HomeMy WebLinkAboutALYESKA #3 BLK 21 LT 18Alyeska #3
Block 21
Lot 18
#076-022--31
Date Drilled:
Otatic Water Level 30
feet
Draw Dow __ feet
ne Material Drilled:
0 feet
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
wo;LL LOG
to t3
t
Bob Johnson
Lt.18 Blk.21
Alyeska
Gallons Per Minute 1
Total Feet of t`asing 248
to
to
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 076-022-31
1. GENERAL INFORMATION
Complete legal description ALYESKA #3 BLOCK 21, LOT 18
Expiration Date: - 1 . ` % 1-71
Location (site address) 205 HIGHER TERRACE, GIRDWOOD, AK 99587
Current Property owner(s) MITCHELL BILLY LLC Day phone
Mailing address PO BOX 1196, GIRDWOOD, AK 99587
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank
Community Class _ Well ❑ Community
Public Water System C Public Sewer
TYPE OF WASTEWATER DISPOSAL:
C
WaiverNariance request for: Distance:
Received by: /it/fr r !J,
e t Date: //
COSA to be released to the engineer, unlest6th rhise requested by the engineer.
COSA Fee $ '19 b -( Waiver Fee $
Date of Payment t\ 1 `g k c Date of Payment
Receipt Number base Receipt Number
COSA# OSC-lea 151a 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.
Name of Firm ARCTERRA CONSULTING, INC.
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS
Phone 868-3791
Date 11/6/13
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 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
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
6. DSD SIGNATURE
k/
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
KENNETH M. DUFFUS/
.7116
bedrooms, with the following stipulations:
a( oEtgN1/4
y���/
O
..a orrr c
By: 7/Es ,
`J VIV-v, - Vhf
0 WATER AND '
WASTEWATER o;
F PROGRAM J�
1/iv • JSERJ /
Original Certificate Date:
The uliti'" horage 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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 70-10-12.doc
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: ALYESKA #3 BLOCK 21, LOT 18
A. WELL DATA
Well type PRVT
Date completed 5/911984
Total depth 248 ft.
Date of test
Static water level
Well production
Parcel ID: 076-022-31
If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Cased to 60 ft. Casing height (above ground) 24+ in.
AT INSPECTION
51911984 10/29113
FROM WELL LOG
30
1.0
ft.
0.13.171.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L Date of sample: 1012912013
B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER
Tank Type/Material
Tank size _ gal.
Foundation cleanout (Y/N)
Date of pumping
58 ft.
2.3 g.p.m.
Collected by: ARCTERRA
Date installed
Number of Compartments Cleanouts (Y/N)
Depression over tank (Y/N) High water alarm (Y/N)
Pumper
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth ft.
Date of adequacy test
Fluid depth in absorption field before test
Soil rating (g.p.d./ft2 or ft2/bdrm)
Width
Eff. absorption area ft
2
System type
ft. Gravel below pipe ft.
Monitoring tube Depression over field
Results (Pass/Fail) _ For bedrooms
in. Water added gal. New depth in.
Elapsed Time: _min. Final fluid depth _
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
in. Absorption rate
>=
If yes, give date
g.p.d.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in. "Pump off' level at _ in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot NA On adjacent lots NA
Absorption field on at NA On adjacent lots NA
Public sewer main f5'r g - T, A7C h W Public sewer manhole/cleanout 4004- f 5 ' Ji' 6?- i3. w.
Sewer /septic service line 25'+ Holding tank NA
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
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
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
1 certify that I have determined through field inspections and review of
determined through field inspections and review of Municipal records that
inspections and review of Municipal records that the above systems are in
Municipal records that the above systems are in conformance with MOA
above systems are in conformance with MOA COSA guidelines in effect on
conformance with MOA COSA guidelines in effect on this date.
COSA guidelines in effect on this date.
on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 111612013
COSA brown sheet 10-10-12.doc
Municipality of Anchorage
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.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parce i.D. - orb - on- 31 COSA # CE0163
`"1 J :/
Expiration Date: 3,y/OS
1. GENERAL INFORMATION
Complete legal description A lyeska 13 B%ock ZI 1.04 • 16
Location (site address) ZoS tr76e2, TEgtace r G:rloocttt Ak 9958
Current Property owner(s) STE.t_. u c a re\ Day phone
Mailingaddress Re. Box (04,61 GirXwooq i Ak 775 Bi -
Lending agency Day phone
Mailing address
Real Estate Agent Sara F v4lk nEU_ Day phone 3914133
Mailing Address
Unless otherwise requested, COSA wilt be held by DSD for pickup. Ok F.r art to /Al,
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 0
❑ Individual Holding Tank 0
❑ Community On-site 0
❑ Public Sewer 1z.
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. 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 Sixtrkb.nA £rin6G121N4 Phone 279- 3916
Address 203 W, (St' Avo X203 r Anclnn oroyet AK 195Dk
Engineer's Printed Name Lor5 Spur' Mc nr\
5. DSD SIGNATURE
Approved for 2 bedrooms.
Disapproved.
Conditional approval for
Date 11 r o\
4\
PE Az
y49TH v //i
a.LAFisE.'`URi;LAN......
kv 0, it
"ANNN`
bedrooms, with the following stipulations:
otlHtfr!f!/////
_�4P�RY OF. '
•_-'n•c
ON-S(TF • = 7
WATER AND t"=
PROGRAM
0 •• (J•p�� ••
�/� bin imp,
rv'tNf
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: ft /4rA
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(RM.11A5)
Original Certificate Date: /71407
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995198650
www.murd.orglonstte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: R1yeAka 3 8L1. tt 1o4 I V
r ,
Parcel ID: orb - Oz2 - 3I
A. WELL DATA
Wee type alY. eke. If A, B, or C provide PWSID s = Well Log (WN) y
Date completed al Sanitary seal (YIN) _t Wires properly protected (YIN) '_
Total depth 24 8 Il. Cased to ‘O ft. Casing height (above ground) 4 2 4 in.
FROM WELL LOG AT INSPECTION
Date of test 5%I8 / ICJ 30' 01-
Static water level 30 j ft. C:s ft.
Well production I 1 D g.p.m. 2. (o g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate ND mgfL Other bacteria 1C colonies/100 mL
Arsenic: ND mgr • Date of sample: lolo} Collected by: / 44.0 5?....1104/
B. SEPTIC/HOLDING TANK DATA Publ,c, S2 'e,..
Tank Type/Material — Date installed
Tank size — gal. Number of Compartments = Cleanouts (Y/N)
Foundation deancut (YM) = Depression over tank (YIN) = High water alarm (YIN) -
Date of pumping Pumper
C. ABSORPTION FIELD DATA . P. ITC. Sewn.
Date installed — Sal rating (g.p.d./18 or f 2lbdnn) — System type
Length -" ft. Width ft. Gravel below pipe — ft. •
Total depth — ft. Eff. absorption area ft2 Monitoring tube = Depression over field
Data of adequacy test — Resutis (Pass/Fail) — For =bedrooms
Fluid depth in absorption field before test — in. Water added= gal. New depth — in.
Elapsed Time: — min. Final fluid depth — in. Absorption rate >_ — g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yes, give date —
D. UFT STATION
Date installed
.gyp on
Size in gallons
el at _ in. 'Pump or
Cyd
Manhole/Access (VM)
High water alar I in.
Meets ala crcuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankNR station on lot N/A f kV r
Absorption field on lot N/4 4100
r98;�
Public sewer main 1B ' 111Vfs[ 1Z Public sewer manhole/deanaut
Sewer /septic service line 4 25 1 Hdding tank N/4
Animal containment areas t 50' Manure/animal excrete storage areas + /COI
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: tau b I C Se km",
On adjacent kits
On adjacent lots
r
y8 i1161
wntva
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: Pc, 4 /, L .Se w e,,,,
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
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems am in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name L4r4 se,r'21 awed
Date 12/3/O1-
COSA Fee S 4 3 0
Date of Payment 11/Z9 /07
Receipt Number OZ66Z
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SCS Rai/
Client Name
Project Name/N
Client Sample ID
Matrix
PWSID
1075837001
Tobbcn Spurkland P.G.
Alyaka No 3 B21 L 18
Alyaka No 3 B21 L18
Drinking Water
0
All Dates/Times are Alaska Standard Time
Printed Date/rime
Collected Date/Time
Received Dale/Time
Technical Director
11/06/2007 13:55
10/30/2007 14:20
10/30/2007 16:30
Stephen C. Ede
Sample Remarks:
Parameter
Results
POL
Units Method
Allowable Prep Analysis
Container ID Limits Date Date Ink
Metals by ICP/MS
Arsenic
Waters Department
ND
Total Nitratc/Nitritc-N ND
Microbiology Laboratory
Total Coliform
0
5.00 ug/L EP200.8 C (<10) 10/31/0711/01/07 Mil
0.100 mg/L SM204500NO3-F B (<10) 11/01/07 LCP
col/100mL SM209222B A (<1) 10/30/07 SDP
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AnchoteRec�rdirtj Precirret ',Alisicii;•arathat the improve:
'merits situated thereon are within theproperty:blies and do nos:.
overlap or en2:rotch on the property lyitadjacent thereto, that
.
no. improvements 9111:/rOpertY lying adjacent thereto enaoach
son the premises 0 question end that Nia,aeetne toachaarc •-
lisruonitoton lines or other Ktsble ease:heed, on said Prolticrty/...
excel)! as Indicated hgreon. • • •••• • ' • • , • ,.
Alated'at Eagle River Alaska 7 ..,
tias 171:i
'rayof P4gr1t: 4. • •2 49a • 7
• • . ,ROBERT c. JOHNScri
SCA/24. Registered Land Sorvegor NO. $8O -LS
2:i.•!;; ; :Box 77-04* EnJ. Tani; Alaska 99577.{?:
.. • ,
Municipality of Anchorage
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.cl.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Spurkland Engineering
Legal description: Aiveska #3. B 21 L18
❑Permit ®C.O.S.A. ❑Inspection Report
The attached paperwork has been reviewed and is being returned for the following reasons:
1. There is a well log on file. The file was scanned under Alyeska not Alyeska #3.
2. Separation distances to the public sewer were found to be much closer for a previous COSA.
Name of reviewer: Deb Date: 11130/07
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
41 E
P.O. Box 198050 ®a®
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Alyeska 43 Block. 24 Loi' IS
A. WELL DATA
Well type R iv AAL,
Date completed Nnow
Total depth > WO ft.
Date of test
Static water level
Well production
Parcel ID: Olio' o zz– 31
If A, 8, or C provide PVVSID a = Well Log (YM) Wes
n Sanitary seal (YIN) 2t Wres properly protected (YIN) Y
Cased to >90 ft. Casing height (above ground) > Z`I in.
FROM WEU. LOG AT INSPECTION
4Al2nown 10j 0}
unknow" fl. (,5 ft.
4niCno W h g.p.m. 2.4 g.p.m.
WATER SAMPLE RESULTS:
Conform 0 colonies/100 mL Nitrate Am mg/L
Arsenic: 4/0 mgll Date of sample: 43401' Collected by: taco
B. SEPTlC/HOLDING TANK DATA
Other bacteria Cif colonies/100 mL
P,151;c. Se.)
Tank Type/Material ^'
Tank size — gal. Number of Compartments —
Date Installed —
Cleanouts (Y/N)
Foundation cleanout (YM) = Depression over tank (YIN) — High water alarm (Y/N)
Date of pumping — Pumper —
C. ABSORPTION FIELD DATA PI,b1;€. Slb.Jt .
Date Installed Sal rating (g.p.d./ft2 or ft%lbdnn)
Length — ft. Wdth — if. Gravel below pipe
Total depth -- if Eff. absorption area =re Monitoring tube = Depression over field
Date of adequacy test -- Results (Pass/Fail) — For = bedrooms
Fluid depth in absorption field before test — in. Water added --• gal. New dept — in.
Elapsed Time: -- min. Final fluid depth — In. Absorption rate >= — g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) — If yes, give date —
System type
ft.
D. LIFT STATION
Date installed Size in gallons
'Pump • level at _ in. 'Pump off level
m Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankNR station on lot N/A
Absorption field on lot
Public sewer main
NIA
1514-
25 I 4-
Sewer
15'+.25I4-
Sewer /septic service line
Animal containment areas 50
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: P4 U ic- Se w tA,
Manhole/Access (YIN)
High water alarm
Meets ala requirements?
On adjacent lots Irk +
On adjacent lots jcx #
in.
Public sewer anholeldeanout
m (00 +
Holding tank
Manure/animal excrete storage areas 100 +
Building foundation -- Property line =
Water main
Absorption field
Water service line — Surface water --
Wells on adjacent lots — L
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ?i.6 LK. 6e ‘J e/�-•
Property line '—" Building foundation
Water Service line Surface water
Curtain drain — Wells on adjacent Tots —
F. COMMENTS:
Water main
Driveway, parkin plrehida storage
G. ENGINEER'S CERTIFICATION
I certify that l have determined thmugh field inspections and
review of Municipal records that the above systems we in
oonformanoa with MOA COSA guidelines in effect on this date.
Lars Spl.sfitlariA
Engineer's Printed Name
Date 1421101-
J �? �► .st 11
�49TH 1(i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 0"11n-1nq,a -(2-11
1. GENERAL INFORMATION
Complete legal description Alyeska, Lot 18, Block 21
T1ON R2E Section l6
HAA# c.1G1?,(`) Ilk
Location (site address or directions)
NHN Highest Terrace, Girdwood
Property owner Robcrt Johnoon hD a 'A nN< °isa ay phone 694-2543
Mailing address P'°'
Box 770456, Eagle River, AK 99577
Lending agency N/A Day phone
Mailing address
Agent N/A Day 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
2
X
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
X ti
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 921
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 Eagle River Eingeering Services Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature ' Date 0 3// 1/93
6. DHHS SIGNATURE
/\ Approved for Tuiv (Z) bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By.
Additional Comments
lQ tAw..u-
Date 3/;,/ A
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
3
Legal Description: ALYESX4 Lor/8 &X V
%!ON g2, SECTION 1(,
A. WELL DATA
Well type Pg /V476 If A,
Log present (Y/N) YC 5
Total depth 248
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Parcel I D
74, -- 0 -3/
B, or C, attach ADEC letter. ADEC water system number JU %A
YES
Date completed 05/09/84 Driller figfTY
Cased to 6P01 Casing height
FROM WELL LOG
30'
Wires properly protected (Y/N) yGS
AT INSPECTION
3///93
ENVIKUNME NTAL LER\ 1: S olVIS10N
MU�'I"�A'.ITY r`F AN''NC)kAUE
4(J
/0 gpm /.g 'g"pm1a1993
;t -30l RECEIVED
UN,tNowN
SEPARATION DISTANCES FROM WELL TO:
N/A
N/A
(iv/live-kJ
Septic/holding tank on lot
Absorption field on lot
Public sewer main 't
Sewer service line 3.9/
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
03//5/9 3
B. SEPTIC/HOLDING TANK DATA
Date in
1-/oo
/98
�8 (w�� -'i& )
Petroleum tank NONE APPAec,NT
D. /0 m6/1._
d Tank size
Other bacteria
Collected by• EN6/A/EE,9
cc
Compartments
Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N)
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping ' Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK T
Well(s) on lot On adjacent lots Fou • : ion
To property line Absorption field Water main/service line
Surface water/drainage
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date ' • tailed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pu . n" level at "Pump off" level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface w
D. ABSORPTION FIELD DATA
installed Soil rating
Length Width Gravel thickness
System type
Total depth
Total absorption are- Cleanouts present (Y/N)
Depression over field (Y/N) Date of adequacy test
Results (pass/fail) for bedrooms
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD
If yes, give date
Well on lot On adjacent Tots Property line
To building foundation To existing or abandoned - stem on lot
On adjacent lots Cutbank Water main/servic- 'ne
Surface water Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name Glow
Date :?//7/y
HAA Fee $ if 7a
Date of Payment j7g- 9
Receipt Number Q21-45-: - (-6 76)
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee• $
Date of Payment
Receipt Number
z a 969
Member of the SGS Group (Societe Generale de Surveillance)
CHEMICAL & GEOLOGICAL IABORATORY
,,:"s c"c A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
IAaONAtOIY
5633 B STREET ANOF1ORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
Chemlab Ref.! :93.1044-1
Client Sample ID :18/21 ALIESKA SUED.
Matrix : WATER
Client Name
Ordered By :STUART
Project Name
Project!
PWSID :UA
:EAGLE RIVER ENGINEERING
Semple ROUTINE SAMPLE COLLECTED BY: STUART.
Remarks:
QC
Parameter Results dual. Units
NITRATE -N
0,10 U mr/1
REPORT of ANALYSIS
Method
EFA 353.2/300.0
Collected
Received
WORK Order
Report Completed
Technical Director
Rsleased By :
Allowable
Limits
10
:03/15/93 t 14:30 hrs.
:03/15/93 t 16:10 hrs.
:64050
:03/16/93
:STEPHEN C. EDE -
Extract Analysis
Date Date Inst
05/16/93 MCE
Municipality
of
Anchorage
December 4, 1987
P.O. BG. 196650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Louis Butera, P.E.
Eagle River Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Subject: Waiver for Lot 18 Block 21 Alyeska #3 Subdivision
Waiver Number WR87-072A
Dear Mr. Butera:
This letter is to amend the waiver written for the subject lot
on November 25, 1987 to include the 48 foot separation of well
to manhole and the community sewer line. At the time the well
was drilled in May of 1984 the separation requirements from a
community sewer line and manhole were 75 feet and 100 feet
respectively.
This waiver applies to this well separation to community sewer
line and manhole only. Any future upgrade to the well will
require all separation distances be met or another waiver
approval from this department.
Daniel J. Roth
Civil Engineer
On -Site Services
cc: Gus Andress, P.E.
Manager, On -Site Services/Water Quality Programs
EAGLE RI v ER ENGINEERING SERVICES
Lou Butera, P.E.
41e$
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694-5195
December 4, 1987
Mr. Daniel J. Roth
Civil Engineer
On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Waiver No. WR87-072
Lot 18 Block 21 Alyeska #3 Sub.
Dear Mr. Roth:
MUNICIPALITY OP ANSRAGS
&
ENVI p PT OF HEALTH
PROTECTION
PEC 4 1987
RECEIVED
The attached waiver should also include the separation distance
to sewer line manhole at 48' as mentioned in our letter dated
11/24/87. As the well was drilled in 1984, I don't believe that there
was a 50' separation in effect at that time; you were correct to
address the waiver to 48'.
Please amend this waiver to include manhole distance.
If there are any questions or concerns, please feel free to
contact me at 694-5195.
Sincerely,
Louis Butera, P.E.
LAB:bjr
Attachment
Municipa_ Lty
of
Anchorage
November 25, 1987
P.O. BC' '96650
ANCHORAGE, ALASKA 99519-6650
(907) 343-4200
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Louis Butera, P.E.
Eagle River Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request For Lot 18 Block 21 Alyeska #3 Subd.
Waiver Number WR87-072
Dear Mr. Butera:
Your request for waiver of a private well to a community sewer
line has been approved. The required 50 foot separation at the
time the well was drilled has been waived to 48 feet.
Precautions taken by the owner to install a PVC liner 200 feet
deep and grout the well from 18 feet where bedrock begins to 60
feet are good. This procedure insures that the well water most
likely will not be contaminated from a leak in the sewer line.
This waiver is for well to sewer line separation only. Any
future upgrade to the well will require all separation
distances be met or another waiver approval from this
department.
Sincerely,
omAf izzov
Daniel J. Roth
Civil Engineer
On -Site Services
cc: Gus Andress, P.E.
Manager, On -Site Services/Water Quality Programs
( EAGLE RIVER ENGINEERLNGCH$RRVICES
ENVIRONMENTAL SERVICES ply✓i,iGN
Lou Butera, P.E.
4 4
November 24, 1987
NO 2 4 1987
RECEIVFr3
Mr. Steve Morris
Civil Engineer, On-site Services
Department of Health and Human Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
RE: Lot 18, Block 21, Alyeska Subdivision
Dear Mr. Morris:
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694-5195
I had previously submitted to your attention a request for
waiver of separation distance to 50' distance for a water well to
public sewer line and manhole on the above referenced lot.
After discussion, it was decided that the waiver could be
secured using the present well location by sealing the well from a
level of 60' up to the level of the steel casing. Consequently,
Arctic Pump and Well was contracted to place a 4 1/2" liner to a
depth of 200' with a well packer (plug) at the 60' level. A mixture
of grout and 4% bentonite power was pumped from the bottom up, to
form a seal with the bedrock surface from approximately 8' depth to
60'.
At this time we are requesting a formal letter of waiver for
the subject well.
If there are any questions or concerns, please feel free to
contact me at 694-5195.
Sincerely,
Louis Butera, P.E.
LAB:bjr
EAGLE RIVER ENGINEERING ,ERVICES
Lou Butera, P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694-5195
01
October 27, 1987
Mr. Steve Morris
Civil Engineer, On-site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
REF: Lot 18, Block 21, Alyeska Subdivision #3
Dear Mr. Morris:
(m.2-17
RECEIVED
On behalf of my client, Mr. Robert Johnson, I am submitting the
information necessary for your determination of a waiver of separation
distance, private well to public sewer line and manhole, to 48' for
the above referenced lot.
The available well log shows that the well draws from a bedrock
confined aquifer through fractures at a depth of 218-228'. The casing
is listed as being 248' in depth but it is possible that the casing is
continuous only to 18' where it is seated into bedrock. A static well
level of 39' indicates that water is not entering above this level
into the well in any quantity. The well recovery test shows a 2.03
GPM average recovery rate from a level of 199' to 155' with a fairly
steadily decreasing recovery rate per foot as the water level is
rising in the well. The well is located at a lower surface elevation
than the sewer line and the subsurface soil is noted on well log and
sewer asbuilt as being a GM type. The sewer line asbuilt shows no
special construction details. Water samples taken for coliform show
zero (0) count; the nitrate results are pending.
It is obvious from the plot plan that there is nowhere on this
lot that my client can locate a well that is within legal separation
distance of the surrounding sewer lines. Due to terrain, there is
also a limit as to the practical location possibilities for well
drilling. We desire to retain this well and location using whatever
method or testing necessary to ensure a safe water supply.
If there are any questions or concerns, or if additional
information is needed, please feel free to call me at 694-5195.
Sincerely,
Lou Butera, P.E.
LB:bjr
lot 3
100'
10' UTIL, ESMT.
M,H, #618
20'
1HIGHLR TERRACE R
S,S,
M,H, #617
100' R
EASEMENT — — — —
MANHOLE PRDTECTIVE RADIUS
SCALES 1" = 30'
WELL LOCATION SITE PLAN
LEGAL: LOT 18, BLK 21, ALYESKA SUBDV, #3
OWNER: ROBERT JOHNSON
CONTRACTOR: N/A
EAGLE RIVER ENGINEERING SERVICES
PO BX 773294
EAGLE RIVER, AK, 99577
694-5195
AV
9
el°41 44: it:
ei
)uis A. Butera•+m. Cr\4
Qu�
CE -6736
'�®s Neooee [.
ROFESS\O'
s�
.:nom
LABORATORIES
CHEMICAL & .GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343
FEDERAL TAX ID # 92.0040440
ANALYSIS REPORT BY SAMPLE
Client PO* : VERBAL Req II::
Client Smpl ID: ALYESRA BASIN, L18, 10-25-87, 1715
Sample Rec'd : OCT 24 87
Ordered By. :
Send
Reports To: EAGLE RIVER ENGINEERING
PO BOX 773294
EAGLE RIVER, Al:. 99577
Special
Instruct:
Chemlab Ref *: 8137
Lab &got ID: 1 Matrix: Water
Parameter Tested Result/Units
NITRATE -N ND(0.10) mg/I
Work Order No. :
Client Account :
Date Report Printed:
Released By .
Reports Address *2
Method
3578
EAGLERP
OC�2887216:04
Allowable
Limits
Sample ROUTINE SAMPLE
Remarks: ANALYSIS COMPLETED: 10-26-87 a.
LABORATORY SUPERVISOR: STEPHEN C. EDE A
10
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
NOV 31987
RECEIVED
1 Tests Performed
NDS None Detected
NA= Not Analyzed
* See Special Instructions Above
** See Sample Remarks Above
LT=Less Than, GT=Greater Than