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HomeMy WebLinkAboutGIRDWOOD ORIGINAL TOWNSITE BLK 3 LT 9Municipality of Anchorage On -Site Water and Wastewater Program U r } (907) 343-7904 5 _F i E T Y Certificate of On -Site Systems Approval Parcel I.D. 075-153-09 Expiration Date: lLi Z 10 ZZ 1. GENERAL INFORMATION: Complete legal description GIRDWOOD ORIGINAL TOWNSITE• BLOCK 3 LOT 9 Location (site address) 245 Main Street *Girdwood 99587 Current Property owner(s) Alicia Foster Day phone 801-554-2101 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class_Well El Community ❑ Public Water System ❑ Public Sewer 19 WaiverNadance request for. Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _2 RO Date of Payment 7 / DO z Receipt Number 665 g 96 COSA# 05C"?21 3 -18 Date: Waiver Fee $ _ Date of Payment Receipt Number, Waiver # M, 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: _Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Gayness Date: -Z, -2- In In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or <— .< `C� • . • • • • • encroachments may exist that were not identified during the evaluation. The operational life of all wells ��•' S� J and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels that may fluctuate during the ( Y g year}, quality of construction (materials and (;' :� �- %�-- workmanship), and the water usage of the family utilizing the systemis. These conditions can vary, and "" . "" "' """"-"""', are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system !') '•' Y r=^'• ess can be installed on the property in the event either of the current systems fail to perform adequately in ��(), CE 79 the future. The content of this report is for the sole benefit of the person/party that retained GEG to !�i� `: t• •. ....e. perform the evaluation. Reliance upon the information provided in this report by any other person or Ai k) ^�'a " ti party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.���p��c' 6. !VIGNATURE \�`�Y(OFq�f/,, System #1 Approved forbedrooms �`ISIQ dll J� O System #2 Approved for bedrooms g DN -SITE Disapproved = WATER AND rn rn WAST_ VI'ATER Conditional approval for bedrooms, with the follow stip as, .O 0RAM � �---� 0 1l�� D Original Certificate Date' f - 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other �Lj Legal Description: GIRDWOOD ORIGINAL TOWNSITE; BLOCK 3, LOT 9 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 917182 Total depth 55 ft Cased to 55 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/8/22 Static water level at beginning of test 13.0 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 D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (ma Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom o ective. If not, state depth into effective ❑ Code -required soil er over field ❑ System pres ed (Required if ant for greater than 30 days prior to date of t G ons introduced _gallons COSA Checklist yellow sheet Parcel ID: 075-153-09 Structure served by this system Well production at time of test 10.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes W No oliform bacteria is Negative Nitrate Sc1 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [arsenic less than MRL (ND) Collected by _ GEG, LTD. Date of Sample 7/8/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station yearss 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 and Any rejuvenation treatment (past 12 months) If yes, enter date M E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ft f7 Yes if No ft M Yes if No ft Neighboring Tank > 100' @J Yes if No ft Private Sewer/Septic Line > 25' Yes if No * ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No Animal Containment > 50' Yes if No ft [D Yes if No ft if No ft If saV is tank is under driveway comment below *SEE ATTACHED AWWU CONNECT CARD FOR GENERAL LOCATION, NO Manure/Anima! Excreta Storage > 100' Community Sewer Main > 75' [DYes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) [HWU1(U SCwtK'I Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' Q Yes if ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' F✓ Yes if No ft Water Main > 10' ❑ Yes if No ft Communi ells > 200' P Yes if No ft Water Service Line > 10' ❑ Yes if No ft If saV is tank is under driveway comment below From Absorption Field on Lot to: (Please enter dist s if less than required) Building Foundation > 10' ❑ Yes ft if absorption field is under driveway comment below Property Line > 10' es if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Se ' Line > 10' ❑Yes if No ft Community Wells > 200' El Yes if No ft ace Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS *SEE ATTACHED AWWU CONNECT CARD FOR GENERAL LOCATION, NO FCO LOCATED. G. ENGINEER'S CERTIFICATION 4=a� QF I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ... , .� - • - _ _ • _ . , .: • . . COSA Checklist yellow sheet --625rr, ess. CE -79 3 e�� co`c0 ,ro f essio�'°o� *AECC88A DATE SCHEDULED / / TIME SUBDIVISION GIRDWOOD ORIGINAL TOWNSITE INSPECTOR BLK/LT/ RACT BLK 3 LT 9 C/o t` Stu PedestaQ SIZE MAIN: `� TYPE MAIN: DEPTAT MAIN: AT PROP. LINE: CONNECT LOCATION:TUb cul' /S "/ fr weST COMMENTS A C 14, / uluTia ' cut � �/ ".St',tt.' af fil Tu 4L'S%� _5 -is -f-r .1w i% 0 I 2`/u S F C0JrN�X C� /`1tot,/.iG INSPECTED BY: 20 - DATE: f,J_ 15/-9G t 19 21A LG ! ! l r BLOCK', •✓tt VE 1 ! UVJ ! ! 1 •` ^ 16 + 2 8 M 19 -L" 4¢0 t - / GT 2 7' TM SET fil V tt -ss to MAINrjJul REET _ _--- _ _ - _,_ „- _ _ .--j --- - - - �-- --- - i A.,Dt 3(6 1 9.7 . t t- .`/�,� STi46+-4OM ----VALVE VAULT, SES SHEET -11, _lD lt TPUMP STATION S SH%T 11� CR AYOUJO/519 STA.6*2 ST , _r� MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907) 564-2762 WASTEWATER CONNECT PERMIT 95 - 0661 DATE OF APPLICATION 07/05/95 SCHEDULED COMPLETION DATE 12/31/95 BLOCK/LOT/TRACT BLK 3 LT .9 Pq SINGLE FAMILY SUBDIVISION GIRDWOOD ORIGINAL TOWNSITE F] MUTT -DWELLING No. APTS LID 60-9 F] COMMERCIAL TAX CODE 7515309 GRID AS -BUILT STREET ADDRESS main street OWNER MURPHY DENNIS H PHONE MAILADDRESS GIRDWOOD,AK 99587-0214 PERMITEE (Please Print) PHONE MAIL ADDRESS SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR O�iftm ASSESSMENTS CONTRACTOR TAM Repair Existing Service On Property Only Hydrant Only Main Tap - To Property Line Only El City Tap 50' or Longer Main Line Extension [] Have Been Levied R To Be Levied comments Main Tap & On Property Connect Disconnect R&R -Main Tap Only OwnerIstaff ISSUED BY SAP CONNECT SIZE 4 INSPECTION FEE $ 0.00 PAID CASH PERMIT FEE $ 0.06 CHECK# $ INSPECTED BY REIMBURSIBLE NUMBER 9494-4170-0016 DEPOSIT $ 0.00 TOTAL$ 0.00 DATE RKS PERMITEE (Please Print) PHONE MAIL ADDRESS SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR O�iftm 77 k rn orn Q) �- m U J to M to \ CTS L O P (n L ''Q^) LU U co cn ❑ (^ co Q � M (D J V LU a-- Q V LLJ LU Q-= COcuCe •�� i 3: ❑. N t 0 8�\ s 1� Q P, C,v Lp n� /� '►"� • m is o e a�z YGk'u,� , or�o�•'���m r S n a FAV\ �'v4 W V r� D QOIH(9)m C :i w F O1-0 Q ❑®® X N Q Y F J QUZw w Q ZMF�aJdo zC[�OQQ : m z o z z 6 9!�OOO J10 = <CL Sao' �° ec CY C a m 0 = O a t o V _ V m p a O c O o m v !1c cmc 2o�pm o Cst Cl m©� Q ow w a Y C�Ow-gym CO OLO ( R rn orn � J to M to \ t O P (n w V cn ❑ (^ 7 7- CD z cr < (D J V p U Q V D QOIH(9)m C :i w F O1-0 Q ❑®® X N Q Y F J QUZw w Q ZMF�aJdo zC[�OQQ : m z o z z 6 9!�OOO J10 = <CL Sao' �° ec CY C a m 0 = O a t o V _ V m p a O c O o m v !1c cmc 2o�pm o Cst Cl m©� Q ow w a Y C�Ow-gym CO OLO ( R rn orn � J to M to \ p J < O (n w V cn ❑ (^ 7 7- CD z cr < (D J V HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER S WATER A INS?&C 110&, PeOA ,q4. .Jm.ith, cc ..At y n",itequest a stow test was pa6ormed on the wete serving the ' ' reseranaee property on October 8, 1990. The static water tevet waa ENGIt:E RING STUDIES measu•ted�ett 21" beeow .the top o6 the weU 'casting and .the 6tow tuAned on ANQyE �@T.4 6u t. • dater Levet measurements were taken (see report attachedll From A.ia tU t' it was concluded the weU .is currently producing a minimum of ` b.2 gattons pen minute (GPM) . This stow rate .is not- guaranteed 'to 9f kemain constant, subsequent variations can occur. a WELL INSPECTION &FLOW TEST Water 6amptes were taken and tested 6or nitrates and coti6orm bacteria: The %ezutU were satis6actory. 16 we may be o6 6urther service, please contact us. SITE PLANS _.., Sin e�y, ROAD DESIGN OB T A. SHAPER, P.E. R g/gm SOIL TEST PERCOLATION RECEIVEDTEST SEP 1 3 1991 of cif icho agg STRUCTURAL d , , Y �, j E� D l MECHANICAL �v - y�� I":i-ai.�J j �t HLi,171 v) 50,,,0909' INSPECTIONS - OCT 6 1990 ON SITE WASTEWATER A . - DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ROBERT SHAPER, P.E ROGER SHAFER' -Its -' CIVIL ENGINEERS `" (907)694.2979- October 15 1990 FAxssa-t2�t `jam 6 3 " O Ms. Linda Smith VISTA REAL ESTATE 3000 C Street #101 Anchorage, Alaska 99503 REFERENCE: Lot 9; Btock 3; G.irdwood Or.ig.inat Towu te; ' ` g ° NHN Main Street, G.irdwood, Atadka " " AHFC # 91676 W.A.# 77314 SEWER S WATER A INS?&C 110&, PeOA ,q4. .Jm.ith, cc ..At y n",itequest a stow test was pa6ormed on the wete serving the ' ' reseranaee property on October 8, 1990. The static water tevet waa ENGIt:E RING STUDIES measu•ted�ett 21" beeow .the top o6 the weU 'casting and .the 6tow tuAned on ANQyE �@T.4 6u t. • dater Levet measurements were taken (see report attachedll From A.ia tU t' it was concluded the weU .is currently producing a minimum of ` b.2 gattons pen minute (GPM) . This stow rate .is not- guaranteed 'to 9f kemain constant, subsequent variations can occur. a WELL INSPECTION &FLOW TEST Water 6amptes were taken and tested 6or nitrates and coti6orm bacteria: The %ezutU were satis6actory. 16 we may be o6 6urther service, please contact us. SITE PLANS _.., Sin e�y, ROAD DESIGN OB T A. SHAPER, P.E. R g/gm SOIL TEST PERCOLATION RECEIVEDTEST SEP 1 3 1991 of cif icho agg STRUCTURAL d , , Y �, j E� D l MECHANICAL �v - y�� I":i-ai.�J j �t HLi,171 v) 50,,,0909' INSPECTIONS - OCT 6 1990 ON SITE WASTEWATER A . - DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 yw--a� cl = 36e ss` 5 rb LD l®aa i /- l1B°'j LOCATION OF WELL (Please complete either'la, Ib or WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. la. Borough Subdivision Lot Block Ib. 1/4gtrs. Section No. Township N❑ Range E❑ Meridian —of_of—of— S❑ W❑ IC. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Street Address and Area of Well Location 2. WELL LOG Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (final) ft. 5. DATE OF COMPLETION 6. ❑ Cable tool ❑ Rotary ❑ Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: __. 7. USE: ❑ Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ Other: 8. CASING: ❑ Threaded ❑ Welded diam. in. to ft. Depth Weight ' lbs./ ft. diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type:' Diameter: Slo1/Mesh Size: Length: Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: ft. Date ❑ Above or ❑ Below land surface Equipment used: II . PUMPING LEVEL below land surface and YIELD ft. after hrs. pumping g.p.m. ft after hrs. pumping 9.p -m. 12.GROUTING Well Grouted: ❑ Yes ❑ No Material: O Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9 -p.m ❑ Subm. ❑ Jet ❑ Centrifical ❑ Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° ❑ F ❑ C This well was drilled under .my jurisdiction and this report is true to the best of my knowledge and belief; Registered Business Name Contract License Number Address: Signed: Date: Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -Customer C: m cn m r 0 2 0 G APPLIC NT FILLS OUT UPPER HAl'--bNLY Property Owner +-11-1 I til/ f ,+�/Z-(2t Phone Mailing Address l� X 4:- 1,1fC� Zip Code `�— j -�� 1 Buyer Address Zip Code Lending Institution '(,�-3")L;� ���_f Phone Address Zip Code Inspector Realty Co. & Agent Phone Address ��,� C- 3 Zip Code Legal DescriptiondD -.-.r---)- ' i j- rt . "_ Street Location t( `} j-i�� %► (�`1 �1/Ul= Type of Residence -J❑ Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply --d] Individual , J ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community f� For wells drilled prior to that date, give well depth (attach log if available). -❑ Public Utility (�) APPROVED BEDROOMS ( ) DISAPPROVED�(T2_S�v.� Sewer Disposal _ t � - 0 Individual Year Individual Installed: Publi.1wility_J ^=1 When Connected to Public Utility: --® Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time 4Y4 %O -- Time /2 O of m Date Date Date q Date Inspector Inspector Inspector Inspector O Q'-4. Field Notes: Lr � MUNICIPALITY ONCHORAGE MF A �� Gy%/• DEPT. OF HEALTH Pt ENVIRONMENTAL PROTECTION, OCT 10193 �v6cco� 'D';RECEIVED (�) APPROVED BEDROOMS ( ) DISAPPROVED�(T2_S�v.� *CONDITIONS OF APPROVAL t ( ) CONDITIONAL APPROVAL' DATE (' 3 - Z BY: , I u Soils Rating Date Sewer Installed Well To Absorption Area�Sepell Log Received /4 tic Tank Size Well to Tank 72-023 (3/82 TO — I R O M SUBJECTLF /,_ .;. �L.. / �� % �•Lt-'�.dLDATE MESSAGEr-y- DETACH AND FILE FOR FOLLOW-UP �1 REPLY GNED �Y REOIFORM ® 4S 472 SIGNED SEND PARTS 1 AND 3 INTACT - 3 WILL BE RETURNED WITH REPLY. DATE POLY PlaK (50 SETS) 4P472PART DETACH AND FILE FOR FOLLOW-UP