HomeMy WebLinkAboutFYFE BLK F LT 20Lot 2
WOODEN FENCE
5' ELECTRICAL EASEMENT
WOODEN FENCE
Lot 19
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Lot 20
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Lot 11////
5' STREET LIGHT EASEMENT
5' UTILITY EASEMENT
Lot 21
-WELL
2.3'x26.3' CANT
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E. 59th AVENUE
PLOT PLAN _ AS BUILT _X_ SCALE _ 11 30' GRID _ SW 1933 Project No. 23-4981A1___
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, In c. (907) 522-6476 Phone
ken®langsurvey.com 4�1�����`�
Professional Land Surveyor s jonathan®Iangsurvey.com . %e, OF At
trovis®langsurvey.com '��! . • !qs
I hereby certify that I have surveyed the following described property:
LOT 20, BLOCK F, FYFE SUBDIVISION (PLAT No. P-251)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the _ ' _ Day of at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
*.49TH .*
•KENNETH G. LANG,-
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State of Alaska AECC963
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Municipality of Anchorage Page I of Z
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 0 9 S PID Number: 009 — 'L73 —.5 3�
Name:
Wastewater System: ❑ New ❑ Upgrade
Address:
b
ABSORPTION FIELD
l o
Phone:
No. of Bedrooms:
l B s:
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
GPD/Sq. Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
;L D t— f.. %y i= t
Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
Ft.
Ft.
WELL: [New ❑ Upgrade
Gravel width:
Number of lines:
Distancebetween lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
.>
14Z- Ft.
Iq7 Ft.
SQ. Ft.
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
�(
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Z Of Ft.
Yield:
Pump Set at: J
Casing Height Above Ground:
TAN:[
O GPM
fie �a Ft.
Ft.
SEPARATION DISTANCES
El Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Well -
"'".
Material:
Number of Compartments:
,_.,
I0�
Surface
LIFT STATION
Water
i Lot
Size in gallons:
Manufacturer:
I Line
Foundation
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Curtain
F-7
Pump Make 8 Model
Electrical Inspections performed by:
Drain
Remarks:
BENCH MARK
Location and Description:
Assumed Elevation:
Fti
ENGINEER'S SEAL
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Inspections performed by: Dates: 1st
7 «
2nd
Department of Health and Human Services approval
ea,
Reviewed and approved by:7:1C Date:
72-013 (Rev. 9/91) MOA 25
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STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
Alaska Hydrologic Survey
WATER WELL LOG Revised 08/18/2016
Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______
City/Borough Subdivision Block Lot Property Owner Name & Address
Well location: Latitude Longitude
Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4
BOREHOLE DATA: (from ground surface)
Suggest T.M. Hanna’s hydrogeologic classification system*
https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD
Depth
From To
Drilling method: Air rotary, Cable tool, Other
Well use: Public supply, Domestic, Reinjection, Hydrofracking
Commercial, Observation/Monitoring, Test/Exploratory, Cooling,
Irrigation/Agriculture, Grounding, Recharge/Aquifer Storage,
Heating, Geothermal Exploration, Other
Fluids used:
Depth of hole: __________ ft Casing stickup: ___________ft
Casing type: __________ Casing thickness: _________ inches
Casing diameter: _________ inches Casing depth: __________ ft
Liner type: _________ Depth: _____ ft Diameter: _____inches
Note:
Well intake opening type: Open end, Open hole, Other
Screen type: _________, Screen mesh size: ____________
Screen start: ________ ft, Screen stop:________ ft, Perforated Yes No
Perforation description: Perf from: ________ ft, Perf
to: _______ft, Perf from: ________ ft, Perf to: ________ ft
Gravel packed Yes No Gravel start: ______ ft , Gravel stop:______ ft
Note:
Static water (from top of casing): _______ ft on____/____/_____ Artesian well
Pumping level & yield: ______ feet after _____ hours at _____ gpm
Method of testing:__________________________________________
Development method:______________ Duration: ____________
Recovery rate: _________ gpm
Grout type: _________________ Volume __________________
Depth: From ___________________ft, To ___________________ft
Final pump intake depth: __________ ft Model: _______________
Pump size: _____________ hp Brand name: __________________
Include description or sketch of well location (include road names,
buildings, etc.):
Was well disinfected upon completion? Yes No
Method of disinfection:
Was water quality tested? Yes No
Water quality parameters tested:
Well driller name: ..................................................................................
Company name: ...................................................................................
Mailing address: ....................................................................................
City: __________________________ State: AK Zip: ___________
Phone number: (________) ________- ______
Driller’s signature:
Date: ______/______/_________
Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require
that a copy of this well log be submitted to the Development Services Department/City
within 30 days of well completion.
City Permit Number: _____________________________
Date of Issue: _____/____/_________
Parcel Identification Number: ______-_______-________
*Guide for Using the Hydrogeologic Classification System for Logging
Water Well Boreholes by Thomas M. Hanna NGWA Press
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
copy of the well log be submitted to the Department of Natural
Resources within 45 days of well completion. Well logs may
be submitted using the online well log reporting system
available at:
https://dnr.alaska.gov/welts/
OR email electronic well logs to
dnr.water.reports@alaska.gov
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FYFE
Silt
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Municipality of Anchorage
ALPINE DRILLING
Gravelly silt
Silty,water,sand and gravel
47
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Gravelly silt
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32 SW
93
51
29
DURABLE DREAM HOMES? ,
Gravelly silt
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47
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0
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Silty,water sand and gravel FULL CASE
93
51
15
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:SW980006
DESIGN ENGINEER:
OWNER NAME:MATT MATTHEWS
OWNER ADDRESS:3340 ARCTIC, SUITE 106
ANCHORAGE, AK 99503
PARCEL ID:00927353
LEGAL DESCRIPTION:
FYFE BLK F LT 20
LOT SIZE: 7500 (SQ. FT.)
NUMBER OF BEDROOMS: 0 THIS PERMIT:
PAGE 1 OF 1
DATE ISSUED: 1/12/98
EXPIRATION DATE: 1/12/99
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THIS PERMIT IS FOR THE CONSTRUCTION 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ASSURE SEPARATION DISTANCES FROM WELL OF 100 FEET TO SEWER
MANHOLE, 75 FEET TO SEWER TRUNK LINE AND 25 FEET TO PRIVATE
SEWER LINE.
RECEIVED BY: /'/l �� - DATE:
ISSUED BY: � ! �G�f2/I�j�Ce- � A. / '�� DATE: '/ - /Z- q<6-
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MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 009-273-53
Complete legal description Fyfe Block F Lot 20
Location (site address) 1705 E 59th Ave. Anchorage, AK
Current property owner(s) Cornelius Sullivan Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank 0 Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $_ ZSO Waiver Fee $
Date of Payment /olz_6 za Date of Payment
COSA # 05C Z__� 14 (Ct Waiver # -
COSAApplication—June 2022
Legal Description: Fyfe Block F Lot 20 Parcel ID:
009-273-53
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
./❑ Well log is filed with Onsite (or attached)
Date drilled 2/15/98 Total depth 142 ft
Cased to rt 42 ft
n Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 27 in.
Date of flow test for COSA 10/4/23
Static water level at beginning of test 30 ft.
Comments
TA
Measured operating fluid lev irv- tats nk _ __
Date of pumping -`_
❑ Required maintenance completed, if AWWTS
Comments:
. BSORPTION FIELD DATA
Which s m tested (date installed)
❑ ALL standpip resent per record drawing
Total measured depth fr rade ft (max)
Measured depth to pipe invert r rade ft (min)
❑ NIA — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced __gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
Well production at time of test 7.4 g p m
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes Q No
✓❑ Coliform bacteria is Negative
Nitrate mg/L 21 Nitrate less than MRL (ND)
Arsenic 15.0 ug/L ❑ Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date IO/A/23
C. LIFT STATION
❑ Required maintenance completed
e of lift station years
Lift station mare?tat--=.. .
Comments:
Adequacy test date
Results ❑ Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
bsorption rate gpd
FIEL TATUS — POST RECOVERY
Effective de(per record drawings) in
Effective depth use in
Effective depth remaining in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
Yes if No NA ft 0 Yes if No ft
Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' FV Yes if No ft
Absorption Field on Lot > 100' ❑' Yes if No NA ft Holding Tank > 100' ✓❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft
n Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Q Yes if No ft 0 Yes if No
❑ N/A — Served by Community Well (not on lot) or Public Water
�eptic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundation _ '
❑ Yes
if No
ft
Surface Water > 100'
[:]Yes if No_
Tank to Property Line > 5'
❑ Yes
i o
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑ Yes
if No
ft
Private Wells > 100'❑Yes
if No _
Water Main > 10'
❑ Yes
if No
ft
Commune > 200'
❑ Yes if No _
Water Service Line > 10'
❑ Yes
if No
ft
If tank or field is under driveway c t below
F. ENGINEER'S COMMENTS
ft
ft
ft
ft
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Arcterra Consulting Phone (907)-696-6111
Engineer's Printed Name Kenneth Duffus Date %'0-A�%
I
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.
The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The
flow and absorption rates may change due to subsurface conditions that may not be observed from the .i
surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year +K
and the water usage of the family being served by the system. The operational life of all well and septic i {�
systems are subject to these various and dynamic characteristics and are outside the control of the evaluator ■
of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will
function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen 00
encroachments, deficiencies or discrepancies exist �j
COSA Checklist—June 2022
Of
i
KEyNETTH M. D FUS ,— i
GES 711 �AV
Ar
ESS�w4�•
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Arsenic Advisory
Certificate of On -Site Systems Approval # OSC231419
Subdivision: Fyfe, Block: F, Lot: 20
A water sample revealed an arsenic concentration of 15 micrograms per liter (ug/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge th,e relative quality of water
from private wells. information on arsenic is available from the On -Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P O Bax 196650 *Anchorage, Alaska 99519 6650 *www muni org e.
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. # 009 - a-73 - 5 3 1 HAA # L-1`1<<Li lt_!
1. GENERAL INFORMATION
Complete legal description L 0 1 2 a U V< 1- i -/ 1= I
Location (site address or directions) EE 51 Lt, A ✓e -
Property owner Day phone
Mailing address 33q A,, ,Lc- t4 f D (,=,
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
Individual well LZ
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
Individual on-site
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
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 t o �-e- L, S v e, 1, Phone
Address I �-k b=4 Z -OI
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
M
DateE
G bedrooms.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
I
G
Date
57, I Z. 9
72-025 (Rev. 1/91) Back MOA #21
E
Municipality of Anchorage MAY 0 8 199
DEPARTMENT OF HEALTH & HUMAN SERVICE'S
UNICIPALITY OF AIVCH
Environmental Services 825 L Street, Room 502 • Anchor age, AlaskDa 99501 • (907)visiony343-4IRONME7 SERVICES Dlylsl®
Health Authority Approval Checklist
Legal Description: LD 1 go, j?, 14 P. V:"q �- E Si i" Parcel 1. D.: o-0 9 273 — 7 3
A. WELL DATA
Well type _P If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed -6-X// g k
i
Total depth / Y Z Cased to / q2 1 Casing height (above ground)
Sanitary seal (Y/N) `/ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test f_& 9 r
Static water level 19
I
Well production i g.p.m.
9•P•m.
WATER SAMPLE RESULTS:
Coliform e Nitrate Other bacteria _ N 1�
Date of sample: /5�%,� Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length Width Gravel thickness below pipe Total depth
Effective absorption area Monitoring Tube present (Y/N) Depression over field (Y/N)
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION '�/
Date installed
Manhole/Access (Y/N)
High water alarm level at* _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at*
Septic/holding tank on lot _ y/� On adjacent lots/�-
Absorption field on lot N/A On adjacent lots
Public sewer main 2, Public sewer manhole/cleanout
Sewer /septic service line 50
Lift station t -/%R -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: "—1/A
Foundation
Property line
Water main/service line Surface water/drainage
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
Building foundation
Absorption field
Wells on adjacent lots
IID 1
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
I certify that I have determined thru field inspections and review of Municipal records that the above systems are
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name ( y r !/` l4LA-t a
Date l q 9' o
HAA Fee $ 1)
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
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