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MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
APPLIC'~"IT FILLS OUT UPPER HAL~'ONLy
Property Owner Lydic~ V~,~(~
Mailing Address ~('~ ~c'~ ~L[~ ~ ~ ~.~0(~
Buyer~.~ ~ .~A~C~ ~'~. -~C~,'~ ¢'~
Zip Code
Address Zip Code
Phone
Lending
Realty C~-~ Agent
- Address
Zip Code
Zip Code
Phone
Phone
Street Location i~(-.) ~X,,,~., ~' ~ I I/~
Type of Residence
~,Sin gle Family
I~ Multiple Family No. of Bedrooms
[] Other
Water Supply
t~ Individual
LJ Community
[] Public Utility
Sewer Disposal
[] Individual
HUblic Utility
olding Tank
ATTACH WELL LOG. A wetl Icg is re(3ulred for all wells drilled since June 1975.
For wells drilled prior to that date. give well depth (attach Icg if available).
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time \
Date Date Date Date
Insp~tor Insp~tor Insp~tor Insp~tor
u,.:~ t 7 ~982
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
let Inspection:
MUNICIPALITY OF ANCHORAG~-~ /';'~
DEPARTMENT uF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 ~
279-2511 exto 224, 225 ~ ~
Date Received: March 14, 1977
~[~~ 2nd Inspection: Time
~-/-]-~k~% ~F~.- Date ~
Z-~
Inspector
Time
Date
Inspector
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
Mailing Address:
Property Owner:
Mailing Address;
Alaska Mutual Savings Bank
Post Office Box 1120'
Kevin H. Apgar
140 Homecrest Place
Phone: 274-3561 x 217
Phone: 333-7423/265-5345
3. Legal Description: Lot 1 Homecrest Subdivision
4. Single Family Residence:
Multiple Family Residence:
Number of Bedrooms:
Number of Bedrooms:
Well Data: Type Individual
Construction°f~
Sewage Disposal System: On-site system
Permit ~ Installed
Septic Tank Size
Absorption Area
Depth
Bacterial Analysis
~ Public Utility
Installer
Manufacturer
Soils Rate Material
Well Log Filed ( )
( )
Distances: Well to Septic Tank
to Sewer Lines Nearest Lot Line
Absorption Area to Nearest Lot Line
to Absorption Area
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
1. Type of Inspection: CMRO VA
2, Property Owner: Kevin H. Apgar
Mailing Address: 140 Homecrest Place
FHA
Day Phone:
CONV. x~X
265-5345 work
3. Name of Buyer: cARLsoN, Donald E.
Mailing Address: 755 W. 42nd Ava. #5
Day Phone: 27?-3567
4. Name of Lending Institution: Ala,qka M1H-.al Raving.~ Bank
Mailing'Address: p. O. gnY '11911
Phone: 974-3561 ex, ?!7
5. Name of Realtor or Agent: none
Mailing Address:
6. Legal Description: Lot 1. Homecrest Suba.
Location: 140 Homecrest ?lace
Phone:
7. Type of Facility to be Inspected: Wa~r ~ S¢p¢~ c
8. Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
No. Bdrms. 2
72-003(3/76)
Individual (on-site)
MUNICIPALiTy OF ANCH ,
E~,_._DEPT. OF FI~A~-- OR, AGE
'~'~vlRONMEN~,, ~ .tN &
"% PROTECTioN
I'dAR 1977
.RECEIVED
,Individual. xxx
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONIVIENTAL QUALITY
3330 'C" Street, Anchorage, Aleska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
Type of Inspection:
CM RO VA
Mailing Address:
Name of Buyer:
FHA
Day Phone
b-~ 42 '~/~-u~..¢+$~ ~i~/SO.~Day Phone ~-~ ~Y-~.~3- ( ~-z.~.
Phone
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
Phone ~'~ ~
Legal Description:
Location:
7. Type of Facility to be inspected: ,--A ,(~1.~ ~T~'~q/I ('
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
No. Bdrms.
Individual
Type of System:
Public Utility
Individual (on-site) ~-.
If Individual, date of installation
,LQ-037 (1/74)
Page, Two
. ~ Department of Health and Environmental Protection
'Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 Homecrest Subdivision
Affadavit Attached: ( )
Letter Attached
Disapproved:
Date:
Date:
Department Worksheet:
~~--~ ~_/~/~
I
Post Office Box i120
A~horag~, Alas~ 99510
~ubj~ot~ LO~ 1 ~ome~rest $%%b~ivi~ion
surrounding groun~ l~vel aha the pit fille~ ~ith soil.
instali~ between th~ hOuSe and' the ~eepag~ p~t.
are escrow~I to upgrad~ the wei1 a~d on-silo se~r by
J%ua~ 15~ 1977.
If there are any further que~tions, please contaot thia
Sin~erely,
Sanitarian
~¢~ Kevin ~. Apgar
Post Office BOx 947
Anohorage~ Alaska 99510
:"61 g 9 10 11
4 •
\ !'iS . E 8
•-1:5..., Municipality of A i--.--41-e p °l
On-Site Water and Wastewa'- -roramvd Li!, w's) q-. 1
11:11 .1 a
(907) 343-7904 0- ' �`� N., SAFETY
�! .c)
Certificate of On-Site System . •- •ECMi
Parcel I.D. 006-042-30 Expiration Date: 1 \(Uuw►'1 Palr a o A ci
1. GENERAL INFORMATION:
Complete legal description HOMECREST; LOT 1
Location (site address) 140 Homecrest Place*Anchorage,AK 99504
Current Property owner(s) Alan&Jeanine St. John Day phone 250-4038
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer
r
WaiverNariance request for: Wel l 0 p‘:`\011 c. `�C:,:%V-- mcg ,A Mcv�Y1Alk Distance: 3 0 hiJ35 V
Received by: (f
Date: /� L7,! 4
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 526 • °0 Waiver Fee $ 1
Date of Payment 12/2-6/1°3 Date of Payment
Receipt Number o8 Q ZI G Receipt Number ....--
COSA#
lCOSA# oSCI8 6S3 Waiver# 0(3V 1S V\03
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,
based on procedures outlined in the Certificate of On-Site Systems 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.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 1:2-1)Lb 1/ 0
000000p,O�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system d OF 4 ` 4%4
in accordance with the guidelines and regulations established by the Municipality of Anchorage and ...1 c�
industry practices. The reported results describe the condition of the system/s on the date/s of the p P�•' ..'°2--�QO
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or i , , , . T aPt.
encroachments may exist that were not identified during the evaluation. The operational life of all wells �' '•.'vn
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 . V�
groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 Q
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary, and
VA
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q e f •. Corne-s.•
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of Q P • o Q`
the well or septic system. GEG makes no representation whether an alternative well or septic system Q �,. CE-7 5 e p
can be installed on the property in the event either of the current systems fail to perform adequately in V�4 P, •1•?r..I.7,lct •• f coop
the future. The content of this report is for the sole benefit of the person/party that retained GEG to '%Papro fess:on°aQ
perform the evaluation. Reliance upon the information provided in this report by any other person or ��OOOOoo�
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right • •-,/y.
whatsoever. :��
`f,L.^
-)N t. #AECC884
6. DSD SIGNATURE 3. ON-SITE 'fcc
/ WATER AND
�/ System #1 Approved for 3 bedrooms WASTEWATER c
System #2 Approved for bedrooms _ PROGRAM
c-
Disapproved '''A +, r�r��. <,r -
r
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: bee 0 a01 s-
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: `/ �/
COSA Checklist 1( Nitrate Advisory I�
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: HOMECREST; LOT 1 Parcel ID: 006-042-30
*TIME HOME WAS BUILT
A. WELL DATA **WELL IS IN PIT ADJACENT TO HOUSE. INSPECTED BY TIM EKLUND
***PER 1983 DNR WATER RIGHTS APPLICATION
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO
Date completed *1966(?) Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth ***58 ft. Cased to UNK ft. Casing height (above ground) **7 in.
FROM WELL LOG AT INSPECTION
Date of test 12/12/18
Static water level �-�'OG
ft. ft.
49.3
Well production g.p.m. 4.1+ g.p.m.
WATER SAMPLE RESULTS:&colonies/100 N� v colonies/100 ml. Nitrates O mg./L. Collected by: GEG, Ltd.
Arsenic: ug./L. Date of sample: 12/12/18
B. SEPTIC/HOLDING TANK DATA AWWU
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts(Y/N)
Foundation cleanout(Y/N) Depression over tank (Y/N) High water alarm •
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2or ft2/bdr r System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorptio - ea ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor. 'in field before test in. Water added gal. New depth in.
Elapsed T.• e: min. Final fluid depth in. Absorption rate >= g.p.d.
• y rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at •• .• wa er 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 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main **30' (APPROXIMATE) Public sewer manhole/cleanout "35' (APPROXIMATE).
Sewer/septic service line 'UNKNOWN Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: A WWU
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIE 1 : I LOT TO:
Property line B ' • foundation Water main
Water service lin- Surface water Driveway, parking/vehicle storage
- -in drain Wells on adjacent lots
F. COMMENTS
'NO REQUIRED SEPERATION DISTANCE AT THE TIME **PER 1/18/79 AWWU RECORD DRAWING-MANHOLE
WAS NOT PHYSICALLY LOCATED-ICE ON THE ROAD AT TIME OF INSPECTION-SEE ATTACHED WAIVER REQUEST
G. ENGINEER'S CERTIFICATION P•..••••""7"J .' ♦♦
�1 4 NM ♦
I certify that I have determined through field inspections and a *;•• 49 i �' _ •', ♦.
review of Municipal records that the above systems are in ••
conformance with MOA COSA guidelines in effect on this
date. ♦ t^•• . - ess NEngineer's Printed Name JEFFREY A.GARNESS ♦♦.;r'••/It'
E 795,3t .4�_::
Date t Z u1144 PROFESS\°NP••.
LICENSE �IIIIli"`s:1014
#AECC884
(Rev. 10/12/12)
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • ` \Vie 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory'
Certificate of On-Site Systems Approval # 0SC181653
Subdivision: Homecrest, Lot: 1
A water sample revealed a nitrate concentration of 5.08 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
.per.t .5.i
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On-Site Water and Wastewater Section
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV181103 COSA#: OSC181653 Permit#:
PID#: 006-042-30
Legal Description: Homecrest Lot 1
Engineer: Garness Engineering Group
Applicant: Alan &Jeanine St. John
Your request for a waiver of the required 50 feet horizontal separation from the private well to
the public sewer main and public sewer manhole has been approved. The approved separation
distance is 30.0 feet and 35.0 feet, respectively. 50 feet was the separation required at time of
installation.
This waiver approval applies to the existing private well only. If nitrate levels continue to rise,
another waiver request and approval from this department will be required.
Waiver is Granted: X Waiver is not Granted:
Date: I )71 a O I S Approved by: 1LCA
Cut:tag
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
•
qilanucs
GARNESS ENGINEERING GROUP, Ltd ,,,„,,,,,c„Tc,,t,P<',,t ,t,..
ENGINEERING SALES CONSULTING Dealer
December 26, 2018
Municipality of Anchorage
Development Service Department
On-Site Water&Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Homecrest; Lot 1
To whom it may concern:
Per Anchorage tax records, the home on this property was built in 1966. Based upon conversations with
the current owner (Alan & Jeanine St. John), and MOA records, the existing well appears to be the well
that was present at the time the AWWU main was installed. In short, the well predates the AWWU sewer
installation in 1979; therefore, a waiver should have been applied by AWWU at the time the sewer main
was designed/installed. It should also be noted that the separation distance from a private well to a
community sewer line/manhole was 50 feet at the time of installation. The private well is approximately
30' from the AWWU sewer main and 35' from the manhole (see attached drawing). We are requesting
that your department issue a variance form the required separation distances of 50 feet from the well to
the community sewer line and 50 feet from the well to the manhole, down to 30 feet and 35 feet
respectively. Justification for granting this wavier are as follow:
• This encroachment has existed for approximately 39 years
• AWWU should have applied for the waiver during the sewer main installation
• The separation distance required at the time of installation was 50 feet. Therefore, it would have
likely been granted given it was a variance of 20 feet(50 feet down to 30 feet).
• The well log in MOA records for Homestead; Lot 7 (southwest of subject lot) shows a varied soil
profile from 34 feet to 98 feet of a silt or clay derivative. Based upon this well log, it is reasonable
to believe the subject lot aquafer is relatively "protected".
• The well head is a higher elevation than the manhole. In short, effluent could not flow directly
from the manhole to the well head.
• Water samples were pulled on 12/13/2018, and the results are as follows:
o Arsenic: Non-Detectable
o Nitrate: 5.08 mg/L
o Bacteria: Negative
We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If
you have any questi•ns, please contact us at 337-6179. Thank you for your assistance.
:incerel, ,
Jeff - °. a ess .S.
'resi•:nt
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
DUNLAP COURT
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PLOT PLAN AS BUILT X SCALE 1" = 30' GRID _ SW 1241 Project No. 18-634/R1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates inc . (907) 522-6476 Phone ooQpppp4
(907) 522-4625 Fax oo 0 F A (O'N
Professional Land Surveyors kenOlangsurvey.com .... 5.\11t)
JonathanOlangsurvey.com , O
I hereby certify that I have surveyed t• : following described property: 1 C/)•.• 49TH i\ ..�• �O0°
LOT 1, HOMECREST SUBDIVISION (PLAT No. P-407)
Anchorage Recording District, Alaska, and that the improvements situated thereon are / ) VA
awithin the property lines and do not encroach onto the property adjacent thereto, that -, Q
no improvements on the property lying adjacent thereto encroach on the surveyed u0�� KENNETH G. LANG
premises and that there are no roadways, transmission lines or other visible0017,% .... (j
easements on said property except as indicated hereon. ��'(i�1�� p0
4 ;F•a•••.LS-5202.•'' 64
Dated this the _ Day of , 7,.)1�h , at Anchorage, Alaska tle,c), • • moo
O �SSIONAL c�
It is the responsibility of the owner to determine the existence of any easements, �4pp`.o33—
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
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