.0 mg/L SM20 2320B D 04/07/11 SDP Aluminum ND 20.0 ug/L EP200.8 B 04/08/11 04/11/11 NRB Antimony ND 1.00 ug/L EP200.8 B (<6) 04/08/11 04/11/11 NRB Arsenic ND 5.00 ug/L EP200.8 B (<10) 04/08/11 04/11/11 NRB Barium 4.72 3.00 ug/L EP200.8 B (<2000) 04/08/11 04/11/11 NRB Cadmium ND 0.500 ug/L EP200.8 B (<5) 04/08/11 04/11/11 NRB Calcium 32300 500 ug/L EP200.8 B 04/08/11 04/11/l 1 NRB Chloride 14.9 0.100 mg/L EPA 300.0 D (<250) 04/08/11 04/08/11 LCE Chromium ND 2.00 ug/L EP200.8 B (<100) 04/08/11 04/I1/11 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 04/07/11 SDP Conductivity 346 1.00 umhos/cm SM20 2510B D 04/07/11 SDP Copper 102 1.00 ug/L EP200.8 B (<1300) 04/08/11 04/11/11 NRB Fluoride ND 0.100 mg/L EPA 300.0 D (<2) 04/08/11 04/08/11 LCE HCO3 Alkalinity 126 10.0 mg/L SM20 2320B D 04/07/11 SDP Iron ND 250 ug/L EP200.8 B (<300) 04/08/11 04/11/11 NRB Lead 2.73 0.200 ug/L EP200.8 B (<15) 04/08/11 04/11/11 NRB Magnesium 11500 50.0 ug/L EP200.8 B 04/08/11 04/11/11 NRB Manganese 3.34 1.00 ug/L EP200.8 B (<50) 04/08/11 04/11/11 NRB Nickel 2.23 2.00 ug/L EP200.8 B (<100) 04/08/11 04/11/11 NRB OH Alkalinity ND 10.0 mg/L SM20 2320B D 04/07/11 SDP · . ::SGS SGS Ref.# 1111287001 Client Name Mat-Su Test Lab, LLC Printed Date/Time 04/20/2011 10:51 Project Name/# MSTL Collected Date/Time 04/06/2011 0:00 Client Sample ID ARI 130 AREI 1-00091 Received Date/Time 04/07/2011 13:00 Matrix Drinking Water Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container 1D Limits Date Date Init Private Individual Analysis pH 8.10 0. I 00 pH units SM20 4500-H B D (6.5-8.5) 04/07/11 SDP Selenium ND 5.00 ug/L EP200.8 B (<50) 04/08/11 04/11/11 NRB Silver ND 1.00 ug/L EP200.8 B (<100) 04/08/11 04/11/11 NRB Sodium 20300 500 ug/L EP200.8 B (<250000) 04/08/11 04/11/11 NRB Sulfate 19.2 0.100 mg/L EPA 300.0 D (<250) 04/08/11 04/08/11 LCE Thallium ND 1.00 ug/L EP200.8 B (<2) 04/08/11 04/11/11 NRB Total Dissolved Solids 203 10.0 mg/L SM20 2540C C (<500) 04/12/11 ATJ Zinc 165 5.00 ug/L EP200.8 B (<5000) 04/08/11 04/11/11 NRB KAR£N EDGE OF ASPHALT-r... I /- .... TRANSFORMER --~-- ~ ,~ PLAYHOUSE POLE ~o~- %~D% ? / . ~ , ' ~ ~ t' E 114 ..... ['[ ~ 164.64(C)~ f~ ' 115.17~C5 l- --~- - -~ ~ :_z~_ .... PIPE ~ICAL 0 ~,, /GREENHOUSE ~ 4"x4" POST · METAL / /~ /W/ ELEC. ~3 RAIL FENCE <~-~/~ d L · BARN RECO~RED $/~ ~ AL-~ON ~ BASIS OF B~RIN~ SB~'~O'~O'~ ~.O~(R) ~ ~.~(C) LOT 125t3 32,078 SF NOTE: LOT LINES DO NOT CLOSE MATHEMATICALLY. ~ }89'50'30"%' 115.07(R) 115.32(C)1 ~' ~"RECOVERED 5/8" REBAR LEGEND; (C)=CALCULATED DATA (M)=MEASURED DATA (R)=RECORD DATA U.G.=UNDERGROUND ohu=OVERHEAD UTILITY BSL=BUILDING SET BACK LINE LOT 128A LOT 128B AVE. RECOVERED 1 "/ IRON PIPE 50' 1"= 50'. NOTES: 1. EXCEPTING FOR GROSS NEGUGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2, THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. .3. THIS DOCUMENT DOES 'NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBdECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE, 4. THIS SURVEY SUBSTANTIALLy COMPUES WITH ASPLS MORTGAGE STANDARDS, 5, TIES TO' PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE :i:1 FT, 6, THIS SURVEY PERFORMED FOR RUSS HARMON. IT SHOUI.J::) ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION, REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRrFI'EN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER ,TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ALASKA RIM ENGINEERING, INC. AS-BUILT P.o. Box 2749, PALMER, AK 99645 9131 E. FRONTAGE ROAD, SUITE 1 PH: (907)745-0222 : FAX: (907)746-0222 EMAIL: akdm@otoskarim.com : WEB: www.alaskorim.com WO: 1t00091 I FB: PAGE: 1 of 1 TM: Engineers: SCALE:' 1" = 50' FILE: I 100091 I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: LOTS 125A & B, RUSS HARMON SUBDIVISION. PLAT No. 84-470, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, _ALASKA. . SURVEYED ON THE 7th OF April, 2011. ©2o1_.~ Municipality of Anchorage ~ Development Services Department .~' ~ Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage,a k.us (907) 343-7904 C.,ERTIFICATE OF HEALTH ~,UTHORITY ~,PPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 051-144-55 HAA# H/c} 1, GENERAL INFORMATION Expiration Date: Complete legal description Location (site address or directions) Cun'ent Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RUSS HARMON SUBDIVISION; LOT 125A 21714 KAREN LANE RUSS HARMON P.O, BOX 670854 CHUCACH 99567 Dayphone 688-9838 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank r-~ 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 pedod 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. Note: Alaska Water and Wastewater Consultants, Inc, shall be paid $ to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER at, or pdor I As cert!~e~ bj/.my seal affixed hereto and as of the validation date shown below, I vedfy that my jn~vestl~'afi~n;' b~sed on procedures outlined in the Health Authority Approval Guidelines for this application, .. '~,. ~h~ws that the ~n-s~te water supp~y and/~r wastewater disp~sa~ system ls(are) safe~ functi~na~ 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. NameofFirm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBAER ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Pdnted Name JEFFREY A. C, ARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineerfng analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desc#bed 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. AKWWC,, Inc. can therefore not provide any warranty or future estimate of how long the system will continue lo 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. DSD SIGNATURE ~ Approved for ~" bedrooms. Disapproved. Conditionalapproval for __ bedrooms, with the ~owing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 12/01) Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 ~OUU1 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wv~w.cLm~x~rage.ak.us (9O7) 343-7S04 Legal Description; WELL DATA Well type lafaVAT[ HEALTH AUTHORITY APPROVAL CHECKLIST RUSS HARMON SUBDIVISION; LOT 125 A; Parcel ID: 051-144-.55 INOTE: THE 1982 WFL[ AND THE 8/8/01 WELL ARE CONNECTED TOOETHERJ If A, B, or C provide PWSID# N/A Well Log (Y/N) NO/YES Date completed '" 1982/5-8-01 Sanitary seal (Y/N) YES Wires property prote~ted (Y/N) . ,. YES Total depth U.K./300 ft. FROM WELL LOG Date of test ,,. 1982/8-8-01 Static water level U.K./66 fl. Well production U.K./0.15 g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Arsenic: 2.5.~_~gJL. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Casadfo 40+/4,1 ft. Nitrate 3.11 mgJL. Date of sample: 7/01/02 Tenkstzej250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Date of pumping 6/29/2002 Casing height (above ground) 12'+/18'+ in. AT INSPECTION 6/29/2002 44/90 ft. *0.91 g.p,m. ~rHE PRODUCTION IS A TOTAL OF THE 1982 WELL AND THE 8/8/01 WELL. Other bacteria 1 colonies/100 mi. Collected by: AKWWC, INC. Depression over tank (Y/N) NO C. ABSORPTION FIELD DATA **LJ~UID LEVEJ. IS 19 INCHES BELOW INVERT Date installed 1982 Soil rating ~r lt~oclrm) 280 System type TRENCH Date installed 1982 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Pumper SANITARY PUMPERS *SUMP DOES NOT EXTEND TO BOTTOM OF DRNNFIELD Depression over field__ Water added 799 gal. i Absorption rate >= Length 136 (3 UNES O 72',11',53',) It. Width 3 ft. Total depth, *5.83 .ff. Eft. absorption ama 1360 ft2 Monitoring tube YES Date of adequacy test 6/29/02 Results (Pass/Fall) PASS Fluid depth in absorption field before test DRY in. Elapsed Time: 80 min. Final fluid depth 25 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Gravel below pipe 5 ft. NO For 4 bedrooms New depth *"'.31 in. 600+ g.p.d. If yes, give date - O. LIFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: S~ze in gallons "Pump off" I~vel et Cycles tested Septic tenk/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ ManholelAcc~-_- (Y/II) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholelcleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lets 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ Water service line 10'+ Curtain drain NONE KNOWN Building foundation 10'+ Sudace water 100'+ Wells on adjacent lets 100'+ Water main N/A Driveway, parldng/vehicle storage 10'+ 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 Printe~l Name Date ¢~/1/~ ~-~ JEFFREY A. GARNESS Rece pt.umper :Z IO (P.~v. 12iol ) Waiver Fee $ Date of Payment Receipt Number 150 · . 6075515]01 T-r74 P.0Z/03 F-790 Jt.'Z.-I 1-02 03:57~ FR0t~CTiE Ef4VII~Ofll~NTAL SRV CT&E Environmental Scl'rico. I.e. CT&£ Rot.# Cllent ~a me Project Neme/~ Clle~tt Sample ID Matrix Ordered fly PWSID Sample £emorks: 1023969001 Ag: Water & Wastewater Consultants Inc. Russ Harmon Property Lot 125A, Russ Han~on Drinking Water All DatedTImes ire Alaska SLtnderd Time Prlote~ Date/Time O?/I 1/2002 15:23 Colleeled Date/Time 07/01/2002 1'/:25 Reeelwd Dote/Time 0'//02/2002 15:00 Technical ~ Stephltw)C. £do Water Is allghtty hard. Hardness of water is not considered to I~ a health related concern, levels of silicon may contr~ute to s~ln I~tafiofl. Si]i~n is not a re~tatcd compound by ~A or the S~to ~idel~es ~ ~ses no health concern. Silicon h ~e second mo~ abundcnt elcm~t ~ ea~h's c~c Total cnlifo~ ~ sa~fa~o~ ~ l other bact~a and no colifo~. ~e State of Ahsk~'s fimk for o~er bacteria ~ public water s~om h 200. Atlowlble Pz~p AnalyeLt Palm.er l~sult~ PQL LTolI~ Melhod Limbo Date Date Private ~ndivt. dual Ana17nie A~uminum 20.0 U 20.0 ug/L EPA 200.8 07/09/02 Arsenic 2.58 2.00 ui/L E. PA 200.8 (<50) 07/09/02 Bar/urn 3.00 O 3.00 u//L EPA 200.8 (<2000) 0'//09/02 Cadmium 0.100 U 0.100 uS/L EPA 200.8 (<5) 0'//0g/02 Calcium 26200 $00 ui/L EPA 200.8 07/09/02 Chromium 4.0OU 4.00 Ug/L £PA 200.! (<100) 07/09/02 Copper 191 LO0 u8~ EPA 200.1 (<1300) 07/09/02 Iron 2~0 U 250 os/L EPA 200.8 (<300) 0'//09/02 Lead 0,$18 0.4D0 ui/L £PA 200.$ (<]5) 07/09/02 Macn~lum 10000 500 u~L EPA 200.8 07/00/02 Manganese 5.00 U 5.00 ug/L EPA 200.8 (<50) 07/09/02 Phospboros 500 U 500 u~/L EPA 200.8 07/09/02 Potasslmu 500 U 500 us/L EPA 200.8 0'7/09/0'2 Sodium 21100 500 og/L EPA200.8 0T/09/02 S/tic, on 8540 1000 ug/L EPA 200.8 07/09/02 Silver 1.00 U 1.00 ug/L EPA 200.8 (<100) 07/09/02 Zinc 189 2.00 eg/L EPA 200.8 (<5000) 0'//09/02 Chloride 12.4 0.200 m~'L F-PA 300.0 (<~50) Fluor/dc 0,200 U 0.200 mr~L EPA 300.0 (<2) 0'//02,/02 'Nitrate-N 3,11 0200 m~L EPA 300.0 (<10) 07/02,/02 'Nitrlt e-N 0,200 U 0.200 eng/L EPA 300.0 (<1) 07~2/O2 SulFate 12.7 0.200 mg,/~ EPA 300.0 (<:250) 07/02/02 Total Dissolvet Solids 184 50.0 mE/L SM20 2540C (<500) 07/03/02 IICO3 Alkalinity 124 rng/L SM20 2320B 07/09/02 CO3 Alkalinity 0.O0 mi/L, SM20 2320B OlIAIkatlnity O.00 mg/L SM20 2320~ 07/09/02 Conductivity 315 I.O0 umhodcm SM 2510B 07/02~2 pH 7.90 0.100 pti units EPA 150.1 (6.5-8.$) Atkotlnlty 124 10.0 mc~L SM20 232QR 07/09/02 ,: Init KeF KGF KGF KeF KeF KGF KGF KGF KGF KeF KGF JDT JDT JDT AS AS AS AS AS AS AS · - 9075615361 T-774 P.03/03 F-790 J51.-11-02 03:$7l~ FRO~I-CT&E ENVII~fltENTAL 9RV · ~t~ CT&E Environmental Service, Inc. Client Name Project Namcl# Client Sample ID ~afrl% Ordered PW$ID 102396900I AK Water & Wn~ewater Consultants lac, Puss Harmon Property Lot 125A, Eau Harmon Drinking Water Units Method All Dates/Times are Alaska Standard 'floe Printed Date.ri'lo e 07111/2002 15:23 Collected Dart/Time 07/01/2002 1'/:25 Received Date/Time 07/02/2002 15:00 T~hnical J)lreetoe Stephen C. F. de AIIowthle Ptvp An&t~is La'nits Date Dote caUlOOmL SMI8 9222B Init (<1) 07/02/02 SBTI ALASIC WATER & WASTEWATER CONSULTANTS, INC, August 2, 2002 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Reft 7/9/2001 Well Concerns for Lot 125A; Russ Harmon Subdivision To whom it may concern This letter is in reference to your concems regarding the 7/9/2001 well. The well was drilled by Sullivan Water Wells and found to have little chance of producing water. The well is still in place; but is not in use. The well has no pump and is not connected to the house. Jim Sullivan with Arctic Well and Pump performed the work for temporally decommissioning the well. Jeffrey A. Gamess, P.E., M.S. President 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 Fax: (907) 338-3246 Website: akwwc.com 'l ~ AMTEC, INC. (Oov) AS-BUILT 125A AND 1258 SHEET 1 OF1 v~ ~' ' ' ' :' ' , J .' . .~?' ~. '"1. ~~ ..~· ~.~ . ~,' . ~ . ., ~. .. ~,~. .~. . ~'. ,(~ ~,~_~_~........ ~ ~ ~.~ .~,~ ~..' {~~ ·· - ~( ' ~ ~ · . .. .. ... ~... ' '.. ~.. ....... ..~h It ts the responsibtllKy of the owner to determine the ex(~tence o~ any ea~emen~,: eovenan(s~ or Te-' strtcttons which do not appear on'the'recorded s.ub-' ' division plat. Under no tire.stances should any data hereon be used for construction o~ for estab- TS OF RECORD~OTHER THAN ~OSE SHOWN ON TilE ~CORDED P~T, ARE NOT ltshinB boundary ot fence l~nes. The sutveyo~ tage~ s~ow~ responsibility fo~ the ~n~ttal transaction onlY. · ' 0 IRO~ PIPe . ANCHORAGE RECORDING DISTRICT ANCHORAGE,' ALASKA 99~01 ' · ALASI(A WATER & WASTEWATER CONSULTANTS. INC. August 1, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Lot 125A Russ llarmon Subdivision. To whom it may concern: We request that your department issue a 0 foot lot line waiver from the north property line to the existing drainfield. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic syste~ms. If you have any questions, please contact us at 337-6179. Thank you for your assis;an~ Pre/~ d~ ~ ~ 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com Municipality of Anchorage George P. Wuerch, Mayor Building Safe ' Dix'ision P.O. Box 10C)C,-50 * 45'00 S. Bragaw Street Anchorage, Alaslm 00519-6C~50 * (007) 13-'13-8301 h t t p://www.cl.anc borage.ak.us 8/2/2002 Jeffrey A. Gm'ness, P.E. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Rd. Suite 2B Anchomge, AK 99504 Subject: Waiver Request for Russ Harmon Subdivision Lot 125A Waiver Request #WR020057 Parcel ID #051-144-55 HA020370 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any furore upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On-Site Water & Wastewater Program M.nicipnlity of Anchorage Development Serviees Department Building Safely Division On-Site Water and Waste'water Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 Waiver Review Worksheet V~t: ¥VR020067 PID~: 051-144-65 Date Received: Legal Description: Ruse Hamton Subdivision Lot 125A Engineer:. Jeffrey A. Gameee. P.E. blaska Water & Waetewatsr Consultants. Inc. Applicant: Russ Harmon Waiver Requested: 0 feet from lot line to ab~omtlon field Criteria: Geology A. Water Table B, Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation H~#: HA020370 Permit#: Points: Total: Waiver Is Granted: Waiver Is not Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec~: 23610 Amount: $160.00 Date Paid: 8/2/2002 Ingress/Egress Easement GRANT made this 2na day of August 2002, between Russ Harmon, PO Box 670854, Chugiak, AK 99567 hereinafter referred to as the Grantor, and of Russ Harmon, PO Box 670854, Chugiak, AK hereinafter referred to as the Grantee. WHEREAS, the grantors are owners as tenants in the entirety of the following described realty: Russ Harmon Subdivision Lot 125 A according to the official Plat #83-10 ! 0 in the Anchorage Recording District, Third Judicial District, State of Alaska, And, WHEREAS, the grantees are desirous ofenjoying the use of a certain portion of the grantor's land for the sole purposes of ingress and egress to Grantees land for the purpose of maintaining a private water well and water line. And, WHEREAS, the grantors have agreed to grant to the grantees as easement solely for said defined purposes and for no other, NOW, this grant witnesses that in return for said specified consideration the Grantors hereby grant unto the Grantees, their heirs and assigns, full and free right to maintain a private well water line upon a portion of Grantors land. This Grant of Easement is intended to be appurtenant to Grantees above described land and touches, concerns and runs with said lands. This is not intended to be an exclusive easement: The Grantor herein expressly reserves unto themselves equal rights of ingress and egress and all other rights as the owners as tenants in the entirety of the described premises. Any dispute or disagreement arising under or in any way concerning this instrument shall be submitted for resolution to the process of binding arbitration in accordance with the Alaska statures made and provided for said arbitration. The jurisdiction of the Arbitrator shall commence 60 days form the onset of the dispute and shall operate to toll all applicable Statutes of Limitation. IN WITNESS WHEREOF the Grantor and Grantee have hereunto set their hands the day and year above written. Russ Harmon - GRANTOR Russ Harmon - GRANTEE STATE OF ALASKA ) ) THIRD JUDICIAL DISTRICT ) SS. TtlIS IS TO CERTIFY that on this 2nd day of August, 2002 before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared Russ Harmon, to me known to be the persons described in and who executed the above and foregoing instrument, and acknowledged to me that they signed and sealed the same freely and voluntarily for the uses and purposes therein mentioned. WITNESS my hand and official seal the day and year in this certificate first above written. ~4~n and for Alaska My Commission expires Municipality of Anchorage George I: Wucrch, Mayor Development Services Department P.O. Box 196650 * 4700 S. Bragaw Street Anchorage, Alaska 99519-6650 (907) 343-8101 Office (907) 343-8125 Fax htr p://www.ci.anchorage.ak.us July 24, 2002 Russell S. tlarmon P.O. Box 670854 Chugiak, AK, 99567 Dear Mr. Harmon: RE: Septic Sewer Pipe Encroachments, Lot 125A, Russ Harmon Subdivision, Grid NW 1258 Right of Way Section has reviewed a request from Mr. Harmon for a letter of non-objection to an existing septic sewer vent pipe which encroaches into the undeveloped fifty (50') foot wide right of way of Karen Lane, located along the northern property line. The petitioner indicated the existing sewer vent pipe on the As-Built survey, dated 810211988, submitted with the request. Right of Way Section issues this letter of non-objection with stipulations, and by using it the petitioner is agreeing to the following: 1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachments. 2. All applicable codes and regulations will be observed and maintained within the easement. 3. This letter of non-objection will in no way preclude MOA from full use and enjoyment of its rights within any portion of the easement. 4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid by the property owner. All letters of non-objection should be retained in your permanent files. Should you have any questions, please call me at 343-8033. Sincerely, Jack L. Frost, Jr. Right of Way Supervisor Concur, Property Owner Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisom, Health Authority Approval # 020370 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 125A of Russ Harmon subdivision, the well's productivity was determined to be 0.91 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 5-bedroom residence is 0.53 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 of the subject Health Authority Approval. by DOC CO. =b~ SULLIVAN WATER WELLS P.O. BOX 670272, CHUG1AK, ALASKA 99567 · TELEPHONE 688-2750 OWNER OF LAND: ADDRESS: LEGAL DESCRIPTION: DEPTH TO /5' DATE: t PERMIT.N.UMI~ER:~)I{~ 4~ ~1 TA~ IDENT1FI. CATION NUMBER: Is we~l I~ated at appmv~ pe~it Dcation? ~ Yes ~ No Method of Drilling: ~ rota~ ~ cable tool ~epth of well: ~ ~ O C~ing Type ~WaU ~ickness ' J~ inches Diametg inches, depth ~ [ feet Date of Issue -'/ -~__. ,,i a_.~ I e--3 5'7 Liner Type: r,-) ,~ ~ Casing Stickup Above Ground: ~' feet Static Water Level: ~'& feet R~over ~te:~~ ~ Meth~ of Testing: ~1 ~ W~I Intake Opting Type: ~ o~n end ~n hole ~ Sc~n~; St~ feet Stopp~ feet O Pedorati~s S~fl ~], Stop~d f~t G~ut Type: ~ ~ Volume ~pth: f~m 0 feet, to ~ O ~ feet Welt Dis~f~t~ Up~ Completion? ~ 2 No Meth~ofDi~nf~tion: ~ ~a~E ~ ~/~ Comments: I Driller's Name A'ITENTION: It Is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: D~partment of Health & Human Sen/ices and/or Department of Environmental Conservation. MatSu Borough: Department of Environmerttal Conservation. ( erti[ie ri[[ing Kog by DOC CO. {~ba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALADKA 99567 · TELEPHONE 688-2750 OWNER OF LAND: ,~ ADDRESS: LEGAL DESCRiPTiON: DATE: '7/'~'/-~,~''1 PERMIT NUMBER~ ! O .~ ~ ~ /~,~ ~ ~,~ ~,,*/ DORE HOLE DATA DEPTH F~'~ To Date of Issue TAX IDENTIFICATION NUMBER: o~'~ - Is well located at approved permit location? (,I.~"s '.~ No Method of Drilling: '~r,r rotary ;J cable "3 Depth of well: .~ ~ O Casing Type ~Wall Thickness ~ c~ ~" ~ Inches Diameter t~ I ~ inches, depth t'Pc[ feet Liner Type: ,-,.~ ~, ,.J ~. Casing Stickup Above Ground: ,'~. feet Static Water Level: feet Recover Rate: t,~ gpm Method of Testing: Well intake Opening Type: Q open end :;J open hole '.J Screened; Start feet Stopped feet Q Perforations Start feet Stopped feet ..... . ,. Grout Type: lie''~'I''~'~ '~''~' Volume / Depth: from (.') feet, to ~ O 'J'"' feet Well Disinfected Upon Completion? [3 Yes ~ No Method of Disinfection: Comments: Driller's Name /~-~ ~. r,---''~''''' ' A'I-i'ENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. 15n~:roachment Non-Obiection and Aareement Page 2 (Second Party) BY: BY: ACKNOWLEDGMENT STATE OF ALASKA : :SS. THIRD JUDICIAL DISTRICT: The foregoing agreement was acknowledged before me this /(4P day of A CKNO WLEDGMENT STATE Of ALASKA : : SS. THIRD JUDICIAL DISTRICT: ,20 The foregoing agreement was acknowledged before me this , by.~ day of Notary Public for the State of Alaska My commission expires: MEA ACKNOWLEDGMENT STATE OF ALASKA : : SS. THIRD JUDICIAL DISTRICT: ,-"- . -r~... · ..... ;,,,, .,,-,,~m~n* ~,=~ ~'l~nnwl~rl~d before me this day of RETURN TO'- MEA, P O BOX 2929, PALMER, ALASKA 99645 ENCROACHMENT NON-OBJECTION AND AGREEMENT THIS AGREEMENT, made and entered into this 16day of July, 2002, by and between MATANUSKA ELECTRIC ASSOCIATION, INC., an Alaskan non-profit member owned electric cooperative, whose post office address is Box 2929, Palmer, Alaska, 99645, hereinafter called "First Party', and Russell S. Harmon whose address is P.O. Box 670854. Chucliak. AK 99567, hereinafter called "Second Party', WITNESSETH THAT: A septic system exists in the easement for a powerline in the Russ Harmon Subdivision, Lot 125A, T15N, R1W, Section 9, Seward Meridian, Anchorage Recording District, Alaska. NOW, THEREFORE, for and in consideration of their mutual agreements and other good and valuable consideration, the receipt of which is hereby acknowledged, First Party, for itself, its successors and assigns, waives its objections to Second Party's encroachment on the said easement for the purpose mentioned, subject to the following conditions: 1. Second Party will hold First Party harmless from liability for any injury or damage to any person or property which may result from such encroachment. 2. The said encroachment will be without prejudice to First Party's full enjoyment of any and all rights it may have in and to such easement. 3. Any facilities or property of First Party which are damaged or destroyed as a result of such encroachment will be repaired or replaced. The cost of repair or replacement will be paid entirely by Second Party. 4. Second Party will comply with all applicable safety codes and regulations. 5. Any expenses which First Party may incur in the relocation or modification of its facilities to accommodate the said encroachment will be paid entirely by Second Party. 6. If second party desires to add second story or modify existing structures, MEA must be notified in advance. By its execution of this Agreement, Second Party agrees, for itself, its successors and assigns, that its encroachment upon the named easement as hereinabove mentioned will be subject to the foregoing conditions. iN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives and agents as of the day and year first above mentioned. MATANUSKA ELECTRIC ASSOCIATION. INC. (First Party) BY: General Manager or his Representative ENSTAR Natura! Gas Company O SION F $ 0 ENERGY t n~ neer~n~g ~:l~ltment 401 E. International Ai~o~ Road P. O. Box 190288 ~omge. Naska 9951~288 (90~ 2~-3740 F~ (90~ ~085 7/22/2002 Russel IS. Harmon P.O. Box 670854 Chugiak, AK 99567 To whom it may concern: ENSTAR. Natural Gas Company has no objection to the encroachment of the Septic System ~n the 50ft Right of Way of Karen Lane on the north side of Lot 125A, Russ Harmon Subdivision. Acceptance and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non-object[?, will in no way preclude ENSTAR from full use and enjoyment of its rights w~thm any portion of its right-of-way. Sincerely, atural Gas Company , E~gineer cc: File Mtmicipality of Anchorage George I; Wuercb, Mayor ,~ Bttilding S,'fl'cty Di~sion ~ P.O. Box 19CW350 * 4700 S: Bragaw Street Anchorage. Alaska .erOS19-6C~50 · (007) 3-t3-8301 h t t p://www.cl.anchorugc.ak.us June 10, 2002 Russel S. Harmon PO Box 670854 Chugiak AK 99567-0854 Subject: On-Site Water and/or Wastewater Permit. Permit Number: SW010224 '":Legal Descripfio-ia: Ru~ Harmon Lot 125A' Dear Russel S. Harmon: An On-Site Water/Wastewater Permit, number SW010224, issued by this office for a single-family system, will expire on July 6, 2002. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to this office for review, approval and documentation. This as-built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As-built inspection reports arc required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee orS100.00 ffthc renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. Jim ross, P.E Manager On-Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jul 06, 2001 Expiration Date: Jul 06, 2002 Permit Number: SW010224 Legal Description: RUSS HARMON LT 125A Design Engineer: 0000 None Required Owner Name: Russel s Harmon Owner Address: PO BOX 670854 CHUGIAK, AK 99567-0854 Parcel ID: 051-144-55 Site Address: 021714 KAREN AVE Lot Size: 46093 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 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 ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soll 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: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wvw.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLI'NG Parcel I.D. Permit Number SW~glO~ Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) ~H 5 Legal description (Section, Township & Range) Lot Size ~,~O°~-~ Acres/Sq. Ft. Zip Code Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage [] Jacuzzi Water Softening Unit I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: .~ /,2. O . ~ ,- Waiver Fees: Date of Payment: (~ - ..~ 7' 0 ~ Date of Payment: Receipt Number: [~ L{x ~k"'~ q , ,~Receip, Number: (Rev. 12/00) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL D~SCRIPTION ~/~ ~/w .~ ~ /?~ LOCATION PHONE -33 ?-5'~',.C~. I '~NEW J--IUPGRADB NO. OFBEDROOMS Liq. capacity in gallons IF HOMEMADE: Inside length Well Dwelling DISTANCE TO: DISTANCE TO: NO. of lines.~) Length of each line of lines g,~ade Material beneath tile Length W~dth J~p t h JWidth ~ Trench widt~.~ ~ inches PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance betv~en lines PERMIT NO. Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Depth Driller DISTANCE TO: Building Ioundation ~, Nearest lot line Septic tank OTHER SOIL TEST RATING APPROVED LEGAL .. - iO"V~ ~"/[-"~ 'O"W"~//$'Ot '~' · Jr, is the respons~b~lJkY of ~he ~ne~ ~ s~r~lons ~Mc~ ~o ~o~ ~ppeat ~n' ~he' teco~e~ s.ub-' dt~tston plat. Unde~ no ctrc~stan~es should any data hereon be used for construction or, fo~ estab- ltshtnq boundary or fence lines. The surveyor taker re?on~tbJltty for the initial transact(on ~nlY. m ' . IRON ~ ~dm i T~CK "' "'~'~' ," °'".-'~/-~ ~ll I ~%." A."...~/,I . ~, [~ .- . ~.~ ~ .. {~4~s .. ~ ~ I { ~TS OF RECb~D~ OTHER T~N SHOWN ON THE ~CORDED P~T~ ARE SHOWN H~EON. :,Certi[ie ritIing SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2750 owNER OF LAND: ADDRESS: .~,~ ~/,~ i,,-/ BORE HOLE DATA LEGAL DESCRIPTION: DATE: PERMIT NUMBER:D I O :9,? 4J Date of Issue -J- T~ IDENTIFICATION NUMBER: Is weft I~ai~ at appmv~ pe~it l~ation? ~,~ No Method of Drilling: l~rr rotar~ ~ cable tool Depth of well: ~,~ o O Casing Type ~Wall Thickness Diameter ~2 I ~ inches, depth Liner Type: ~1_) O ,,,.) ~. Casing Stickup Above Ground: Static Water Level: Recover Rate: O gpm Method of Testing: _~! ~ inches feet feet feet Well Intake Opening Type: ~.1 open end rj open .hole ;J Screened; Start feet Stopped feet Q Perforations Start feet F:~ppped feet Grout Type: /~.~..,'t-o-' ,'r~' Volume //~0/. a I~ Depth: from (_"~ feet, to ,~ *3 ~ feet Well Disinfected Upon Completion? ;.1 Yes Q No Method of Disinfection: Comments: Driller's Name ~--."~'--'" ' A'I-rENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Sen/ices and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation.