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Home My WebLink AboutFINLEY LT 4Finley Lot 4 #015-112-47 /6 u Cavzlap^tr_ r cervices Departnzn Y* Builuing Safaty Jivisian ?,Q Sax lcbc5C i�l2 yar - nvw;euni.arainn=ira (90 7-1'4?.icfjs Pump Installation Log DriMn5 Permit i umber: SN Date of Issue: _ el Identification Yum6er:— LDescription �f o Installation Date: 7 83 /1— a Intake Depth Belo•,v7ap of-NeE Casing: feet p Nj,.Luufacturer's Name: /(q,�o�,� 1� p Njodel: a�07,�'U3� /J P size 7s hp ss Adapter Burial Depth: / feet is Adnpter M'nnfactarer's Mame: Al>wxil- Lx mems: , .p installer ! ame: /0 Property Owner N=e & Address: /467(jh CG,65 ratio a: ne pump instaUar shall provide a pump installation log to the DSD •xitlun 3Q dies of pump installation_ Municipality of Anchorage O ,.•_ �. .,, Development Services Department � •_ = y :�, Building Safety Division i On-Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System andfor Well Inspection Report . Permit Number. SW020183 PID Number. 015-112-47 Name: WILLIAM JACOBS Wastewater System: O New ■ Upgrode Address: 10510 FINLEY CIRCLE ABSORPTION FIELD Phone; No. of Bedroom: (907) 346-3993 5 8 Deap Trench O Shallow Trench 0 tied O Mound O other LEGAL DESCRIPTION sa "` 0.8 cm/4 R TOW °': e1 i.73 10.74 R Block: Lot* Subdivision: 0"th to PNPB belt" can 060.0 raft po..t A,Pm bwwalh Plat 4 FINLEY SEE DWG R we 7.01 / 7.01 R Township: Range Section: ra edea sew. er4M peat pawl l.apn: SEE DWG R 2 ® 40' EACH R pewit BIM: I61" e1 Mew DIAa Messn Ano WELL: p New 0 Upgrade 2.5 R 2 16'+ R cberfflco n (Prhate, A&C): ToW Caved Ta Total ob wpam tier focus t R R 1120 so. R D 3034/ F-810 Orwer: Date DrWd: static water Lwer: MIa1a: Dob YrtslsG R DENALI DOW /i I.anp so At: itis«^` „. ,eve. aw.r« TANK oft R 1 R SEPARATION DISTANCES ■septic 0Holding aS.T.EP. 13 Other To SepUe Absorption lift Holding Pubsc/Prkats Yerarr vta . c°pOr� h pp1t Prom Torek Fiala station Tank sww lku. ANCHORAGE TANK 1500 Well 100'+ 100'+ — — 25+ STEEL tea veer of awen� 2 Surface Water 1000+ 100'+ — — — LIFT STATION Lot Una 5'+ 10'+ — — Foundation 5'+ 10'+ — — — T m lww st rpunw erraL r watt atarrr rt Curtain Drain NONE KNOW yew race I Perm by*. Remarks: BENCH MARK Lomtwn w Dssalpam: BOTTOM OF TANK ® OUTLET = 94.15 •• WEST TRENCH / EAST TRENCH TOP OF HOSE BIB = 105.75 IArer,W Bw.ttac R ENGINU" WEAL ,�O�000 .. F .... qs0� AKWWC, INC. p... Inspections performed by: Dates: 1st 8/8/02 �....:.... .. ...... :.*..� 2nd 8/9/02 3rd 8/10/02 �Q .ef re A. a ess: 1p Development Se Ices Department Approval 00" • -7953 Reviewed and approved by: r Date: 7/3'/ �QO-1***. edp, nacrew. 12/01) Qoroo�o��' CSEP_nC LOT 3 / FINLEY S/D \ 112 MT Ilt I IWH I IIt II II III �Tidcot►rt3y 103 ' � I �\ s FD / DB DBL —'n A B A SM STI 28.87 70.81 S12 32.42 72.01 FOO I t \ DBLI 33.77 72.38 I DBL2 34.29 72.53 ST FD 35.29 72.78 FS 88.31 85.30 Col 70.51 80.18 Nrt 71.73 79.85 CO2 102.41 95.01 MT2 98.53 92.48 RESERVE CO3 88.10 99.97 t MT3 88.87 99.59 ' -- C04 118.04 112.72 MT4 113.37 110.82 _—f.�-------------___—_---_— DATE o�,p6op0 8/19/02 4 GF ALASKA WATRR R WA DRAWN BY: i WASTE, SCALE: B.S.G. 49� CONSULTANTS, INC....... = 40• • ' •••••••••••• COOT DF6AAA AOAD, SURF 20 • ANfAOAnGF. 0K 095"• PNONF (907)357-6170 • FAX (001)116-31L6 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: WILLIAM JACOBS 346-3993 2 OF 3. . :effr Ga ess.• LEGAL DESCRIPTION: QA s 79 k) FINLEY SUBDIVISION, LOT 4 V�O� TYPE OF WORK: o�4od !oleesloo�t�lwe AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PERMIT NUMBER: SW020183 TOP OF TANK AT INLET - 99.06 AS -BUILT DRAWING FINAL GRADE - 101.56 - 101.67 NEW 1500 GALLON INVERT OF BUNG AT INLET - 98.1 SEPTIC TANK U ORIGINAL GRADE - 96.17 rj"z,_m= 0 AL GRADE - 97.17 - 99.04 6$ ORIGINAL GRADE � 97.06 - LTE i1LTER FABRIC OF PIPE - 93.78 14'+ OF TRENCH - 86.77 ooix ALASKA mTATER & WASTEWATER CONSULTANTS, INC. 6001 DFRARR ROAD. SUITE 79 • ANCHORAGE. AK 00500 • PNONF (007)117-6170' FAX (001)3)R-3766 PREPARED FOR: PHONE NUMBER: WILLIAM JACOBS (907) 346-3993 LEGAL DESCRIPTION: FINLEY S/D: LOT 4 TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PARCEL ID NUMBER: 015-112-47 OF TANK AT OUTLET - 99.02 \_4NVERT OF BUNG AT OUTLET - 97.60 FAST TRENCH DATE' 08/19/02 DRAWN BY: B.S.G. SCALE - 1 " = 40' CAL.E1"=40' PAGE NUMBER: 3OF3 GRADE - 97.91 - 99.12 ;UTATION OVER SOUTH END HERE THERE IS LESS THAN 3' OF COVER -FILTER FABRIC T OF PIPE - 94.96 OF TRENCH - 87.95 oa"0F C� 91H .: y.� � . . ... ... ..... ....... fl@ A. SS: oP4 •, C -7953 MUNICIPALITYOFANCHORAGE2 vd Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade C' 2'30 Date Issued: Jun 20, 2002 Expiration Date: Jun 20, 2003 Permit Number: SW020183 Parcel ID: 015-112-47 Legal Description: FINLEY LT 4 Design Engineer: 0041 AK Water & Wastewater Consultar Site Address: 010510 FINLEY CIR Owner Name: William Jacobs Lot Size: 51604 SO. FT. Owner Address: 10510 FINLEY CIR Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99516-6352 This permit is for the construction of. ❑V Disposal Field ❑✓ Septic Tank Holding Tank E] Privy Ej 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 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 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: I Date: 6-21-0s Date: fr1ao%Z Municipality of Anchorage °• Development Services Department Building Safety Division On -Site Water & Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.sk.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. �� iiZ t(7 Permit Number Property owner(s) WILLIAM JACOBS Day phone 346-3993 Mailing address (1) 10510 FINLEY CIRCLE + ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) FINLFY SUBDIVISION: LOT 4. Legal description (Section, Township & Range) N/A Lot Size S/6 t)'7 Acres/Sq.Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. ALASKA WATER & WASTEWATER CONSULTANTS, INC. (Signature of property owner or authorized ogent) Permit Fees: " t oo Date of Payment: to — \) — or'] Receipt Number. 2 v S2-4 Waiver Fees: Date of Payment: Receipt Number. 1"Be ALASKA WATER & WASTEWATER CONSULTANTS, INC. June 18, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 4, Finley Subdivision To whom it may concern: The existing 5 bedroom house is served by a private well and septic system. The existing septic system consists of a 1500 gallon septic tank and a bed type drainfield. The existing drainfield is in a surcharged state and needs to be upgraded. A test hole was excavated north of the existing septic system in the area of the proposed septic upgrade. The septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1500 gallon septic tank and a dual deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. The allowable application rate is 0.8 gallons/dayV. 2. TRENCH DESIGN: a. Percolation Rate: 15 minutes/inch b. Proposed Application Rate: 0.7 gallons/day/ft2 c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 1072 W f. Total Depth: 12 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 80 feet total length (2 @ 40 feet long each) k. Effective absorption area = 1120 ft 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography is a 1 to 5 percent slope running from approximately south to north. The proposed trenches will have a 2 to 3 feet difference in elevation from the north end to the south end. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, 11-'� e PIE.. M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road Suite 213 • Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: akwwc.com FINS 3/D 1WELL LOCATED I - ; -• 100•+ WEST OFI SEPTIC AREA 1 I I I I I I I I T12N, REW, SEC. 15 1 �� LOT IBA I 1 I i 1 I I I 6 T12N, REW, SEC. 15 1 lulX LOT 158 \ I � I 1 I LOT 2 1 I LEACH S/D 1 \ \ \� \ I \ I 1 1 I I I I I I - i I � I I i I / � I -----------------� FINS 3/D 1WELL LOCATED I - ; -• 100•+ WEST OFI SEPTIC AREA SHELL �� LOT 1, 1 �I I H SD U LOT Imo, BLO/CK1 m \ z z FINLEY S/D ��'_----�\`CL 1 I LOT 2 1 I LEACH S/D 1 \ LOT 2. BLOCK 1 \� 1 1 . 1 • 1 - GEpp�TII \\ FINS 3/D 1WELL LOCATED I - ; -• 100•+ WEST OFI SEPTIC AREA DOSTING S BEDROOM HOUSE IXSEPPTIC --- SYSTEM SHELL S/D 12 SHELL �� LOT 1, 1 �I I H SD 1 LOT Imo, BLO/CK1 m \ I 1 `♦ 1 I SHELL S/D 12 LOT 10, BLOCK 1 ♦\ 1 I LEACH S/D 1 \ LOT 2. BLOCK 1 \� DOSTING S BEDROOM HOUSE IXSEPPTIC --- SYSTEM SHELL S/D 12 SHELL LOT 11, BLOCK 1 / LOT 1, 1 130' WFI1 RADIUS '. -�• w 1 m \ SHELL `♦ LOT 2. SHELL S/D 12 LOT 10, BLOCK 1 ♦\ �I ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6001 OFRARR ROAD. SUTF TR • ANGHORAGF. AK 00506 • P„ONF (001)117-0170 • FAX (00)1118-1P66 PREPARED FOR PHONE NUMBER: WILLIAM JACOBS 346-3993 LEGAL DESCRIPTION: FINLEY SUBDIVISION; LOT 4 TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC UPGRADE TH1 DATE: 6/18/2002 DRAWN BY: C.J.G. SCALL 1" = 100' PAGE NUMBER: 1 OF 2 i� 712N, RX SEC 1 \LOT 14\ 1 I FIELD VERIFY WELL 7' LOCATION PRIOR TO 1 CONSTRUCTION OF `. NEW SEPTIC SYSTEM PROPOSED SEPTI: UPGRADE (SEE DESIGN PAGE 2 OF 2.) AARP SHELLS/D /1 r ��' LOT 11. BLOCK 1' ---- SSE IIC MFA SHELL S/D 11 = LOT 10. BLOCK 1 FI I \ 1�0 ( R4I111IP-� SEPTIC AR E�D / LOT 3 FINLEY S/D I PROPOSED DRAINFIELDS. EXCAVATE / TWO TRENCHES THAT ARE 12 FEET O DEEP MAXIMUM BY 2.5 FEET WIDE BY , MTrI jT ' t0 FEET IANC EACH %8 FEET LONG TOTAL), ADD 7 FEET OF CLEAN I , WASHED SEWER DRAINROCK. -- INSTALL FLOW �OTVERTER— yy, AS T GAtLU INSTALL FLOW SPUTTER / L----- ryC Q D N v � L^S6 Fo�- G1..T S �TFi�'1 Gl!/ EXISTING SEPTIC TANK TO IXISTINC DRNNFlELD TO BE 'j Y BE ABANDONED PER UPC USED AS A RESERVE SITE NOTE: THE�CONTRACTOR HALL HAVE ALL THE 700 FOOT J'�"'J�� I WELL RADII S�JNH AN(�E EAST LOT UNE FLAGGED BY A T7� REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. vtxj-%" S � pLs->b.a -m ON L-cr iv -mat DATE'6/18/2002 0 DRAWN ALASKA NVA1'LWASTE VATLBY. .G. d� ��c• ; ..... X40 NR � �:• 4y v* CONSULTANTS. INC. :•• •• :.., 6001 OFSARP ROAD SUITE 7R • ANCHORAGE, AK 00S06 • P F (007)317-0170 • FAX (007)336.3T46 1 40 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: WILLIAM JACOBS 346-3993 2 OF 2. �O Jef DmesS: LEGAL DESCRIPTION: Q E-7953 St FINLEY SUBDIVISION, LOT 4 TYPE OF WORK: 4�DedpiofessloeaaQod DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE 044o�c�oK� ALASKA WATER S WASTEWATER CONSULTANTS, INC. 8901 U.M" ROAD. SURE 58 • ANCNORIdi, AIL W04 . NOW-- (907=-5179 • FA7L (907p3a- " • Y'omm- ak a SOIL LOG - PERCOLATION TESTI LEGAL DESCRIPTION: FINLEY SUBDMSION; LOT 4 PERFORMED FOR: WILLIAM JACOBS DATE: 5/29/2002 °t e1 NEST HOLE #11 V��000000a�P ( t ===== 1 — ____= ORGANICS SOIL CLASSIFICATIONSGp ML \ / b^- i GW GM CL MF.0 4 1 GC OL SW MH • SM OH I 6— SC 1` i J � 7 GR UNDWATTH ER DATEEXISTING - ;JCJ I 8— DRY 5/29/2002 5 BEDROOM SEPPTICJ DRY 6/3/2002 HOUSE SYSTEM 9— DRY 6/7/2002 �� SITE PLAN 1 1•-100• 10— 11— GM/ML DATE READING CLOCK NET (MINUTEME S) WATER READING EL NET DROP (INCHES) MORE SILT 12— WITH DEPTH 6/3/2002 1 2:45 - 6• - • 2 3:15 30 4• 2- 13 — •13— 3 3:15 - 6. - 4 3:45 30 4- 2- 14 — •14— 5 3:45 - 6' - 15— 6 4:15 30 4• 2- � 16— 17 — I�• 18- 19 — 8 19— PERCOLATION RATE 15 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.5 FT. AND 7.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: JASON WOOD PERCOLATION TEST PERFORMED BY: ZACH CALL COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASgERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: (0 (16 /02 �•. 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 e J14e6 PHONE NEW a M 1C A N <t 7%-�i262 1:1 UPGRADE MAI LING ADDRESS ANON- Ak_ 2 A c,642K LEGAL DESCRIPTION D, �' A 2 6 LOCATION NO. OF BEDROOMS r/NCS ,j Well NdT 13P 14L&13 Absorption area Dwelling PERMIT NO. U Y DISTANCE TO: 5ZKb, 47 . E Z Manufacturer Material No. of compartments yS72w-cZ Liq. capacity in gallons /45�00DISTANCE IF HOMEMADE: Inside length Width Liquid depth TO: Well Dwelling PERMIT NO. G Manufacturer Material Liquid capacity in gallons Jx DISTANCE TO: Well T 4'•00_rLtw Foundation !Z Nearest lot line /0 PERMIT NO (390377 LU J E Z No. of lines 3 Length of each line Total length of lines Trench width Distance between lines F Lu .ti "7 1.11/ 211, inches 6, Q F Top tile to finish Material beneath tile Total of grade effective absorption area 6 inches /.26V Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. F!ss DISTANCE TO: Building foundation Ov r 1 ®� Septic tank Absorption area(s) q �t OTHER f' • 4d0 G NQ PIPE MATERIALS d'' �: m, „' L�, •� 1 �/�S / I �.- t�� _ y� oea° .o a si .��• 5 10 , SOIL TEST RATING ',.� ••••• Dale do F INSTALLER REMARKS ?Zu b' 1 70 x) $ = 2EFF- AR6 6_4 a / Ti.4 Z Fje)M ;2'S b / F/IV4 L TUF - E1 5 T W t -)o . 6 2 fWlltvAr)o�✓ /N O APPROVED DATE LEGAL PIA 72-013 (Rev. 3/78) 1 1 KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE 30 YEARS ALASKA DRILLING (907) 243.2282 3163 LINDEN DRIVE KEN JOHNSON ANCHORAGE, ALASKA 99502 JUNE 301 1984 J. Be BENSON ( BUILDER ) AMERICAN HOMES 2221 E. Northern Lights Blvd, Anchorage, Alaska 99508 ( 276-4282) ( Hm 248-5048 ) W. A. JACOBS ( OWNER ) 12592 Tanada 2P Anchorage, Alaska 99515 ( 786-1728 ) ( Hm 345-4475 ) RE. LOT 4 FINLEY SUBD. WATER WELL LOG 0 ft to 10 ft Medium gravel and brown silt 10 ft to 30 ft Same with courser gravel 30 ft to 75 ft Course gravel & gray silt ( hardpan ) 75 ft to 81 ft Same with courser grav 81 ft to 115 ft Brown silt & med grav 115ft to 130 ft course grav & gray silt 130 ft to 138 ft Med. grav & brown silt ( weeps 1 GPM ) 138 ft to 184 ft Med. gravel with some course grav with brn silt...has small water bearing seamsthat yield 1 -to 3 GPM..low head.. 184 ft Clean water bearing Sand and med gravel Static water level 152 ft ( 32 ft ) ( TUC ) Total casing 184 ft. ( TOC ) Depth 184 ft ( GL ) TEST PUMP DATAi (Static WL 152 ft ) Time GPM Drawdown ft Remarks 1116 7.5 2-4 Dirty 1122 7.5 2-10 Blearing 1125 8*5 3-4 to 1135 8 5-5 cloudy 1145 8.5 5-1 clearing 1200 8 5-7 it 1210 7.5 5-8 lt. cloudy 1220 Shut of pump to fuel 1224 7.5 5-5 toto 1238 7.5 5-7 very lt. cloudy 1300 7.5 5-7 clean and clear End test pi,,rnping good recovery 0 Fri ILS M -d I t=- I F' 1=1 L_ I T Y X11 F F=l " 0 "f;' F' F.4 r� E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET: ANCHORAGE, AK. 59501 264-4720 I TE E=WE: WF=L -1 F•EF:�M I T PERMIT NO: 840377 GATE ISSUED: 05/23/84 APPLICANT: C/O AMERICAN HOMES WILL JACOBS ADDRESS: 2221 E. NO LIGHTS ANCHORAGE, AK 99508 CONTACT PHONE: 276-4212 LEGAL DESCRIP LOT SIZE: LOT LOCATION MAX BEDROOM'S SUBDIVISION: FINLEY SECTION: 15 TOWNSHIP: 12N 51604 (SQ. FT. OR ACRES) FINLEY CIRCLE 5 LOT: 4 BLOCK: NA RANGE: 3W LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC: SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR CIN -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOR CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IE, VALID FOR A MAXIMUM OF 5 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES.- THEN ODES,THEN i1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3.) THE ELECTRICAL WORK MU- E DONE BY A LICENSED ELECTRICIAN. SIGNED ------ DATE: --------------- APPLICANT: eClHOMES WILL JACOBS ISSUED BY v (�� _ DATE: T FZ E rJ 0 t -i E� E Ca tol . GN F IFi I t-4 DEPTH TO PIPE BOTTOM (FT.) 4.0 4_0 4.0 GRAVEL DEPTH (FT.) 2.0 0.5 .� 1.0 TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) 6. 0 2.5 0 25. � 5. 0 GRAVEL LENGTH (FT.) 207. 0 ** 3 .�I �6 /1145.0 *» GRAVEL VOLUME (CU. YDS.) 47. 946.2 o ($ X � 40. 2 TANK SIZE ( GALS) 1,500.0 m* 1,500.0 ** -fA i, 500. 0 » KW SOIL RATING CSO. FT. e,BR) 165 165 IE�`165 IG ldtEDAG ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT E 75 FT. EACH) Wf TANK MUST HAVE AT LEAST - - - - - - - - - - - - - - TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR CIN -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOR CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IE, VALID FOR A MAXIMUM OF 5 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES.- THEN ODES,THEN i1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3.) THE ELECTRICAL WORK MU- E DONE BY A LICENSED ELECTRICIAN. SIGNED ------ DATE: --------------- APPLICANT: eClHOMES WILL JACOBS ISSUED BY v (�� _ DATE: Al MUNICIPALITY Or ANClloHAGL r .:. OEPAII 1'.,fN I UP IWALTII AND LNVIHONMLIVTAL PIi0l"ECTION W. O1S L. Shunt, Archotayo, Alo%kd 991,01 264 4120 601LS LOG — PERCOLATIC,1,; TE`, f f� I'l Iif Ot A I IrtN TL`:I PEHF OHMtO FCiH ___ __T n.:,g /"Ia/ey ___--_---UAIt. VIE IIFORM I D _�j- y'.9,a- LCGAt Of sc:HiPnur, cN .5fs1__.2S__r-1.3IV-_JZ3 w) -__001 N. `CPVAer gvnJ 1,E.ini JLu�r SIT_NA% vtl n ir,F�Lid L - --- M�- NI S�r' f bra/. 6rore//r 1 3 sw` Silnif r,n to Cr.xfsr_ wl- SM Som♦ ji /f /H�ry/, /'cn6 c ( ,t _ � / � , r � F/iia {1{'..,t 1✓rJW �,d �t I �w�'�/r r ; f I l i s Fig c,....� '.;/,r, �•,.,rr//� rl 10 , SVN1 ,,,-•.t0/o a��t ll�N 11 iu Ul /�(. I -.. -1__-_.- I .� -. li (12 — lt57 1217 �u,x✓� J 't Y1 Al MI/ki � 13- 4-�•g1 _- 14 -Net a .u. n, It,..Jini 0,1 1 N t lime F A(giyf rf;vL Al �" "'' •1 1s �• ........ • •��I 3 w / /�Q,. . •r•��" I U. � Z yYy J/y fo♦h�••. exAp • * (1p 4 _..� l l: V V to • . •••It• •ar n l 1 goI Ott Mely R. Nichols �� / 1�e Jb� dig N . 4113-E 20 ee��pR L r sJ_... '► w `. �i�"'> Pi Ii:U LAII(tN I(,1IE %0 Iminuty''i�i5r �.•. ��•♦Jis f3aIklle TL::T ItuN ItI WiLLN —._.�_ tI AND rrV� �.c.1-. •'•;��y4� COMMrN1 _-.._Sur l��7Qr)p n area Sf ef_00 a l PCHFOHMEf,Bvcr.HTit It.ua,00 SOILS LOG MUNICIPALI'l Y OF ANCHORAGE j • v DEPARTMENT OF HEALTH AND ENVIRONINIENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: c"rANCS F/NCE y DATE PERFORMED:_ 9-Z-11 2 Goy. LEGAL DESCRIPTION: 1.07 SCc. it_ 7 ISN _ . 5_w (LOT �f FiNcFr <v2) DEPTH Ij'� jISLOPF SITE PLAN (FEET) TdpSO/L ~ L_ I'1--_.FT-1 rl -3 2 1 SM �I 2 3- 510 4- 5- 6- 7 56 7 8- 9 10- 11 12 13- 14- 15- 16- 17 314151617 18- 19- 20- COMMENTS 81920 COMMENTS PERFORMED BY: 72.008 (6/79) NFS 6QAy S -*1-7 y 54,ov D TCS t Oi l Co MOL -769 9-2-ps% A1R5k.1 7f3714d WAS GROUND WATER S ENCOUNTEHED? No L 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross. Net Depth to Net Time Time Water Drop S� r L PERCOLATION RATE !rdo 11r[<eMMeh► McNIn 2 Nichols ;EST RUN BETWEEN FT AND FT No. 4113•E t^ j + CERTIFIED BY: _IVCtt.-.1-`V- ' DAf DO SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TERcoLArloN TEST 826 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: TAM •S IC', • DATE PERFORMED: LEGAL DESCRIPTION: dW.4,c :Z /S SPe r i g T /7 N R 3 W l Le s y FiNs.Pr 5 DEPTH SLOPE SITE PLAN (FEET) TGPSelL 1 'y�- S Gray. Orrir t Sl/i �� r 2 3 Sw- SM 4 5 6 7 5 nl 8 9- 10-- 11 1011 SM 12 13- 14- 15- 16- 17- 18- 191 314151s171819 20 COMMEN NFS�Fty l+rar Growl///r �tnd� Fr'ae 40 Coarbe, t✓J Son7e `r /f, /ydiw, Oens 4 PrK. 0k- 01 44/ F:l# Gras 5:/// Ore re//y Soon/ , ^P166 dens a (6/au'al -w/1) L F•, Gltay S,'// Gr-ave//y /WAS GROUND WATER S SON?, I0-20*70 ENCOUNTERED? NO L ti /fp IF YES, AT WHAT E %EST P1 T CelslOt Q7lC DEPTH? 4 -3- $1 Refill 3 Reading Date Gross Net Depth to Net Time Time Water Drop a • 2. 7 9 't 9l M ; 3 //; S& to yyy Jiy/,om;" ' s� r r #,L! .. • #L: Z.4 10 IV lb ; 7 11.33 /0 �" o PERCOLATION RATE T' &&these Too A T. TEST RUN BETWEEN FT AND —! PERFORMED BY:� CERTIFIED BY A�Asc� r�srcq� 72.008 (6/79) Melvin R. Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-112-47 Expiration Date: of 1. GENERAL INFORMATION Complete legal description FINLEY, LOT 4 Location (site address) _10510 FINLEY CIRCLE *ANCHORAGE, AK 99507 Current Property owner(s) WILLIAM JACOBS Day phone 346-3993 Mailing address Real Estate Agent 10510 FINLEY CIRCLE *ANCHORAGE, AK 99507 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Day phone TYPE OF WASTEWATER DISK SAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ ..1 Received b, - COSA to be rete:.: -d to the engineer, unless othem+ise requested by the engineer. COSA Fee S 9010 Date of Pa •'lent�� T� �3 Receipt Num:)er " COSA # 05c 1311 bS Date: i> %' ar'' ✓ Waiver Fee $ _ Date of Payment Receipt Number. 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. /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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 3 ZS 13 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the the the time the test, 000; �� p�44 c system under conditions encountered at of 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. �� '•, Q �oO These conditions are outside the control of the evaluator of the system. Satisfactory test * ,1 .� `t _ results do not guarantee future performance of the system, nor do they guarantee that 0 there are no hidden defects or encroachments. GEG, LTD. can therefore not provide !7 any warranty or future estimate of how long the system will continue to meet the "" . .... ..... ..":.. '• f A. n ess, _ operational requirements of the ADEC or MOA DSD. The content of this report is for y 0n the sole benefit of the owner listed above. Any reliance upon or use of this report by any is it VO y. •. CE 795 05� 3TZ�' other person or party not authorized, nor will conterany legal right whatsoever �^ e^ • . c°jo0 V40Qa 6. DSD SIGNATURE pro fessioo°ate �04poo�� System #1 Approved for bedrooms. System #2 Approved for bedrooms. `��\CYtOF iVV'(r Disapproved. `_ ON-SITE z WATER AND Conditional approval for bedrooms, with the following stipulations: � �.o WASTEWATER By: r Original Certificate Date: / 3 The Municip lit rAnchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) ba: E -d only upon the represenatations 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 engineer's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory V Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev -11/05) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: FINLEY, LOT 4 Parcel ID: 015-112-47 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Date completed 6/30/84 Sanitary seal (Y/N) YES Total depth 184 ft. Cased to 184 ft. FROM WELL LOG Date of test 6/30/84 Static water level 152 ft. Well production 7.5 g.p.m. WATER SAMPLE RESULTS: Coliform (D colonies/100 ml. Arsenic: oug.IL. B. SEPTIC/HOLDING TANK DATA NitratA9? mg./L. Date of sample: 3/19/13 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3/18/13 140 ft. 5.90 g.p.m. Collected by: GEG. Ltd. Tank Type/Material SEPTIC/STEEL Date installed 8/8-10/02 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping a. Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 8/8-10/02 Soil rating (g.p.d./ft`or /bdrm 0.8 System type DEEP TRENCH Length 2 @ 40 = 80 ft. Width 2.5 ft. Gravel below pipe 7.01 ft. Total depth *1 1.58 ft. Eff. absorption area1 1 EO ft2 Monitoring tube YES Depression over field NO Date of adequacy test 3/18/13 Results (Pass/Fail) **PASS For E bedrooms Fluid depth in absorption field before test 0 in. Water added 1440 gal. New depth 30 in. Elapsed Time: 1294 min. Final fluid depth 4 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date **TESTED EAST TRENCH ONLY. WEST TRENCH HAD 51 INCHES OF LIQUID IN IT AT TIME OF INSPECTION. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ltft station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line 25'+ Public sewer manholeldeanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ 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 lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Properly line go* Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 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 COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 317't3 ! t 3 (Rev. 11105) Municipality of Anchorage Q� E , Community Development Department s �s Development Services Division s s; E,r On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 131105 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 4 of Finley subdivision. This inspection revealed a nitrate concentration of 8.98 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ! 6# � ! � Q> � )(§) , !;) 6# � ! � Q> � MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) uiz,AVSN. Location (address or directions) (b) Applicants Name rt -.L GOI C Telephone - Home Business Applicants Address ? :z_ z � E- /V . ,i l6 r17 -K (c) Applicant is (check one) Lending Institution ; Owner/builder Buyer ; Other E::j (explain); _ _^ (d) Lending Institution A k"_ o -�'A , Telephone - Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family �1 Multi -Family Other (describe Number of Bedrooms C_� 3. Water Supply Individual Well EQ Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Q Public 1-1 Community 1__7 Holding Tank L-.--1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows 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 Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm F ; 7Tt Telephone E Address 2']-2c� �E- to, C, t-4 AVAQ 4ycr4orlAraa- r102#40 -rig A?��. �ouoer r r Date (ENGINEER SEAL) • 4°00 0 O F $ Dale R. Mc•+ (11 205 6. DHEP Approval Approved for bedrooms By �' �� ➢ate_ Approved Disapproved Conditional Termsjof Conditional�Approvalc� C12Gtioc✓iZe vtE •�<<� 'r <'J CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY_ UPON T11E ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHOR1,GE IS NOT RESPONSIBLE OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 PROTECTION REPRESENT -- REGISTERED DOMES AND REQUIRE - BEFORE A FOR ERRORS [Page 2 of 21 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG 141984 RECEIVED Legal Description: FlNJ-E' S�,.,T>ySN 4-m•r zl Well Classification -SvN6L6- F.t.1_ If Well Log Present (Y/N) y Date Total Depth /Sy -� Cased to ,, B, c>r Cr D.E.C. Approved(Y/N) Ccimpleted _6 o g< Yield Depth of Grouting Static Water Level Set At Casing Height Above Ground Sanitary Seal Electrical Wiring in Conduit (Y/N) Y Depression Around Separation Distances from Well: on Casing (Y/N) i W611head (Y/N) Al To Septic/Holding Tank on Lot /02-/ ; On Adjoining Lots /to f To Nearest Edge of Absorption Field on Lot /D.QL ; On Adjoining Lots /o0 t To Nearest Public Sewer Line ^'�p- To Nearest Public Sewer Cleancut/Manhole ,vlA To Nearest Sewer Service Line on Loth Water Sample Collected By Date e Water Sample Test Results 547/Si-6 c'ic 7 CaRnantsRQ2e1r AT-t->-IJe, B. SEPTICA46bH£Nfr TANK DATA Date Installed 2 7 , Size ea No. of Caspartments '2 - Standpipes Standpipes (Y/N)Y Air -tight Caps (Y ) Foundation Cleanout (Y/N) Depression over Tank (Y/N) /(/ Date Last Pumped NIA) Pumping/Maintenance Contract on File (Y/N) — ; for Holding Tank High -Water Alarm (YM) v Temporary Holding, Tank Permit (Y ) N Separation Distances frau Septic/Hdidfng Tank: To Water -Supply Wa11 102-1 To Building Foundation To Property Line 75' To Disposal Field f3 To Water Main/Service Line !t/A/ To Stream, Pond, Lake, cr Major Drainage Course .V/A Comments (Page 1 of 21 OL> 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /b ret ,, Type of System Design 13r7� Date Installed _� Length of Field 740 J� Width of Field /0 ' Depth of Field Gravel Bed Thickness Square Feet of Absorption Area / 2Az, Standpipes Present (Y/N) _ Depression over Field (YM) V Date of Last Adequacy Test N Results of Last Adequacy Tbst fA Separation Distance from Absorption Field: To Water -Supply Well )004- To Property Line / a To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots _ &1 To Water Main/Service Line N To Cutbank(ifpresent) iv . To Stream/Pond/Lake/cr Major Drainage Course aA To Driveway, Parking Areal or Vehicle Storage Area w Convents Date Installed Sime in Gallons "Pump On" Level at Dimensions Manhole/Access (YM) "Pump Off" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) Comments Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the dat f this ction. SignedDate Come Ross' c o n c MOA No. KB1 (Page 2 of 21 2 -15 -aa Location: BESSE, EPPS : POffrS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WATER WELL TW.V Subdivision: /V Lot: Block: N,4 -7' Date: Client's Name: w/L.L TA C,o1�S Address: 2221 ZE�, - N 4-1 B tt7 $ Tester: p,,�. Ml , Initial Reading on Meter: 1666 TIME GPM GALLONS 0 VOLUME GALLONS TOTAL VOLUME 1)-ob II-iO 2 76 y I '•+0 7,,' I9zi :5u ,-Z 1998 •oo 7,8 2026 I,Z-. ,"7 77 .20 08 1z, 7, s _ 115 2-353..�_. _ izs , 7 9 79 y 2-q-12 NOTES: ei,r_ = -7"AnA Production Rale: 7.7 � GPK 21k--tiour C;ipacity�_ Gallom