HomeMy WebLinkAboutALPINE VILLAGE BLK 2 LT 12BAlpine Voallge
Block 2
Lot 12B
#014-132-38
C
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
LOCATION OF WELL WATER WELL RECORD
BOROUGH
SUBDIVISION
LOT
BLOCK
SECTION GTRSSECTION
TOWNSHIP
RANGE
MFAIDIAN
Z
13oR
aw
LOCATIO
R /St ETCH:
WELL OWNER:
DEPTHS MEASURED FROM:wsasing top ❑ground surface
v
WELL DEPTH: DATE OF COMPLETION
Depth of hole. 14:.-s ft
Depth of casing: /y i. ft' �/�/ i
BOREHOLE DATA: Depth
Material Type and Color From To
0
2r
DEP nTO STATIC WATER LEVEL:
F�Q
ft below �fftop of casing ❑ ground surface
Q
Date: / / t /
/
METHOD OF DRILLING: hair rotary ❑ cable tool
❑ other
USE OF WELL:11 domestic C1 irrigation ❑ monitor
Y
�+
i?!�
�'J'y
❑ public supply ❑ other
CSO
�7.h
Q
CASING STICK:_. Z- ft. Diam: in. to ft
Casing type: -fit+% T. to ft
J�t1
6'
WELL INTAKE OPENING TYPE: open end ❑ screened
7
s
❑ perforated ❑ open hole
Depths
1 21
-Gis..�/��g
,Q
of openings: to ft
f
/
SCREEN TYPE: Diam: in.
—Length:
Slot/Mesh Size: ft
/
// 5*
y�
GRAVEL PACK TYPE:
•j
/r
Volume used: Depth to top:
GROUT TYPE: Volume:
Depth: from ft to ft
/
DEVELOPMENT METHOD:
Duration:
PUMP y.LEVEL AND YIELD:
00,
ft after hrs pumping gpm
PUMP INTAKE DEPTH: ft Horsepower:
WELL DISINFECTED UPON COMPLETION? -9 YES ❑ NO
CONTRACTOR INFORM / O , _j y— REMARKS: RECEIVED
less Name SEP 12 1997
PLEASE MAIL WHITE COPY OF LOG TO:
thonzed espresentatl e atb to DNR/DIVISION OPVAIMNGi Tr.R;MDlflje
i ANCHORAGE AK�89503 6935 $ervices
Phone (907)269-8639, Fax 19071562.1384
r_ PAGE 1 OF
'11
MUNICIPALITY OF ANCHORAGE `
DEPARTMENT OF HEALTH AND HUMAN SERVICES hO
P.O. BOX 196650, 825 "L" STREET, ROOM 502 �\
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW960288 DATE ISSUED: 9/10/96
DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 9/10/97
OWNER NAME:MCBIRNEY EDWIN R & BONNIE A
OWNER ADDRESS:1200 W DIMOND #612 1
ANCHORAGE, AK 99515
PARCEL ID:01413231
LEGAL DESCRIPTION: � LOA
ALPINE VILLAGE BLK 2 LT 13 P L4 n
LOT SIZE: 0 (SQ. FT.) -bill
NUMBER OF BEDROOMS: 0 THIS PERMIT: 0
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:
RECEIVED B
ISSUED BY:
DATE:-
DATE
ATE•
DATE
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EASEMENTS OF RECORD, OTHER THAN F89(o—/ FCTZ9
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON.
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() OCC Ofd D PGiIT
(M� = MCAiU,--'ED /V F/EGD
AS -BUILT Z. CORNERS SET THIS DATE
I hereby certify that I have performed a MoKgaga;ee+ri*peotion
of the following described property:
LoT /3 LOC,L Z
AL P/N ✓/GLACGE SUYD,
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines and
do not overlap or encroach on the property lying adjacent thereto,
that no improvements on property lying adjacent thereto
encroach on the premises In question and that there are no
roadways, transmission lines or other visible easements on said
property except as indicated hereon.
Dated at Anchorage, Alaska
Z
this 771• day of Ai'�lL 19 0
FRED WALATKA 8 ASSOCIATES
(907) 248.1666 Engineers and Surveyors
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STREET
U-1
Parcel I.D. 014-132-38
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date:
Complete legal description Alpine Villages, Block 2, Lot 12B
Location (site address) 7317 Bern St.
Current Property owner(s) Craig Rennison Day phone
Mailing address
Real Estate Agent
7317 Bern St. Anchorage, AK 99507
2. TYPE OF DWELLING:
Fx_1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
,retchen Stullar
j4 -16 -is"
4. TYPE OF: WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
M
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Communit y
n
u
Public Water System
❑
Public Sewer
El
Waiver/Variance request
Received by:
COSA to be released to the
unless otherwise requested by the engineer.
COSA Fee $ 5aL -
Date of Payment IW//s
Receipt Number Qq-�Loa(:7 -
COSA# aSCtSIVD" 6
Date: 1116 I Z6 15
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Date 1/13/2015
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date:
The ni p nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations 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 engineers work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet f
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of I
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Alpine Villages, Block 2, Lot 12B
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 9/24/1996 Sanitary seal (YIN) Y
Total depth 143 ft. Cased to 143 ft.
FROM WELL LOG
Date of test 9/24/1996
Static water level 70 ft.
Well production 12 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 0.156 mg/L
Arsenic ND ug/L Date of sample: 12/19/2014
G TANK DATA
Tank Type/Material
Tank size gal. Numbermop
Foundation cleanout (Y/N) _ Depression over tank (Y/N)
Date of pumping Pumper
Parcel ID: 014-132-38
Well Log (YIN) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
1/12/2015
45
5.6
Collected by: PES
Date installed
Cleanouts(Y/N)
BSORPTION FIELDDATA
Date instal a Soil rating (g.p.d./ft2 or ft2/bdrm)
Length t Width ft.
Total depth ft. Eff. absorption ar ft2 Monitoring tube
Date of adequacy test Results(Pas
Fluid depth in absorption field before test in. Water
Elapsed Time: min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
ft.
g.p.m.
(Y/N)
System type
Gravel below pipe ft.
Depression over field
For _ bedrooms
gal. New depth in.
Absorption rate >= g.p.d.
If yes, give date
Ste_
Date installed
"Pump on" level at
Datum
in. "Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
ICS /HOLDING TANK ON LOT TO:
Building f\ounda ' Property line
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line Building foundation _
Water Service line Surface water
Curtain drain Wells on adjacent lots
F. COMMENTS
Manhole/Access (Y/N)
tii er alarm level at
Meets alarm & circuit requin
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 1/13/2015
COSA brown sheet 10-10-12.doc
Absorption fiel
Surface water
Driveway.
in.
(3acP T lJarcerJ
Municipality of Anchorage
141,
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program ,
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-112-38- COSA
Expiration Date:.-._/
1. GENERAL INFORMATION
Complete legal description Alpine Village Block 2, Let 12R
Location (site address) 7117 Bern Street Anchorage AK
Current Property owner(s) Day phone
Mailing address
Lending agency
11
Mailing address
Day phone
Real Estate Agent Alpx Mitchenkay - ReMax Day phone 227-5566
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: --1
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑
Individual Holding Tank ❑
Community On-site ❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site
Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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.
• ��al.
—1
Engineers 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 surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the
year and the water usage of the family being served by the system. The operational life of all well and
septic 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 �F A���1
system will function satisfactory for current or future �P�F, L,NIi)
occupants or can ArcTerra guarantee that no unseen �%�C f•.••'��~•� ''•.��
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
✓ Approved for �_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
. • ON-SITE •
WASTEWATER
Attachments:
COSA Checidist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:k/0_
Municipality of Anchorage
+ Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 Bregaw Street
P.O. Box 196650
Anchorage, AK 99519650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:_AlniD M1189e Bleck 7- 101 126 Parcel ID: 014-132-38
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID #
Date completed 09/24/96 Sanitary seal (Y/N) Y
Total depth 143 ft. Cased to —143--ft-
FROM WELL LOG
Date of test 09/24/1996
Static water level 70 ft.
Well production 12 9 P.M.
WATER SAMPLE RESULTS:
- Well Log (Y/N) Y
Wires property protected (Y/N) Y
Casing height (above ground) 22 in.
AT INSPECTION
09/19/2007
5 3 ft.
5.67 g.p.m.
Coliform __colonies/100ml. Nitrate N_mg/L Other bacteria 0 colonies/100 mL
Arsenic: —0 mgll Date of samplic 09/19/07 Collected by- ArcTerra
B. SEPTICIHOLDING TANK DATA — PUBLIC SEM
Tank Type/Matanaj Date installed Tank size gal.
Number of Compartments_ Cleanouts (Y/N) _Foundation cleanout (Y/N) _Depression over tank (Y/N) _
High water alarm (Y/NL----Pate of pumping Pumper
C. ABSORPTION FIELD DATA -PUBLIC SEWEB
Date installed _ $oil rating (g.p.d./fe or fe/bdrm) System type
Length _ ft Width _ft. Gravel below pipe ft. Total depth
Eft. absorption area _ft2 Monitoring tube _Depression over field _
Date of adequacy test Results (Pass/Fail)----For _ bedrooms
Fluid depth in absorption field before test._ in
Elapsed Time: ___-min. Final fluid depth in
Water added_ gal. New depttL_in.
Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date -----
M
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at n. `Pump off" level at n. High water alarm level at in.
Datum Cycles testecL. Meets alarm & circuit requirementsZ
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankdlft station on lot NA
Absorption field on lot NA
Public sewer main 75'+
Sewer /septic service line 2S'+
Animal containment areas SO'+
On adjacent lots _NA 1100'+1
On adjacent lots NA (1001+)
Public sewer manhole/cleanout 10 0 1 +
Holding tank 10 0 1 +
Manure/animal excrete storage areas 10 0 1 +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line Building foundation Water main
Water Service line Surface water. Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION �'pw "
I certify that I have determined through field inspections and % x 49
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date. V.
C,
Engineer's Printed Name _Kenneth M. Duffus Ifs S'•
Date _10/02/2007
COSA Fee Waiver Fee $ _
Date of Payment 3 07 Date of Payment
Receipt Number 040-73 7 Receipt Number
(Rev.11M)
�im �HhtE�-L
Municipality. of Anchorage
�wi y4
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. t)J- 32- 3$ HAA # n�nN 5v
t1 -A-0 Expiration Date: 2 - - O,S
%Giption t -or m,P) -&-oc - *Z A[.si,uC= %Jt LA_ACE
1.6cejeur(siteaddressordirections) :j3ra -Zc.a s,octr
Curr`erit Property owner(s) T...., Scu.0 Day phone 3sl - y&dt:
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Day phone
Day phone
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
TYPEOF WASTEWATER DISPOSAL:
it
Individual On-site
❑
❑
Individual Holding tank
❑
❑
Community On-site
❑ '
❑
Public Sewer
d
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. 1 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 -.?,74 !'e Phone X230- 3" a
Address ?-o. -ge>r tf035%' A._, ,4. Arc,. 4ci4nI
Engineer's Printed Name T aA2Tr,A Date of -C.- 2evs,
O
49TH
BRIAN T. HARM �� o
S. DSD SIGNATURE CE r�9 �q . 10068�
Approved for 3 bedrooms. C�Of� BOFESStgNt v
Disapproved. �9p�°pO�aOo
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: %� l�' Original Certificate Date:
(Rev 01102)
Municipality of Anchorage
(• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST'
Legal Description: Lrr- 12 3 a -y— 2 AtAAE Urc."44c Parcel ID: 0)!f--32_-.39
A. WELL DATA
Well type JMt= If A. B, or C provide PWSID # _ Well Log (YIN) ytS
Date completed 9_24-96 Sanitary seal (YIN) Wires properly protected (YIN) Ye L
Total depth '143 ft. Cased to E6 ft. Casing height (above ground) 2A in.
FROM WELL LOG
Date of test Q- 24f - 9.4
Static water level 40 ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 mi. Nitrate
Arsenic: mg./I. Date of sample: '_24-05'
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartments
AT INSPECTION
9S'�o-os
"47.3 ft.
4•s g.p.m.
Other bacteria 46 colonies/100 ml.
Collected by: w,..
-r--_
Date installed
Foundation cleanout (YIN) _=De on over tank (YIN) _ High water alarm (YIN)
Pumper
C. ABSORPTION.F,IELD.DATA
Date installed Soil rating (g.p.d./ftp or ft2lbdrm) _ System type
Length ft. Width ft. Gravel�ov
Total depth _ ft. Elf. absorption area —_ft2
Date of adequacy test Results
Fluid depth in absorption field before _ in.
Elapsed Time: Final fluid depth _ in
Any r ' nation treatment (past 12 mo.) (Y/N & type) _
ft.
Monitoring jube = Depression over field _
s Fail) For _ bedrooms
Water added_ gal. New depth_ in.
Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at _ in. "Pump off" 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 JIA On adjacent lots tet(.
Absorption field on lot �J (A On adjacent lots o, JA
Public sewer main 7 75 r Public sewer manhole/cleanout 7 t"
Sewer /septic service line 7 Z5r Holding tank �J IA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO
Building foundation
Water main
Property line
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation r main
Water Service line water Driveway, parking/vehicle storage
Wells on adjacent lots
F. COMMENTS wbw was „� 5,,,c,Eo wry 1 f`�ey�r,t lE<.�t twrS Lpr r3 8r +t Z,
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name T daaTsJ
Date °I— 6- 2-05'
HAA Fee S 47o to
Date of Payment 9,17t5--
Receipt Number �J55f IkA /
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
491H
601AN t4 N�R871 �
CE • 10068 t ��
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o R • 6 •Z� •E�Go
BTH CONSTRUCTION, LLC
EXCAVATION & ENGINEERING
P.O. Box 110358 • Anchorage, AK 99511-0358
Phone1Fax:3383447 • E-mail: bth@gci.net
September 6, 2005
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Health Authority Approval, Well Only
Lot 12B, Block 2, Alpine Village
To Whom It May Concern:
The above referenced property was originally specified as Lot 13 Block 2 Alpine Village per plat P-663.
This is currently what MOA On-site records have the well log and other data stored under. Additionally, this
is the legal description of the lot when the City sewer service line was connected to the property.
Then, on December 31, 2002 lots 13 and 12 were replatted into one lot, known as Lot 12A, per plat 2002-
177. Then on July 9, 2004, Lot 12A was divided back into two lots, now known as Lots 126 and 12C, per
plat 2004-71, which are the current legal descriptions.
Attached please find the HAA application, HAA checklist, well log, water well test report, water sample test
results, on -property sewer service main tap diagram, on -property sewer service line diagram and original
site plan for the water well construction. The property owner will attach the current survey as -built to this
submittal when he turns it in.
If you have any questions, or require additional information, please feel free to contact me at 230-3992.
Regards,
Brian T. Harten, P.E.,
BTH Construction, LLC
.30°
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Lot . /Z 8 , Block Z
A/pore I/i/lo9e
Anchorage Recording District, Alaska
LOT/4
N 69e 59'Go"E
/30.Gt7'
. 'EXIST/MG
._ST.eLCTua6 N
22= . ...
: FZ h 26`
•
WELL
130.00'
S 69e 59' Co"W
LOT l2C
LOT SURVEY CERTIFICATION
I hereby Cattily that I have estveysd the property shorn and described
hereon, and that the Improvement, situated thereon are Within the prop-
erly lines and do not werlop orenerdoeh an adjacent property and that
no Improvemante an adjacent property overlap or encroach es the promisee
In question and that Mere we no roadvayes utility lines, or other visible
easements an mid property except as Indicated hereon.
M
�V':
Meee
L euth o
iaV pFESSI lim."
[ e plot o of heard ether than Mow shows on �0
otherwise
plot or noted. are Bot shorn Mnoa onpes,
etber.lw pored.
LEGEND
0 Brass or Aluminum tapped monument recovered
O Iron pipe and/or rebar recovered.
O 2 x 2 hub 6 tack recovered
• 5/8"x 3e rebar tet this survey
Scale ua Date Prepared by: R. L. BUTTON
/ o ReDistered Land Surveyor
(9OMM-6200 5/9 W. Eighth Ave. Anchcvope A/csko9950/
Ref. F.B. No. 33 Property of: ��m ohne//
2133
.AUG -25-2014 02:11A FROM:
70:3363447 P:2/2
WATERWELL -TEST PUMP REPORT
Conducted by: &afrv,2 50f0rp
Owner• 'T. u. Sr n I/ Addresa-
WellLocation: 7;17 RrI K 57�.K ra M. A k
Well Information: / �s t r `r
Total Depth:'--' f� DepthofCasing: ;Y5 Sereea]From=To
Casing Stu• � creen Diem: Screen Slot -
Remarks: _AT �n�rtora l ie� s a �n✓r O'
Pump Information I -°—
Intake Depth; _.= Pump Size r Line Depth:
Static Water Levet:- 7 r4 per• Dbcbartr. GPM; Max Drawdwn:
Pump On —
Time: Date: Pump Off. Time Date:
Time
Water
•ievd
Flow
GPM
--Remarks
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DATESCHEDULED TIME INSPECTOR
SUBDIVISION ALPINE VILLAGE BLOCK&CITITRACTBLK 2 LT ;Z129
INDIC)�TE NORTH
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SIZE MAIN:
TYPE MAIN:
DEPT AT MAIN:
AT PROP. UNE: 8 /�
CONNECTLOCATION: 3 7' S OF X! Ago
COMMENTS: OM80- AT CON SO'
CDR & Al OF 5 Pc
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INSPECTED BY: Pi GI)
DATE:
10 39Vd IWIV LZD9Z99 81:91 900Z/90/60