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HomeMy WebLinkAboutOSMOND OLSEN LT 4s�rno�9 coys� r aq a e2 - S Sep_20.2022 12:04 PM Anchorage Well & Pump Service Inc 9072430742 #0502 P 1/ 1 MUNICIPALITY OF ANCHORAGE Development Services Department # Phone:907-343-7904 On -Site Water & Wastewater Section Fax: 907-3437997 Well Drilling Permit Number: Pump Installation Log Date of Issue: - - Parcel Identification Number: 012_242 '5 Legal Description block Lot Property Owner Name & Address: HALGRO MARY E O MDNp QLSEN I II ANCHORAGE, AK 99602 Pump Installation Date: 09 - 13 - 2022 Pump Intake Depth Below Top of Well Casing: 90 feet Pump Manufacturer's Name: BERKELEY Pump Model. B7 P4J P07221 -Q2 Pump Size: .7 hp Pitless Adapter Burial Depth: 10 Pitless Adapter Manufacturer°s Name: Pitless Adapter Installer: feet MARTIN ON Well Disinfected Upon Completion? ) , Yes Method of Disinfection: PELLETS Comments: Pump Installer Name: Company: Mailing Address: City: ❑ No ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE, AIC 99518 907243-0740 State: -Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE I ' ` 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 PHONE ❑ NEW C IS t,:YCaVc— J�Llia ��� UPGRADE MAILING ADDRESS F 13oX I l a 8'3 /V)�hol-�L�o LEGAL DE=SCRIPTION C�Srncwt5u t L Ttz N h 4 w LOCATION NO. OF BEDROOMS U— X Well Absorption area Dwelling DISTANCE TO: 1� -Z„ �- _ --_ =� PERMIT NO. e LI C� —. 1- 2 Manufacturer Material S e I No. of compartments Z LIJ w Liq. capacity in gallons - Inside length Width IptyU IF HOMEMADE: Liquid depth s �O� DISTANCE TO: Well Dwelling f PERMIT 0. ©z Q Manufacturer Material Liquid capacity in gallons o 2 Well DISTANCE TO:_ 1'Z 3 Foundation S b Nearest lot line 3 U PERMIT NO. -1.0 FS�4 ) a J. No. of lines Length of each line 1-f Total length,of lines Trench width Distance between lines 2 w t S Gid 'i inches -� F' Top of tile to finish grade f Material beneath tile Total effective absorption area f t -LO .(�t}� a inches "' 3571 �f'v Length Width Depth PERMIT NO. al 4 f- Type of crib Crib diameter Crib depth Total effective absorption area ul ul Well Building foundation Nearest lot line DISTANCE TO: I I _ r Class Depth . Driller d� Distance to lot line PERMIT NO. o at DISTANCE TO: Building foundation Sewer line Septic tank Absorption area OTHER PIPE MATERIALS — /0 Vc I SOIL TEST RATING 1SOL7' INSTALLER REMARKS F1uus _ /os ec kw l Glc Muk C7 ilU a 4--c� S &n -/_• -- .� WIN C ccNse !� 0 Fe,ice Uh APPROVED DATE LEGAL^ /'� _ �.... 1E.1.11 If ��������� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE� AK 99501 264-4720 IEJ 111% 11-~1 1; If- '1-�� ����WW���� ���������'� PERMIT NO: S40B71 '~ }�.^ DATE IgSUED: 10/12/8 '~ ' y APPLICANT: CARL'S EXCAVATING ADDRESS: P O BOX 110383 ANCHORAGE, AK 99511 CONTACT PHONE: 346�3568 LEGAL DESCRIP: SUBDIVISION: OSMOND (.H -SEN LOT: 4 BLOCK: NA SECTION: 11 TOWNSMIP: 12N RANGE: 4W LOT E|IZE: 40920 (SQ^FT" OR 8CRES} MAX 8EDROOMS: 2 Listed below are the options available to you in designing your septic system. Choose the option that best [its your site. !1IF7����� DEPTH TO PIPE BOTTOM (FT.) 4"0 4"0 4.0 GRAVEL DEPTH (FT4.0 TOTAL DEPTH (FT"> 8"0 4"5 7"0 GRAVEL WIDTH (FT^) 2"5 5"0 GRAVEL LENGTH (FT^) 38.0 30"0 5 GRAVEL VOLUME <CU,YDS") 15`9 16,7 22.7 TANK SIZ� (GALS) 1,000.0 ** 1,000,0 SOIL RATING (SQ,FT./BR) 150 15O 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi1'y that: 1. I am 4'a(Ti iliar with the requirements {or on-site sewers and wells as set f'orth by the off Anchorage <MOA) and the State o� Alaska. 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit, 3^ I will adhere to all MOA and State of, Alaska requirements �or the set back distances from any existing well, waste1,'4ate1, disposal system or p�blic sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid If"or a maximum of, 2 bedrooms and any enlargement wi1l require an additional permit" � IF A LIFT STATION IS INSTALLED IN AN ARE* COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AiND (3) THE ELECTRICA NSED ELECTRICIAN. SIGNED DATE: ... .... ..... ~... ....... ~^� �-�^�~~~-7~�.... ... ... ..... APPLICANT: C�RLrS EXCAVATTNG ISSUED BY SOILS LOG MUNICIPALITY OF ANCHORAGE s \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATION TEST \ 7 B25 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: cj �' — DATE PERFORMED: J /0/11 /cq -- LEGAL DESCRIPTION: rr_1_—n SLOPE SITE PLAN OL) cel l�Q t C s 2 r 3 — M a a 4 e e 5- o c S P C.I eo (4 6 G a 7 _ r ! � 6 8 s f 0 9- r a 10- e I 11 a r p C a 12 - J30H 13 14 15- 16- 17 18- 191 20 819- 20 COMMENTS i WAS GROUND WATER S ENCOUNTERED? --A!J L �n O IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ONNO mom WAS GROUND WATER S ENCOUNTERED? --A!J L �n O IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN ( 1 � ` PERFORMED BY:� hf t OJL/ Kl' 1/—CERTIFIED BY: 79-0na rengi (minutes/inch) FT AND —® FT I_ r �' 3 (i DATEil10 v561 8`70% 77 Municipality of Anchora,*0 r�� On-Site Water & Wastewater Program (907) 343-7904 SEP 0 3 2615 CERTIFICATE OF ON-SITE SYSTEMS A Parcel I.D. 012-242-35 Expiration Date: 1 Z `C( S 1. GENERAL INFORMATION Complete legal description OSMOND OLSON, LOT 4 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 7727 JEWEL LAKE ROAD K & E 2009 FAMILY TRUST Day phone 7727 JEWEL LAKE ROAD CARRIGAN GRIGSBY Day phone 250-0836 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. n/O Distance:= Received by: ���� m t/ Date: COSA to be releasee to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52& Date of Payment 9)-3/15 15 Receipt Number olil B G COSA# o50-`5!`{gI Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF I SPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments, In conducting this evaluation, GEG provided an engineering evaluation of the visit andforseptic system in accordance with the guidelines and regulations esfablishedby the Municipality o/Anchorage and industryprachces. The reported results describe the condition of the systemle on the dale/s of the evaluation. Separation distances vrere measured to readdyidentifiable features Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwaterlevels (that may fluctuate during the year), quality of construction (materials and vrorkmanship), and the water usage of the family ufifinng the systeM .. These conditions can vary, and are outside the control of GEG. Satisfactory fest results do not guarmffee future performance of the systems; therefore, GEG makes no waninfy (express orimplied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed an the property in the event eikherofthe current systems fail The content of this tape(( is for the sole benefit of the persordpady who retained GEG. Reliance upon the information provided in (his report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/early who paid for this report. 6. DSD SIGNATURE System #1 Approved for _ bedrooms. System #2 Approved for bedrooms. Disapproved. 337-6179 Date % Cl 94 Conditional approval for bedrooms, with the following stipulations: QTY OF .d;: ON-SITE PROGRAM Original Certificate Date: The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based 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 Septic System Advisory Well Flow Advisory (Rev. 10112112) Nitrate Advisory Arsenic Advisory Other 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: OSMOND OLSON, LOT 4 Parcel ID: D12-242-35 A. WELL DATA *SEE LETTER IN MOA FILE OF TED MOORE, P.E. LETTER DATED 3/22/19991 Well type PRIVATE If A, 6, or C provide PWSID# N A Date completed *1954 Sanitary seal (Y/N) YES Total depth *240 ft. Cased to UNK ft. FROM WELL LOG Date of test *1954 Static water level *110, ft. Well production *12 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.208 mg./L. Well Log (Y/N) Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/5/2015 80.7 ft. 3+ 9.p -m. Collected by: GEG. Ltd Arsenic: 20.9 ug./L.. Date of sample: 8/5/2015 B. SEPTIC/HOLDING TANK DATA ISEE ATTACHED RECEIPT FOR FCO INSTALLATION Tank Type/Material SEPTIC/STEEL Date installed 10/17/1984 Tank size 1000 gal Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 2 7- 3 it Pumper W -KA S'E-LAJ&R t Oa'W C. ABSORPTION FIELD DATA RBELow EXISTING GRADE Date installed k10/17/1984 Soil rating (g.p.d./ftor /bdrm 150 Length 45 ' ft. Width 5 ft. System type SHALLOW TRENCH Gravel below pipe 2.5 ft. Total depth *9.5 " A. Eff. absorption area 351 ft2 Monitoring tube YES Depression over field NO Date of adequacy test $/5/2015 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth, in absorption field before test 19 in. Water added**455gal. New depth 22 in. Elapsed Time: 5 min. Final fluid depth 22 in. Absorption rate >= .300+ g;p.d: Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **THE LAST 368 GALLONS INTRODUCED CAUSED NO RISE IN THE LIQUID LEVEL. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump oft" level • . High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ 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 LOT TO: Building foundation 5'+ Property line 5'+ Absorption :9 Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ 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 1 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 q b /t,i (Rev. 11105) o��F000 v 500 T...NZ 4 cam.. •_J . Gar n ........ ss/ 53 Osr hI _ 1 � ... GS�'O� Municipality of Anchorage s , Community Development Department Development Services Division a On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 151487 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 Osmond Subdivision. This inspection revealed an arsenic concentration of 20.9 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. MUNICIPALITY OF ANCHORAGE • " DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section ik P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # D 12 - Z y Z - 3 Y HAA # 1. GENERAL INFORMATION Complete legal description L.o t y, ` Gsrnona-� - 01Sel) sS_ Location (site address or directions) 7 7 z7 J-ewal G a lT� Rct Property owner �5 l me r l -Cos /—,e Day phone v 76' - 96s9_ Mailing address _ F'• a. 3�n g 1sz iv �.s k; ,9 - 9 - Lending agency N.4. Day phone Mailing address_ Agent _N_Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well 1. Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site v I -folding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA R21 S. 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 of this Health Authority Approval application 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, ordinan es, and regulations in effect on the date of this inspection. ReQ�r,.eo( use//heu�( Y�'1oG<< CGino�,( 7tv �rl7 /11/0 comlqJrunce w,Fri Cbole :z, -e i7c.c�Corn/,/t/Y' Name of Firm F!a_f-6oC %cynrca/ Sprv,cv _ Phone 3 °rsd�3s5— Address _ I `3 U fF o ST. n( ho,- /f-(- 99 _/1 ~ Engineer's signature Date Y//'KI 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for _ Additional Comments �7L �,,��•.�ooae66�o „w�•,�rtf 00Ba Do 0000o�000a0o09'D//4y/�,''/g^,�h^ 6 a DD D 0 aDDODEO; 0D00@ q�TM£ODOR£.F. MpOORe ye° y g CL - ��QY `jf�,�6a06 �b'66�a Zv bedrooms, with the following stipulations: Date / _- /V_ 2c The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(RM.1/91) Back MOA#21 RECEIVED /'V Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE$PR 19 1999 Environmental Services Division Mk�ity�gt,q�7chorago 825 L Street, Room 502 • Anchorage, Alaska 99501 U an Servlc9s Health Authority Approval Checklist Legal Description: 1_0 � '4 ©S�'nc,?d — (2(f el) S/l, Parcel I.D.: O 1,2 -- 2 Yz s 3S` A. WELL DATA Well type 1�7rt ucuI-e' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Skel c a Date completed Total depth 237 Cased to Z 3 7 Casing height (above ground) m eav W /16/99 Sanitary seal (Y/N) Y Wires properly protected (Y/N) _ FROM WELL LOG Date of test Static water level Well production g,p.m. WATER SAMPLE RESULTS: AT INSPECTION 3 / • /S / N. 4 - '?,5 1 7�5 Yll6/99 ,- g.p.m. Coliform o cc,/ /1ov M _f Nitrate 0. 6C5 nx R l -e Other bacteria Date of sample: 3/�5'/99� .3119199 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Tank size Number of Compartments Cleanouts (Y/N) Depression (Y/N) High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA - Date installed Length Width _ Effective absorption area Soil rating (g.p.d./ft2 or ft2/bdrm) System type Gravel thickness below pipe Total depth Monitoring Tube present (Y/N) Depression over field (Y/N) Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = _ Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N).— High Y/N),_High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main "Pump off" level at* On adjacent lots - On adjacent lots Public sewer manhole/cleanout Sewer /septic service line _ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line Absorption field Water main/service line _Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line _ Surface water Curtain drain F. ENGINEER'S CERTIFICATION Building foundation Water main/service line Driveway, parking/vehicle storage area _ Wells on adjacent lots i certify that I have determined thru field inspections and review of Municipal records that the above syste in conformance with MOA h1AA guidelines in effect on this date. Regu,�e a wel�4w_04o�r�c bring //1 i79 LoM�JrunCP ui<c�r/�! Gid nc.c� Cvm�lt���y fi$;aFy Signatureof v t i E o if Engineer's Name TtieG���re MGp' e�,I r a 10 ®000eoeos6c.�oaiSaair'ggdoa'ni Date Ap.-',/ 16,i%� e_TFEODORO F. laooRf! .6 HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 009PNIL4C are ,n1' fa CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345.1355 March 22, 1999 Ken Johnson 3163 Linden Drive Anchorage, AK 99502 Dear Mr. Johnson: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Per your request on March 15, 1999 I conducted adequacy tests of the water supply and wastewater disposal systems serving the residence you are purchasing on Lot 4 of Osmond Olsen S/D, located at 7727 Jewel Lake Road. The test results indicate that both systems are functioning adequately at this time. I am submitting an application with the Municipal Health Department for a Health Authority Approval (HAA) certiFcate today. If you wish to expedite the review process you can call the Health Department at 343-4744 to find out if the HAA is ready, and then pick it up from their office at 825 "L" Street. The following is a report of our test procedure and findings. I was unable to locate a driller's log for the well, however a sketch you provided to me which was apparently prepared by the property owner in 1954 shows that the well has a total depth of 240 feet, a static water level of 110 feet, and a yield in excess of 12 gpm. Because of the configuration of the well with the pump being suspended from the well seal in a pit, we were unable to remove the seal to measure the current static water level or the drawdown during the yield test. To determine the yield of the well I pumped a total of 931 gallons of water from the well at the maximum pump output of 6.3 gpm. Steady pumping at this rate never caused the water level to be drawn down to the level of the pump intake. Based on the test data I determined that the total yield of the well is in excess of 6.3 gpm. This yield exceeds the Municipal criteria for approval of a single-family residence, and also meets the FHA lending criteria that a well be able to supply 720 gallons of water within a 4 -hour period. Water samples collected on March 15, 1999 showed 0 coliform bacteria per 100 ml., and 0.68 mg/1 of nitrate - N. Both of these results are satisfactory, however the bacteriological sample also contained 21 colonies of unidentified "other bacteria", which the Health Department will not accept for HAA purposes. Accordingly, I resampled the well on March 19, 1999 after further flushing of the water system, and the lab results from this retest showed there to be 0 coliform or other bacteria in the sample. Because the wellhead is located in a pit below ground level which no longer conforms to code, the HAA certificate will have to be conditioned upon the installation of a pitless adapter, extension of the well casing 18 inches above ground level and backfilling the pit so that the ground slopes away from the well casing. You should discuss with the Health Department any terms they may require regarding escrow of funds to ensure that these well pit modifications are accomplished by June 15, 1999. According to the as -built inspection report on file at the Municipal Health Department, the wastewater disposal system was installed in October of 1984 and was sized for 2 bedrooms. It consists of a 1000 -gallon septic tank that discharges effluent into a 45 foot long by 5 -foot wide soil absorption drainfield containing 2.5 feet of sewer gravel. To assess the adequacy of the system I ran 931 gallons of water into the system through the second compartment of the septic tank, while monitoring fluid levels in the septic tank and in the soil absorption system standpipes, before, during and after the flow of water was stopped. The initial fluid depth in the drainfield monitor tube was 0 inches and the maximum depth achieved was 5.25 inches. After the flow of water was stopped the fluid level receded at an adequate rate for a 2 -bedroom residence. In conducting an adequacy test I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and the separation distances are measured to readily identifiable features. All systems eventually fail and satisfactory test results do not guarantee future performance of the system under different conditions, nor do they guarantee that there are no hidden defects or encroachments. Please feel free to give me a call if you have any questions on this report. Sincerely, ar Ted Moore, P.E. MHN -L4-1777 11 m 3tl F -LH I I OF I LCH. S iVUb. 9073451355 P.02 'f .. s irk • :;' - . I, `ws i w C1VQ, & ENVIRONAAENTAL ENGINEERA'G ENERGY CONSERVATION & ANALY51S THEODORE F, MOORE, P,E. I4530 ECHO $T. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 2: 3: 4: 5: 6: Lot 4, Osmond Olsen S/D 7727 Jewel Lake Road Wellhead modifications to bring existing pit well into compliance with code Excavate around existing well casing and waterline to a depth of 10 feet below ground level Install pitless adapter and new copper water line to and through concrete floor of residence located approximately 25 feet from well. Ensure continuous slope of water line to drain into well. Weld on extension to existing 6 inch well casing to bring it at least IS inches above finish grade Backfill excavation around well and waterline sufficiently to ensure that there is a positive ground slope away .frons the wellhead after the backfill material has compacted Install sanitary seal and conduit enclosing the aboveground portion of wires entering wellhead All materials and work shall be in compliance with AMC 15.55 — Anchorage Water Wel I Ordinance TOTAL P.02 MUNICIPALITY OF ANCHORAGE • `� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # D Z- 2 41? - 3 S HAA # L= L L � ice' 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 7 > 2 7 J e w el LU he R Property owner i- /m l of he let - Mailing address P. C'• Ro K '9 1s' 2, /V hi , Lending agency ��^e Mailing address Agent No/7e -- A Arl roto Day phone k 9 9 G Day phone Day phone 7 76 -,9659 3S Unless otherwise requested, HAA will be held for pickup. Pleare ccc ll hu y�r. ITenn E f -h !-'�. �7'ohnsv� 2. NUMBER OF BEDROOMS: @ ZH3- ZZ&2 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1191) Front MOAN21 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 of this Health Authority Approval application 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 regulations in effect o,e The date �f tUi�inspection.k � `�, ryrfG�,s /9G�fc' eaJ,ry ex��7 Qom[ r6 ecyo�t rain Name of Firm F(affo,e e ,« Phone 3s— Address e I YS 30 EG%o rA, /tom+ ctio,-afP At< 99g" /0 Engineer's signature �� %�Zao , ` _ Date 3 / 2 z- / 9 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. X Conditional approval for _ 2 bedrooms, with the following stipulations: Money shall be put in escrow in the amount of 1.5 times the high bid of three bids to perform the necessary work on the subject water well as stated in the attached description dated March 22, 1999 paragraph 3 by the engineer. Additional Comments work_ sh-all be accomplished by no later than June 15. 1999. wTlc The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Pw 1 M) Back MOA Y21 RECE1Vhi Municipality of Anchorage MAR 2 2 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY QF ANCH 825 L Street, Room 502 • Anchorage, Alaska 99501 • (903nNY-KhSERVICES Health Authority Approval Checklist Legal Description: l vf- yOx moOa O /s en S' /1) Parcel I.D.: 0 f? – 2 Y 2=3 A. WELL DATA Well type Pr(v a fe _ If A, 13, or C, attach ADEC letter. ADEC water system number N. A _ Log presen (Y/N) S'ee S( -.e c h Date completed _ /9U ,_ Pres enFly Total depth a Yo' _ Cased to 2 'YO' Casing height (above ground) y 6 e 10 Sanitary seal (Y/N) }'e s— Wires properly protected CYYM) _ r"U `'/' F' P� 1'% 6/I,5' T,r �e moc;-',Aece FROM WELL LOG AT INSPECTION Date of test _=195 y Static water level /101 Well production 1 g.p.m. WATER SAMPLE RESULTS: 3 / /S^/ q �9 _ GinGc cau(cC no/ r'emow well seac1 ��ring well _f/C�:V 1-1-9(f -?+ g.p.m. Coliform O Cc,(/ /00 en,"' Nitrate 0. 66 ; / Other bacteria nt>ne on .3/ 19/99 Date of. sample: 3/ /6'/ 99 3 / 19 / 9 9 Collected by: (--(ce -73,ctin, cr, / Ser B. SEPTIC/HOLDING TANK DATA Date installed _L0 / 17 / 92 Tank size t OOC a/ Number of Compartments 2 Cleanouts (Y/N) Y Se[u er 17,,77 eaneru/ I.0 laeaI-ea ,nj.lcre e-e'o cpene P Foundation cleanout (Y/N) N A Depression (Y/N) N High water alarm (Y/N) _ N. A Date of Pumping 9/IS- 19e Pumper/laces C<rj' oor C. ABSORPTION FIELD DATA Date installed (v /? i % � _ Soil rating (g.p.d./W or ft2/bdrm) I90 o� _ System type Length HS�Width _ Gravel thickness below pipe 2••s ' _Total depth 9 _ Effective absorption area 3S1 �' Monitoring Tube present (Y/N) i Depression over field (Y/N) N Date of adequacy test 1/ L5" / 99 Results (Pass/Fail) _Pas For _„ -2 bedrooms Fluid depth in absorption field before test (in.); D Immediately after93/ gal. water added (in.): 2g Fluid depth 3. 87s" (ins) Minutes later:I? Absorption rate =__> > 1(0 _g.p.d. Peroxide treatment (past 12 months) (Y/N) None kn o cv n If yes, give date N - A 72-026 (Rev. 3/96)" D. LIFT STATION N• A. Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot I 0g, On adjacent lots > too ' Absorption field on lot 1),5" On adjacent lots > /Oo ' Public sewer main > 7S Public sewer manhole/cleanout > / O a Sewer /septic service line > 25 Lift station N - A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 1/0 Property line > 10 Absorption field S Water main/service line > 2-s" Surface water/drainage > rao' Wells on adjacent lots > /Oa ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 30, Building foundation So' Water main/service line > �5' Surface water > (00' Driveway, parking/vehicle storage area /00, Curtain drain Nona se ell-) Wells on adjacent lots 120 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name -7-4 eoe 2eb l=• >-tvc�� Date 3 / 2 2 l99 HAA Fee $ ao Waiver Fee $ Date of Payment J�2 ,L-2 Date of Payment Receipt Number !�` GP 5; Receipt Number 72-026 (Rev. 3/96)* o9e0'9ao6tfg0$O,$A�so CE . 3589 mbo* ,I ����7 m0000nn "��e•,q3 ��: are i L Uf ly OSrrtonc� Olsen S/b I/ e / ch c� f ct-, (Cvnl "�" r,? ctOl 6y c�cf— )n 19s`-/ i MMR -19-99 09:56 FROM --CTE ENVIRONMENTAL 5615301 CUE Environmental Services Inc. JAL Laboratory Division Chemi-au Ret. tt: Ghent Name: Prdjeci Name: Client Sample ID- Matr x_ PWSID Sample Remarks: 99.0966 Flattop Tom Svc. nla 1-4 Osmond Olsen SID Drinking Water 200 VV Potter Drive Anchorage, AK 995 8 Tel. (907) 562-2343 Fax, (907) 561-5301 T-455 P 01/02 M56 Client PON: nla Printed Date/Time: 3119/99 10:00 Collected Date/Time: 3115199 10:40 Received DaterTime: 3115199 14 00 Technical !director. Stephen Ede Released 9y: Z% Allowaole Prep Analysis Parameter Results POL units Memo Limas Date Date Irot Total Coliform (MF) 21 013 w/o call cov100 ml SM92228 3115199 KAP Nitrate 0 680 0.1 mg/1- EPA 300 100 3115199 SCt. MAR -21-99 19:51 FROM -CTE ENVIRONMENTAL 5615301 T-510 P 01/01 F-029 CT81E Environmental Services Inc. ZtL Laboratory Division .���ii.Iii►ori�r��wvva�uari�'.�+v�rrt�sr��.�.�.®�s®w®'ars� Drinking Water Analysis Report for Total GOUOIT HEAD I'VS7'RUC'770NS ON Re VERSE SIL1E BL'FOR£ COLLECTING muST BE COMPLETED BY 1FRSUPLIER PUBLIC WATER SYSTEM 1.0, N EPn] iq PRIVATE WATER SYSTEM G Send Rewln 0 send Invorcr it 4 4niol l ..r vau. my m . r ur,e trvnuc,nme xxm r l S3 0 (�o Send RerNlr, L7 Srnd Inlrotn ��- ---�— a,..cr iwnc SAMPLE DATE [� 41 ! 9 KE Month Day Year yAMPL£ TYPE Routine g Repeat Sample (for, routine •»m pIe Ntth tab rrl. no. C) Special Purpuse '5A)IFL i LOCATION Comments Q Treated Water lK Untre4ted Water Time Collected Collected By Yio.w Prue, 200 W Potter Drive 1 BaCterIa Anchorage, AK 99518.1505 Tel (907) 562-2343 SAMpie Fax (9071561.5301 TO BE COMPL BY L. -,BOR -,\TORY ,',nal�sts >hoa s this Vv ller S�MPL £ ro oe Satist:ioory 0 Unsatisfactory 0 Samplt over 30 hours old, results mar be unraliable 0 Sample too long to transit, sample Should not be over 4E hours old at examination to tndtcate reliable results. Pleasc send new sample via spec al d hvcry mall Date Received —4111 110-7 Time Received — Analysis Began E � 1 Analytical Method: ,Membrane Filter a ;MMO-MUG • Numberofcolontesi100m1 -- esult' Analyst SE3103I Fok> Jun Faxca Daly Time Client notified of unsatisfactory results: ❑ — C Phonon SpuKe with fxxea Date _ l.mr BACTERIOI.OGICAL WATER ANALYSIS RECORD "M0•MUG Result: Total Coli oral £- Cilli Memurane filter: Direct Cuunt (��,� Cctonre5rl00 ml verification: LTB BGa C0WFlRM Fccal Cuhform Contirmauvn ----- Final !vlcmnrane Filter Re>,ult5 Collfornu100 mi Reported Uy _pate Time _ 4 — hrs h rC - !.m :1.m.,o. � T. c w . . OB - 01A" dgiv"a Membar of Ino S G 6 Group ISocIot0 Gan0ra10 a SvnbIIIanca) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND MICHIGAN. MISSOURI. NEW JERSEY. OHIO. vvESr vIRGIN,A