HomeMy WebLinkAboutDORA LT 2 )OI"Q
Lot 2
#014-251-17
F'ERMIT N0.
[,EPFIF.'TMEI'.,!~ ..... HEFIL. TH RND EIq'v' IRC N. hlENTFIL 'C TECT I 0N
:325 '"L'" :~iTREET., RNC:HORFIGE.~ FIK. 9950:t
264-4720
,:: 828327 ::,
I-RF"PL I CFINT GRR"r' J'. MELLOTT
LOC:RTION ;3200 E. 84TFt. ST.
L. EGRL LOT 2 E:,OF.:R SUB
±74i--.M SF.':R
LOT SIZE
272-:1.2:52:
6000 S6!URRE F'EET
h'iINIh'IUM DtSTRNC:E 8ETI.4EEN R I.,.IEL. L FIND FIf-,l'¢ ON-SITE SEWRGE DISPOSFIL S"r'STEht IS
:.t00 FEET F'OF.'. FI PF.:ZVFITE NELL OR :1.50 "FO 200 FEET FROP1 FI F'UBLIC WEL. L E:'EPENE:'tNG
UPON THE ]"¢F'E OF PUBLIC WELL.
hllNIMUM DISTFINC:E FROM R PRIVFI"FE HELL TO FI PRIVFITE SEI.4ER LINE tS 25 FEET RN[:'
'TO FI COP1MUNIT',? SEWER LINE IS 75 FEET.
14EL. L LOGS FIRE RE6!LIIRED FIND MUST BE RETURNED TO 'THE DEPRRTMENT 1.4ITHIN :2:0 [:,FI'CS
OF 'THE 1.4ELL COMPLETION.
OTHER RE6!UIREP1ENTS MFI'¢ FIF'PL¥. L=;PEC!FICRTIONS RN[.', CONSTRUCTION DIRGRFIhlS RRE
FIVFIILRBLE TO INSURE PROPER INSTFtLLFITION.
F' E: R I"'~ I T' E: >-~-: F' I F..: EC S-~, I::, E: C: E P'I E: E F.'.; ~: J_., ::L :.-'.~ C~; iZ
I CERTIF'¢ THFI'F
i: I FIb1 FFIMILIRR WITH THE RE(;!LIIREMENTS FOR ON-SITE SEI.qEF.:S F~ND WELLS FIS SET
FORTH BY THE MUNICIPFILIT¥ OF RNCHORFI('~E.
2: I WILL INSTRLL THE S'¢STEM IN RCCORDFINCE IqITH THE CO[:,ES.
V4. 0
~UN1CIPAUTY OF ANCHORAGe:
~,~T Cc ,.,~'~T'.l ~.
RECEIVED
TIm~ rime
?
Date ~- Date Date
Inspector Inspector ' Inspector
Comments . ~ Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
~ Holding Tank Size
SOils Rating Well ~'o Absorption Area ' Well Log Recetved
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY ~ ·
UalllngAddress /~"¢//"'/u7 .y/?_ ~"/ ,~l'/t.., ~/~ ~"~ 5"~, 7'
Buyer ,~/C.,*'~,. ~---/flo~,/~V'/~ d'
Address
Lending Institution ~/,?/¢'~1 ~ c,, e~t,,/~, Phone
Address
' ' 'Phone ....
Realty Co. & Agent ' -~.
Address .' ...
Street Location z./~/-/ .~.~- . '
Type_o. f Residence
l~ Single Family
[] Multiple Family No. of BedroOms
[] Other . , ·
Water, Supply -
~ Ind]vldual ' ATTACH WELL LOG. A well log Is required for all wells drilled since June
[] Community 1975. For wells drilled prior to that date, give well depth (attach log If
[] .Public Utility , available.)
Sewag~ Disposal
[] Individual Year Individual Installed:
~. Public Utility When Connected to Public Utility;
[] Holding Tank ' ~-,~i~
~ NOTE: THE' INSPECTION FEE ~ST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
CHEMICAL
_JGICAL LABORATORIES ,_ .4LASKA, INC.
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
TELEPHONE (907)-279.4014
274-3364
Drinking Water Analysis Report for Total ColifOrm Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Water System Name Phone No.
Mailing Address
City State Zip Code
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
) [] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
Time Collected
Collected .. By
TO .BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
mew sample.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
[]'"Membrane Filter
Lab Ref. NO. Result* Analyst
I
*No. of colonies/100 mi or No, of Posture portions
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date CollectecI Source
Data Received Time Recelve~ p.m. Lab. No,
Presumptive 10mi 10mi 1Omi 10mi 10mi 1.Omi 0.1mi
24 Hours
48 Hours
Confirmatory .
24 Hours
,46 Hours
EMB Broth 24 hours: Broth 48 houri:
Multiple Tuba Report: :10ml Tubes Positive/Total 10mi Portions
Membrane Filter: Direct Count Collform/100ml
Verification: ITB BGB
Final Membrane Filter Results Colllorm/100ml
Reported By , ~' ; , Date
Time:. , , , a.m.
10.m,
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
CERTIFICATE
FOR A
4700 Braoaw Street
Anchorage, AK 99519-6650'
www.muni.org/onsite ,_~ ....... ) ~/,~/,~.
(907) 343-7904
OF 0r,I-SITE SYSTEMS APPROVAL
SINGLE FAMILY DWELLING
Parcel I.D. 014-251-17
1. GENERAL INFORMATION
COSA# 0 S
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
M. ail!'ngaddress
DORA LOT 2
3220 EAST 84TH AVENUE *ANCHORAGE~ AK 99507
MARC LICKINGTELLER Day phone .360-1942
*ANCHORAGEt AK 99507
Day phone
3220 EAST 84TH AVENUE
Day phone
Unless otherwise re/quested, COSA will be held by DSD for pickup.
2. NUMBER OFBEDROOMS: 3
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 professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal aNxed hereto and as of
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.
Phone 557-6179
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 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.
DSD SIGNATURE
Y'"'~ Approved for
bedrooms.
Disapproved.
Conditional approval for
\
ON.SiTE
¢ WATER AND
_ . STEWAT
*, PROGRAM .
bedrooms, with the following sb ulat~ons-~_~..,<~,~ o "~
P -~2 ~, ' - · - . . ' ' ~_~.~
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
~': ..... Advisory
(Rev, 11/05)
Arsenic Advisory.
Maintenance Agreements
Supplemental. Engineer's Report
Other
,~Y~~, Original Certificate Date:
Of
B A.~-ROVAL' .C H ECKL.IST
P.:~cel I0:. '0'1 4='251.- 17
.ENG;~,EERI'NG ,TEST,". 6/7/0;?.
.219 ft.
g.p.m.
YES
JRt.
:D~ ef samplei, 1 t:/f,9/10,
" PUBUC .S£-:W, EiR
Datei.,aslalled
· .GEG' Lf, d.
:ft, :Eft:
S:ystem. :'t~
__ ft '. Moaiton~g tabe : !D~~ over fie~
R, eSUl~S"(pass~fe'~l): ':Fo]' ,..be(~roems
i;",,.' L ~ ,
__ in'. Wat~¢ added. 'gal: ,, ,New (Jepth,'. ' in.
g;p.d.
I,f yes~, g~Ve,date.
D. t. IFT S~A~N
'E. S~ARATK~' DIST,~
Septic tank.~ft Stab'on 'on lot
Pubtic sewer *main 75'+
25'+
Sewer. /septic ,service. tine .
Animai:'COr~inrnent'afeasL 50'+
Building foundation
On adjacent ,lots
On adjaCent 10ts
PubriC'seWer manhete/cle:anoUt
HOldir~g tank
Manure/a~imal excr~, stor. ~age-areas
P~C. SEWER
Pmpe~ line r Abserption.~e~d'~
1.00~+
F. i'C~N ~TS
En~eer's 'Pfi.nted,'Na~. e
,~E~E"Y A. GARNESS
Da{e
COSA Fee
-'Da~e.ef Parrot',
Receipt Number
(Rew 11/05)
Waiver Fee $
Date .of Payme~
Receipt NUmber
SGS_
SGS Ref.# 1106101001
Client Name Garness Engineering Group, Ltd Printed Date/Time 11/12/2010 16:49
Project Name/# Dora Lot 2 Collected Date/Time 11/09/2010 15:00
Client Sample ID Dora Lot 2 Received Date/Time 11/09/2010 15:20
Matrix Drinking Water Technical Director Stephen Co Ede
Saml~le Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 8.32 5.00 ug/L EP200.8 C (<10) 11/10/10 11/12/10 NRB
Waters Department
Total Nitrate/Nitrite-N ND 0.I 00 mg/L SM20 4500NO3-F B ('<10) 11/1 I/10 AYC
Microbiology Laboratory
E~ Coli Nelzative I 100mL SM20 9223B A 11/09/10 DLC
Total Coliform Negative 1 100mL SM20 9223B A 11/09/10 DLC
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.muni, org/onsite
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORI'rY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-251-17
1. GENERAL INFORMATION
. Complete legal description Dora S/D, Lot 2
Location (site address or directions) ,3220 East 84th Ave., Anchorage
· HAA # ~5C~ I '-iq
Expiration Date: '~_ ~ cj . 43 ~
Current Property owner(s) Jamey & Dayna Durr Day phone
Mailing address 3220 E, 84th Ave. Anchorage, AK 99507
Lending agency
Mailing address
Day phone.
Real Estate Agent
Mailing Address
Cody Gibson
Prudential Real Estate
Day phone 273-7272
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 3 ·
3. TYPE OF WATER SUPPLY:
· Individual Well
Individual Water Storage
Community Class - Wet[
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Indiv!dual On-site
Individual Holding tank ~
I-I Community On-site r-I
· [] Public Sewer []
The Municipality of Anchorage Development Sen'ices 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 am required for the transfer of
title (except between spouses) for properties sewed 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 pmporties sewed by a pdvate or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a pedod 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
Munidpality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
. 4. STATEMENT OF INSPECTION BY ENGINEER
As co,lifted 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(am) safe, functional and adequate for the number of
bedrooms and type of structure indicated heroin. 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(am) In compliance with all applicable Municipal and State cedes, ordinances,
and regulations in effect at the time of Installation.
Name of Firm Watkins Engineering. Inc.
Address P.O. Box 110443. Anchorage, AK 99511-0443
Engineer's Printed Name CindyW. Elas
5. DSD SIGNATURE
. ~ Approved for ~
Disapproved.
Conditional approval for
b~dRDoms.
Phone 349-1851
Date
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: Z/Z .- ~ ~ - 0 ~
Municipality of Anchorage
Development Services Department
Bulkling Safety Division
On-Site Water & Wastewater Program
4700 South 6ragaw St,
P.O. Box lg66,50 Anchorage, AK 99519..6650
www. murd.org/onslte
(~07) 343-70O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal DescflplJon: Dom Lal 2
A. WELL DATA
Well type Pti
Data completed
Total depU1 70
IfA, B, orC plovffie PWSID # -
Sanitary seal (Y/N) ,Y
Cased to 7O lt.
Date of teat
Static water level
Well pmcluctinn
WATER 8AMPLE RESULTS:
Coliform 0 colonlas/100 mi.
'' Arsenic: NA
B. SEPTIC/HOLDING TANK DATA
Tank T~e/Materlal ICA
Tank size __ gal.
Foundation cleanout (Y/N)
Date of pumping
C. ABEORPllON FIELD DATA
Data installed NA
Length
Total depth ff.
Date of adequacy test
FROM WELL LOG
7/10/81
NA It.
10 g.p.m.
Nitrate ,~:1 mgJI.
Date of sample:
Nun~er of Compartments
Depmssinn over tank (Y/N)
Pumper
3,4
Soil rating (g.p.d,,dt~ or~radrm)
Eft. absoq~tion ama
R~u~ ~a~a~
Parcel ID: 014-251-17
Well Log (Y/N) Y
Wires pmpen~ protected (y/N) Y
Casing height (abeve ground) t8
AT INSPECTION
31 It.
g.p.m.
Fluid depth in absorption field before lest in.
Elapsed Time: min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (y/N & type)
Other bacteria 4
collected by: C. Ellis
Date installed
Cteanouta (Y/N)
High water alarm (y/N)
System type
Gravel below pipe
Depression over field
Water added gal.
in. Absorption rate >~
If yes, give date
in.
colonies/100 mi.
For bedrooms
New depth in.
g.p.d.
D. UFT STATION
Dat~ Install~l N~
'Pump on' level at in,
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump o~ level at
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lilt station on lot .NA
Absorption field on lot NA
Public sewer main 96
Sewer/septic sen/ice line .40
in.
Manhole/Access (Y/N)
High water alarm level at.
Meet~ alarm & cimutt requirements?
in.
On adjacent lots NA
On adjacent lots NA
Public sewer manhole/cleanout 100+
Holding tank NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation NA property line At~orptlon field
Water main Water sewice line Surface water
Curtain drain
F. COMMENTS
Wells on adjacent lets.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line NA Building foundation Water main
Water Service line Surface water
&,'Veils on adjacent lots.
Connected to AWWU sewer.
G. ENGINEER'~ CERTIFICATION
I certify that I have determined through ~eld inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's printed Name Cindy W. Ellis
Date _ 4-* -~..~.~.
Driveway, perkingNehicte storage
HAA Fee $ /-~'~ ' 4~
Date of Payment ~/~ ~/~-.~'
Receipt Nu~er ~ ~
(Rev. 1~)
Waiver Fee $
Date of Payment
Receipt Number
S Ref~
ent Name
oject Name/#
ent Sample JD
1051922001
Watkins Eng|neering
Do~ S/D Lot 2
Dora S/D Lot 2
DrinkinR Water
All Dates/Times ore Alaska Standard Time
Printed Dale/Time 04/26/2005 14:22
Collected Date/rime 04/14/2005 12:30
Reeeived Date/Time 04/14/2005 13'.23
Technkal Director Stephen C.
opic Remadc$:
Units
0.100 U 0.100 mg/L EPA 300.0
C0mair~t ID Limits D~e D~e
Init
B (<-I0) 04/14/0~; XM
crob4olo(~, X. aboz'a boz-'V.
total Coliform
4 OB, No Coli
col/lOOmL SM20 9ZZ2B
00626 0.0400 mg/L EP200.7
0.00480 0.00-100 mr,/L EP200.9
A (<-I) 04/14/05 TLF
C (<-1.3) 04/15/05 04/21/~5 BAG
C /<-0.015) 04/15/05 0.1Il&'05 BLA
Developme.nt. Serv,ce.s. Department,//
www.ci.anchorage.ak.us . ,~t ~-"~
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-251-17
Expiration Date: ~'- ~ ~ - (~ ~
1, GENERAL INFORMATION
Completelegaldescription T,ot, 2, Dora SuhdivfLsion
Location (site address or directions) 3220 E. 84th Aveo Anchorage, Alaska
Current Property owner(s) Tim Miller
Mailing address 8210 ]]art, sell Road.
Lending agency
99507
Dayphone(90?) 349-9450
Anchorage, Ak 99507
Day phone
Mailing address
Real Estate Agent Terri Davis
Mailing Address Next Home Real Estate
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
Dayphone(90?) 727-5130
3400 Spenard ~5
Anchorage, Ak 99~03
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
[]
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank . []
Community On-site .. ''/' []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authcrity
Approval (HAA) based only upon the representations given in paragraph 5 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 Class C well and may be reissued with
new water sample results less than 30 days old. (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 Anchcrage is not responsible for e,,Tors 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 instaltation.
NameofFirm Pinard Engineering
Address PO Box 8713&7 Wasilla,
Engineer's Pdnted Name Paul E. Pinard'
DSD SIGNATURE
~/ Approved for
Disapproved.
Phone (907) 357-3647
Alaska 99687
Date
C.o.~ditional approval for
bedrooms, with the following stipulations:.
Additional Comments
:/'7"/77);) ~))))P~
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date: ~c - ~- ~ ' 0 ''~
Municipality of Anchorage
Development Services Department
Bulldln0 Safety Division
On-Slta Water & Waste~rater Program
4700 Sou~ Bregaw St.
P.O. Box 196650 Ancherage,'AK gg519-6650
www.d.anchomge.ak.us
(gOD 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desoription:
A. WELL DATA
Well type Pvt,.
Date completed .7/1 0/81
Total depth .70 ff.
Lot 2~ Dora Subd~vieion
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 oolonies/100 mi.
Date of sample: 6/?/02 &
6/17/02
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size __ gal.
Foundation cteanout (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length
Total depth __ ft.
Date of adequacy test
Parcel ID: 01/~-251-17
Fluid depth in absorption field before test in.
Elapsed Time: min. Final fluid depth
Any rejuvenation b'eatment (past 12 mo.) (YIN & type)
If A, B, or C provide PWSID # Well Leg (Y/N) ·
SanltaP/seal (Y/N) ~' Wires properly protected (Y/N) ·
Cased to .70 ft. Casing height (above ground) 1'7
FROM WELL LOG AT INSPECTION
7/10/81 6/9/02
55 ft. ;~1.2 ft.
10 , g.p,m. 5 · 2 g.p.m,
NitrateO,2Olrng.~. Otherbacte~ .
Coltected~: Ptnard Engineering
N/& - Public Se~er
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
System type
Gravel below pipe
__ Depression over field
gal.
Absorption rate >=
If yes, give date
~1- colonies/100 mi.
Number of Compa~ments
Depression over tank (Y/N)
Pumper
~i/& - Public Set~er
Soil rating (g.p.dJ~ or ft2fodrm)
Width ft.
Eft. absoq~don area ~ Monitoring tube
Results (Pass/Fail).
Water added
in.
For bedrooms
New depth in.
g.p.d.
O. LIFT ~'FATION
Date installed
'Pump on" level at
Datum
E. SEPARATION DISTANCES
li/A - Public 8ewez-
Size in gallons
in. 'Pump off' level at
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ~I'/A
Absorption field on lot ' I~/fA
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & ctrct~ requirements?
On adjacent lots B/A
On adjacent lots E/A
Public sewer main ~0 t Public sewer manhole/ctsanout . 1 O0 t +
Sewer/septic se~ce line ~ t Holding tank ]~/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I~/A - ]~tb:].:].o Rewez,
Building foundation Property line
Water main Water service line
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation
Water Service line Sun<ace water
Curtain drain' Wells on adjacent lots
F. COMMENTS
Absorption field
Sudace water
lli/~ - l~blio Sewer
Water main
Driveway, paddng/vehlcle storage
t'luehed & re-eaap~Led. Eeeulte showed ~ OB
HAA Fee $ '~ "~ ~"~'
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
CT&E Environmental Sewices
Labmltory uwmon ~,....~---~,~---~--, ....
SAMPLE DATE: Month
SAMPLE TYPE:
~1~ Rantlne
n Repeat Sample (for routine sampk
wHh lab ~f. no. . )
SAMPLE L~ATION
Day yee~
Treated W'ter
Un.eared ~;nter - I~te: _ Time:
CHeat natUled or ~sulu:
Time Co1~'
Ana~yds sho~ ~s We~ SAMPLE m be:
,,~ Satisfactory
D ~fncto~
S~p e mo Ion~ n ~sit; s~e s~ould
~ in~c~ TeUmble ~;ul~. Pleue
An~b
L~ bf. No. Result* Aflaly~t
BACTERIOLOGICAL WATER ANALYSIS RECORD
Fa~[ed
CT&E Ret.# 1023261001
Client Name Pinard Engineering
Project Name/~ Lot 2 Dora S/D
Client Sample ID Lot 2 Dora S/D
Matrix Drinking Water
Ordered By
PWSID 0
Sample Rcmatks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 06/11/2002 12:07
Collected DateZi'lme 1"06/07/2002 '?14:'~0
Received Date/Time 06/07/2002 15:00
ResulL~
PQL Units Mc~hod
Allowable Prep Analysis
Limits Date Date Init
Wa~ers Dep&r~men~
Nitrnte-N
0.200 mg/L EPA 300.0 (<10) 06/07/02
JDT
Microbiology Laboratory
col/100mL SMI8 9222B
06/07/02 YAP
Held For Confh'ma*t~n
CT&E Environmental Services Inc.
Laboratow Division ~~.),,a~jr)-~,),~,.arj~)')'~'~'~'~'~'~'~',e
200 W. Porter Drive
Anchorage, AK 99618-1605
)rinking Water Analysis Report for T~)tal Colifo,m Bacteria tel: (907} s6=.:343
· ;ax: 1907}
READ INSTRUCTIONS ON REVEJ~E SIDE BEFORE COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
o puBuc WAT£RSYSTm LD'#
~ PRIVATE WATER SYSTEM
SAMPLE DATE: ' Month Day Yenr
SAMPL£ TYPE:
13 Treated Water
'~ Routine
° Repeat Sample (for routine sample ~ Untreated Water
with lab ref. ~o. )
0 Special Purpose
lalysls shows this Water SAMPLE to b~:
Sadsfactot~
Unsatisfactory
Sample ovO' 30 hours old, rcsu(~ m. ay
~ un.liable
S~plc t~ long in ~nsit; sampl~ shguld
not be ov~ou~ old at exammanon
to indicate ~liable msul~. Please
n~ sample via sp~ial deliw~ mail.
Anal~icnl Method: ~M~b~ne Fih~
~Q -MM~MUG
Humb~ of colonieEl~ mi.
- -' E~ult* Analyst
SAMPLE LOCATION
Time Cofit'~ed
Collided By
Date: Time:
Client notified of unsatisfactory, results:
Fazed
· phonics Spoke with
Date: , Time: _
BACTERIOLOGICAL WATER ANALYSIS I:~CORD
MMO-MUG Result: 'Total Coliform _ ~, C~lI
· CeLl FIRM
Coliform/lO0 mi
o,'
, "-'-'--'-'-' ~ Member of the SGS Grout) ISociit~ G6n6rolede SurveillanCe} ~ T~
~ ~&nVt &Net. MICHIGAN, MISSOURI N~ JERS~. OHIO. ~Sl VIRGIN~
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
WELL FLOW TEST.
LOCATION: Lot 2, Dora Subdivisio~
DRILLER: Anchor Drilling
DATE WELL COMPLEIED: 7/10/81
WELL DEPTH:
STATIC WATER LEVEL (top of casing): 31.2'
JOB NUMBER: 02-104
DATE OF TEST: 6/7~)2
FIELD STAFF: A. Wien
Elapsed Static Flow Cumulative
Time TIme Water Rate Gallons Remarks
{Minutes) Level (gpm) Pumped
10:33 AM 31.2' 6.3 Start Flow- Meter 107994
10:48 15 58.4' 6.3 95 108089
11:03 30 * 5.5 189 108183
11:18 45 * 5.3 271 108265
11:33 60 * 5.2 351 108345
11:48 75 * 5.1 429 108423
12:03 PM 90 * 5.1 506 108500
12:18 105 * 5.1 583 108577
12:33 120 * 5.1 659 108653
12:48 135 * 5.0 735 108729
1:03 150 * 5.0 810 108804
1:18 165 * 4.9 885 108879
1:33 180 * 4.9 959 108953
1:48 195 * 4.9 1033 109027
2:03 210 * 4.9 1107 109101
2:18 225 * 4.9 1180 109174
2:33 240 ' - 1253 Stop Flow- 109247
RECOVERY
2:53 20 37.0' * Water level ~/pump intake - cannot get probe beyond 60'. No indication
ofany perforations in the casing.
Average Flow Rate: ~;.2 gpm
Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 6.3 GPM. THIS TEST DOES NOT CONSTITUTE A
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE.
Reviewed by:. Paul Pinard
Date: 6/8/02
EAST 84 th. AVENUE
LOT 1
S 90'00'00" E 60.00'
- i0' UTILITY EASEMENT
IrXISTINC
HOUSE
.0 42.4' 00
°
I LOT 2
d 10' UTILITY EASEMENT
N 90'00'00" E
60.00'
LOT 3
LOT 9
LOT 8