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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 O oQ r 00 Q\ a' -yo 703 /© P� Cl)10 N a me i f Z CL a y c V 1:0 Uj O @ E p L X20 3 Q ID tUtJ W W c m _ o ° t �m 'a°i ` oWo ZZ mac Idn v WZOcn Np12 2 c o '> p o o m LL cj) 8 m J �'agp 9� nj cli c > Q 01— w p+ N 0 o o n F-OZS c �Y N Z/ map �'9f cn Z = W O min is o� ¢ wU,aU) :° ai `: 41E��/ o o t'© CTjry (Wo OQ� E>wa / N QZJZ =cmN F- wt—MZ) $� Co J/ ON. J s aW m Q O M N D ~ y Q P om17 PV cej a N m co ♦�� ® , N rn a m mm yew 04 w�9 nrl.� v• m / � N S Q. 00•� Cq • .� ® C N N . J • Z '..p�er.p / m 001, J °®� U N N m ' • l4 s E p c � tl 6V+► w a o R c E m `o m I► \ t\`'�► w m ED m ra m v o tr5'06 L HllAON ro € I p Q a G �N W N N 3 N w���pmm 4 O.� N 30VId �OAISOA 00 -0a iml C_ pW p P o .c ¢ ID LO w_c CO .om -tv>7W "0— :0'- 0-og o E m2CU E cjvZ 2ym m YNmWOcm Zvm0 0 �moaL�� y m may, DeP'com�W WWo ° n -- U.w p:z aq rn NQ� mwT 0_ UL.o lc o: N� mrC 1 pC Tmfl °EC>C`a"Om rCL 4) 1m1 pm -0 T> a o NN =pq>P0 Lc.0° 28m0>Soy, v E" N O D VOoQ9 tumNJ 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 <image006.png> <image007.jpg> <image005.jpg> <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 'T'CI '.r'CIIJ ]: I",l !)l!ii:5 1C:il",l .T. NG "r'OIJR: SEI:::'T :[ C F ill T'.:!!; 'T'C~I...Ii~;: :!i; i[ TE. IL4 .. Iii:i:,, IF;ii:: Fli 3[: th.d ]: I::' FIL ]: FT 15TF:I"F :[ Cff',i 3: S 3: bls TI:::IL..L..ED :[ N FIN i'::IF;?.E:F:I TH!Et',i ,:::t!.. ::' I::li"d EL. IECTI:;;: :t: CF:II.... F:'tZFi:I'1:1: "i' FII",ID '[ bI'.51'::'E:CT H :i: M.... I",IOT E:Ei': F:IF'I::'Fb3'v'Ii~D I.,J :( THOLJT FIN EL.E:CTF: :t: C:FI!... ]: N':'~;F::'ECT :1: ON Fi:EF:'OF,~:T.~ I:::II",ID ,(2: ::' THE i~;~I...EC:TI:;i: ]: !::F:!L. t.,IOF:I.( I I'II...I:i~;T 13E l]:,l:)ll',Jl!~: li3'-/ I:::1 L :[ (]:~!i:h,J:~i;E::t:) HF"F"I.... ]...'~.F'It',I 'l : 15 J. L. J~..~ ',' . ..... ....... DEF::"TH "I'CI F::' :1: F:'E 13OTTCff'I F::'T. 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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