HomeMy WebLinkAboutHILLCREST BLK 6 LT 9Onsite File
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Lot currently served by public water and sewer. 2013
well on lot is to be decommissioned.
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City/Borough: I Subdivision: I BLOCK I LOT
anchorage 'I Hillcrest 1 6 1 9
WELL LOG ID 56274
STATE OF ALASKA
DE13ARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
WATER WELL LOG
Drilling Started: J2-/-J;•?n1 Completed: J2,%__j9 20_ a _
Property Owner Name & Address: Rafael & Gloria Barboza
iite:1101 Contrary Court 1211 Contrary Court
Meridian Township Range Section �/a of /4 of%a of '/4
BOREHOLE DATA(from top of casing)Depth
Drilling method: (X) Air rotary, ( ) Cable tool, Other
Material: Type, Color & wetness From To
_
Well use: ( ) Public supply, (X) Domestic, Other
stickup
0
3
Depth of hole: 180 1-1, Casing stickup: 2 ft
Casing type: steel __ Thickness: _.250_ inches
_
overburden
3
6
Casing diameter: 6 inches Casing depth: 180 ft
Liner type: Diameter: inches Depth: ft
silt &gravel
6
45
Static water (from top of casing): 2 ft on 12 % 19 ,2013
Pumping level & yield: feet after _ hours at gpm
Recovery rate: 20gpm, Method of testing: airlift
sandy clay w/ gravel
45
78
Development method: airlift Duration: 1 hour
silty sand w/gravel &H2O
78
85
Well intake opening type: (X ) Open end, ( ) Open hole, Other —
Screened: Start: ft, Stopped ft
moist clay
85
90
Screen type: Slotimesh size:
Perforated: Start: ft, Stopped: ft
sand & gravel w/w/1-120
90
95
S tarftStopped:
, 1
.t: ..............................
Note: ..... ................ . .............................................
silty sand w/ gravel
95
135
Groat type: _.bentonite Volume -
Depth; from ground surface , to 20 ft
sand &gravel
135
160
Pump intake depth: _ _ ft
Pump size: hp'. Brand name:
sandy clay w/ gravel
160
173
Was well disinfected upon completion? (X) Yes, (' } No
Method of disinfection:.CalciuJ:-HypoChlQCIte..l.ChlOrlrle)...
coarse gravel w/ H2O
173
180
Driller comtnentsi disclaimers: .............................................................
.............................................................................................................
........................................................................................... .................
.............................................................................................................
WATER QUALITY TE
STING
Well driller name: ..,1.O.Ear►ny............................................ ....................
Coliform C
01/100m
Company name:... Hefty Drilling, Inc. .....................
Mailing address:... 3540 Akula Dr.
Ntrates
L
city: Anchorage _ state: AK Zip 99516
Phone number: ( 907 } 345 - 0593 fax:345-4700
Drillers si-nature:
aska state law requires that a copy of this well log be sent to the
:partmcnt of Natural Resources within 45 days: faxes are
,eptable. (AK statutes 38.05.030, 38.05.035.4 1.08.030.
_15.030 and AK regulations I I AAC 93.140).
�R/ Division of Mining, Land and'Vater,
i0 W 7th Avenue, Suite 1020
nchorage, AK 99501- 3562
one (907)269-8639 and fax (907)269-8947
Within the City of Anchorage, it is required that a copy of the well log b
sent to the appropriate city office within 60 days and that another copy of
the well log be sent to the well/property owner within 30 days.
Permit Number: OSP131454
Date of Issue: Dec t' 11 2013
Parcel Identification Number: --
Is well located at approved permit location? ( X) Yes or ( ) No
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite 0
Well Decommissioning Lo
Legal Address: I
Subdivision t l c re Block L Lot
T R Section Lot
On-site Water & Wastewater Section certified contractor performing the well decommissioning:
Name: \
Signature:
v Aefty Did*,Inc.
Company:
P.O. Box112130
121-11r e, AR99511
Well decommissioning date (� ' �j Method of decommissioning: AMC 15. 5.060L1 a. ❑ b. ❑ C.
Location: Use the space below to provide a drawing of the property showing the following items:
• North arrow J
• Decommissioned well location V �) / 5P I �1 `i s L4
• 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 corners.
l
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G:\Development Services\Building Satety\On Site Water and Wastewater\Forms\Gllent Forms\Well Decommisioning torm.doc
Municipality of Anchorage
Development Services Department
Building Safeb/Division
On-Site Water and Wastewater Program
4700 South BragawSt.
P.O. Box ~196650 Anchorage, AK 99519-6650
www. ci. anchorage.ak, us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE-FAMiLY DWELLING
Parcel I.D. _ O 16 - 2 .'7 ! - ~ / HAA ~ O/-f o ! o '7
1. GENi='~'~L INI~O'R~'ATioN Expiration Date: .__._~_,5'"-
' ' - ,: . ': - ' ;.r
Loc~tioh'(~i~e' add[~;'~ ~r:~irections)
Current Properly owner(s) _~
NUMBER OF BEDi~O~'~:
TYPE oF WATER.suPPLy:.,
Individual Well '*
"Individual Water Storage
Community Class
Public Water System
Mailing address/:."'" _ ,S~,,~ ~
Lending agency
Mailing address ....
Real Estate Agent
Mailing Address
Uniess otherwJs'e i'eque, sted, HAA will be held by DSD for pickup.
~[~,~vt£ ___ Day Phone_.~2~ _2...- 2~(~
Day phone
Day phone
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site E]
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development serVices Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 ....
e
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 Health Authority 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. . .
Address ~OG ~ F,'~-~v~e~J L, ! /~._~¢~ov'~3e-
-Sngineer'sPrintedName [.,c~v-.r-,/ /~, ~1~'-[.~',5o~.4_. " Date '
5.
bedrooms. "'
DSD SIGNATURE
~ Approved for -~
Disapproved..
ConditiOnal approval for
bedrooms, with the following {tipulations: '
Additional Comments
Attachments:
HAA ·Checklist _ X ..
septic system AdvisorY. ~. -
Well Flow AdvisorY
By:
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:~/'~'
(Rev. 01/02)
mpa of A~chorage ,, ::..
- .L/ io nt. ,.~5 ices Department,~.,.
: Building Safety Division :::
",::,' - . . On-Site Water & Wastewater Progmm :, i '
";4700'South'Bm~a~'st." ,' ~'=''-, ~ . !:' -. :
P.O. Box 196650 Anchorage,, AK 99519.:6650' "
:' :~i ...... : ...................... : ~w~, ,..ci.anchomge.ak:us
,. ., (907) 343-7904 :~ ....:-': ...... ~' :;~ ....ll"i ........
':' HEALTH AUTHORITY Ap· CH:~ "-
: PROVAL- ECKLIST !
Legal Descr, iption:
.... : ,, Paroe O ! ' 3 /
A. WELL DATA . ~ I~ ~ ..... , '.. .
. :Welltyp,e.~ . . ifA, B, orCpr0'~idePWSID#/~f//~- .r: "~''"'''k ~V/;,,, /¥ '
. .. , ..... - . ~,,. ) _ . .
,)f, , ~n,tary sea!, (Y/N)% Wires pro erl rotected 7
~.. : · ~' ..... P N
' .,.., ! .... : ' . : ; . ,"-'-', ',~,'""L":i ;"i,:;: i;'r" uasingneight(ab0veground)..,.~"7 ~in "
. . ~ - , FROM WELL LOG , ,., ; .....
~ ' ' ' . , ' - r "*" ' ATINSP;EOTION ...... · ..-
:. Stat c water level .
. Wel product on' . ·
~ WATER SAMPLE RESULTS.
,, ; ~ .... ~. ., , I . . · - olones/1uuml.
~e/Matedal..
', ;!1 ., :.,
'--::1t ',, .:.-i.,
Foundation cieanout (Y/
Date ot pumping . i '"':;': .i' !:: ":
C. ABSORPTION FIELD DATA ::. ,,.
. . ;~ ;: .,
Date ink.lied
Length'~,
: Total d~pth
' Dare'of ~
Pum
-!
i;, ff. ~rptionat:~at !: ':ft2
Results
absorPtion field before te§t
im -:.: Fin~"'"'d L~ ~ ' . ~
~:~ in. '- I p
/bdrh~)
Date in~talled
:e~ added.
]~
~¥pe
~elow
el
pe
over field
I
" -,~0r bedroorris
'gal. [' JNewdepth, - i~.!
rPtion ,rate >- ~ g.p.d.'
'Date installed
"Pump On" I~vel'at'
Size in
"Pump off". level at . in.
~Manhole/Access (Y/N)
iHigh water, alarm level at '
Meet= ..~ & ......... ~,~..~..~nt~ ~
iEPARATION DISTANCES
SEPARATION DISTANCES FR°M WELl' oN LOT TO:
septic t~n~i'ft station on lot'
Absorption field on lot A//,A-
Public sewer main : I Od! '~ ,
. 'Sewe~: isepti~'serVice line -
- On adjacent'10(~ ~ "; ,-
On adjacent lots'
Public sewe~' manhole/cleanout
"' y.i.'tl '
-'"'-'~ ^'~ ^'"'"'~' "'"""'^ '"""'~' FROM S~=,=~-iciHOLDiNG TANK ON LOT TO:
· i~' ~'-"-'A-b-~orption field
Building foundation . . : ' ......
Water main ' :'~ Water serVice line Surface water
~W~~nt lots ': " ' "'
PiopertY li~'. ':!", ~ding foundation r' Water main "'
'~e - .' Surface Water ,_, '':' :Driveway' parkingNehicle storage'
- O~MENTS i: .......................... ' ...................................... : ........... .'i .............. ," .....
Ge
ENGINEER'S, CERTIFICATION
I ced/fy that I have determined through fieId inspections and
review of MuniCipal records that the above systems are in
conformance With MOA HAA guidelines in effect~on this date.
Engineer's priitedName k~-~/'
Date ~ .... ~: '
Waiver Fee $
Date of Payment
Receipt Number
~we Ii
-8
x,,v,',,./,t--~.-.~,~ ~.JL/
· AS-BUILT NO CORNERS SET THIS DATE
..~ CA
EASEMENTS OF RECORD, OTHER THAN F[ 04-lj
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. /::~' S/
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: _LOT-'
.,BLoc. lc ~) t-IILLC-RIE5T
Anchorage Rocording Precinct, Alaska, and that the
improvements situated thereon are within the property lines and
do not overlap or encroach on Ihe property lying adjacent
thereto, that no improvements on property lying adjacent thereto
encroach on the premises in question and that there are no
roadways, transmission lines or other visible easements on said
property except as indicated hereon.
Dated at Anchorage Alaska
this ~ B ~-d
day of A///}A' cid 20 ~ 4
FRED WALATKA & ASSOCIATES
(907) 248-1666 · Engineers and Surveyors '
GREA1ER ANCHORAGE AREA BORu Gt-I
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
NAME /,.,~fl/t}~O ~. '..~/¢~/Z2/-.Z~-CMAILING ADDRESS. ./~O,.¢ ¢~/¢,,z __ PHONE
LOCATION ',--)/.*' e/? ~" ?~';,-~ ¢,t?/-i2/C/Z¢/ ,~"~ LEGAL DESCRIPTION_~, ~ ~/ ,'~--4¢Q-/¢ ~
S:~ TANK: /
DISTANCE NUMBER OF
FROM WELt MANUFACTURER MATERIAL COMPARTMENTS.__
INSIDE LENGTH
_ INSIDE WIDTH
LIQUID DEPTH LIQUID CAPACITY. GALLONS.
LINING MATERIAL/ _.CRIB SIZE: DIAM~T-~ DEPTH DISTANC~F~OM.' WELL
BUI/I,.I,.I,.I,.I,.I~H~G FOUNDATION .... NEARES~T~T LINE _ , ABSORPT~ AREA (WALL AREA) / .SQ, FT.
WELL:
TYPE ..~,/,O/~2/~:~t'/¢~-- CONSTRUCTION
BUILDING NEAREST
FOUNDATION __ LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DEPTH ~-'~ / DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK__ SYSTEM
REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL,
LOT SI_OPE:
REMARKS:
DIAGRAM OF SYSTEM
GRE ZR ANCHORAGE AREA BO UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "CI' STREET ANCHORAGE:, ALASKA 99503
TELEPHONE 2.74-456!
SEWAGE DISPOSAL SYSTEM -- APPLICATION AN[) PERMIT
' ,} 7- Z - ' . --
INSTALLATION LOCATION ~~ ¢ C/?~-7~ ,~ r~~~¢~ , .
LEGAL DescrIPTION ~ - -
INSTALLATION Of: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
TO BE INSTALLED SY ~ :J/
NOTE= TI'IlS PERMIT IS NOT VALID WITHOUT SOIL TE~'I'
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.
S~=~t~TANK SIZE TYPE , SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCE~., REQUIREMENTS
· DRAIN FIELD
· DRAIN FIELD
SEEPAGE PIt
ALSO CONSIDER AREA WELLS.
· SEEPAGE PIt
, DRAIN FIELD
DIAGRAM OF SYSTEM
TO RIVER, LAKE· STREAM.. , . ~ .
CAST IRON INTO AND OUT OF SEPtiC ]'ANN AND INTO CRIB CROSSING GAP OF '
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
~~ [ L FAMILIA~WlTH T2E-~QUIREMENTS OF Greater AN h RA e '
. ' C O O AREA ~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
JAY S, HAMMOND, Governor
~)EPT. OF EN¥~It~O~N~MENTA~
SOUTHCENTRAL REGIONAL OFFICE
MACKAY BLDG.
338 DENALI STREET
ANCHORACE 99501
July 2, 1975
Mr. Lynn Coad
GAAB--DEQ
3330 C Street
Anchorage, AK
99503
Subject: Lot 9, Block 6, Hillcrest S/D
Dear- Mr. Coad:
V!e have no objec-l-ions I-o the instal la-l-ion of a holding lank on the
subject property with the restrictions sta~led in our previous let-
ter on other lots.
Sincerely yours,
Regional E n v i r o n rr:e~:'r"a
Supervisor
., V':"'.~;.~;..'.~=., . ,' ...: ~ .... .', ......
· , ,~·., ,, DRILLING, ': Inc. ' . ,
?~..'~ . .~.~ ? .... , ~ ?... ~ . ~ .. ~ · ~. . .
v;', ~ : . ~;' P.O. Box 4-1224'* ,]3]0C International Airport Road ' .
: ..... :. .' . ' ~ .. -;..;".(907) 274~61]'.'.. ' ... .'.
. '/"" .... ~" ' .--. ':.~." :' ..:-. ' ANCHORAGE,'.A~ 99509 '-~
-- ,. · .... . ..:.,~- . '. .?,'~ , · : .. . . : - -.
· · -.. · '" "~ :'.'-~': ;~::;~DRiLLING ~0G ' ~ .... .. .: ~ ' '""
. Well Owner P.D.: ~'de~ :.': ' '~ ' .... '" "~ ........ - ' ' .use'o~ We]]
: :.... = :: .:..:..:.. '- c..:'..:. ,..~ ;- ...'::;(?; :;..' ...;. :' ..' ':~:.~F "..'- '::":.: ;~, -'.' ',' ' '.
- .' ' ':~':~o~.::v~-=.~, 6 H~ZZc~es~:,Subdv. ':-' ,~ .. -~'.' ~-'.- .'::'.: ' '. . --' .- .' :'- -
"' .~'~~. · .' . , · -. " . ......':2.. . ~~" "? ~":,,'--;.'.';,~,~'~,~".;~,;: ~w';~:;-'~-'.'.'~".::-'~,.,.';'~'"..: '.,.,'~. .... ". ' ' '..'
. Size 0~ casi~ 6 ..... ~epth. o~ ~ole .6~ :':- ~, '...r?.~e{~:.~::.~;,;:,C~se8 ~d¥''64 ,. :~? ..... ~'f~eL' '~'~-; '., '"
'.. Static wate?.l~vel '.' '~ :' '.':-".ft:~::(~):,~(below)?l~d sUrface:'~.Finish of w~ll (ch~k One) open end ( x'. ,); '. '.,
· ./. . .' ... .. '~.;~..,.~:~ ,' '~*'..-.~::'.' .. ,~[~'~;.~'..~-.7:'".'~'~'~t.~','t~.;..~,.'~; ;,W :.k"~,;."..'.-';,[(,~;.'lY.:',.,". .,..'' "'.;.'" '. ' '' ..... ,' , ·
. . Describe screen or.-perforabon ~ ,Nolle .. ,.~., .-.;.- .'- ..... ..~., ......... · .... ~.-., . · -. ,~... -. .... . · . ·
ground surface -.':; ..;; : ;....- :.Give deta]]s,of~f, ormatzons penetrated, size of material, color and hardness-' ' ':' - .
.b
b~
b ~''~ Is the responsibilit.y of the owner
klildol', pl'JOf to co~¥~t'lct .i}, (o
proposed building grande rc ; iv, ~o [h~-
b:hcd ~rade and ut{'li~¥ connectlon~ and
IIIOD[S, COVCIIP. II~S, Of i'C5~FiC[.iOIIS
do not appear on Hie recorded .sill;divi:
~lon pla~.
I
~V~ 2..· ......
LEGEi'~D:
SURVEy CE~TIFICATIOH (D Bros~ Cop tdonamont
LOT
0 Iron Pipo
Lot ~ , Block ~ o Sfool Pin
CZ) ~ Survey Hub ~ Tack
Anchorage Recording PmcincL Alaska