HomeMy WebLinkAboutTHE VILLAGES-PINE RIDGE LT 4The V i I I ages
Pine Ridge
Lot 4
#020-291-41
Municipality of Anchorage Page I of _.uj_._
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On'Site Wastewater Disposal System and/or Well Inspection Report
Name:
~~ ~~_~ Wastewater System: ~New ~ Upgrade
Address: .
~o ~ ~~o~ ~ ABSORPTION FIELD
Phone:
~ ~_ ~ I N°'°fBe~cms: ~ Deep Trench ~ Shallow Trench ~Bed D Mound
~ther
LEGAL D ESC R I PTI O N so, Rating: Total Depth from original grade:
Lot: ~ Block: Subdivision: Depth to pipe bottom from origi~grade: Gravel depth beneath pipe
~ Ft. ~ Ft.
Number of lines: I Distance between lines:
WELL: D New D Upgrade Gravel width: ~ Ft. ~I ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe ma~rial:
Driller: Installer: Date installed:
. Date D~ i~led: Static Water Level:
Yield: ,' '~ GPM J ~ Ft. Casing Height Above Ground:
" ~ F,. TANK
SEPARATION DISTANCES ~septic D Holding ~ S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacityin gallons:
From Tank Field Station Tank Sewer Lines AN~
[ I Material: Number of Compa~ments:
Well I I -- -- . sT~
Surface
Wa~er .... LIFT STATION
LineL°t ~ j~l __ __ Size in gallons:IJ Manufacturer:
Foundation ~ ~'~ __ -- __ "Pump on" level at: J"P,mp cfr' ,e,e, ~,: J High water alarm at:
Curtain Pump Make & Model J Electrical Inspections pedormed by:
Drain
I
Remarks: -'. ~ BENCH MARK
J Location and Description:
Assumed Elevation:
ENGINEER'S SEAL
Inspections performed by: ~~ ~A4 Dates: 1st
e.ar, men, o, .ed,,. .uman Serv,ces a..rova,
Reviewed and approved by: _ .~,.
72-013 (Rev, 9/9t) MOA 25
polarconsult alaska, inc.
ENGINEERS · SURVEYORS · ENERGY CONSULTANTS
Municipality of Anchorage
DHHS, Environmental Services
P.O. Box 196650
Anchorage, Alaska 99519
Attn: Daniel J. Roth
On-site wastewater disposal permit SW940299
Lot 4, The Villages - Pine Ridge Subdivision
Dear Dan:
November 16, 1996
~unictpati~Y ot Anct~orage
Dept. Hearth & Human Services
:Enclosed is the updated as-built of the on-site septic system constructed last summer. The house
!lOcation and swing ties to the foundation have been added to the as-built. The system is
complete and ready to operate. With the attached as-built I would request a permit to operate for
this lot.
Sincerely,
Senior Civil Engineer
encl:
Sheet 2 of 4, Plan Sheet
Sheet 3 of 4, Profile Sheet
NETWORK~SEPTIC~VI LPINE4~L6 ! 116DR.DOC
1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 · TELEFAX (907) 258-2419
× I
CIRCLE
//
/
/
LOT 3
O' DRAINAG£ EASEMENT
10' DRAINAGE F--A,SEM£NT
LOT 4
o
I~ICHAEL D. DAHL
No. CE-8480
0000000004
SCJ~LE 1"=40'
4 BDRM
3 STORY
HOUSE
01 ~Z
~.' .i ~
~, ~ LEGEND
WELL MWo
NOTE
FINISH FLOOR ELEVATION = 186.5
FINISH FLOOR ELEVATION = 197.0
INSITU SOIL = 61~ PASSING #4 SEIVE
SEPTIC SYSTEM, TANK AND PIPING COVERED WITH
2' RIGID STYROFOAM INSULATION
(~ - FOUND 5/8" REBAR W/YPC
128.9_ SPOT ELE~/'ATION (ASSUMED DATUM)
( )- RECORD DIMENSION (PLAT 79-255)
- EXISTING CLEANOUT
- EXISTING MONITORING WELL
~[s,~o: ~oI olarconsult alaska, inc
DRA~: DJ.I
CHECKED: ~1mmENGINEERS · SU~EYORS · ENERGY CONSULT~TS m
DRAW I NG
SEPTIC SYSTEM AS--BUILT
PROJECT
LOT 4 PINE RIDGE
Anchoracje.
SUBDIVISION
Alaska
SHEET
) 2
OF 4
Z
0
186'
184'
182'
180'
178'
174'
172'
170'
168'
PROFILE - HOUSE TO INFILTRATOR BEDS
SCALE: 1' = 20' HORIZONTAL
1' = 10' VERTICAL
m
PROFILE - INFILTRATOR BEDS
SCALE: 1" = 20' HORIZONTAL
1" = 10' VERTICAL
178'
176'
174'
172'
170'
168'
166'
164'
~s,c~E0: ~J Jpolarconsult alaska, inc.
RAWN' O JR J !
Econo: ~jJ ENC,NErRS · SURVEYORS ' ENERGY CONSULTANTS
Lr:~J J, 503 ~St 33,O AV£. SU,~ 3,0 P.ON~ (907)
ILk' S£PTI~LANCHORAGE. ALASKA 9950,3 FAX (907) 258-2419~
DRAW I NG
SEPTIC SYSTEM AS--BUILT
PROJECT
LOT 4 PINE RIDGE SUBDIVISION
Anchorac~e, Alaska
ISHEET
I or 4
polarconsult alaska, inc.
~[503 West 33rd Avenue · Suite 3:tO
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-2419
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SHEET NO.
CALCULATED
CHECKED BY,
SCAU~
DATE
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PERFORMED FOR:
LEGAL DESCRIPTION:
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~/(~ r~ I
"~ [/l'/~j'-J0/~.. ~;~..Township, Range, Section: "7"///,/~/ ~.~/.~ '..~z~¢. 15
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT ~ O
DEPTH? p
E
Deplh to Water After
Monitoring? ~"'.~' Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ~,~e ....
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER
FTAND ~J/ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES I. EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
polarconsult alaska, inc.
ENGINEERS., SURVEYORS · ENERGY CONSULTANTS
Municipality ofAnchorage
DHHS, Envirbnmental Services
P.O. Box 196650
Anchorage, Alaska 99519
On-site wasterwater disposal permit SW940299
Lot 4, The Villages - Pine Ridge Subdivision
January 6, 1996
RECEIVED
FEB 21 1996
D Municipality of Anchorage
ept, Health & Human Se~i~eg
Dear Robby:
Enclosed is the as-built of the on-site septic system constructed this summer. The house will be
constructed next summer. An updated as-built will be submitted when the house is constructed
and prior to operation of the system. Swing ties to the new house and the piping from the house
to the existing septic system will added to the as-built at that time.
Senior Cix>il Engineer
NETWORK~S EPT! C-~VI LPINE4~L0106.DOC
1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 · TELEFAX (907) 258-2419
0
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//
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LOT ~
_DRAINAGE EASEMENT ~
10' DRAINAGE EASEMENT
LOT 4
:CHAEL D. DAHL
CE-8480
OoooooooO~
41.000 SF
SCALE 1"=40'
0
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.'1
~ ~1 II
P/~E ~/DcE ~ WELL
C/~C4~
H~[D:
~LE' ~'~0'~'~ ~1505 ~ST 35R0 AVE, SUITE 310 P~NE (907) 258-2420
LOT 2
100'
NOTE
PROPOSED (HOUSE) FINISH FLOOR ELEVATION = 186.5
PROPOSED (GARAGE) FINISH FLOOR ELEVATION = 197.0
INSlTU SOIL = 61% PASSING #4 SENE
SEPTIC SYSTEM. TANK AND PIPiNg COVERED WITH
2" RIGID STYROFOAM INSULATION
SWING TIES TO SEPTIC SYSTEM TO BE PROVIDED
OFF BUILDINg FOUNDATION WHEN CONSTRUCTED.
X~ LEGEND
(~ - FOUND 5/8"
x 128.9- SPOT ELEVATION ,,(AS.SUMED DATUM)
( )- RECORD DIMENSION (PLAT 79-255)
e - EXISTING CLEANOUT
MWe - EXISTING MONITORING.:WELL
DRAWING '. c' ' ''~ III' 1
SEPTIC SYSTEM AS~O'ILT ' ~....]SHEET
PROJECT
LOT 4 PINE RIDGE SUBDIVISION
Anchorage, Alaska ~,.or ~,
polarconsult alaska, inc.
1503 West 33rd Avenue · Suite 310
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-2419
CHECKED ~Y OATE
sc^,~ ~1 T'~
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p~larconsult
MEMORANDUM
TO:
RECEIVED
APR 2 6 1995 DATE:
Municipality .o.! Anch..ora .~U BJ ECT:
Dept, Health & Human ~en/ices
FILE:
polarconsult alaska, inc.
ENGINEERS * SURVEYORS * ENERGY CONSULTANTS
Municipality of Anchorage
DItHS, Environmental Services
P.O. Box 196650
Anchorage, Alaska 99519
Amendment to Permit SW940299
Lot 4, The Villages - Pine Ridge Subdivision
Dear Sir or Madam:
March 30, 1995
RECEIVED
APR § 1995
Municipality of Anchorage
Dept. Health & Human Services
Our client has requested that we amend the design of his previously approved septic
system. He would like to use an Infiltrator leaching chamber system to: (1) more readily
accommodate his proposed construction plans; and, because he believes a system
designed with Infiltrator chatabers will be more efficient than a gravel system. We have
amended our design and hereby submit it for your review.
Please note that septic systems designed with Infiltrator chambers have been approved for
use in the State of Alaska by the ADEC and have been in use for Close to a decade in the
continental U.S. - over 100,000 systems are currently in operation. Leaching area was
limited to the bottom of the trench.
Thank you for your consideration in this matter.
Sincerely,
Senior Civil Engineer
MD:be
Attachments:
Revised Site Plan
Revised Design Calculations
Revised System Cross Section
Cut & Fill Typical for Infiltrator Chamber Construction
Infiltrator Leach Field System Support Documentation
1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 · TELEFAX (907) 258-2419
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ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258.2419
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SHEET NO.
CALCULATED BY
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polarconsult alaska, inc.
'~[503 t/~/est 33rd Avenue · Suite
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-24~.9
CALCULATED BY ~ DATE "'~/*'% 0/~ ~~"''"'
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polarconsuit alaska, inc.
'[503 West 33rd Avenue · Suite 310
' ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-24~.9
SHEET NO. OF
CHECKED BY. DATE
: I
,I
Rick Mystrom.
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
August 21, 1995
Robert B & Michelle J Coburn
10601 Constitution Street
Anchorage, Alaska 99515 2511
Subject:
Lot 4 The Villages-Pine Ridge Subdivision
Permit #SW940299, PID #020-291-41
The subject permit, issued August 17, 1994 by this office for a
single family well and/or on-site wastewater system, has
expired as of August 17, 1995.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Si~erely, A
Program Manager
On-site Services
enc:
Copy of Permit
cc: Polarconsult Alaska, Inc.
PAGE 1 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUlVIBER:SW940299
DESIGN ENGINEER:POLARCONSULTALASKA, INC.
OWNER NAME:COBURN ROBERT B & MICHELLE J
OWNER ADDRESS: 0202914100088
DATE ISSUED: 8/17/94
EXPIRATION DATE: 8/17/95
PARCEL ID:02029141
LEGAL DESCRIPTION:
THE VILLAGES-PINE RIDGE LT
4
LOT SIZE: 41000 (SQ. FT.)
NUFIBER OF BEDROOMS: 4 THIS PERMIT:
4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A ~UBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHERMUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
i~,HIS i AMENDED';PERMIT' ~ALLOWS "!.THE "USE i:. ~F:IIAN i iNFILTRATOR
EACHING ~'SYsTEM i INSTEAD OF i THE CONVE.NTIONAL ~GRAVEL 'SYSTEM.
TOTAL' DEPTH ~OF THE iABSORPTION' TRENCH MUST NOT EXCEED
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORACE, 99s 9-665o
FEET. SAND :FILTER~ERIAL WILL NOT BE REQUIRED 'iF ~ SEIVE
(ANALYSIS OF .THE ABS~ORBING.-SOIL-~H~ 51% OR MORE 'SAND.
RECEIVED BY: - ~
ISSUED BY:
PAGE 2 OF 2
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940299
DESIGN ENGINEER:POLARCONSULTALASKA, INC.
OWNER NAME:COBURN ROBERT B & MICHELLE J
OWNER ADDRESS: 0202914100088
DATE ISSUED: 8/17/94
EXPIRATION DATE: 8/17/95
PARCEL ID:0202914i
LEGAL DESCRIPTION: THE VILLAGESrPINE RIDGE LT
4
LOT SIZE: 41000 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE wITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED,'SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
EXCAVATE THE DRAINFIELD TO_THE TOP OF THE FRACTURED
RECEIVED BY: /'7.)"~>~ (~(;-----~ DATE:
ISSUED BY: , , DATE:
polarconsult alaska, inc.
ENGINEERS · SURVEYORS · ENERGY CONSULTANTS
July 21', 1994
DHHS, Environmental Services, On-site Services
P.O. Box 196650
Anchorage, Alaska 99519
Attn:
Re:
Permit Review Officer
Design and Construction Approval for On-site
Sewer System at Lot 4, The Villages-Pine Ridge
S/D.
Dear Sir or Madam:
Please accept the following design for review and permitting. The proposed system
does not affect the current use of the adjacent properties and will have minimum future
impact.
The ADEC approved a variance granting a 100 foot separation distance from the Class
C well located on Lot 2, which will serve two families (Lots 2 & 4), to the septic
tank/field (please see attached certificate).
If you have any questions or concerns regarding this matter, please feel free to give me
a call.
David Ausman, CE
POLARCONSULT
Attachments:
On-site Sewer/Well Permit Application
Site Plan, Sheet 1 of 7
System Design Calculations, Section, Sheet 2 of 7
Flow Divider Detail, Sheet 3 of 7
System Cross Section, Sheet 4 of 7
Percolation Test Hole One--Soils Log, Sheet 5 of 7
Percolation Test Hole One--Soils Log, Sheet 6 of 7
State of Alaska Construction and Operation Certificate (Well), Sheet 7 of 7
$320 Check for Permit Fee
1503 WEST 33RD AVENUE * SUITE 310 · ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 · TELEFAX (907) 258-2419
... * po!arconsult alaska, inc. ·
1:503 West 33rd Avenue -.,Suite 3:10
ANCHORAGE, ALASKA 99503
~307) 258-2420 Fax (907) 258.2419
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CHECKED BY
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DATE
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1503 West 33rd Avenue · Suite 310
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-2419
CALCULATED BY
CHECKED BY,
' '0'~.
DATE
DATE
polarconsult alaska, inc.
150~1 West 33rd Avenue · Suite 310
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258.2419
CHECKED BY, DATE
SCALE
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Municipality of Anchorage L~~
DEPARTMENT OF HEALTH & HUMAN SERVICES r~~ --~.~ ~
825 "L' Street. Anchorage. Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST ~ ~.'
PER OR ED OR: DATE PER OR ED:
LEGAL DESCRIPTION:
O
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
/__ z~ Pl'n.~ ~,'d/c~ ~'/~ Township. Range. Section: '7"///~/, t~V~,
SLOPE SITE PLAN
COMMENTS
WAS GROUND WATER
~:~ ' O,/"// ENCOUNTERED?
$o/,~ ~.,=lr s
L
IF YES, AT WHAT -- O
DEPTH? p
Depth to Water Alter [)~,¥
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
?~J-~o,~ 515 o - - -
I ' / r,,~' - r~,, ~-
~ /. ~,~ o.~ ~,~ / Y~ I"
~ 2 ~,h o.~ ~,~ ~Yz I"
~ ~ ~ ~h o,~ ~,~ ~ I
PERCOLATION RATE O' 5
TEST RUN BETWEEN 7
__ (minutes/inch) PERC HOLE DIAMETER
__ FT AND (~ FT
PERFORMED BY;
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
2
4
5
7
-'/'///,' /
Township, Range, Section:
SLOPE
T'IIN, [ v,/, .15
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
&,o./-/
COMMENTS
WAS GROUND WATER
ENCOUNTERED? //~
· S
L
IF YES. AT WHAT ~ O
DEPTH? p
E
Depth I° Wmr After D~.¥ 5//~Z/~q
Monitoring? Date:
Gross Net .Depth to Net
Reading Date Time Time Water Drop
?~zo,~- -~/5 o - .-- -
I I *""~ -- '//2" --.
z 4 ~,~ o~ ~,~ I Y~ I"
~ z ~,~ 0,5 ~,~ 2Yz l"
PERCOLATION RATE O. 5 {minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 7 FT AND ~ 1=3.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:~'z/
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
S
IF YES, AT WHAT / L
DEPTH? ~} 0
Depth t° Water After~ov Date
Monitoring? ~,,x~ :
Reading Date Gross Net Depth to Net
Time Time Water Drop
I Z ,.--.,;n - J" --
:z z.5 ,.,.:, o.~' ~;,~: 2.,, /,,
e .3?-/0. 0.~7-; ~" /"
¢ .t, /--J: ~o o. ~, ?,..: 5;" /"
PERCOLATION RATE
TEST RUN BETWEEN
~, ~Z tminutes/mch) PERC HOLE DIAMETER
.,t../ FT AND 5 FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: ~'/.~ ~/~ z//
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION :TEST
/--~ T/az V/'/~,.~-J0/~./~..Township, Range, Section: -'r'///,/~/~ IP.,,S~J.1
SLOPE SITE PLAN
WAS GROUND WATER vf/_ '
ENCOUNTERED?
· S
L
IF YES, AT WHAT O
DEPTH?
P
E
A
Monitoring? ~ )/ Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop --'
I 5,~fn -. f" -
5 IO ~,, I ,~;~ z ~" Y,/" ..
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~ FT
COMMENTS
PERFORMED BY: r'c~w'~-H/~/" I CERTIFY THAT THIS TEST WAS PERFORMED IN ·
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE:
72-008 (Rev. 4/85)
MUNItIPALITY OF ANCHORAGE.,
Department~Health..and Environmental..~,rotection
8'25 =. Street, Anchorage, AK. ~.,'501
~' " 264-4720
* * * HANDWRITTEN PERMIT * * *
Permit # ~ ~C3%~ WELL.AND/~I~ON-SITE SEWER PERMIT
Lo~atie~: ~ Phone N~er:. .~~~ ~" ,
T~.e of'.Soil ~so~tio~:' Sys%em .Is :'. '
Trench: Drainfield:. Sg~page Bed: .. ~01ding Tank: ,
Max~m.N~er. of Be~°oms':,· Soil Rating(sq,ft/br).
The ~Required Size. of the Soil ~so~tion System_Is
DEPTH
GRAVEL DEPTH .' 'WIDTH. '.
The length d~ension.'is the..length(in feet) of.the trench or. drainfield~,.The.,
depth of'a trench or pit is-.the-distance, between the s~face of the ground.and
the bottom of-the excavation'(i~.,feet).. There is no set:.widtk-for trenches.
The gravel depth'is the minim'depth of gravel, between-the outfall pipe and'
the bottom of the exca~ation.(in..feet)..
*..* REQUIR~ sEPT'Ic(HO~.ING).TANK SIZE.= GA~oNS * *
~astallat&o~ i~s~ect~o~s of"a~y wells-aS~ace:t to this ~=o~e=t~ a~d. tbe :~e=
* *'* TWO(2) INSPECTIONS 'ARE REQUIRED"* ""*
E2~ 8~sta~ce bet~e~ a.~ell .a~8 aay o:-site-sew&ge 8&s~osal-s%stem is 100 ~e~
a~8, must'be =etu=~e6'.to tb2s ~e~a=tm~t'w~thi~-'30 8aSs o~ the well comglet~oa,
I' ce=t~ that:
set ~o~tb b~ the Mu~c&Bal~t~-o~ ~cho=age,
(2) I w&ll '&astai% tbe s~stem'"&~ acco~Sa~ce w2tb coSes, "
(3) I u~Se=staa8 that the o~-s2te' sewe= s~stem
the.=es&Se~ce is =emoSete~.to 2~cluSe mo=e. tha~t .beS=ooms,
Sign~, ,~s,sued by:~.~
Applic,t.Date:
I~~e~o~-l~atth-an~l~ li~aVironmentai-- ~ro~e~:ton-.' , ' ' .....--.'"
',7¢' ,~ " " '
~H~,:'- ~ :-"-'- · ~-.~'.LE~GT~;"'" . . GRAVEL" ~EPTH'" _'_ ~IDTHx
:*' "
~d~g[h:; d~n~zon.: t'~ .~he length (&n- feet)., o~' the trench-- or: d:a~fi~ld.,..
t~'~{of: a.~ ~nch" or- pit: '~-~--~i~tan-e'e= b'etween'-~ the' -s~face 'of-' the' g=o~.: aha ~."
Jb~tt~:of: the exeava~zon (h.-feet)~. I ghere.- is .no ~et ~i~th~for- trenche~,.
~aVel~ depth-: i~.: ~e: ~~- depth;,O~.'grnve$- between, the. outfalI~ ~ipm --and/ ~;-'
f~t'om,of~ ~ho excava~x'on (in.-feet)~.: .5.~:':';:: . '-.:..:: .:: ::.'.'~'72.~::~':~
~' 'RE~UI RED~ SEPTIC (HOLD I NG)~: TAflK"eIZE. = ........ G~LLOflS' ~
t.~pp~'ioan~-, ha~ .~he ~eepone~b~l-ity to; ~nfo~ -th~s. ~epnr~ent: ~ing., the-
~latfOn ~peetions .cE any.wello adjacent, to. th/~ ~ro~rty and.~he n~er--
;.[~ences:th'at.the well wi11' se~e. ~ '
' ~ ' TWO(2)~ INSPECTIONS:ARE REQUIRED~a a ·
{:ll~g -uf:'~y -~yst~' without ~al.,ins~eetton..an~_app=oval: by.. th~ s 8ep~en{', ·
Eee~',and to ,a ,co=~[y sewer 3~ne-is 75 ~eet. ~eZl ~oge-are
h:'be return~:-{o..this.-de~zt~nt ~in.,30~ays o~ the weZZ c~pZet~on.
~.e~u~emento-alay apply. Specifications and c0nst~uct~on d~agr~..~e-
~le- to: ~sure proof installation, ..: ...~.~,,-~:~:~,
rt~'fy that: '
:[) Z: ~ f~ilfar with ..~e-re~uire~nts .-for. on-~tte sewers ~d'~lls.'as
~e~ forth by-the Municipality, of ~ohora~e;-
'I ~derstanfl -that. :the on-Site-~ewer system.may re~e-enlar9eman~- if
~_~~'II' the ?~s}~enee..ie~~~z'e~elefl
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
DATE PERFORMED:
SLOPE SITE PLAN
10
1
~.t,'
12
· 14
15
16
17
18
19
2O
COMMENTS /ZD
/v/2 f/dT-8~-JOz,-/
72-008 (6/79)
11
WAS GROt~ND WATER
ENCOUNTerED?
IF YES, AT WHAT
DEPTH;/
Reading Date
,
,PERCOLATION RATE '~' ~ (minutes/inch)
TEST RUN BETWEEN ~' ~ FT AND 2 .~ FT
CERTIFIED BY~ ·
Time Time
I:~' ~ - ,~-~
~.'0¢ I~/'~/~. ,02 . /-/~z
z:/~ /O~/~. , / /
Z:iC,
Z:
2:.5{,'
Depth to
Water
Net
Drop
ALASKA rlulRonm nTAL. CONTROL $1 RiJICI $, Inc.
~ncjin~rincj F~ ~nuironm~ntal $1uclics
SPECIFICATIONs FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM-'
LOT :4, THE VILLAGES-pINE RIDGE SUBDIVISION
1.0 GENERAL
1.1 THE DRAWINGS, SHEETS 1 THRU 2, SHALL BE A PART OF THIS
SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE
VERIFIED OR MODIFIED.IN THE FIELD BY THE CONTRACTOR
AND FIELD'ENGINEER.
2,0 THE LIFT STATION(NOT 'USED)
3'0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES
INDICATED; 0.5 TO 2.5 INCHES.
3.2.THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION.
3.3 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3003 D-3034. THE
SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5"
HOLES @ 6 INCH__CENTERS ON_OPPOSITE SIDES OF THE PIPE
.OR A SECTION OF REGULAR PERFORATED SEWER PIPE~MAY BE'
CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR
SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL)
SHALL BE PLACED ON THE TOP OF THE PIPE.
3.4 INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD
OR EQUIVALENT.
3.5 .THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS.
3.6 THE SEPTIC TANK OF BED MUST NOT BE CLOSER THAN 100 FT.
TO ANY EXISTING WELL OR BODY OF WATER AND SHALL BE
NOT CLOSER THAN 150.FEET FROM EXISTING COMMUNITY WELLS.
3.7 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL.
3.9 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6
MM AND A UNIFORMITY COEFFICIENT OR NOT MORE THAN 4.
3.10 THE BERM AROUND THE SEEPAGE BED SHALL BE CONSTRUCTED OF
IMPERMEABLE MATERIALs AND ON A SLOPE OF 1 FOOT VERTICAL
PER 2.5 TO 3.0 FEET HORIZONAL.
1200 UJcsl 33rd Aucnu¢, $uii¢ B · Anchorac~¢. Alaska 99503 · {907) 276-1361
~ ALASKA ENVIRONMENTAL · CONTROL SERVICEP"~NC.
-~' ~ 1200 West 33rd Avenue' ~ite B
· ANCHORAGE, ALASKA 99503
Phone 276-1361
JOB
SHEET NO.
CALCULATED
CHECKED DY
SCALE ~ =' = ~°
OF
DATE
DATE
i
O :
i i
.......... ? ........... ? ................................ I .......... ~ ....... ~ ....... ? ........ ? ........ : ............
z- ~ ' ALASKA ENVIRONMENTAL Jo, =~ ~'-'~-~'T-°~' ~ \
" SERVICE?' .
...~.....~ CONTROL ~NC S,EET,O.
· ,, 1200 West 33rd Avenue ~ obite B
· ANCHORAGE, ALASKA 99503 CALCULATED BY
Phone 276-1361
CHECKED BY
SCALE ~ 4 '.* ~/'
DATE
oO
i.-,...---.i ........... i ......... : ............. · ............ ~ .......... ~ .......... ~'"'"'"~"'""~ ....... i ............ i'"""~ ........... ~ ............ ; .......
~'~:~;~'~'"-': ........................ i ........................ ~ ...................... ~'"-'~ ~ i ~ ...........
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, . . .................. ::_.._~.......~: ........... : ............ :......~ ............ i ......................
~'-'~ ..................... ~, ............. ~ .............. ...... -~ ..... r .......... ~'-"-""~-'"'"~ ............ ! ............ ~'-'~""~'"""~ ..........
,~;~.....~ ............ :. ............ i .................... ~ ..... i ......... ~........~. n .................... ~-~:. ......... ~ ...........
".:- ~ ~ .,', ................. :......p......t~ .......... -.":. ............. !.......~ ....~ ............ ! .............
I ~ ......... ~ :~ ....... : :, ............................................... : ~ i : ""- ~' , ....................... i L._...~;.......~ ~ ;.'1 ........... · i ~ .............
........... ~/ ....... ~ ............. t ........... · ........... ~ ........ / .... ? ......... .~ ......... ' ................................ + ................ ............. ! ............
._,_....L..-_...i ........ : ................ i ............. i .......... .~ ....... ~ ............ ~........~....-.!~ ....................................... i._...~:. ......... i .......... I
· i. ! ........... ',.......~ ............ i ......................... i ........... ! ............. i ............ i.-...-~, .......................................
. i ' ~ '
~ . ~ ~ ....... i .......... ~'""-~: ............. i ............
~ ........ : ............ i .......... ., ............ : .................. .. i'~' "~ ......... i .............
.......... ~ ............. ~"'"~""'~ ........... i' ........ ~'-"~i'"'-' ........... i ............
. ~. ~ ~ -. J . ~ ~
:-.-.'--'~- ............. i ............. ~.---.-~u.-.--O.----~ ............................... ,"2 .......... -:, .......
O '~'
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUBLIC WATER SYSTEMS
APPROVAL TO CONSTRUCT
Plans for the ~-~r-~,~e~'t*~'modification of_~.e.~ ~/~
.4/£~Y~ ~1~ 7'/I,~, ,~..~ .~.~/, ~q21-P~v-/~3-/~,O : q~/Z/- k/v--/5-~ -O~.public water system located
in. /-,/~,c_~.,-.~f~.
[] approved.
, Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
[] conditionally approved (see attached conditions). /~z¢,. &//~/?f/
;- o2/,,
If construction has not started within two years of the approval date, this certificate is void and new plans and
specifications must be submitted for review and approval before construction.
Change (c~r~-~ ~ ~. ~ ~.~p,, -~.~,--I Approved by Date
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
is made available to the public.
The construction of the
water system was completed on
granted interim approval to operate for 90 days following the completion date.
public
· (date). The system is hereby
BY TITLE oArE
As-buill plans submilted during the interim approval period, or an inspection by the Depa~menl. has confirmed
the system was conslructed according to the approved plans. The system is hereby granted final approval to
operale.
TITLE
DEPT. OF ENVIRON MENTAL CONSERVATION.
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
June 6,1994
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
Mr. Michael Dahl, P.E.
PolarConsult Alaska, Inc.
1503 West 33rd Ave., Suite 310
Anchorage, AK 99503
RE:
Lot 4, The Villages -,Pine Ridge Subdivision, NE 1/4, Sec. 15, T11N, R3W, S.M.;
Request for Waiver of Separation Distances Proposed Class "C" Public Water
System. ADEC Project Nos. 9421-DW-153-160, 9421-WV-153-038. Review
Dear Mr. Dahl:
This letter is in response to the materials received in this office June 2,. 1994, requesting
a waiver from the required separation distance of 150 feet between a proposed on-site
wastewater disposal system and Class "C" well. The Department has completed its
review of the submitted information which included a cover letter, survey plat, well log,
soils log, and a site survey. Based upon this review the Department has the following
comments:
Waiver of Separation Distances
From the information provided to this office, it appears that a variance from the required
150 foot separation distance between a Class "C" well and a proposed on-site wastewater
disposal system is necessary because the existing terrain prohibits placement of an on-
site septic system elsewhere within the property boundaries. Based upon the information
provided regarding subsurface strata, depth of the existing well from the well log, and
upgradient location of the well, it appears that contamination due to a' reduced separation
is unlikely. Therefore, in accordance with State Drinking Water Regulations (18 AAC
80.030) the required 150 foot separation distance waiver is granted subject to the
following conditions:
1. Proposed location of the wastewater disposal system must be at least .?'100 .:....:.
feet from the well. ,~' , :-.. ,:::~.,
~ . -~: ~ ;' .'...",-. ...
2. The well will provide service only to Lots 2 and 4 of the Villages - Pine R~dge
Subdivision. ' .........
,~.' ..~:' ',~, , '~ .,,, .~....
,:'~ . ~.-..
Mr. Michael Dahl, P.E.
2 ,June 6,1994
Drinking Water System
Approval to construct a Class "C" Public Water System to provide water service to the
subject lot is granted by this Department in accordance with State Drinking Water
Regulations (18 AAC 80.300). This approval is subject to the following requirements:
Location of the well in longitude and latitude must be submitted to this
office.
Approval to operate will require completion of items identified under part II
of the Class "C" checklist. The system must be designed to meet peak
demand and storage requirements as identified by a well flow test.
An application for water rights from this well should be submitted to the
Department of Natural Resources.
Attached is a Construction and Operation Certificate for Public Water Systems
verifying this Department's approval. An approval to operate this water system will be
granted when the above items are received in this office for review. This approval does
not imply the granting of additional authorizations nor does it obligate any federal, state
or local regulatory body to grant required authorizations.
Thank you for your cooperation with this Department, if there are any questions regarding
the above please do not hesitate to call.
Sincerely,
ML/cf
attachments
Michael Lu, E.I.T.
Environmental Engineer
polarconsult alaska, nc.
ENGINEERS · SURVEYORS · ENERGY CONSULTANTS
State of Alaska
Department of Environmental Conservation
800 East Dimond, Suite 3470
Anchorage, Alaska 99515
July 14, 1994
Attn.: Mr. Mike Lu
Environmental Engineer
RE: Lot 2, The Villages - Pine Ridge Subdivision
Dear Mike:
Enclosed is the additional informatiOn you requested regarding our submittal for approval
to operate the well located on the property referenced above.
The well is located at 149o46'36.. West longitude and 6 IO02'52" North latitude.
Well log prepared by Penn Jersey Drilling, Inc. is attached.
Satisfactory fecal coliform and nitrate test results prepared' by Northern Testing
Laboratories, Inc. attached.
Penn Jersey Drilling, Inc. Conducted a well flow test on June 20, 1994. They determined
a yield rate of 10 gallon/minute. Copy of report attached.
Attached are plans and specifications that detail the water system, including a pump yield
specification sheet for the Gould pump that will be installed in the well. The system has
been designed to meet peak demand and storage requirements for a four bedroom house
with a 44 gallon storage tank and the specified pump.' Further, only lead-free pipe, flux,
and solder will be used in construction of the water system.
The system is owned jointly and will be operated, maintained, and repaired by Mr. and
Mrs. Robert Bret Coburn and Ms. Nancy K. Schmidt.
A copy of the site plan with topography for the site is also enclosed for your use.
I hope this information sufficiently meets your requirements for approval of this water
system. Please let me .know should you have any questions.
Sincerely,
Michael D. Dahl, P.E.
Senior Civil Engineer
JOBS\COBURI'~LU7 i 4.DOC
1503 WEST 33RD AVENUE o SUITE 310 · ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 · TELEFAX (907) 258-2419
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
July 20, 1994
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
Mr. Michael Dahl, P.E.
PolarConsult Alaska, Inc.
1503 West 33rd Ave., Suite 310
Anchorage, AK 99503
RE:
Lot 4, The Villages - Pine Ridge Subdivision, NE 1/4, Sec. 15, TllN, R3W, S.M.;
Request for Waiver of Separation Distances Proposed Class "C" Public Water
System. ADEC ProjeC~ Nos. 9421-DW-153-160, 9421-WV-153-038. Review
Dear Mr. Dahl:
This letter is in response to the materials received in this office July ~5, 1994, requesting
operation approval for the subject water system serving lots 2 and 4 of The Villages - Pine
Ridge Subdivision. The Department has comp;~;ted its review of the submitted materials
which included a well log, well flow test results, itemized system components, site survey
and satisfactory results from raw water sample analysis for total coliform bacteria and
nitrate. Based upon this review this office has the following comments concerning
approval of this water system:
The submitted materials for the water system should be under the stamp of
a Professional Engineer (P.E.).,
o
An engineered as-built plan of the water system including any storage tanks
will need to be submitted by a P.E.
Final operation approval of this water system will require that the above two items be
satisfactorily addressed.
Thank you for your cooperation with this Department, if there are any questions regarding
the above please do not hesitate to call.
ML/cf
Sincerely,
Michael Lu, E.I.T.
Environmental Engineer
STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES
DIVISION OF .WATER
[] Southcenl~al Region
P.O. Box 107005
Anchorage, Ak 99510
(907) 762-2575
lax: 562-'1384
[] Southeast Region
400 Willoughby
4th Floor
Juneau, AK 9980!
(907) 465-3400
fax: 586-2954
~ Northern Region
3700 Airport Way
Faitbanka, AK 99706
(907) 451-2700
fax: 451-2751
APPLICATION FOR WATER RIGHT
~ Mat. Su/Copper
Basin Area
1800 Glenn Hwy. Ste 12
Palmer, Ak 99645
(907) 745-7200
fax: 745-71'12
OFFICE USE
DAi'T~I'iME 8TAmp
INSTRUCTIONS: Please lype or print in ink. Complete and sign the application; incomplete appl~cal~ons will not be'accepted and will be returned.
Submit one application for each water soume. Attach the required items and return to Ihe DNR Regional o~ce in lhe ama of the water use.
1. APPLICANT INFORMATION
Full legal na e(s) --- '
s- . n.J
Social Security or Federal Tax ID # (optional)
Mailing Address
Home Telephone Number
Co-owner (full legal name)
Social Security or Federal Tax ID # (optional)
City, State and Zip
2. LOCATION OF WATER USE
Provide the legal description of the property where the water will be used:
Lot Block
Business/Daytime Telephone Number
_ 1/4
ASLS, ATS, or US Survey
1/4 ,
Subdivision Name
Aliquot Pads Section Township Range Meridian
Do yo~ lease this properly? YES
If yes, attach a signed copy of the patent-'~eed,'~'r lease; OR
If no, you may not be eligible to apply for water rights. Contact your DNR regional office for advice.
~ 3. LOCATION OF WATER SOURCE
Is the source of water within the boundaries of the same property as described in Section 2 ? YES /NO
If yes, skip the rest of section 3 OR
If no, complete the following section giving the legal,descril~tion of the wato,r source.
Lot- Block ASLS, ATS, or US Survey Subdivision Name
_ 114 114
Aliquot Pads Section Township Range - Meridian
Do you own or lease and have righl o! access to Ibis properly? YES.~ NO~
If yes, altach a signed copy of tho patent, deed, lease, or document(s) granting access. OR
I~ no, you will need Io obtain a right o! access Io this propedy Io obtain walor rights. It Iho water soume is on state
land, you taus! tile an applicalion for a dghl-ot-way permil wilh tho appropriate DNR oflico listed above.
10-102 [l~)v.
Page I o! 4
II 4. SOURCE INFORMATION
Is. y.our waler source groundwater (ie. a well)? YES v/''' NO
If yes, check one of Ihe followinrj well types: '
Drilled [ v]/'
Driven [ J
Dug []
Total depth, in.feel~/~..) ~ Slalic water level, in feel
Diameter. ~ t, Attach a copy of tho well log if available
OR
Is your water source surface water? YES.
If yes, check one of the following:
Stream
River
Lake
Spring
Geographic name (if unnamed, state so).
[] 5. LOCATION MAP
Attach a complete 1:63 360 (inch to mile) USGS map, 1:25,000 USGS map, or a subdivision plat Identifying the
section corners, township, range, and meridian and indicate the following on it:
* Point of water withdrawal, impoundment, or diversion AND
* Route of water transmission AND
* Point of water use AND
* Property boundary for the area of water use.
[] 6. COASTAL ZONE MANAGEMENT AREA?
Is this appropriation within a Coastal Zone Management Area Plan? YES NO
if yes, and you are using more than 1,000 GPD from a surface source or $,000 GPD from a subsurface source,
you need to submit a completed Coastal Zone Questionnaire.
If no, disregard. For more information on Coastal Zone Areas ca//the Division of Governmenta/ Coordination;
Anchorage 561-6131, Fairbanks 451-2819, Juneau 465-3562.
[] 7. METHOD OF TAKING WATER (complete the following table)
p / J Pump intake I.P~."'inches
ump YES I/ NO
~ I Hours workin~Hr/day
~Pipe diameter inches
Gravity YES 'NO.
-- ' I Length of pipe ~t.
(take poi'
Ditch Yes
~~ W ft.
Reservoir Yes =
W_
Pump output ~ GPM
Length of pipe, ~;'(PO / ft.
(from pump lo point of use)
Head ft.
Diversion GPM or CFS
Water storage. AF
Water slorage_ AF
~a OhS = u lC ee per econ
10-102 Rev. {08/93)
Page 2 o! 4
· [] 8. WATER QUANTITY AND USE
Expected date for system to bo completely developed /~.-~?/~-~
Fill out Ihe chart below if you are proposing lo use water fo~one of Ihebe uses. For all '
-----.---._ other uses, describe Ihe lype
~' o'f use and explain how much water is requested by showing calculations, etc.
COMMON WATER USES AND STANDARD QUANTITIES
TYPE(S) OF HOW MANY
USE
Fully plumbed single family
Fully plumbed single family with
'mother-In-law' apartment # Homes
Partially plumbed single family # ..__~Homes
Unplumbed single family # Homes
Duplex or Triplex # Bldgs.
Fourplex and larger
Moblle Home Park
Motel or Resort
#._~7.__ Homes
# Units
# Units
# ____._._.Rooms
Cattle (not dairy cows) # Cows
Dairy Cows # ____.~Cows
Horses #
.____~Horses
Poultry or Rabbits # _._._.~Anlmals
Dogs (Kennels) # Dogs
Crop irrigation (# acres or sq. ft.): #_._...~Acres
Work Camps # .
.__.~People
*Other Water Uses:
STANDARD TOTAL MONTHS OF
QUANTITY QUANTITY USE
REQUESTED
500 GPD =
750 GPD
25O GPD
75 GPD
1000 GPD
250 GPD
25O GPD
150 GPD
12 GPD
35 GPD
15 GPD
0.5 GPD
I GPD
0.5 AF'Y
50 GPD
GPD
= GPD
= GPD
= GPD
= GPD
= GPD
= GPD
= GPD
= GPD
= GP
= GpD
= /00 GPD
= ~/'~ GPD
= AFY
= GPD
FROM THRU
GPD - gallons per day AFY - acre feet per year CFS - cubic feet per second
Fully plumbed single family - Water piped into the house for domestic uses. Hot water healer;, flush toilet and irrigation of up to 10,000
sq.ft, of yard and garden are included.
Partially plumbed single family - Waler piped into the house for limited domestic uses. Generally no hot water heater and no water
flush toilet included.
Unplumbed single family - No walor piped into tho house.' Water is hand carried.
°Olher Waler Uses - Quantities of water roquoslod over lira standard amounts musl bo accompanied with juslificalion for Ihe additional walor.
10-102 f{,~v. (00~J3)
Page 3 of 4
9. FEE
$ 50.00 FOR USE OF 5,000 GPD OR LESS.
$ 100.00 For{ USE OF MORE THAN 5,000 GPO BUT LESS THAN 30,000 GPD.
$ 200.00 FOR USE OF 30,000 GPD OR MORE BUT LESS THAN 100,000 GPD.
$ 300.00 FOR USE OF 100,000 GPD OR MORE BUT LESS THAN 500,000 GPD.
$ 500.00 FOR USE OF 500,000 GPD OR MORE BUT LESS THAN 1,000,000 GPD.
$1,000.00 FOR USE OF 1,000,000 GPD OR MORE EXCEPT...(see next line)
$1,500.00 FOR USE OF 1,000,000 GPD OR MORE, OUTSID~ OF THE HYDROLOGIC UNIT FROM
WHICH IT WAS REMOVED (based on currenl USGS Hydrologic Unit Map of Alaska).
$ 500.00 FOR USE OF ANY QUANTITY OF GLACIER ICE.
Attach payment with application (Use table below to del, 'mit
- - · - ................... ,,,,,,~ mu~, your quantity IS not in GPO).
WATER CONVERSION TABLE
S.OOO GPO= 30,000 QPDz 100.000 (3PDz SO0.O00 QPD= 1.000.000 QPD~ DEFINITIONS:
.01 CF$ ' .05 CFS -- 0.2 CF$ 0.8 CF$ 1.5 CF~ ~FS~, CUBIC FEET/SECOND
3.47 GPM 20.83 GPM 69.4 GPM 347.2. GPM t~4A (]PM GPM- GALLONS/MINUTE
5.60 AFY 33.60 AFY llZ.0 AI~ S60.1 AFY 1120.1 AFY AFY, ACRE-FEET/YEAR
.02 AFD .Og AFD 0.3 AFD 1.5 AFD 3.! AFD AFD- ACRE-FEET/DAy
.01 M .03 M 0.1 M O.S M 1.0 M M- MILUON GALLONS/DAy
10. SIGNATURE
For this application to be complete it must include: _~/Completed and signed Application Form.
_'~ USGS Map (inch to mile) or Subdivision Plat (Section $).
_~/Deed to property or possessory interest (Section 2).
_~/Well Log if applicable (Section 4).
_'~ Legal Access Documents if applicable; ie. Rights-of-Way or Easements (Section
_'~ Coastal Zone Questionnaire if applicable (Section 6).
_~/Filing Fee (Section 9).
The information presented in this applicalion is tree and correct to the best of my knowledge. I understand that per
11 ..AAC. 93.0~_ 0.and.11 AAC.93.050 additionpl~nformation may be required by the Division of Water to adjudicate this
application. ~-aisure to provicle requested i~orr~atio.n could result in this fil.~being closed.
~)ne apl~c~nt on-fy .... ' .
/ · Name/ (please print) Title
11. STATEMENT OF BENEFICIAL USE OF WATER
.If yes, sign the ~ affidavit of use in the presence of a notary. OR ti no, skip this sect~n.
i~ certify under penally of peril:B, !hat the above is a true and
accurate statement of the extent lo which the above water use has been fully deve!oPed and am using the
stated quantity of water.
UNITED STATES OF AMERICA )
) SS.
State of Alaska · )
This is to certify that on the. day o!
.19 ~ before me personally appeared
known by mo lo be the person named in and who executed this document and
~cknowledged voluntanly sigmng the santo.
IN TESTIMONY WIIEREOF, I have hereunto sot my hand and affixed my offici,'.d seM. the day and year in Ihis document first above written.
~lota~,, Public in and Ior tho State el Alaska
My commission expires:
10-102 Rev. (08/93)
Page 4 of 4
Lowmnc~ A. Schochle - Pr~dont
r-ed Id f 92-013 T665
Penn Jersey Drilling lnc,
ABC Pump & Well Supply
'Speciality work s/nee 1952"
Mile 52 Park~ Hwy.
HC 84 Box 2201
Wasilla, Alaska 99654-9604
P-~]2
Telephone 892-7~¢)8
FOX ~ 892-6278
JUNE 20, 1994
~. BtLET COBURN
10601 CONSTITUTTON
ANCtIOI{AGE, ALASKA 9951'5
PR. 522-I~60 H
562-3100 WK,
FAX-562-3155
"WELL FLOW TEST"
WELL 30TTOM - 294 FEET. APPARENTLY BED-ROCK CAVED IN FROH EARTtt QUAKES
279' 294' PLUS.
STARTED TEST AT 283'. SAND & ROCK CItlPS.
DID WELL TEST AT ~83'. SET PUM1~ AT 260'- T00K WATER SAMPLES.
WELL BOTTOM 294'
TEST PUMP SET AT 173'
STATIC - 11'8"
_ TIME _.CFM STATIC
2:00 4 11.8
2:30 4 13
3:00 4 13
3:30 4 13
TEST
4:00 10 80.6
4:30 I0 80.6
5:00 10 80.6
5:30 10 80.6
6:00 10 80.6
6:30 10 80.6
7:00 10 80.6
7:30 I0 80.6
8:00 10 80.6
PUMPED WELL DOWN TO 173' AT 16 CPM. LET SET 5 MIN. ~IEN PUMPED
OUT 50 GALLONS OF WATER.
P. 1/,o
NORTHERN TESTING LABORATORIES, INC.
3330 INDU6'I'RI^L AVENUE FAIRBANKS. ALASKA 99701 (907) 466-3116 -FAX 458~125
2505 FAIRBANKS STREET ANCHORAGE, ALASK~ 9950'3 (g07) 277-8376 * FAX 274-9646
Bret Coburn
10601 Con~t£~ut£on
Anchorage Ak 995Z$
A~tn:
Our Lab ~:
Location/ProJect~
Your Sample ZD~
Sample Matrix:
Comments~
Lab
Number Hethod
Report: DaCe: 06/16/94
Date
Date sampled~
Time Sampled;
Collected By:
06114/94
06/13/94
0643
A131275
Lot 2 Villages/Pink Ridge
Wellhead
Water
* Definitions t
B ~ Below Regulatory Hin.
H = Above Regulatory Max.
E - Estimated Value
M ~ Matrix Interference
D = Lo=t to Dilution
~DL - Method Detection Limit
Parameter
Uni=~
Date Data
Result * MDL Prepared Analyzed
A131275 EPA 353.3
Nitrate-N
1.05 0.20 06/14/94
Rel~¢~rt,.'.d Uy: AntOny J. La~ge
Ch~:mi.~tr¥ St,l)ervi.~or
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 Ig0?! 4~6~115 * FAX 456-3125
2505 FAIREANKS STREET ANCHORAGE, ALASKA 995Q3 1901! 271~37a- FAX 274-8645
DRINKING'WATER ANALYSIS REPORT FOR TOTAL COLZFO~ BACTERIA'
aret Cobu=n
1060! Constitution
Anchorage, AK 99515
~ollected by: RS
Sample Type=
Routine
(ethod of Analysis=
M~O-HUG (Colllert)
~mment= =
Public ~a=er System I.D.S
Date Received:
Date Analyzed:
Date Reported=
Next Sample Due:
Commenta:
$
U
POS
ND
06114/94 Time Received:
06/14/94 Time Analyzed= 13:1S
06/16/94 Time Re~orted= 13=01
Sati=factory
Onsatiefac=cry
Positive Test Result
None Detected
TNTC = Too Numerous To count (>200 Colonies)
CG = Confluent Growth
= Heavy Sediment Ha=king, Result~ Hay
Not Be Reliable
SA "Sample Age >30 Hours ~ut <48 ~ours,
Results May Not Be Reliable
Old = Sample Age >48 Hour~, Too Old For
Analysis
R = Resample Required
RT = No Test
Sample Sample
Location Date Time Lab~
* # Colonies/100 mi ** f Colonies/mi
Total* Fecal* Other~
Coliform Coliform Bacteria Result Comments
· Lot 2, Village/Viniz
Wellhead
06/13/94 18:43 AE4353
ND ND NT NT S