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Home My WebLink AboutT12N R4W SEC 10 LT 51 LESS S70'DRILLING, INC. Well Owner_ Warren ~4at/hews DRILLING LOG .Use of We]l Location (address of: Township, Range, Section, if known; or distance main road Dom. Size of casing. 6" .Depth of Hole Static water level '~0 ' ft. ~ Screen ( ); Perforated ( 21 g ' feet Cased to 21~ .~ 'feet (below) land surface. Finish of well (check one) ). open end ( ,MX ); Describe screen o~per~(~ration Well pumping test at [ 1,5/dalfons per ' of drawdown fro%m~s~atf~ level. (minute) for 1 hours with 100% ft. Date of completion 10./25/76 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO_ 2 2 TO 6 6 TO_ 212 ~TO TO TO TO_ TO_ TO __TO TO TO Casino Stickup Silty Gravel Silty Clay - blue Sandy Gravel - Water Certificate No's. 814 & 973 1--CUSTOMER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section · P.O. Box 196650 Anchorage, Alaska 99519-6650 343-'4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # {'~i\ -~, -'~,,~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72*025 {Rev. 1/91) Front MOA 5. STATEMENT OF INSPECTION, BY ENGINEER So As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm -'~¢ ~,~.¢ ~d ---~ ~ ¢ ,' P,- I ~t HJ ~t~ Phone Address /~g'~ ~ ~g Engineer's signature DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal an¢ state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Casing height F Wires properly protected (Y/N) AT INSPECTION Date of test I~)/,z3~..¢ h'1:~ (~ ]10 IQ ~ Static water level ? ~:) Lit '7 Well flow [ .-~ g.p.m. ~'~ g.p.m. Legal Description: ~.~"'7~) ~,'~' ~J) ~.~ I C) Parcel I.D. A, Well Data Well type ~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed 10/~...~--/,7 G, Driller Log present (Y/N) '"/ Total depth ~ Cased to ,.~,/ ~ FROM WELL LOG Sanitary seal (Y/N) SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots /~//'~r' ; On adjacent lots Public sewer manhole/cleanout ~--~ Petroleum tank '~c:: OZ z~ WATER SAMPLE RESULTS: Co,term Date of sample: I- 0 B, SEPTIC/HOLDING TANK DATA Nitrate < 0.; l 0 Collected by: Date installed Tank size Other bacteria Compartments Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line On adjacent lots Absorption field Foundation Water main/service line Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (WN) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D, ABSORPTION FIELD DATA Date installed Length Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Well on lot To building foundation On adjacent lots Surface water Curtain drain E, ENGINEER'S CERTIFICATION On adjacent lots Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) Results (pass/fail) Surface water System type Total depth Depression over field (Y/N) for After test .If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Bedrooms HAA Fee $ ~'~P~ ' (-]~r'~ Date of Payment Receipt Number ,~-',/~:~ 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number 6751W. DIMOND BLVD. ANCHORAGE, ALASKA 99502-5904 (907} 248-5095 Municipality of Anchorage Division of Environmental Health Department o~ Health and Social Services 820 L Street Anchorage~ Alaska 99501 September 20, 1993 REQUEST FOR WAIVER OF SEF'ARATION DIS]-AN[]ES FOR PRIVATE WEL~S TO PUBLIC SEWER ~U LOT 51 ~E~ 10, T12N R4W We are submitting a r-equest for waivers from the separation distances~o'-' in Title 18, Alaska Administrative Code~ Chapter During a HAA inspection it was found that the required separation distance between the well and the public sewer serving this property is less than the distance required at the time o~ well installation. October i976. The actual distance is 44 ~eet more er less~ and the required distance was 50 Yeet. The sewerline was installed in 1974. At that time there was a residence on thi~ lot and a service connect was installed on 8/14/74. The sewer construction drawing shows a well on lot but this well served two residences~ and a separate well to serve this property was installed in 1976. A municipal inspection form dated March 25~ i977 shows that the distances to the public mewer We have inciuded well logs Yet this well and for' the well on lot liB Block 7 Lakehurst S/D. Beth logs show substantial amount of clay to a depth in excess of 200 feet. ]'be sewerline' is con-- strutted o¥ ductile iron pipe and the manholes are water tight with formed concrete inverts. Tobb~d F'. E. N 10 20 20 40 50 SCALE 1' = 20 FE I I I I I 6O RIGHT OF WAY '~*J.%* TBBBEN SPURKLAND P,E, 203 ~ i~TH, AVENUE ANCH, AK~ 99501 S7~' LOT $~ SEC. 10 T18N R41V ~/A£REfl NATTHEIVS 8910 6LORALEE STREET SEPTIC SYSTEM 3ESIGN DATE' SEPE2~ 1993 SHEET, 1/I GRID, 2325 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LAI)ORATORY SERVICES Chemlab Ref.~ :93.4721-1 Client Sample ID :8916 GLORA LEE Matrix :WATER REPORT of ANALYSIS 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :TOBBEN SPURKLAND, P.E. WORK Order :70808 Ordered By :TOBBEN SPb~RK[,AND Report Completed :09/14/93 Project Name : Collected :09/10/93 @ 14:13 hrs. Projects : Received :09/10/93 @ 14:20 hrs. PWSID :UA Technical Director:STEPHEN Q. EDE Released By :~/~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: STUART. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 09/11 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed u = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ~SGS Member of the SGS Group (Soci~tO G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORAOO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA POST INCA CONSPICUOUS PLACE SEWER CONNECTION APPLICATION & PERMIT GREATERANCHORAGEAREABOROUGH 3S00TUDORROAD ANCHORAGE, ALASKA99507 CONNECTION STREET ADDRESS PAYERNAME ACCT. NO CUSTOMER BILLING NOTICE JB LL[NG DATE Tom Fink, Mayor ] uniC pality of ' k 3rage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 1, 1993 Tobben Spurkland, P.E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 Subject: Waiver Request for T12N R4W Section,S70' Waiver Request #WR930061, PID #011-213-32, of Lot 51 HA930581 Dear Mr. Spurkland: Your request for waiver of the required 100 foot separation of a private well to public sewer manhole has been approved. The approved separation distance is 42 feet and a private well to the public service line is 38 feet. This waiver approval applies to the existing well and public sewer manhole only. Any future upgrade will require all separation distances be met or another approval from this department. Daniel J. Roth Civil Engineer On-site Services ~ncur: .~ ~hn Smi rogram manager On-site Services ljw #9 · MUNICIPALITY OF ANCHORAGE~.j Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR930061 PID# 011-213-32 HA# HA930581 Permit Date Received: September 20, 1993 Legal Description: T12N R4W Section 10 S70' Lot 51 Engineer: Tobben Sprukland, P.E. 203 West 15th AVenue, #206, Anchoraqe, Alaska 99501 Applicant: Warren Matthews Waiver Requested: ~-t--~m--yr~J~Ilc sewer line oi 44 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: X. WaiveI List Conditions or Reasons for above: Date: /0--27-- 93 By:~ Fees were not paid Rec #: Amount: $ 1-12- MhlI)ER R£¢¢£.<.<.T' For( I,,.EI.I.- ~'¢ ?~Bztc ~£~ER l] O l ~, pO, , . 6. Fo~- $. C, If. '~-"MUNICIPALITY ,OF ANCHORAG~ 'DEPARTMENT'~uF HEAETH:,AND ENVIRONMENTAL. ~ROT:ECTION I _~ 825'~L Street, Anchorage, Alaska 99501 279-.2511, ext. 224, 225 Date Received: March 25, 1977 1st Inspection: Time /_7~ ~ 2nd Inspection: Time Date Z-/~j~-'7 '7 ~S ._ Date Inspector DI~- ~j~h,6~/D Inspector REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 2 t Lending Mailing Institution Request: Address: Post Office Box 1120 Property Owner: Mailing Address; Alaska Mutual Savings Bank Warren W/Donna Matthews Phone: 274-3561 x 216 ~LI,~'- Phone: ~ (h) 8916 Gloralee Street 276-4331 (w) 3. Legal Description: T12N R4W Section 10 S70' of Lot 51 Jewel Lake Small Trac 4. Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Sewage Disposal System: On-site system ( ) Public Utility Permit # ~ C~',O' Installed Septic Tank Size Absorption Area Manufacturer _~/~ Soils Rate ./ Material 7. Area Distances: Well to Septic Tank ~/~ to Absorption to Sewer Lines ~ ~' Nearest Lot Line %/~ I Absorption Area to Nearest Lot Line ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES March 24~ 1977 ATTN: Debbie Johnson 1. Type of Inspection: 2. Property Owner: CMRO VA FHA Warren W. and Donna Matthews CONV × Mailing Address: 8916 Gloralee Street Day Phone: Warren W, and Donna Matthews 3. Name of Buyer: Mailing Address: Same Day Phone: 4. Name of Lending Institution: Alaska Mutual Savings Bank Mailing Address: P.O. Box 1120 Phone: 5. Name of Realtor or Agent: N/A Mailing Address: Phone: 6. Legal Description: Location: So. 70~' Lot 51 Jewel Lake Small Tracts S10 tl2N R4W SM 8916 Gloralee Street, Anchorage,Alaske 276v4331 BUSINESS ~4~/5Z HOME 274-3561 ext. 216 99502 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Pvt, drill well SF No. Bdrms. Public Utility. Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) 1 X MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION IvlAR 2 5 1977 RECEIVED 72-003(3/76) Page'Two , ~" "~' '-~ ~' .... Depart-men'% of"Heal, th'and Environmental Protectfo~ ~eques% for, Approval of I.ndividual Sewer and Wate~ Facilities Legal Description: T12N R4W Section 10 S70' of Lot 51 Jewel Lake Small Tracts Comments: Affadavit Attached: ( ) Approved: ~~ Disapproved: ~/ Letter Attached: ( ) Date: Date: Department Worksheet: