Loading...
HomeMy WebLinkAboutMCCARREY LT 3McCarrey Lot 3 #017-092-83 Municipality of Anchorage Paget oto 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: S w 935221, 5-3 PID Number. Can ` 00la-SS'J Name` Wastewater System: New ❑ Upgrade MIKE #-14uPA Address: 602 45E- ///Z/ 74- ABSORPTION FIELD Phone: z.7l&- 833 eX Z No. of Bedrooms: ;A Trench ❑ Shallow Trench 0 Bed ❑ Mound ''Other LEGAL DESCRIPTION Soil Rating: Total Depth from or� at grade: Z {N G GPD/Sq. Ft. 7 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Ft. 3 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 5-$ '-.' 0 r Ft. Ft. WELL: New ❑Upgrade Gravel width: Number of lines: Distance between lines: I S Ft. I Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: - Pipe material. IVA"iTe,- 2q-7- " Ft. /01 FL 11116aO So. Ft. d R 6$Ak '303q Driller Date Drilled: Static Water Level: Installer: rAGG IZAhE Date installed: LPIi4E-DTRtCu,t,7 B-q-OJ3 �� Ft. - �lut,Y 30 /% Yield:Pump 2 GPM Set at: - 2.Zi Ft. Ca sing Height Above Ground: Ft. TANK SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin HoldingPublic/Private Manufacturer: Capacity in gallons: /-z From Tank Field Station Tank Sewer Lines - - Sb Well l l S t 2 S� �! �/rl Material: STEL G. Number of Compartments 2 Surface ��� Nld� LIFT STATION Water Lot t Size in gallons: Manufaclt�' Line ZA ZO �V Foundation t .J 6 �" (� 'Pump on" level at: "Pump off' level at: High water alarm at: Curtain "-! A -y/ A Pump Make & Moder Electrical Inspections performed by: Drain Remarks: Q 4AN 1,T ? BENCH MARK Location and Description: f l L `zlu rl41P T tt '�%,A45�—r,0S7r LLL Assumed Elevation: /ODa „r Ft ENGINEER'S SEAL �ag>�'0 o�� OF �C@e� Inspections performed by: S•��0_(PtVE; AP6. Dates: 1st 'z -3c,'03 2nd A Stevan R. Pannone 6 Department of Heal d Hu ervices approval C, ^r-•°'{�`���� 1�`p�F, Reviewed and approved Date!'��!� h Q ES5�O s� __ 72-013 (Rev. 9/91) MOA 25 RECEIVED NOV 2 41993 fV;un'c;pality of Hnc dopt' HeaPth & Human -At-2- ,A -T,q 0 �� R 63 N U C10 to r V u; J � J u � C V u; /�VNiC[�h1LITY c?= A1vcAc>2Aga- t` V 3DJ 0)°J3 ��'PARr/r,�✓ur CIF #aAL7 htu,,A.�) s�evices E�yi2or�✓q E-N'c`AL .SE.2V7C�S o. 7A o Yc !9 66 se ,A,v cAoAA4 e / ,A K e 9Sie5 -66sn A -T -I-/-4 : pMTL- Q2o'$swer 2o-Qwsor �) Lor 3 / n c GA RR S vi3A. i�02,Nc , s-4.0, E. LV 93 0 /Z3 —laE,A2 fY�IZ. 02o�jiNSDN� O�lc�2 Std ems= b2 -7-A s #C>osp. -T-#a A7JDi-r/o.vAe -:x7r-= Yom 9AuP- A,,l✓��STiotiLS� /�C S� cAe-&- S,nJca�rtac `Y� k1 N c>fl-o 2A G E:./ A k °LTJ S/u-2cszs Steven R. Pannone t �� C��� CE -8149` E 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 PERMIT PERMIT NUMBER:SW930153 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:MEADORS MICHAEL L & LAURA 0 OWNER ADDRESS:6025 E 144TH AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01709283 Iti LEGAL DESCRIPTION: MCCARREY LT 3 LOT SIZE: 61725 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/11/93 EXPIRATION DATE: 6/11/94 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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: 'ISIS AN AMENDED DESIGN_SYSTEM SYSTEM HAS BEEN MOVED AND <.-REDESIGNED. RECEIVED BY: DATE: 7—Z Cf—l3 ISSUED BY: 1e� '" �"�'DATE: 1 1 .:),i -1 -I -S fCS_%a0W- L � A.)vLn kt-e-- Municipality of Anchorage Department of Health and Human Services Environmental Services P.O. Box 196650 Anchorage, AK, 99519-6650 ATTN: Ms. Susan Oswalt RE: Lot 3, McCarry Subdivision Permit No. SW930153 Dear Ms. Oswalt, During the construction of the leach field at the design location, we encountered very stiff soils at the design depth. The soils were not what was expected and did not have the absorption capacity the design required. The contractor excavated an exploratory hole approximately 40 feet north of the design location. We encountered good clean sands. The sand perked at a rate of 2-3 minutes per inch. See attached soil log. The new area is more condusive to a wide trench. We will be installing a 5' wide by 3' deep by 58' long wide trench. The location has move 40 feet north of the design location. The movement of the field does not impact any existing wells or septic systems. The north end of the field is located approximately 10 south of the north property line. If you have any further questions, please give me a call. Sincerely, Steven R.Pannone, P.E. P.O. Box 142025 Anchorage, AK 99514-2025 (907) 274-0308 (907) 276-4245 saolAaas ueiunH �2 4lla9N'1da aBeaoynuV 10 AlHedlalunn £66[ 6 z Inp (13AI33m Municipality of Anchorage Department of Health and Human Services Environmental Services P'Box 196650 Ancho,rage, AK, 99519-6650 ATTN RE: Lot 3, Mc( Permit No Dear Ms. Oswalt, Oswalt Subdivision 930153 7—z.v,y3 _,12--14---7L2- *--06�tj (0l4�55 During the construction of the each field at the design location, we encountered very stiff soils at the design depth. The so s were not what was expected and did not have the absorption capacity the design req 'red. The contractor excavated an exploratory hole approximately 40 feet north of the d ign location. We encountered good clean sands. The sand perked at a rate of 2-3 minutes p inch. See attached soil log. The new area is more condusive to a wide trench. We will bei stalling a 4' wide by 3' deep by 50' long wide trench. The location has move 40 feet nort of the design location. The movement of the field does not impact any existing wells or se tic systems. The north end of the field is located approximately 20 south of the north property line. If you have any further questions, please give me a Sincerely, Steven R.Pannone, P.E. P.O. Box 142025 Anchorage, AK 99514-2025 (907) 274-0308 (907) 276-4245 RECEIVED JUL 2 1 1993 MuniapaNlY or Anchorage Dept. Health & Human Services /I�\100*0 s .00 0 01 6) ,SOo00S wl °J ~ N Z CAM LIJ co • 6► W 3 Whti C3 /Uj 0LU VI 0 { poi j oILM ODs.. N { �. - o i 01 101 a p MW{ W 5 S90IA $ uewnH V 431eaFl 'idea - - ` - so o6ei ony 4o AvIe¢xownw gnMI 7---� 2661 t/0) N dw co _.__ _ co � iedjOO""' �z ,a f J I qr Vo SID t V 101 ; 6L'081 t t I a3 m 90tS o00 _ t W i n qr �'a .Iz�.,,� - 0 ��i+retN1E'ER(e'�;�4�gn Municipality of Anchorage ' - e DEPARTMENT OF HEALTH & HUMAN SERVICES >.........,.s..� 825 "L" Street, Anchorage, Alaska 99502-0650 Steven R. Pannone F SOILS LOG —PERCOLATION TEST �:`<? �a CE -s1 9 R. PERFORMED FOR: TSI G e �' L- ou U CLQ M C. ct`Lo4 `�- DATE PERFORMED: re LEGAL DESCRIPTION: t4CCol r'r_h eU Township, Range, Section: nrf— rv� SLOPE SITE PLAN (FEET) 3 4 yh 5 6 7 V0 9 10 t �4 141, 1 �-,-1 '�Go4. c� P �'(CEI ED 14UL 2 1 1993 Dept. Fm , ,y ul Anchorage h & Human Services 15 16 (So J.. 1s E WAS GROUND WATER Ci ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water ABe��� Monitoring? �6 _ Date zo UPERCOLATION RATE Z' (mmutesnnch) PERC HOLE DIAMETER r TEST RUN BET/WEEN �FT AND a FT 30MMENTS l `d04C'O' r-` f O ei �?' 't G V'C L G G` U cL et -r, PERFORMED BY: i'?I ?' V 0 2'r 14yg k. r- I Gw 'r- `-rut POPPE CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: --7'// a6A 3 72-008 (Rev. 4/85) J R9th Y 'Y �t^ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 3' wft P- p"""0^' SOILS LOG — PERCOLATION TEST '° CE -8149 c� n'^ PERFORMED FOR: �IIkT '1 tAM V W� g,./�©O�%� DATE PERFORMED: LEGAL DESCRIPTION: CD'i`� ^4 (CYa1R-'�-Y StJ�.TOWnship, Range, Section: DEPTH SLOPE SITE PLAN (FEET) 2 3 4 �W 5 6- 7 8- 9- 10- 11 91011 12 13 IV 14 Dep 51617 15- 16- 17 81920 18- 19- 20 (10"�:OMMENTS Ntc.6,111P 4 RAV a /- ■■■■■■■�■■ WAS GROUND WATER ENCOUNTERED? RECEIVED AT WHAT S L � rl„ eC) DEPTH? O ■■■■■■■NI■ —� n JUL L u U 2 91993 s` E Depth to Water After Monitoring? �k-t Date: nicipalify of Anchorage Health & Human Services ■■■■■■■�■■ Net Drop O eC) ` Zo ■■■■■■■NI■ ie co) s` ■.■■■■■■ IN ■■■MMEMMIMIN R■..■■■ MEMENNOMMIN MEMEMEMENIN ■■■■■■■■■MI ■■■■■■■■■■ .■■■■■■■■■ ■■■■■■■.■■ ■■■■■■■■■■ Reading Date Gross Net Depth to Time Time Water Net Drop O eC) ` Zo ` ie co) s` PERCOLATION RATE 2O � ate- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN sL� FT AND LIE FT PERFORMED BY: S , Q-�pANNoNIS 1 9-22"aiatt/E CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:�Z3 —`J2 72-008 (Rev. 4/85) So© - i l� tj� l32 � o� FAc - 16, 3 _ � _ RECEIVE « w JUL 2 91993 . 049 At. Health &Numbs' 21 r-O&P-Aat c Ir -tJf Aj Rock �4'A� QAC. `C_c?'rd•^-. _ OF A OF CIOS 49th .. : '�► �o Aaysn k Panna,. CE -8149 9 3leven R Pennons �J cJ, CE - 8149 �4, �� pf'"f PAGE 1 OF 2 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 PERMIT PERMIT NUMBER:SW930153 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:MEADORS MICHAEL L & LAURA 0 OWNER ADDRESS:6025 E 144TH AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01709283 LEGAL DESCRIPTION: MCCARREY LT 3 LOT SIZE: 61725 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/11/93 EXPIRATION DATE: 6/11/94 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 EACHPECTION. PROVIDE NOTIFICATION BY CALLING 343-43� OR 343-4681 AFTER BUSINESS HOURS 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: 1. EQUIPMENT MAY NOT BE DRIVEN OVER BASE OF SYSTEM. 2. INSTALL REQUIRED CLEANOUTS AND MONITORING TUBE IN BED. 3. AMENDED DESIGN AND APPROVAL NECESSARY IF LIFT STATION IS USED. 4. WELL PERMIT RECEIVED BY:. ISSUED BY: At-, PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 QUIO TO DRILLING. 2P DATE: �� q J c/cu DATE: 6-7-93 Department of Health and Human Services On-site Services 825 L Street, Suite 504 Anchorage, AK, 99501 ATTN: Ms. Susan Oswalt RE: On -Site Sewer for Mike and Laura Meadors Lot 3, McCarry Subdivision Dear Ms. Oswalt Attached is a request for an on-site sewer permit for a new residence located at the above address. The soils were tested on May 3, 1993. The test results indicated that the soils percolated at 26.7 min/inch. The water table was monitored for one week. There was no indication of water being within fourteen feet of the surface. No impacts to the surrounding properties are foreseen Lots to the South and West have existing wells and on-site sewer systems. Lots to the North and East are yet undeveloped. The 100 foot well radios for the new well on lot 3 will over lap onto Lot 4. The impact is negligible. The topography of Lot 3 is flat were the system is being placed. The land to the east slopes up from the proposed septic system. Also the land west of the proposed system slopes downward. The possibility of the proposed system contaminating the surrounding wells is minimal due to distance and well drained soils. If you have any questions, please don't hesitate to contact me. Sincerely Steven R. Pannone, P.E. P.O.Box 142025 Anchorage, AK 99514 6 IryOr 006 ^400e .. poi �. Zs•sbt £,80000S iii m 401 6l'081 I 03 sPI -- --} -- ----#Q �I b'501;` ---- -- 1 m in90,S o00 NlBmvb as o, 111 28 •� �. iL do cnCY a O � saoinIag uewnH V qllBGH,idecj abojouot,b to 4vjpdioiunVq 2661 L t Nnr _ iii m 401 6l'081 I 03 sPI -- --} -- ----#Q �I b'501;` ---- -- 1 m in90,S o00 NlBmvb as o, 111 28 •� �. iL do cnCY fNl l K E� LAV Q A M SAho'2S G.bT 3', M cc A (ZP-a-lr vnD;9r-') �ACKFIeL wtrVA'Vfva✓ -r&-eFA-% PAA -r -60'A L' i tFti,� ', �`j ,•2yt cam" rF�tcK �2Ll�,uQDa« '. '.,.. - �tJwawa�oaonnwoa a:aassarvtaro� cu'1 ', y. »�orveroeemo oe e�n.mj� CF;Yp a RS°voenC Q. iyy:9,,tnt(n]Cn F RECEIVED 10p90FESSO�a� .2 JUN 1' 1 1993 Municipality of Anchorage ' Dept. Health & Human Services Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:_M1K&- 0, G4,,2#% M&4 -T02.& DATE PER LEGAL DESCRIPTION:_4o-r 3 M1:CARR4`r S�s$1'�. Township, Range, Section: DEPTH "C't}3 SLOPE SITE PLAN (FEET) jam} 1 2 SM 3 4- 5 6- 7 8- 9- 10- 11 91011 12 13- 14- 15- 16- 17- 18- 191 3141516171819 20 ('� �,OMMENTS a1zSArvtc 4RAt Sr t z Y SAob 'Uo if RECEIVED JUN 11 1993 MWi:C-p.W�ty of Anchorage 0QPt. Health & Human Services WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? r� ! E Depth to Water Ager Monitoring) k0 N.19 gate: Reading Date Gross Time Net Time Depth to Net Water Drop (v—/ b p L7 — 2 0 10 T✓l 3 01,153/ e-(0 3/ n PERCOLATION RATE 27 (minutes/inch) PERC HOLE DIAMETER 2 TEST RUN BETWEEN Z FT AND 2•,S` FT PERFORMED BY: 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: b `9 3 72-008 (Rev. 4/85) a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: M lka C.Arj e A AA aA%oQS DATE PERFORMED:'��''`c�.i'-�ur'''"� -Ig6�� LEGAL DESCRIPTION: LO -C-' MCC (?ftr, Township, Range, Section: DEPTH „ 1 SLOPE SITE PLAN ICCCTI l 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 OMMENTS DekPNccS C ->RAY S16TV&AN3, a iZAt-SAeL0D CRweL q aA,c Cc Ar "% G,[2 p4N t<- c - G, T AV e"z- WAS GROUND WATER w) 4 ENCOUNTERED? t -t S IF YES, AT WHAT L O DEPTH? P E Depth to Water Ager Monitoring? Ni7K 1E Date: 4�11-43 r W Reading Date Gross Time Net Time Depth to Net Water Drop $ ^ © b �! v o 3/ ' So >3' i!o n PERCOLATION RATE 2rD'� (minutes/inch) PERC, HOLE DIAMETER !Z TEST RUN BETWEEN S FT AND & FT PERFORMED BY: rte—' E�h��%r✓ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage .......... P ,.•................ DEPARTMENT OF HEALTH 8' HUMAN SERVICES 825 "L•• Street, Anchorage, Alaska 99502-0650 "•, c_� 74 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ✓Of^JN1A `AeE�f DATE PERFORMED: !'J PKI L. V•!'S 1992 PP -0 pasi&D LEGAL DESCRIPTION: LOT rL e £ � Sac•TownshiP• Range, Section: SLOPE SITE PLAN DEPTH 1 FEETI F—I---i---i 2 3 GI?�-/' MCI 5T 511,7'1 Sfi-+o5 4 SM 5 M 11 7 G![ y SA++D M�cDIuN' w/ 5 P ' 6fx-1ate 8 9 13 G W ✓fir G���`1 14 15 ( L I GRA i 1 CLAN a/MC�' 16 goTTuM of tkOL; 17 18 ID WAS GROUND WATER , 1n tNUUUrv'cncur •4L- IF YES, AT WHAT DEPTH? ]split to Water Atter Monitoring? /Jo G•y/ Dam I - S I 0 N A P E 4 24-4Z -- - 4 Reading Date Gross Time CM(►�) Net) Time CM' -Water Depth to Net Drop '1 -re -9z o 0 to to 1. 75 ' Zo to 3d 10 ZS" 20 a,„,( Human g L-1 PERCOLATION RATE B (m'nutesnnch) PERC HOLE DIAMETER Services TEST RUN BETWEEN 7 FT AND S FT AMENTS P055(61-rz 1)tSPC50"- Z7'Fif-D 77A --f-- 7 IL F007 t,A'� Qx-S A p PERFORMED BY: /t'I(Ke 4.jc r zsoZ A/LC*Akr- i�.o0'f- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. rT� �� t- z �f Iql Z- 72-008 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST _t!ilbi_�A—_ E.r 49th `..Haven % Pennon® CE -8149 PERFORMED FOR: NI1kGs L�V`"'Y`t /Vl LS-%%���5 DATE PERFORMED:'' p, LEGAL DESCRIPTION: 1_6--C J rA C C N 9 pr -'V S Township, Range, Section: DEPTH '1-" "'Z SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS -'R - ©. 4 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Ager Monitoring? Date: 0 S L 0 _ P E ReadingDate Gross Net Time Time Depth to Net Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: I .S t CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: s / `� ._C 72-008 (Rev. 4/85) .r PAGE 1 OF 1 J 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 PERMIT PERMIT NUMBER:SW930197 DATE ISSUED: 7/01/93 DESIGN ENGINEER:STEVEN R. PANNONE EXPIRATION DATE: 7/01/94 OWNER NAME:MEADORS MICHAEL L & LAURA 0 OWNER ADDRESS:6025 E 144TH AVE ANCHORAGE AK 99516 PARCEL ID:01709283 LEGAL DESCRIPTION: MCCARREY LT 3 LOT SIZE: 61725 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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: SEE PERMIT NUMBER 3015 FOR WASTEWATER SYSTEM RECEIVED BY: DATE: l ( -� ISSUED BY: oHt'4 &x(T7-F DATE: T7 I m m zs•sbi Q� £180000$ Q 0 .YEA• seoin.teg uewnH V qlluGH,;deC] o6eJou:?Ily 40 Al'ledimunvq 2661 L L Nnr Imm 9'611 b'SOi, I Cb • g ' , W W t.. V W O W W Oor �0 100040 Z '-101 --t-4 M 901St MOW • C J D �0 CF,�s•�� I4 M I - v �N I fpm fi sL'0811 3 --- 044 / i 11 1 O No '6 1 W I n cn I II D�' iw !� ft I.nr_ATInN nF WELL t F f m i"1 Mo. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD BOROUGH SUBDIVISION LOT BLOCK SECTION OTRS SECTION TOWNSHIP RANGE MERIDIAN A,{ ICL I [IN ❑S ❑E ❑w LOCATION/SKETCH:WE�L} OWNER: NI ICZ*d �i (n1. irCL. �,c�^r5 DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: C2 /7/ ft Depth of casing: L7 ft BOREHOLE DATA: Depth Material Type and Color From To - DEPTrH O STATIC WATER LEVEL: 1 ft below Estop of casing ❑ ground surface Date: METHOD OF DRILLING: )I air rotary ❑ cable tool /7 ❑ other i� USE OF WELL:;? domestic ❑ irrigation ❑ monitor ❑ public supply ❑ other �J�, CASING STICK-UP, ft. Diam: in. to%e/ft Casing type: in. to o 7At 6 WELL INTAKE OPENING TYPE: ❑ open end ❑ screened r /t d v`Q.(/- �.C•% rYk e ❑ perforated j9 open hole Depths of openings: to ft q 117 SCREEN TYPES Diam: in. izeLength: ft Slot/Mesh S: GRAVEL PAC PE: Volume Used: Depth to top: AF i `/ E® GROUT TYPE: � R E C E iJ Depth: from to ft ft 2 DEVELOPMENT ET D: NOV 41993 Duration: ' Municlpatlty of Anchor & Human S LRO vices PUMPING LEVEL AND YIELD: [7- Dept. Health ft after hrs pumping .2 gpm PUMP INTAKE DEPTH: Z- ft Horsepower: 112— WELL DISINFECTED UPON COMPLETION? Iq YES ❑ NO CONTRACTOR INFORMATIC A % r REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: �L3 DNR/DIVISION OF WATER Authorized Resprestative Date .PO BOX 772116 EAGLE RIVER AK 99577-2116 L Lr]CAT1r1N (1F WFLLEr m i 1 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD BOROUGHLSUBONLSiON LOT BLOCK SECTION GTRS SECTION TOWNSHIP RANGE MERIDIAN ON ❑E iKC7I�'�e �%' ❑S ❑W LOCATIONISKETCH: WELL OWNER: N1 ci1c�eli Lac. l'�C� j ."��ic�r5 DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Y/ Depth of hole: C2 �% ft G Depth of casing: BOREHOLE DATA: Depth Material Type and Color From TO DEPTH 40 STATIC WATER LEVEL: ® S I ft below Mtop of casing ❑ ground surface Date: METHOD OF DRILLING: air rotary ❑ cable tool it /-7 ❑ other t USE OF WELL: domestic ❑ irrigation ❑ monitor ❑ public supply ❑ other / � CASING STICK-UP ft. Diam: bin. toIve%t � AL s� 7 6 q Casing type: -Z--in. to o 7/t WELL INTAKE OPENING TYPE: ❑ open end ❑ screened 11 perforated open hole Depths of openings: to ft SCREEN TYPEL Diam: in. Slot/Mesh Size: — Length: ft GRAVEL PACIk�PF- a Volume used: Dep: I to top. j GROUT TYPE Volume: d Depth: from ft to ft DEVELOPMENT METkIOD: az/L Duration: C- 1YI111!vI V iii./ �+ h =•. , , :man Cl vices PUMPING LEVEL AND YIELD: X17 Z7Z hrs pep[.:-.� I n2_ ft after pumping—.2 gpm PUMP INTAKE DEPTH: 2 Zy ft Horsepower: t/2— /yWELL WELLDISINFECTED UPON COMPLETION? [q YES ❑ NO CONTRACTOR INFORMATIC a REMARKS: ;Name / r PLEASE MAIL DNR/DIHITE COPY VISION SION OF WATER LOG TO: rized Resoresentanve Date PO BOX 772116 EAGLE RIVER AK 99577-2116 VIA:J, v Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 {% ori 7V bo Y� CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-092-83 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: of oc [Y MCCARREY LOT 3 6025 EAST 144TH AVE *ANCHORAGE TRACEY O'REILY Day phone 808-283-3987 6025 EAST 144TH AVE *ANCHORAGE ALLISON LANE Day phone 351-7832 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance 4 TYPE OF WASTEWATER DISPOSAL: Individual On-site . ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ Received byL COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA# ds�_LS/JC�7 Date: 1� / 4/l Waiver Fee $ Date of Payment Receipt Number Waiver # —_ Distance: — 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting Ibis evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with (he guidelines and regulations established by the Municipality of Anchorage andindustrypractices. The reported results describe the condition of the system/son (he dates ofthe evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables induding but not limited to, soil conditions, groundwater levels (that waylluduate during the year), quality of construction (materials and wdrkmanship), and the water usage of the family untiring the systends. These conditions can vary, and are outside the control of GEG. Satisfactory, test results do not guarantee future performance of the systendr therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sale benefit of the mrsoNparty who retained GEG. Reliance upon the Information provided in this report by any other person orpady, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the personiparty, who paid for this report. 6. DSD SIGNATURE System #1 Approved for _L _ bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date It 1 Idil bedrooms, with the following st Original Certificate Date: Mi r. — " , . —, e Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist _� Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory _� Other (Rev. 10112112) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MCCARREY; LOT 3 Parcel ID: 017-092-83 *PER HOMEOWNER, THERE IS A 500 GALLON HOLDING TANK INSIDE THE HOUSE A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/9/1993 Sanitary seal (Y/N) YES Total depth 247 ft. Cased to 104 ft. FROM WELL LOG Date of test 8/9/1993 Static water level 78 ft. Well production 2 g.p.m. WATER SAMPLE RESULTS Well Log (YIN) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/31/2015 110 ft, 0.7 g.p.m. Coliform 0 colonies/100 ml. Nitrate 0.121 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 7/16/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/30/1993 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 6/16/2015 Pumper DENALI PUMPING & WATER WORKS LLC C. ABSORPTION FIELD DATA Date installed 7/30/1993 Soil rating O.pPrfltlbdrm) 1_2 System type WIDE TRENCH Length 58 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth *6+ ft. Eff. absorption area 500 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/22/2015 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 2_5 in. Water added 623 gal. New depth 7 in. Elapsed Time: 120 min. Final fluid depth 1_5 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump ofP' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots *100'+ (WITH CAVEAT) Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1'00'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *NORTH END OF TRENCH SERVING MELINDA VIEW ESTATES #1, BLOCK 1, LOT 1 HAS NO CLEAN—OUT OR SUMP, SO IT WAS NOT POSSIBLE TO CONFIRM SEPARATION; HOWEVER, IT IS REASONABLE TO BELIEVE THAT THERE IS 100' OF SEPARATION. G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and Q V. 4 x* review of Municipal records that the above systems are in 0 """ ' """"'"""' conformance with MOA COSA guidelines in effect on this date. J G Hess; Engineer's Printed Name JEFFREY A. GARNESSQQ a 15kCE 3 0A Date Q�04neapr(�' I fso\ vao (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC151505 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 3 of McCarrey subdivision, the well's productivity was determined to be 0.7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. NIO �ooszs3rvaor 6L"004 M.90.90o0N �LZbB Q n m N m 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. # 017-092- . 83 HAA # '113SLQ CI 1. GENERAL INFORMATION Complete legal description Lot 3, McCarrev Subdivision Location (site address or directions) 6025 E. 144th Avenue Property owner Michael & Laura Meadors Day phone - '145-8165 Mailing address 6025 E. 144th Avenue Anchorage AK 99516 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Four (4 ),, 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M (Rev. 1M) Front MOA #21 5. 6. By: STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Anderson Engineering Phone 522-7773 Address P • o • Box Engineer's signature —_ 773 Anchoraqe, AK 99524 DHHS SIGNATURE L� Approved for E0 US bedrooms. Disapproved. Conditional approval for Additional Comments Date 914198 6.7 mAl MICHAEL E. AMQEMON �• asst -E bedrooms, with the following stipulations: Date % --1— 9 1 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(Rev. 1/81) Beek MOA 021 s Municipality of Anchorage ,.RE CE I �f E DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 8 198 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 349-T744 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: Lot 3, M arrey_Stihdi v,i c nn Parcel I.D.: 017-092-81 A. WELL DATA Well type PrivateIf A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 8/9/93 Total depth 247' Cased to 104-1 Casing height (above ground) r.2 1 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test s / 9 I9 3 21421 /99 Static water level 7 8 ' 7 R ' Well production 2 g.p.m. 1 -0 g.p.m. WATER SAMPLE RESULTS: - Coliform 0 Nitrate .10 mg/L Other bacteria 0` Date of sample: 8/21/98 Collected by: T Ni cocipmri c B. SEPTIC/HOLDING TANK DATA Date installed z/ z n /Ta 3 Tank size 1 , 2 5 0 Number of Compartments 7 Cleanouts (Y/N)y_ Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Date of Pumping 9 /d_� __r 9a -Pumper A Plus Home Sez; i ces C. ABSORPTION FIELD DATA Date installed 7/30/93 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 2 System type 5 wi d Trench Length 58' Width 5 Gravel thickness below pipe 3' Total depth 7' Effective absorption area 500 SF - Monitoring Tube present (Y/N)-x— Depression over field (YM) N' Date of adequacy test 8/21/98 Results (Pass/Fall) Pass For Fob_ bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after6_Dkgal. water added (in.): 0 - Fluid depth 0 (ins) Minutes later. 1 Absorption -rate = > 6 0 0 - / –9.p -d. Peroxide treatment (past 12 months) (Y/N) N if yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION - None on Lot Date installed Manhole/Access (Y/N) _ High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump off" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot >100' On adjacent lots >100, Absorption field on lot >100, On adjacent lots "100, / MEA Public sewer main AI! A 9415!` Public sewer manhole/cleanout >100' Sewer/septic service line >10' Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation >51 Property line > 5' Absorption field >5, Water main/service line __L1 ' Surface water/drainage > 10 0Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 1 n' Building foundation 10 Water main/service line Surface water >1001 Driveway, parking/vehicle storage area _> Curtain drain None on T.r)t Wells on adjacent lots >1001 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal re&iriCtj►8t in conformance with MOA HAA guidelines in effect on this date. 's AP Signature Engineer's Name Mi rhaal F: _Anderson, S P. ° °,101113 Date 9/4/98 li .". 4381-E HAA Fee $,_2m, nc-) Waiver Fee $ Date of Payment Ol - 1' slR Receipt Number -,-� 0 gy to l [r � 0-3 9� 72-026 (Rev. 3/96)* Date of Payment Receipt Number are AWG -2688 11:54 FROM -CTE ENVIRONMENTAL 'AL CTU rEnvironmental Services Inc. CT&E Ref.if Cheat Name Project Nnme/l+ Client Sample ID Matrix Ordered By PWSID 984642001 Anderson Engineering U 3 McCurrey SID Sink Drinking Water 0 5615301 T-706 P.02/02 F -T38 Client PON Printed pate/TIme 08/26/98 10:45 Colimed Date/Time 08/21/98 13:40 Received pate/Time 08/21/98 15:45 Technical Director: Stephen C. Ede Released By 94 Atlowable Prep Anatysis Parameter Reswlts POL Units hethod Limits Pate Date Init Total Coliform 0 col/100m1 SM18 92220 08/21/98 RMV Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 10 max 08/21/98 08/21/98 RMV 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. # QC) - Y�Q-R I – 1. GENERAL INFORMATION HAA # Complete legal description /_0-Z` 3 M 0CA212`e 5v'L�D. Location (site address or directions) 6� o zS 150_� /`'"l'-& P, ,43 Property owner M llce LAy2A M P_P'�o4z Day phones / 'z F -b " LEO cap- z83 Mailing address t/, 0 trzt4e Lending agency L �AD✓ Dayphone ailing address Lk�y �V �C(,tcic�l' �!t�' `(�C44e AV– Agmit N`.,n1Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 'R A NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site k Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOA #21 .w..,._....,. _.�., Vii. Lza vow NOBS (l6/l'ned) sto zc •�aom sdaeul6u9 leuolssaloid 941 ul suolsslwo ao saoaaa jol alglsuodsai Sou si a6eaoyouy to AllledlolunW 9141 •penssl sl aleolppeo a ejgeq elep azAleue ao suolloadsul lonpuoo ( lou op SHHa Io seeAoldw3 •sluawaalnbaa alels pue leaapej ulelaao A4siles oliepio ul suollnl!lsul bulpual919141 pue sawoy to saasugoand of Aselinoo a se slyl saop SHHa 941 •e�sely to elelS ayl ul paJelslOei iaeul6ua leuolssaload luapuadopui up Ag anoge g gdea6eaed ul UGn16 suolleluesaidaa 9143 uodn Aluo paseq seleo!llliao lenoaddy Aluoylny ylleaH sanss! (SHH4) s901nu9S uewnH Pup ylleaH to lumijudap 96ejoyouy to Allledlolunn aq I :suo!lelndlls bulmollol ayl yllM 'swooapaq += 9964 1A , 46 sluawwoo leuolllppy aol IMAM Ieuolllpuo0 •panoaddesla •swooapaq aol panoaddy 3kinIVNJIS SHHO '9 �—\-271aleQ inleu6ls s�aaul6u3 J7 /-T co it V -H0 NC/ z0Zf,/ xo,�:p•o- ssaaPPd auoyd s,��,nc,�s hr,crd�n ,yrv� � rvorvrv',ZkL wa!J lO aweN •uolloadsul sly1 to alep ayl uo 109.49 ul suollelnbej pup 'saoueulpio 'sapoo alelS pup led!o!unW Ile yl!M eouelldwoo ul sl weleAs lesodslp aalemalseM ao/pue llddns aaleM alts-uo ayl 'uolloadsui Pup uo1le6lls9nul Aw woal pup salll 96eaogouy to lllledlolunW ayl woal paulelgo uollewiolul ayl uo paseq ley. AllaanaaylJnl I •ulaiay paleolpul aanlonils to adAl pup swooapaq to aagwnu ayl aol alenbope Pup leuollounl'ales sl walsAs lesodslp aalemalsem ao/pue AIddns aalenn ails-uo ayl leyj smogs uolleolldde lenoaddy Al!aoylnV ylleaH s!yl to u01le61ls9nul Aw ieyl Al!aan I 'molaq umoys alep uo!lepIlen ayl to se pue olaaay pexllle leas Aw Aq pagpiao sy H33NION3 AG N01103dSNl d0 LN3W31t11S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1, 3! M CCA 12R%� i50%b Parcel I.D. old"` o qz- 83 A. WELL DATA Well type! � A ( � If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ye— S Date completed 8�9'-g 3 Driller �G�F r,���V2rLG/N4 Total depth Z 61_7- Cased to /0q Casing height r Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Date of test Static water level Well flow FROM WELL LOG 2 Q_pfn, 9 -p.m Pump level _ 22q -PT SEPARATION DISTANCES FROM WELL TO: AT INSPECTION ,. �M rn_ < � N ZZ Q Septic/holding tank on lot // r ; On adjacent lots /cA-D'r Absorption, field on lot 1-25- Public 2S- Public sewer main r,- / Sewer service line AdA WATER SAMPLE RESULTS: �G Coliform 0 6'1CNJe-S OQ 110Nitrate ; On adjacent lots /ov Public sewer manhole/cleanout Petroleum tank /V 6A ©+ (A' 4-C44clOther bacteria Date of sample: l L --at-43 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 7-30—c)3 Tank size /2S-Z� e,, Compartments -2 Cleanouts (Y/N) 'it' -s Foundation cleanout (Y/N) Depression (Y/N) Nd High water alarm (Y/N) Alarm tested (Y/N) Date of pumping y4 ccLAT ,) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ,V(A Well(s) on lot �� S On adjacent lots /Do Foundation 5-6 To property line -Absorption field /0 Water main/service line 04 Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION /� Date installed _ Manufacturer Size in gallons Vent(Y/N) High water alarm level Manhole/Access (Y/N) "Pump on" level at "Pump off" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed 0-9-S Soil rating 2eot,41ZrUCld System typedTi24?.n1CN Length 5-33 Width S Gravel thickness -3 Total depth Total absorption area VS005 5p Cleanouts present (Y/N) Y"zs Depression over field (Y/N) tick Date of adequacy test A-2 P-3-0 zNSTrA Lt A�nO,u Results (pass/fail) �"d for bedrooms Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date Well on lot On adjacent lots /00-t- Propertyline_ To building foundation 6 To existing or abandoned system on lot On adjacent lots Cutbank ��A Water main/service line A/11A Surface water Z2Driveway, parking/vehicle storage area �� t Curtain drain A//A E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. as c c Signatur —� $ m` ` v' t ro. M.w�NEp a o. a+aeM.wo4puc.eoecoacuuSuwr Engineer's Name S"��/e-� �• ..�.v�� cT Date ` Z I�Q� P+ va Steven R. Pannone dV �p Ij c t CE - 3149 ". ®te PRDFESSI0- 0 HAA Fee $ �� Waiver Fee: $ Date of Payment Date of Payment Receipt Number t 9 2 Receipt Number COMMERCIAL TESTING & ENGINEERING CO. lk ENVIRONMENTAL LABORATORY SERVICES IIIIIIIII11k SINGE 1906 REPORT of ANALYSIS 5633 B STREET Chemlab Ref . # :93.6293-1 ANCHORAGE; AK 99518 Client Sample ID :WELL WATER 6025 E. 144TH TEL: (907) 562-2343 Matrix :WATER FAX: (907) 561-5301 Client Name :MEADORS, LAURA WORK Order :73484 Ordered By :LAURA MEADORS Report Completed :11/23/93 Project Name Collected :11/21/93 @ 12:30 hrs. Project# Received :11/22/93 @ 08:05 hrs. PWSID :UA Technical Director:STEPHEN C. EDE Released By : /'L Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.R. PAWNONE,P.E., WITNESSED $Y LAURA MEADORS. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init --------------------- ------------------- =-------------------------------------------------------- Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 11/22 LLH See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than r.®,11SGS Member of the SGS Group (Societ6 G6n6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA �i PLEpSE IF P -14"P44 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Drinking Water Analysis Report for Tot, READ INSTRUCTIONS ON REVERSE SIDE BEFORE t MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # rq PRIVATE WATER SYSTEM Send Results Send Invoice M12AI)CaS 2estD6Ncti Z.AL;nAnQAboa.5 Wats System NM&Company Name Contaetnatne Qao 3Q. Iu2o�- V Phone Number azlINum ear rlt Sli AIG 9415 y _"amm Stam f�NC' da lL °J�JSII ,ry state % Send Results ❑ Send Invoice rfi ii;t. LN S C--"z.V%C &% STELS Company Name ConGet name Qao 3Q. Iu2o�- V v A 7 ess 'ES Routine Ar C9- AIG 9415 y ,y Stam SAMPLE DATE: l t 2 _L Felt 3 Month Day Year SAMPLE TYPE: V 'ES Routine ❑ Treated Water ❑ Repeat Sample (for routine sample `C- Untreated Water with lab ref. no. ) ❑ Special Purpose Time Collected SAMPLE LOCATION Collected By 4 j twt 4SA D l Z `3d s •R� Plew Print Comments: Ll Coliform Bacteria 5633 B STREET ANCHORAGE, AK 9518 ;OLLECTINGS"PLE TEL: (907) 562-2343 FAX: (907) 561.5301 TO BE COMPLE" ,BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination . to indicate reliable results. Please send new sample via special delivery} mail. Date Received Time Received / Y Analysis Began Analytical Method: Membrane Filter ❑ MMO-MUG * Number of colonies/100 ml. Lab Ref. No. Result* Analyst 93-6293 F -D] V Sent to AD.E.C. Anch Fbks Jun ❑ Faxed Date: Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Faxed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Coliform Confirmation BGB Final Membrane FilterReIts Reported By ^� "' Date fr 2s 9� SGS Member of the SG� rrilnnnrn.r.,r., -ter- iei n1 A ZVA hni 11n11 •—.i1 i1 i 1-11 E. Coli Q Colonies/100 ml COLIFI&M TATC=Too Numerour To Count Time Coliform/100 ml /J^ �" hrs OB -otnPBadff+a PART ONE OF TWO: REMAINDER TO FOLLOW VA