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Home My WebLink AboutHILLCREST BLK 6 LT 7H1*11crest Block 6 Lot 7 #016�271�33 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT " 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Well Decommissioning Log 'J,� Legal Address: NTI�C Subdivision �ZEST Block % Lot T R Section Lot On -site Water & Wastewater Section certified contractor performing the well decommissioning: Name: r Signat ..v✓ / Company: Well decommissioning date �� 2� Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ C. Location: Use the space below to provide a drawing of the property showing the following Items: • North arrow • Decommissioned well location Location of other water wells on the property Two separate swing -tie distances for each well shown on the drawing Note: The swing -tie distances shall be measured from either permanent structures or the property comers. ,A^ N Two 13` 3 y G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc GREANER ANCHORAGE AREA BWJGH Department of Environmental Quality SON) 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE, DISPOSAL SYSTEM NAME MAILING ADDRESS (WE LEGAL DESCRIPTIO eV '�2 -ATION M46T-W;r /T AN K: DISTANCE NUMBER OF FROM WELL IZ)6 MANUFACTURER MATERIAL COMPARTMENTS— INSIDE LENGTH-- INSIDE WIDTH__LIQUID DEPTH—LIQUID CAPACITY— GALLONS. SEEPAGE PIT: --- NUMBE R OF PITS DIAMETER —OR WI_DT+� LINING MATERIAL — CRIB SIZE: DIAMET BUILDING FOUNDATION_ NEARE-ST-r6�1 LINE ADDITIONAL 8B,5eRT5_rI0N LENGTH T)EPTH__::_--Q,1�TANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL-APEA) —SQ. FT. WELL: TYPE CONSTRUCTION 140 e'�' DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION—, LOT LINE—, SEWER LINE.--, TANK - CESSPOOL OTHER SOURCES-- APPP0\/FF) F)]qAPPPC)\/FF) PP:KAAPVq DISTA DIAGRAM OF SYSTE-M — DISTANCE FROM: SEEPAGE SYSTEM INSTALLED BY: PIPE MATERIAL6� dix-y LOT SLOPE REMARKS: /2 DATE X_ APPROVED _417 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PE NAME OF APPLICANT "AILING AE)DR INSTALLATION T -f vyx -1, LEGAL. DESCRIPTION INSTALLATION OF: SEP EEPAGE PIT-, DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY v T - SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT COMPLETION DATE ANTICIPATED k/ - PERMIT NO.�Yf)/L kJ ///V �/"vl 8 PHON,,., /8/ Z;,K3 OTHER WITHOUT SOIL TEST 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. :5:E� *NK SIZE C7Z TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL [DRAIN FIELD SEPTIC TANK SEEPAGE PIT __ DRAIN FIEL.0 TO NEAREST LOT LINE. WELL To SEPTIC TANK DRAIN FIELD - WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE AREA SIZE SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, SEEPAGE PIT .-. 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. 7-G.A.A.El. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER �NCHORAGE AREA 130ROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAIL) CODE. 'cl DATE APPLICANT'S SIGNATURE GRE. ER ANCHORAGE AREA Bo. UGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 2,74-4561 51'sTr M — APPLICATION AND PERMIT 14, NAME OF APPLICANTI�, MAILING ADDRESSIX'W) 14) 40,V10 1 PHONE INSTALLATION LOCATION LEGAL DESCRIPTION— - — 2 1A6 INSTALLATION OF: SEPTIC TANK SEEPAGE PIT--. DRAIN 171ELD ___ OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS N14 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 ryPE SEEPAGE AREA SIZE __ TYPE MINIMUM DISTANCES, REQUIREMENTS FOUND ION TO SEPTIC TANK FOug E PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTplC_T,A)K SEEPAGE PIT -"0 NPXF;,>C)T LINE. r _—, DRAIN FIELD L_ /�,_ WELL TO SEP C SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER E IC TANK c SEEPAGE PIT 'r/Epl-I e— DRAIN FIELD SEPTIC TANK, SEEPAGE PIT __ DRAIN FIELD TO RIVER, LAKE, STREAM. CAST [RON 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 13ACKFILL CONFORM To BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DUSIGNE�R I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREAl DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE __ lot -is APPLICANT'S SIGNATURFL-t�.j FORM NO. EQ -01 6 DIAGRAM OF SYSTEM ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.6B AND THAT THE ABOVE APPLIC NT FILLS OUT UPPER HAL ONLY Time r-operty Owner Time Phone Mailing Address Zip Code Date Buyer yy\ 1-\� D to Address Zip Code Inspector Lending Institution -IVA T I ATr'. r\ r,+kL.9-Q P\ Phone lnspoctqr 61 "'Zip Address Code Realty Co. & Agent qm'j�""� Phone Address 2'ol� �Aj Zip Code ENV] R�ji VT : r 1�1 --'—TION Legal Description P Street Location 1 2 c. T L Type of Residence Ll Single Family RECEIVED L,�—APP146VED BEDROOMS 11 Multiple Family No. of,Bedrooms 1—) 1,3 , e I DISAPPROVED 41W4 (3) CONDITIONAL APPROVA L Other ITY%AV, t DATE /—d— Water Supply -(A F 54 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. E) Community For wells drilled prior to that date, give well depth (attach log If available). 1-1 Public Utility Well to Tank Septic Tank Size Sewer Disposal E) Individual Year Individual Installed: El Public Utility When Connected to Public Utility: 151, Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time C Date Date D to Date Inspector Inspector Inspector lnspoctqr Field Not I s: Lei MUNICIPALITY OF ANCHORAGE DFPT C'7 P. .0 ENV] R�ji VT : r 1�1 --'—TION L RECEIVED L,�—APP146VED BEDROOMS *CONDITIONS OF APPROVAL I DISAPPROVED 41W4 (3) CONDITIONAL APPROVA L ITY%AV, t DATE /—d— -U4 I -(A BY: T-1 A 0 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 2 023 (31U) Municipality of Anchorage,, On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL i Parcel I.D. 016-271-33 Expiration Date: / - �') - / 3 1. GENERAL INFORMATION Complete legal description Hillcrest Subdivision, Block 6, Lot 7 Location (site address) 1125 Contrary Court Anchorage, AK 99515 Current Property owner(s) Alton R. Staff Day phone Mailing address Real Estate Agent N9254 Country Road P B lair, WI 54616 Chris Swires 2. TYPE OF DWELLING: El Single Family (w/wo ADU) 7 Duplex Ej Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 338-8292 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual F� Individual Water Storage EJ Holding Tank El Community Class _ Well El Community n Public Water System n Public Sewer E Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ q-"A(D (ZU5VN Waiver Fee $ Date of Payment 11b L'�kr Date of Payment ReceiptNumber (jn_7?-0 CA Receipt Number COSA # Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seaWfixed hereto and as of the validation date shown below, I verify that my investigation, based on proc?Aure% 'outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows t t the oh--,Sltd V�ater supply and/or wastewater disposal system is (are) safe, functional and adequate fi 1K herodedrooms 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. — Da... ,�34Q12 4! & M 49 6. DSD SIGNATURE 0.; -0 01 AvcHAa L AW960H AW System #1 Approved for. bedrooms. CEe4381, 4� System #2 Approved for. bedrooms. ........ *.1% lc�� Disapproved. Conditional approval for _ bedrooms, with the following stipulations: 0 By: Original Certificate Date: /() -a — The<��Umc/alirof /chm-age 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 engineers work. 7. ATTACHMENTS: COSA Checklist x Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12,doc If more than 1 septic system is on the lot: COSA Checklist # —of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: Hillcrest Subdivision, Block 6, Lot 7 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed U Sanitary seal (Y/N) Y Total depth 54 ft. Cased to 54 ft. FROM WELL LOG Date of test Static water level ft. Well production g. p. m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic: 123 ugJL date of sample: 9/17 B. SEPTICIHOLDING TANK DATA Tank Type/Material AWWU Sewer Tank size — gal, Number of Compartments Foundation cleanout (Y/N) Date of pumping C. ABSORPTION FIELD DATA Depression over tank (Y/N) — Pumper _ Parcel ID: 0 16-271-33 Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 9/26/2012 9 9 Other bacteria Collected by: Date installed 9 P.M colonies/1 00 mL MEA Cleanouts (Y/N) High water alarm (Y/N) Date installed Soil rating (g.p.d./ft'or ft/bdrm) System type Length ft. Width ft. Gravel below pipe _ ft. Total depth _ ft. Eff. absorption area — ft2 Monitoring tube _ Depression over field _ Date of adequacy test Results (Pass/Fail) — For — bedrooms Fluid depth in absorption field before test — in. Water added_ gal. New depth— in. Elapsed Time: — min. Final fluid depth — in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at — in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Size in gallons "Pump off" level at — in. Cycles tested N/A N/A >75' Sewer /septic service line >25' Animal containment areas >50' SEPTICIHOLDING TANK ON LOT TO: Building foundation — Propertyline— Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Service fine Surface water Curtain drain Wells on adjacent lots Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >1 00' On adjacent lots >1 00' Public sewer manhole/cleanout. KI/A >100' Holding tank Manurelanimal excrete storage areas >100' F. COMMENTS Well Casing Verified Free of Perforations. 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 Michael E. Anderson, P.E. Date 9/27/2012 COSA brown sheet-9-1-12.doc Absorption field Surface water Water main Driveway, parking/vehicle storage M Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 121453 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 7 of Hillcrest Subdivision. This inspection revealed an arsenic concentration of 123 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (NICL) of 10.0 ug/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. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/qnsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. co C\j CONTRARY COURT LINDER NO CIRCUMSTANCES S"OuL�, AN AS-BLALT BE L'StO FOR CONSyRLjCTION, OR FOR ESTABLISHING BOUNrARY OR FENCE LJNFS� THE SURVEYOR TAKES RESPONSSILITY FOR TItir- N:TiAl_ TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOP, USTED DISTANCE�S PREVAIL OVLR SCAUNG. PHE COST OF TIlE SLI-4vEy REPRODUCTION MAY CAUSE ERRORS JT4 SCALE. Lar �Rwv SURVEY TYPE FOWNDATOR AS—"—T FNA� slkv�Tulw �S_Dn_t PLO', PLAN . AS-AULT . , , �07 TOP�.APHY 0! PLANS &, Lo I &jR'VFYS ,T IS THF RESPONSIBlu-Y OF THE EIOI�DEDR OR OWN-Q� PRIOR -0 ZoNqmjcnOiq, TO VE�RIF' PROPOSED SUI�OIWG --RAf)E RE:�_ATIVE ro FINISHED rFADE AND UnjTY �P,(ECRO,,IS TO G:—�PV;Lj� �HE EYISTENCE OF ANY EAsFvE:Nrrs, COVENAN7� �k RES-IRECTIO-4- C-0 N07 APPEAR Of, -,f4E REDORO�_D P___m A, �.� �� W I S'NBOLS SET REPAR ASPfj/-J T, FOUND PESAF, wocc FENc Co�,ICRETE METAL PENCE I 'f4 - V. -� T�OSE WIPPOVWHENTS i,80' , ak,�UKL WILL LIE S"Oww FrNC_�S S�:FC CLSANotm, ZCEWALT�S, ORIV�_*A�S� WAY PRE- � FMIE 5Mq-F�v-�m "pp D O� E'C S'o*T' LOCA-�� ", ILl. SNOW ,,=k� I Hzu.,ic q- Lc�CAT=_. �ECoo. "reDc-ed _ny r La n d Su,vevors 3 L5.S. s 0, � _110 'I'D' pfot F -k No G, 12 7 /12 RE Z4 'K I LL TRJ W S'NBOLS SET REPAR ASPfj/-J T, FOUND PESAF, wocc FENc Co�,ICRETE METAL PENCE I 'f4 - V. -� T�OSE WIPPOVWHENTS i,80' , ak,�UKL WILL LIE S"Oww FrNC_�S S�:FC CLSANotm, ZCEWALT�S, ORIV�_*A�S� WAY PRE- � FMIE 5Mq-F�v-�m "pp D O� E'C S'o*T' LOCA-�� ", ILl. SNOW ,,=k� I Hzu.,ic q- Lc�CAT=_. �ECoo. "reDc-ed _ny r La n d Su,vevors 3 L5.S. s 0, � _110 'I'D' pfot F -k No G, 12 7 /12 RE Z4 'K I LL SGS Ref.# 1124434001 Client Name Anderson Engineering Project Name/# Lot 7 Block 6, Hillerest Client Sample ID Lot 7, Block 6, Hillcrest Matrix Drinking Water Printed Date/Time 09/26/2012 8:23 Collected Daterrime 09/17/2012 15:30 Received Date/Time 09/17/2012 16:00 Technical Director Stephen C. Ede Sample Remarks: Parameter Alfo.abe ReSUItS LOQ UnIts Method Container ID Limits Prep Date Analysis Date [Inq Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E Coll -1 otal Coli form 123 5.00 ND 0,100 Negative I Negative I ug/1- EP200.8 C (<10) 09/21/12 09/25/12 NRB mg/L SM21 450ONO3-F B (< 10) lOOmL SM21 9223B A 100ml- SM21 922' B A 09/18/12 CIVIA 09/17/12 DLC 09/17/12 DLC page I of I Mike Anderson 2- -) LO From: johnnie netherton Uohnn ie—netherton @yahoo, com] Sent: Thursday, September 27, 2012 7:48 AM To: Mike Anderson Subject: Re: Well Flow Mike here is the info on the well flow and camera job on contrary ct. total Depth 54' S.W.1 , 9' Casing stick up 3' Cased to 54' Saw no breaks or perforations. the well flow yielded 9 gpm +. At open discharge the pump ran 9 gallons per minute but it was not able to pump enough to draw down the well. S.W.L stabalized at 17'. We did replace the sanitary seal and repair of conduit. Can you please forward me the billing info for the customer so I can invoice them out. Thanks!