HomeMy WebLinkAboutALPINE VILLAGE BLK 3 LT 13Alpine Village
Block 3
Lot 13
#014-133-31
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ML.tF'�I I C I F~x=iL_ I T'r' OF FitVCH��RFiGE
DEPARTMENT { 'HEALTH AND ENVIRONMENTAL' 'OTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4720
LJELL FAErF2M I T
FEP.MIT NO. C 830291 ) �
APPLICANT COLONY BUILDERS INC
LOCATION
LEGAL L13 63 ALPINE VILLAGE
1407 W 47TH #2 99503
56'2-5339
LOT SIZE 999999 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LIFJE IS 25 FEET AND
TO A COMMUNITY SEWER LIFJE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT LIITHIFJ 30 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F='EF<tl I T EXF" I FEES F7ECEMEEFR -M1.s 1
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED: -----=------------------------
APPLICANT COLONY BUILDERS INC
ISSUED BY
a
V
--)-7- ?I
V4. 0
Time
APPLIC"NT FILLS OUT UPPER HA! -1 ONLY
/ -nL Phone
PropLity Owner C t C, [� n r , �l f —�.
r.� 2 `� j7�
Mailing Address 1 0)
l
Buyer t d-1
r 1
[ ..� .. %1 . C Vic._ �Gr a� r ✓�
Address y
Zip Code tc
Lending Institution
nn Phone
r`
276,-
AddressX. .-
zip Code
.
Phone
Realty Co. & Agent
l
ICIPALI ANCH
_ _1 zip Code
Address �, -7
Ir
Legal DescripIkm L f
i 1 -�� e K
Street Location
- c
(�) APPROVED BEDROOMS
Type of Residence
( ) DISAPPROVED
9 Single Family
L APPRO L'
( ) CO�NDIkL
Multiple Family
No. of Bedrooms
❑Other
DATE
BY:
W r Supply
Date Sewer Installed
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
Individual
Well Log Received
For wells drilled prior to that date, give well depth (attach fog If available).
Community
Well to Tank
❑ Public Utility
Septic Tank Size
Sewer Disposal
❑ Individual
Year Individual Installed: �, ?
Public Utility
When Connected to Public Utility:
Holding Tank
L
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Il
Inspector )
t
r\1 MU
ICIPALI ANCH
Field Notes: .L hO`!y a'A
CEPT.
ENVIRO,-,`A`NTALPROTECTION
AUG 3'083
RECEIVED
(�) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
L APPRO L'
( ) CO�NDIkL
9TION
DATE
BY:
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Well to Tank
Septic Tank Size
724231
F:o Lf boLtf.
Municipality of Anchorage
a,a •o.
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
Parcell.D. 014-133-31 COSA# Qr05?;:-
Expiration Date: - 31-07
1. GENERAL INFORMATION
Complete.legal description Lot 13, Bb& 3. Aiplw vUlage subdivision
Location (site address) 7311 Basel Street
Current Property owner(s) Taylor 6 shana MdOrvney Day phone
Mailing address 615 Say View Drive Aptos. CA 95003
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual On-site ❑
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite 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 resufts. (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 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
Approved for � bedrooms.
Disapproved.
Phone 522-7773
Date 1013=006
Conditional approval for bedrooms, with the following stipulations:
/�\\G1.11111C1 lll.
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory / Other
By: Cl/,
Original Certificate Date: JO-31-0
(Rw 11M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water d Wastewater Program
47W Bragaw Sheet
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfte
(9D7) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 13, Block 3• AO"e ~ SubdMWw Parcel ID: 01613331
A. WELL DATA
Well type Ensa If A. B, or C provide PWSID # _
Date completed Qrre3 Sanitary seal (Y/N) Y
Total depth 90 fL Caged to R.
FROM WELL LOG
Date of test enngo
static water level Www" R.
Well production 12 g.p.m.
WATER SAMPLE RESULTS:
Colllortn o colonies/100 mL Nitrate NO mg/L
Arsenic: WD mgA Date of sample: 10rJ=
e. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank sae gal. Number of CompaNnerds _
Foundation cleanout (Y/N) _ Depression over tank (YM)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Pumper
Wall Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
10/2AriD06
34.2 rt.
as 9 -
p.m -
Other bacteria 2 colonies/100 mL
Collected by: F. LODcu:
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Soil rating (g.p•d.fie or ft=/bdnn) System type
Length fL Width
ft. Gravel below pipe fL
Total depth fL Eftabsorption area _rt' Monitoring tube _ Depression over field
Date of adequacy test Results (Pass/Faiq For _ bedrooms
Fluid danth in absorotion field before test in. Water added gel. New depth in.
Elapsed Tkne: min. Final fluid depth in.
Any re)uvenatbn troabnent (past 12 mo.) (Y/N & type)
Absorption rate >- 9 -p -d -
If yes, give date
D. LIFT STATION
II Date installed Size in gallons ManholWAccess (YM)
'Pump on' level at _ in. 'Pump off level at _ in. High water alarm level at in.
Datum Cycles tested Masts alar 6 cucuil requirernenb7
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot NIA
Absorption field on lot WA
Public sewer main es'
Sewer/septic service One 17
On adjacent lots
On adjacent lots
>1W,
>1W
Public sewer manholaicleanout 91,
Holding tank WA
Animal containment areas None Manurelanimal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation Property line _
Water main
Wells on adjacent lots
Absorption field
Water service line Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line Surface water Driveway, ParkimgAehide storage
Curtain drain Wells on adjacent lots
F. COMMENTS: See Wmkw for Separation Behmm wee and Saver Main and Sewer Manhole. sea Waiver for Separation
Bahvaen wan and sewer Savics Lka.
G. ENGINEER'S CERTIFICATION
I car* that l have determined through !Feld mspecflons and
review of Municipal records that the above systems are m
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 1oryr2m NVO--% �"v F
44 is kuto
\p\\�
COSA Fee S q � Waiver Fee $
Date of Payment _ IO 3%%1�1� Date of Payment
Receipt Number O -j Receipt Number
(Rev. 1 Vee)
SCS RcLN
1065943001
Client lame
Anderson Engineering
Project lame/N
2311 Basel Sl.
Client Sample ID
2311 Basel SL
Matrix
Drinking Water
Sample Remarks:
All Dates/fimes are Alaska Standard Time
PrintedDate/fime
10/12/2000 12:38
Collected Date/time
10/032006 15:00
Receired Date/rime
10/032006 15:30
Technical Director
Stephen C. Ede
Allowable Prep Analyses
Parameter Results PQL Units Method Container ID Limits Date Date Inil
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/05/06 10/11/06 TK
waters Department
Nitrate -N ND 0.100
Microbiology Laboratory
Total Colirorm 2 00, No Coli
mg/L EPA 353.2 D (<10) 10/03/06 ALR
coV100mL SN1209222B A (<I) 10/03/06 DPT
Municipality of Anchorage
• '� Development Services Departments.
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-133-31 HAA# al, d,00-7 9
1. GENERAL INFORMATION Expiration Date: to — 13 ~ O 2
Complete legal description t ALPINE VILLAGE SUBDIVISION- LOT 13 BLOCK 3
Location (site address or directions) 7311 BASEL STREET • ANCHORAGE AK 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
BRIAN k STEPHANIE LAKER Day phone 522-2257
7311 BASEL STREET ► ANCHORAGE AK 99507
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
❑
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
Public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ CPaf, orprfor
to closing for the engineering services provided.
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. /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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SURE 28 * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any
otherperson orparty is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone 337-6179
Date 6 o Z
Conditional approval for bedrooms, with the fllowing stipulations:
. rim
Jam: • ON-SITE
• fr
:WASTEWATER
Attachments: C•'•,
HAA Checklist Manitenance Agreements J�jJ�OA • "M1�cs .�'`\
Septic System Advisory Supplemental Engineer's Reort l/��y1 11Cl t1
Well Flow Advisory Other
8y' � AOriginal Certificate Date:
�5 ��
Municipality of Anchorage .
• Development Services Department
Building Safety Division 4 „' ...
Onsite Water 6 Wastewater Program
4700 South Bragaw St.
P.O. Box 190850 Anchorage, AK 99519.8650
www.d.arrdrorg9.ak.ua
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
P LegalOescrotion: ALPINE VILLAGE SUBDIVISION; LOT 13, BLOCK 3. Parcel ID: 014-133-31
A. WELL DATA
A If A. B, or C provide PWSID# N/A
j wen type PRN 1E
Wen Log (YIN) YES
Data completed 6/1/19B3 Sanitary seal (YIN) YES
Wires property protected (YIN) YES
Total depth 96 It. Cased to 96 ft.
Casing height (above ground) 12+ in.
FROM WELL LOG
AT INSPECTION
Date of test 6/1/1983
3/1/2002
I
Static water level UNKNOWN ft.
29 ft.
Well production 12 g.p.m.
8.0+ g,p.m.
WATERsAMP E RESULTS:
4-
ml.
Coliform colonies/100 ml. Nitrate mgJL.
Other bacteria colonies/100
Arsenic: N/A mg./L. Date of sample: 3/11/2002 Collected by: AWWC. INC.
B. SEPTIC/HOLDING TANK DATA P U P LI C
SEWER
j Tank Type/Material
Date Installed
i; Tank size—gal. Number of Compartrnenis _
s (Y�)
Foundation deanout(YIN) over tank (YM) _
High water alarm (YM)
d Q ing Pumper
'1
C. ABSORPTION FIELD DATA P U P LI C
SEWER
Date Installed Soil rating (g•p.dJft'or ft1bbdrn)_
System type
Length — ft Widthft. Gravel t ft
Total depth ft. Eff. absorption area_ W Monnodng to Depression over field
Date of adequacy test Results ail)
For—bedrooms
Fluid depth in absorption field befo _ in. Water added _gal. New depth _in.
Final fluid depth _ in.
Final
E==n
Absorption rate >-
ment (past 12 mo.) (YIN 3 type)
it
If yes, Hive date
D. LIFT STATION
Date Installed Stm in gallons
"Pump on' level at _in.
E. SEPARATION DISTANCES
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanklliR station on lot N/A
Absorption field on lot N/A
Public sewer main •63'+
Sewer /septic service line •'12'+
'WAIVER /WR940035
"FROM EDGE OF WELL TO EDGE
OF FOUNDATION CLEANOUT.
On adjacent kris 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout •91'+
Holding tank - N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property Iine Absorption field
Water main
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Iine
Water service line
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water,
Building foundation Water
Surface wale nvew
Wells on adjacent lots
PUBLIC SEWER
parkingIvehicie storage
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect an this date.
ei...A.. .... ........
Engineer's Printed Name JEFFREY A. GARNESS : _79
Date 4�•.,_
HAA Fee $ 315 , ov
Date of Payment 3-6-02
Receipt Number D 1 LQ 47/
(Rev. oyor)
Waiver Fee $
Date of Payment
Receipt Number
3/12/2002
Municipality of Anchorage
George P. IVuerch, Mayor Department of
Public Works
Building Safcty Divisiorl —�
P.O. Ik)C 196650 a 4700 S. Itragaw Street
Anchorage, Alaska (1`)319-GCZ0 a (907) 343-£3301
h tq,: //awa.cl.anchoragc.ak.us
Jeffrey A. Garness, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
Subject: Waiver Request for Alpine Village Subdivision Block 3 Lot 13
Waiver Request #WR940035
Parcel ID 4014-133-31
Health Authority Approval Certificate Number 020078
Dear Mr. Gamess:
Your request for a waiver of the required 25 feet horizontal separation from the
sewer service line to private well has been approved. The approved separation distance
is 10.0 feet. This waiver approval is in addition to the already approved waiver
separations issued in July 6, 1994.
This waiver approval applies to the existing sewer service line to private well separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
'4JCt�/.
Daniel J. Roth
Civil Engineer
On -Site Water & Wastewater Program
111111 lll�
Feb 26 02 04:05P Laker Electric 907-677-7887
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VILLAC3E SUi�D.
hartaslo+l����i' ALPINE
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. M
ory- I'53-31 v HAA# i1WNLICS0� )
1.
2.
3.
GENERAL INFORMATION
Complete legal description LC 1 13 R L -3
/Ar l_t) I N C \i 1 L I A- E-, c
Location (site address or directions) T3 1 1 2 A-'�' I. l C_' Qt t- T -
Property owner -?::,A LD w' Ita t k f�_ 1 t Day phone ? lk, I - _1 77 1
Mailing address
Lending agency
Day phone
Mailing address
Agent l ^^ -N:z , + Day phone
Address ' ' 0
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3 v
IVA
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
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.
12.=(Rw.1/91) Front MOAR21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system Is In compliance with all Municipal and State codes,
ordinances, and regulations In effect on the date of this inspection.
Name of Firm I e)We h S o + 1•C L4 L-1,Cv L Phone v9-7 g — 3 `r f .b
Address
Engineer's signature
6. DHHS SIGNATURE
M
0
X Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date f z
bedrooms, with the following stipulations:
Date %—e— 9'Z
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. 0
naa(n...IAt) BKk MOAni
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L,-� 13 -6Y,--" Parcel I.D. O 1 y - 133 — "3 f
,4Lp1N� Vtt_L,4�+t-
A. Well Data
Well type ?=_If A, B, or C, attach ADEC letter. ADEC water system num^bee
Log present (Y/N) — Date completed 61116-75 Driller T e H H 'Y< /c—_
Total depth 96 Cased to 4' ✓e Casing height
Sanitary seal (Y/N) Wires properly protected (YM)
FROM WELL LOG
Data of test
Static water level
Well flow l �— g.p.m.
Pump levelt t�o 44a,"
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
T"
L
o
,'�
rn
410
— rt�
Septictholding tank on lot N/a ; On adjacent lots
Absorption field on lot `
Public sewer main
A ; On adjacent lots
Io Public sewer manhole/cleanout—C?
Sewer service line to Petroleum tank o
WATER SAMPLE RESULTS: `` '�
Coliform Nitrate < 0 la _Other bacteria I V a N e -
Date of sample: (� m °%` G rfi LLCollected by: S
B. SEPTIC/HOLDING TANK DATA
Date Installed Tank size Compartments
Cleanouts (Y/N) ndation cleanout (Y/N) Depression (Y/N)
High water alarm (Y/N) \ Alarm tested (Y/N)
Date of pumping \ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANKTO:
Well(s) on lot On adjacent lots Foundation
To property line Absorption field Water main/service line
Surface water/drainage
CONTINUED ON BACK PAGE
72-028 (n3)- Fmnt
C. LIFT STATION
Date installed
Size In gallons
Vent (Y/N) Pump on' level
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT�TATION TO:
'ss (Y/N)
'Pump oft' Level at
tested
Well on tot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date Installed Soil rating (GPD/Ftz) System type
Length Width Gravel thickness Total depth
Total absorption area Cleanout presept (YM) Depression over field (YM)
Date of adequacy test Results (pass/fail) for Bedrooms
Water level In absorption field before test \ After test
Perox de treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots
To building foundation
yes, give date
Property line
To existing or abandoned system on lot
On adjacent lots Cutbank
Surface water Driveway, parking/vehicle
Curtain drain
E. ENGINEER'S CERTIFICATION
main/service line
area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
OF 4(1'till
e.
Signature - i "r
gip..
Engineers Name In L 2 .-t S v rk1 o, ryd
Date
dei
HAA Fee $ �
Date of Payment 6-02—
Receipt Number ��/ 6L%
'n -W6 (sea)• Sack o5 o 00 3 ti
Waiver Fee $
Date of Payment
-a�
Receipt Number
o5060
Munic pality of Anchorage
Department of Health and Human Services
825 "L" Street
MO. P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
July 6, 1994
Tobben Spurkland, P.E.
203 West 15th Avenue #206
Anchorage, Alaska 99501
k 3 Alpine
Subject: Waiver Request for Lot Waiver Request #WR9400353 PID c#014-133-31`,1HA940305
Dear Mr. Spurkland:
Your request for waiver of the required 75 foot separation to
a public sewer main and/or 100 foot separation to a public
sewer manhole has been approved. The approved separation(s) are
a private well to the sewer main of 63 feet and a private well to
the manhole of 91 feet.
This waiver approval applies to the existing well and public
sewer manhole only. Any future upgrade will require all
separation distances be met or another approval from this
department.
Sincerely,
s�
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljm#9
MUNICIPALITY OF ANCHORAC
Department of Health and Human Services
- On-site Services Section
Waiver Review Worksheet
WR# WR940035 PID# 014-133-31 HA# HA940305 Permit #
Date Received: June 22, 1994
Legal Description: Lot 13 Block 3 Alpine village
Engineer: Tobben S urkland P.E.
203 West 15th Avenue#206, Anchorage, Alaska 99501
Applicant: Keith Baldwin
Waiver Requested: Private well to the sewer main of 63 feet and
private well to manhole of 91 feet
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
bt -6
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above: 5" — ^ r -
Date: 7 -S -C/4- By: �� �=
Name of Reviewer
Rec #: 00038/5165 Amount: $ 920.00 Date Paid: .Tuna 27. 1994
1v/}IvER
1?E4uCfr FOR Lor' 13 91-K 3 ALPINE vu�AGE s/�a
�.� lvRlveR )?IE4uEtT Nu.MB6R WR 7¢0035
Wf1/✓ER REQuESr FOR WELL TO PUP41C SSEW6IQ LINE ANp
M&,vHoLE OF G3 FEET RNO q1 FACT RFS'r6C7"/v EL r;
SEb„61? LI..E A+M
THE SE �-F�R L/�'Jf � /y.s►a{lOcE /.. QwLfT/e4 l..wf Cca/rnvw sTEO fN P119,
\ �•
J98Z ANO--TrlF Xan,- M -/rt 1400/C6O to IT IA. /Y /LRLN OF /983,
THN
.af
ilk
Lv E L L OH Ti4 —
f}4w/rrR
Li.ELC
/n/ 4?uEsr1vov IS
AI TOTAL pFPr14 of
iC FEET.
%j,6RRliv
Irk(F_
rNE Af*rEl?/ALr rK,E h -ELL If
rNRow6m A
Co..r/,v/owr
/"
m,* rr-1?1.4, OF
CL/9i/ a 6R,4vb4.
La.,r/L n4 dr 1.mrrn
vs,9,eW1,
f}4w/rrR
/J [,vCOa�TcPEO
�r 94
To 9L FEET t•�//LN /t
A F-'474
%j,6RRliv
GR/ivEL, 77H
4.f_LL
L/fYr CoNJr!?UCTED IA/
,fun,C /91
o4c fr/rr/c WAr6R L. ✓5L of MIS I�64L /l 2 i FEET TT I/J
f 4 F TO Aff"IL4C TIl N -T THIS CdgTJW OEA•RItii /f Gs�F/i,EG
Fn..4 jrwmoFncer CoA.rf►HIA,Rr/ov 1?614t<NtiG Ir.
L,..ELL S4¢"PtBS -3=XW! /NO/tArE ruAr NO N/rRArEr ARK ACMP1104!
^ND ao el"r-*RPj /9PtC PI?CrF,/T.
rkc w1;4 IJ UP 6R&P/F_4,7- FRl9H 77 -CE ov A S'/o
$LOPE. rKc* wELG /r ALfo Loc/►TE'O Eo+fr F?eh r/dE fE. Clr L/ E
w1{ILf/ l..Oc4tp Pic TS IT µi G/P/f/7/Err FRont 714E IB&.CR L /� IPL i/E T Ti
fKF_ w4ileA r/*91-E 6NA-V►ea7- AS ME c..wTLR r4 -ALE TYPrC41*41LY I.-
r14E H/LLf/nE f-jv.;r r/Po— r/ -[C E/4fr Tvw/*r+p3 r> -0E WOrT.
G Rl4a � TOTAL / 7 �
ON C L k S., 0 ti
61?AA,'7 tVAIVEiP /
tN>arE rAPLE
A orof pale dEblwf AT 9f — I* TVPi CAL
SlWSq
ff =
SO/L SORIiT/ON
(OY YIY IIM t CCR,✓ ! 6.A40EL TO
AQui.[X AT %'i
g• S
CV>
p�RnfaB/� TY
t
/Tr &Dove
(vlzreR TAQLE 6naD1rN7'
A 53.1.4E Cow Sf (lV AT/✓C O%
jL n/°E
O
2. /
f/uRl2uu q SE PA RN TION
63 i➢
2s
G Rl4a � TOTAL / 7 �
ON C L k S., 0 ti
61?AA,'7 tVAIVEiP /
d •A'
I
_�
J i-
-, -
_L_{
--I-
I
f
-
7i
L
LD i 1- 3 3 - 3 \ MUNIGPALIry OF ANCFIORAGE
FNVIRONMENRAL SERVICES DIVISION
Qq��o3S
T.SPURKLAND P.E. `UN 22 1994
6751 W. DIMOND BLVD.
ANCHORAGE, ALASKA 99502-3904 RECEIVED
(907) 248-5095
Municipality of Anchorage June 21, 1994
Division of Environmental Health
Department of Health and Social Services
820 L Street
Anchorage, Alaska 99501
Subject: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR
PRIVATE WELLS TO PUBLIC SEWER MAIN, MANHOLE
LOT 13, BLOCK 3 ALPINE VILLAGE
Gentlemen;
We are submitting a request for waivers from the separation
distances stated in Title 18, Alaska Administrative Code, Chapter
80.020.
During a field inspection on June 2, 1994, it was discovered that
the top of the well casing on Lot 13 was 91 feet distant from a
manhole and 63 feet distant from the main sewer line serving this
subdivision.
We have included the well log for this well. Impermeable layers
of clay are shown from 3 feet to 94 feet. The attached site plan
shows the location of the well in relation to the manhole and the
sewer line. The natural ground slope is indicated.
Due to location of streets and buildings surface contamination of
the well is not likely. The topography of the area is level.
A water quality sampling of the well water on June 2 indicated no
detectable nitrates and 2 colonies of bacteria,(OB). A resample
on June 15, showed no bacteria.
Yours ' l/
Tobbe4 Spurkland P�-.
T.SPURKLAND P.E.
WEST 15TH. AVENUE SUITE 203
ANCHORAGE, ALASKA 99502-3904
(907) 279-3916
Fax (907)-276-6013
RESIDENTIAL WELL INSPECTION
LEGAL: Lot 13, Block 3 Alpine Village
LOCATION: 7311 Basel Street
OWNER: Keith Baldwin
TYPE OF WELL: Private, Single Family
WELL LOG AVAILABLE: Yes
INSTALLATION REQUIREMENTS MET: No Too close to public sewer
WAIVERS GRANTED: No, Waiver applied for June 22, 1994
WELL YIELD FROM WELL LOG: 12 Gallons per Minute
PUMP YIELD FROM TEST: 6.5 Gallons per Minute
DATE OF INSPECTION: June 2, 1994
TEST PROCEDURE: Well was pumped at a constant rate while the
drawdown was monitored with an acoustic probe. At the beginning
of the test water level was, found at 29 feet below top of casing.
At a pumping rate of 6.5 gallons per minute the water level
stabilized at 40 feet after 20 minutes of pumping. A total of
760 gallons were pumped in a period of 130 minutes.
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli
and total nitrogen on June 2, 1994.
E.Coli 0. Total Nitrogen - None Detected mg/l.
Max. allowable Total Nitrogen 10 mg/1.
TEST RESULTS: This well meets the requirements of the
Municipality of Anchorage.
THIS WELL WILL'PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR 'MORE
THAN FOURiHOURS
The Municipal requirement for well flow is 150 gallons of water
per bedroom per day. This well exceed this requirement. The
assessment of the condition of the well applies only to the
conditions as of the day tested. The flow rate may change due to
subsurface conditions that may not be observed from the surface,
and changes in the land use and other factors that may impact the
aquifer feeding the well.
25 0 25 50 75 100 125 150
SCALE. 1' = 50 FT.
BERN STREET
I I I
I I I
LOT 5LNT 6 LOT 7
LOT 14,�\
\' , LOT 13 I I
I I LOT 12
We1I
BASEL STREET '.,' a
c
8 01 CL 50
SANITARY SEWER J
NI
TOBBEN
SPURKLAND P.E.
LOT 13, BLOCK' 3 ALPINE VILLAGE SID
SITE PLAN
203 W
15TH. AVENUE
KCITH BALDWIN
I
DATE: JUNE 11, 1990
I 1/1 GRID: 2133
ANCH.
AK. 99501
7311 BASEL STRCCT
SHEET: