HomeMy WebLinkAboutSTELIOES LT 4teli'*oes
Lot 4
#017-422-35
Municipality of Anchorage Page _L_ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
�Jinq+Z-2
Permit Number: PID Number:
Name �n
Wastewater System: New ❑ Upgrade
Address:
Iia .J . .
L�
ABSORPTION FIELD
Phone:
No. of edrocros:
eep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating: //�
Total Depth from originalgrad1
�- �TL
LJ• GPD/S . Ft.
Lot:/j
Block: Subdivision:.//
Depth to pipe bottom from original grad
Gravel depth beneath pipe
Township:
Range:
Section:
Fill added above original grade:
Gravel length: /
O r— 1 Ft.
I Ft.
WELL: —0 -New ❑ Upgrade
Gravel depth.-LAJ f r"
Number of lines:
Distance between lines:
I
Ft.
I (D Ft.
Classs�"i/a�ti7on (P/rival-er A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: IQ
+ lC,� �J t vi
Ft.
Ft.
DL./� SQ. Ft.
(, /
Driller:
Date Drilled:
Static Water Level:
taller:
Date installed:
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
eptic 7) Holding ❑S.T.E.P.
To
Septic
Absorption
Litt
Holding
Public/Private
Mapufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
6n
Well
'JI t
+UQ
-_
I
+
C
Maleria�
Number of Compartme ts:
Surfac
1I
lba1�
16Dv1-h
——�-
LIFT STATI N
Watee
—
Lot
,ma'I4 y (
f
�—
�
Size in gallons:
Manufacturer:
Line
Foundation"Pump
.i-IOIa!�
i�l
r�111
on" level at:
"Pump ' level at:
High water alarm at:
Curtain��
J
r f
Pump Make &Model
Ele Ical Inspections performed by:
Drain
Remarks: Aol,
BENCH MARK
Cb(�
Location and Description: i
Assumed Elevation: h
ENGINEER'S. SgAL
p Y £ s
�
7
0_1 a `.
ZJ'�� { I
Inspections performed by:6"� E� I���a t�-�?ates: 1st C� `
.. .... .... ... .....
2nd 0- 0A
.FER P.E. :*0!0
�'p RoBe J.8
Servic approval
Department of Hea=47,71A5�%ate:
��d sTF . •64y K5
la
PROFESSIOA
Reviewed and approved by: 1d "/®0®®®®®�®�
72-013 (1/91) MOA 25
i
Permit No. 'rJ1..L�101 �9
Page Z of *2,
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well•Inspection Report
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72-013 A(2/91) MOA 25
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72-013 A(2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL
PERMIT NUMBER:SW910199
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:CAMPBELL BRUCE A OR
OWNER ADDRESS:17034 EAGLE RIVER LOOP RD.
EAGLE RIVER, AK 99577
PARCEL ID:01742235
LEGAL DESCRIPTION: STELIOES LT 4
LOT SIZE: 37318 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
SYSTEM PERMIT Z4w S`'/*
5s5 E�
DATE ISSUED: 7/17/91
EXPIRATION DATE: 7/17/92
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED
ISSUED BY
DATE:
DATE: / /
Juey 14, 1991
ROBERT SHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694.2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS Mun%ei-patity o6 Anchorage
DEPARTMENT UP HEALTH AND HUMAN SERVICES
825 L Street
P.U. Box 196650
SEWER &WATER Anchorage, Atasha 99519-6650
MAIN EXTENSIONS
REFERENCE: Lot 4; S.teti-ou Subdivision;
PERMIT REQUEST NARRATIVE
SEWER & WATER yy�� pp�
INSPECTION Request you issue a permit to draie a weU and inStlu.c. a septic system
per. the. attached design dated Juey 14, 1991.
Two soie tests weAe per4onmed boa the or.ig.ina2 aseptic system site. In
ENGINEERING STUDIES addition soil tog and test bo,%ings were per6ormed by Huwit.t, V.
ANDREPORTS Loungbcuy and Associates 6or subdivision purposes on this particutaA
tot showing the soiZ6 to be consistent, there6ore a third test hole was
not excavated 6or the a lecnate site. It i6 our opinion that a test
hate in the a ternate site wooed not have provided any additionat
WELLINSPECTION
8 FLOW TEST in6ormation that was not provided with the ava%eabte soi es in6o4mati-on.
Test hate 01 reveated groundwater at 11 6t. a6ter. the monitoring
period. Even though test hate 02 showed a more permeabte sole the
system was designed based upon the water teveez and soils pe meabitity
SITE PLANS in test hote #1. This tot is eurrentey surrounded by undeveeoped
properties. Thene6ore, the siting o6 the wet and septic system on
this tot witt not have an ,impact on adjacent properties. There i6
adequate roam on each tot to tocate we22s and septics within a pattern
ROAD DESIGN consistent with the tocations e6tabt"hed on this tot.
16 we may be o6 6uAthec service or i6 you require additionae
in6ormation bar your review, ptease contact us.
SOILTEST
Sinc y,
PERCOLATION
TEST
gm
STRUCTURAL&
MECHANICAL
INSPECTIONS
A. SHAFER, P.E.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE � v
a
m
m
i
D
PERFORMED
LEGAL DESCRIPTION: L
(FEET)
2
0
3 // l
4-
5 5
6
7
8
c
9 Uc
10 `�1
U
16
17
18
19
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
8 1/ (Ole)
S7/14
C�-/V
co RBLc- -C
DATE PERFORMED:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
/
IF YES, AT WHAT LO
DEPTH? P
E
f
Depth to Waler Aller /� 7 /'
Monitoring? ` Date: / L�
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
2
:'F
l0
7yR
78r,
!O
Ir
S
ID
O
7 yt`
72-
� a"
/ zr.
20
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ` FT AND S FT
COMMENTS
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Z.,
PERFORMED FOR
LEGAL DESCRIPTI
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
8 7rb ,,
sA--I
j/10
7 -7'O M 095
Ho CSC
SLOPE SITE PLAN
u
WAS GROUND WATER ,7 Ji1
ENCOUNTERED? /y V
S
IF YES, AT WHAT '� OL
DEPTH? p
E
Depth to Water After
Monitoring? Date:
®=mmm
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND --;F— FT
PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND --;F— FT
PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
LOG OF TEST BOR/NG
m 1-ZB•1°i1$ Hole k&
completed \ 2@• 1914s Hewif! V. Lounsbury Associates sheet 1 of
ig No - Engineers — Surveyors _ Toro) Depth 13 FT.
,roject No 77- 056 .Anchorage, . Alosko - -
- G Nome STEL) OS -
Ground Water Tob/e
vocal/on L9T
'ethod used Swi'L"De Depth in FL
1 we Port/ Geologist W .ST Time
I, leather Dote
Scmp/Ing
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8
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F
DESCRIPTION Location Notes E Diagram: ••
So// type, colo/,le/tu/t, =1401
estimated particle sire, -
sampler er/ving notes, {
depths circulation /as/, 90.�'�._
notes on drilling ease, LTa
bits 'used, etc. SE clog. f060.
Vegetation:
CLEARED lAWA GoASi
O
2
3
4
5
7--
9--
9/D
/0--
GM
<ap
C
_
SAMPLE !11
MPLE 7--
15 J5
/6
17--
18
/9
nM J
_...� ..0 ...,,..,i .,.. MAP" w/14 -ID SIondard Pcnetratlon Jompre- cf:vm7 w""v.�• ....•• �•- -•-�•
1201 Ramona St. 99515 ANCHORAGEV AEAfSIKA
344-7714
SIX INCH WATER WELL DRILLED --------- OUT TO THE DEPTH OF 430 ft.
DRILLED AT THE RATE OF 23.00 PER FOOT. Steel casing seated to 26 feet.
PROPERTY OWNER Sallye Werner 347-054 (7841 Talisman Rd.)
LOCATION OF WELL
Stelioes L,t. 4 (Upper DeArmoun)
DRILLER Bernie Claus Of Rampart );rifling ',^forks.
OOT r 1991
WELL LOG: Municipality of Anchorage
0 - 16' Silty sandy gravel with 3056 clay binder. Dept. Health &Human Services
16 - 20' redrock. A broken weathered bedrock. Casing seated into very
hard sediaentary bedrock, at 26 feet.
26 - 43j' --ecrock. A sedi-metamorphic rock. Very little water yield in
the first 200 feet of drilling. Thin areas of fissures producing less than
1/2 grm. Several areas beyond 250 feet showed good potentiai & may break in
substantially with time. Good clean wet areas of porous rock from 26u to
293' snoula yield a great amount of water in years of heavy rainfa.ii.
Water production beyona 405 fett (406 - 416) made the difference between
a marginal Well & a good i±;jell. A steady production of 1,440 .'Pa (gallons
per day. 24 hours.) 60 gallons per hour. This tNell will pump, on draw down,
90 gph for a sort duration of about an hour, then hold steady at bu gph.
The area from 406 - 414' is a porous bedrock material. (bhle would have li4ed
to have seen a greater yield, however, if needed, this Gell can be deepened
in the future.) "nater recovery is back up to 60 feet of surface in 12 hours
rest time from 100/ drawdown. One horse submersible pump should be installed
10 to 17 feet off bottom.
Total cost of Well with a 30 -foot discount has been paid in full by Sallye
Werner.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
-
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF --------------
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WO S
DATE August 15, 1991
SERVICE CHARGE OF 1V2% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
N��
" - •
-
g
/�
LUGU!' !t J! l7 Ur" L, _ A -
Hole NO. T
,Dole Begun1-
29.19,
It
V. Lounsbury f Associa/
h.o< of —
Date
\ • 28. B 18
f
F'bmpleled
"
Engineers — Surveyors
- Total Death
Big Na
Project No
77- O9(6 __
Anchorage, . Alas-ka
FIWt tame
S-rCLA OS SUg
%.41110nj
Ground ;eater Table
Location
T 4'
Depth in Ft
bfethod Used
ga-N0�
Time
Geologist W JT
Field Party
_
Dote
Weather
Scmp//ng
C
G v
O
o
e
i h
4 o
/2 B P
DEscR/P r1 oN
Sol/ type, co/or, texture,
estimated particle size,
sampler driving notes,
depths circulation lost,
notes on drilling ease,
bits used, etc.
Location !totes f Diagram:
N ± 90. -
triq
Se r;olt.
Wn10 , 4PAS
k _l
40 /b. ham
Un/ess olMnvise noted a// sump/es ore lcken w//.4 %O Standard Pcnetrotian Samptei driven ;✓/1mers 3D diop- j
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-422-35 COSA# i)SC 1016Q,?
1. GENERAL INFORMATION Expiration Date: R - 1-7—M
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
STELIOES LOT 4
12731 CARDINAL CIRCLE 'ANCHORAGE. AK 99516
SALLYE WERNER Day phone 345-6354
12731 CARDINAL CIRCLE *ANCHORAGE, AK 99516
Day phone
JUDY ROSENBERG W/ PRUDENTIAL Day phone 229-1097
3801 CENTERPOINT DR. #200 *ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
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 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 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 ofAnchorage 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
Address 3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
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 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lost 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 warranty or tuture 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 ownerlisted 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
Approved for bedrooms.
Disapproved.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory I/
Nitrate Advisory
Phone 337-6179
Date O
bedrooms, with the Illowing stipulations:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
idly
ON-SITE
WATER AND •:
WASTEWATER
PROGRAM
By: • Original Certificate Date:/7—/0
(Rm I V05)
\\ 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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: STELIOES LOT 4 Parcel ID: 017-422-35
A. WELL DATA *CASED TO BEDROCK
Well type PRNATE If A. B, or C provide PWSID# N/A Well Log (YIN) YES
Date completed 9/15/91 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 430 ft. Cased to ►26 � ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 9/15/91 4/20/10
Static water level UNK ft. 23 ft.
Well production 1.0 g.p.m.. - --- - ... 0.66 g.p,m,
WATER SAMPLE RESULTS:
ID.I t2 -S
Coliformcolonies/100 mf. Nitrate g./L. Other bacteria colonies/100 ml.
Arsenic: <5.0 ug./L. Date of sample: 4/7/2010 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA 41zl IZot O
Tank Type/Material SEPTIC/STEEL Date installed 8/5-6/1991
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 4/21/10 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA ow EXISTING GRADE NORTH/SOUTH
Date installed 8/5-6/1991 Soil rating (g.p.d./ft'o /bd 0_6 System type TRENCH
Length 71+55 =126 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth•7.67/•7.67 ft. Eff. absorption area 1006 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test "4/20/10 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before lest DRY in. Water added 600 gal. New depth 8 in.
Elapsed Time: 195 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date -
*"SOUTH TRENCH TESTED ONLY.
NORTH TRENCH WAS VISUALLY INSPECTED AND HAD ' 13" OF
LIQUID AT THE BOTTOM.
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/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent tots 100'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 59+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 100+ 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 100+ 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 COSA guidelines in effect on this
date.
Engineers Printed Name JEFFREY A. GARNESS
Date 5k -ho
1J .tu-
COSA Fee $ / 7O
Date of Payment 5/5 I O
Receipt Number 0 ? U
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
• Development Services Department
Building Safety Division `
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Nater Well Advisory
Certificate of On -Site Systems Approval (COSA) # 101022
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 4 of Stelioes subdivision, the well's
productivity was determined to be 0.66 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 4 -bedroom
residence is 0.41 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
• Development Services Department
/ Building Safety Division
a sar♦
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 # 101022
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 Stelioes subdivision. This inspection revealed a nitrate concentration of
12.5 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.
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
12731 Cardinal Circle
4/20/2010
The well camera was ran down 100'. The casing ended at 21'8" with no perforations or incoming
water. We did find a fracture at 38' that was bringing in some water.
Brian R. Wille
Aarow Pump & Well Service
�
S�r
SCS ReEO
1101698001
Client Name
Garness Engineering Group, Ltd
Project Name/N
12731 Cardinal Place
Client Sample ID
Outside Faucet
Matrix
Drinking Water
Sample Remarks:
Printed Date/time
Collected Date/fime
Received Date/time
Technical Director
04/30/2010 8:54
04232010 9:05
04232010 9:48
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Mcawd Container ID Limits Date Date [nit
Waters Department
Total NitratcMitrite-N 10.1 • 0.100 m8/L SM204500NO3-F D (<10) 0427/10 AYC
Microbiology Laboratory
Colony Count 0
Fecal Coliform 0
Total Coliform 0
cal/100ml- SM209222D
col/100ml- SM209222D
col/100mL SM209222B
A (<200)
A (<I)
A (<I)
0423/10 DLC
0423/10 DLC
0423/10 DLC
SGS ReEN
1101450001
mg/L
Client Name
Garncss Engineering Group, Ltd
Printed Date/Time
Project Name/#
Stelios Lot 4
Collected Date/Time
Client Sample ID
Stelios Lot 4
Received Date/Time
Matrix
Drinking Water
Technical Director
Sample Remarks:
04/132010 13:56
04/072010 14:15
04/082010 8:00
Stephen C. Ede
Allowable Prep Analysis
Pvamctcr Results LOQ Units Medved Container ID Limits Date Date Init
Metals by SCP/HS
I lardness as CaCO3
Waters Department
Total Nitrate/Nitritc-N
Private Individual Analvsis
Aluminum
Antimony
Arsenic
Barium
Cadmium
Calcium
Chromium
Copper
Imn
Lead
Magnesium
Manganese
Chloride
Fluoride
Selenium
Sodium
Silver
Thallium
Sulfate
Zinc
295
5.00
mg/L
SM202340B
C
04/09/10 04/12/10
SCL
12.5
0.100
mg/L
SM204500NO3-F
B
04/09/10
AYC
20.0 U
20.0
ug/L
EP200.8
C
04/09/10 04/12/10
SCL
1.00 U
1.00
ug/L
EP200.8
C
(<6)
04/09/10 04/12/10
SCL
5.00 U
5.00
ug/L
EP200.8
C
(<10)
04/09/10 04/12/10
SCL
82.3
3.00
ug/L
EP200.8
C
(<2000)
04/09/10 04/12/10
SCL
0.500 U
0.500
ug/L
EP200.8
C
(<5)
04/09/10 04/12/10
SCL
91700
500
ug/L
EP200.8
C
04/09/10 04/12/10
SCL
2.00 U
2.00
ug/L
EP200.8
C
(<100)
04/09/10 04/12/10
SCL
298
1.00
ug/L
EP200.8
C
(<1300)
04/09/10 04/12/10
SCL
250 U
250
ug/L
EP200.8
C
(<300)
04/09/10 04/12/10
SCL
1.42
0.200
ug/L
EP200.8
C
(<15)
04/09/10 04/12/10
SCL
16100
50.0
ug/L
EP200.8
C
04/09/10 04/12/10
SCL
6.19
1.00
ug/L
EP200.8
C
(<50)
04/09/10 04/12/10
SCL
127
1.00
mg/L
EPA 300.0
D
(<250)
04/09/10 04/09/10
RJT
0.100 U
0.100
mg/L
EPA 300.0
D
(<2)
04/09/10 04/09/10
RJT
5.00 U
5.00
ug/L
EP200.8
C
(<50)
04/09/10 04/12/10
SCL
92100
500
ug/L
EP200.8
C
(<250000)
04/09/10 04/12/10
SCL
1.00 U
1.00
ug/L
EP200.8
C
(<I00)
04/09/10 04/12/10
SCL
1.00 U
1.00
ug/L
EP200.8
C
(Q)
04/09/10 04/12/10
SCL
37.9
0.100
mg/L
EPA 300.0
D
(<250)
04/09/10 04.'09/10
RJT
2990
25.0
ug/L
EP200.8
C
(<5000)
04/09/10 04/12/10
SCL
SGS Ret#
1101450001
Client lame
Gamess Engineering Group, Ltd
Project lame/#
Stelios Lot 4
Client Sample ID
Stelios Lot 4
Matrix
Drinking Wetcr
Printed Datelfline
Collected Date/time
Received Datelfime
Technical Director
04/132010 13:56
04/072010 14:15
04/082010 8:00
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Private Individual Analvain
Total Dissolved Solids
550
Nickel
6.21
I ICO3 Alkalinity
213
CO3 Alkalinity
10.0 U
Oil Alkalinity
10.0 U
Conductivity
959
pit
7.70
Alkalinity
213
Colony Count
TNTC
Total Coliform
Invalid
Fecal Colirorm
Invalid
• 10.0
mg/L
SN1202540C
D
(<500)
04/09/10
AYC
2.00
ug/L
EP200.8
C
(<100)
04/09/10 04/12/10
SCL
10.0
mg/L
Sh120 23206
D
04/08/10
RJT
10.0
mg/L
SM20 23206
D
04/08/10
RJT
10.0
mg/L
Sht202320B
D
04/08/10
RJT
I.00
umhos/cm
Sh120 25IOD
D
04/08/10
RJT
0.100
plI units
SM20 4500.11 D
D
(6.5.8.5)
04/08/10
RJT
10.0
mg/L
S%120 2320B
D
04/08/10
RJT
col/100mL
SM20 92226
A
04/08/10
DLC
co1/I00mL
SM20 9222B
A
(<I)
04/08/10
DLC
col/IOOmL
Sh120 9222D
A
04/08/10
DLC
04/22/2010 06:10 8686770
APLUS
A+ HOME SERVICES , INC.
CUSTOMER
Block
7501 E. 140th Avenue
Anchorage, Alaska 99516
345-1890
12731 Cardinal Circle
Anchorage, AK 99516
1
PAGE 01
INVOICE# •37827
DATE
DESCRIPTION
AMOUNT
04-21-10
$15300
::. AW WU's "2009" raft increase ' 4:m M" : 8'y
'Next Scheduled increase Aug. 80;2010'*:345-6334
-" os
t j
TOTAL
P
RE(fiIARKS "•' 4';
/agGallons Septic Leach Area Holding Tank Z
❑ PROBLEM AREA— CALL FOR MORE INFORMATION
❑ NEEDS TO BE DONE AGAIN IN B MONTHS
R Good Shape ❑ Sludge buildup on bottom
❑ Jim cap missing or ❑ Cut standpipe to 1' above ground
needs replacing
Standpipes .5-0Time
❑ Floater on top
❑ Needs Septictrine
A -z,6
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
Parcell.D.# ��-1 ����- �5 HAA#
1. GENERAL INFORMATION
Complete legal description Lot 4; S.te2i,oea
Location (site address or directions) Candinat CitLete (fonme4ty SteZioa C.i&cte)
Property owner SaUye-WeAneaDay phone 345-6354 (h)
349-1561 (w)
Mailing address 12731 Cah.dinat CiAete Anchorage, AK 99516
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: _
Individual well XXX
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 XXX
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(11ev.1191) Front MOA#21
i
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 on the date of this inspection.
Name of Firm
S & S ENGINEERING ,.-:omw Phone e� % �_Z92e
—
Address Eagle River,
Engineer's signature
Date
acF2 A.:tAlmkv
6. DHHS SIGNATURE
X Approved for 6011n (�4 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
0
1l1TIC
Date
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 engineers work.
5.,.Y 4r6E 3
'7
rie.:
acF2 A.:tAlmkv
6. DHHS SIGNATURE
X Approved for 6011n (�4 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
0
1l1TIC
Date
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 engineers work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Loj ¢ S2-UoES yV Parcel I.D.
A. Well Data
Well typeZ (U A79 If A, B, or C, attach ADEC letter. ADEC water system number
0
/t//A
Log prese (Y/) Date completed O /S / Driller K A✓1,1P91ZE 1)'t-(LL(N(l W044S
Total depth
Cased to
2 Casing height
Sanitary sea&)
Wires properly protected69N)
y�5
FROM WELL LOG
AT INSPECTION
m
l S /I
l %3
c
Date of test
/
(3ELor1 G2o��» �AlAc` Z3
rrn$
o
Static water level
f
Well flow
. (�
g.p.m. Z % G%�/f
g per—
Cn
p o
U K
L//
r
`g
C Z
Pump levell
rttrV
w
N =
o 0
SEPARATION DISTANCES
FROM WELL TO:
Septic/4e"tank on lot
/
/o
; On adjacent lots
f
Absorption field on lot
� Q��
; On adjacent lots 100r
74 -
Public sewer main
Public
/f
Public sewer manhole/cleanout
Sewer service line ZS
Petroleum tank
KNo�J tJ
WATER SAMPLE RESULTS:
Coliform
Coliform d Zw00 /vheq Nitrate Z S d Other bacteria X-01c-ic
Date of sample: l I Z� C 3 Collected by:
B. SEPTIC/H06119I IGTANK DATA
Date installed 46 / 2 ( Tank size Compartments Z
Cleanouts Y%) '(6S Foundation cleanou Y/ 1) �S Depression (Y6 Jo
High water alarm Alarm tested (Y/N) /VA -
Date of pumping __Jr— 913 Pumper
SEPARATION DISTANCES FROM SEPTIC/HetOff4Q-TANK TO:
Well(s) on lot On adjacent lots
/Uy / _�__ Foundation 3�rfi
I
To property line Absorption field �� / Water main/service line /C)
Surface water/drainage
72-026(3/93)'Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Manufacturer
Manhole/Access (Y/N)
"Pump on" level at
Meets MOA electrical codes (Y/N)
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
Date installed
On adjacent lots
off" Level at
Surface water
(v G% Soil rating (GPD/Ft2) Oe (� System type %2E/.1CHES C2
Length lZ6 rT67_,11t_ Width r7 /
Gravel thickness Total depth
Total absorption area Za2 Cleanout preseri!�( >) Y CS Depressio/nn over field (YdI Na
Date of adequacy test �/ �� Results ass ail) AA S S for � U � Bedrooms
T //
Water level in absorption field before test (0;¢ After test 8
Peroxide treatment (past 12 months) (Y/N) ti°NL�_ K/J)0(J/_) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /O S / On adjacent lots 400 /f Property line
To building foundation '30 To existing or abandoned system on lot AJ6,uC Piz�s�rT—
On adjacent lots �O rf Cutbank 403-06-p/7-fSV-fTWater main/service line ZS
Surface water Ci0 r_1�
Driveway, parking/vehicle storage area
Curtain drain Ub.c/� 1�1-ESC�N
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect or,.the, data.: f this inspection.
s
J%
Z �7
14
Signature "
Engineer's Na EN ERING
17034 Eagle River Loop Road No.:2r44
DateEagle River,
J
x ;r.
HAA Fee $ J100 e14-� Waiver Fee $
Date of Payment Oz,—/S-- �3 G� 7 Date of Payment
Receipt Number 9,�_) 7l G / Receipt Number
72026 (3/93)' Back
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
SINCE 1908
Chemlab Ref.# :93.4560-1
Client Sample ID :L4 STELIOES S/D
Matrix :WATER
Client Name :S & S ENGINEERING
Ordered By :R. SHAFER
Project Name
Project#
PWSID :UA
REPORT of ANALYSIS
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S.
Parameter
Nitrate -N
5633 B STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
WORK Order :70432
Report Completed :09/08/93
Collected :09/02/93 @ 10:04 hrs.
Received :09/02/93 @ 12:00 hrs.
Technical Director:STPHEW C. EDE
Released By : / ' —'
QC Allowable Ext. Anal
Results Qual Units Method Limits Date Date Init
2.95 mg/L EPA 353.2/300.0 10 09/07 LLH
-------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
10VISGS Member of the SGS Group (Societe Generale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA