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HomeMy WebLinkAboutDAWN VILLAGE BLK 1 LT 5Drawn Village Block 1 Lot 5 #014-061-52 CD r+ t-� H � C x H ►i Z E+ x 't t m M M N'f � A SO � S � i w m N N rw y d p• :t R w "OA n 7 • N � 3� vt r � y G� .•J fG)U 3 H H H H H H H H H H H H O O O O O O O O O O O O i E i j t V i ;V W 3 iC 100 i s ON t i L'Ii ice, L ire i i n n int (tc n ?y n n 3H n i a irl jjrji.4 j0 � is i0 .. .j 3� i a rte+ ( a rs i s a `'!< a ;e :o �+ .+ is t r+ i !..• iiia a t a i o. ir• j.< mia i o I n i0 !w i n ic.! i ani .:.L; i •C ?"II i G V (D t..1 t.J ' r3 rt O. O. O O O O O M r M �0j •J �Oj 4 �Oy Fi �. r •O� f'• ••� � r 3' i i i 3 i i i i i t ice] �] ►j y ►i . ►1 ►i �] � �l H H H H H H H H N H H H 0 0 0 0 0-0 0 0 0 0 0 0 i ! °•e� ! S 1 i t i tt� H � C x H ►i Z E+ Z 't t m M M N'f � A SO � S � i w m N N rw y p• :t R w M n 7 N � 3� vt a i•� y CT Ln r -t rw � C x H ►i Z E+ Z 't t m s N'f � A 1 � S � i m N N rw GI La cl m Z Z m s N'f � A 1 � m N N rw GI p• 10/15/13 11: 12AN ANCHORAGE HELL 5 PUMP 19072430742 Well Drilling perrnit !Yuiarbor: SW`-- Date of Issae: 1. 4"/ 4'-3 Parcel Identification Number:—.— Legal Description — – Property Owner Nume & Address: Pump Installation Date: ;a"7 M*�' pump Intake Depth Selow Top of Well Casing:.5--3 feet pump Manufacturer's Name: f"tIE;' !3 'J4 Pump NIodel: Pump Size VZ, hp r Pitless Adapter Burial Depth: I0 feet pitiess Adapter Manufacturer's Nu ne: C .'> 111) /9?, .P plfiess Adapter Installer; G`i�,j,'�,«.,'ia Well Disinfeetcd 1111011 Completion's Yos' No Method of Disinfectlnn: Cd �r fir :, ✓':.�h:f a Comments: ,,y"{u fy�. t- «-r rr` 114 el, '/ Anchorage Pump & VVefi ServiCe Pump Inscailer N'IM"' 330 East 75th Avenue , li ...) Anchorage, Alaska 99518 Phone: 907.243-0740 Fax: 907.243.0742 T attention: The pump installer shall provide a purrs: installation log to toe DSO within 3i1 bays o pump installation. G^:':2locme: i .services Department 'J \ O--uildin9 SOMTy Divisian x'A°*d' 1 L17_�.jr� civ r,�,t;7 �" .�..' 4�%gStt, yVQie^.• 'rO9iUt':1 d 65'�Q M19ark Begicn r'wayof _ Pump Installation Log Well Drilling perrnit !Yuiarbor: SW`-- Date of Issae: 1. 4"/ 4'-3 Parcel Identification Number:—.— Legal Description — – Property Owner Nume & Address: Pump Installation Date: ;a"7 M*�' pump Intake Depth Selow Top of Well Casing:.5--3 feet pump Manufacturer's Name: f"tIE;' !3 'J4 Pump NIodel: Pump Size VZ, hp r Pitless Adapter Burial Depth: I0 feet pitiess Adapter Manufacturer's Nu ne: C .'> 111) /9?, .P plfiess Adapter Installer; G`i�,j,'�,«.,'ia Well Disinfeetcd 1111011 Completion's Yos' No Method of Disinfectlnn: Cd �r fir :, ✓':.�h:f a Comments: ,,y"{u fy�. t- «-r rr` 114 el, '/ Anchorage Pump & VVefi ServiCe Pump Inscailer N'IM"' 330 East 75th Avenue , li ...) Anchorage, Alaska 99518 Phone: 907.243-0740 Fax: 907.243.0742 T attention: The pump installer shall provide a purrs: installation log to toe DSO within 3i1 bays o pump installation. tlu1'.1 I , r1til1— I _ry 0=1F' s'1t-40F:;"1=41GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION " 2.51.6 E. TUDOR RD. , ANCHORAGE, AK. 95507 276-2221 !.TELL. J?ERIY1 I T PERMIT NO. ( 77010 ) APPLICANT .PETEP_Sa r..pNS.TRUgj SRA BOX 1718X 344-8638 LOCATION TESHCAR ST LEGAL L5 B1 DAWN VILLAGE LOT SIZE 10000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND A14Y 01.1 -SITE SEWAGE DISPOSAL SYSTEM IS 100 `FEET FOR A PRIVATE 14ELL OR 200 FEET FOR A PUBLIC WELL, WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER, INSTALLATION. F�EFZM I T ti1k=IL I r> Jr 10FZ Ot IE VEt"-iR I :SS?IJE I CERTIFY THAT 1: I AM FAMILIAR WITH THE REOUIP..EMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. APPLICANT 08TER�ON C'ONSTP.UCTION ISSUED BY--"------------ DATE_ 1 _L.�'�_..,)_--- MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Arsenic Advisory   Certificate of On‐Site Systems Approval # OSC201468  Subdivision: Dawn Village, Block: 1, Lot: 5  A water sample revealed an arsenic concentration of 12.4 micrograms per liter  (ug/L).  The Environmental Protection Agency (EPA) has established a maximum  contaminant level (MCL) 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/onsite) or at 343‐7904.    This advisory must be attached to all copies of the subject Certificate of On‐Site  Systems Approval.    LOT 5LOT 4LOT 6LOT 5LOT 632.6'33.7'14.5'3%10' UTILITY EASEMENT10' UTILITY EASEMENT N89° 45' 36"E 152.13'S89° 39' 03"W 141.63'N00° 02' 25"W 70.20' S08° 29' 40" W 7 0 . 7 5 ' 34.4'26.4'34.4'26.4'EXISTINGHOUSETESHLAR DRI V E 25'25'LINE BETWEEN ADJ A C E N T S E W E R M A N H O L E Sco SHEDSHEDGREEN HOUSE19.4'LOT 5, BLOCK 1,DAWN VILLAGE SUBDIVISIONAS-BUILTLEGEND:NOTE:THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLANWITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH.DRAWN DATE:DRAWN BY:SCALE:CHECKED BY:8/6/2020SCAP1" = 20'PLAT:WORK ORDER:2005876-229FB/PG: 818/18GRID:SW2034LEGAL DESCRIPTION:ORDERED BY:TONY LEWKOWSKI, REBOX, AND JOE BELL, NOTCH REALTYSURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THEPROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTSSITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXISTOTHER THAN NOTED.EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCEOF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DONOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCESSHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTYLINES, OR FOR PLOT-PLAN PURPOSES.CLEAN OUTWATER WELLFENCEAsphaltConcreteOverhangWood Deck250 H StreetAnchorage, Alaska 99501Survey DepartmentPhone 562-5291MainlinePhone 243-8985AECC 668ADDRESS: 6710 TESHLAR DR. PARCEL #: 014-061-52-000REF: 98L687CO Municipality of Anchorage • 'tel Development Services Department Building Safety Division, - On -Silo Water 8 Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99onsite w (907) 343-7 onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Dl y-1)(01- 5p� COSA# 1. GENERAL INFORMATION Expiration Date: Complete legal description DAWN VILLAGE S/D: TYPE OF WASTEWATER DISPOSAL: BLOCK 1. LOT 5 0 Individual On-site ❑ Location (site address) _6710 TESHLAR DRIVE • ANCHORAGE. AK • 99507 Current Property owner(s) DAVID JOHNSON Day phone Mailing address Lending agency Mailing address 6710 TESHLAR DRIVE • ANCHORAGE. AK • 99507 Day phone Real Estate Agent BETH SIMPSON W/ KELLER WILLIAMS Day phone 865-6556 Mailing address 101 WEST BENSON BLVD. #503 • ANCHORAGE. AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 samples. (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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal &A t od hereto and as of the validation date shown below, I verify that my t investigation, basil &'proNdures outlined in the Certificate of On -Site Systems Approval Gui 4S fOf this application, shows that,0tt on-site water supply and/or wastewater disposal system is (are) safe, functional n44ade j'uate for the rkber ofbedrooms and type of structure indicated herein. I further verify that based on the k+awF� , informatio bfained from the Municipality of Anchorage files and from my investigation and inspection, th 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance oftho system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may auctuato during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory v Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other ,rq1 .1 rj .�PV,\0 OFgiy rr-i. ONSITE , c WATER AND WASTEWATER PROGRAM By: 12,, Original Certificate Date: 1 (Rev 1105 \ Municipality of Anchorage o "1 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DAWN VILLAGE S/D; BLOCK 1, LOT 5 Parcel ID:6 / ©G ^ 5v2 - A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 4/25/1977 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 76 ft. Cased to 76 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 4/25/1977 Static water level 38 ft. Well production 12 g.p.m. WATER SAMPLE RESULTS: i Coliform 0 colonies/100 ml. Arsenic: �c ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Nitrate NO mg./L. AT INSPECTION 1/9/2009 28 ft. 7.58 g.p.m. Other bacteria colonies/100 ml. Date of sample: 1/8/2009 Collected by: GEG Ltd. Tank size gala Number of Compartments _ Foundation cleanout (Y/N) _ esiorrS i Date o roping Pumper C. ABSORPTION FIELD DATA Date installed i Length ft. Date installed it tank (Y/N) _ High water alarm (Y/N) Soil rating (g.p.d./ft'or ft21bdrm)_ Width ft. PUBLIC SEWER System type Gravel below ft. Total depth ft. Eff. absorption area ft' Monitoring tube Depression over field Date of adequacy test Re/sults ail) For bedrooms Fluid depth in absorption field befor_ its n.Water added _gal. New depth _in. i Elapsed Time: n. Final fluid depth _ in. Absorption rate >= g.p.d. Any-re—juvenation treatment (past 12 mo.) (YIN & type) If yes, give date I D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on' level at in. "Pump off" Ievei High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent tots N/A •38' 83' APPROX FROM EDGE OF Public sewer main Public sewer manhole/cleanout WELL TO EDGE OF MANHOLE Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water service ' u ace water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS WAIVER. G. ENGINEER'S CERTIFICATION Building foundation Water Surface water Wells on adjacent lots - 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 JEFFREY A. GARNESS Date 1 1 16/09 COSA Fee c 4 9 U+)Lq `i Date of Payment Receipt Number. Q 3-5- (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number PUBLIC SEWER storage &VAMIM AtIJe r A. G Mess: 1 CE 9 SGS Refq 1090099001 Client Name Gamess Engineering Group, Ltd. Project Nlme/N 6710 Teshlar Client Sample ID 6710 Teshlar Matrix Drinking Water Printed Date/rime 01/16/2009 13:26 Collected Date/time 01/08/2009 15:00 Received DatelTime 01/0812009 15:30 Technical Director Stephen C. Fade Sample Remarks: Allossable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic 7.29 5.00 ug/L GP200.8 C (<10) 01/12/09 01/13/09 SCL Waters Department Total Nitmic/Nitritc-N ND 0.100 mg/L 511204500NO3-F D (<10) 01/15/09 JDZ Microbiology Laboratory Colony Count 0 col/100m1. SM20 9222O A (<200) 01/08/09 DLC Total Coliform 0 col/100mL SM209222B A (<I) 01/0V09 DLC Fecal Coliform 0 eoUl00mL SM2092226 A (<0 01/08/09 DLC I- 1 _ • MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services cam On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 014-061-52 Aj HAA # iA CVqSr 1. GENERAL INFORMATION Complete legal description Lot 5; Block 1; Darn Village Subdivision Location (site address or directions) 6710 Teshl.ar Circle Anchorage, AK Property owner Mailing address Lending agency Stan Niziol Day phone Day phone Mailing address Agent Ynt•hv rn-nanAa7/Prm1-r1-i s11 Vi g}A Day phone 441-9000 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \° 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02S (Rw.1/91) Front MOA R21 5. 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 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 all Municipal and State codes, ordinances, and regLj1dt WrWR%� % t j inspection. Consultants, Inc. Phone 3:13-7- 617 r'I Name of Firm .�, _ Address Engineer's signature ALASKA WATER & WASTEWATER CONSULTANTS IS TO BE PAID $906.25 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE Approved for Disapproved. -� bedrooms. Conditional approval for Additional Comments By: auTlr Date `)//y/w,5 OF t raffre A. Ga n� ess /' :7953 ��3��pR0;.ESSI�NA�+ bedrooms, with the following stipulations: Date 9-29-98 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 DHHS does this as a courtesyto purchasers of homes and theirlending institutions in order to satisfy certain federal and 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. 72-M (Rev. W) Beck MOA 121 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES C L t j v E Environmental Services Division ��1' �3;,��4 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3�Z 1 Health Authority Approval Checklist MUNICIPALIIV OF AWHVXAGE Legal Description: L-� 5 g 14 1 >�4�•t � VI L� EIWIRONh�EWAL SERVICES DIV131014 � ,Paroel I.D.: A. WELL DATA Well type PVT, It A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Date completed 4/25 /77 Total depth �!�o Cased to %b Casing height (above ground) Sanitary seal (YM) Date of test Static water level Well production NEES FROM WELL LOG 4 A51-1 7 381 12 214 - Wires properly protected (Ym) \ice AT INSPECTI N 9(d96 Z3 g.p.m. 4 7,1B g.p.m. f -a L- 4- Nkkrr. OnANJDvvw WATER SAMPLE RESULTS: OF- t s " Coliform Nitrate �► _ Other bacteria 1 Date of sample:I i L9 g Collected by: AtA-SleA %-�1 l r �1dPeG'2- B.tSMC/HOLDING TANK DATA Date instal Tank size--, Number of Compartments Foundation cleanout Depression (Y/N) High water alarm Date of Pumping C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area Date of adequacy test Soil rating Tube present (Y/N) Results (Pass/Fail) Cleanouts _ System type Total depth esssion over field (YM) For Fluid depth In absorpKn field before test (in.); Immediately after_ gal. water eaftdd (in.): Fluid dept (Ins) Minutes later. Absorption rate = treatment (past 12 months) (Y/N) 72-026 (Rev. 3196)• If yes, give date Q Date installed Manhole/Access (Y/N) High water alar 1eyAl Size in level at* "Pump off' level at` 'Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1-3 tA- On adjacent lots tco 4 - Absorption field on lot N1A On adjacent lots 100 E + s'n�w7� g 3 60 `APvI�X. Fno-� FO Public sewer main � 3$'� Public sewer manhole/cleanoutwg� 't -o t5.06f+ OF LE Sewer Sewer /septic service line Lift station N DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Water main/service line SEPARATION DISTANCE FROM Property line Surface water F. ENGINEER'S CERTIFICATION I certify that I in conforrnan Signature Engineer's Name Date $ Property line hj&Wce water/drainage TO: Abs=on field �Qfeadjacent lots Water main/service line Driveway, parking/vehicle Stora Wells on adjacent lots spectfons and review of Municipal re o�+f'y�4ttQhd A% kms are in effect on this date. . i y,•i-� /? % 10 HAA Fee $ Date of Payment a Receipt Number O 72-026 (Rev. 3/96)• Waiver Fee $ Date of Payment Receipt Number f •� C 993 �,ti� ROFESSION i n ME Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Parameter 984965001 AK Water & Wastewater Consultants Inc. N/A Lot 5 Blk 1 Dawn Village Drinking Water n Client PO# Printed Date/Time 09/08/98 09:05 Collected Date/Time 09/01/98 05:20 Received Date/Time 09/02/98 13:00 Technical Director: Stephen C. Ede Released By Results POL Units Method Allowable Prep Analysis Limits Date Date Init Total Coliform 0 col/100mL SM18 92228 09/02/98 KAP Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 10 max 09/02/98 09/02/98 GCP 1�Iunicipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mysrrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.anchorage.ak.us September 29, 1998 Jeff Garness, P.E. Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle Anchorage, AK 99504 Subject: Waiver Request for Dawn Village, Block 1, Lot 5 Waiver Request #WR980065 Parcel ID #014 06152 Health Authority 4HA980301 Dear Mr. Garness: Your request for a waiver of the required 50 feet horizontal separation from the public sewer trunk to private well has been approved. The approved separation distance is 38.0 feet. This waiver approval applies to the existing public sewer trunk to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 3434744. Sincerely, Daniel J. Rot Civil Engineer On -Site Water Quality Program ` MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet i WR# ( I )Qoiq,(7�I`PID# 014-061-52 HA# Permit # Date Received: September 28, 1998 Legal Description: Lot 5 Block 1 Dawn Village Subdivision Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Services 7320 East Chester Heights Circle, Anchorage, Alaska 99504 Applicant: Stanislaw 7 Barbara Niziol Waiver Requested:private well to public sewer main of 38 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation i i I i I �l / wovilER REQUEST FOX LOT S' QLOCK / DAW41 VILL/*GE Su WIgivEI? REQutsT NUMBER WR990065" WAIVr,R RFQNESr FOR ON -LOT WEL4 TO comlim try SEWER LINE OF 38 FEET wELt 1 SEWER LINE L%14TA— r14E Su@T6CT ►SELL wlQs 2f� /97% T'NE 5rua,TECrfEkv6R LINE IVA$ /A/ PLACE Ar THE T/.uE (ONJTIQw rsv /A/ rmt Summvje OF 197(,. rmE /4)rv.4 1J RELATI✓aty fL/gT a•ITHO THE' fvELL LOGI*rE0 W6fr OF 7we SEw6R LINE AocxriA+6 IT P01✓A✓ 61?*9G/EA✓T HYPI(A ,L/c/4LLY. (,0JUAA/A16 THE vvEKALL HYORAk[I[ pt.Owoc PE6/ wAT6R Agrr� /s tROµ 7t[E CK46A4CH AlTu! fOwl►ROJ TKE /NL6T. TwE �Oc�T�v�v o>: TKi SkQO/✓�JIOa /s R7 T1K� t00 i OF TKa Nlttrlve. TKlR! NRt bwwtRfKf WP -LL tObS fOR TKE f,4*.racr. Lor 9APO 04440aIv0/06 LOTS. Att rAt westc L,*bS lA/n/C*it .4 tvArgK ON -4011019 NORIPOR AT /4PP1t#xtAtpT/sLY 7Sr'* TO VrPsEr. TN6RE ARE ANUAuBAOu1 L.AYOR3 Ott DENSE f/L T 6RRVE1 " SAAiD L/4y6)Qf.. /µNA C'L*Y L.,QyCRs ' /lETt.6EN T111r 6ROww0 SuRFACf Aa0 r'tE JK0v,°LYdAo6 j,&Ar jc TD T,t(Is WELL. wA7c)q S#MPL65 INDIL147E rKAT NO P/KTiRIA RRE I0RES6N7' Al7V *ITRA.'.ff ARE uwOET�trI4Pi�. S, of A. ;G. for S, C. R. O. - JVD/NT S WATER rooLE 7.7 .. 4r $3 -. N0R/ZON7AL SE/Dp�/1.T/oH i 38 2r= /s x =n+.� !s / 60NC(.14 f /o.v Gn#Nr w14'IVER V SOIL SORBT/ON NNN H H H W W W V1 h Yf 2� i•�t���>6 ' 3.¢ goo ►tva V -1 PT lV N Cl N h h PERM �AOi� �rY f� W14Mt 69"'For sr N0R/ZON7AL SE/Dp�/1.T/oH i 38 2r= /s x =n+.� !s / 60NC(.14 f /o.v Gn#Nr w14'IVER V Alaska Water & Wastewater Consultants , Inc. 7320 East Chester Heights Drive — Anchorage -- Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 . Consulting Engineers September 25, 1998 SEP 28 Municipality of Anchorage Department of Health and Human Services . P.O. Box 196650 Anchorage, Alaska 99519 Attn.: Dan Roth ENVI►K)N AYALURVICE$01V191UN Reference: Dawn Village Subdivision, Lot 5, Block 1. Waiver of separation distance between the well serving the reference property and the public sewer main. Dear Mr. Roth: The referenced property has a 3 bedroom house, and is served by a private well and by public sewer. Records from your department indicate that the well was permitted and drilled in April 1977. Per Anchorage Water & Wastewater Utility (AWWU) records, the public sewer was installed in 1976, prior to the existence of the well. Based on our field measurements, and AWWU drawings, it appears that the well is approximately 80 feet from the manhole and approximately 38 feet from the sewer main. The required separation distance requirements in 1976, between a private well and a sewer main/clean-out was only 50 feet. We are requesting that your department waive the subject separation distance to 38 feet. Justification for the waiver is summarized as follows: 1) The existing encroachment has existed for 21 years with no adverse impact to the aquifer. Recent water samples indicated no bacteria are present and nitrate levels of 0.1 mg/1(see attached water analysis by CT & E Environmental Services). 2.) The driller's log for the referenced well indicates that the aquifer is confined by several clay and clay/gravel soil stratas (42-54 feet, and 59-68 feet). These confining layers act as a protective barrier between the sewer main and the aquifer. Based upon the facts, it appears that there is minimal risk in granting the subject waiver. If you require any additional iliformation for your review please contact me at 337-6179. M.S. I(s-e o`-tmb q -VSs -U- �)U. OU Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle — Anchorage — Alaska 99504 Phone (907) 337-6179 —Fax (907) 338-3246 September 19, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well at Lot 5, Bk 1, Dawn Village. 6710 Teshlar To whom it may concern: The subject lot has a 3 bedroom house on it which is served by a private well and public sewer. The results of the field investigation and adequacy tests are summarized as follows: The static water level in the well was measured on 9/8/98 to be 23 feet below the top of the casing (BTC). Over a period of 4 hours, 1027 gallons was pumped, which corresponds to a flow rate of 4.28 gallons per minute. The maximum drawdown was 18 feet (to 41 feet BTC). Based upon our test results, it was determined that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (.31 gallons per minute), and FHA requirements, in that it will produce 3 gallons per minute for at least 4 hours. It is important to note that seasonal fluctuations in the well flow may occur, and that future performance is not guaranteed. According to Anchorage Water & Wastewater Utility (AWWU) records, public sewer was installed in 1976. The connect card at AWWU indicates that the service line was inspected on 10/8/76. According to DHHS file records, the well was drilled on 4/25/77, which post dates the installation of the sewer lines. In that era there was no required separation distance from a sewer service line to a well, and the required separation distance to a sewer main/clean-out was only 50 feet. Based upon our field measurements, and the AWWU drawings, it appears that well is approximately 80 feet from the manhole, but only about 38 feet from the sewer main. A HAA was applied for on May 4, 1977 and granted by DHHS. Please provide direction from your department. If you have any questigj} l please contact me at 337-6179. Thank you for your assistance. 0 _ 0' ,Oz'oz .guo.00 s R= ACEIMMA _ 1 _ 4XV13SV3 kinin ,ot 1 1 1 'I 0 I Ln dA a°o 5 M, ` 1 W W c a) r '•I O 0 0 _ 0' ,Oz'oz .guo.00 s R= ACEIMMA _ 1 _ 4XV13SV3 kinin ,ot 1 1 1 'I 0 I Ln dA � 1 W W rs: :r r O r r O N) 00 0 04-- ,rA )+ I R. 11.4 11.4 V6 -N- it JAE ...... ------ Indicate North W DK APPROVED -4- o O X 0 40 0 DK APPROVED -4- 40 XJ. 71 Z (A Cl) r- CA 2 CA E. cr to rn a x ci (D rn O —.0-0 0 0 .0 o a 0CD 139 0 0 z n - z MO %Cz 0 CD 0 r 10 z 0 > 10. 0 0--a CID 0 0 M c 0.0 o CL CIS < 0 — cx = (D 0 0 0 0% cn to (in) 6�m ITI n 0 > z 0 [CA C-) 10 4 0 M r 9 C) 10 rn 7` 0 > 1 C) 0 at 74 cn CD 0 r> rn :E "N )Z�m (.1 (n r - U) C/) rn CA) 40 0 C cl > 0 Cl) C) -C 'n rn CD z 21 z x N0. (ngn o c Q0 O z CL0 > o th S'0> 0 " CDN. CD 0 0 W XJ. 71 y,. 5. LEGAL DESCRIPTION DATE RECEIVED do .. - INSPECTION APPOINTMENTS TIME TIME TIME MR LnL; NUMBER OF,8EDR OMS 1 C IC'SI 1�• * r DATE DATE .— DATE Three ❑ Six 7. WATER S PPLY A INSPECTOR INSPECTOR INSPECTOR since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY 1 / 111�.I'�WALJiT OF ANCHORAGE MUNICIPALITY OF ANCHORAGE OF HEALTH & Fuv`�DEPT. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC7t6WONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 OCT 2 2 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEI V_REQUEST AND SEWER FACILITIR FOR APPROVAL OF INDIVIDUAL WATER 1. be Please (10) days 6r DIRECTIONS: Complete all parts on page Incomplete requests will not processed. allow ten processing. 1. PROPERTY OWNER�— ob� , .T , SuGLI i1A PHONE MAILING ADDRESS )0, n , l6oK -4--eal -)c H PROPERTY RESIDENT (If different from above) 7/0 ?2-7sHLATz QZe AA)CH, PHONE Zi 9-33s/ 2. BUYER STiq N I S L lti O.� PHONL MAILING ADDRESS s 3. LENDING INSTITUTION HaTuALVi�v S f�Aly PHONE 27 -,zss/ MAILING ADDRESS 4. REALTOR/AGENT PH ONE MAILING ADDRESS 5. LEGAL DESCRIPTION G 7/0 TE S"L STREET LOCATION DAwiu ZSL4-ISDI'V1S16Aj 6. TYPE OF RESIDENCE MR LnL; NUMBER OF,8EDR OMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER S PPLY INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. 'PUBLIC UTIL Y NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) r- THIS SIDE FOR OFFICIAL USE ONLY ' 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FORZ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE fv —mac - �' BY 72-010 (Rev. 6/79) 0� MUNICIPALITY OF ANCHORAGE 0 DEPARTMEr"%,OF HEALTH AND ENVIRONMENI� PROTECTION 825 L Street, Anchorage, Alas,.a 99501 ' 1 279-2511, ext. 224 or 225 �d �0 Date Received: May 4, 1977 #1: Time 2:30 p.m. #2: Time #3: Time Date 5-4-77 Tues Date Date r Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Mutual Savings Bank Mailing Address: Post Office Box 1120 99510 Phone: 274-3561 2. Property Owner: Pederson Construction Mailing Address: Star Route A Box 1718X 99507 Phone: 344-8638 3. Legal Description: Lot 5 Block 1 Dawn Village Subdivision r 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: 2 5. Well System: Individual Well (x) Cor.%munity/Public System ( ) Permit # 77010 Depth of Well 76' Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System ( ) Public Utility (x) Permit # Installed Installer Septic Tank Size Absorption Area Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area MUNICIPALITY OF ANCHORAGE ,,; C1PATIT; C" tJiCllo:/.: 0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIOND_PT. C I;°?JT.i C 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 UIlI: 0, 2; FriT.u. P,.oTCCTICN - REQUEST FOR APPROVAL OF HAY 4 11Y7 INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO //�1 VA FHA CONY 2. Property Owner: (2y,&,,4,ni oa �ntticr000 c�zri• Mailing Address:Sle-l' 09tV /7/ f4"'Q b--tr4 Day Phone: 99s'e7 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: a �a� `7�Ylccc/ate •P�(� ..� Mailing Address: Q0. &Z I Io?a Phi, phone: 5. Name of Realtor or Agent: [:3 Mailing Ai Legal Descripti Location: 7. Type of Facility to be Inspected: 0L'4 �—�a Q� No. Bdrms. B. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served i If Individual, depth of well :211- 9. 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block"I Dawn Village -Subdivision Comments: Affadavit Attached: ;�,) Letter Attached: ( ) Approved: ��. Y� Date: Disapproved: Date: Department Worksheet: j x