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HomeMy WebLinkAboutKASILOF HILLS BLK 5 LT 10Onsite File
#015-133-09
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
pOBox 18VG5O o7DVElmore Road
Anchorage, Alaska 9S519-6650 Po 90 343-7904 Fax: (907) 343-7997
F. -TIT 11
mriiiiij 1111111111
iM
Permit Number: OSP201225
Work Type: SeoboTankUpgrado
Tax Code Number: 01513309000
Site Legal Address: KAG|LOFHILLS BLN 5 L 10 G:2541
Site Mailing Address: 1OO4OKAS/L{}FBLVD, Anchorage
Owner: EVANSVNLL|AM K&BARBARA J
Design Engineer: GARNESSENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
7/10/2020
7/10/2021
0 Disposal Field 10 Septic Tank M Holding Tank 0 Privy 171 Private Well 0 Water Storage
All construction shall beinaccordance with:
1. The attached approved design.
2. All requirements specified inAnchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC8O)
3. The wastewater code requires inspections during the installation, The engineer shall notify the Development
Services Department per AMC 15.85.Provide notification bycalling (8O7)343-7904(24/7)�
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
e. Opened and Closed onthe same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
1. 5bedroom approval isfor septic tank only. Existing dnsinfieldioonly sized for upto4bedrooms.
2. Prior to COSAapprova. the following will need to be completed:
o)The bedroom count vs drainfield size will need to be addressed.
b)The well located inthe utility easement will need aRight ofWay permit.
c) All wells that are to remain out of service will need to be properly decommissioned.
~
Received By: Date:
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-133-09
Property owner(s) WILLIAM EVANS Day phone 907-330-4055
Mailing address 10040 KASILOF BLVD.'ANCHORAGE, AK
Site address 10040 KASILOF BLVD."ANCHORAGE, AK
Legal description (Sub'd, Block & Lot ) KASILOF HILLS: BLOCK 5, LOT 10
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 5
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN:
Initial ❑
Upgrade IK
Renewal ❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
N/A
TYPE OF DEWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance: -
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: ' 71 %�
Receipt Number: a 3 3 Z-66
Permit No. oSP ZD 1 Z Z S
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
(Rev. 01111)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201225, Rebecca Carroll, 07/10/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201225, Rebecca Carroll, 07/10/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201225, Rebecca Carroll, 07/10/20
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SGS
SGS Ref.#
1202486001
Client Name
Gayness Engineering Group, Ltd (GEG)
Printed Date/Time
06/30/2020 13:57
Project Name/#
Kasilof Hills; B5, L10
Collected Date/Time
06/08/2020 16:30
Client Sample ID
Kasilof Hills; B5, L 10
Received Date/Time
06/09/2020 12:15
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
LOQ
Units
Method Container
ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
5.33
5.00
ug/L
EP200.8
B
(<10)
06/22/20 06/29/20
ACF
Waters Department
Total Nitrate/Nitrite-N
ND
0.200
mg/L
SM21 450ONO3-F
C
(<10)
06/16/20
EWW
Microbiology Laboratory
E. Coli
Negative
1
100mL
SM21 9223B
A
06/09/20
VAB
Total Coliform
Negative
1
100mL
SM21 9223B
A
06/09/20
VAB
David Garness
From:. David Garness
Sent: Thursday, July 2, 2020 10:45 AM
To: 'Cindy Evans'
Subject: RE: Kasilof Hills; Block 5, Lot 10
Cindy,
I did not see the decommissioning log in the MOA records. It appears as though several of the well have been
"abandoned in place". The MOA will not allow this. In short, the wells will have to meet code prior to COSA approval.
Dave Harper (242-0735) can complete this work for you. Please let me know if you have any questions.
Sincerely,
David Garness, P.E., M.S.
Civil Engineer
Garness Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, Alaska 99507
Phone: (907) 337-6179
Fax: (907) 338-3246
Mobile: (907) 632-4528
Website: www.garnessengineering.com
ENGINFERiING 5AiLES^C0nSULT1NG
From: Cindy Evans <minichena@gmail.com>
Sent: Tuesday, lune 30, 202010:02 PM
To: David Garness <David@garnessengineering.com>
Subject: Re: Kasilof Hills; Block 5, Lot 10
We do not have any documentation of decommissioning. So I am not sure what to tell you. The two people who have
worked on our wells are Alpine Drilling and Rampart drilling Bernie Claus. (deceased)
If the one well that is now under the shed was decommissioned would the muni have that documentation?
Sent from my iPhone
On Jun 30, 2020, at 6:19 PM, David Garness <David@garnessengineering.com> wrote:
Cindy,
The wells that we have observed do not appear to be decommissioned but abandoned in place. Is there
any documents on of the "decommissioning" Of the old Wells, or the well that cannot be locates?
Sent from my iPhone
On Jun 30, 2020, at 6:09 PM, Cindy Evans <minichena@gmail.com> wrote:
Yes my father who had this house built says yes that well was decommissioned as well
as well #1.
Sent from my iPhone
On Jun 30, 2020, at 2:19 PM, David Garness
<David@garnessengineering. com> wrote:
Hello,
Attached is on old survey from Walatka's surveying with the well
locations. Do you know if well #2 was decommissioned? It is the only
well that has not been located at this time. Thank you
Sincerely,
David Garness, P.E., M.S.
Civil Engineer
Garness Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, Alaska 99507
Phone: (907) 337-6179
Fax: (907) 338-3246
Mobile: (907) 632-4528
Website: www.garnessengineering.com
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<doc08149620200630141159.pdf>
Jun 25 21 02:01 p tncho;-a ge'Ofell & Pu:i-ip Set
-072430742
& p.2
MUNICIPALITY OF ANCHORAGA
Develooment services Department
On -Site Water &VVasteWater section Phone: 907-343.71,904
Fax: .907-343-7997
Pump Installation Log
Well DrffiD2, Pennit Number: Date of issue:
Parcel Identificatiop, Number: 015 - f33- 0%
Legal I Descript
ion=frrk
I Lot Pr�ferty Owner -Name & Address.
Pump Instal Iatior Date7
Pump intake Depth Below Top of well Casing.2 reet
X!
Pump Model-
Fulup Size: �'�bp
Pitless Adapter Burial Depth: V1 feet
Fitless Adapter Name:
Pidess Adaprer lastaller:
Well Disinfected Upon COM 'iletion? �a/,es 0 No
P
Melhod of Disinfection:
Comments:
PUMP installer N ANCHORAGE WELL & PUMP SERWCE
7640 King Street
Company: Anchorage. AK 99=18
PH: 1,947;'243-074
Mailing Address:
City: State:
Attention., Thopunapirlsialler &hail Pre %ire
aF"-'r'P 4"3!a,'Jdti0n 100't0 Cn-Site i4,itbin:310 days Of DwnP instaltation.
jun 25 21 02.00P Pnoho t -9 g-,,; 'Ole ii P-,. P u 'i-ip Se%
Z-1072430742) p.1
MUINUCIPALITY OF ANCHORAGA
Development Services Department Phone: 907-343.7904
On -Site Water & Wiaotewater SeA,,Jon
rax: 907-343-79q.7
Pump Installation Log
Well DrMw9 Nrmi�c Number., D2& Of ISSIle:
Parcel Idelitification Nuniber: qL5
Legal Description 7,�!B_10—,ZTot P1*0 rty Owner Name & Address:
HIHs 5 110
Fu m� I Tns ;rat- �an Date:
PUMP Intake D*, th Below I*vp of %rel, Casing:
-'
PUIMPAlaruracturer's-Name: ..7,
Pump Model.
Pump Size: —lip
Pitiess Adapter Burial Depth: feet
PitIVS& Adapter !V121111faf-lurer's _Nazne:
Pitless Adapter installer:
Well Disinfected Upon C
o 'mpytion? ayes O.No
aN
lethod of Disinfection:
Comments:
PUMP Installer N ANCHORAGE WELL& PUMP SERVICE
7640 Ki.)g S-reet
Company: ___ Ar.c-.o,age,AK 99518
PH: (9017) 2.,13 41740
Mailing Address.
City: ---State;
Attention, The puln,.p i�stzdlati= 1'09 tc, withir, 30 days of pump insta , flation.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPI:!CTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Manufacturer
Liq, capacity in gallons
DISTANCE TO:
Manufacturer
Absorption area
Inside length
PHONE
Dwelling /
//
Material
Width
NO. OF BEDROOMS
PERMIT NO. ·
No. of compartments
Liquid depth
IF HOMEMADE:
Well Dwelling PERMIT NO.
Liquid capacity in gallons
Foundation
Total length of lines
.3 ~Z
Material beneath tile
Well
DISTANCE TO: /~/~C(:_~ / q~
Length of each line
No, of lines / ·'~ ~
Top of tile to finish grade ,~ /
Length Width
Type of crib Crib diameter
Depth
Crib depth
~U~.. Depth
DISTANCE TO: Building foundation
Well Building foundation
DISTANCE TO:
Driller
OTHER
PiPE MATERIALS
Sewer Pine
INSTALLER
REMARKS
Material
Nearest lot line
Trench width
inch~
PERMIT N Old~//(.) ~,~/,~ ~
Distance betw~)/~ines
Total effective absorption area
PERMIT NO,
Total effective absorption area
Nearest lot line
Distance to lot Pine
Septic tank . /
PERMIT NO.
Absorption area(s)
~ NEW
[] UPGRADE
DATE
BoX 1869, J~TAR I{OI3'I'E A ANC]~O]RA~]~, ALASKA
~-~4
SlX'INCH:WATER WELL DRillED AND CASED OUT TO THE DEPTH OF ~5 ~ "
DRILL~D'A~.THE RATE OF'. ~.00 PER FOOT.
PROPERTY OWNER ~' ~ ~' ~ & B~ ~ ~7-7~
Cha,~.~.~ 'and~ l.o,t ~ ~ 350 ~: a/c ~ ~ ~ ~ ~ ~ ~
COS~., INCLUDES. ALL~.. LABOR AND MATERIAL FOR COMPL~IQN,... Of SAID DRILLING.
WRITE CHECK pAyABLE TO ~MPART DRILLING WORK~fOr THE SUM OF
THANK YOU VErY MUCH. ~ ...........
BERVICE C:HARGEOF 1~/1~/~ PER MONTH WILL BE A~;SESSED on PAST DUEACCOUNT~.
BOX ~3160" ~ Ro~rll' A ASClIORA{~I~,
.~'~' v~ ': ' ' · : L CASED OUT TO THE DEPTH OF 7
~ DR~LLED"A~ THE ~E oF .~,00 ,. Per FOOT.
PROPERLY OWNER '~ ~ ~S 337-1326 333-1.3g~
LOCATION Of WELL SlT~ ~ /~ ~* ~ S~. /~/~e~~ ~ .('
r
: ,fgcaue,,~ .,U,a,t. u~"~ tu~e. at, ~ 6~0 ~ e~_~ ~ ~ ~ ~ 5~
COST INCLUDES ALL ~R AND MATERIAL FOR COMPLY[ON OF SAID' DRILLING.
: WRITE ~'HEcK PAYAB[{E O RAMPART DRILLING WORKS FOR THE SUM OF ~~0
. . . . ~RAMpART DR ......... ~ .__
~ ': BERNIE CLAUS OF RAMPART DFHLLING WORKS
J ~;' DATE ~1~ I 4 '
· .. ' SERVICE CH:AE~E O F I~% Per MONTH WILL BE ASSESSED ON P /, ~ .~/ /~ /
:~'i-?Box 1869~, STAR RO~*T~ A ANCHORAGE~ ALAgKA
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 405 ~. PER FOOT.
DRILL~;D A~ THE RATE OF _$23°00
PROPERTY OW, NER ~' & g~' BJ~ & B~oJt~. F~/~S.
LOCATION OF WELL SITE
DRILLER
WELL LOG: ~'-
02...18~
Co~ o¢ ~d~: IZ3.00 p~ /~ X ,405 ~t~: [1~:~ ~¢ 0¢ ~7,500.00 onJ4r.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID'DRILLING.
WRITE CHECK payabLE TO a'MPaRT DRILLING works FOR THE SUM Of ~?~500o00
THANK YOU. very MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
i'"DATE ~~~ Z '~~'-O~U
1201 ~ct~on~
995?5
1984
344-7714
DEPARTIdENT OF HIEAI.'FH AND IEIqVIRDNMENTAL F'R[iTECTIOIq
825 L S'FREET~ AIxlCHORAGE~ AK 99501
264-4.720
F'ERMI T NO:
DATE ISSLIED:
8402.1.5
04/20/1-]4
APF:'L. I C AI",IT
ADDRESS
CONTACT PI"tONE:
BILL EVANS
8C)5 GAMBELL ST,
ANCHGRA[~E, AK
276-2424
99501
[...lEGAL DIZDC',R ]: P:
I_OT SIZE:
MAX BEDROOMS
SUBD]:V]:S]:ON: KASII..OF HILLS
SECTION: 15 TOWNSHIP:
577'~.'1, (SQ. FT. OR ACRES)
4
LOT:
RANGE: 3W
BL D Cl..'.:: 5
L. ist. ed belc)w ape the ~pt. ic~rl.s available 'Lc) y(]u in designing yotiP septic
system, Choc~se '[he option that. best [its your' site,
DEPTH TO PIF'E BOTTOM (F'~.) 4,,0 4.0 4,,0
GRAVEl_ DEPTH (F:T.) 8.0 ().5 :3,,5
TGTAL DEF'TFI (FT.) J..'-"" ,, 0 4.5 7.5
[.,]RAVEL. WIDTFI (FT.) 2.5 20.0 5,, 0
GRAVEL I_ENBTH (FT.) 32.() 58.0 54.0
GRAVEL VOLUME (CU. YDS. ) 25. ! :-]8. 1 38,, ~
T'ANK S I ZE (GALS) 1, '.-?'.50. () *.~ ~., 250 ,, 0 ~,~ ~, 250 ,, 0 '~'~
SOIl_ RATING (SQ.FT,/BR) :LR5 125 125
.~'~ 'TANK MUST HAVE AT LEAST TWO COMPARTMENTS
Icert, ii:y that:
1,, I am ~'amiliar' with the r'equir'ement.s l'of on-site ~e~ers and we:[].s as set
/c:mth by [,he Municipali'Ly of Anchorage (MOA) and the State c)f' Alaska.
2],, I will. install the ~ystem in accordance wi'Lb all MOA cc)des and regulations,
and in complianc:e with {he design cPitePia o~' this pePmit,.
3,, I will adher'e to) all MOA and State of Alaska r'equiPements ¢uP the set. back
distances ¢r'om arly existing well, wastewater' disp'osal system op publ:i.c
sewePage system on t.I]:i.s c)n any adjacent ~p neapby lot.
4,, I undePstand that '[his pel*mit i~ valid fc~r' a maximum o¢ 4 bedr'ooms and
any enlaPgement ~il]. ~equi~e an additic~nal permit..
IF A LIFT STATION IS INSI'AI...LED IN AN AIRIEA COVERED BY MOA BUIL. DING CODIES,
THEN (1) AN EI_ECTRI(]AI_ PERMIT AND INBPECTIOIq MUST BE (]B'TAINED; (R) AS-BUII_T8
WILl_ NOT BE APPROVED WITHOUT AN EI_ECTRICAL ]:NSF'ECTION REF, ORT~ AND (5) THE
ELECTRICAL. WORK MUDT BE DONE BY A LIDEIxI~ED EL.EC]"RICIAN.
AF:'PL I CAI I
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GF~:FJ',,,'EL 'v'C)L. LU'"iE ':: C:I.J. 'T'I:)S. ~.,:3. E~mj ~ ~ ~ ;~i. S~ ~ ~
:J..' ]'.I::lJ"t f::'FII'! ]'. L.. ]: I::'11:;~: I.,.! :1: 'I"H TI...IE I:;~:k~:(;:~l.J :[ F;:FZI"IEI'.ml"I':~; I:::()[;;: Ok,t~"':~]5:1: TE: :5;E:I.,.II;SFi:E; ~[:, I.,.IELLS FI:E; SET
J:OF?."i"H t3'T' THE: I'Ii...IbI:[(::::i:F:'FII...:f:T"/ Cfi::' I:::INCI'IOF;;:FI(:;ii~[ (HOFI) Ftlq[) Tile :~?FFt'T'~: CtF 1::I1....1:::1'.~5~(1:::1.
2. ]: H:[M... :(NE;TFIM... THE: S"J":STIEH :!:N F:ICC:OFi:DI::II'.4(::E I.,.l:[Tlq FILL.. HOFI C:OI)ES FII'.,ID F;~:IE(31...ILF:IT:[CU'.,I:~;.,
FIt",ID :I: N C:OHF::'I.. ]: Fllq(:::l~: 14 ]: TH THE DE::5:1: J3N C:F?. ]: 't'EI:~::[ FI OF' TH :1: S PEI:~:H ] T.
2:. :l: H:I:I...L. FIDHEF;?.iE TO I:;'IL.L HOFI Fli',E::, STI:::ITE Cfi::' I:::II....F:I~;~(I::I FtE~J:)IJZI~?.E:HtENTS F'OI~: THE: E;ET E:FICI'(
D :[ STI::~NCE:S I::F;;:OH I:::liq'~" I~:::':: :I: ST :[ i",IG I.,JE:L.I .... FIF:ISTE:I.,.IF:ITIEI;: !:::, :[ SF'OSFIL.. SVSTEH (;~F;: PLIE',I...:[ C
SIEI.,.IEI:~:FIGE: S'-/STEH Ol",l TH]:E~; (:)1;~: I::'11'.,1'./ I=ID..TFI(:::tZI",IT O1:;~: I",IEI:::II~:B"r' L. OT.
,4. ]: t...II",I[::'!~F;:STF::IblI) THF:IT TF1:1: :~; I:='EI;::P'I :[ 'T' :[ L., ',,,'I::IL :[ I~:' F'()I:;: I::1 I'IF:I::':: :t: Ptl...IPl (:)F 4 E',EDI?O(3H:~; F:Ih,ID
I::II",I'T' E:i",IL.F::iF~:(31~:i'iE:I:',H' H :[ L.L. I;~:E:(;:~i...1:1: F~:E: I:::iN I:::I[)D ]: T :1: O1",11::ti.... F'EF~:H :1: T.
PERFORMED FOR:
LI:-GA L DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2o
COMMENTS
PERFORMED BY:
72-008 (6/79)
SOILS LOG
MLJNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
/
PERCOLATION RATE (minutes/inch)
DATE :~F~ ~U-
Tom Fink,
Mayor
A/unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 20, 1994
William K. Evans
805 Gambell Street
Anchorage, Alaska
99501 3756
Subject: Lot 10 Block 5 Kasilof Hills Subdivision
Permit #SW930060, PID #015-133-09
The subject permit, issued April 20, 1993 by 'this office for a
single family well and/or on-site wastewater system, has
expired as of April 20, 1994.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Manager
On-site Services
enc: Copy of Permit
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930060
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:EVANS WILLIAM K &
OWNER ADDRESS:10401 KASILOF BLVD
ANCHORAGE, ALASKA 99511
DATE ISSUED: 4/20/93
EXPIRATION DATE: 4/20/94
PARCEL ID:01513309
LEGAL DESCRIPTION: KASILOF HILLS BLK 5 LT 10
LOT SIZE: 57751 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
ISSUED BY: ~~
DATE:
DATE:
[:;E)N'I"{:.',.C','I" I:::'HE)l".llii: ::
L.I!!:(3 F.'~ L :0 IE S C I::~ ): F::' ::
l.,i'.:) T S :1: Z 1'5: ::
I..(:]'T :: :L O
l:~(.'~Ix!(3 I!!!: :'. :2!;N
;:!',I.. E) C l<: ~', !:5
FfO~t/.CIPALI%~Y OF ANCHORAGE
DIVISION OF ENVIRONME~fAL
DEPAlt~MENT OF HE~J~TH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR IiFJkLTH ADTHORITY APPROVAl, CERTIFIC.A.TE
i o General Infor~aation
(a) Legal Descript, ion (inc%ude lot, block,
Location (address or direc~ions)
Application Date
subd:Lvision~ section~ i:ownshJ, p~
Bus:t~ess
~,.~. __ ¢ L,:-~-~-.~ ........ ],el~)hone ~ Home
AppZ~.cants Addre.~s
(¢) Applic,a.nt ,is (cheek one) Lending !ns~it~Ition ~ ~ Owner/builder
(d) Le~ding Institution ............................... ~elep~one~
Address
(e) Real Estate Cc,. & Agent
Address
(f.)
Telephone
Mai]. the HAA to the follovring address:
O~c her (describe)
Note: Iff community well system, must have written confiz~ation fz'om the State
Department of Enviromnental Conservation attesting to the legality and stat'as.
4..Sewage Dis_~..gs~l~
On~.~ ~?: ~,...h~.l~ [:LiI Comm~,n~.ty [:27 ~o~.ai~.g ~.~,~. ~
Note: if co.unity well system, mus~ have ~J. tten coufirmat:ion from the State
Department of Enviro~mnental Conservation attesting to the lega!:[ty and status.
En ineerin~ Firu% Prov:[ding Inspections. Test% File Search. Data and Infot~nation
As certified by my se~. affixed hereto and as of the validation date sho~m below, I
verify thal: my investigatlot~ of this ttealth Authori~y Approval shows that the on-site
wa~er 8apply and/or 9~s~ewa~er disposal system is safe~ function~ and ~equa~e for
the number of bedroom8 and D/pc of structure lndica~ad herein.- I further verify that~
base~ on ~ha i~formatiom obgatn~ from ~he ~nicipality of ~chorage files and from ~y
Investiga~ion ~d inspec~ion~ the on-site %roger supply and/or ~stewager disposal
sysg~m is in compliance ~[th ~1 ~nictpal and Stage codes, ordinances, and regula~
Cioms In effec~ on the dage of this inspecCion.
................. IA /I t ... ~ ~;~ ~ _ o,e,~,~YX:'
App~'oved foz %-" bedrooms By - ..~%e z..)~u~ ....... ~' ~;:~' Date ~ -. 0 ~, :~...~:~.2
. : ~ .~,.,Z~~ -'z ~ /~ .~:.. ..- . ~ ~J .. - . -. --., -,,, .~ ~. -'
CAt~£ION
TIlE MLrN!cIPALITY OF ANCHORAGU~ DEPAR~4ENT OF HEALTH ~ND E~FVIRO~NTAL PROTECTION
(DHF. P) ISSUES I~ALTH AI.YfHORITY APPROVAL CERTIFICATES BASE~D SOLELY UPON TB~; REPRESENT.~
ATIONS GIVEN IN PARAGRk[~t 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINE. ER REGISTERFD
i[N' ')."HE STATE OF AIa%S!(i. %~iE, D~EP DOES THIS AS A COURIUdS_. TO PURCHASERS OF HOMES AND
~HEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CEllTAIN ~%DEIQkL AND STATE F~JQUIRE=
MEN~fSo EMPLOYEES OF DI-IEP DO NOT CONDUCT INSPECTIONS OR. ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. TEIE MUNICIPALITY OF ANCHORAG~ IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE, PROFESSIOM~L ENGINEER'S WORK~
(DHEP SEA[,)
ILR4/eJ/D18
[Page 2 of 2]
7--~. 9-84
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH ~3THORITYAPPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
I985
WELL DATA ...........
Well Classification ~/--I"~/¢t'/C, If A, B, or C, D.E.C. Approved(Y/N) ~/~
Well Log P~esent ¢~) Date Co~leted _ Z~.g'/~c/ Yield
Total ~pth q~'/ Card to flee'/ ~pth of Groutinq ,e/
Static Water ~vel ~D¢ Pu~ ~t A~.~/
Casing ~ight ~ Ground [~/ Sanitary S~al on Casing ~N)
Elec~ical Wiring in Conduit ~) ~pression ~ound ~l~ead (Y~
Sep~ation Distends fr~ ~11:
To ~ptic/$olding Ta~ on ~t .~~/~/~ ; ~ Adjoining Lots .~/~O
To ~arest Edge of ~sorption Field on ~t 1~ _.; ~ Adjoining nots~/o0'
To Nearest Public ~r Line ~/~. To Newest Public ~r
Clean~t/Manho].e ~//~ To ~est ~r Service Li~ on lot
Water Sample Collected By -' ~~ ; ~te ,[/~ ~
~,E~FIC/HOLDING TA~ DATA ~ ~ ~ -- " '
Date Installed 7'/2o/~'%/' Size lL~)O No. of Ccatoa~t~ents __~=_ _.~
Standpi~s~) Air-tight Caps.) Foundation Cleanout~N)'
~pression over Ta~ (~ Date Last Pu~d __~/~
P~ing/Maintenan~ Contract on File (Y~) AT~; for
Holding Tank High-Water Ala~ (Y/N) .~'e~rary Holding Tank Permit (Y/N)
Sep~ation Distends fr~ ~ptic/Holding Tank:
To Water-Supply We 11 ~- I O0 !
TO Property Line _ ~-.~Ot
To Water Main/Service Line 'f-11 /
To Building Foundat:ion__Jl/
TO Disposal Field_ ~ d'¢
To Strewn, Pond, ~nke, or Major Drainaqe
[Page 1 of 2]
Receipt ~
Date Paid:
Amount:
2-!5--84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/;-O(~-~
Width of Field ;Z.~' z
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
/~_~-- ~'- Type of System Design
Length of Field
Depth of Field_ . /~ /
Gravel Bed Thickness
~ ~ Standpipes Present ~N)
Date of Last Adequacy Test
Separation Distan~ from Absorption Field:
To Water-Supply Well ~ / To P~operty Line ~
To Building Foundation ~ To Existing or Abando~d System on
Lot /L//~4~ . ; On Adjoining Lots .~ J~/
To Water Main/Service Line .~- ~/ To Cutba~(if pre,At) .~7~'z ~
To Stream/Pond/Lake/orMajo~DrainageCourse ~/~'
To D~iveway, Parking Area, or Vehicle Storage Area ~/~
De
LIFT STATION
Date Installed
Size in Gallons ~/~I d ~rmh61e/Access _(Y/N)
','~mp ~" ~1 at / "~ Off" ~vel at
High Water Ala~ ~vel Vent (Y~)
Tested fo~ / ~ing Cycles d~ing Adequa~ ~st.
Electrical Co~)
Counts
Meets MOA
./
Check Permitted Bedrocm Rating Against HAA Request
I certify that I have checked, verified, or confor~ed to all MOA HAA Guidelines in effect
on the date of this inspection.
[Pa~ 2 of 2]
2-15-84
BILL SHEFFIELD, GOVERNOR
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
274-2533
December 28, 1984
Ms. Gwen Turner
Alaska Environmental Control
Services, Inco
1200 West 33rd Avenue
Suite "B"
Anchorage, Alaska 99503
SUBJECT: Lot 5, Block 10, Kasiloff Hills - Anchorage
Well Abandonl~ent (8521-FA-088)
Dear Ms. Turner:
The Department has reviewed your waiver request and hereby gives
approval. Well abandonment should occur by August 31, 1985 according
to procedures set forth by the American Water Works Association (AWWA).
Inspection should be done by a professional engineer to assure compati~
bility with the AWWA.
Sincerely,
Steve Eng, P. E.~-
Environmental Engineer
SWE/dd
~ .~'f~ ~r ..... , , ~,'N ~ II
~' , t EN I IRON MENTAL CONSERVATION
~'~ : ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
274-2533
December 28, 1984
Ms. Gwen Turner
Alaska Environmental Control
Services, Inc.
1200 West 33rd Avenue
Suite "B"
Anchorage, Alaska 99503
SUBJECT: Lot 5, Block ~0, Kasiloff Hills - Anchorage
Well Abandonment (8521-FA-088)
Dear Ms. Turner;
The Department has reviewed your waiver request and hereby gives
approval. Well abandonment should occur by August 31, 1985 accordin§
to procedures set forth by the American Water Works Association (AWWA).
Inspection should be done by a professional engineer to assure compati-
bility with the AWWA.
Sincerely,
SWE/dd
~teve l"ng, P. E.
Environmental Engineer
$ RUtCI $, I[1C.
December 11, 1984
Alaska Department of Environmental Conservation
437 E Street
Anchorage, Alaska 99501
Re: Lot 5, Block 10, Kasiloff Hills
Request of Waiver to Abandon Well Later
Three wells were drilled on the subject property. Two of them are
located over 100 feet from the septic system. One ia plumbed to the
house and the other is properly sealed (kept for a backup).
The third well is located 84 feet from the septic system and is to be
abandoned. It is located next to the driveway, on the east side of
the property (see attached diagram). The casing has been cut off 16
inches belowgrouud and.a steel plate has been welded over the top.
The well is reported to be cased to the bedrock encountered at 39
feet (see attached well log). A letter from the driller explaining
the capping of the well is also attached.
The ground is frozen at present and the Contractor is requesting a
waiver to properly abandon the well in Spring of 1985. The casing and
welded top will protect the aquifer until conditions permit proper
abandonment of the well.
~Approved:
Sincerely,
wen Turner
Environmental Scientist