HomeMy WebLinkAboutANGELA HEIGHTS LT 1Angela Heights
Lot 1
#050 - 283 - 37
�1....111r-4 11--" »-lir �L., 11-1 Lfi V< r'l��
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 ' STREET, HNCHORHGE, AK. 9 �1
279-2511
PERMIT NO. ( 77198 )
APPLICANT P 0 BOX 733 E. R. 688-2430
LOCATION CHICKHLOON ST
LEGAL L1 ANGELA HGTS LOT SIZE 11439 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETIOR
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTHLLHTIM
F" F.:: FN I_ I CR �11-1 r-4 F: ri S: 7E; kJ ET.
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF
2: I WILL I-HLL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED�___
AP
ISSUED BY
-NT J & J
_DATE 44-5,-72
�
WE
November 30, 1983
Herman and JoAnn Pittman
95 Chickaloon
Eagle River, AK 99577
Subject: Lot 1, Angela Heights
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° The top of the well casing should be sealed so that it is
CAI -
tight.
° Exposed electrical wires to the well head are in violation
CA -4
f the Municipality of Anchorage codes and must be encased
n conduit.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there Are any
further questions, please call this office at 264-4720.
Sincerely,
Cory Willis, R.S.
Acting Sewer & Water
Program Manager
CW56/e j/E1
(1rrtifir1 drilling ?Ltug
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588
OWNER OF LAND ! C (.ir i."C � ` O /\if
ADDRESS (-:-/7/1(1-:,
LEGAL DESCRIPTION /67- / 16//"li( F - ( //7,
DATE - Started
0 r-' /7
I Ended
/(7)-- 77
DEPTH OF WELL /
STATIC LEVEL OF WATER FT
DRAW DOWN FT t
GALS. PER HR
...'. 6o .�._,
PERMIT NUMBER / i . / (' KIND OF CASING /1 0
KIND OF FORMATION:
From %` Ft. to -:'j. Ft 6V E i / (a it . _t.) &-- 1 V/ From Ft to Ft
From <�-',, Ft. to ;\ Ft. ($`//JV --L) /`. ((/ // V' From Ft. to Ft
From f Ft. to .A l `') Ft. _/A/ 1 j' /--')///1/ From Ft. to Ft.
From •-> Ft. to 0 Ft. CI— r- Vg -Z-- From Ft. to Ft
From Ftp to 6 Ft. I / /Y // /firer) From Ft to Ft
From li Ft. to / 0 Ft.,_ / NI), (7)(-4 {i .L fl i i6m Ft. to Ft.
�<
From !-'� Ft. to {r' _.�> Ft., ----41/10) t7± (Y1/724) VT' 4--. From Ft. to Ft.
From /�.._:' Ft. to 1 ! Ft. L 4_ y (T" ',e> A..-: L._, From Ft. to Ft.
From , U Ft. to -�
Ft. //0 7—/(7 / /(7 frr ter' . /`lW .�� From Ft. to Ft.
From ;`` /c
Ft. tot/6 Ft. %/Jl/ :� (/.,�L.
� � � /C� �!c- From Ft. to Ft.
From //l(<, `Ft to t---;,3 Ft. /7'N1) , `r,-7 A-) t/7L-. 1 ( 7 EI%:'rom Ft to Ft
From Ft to Ft From Ft to Ft
From Ft to Ft From Ft to Ft
From Ft to Ft From Ft to Ft
From Ft. to Ft. From Ft. to Ft.
From Ft. to Ft. From Ft. to Ft.
From Ft to Ft From Ft to Ft
MISCL. INFORMATION:
/ J -
DRILLER'S NAME
APPLI( .NT FILLS OUT UPPER HK ' ONLY
Property 0.4iner /k:---/e//,/,/.)/c/ -v 76_ 4Ami 7/3,7L i.,,"a ,,,-)
Mailing Address /77„:-.) (i.--..!/,//e/e/7-1z. 6.,..; A/e._.-- /9 C 2. 6 / j -)t2 Zip Code c'77C-1,;- /2 7
Phone(,(2,..,/
-riJSY
Buyer Ziii.))//-'
..."
Address /66-4 ,, 5 .,7 6, 4.. ,,,,, 7— 1- fr: /,/ . A e, Zip Code
Lending Institution ,/) / /:/-//j 7,.../a 7-7 / t)Z.-
Address (-17-i-7 (/ [//i/e---/c- 3:-,/,04.1 r(7),„)11/4 k A ) Zip Code
Phone 27
(' - - S " 2 /
../-
Realty Co. & Agent k.16.7„). ci:j/c,i 17e,- 7 7--,7 r A/ --);,...JD A: 2-
(-.7.1 t_ 7- 1/
/ i , 7
Address .7/-,',/ /!'i,' -,--,7, Z/; -/k. 4 /j(„e,k, /-11-:-'///// -707,-7-g, Zip Code (79(:). 9 7
Phone (c(7/ ..
Legal Description 4 -7,-; / / /2 /./(7e,/,,,..? XILL s
Street Location 6/6 /. - ' Ay6--A-2 ( //:7-- (1) - ,zi / e. - /---/4 / (>04) ',./ - • ‘1,9 i) ,
Type of Residence
,r -Single Family
0 Multiple Family No. of Bedrooms '7
Inspector
0 Other
Water Supply
,,IFC Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
------N\
0 Community
0 Public Utility
Sewer Disposal
0 Individual 4 fr'
Public Utility CO3--01
0 Holding Tank ,--
.
Year Individual Installed:
When Connected to Public Utility -
NOTE: E INSPEC 1 N FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
)
Time
Time
Time
Time
ri
Date
Date
Date
Date
I 1-a9- U ni_o_s
Inspector
Inspector
Inspector
Inspector
1 -13L -MS
Field Notes:
t
W4-0 %alk,434.31 C-C....404•••••••P \
1 MUNICIPALITY OF ANCHORAGE
tArtNivik. V\SLA-d DEPT. OF tif.LTII et
Ii‘L.) ENVIRONMENTAL PROTECTION
-2, f
NOV 1 7 •Htb.")
-
RECEIVED.
( APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE 1
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to to Tank
Well Log Received
Septic Tank Size
72-023 (3182)
I -PAL ITV OF ANCHORA6E-
EFARTME OE 1EALTH AND ENV I RONMEN':s . PROTECTION
825 treet, Anchorage, Alaska 99501
27-9-2511, ext. 224 or 22.5
Date Received: August4, 1977
#3: Time
Date
Insp
tiltle= 9:x_0 _a.in. f2: Time
anday Date
Insp
EQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
eluting institution Request:
Alaska National Bank of the North
fling Address: 3301 C ' Street, Calais I1
r perty Owner:
Mailing Address:
& J Builders, John James
Phone_:
Phone:
688-2430
Legal Description: Lot 1 Angela Heights Subdivision
Single Family Residence: (x) Number of Bedrooms: Three
ult-iple ` Family Residence: ( ) Number of Bedrooms:
Well System: Individual Well (x) Community/Public System ( )
hermit # 77198 Depth of Well 123' Well Log on File (x)
Construction Bacterial Analysis
age Disposal System: On-site System ( ) Public Utility (x)
Permit # Installed Installer
Septic Tank Size Manufacturer
Absorption Area Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line
to Nearest Lot Line
Absorption Area
MUNICIPALITY OF ANCHORAG NICIPALi'Y OF ANCHOP,AGC
Department of Health and Environment (��r; DER t� itli PPxmoty
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225 AUG A,177
equest for Approval of Individual Sewer
1. Property Owner: pd
Mailing
and Rt E lVttities
Address:‘7:17---,9-4_, /•E -c -«-env Phone: -a SLS
2. Name of Buyer:
Mailing
3. Lending
Address: d‘ QKF n .,--.a Phone: ,53 7- 9 /
Institution: 12,c e.
Mailing Address:
4. Realtor/Agent:
Mailing Address:
Phone:
i d. ia/ 9c 91
///�d'ra�L
5. Legal Description: yY /
Street Location:
Phone:
�j�oG��ecly
6. Single Family Residence: (X) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well (X) Public/Community System
If Individual Well, well depth /3
If Community System, name of system
8. Sewage Disposal System: On-site System ( ) Public System
If On-site System, date, of installation:
*NOTE:
3/77
(Y)
A well log is required on ALL wells drilled since 6/75.
' Department of Health and Environmental Protection
eguest -for Appr-oval of -Individual Sewer and Water Facilities
=Description: Inst_ -1 Aia��. __Heicthts 'Subdivisio
Approved:
Disapproved
06-1220(a Rev. 1973
Alk DEPARTMENT OF HEALTH AND SOCIAL S)CES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL -`WATER AN -A
INDIVIDUAL SEMI-PUBLIC 0 CHLORINE RESIDUAL PPM _
REPORT RESULTS TO
ADDRESS
CITY
ADDRESS
OF SOURCE
OFFICE
Atlalytls shV7'} this, Water- SAMPLE to be:
lifettfory
❑ Unsatisfactory
❑ Qu$kiionoble
❑ Samle too long in transit; sample should not be over 48
`' hoyfs old at examination to indicate reliable; results. Please
tendnew sample.
❑' Bottle broken in transit, please send new sample.
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER"IS ANS INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY
DATE COLLECTED t i-3 7 TIME COLLECTED
Sample Collected From (aKitchen Tap 0 Bathroom Tap
❑ Other (List)
Well — ❑ Dug 0 Driven Drilled; ❑Bared
SOURCE: ❑Spring ❑ Cistern 0 Other,.._.
DugWell or Cistern Construction:
Walls —❑ Wood ❑ Concrete [ Metal Tile Brick
Top - ❑ Wood ❑ Concrete ❑ Metal ®Open Top 0 �nc1
LOCATION:
❑ In Basement 0 Basement Offset 0 Under House
Din Yard 0 Other
DISTANCE TO:, or Other Drainage Pipe - Feet Tank Feet.Building Sewer Septic
Tile Seepage r Cess -
Field Feet. Pit Feet. Pool Feet. Privy Feet
Other Possible
Sources of Contamination
MATERIAL: Building Sewer- 0 Cast Iron 0 Wood 0 Tile 0 Fibre 0 Asbestos
Cement
0 Plastic Joint Material - Type
GE I 1i:AL;. Does Water Becnme Muddy or Discolored? ❑ Yes ❑ No
When?
Diameter of Well
Well Casing
Material Diameter
Length of Water Depth
Drop Pipe irr
���y
i
PUMP LOCATION: 0 In Well ❑-Ba ement 0 In Basement
On Top
0 Of Well 0 Other
PURPOSE OF EXAMINATION: Illness Suspected? 0 Yes
New Source of Supply? ❑ Yes 0 No Repairs to System?
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220 (b)
Rev. 1973
B,4CTERIOLOGICAL WATER ANALYSIS RECORD
f F
Date Received 1� .- Time Received Lab. No.
Lactose Broth
24 Hours
48 Hours
Brilliant Green
24 Hours
48 Hours
EMB AGAR
Lactose Broth, 24 hrs. 48 hrs Gram's stain
Coliform Density (Most probable No. per 1OOcc)
MF Results
Reported by _ " ' Date
This dnalysis indicates Coliform Organisms to be: bsent
Present
:CHEMICAL & Gi:,)LOGICAL LABORATORIES,„, ALASKA, INC.
TELEPHONE (907) 562-2343
ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER55
WATER SYSTEM:
ID NO.
I litl`\ kg IA/
Water System Name
Mailing Address
City
SAMPLE DATE:
SAMPLE TYPE:
O Routine
Mo.
2
ot
Day
Su:AV
Zip Code
O Check Sample (for routine Ankimple
with lab ref. no
O Special Purpose
SAMPLE
NO. LOCATION
1
2
3
4
5
L
TO BE COMPLETED BY LABORATORY
Analysis !shows this Water SAMPLE to be:
\tit/ Satisfactory
12 Unsatisfactory
El Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Rrelved
2/(
7 :JZ) -1)
Analytical Method:
Fermentation Tube
Membrane Filter
' - -
kotiNaiimottog
READ INSTRUCTIONS ;
BEFORE
COLLECTING SAMPLE
"6-1220 (b) BACTERIOLOGICAL"'
Rev. 1978
Date Collected
Date Received Time Received
Source
'SIS RECORD
a.m.
Presumptive
10m1
10m1
10m1
10m1
1Orni
1.0m1
0.1ml
24 Hours
48 Hours
Confirmatory
24 Hours
48 Hours
_.._
froth 24 hours:
Broth 48 hours:
10m1 Tubes Positive/Total 10m1 Portions
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
BOB
Date
Time:
Coliform/100m1
Coliform/100m1
am
p.m.
RUSH
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
4
0.
Certificate of On -Site Systems Approval
ParcelID.050-283-37 r
1. GENERAL INFORMATION
RUSH/
a
Expiration Date: 9 .9- 7-
Complete legal description Angela Heights, Lot 1
Location (site address) 10007 Chickaloon St.
Current Property owner(s) Warren Coonce Day phone
Mailing address 10007 Chickaloon St. Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Ij Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
SUBIVIITTAL
JUN 202014
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual ❑
Individual Water Storage E. Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer x❑I
WaiveriVariance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date: Air'/72
COSA Fee $ 6-4 /2e. 5rabc� Q i-(00 Waiver Fee $
Date of Payment (o 1,41 111/4i 1/4i Date of Payment
Receipt Number OPO? -(P G. Receipt Number
COSH# 05C-Ni12-22 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 Pannone Engineering Services LLC • Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak.'99510
Engineer's Printed Name Steven R Pannone
6. DSDi./..-..-System
SIGNATUREIG
V System #1 Approved for 14" bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Date 6/20/2014
9�-mX1®fit
1
:c°? A 4h
v
•Meven isannone • p
%I.... CE -8149 . k2 "
�� a
4�k,id5sc`Y%".r
bedrooms, with the following stipulations:
lciatl(trt/(
TA OF CA/ (cr,tRi
j ON-SITE G>
iS WATER AND
�o WASTEWATER o^
pROGRAM i
By: ray Original Certificate Date: (a ` 2 7"1 yThe Municipality o A rage 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet S c
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Angela Heights, Lot 1 Parcel ID: 050-283-37
A. WELL DATA
Well type Private
If A, B, or C provide PWSID #
Well Log (Y/N)
Date completed 5/19/1977 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 122 ft. Cased to 122 ft. Casing height (above ground) 1$+ in.
FROM WELL LOG AT INSPECTION
Date of test 5/19/1977 6/19/2014
Static water level 100 ft 94 ft
Well production 20 g.p.m. 3.9+ g.p.m.
WATER SAMPLE RESULTS:
Coliform /14 colonies/100 mL Nitrate 3.mg/L
Arsenic '1] D ug/L Date of sample: 6/18/2014 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date installed
Tank size gal. Number of Compartments _ Cleanouts (Y/N)
Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm (Y
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ft2/b. ) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorpti• • . rea ftMonitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in abso : on field before test in. Water added gal. New depth in.
Elapsed T e: min. Final fluid depth in. Absorption rate >= g.p.d.
rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
L _
Size in gallons
in. "Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line
Manhole/Access (Y/N)
water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Absorption field
Water service line Surface water
Property line _ B
Water Service lin- Surface water
ain drain
oundation
F. COMMENTS
Wells on adjacent lots
Water main
Driveway, parking/vehicle storage
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 6/20/2014
COSA brown sheet 10-10-12.doc
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SGS Ref.#
Client Name
Project Name/it
Client Sample ID
Matrix
1142558001
Pannone Eng. Srv.
10007 Chickaloon St.
10007 Chickaloon St.
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
06/25/2014 16:46
06/18/2014 14:45
06/18/2014 16:29
Stephen C. Ede
Sample Remarks:
Parameter
Results
LOQ
Units Method
Allowable Prep Analysis
Container ID Limits Date Date hilt
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
ND
5.00
ug/L EP200.8
C (<10) 06/19/14 06/20/14 ACF
06/20/14 CDE
3.74 0.100 mg/L SM214500NO3-F B (<10)
Negative
Negative
1
100mL 8M21 9223B A 06/18/14 SLC
100mL SM21 9223B A 06/18/14 SLC