HomeMy WebLinkAboutSOUTHWOOD PARK BLK 3 LT 23mo
•
#012-073-56
Municipality of Anchorage
Development Services Department •
Building Safety Division , .
On-Sfte Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page t of
www.cl.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: Svso4ot,33 PID Number: oL2-
Name:
Wastewater System: ❑ New ❑ Upgrade
Address:
2164 w
ABSORPTION FIELD
Phone: Number of Badmos:
�.'� m
O Deep Trench O Shallow Trench O Bad ❑ Mound p or.
LEGAL DESCRIPTION
Soil Rating:
TolalDepthIno °rade:
GPDIFF
Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Greve) tl beneath pipe:
FI.
Ft.
Township: Range: section:
Fill added above on inal rade:
g g
Gravel Length:
FL
Ft.
Well: New ❑ Upgrade
Gravel vAdth:
Number of lines:
Dislanq between lines:
FL
FI.
Classification (Private, 0. B, C):
Total Depth:
Casatl to:
Total ebaorp°on en
Pipe Material:
2ro Ft.
2,ao FL
Fla
Driller��aa
��
po-R%9iz
Data Drilled:
CO
Static wirer Level:
Ins411e
Date Installed:
g Ft.
Yield: ^-
+
Pump sat at: casing Height Above GmuM:
TANK
�AGPM
Ft. Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding ❑ S.T.E.P. ❑Other:
To
Septic
Absorption
Lift
Holding
lublictPoxile
Manufacturercapacity:
From
Tank
Field
Station
Tank
Sevier Une
Gel,
?414
a4(h
01A
NIA
f
Material:
Number of Compartments:wen
Surface water
NIA
r4A
N ,t
N(a¢
LIFT STATION
Lot Line
N A
as 1A
rJih
NAL
Size,
cal.
Manufacturer
Foundation
1A
1*
A
'Pump on. level at:
"Pump off
High avatar alarm at
N
rQ A
N
N
i
in.
in.
Curtain Drain
N A,
4 lA
NIA
M 1A
Pump Makes
ElecIncal Inspections performed by:
Remarks:
BENCH MARK
Location and Dssaiptlon:
Assumed Elevation:
Ft.
Milciitamp
4* .. F ......
Inspections performed by:� µ4_IA�T�_I Dates: tat
* 49�
a�a•; •.a••aS.k.�j
'Inde�sisi�:a
...s%
Development Services Department Approval
WIA" T. NaAta :1 W
68 ea
•��I�P9L
Reviewed and approved by: � Date: 12-2 �' Orf
'11 .-. 0 • . �����
t
(Bivalve`)
x,10 TOFES
Dec 28 2004 6:26PM BTH Construction, LLC 907-336-3447 p.2
I -I
Permit Ni
Legal Desc
Design En
Owner
Owner A<
This permit B
❑ Disposal
UfV.
1. The
2. All r
3_ The engi
(907) 34;
4. From Oc
must be
Received By.
Issued By:
MUNICIPALTY OF ANCHOR4GE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O Box 19WW, Anchorage, AK 99510-8850
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
SWO40133
Southwood Park SID Block 3 Lot 23
0836 Brian T. Herten
Matt Matthews
2804 West Northern Lights, Ste 6
Anchorage. A 99517 -
Date 'ssued: May 20, 2004
Expiration Date: May 20, 2005
Parcel ID: 012-073-50
Site Address: 241a W 80th
Lot Size: 7000 SO. FT.
Total Bedrooms: 3 Penn t Bedrooms: 3
the construction of:
J ❑ Septic Tank ❑ Folding Tank ❑ Privy Q Private Well ❑ Water Storage
must be in accordance with:
d approved design.
its specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
itsposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18MCSO ).
must notify DSD at least 2 hours prior to each inspection. Provide notification by caping
4 ( 24 hours ). ( Not required for a Water Supply Permit only ).
15 to April 15, a subsurface soil absorption system under construction during fnrezing weather
A. Open and dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Data: G 9 D y
Dater, S Zr� 0 ►�
FROM : ALPINE DRILLING FAX NO. : 907 345 0202 Nov. 17 2004 11:05RM P1
Municipality of Anchorage
Department of Health and Human Services
825'L\ Street
P.O. Box 196650 Anchorage, Alaska 99519850 ME
Rick Mystrom Mtp:t/w+w.ci.sncholepe.ek.us
Mayor
Permit Number: #SW 040133 Date of Issue: X20 04 Parcel Identification Number: 012-073758
Date Started: 14-04 Date Completed: 6-17-04 Ts well located at approved permit location? No
Legal Description: Southwood Park Block 3 Lot 23
Property Owner Name & Address: MattMathews
2804 Northern Uaht3
Borehole Data:
Depth (ft)
Soil Type, Thickness a: Water stain
From
To
Stick up
0
2
oranics & silt
2
11
silty sand
11
33
silly gravelly sand
33
38
silt
38
73
silty sandy gravel H2O Wont dear
73
76
silt
76
176
gravelly slit
176
270
silty sandy gravel H2O
270
280
99517
Method of Drilling ® air rotary ❑ cable tool
Casing type: ,steel'
Wall Thickness: W inches
Diameter; Q inches Depth: 280 feet
Liner Type:
Diameter; inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): ALfeet
Pumping level:-U-0feet after
I hours ptnnping 2ft gpm
Recovery Rate: 20+ gpm
Method of Testing:la r Iltt
Well Intake Opening Type:
® Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start fed Stopped feet
Grout Type: bentonite # 8 Volume:
Depth: Start Q feet Stopped.Z feet
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes [3 No
Method of Disinfection: ailorine tablets
Comments:
Well Driller. Alpine Drilling & Enterprises
PO Box 110496
Anchorage Alaska 99511
Attention: The well driller shall provide a wall log to the property owner within 30 days of completion and the property
...... ...1 .....11 ).91...1..11 _...!J. .\\ 1.... .a. T._. .!\\..\.1. 0 \\.. -. ... f.. -.•..-..!.al.. 1n ..... .I..... ..1 .... ..
Municipality of Anchorage •.,
Developliient Services Department
Building Safety Division .. ...
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650 1
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOUR "A SINGLE FAMILY DWELLING
Parcel I.D. 060-0913- COSA#
1. GENERAL INFORMATION Expiration Date: 7 - _t2_7
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SOUTHWOOD PARK SUBDIVISION, LOT 23, BLOCK 3.
2416 W. 66TH AVENUE * ANCHORAGE. AK 99502-2204
MIKE TOMCO Day phone 522-4515
2416 W 66TH AVENUE • ANCHORAGE AK, 99502-2204
Day phone
TODD HELD W/DYNAMIC PROPERTIES Dayphone 261-7600
3111 'C' STREET • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
❑
Community On-site
❑
Public Sewer
0
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only 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 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, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the onsite 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 riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers 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 8 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 Axel 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
_L -**`c Approved for ? _ bedrooms.
Disapproved.
337-6179
Date ?,IZ t /o -4-
Conditional approval for bedrooms, with the tllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Nitrate Advisory / / Other
By: ,t •
(Rev. 11AS(
I I
�\'4\SY OFA& .
��.•••.... h
ON-SITE ••:��i
WATER AND
WASTEWATER
PROGRAM
Original Certificate Date: a-2-7— O %
Municipality of Anchorage
• Development Services Department
Bulkl ttg Safety Olvision ,
On-Ske Water d Wastewater Program
470D ll Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.ory/oroite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SOUTHWOOD PARK SUBDIVISION, LOT 23, BLOCK 3. - Parcel ID: 6I.Z-0 % 3 —,5'6
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID# N/A
Date completed 6/17/2004 Sanitary seal (Y/N) YES
Total depth 280 ft. Cased to 280 ft.
FROM WELL LOG
Date of test 6/17/2004
Static water level 38 fl.
Well production 20+ —
g -p.m -
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 18 in.
AT INSPECTION
2/2/07
30 fl.
4.5 g.p.m.
WATER SAMPLE RESULTS: .,^
Coliform _0 ry
oolonies/100 ml. Nitrate r� mgJL Other bacteria_0 colonies1100 ml.
Arsenic: %a al ug./L. Date of sample: 2/2/2007 Collected by: GEG. Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of
Foundation cleanout
C. ABSORPTION FIELD DATA
Date Installed
Length ft.
PUBLIC SEWER
Date installed
over tank (Y/N) _
Pumper
Soil rating (g.p.dJfl'ot�—
Width ft
(Y/N)
High water alarm (Y/N)
System type
Gravel blow pe ft.
Total depth ft. Eff. absorption area_ fe Monitorin tw' Depression over Heid
Date of adequacy test Resu ss/Fell) For bedrooms
Fluid depth in absorption field bef _ in. Water added _gal. New depth _in.
Elapsed Time: n. Final fluid depth —in.
Absorption rate >= 9•P•d•
treatment (past 12 mo.) (YM 6 type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N
'Pump ofr I High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NSA On adjacent lots 100'+
Absorption field on lot NSA On adjacent lots 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
Public sewer manhole/cleanout 100+
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: PUBLIC SEWER
Building foundation
Water main
Property line Absorption
Water se Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water
Water service line
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface
Wells on adjacent lots
1 certify that 1 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 "r-' 21 /o -,;L-
COSA Fee ��o U 0
-11
Date of Payment -1 Ijoz
Receipt Number 3 L
(Rev. iIM)
Waiver Fee $
parking/vehicle storage
Date of Payment
Receipt Number
Q
SGS ReLM
1070439001
All Dates/Times are Alaska Standard Time
Client Name
Gamcss Engineering Group, Ltd.
Printed Date/Time
02/20/2007 13:08
Project Name/M
Southwood Park SD Lot23 BIk3
Collected Date/Pime
02/02/2007 11:30
Client Sample ID
Southwood Park SD Lot23 BIk3
Received Date/Time
02/02/2007 13:30
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
300.0 - The Practical Quantitation Limit is elevated due to matrix.
Allowable
Prep Analysis
P=mgn
Results
POL
Units
Method
Container ID
Limits
Date Date
Init
Metals Department
I lardness as CaCO3
116
5.00
m8/L.
SM20 23408
C
02/14/07 02/15/07
TK
Waters Department
Nitrate -N
ND
0.200
mg/L
EPA 300.0
B
(<10)
02/02/07 02/02/07
IDS
Nitrite -N
ND
0.200
mg/L
EPA 300.0
B
(<I)
02102/0702/02/07
IDS
Private Individual Analysis
Aluminum
ND
20.0
ug/L
EP200.8
C
02/14/07 02/15/07
TK
Antimony
ND
1.00
ug/L
EP200.8
C
(<6)
02/14/07 02/15/07
TK
Arsenic
6.63
5.00
ug/L
EP200.8
C
(<10)
02/14/07 02/15/07
TK
Barium
58.6
3.00
ug/L
EP200.8
C
(0000)
02/14107 02/15/07
TK
Cadmium
ND
0.500
ug/L
EP200.8
C
(<5)
02114107 02/15/07
TK
Calcium
32700
500
ug/L
EP200.8
C
02/14/07 02/15/07
TK
Chromium
2.31
1.00
ug/L
EP200.8
C
(<100)
02/14/07 02115107
TK
Copper
1.04
1.00
ug/L
EP200.8
C
(<1300)
02/14107 02/15/07
TK
Iron
ND
250
u8/L
EP200.8
C
(<300)
02/14/07 02/15/07
TK
Lead
ND
0.200
ug/L
EP200.8
C
(<I5)
02/14/07 02/15/07
TK
Magnesium
8350
50.0
ug/L
EP200.8
C
02/l4/07 02/15/07
TK
Manganese
173
• 1.00
ug/L
EP200.8
C
(<50)
02/14/07 02/15/07
TK
Phosphorus
323
200
ug/L
EP200.8
C
02/14/07 02/15/07
TK
Chloride
2.22
0.200
mg/L
EPA 300.0
B
(<250)
02/02/07 02/02/07
JDS
Fluoride
ND
0.200
mg/L
EPA 300.0
B
(<2)
02/02/07 02/02/07
IDS
Potassium
1740
500
u8/1.
EP200.8
C
02/14/07 02/15/07
TK
Selenium
ND
5.00
ug/L
EP200.8
C
(<50)
02/14/07 02/15/07
TK
Sodium
11100
500
ug/L
EP200.8
C
(<250000)
02/14107 02/15/07
TK
Silicon
11800
200
u8/1.
EP200.8
C
02/14/07 02/15/07
TK
SGS ReEM
1070439001
Client Name
Gamcss Engineering Group, Ltd.
Project Name/N
Southwood Park SD Lot23 BIk3
Client Sample ID
Southwood Park SD Lot23 BIk3
Matrix
Drinking Water
All Dates/times are Alaska Standard Time
Printed Date rime 02/20/2007 13:08
Collected Date/Time 02/02/2007 11:30
Recehed Date rime 02/02/2007 13:30
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results POL Units Method Container ID Limits Date Date Init
Private Individual Analysis
Silver
ND
1.00
ug/L
EP200.8
C
(<100)
02/14/07 02/15/07
TK
Thallium
ND
1.00
ug/L
EP200.8
C
(Q)
02/14/07 02/15/07
TK
Sulfate
ND
0.200
mg/L
EPA 300.0
B
(Q50)
02/02/07 02/02/07
JDS
Zinc
ND
5.00
ug/L
EP200.8
C
(<5000)
02/14/07 02/15/07
TK
Total Dissolved Solids
165
10.0
mg/L
SM20 2540C
D
(<500)
02/08/07
ACF
Nickel
ND
2.00
ug/L
EP200.8
C
(<100)
02/14107 02/15/07
TK
I IC03 Alkalinity
135
10.0
mg/L
SM20 23208
D
02/13/07
KP
CO3 Alkalinity
ND
10.0
mg/L
SM20 2320B
D
02/13/07
KP
011 Alkalinity
ND
10.0
mg/L
S%120 2320B
D
02/13/07
KP
Conductivity
230
1.00
umhos/cm
SM20 2510B
D
02/02/07
PLW
pit
8.09
0.100
pll units
EPA 150.1
D
(6.5-8.5)
02/02/07
PLW
Alkalinity
135
10.0
mg/L
SM20 2320B
D
02/13/07
KP
Total Coliform
0
coVl00mL
SM20 92228
A
(<D
02/02/07
DPT
k
10x T ti P71 -1J ET!
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program g
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 FAMILYDWELLING
Parcel i.D.az-oa?; ;L
HAAtE
�0_ `1��0�, Expiration Date: , 3 — a� ^�- 0
1. GENER�bf�MA-ff&.
Complei6-f g �rillvti" `i 5 %cam 9 Se. lr%4L &T l ? •.
Loo itloin.( iteaddcess cu•dir Gtisu) • 41& LQ 1..I I'h /IL, qq�
Current Prty re4a) . 11�Ca+htr t ^Arnw. Day phone 244- cmt-o
Mailing address 9sok W, .3ertNraA tx.�trsi AaGu. Aug gas^ta
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF$EDROQMS: 03
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:..«'
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank'"'
❑
Community Class Well
❑
Community On-site'
❑
Public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Glass C well and may be reissued with
new water sample results. (Certificates may be reissued fora periot( of up td one year with Ivalid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or & Public w$ter 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, I 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. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water. supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm �^ �1VLZ,-j-_1. �' ^ ?hone '36.
Address V 36se 11635"8' aae&kAu- 4gc'i 1
Engineer's Printed Names
5. DSD SIG.NATkJRE
Approvedfor.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments `� � WRYER a.- ANS
,cic�,t�DTi's �*
17
34
R sI
.. j tk.;. „ • • ,. a =` �'> ...., S1-iNyoL Rr* ,y :+s-� y.� T,� ,`!
�—
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By:
a Original Certificate Date: °I - fl f f
Municipality of Anchorage . a`
' 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
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Jor -2S A .e.. 2 sy*ru a&ar� •• Parcel ID: Olt- 043 - 5*/*
A. WELL DATA
Well type jivA m If A, B, or C provide PWSID # Well Log (YIN) Yes
Date completed G_I' -O¢ Sanitary seal (Y/N) g Wires properly protected (Y/N) y-S
Total depth 24o ft. Cased to 20 ft. Casing height (above ground) ;2�_in.
FROM WELL LOG AT INSPECTION
Date of test (0-104-04 o�
Static water level 91 ft. ft.
Well production PA
g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliformcolonies/100 ml. Nitrate _� mg./I. Other bacteria _A—colonies/100 ml.
4
Arsenic: 3� uv%.A. Date of sample: II"19- o¢ Collected by: leAA J I4,gazF-.3
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Date installed
Tank sizd, = gal. Number of Compartments eanouts (YIN)
Foundation-cleanout (Y/N ression over tank (Y/N) _ High water alarm (Y/N)
k Pumper
Pumping,
C. ABSORPTION FIELDDATAn11A, ?u8uc. a
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type _
Length ft. Width ft. Gravel be ee ft.
Total depth ft. Eff. absorption area ftz Monitorin Depression over field
Date of adequacy test Res ss/Fail) For _ bedrooms
Fluid depth in absorption field b st _ in. Water added_ gal. New depth_ in.
Elapsed Tim --min. Final fluid depth _ in. Absorption rate >= g.p.d.
ny rejuvenation treatment (past 12 mo.) (YIN & type) 1f yes, give date
Date installed Size in gallons Manhole/Access Y/
"Pump on" level at _ in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot 70MOO eJ IAr -On adjacent lots 7 t o'O
Absorption field on lot NIA On adjacent lots 'tM1
Public sewer main 1-2,4' Public sewer manhole/cleanout
Sewer /septic service line Sl' Holding tank _i 1A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO
Building foundation
Property line
field
Water main service line Surface water
14teHs-oriadjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t 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.
Driveway, parking/vehicle storage _
n
*r 49MI
in.
`"Mm :ta i
�
Engineer's Printed Name '4)aAa,T. t1A4Lxw. .
I �q'�?-g- Q4 .•*4 A
Date19—$'— 64
HAA Fee $ Waiver Fee $
Date of Payment—/ Date of Payment
Receipt Number Receipt Number
(Rev. 12/01)
SGS Ref.#
1047649002
Client Name
BTH Construction
Project Name/#
L25 B3 & L23 B3 Southwood
Client Sample ID
L23 B3 Southwood
Matrix
Drinking Water
PWSID
0
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 12/06/2004 11:57
Collected Date/Time 11/19/2004 14:40
Received Date/Time 11/19/2004 15:55
Technical DirectorSite C. Ede
Released�� /
Pan uneter
Results
P L
Q
Units
Method
Container ID
Allowable
Limits
Prep Analysis
Dale Date
Init
Metals by ICP/M3
Arsenic
5.93
5.00
ug/L
EP200.8
C
11/24/0411/30/04
SCL
Waters Department
Nitrate -N
0.100 U
0.100
mg/L
EPA 300.0
B
(<=10)
11/20/04
BJA
Microbiology Laboratory
Total Coliform
0
coU100ml,
SM209222B
A
(<=1)
11/19/04
DKC
- PRELIMINARY -
P-279
SOUTHWOOD PARK SUBDIVISION
LOT 23, BLOCK 3
7,000 S.F.
WEST 66TH AVENUE
0
04
SIDEWALK ESWT.
111=20'
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_♦ Aco ,.• •qs�'
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..ery A..ga.;co..ia.i.....
'•. LS -6091 .•'
06
^. A�Cf@JlIOOOI L�C.�•
_A `J —t U + L I
1-HERE13Y CERTIFY THAT -I +IAVE SURVEYED THE `
PROPERTY DEPICTED ABOVE AND THAT NO
GASTALDI LAND SURVEYING
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
JEFF A. GASTALDI, R.L.S.
IT IS THE RESPONSIBILITY OF THE OWNER TO
4726 WEST 88TH AVENUE
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
ANCHORAGE, ALASKA 99502
COVENANTS OR RESTRICTIONS WHICH DO NOT
PHONE 248-5454
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
GRID
DATE
HEREON BEUSEDFOR CONSTRUCTION OR FOR
2027
9/29/2004
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
F.B.
JOB NO.
04-11
SWP233
NOTE: NO CORNERS SET THIS DATE.
SIDEWALK ESWT.
111=20'
.P •'OF"'q4
_♦ Aco ,.• •qs�'
�•49T1........ 06
..ery A..ga.;co..ia.i.....
'•. LS -6091 .•'
06
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