Loading...
HomeMy WebLinkAboutLEACH LT 4Leoch Lot 4 #015-112-36 Marlo Ee~ich Maycr Well Drilling Permit Number: SW Parcel Idenfilication Number: Legal Description Building 5cf~ Divi=ion 4700 8e~w 5rr~t (gO~ Pump Installation Log Pump Inm.ke ~)epth Below Top of Well Casing: Pump Model: ..~'~'/I Pump Size .y~.. hp Pitles~ Adapter BurL~l Depth:/~ feet Pifiess Adapter blanafacturer's Name: Pitless Adapter Instnlhr: Well Disiat'ected UOon Comple~oa?~:~ Yes [] No Comments: Pump InstaLler ~tame: Atte,,tion: The pump ~'~I~ shall provide a pump haztallav.'on log to the DSD v. dfl~5= 30 dayz of pump imt.~!!~trdo~.. Municipality of Anchorage Page J of 2 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 Permit Number: .SbO'q'~O~'/ PID Number: d)l~ N~: ~ ~T~4~ Wastewater System: D New ~ Upgrade Address: I~o~ A~o-~ l~o~ ~. ~.~ ABSORPTION FIELD ND. Of Bedrooms: ~Deep Trench ~ Shallow Trench D Bed ~ Mound ~ Other ~otal Depth from original grade: LEGAL DESCRIPTION so,,~,i~: ~,2 ~/s,.~. Lot: ~ Block: Subdiv~ion:_ Depth to pipe bo.om from original grade: Gr~vel depth beneath pipe --~ ~. ~ ~t. ~- ~ ~t. Township: Range: Section: Fill added above original grade: Gravel length: WELL: EXtST~ ~ew C Upgrade erave~ width: Z { Number of lines: Distance be~eenlines: Classification (Private, A,B,C): Total Depth: ~ Total absorption area: Pipe material: Driller: ~~',eDrilled: StaticWaterLevel:Ft. 'lnstaller:¢oO~ ~ ~ ~<~' D~toinstal[e;/~ ~ GPM I Fl, Ft. SEPARATION D~STANCES ~Septic U Holding D S.T.E.P. To Septic Absorption Lie Holding )ublic/Private Manufacturer: Cap~city in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ O~ ~ ~ Well' ~01+ I~[~ ~ I OOl+ Material: ~TE~ Number of C~pa~ments: su,~ -- LIFT STATION Water I ~ I+ ~OOt+ ~ ~ LineL°t ~ I~ ~O l~ .... Size in gallons: Manufacturer: I "Pump on" level at: I "Pum~[ at: High wate~ alarm at: Foundation Curtain Drain Remarks: BENCH MARK Location and Description: JNGI~EEWS SE~L '" Inspections ~edormed ~-,.- ~.,-- ~ ~--*-~*~,_ 73~"~s~'~st~ ~t'~[~i~ Dates: lSt2nd q/z~j~SH/zz/o8 Depadment of Health and Human Se~ices approval Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 PERMIT NUMBER AS BUILT [)RAWING PARCEL I.D, NUMBER SW980067 ' 015-112-56 ~FINAL ~-r,'~ /4 FOOl' I,,41N, ~ _ ~5' ~ 22,5~ ~45' ~ ~2,5' ~ m FOOT M~N; CBL1 OF COW~R~ M~ 604 ~ ~ ~BL~ ~- CO~o3 ~ ~_ ~ - MT1 = 95.5~ / ~Wf~-/  ..... ~ =~_. _~=,_] UFILI~ BOX ~ DBL1 -- .~2~5% ~ WEH GREEN ./' ~i~ ST1 - ~ 0~.5, *FOP OF ~OX ~/' u,~w ~ ST2 - 110,0 50,5 IS IBM ~- ~¢ ~ .......... PO~ DBL3 - 106,5 ~B,O _ l'with ~ 9ox Dl~ - 105,~ 47.5 TELEPHONE PROERW CORNER / ~- ~ ~-]- ~ ~EO WITH REaR~ ~-~-~- 7Z ALAS WATER WAS WA R o¢ X... ..,~ LEACH SUBDIVISION; LOT 4, ~PE OF WORK: .s-.um T JIM ARMSTRONG (907)265-8986 '~¢¢ I'. *'..~.;'";~4 ]~T~4.'30'98// ~O~WN ~: Sr~L., ~: "~% ~ .......... ,LL.M. 1 = 40' 2 OF 2 PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PEr,MIT PERMIT NUMBER:SW980067 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:ARMSTRONG JIM OWNER ADDRESS:10701 ABBOTT LOOP RD ANCHORAGE, AK 99516 PARCEL ID:01511236 DATE ISSUED: 4/20/98 EXPIRATION DATE: 4/20/99 LEGAL DESCRIPTION: LEACH LT 4 LOT SIZE: 29698 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~.--~//z~_~.~.~ ~_/~_.~.~r~--~;~-/~-/- DATE: ISSUED BY: DATE: 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers April 8, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 Ref: Septic Upgrade for Lot 4, Leach S/D To whom it may concern: The subject property has a 2 bedroom house on it that is served by a private well & septic system. The existing septic system is failed and must be upgraded. The specifics regarding the design are summarized as follows: 2. REVISED TRENCH DESIGN: a. Percolation Rate: 1.2 minute/inch b. Allowable Application: 1.2 gallox~/day/ft2 c. Number of Bedrooms: 2 d. Design Flow: 300 gallons per day e. Minimum Absorption Area: 250 ft2 f. Maximum Depth: 9 feet g. Effective Depth = 5 feet h. Width: 2 feet minimum i Minimum Length: 25 feet. j Proposed Length: 30 k. Effective absorption area = 300 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic upgrade. 4. TOPOGRAPHY: The lot slopes downhill from east to west at a slope of 15-24% immediately above the proposed trench, and approximately 15% below it. There are no slopes greater than 25% on the downhill side, and within 50 feet, of the drainfield site. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. ~Sincerely, "~ .MS~ Prin6ip~' 0 LOT 1, LEACH LOT ~, LEACH S/D LOT 4, LEACH S/D LOT 5, LEACH S/D LOT 6, LEACH S/D 0 MAL EY LOT 11, SHELL LOT 10, SHELL S/D #2 9, SHELL .q/D #2 LOT 8, SHELL LOT 7, SHELL LOT 6. SHELL S/D #2 ROAD SII'E PLAN~ L. DT 4, LEACH SUBI)IVISIDN PREPARED FDR~ PREPARE:]] ]]Y~ TE~ 418198 JIM ARMSTRF]NG ALA.%I<A WATER & WASI'EWATER DRA\'/N~ J,L,M, SCALE: 1.~ : 100' -7955 ~ F NDTE, TIlE gDNTRACTUR SHALL NAVE ~. WE~T AND ~DU'FH PRDPERTY LINE I F'L~GGE~ ~Y ~ REGISTERE9 LAN~ ~ ~ ~(D~l~ su~wva~ ~m~ T~ m~ST~UCTr,nN:, ~-TD ~E ~DMPLE]ELY ~~'~~,. / ', ~NE~ tODO GALLDN TANK -- ~ --.-CID A~ ~~~ / 9 FDOT DEEP BY 30 FEET LDNG ~IITFI gEWER DR~INRDCK, TRENCH f4T~C/U TU ~E IN~T~LLED PARALLEL /~ ~o 'rD THE SLDPE CDN'rDUR,, ~// 30 FI]PT UTILITY EASEMENT DATE~ 4/8/98 DRAWN BY, J,L,M, ~CALE~ ~' = 30' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST LEGAL DESCRIPTION: L-O'~ L~ , L.~:Ac.~ ~'/~o Township, Range, Section: ..... -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT .,.-~-~ O DEPTH? p E neplh to Waler Alter _ Moniloring? ~fz~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE J, I I~ [m~nutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN ~,~,7-~ FTAND t~'~';~_FT COMMENTS PEREORMED..: G¢¢¢ i CERTIF. THAT T ,S EST WAS PER.ORMED .N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ON-SITE SE NAME . MAILING A D D P,.ESS Manufacturer Liq. c DISTANCE TO: DISTANCE TO: No, of lines f Top of tile to finish grade IF HOMEMADE: Inside length Well Dwelling Length ] Le.gth of e.ch Width Materiel NO. OF BEDROOMS PERMIT NO:, No, of compartments Liquid depth PERMIT NO. Type of crib Crib diarneter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) j Material I_iquid capacity in gallons ota ength of lin,~.~ (/~/I Trench widt~z._[.inohe, ~ I~,~e between Material beneat~ tile I Total effective absorpAiDf%area Depth I P~MIT NO, OTHER PIPE MATERIALS APPROVED DATE LEGAL 72-013 (Rev. 3/78) Static Water Level_~j~ feet Draw Down ~--- feet 'FELL LOG Gallons Per Minute Total Feet of Casing ~ype Material Drilled: 0 feet to c/D F/ to to Hefty Drilling S.R.A. Box 1553 H Anchoz~ge,Alaska 99507 (;!iI:;;:Cll. Ji':iD FIN[) f'HE [:~i::l']""r'(:li"l OF: 'THE E:?:;CFI',/f:!T:[Cll'~ ':: L]"! i'::'EE?'). 'T'HE[d:'i: :[ '5 N(:~ :SET H Z [::,"I'H FOR 'T'HE (:}[;;:1:::~',,¢[,~;[.. !?,EF'TH :i::}~; THE HZh!ZHLIH DEF"TH OF' G]:;~:FF/EI,. t~;E:'i"!,,i[}}:I~:I',,I THE Fff,ll:::, 'T'HE ?,OTTOH OF' Ti..]E E: ::':: C R ',,,' F:! 'T' :1: ON ,:: :l: ~',! FEE !' ), :!.: :[ l:::!l'"i F'FIH:!:I..:!:FIF?. !.,!:i:!'H 'T'FI[i: i:;;:E(;!l..t:[iq:~:::]"lEi',!!':~!; [::'(:It:,':: Oh,F-.:i;:[ !'!~i: SE!,![::Fi::i:i; F:!I'.,IE:, HE:!..L.S i:::'Cd:;~:"I'H [%.' THE ?'t!...!F,I:[C):[::'?IL.:['T".¢ CI[::' ?: :[ H:I:L..L.. ]:N:~}~;TF!L.!... THE :~{;'T'ST'EH :(!",] FI(::CC~F:DF:INCE: 14]:'TH 'TI-II::: 2:: :!: t. JN[:)tEf~:STFiFE:, 'THFIT '['HtE OH-..:~};Z'TE '~;[}}:I.,.!E:F?. :~;'~"'~']'[~i'"I HFI"/ F;: E~: C4 !. .i ): F: iE ................ L.. ,.. ........ I ........ [..., ,~. LI......[.. , U J: ,...,....L.I ......... !'IUR,::. , h,!'h',! .:? f:::,!::.L., '*.UU!'I::,. :" PO[lOll O 650 A 'ii;I-I()!b':,,:3f: ,,',,~ ,,,', January 4, 1982 Harry Warner SR Box 4-2784 Anchorage, AK Permit ~ Subject: 99509 811129 L~ B1 LEACH A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. ~ Program Manager~-/ Sewer and Water Program Enclosure: Copy of Permit ']'!l"!l~i; F'F' f. :1: Fi:E:[::, S I ;ZIE IitF' THE: SO I L_ FIE E ": F~'F'"F i 7 N .:,~ .: I [:ri I i S : F". ~'::" ::'"" _. ' .... ~ ............ '1 ..... ....... '.,:.. ~" 'T ~"~ ....... "::~ L,,.. ~:,, ~1 ",~ ..,,:~ ~ ~-, ......... :~., EE~ "" :"' ....' ~ ' ...... "..,= I1'~'. ,-'"1 -.. E=:.," .... E:::" E: !F:::~ 'T Fdl =' THE: LENGTH I.?':[ MENS I ,'.'::~I",t Z S THE: LE:.NG]'H ,:: I I",! FE:E'I" ::, Ol::r THE: TI:~rE:NCH OFf. C, Fi:F:! l NF' I Ei..E:,. 'T'HE: [::,EF'TH OF Fl TF.~ENC!..J OR PIT IS TFIE E:,~E;TFti'.,tCE E',E:"I'HEti:N 'THE %UF.::I:=F:!CE: OF' 'T'HI'.E: EiFrOLII'.,II) FII'.,IE:, THE: DOTTOH O1:::' THE: EHCFI',,,'F!TION ,:.' tN F'E:ET::,. 'T'HEF:E'; :IS NO SET 14IE:,'I"FI FOR TRENCHES. "f'H[~:: EiI:;;tFI'v'E:L. C, EI:::'TH :1: S THE I"!]: N.T. MLtH DIEF'TF! OF' GRF!',,,'EI.. E:IETHI!i:EN "FHEi OU"f'F'F!I...L. F::' FINE:, THE E',OTTOH OF' 'T'HE EXCI::I'v'FIT I ON ,:: ~ !'-,I F',E=:E:T ::,. F'E[;'I'". :? "1" !::IF'I::'L. I E:FINT HI::tS 'THE FE:ESPEd'-,tEi!; i E: :t: L :t: T'T' "f'O I 1"4F'I:'.'~I;i:I'"I TH .f. S .Ii:,EI:='f:IF;'.'T'ME:NT .::,l .!t:;i¢ '[ NG :[ NSTI=It....I....FFt" I EIN 1' i'.!':~ F'E': T '.' i bi'J: OF' F:It'.,I'T' I,.IEL. L..S FI[::,J'FICE:N"f' "."F "f'l-..l Z ':-:; F'P. OF:'E:F;FI"'./ FII'.,E::, 'THE: NLIHE',EF: E' F' I:;;:E:% :1: C,E:NE:ES THF:Ft' TI'"II!~; HE:L.L. !.,.I ! LL :E;EF, t',,,'E. E~F~E::K:F' I L.L. I N{.".'i OF FIN"¢ S"r'E;TEH I-,.! 'J: 'FHOLIT F' I NI=IL I I",kE;I:'E:E:T 'J' '3N FIN[::' I::II:::'F'F:" ","FIL E~'T' TH :[ E; DEF'FII:;;:THE:I",H" t'.I]: LI_. E:Ei: ';i. E '% i T TO f:'E'.Og:;EE:LITt ON. M :.r. i'.,l I HUH B, I :L'7'f'FINE:E DIETHE:EN I:::I HEL. L. FII'.,IE:, .8t",1'¢ O1"4-S I "I"E :i'Ni':HRGE: L':, t SF'OSFI!... S'.?:..'5,']"E:H I ::!..E~E~ F'I:!!:E]" F:OFi Fl PR I',,,'I:::FFE: HIELI.... OF..: :L.L'.;I;EI "f'O ;2E~Ei F'EET F'l:~:%d"l F! F:'UBLIC HELL. UPOI'.,I THE T'¢PIE OF' F'UDL]:E: 14EL. L. I"IlN):HtJH DISTFIi~CE I:=,~:Ed',l I::1 I='f~:I',,,'FFIt: I,.!EI....L TO FI F'I:~:I',,,'FtTE: :E;EI4EI:(: L.INI).' I:il; 2!11 I:::'!EET ']"E~ FI CEd"IHUN :1: T"r' 'SE!.,.E:R L :[ NE Z .'5 75 F'E;ET. I'.!EL.I... I....OGS FIE:E: REE:!IJ.T.F:.'ED FIND t"!U'iii;T DE: Fi:ETUF:I'q.~E:, TO THIE DEF'FII:;;'.T'HEI",Ff' H]:THIi",I OF: THE: HELl. I;:)"i"l"tE~;~ I:~::E:I]:!U :[ I:~:EHEI,I'f'% I"tF:I"/ FIF'F'L'T'. SF'EE: :1: F'~T CFII Z Ed"4E; I:::INE:, COI',!STRLICT I Ed",l t'.':' I FIE!d:4:F!HS I:::IF:.'E: R',,,'FI I L. RE%.E; TO :1: I",ISUI';i:E F'ROPE:F'. I NSYFILI..FI]' :t.' OI",L I E:EI:;;:"i'I F'"r' 'I'HFIT ::I.: I 1::~t'"1 F:'FIH:[L. iFff;.: HITH 'T'FIE E:E:(;!I..II,q:Eif,IEI'.,!T'!i.; FOF~: Oi'.4--.SI"I'E: '..SE:klE:R:~; FIN[::, 14EL!2!ii; F!S E;E:'T F'OP:t'f'H D'.r' THE: HUN :!: C: Z I:::'f:lL :.t: '1"'¢ OF' FINE:HOF4',I:::t{:iE:. ;2: ! !,.I :f. [...I... I NSTFIL. L. ~FHE: ?:,"r%TEM :[ N i:::ICCORDFINCE !.,.! I 'TH THE: COE:,EiS. !:: I IJNI:::,IEI:~%TFINE:, THFFF THE': Ot",!--.E;]:TE: t.'7.',IEHEF.': :P¢'-:..';TEH t"IFW F:EE. PJ:!:Fi:E EI'.,!I....I:~,F;'.~::iE:I','IE:I'.!"I'' I!::: ]",'dEl: ~:E:SII3,1iENCE I257 !~:EHOI;::,E::L~B, ~L~'"-"fL.'(l'6,/~ - t ,~{'-0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 829 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /,~ SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:__ 1 2 3 4 5 6 7 8 10 ~2 ~4 ~7 2O COMMENTS PERFORMED BY: 72-008 (6/79) SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop 'cz /' q : ~f /o 0,¢~ , PERCOLATION RATE ¢ ~-'~ (minutes/inch) TEST RUN ,,ET,,,'EEN '4'-'0 CERTIFIED BY: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 E!more Road P.O. Box 196650 Anchorage, AK 995I 9-6650 v,r~w~'.m u n i.org/on site (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-112-,56 1. GENERAL INFORMATION Expiration Date: / / - //'~ "// Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent .' Mailing address LEACH S/D; LOT 4 4225 OMALLEY ROAD * ANCHORAGE, AK * 99507 BECKY & CHARLES STRUB Day phone 4225 OMALLEY ROAD * ANCHORAGE, AK * 99507 Day phone 644-9986 SARAH HALTNESS W/ DYNAMIC Day phone ,5111 C STREET * ANCHORAGE, AK * 9950,5 227-0599 Unless otherwiSb:requested, COSA will be held by DSD for pickup. NUMBERoF BEDROOMS: 5 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 ~NSPECT]ON BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below; I verify t,ffat 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, functiona! and adequate for the number of bedrooms and type of structure indicated herein. I furt,~er verify that based on the information obtained from t,~e Municipality' of Anchorage files and from my investigation and inspectio.':., the on-site water supply and/or westewater 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 337-6179 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 ebove. 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 ~ Approved for bedrooms. Disapproved. Conditional approval for .....;:.. ~: ~ATER AND bedrooms, with the following stipulations: ~ ..... .' ~.,~ S,-', ChecK~lsc Septic System Advisow Well Flow Adviso~ (Rev, 11/05) Arsenic Advisow Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:_ '~ ~ / ~..C~ ~//' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite CERTIFICATE OF ON-SI(~)~F~MS APPROVAL CHECKLIST Legal Description: LEACH S/D; LOT 4 Parcel ID: 015-112-56 WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/20/1981 Sanitary seal (Y/N) YES Total depth 180 ft. Cased to 180 ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) YES YES 12+ in. Date of test Static water level FROM WELL LOG 10/20/1981 145 .ft. AT INSPECTION 7/21/2011 1 67 ft. Well production 5 g.p.m. 1.5+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 7.71 mg./L. Collected by: Arsenic: ND ug./L. Date of sample: 7/21/2011 GEG, Ltd. Bo Co SEPTIC/HOLDING TANK DATA *DOUBLE CLEANOUTS Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO Date of pumping 10/11/2010 Pumper BEFORE TANK. Date installed 4/22-23/1998 Cleanouts (Y/N) YES High water alarm (Y/N) N/A MCDONALDS PUMPING ABSORPTION FIELD DATA I'BELOW EXISTING GRADEI 4/22/1982/ 160/ Date installed ~,/22-23/1998 Soil rating (g.p.d./ft20r ft2/bdrm) 1.2 Length 57/31 ft. Width 2/2 ft. *8.5/ 570/ ft2 Total depth *{~,7 ft. Eft. absorption area 31o Monitoring tube YES Date of adequacy test *'8/8/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 530 gal. Elapsed Time: 120 min. Final fluid depth 10 Any rejuvenation treatment (past 12 mo.) (YIN & type) 1982 TRENCH/I 1998 TRENCH System type TRENCH/ TRENCH Gravel below pipe 5/5.5 ft. Depression over field NO For 5 bedrooms New depth 14 in. 450+ g.p.d. If yes, give date - in. Absorption rate >= NONE KNOWN **TESTED 1982 TRENCH. TRENCHES ARE CONNECTED BY DIVERTER VALVE.... :,~Tg::, ."~0! ~ Q~ULD, NOT BE LOCATED DURING IN~cTION~ TRENCH iS ACCES~LE THROUGH ~ ~:ANK'CLEA~uTS.:: NOTE: 1998 TRENCH HAD ,31" OF LIQUID IN IT UPON INSPECTION (7/21/2011). LIFT STATION Date installed "Pump on" level at in, Size in gallons Manhole/Access (Y~.~_) ~ "Pump off" level ~,~ High water alarm level at Cycles tested. Meets alarm & circuit requirements? SEPARATION DISTANCES SEPARATION DISTAN .CES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ .in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ PRIVATE/150'+ COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON jLOT TO: Property line 10'+ 10'+ Water service line Curtain drain NONE COMMENTS KNOWN Absorption field 5'+ Surface water 100' + Building foundation, 10'+ Surface water 100,+ ~ Wells on adjacent lots 100% Water main N/A Driveway, parking/vehicle storage PRIVATE/150'+ COMMUNITY NOTE: STEEL MONITORING TUBE DRIVEN THROUGH SUMjP TO BO'I-rOM OF 1982 TRENCH. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Date of Payment Receipt Number (Rev, 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services Division 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 # 111307 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 Leach subdivision. This inspection revealed a nitrate concentration of 7.71 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. SGS Ref.# 1113293001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 07/27/2011 16:02 Project Name/# Leach Lot4 Collected Date/Time 07/21/2011 12:05 Client Sample ID Leach Lot 4 Received Date/Time 07/21/2011 13:00 Matrix Drinking Water Technical Director Stel~hen C. Ede PWSID 0 Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<I0) 07/21/11 07/25/11 NRB Waters Department TotalNitrate/Nitrite-N 7.71 0.100 mg/L SM20 4500NO3-F B (<10) 07/21/11 AYC Microbiology Laboratory E. Coil Ne~zative 1 100mL SM20 9223B A 07/21/11 DLC Total Coliform Ne~zative 1 100mL SM20 9223B A 07/21/11 DLC ~zv. (ASSU~) 33' N89 57' 00"W 296.98' CO~ EXISTING ~ ~ :::~ 20 296.98' N89° 57' 00"E UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE, [] LOT SURV~Y SURVEY TYPE [] FOUNDATION AS-BUILT ] FINAL STEUCTURE AS-BUILT [] PLOT PLAN . . . AS-BUILT . . . LOT SURVEY . . . TOPOC.~APHY [] AS-BUILT . . . NO CORNERS SET [] RECERT1FICA~0N AB-BUILT . . . NO CORNERS SET PLOT PLANS &: LOT SURVEYS IT IS THE RESPONSIBILITY OF' THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO F~NISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SYMBOLS SET REBAR ~:~ ~ DRAINAGE ~ ~ ASPHALT FOUND REBAR o C C WOOD FENCE ~ CONCRETE ASSUMED ELEV. X X X METAL FENCE ~ WOOD DECK NOTE: ONLY THOSE: IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPT{C CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ::'LOT PLAN --OUND A TION AS-BUILT :INAL STRUCTURE AS-BUILT Prepored by Robert E. Johns, Jr. & Professionol Lond Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504. Assoc. Sco,e; 1 "= 50' o,,t~ Surveyed: 7/14/11 ~o~e Dr°w.: 7/14/11 Legal Description: Rec. Lot S.F. Rec. Plot File No. ct'd: 2536 ~w8°-'024/11-21, Lot 4 LEACH GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL August 18, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Request to Allow 1998 Drainfield as a Reserve Drainfield for Leach, Lot 4 To whom it may concern: The existing 3 bedroom house is served by a private well and septic. Two drainfields serve the home, the first was installed in 1982 and is sized for three (3) bedrooms, and the other drainfield was installed in 1998 and is sized for two (2) bedrooms. Both systems were tested (8/8/11 & 7/21/11) and both performed to a level to support a three (3) bedroom house even though the 1998 drainfield is only sized for two (2) bedrooms. The MOA had requested that the 1998 drainfield be abandoned because it is not adequately sized for the house but we believe it should allowed to keep serving the home, our justifications are as follows: · The 1998 drainfield was tested as a three bedroom system and it absorbed 450+ gallons for the day. · The 1998 drainfield has 310 square feet of effective and the square footage requirement for a three (3) bedroom with soils rating of 1.2 GPD/Sq./ft. is 375 square feet. · Leaving the 1998 drainfield place will allow the homeowners to switch drainfields to allow the other to rest and Abandoning the 1998 drainfield has no positive gain only negative. If you have any que PresidentJ ~,~ please contact us at 337-6179. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-112-36 Expiration Date: ,/~/ -' ! ~ - ~).3~ 1. GENERAL INFORMATION Complete legal description Lot 4, Leach Subdivision Location (site address or directions) 10701 Abbott Loop Road Current Property owner(s) Andrew Dimitriou Mailing address 10701 Abbott Loop Road Lending agency Mailing address Real Estate Agent Mailing Address Unless othen/vise requested, HAA will be held by DSD for pickup. Two (2) 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Day phone 868-1416 Anchoraqe, AK 99515 Day phone Day phone Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] ~E] Individual Holding tank [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HA,A) 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. (Cedificates 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 eh'ora or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation. based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are} safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Enqineefinq Phone 522.1//3 Address P.O. Box 240773 Anchoraqe. AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 812/2002 5. DSD SIGNATURE ~ Approved for ~. Disapproved. Conditional approval for ~-. :%,, . . '._'_-:~.~... bedrooms. *- ,,~ .. ..* %' .~, · ,ttl t¢ rr rr.r. bedrooms, with the following stipulations: ~.kkkk~'_~LqJx~. Additional Comments Note: '['be well ~'or this propcrt7 meets existing State and Municipal Codes. There are nitrates preseut. It is suggested that periodic testing be performed lo insure the wells continued suitability. Current nitrate concentration is 5.54 mg/I. EPA maximum concentration is 10.0 mg/I. More information on nitrates is available from the On-Site Services Program, at 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Bu,dlng Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchomga.ak.us (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Desc~3tion: A. WELL DATA Well type PTlvate Date completed 10/20/1981 Total depth 180 ft. Parcel ID: 015.112-36 Well Log (Y/N) Y W, res properly protected (Y/N) Y Casing height (above ground) >t2 AT INSPECTION 7/27/2O02 149 ft. 3.4 g.p.m. Lot4, LeachSubdiv~lon IfA, B, orC provide PWSID # San eny sea (Y/N) Y_ Cased to 180 ft. FROM WELL LOG Date of test t1~0/1981 Static water level 145 Well production WATER SAMPLE RESULTS: Coliform 0 c~onies/19o mi. Date of sample: 7/26r2002 - B. SEPTIC/HOLDING TANK DATA Tank Type/Mate~al Se~c/Steel Q in. g.p.m. Nitrate 5.54 mgJI. Collected by: IlEA Other bacteria 0 colonies/19o mi. Date installed 4/23/1998 Cteanouts (Y/N) Y High water alarm (Y/N) N Tank size t,000 gal. Number of Compartments_2 Foundati~ cieanout (Y/N) Y Depression over tank (Y/N) N_ Date of pumping 7J31/2002 Pumper Ancheraffe Cesspool PumplnQ C. ABSORPTION FIELD DATA Date instafled 4~23Z1998 Soil rating (g.p.d./~2 or ~/bdrm) 1,.2 GPD/SF Length 31 ft. WVlth 2 ft. Total depth 9.5 fl. Eft. absorption area 310 f~ System ~ DeepTrench Gravel below pipe 5.3 Menib:~ng lube Y_ Depression over field FI Date of adequacy test 7/27/2002 Fluid depth in abea~flon field before test 3.5 in. Elapsed T'.ne: t,200 min. FinaJ fluid depth 3.5 in. Any re'juvenafien ~matmenl (past 12 mo.) (Y/N & type) N Results (Pass/Fail) Pass For ~ bedrooms Water added300 gal. Nmv depth1?.?5 in. Absorption rate >= 300 g.p.d. If yes, give date D. UFT STATION Date installed 'Pump on' level at __ Datum E. Size in gallons in. 'Pump off' level at __ in. Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tift station on lot >100' Absorption field on lot >t00' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent Iota >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cieanout N/A Sewer/septic service line >25' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5" Water main N/A Water service line >15' Surface water >t00' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line >t0' Water Se~ice line >10' Curtain drain None Noted COMMENTS Building foundation >10' Surface water >100' Wells on adjacent lots >100' 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 HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 8/2/2002 Water main >10' Dmeway, paddng~ehicie storage >25' Date of Payment Receipt Number ~'~ (Rev. 12~0o) in. Waiver Fee $ Date of Payment Receipt Number % L ~.~ un ~ SURVEY TYPE PLOI PLANS a, LOT SURVEYS S/JRVIc-Y C~R*flF~CATION SY~B01.S 4121~S Prepared by Robert E. Johns; Jr. & Assoc. Professional Land Surveyors 1" = 60' 3-25-98 LOT 4, 2536 LEACH SUBDIVISION 98-024 AU~-01*0Z 04:54Pg,. FR0tH:T&[ ENVIRON~KTAL SRV 9015615301 T-384 P.03/03 F-645 ,~t~.. C?&E £nvlmnmen=l Se~lces Inc. CT&K R e f.,'V 1024675002 Client Name Anderson Engineering Project 1~ a me~# Client Sample ID L4 Leach Matrix I~inking Water O~ered By PW$1D 0 All Dates/Times are Alaska Standard Time Printed Date/Time 07/30/2002 14:15 Collected Date/Time 07/2fi,r2002 14:30 Received Date/Time 07/26/2002 16:00 Technical Direeto~17,...-~~ Stephe~de Releaaed By ~~ Sample Remarks: EP 300.0 - Detectable amount of Ni~'ate in the calibration blank; concenWatlon of Nitrate in Ibc sample is ! 0X greater. Allowable I~ Par~m~o' ResoI,~ PQL Uni~ M~M ~mits Date Anal~is Da~ Init Ni~r~c-N 5.54 0.200 mg/L EPA 300.0 {<10) 07/27/02 JDT l~Lc:ob:l.o't o~z Labo~&toz'T' Total Coliform 0 col/100mL SMI8 9222B (<1~ 07/26/02 gAP Received Time Aus, 1. 4:02PM 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. # I~-~\'~D-'~qL'2 HAA# ~¢,~C~ 1. GENERAL INFORMATION Complete legal description Lot. 4; Leach Subdivision; Location (site address or directions) 10701 Abbott Loop Road Property owner Mailing address Lending agency Mailing address Phil Lake 2115 Crcateagus ,272-6865 Day~e ~46-~295 Anchorage, Ak. 99508 Day phone Agent T&r~ Pisa 2001 Realty Address Day phone 276-2001 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: X~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: X~ Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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/orwastewaterdisposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. Ifurtherverifythatbased 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. phone o Name of Firm Address ~ ~ ,.3~;.; 2, ;',.~ ?j,zer L~¢p RoacJ Ne, 204 Engineer's signature bedrooms. DHHS SIGNATURE ?/'~ Approved for .~?¢~r~_/? Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 Jn 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~)25 (Rev. 1/91) 8ack MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIS'r Log present (Y/N) u~ Total depth t ~;>0 A. WELL DATA Welt type ~~.~flf A, B, or C, attach ADEC letter, ADEC water system number Date completed / 0 -~--~.0-~ L Driller Cased to J 90 Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test I 0-,~o- ~, I Static water level ( ~ ~' //~' ~ ' Well flow ~ g.p.m, zt, ~- Pump level L) (~' LJ ~'~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout_ Petroleum tank Nitrate ~~'~ ~. ~-~ Other bacteria Date of sample:_ ~- 2_ ~'- ~' / Collected by: lB. SEPTIC/HOLDING TANK DATA Date installed ~ - ~--~ Z - cc-') ~. Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size f' ¢¢(~ Compartments Foundation cleanout (Y/N) /It ~'/~'¢~ /ZC/z.C//'~¢DePression (Y/N) /k,,) [/~ -'-: Alarm tested (/Y~N) f'~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~ 0 On adjacent lots Topropertyline (f2 '~ Absorption field Surface water/drainage ,/©L'~ ~ Foundation Water main/service line I 72-026 {Ray. S/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons __ Vent (Y/N) n" level at High water alarm level . ) ~ ~ /'., Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT ST~ION TO: Well on lot On adja6~nt lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length ~ "~ Width Total absorption area Depression over field (Y/N) Soil rating [ ~O ¢/~ System type '-~C Gravel thickness ~¢ Total depth Cleanouts present (Y/N) ~ Date of adequacy test ~- Results (pass/fail) ~,/) ~ ~ .C- Peroxide treatment (past 12 months) (Y/N) for ~ If yes, give date K)/~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot / ~:~' ~ Onadjacentlots IP~ '~ Propertyline !~' / '-f / To building foundation ' / ' On adjacent lots Surface water Curtain drain bedrooms Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature HAA Fee $ //~dJ, ¢/~ Date of Payment __ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633B STREET Client Sample ID:L4 LEACU S/D PWSlD :UA Colleoted MAY 29 91 @ 16:30 hrs. Received MAY 30 91 @ 14:45 hrs. Preserved with :AS REQUIRED ANCHORAGE, ALASKA99518 TELEPHONE (907)562-2343 ANALYSIS REPORT EY SAWLE £or ~ORKorder~ 346?7 Date Report Printed: MAY 31 91 @ 16:24 FAX: (907) 561-5301 4,4 Client Name :8 & S ZNGIUZERINO BPO ~ PO # NONE RECEIVED Req S Ordered By :R. BMA~ER Analysis Completed :MAY 31 91 Send Reports to: Laboratory Super~vt, o :qo~ :__j~.~.F~tEN C. EDE 1)S & 8 ENGINEERING Released gy : Chemlab Ref $: 912342 Lab Smpl ID: 17 Hat,ix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 4.3 ~/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: R.D.J. Remrks: 1 Iests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected "Hoe Sample Remarks Above UA- Hot Analyzed LT-Loss Than, GT-Greater Than Date Date ~ Dat~ Inspector Inspector I/,~ - Comments Conditional Approval ~'~ - % "T~_,,r''~ l( ~provod :Bedrooms "x ~-~- 'J'/ Date Sewer Installed Permit No, ~ Septic Tank Size ~ ~ ~- ~ Holding Tank Stze Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~[~'~-]t~ /~ x/ ' ' ~ ' ~ .... ..-, -Le~dinglnstitution ~('",( ~:'/* VV(t.)~t.)/~( 'I(;AX,¢ I~ % ~y ~ ~ ~ W Phone Legal Description k¢~ ~ ~b~d:,'~.~ ( L~ /%0.~ ~,t2 ~, Type esidence ~ngle Family E} Multiple Family No. of Bedrooms ~ E] Other Wate~ply E] Individual A~ACH WELL LOG. A Well Icg is required for all wells drilled since June E] Community 1975. For wells drilled prior to that date, give well depth (attach Icg if E] Public UtilitF available.) E] Individual Year Individual Installed: ~ ~ Public Utility When Connected to Public Utility: E] Holdin~ Tank NOTE: THE INSPECTION FEE MUST AOOOMPANY EAOH REQUEST BEFORE PROCESSING CAN BE INITIATEB,