HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 6Skyline View
Block 1
Lot 6
#051-192-49
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion?;;<HV No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
051 192 49
SKYLINE VIEW 1 6
HULSEBUS LAURA ANN
PO BX 670871
CHUGIAK, AK 99567-0871
02 27 2023
215
STA-RITE
S7P4HS07231-02
.75
12
MARTINSON
PELLETS
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE AK 99518
GREm I'ER ANCHORAGE AREA BOku0GH
Department of Environmental Quality
���� 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
PH ONE_A�&N
E A) J. f j3C(l (%[S 4)S MAILING ADDRESS
NAM /
� �� !� "' � � LEGAL DESCRIPTION 0 �
/-
LOCATION � y���e
SEPTIC TANK:
_ NUMBER OF
DISTANCE H1 iV d 4 c -°M t'J —COMPARTMENTS -1
FROM WELL
MANUFACTURER /` i�0 �! K� MATERIAL
INSIDE LENGTH
INSIDE WIDTH LIQUID DEPTH ----LIQUID CAPACITY J�"S�� GALLONS.
y KGotiuil�e�
SEEPAGE PIT: /
i Y
NUMBER OF PITS DIAMETER __2_013 WIDTH—, LENGTH -t, DEPTH
LINING MATERIAL __-- CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM: LLL Iver
TOTAL EFFECTIVE
BUILDING FOUNDATION NEAREST LOT LINEd ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION /v /2
WELL:
TYPE
BUILDING
FOUNDATION
CONSTRUCTION
NEAREST
LOT LINE
CESSPOOL OTHER SOURCES
APPROVED-- DISAPPROVED—
DISTANCES:
PPROVED—.DISAPPROVED—
DISTANCES:
INSTALLED BY
PIPE_ MATERIAL:-�AL 01-5 r
LOT SLOPE:
REMARKS:
s4 /,C. '� S %` � /4
n,., cn.nat
DEPTH
NEAREST SEPTIC
SEWER LINE —, TANK.
REMARK
DIAGRAM OF SYSTEM
', 13 191?M
DISTANCE FROM:
SEEPAGE
SYSTEM _
%7h'aP�Rry�o` -
DATE 7 — APPROVED
G.A.A.B.
UK; OF DRILLING by A. 10, 1, LWMLIAHi(�i
01WHER OF LAND DI"'I"A"IT OF V"ETIL
ADDIIESS
WELL SIT) 1,001-1-1 ......
DATE- -STAMTEn
--F:ND',7
DATE J)
KIND OF' FORMATION:
/
STATIC LEVEL 01' WATER L.C. V I
DIIAMT DOWEf F.I..
GALS. PY-11 HT1.
KIND OF' CASING
MISCL. INFORMATION:
011ILLEII'S NAME
FT.
iQ
CAN"
J
Ell 0 ?4
FT.
TO j/ )
C 11)
)
rIqoj,4
FT, TO-
FT.
FT.
TO
. .. .. .....
.
FROMPO..
FT. TO
E -T.
FRO'M
I'T.
To
FT.
MOM
FT, To
E.11 0 114
FT.
TO
FT.
F I I () T.YT.
.. .....
FT. TO
F T
FROINI.-
I -l'.
To
FT.
FT. TO
f
FROM
I 'T
. T 0
FT,
To
'
f
FIMI
FT.
TO
i T.
111OW-1.00
FT. TO.
"I.
__I
"C.
'10
I -T.,
MISCL. INFORMATION:
011ILLEII'S NAME
GREATER ANCHORAGE AREA BOROUGH
FI�.Rbf
y �q
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT O.
3330 "C" STREET ANCHORAGE, ALASKA 99503
SY.\151 ✓ f TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION
y AS
NAME OF APPLICANT ND PERMIT
�,L" G'�'" MAILING ADORS. %v �/-"_" PHONE
j'LJZ�
INSTALLATION LOCATION (L/
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK l� SEEPAGE PIT if DRAIN FIELD,) OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS J TL NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE GJv
TYPE lJ'�SEEPAGE AREA SIZE '/z �` �� TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT �'' DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /}
SEPTIC TANK `J ` SEEPAGE PIT L) DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK C' SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK /C'? SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK. J SEEPAGE PIT SDC-"� DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHO AGE AREA BOROU H ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEMMi IS IN ACCORDANCE WITH SAID COD DATE APPLICANT'S �"J APPLICANT'S SIGNATURE
FORM NO. EQ -016
GREATER ANCHORAGE AREA BORC 'I
Department of Lnvironmental QU" ity
3330 "C" Street
Anchorage, Alaska 9.9503
_ SOILS LOG-/YEROLATION ` EST
Performed for 2
Legal Description:
This form reports: Soils log Perco
Depth
Feet
2 •-
3 - eO Kee
4 Pf A/ ®y aR����
- (� Id 6 PJ
6 - cof&4�S
- Mops
8-
9-
Date
10 -
S)o/)e
11
Net Drop
17 -
U
Date Performed����
ation test
13 -- r—J---
141-
Was ground water encountered? _f`�!1 ^_ If yes, at what depth?
reading
Date
Gross Time
Net rime
Depth to Water
Net Drop
Percolation rate minure.
Proposed iris tallalion: Sec'rage Pit Drain Field _
)epth of Inlet Depth to bottom of pit or trench
COIdh1ENTS: 18— -s _ r_l�.l.� .___.
N ified Ce
_c�.. '
-- e, ri.L' -
Perform , ed (3y:_.. - �'IM--��11'�_6�------- y LG.��----_ _ ----
ERZ-040 (6/74)
ZeF,.�I,ksis d
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.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-19249 COSA # CROY01
Expiration Date:
1. GENERAL INFORMATION
Complete legal description SKYLINE VIEW BLOCK 1, LOT 6
Location (site address) 19327 PENSTEMON LANE, CHUGiAK, AK 99567
Current Property owner(s) IAMES k NANCY MCGEE Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
PO BOX 670152 CHUGIAK, AK 99567
Day phone
KARA RUPP Day phone 632-85-18
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 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, 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 ARCFERRA CONSULTING INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNM, 1 M. DUFFUS Date 10/20/2009
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 1
system will function satisfactory for current or future P(� OF .44 NIS
occupants or can ArcTerra guarantee that no unseen �'� ,.•"� �' •.•
encroachments, deficiencies or discrepancies exist. i '?_ _ _ 9,I.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
t'KUGRgM ;
/���1b//1111111111
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:OJ
(Rev. 11105)
�\ Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & 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 CHECKLIST
Legal Description: SKYLINE VIEW BLOCK 1, LOT 6 Parcel ID: 051-192-49
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed 1IL27PM Sanitary seal (Y/N)1( Wires properly protected (Y/N) Y
Total depth 229 ft. Cased to 229 ft.
FROM WELL LOG
Date of test 11/22/1975
Static water level 167 ft.
Well production 25 g.p.m.
WATER SAMPLE RESULTS:
Casing height (above ground) 24 in.
AT INSPECTION
__jROQ0Q09
165 ft.
5.45+ g.p.m.
Coliform o ' colonies/100mL Nitrate '10.7 mg/L Other bacteria 0 colonies/100 mL
Arsenic: ND mgll Date of sample: 10/08/09 Collected by: ArcTerra
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Concrete Date installed Tank size 1250 gal.
Number of Compartments 1 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (YM) N Date of pumping Al2VIV9 Pumper JRs
C. ABSORPTION'FIELD DATA
Date installed 09L09�5 Soil rating (g.p.dJft? or fe/bdrm) 85 System type SMage Pit
Length 9 ft. Width 9 ft. Gravel below pipe 9 ft. Total depth 13 ft. (measured 10/8/09)
Eff. absorption area 324 ftp Monitoring tube Y Depression over field N
Date of adequacy test 1Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 19.2 in. Water added 600 gal. New depth X19_2 in.
Elapsed Time: 1350 min. Final fluid depth 22.8 In. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _MIf yes, give date
D. LIFT STATION
Date installed
Pump on" level at _in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N)
`Pump off" level at _in. High water alarm level at in.
Cycles tested Meets alar & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot •'82'+/ -
Absorption field on lot 100'
Public sewer main 751+
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 1001+
Public sewer manhole/cleanout 100'+
Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+
Absorption field 5'+
Water main 101+ Water service line 101+ Surface water 1001+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+
F. COMMENTS
'Sec attached AAROW letter. "MOA approved well & septic separations and constnrction on 11/07/1977—official waiver
Mnn Ott tllh m d . ...,.l6 •6... n
G. ENGINEER'S CERTIFICATIONOF ..•��• q�q��,
i < .•
I certify that I have determined through field inspections and for C2 •..••ys'f
review of Municipal records that the above systems are in * r4 TN
A S )
conformance with MOA COSA guidelines in effect on this date. ap
«�• ,�
Engineer's Printed Name KENNETH M. DUFFUS '•••� • ••••••••
if C : Kenneth f. vu, : W •
Date 10/20/2009 Il -re•. �o%!1%..� �a•"i
COSA Fee $490.00
Date of Payment IO S-7 0 C(
Receipt Number Ofig oc
(Rev. I V05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage °
• �` Development Services Department
j Building Safety Division °
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsitc
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 090401
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 6 of
Skyline View subdivision. This inspection revealed a nitrate concentration
of 10.7 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
SCS WE#
1095484001
Client Name
ArcTerra Engineering and Surveying
Project Name/#
Skyline View BI,L6
Client Sample ID
Skyline View BI,L6
Matrix
Drinking Water
Sample Remarks:
Parameter
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitritc-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
Results
ND
10.7
Printed Date/time
Collected Date rime
Received Date/rime
Technical Director
10/15/2009 16:36
10/082009 13:30
10/082009 16:40
Stephen C. tide
Allowable Prep Analysis
Units Method Container ID Limits Date Date Init
5.00
ug/L
EP200.8
C
(<10)
10/14/0910/15/09
NRB
+ 0.100
mg/L
SM204500NO3-F
11
(<10)
10/13/09
LCE
0 col/100nd.
SM20922211
A
(<200)
10;08.'09
SDP
0 col/100mL
SM20922211
A
(<I)
10/08/09
SDP
0 col/100ml.
SM20922211
A
(<I)
10'0&'09
SDP
Aarow Pump & Well Service LLC
Inspection Report
907 346 9355
Camera well at 19327 Penstemon lane, Chugiak Alaska down to 130'+. No water coming into well above
130'. It appears nitrates in this area coming from a different source.
Brian R. Wille
Manager
II ;u
c
�7
<
64� etre,'
00
2�
Ir
In
00,
' =�s€3
m
f)
1092390
1
"
tv
�, . ap Q
••
Q
Q
14�r wa•• a\�47
• 333
v
®a • Acv
A
o
\
o
o
3
�
n
N A N
•
r+
0 1 d ry
N 3
S z D Zo O Z P C
.. O r r n 0 m --I77
N
= n Q
o v' � y
3 S f
,�
Q
f j c z frl
II = m m 5 y= cn (/1 .
N .Z7
'o
rp
-I 'l
� O p
Jill
0
rn �N A N �cz Q
A m m m 0 (n
z �N
,.,
Q
W
�� O
l
h II
O m O m
O
`"'
�D N
1
.$'8c
C v W
O
-01 � m mz O ) O
IM >_xN
W�
.
mO N A m0 '3
v
o
0
Z
In
z0z m cc
n O In N yN
CD
A
C D mA
m Z O m On A
N
-
v
Z m D= � A n0
r
O
H
Nm 0 zN Q
—I
r
rNv0 O
0 0D
Ln
<D �D v
z�
X
r�i
r
o
D = my
N OO
r
o
m
N A x_ N
f•1
Q
D
..
m p
3
00
D
v m D
0 y cy�
(105.00')
(N 00'01'00' W)
11
m N NN 0
c D ?
N
o
o Z Z O to N
o
00 m I'' •� tom CID
=
Lupine Street
S D CDz'
D
N
Ln C
rrr W
1�
N O Z N
p m
�L r
Q
o
o Q
o� � z 2 o O� <
3NIaV3S 30 SISdfi
X c 0 X ton o f
ti
W.201901 (100'901)
ti
o Z L
o
a
(M .00,10.00 N)
a r
C) g
CA z C)
O
z O
Dow o
0
n3
I `
r-
FL)
9 d
;,coo
�Iy �:��$
°
20
�6�Ua11
� •.• 2 . %,9�'/ Q
dD
(N 16'00'0 A((E,y
a
• }r.
/,0
.-nA9� � R
vac• • C ��33
�'
v
wc7
y �
�
A
.
.. 47
II 1
t� i-
r
O (O `G I
it
\
O
O
3
0
n
U A N
Z
N
h
0 1 tjlv
N 3
r
P
N O D p 011,12
D 0
F r r 2 Zv z
o
��
Z S
Q
11 m y=N (n •
y Q
'o
N
M C3 --4
d 0 p
5
=rm 5
m m m f- m O C(
� >Z
N
:il O
,+
II
A m z
ID
N
`G
iS SE
O
O Z i
O � -� m ZOO V1
�D
3
!Z
.p
m N � D m -� f O
N
.�''�
v
0
0
3
Z= m mo n
O� N (DW
O Ny
C ti D maln
O ."i1
v
?
W m O y N
Z m
im D 2 AA O
r
0
�� r
m o mm
z N
—�
r
CO ED
N
N 4.
z
O �D
s
p
o
..
Mm
<; Z>Ul
o
m 1y my
x
N IN ;D �1
r
r
o
.ZD) p
m ;0
c > Q
M D
H L
< m O
3
00 .+
D
o y
(105.00')
(N 00'01'00' W)
N
00 z Z
oA D� �r>
W
0
w< Z N Z O N oN
p
0 (n m m co
o 0 < '�
Lupine Street
r
N
_
DD <
N
NPZ fTl -pc cum 3
1�
N
0
Q
o 0 z z O rrl <
E)NINV3S 3O SISdS
X c A (n n o
Z
W.ZO'SOI
<.00'SOI)
ti
D c o z rn
(M .00.10.00 N)
a r
N(A Z
DC y O <
C
—i
V1 y
1 O
A 3
,a �µCTERRq 'i.
ARcTErZ A
CONSUILPING, INC
212 E. 51" Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
October 26, 2009
Jeff Poet, On -Site Engineering Technician
Municipality of Anchorage
Development Services Department
On -Site Water R Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: SKYLINE VIEW BLOCK 1, LOT 6—WELL/SEPTIC TANK WAIVER
Dear Jeff,
Per your instructions, we are submitting a waiver request for the separation distance
between the septic tank to the well located on the referenced lot. The Municipality of
Anchorage approved the existing separations on November 7, 1977.
Per the attached as -built survey dated October . 24, 2009—the septic tank first
compartment cleanout was measured at 82' +/- to the subject property's well and request
that an appropriate waiver be granted at this time. This well and septic are located on the
opposite sides of the house and have been in operation for 34 years. The septic tank is
down gradient from the existing well.
Per ADEC Separation Distance Waiver Guidelines for SCRO:
• Water Table (165' static water level on 10/08/09)
• Soil Sorption (See well log)
• Permeability (See well log)
• Water Table Gradient (10.33%)
• Horizontal Separation (82')
7.50 points
1.43 points
1.45 points
6.10 points
2.30 points
TOTAL: 18.78 POINTS
The point total indicates that the well would almost sure to be free or no contamination
possible from household sewage contamination from this septic tank. It appears that the
elevated nitrate levels (10.70 mg/I,) of the recent water analysis of October 8, 2009 are
not just isolated to the referenced well, but to the local area in general.
SKYLINE VIEW, BLOCK 1, LOT 6
October 22, 2009
Page 2 of 2
We respectfully request that the waiver and the Certificate of On -Site Systems Approval
be granted. If you have any questions or require additional information, please contact
me at 868-3792 / FAX 868-3793.
Respectfully,
ArcTerra Consulting, Inc.
Kenneth M. Duffus, P. '.
Attachments: COSA
SGS Water Analysis
Arrow Letter
As -Built Survey
20441 PTARMIGAN BLVD • EAGLE RIVER. AK 99577-8736 • PII (907) 868-379I • FAX (907) 868-3793
MUNICIPALITY OF ANCHORAGE
DEPARTMEN" )F HEALTH AND. ENVIRONMENTA
825 L Street, Anchoraop.. Alaska
264-4720
PROTECTION
99501
Date Received: October 31, 1977
#1: Time 1'Sn PI) #2: Time #3: Time
Date l I -1-7 `1 l % Date Date
Insp Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. .Lending Institution Request: First National Bank of Anchorage
Mailing Address: Post Office Box 720 99510 _ Phone: 276-6300 T�
2. Property Owner: Marco/Faith Spezialy _ Phone: 279-4064
Mailing Address: 2524 Redwood
3. Legal Description: Lot 6 Block 1 Skyline View Subdivision
4: Single Family Residence: kyj Number. of Bedrooms: Three
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: Individual Well (y) Community/Public System ( )
Permit # L Depth of Well Well Log on File ( )
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System fix) Public Utility
f vis 11611-a
( )
Permit _ Installed °( ]Sl Installer t�1(A e.
Septic Tank Size 1--15-0 ��TT MMaanu—factur/e�('A.v�ncI9�1
Absorption Area a'a-4 Soils Rate Material ^
/6 q X at fit` 9 3 '
r,)J i s 01 71 nAt 4 r-^ I
7. Distances: Well to Septic Tank -- to Absorption Area /Q j
to Sewer Line Nearest Lot line au A Absorption Area
to Nearest Lot Line 4
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water facilities
Legal Description: Lot 6 Block 1 Skyline View Subdivision —
Comments: [ 1.,/ f-.1 a)(0 1-0v
Affadavit Attached: ( )
Approved:
Disapproved:
35►��lli
Department Worksheet:
Letter Attached: ( )
Date:
Date:
*0L2
MUNICIPALITY OF ANCHORAGE �\/\y
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 i J/
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMROVAl� FHA _CONN
2
3.
a
5.
Property Owner: //
Mailing Address:�� � / Day Phone:,9.1
Name of Buyer: aLIe
Mailing Address ��� t�� . 26-I&LDay Phone:
Name of Lending Institution:—/..
Mailing Address: y t� r..���?�i� Phone:
Name of Realtor or Agent: "1_'-e'7_
Mailing Address:
i
6. Legal Description:
Location:
7
7. Type of Facility to be Inspected: ��!'� f�1�.No. Bdrms.
0
8. Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site)
If Individual, date of installation
72-003(3/76)
e