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HomeMy WebLinkAboutDAWN VILLAGE BLK 2 LT 10 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys LOCATION OF WELL (Plaaee complete either la, lb or lc.) A.D.L. No, . /g)/~ *:~_~1 "~-'""7 Io.llBorough Subdivleioa Lot Block ih.Il ~/4dtrl. Section NO. TownehlPN[:~ Range Er] Meridian ic,jJDISTANCE AND D~ECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Addrees: Street Address end Area of Well LOCQIIoh WELL LOG Feet 8slow 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Material Type To9 Bottom 9. FINISH OF Type: ~ Diameter: / - Set between ft. and ft. ........ I ~ OF A~( ~ I0. STATIC WATER LEVEL: ~ ~ ft. //' /~Date-- ' fl. after hrs. ~umplng ~ I2.GROUTING Well Grouted: ~ Yes ~ NO Material: ~Neat Cement ~ Other: I~. PUMP: (If available} HP Le~gth of Drop Pl~e ~ fl. ca~eclty 14.REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. W~fer Temperature o ~ F ~ C Thl~ wlll~as d~illed un,Ir my Jutlldlcl[Q~ and Ibis report Is Irue lo Ihl bell of my k~owledge end belief; C I F' A L I T Y 0 F A N C H 0 F~ A G E Departmc, nt o[ Health & Human Services Street, 'Anchorage, Alaska 99~,)1 0 N - S I 'f E W E L L, P E R M I T F'e:rmit Number: 8'70291 Date l:=s~.~.d.~ · 1L]/~9/87~ Upgrade Owner. Name: HUD C/0 CORWIN ASS. Day Phone: Own~)r Address: 710 C STREET, BOX 64 54.5-4440 ANCHORAGE, AK 99502 L~'L L.e~]al: ,~u~vzszon: DAWN.VILLAGE Lot: .;10.: Bl'ock: 2 . Lot Size 11810 (sq. ft. or acres) Max ~;r~d~'ooms: This Permit: ~ Total Capacity: 3 WE:I.L: Log must be submitted to Municipality oE AnchoragE? Department oI Health and Human SE:.rvic~:?s within 30 days oE w~ll completion. INSTALL IN PREDESIGNATED LOCATIOIq (SEE SITE PLAN) HAXIMIZE SEF'ARATION TO MANHOLES. GROU'f WELl_ TO A MINIMLIM OF~ ~0 FEET. ENGINEER MUST INSPECT WELL INSTALLA[ION. DOCIJHIZNT' ENGINEER INSPECTION ON WELL LOG. I CERTIFY THAI: 1. I am familiar with the requirements l'or on-site sew(~rs 'and wells as set ~orth by the Municipality of Anchorage (MOA) and the State o¢ Alaska. 2. I will install the system in accordance with all MOA codes and regul~ations, and in compliance with the 'design criteria of this permit. 3. I will. adhere to all MOA and State of Alaska requirements for the set back di. stanc:6~s from any existing well, wastewater disposal sysEem or public sewerage., system on this or any ~djacent or mear'by lot. 4. I i.indersta~ that tf~is permit is valid for a maximum o¢ 0 bedroom~. I also undeCs/_and tha~ the capacity of the total system is 3 bedrooms and any enl. ap/:~r~lent wilCO, quire an additi, onal p~rmit. SJ rinod: ~ . D~I'E -. _ ........................................ j_~j~ ........ / unicip ' tYof Anchorage P.O. BC~ 96650 ANCHOHAGE, ALASKA 99519-6650 (907) 343-4200 TONY KNOWLES. ' MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES October 29, 1987 Bruce J. Corwin, P.E. Corwtn & Associates, Inc. 12001 Industry Way, Suite 11 Anchorage, Alaska 99515 Subject: Lot 10 Block 2 Dawn Subdivision Waiver Request WR87-06§ Dear Mr. Corwin: This department has considered your request for a permanent waiver of the required sewer-to-well separation distance. The 33 foot separation existing between the well on the subject lot and the sewer line was given a temporary waiver by ADEC in 1985. This waiver will expire in May of 1988. The expectation was that public water would be available before the waiver expired. Because it is apparent that public water will not be available by May 1988, you have requested that a permanent waiver be issued for the well on the subject property. /%DEC has established a consistent policy regarding well-to-sewer setbacks in Dawn Subdivision. This policy is to require "upgrade to code" if public water could not be provided within three years of issuance of the temporary waiver. Normally upgrade to code would require that a new well be constructed to meet the required present day setbacks.:o~-75 feet to the sewer line and 100 feet to sewer maruholes. Given the fact that the subject lot is surrounded on three sides by public sewer making it impossible to meet these present day setbacks, it seems reasonable to waive these requirements down to the 50 foot setback required at the time of the original well and sewer line installation. This waiver to 50 feet is contingent upon grouting the new well to a minimum of 20 feet and properly abandoning the existing well.' The weld installation must be inspected by a registered civil engineer to insure that the well has been constructed to these specifications. Sincerely, Stephen S. Morris ' Civil Engineer On-site Services cc Gus Andress, P.E. Manager, On-site and Water Quality Programs Consulting Engineers 12001 Industry Way · Bldg. B · Suite Eleven · Anchorage, Alaska 99515 · (907) 345-4440 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & October 26, 1987 ENVIRONMENTAL pRoTECTION Ms. Susan Oswalt On-Site Services Municipality of Anchorage Department of Health & Human Services 825 L Street, 5th Floor Anchorage, Alaska 99501 OC, T 2 6 RECEIVED SUBJECT: WAIVER REQUEST - WELL TO MUNICIPAL SEWER LOT 10, BLOCK 2, DAWN VIT~GE SUBDIVISION Dear Ms. Oswalt: As discussed with you by telephone today, we are applying for a waiver for the separation distances between the well on the subject property and the Municipal sewer system. A waiver is currently in force and was granted by the Alaska Department of Environmental Conservation (A.D.E.C.) on May 31, 1985. This permit will expire on May 31, 1988 and our request is that a permanent waiver be issued on the subject until such time as the public water system is extended to this property at a date uncertain. Our concern with being able to satisfy the conditions of the original 1985 waiver request have led us to request that a new waiver be issued prior to the expiration of the current waiver. We hope to demonstrate within this correspondence that there is no logical solution to the problem which could be solved by May 1988 except for the continuation of the waiver as currently in force. We do hope you will review this matter in a cooperative vain and urge your understanding of the critical situation created when the sewer was installed. Current Distances Requiring Waiver The well on the subject property is located 33 feet from the nearest public sewer line and 68 feet from the nearest public sewer manhole. The distance to other manholes near the property is over 100 feet and the distance to a drainage ditch on the property is over 100 feet. This information is contained on the files of your department and was field verified in October of this year. Well Vs. Sewer Construction Throughout the Anchorage area, sewer lines have been installed in subdivisions served by wells and separation distances were not provided adequately to meet the current separation distances in force today. In the subject case, a sewer line Ms. Oswalt ~ctober 26, 1987 · Page 2 was installed in the main street (Teshlar Drive), along the east property line and along the north property line. After investigation of possible solutions, it can be readily seen that there is no location on the subject property to place a new well to meet the current separation distances required. The original well was built under Municipal permit dated 1/18/77. The well is cased for the total depth of 90 feet and the sewer line is installed approximately 9 feet deep. Static water level measured in the well on 10/16/87 was 24 feet. The sewer was constructed utilizing standard methods and procedureswi=hout protective features to protect neighboring wells. SOILS/GEOLOGY AND CONTAMINATION POSSIBILITIES The well log displays tight sand and gravel from 0 to 39 feet, sandy clay and gravel interbedded from 39 to 80 feet and water bearing gravel (assumed) to 90 feet. In te~ms of contamination possibility, one must first look at ground slope. Generally, the subject property is flat with a slight slope to the north. Next, the sewer line is installed approximately nine (9) feet deep and any probable contamination would travel to the well aquifer through approximately 70 feet of sandy gravel material. Static water level in 1977 was '21 feet and presently at 24 feet of sandy gravel to reach the static level. We doubt that the real aquifer is any higher than 80 feet and contamination vertically would be highly improbable given the high quality of treatment in sandy gravel material. The final contamination possibility would be for the sewage to move out of the sewer line or manhole horizontally, 33 feet minimum, to travel down the well casing and .into the acquifer. Even this occurrence would be highly unlikely as we would expect a combination movement both vertical and horizontal, not just horizontal. The level of treatment obtained by the time it reached the well casing should be substantial. To prevent the possibility of horizontal contamination, A.D.E.C. has allowed the use of grout on the exterior of the casing to 20 ft. +/- below the surface. While this may prevent downward movement along the casing, we do not believe it is needed in this case, but it could be provided. Ms. Oswalt October 26, 1987 · Page 3 POSSIBILITY OF PUBLIC WATER The waiver issued by A.D.E.C. in May 1985 required that a request for a W.I.D. be initiated. Dawn Village residents voted on a W.I.D. in the summer of 1986 with only a 12% positive vote. Over 70% voted to defect the issue, basically because because the cost per residence was an average of $10,000 to $12,000 per lot. In the case of the subject property, the assessment would have been $13,236.00. Since the street is only about 500 feet long, and 18 lots are served off the property; an assessment of $12,000 per lot would provide a total of $216,000.00 for waterline construction. This would equate to nearly $432.00 per foot of construction cost. Perhaps $50 to $75 per foot would be more reasonable and the total cost would be closer to $25,000 to $37,500 or an average of $2,100.00 per lot. In any case, we believe a new W.I.D. request with a lower cost may be warranted. RECOMMENDATION We recommend that a waiver be issued to the Municipal Sewer as follows: · 33 feet to sewer line · 68 feet to manhole We feel the waiver should be issued until such time as Municipal water can be brought to the property. We also feel that there is reasonable protection of the well without the grouting as discussed, but this could be provided only if you deem it necessary. Since the issuance of this waiver has effect on the sale of this property, we request your immediate consideration. Should you have any questions, please let us know. Very Truly Yours, Ass AT ,s, · Bruc~_~._ Corwin, P.E. ' Pre,dent BJc:jn P~DERSON CONSTRUCTION, INC. t. OWNER Domestic Well, 6" SUBSURFACE EXPLORATION Shift Report of Operations Dawn Su~xiiviston, Lot 10, Block 2 ~rES~I~N ~STATF~ ASSOCA~ES 22W TO Herb Johnson TIME DISTRIBUTION HOURS RIG HOURS CASING LOG 1 10'6 2 17'1" 3 24 ' 10" ~ 32 ' 6" 5 39'10" 6 h8'3" 7 8 9 67,½,' 10 11 12 ,o. SOILS LOG. DEPTHS t'IATERIALS AND REMARKS Tight sand grmvel 3andy clay and g-z~vel inter~dded Water bearing, 12 gallon per minute. Water level21 feet from surface Water levels 21feet. 12 gpm production. DRILLER INSPECTOR PERMIT NO. I',ILII'.I I m~_. ]~ :F-IL I T'~-' OF I--INCI-~"~')Ri;IGF- DEPARTHENT OF HEALTH AND ENVIRONHENTAL PROTECTION 2516 E. TUDOR RD,, ANCHORAGE, AK. 99507 276-2221 ~ELL PERI"1 I ~' 77021 ) APPLICANT LOCATION LEGAL .PETER.SON CONSTRUCT I ON.. TESHCRR ST L10 B2 DANN VILLAGE LOT SIZE 344-8638 IO000 SQUARE FEET HINIMUH DIST6NCE BETWEEN A I,IELL AND 8NY ON-SITE SEPIA(]E DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE NELL OR 200 FEET FOR A PUBLIC NELL NELL LOGS ARE REQUIRED AND MU-~T BE RETURNED TO THE DEPRRTHENT I,IITHIN 30 DAYS OF THE NELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIRGRAHS ARE AVAILABLE TO INSURE PROPER I NSTAL[.RT I ON. PERi'"I I T VRL I D FOF~ ONE YERR I='ROI'~ I$$UE I CERTIFY THAT l: I Afl FAHILIAR NITH THE REOUIREHENTS FOP, ON-SITE SENERS AND I.IELLS AS SET FORTH BY THE HU)mIICIPALITY OF ANCHORAGE. 2: I I.IILL INSTALL THE SYSTEM IN ACCORDANCE NITH THE CODES. APPL I C~NT PEI'ERSEIN ~ CONSTRUCT I ON . . '--, .-'t'"~- S 89°57'20"E ? - IO'UTIUTY -., EASEMEN ? PT ? LCT I 10,71DS SQ Irt 152.13 5 ICX2~O $: rt. : 39~o~ ~-- [AFC 9,491 SOrt e, 0 3 ; 8,994 SQ. FT I 9,41G SQ F'T. ! ~'7. WEST :~29 76 __ ~1)19 08 (meos) ~ERRY ~EGEND "' Set this ~r;~ ~n~ ~Crlptl~ 5/8 x30 R~bar w/ Alum cap set flush w/print · ..r. PrOper hcrl 5/8"x 3d' Reb~ USK Mort. 3"x ~'l Alum Cap 32986 8 7 · ,994 SO Ir/'. 7.?~0 SO ,5'60' ~ 5 EAST "-[ I ROAD UTILITY EASEUENT PC SEE $-S2S4 SURVEYOR'S CERTIFICAT I,. ?-RL D ~K .O~YNTA plat of sentotloa of lands actually shown oorrectly and lhat all monurr'~nts and lot corners. 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. # L"~1~4 -/"~r~t - L[~ 1. GENERAL INFORMATION Complete legal description e e Location (site address or directions) Property owner Mailing address Lending agency Mailing address Ma~k G~ucnbu~ P.O. Box 520495 ' 3330 A~ctlc B~ud. B~g Laker AK Monte HuffmanDay phone Anchorage , AK 99503 Day phone 99652 561-5122 Agent AAR INVESTI~ENTS - Linda Ga~L~.6on" Address 401 E. No/t:the~cn LJ. qht6 B~ud., Su.~t~ 212 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 'N TYPE OF WATER SUPPLY: NOTE: Day phone 277-5446 Ancho~z~ge, AK Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system, If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site 'Public sewer NOTE: 72-025 (Rev. 1/91) Frof~t ' MOA #21 SlUaLULUO0 leUO!l!ppv :suo!lelnd!ls §U!MOIIOJ eql ql!M 'StUOOJpeq Jo,( le^oJdde leUO)l)puoo · stuooJpeq ~;~ -pa^oJddes!a JOj pa^oJddV ~ =I~IflIVNOIS SHHQ · UO)lOadsu! s!ql lo m, ep eql uo lOaJia u! suo!leln§aJ pue 'saoueu!pJO 'sapo3 elelS pue led!o!unlAl I1~ ql!M eOUe!IdLUO0 U! S! LUalS,(S lesods!p JaleMeiSeM Jo/pue ,(Iddns JaleM ei!s-uo eql 'UO!lOadsu! pue uo!le§!lSa^u!/~uJ tuoJi pue saul e§eJoqouv tuoJt pau!elqo uo!leuJJolu! eql uo p~seq leql ~J!Je^ J~qlJnt I 'u!aJaq pa)eo!pu! eJnlonJ)s jo ed,~) pue stuooJpaq ,to Jeqtunu eqlJOJ e)enbepe pue leUO!lOunj 'ei~s s! tUalS~S I~sods!p Jal~MelSeM Jo/pue Y~lddns JaleM el!S-UO eql leql SMOqS UO!leO!ldde leAoJddV ~l!Joqlnv qlleaH s!ql jo UO!1e§!lS~AU! ~uJ leql ~J!Je^ I 'MOleq UMOqS olep ua!laP)lea eql lo se pue OlaJaq paxuie lees ,{uJ Xq pa!l!lJaO sv '9 1:I:I3NION:I Ag NOI.LO:IdSNI dO .LN:IIN:I.L¥.LS 'S Municipality of Anchorage Department of Health'& Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Log present~N) Total depth ~:~.~ Sanita~'~sea (YI~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~ ;[ Casing height Wires properly protected ~N) FROM WELL LOG Date of test Static water level ~'-~' Well flow Pump level ~-') g.p.m. Driller AT INSPECTION r~ ; On adjacent lots ;On adjacent lots /~//~ Public sewer manhole/cleanout SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Petroleum tank Absorption field on lot ,/4-.'J/,~1 Public sewer main ' ~ /~O/ ~/~ Sewer service line ~--.5' ~ ' WATER SAMPLE RESULTS: Coliform ~//~~ Nitrate Date of sample: ~- ~ - ~ Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria S & S ENGINEERING. 17034 Eagle River Loop Road No, 204 Eagl~ River, Alaska 99577 "-Date installed Tank size Compartments ~__ Foundation cleanoUt (Y/N) , i High water alarm (Y/N) ~ Alarm te~N, )... ,' .-~:'.~ ', Well(s) on lot '~.~"- on a~acent ~ots t-ounaauon'--. ~.._ To Property line~ AbsOrption field Water main/service line~ ~ rainage 72-026 (Rev, 7/9~)Front CONTINUED ON BACK PAGE C. LIFT STATION /V~(.//dt(..[/'~,,~(..-  Manufacturer Size in gallons -'"'--. Manhole/Access'(Y/N) ~~t ' . i' '- ~' !'~'~'/~f'~iev~iat Vent (Y/N) . High water alarm level ""'--. ~s tested ~_ _ · Meets MOA electrical codes (Y/N) ~ Wel et ' __ _ On adjacent lots ' 'Surface water '"'.-._ ..~~t ~ 7 ( -..,. · D, ABSORPTION FIELD DATA /'V[O/~)l~--.t'/~(-- ._~'~(./,J~'//'~ - '' TotA'l ab~o'rp~ .- · Depression ov~r-field (Y/N) '"-.. Soil rating System type Gravel thicknes;, ,'_" Cleanouts p~/N). ~e,-ofad~equaCy test .-.""for' Results (pass/fail) Per(~ide treatment (past 12 months) (Y/N) If yes, give date Well on lot _,,"" On adjacent lots ' "-..P..roperty line To building fou~ To existing or abandoned ~ On adjace.,,~,[et's Cutbank ~Wate. r main./service line '"-.._ Sudac.e4vater .-- ~ ~ Driveway, parking/vehicle storage area '"--. E. ENGINEER'S CERTIFICATION ~ '.'. I certify that I have checked, verified, or co all MOA and HAA guidelines in affection the date of this inspection. bedrooms HAA Fee $ / '~, Z~ Date of Payment ,~"-'"//~ Receipt Number Waiver Fee: $ Date of Pay::ent Receipt Number 72-026 (Rev. 3/91) Back MOA 21 ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO i ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~,f~L' ~'-. Iq,~'"7 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) J..~T' I~ . FI_Il-. ~.. ]~i4~JIt/ I?I/--/_..~G~" Location (address_~,,,~ ~"~ ~,../°r directi~ons)/~;~,~,,) ~¢~'/"' (b) Applicant Name ~"/~/~r~//'~ Telephone: Home ,~1~-.~'~..4:)c~' Business Applicant Address ~"~'/ ~,~A ~'"~'r- ~"~.~:;;~ "7 (C) Applicant is (check one): Lending h~stitution I-I; Owner/builderl-I; Buyer[~; Other ~'~explain);~_ (d) Lending Institution Address (e) Real Estate Companyand Agent Address Telephone (f) Mail the HAA to the f_~oIIowing address: ' Telephone 2. TYPE OF RESIDENCE/, Si'*.ngl.e-Family~ :Multi-Family [] Other · N, umber of Be'dr*ooms "/~ .- :7, .:.:i 3. WATER SUPPLY ; Individual We I"J~_., Community [] Public [] . '%. Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72.025 {11184) DA,*"""3A N D ENGINE~ERING FIRM PROVlDIN'. '~SPECTIONS, TESTS, FILE SEARCH, INFORMATION 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 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 regulations in effect on the date of this inspection. Nameo, Firm ~ Date "7 / I DHEP : Terms of Conditional Approval ":" '" ' ' ' ' :' ' ":""' - - '- CAUTION ....... " ' ' .......... The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issue~ H~alth Auth(~;'Jty' '.;-: Approval certificates based ~olely upon the representations given In paragraph 5 above by an independent professi.on.a!. ~.~i.~. engineer registered in the State of Alaska. The DHEP ooes this as a courtesy to purchasers of homes and their lending '~.:" institutions in order to satisfy certain federal and state requirements· Employees of DHEP 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. Page 2 of 2 72-02~ (11/84) Bo DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV ,5 1987 WELL DATA RECEIVED Well Classification MUNICIPALITY OF ANCHORAGE (MO,,/ HEALTH AUTHORITY APPROVAL (HAA) MUNIoPAUTY OF ANO. IOEaZ~CHECKLiST . FEBRUARY 1984 264-4720 Legal Description: L. oT Y Well Log Present (Y/N) Total Depth ~ Cased to Static Water Level ~-,-,'5"t Casing Height Above Ground ~.,4: Electrical Wirir{g in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '7~) ! / Cleanout/Manhole //' ~,~ Water Sample Collected by ~/'c~/ Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed ~/ 5". [q~"7 Yield Depth of Grouting ,c~ / Pump Set At '70 ~ Sanitary seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date ;:>/0 / Comments SEPTIC/HOLDINGTANKDATA~ PU~L.,,[ C ~"~~ Date Insta~ Size No. of Compartments Standpipes (% Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over'l~k (Y/N) .... Date Last Pumped ~ Pumping/Maintenan~tract on File (Y/N) _ ~ ~; for __ Holding Tank High-Water A'I~Y/N) ~__ Temporary Holding Tank Permit (Y/N) Separat'~ces from SepticTt~ng Tank: To Water-Supply Well '",,. ~ To Building Foundation .... ~ ~,p~;e~rtMYa~Lrvice Li ne ~'~)"~ ~'- T° Disp°sal Fie~o ~ p-~nd, L~ke, ~)r Major Drainage Cour. Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA ting in Major Drainage Course Area, or Vehicle Storage Area Absorption Strata Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service To S To Comm~ Type of System Design Length of Field . Depth of Field ~ Gravel Bed Thickness [Y/N) Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Date Ins~d Size in "H~; ~ ~aOt~; ~ar Im~eve, at Tested for Electrical Codes Dimensions __ Manh ~ Off" Level at Vent (WN) Pumping Cycles during Adequacy Test. Meets MOA Comments °* Check I certif Signed Corn Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 3m Rating Against HAA Request ** . HAA guidelines in effect on the date of this inspection. ~°~ I o · .7oi W,O NO. ~ I F.~. NO. AS WI~IL I i I I I I I I I I I I I I I I I I SH££rNO. I o~ I / hereby ce,t/fy /hot an accurate survey of the fo//o~/ng described property. was made on //1t£/P7 and that the improcements situated thereon ore within the property lines and do not over/aR or encroach on ~e p~op~rty ly~g od]ac~t the~, t~t no 1m~ov~m~n~ p~perty /y/no adjacent ~ereto enrich on the premiss in ~e~tlon and visible a~ements ~ said proper~ ~ca~t /nd~c~fed hereon. COHWIN 8 ~OCIATES /~00/ INOUSVRY WAY B~DG. B, SU/~ H f907) 34~- 4440 '- '** ' ' ~ MUNICIPALITY.OF ANCHORAGE "' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION · ' ' ': DIVISION OF ENVIRONMENTAL HEALTH ~ ...... --..:: . . _ ._ OF ON-SITE SEWER AND WATER FACILITY .... -.....: ...... .:, Application Date 1. GENERALINFORMATION~':-,.'*,.,:.,: .; .~'",. ',,* ~ ..'.- . ~ . ..'.; ~.~',,,. :' (a) Legal Description (include lot, block, subdivision, section, to~ship, range)_' . :':' ;:~ ~ (c) ~ Applicant is*(che¢~ne)[ Lendin~ Institution ~; Owner/build? ~; Buyer ther plato); * ;(d) , Lending institution · .... ' ...... ~ ............. ' .............. Telephone ~ : ,.,,. .... (e) 'Rea ~tateCompanyandAgent~ · /~ ~ : · ~ ,'..~ :~ :-. , ' · ~.. ................ ........ ........ - :2 ........... "-~'.' ~'" ~ --' .*':' :* "."~:*; ':' . '..' ... Ons~te ~ .: :; Pubhc ~ ::. Commumty ~.::-~o~o~ng Tank ~ .~ :~.~;~:::..~-:;::: ,,'; :. :: ,.: ....:, . ,. :; .-:::..:.:. ...... ,. ::. ,.:.; :::. , : . · '- · Note: If cO~munity'w~ll sYstem,'must have Written cOnfirmation from the State Depa~me~t of Environmental Conse~ation -'. 5. ' ENGINEERING FIRM PROVIDINL ;SPECTIONS, TESTS, FILE SEARCH, DA', AND INFORMATION 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 shows that the on-site water supply,~nd/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 regulations in effect on Date ; ,,,.,,,-;,..~.,.~..~ ..... .,,., ,..;..; :.~-~ . .~.,., .... ,, . ..,,..~,!. ,...,.,,.,, ,..,~.,~.r,:.,....,..- ........-., ,.~, .,. ..... , ~ ~ ,,.~ .... , ,. ,,,.... ,~ ...p_ :-: ...... '.-'~ -: ,..,:-:~. . '. : ...... :. . · ~. ~.~;:,.~...~ ; .:.' : .- .,. .,.". -. . , .- . ...... : . .... :-..~i.~';,~':::,, ....- :-:- .... ' .... "-" .."'."'" ":;'- · ' '~'.',"-"'-' ' '~ ""." "- ...... ~": -' :'- ..... · :.,...-: ~,, :~.:..~.,.':~, ?-:,..:,~ ,.. .... .,-.. ,.:.,~ ,.-. :. ..~.....-,.. ~ .. -.,;.~...~.~....,,. ,,:~..-.....:,~.': .:,,',:.::; :,.~. ,~-.,..,.., ~:~:....: .!.:., ..~-, :....,..:,.. :?........~. ;: -... .' . :;.':-'"'-Approved for; ?,)bedrooms by.~ ~'~ 'Da e '.::., .... ~ !.,,'.~ · ~'~?.'.£:~:-i~;- --; '--~/~.~"' ~. ,'-."~:~:,;~ -","~', '- .;-' ,. ~"(,/~-~,";:;~.L. :. :.~...~, .~'..:-?,, .,', .~ '-,~ :~...:~-- '; ~, ','..: J:-, :.:',;!,~:~.., '~.'~., ;:,:~,.r;,~ ,: ~ :.;,~' :.,,,...,,-,. ' ":': ,,":Terms or L;ondifional Approval · ' '----' ...... ----,' "' ....... ; ..~.~' · " :~Th~'Mdncipality of Anchorage Department of Health and finvironmental Protection (DHEP) i~ues Health Authority Approval certificates based solely upon the representations given in paragraph $ above by an independent profe~siona~ ./~' engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state ~equirements. Em ployees of DHEP 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. Page 2 of 2 72-025 (11/84) A. WELL DATA MUNICIPAUTY OF ANCHORAGE (MO~I' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~.~,7"' Well Classification [C~r'; ~/c~ ~ Well Log Present (Y/N) Y Total Depth (~)) Cased to ~) ! Static Water Level ~, 4 ~ Casing Height Above Ground ~{~) Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~ ~ If A. B. C. D.E.C. Approved (WN) Date Completed /¢~ '7'7 o~ Iq"/' Depth of Grouting Pump ~t At ~nitary ~al on Casing (Y/N) Depre~ion Around Wellhead (WN) ; On Adjoining Lots J,.l~ · On Adjoining Lots / ' To Nearest Public Sewer To Nearest sewer service Line on Lot O Water Sample Collected by Water Sample Test Results Comments Date Installed Size No, of Compartments '~ Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Clean~ Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~ . f..,-,"~'or ~ Holding Tank High-Water Alarm (Y/N) .. ~ Temp~q~ing Tank Permit (Y/N) separation Distances from septic/Holding Tank: ~--""~ ' To Water-Supply Well ~.--'~ / To Building Foundation To Property Line .~' To Disposal Field To Water Main/service Line,~ To Stream. Pond. Lake. or Major Drainage Course J' Comments J Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Width of Field ~ ,J Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field Depth of Field Gravel Bed Thickness / __ Standpipes'Present (Y/N) .~ Adoquacy Test ~ To Property Line To Water-Supply Well To Building Foundation / To Existing or Abandoned System on Lot / ; On Adjoining Lots To Water Main/Service Line / To Cutbank present) To Stream/Pond/Lake/o~jor Drainage Course To Driveway, Park'.~,g"Area, or Vehicle Storage Area Comments LIFT STATI(~N Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments k.Jaflhole/Access (Y/N) s during Adequacy Test. Meets MOA Signed ~ Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Beg~room Rating Against HAA Request ~Y~e,c h.~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. /_ //~-/// C/ ' ~ Date ~"~ CHEMICAL & GEOLOGICAL LABoRAIORIES OF AIASKA, INC. ~,,~..~~. 5633B STREET ANCHORAGFEDERALE, ALASKATAx ID #g9592-004044018 TELEPHONE (907) 562-2343 Client b-~-pl ID: LIO, ~2 DA~t VILLAGE $,,~le £ec'd : OCT 16 87 Ordered By Se. nd £eports To: CO~'I~ & ASS(DC 1~0 II;DOb-'II~¥ WAY, BLISG B, ~11 AI~CHD~,C-Z, AK. 99515 ~crk Crd~r b~. Client Acc~Jnt ~ ~glIIP D4te ~epo~t ?rintea: 0~I 20 87 g 11:26 ' ~eleased Bt : 2~/,~'~ Repcrts Mck~ess )2 Special Instruct: Ch.~l~ ~ef (~ ~6B Lab S~t ID: I Matrix~ Water Allo~able Par&meter lested ~e~Jlt/Ustts Method Limits I~ITRAT~-H N~(O.OI) mg/I 10 ~le Re;arks: I~YJTI~ S~.~.P LE A~L.~LYSIS CGCJSLETED: 10-19-87 Tests Perfcnned ~ See Spe:ial Inst~ctl~ns ~ve ~one ~tected ** See ~le Hot Anaiyzed LT~ss lhan, ~reater DEPArtMENT OF ~R.4LTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~R. iLTH AUTHORITY API~OVAL CERTIFICATE Info~-tion · Application Date (a) Legal Description(include lot, block, ~ubdivisiou, section, tovuship, range) · ~ot 10, Block 2, Dawn Village Subdivision ~catiOu (address or d~rections) . ' ,bb21Teshler Circle ~ncnorage, AK ~9507 (b) Applicants N-&e Mt eha~] ~A?eC Telephone - Home 263~0~ines"' · ApplicantsAddress 6621 Teshler Circle Anchorage, AK 99507 (c) (d) (e) .2. Applicant is (check one) LendinB Institution ~--~ ; O~ner/builder J-~; Buyer ~; O~her ~ (~plain); Lend,ns Iust~,utiou ~ff?~,~,'~ ~,~,~,~. ~~ '. ' Telephone ~$ 7W~ ~' ~ - Real Estate Co. & Agent Red Carpet Seahawk Sharon Marvin Address 2909 Arctic Blvd. #203 Anchorage, AK 99503 Telephone 561-5544/333-0645 MaLl the HAA to the followin~ address: Type of Residence Single-Family ~ CPLL Multt-FamLly ~--~ Other .(describe) Number of Bedrooms l~ater Suppl7 Individual ~ell ~ Comnnmtty ~--~ Public ~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesttnB to the legality and status. &. Sewase Disposal Onstte [-----[ Public ~ Community ~--~ '* Holding Tank ~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page i of 2] ! B~_~ineerin~ Firm Vrovidin~ InspectionsI Tests~ File S~archl Data and Inf:t~ation 'certified by my seal dfixed hereto and as of ~he v~alidation date shc~ belov, I verify that my investigation of this Health Authorit~' ',-Approval sho~m tha: the on-site "ater supPlY and/or vastevater disposal system is sss---.;, functional and adequate for the ..~mber of bedrOoms and type o£ structure indicat~i~ herein.- I f~rthe: veri/y that, based on tha information obtained from the PbnicipaL~-y o£ Anchorage files and from my ,investigation ..t inspection' the on-site rater ~uppLyz and/or vastevater disposal tinua in e~fect on the date of this inspection, excem~ as noted. 'Name of Firm' Brust' & Associates Telephone 562-78?8 ,:Address 1610 Dimond Drive, Anchorage. AK~ ~9507 Approved ~! Disapproved ~ Cor'~ ~ionalJ Terms o~ Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE I~PARL~IENT CF ~,'ALTH ARD ENVlROh%iENTAL PROTECTION (DHI~P) ISSUES HEALTH AUTHORITY APPROVAL CE~TI~S !~.~ED SOLELY UPON T~Z REPI~ESENT- ATION~ GIVEN IN PARAGRAPH ,5 ABOVE BY AN I/TDEPE,~-~-NT PROFESSIONAL ENGINEER REGISTERED IN TH~ STATE OF ALASKA. THE ~EEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIO~IS IN 0RDEI~ TO SATIriC- CERT~TN FEDERAL AND STATE REQUI3~E- HENTS. EHPLOYEES OF lliEP DO NOT CONDUCT I~'~ECTIOL~ OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TH~ HUNICIPALITY CF A~HORAGE IS NOT RESPONSIBLE FOR ERRORS OZ (~IISSIONS IN THE PROFESSIONAL ENGINEER'S ~ ', · [Page 2 of 2] (DEEP 7-19-84 'MUNICIPALITY OF ~NC~DRAGE (M~) CHECKLIST - FEBRUARX 1984 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF Ht.,Lf~ & ENVIRONMENTAL F,..C, T,oR C£/V ED o~,.10 Block 2 Dawn Village Subdivision Well C/~-~sification Individual Well Log Pmesent (Y/N) Yes Total Depth 90' * Static Water Level 31.5 ' Casin~ ~eight Above Ground 40" Electrical Wiring in Conduit (Y/N) Yes Sepa~ation Distances fmc~ Wall.- To Septic/Holding Tank cn Lot NA To Nearest Edge of Absorption Field c~ Lot To Nearest Public Sewer ~ine $~' ~ ~ Cazed to 9©' *. Pum~ Set At If A, B, c~ C, D.E.C. Approved(Y/N) NA Date Completed 1977 or 78 * Yield8.5 gpm - at 2 ' d'wdn Depth of (~tin~ none unknown Sanitary Seal on Casing (Y/N)Yes Depression Around Wellhead (Y/N)No ; On ~djoining Lots NA NA ; On Adjoining LOts , NA To Nearest Public Sewer Cleanout/Manhole 68' # To Nearest sewer Servi~e Line on LOt over 25' Water Sample Collected By Brust ; Date 5/23/85 Water Sample Test Besults Satisfactory C~tm=nts * Information obtained from well log'and MOA DHEP records # ADEC has waived seperation distances per the attached letter. B® s~rzc~omn~ ~ na~ Date Installed Stand~ilms (Y/N) ~ssi~ ~r Ta~ (Y~) Property is served by public sewer, as per A~qU on 5/21/85 Size No. of Oa.,¥,'m'tmenta Aid-tight Caps (Y~) F~ti~ C~a~t (Y~) ~i~in~ ~a~ ~ File (Y~) ; f= Hold~ ~ ~g~t~ ~ (Y~) ~~ ~ldi~ T~ ~t (Y~) To ~u~ly ~11 T9. Pfc ~t:e-,,'t:r,.z,ine [Page 1 of 2] To ~uilding Foundation To Disposal Field To Stm~am, Pond, Lake, c~ Major Drainage Receipt Amou~ t: 2-15-84 AB,SOI:~CX~I FI:ELD ~ ~ NA Soils Rating in Abs°rgtic~ S~ata Width of Field Feet of Absor~ti~ A=ea Dep=ession over Field Resulte of Last ~leguac~ Test Type of System Design ~encjth of Field Depth of Field Grail Bed Thickness Star~il~s I~esent (Y/N) Date of Last Adequacy Test TO P=c~erty Line To Existin~ c= Abandoned System D..L~FT S'I~TION Sim in Gall~s 'Pure9 On' Leal at High Water Alarm ~evel at Tested for Dimensions Manhole/A~ess (Z/N) ~ Off' Level at vent (z/N) romping Cycles ~u=i~ A~eguacy Test. ** ** Check Permitted Bedrocm Rating Against ~AA Bequest I c~rti~y that ! have checked, ~rified, cz- conf~,~d to all ~OA H~A Guidelines in effect on the date of th~cn. Signed d '- / Dete 5./~'/R5 Ccmpany Brust & Associates [PaGe 2 of 2] ....~ y',..~- ' ,~ -. ~/,. .:'--f z..: ~h/ :':' . 2-15-84 BRUST & ASSOCIATES Engineers. Planners. Surveyors 1610 Dimond Drlvc Anchorage, Ala~k:~ 99507 (907) .~62-7878 May Z8, 1985 Alaska, Department_of_Environmental_Conservation h37 "E" Street, Suite 303 Anchorage, Alaska 99501 SUBJECT: Horizontal Separation Waiver Between Well and Public Sewer, Lot 10, Block 2, Dawn Village Subdivision Dear Sir: An inspection was made of the well serving a three bedroom single family residence at Lot 10, Block 2, Dawn Village Subdivision. The property is.served by public sewer, with an eight inch sewer line located in an easement at the east side of the property. This is shown on the attached sketches. The distance from the well to the public sewer was measured at 33', and the distance from the well to the center of the manhole was measured at 68'. The distance to the manhole at the NE corner of the lot was over 100'. There is also a large ditch at the north boundary of the lot which had about 18" of flowing water in it. This is also over 100' feet from the well. The attached well log is undated. A permit from the DHEP was issued 1/18/?? and a satisfactory water sample was taken on 5/12/78, indicating the well was completed between these dates. The water sample taken 5/23/85 was also satisfactory. The topography of the area is flat, with a slight slope to the north. The pump test showed the well delivered 8.5 gpm at a 2' drawdown. Recovery was immediate. A copy of the MOA checklist is enclosed. Assuming the sewer line is 9' deep and the water table is 21' any leakage from the sewer line or the manhole would be filtered by about 12' of unsaturated soil and would then have to travel another 69 vertical feet of relatively impervious soil to reach the well screen. It is therefore considered unlikely that the well would become contaminated from this source. It is therefore recommended that the separation distances from the manhole and the sewer line be waived for this lot. Stanley Brust, PE DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 May 31, 1985 Brust & Associates 1610 Oimond Drive Anchorage, Alaska 99507 SUBJECT: Separation Waiver between Well and Public Sewer Lot 10, Block 2, Dawn Village Subdivision Anchorage, Alaska {8521-WA-176) Dear Sir: The Department has reviewed the above waiver request. Since this system was formerly approved by the Municipality of Anchorage, a temporary three . year approval is given with the stipulation that: 1. Applicant shall initiate a request for a Water Improvement District (WID) in the manner prescribed by AWWU. 2. Property owner shall hook up to new water line when constructed, and 3. Property owner shall conduct approvable revisions to on-lot water and/or sewerage facilities after three years if community water is not available by that time. Sincerely, District Engineer SWE/msm MUNICIPAUTY OF ANCHORAGE i DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION Telephone 2644720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on p.9~ 1. Incomplete r.qu~ will n~t be proceed. Please allow mn (10) days for procming. 1. PROPERTYOWNER ~ I PHONE PROPERTY RESIDENT (If diffe t from abo~) ' ~ PHONE ,,, 3. BUYER PHONE MAILING ADDRESS 3. [.ENDING INSTITUTION ~ PHONE MAILING ADDR ES)~ 4. REALTOR~AGENT ~ PHONE I MA~DRESS STREET LOCATION S. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL* I--I COMMUNITY I--1 PUBLIC UTILITY 8. SEWAGE OlSI:q)SAL SYSTEM I'-I INDIVIDUAL/ON-SITE** ~fl~ PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ,,~_Three [] Six [] Other * ATTACH WELL LOG. A well log is mqulr~d for ail wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ** If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Departmen, t. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72.Ot 0(3F/8) i! THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPECTION APPOINTMENTS ~r-~C)~' ~. ~,.~, \Or-')<~ . TIME TIME TIME :)ATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~' SINGLE FAMILY [] ONE [~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SlX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line [~APPROVED FOR '~ BEDROOMS [--1 CONDITIONAL APPROVAL (Fetter must accompany certificate) [] DISAPPROVED DATE BY~I~ LEGAL DESCRIPTION 72-010 (Rev. 3/78)