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Home My WebLink AboutTHE 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 Jo8 SHEET NO. CALCULATED CHECKED BY, SCAU~ DATE I~,~CIJCT ~O4.1 ISe~ SJ~l~) 2~- I (Pad~/',s~e/® Ir,~ ~1~. i4~s. 01471. To i)n~. i~01df TI~U. i~1~ i ~C0.225.6~0 PERFORMED FOR: LEGAL DESCRIPTION: O 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 0 Q. // / I LOT ~ _DRAINAGE EASEMENT ~ 10' DRAINAGE EASEMENT LOT 4 :CHAEL D. DAHL CE-8480 OoooooooO~ 41.000 SF SCALE 1"=40' 0 \" "i ',, J\ .... .' @ · '1 ~o .'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'~ FR~I~ 204-1 (Skid Sands) 2~ I II~ddded)//~------'~e k~ G~Od~ 1,4a~ e1471. TO 0~' P, Cf~ TGLL Fl~l~ I~Q-22~380 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 J 0 0 0 0 0 -_ (,] · J ^ Oo ~n 0 polarconsult alaska, inc. '].503 ~/est 33rd Avenue * Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258.2419 job L.L~ SHEET NO. CALCULATED BY CHECKED BY DATE SCALE ..................... ! i_~.~..i.. ............ PI~OUCT 204. I (S~-41e Sheets) 205.1 (pad,~ed) ~e k~. G~lcat. ¥,T~. 01471. To Oflhi. pi401~ iT~ I~ i .800.22~ polarconsult alaska, inc. '~[503 t/~/est 33rd Avenue · Suite ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-24~.9 CALCULATED BY ~ DATE "'~/*'% 0/~ ~~"''"' C. ECKED B~ 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 i i 'i CHECKED BY ~ /" = ~0' DATE i · ~ ~4-1 ('~Wlk Sla, ts) 20~ I (pslded)/~---~e lac. Cdaoa, kbss. O 147 i. To O(~.f iTiOi( 'I~U. I~IZ 1-1~-225-1310 i ......... pol.arconsult alaska, inc. 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 PROi~'T 2~4.! ~e She~) 205-1 (F*a~I/~------~o b~c. GIO~. ~AaSS 01471. TO 0rcler PH{~ 'roLL · , .. polarconsult'a!aska, inc. '~ ~' 1503'west 33rd'Avenue *Suite 310 · ~. ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 CHECKED BY. SCALE/"=5' DATE ' '~eee~ee° i--T .... ~ .... F'--F ............... ~-["~] .....~ .... ? ...... ~ ..... ~-'-~---T .... ~'---~ ...... Ii ]']FT-T~ F'T ..... ........ .... ~'-} ..... ~-]~ ..... ...... Y F'-~-'7-"F ] ........ .... ...... F-P ...... 7' "' [ [--- : It ~ -T ..... ~-' ~ ..... ~ ...... T .... ?--?'~ .....~ ?--t--"~ ........ i ...... ~ ...... i~ ....i- [ .... [---~ ': .... 1_~_4__L ..... ~__.[ ] .... ] ..... L._~ ..... L__~ .... L_~ .... L__~ ~ ~ ~ ~ ~ ~ ~ ~ [ [ II ~ ~~ ~[ ~ ~ : ~ .~ [ [ ~ ~'~ i [-] ~ { F ] ..... .... ........ .... .... F-7--F"~---- I I.--~cm.Z~icip~-o~c~omgc.-(csi~qab~mcR~.--~o~c~ult-.~-a6-w~,..c~...of...~lic~ _.:.l°"gcvi~.. o~ ~c;~ sy~cm, ~d, i~: no( ~spons~le,. : for: ~a~cs= ~ ~sociatcd: : : wi~: i~ ~c~6~cc ...... 6r lo~[c(i~. ~is~dcsi'~ h~. b~cn ~c~: : on or ~ot bo a~lc t6 bo 6ons~ctbd a~ all ~c [lom[ion~ of ~c s6ils tbs~,[mo~ito~g Gclls,{ ~d~Icac~ficl~ ~c a~pro~a~c ~ habc b~cn _.bc?c~ficd::.by...a ..rcg~tcmd .]~d.[ s~cyo~._pfib~..~d ..si~...plnn,i,g. n,a_s~s~...~btio~.....~o~nsuk_w~l...,6t ..b~..r~ ~ag~s ~soci~tcd Fin~c~o~ rdat~~ to ~c 16carl% ~s~ptiobs. ~ ~ [. · . . 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 ~ ........... ............... i' ...................... ~ ...... :. ............. ~;'-"Y'"-'~' ....................... i ......... ~ .......................... i ............ , . . .................. ::_.._~.......~: ........... : ............ :......~ ............ 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