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HomeMy WebLinkAboutGIRDWOOD ORIGINAL TOWNSITE BLK 2 LT 1Onsite File STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER WATER WELL LOG Drilling Started: 6 ; 19 2012 C'oinpleted: 6--.,--- 19/20.12 C'ity!Borough: Subdivision-. 131-OCK LOT Propert-,Owner ?Namc& Address: Nik Nielson Girdwood Site:305 Old Dawson P.O. Box 397 Girdwood, AK 99587 Meridian Township Range Section €�a of €/4 of €A of V4 DATA(froM top of casing)Depth Drilling method: (X) Air rotary, ( ) Cable too], Other FBOREHOLE atcrial: Type, Color & wetness From To Well use: ( ) Public supply. (X) Domestic, Other - - stickup 0 Depth of hole: 80 ft, Casing stickup: 211 j Casing type: steel Thickness: _250 inches Casing diameter: 6 inches Casing depth: �� ft gravel pad 2 5 -- _– Lincr type: Diameter: inches Depth: ft Static water (from top of casing): 5 ft on 6 ` 19 i 2©12 peet 5 8 Pumping level & yield: — feet after - hours at _ -pm Recovery rate: 50 gpm, Method of testing: airlift , clay 8 18 E Development method: airlift Duration: 1 hour 1 Well intake opening Type: ( x) Ogren end. ( ) Open hole, Other ' silt &gravel 18 25 -- - Screened: Start: ft, Stopped ft Screen type: Slotrmcsh size-. wet clay w/ gravel 25 44 Perforated; Start: ft, Stopped: _ ft Start: ft. Stopped: it gravel w/ H2O 44 68 Note: ............................................................-------------------- .-.. Grout type: bentonite Volume -- gravel w/ H2O w/ clay layer 68 72 __ Depth, from around surface to 20 _ ft Pump intake depth: ft coarse gravel w/ H2O 72 80 _ Pump size: hp, Brand name: Was well disinfected upon completion`' (X) Yes, ( } No Method of disinfection:.Calcium.HypochI.orite-(C.hlorin-e).-- Driller comments'; disclaimcrs:............................................................ .........................................................................................................•-•- ............ ......... ..................................... -------•-- •---------- --------- --------- j Well driller name:....... JohnnY.KaY.................................................... I4 Heft Drillin Inc. Company name:..-•-•----•-�•------------�'• - 3540 Akula Dr. Mailingaddress: ................................................................................... City_ Anchorage -- State. AK zip 99516 Phone number: ( 907 345-0593 E Drillers signature: Alaska state lav requires that a copy of this well log be sent to the Department of Natural Resources within 45 days: favcs are acceptable. (AK statutes 35.0;-020, 35.(15.1)35, 41.08.020, 46-15.020 and AK regulations 1 1 AAC 93.140) - DNR' Division of Mining, Land and Water, 550 %V7th Avenue, Suite 1 020 Anchorage, AIL 99501- 3562 Phone (907)269-8639 and fax (907)209-8947 Within the City of forage, it is required that a copy of the well log be sent to the appropri to city office within 60 days and that another copy of the well log be sent to the well,.,property owner within 30 days. Pcrmit Number: Date of Issue: _ T. .-------------- --- Parcel Identification ?Number: - Is well located at approved permit location? ( X) Yes or ( ) No Pump installation Log -, wID6k fef�y T)rffling, Inc. L€rC�EG�� 3v`� o l ARl1VF (:47[]i mn BATE: 1r-- �6�Ica .s 1!2 ORCP TYPE: Type c— condition FX.Sp m�'-U�- Type `G— lAZ- SLve ewdition 4.L ?=��• EUC RiCAL: Volts V }1ATER TARN-: T}pe Ii +f-0 I /1 r.ASM KOLF- From d 0 KE STRUCTURE: Type G� G� From To OPEN HOLE: F,,r,,//om // �— 7c�— 1 IC�1 --L✓G fX_1'7In—K LtJ� i2+rI&I �a�5 Received Date/Time 10/06/2017 14:12 10/06/2017 8:00Collected Date/Time 1177173001 Matrix SGS Ref.# Client Sample ID Kitchen Client Name Project Name/# Location/Well ID Printed Date/Time 10/13/2017 16:09Residential Testing-Cash Account Technical Director Stephen C. Ede Nik Nielsen 305 Old Dawson Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS VDL10/10/17EP200.8ug/LArsenic 10/09/17ND5.00 (<10)C Waters Department AYC10/12/17SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.100 (<10)B Microbiology Laboratory K.W10/06/17SM21 9223B100mLE. Coli Negative 1 A K.W10/06/17SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121133 Tax Code Number: 07515201000 Work Type: Well Renewal Permit Effective Dates: June 20, 2012 to June 20, 2013 Design Engineer: Subdivision: GIRDWOOD ORIGINAL TOWNSITE Site Legal Address: GIRDWOOD ORIGINAL TOWNSITE BLK 2 LT 1 G:5112 Owner/Address: NIELSEN NIKOLAUS PO BOX 397 GIRDWOOD AK 995870397 Site Mailing Address: 305 OLD DAWSON RD, Girdwood This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sq Ft: 5723 Total Bedrooms: 3 N Privy Y private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. o1 5 ' 1 SZ -U Property owner(s) �Jh kn It -,L., > Ue lsen Day phone U U I z 2 - Mailing addr( Site address Legal description (Sub'd., Block & Lot) o io c. E 7 G, I-� v ,�,bd,vu.a Legal description (Township, Range & Section) _ �� bi 2kAJC- d CA 9thQA Lot Size 5 1 7 Sq. Ft Number of Bedrooms _ Tcwr%.Sl ie THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (®-all that appw Absorption Feld ❑ Initial Septic Tank ❑ Upgrade ❑ Holding Tank ❑ Renewal Nr' Privy ❑ Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Singlmilellin,� in accordance with applicable Municipal Codes. owner or Permit/Rush Fees: doll' Date of Payment: (&h. -Aa Receipt Number: [f5 s' OA Permit No. 05P=33 Waiver Fees: Date of Payment: Receipt Number:. Waiver No. . G:laulldinglon SiteTormsUient FonnsTermit App_010411.doc (Rev. 1/11) Lai I 3/6,k 2 - i MFNH X07 1 � � 40 r o \ t � D GIRDW01 LOT 61 GigDk tOr?� TOkN �� G 10 A LOT 3k BLOCK 2 SERVED BY PUBLIC. SEf" �wner ON G,iJw�O J PRESSURRED � SEWER WJNS JWNYIFE C.O/ .OAK 2 Q Q� EXISTING SEWER UNE STUB SEWER 1WN GIRDWOOD TOWNSIfE, LOT 20. BLOCK 1 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water b Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Mar 14, 2007 Expiration Date: Mar 13, 2008 Permit Number: SW070019 Parcel ID: 075-152-01 Legal Description: GIRWOOD ORIGINAL TOWNSITE BLOCK 2 LOT 1 Design Engineer: 0855 GARNESS ENGINEERING GROUF Owner Name: STORMY HAUGHT Owner Address: PO BOX 536 GIRDWOOD , AK 99587 - Site Address: NHN OLD DAWSON STREET Lot Size: 5723 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of. ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED UNTIL AN APPROVED WASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED. Received By: te" /L' Date: - 3 f Lrl C7 Issued By: ( v r Date: ,1 0-) XV Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 975— /59-0 Property owner(s) •:.,1 HAUGHT Day phone 783-1114 Mailing address -• 13OX 536 GIRDWOOD. Site address(Y.I) DAWSON STREET Zip Code 99587 MQK)A' _ Legal description (Sub'd, Block & Lot) GIRDWOODtTOWNSITE SUBDIVISION.OT 1 B 0 K 2. Legal description (Township, Section & Range) Lot Size 51 Y95 Sq.Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well El Water Storage ❑ Number of Bedrooms 2-3 THIS APPLICATION IS AN: Initial Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: t'_1 --7 5 pef J77l � Waiver Fees:_ Date of Payment:?) r 1 -1 -0 7 Date of Payment: Receipt Number: � F1 d 61 Receipt Number:, (Rev. 11/05) ' GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS v % -V - March 6, 2007 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Well for Girdwood Townsite Subdivision; Lot 1, Block 2, To whom it may concern: The proposed 2-3 bedroom house is to be served by a private well and public sewer. Attached is a site plan showing the proposed well location. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your ., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337.6179 0 Fax: (907) 338-3246' Website: www.gamcssengincering.com Q MANF h� PRESSURIZED SEWER MAINS Crpp/ tOT Doo l 76 '9T a O <p kCbp 7 9110µ 7 (pp Opp TOµ \ \ Cappµ 401 �O 77 Tp 64 '_ �Rpµ (OT �p TO SGT- ?Op0TO�µ�s'�: C/,pp 7 EOT �O 79 �Oq,•_ V, _- GIRDWOODTOW SITE C.O LOT2. . O LOT 2, BL K 2 2 P / GIRDWOOD TOWNSME, LOT 3A. BLOCK 2 SERVED BY PUBLIC SEWER LETTER THAT PERTAINS TO THISDESIGN. TO OBTAIN A COPY OF THE LETTER \ CONTACT CEO. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, GIRDWOOD TOWNSffE, WELL DRILLER, CONTRACTOR AND LOT S. BLOCK 2 PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND PROPOSED WELL PROPOSED 2-3 BEDROOM HOUSE EXISTING SEWER UNE STUB SEWER MAIN GIRDWOOD TOWNSITE, LOT 20, BLOCK 1 GIRDWOOD TOWNSITE, LOT 19, BLOCK 1 GIRDWOOD TOWNSITE, LOT 18, BLOCK 1 / O GIRDWOOD TOWNSITE, LOT 17, BLOCK 1 GARNGSS ENGINLLRING GROUP, Ltd. : 4 I - -- CONSULTANTS & GENERAL CON�....: J"' L TOW I.UD, illlC 101 • MOOMCL " N 7 • N (Mf)W) lA • FAY (M))}y " • II091L �.p,rrprww,.sni PREPARED FOR: PHONE NUMBER: PACE NUMBER: 0 STORMY HAUGHT 907-783-1114 1 OF 1 P '•J r y 'LEGAL DESCRIPTION: DRAWN BY: Q4ep, E GIRDWOOD TOWNSITE SUBDIVISION, LOT 1. BLOCK 2. K.D.M. TYPE OF WORK: DATE. �QOO4e SITE PLAN FOR PROPOSED WELL LOCATION 3/6/2007 -7953 ; ' :g' t ��/�UMUPALr y OF AMC HORAGIE ---------------- Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 075-152-01 1. GENERAL INFORMATION Expiration Date: 3-21_a0z0 Complete legal description Girdwood Original Townsite, Block 2, Lot 1 Location (site address) 305 Old Dawson Road, Girdwood, AK Current property owner(s) Jeremy & Natalie Huffman Day phone 907-388-4490 Mailing address PO Box 472, Girdwood, Alaska 99587 Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer El Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ��Jr Waiver Fee $ Date of Payment Date of Payment Receipt Number ������ Receipt Number COSA # 0,5c l q 16-q 9 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 12/20/19 By: V h / Original Certificate Date: Z" 23'-0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet �•Imp 47 o°°o 49th 0 6. DSD SIGNATURE a ..... ii .................... .... .. .....o —7/— System #1 Approved for bedrooms D................................................p °off, ;MICHAEL E. ANDERSON f( d ,� System #2 Approved for bedrooms Y pp ©©off©,pF., 12/20/19 3at'••��C�woo ° `I�'�' Disapproved QOoo©oaoES�S\Coo®P_® Conditional approval for bedrooms, with the following stipulations: .Iittllt4dWfZ1. By: V h / Original Certificate Date: Z" 23'-0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet t Legal Description: Girdwood Original Townsite, Block 2, Lot 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled 06/19/12 Total depth 80 ft Cased to 80 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 2/19/19 Static water level at beginning of test 4.5 ft. Comments B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Public Sewer D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over. field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Public sewer COSA Checklist yellow sheet Parcel ID: 075-152-01 Structure served by this system Well production at time of test 6.9 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate •269 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Anchorage Well & Pump Date of Sample 12/4/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) - Public Sewer Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' [7 Yes Yes if No ft M Yes if No ft Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) - Public Sewer Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No _ Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ft Private Wells > 100' ❑ Yes if No Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No _ Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) - Public Sewer Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS This lot is served by the AWWU sewer system. G. ENGINEER'S CERTIFICATION o.....++... I certify that l have determined through field inspections and review �4" .."" zz of Municipal records that the above systems are in conformance with MOA MOA COSA guidelines in effect on this date.`,`+ `• 9th_ MICHAEL E. ANDERSON i �� •. No. CE -4381 .+ COSA Checklist yellow sheet........ ft ft ft ft ft f U.S. SURVEY 9010 ALASKA RAILROAD i, F �pj• pyo WELL��' LOT 1 7 r f SHED r r 7 , I (T CO�APOST STORAGE C + LOT 2..• •J ,r OF 4,1 AY.R VIA IT ©... ..... ... ...... L .. ��i %/ `•. STEV�ALN a` LS-12034 QrO�sSbnot c' NOTES: THIS DRAWING SHALL. NOT BE MODIFIED FOR USE ASA PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. SNOI," ANO ICE N4AY CONCEAL MINOR SURFACE FEATURES, ORDEREDBY: NIKOLAUSNIELSEN PARCEL#: 076.152.61-000 SUVEYC€RTIrICATSmJCG1,ANTRcI,INCiASCCNc'rTFDAPf1rsl;sLSURVFYOF Tt,E PROPERw As aHD,RM'JI: Ttil$ ORA.1V11i1 AND y"ERT�tEs THATTh� I.OVEMEICT55RUATED THEREON ARE W17HIN THE PROPERfTY LINES AMD NO LEGAL DESCRIPTION., ADDRESS: 3050LDpA�AISONROAD ENMOACHMENisoosroTI-"THAN NDiM. AS -BUILT EkC4USIDNARYNOTE:s71,STHEtiv:NL-CtS'tiESPIIt15i2UJ1'YTtlOETEhAIciErfic U.S. SURVEY EXV,TENCE OF ANY EASEMENTS, COVE WS; REaTR1CTION$ OTi R!GHT•cf YAy U LOT 1, BLOCK 2, SSl. RVEY NO. 1177 TAKINGSSYHCH DO NOT APPeARQN ME RECGP.4EDSUSCNT WILAT. UNDER NO GIRDWOOD ORIGINAL TOWNSITE Es Fells INGPAOPM.r4°yANY LWE FOR 250 H Street 1. OM SEPTIOSTANOPiPE ( Ovs han .:sLti Anchorage Alaska 99501 riArm INSA, R A VGra.el PENCE —X—X— r ; �a D� �� ron�ratc', . 71 Survey Depart n-nt Prone 562-5291 DRAWN DATE Z1412018 WORK ORDER: 18905 Inc Mainline DRAWN BY_ 6111 PLAT; USS 1177 Phone 2'13 $885 wwce,if-lCl,.ht n9urtE2tnq..pcoii� jitiry -& ECKE6 Y: SC y~,GRIO: SE51i2&SE51t3 SCALE: 1 20' REF:2013LI51 • • ?,E 8� •� .� Municipality of Anchorage ° • On-Site Water and Wastewater Program ■.1 i (907) 343-7904 S f CTY Certificate of On-Site Systems Approval Parcel I.D. 075-152-01 Expiration Date: � 27—12 1. GENERAL INFORMATION Complete legal description Girdwood Original Townsite, Block 2 Lot 1 Location (site address) 305 Old Dawson Rd, Girdwood, AK 99587 Current Property owner(s) Nikolaus Nielsen Day phone 301 -2227 Mailing address PO Box 397, Girdwood, AK 99587 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer El WaiverNariance request for: Distance: Received by: vQ/l 64(/('J44/9O f! ) Date: ‘::///7//S) COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ C Waiver Fee $ Date of Payment 2/ 2J Date of Payment Receipt Number Q OQ Q S Receipt Number COSA# 9S C(R/ os-7 Waiver#_ 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone 577-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 2/20/18 6. DSD SIGNATURE •• •• • 1y System #1 Approved for y pp � bedrooms r, Ben'. In Schiller System #2 Approved for bedrooms .s��a•A ad •:0� DisapprovedYa0�EsS�? 4 Conditional approval for bedrooms, with the following stipulations: .Q \-r,( OF* ON-SITE • WATER AND m WASTEWATER oz: ' PROGRAM ,G, " '''`4'?'SFR\I'c�S to„ Original Certificate Date: Z.-2. 7-If The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet i '. c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Girdwood Original Townsite, Block 2 Lot 1 Parcel ID: 075-1 52-01 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/19/12 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 80 ft. Cased to 80 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 6/19/12 2/19/18 Static water level 5 ft. 4.5 ft. Well production 50 g.p.m. 6.9 g.p.m. WATER SAMPLE RESULTS: Coliform /pct colonies/100 mL Nitrate i :-' mg/L Arsenic ND ug/L Date of sample: 2/15/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Public Sewer Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed N/A Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at _ in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots >100' Absorption field on lot On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas 100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION ,.,`'�.►�'�.Vvit kk I certify that I have determined through field inspections and r,.�.�V •• • _) •66 .,4" 66 review of Municipal records that the above systems are in *;' y, m / .:vi, �,ii conformance with MOA COSA guidelines in effect on this date. fA% , Engineer's Printed Name Benjamin Schiller, PE ...�•�. Ben .min Schiller Date 2/20/18 �� ;',.•. C E i2592 „•74 -.1.' fir f _' 1 .•;,v"- �ALt COSA brown sheet 10-10-12.doc LOT 26 c'0, U.S. SURVEY 9010 / ALASKA RAILROAD i = t^o /, , WELL® 0 V 9 20. o`n N• oO,F 20 �� LOT 1 '2oos, SHEDC.7 a 906, / EXISTING _ HOUSE '... 4, "1`" 406, ..5:it1.`b's. .... `, ,' •g •�',fir;f;. ,........, o6 6'00 ""--_COMPOST .-- s �c STORAGE 74!).0 0, •4 /0 30• ,' ,•off LOT2 •.i ' ' / Q/ 1<1 OF..A L,q°4p / 6'7 c? Q 40 0(P:. 4911u 1" ...... / o f. / D OV 0 STEVEN CALLA SAN. �� DO�� % LS^12034 �iW / d�~B � t�?;2 oma' ��00°feSSIOn°�.�=' NOTES: bOppd�`� THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN / WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES. SURVEY CERTIFICATION.LCG LANTECH,INC HAS CONDUCTED A PHYSICAL SURVEY OF ORDERED BY: NIKOLAUS NIELSEN PARCEL#: 075-152.01.000 THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO LEGAL DESCRIPTION: c ADDRESS: 305 OLD DAWSONROAD ENCROACHMENTS EXIST OTHER THAN NOTED. AS-BUILT EXISTENCE IF ANY EASEMENTS,ITISTHE OWNERS'CQ ENANTS.RESTBILTTY RICTIONS ONO DETERMINE THE WAY U.S. I R I" A K I 1177 CIR RL SHINC.ES HOULD ANY DATA HEREON PLAN DPFOR CONGS WHICH DO NOT APPEAR ON THE RECORDED STRUCTION,PLAT.UNDER NO LOT 1, BLOCK 2, TSTA MSTANCkS SHOULD ANY DATA HCRCON BE USED FOR CONSTRUCTION,FOR --...�..� r,olr�rt\IAI Tc�wNSITE