HomeMy WebLinkAboutALYESKA #3 BLK 22 LT 3
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Water System Permit
Permit Number: OSP231089
Work Type: Well Upgrade
Tax Code Number: 07602210000
Site Legal Address: ALYESKA #3 BLK 22 LT 3 GA916
Site Mailing Address: 156 HIGHER TER, Girdwood
Owner: PERONI LUKE J &
Design Engineer:
This permit is for the construction of:
Effective Date:
Expiration Date
�»cnr
J-0-
Department
Lot Size in Sq Ft:
Total Bedrooms:
5/12/2023
5/11/2024
13500
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy R1 Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
To close this permit please submit:
j 1. Well Log
2. Pump Install Log
3. Water sample results
4. Well Decommissioning Log
may:
Issued By:
Date:
Date:
3
111Cn(
Municipality of Anchorage
�
Uepartmr.nt
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV231020 COSA#:
PID#: 076-022-10
Legal Description: Alyeska #3 Blk 22 Lt 3
Engineer: David Coolidge
Permit#: OSP231089
Your request for a waiver of the required 100 feet horizontal separation from the
public sewer manholes to the private well has been approved. The approved separation distance
is 92 feet to the northeast manhole and 81 feet to the south manhole.
This waiver approval applies to the proposed public sewer manhole only. Any future upgrade to
the on-site water system will require all separation distances be met or another approval from this
department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: / 2-h- Approved by:
Name of Reviewer
............................................................ MEN............ ■ 1
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Development Services Departments r Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 07602210000
Property owner(s) LUKE J PERONI & JULIE B WOLFE Day phone
Mailing address PO BOX 1126
Site address 156 HIGHER TERRACE ROAD, GIRDWOOD, AK 99587
Legal description (Sub's., Block & Lot) ALYESKA #3 BLOCK 22 , LOT 3
Legal description (Township, Range & Section)
Lot Size 13,500 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial 0
Single Family (SF) 0
(w/wo AD U)
Septic Tank
ElUpgrade
ElDuplex
(D) E]
❑
RenewalTank
Renewal F]
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
0
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Well to public sewer manholes 92.4' and 81.4' Distance:
I certify that the above information is correct. I further certify that this is in accordance with
ap Icab Municipal Codes.
5.10.2023
(Signature of property owner or authorized agent)
Permit/Rush Fees: 42gn
Date of Payment:
Receipt Number: Orf z y 7
Permit No. 031923108q
Waiver Fees: . 217. SO
Date of Payment: SaH, e
Receipt Number:
Waiver No. O5 VZ310ZO
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
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April 25, 2023
WELL PERMIT AND WAIVER REQUEST LETTER
MOA Development Services, On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Alyeska #3 Block 22 Lot 3: NHN Higher Terrace Rd
Well permit and waiver request letter
Dear On -Site Services Engineer:
The owner of Lot 3 intends to construct a new single car garage on the property. The existing lot
has public sewer available but not public water. Lot 3 is currently serviced by a private onsite
water well. The attached site plan identifies the new location of the proposed garage as well as
the proposed new well. This location does not conflict with any septic systems on adjacent lots.
The proposed garage was sited to be accessible from the existing driveway and to minimize
excavation of the sloping lot. This will be a one -car garage with additional space for interior
stairs that will lead up to the house. Entrance to the existing residence is about 10' above the
existing driveway. Interior steps to the house will provide the owner with safe, snow and ice -free
access to the residence. The proposed garage will be located outside of the existing 10' utility
easement on the east side of the property.
The current topography of lot 3 slopes to the north/northwest toward Higher Terrace Road. The
new well will be located behind the proposed garage by necessity to keep setbacks above 100'.
Two of the four existing manholes exceed the 1 00'required setback. The manhole at the
intersection of Andre Avenue and Higher Terrace Road will have a setback of 92.4' and the
manhole within Lot 13 will have a setback of 81.4'. The proposed well location also will exceed
the 75' minimum setback (82.5') from a public sewer and the 25' setback from all existing private
sewer lines.
The existing well is located at the top of driveway retaining wall. It is about 5' to 6' above the
level of the driveway. In order to construct the garage, the area around the existing well will
need to be excavated. The well pressure tank and control equipment will be located inside the
new garage and connected to the house through the house crawl space. Once the new well is
developed, pump -tested, sampled and confirmed acceptable, the existing well will be
decommissioned in accordance with State and Municipal requirements.
Well log information from the Alaska DNR for five nearby properties show typical depth to
bedrock in this area.
Alyeska #3, Block 21 Lot 14: 34' to bedrock
Alyeska #3, Block 21 Lot 18: 18' to bedrock
Alyeska #6, Block 22 Lot 8: 18' to bedrock
Alyeska #6, Block 22 Lot 13: 30' to bedrock
Alyeska #3, Block 22 Lot 4A: 45' to bedrock (Lot 4A is adjacent to Lot 3)
PERONi GARAGE PAGE 1
LqG,
"' Trtr
WELL PERMIT AND WAIVER REQUEST LETTER
The closest parcel (Lot 4A) has 45' to bedrock. Bedrock depth for Lot 3 should be in that 35-45'
range as well. The relatively shallow bedrock will provide an impermeable layer to any effluent
that potentially might leak out of the public sewer main or manhole. As the new well will be
required to be cased for a minimum of 40', the effluent will be unable to contaminate the well. In
addition, per the MOAAWWU sewer plan as -built, the easterly manhole (with the 81.1 waiver
setback) has no upstream sewer leg so that manhole has no effluent flowing through it for
possible contamination.
Per the above discussion, we hereby request a waiver for the new well to be located 81.1' from
the easterly public sewer manhole as shown per the enclosed plan. Enclosed with this letter
request is a site layout plan for Lot 3 along with the completed well permit application, well test
results and other reference material.
Please let us know if there are any questions or any additional information needed. Thank you.
Sincerely,
David Coolidge, P.E.
LCG Lantech, Inc
Enc: Lot 3 Site Plan; Well permit application; well test results; other reference material
PERONI GARAGE PAGE 2
SEWER MAIN HIGHER TERRACE ROAD
(BASED ON
AW AS -BUILT)
_. .._ 01)
S C / ON �J
J'i EAST 100.00'
10' UTILITY EASEMENT GRAVEL PARKING '
ca
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EXISTING WELL
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PROPOSED WELL
c BUILDING
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LA/
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LOT 4A
N
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Z
/
\
-704
N
100' WELL RADIUS FOR PUBLIC
O
SEWER CLEANOUT/MANHOLE
1
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PROPOSED
(o
GARAGE
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600 SF KI
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PROPOSED WELL
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25' WELL RADIUS FOR
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cn '
LOT 3 ,OF AC,4ca
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...............
DAVID R. COOLIDGE
CE -8474 ,.�����/
\ 10' UTILITY EASEMENT F�PROFESSIO��.
EAST 100.00'
10' UTILITY EASEMENT
LOT 12 SEWER MAIN SEWER TO CABIN LOT 13
SEWER STUB -OUT (BASED ON AWWU AS -BUILT) I ON LOT 13 10' SEWER EASEMENT
WELL AND SEWER PLAN
SCALE: 1" = 20'
NOTE: DIMENSIONS SHOWN ARE TO FACE LOT 3, BLOCK 22,
OF SEWER CLEANOUT OR MANHOLE. ALYESKA SUBDIVISION #3
—S,-. - —G- — � � S- —
Fd'
SGS Ref.#
1231475001
Client Name
Residential Testing - Cash Account
Project Name/#
LukeJ Peroni
Client Sample ID
Kitchen Sink
Matrix
Drinking Water
Sample Remarks:
Printed Date/Time
04/25/2023 8:37
Collected Date/Time
04/14/2023 7:00
Received Date/Time
04/14/2023 8:48
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00
Waters Department
Total Nitrate/Nitrite-N ND 0.200
Microbiology Laboratory
E. Coli Negative 1
Total Coliform Negative 1
ug/L
EP200.8
B
(<10)
04/21/23 04/22/23
ACF
mg/L
SM21450ONO3-F
C
(<10)
04/17/23
EBH
100mL SM219223B A
100mL SM219223B A
04/14/23 HGS
04/14/23 HGS
Page 2 of 5
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RETURN TO: Division of Geological and G esical Surveys (DGGS)
3001 Porcupine Drive (Tele,. e: 277-6615)
Anchorage, Alaska 99501
Drilling Company Name
In[ATION OF WELL
W A T E R W E L L R E C O R D
Please complete either la, lb, or lc.
U.S.G.S. Local No.
Drilling Permit No.
A.D.L. No.
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
Ia. Borough
Subdivision
Lot
1 Block
I lb. Fraction
Section No.
TownshipRange
—
E/W
Meridian
lc. Distance and Direction from Road Intersections
Street Address and Area of Well Location
3.
OWNER OF WELL:
Address:
2. WELL LOG
Feet Below
Surface
Material Type Top Bottom
4.
WELL DEPTH: (completed)
ft.
Surface Elevation
Date of
Completion
5.
Cable tool Rotary Driven 11 Dug
❑ Auger ❑ Jetted ❑ Bored ❑ Other:
6.
USE: 0 Domestic FiPublic Supply industry
ElIrrigation ❑ Recharge ❑ Commercial
Test Well Other:
7.
CASING: Threaded Ej Welded
in. to ft. Depth Weight lbs/ft.
in. to ft. Depth
8.
FINISH OF WELL:
Type: Diameter:
Slot/Mesh Size: Length:
Set between ft. and ft.
Fittings:
9,
STATIC WATER LEVEL: ft.
Above 7 Below land surface
Type of Measurement:
10.
PUMPING LEVEL below land surface
ft. after hrs. pumping g.p.m.
ft. after hrs. pumping g.p.m.
11.
WELL HEAD COMPLETION: In Approved Pit
Pitless Adapter inches above grade
NCHORAGE
DEPT
12.
GROUTING: Well Grouted: Yes 11 No
Material: ❑ Neat Cement ❑ Other:
ENVIRON EN o •. u
13.
PUMP: (if available) HP
Length of Drop Pipe ft. capacity 9•P•
Type: ❑ Submersible ❑ Reciprocating
❑ Jet ❑ Other:
r r
14.
REMARKS:
15. WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and this report is true to
Registered Business Name
Address:
Signed:
the best of my knowledge and belief:
Contract License -Number
Date:
Form 02-WWR
Authorized Representative
Copy Distribution: WHITE - State DGGS, PINK
- Driller, CA14ARY - Customer
PERMIT NO.
DEPARTMENT L.. HEALTH AND ENVIRONMENTAL ~.t;'.OTECTION
825 "L" STREET, ANCHORAGE., AK. ~DSE~t
2~54-4720
I..~ELL F'E E:r-1 I 'T
,:: 8~0124 ::,
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LOCRT I ON G I RE:,WOOD ALASKA
LEGRL LOT < E:LK '""-' ~ '- ' -''
,:.,:. -,UE,. LFIT S I,~E %._.....,L. Iv '-"E~I IA~ FEET
- ,- c ,'lc- IS
MINIMUM DISTANCE BETWEEN A WELL AND ANY UN---,ITE SEWF93E [)I_,FL_,ML S'~'STEM
1~.q~3 FEET FOR A PRIVATE WELL OR i.SEi TO 2Et(q FEET FROM A PUBLIC WELL DEF'ENDING
UPON 'THE TYPE OF PUBLIC WELL.
,- ~ .... ,- , -
MINIMUM DI_-,TAN_.E FE. UM A PRIVATE WELL TF~ A PRIVF~TE SEWER LINE I'_-, .--._ FEET AND
TO A COMMUNIT'~' SEWER LINE IS 7.-=, FEET.
WELL '
LU.~=, ARE REL.]UIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN
OF 'THE WELL COMPLETION.
OTHER F..Eg!UIREMENT_, MAY AF'F'L'~'. SPECIFICATIONS AND RONSTRUC'TION DIAGRAMS ARE
AVAIL. ABLE TO INSURE PROPER INST~LLATION.
I E:ERTIF~ THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH B9 THE MUNICIPALIT9 OF ANCHORAGE.
2: I WILL INST8LL THE SYSTEM IN ACCORDANCE WITH THE CODES.
S I GNE[:,:
ISSUED
APPL. ICANT DFIYID W. SERRS
)
E:,,'~~i_~_ ~ _~_~_~-.~__~~ ..... E:, A T E_~/~__ ~--~-~'~-
V4. C*
LO'( :c I~K ~ ~LL~C~ ~-~-
LOT
~'d~ ~ FEE1
~:iFEE1 FO~ A PI~)~iE I~ELL ffi ~ lO ~ FEET
!1~:' 1~ 1~ ~ ~3~
it: ~]lY ~R L]~ )S ~ FEET.
I~ ~LL C~E1]~ 0
Fff:Y~ICFIlq'I" D,FIVID ~
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lot 3; Block 22: Alyeska Su6divi~io~ #3
Location (site address or directions)
NHN Hi~h~r Terrace
Girdwood
Property owner
Mailing address
Le~nding agency
Mailing address
David and Laurie Scars Day phone
7801 E. 130th Ave. Anchorage, AK 99516
Day phone
345-3657
m
Agent Geor_qe McCoy/ Jack White Co. Day phone
Address 3201 "C" Street Anchorage, AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
NOTE:
762-3118
Individual well ~( Y. Y.
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
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
5. STATEMENT OF INSPECTION BY ENGINEER
Se
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.~.~his inspection.
Name of Firm s & $ ENGINEERING..,/ /
Address
Engineer's signature
DHHS SIGNATURE
Phone (~ ~//' - Z- ~'~?
~ Date ~"_//'~///~/'~
Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 independem
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 and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A, Well Data
Well type ~/'& I
Log present(~N)
Total depth / O/
Sanitary seal (~N)
Parcel I.D.
If A, B, or C, attach ADEC letter, ADEC water system number
Date completed ~' / I~' J ~/ Driller
Cased to ~ ~ ! Casing height
Wires properly protected(~N)
FROM WELL LOG
Date of test
Static water level ..~'~
Well flow ~',~'
Pump level1 ~/~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /~o~J~ ,~,~.~_.~J'T'
Absorption field on lot
Public sewer main
Sewer service line ~-~'/"/'-
WATER SAMPLE RESULTS:
Coliform (~///'OO ,,~ Nitrate
Date of sample: ~ /
AT INSPECTION
57
g.p.m. I~' g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
~O
(~,/O z"~/~_. Other bacteria 0//'c~ ~
Collected by: ~~ ~-,'"--~/~-/F--~
Tank size
Foundation cleanout (Y/N)
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES FROM S~K TO:
Well(s) on lot ~ adjacent lots
To property line ~ Absorption field
nage
72-026 (3/93)* Front
Compartments
_ _ ~Y/N)
~,la~:H~/N)~.rnper .
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATI TO:
On adjacent lots
Wellj3p, Aot~
D. ABSORPTION FIELD DATA p(J,'~ ~_ / d._ .~' ~--C~(~
Date installed
Length
Total absorption area
Width
Date of adequacy test
Water level in abso~ t~,~~.
(past 12 months) (Y/N)
Manufacturer ~
Manhole/Access (Y/N) J
C.y.c~ted
Surface water
Soil rating (GPD/Ft2) .S~ ~~.
Gravel thickness . ~ Total depth
Cleanout present (Y/N~..-~ Depression over field (Y/N)
~ail) for
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Su dace water
Curtain
After test
If yes, give date
Bedrooms
On adjacent lots P~
To existing~em on lot
Cutbank ..-----~ Water main/service line
~ Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
Signature ~ .e. ~_ c_HG!Hc_Ep.:~ _/ _J~.~
~nnineer's Na~e034 Eagle Rive~e)~Jd No. 204
-"~ E~tgle River, Aiaslca 9~5.7~X ./ / ~./.
Date ~ ~//// / '~ Y
~dHAA
HAAFee$ ~, ~
Date of Payment ~ f {'~ (~ ~f
Receipt Number .~.~o~ (.
Waiver 1~
Date of Payment
Receipt Number
72-026 (3/93)* Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4726
Application Date
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
CORhI~R t~LPi'IV~ f)EE ¢' I-H6/-:tEt~ ~ ~.l~flA -E
Applicant Name D~t01D ~<-)F~iqrJ~.~ Telephone: Home
Business 72 - I¥ I
Applicant is (check one): Lending Institution []; Owner/builder [~['; Buyer []; Other [] (explain);
(d) Lending Institution {'~-O?'c,.q~ ~%~ ~'vxc\.%. Telephone
(e) Real Estate Company and Agent ~ ~ ~
Address
Telephone
(f)
Mail the HAA to the following address:
t
TYPE OF RESIDENCE
Single-Family I~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] PublicJ~ Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 (11184)
L.3 4ZK s/f4
~N~NI=FR~NG ~BM PBOWD~NG ~NSP£OT~ON$, T£$T$, F~L£ $~ABOH, DAIA AND ~N~OBMAT~ON
As certified by my seal affixed hereto and as of the validation date shown be~ow, I verify that my investigation of this Mea~th
Authority Approval shows that the on-site water supply and/or wastewater disposa~ system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. ~ further veri~y 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 /~' F_. C S I ~. O.,
Address
/ /
Telephone
,.5'- G/i TE:
AK
Approved for '~ bedrooms b ate
Approved ~,~ Disapproved Condition(I''--~
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR30198
WELL DATA
Well Classification !/V ~//I 0(//0/(-..-. If A, B, C, D.E.~. Approved (Y/N)
Well Log Present ~)/N) Date Completed L~--/'~I~i,./,~.,/-/~/- 01'/~ Yield
Total Depth IOI / .,.Cased to / ~'~ /
..... Depth of Grouting
Static Water Level W~, ~'_~0 ~.
Casing Height Above Ground
Electrical Wiring in Conduit {~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
h
Pump Set At _~JAI~[NO~II~
Sanitary Seal on Casing ~)N)
Depression Around Wellhead (Y~
/V/,~ ,On Adjoining Lots ~f/~
I
TO Nearest Edge of Absorption F e.L,~. NIA 'on Adjoining Lots
/ I
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by "~~'r'c/,-t~/c/~ . Date ~I~zI~
Water Sample Test Results
Comments ~ ~L ~~ ~~ ~~
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No. of Compartments
Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumpe~_.
Pumping/Maintenance Contract on File (Y/N) . ....." ; for _
Holding Tank High-Water Alarm (Y/C) __ Terp, P"0'r~olding Tank Permit (Y/N)
Separation Dista nces fro ml~;efc/?l,~an k:/ .,~~Tn Rllildincl Fnllnclatinn'~'
To Water-Supply Well ....... To Building Foundation ___ __
ToPropertyLine [ ~/ ! )~~ ToDisposalField______
To Water Main/Service Line I ~ To Stream, Pond, Lake, or Major Drainage
Course ~
Comments ~
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA f)(,,IB LI ~,
Soils Rating in Absorption Strata Type of System Design~
Date Installed ____ Length of Field
Width of Field ____ _ Depth of Field/
Gravel Bed Thick~
Square Feet of Absorption Area __ StanCes Present (Y/N) ___
Depression over Field (Y/N) j Date~f Last Adequacy Test _____
Results of Last Adequacy Test ! / ,/~
Separation Distance from Ab~/n/ie~ ~
· To Water-Supply Well ~ · / / To Property Line
To Building Foundation i / To Existing or Abandoned System on
Lot / ; On Adjoining Lots ___
To Water Main/Service Line / To Cutbank (if present)
To Stream/Pond/Lake/or M.~'q3rainage Course _ _
To Driveway, Parking ~", or Vehicle Storage Area _
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimension.~
Manh,
(Y/N)
Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted
Rating Against HAA Request **
I certif'
Signed
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
'conformed to all MO.~ and HA~ guidelines in effect on the date of this inspection.
Date
MOA NO. '
Time Time ..,le
Date Date Date
Inspector Inspector Inspector
Comments ~. Conditional Approval
~~ln~ PermltNo. Sept lo T~nk 81ze
Holding T~nk 81ze
Golls ~tlng Well To Absorption Are~ Well Log Received
Well to T~nk
APPLICANT FILLS OUT LOWE HALF ONLY
Property Owner /~/~/ [J~' ~'c'T F B
Buyer
Addres~
Lending InJtltutlon Phone
~e~lly ~o. & Agent - Phone
Address
L~gal Description
~S~ng~e F~mHy
~ Mu~Up~e F~mHy No, o~ Bedrooms
~ ~nd~v~du~ A~ACH WELL LO~, A well ~og ~s mqu~md ~o~ ~H weH~ ddUed ~nce June
~ Gommun~y ~g75. Fo~ weH~ ddHed pdo~ ~o ~h~ d~e~ g~ve we~ depth (~ch ~og
NOTE: THE ~NSPECT~ON FEE ~T A~CO~PANY EACH EE~E~T ~EFOEE P~OCE~N~ ~AN ~E ~N~T~ATED.
~UNICI~A',TY OFANCUORAGE SEW ER
CONNEC'T-PERMIT
81 017!
DATE OF APPLICATION
WATER A SEWER UTILITIESSCHEDULED COMPLETION DATEd
:5000 ARCTIC BOULEVARD J),~SINGLE FAI~ILY
PHONE-277-7622
(.L9%/TRACT ,-3 BLOCK ....
SUBDIVISION '*?/-'//-
.--= ,;7,/., -../..,.2}-IO .GRID
TAX CODE ""
BUILDING ADDRESS_ '/7/'"'
OW N E R ~)'"? ;//
[] MULTI-DWELLING
No. APTS
[] COMMERCIAL
[] INDUSTRIAL
MAiL ADDRESS "~'~ ''-? "-:)
DRAWING No.
PHONE
CONTRACTOR: '~'(._ '~.,v,t 27l_~
(License ~ bond required)
/
~N PROPERTY ONLY
[-] MAIN TAP-:..TO PROPERTY LINE ONLY
E]MAINTAP &ON PROPERTY CONNECT
CONNECTION SIZE '''/' CHARGE
INSPECTION_ FEE
PERMIT .FEE.,
REIMBURSIBLE
NUMBER DEPOSIT
ASSESSMENTS
[] Paid previously
[] Mob exfension ogreemenf
,[~,(,Subdlvl Gig n agreement
[] Extended connect agreement
[] Pending-AMOUNTS
.TOTAL ~; /
PERMI,T ISSUED BY"
Fl/CASH
~ cx.~ ,
INSPECTED BY:
DATE:
PER M ITTEE ,.._... :.,..~ ~ :;,?,..:..? ,;.:~ MAI L
(PLEASE PRINT)'"' .. .... ... ~ :: --~">ADDR.
PHONE:
I HAVE READ THE CONDITIONS .~ND REGULT, JONS dN THE."
REVERSE SIDE OF THIS PER~ITAflD AGREE TO COMPLY,:,~'ITH,THEM
PERMITTEE SIGNATURE ..
POST IN A CONSPICUOUS PLACE ATTHE JOBSITE
eo-oal (4/80)
Indicate North
n~
z
o
>-
w
w
w
n~
B1 ock D 9
Sub(t/vision or
Prope~'~l Owner
Water Size Permit Yes No
Sewer X Size Permit Yes No~
,_<
2
ALASKA ENVIRONMENTAL
CONTROL SERVI¢'r '~, INC.
1200 West 33rd Aven~., Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO.- OF
CHECKED BY DATE
/
HOd.SE:
ALASKA ,,dlROFImEFITAL COFITROL SEr,.IC $. IFIC.
J~nqineerinq 6 ~nuironmcntal Studies
I)AVIr) Sp~rLS
7108 E 130TH AVENUE
ANCltSR/W~ALASKA99516
.>,.LLER-DAVI D SEARS
0~/25/$6
DAVID SEARS
7108 E 130TH AVENUE
~ ALA,.,q<A 99516
60161
LEC_,AL:ALYESKA-//:2 BLCX3ZI< 22 LOT 3
FLO/V TEST ON WELL
WELL FLO~ DATE-04/22/86
A FI.C~ TEST WAS PERFOR/VED ON THE WELL. #09 GALLONS OF WATER WAS
PtNPED AT A RATE OF 1.9 ~ OVER A DURATION OF 3.5 HOURS.
THE DRA~ WAS 15.5 ' WITH A REODVERY TINE OF 60 MINUTES
AND THE STATIC WATER LEVEL WAS 63.2 FEET.
THE WELL I S ADEC~UATE FOR TH I S 3 BEDRCCM
1200 U Jest 33rd Auenue, Suite J3* Anchoraqe, Alaska 99503,(907) 561-50Z10