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Home My WebLink AboutWOODLAND PARK LT 10E-2 Onsite File Woodland Park Lot 10E - 2 #010 - 092 - 41 R_ DOC CO dba SILL � GOLE ;%. ULLIVAN WATER WELLS vit P.O. Box 670269, Chugiak, AK 99567 688-2758 OWNER OF LAND: Jim & Joyce Paulus ADDRESS: 3309 Willow Lane Anchorage, AK 99517 Bore Hole Data Depth From To LEGAL DESCRIPTION Woodland Park Lot 10E-2 DATE: 8-7-19 0 2 PERMIT NUMBER: OSP191313 DATE OF ISSUE: 8-5-19 TAX IDENTIFICATION NUMBER 01009241000 is well located at approved permit location: ®Yes ❑No Method of Drilling: F7 air rotary ❑cable tool Depth of Well: 165' Casing Type: Steel wall thickness .250 inches Diameter: 6 inches, depth 165 feet Liner type Static Water Level: 60 feet Recovery Rate 25 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ❑yes Ono Method of Disinfection: Chlorine 50 PPM Comments: 2 4 4 75 75 101 101 133 133 145 145 155 155 165 Casing Stickup Overburden Sand Silt w/ Gravel Clay & Gravel Clay Silt & Gravel Gravel & Silt Water Sand & Gravel Water Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. DOC CO dba BILL Sc COLE ULLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 www.suilivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW OSP191313 Date of Issue 8-5-19 Parcel Identification Number: 01009241000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. SGS Ref.# 1194620001 Client Name Sullivan Water Wells Project Name/# 3309 Willow Ln Client Sample ID 3309 Willow Ln :Matrix Drinking Water Sample Remarks: Parameter Results Printed Date/Time 08/27/2019 14:19 Collected Date/Time 08/14/2019 13:10 Received Date/Time 08/14/2019 13:37 Technical Director Stephen C. Ede Allowable Prep Analysis LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS EP200.8 Arsenic 74.0 x 5.00 Waters Department mg/L Total Nitrate/Nitrite-N ND 0.200 Microbiology Laboratory 08/19/19 EWW E. Coli Negative 1 Total Coliform Negative I ug/1- EP200.8 B (<10) 08/15/19 08/24/19 ACF mg/L SM21 45OONO3-F C (<10) 08/19/19 EWW 100mL SM219223B A 100ml- SM219223B A 08/14/19 AI 08/14/19 A.L. 2 of 4 Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 Well Decommissioning Log Legal Address: SubdivisionBock T R Section Lot Lot IDE -Z On-site Water & Wastewatef Program certified contractor performing the well decommissioning: Name: i J Signatur . Company: L "J�u1h'JI-A14 fA,Y,,A;' V I t7P/('i'l Well decommissioning date jib - ( ( - Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ C. Location: Use the space below to provide a drawing of the property showing the following items; • North arrow • Decommissioned well, • Other water wells on the property, • Two separate swing -fie distances for each well shown on the drawing, Note: The swing -tie distances shall be measured from either permanent structures or the property comers. ea V � za 4 W3 Site Water and WastewaterTormS\Client Forms\Welt Decommisioning form.doc • "" MUNICIPALITY OF ANCHORAGE i �\ On-Site Water& Wastewater Program C". 'S�• PO Box 196650 4700 Elmore Road " �f•. Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343.7997 ,Tht"• "'' - ,� t < http://www.muni.org/onsite !. �., Department On-Site Water System Permit Permit Number: OSP191313 Effective Date: 8/5/2019 Work Type: Well Upgrade Expiration Date: 8/4/2020 Tax Code Number: 01009241000 Site Legal Address: WOODLAND PARK LT 10E-2 G:1628 Site Mailing Address: 3309 WILLOW LN, Anchorage Owner: PAULUS JAMES A& JOYCE E • Lot Size in Sq Ft: 14261 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 2 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank 0 Holding Tank 0 Privy Q Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development _ Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: For the well waiver approval, this well is to be grouted to a depth of thirty feet minimum. . x To close this permit please submit: 1. Well Log 2. Pump Install Log • 3. Water sample results 4. Well Decommissioning Log ) R � � f Received By: �� ✓ �d•1T 641/ Date: Issued By: ,e,-G' --LOQ�yt,.__ Date: 5/�,1Cf Municipality of Anchorage hartmrnt P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program • **** VARIANCE/WAIVER REVIEW xxxx Waiver#: OSV191066 COSA#: Permit#: OSP191313 PID#: 010-092-41 Legal Description: Woodland Park L10E-2 Engineer: Pannone Engineering Services Your request for a waiver of the required 75 feet horizontal separation from the public sewer trunk to the private well has been approved. The approved separation distance is 70 feet. In addition, your request for a waiver of the required 100 feet horizontal separation from the public sewer manhole to the private well has been approved. The approved separation distance is 80.0 feet. For the well waiver approval, this well is to be grouted to a depth of thirty feet minimum. This waiver approval applies to the proposed well only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 0/0/9 Approved by: L/A6Z-r / Name of Re ewer **** VARIANCE/WAIVER REVIEW **** EPtANS MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 010-092-41 Property owner(s) James & Joyce Paulus Day phone Mailing address 3309 Willow Lane, Anchorage, Alaska 99517 Site address SAME Legal description(Sub'd., Block& Lot) Woodland Park L10E-2 Legal description (Township, Range & Section) Lot Size 14,261 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family(SF) ❑x (w/wo ADU) Septic Tank ❑ Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy Cl (SF and/or D) Private Well ❑X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ownerQ1D. A(Ci6 or authorized agent) (Signature of property g ) Permit/Rush Fees: 19•35 Waiver Fees: . (( gr) Date of Payment: �/1aa�(4 Date of Payment: G/6/9 Receipt Number: 10q X.376 Receipt Number: O.Gl G' Permit No. O Aq 13l3 Waiver No. Ori>U 191 (D Permit App_;-:•::...c; Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191313, Deb Wockenfuss, 08/05/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191313, Deb Wockenfuss, 08/05/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191313, Deb Wockenfuss, 08/05/19 7Z, :==7T 60 J�' 1 1 1 I -I I — I - i I III ItII 74- tt 7 7 F_? A. I t U_L 1,17'. __to_c, 1. A C- a, / .......... TTq r...... _O_ZS JIF I 17y, W—ZE&& ;,v -7,7; ge a me /too 2100 j 100 4 tOO 51-00 a too 721-00 &too ao POST IN A CONSPICUOUS PLACE 00481 SEWER CONNECTION APPLICATION & PERMIT TRUNK SERVICE PROVIDED .._.. III IIII IIII III VIII IIII IIII III V IIIIIIIII P RF55 BILLING AGENT IRATE CODE IAC T. NO, CUSTOMER BILLING NOTICE BILLING DATE DATE FVR.. CORRECTED BILLING ADDRESS CORRECTED BILLING ADDRESS MAINTENANCE DEPT. GREATER ANCHORAGE AREA BOROUGH 2207 MC RAE ROAD, ANCHORAGE ALASKA 99NO3 IS BD GRID LOT30 RLGS GI/IC (IBX IGU r FAIK ]iA CONNECTION STREET AOORESS J. ary T. zm co DET. h�- Lw Im P. DIRT. PROPERTY GRINER NAME V III IIIIIIIIIIIIIIIIII IIIIIIIII II II V III PRGPERr DINNER Aooaess TRUNK SERVICE PROVIDED .._.. III IIII IIII III VIII IIII IIII III V IIIIIIIII P RF55 BILLING AGENT IRATE CODE IAC T. NO, CUSTOMER BILLING NOTICE BILLING DATE DATE FVR.. CORRECTED BILLING ADDRESS CORRECTED BILLING ADDRESS MAINTENANCE DEPT. a a .sCaAftp-so' �6-4-00 \5 "P LY %o a$- / 8F KR6SERWVE \ I-------� E 9F I N I. P/Op My is Zwxd R- 1 z ropograply /s baslod/y flot. property is dwops I I589'S9'OOW /3857' \ I L F loF I ------J (� J• ( / 47�7g5gSF� I Secs N-�eWd llF I N89'S9'OPE /72 12F i /2E I OF I 3E N I. P/Op My is Zwxd R- 1 z ropograply /s baslod/y flot. property is dwops My Comnisslon Explres': NOTARY'S ACK NOW FDGEM NT for, Subscrlbed and sworn before me th/s_day of Notary Public for Alaska My Comm/ss/on Explres, IS-?� SGE:- 3s'€' 6 VICINITY MAP Scale: /'-I Mlle 7uthorlfY ie Anchoragea MI�l 'ue dole, an amount he current year. M — 'ull. and If :: ME - 2000. JUL 19 2000 AWWJ ENC. PLANNING DEP! LOT K)E--/. WOODLAND PARK S( &WIS/ON A RESUBD/VISION OF LOTS /OE AND I/E.WOODLAND PARK SUBDIVISION fP-6//EXCEPTING THE SOUTH 5 FEET OF LOT BE Located wnhln NWV4Sec. 25. T/3N. R4W. S.M-Alaska and aonfoln/no 025 Acres.l Loi. and no Tracts ANCHORAGE RECORDING --- Date FRED WALATKA & ASSOCIATES 3/07 W.291h Avenue Anchorooe. Alaska 995/7 GRID, 1628 SCALE: P-100' DATE: JUN 2000 F.B.: P9. DRAWN: CR FILE NO., W.C. NO< 8209X i CASE: 5-