HomeMy WebLinkAboutGIRDWOOD ORIGINAL TOWNSITE BLK 6 LT 4Girdwood
Original
Townsife.
Block 6
Lot 4
#07§- 151 - 14
"""' HEFTY DRILLING
,. 3540AKULA DRIVE
'~.'ANCHORAGE, ALASKA 99516
(907) 345-0593.
SuMivlsion/USS:
........... Township
...... Lea§: W
DATA: (from ground sltrfuce) Depth
Color&wemess J From J To
i witllhi 45 days. a~..~.X~i~re aceeElilhlc (Al( S~IUl~ 38,05.020. 38.05.035.
4 ~18.020, ~; 11.0~ ~ lK ~g;[~ions I I AAC 93.140).
~ . DEP~TMENT OF NATURAL R~SOURCES
Mlnlng~ Land & Water HydroloRie Sm~'ey
~0 W 7Ut Ave,, Suite 900A
. An~o~ge, AK 99501-3577
· Telephone(90~ 269.8639 and FAX (907) 562-1384
I)EPAR'I MEN I ()1, NATURAL
MINING, [,AND, WA'['I~R I~ROLOGIC
· Casing dia~ter: ~ i,¢hcs Casing dcp~
h
Wellintakc opening [ypc: pm cad, ~ Openhole ' -,-'~ '. ', ·
a Screened; Start: ~t, Stopped .. , .":'~
SCfCCI1 type:
E1 Perforated;Start:
Sbu'l:
Note:
Grout type:
Depth; from
Pump intake depth:
SIo[/mesh size ;"
f',, Siop;cd ' .: ' :t~
ft, Stopped :' '.'iq:.
VoII.IrI~ . .,..
fl, to .__~
Pump size
}lp. Itt;md nar~: :
Was well disiol'cctcd upon cm;~plcdon? ~Yes,
Method of disinfection:
Driller comments/disclair:tcrs:
ENo ,
Well Driller Name. ~'; '
Company Name:__ HEF'__rY DRILLING
Mailing Address: 354n._A.KULA DRIVE
City:_ ANCHORAGE S';,t~' ALASKA Zip:% 99516
Phone Number: 1.:.?)._7 ._3~,~ b _,-15 9 ,~
r'within tile Oily of I nc orauc r is rcquired that a copy of the well log be
sent (o thc appropriate CID,' ol'[i~ C :vjlhin 60 da'.~' sad
thc well log be scnl to Ihc'~,'cll: ~'"l crlv owner within 3" '
Municipality of Anchorage
Mark Begich, Mayor
Bull ding Safety Division
P.O. Box 196650 · 4700 Bragaw Street
Anchorage, Alaska 99519-6650 * (907) 343-8301, Fax (907) 843-8200
http://www.rnuni.org
July 19, 2004
David & Camilla Seifert
P.O. Box 116
Girdwood, AK 99587-0116
Subject:
On-Site Water and/or Wastewater Permit.
Permit Number: SW030307
Legal Description: ~"~[wood O~g~l~o~it~ ~k'~6t~
Dear Mr. & Mrs. Seifert:
An On-Site Water/Wastewater Permit, number SW030307, issued by this office for a single-family
system, will expire on August 11, 2004 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 are 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 of$115.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
Daniel Roth
Program 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: Aug 12, 2003
Expiration Date: Aug 11, 2004
Permit Number: SW030307 Parcel ID: 075-151-14
Legal Description: ~|RDWQOD ORIGINAL TOWNSITE ~LK' ~ LT ~4
Design Engineer: 0000 None Required Site Address:
Owner Name: David & Camilla Seifert Lot Size: 6000 SQ. FT.
Owner Address: PO BOX 116 Total Bedrooms: 2 Permit Bedrooms: 2
GIRDWOOD, AK 99587-0116
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Cede 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:
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
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJ~/ELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s)
Mailing address (1)
Permit Number SWO ~O.YO
Day phone
Mailing address (2). ~ ~ l Rl~luOOJ~ ORI &I/YRI... Tz?~V~o~elTg EL OCg ¢ [01'4
Legal description (Lot, Block & Sub'd.) ~
Legaldescfiption(Section, Township & Range) I).~,~--~'c~ J~o~
Lot Size ~i~P Acres/Sq. Ft. Number of Bedro~oms '7..
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 (;~.a~thorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
~//~'~- Receipt Number:
LOT
,_., ANCHORAGE
TRAFFIC D E pa RT,~VlENT
PPRO~/ED AS SUBMIT'FED
PPROVED AS AMENDED
LAND & CONS~UCTION SURVEYOES-PLANNERS-ENGINEERS
440 WEST BENSON BLVD. ~ 105
, ANCHORAGE, ALASKA 99503 562-5291 (fex)561-6626
[wo#,.,+~ I-1-=20.1~'0v. ,.2~2 I-'c~.
LOT 5
4
AUG ~' 20
PROPOSED
HOUSE
FIN FLR=19.0'
LOT 3
DRIVE
LOT 2
PlOT PLAN OF:
LOT 4, BLOCK 6,
U.S. SURVEY
~,~ I'~m I~'~
LEGAL DESCRIPTION:
NO. 1177
,,~ DRAINAGE
LEGEND: ~ FND
5/8".B w/~ 5/~" RB 0
HUB & T~X n
-~_[v.(~o oA~J~ I ~.u' I
orn
G) O7
I? I?
I—
CD 0
—
OO
CY) 0)
n I
Pi -
0
O M
0
a�
Q.
0
aE
CL
O
3
U)
C�pp
_ o
U
O rrN^
jI ll
o
L
L
Q —
0
CU
U) q)
L
LO
N
O
N
co
N
N
C
O
Q
x
W
J
J
ED
W
/I--
V /
0
J
Z
0
120
V
c
O
Q..
U
U)
0
O)
N
J
J:
IV
C
In
O
O
0
m
Wq
A
L)
0
0
0
a�
Q.
U)
CL
O
3
U)
�_
•=
(Q
L
CU
0
s
N
U)
t
E
O
�—
ami
w
U
N
r_
O
Oa)
+
V
C
N
N
N
O
a)
L
O
>L
>,
o
_
O
-0
U)
N
p
o
Q
Q
U
a
Um)
2
N
0
z
Q
N
cn
E
CE
>
Q
O
O
O
N
O
Q.
E
Q
Qi
N
L
N
v
0
O
L
X
mcuL
_
_
M
'>^%
cn
=
^
ii
AO,
a/
L
O
W
N
U)
I
0
E
-0
Q
O
0-
o
C
>
O
N
O
0
.
Oi
d
Q
Q)
O
p
�
O
Q
U
o
(1)
L)
N
O
N
Q
a
Q
i
NW
0
O
-�c N
c�
U=
a�
t
aNi
s
U
N
Q
cn
Q
i
Q
Q
NT I-
C) 0)
a) Cf)
00
O
Ca
d
Q
CCS
O
0-
E a)
U)
co
a)
VJ
c
0
O
a)
U
N
Ak
z
O
T
a
T
LO
T
O
UL
Z o
W
W
CD a
e-
d'
I-
O
U
0
m
F_- Q
CO p
3: p
0 o
�
J
z c�
0
w
o z
p W
o >
0 0
o
C� 0
c N
o c')
-L
U �
U �
� a
a -a
c�
C
a
O U
U 0
LO
(1) x
C ,m1
U_
N
a
T
�
�
z
t
0
C
O
a
O
❑
3
a
N
C
oU
U
❑
�v,
Q)
n
O
U)
()
C7—
N
cu
Q .0
(D
m
C
E ()
L
>
O
❑
O
U m
a) Cf)
00
O
Ca
d
Q
CCS
O
0-
E a)
U)
co
a)
VJ
c
0
O
a)
U
N
Ak
z
O
T
a
T
LO
T
O
UL
Z o
W
W
CD a
e-
d'
I-
O
U
0
m
F_- Q
CO p
3: p
0 o
�
J
z c�
0
w
o z
p W
o >
0 0
o
C� 0
c N
o c')
-L
U �
U �
� a
a -a
c�
C
a
O U
U 0
LO
U_
N
a
T
�
�
,
O0)
U)
0
C
O
a
O
❑
3
a
N
C
oU
U
❑
�v,
Q)
n
O
U)
()
C7—
N
cu
(D
m
C
>
O
❑
O
0
C
U)
N
cu
z
O❑
WM
—
CL
0)
o
i
El
LL
LL
CL
o
N
0a
LL
N
>
C
IL
a
?co
❑
U)
❑
a
U)
cn
LU
1-
a
CL
c
w
H
U.
O
LL
O
U
z
O
a
I} -
C
❑
w
CL
N
M
I
Q)
Q)
LL
C
a)
E,
Ca
[L
0
N v '
J
/V�v1 1
l V
a)
()
a) a
LL o
Q Q
CO a) U)
0 0 o
�,
U)
Q)
N
`-)
a)
O
C
ILU
L
El
C
CL
O
Q.
C
❑
m
U)
Q
a
O
E
V
E
❑
a)
CL
U
cu
N
L
El
CD
�
CDN
a)
a)
O
co Q)
O
U
N
ai
El
c
aai
co
m
O
Q. CL
❑
L
_
❑
Q C
O
U
cn
ca
E
�
❑
Q
❑
�°
c .m
G
ai
O
as
"+
CO
>
aa),
(n
C O
a)
W
v
9u'
i-:
Q))
N
Y
z
L
z
4-L_
L)
a
°
U)
I°
ILo
U
U)
�
Q
m
a
�>
cu
a
W
m
w
I
Q)
Q)
LL
C
a)
E,
Ca
[L
0
N v '
J
/V�v1 1
l V
a)
()
a) a
LL o
Q Q
CO a) U)
0 0 o
Legal Description: GIRDWOOD ORIGINAL TOWNSITE; BLOCK 6, LOT 4 Parcel ID: 075-151-14
Ifmore than Iwell and/or septic system onlot, provide separate checklist. Structure served bythis system
A. WELL DATA
FORWell log hufiledwith Onsite (or attached)
Date drilled 4/12/2004 Totaldepth 40 ft
Cased to +u ft
F9 Sanitary seal is functioning correctly
Alwires are properly protected
Casing height (above ground) 18+ in.
Date offlow test for C[]SA 2/6/2024
Static water level atbeginning oftest 282 ft.
Comments
I SERVED BY PUBLIC SEWFR
TANK DATA
operating fluid level inseptic tank
_____
Date of puNQinc
F-1 Required ma
ncecompleted, ifAVVVVTS
D. ABSORPTION FIELD DAT,
Which system tested (date installed)
F-1 ALL standpipes present per record drawl
Total measured depth from grade _ft (max
Measured depth to pipe invert from grade ft (min)
F-1 N/A — pressurized field.
F]Per record drawings, fieldkoinoulated.
UMonitor tubes gotobottom ofeffective.
If not, otmbs depth into effective_____
FjPresoaked required if
(Required ifhouse vacant orfield not used for more
than 3Odays prior todate oftest)
Gallons introduced _gallons date
Any rejuvenation treatment (past 12months)
If yes, enter date
Comments/Deficiencies:
COSAChecklist—June 2022
Well production at time of test 4.3+ ~m
Water storage tank volume NO Qo{bno
Well disinfected for coliform test? E] Yes �� No
E1Co|Jonnbacteria ioNegative
Nitrate 0. q9!5mg/L FlNitrate less than MRL (ND)
Arsenic ' uo/L nicless than MRL (ND)
Collected by GEG
Date 2/6/2024
C. LIFT STATION
ElRequired maintenance completed
Age oflift station years
Lift station material
Adequacy test date
Results F� Pass
Fluid depth prior totest in
Water added _ gal
New fluid depth ___in
Nwed time min
FIELD STATUS — T RECOVERY
Effective depth (per recaK,,drawings) _ in
Effective depth used__- �� ��
Effective depth remaining
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Yes if No ft
Tank to Property Line > 5'El
Community Sewer Manhole/Cleanout > 100'
DYes
if No
ft
p■ Yes
if No ft
Neighboring Tank > 100' RN Yes
if No
ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' ME Yes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Q Yes
if No ft
R Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
0 Yes
if No ft
SERVED BY PUBLIC SEWER R N/A — Served by Community Well (not on lot) or Public Water
'Pref%JQ4Rtic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations —
Yes if No ft
Tank to Property Line > 5'El
Yes i ft
Field to Property Line > 10'
❑ Yes if No ft
Water Main > 10'
❑ Yes if No ft
Water Service Line > 10'
❑ Yes if No ft
Surface Water > 100'
Wells on Adjacent Lots:
s > 100'
Community Wells>
❑ Yes if No ft
❑ Yes if No ft
Yes if No ft
If tank or field is under driveway comment
F. ENGINEER'S COMMENTS
'PER CONVERSATIONS WITH OWNER (SCOTT SMITH) OF LOT TO THE SOUTH (GIRDWOOD ORIGINAL TOWNSITE; BLOCK 6, LOT 3)
THE STRUCTURE ON THE LOT IS A "DRY" STRUCTURE AND DOES NOT HAVE WATER OR SEWER
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Gamess Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist June 2022
�.... .. ....... .... ...
e rey A Go ness:'
Q
CE 795
y �G
LICE NSE
44dProfesS10f% �
#AECCee4
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
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 075-151-14
1. GENERAL INFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
GIRDWOOD ORIGINAL TOWNSITE; BLOCK 6, LOT 4
526 GOLD AVENUE *GIRDWOOD, AK
DAVID & CAMILLA SEIFERT'
,326 GOLD AVENUE *GIRDWOOD, AK
Day phone C/O AGENT
Day phone
BRIAN EPLY W/ REMAX OF ALYESKA Day phone
PO BOX 1029 *GIRDWOOD, AK 99587
225-9799
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
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 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 p~ofessional engineer's work.
4. STATE.¥.ENT OF INSPECTION BY ENGINEER
As certified by my sea/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 s~,~tem 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 rny investigation and inspection, t.~e
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 537-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. 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
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any wat:ranty or future estimate dhow 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 w,~atsoever.
DSD SIGNATURE
~"'/ Approved for ,~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
~..ta ~,, t,, ,e, its. COSA ~,heck~is~
Septic System Advisory
Well Flow Advisory
~,~u ~te AdvisoFy
(Rev. 11/05)
Arsen.c Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /7~-/~ -/t
Ag
CERTIFICATE
Legal Description:
WELL DATA
Well type PRIVATE
Date completed 4/'2/04
Total depth 40 .ft.
Municipality of. Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
OF ON-SITE SYSTEIVlS APPROVAL
(;IRDWOOD ORI(;INAL TOWNSITE; BLOCK 6~ LOT 4
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Date of test
Static water level
Well production 40
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: ND ug./L.
SEPTIC/HOLDING TANK DATA
Cased to
FROM WELL LOG
4/2/04
8
40 ft.
g.p.m.
PUBLIC SEWER
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cle~
Foundation cleanout (Y/N) De~ High water alarm (Y/N)
Pumper
ABSORPTION FIELD DATA ~*BELOW EXISTIN(~ GRADEI
rating (g.p.d./ft2o~.~ System type
Date
installed
Soil
Length ft. Width ft. Gravel below pi/jl3J~'~ ft.
Total depth ft. Eft. absorption area ft2 Monitoring tube_-..---""~epression over field
Date of adequacy test Resul~ (P~ss,~'~ For~bedrooms
Fluid depth in absorption fiel~ in. Water added ~gal. New depth min.
Elapsed Ti~~Final fluid depth in. Absorption rate >=__ ~ _ gJP.d.
An ' enation treatment (past 12 mo.) (YIN & type) If yes, give date -
Well Log (Y/N)
wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
3/'24/'11
25 ,ft.
4.52 g.p.m.
Nitrate 0.359 mg./L. Collected by: GE(;, Ltd.
Date of sample: 3/24/11
YES
YES
24+ .in.
CHECKLIST
Parcel ID: 075-151-14
D. LIFT STATION
Date installed
"Pump on" level at
in.
Size in gallons Manhole/ACcess ~ ~
"Pump off" levet_.a~. High water alarm level at
Cycles tested. Meets alarm & circuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/'A
Absorption field on lot, N/'A
Public sewer main 75'+
Sewer/septic service line 25'+
Animal containment areas 50'+
.in.
On adjacent lots N/A
On adjacent lots N/~A
Public sewer manhole/cleanout
Holding tank N//A
Manure/animal excrete storage areas
100'+
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
PUBLIC SEWER
Building foundation
Property line
Absorption field
Water main Water service line. Surface water
Wells on adjacent iota _ ~~
SEPARATION DISTANCE FROM ABSORPT~T TO:
Pv~e~ sr~e li~e- li~e -- ~ne~ati°n Water main.I
Driveway, parking/vehicle storage
~ Wells on adjacent lots.
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 COSA guidelines in effect on this
date.
Engineer's Printed,Name JEFFREY A. GARNESS
Date /-~/~/I,
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number.
SGS ReL# 1111083001
Client Name Garness Engineering Group, Ltd Printed Date/Time 03/31/2011 8:15
Project Name/# Girdwood Org Townsite B6 L4 Collected Date/Time 03/24/201 I 14:10
Client Sample ID Girdwood Org Townsite B6 L4 Received Date/Time 03/24/2011 15:03
Matrix Drinking Water Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container iD Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/k EP200.8 C (<10) 03/25/I 1 03/29/11 NRB
Waters Department
Total Nitrate/Nitrite-N 0.359 0.100 mg/L SM20 4500NO3-F B (<10) 03/24/11 AYC
Microbiology Laboratory
E. Coli Ne~zative 1 100mL SM20 9223B A 03/24/11 DLC
Total Colitbrm Nep. ative 1 100mL SM20 9223B A 03/24/11 DLC
-- 0 ~
(/) ,-+.
7°--5
Z
::::::::::::::::::::::::::::::::
F-"
:Ex
LANTECH