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DELUCIA LT 21
· Deluc a Lot 21 #051-141-38 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bmgaw SL P.O. Box 196650 Anchorage, AK 99519-6850 ( 07) 4 7504 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 - 141 -.38 t. GENERAL INFORMATION F_xplmtion Data: Complete legal description DELUCIA SUBDMSION; LOT 21 Locaflon (sita address or directions) 22611 NEEDLES LOOP * CHUGIAK, AK 99567 Currant Prope~ owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROD CLIFT Dayphone 22611 NEEDLES LOOP * CHUG~K~ AK 99567 Dayphone 561-6712 JAN STEIGLEMAN w/ DYNAMIC PROP. Dayphone .3111 C STREET * ANCHORAGE~ AK 99503 261-7600 Unless othenvise requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: 3 TYPE OF WASTEYVATER DISPOSAL: Individual Well Individual Water Storage Community Class Well Public Water System Individual On-site IndMdual Holding tank Community On-sita Public Sewer The Municipality of Anchorage Development Servlcas Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the mpresontations 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 Iransfer of ti~e (except between spouses) for pmpe~es sewed by a single family on-sita wastawatar disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authorffy Approval am vailc~ for 90 days from the date of Issue for properties served by a pdvata or Class C well and may be mlssued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to or? year with valid water samples.) CerlJficates 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 professlonal engineer's work. Note: Alaska Water and Wastewater Consu. ltents, Inc. to closing for the engineering san4ces prowded. 4. STATEMENT OF INSPECTION BY ENGINEER shall be pald $ ~at, or pdor As cer~fied by my seal affixed hereto and as of the vallda#on date shown below, I verify that my lnvesggation, based on procedures outlined in the Health Aulhodty Approval Guide#nes for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functtonal and adequate for the number of bedronms and type of structure Indicated herein. I further vetffy that besed on the Information obtained from the MunldpaliO/ of Ancherage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In complisnce with all applicable Munldpal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm ,ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 Englneer~s Printed Name JEFFREY A. GARNESS. P.E. Date Engineer's Comments: In conducff~g b',~ evaluatlon, AWWC, Inc. attempted to pn~4de a ~xxough, consde~ffous englneering ana~ of ~e wstem ln acconfance wl~h ADEC and MOA DSD Guld~ines & Regulaffor~. The mpon'ed msult~ described ~he pedom"~e o~ the DSD SIGNATURE Approved for .~ bedrooms. Disapproved. Conditional approval for ~ Attachments: HAA Checklist SeplJc System Advisory . Well Flow Advisory Manitenence Agreements Supplemental Engineer's Reert Other Original Certificate Date: ..~'"' .,.~--'~ - 0 / Municipality of Anchorage Development ServioGs Department On-Site Water & Wmt~vater Program 4700 ~mlh Bregew ~L P.O. l~x 196650 Anchorage, AK 99519-6650 legal 0esc~Uo= A. WELL DATA Weft type HEALTH AUTHORITY APPROVAL CHECKLIST DELUClA SUBDNISlON; LOT 21 IfA~ B. or C pllDVkle PWSID# N/'A Date completed 1082/1092 6anltery~eal(Y/N)'~s/*~gs Totel depth ~4s'/4,m'fl, Cased te 54°/5~° ft. Oate oftest Stetlo water level Well preductto~ WATER 6AMPLE RESULTS: ColEorm 0 co~nJes/lO0 mi. Oate of ~ample: 4/13/'2001 B. SEPTIC/HOLDING TANK DATA FROM WELL LOG 1982/'1992 NOT LEGIBLE/'131' It. 0.5/0.4 Tank Type/Material TankMze 1000 GaL Foundal~m deanout (Y/N) YES Oate of pumping 4/5/20Ol C, ABSORPTION RELD DATA Oate Installed ~/22/lo82 t~n~h 34 f~ Parcel ID:. 051 - 141-58 wen Log (Y/N) YES,,~ ~ propedy protected (Y/N) YEN/YES Casing height (above ground) 12'+/12'+ irk AT INSPECTION 4-4.-01/4-6.-01 *VfEU. ORAWNOOr~H USAGE. "'*0.25 COIdBINED o. 1~/'o. 12 Iq~te ~.o5 m~.&. O~r~d~ 0 Collocted by:. AWWC~ INC. STEEL Number of Co~nte 2 Depression over tank (Y/N) NO Pumper PBELOW FINN. GRAD£1 son mung ~.p.d~) 9o Wklth 5 .ft. Date Installed 3/'22/'1982 Cleanoute (Y/N). YES High water elarm (Y/N) N/'A JR'8 PUMPING Total depth. ,~.e .It. Elf. ~ ama 210 ttI Monlt~lube YES Date of adequacy test 4/4./01 Resulte (Pas~/Fel~ PASS Rulddep~ln~d~orpliontleldbefomtest 0 In. WatereddedlOOOgal. Elapsed Time: 0 min. Finalauld depth 0 Any mJuvenntlon Iream~ent (past 12 mo.) (Y/N & type) System type DEEP TRENCH Gravel below pipe 3 lt. D~pr~sslon Over ~old NO For 3 bedrooms New doplh 0 450+ g.p.d. In. A~mte ~ NONE KNOWN D. UFT STATION Date Installed. Size In gallons ~ "Pump on" level at In. 'Pump . High water almm level at In. ~ Cycles tested Meste alarm & drcult requlmmente? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO.' Septic tank/llft station on lot .87'/.96' Absorption field on lot 100'+/100'+ Public sewer main N/A Sewer/esp~c eswice line 25'+ · Sn:' WNVER REQUEST I.J=tiP. J<. On adjacent lots 100'+/100'+ On adjacent lots lOO%/10o'+ Publ]o ~vel' manhola/clesllout N/A Holding tank SEPARATION OlSTANCE~ FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property Erie 5'+ Water main 10'+ ~/p. Water service line 10'+ Wells on adjacent lots ,80' SEPARATION DISTANCE FROM ABSORPTION REID ON LOTTO: Prope¢o/line ,*4' Budding foundaflort 10'+ Water eswloe line. 10'+ Suiface water 100'+ Cmlain drain NONE KNOWN Wella on adjacent lots COMMENTS $SEE WANE]~ RE"~.~i Absorption field. 5'+ Surface water. 100% **LOT UNE WANER ii;WE920082 'SEE WAN'ER REQUt~I Water main lO'+ Odveway, pa~ng/vehlcie storage 1'+ G. ENGINEER'S CERTIFICATION I cerffl~/Umt I have determined ~hmugh field InspeciJons end review of Municipal records ~hat the above systems ere In conformance with MOA I LAA gu/defines in effect on this date. Englnesr'e Pd~ted tlame ,+l..xo/o, JEFFI~EY A. C, ARNESS Date of Payment 5 Waker Fee $ Date of Payment Receipt Number, 05/16, 15:25 FA/: $07+$61+6713 $£CUP,~TR,~$ II~C K & L PLUMBING P-, HEATING. INC. P.O. 9o;, 7'14769 IgO?l Z77.ZS05 9~.?} 696.2441 FAX (907) 694.~44 t I '~'~"~r--""'"'m' ~.,,/?JL~%~ ...// .... JOB II{VOICE 16112 IOTA[ ~01 Municipality ,of Anchorage George P. I1 uerc~. Mayo~ Btdlding Sati:ty Division P.¢). I~x 1.q~k'~0 * 4700 $. Bra#aw Street Anchon~gc, Alaska 90519-6C~0 · (~)7) 3~-8301 hltp://x~v.ci.nnchoragc.nk.us 5/22/2001 Jeffrey A. Garness, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Elmore #I Subdivision Block 3 Lot 14 P-635A Waiver Request #WR010025 Parcel ID #018-171-48 Permit Number SW010127 Public Works Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program Mtmicipaliq of Anchorage -- George P. IVuerch. Mayor May 23, 2001 Department of Public Works Jeffrey A. Gamess, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Re: Waiver Request For Delucia Subdivision Lot 21 Parcel Identification Number 051-141-38 Waiver Request Number WR010026 Health Authority Approval Certificate Number HA010194 Dear Mr. Gamess: Your request for waiver of the required 100 feet horizontal separation distance between an on-site wastewater disposal system and pdvate water well has been approved. The approved separation distances are as follows: The water well on Delucia Subdivision Lot 9 to the subject properties septic tank and absorption field of 80 feet and 90 feet respectively. The "1982" water well to septic tank and absorption field of 87 feet and 97 feet respectively. The "1992" water well to septic tank of 96 feet. This waiver approval applies to the existing water wells to septic system separations only. Future upgrades to any item will require all separation distances be met or another waiver approval from this office. If you have any questions please contact this office at 343-7904, Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program 04-17-01 14:51 flUTE ENVIRONI,ENTAL ,~ CT&E Environmental Services Inc. 5615~01 T-427 P.02/05 F-S00 (2~ent ~ c'r&£ ReC~ 10I I82200! Printed Date/TTtme 0411'//200 ! 12:17 Client ~qame ~ Wat~ & Wastex~ateT Cons~ltnnts ~nc. Collected Date/Time 04/13/2001 8:i 5 Pro]eel l~nme/ff I~IA Received Dnte/'Time 04/13/2001 13:50 (21tent Snmple ID Dclucia S/D Lot 21 Ttthnleal Dlrettor Stephen (2. £de Mntrtx Drinking Water -- - - 0 Sm'nple ~ Allowable prep Anal/sis Results P~L Uni~ Mctho4 Limits ~ ~te IMf Ninate-N 3.05 0.500 mg/L EPA 300.0 10 max 04/13/01 SCL ~.crobLo't og'y La~ora~ory Total Coliform 0 coVlOOmL SMI89222B 04/13/Ol SKW Municipality ,of Anchorage George P. II ucrch. Mayor P.O. Ik~x 196C~50 · 1700 $. Bragaw Street Anchorage, Alaska 99519-G6,50 · (907) 313.8301 http//www cLanchoragc.ak.us May 23, 2001 Public Works Jeffrey A. Gamess, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Re: Waiver Request For Delucia Subdivision Lot 21 Parcel Identification Number 051-141-38 Waiver Request Number WR010026 Health Authority Approval Certificate Number HA010194 Dear Mr. Gamess: Your request for waiver of the required 100 feet horizontal separation distance between an on-site wastewater disposal system and pdvate water well has been approved. The approved separation distances are as follows: The water well on Delucia Subdivision Lot 9 to the subject properties septic tank and absorption field of 80 feet and 90 feet respectively. The '1982" water well to septic tank and absorption field of 87 feet and 97 feet respectively. The '1992" water well to septic tank of 96 feet. This waiver approval applies to the existing water wells to septic system separations only. Future upgrades to any item will require all separation distances be met or another waiver approval from this office. If you have any questions please contact this office at 343-7904. Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program luItT~R 7/9~1. r C.t~. O. Po /~ rs /78_2 . H~.2. I or ? /£ e' 1~.4 ALASIG WATER & WASTEWATER April 30, 2001 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 CONSULTANTS, INC. Reft Waiver Request and Health Authority Approval for Delucia Subdivision; Lot 2 I, The existing 3 bedroom house is served by two private wells and a septic system. The first well was drilled in 1982 and the second well was drilled in 1992. The existing septic system consist of a 1000 gallon septic tank and a 34 foot long drainfleld that has 3 feet of effective. An existing waiver (WR#920007) was granted for the 1982 well for a 95 foot waiver from the well to the septic tank. On 4/6/2001, separation distances were shot with a total station and found the following encroachments: · From the edge ofthe 1982 well to the edge ofthe first cleanout ofthe septic tank = 91.08 feet. · From the edge of the 1992 well to the edge of the first cleanout ofthe septic tank = 99.91 feet. · ' From the edge of the abandoned well located on Lot 9, Delucia Subdivision to the edge of the first cleanout of the septic tank located on Lot 21, Delucia Subdivision = 84.475 feet. We request you grant the following waivers which are shown on the attached detail drawing: · We request that the waiver for the 1982 well be amended from 95 feet to 87 feet to the existing septic tank. · We request that a 96 foot waiver be granted from the 1992 well to the existing septic tank. · We request that a 80 foot waiver be granted from the abandoned well located on Lot 9, Delucia S/D to the existing septic tank located on Lot 21, Delucia S/D. · We request that a 90 foot waiver be granted from the abandoned well located on Lot 9, Delucia S/D to the existing drainfield located on Lot 21, Delueia S/D. Lot 9, Delucia S/D is undeveloped and there is no record ora well log. According to the M.O.A. records, it appears a permit was issued in 1976 and than after no well log was submitted, the permit was voided. The following items are justification for the waivers: 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com · The lot is generally fiat with the ground elevation around the wells slightly higher in elevation than the area of the septic system. The house location is directly between the wells and the existing septic system. If the septic system was to overflow, the effluent would not travel toward the well heads. · The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration. As can be seen on the attached well logs, the aquifer is relatively deep, with silt, sand, hardpan soils, and confining layer ofclay that have served to inhibit the migration of untreated wastewater into the aquifer. Recent water sample results indicated nitrate levels and coliform bacteria results to be satisfactory. Also, it is our opinion that the mitigation factors given by Eagle River Engineering for the waiver granted in 1992 should still apply. Based upon the aforementioned facts, it appears that there is minimal risk associated with the separation distance waivers. We also request that your department issue a Health Authority Approval. If you have an/yf0uestions, please contact us at 337-6179. Thank you for your assistance. Presi~lei! · 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com // / . ~ / /'~ ~ / / k ~ ~o~ x ~'~'~.~ ~_.~ ~.~ NEEDLES LOOP . Ro~ CU~ (eoT) ~e~-eT~ DELUCIA SUgDIVISION; LOT 21 ,"'"'" D~AIL DRAWING OF WAIVER REQUEST DELUC1A S/D; DELUCIA S/D; LOT 20. -- :.---------.~LOT 11, I :...',,, , ,' 'r'/ ,,r{ ' '"'' °', ~.1 DE:LUC~ S/D; r~ . I ~. I I. ~ I~ LOT 10. I ! I I ; v "~ x t ~.~ / -'r ; ~ DEL~-'1A S/D; //'--. ..... -I~-. / I I , LOT 24, LOT 23, \ , ,~ / ~ __ N,,,s~/ / / LOT 9, ~-~,, ..... _~--.......... 11JNDRA dEWEL RANCH S/D; 11~NDRA JEWEL RANCH S/D; LOT 15A. LOT 1gA. ,~~',~. '~ ~ '-' ....... 4/26/2001 ALASKA WATER & WASTEWATER ~ CONSULT^NT$, lNG. 7..~.: ...... ROD CUFT 561-6712 1 OF 2 " DE:LUCIA SUBDIVISION; LOT 21, SITE: PLAN FOR SE:PTIC SYSTE:M UPGRADE: ~.,.~..~-..~"~ i~Vl~ · ~.'..~! ~: IDFPARTidrNTOFNATUI~&L~'SOURI~B~ l. ri#liN OP' UILLt '·"t ' ..'lJ.~ IIII/Mlill Illll Lie ~' %:' ' }?2. IIllif$111'l ,, Ilflltl pll ' ! :.3 . ~o z_ ~7Z-% 5¸1 Us.. I ~t '/SI T'o /~e -Jr' 'z.I OWNER OF LAND dl~ ADDRESS ~/~{I I~ LEGAL DESCRWTION DATE-S~ned PERMIT NUMBER SULLIVAN NVATER WELLS p.o. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 668.2759 (:;'1 I:t 3 I)EI'TH OF WELL STXTIC LEVEL OF W~.TER F f. DRAW DOWN FT. GA~. PER IIR KIND OF CASING KIND OF FORMATION: From~l FI. tn-'~ .Ft. C~-~I4,/G J"T'lc/L'd/OFr°m F,.to From ~ FI. to ~t.,S/~,tl~) ~ (~'J~Q.- F,om FI. to From .?.~Ft. to~ Ft. //~~ From FI. lo F,om~Ft. to .~.~FI. ~IT~,~C ~ ~7~ Frol,t FI. lo From Ft. to Ft.~ /~ ~ C ~ '''J& ~ F,om Ft. to From ~(~Ft. to ~/f3 Ft.~~C~ ~'~ From FI. to - From Ft. to Ft. ~ ~'T~ ~ ~/~/~ From Fl. to From~lO Ft. to~*~-~ Ft. ~C~ ~ From FI. to From FI. to Ft?~ ~d~ ~'~ From FI. lo F~om Ft. to Ft. (~ - ~.~// From~FZ. to Ft. FI Ft. Ft. Ft.. From .Ft. From__F,. to__ E Dept. Health & Human From~Ft. Io~Ft.-- MISCI.- INFORJ, IATION: Anch De'lucia '!'10 .-:.:;_,,.;.,,__,f__ ~O wE] . i~.~J. OtSTJ,#C! AND OlI£CT~ON I'~OU #O&O I#T~R~ECTION$ · '' "'" -'"' '"' ~1 ~.0. ~ox 771986 : - ': " ~a~e E~er, Ak. wELL LOI 1~ ,.. · I~. ' G~eenetone, water. ureene~one'.. I · · - ..t -. , , 60 9/2/ ~oduetton. of ~0 Ma~uson ~Lll~ng ~ 5585 · DRII.UN~ LOG ell Owner Rzc~.~=~ ~t_c~t~a / , ~t~ (.ddrfls of: Township. R~ge. ~tion. ir ~own; or ,is~n~ ~.J. r~, Use of We,~OMutio ' ~ ... S:-'e of cnsm~.--='~"-- Depth of ll(,le..2?~~ Case~ to 161 f~t .. c w~ter level ,l~_~t. ~]Z~I) (~low) l~d surfm~. Finish of well (ch~k ~e) o~n ~d (z'.- ) .-' ground surface Give detalb of formations ~netrat~. size of material ~lor ~d ~': ~"" ~,~ Date of completion unicipality of Anchorage Department of Health and Human Services Tom Fink. 825 "L" Street Mayor P.O. BOX 196650 Anchorage. Alaska 99519-6650 343-4744 March 19, 1992 Lou Butera, P. E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 21 Delucia Subdivision Waiver Request %WR920007, PID ~051-141-38 Dear Mr. Butera: Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance is 95 feet from the well to the septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services hn Sm Program Manager On-site Services ljm:%6 ~.~ MUNICIPALITY OF ANCHORAGE '?"O '?' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION '~ ~'/ 825 L Street-Anchorage, Alaska 99501 Telephone 264-4720 ~/ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I LEGAL DESCRIPTION LOCATION ~ NO. OF BEDROOMS ~ Z Manufacture-- Materi~ No. o~partments ~ Liq.,c~acity in gallons I Inside length Width Liquid depth ' {( 'F (' J IF HOMEMADE: ~ DISTANCE TO: Welt Dwelling PERMIT .O. ~ -- ~ Manufacturer ....................... ] Material Liquid capacitv in gallons ~ Welt ~ No. of lines ~ Leng~ of each line Total ~gth 0f lines Trench w~th Distance ~t~ines F ~ [ ~SF~(-~]~to finish grade Total bsorption area Length Wid Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer tine Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIAL~ SOIL TEST~TING -- I APPROVED/'" DATE LEGAL 'l-':..~:::' !:7~ ~.i ;:' -7 :--i !'"d:::' !:::~ '~ ~"::: ?-h"' i.~.i ,"u.;:' i'::.' ii 'r i' ...... ' ' ......' ' ~-. ...... -' c:,',::' ':"h I::':: ,. ':' ~...¢ c:' '.::'~ i',;:' :::"::~": .... .. :::, : ~.-.u-:. L' !. '::: ~;..!u,,~_!::: ......... ; ..................... (?F !"~-"!F:: ii'" iL...R F,:;.: ~- 6;;;::, :fi'i;::" ~,. it ~'"' .- L~..~ ~ .. ;~ "~ ~"-',~ ";J" :~.--.~I~ '!~" ,,£4:;'; ~: ::::;; ~]7;::'~ ;~'::::~ ~;7;::'~ Ii;Z:" ~S:Z:' ~Z::" '? :.u.::': .. (':?;:::!:":i!? !3:-}.i::., 'i ~...~ :'.....-7 ?,, :;..!4c ?,': ':',..._ .,.. :...i'.* ;" h'u i.'-,-i ;; "* .r'::' C:' '" .................... ;..4 ,-'~f::: ....... ! .?,. '"'r~t., :..*' ..................... ~ ,- ~.* .... ': .,*~..- ........ ,,... ,,, r~-., ........ :: * rT',-:: :-:,~ ....... : : ?:'!iii; ~':i!".i;.' ! ¢'-'{i!!;i ,,::,~v'r'" 'r",r4 ,'~:.' '"."~...:c L:"". ,'" ,:::, ,. .* ,::., 'i- , ¢ .:. ':: ...... O & E ENG..,IEERING & DEVELOt .vlENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed fo r: SOIL LOG Name: /~ L}-~/~//~*/~ /--' /~'/~")~--~- Tel. No. Earl Ellis 688-2280 Mailing Address: Legal Description: L~-; 2' ~/t Depth (feet) Soil Characteristics 0 1 2__ 3__ -----4__ 5__ 6__ __.._,7__ 8__ 11 12__ 13__ PERC. TEST 14__ 15__ 16__ Ground Water Encountered: Yes__ No Proposed Installation: Seepage Pit Comments: / If yes, what depth Drain Field Performed by: Date: WATER WELL RECORD MUN!CIPALITY OF ANCHORAGE STATE OF ALASKA ENVI,: ~ ,_, ~ iDEPARTMENT OF NATURAL RESOURES Division of Geological I~ Geophysical Surveys R ECE i V E 1).,,.,.....m,, .o. LOCATION OF WELL (Pleoee complete either Io~ lb or lc.) A.D.L. No. ,a.lJBoraugh Subdivision Lot Block ~ '/4qtr$. Section No. TownehiPNC~ Range Er"1 Merldian Address: Street Address and Area of Well Location 2. WELL LOG Feet Below 4. WELL DEPTH: [final) 5. DATE OF COMPLETION Surface Material Type Top Bottom 6. O Cable tool 0 Rotary 0 Driven ~Dug D A.ger ~de,fed 0 ~ored ~ Other: 7. US~; ~ Dome,~ic 0 Public Supply ~ Indu,trv ~ Irrigation ~ Recharge ~ Commerical ~ Test Well ~ Other: 8. CASING: ~ Threaded ~ Welded diam.~in, to~ ft. Depth Weight ~lbs./ft. : diam. in. to ft. Depth Stickup~ ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Slzl: Length: Set between ft. ond ft. Backfilling GrGvel peck I0. STATIC WATER LEVEL: ft. Date ~ Above or ~ Below land eurface Equipment used: Il. PUMPING LEVEL below land surface and YIELD ft. ~fter hrs. pumpin~ ~ G.p.m. ft. after hrs. pumping ~.p.m. 12,GROUTING Well Grouted: ~ Yes ~ NO Material: ~ Neat Cement ~ Other: ~5, PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. -- ~ Subm. ~ det ~ Centrificol ~ Other 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature __o ~ F ~ C This well was drilled under my jurisdiction and this report is true fo the best of my knowledge and belief; Registered Business Name Conlroct License Number Address: Signed: Date; Authorized Representative Form 02-WWR (~1/81) Copy Distribution: WHITE-State DGGS, PlNK-Drilter~ CANARY-Customer 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 SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920003 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:THOMSON JOHN E OWNER ADDRESS:PO BOX 671433 CHUGIAK, ALASKA 99567 DATE ISSUED: 1/17/92 EXPIRATION DATE: 1/17/93 PARCEL ID:05114138 LEGAL DESCRIPTION: DELUCIA LT 21 LOT SIZE: 12195 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: 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: THE EXISTING WELL MUST BE PROPERLY ABANDONED, AND THE NEW WELL MUST BE TESTED FOR NITRATES. ISSUED BY: ~-~ ~: . DATE: DATE: EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 694.5195 SHEET NO, / OF CALCULATED BY ~. ~ DATE CHECKED BY *,*~,,./,v DATE PRODUCT ZOO4 ($~ ~ee~) 2C~1 (Pa~l) ~ k~,, G~o~, MASS, 0t471 TO O~ ~ TO~ FREE OWNER OF LAND %.,] ID ADDRESS I)() LEGAL DESCRIPTION DATE - Started PERMIT NUMBER OZ-4, lC_. Ended ///;~< ~)' / DRAW DOWN GALS, PER HR Klnl)oF c^s~no KIND OF FORMATION: From 0 Ft. to From ~ Ft. From 4 Ft. From q'6 Ft. From ,.~Z~ . Ft. From_~'_~3 Ft. From ~ Ft. From~ r~ Ft. From~Ft. From 0 & tFt. From Ft. From/~ / 0 Ft. From Ft. From~Ft. From'q ~ -~ Ft. From Ft. C From~ From Ft. to ~3 o~ Ft. ,>/?,-tlz) to qb Ft. /{,q.~,Op, a .d Fro..~ to ~ Ft L~'/'~J () ,'~/~d,~"/. ~,,/ ~/'C/From to Ft. z / 7-7'~ C c_,/>!'u c~ ;s From ~ to ~,2.> rt. tt:~ ~C tZ C~,:~ From to.~ Ft. From Ft. to, ., Ft. ~ Ft, to _Ft. Ft. to Ft, Ft. to Ft, Ft. lo~Fl Ft. to FI. Ft. to Ft. FI. to , ,Ft. Ft. to Ft. Ft. to_ .Ft. _Ft. to _Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to__Ft. Ft. to Ft. ,.,o_REc E ! V E D MISCL. INFORMATION: 1 199 , Municipality et Anchorage Dept, Health & Human $orvic~ DRILLER'S NAME /,: ........... unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 19, 1992 Lou Butera, P. E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 21 Delucia Subdivision Waiver Request ~WR920007, PID ~051-141-38 Dear Mr. Butera: Your request for wazver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance is 95 feet from the well to the septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur: . // Program Manager On-site Services ljm:~6 7-a 7-,q/__ -ARY ! ! ! ! ! ! ! ! (SADTLERS DR.) HUNTERS !22724 ~22740 OLD S~DLERS / I 22980 2295~ N __ -22961 19857 18 I$ I 12 I~ 20 / 19746 // )74 I ~ '7~ >19740 19741 ~ /o 19726 _E[ 22539 3~256~" ~' i I 22575 NEEDELS )633 22570 22606 22636 ~G CABIN VIDEO /Z~ /~ 19617 ~/ ~URCH February 19, 1992 John Smith, P.E. Municipality of Anchorage On-Site Services 825 L Street Anchorage, AK 99504 .< Re: Delucia, Lot 21 Waiver Request Dear Mr. Smith: On behalf of my client, Mr. John E. Thomson, we are submitting a request for determination of waiver of horizontal separation distance for the above referenced three bedroom residence. The request is for a waiver of well to septic tank distance of 95'. There is a site plan attached. The topography of the area is basically < 5 % with a slight slope to the West. The septic system was installed in 1982 by Muscrat Builders, Inc., and the original well drilled in 1982 to a depth of 545' produces 6 GPH. A new well was drilled by Sullivan Water Wells in January 1992 under permit number SW920003 and produces 16-27 GPH. The permit noted that the existing well must be properly abandoned. Due to the lack of water in the area, the owner wishes to retain the original well as it does produce a limited supply of water, and has a large volume capacity of approximately 600 gallons at static water level. Soil characteristics in the area are well documented and are fairly consistent. The immediate subsurface soil is a sandy gravel down to the maximum test hole depths of 16'. Soil logs are attached for lots 9 and 10. Lots 20, 21 and 24 are in Municipal files. No ground water levels were shown on lots 9 and 10. Well logs in the area show a fractured bedrock type aquifer. The well log for lot 21 shows gravel and sand soil layers from surface to a "hardrock" level of 54'. There are indications of a solid bedrock layer overlaying the fractured bedrock plane as demonstrated by the static water level of 127' in both on lot wells, and the test by S & S Engineering dated March 21, 1987 showing a static water level of 119' for lot 24. The bedrock surface gradient is not really defined, but static water level readings taken by us on lots 10 and 21, show a slight water surface gradient to the West along the general slope of the surface topography. This would provide a favorable gradient for our septic tank location. Page 2, Lot 21, Delucia Waiver Request There are other mitigating physical characteristics that should be taken into consideration in the evaluation: 2. 3. 4. The distance requiting waiver is slight, 95' versus 100'. The tank was installed in 1982 when mechanical couplings were required. The house is located between well and septic tank providing a physical barrier to near surface flow. Water samples of both wells show no evidence of coliform, and low background Nitrate levels (2.5 mg/L old well, and 1.9 mg/L new well). There is a waiver on record for lot 22, located to the West of our subject property, for tank to well of 95'. As part of our waiver request we are also requesting that our combined well water supply plan be pre-approved prior to installation and subsequent Health Authority Approval application. The plan calls for utilizing both wells to supply water to the home through an alternating pump system with timers and pump protector. The system will allow use of both wells so that one well will not stagnate. The timers will put priority on the well that produces the greater amount of water. The pump protector will protect either pump if the well is overused, and will automatically activate the alternate well. The system diagram is attached for review. Please review the attached data and if you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. WE~L ~ JOB EAGLE RIVE,. SHEET NO. ENGINEERING SERVICES P,O. Box 773294 CALOU~TEDBY EAGLE RIVER, AK 99577 694-5195 CHECKED BY ~/~ DATE SCALE ~OI~UCT ~04.1 I51~gle $1~e~t~) 2~5.1 (Pm~l) ~ I~,, GmS, ~#. O1411 To O~r FHONE TOLL ~EE ~C l,3 LOCATION Oil' WELL DA'ri OP OOIPt, l'rmN {PIIIII almplltl lltl)af fa. fl) Ir lc.) Iwblllalllll ILO, l j,,,~'"~"~ l~1/41ft'l' ~"t'¢'-~ I~ ! / I--"--"--"-- Ail) OIIECTIO# Irl~oII IO&D I#?ERIECTIO#I A4It~II ItJ Ifil If 1111 Ltllfll~ I. WELL LOI Fracture h~rd~ncK lure Burd rock · h,,rd roc;l I-1A.,.. 0"".' 0 ,.b,,. ,.., . 0 ,.d..,,,~f:~ Jill. , I. FINISH OF WELL: JlllJJll} Jill: ~J}~ J '~' ~'; Beekfllllnl I,ivel poll ..... ~o. ,,,~c II. tUi~INI LIVIL JIlIi JI~J IItfI. -'"' "~' ,. ' LI~tt~ Ilar-~ t ack _' tk ',':L t ar .~ Subm. 14. lIE MAP. WI: Te~ ~ed ',t ~ll. WATER WELL CONT#ACTOW'S CENTIFICATION: .~q"'"":,,,~,~.. ,,,..,..." j.~ "':. '"', .: ,. .'. .... . ,~,. <~.~r .t~ .~..,,.....,....,.,,.. Jet rl CoiIeIfliiI 1/? OWNER OF LAND ADDRESS Z° O LEGAL DESCRllrrlON ~ DOC Co. dba .,~' SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567. · TELEPHONE 688.2759 .,DEl'TH OF WELL 0 'STATIC LEVEE oF W,&TER'FI'. ' ':iDRAW Down FT. DATE - Started PERMIT NUMBER Ended iGALS. PER HR . KIND OF CASING KIND OF FORMATION: -' 'C,~J/4dg 5'T~ c.t,:'d ~)From.-- From d3 Ft. to" .Ft. From ~ Ft. tO"/' Ft. 00~' ~ L~O ~°,,t;',~/'b} From From .Ft. to '~ Ft. ~_~/-~4J[) '~ ,~O~-~ From F,om F,om+~ ~t.,o~-~.._F,.5~a;4~'C~ ~/~;~,om From 5 '~ Ft. ,o~:~ _Ft. !y~/Z~'~ From Fro~ F~om Ft. to Ft.Z/TT~ ~ C/~ ~ ~ ~o~ From~ From Ft. to ~., .'~6~ From From _Ft. to .Ft. AtT7~ ~ " - Ft. to . . Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to ' . Ft. to Ft. to. .._Ft. to Ft. to Ft. Ft. Ft./' Fl, ' Fromq ,0 Ft. to~r~?,,h Ft. fit_~Z~t~,3C..~ (?'~z_.'-'/O From From .Ft. to Ft?~ q ~t~Z S~/~~ From-- From _Ft. to Ft. ~}~ - ~ From ._ Fromqa~ Ft. to/~/~ _Ft. ~ ~OC&: 6~'d~From From_ Ft. to__~Ft. From MISCL. INFORMATION: Zro6t 9 ?, '. .':: · DRILLER'S NAME /~/ ¢ ? Louis Butera, P.E. "--"' Registered Civil Engineer February 10, 1992 John E. Thompson P.O. Box 671433 Chugiak, AK 99567 Re: Delucia, Lot 21 Dear Mr. Thompson: At your request we have tested the two wells located on the above referenced property. The previously drilled well is designated well "A" and the newly drilled well is designated well "B", The wells have the following characteristics: ~ Date of installation Static water level Total depth Pump level 24 hour recovery rate First hour recovery rate after total drawdown Average recovery rate in 24 hours 24 hour recovery storage potential in well casing Well A. Well B.. 1982 1992 127' 126' (Sullivan) 545' 440' 545' 420' 154 gallons 391 gallons 6 GPH 27 GPH 6 GPH 16 GPH 144 gallons 385 gallons .-. Well "A," the pre-existing well, has a very low recovery rate and would not provide a very beneficial amount of water. Well "B" would appear to be capable of providing 450 GPD, but only if provided with a storage facility utilizing a secondary pump, and timers that would allow the well to produce at its optimum rate of 27 GPH. You have indicated that you would prefer to keep well "B" on line rather than permanent abandonment. This will require a waiver of separation distance application estimated at $750- $1,000. A pumping arrangement will be required utilizing both wells pumping to a common pressure tank and activated by an alternating control with pump protection. I would recommend we obtain Municipal approval of the waiver and well tie in scheme prior to installation of pump controls. The MOA waiver fee of $410 will be required to be paid at time of application. 773291 · Ea~le River, Alaska 99577 · Telephone (§07} 694-5195 · Fax {907) 694-3297 ) WATER WELL RECORD .... IOEPART~,~T OF; ~I~T~J~qAL RE$OURES Divtsion of,Geologico. I I~ Geophysicol Surveys · .* ....., . . . ~-' k.-, OrJIlin! Pormlt Ne. A.D.L. Ne. ~ , Form OZ'WWR (11/81) Copy Diltribuliom: WHiTE'Slate DGGS, PINK-DEli!et, CANARY-Customer LOCATION OF WELL ; [Pleoee complete ol~r IO, IO or lC./ ..v ....... OISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL: ~8. ~ Stre.l ~ddreso end Aria of Well Location Feel Below 4. W~LL DEPT~: (final) 8. DATE OF COMPLETION ~. WELL LOG " ':.. ~- '.. Surface ' Motbrlol T~pI :'. Top Bottom , . - Greenstone wi~h lay ers 125 165 O Irrlgollo, O ,.ehor$. O uf ~'~y tuck, ~ 8. CASIng: ~ Threaded ~ : - ~ dlom. .la. to fl. Depth Sllckup.~ fl. , ~ ~ 9. FINISH OF ~ELL: Tyet: Dlomellr: ~ [ Set bllween : ft. and fl. I Boekfllllng Grovel ~ock ,- I0. STATIC WATER LEVEL: , ft. I Dote Equipment II. PUMPING LEVEL beloe land lurfoci e~d YIELD .fl' otter .~rl. pumping~ ft. otter ~ra. pumping g.p.m. IZ.GROUTING Will ~routid: ~ Yea ~ No Molirl~l: ~ Neat Cement ~ Olher: I~. PUMP: {1~ available) HP, Length ef Drop Pipe __ft. copecily ~g'~'m 14. REMARKS: ~oductton. of 70 GPH ~6. WATER W~LL CONTRACTOR'S CERTIFICATION: ~5. Wel,r ?em~e~el~re ~ O.F ~ C Ma~uson ~illing AA 5385 Rag~atere$ Bu~i~ell Nome Conl~oct Licenle Number WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological I~ Geophysicol Surveys Drilling Permit No. LOCATION OF WELL (Pleaee complete either la, lb or lc.) A.D.L. No. Io.llsoro.,oh Subd'v','on Lo,,loc, V'"'r'. S,c,ion No. Tow,,"i, NO ko.o, Em t' ".' ~of-- of~of -- S~ W~ ,~.JJ. DISTANCE AND DIRECTION FROM ROAO INTERSECTIONS 3. OWNER OF WELL: _. Address; '' Street Address and Area of Well Location Feet Below 4, WELL DEPTH: (final} 5. DATE OF COMPLETION 2. WELL LOG Surface .~ , -- ft. Material Type Top Bottom ]]~i{¥'P- .r;'; .. 7. USE;:'.~ Domestic 0 Public Supply 0 Industry ~'~-~{~;]'~;.~ ~..~ :~7;'~ diam.__in, tO'~ ' "~ ft. Depth Weight ~ ;.:~ ~ ~.~ ~-~,~;! *;'~. :' diom. in, fo~ ft. Depth Stickup~ ft. 9. FINISH OF WELL: '~ ' Type: .......... 77~3';:~'~:* ~ ,~-. ::.: ' ':: ' ' : ~' -:~":: ':{~' ' Slot/Mesh Size: Length: .~P~"~ ~:~C'~7. --. =' · Set between ft. 0nd ft. 2 ;_';~.'~ ~:.~'C 2; .t~ ,~{3~'~ Backfilling Gravel pack ';:T~ ~".~{~.' ' ';:L:}~ :;.:'.;;. ;fk~ ~'{'*;' I0, STATIC WATER LEVE.L: -~';:'J ft. / / ~ Above or ~,~ Below.land surface -"-'- ' " ~' Equipment used: II. PUMPING LEVEL below land surface and YIELD ft. utter hrs, pumping~g,p.m. ~;U;q;C;PALiTF OF ~CH~x~: fa. after hrs. pumping g.p.m. Material: ~ NeGt Cement ~ Other: ~ ~ ~ ~ ~'.~ 1~0~ 13, PUMP: (if available) HP Length of Drop Pipe ~,'~0 ft. capacity ~g.p,m. m: ElVEum ~ ~ Subm. 0 Jet 0 Centrifical 0 Other 14. REMARKS:. ~ m . , , 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature __o 0 F ~ C This well wos drilled under my jurisdiction end this report is true to fha best ~f_my..knowiedGe end belief; Registered Business NGme gontroc* License Number Address; Au'~horlzed ~orm O2-WWR (11/81} Copy Oistributio~; WHITE-Sf~Ie DGGS, PIN~-Brill~r, M-V~/ DRILLING, Inc. P. O. ~Os 4.1~4 * 1310(~ Intenational A~r~ R~d {907) 27N61 l ANCHORAGE. ~S~9 DRILUN~} LO0 ? .U~e of WellD°m*I+-t.o Depth in feet from ground surface !2 TO _ ~TO___ ..... 3,!. TO . TO _~TO i62_ _l TO .... ~_TO. _.: .... : .... TC) ........ $~at~c water level_ !-~----ft ~i:~Screen ( ); Perforat~ ( ,~cti~ scr~n or ~rforntion Well ~ping test at 1 gallons o[ d~wdo~ from static level. Date of completion August ~, ,1982 ~ A _ _.fee (below) land surface. ). None Cased to 161 feet Finish of well (check one) (minute) for 1 WELL LOG hours with open end ( x ) ;' ~i -.., 4'~ ~i.':' Give details of formations penetrated, size of material, color ~nd h~Lqe~ Casin~ stick-ap Organic materi al Loo se f~__avel $i.!~_h~and,:_~avnl . ~1./' ~ I Eagle River, Alask199577 CIVIL ENGINEER ?~ ~'--' '~ WELL O E ~ H' E~ED TIME SINCE ' PUMPINGSTARTEW WATeB ~ , REhhUeBv BIT~U REMARKS TIME O 1 S 10 15 25 3O 35 4O 46 50 ~:. .... :.~! ': Ii t :" I'.! . 150 77a¢ ~ :" 210 ~' 240 (4 RECOVERY 0 10 15 t ~) ~ 0 DEPART~ NTOF HEALTH & ENVIRONMENTAL PRO VlRONMENIAL ENGINEERING DIVISION . ~ ::,,~. ,,~: ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL IN~ECTION RE.AT Malpri~ Well Bwelhn¢ PERMIT NO. Length W~dlR ~l)lh ' PERMIT NO. ' ' ..... Well Omldinq Immdntiofl Neer~t lot line DISTANCE TO: - ~l O~lh ~r~Jler D,slance to lot DISTANCE TO: Buildlnq foundation ~r I,n~ Se~tlc tank Abtorptt~ OTHER [ '-~MATERIALS ....... ~, , ,~ A~PROVED' /'% DATE LEGAl. D~vit St.. Eagle R~. Al~m ~ ' ~'~'' ~ ~'~ .,~ SOIL L~ Soil Chlric~lrtsttfl . Ground ~llter Encountered: 'il rop~sed lflstlllatton: Conlnents:, ,, Performed by:,, ;'~:~i '~ ,, ~~,,~ ~ '~. Seepage Pit Drain Fteld ~ ' ;'~ ~ PERFORMED FOR: '; " MUNICIPALITY OF ANCHORAGE"/ DEP~TMENT,,,,~ _ OF HEALTIt AND ENVIRONMENTAL P~IOTECTION ~'":' ' SOILS LOG - PERCOLATION'TEST PERCOLATION TEST ~ATE PERFORMED: LEGAL UJESCP. Ir' TION: 1 C) i/"y~Z: S/vi 5 6 ? 9 10 1! 12 13 14 15 16 18 ~9 20 SLOPE COMMEra TS SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES. Ar WHAT DEPTH? Reading ["}ate PEFIC(JLATIOtq RATE l'ES1 F~U~I I:IETWEEN CE:tR TIFIED Time Water Drop .... 1 Gt'o$s Time (minutes/inch) FT AND FT EAGLE RIVER ENGINEERING SERVICES P.O, Box 773294 EAGLE RIVER, AK 99577 694-5195 SHEET NO. ~ OF CALCU~TEO BY ~ ~ DATE CHECKED BY DATE SCALE ~' ~' P~OOUCT 204.1 I~1 $1~ltll 2~'I (Pidd~l) ~® ~., Store, Mm 0141~ TO O~dlr PHONE TOII 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. # 0 ~'-/ - Iq/- -~ ~ ~ HAA # /L/-/z~ 1. GENERAL INFORMATION Lot 21; Delucia Subdivision Complete legal description Location (site address or directions) 22611 Needles Drive Chuqiak, AK Mailing address ~P.o. Box 671925 Ohugiak, kondin~ a~ency Mailin~ address "Agent Address __ Day AK 99567 C88-0E50 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well xxx ,. Commun'ity well Public water NOTE: RECEIVED APR 2_ 4 1997 Municipality of Anchorage Dept. Health & Human Services If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX ~?dividu-?! on- "':, Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #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/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. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Raa~ ~uo. -'204 Phone (~ Eagle River, Alaska 995,77 Address Engineer's signature "?./~'~Z'Z, ~ Date DHHS SIGNATURE · ~ Approved for '~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date .~- ~ ! - ? 7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage. is not responsible for errors or omissions in the professional engineer's work. 72.-025(Rev. 1/91) Back MOA#21 I=NVIRONMI=NTAL ~FR¥1¢I~ Municipality of Anchorage APR Environmental Services Division R C4EE 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-474 Legal Description: Health Authority Approval Checklist .~ '~-~--~-~-~'/~- ~ ~ Parcel I.D.: o,s-' / _/,4/-,z~ A. WELL DATA Well type ~'/~.! U4--¢(,,,- If A, B, or C, attach ADEC letter. ADEC water system number Log present~) y /~-/ Date completed /~Y2 //~ ~ 2.- Total depth 5'-~/ 5"-' / z./'~o' Cased to J"- ~/~'-'~ ' Casing height (above ground) Sanitary seal ~1) Date of test Static water level Well production WATER SAMPLE RESULTS:--.~Pr~ y //v' Wires properly protecte(~_JN) FROM WELL LOG AT INSPECTION I~XZ //~?z '-/-/ -- / 15/' 0,5- / O, ?/ g.p.m. g.p.m. Coliform 0 Nitrate ~. ? Other bacteria Date of sample: ~' -,~ U - ) 7 Collected by: ~-~ t .~ ~-~-~,~ ~ B. SEPTIC/HOLDING TANK DATA Date installed ~ ~?--1-- - ~'*'~-~ Tank size \oc, c~ Number of Compartments ~ Cleanouts(._~N)~__ Foundation cleanout (~) ,.~ Depression (Y~ ~) High water alarm (Y/N) Date of Pumping ~/~"-~? Pumper ~'"/~' C. ABSORPTION FIELD DATA ~ ° ¢,¢~-System type Total depth Date installed Soil rating (g.p.d./fF or ftqbdrm) Length ~ ~l , Width "2~ Gravel thickness below pipe Effective absorption area ~- '~ z~ + (~;'~toring Tube presen (Yt~) 7 Date of adequacy test 4 ~ l - ~ 7 Results~ail) ~ Fluid depth in absorption field before test (in.); C) Immediately after ~/5'b gal. water added (in.): Fluid depth ,I~ (ins) Minutes later: ~ Absorption rate = ~5"-c> 4- g.p.d. Peroxide treatment (past 12 months) ~ ~,o~J~- F--~,~,,a ,,3 If yes, give date ~3J ~, _ Depression over field (Y~D For ~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ~ High water alarm levo ~~''~ *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL,~ON LOT TO: , '/ Septic/holding tank on lot o[5' ~o ~ ~ Absorption field on lot \ o o ~ ~- ~ o ~ On adjacent lots On adjacent lots Public sewer main Sewer/septic service line 7- ~ ~ '~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Public sewer manhole/cleanout Foundation 5'- / ~' Property line t~ ~ ~ Absorption field ~"- J Water main/service line Surface water/drainage \o c~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line "~ / ~'c~,4. ~ Building foundation ~ ~ ~'~ Water main/service line Surface water ~ ~ ~ ~' Driveway, parking/vehicle storage area Curtain drain ~ }/x- Wells on adjacent lots \ ~ o ~ ~ L~ ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor~l~~stems are in conformance with MOA HAA guidelines, in effect on this date. Signature "~-/~¢ ' ¢~ ~L'~. ~'~ ~-,-.~ / / Date 7 Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL During a recent Health Authority Approval on-site inspection and test ef tile potable water supply well on Lot Block ~ of P~/~ ~6{~ Subdivision, the productivity was determined to be ,~ gallons per minute. The minimum well productivity required by this Department {AMC 15.55) for a ~ bedroom residence is ,~ gallons per minute. Although the subject we!~ currently exceeds this minimum requirement, all parties concerned are advised that the production capacity ef ~he we!} 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 te all copies of the subject Health Authority Approval. · ':ASBUILT-NO CORNERS SET THIS DATF ............ m~.~,, ~ A,5:SUL;,ArrF~' LAN]) SUttv~.~IiNG 688-4566 I HERE~ CERTIFY .THAT I HAVE SURVEYED THE SC~ FOLLOWING DESCRIBED PROPERS= ~9 ~AT NO ~~R.ENTS EX~ST ~C~ ~ ¢¢~Z ¢~&~,,'. ~'.<?~%. INDICA~. IT IS THE RES~NSIBILI~. OF THE ~ ~ D~MINE T~ .~iS~ OF ANY ~ENTS, CO~NA~S, OR RE'RIgOrS .~/~ .~~~~j~~ ~I~ ~ NOT ~R ~ ~E R~~ ~BDI- VISION P~T. U~ NO CIRCUMSTANCES ~ DATA H~N BE US~ ~R CON~U~ION ~-~ ' ~"~--". :~ ."~-~-~ ARY LINES. ROBERT C. GOWAN, RE. ROBERT A. SHAFER, RE. GIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS ~'E LL INSPECTION & FLOW TEST SITE pLANS WELL RECOVERY TEST DA-FA (907) 694-2979 FAX (907) 694-1211 ,/ . CLIENT: .¥---~,~ WELL LOCATION.(legal): TEST DATE: WELL DEPTH: CASING DEPTH: TESTED BY: WELL DRILLER: DATE DRILLED: ~. ~%'L- TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min, recovery. TEST DATA: START TIME: MISC DATA: Casing Height: Sanitary Seal? Wires in Conduit? Grading O.K.? Pump Depth: Samples Taken? Date: STATIC WATER LEVEL: 'Z- 1..-7...- TRIAL II PUMP II T,ME II METER II GAL. . o* OFF O' o~ ~.'Z.I, ~ ~,~ OFF OFF O~ o ~ ~ ~,7 2 ON ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER & WATER MAiN EXTENSIONS SEWER & WATER INSPECflON ENGINEERING STUDIES ANDREPORIS WELL INSPECTION & FL OW TEST PLANS ROAD DESIGN SOILTESf PERCOIA]ION IEST STRUCTURAL & MECIIANICAI. INSPECTIONS ON SITE WASTEWATER D~SPOSAL SYSTEM DESIGN WELL FLOW TEST DATA (907) 694-2979 FAX (907) 694- CLIENT: ~-~-~ ~' t LEGAL DESCRIPTION: WELL DEPTH: ~' CASING DEPTH: ~ I DATE DRILLING COMPLETED: J~ ~ DRILLER: DATE: ~"~-Cll MISC. D.,~TA: CASING HEIGHT: IZ.. SANITARY SEAL: WIRES IN CONDUIT: ~/,~' GRADING O.K.: BACTERIA AND NITRATE~AMPLES COLLECTED (date): TEST DATA: METER PUMPING DEPTH TO CLOCK READING RATE WATER REMARKS TIME (GAL) (GPM) (FT) '1 RESULTS: WELL CURRENTLY PRODUCES ~', ,/O GPM WITH A 41~rI DRAWDOWN TESTED BY: FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTtt EAGI E RIVER t COP ° SI lITE 204 ° EAGI E RIVER, At ASKA 99577 RPR-O~-1997 12:~3 CT&E ESI RNCHORRGE 90? $61 5501 P.0~/05 ZT~m~ CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Orde~l By PW$ID 971480001 $ & $ Engineering Dnnking Wate~ L21 Deluc~a S/D Drinking Water Client PO// Printed Date/Time 04/02/97 1 I:05 Collected Date/Time 03/26/97 15:00 Received Date/Time 03/27/97 13:20 Technical Director: Stephen C. Ede Sample Remarks: Sample collected by: Ray Parameter Nftrate-N Total Coliform ResuLts 2.7 0 PQL Units AllOwabLe Prep Analysis Method L~m~ts Date Date Init 0.100 mg/L EPA 300.0 cot/lOOmL SM18 9~ZZB 03/28/97 SPM 05/~7/97 RAFt 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-141-38 GENERAL INFORMATION Complete legal description Delucia Lot 21 T15N R1W Section 9 Location (site address or directions) 22611 Needels Loop, Chugiak Property owner John E. Thomson Mailing address p.o. Box 671433, Chugiak, AK Northland Mortgage/Liz Lending agency Mailing address 11421 Old Glenn Hwy., Eagle Agent 16600 Centerfield Drive, Address 99567 River, AK Day phone 696-5070 Day phone 99577 694-7872 Day phone 694-4200 Eagle River, AK 99577 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: Individual well x Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site x Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91} Fron! MOA #27 o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date st]own below, I verify that my investigation of this Healtr] 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. 694-5195 99577 Phone Name of Firm Eagle River Engineering Services Address P.O. Box 773294, Eagle River, Ak Engineer's signature -- Approved for / ~7&,.~¢~. ~ bedrooms Disapproved. Conditional approval for bedrooms, with the following stipulations: 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 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. 72 025 (Rev 1'91) i~ack MOA ¢21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~EE.~C)01,4 /~4'¢ ~./ A. WELL DATA /~//~ Well type ~/~ If A, ~, or C, a~t~ch AD~C letter. Log present (Y/N) Totaldepth ~' Sanitary seal (Y/N) Parcel I.D. ADEC water system number /~./.'~ Casing height ~ ~ ~ FROM WELL LOG AT INSPECTION Static water level -- / / 3/' / Z/'/' / / ~' Well flow ~' ~' / ~'~ g.p.m. / ~' ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/betting tank on lot Absorption field on lot ~ Public sewer main ~/,~ Sewer service line ~5"- ~ / WATER SAMPLE RESULTS: Coliform / / /4~/' Nitrate~'~ Date of sample: g~¢/~(//~Z ¢ ///,,3.3'/~'~ / /"/'~ · On adjacent lots ; On adjacent lots / Public sewer manhole/cleanout Petroleum tank /.9 Collected by: /v/,~ Other bacteria B. SEPTIC/NOL-~+NG TANK DATA Date installed /~- ~ ~7 ~'~ · -' Tank size Cleanouts (Y/N) ,Y /00~ Com part ments Foundation cleanout (Y/N) /v Depression (Y/N) /¢ /,4 Alarm tested (Y/N) /¢ l ~ /~,- ~Z- Pumper _,~/r~ ~ High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOEEHNG-TANK TO: Well(s)onlo~' ~'-~ / To property line '~'~ / Absorption field Surface water/drainage Foundation -~'~ Water ma~/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at Meets MOA electrical codes (Y/N~-~ SEPARATION DIST~,NC~ FROM LIFT STATION TO: Well on I..¢-'''~' On adjacent lots D. ABSORPTION FIELD DATA ~-~ Date installed Length Z ]~f Manufacturer / M a n h ole/Acce~)'"'""~ .-~-~"'""' "Pump off" level at Total absorption area ~.'2 ~' ¢z5 Depression over field (Y/N) /~ Results (pass/fail) Cycles tested Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness -..._~/'~' /' Surface water System type Total depth Cleanouts present (Y/N) Date of adequacy test ,'DR ~; ~ for k.~<~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: , Y~'Z. / I']gZ_ Well on lot io~' //~- To building foundation ~ '¢- On adjacent lots t-/'~ ~ ' Property line To existing or abandoned system on lot On adjacent lots /~/t Cutbank ,,¢/.4 Water mair,/service line Surface water /'///¢ Driveway, parking/vehicle storage area Curtain drain ~'/~ 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 Engineer's Name Date Waiver Fee: $ Date of Payment Receipt Number HAAFeeS L/"~ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Tom Fink. Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 8, 1992 Lou Butera, P. E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 21 Delucia Subdivision Waiver Request %WR920082, PID %051-141-28, HA920815 Dear Mr. Butera: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 4 feet from the property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Susan Oswalt On-site Services HOV Z? '92 10:g5 HORTHERH TESTIHG, AHCHORAGE NORTHERN TESTING LABORATORIES, . !INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-4~6-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99693 ! 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CUENT [] PUBUC WATER SYSTEM ,,D.# ~-~--I I' ..1~ I _ I I~ PRIVATE WATER SYSTEM NAME Mailin9 Addre~ Cip/, Slate, Zip Code SAMPLE DATE: // . ~ _~ ~.~ Phone , /_a _~ t.~ ~./<:~., Day Yee~ Purchase Order No, SAMPLE TYPE: Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. METHOD OF ANALYSIS: [~vlF Membrane Filter Treated Water .,Untreated Water MPN -- Most Probable Number [aber~r*/ReL Ne. 5 6 7 8 Signature of Representative ~ V' ' / FOR LABORATORY USE ONLY INSTRUCTIONS TO BE COMPLETED BY IL.~BORATORY Received at: ~Anch, ~ 0 Fbks. Date Received I ll~/~ Time Received J!b I 0 Next Sample Due.,_~ COMMENTS: SATISFACTORY UNSATISFACTORY I U RESAMPLE " R OTHER BACTERIA OB TOO NUMEROUS :i TNTC TO COUNT Vedfi~tion LSB BGli t · No. elopeI ' R~'~t~d b~Z' ' Date 100 mis. NOV 10:04 HORTHERH TEoTIH.:, AHCHORAGE ' NORTHERN .TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 g07-456-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99603 !KI7-277-837B Drinking Water Analysis Repod for Total Colilorm Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. · L, I ,, I'- 1 {~ PRIVATE WATER SYSTEM City. ~ttt~. Zip Codl Year Purchase Order No. [] Treated Water ~ Untreated Water SAMPLE DATE: /~, ~ Mo. Oay SAMPLE TYPE: '~ Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. METHOD OF ANALYSIS: F Membrane Filter [] MPN -- Most Probable Number Laberato~ RM. Ne. 3 4 8 Signature of Representative Date Analyzed Time Analyzed Next Sample Due TO BE COMPLETED BY LiABORATORY Received at: ~ Anch. [] Fbks, Time Received l~ ! 0 COMMENTS: SATISFACTORY · UNSATISFACTORY RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT R OB [TNTC Count I~B ~S © -- COmm~lnl;~ *No. of Total Coliform per 100 mis. P.I/t NORTHERN I STING LABORATORIES,' !NC. ~330 INOUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 901-466-3118 2605 FAIRBANKS STREET " ANCHORAGE, ALASKA ~)'~ 907.277~1/B Drinking Water Analysis RePOrt for Total Coliform Bacteria TO BE COMPLETED BY CLIENT PRIVATE wATER 5YBTEM State SAMP~DATE: 0~ ~ 9Z Phone Purchase Order No. PLE ~PE: .:. Routine; ~ TreAted Water Special Purpose ~ Un,reared W~ter . Check Sample (for original contaminated '~____~. sample with lob reference no. ~"/~Impl~ 'tlme Lee. etlon ~1~ ~ ~-.~u~ ~., 2 /~ TO BE COMPLETED BY LABORATORY Received st: ~' Anch. E} Fbks. D.to .oceived ,Z / / ~/.9 2-, ! Time Received ..... / '~ -~ Next Sample Due COMMENTS: SATISFACTORY "~(,~ ) 2 4 5 6 7 9 10 - Signature of RepresentAti~e "~'~"}: ~''''':' ' UNSATISFACTORY U R RESAMPLE ,'"~ OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT DAI~ ,~IALZYEC 2/12/92 26t'65 FOR LABORATORY USE ONLY , ' ' PIC~P N.o. of lotal>~ollform Co/Jj~le~ per 100.'mi Reported by . i../ ~ /- I, i,l't::D ' ~ ) Date · NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-456-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. # RIVATE WATER SYSTEM Msilin, Address ~ .4K City State SAMPLE DATE: 0'~ Ob ~'Z-Phone Mo. Day Year ~94,-$z.97 ,¢,4Y-z:pc°"e bg4- 51F5 Purchase Order No. SAMPLE TYPE: [~outine [] Special Purpose [] Check Sample (for original contaminated (~ sample with lab reference no. Sample Time No. Location Collected [] Treated Water NUntreated Water Collected by 3 6 7 8 9 10 Signature of Representative CASH CHARGE FOR LABORATORY USE ONLY MAll. HOLD FOR PICKUP TO BE COMPLETED BY LABORATORY Received at: ~i~/Anch. [] Fbks. Date Received Time Received Next Sample Due COMMENTS: SATISFACTORY (~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final LSB BGB Result* / .z~//o/'3;~--. ~ Time NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Eagle River Engineering P.O. Box 773294 Eagle River AK 99577 Attn: Louis Butera Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Al16208 Delucia 21 (New) Water Method Parameter Units Report Dates 02/13/92 Date Arrived: 02/07/92 Date Sampled~ 02/06/92 Time Sampled~ 0630 Collected By: LB MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Result Flag Date MDL Analyzed EPA 353.3 Nitrate-N mg/1 1.9 0.3 02/12/92 Microbiology Supervisor NORTHERN TESTING LABORATORIES, INC. (g07) 2T/.83?B · FAX 274.9645 Eagle Rivet Zng£nee~ing Report Date~ 02/18/92 P.O. Box 773294 EagLe R£ve~ AK 99577 Attn~ Loule Butega Oug Lab #= Al16230 Location/P~oJeC~ - ¥ou~ sample ZD~ DeLucl& 21 (old) sample Mat=£x~i ware= CommentB~ Method p rameter EPA 3S~.3 Nlt~ate-N ' Date Ar~£ved~ 02/Z2/92 Date Sampled8 02/11/92 T~mo Sampled~ 1800 CoLlected B~ LB B ·Below R~gulatory H - Above Regulato=y Max. E u Below Detection L.~mit sstima~ed'Value. Date Unite Remul~ Flag MD~ Analyzed mg/L 2.5 0.3 02/12/92 : H£c=0b!olog~f Supe=v£~o~ I Time Time ~e Date Date Date Inspectur Inspector Inspector Comments Conditional Approval Date Sewer Installed "~'.~,.. Permit No. Septic Tank Size __(~ ~.. Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank I APPLICANT FILLS OUT LOWER HALF ONLY Property Owner -.;'. :.....;:. ' ...,: -, =~,~/;~--~ ,~'~..~.-'- ~:- ~Z~::~-~ .... Phon~:~? ~'~. Mailing Address ,.. .~%?_~,~- / -~ ,:,', '; * ~;~ -~ ? ~~ · Buyer ','/?~C~ "~?/- Address Lending Institution ~.~..:.~.Z¢ 3~ ' , ,~ Phone Address - ._ / ~ , ~' . , ... .-,;.. . ,,,. . Y · g ~ ,~ ~2 ~ ~ ~' ,' ~ '~/~_~ .~. ~ _, 7;.~. Phone Address . -"/:" · :;:) .... :?;..-~- .-'. . - . /~ . . . . .... ;, .~'~ ...~"' ~/'~, -.. Legal Description - -" Street Location /,~.~,/~ - · ," . /' ,' , ..,:;.~_,/.g~;~_.~{~ Type of Residence ~ Single Family % Multiple Family No. of Bedrooms -J Other Water Supply ~ Individual 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 Utilit~ available.) Sewage Disposal ~,~ ~ Individual Year Individual Installed: ,~ Public Utility When Connected to Public Utility: % Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.