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Home My WebLink AboutUS SURVEY 3044 LT 36C T10N R2E SEC 17US Survey 3044 Lot 36C #075-064-03 Sep 20 OE 02:02p Kevin McDermott .tr+-nv; �.•. At. u'...; •: l.i:i i ••. 70: i •/H7.t+o11 (907) 703 -DOGS p.2 STATE OF ALASKA DEPARTNIENT OF NATURAL RESOURCES DIVISION OF rmNING, LAND & NATER WATER NN ELL LOG Drilling Started: 10 �3,2OO5c umrlcted: 10 14 --2005 Ciq Ounwch: 5uWieision:I BLOCK LOT PraporyChtticrKames»Addl,:Alen Cornelison & Kevin Mcder P.O.Box 1148 Girdwood, AK. 99587 I Girdwood US Survey 3044 36c \Iendlaa TOw1lNhlp _� Ratlge �___ $lCllan _ _ _ r/, U _:5 of 1/1 or _ BOREHOLE DATA' (from T.O.C. ) Depth Drilling method: (x )Air rotary, I ) Cable Tool. Other Material: Type. Color & wctn,s% From To Well use: ( ) Public surr y I (x ) Domestic- Other overburden 0 3 Depth orhole:—12g..- - fi. casing stickup: 2 it ' Casing type:steel Thickness: Q,2W— inches i grey sift &gravel 3 24 Casing diameter: 6 inches Casing depth: 128 _ R Liner type: - Diameter: =inches Depth: - ft sand & gravel 24 Scuic water (from top of castng): 3]_ It on 1Q-' 14.2DO5 Pumping level & yield: _ feet afrcr_ hours at _ gpnt Recover• rate. 30 _ gpm. 3Iclhod of resting: airlift wet gravel &sand 53 55 [hvclopmcnt method: airlift Duration: 1 hoof silty gravel w/ some H2O 55 58 Well intake opening type: (3C ) Open end. ( ) Olson holt, Other Screened: Start: fi• Stopped ` li j clay & rock 58 100 Screen type: - Slovtttcsh size: _ I Pciforated: Start: it. Stopped: - it Stan: 1), Stopped: fr wet clay & rock 100 110 Note: .................................................................................................... silty gravel w/ H2O 110 123 Grout typc:.hentori to Volume Depth: front n ft. to 20 ft i -- - coarse gravel w/ H2O 123 128 Pump intake depth: a Pump size: hp. Brand name: Was well disinfected upon completion'.' (x) \•es. ( ) No Method of disinfection: ... CN917ine Driller comments' disclaimers:........................................................... ............................................................................................................. ..................................................................................... Well driller nine: -Johnny.Kay.................................................... Company name: ... HetS -Dr hien..al;............................................ ; hdailingnddress:.3W.AkM!a Dr :................................................ City: Anchorage state: AK zip 99516 Phone number: 907 ) _ 345_ - _0593 Drillers signaut Alaska state law requires that a copy of this well log he sent to the Depunnlcot of Natural Resources within 45 da)y: Cit, it aveenuble.(AKatatutce3x.4)5.010.3S.05.03<.4I.08.01U. 4h.1 3,0211 and AK rcgulatiotlx 1 I AAA. 9:.140). DNW Division of Mining. Lind and water. 550 W All Avenue. Suite 1020 Anchorage. AK 995(11- Phone (9071:69-1:639 one.tax 4907)210-1447, Within the City ofArlcorage. i squired that a copy uftbe well log be sent to the approrrints city office within 60 drtys and that another copy of the well log be sent to the wol:rropcny owner within 30 days. Permit Number: sw_Q50367 Date of Issue: -seRi.26_'2005_ Parcel Identification Number. Is well located at approved Permit Ioention" ()() Yes or ( ) No MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & 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: Sep 26, 2005 Expiration Date: Sep 26, 2006 Permit Number: SWO50367 Parcel ID: 075-061-10 Legal Description: US SURVEY 3044 SUBDIVISION LOT 36C W99' Design Engineer: 0000 None Required Owner Name: ALLEN CORNELISON & KEVIN MCDER Owner Address: PO BOX 1148 GIRDWOOD , AK 99587 - Site Address: NHN ALYESKA HIGHWAY Lot Size: 30967 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. -THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IT IS THE BURDEN OF THE PROPERTY OWNER TO DETERMINE THIS WELL INSTALLTION WILL NOT AFFECT THE FUTURE DEVELOPMENT OF THE SURROUNDING OR EXISTING LOTS. 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. IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received By: 'lam 414 Date: 10 /3 °S Issued BY: �' Date: , 2 1� f'� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw St. 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. _ _D�5-OCF(- to Permit Number SW Property owner(s) AaE#J 6' *igtt�pp S KLJuI 1`i,7eVt46Ti Day phone ASO-1�2o Mailing address 170 15vy, 1145_&any400p 4115$I Zip Code JIM Site address 1.6 &r5VA e-IIRO14000 Zip Code q`iS$% Legal description (Lot, Block & Sub'd.) (I SS 9o441 !or- 3!c G W -TV Legal description (Section, Township & Range) Sctr. 101.i R Lot Size 3r7 %�0 Acre q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. I (Signature of property owner or authorized agent) Permit/Rush Fees: 1-75' [3Zi Waiver Fees: Date of Payment: /'�� ° Date of Payment: Receipt Number:? f� r. y Receipt Number. (Rev. 09/04) Tract A Lot 35 Lot 16C 2%482 ig.ft Q.... 1 QOa :Michoel L Jokela: �O o��: '•. LS -7839 US Su%z\,rj 3o94 i QAoIvs IgW0 Lot 36A \ : 126.5 - ...-'... �Q w.t • ggQ� c'G / ''. PFG 126.5 I \ \ Lot 36B Lot 36D SALE �� =o Tract A / \ 566.1 .Za / \ SGPRP a rn .':..'• a •:' �' 2a LA 6 o� 9' y Lot 36A 9.9 \ po. on \ EXISTING p t' "P AHOUSE LA 3 3 cT �9 Z N Lot 1 \\ \\ Lot 36C a N66 45 00 W 6�. 7p9 \ 80 Lot 36B aw Lot 36D \ p op Lot 2 \ 0000Opp� 66 �pe� S Opo N za° \• / o P ; o. o .......:.moo '•A Q n lh ny H n; 00 alp �; '• LS-9020: p� • ,�o ofess On Ol bpm r\�000 �o� N�9 ° 06) /ko R k P\ye s gee t° G AS-BUILT NOTE: THIS DRAW7NC IS N0T TO BE MODIFIED FOR USE AS A PLOT PLAN. Legal Description: Ordered By. Kevin McDermott Lot 36C, US Survey 3044 Legend eptic lndpipeo :..:.,�, p•t.::"•: Water Well Fence—x—x— Wood Dx�� SURVEY CERTIFICATION: LANTECH has conducted a physical survey of the property as shown on this drawing and Certifies that the improvement: situated thereon are within the property lines and no encroachments exist Arm Mrr.Mirh LAND do CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS 440 West Benson BOUIEVafd, $UI1e 200 Phone: 562-5291 other than noted. EXCLUSIONARY NOTE: It Is the owners' responsibility to determine the existence of any easements• covenants• restrictions or right—of—way takings which do not appear on the recorded subdivision plat. Under Anchorage, Alaska 99503 Fax: 561-6626 no circumstances should any data hereon be used far construction, to establishing property lines, or far plot—plan purposes. plot: 2006-141 Grid: 4814 Date: May 4, 2007 gown By NRB Work Order: 2007-L-052 Fb/Pg: 682/71, 72 scale: 1'-40' lChecked By. APH Municipality of Anchorage �1 Development Services Department Building Safety Division _ On-Site Water 8 Wastewater Program 4700 Bragaw Street /,, P.O. Box 196650 ^ Anchorage, AK 99519-6650 �I�• www.munl.org/onsite � � ► (907) 343-7904 1 a l,,p' CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D 7; O 6'/ _ 0 3 COSA# 0 2 Of Ve 1. GENERAL INFORMATION Expiration Date: R — / O - D Z Complete legal description US SURVEY 3044, LOT 36C Location (site address) 1853 ALYESKA HIGHWAY • GIRDWOOD. AK 99587 Current Property owner(s) ALLEN CORNELISON Day phone Mailing address 2400 FANTAIL CIRCLE * ANCHORAGE. AK 99515 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well )♦ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my IvestwtiQQn, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, hows thafthe orf s1(e water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the fest, and separation distances measured to readily identiriable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test resufts do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any otherperson or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date 5-110 O Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other ON-SITE WATERAND •; WASTEWATER PROGRAM By: Original Certificate Dater 0 7 (Rev. 11105) Municipality of Anchorage Development Services Department`; Building Safety Division On -Sits Water b Wastewater Program ' 4700 Bragaw Street P.O. Bar 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: US SURVEY 3044, LOT 36C Parcel ID: o z }-- 06q -D3 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Date completed 10/14/2005 Sanitary seal (Y/N) YES Total depth 128 ft. Cased to 128 ft. FROM WELL LOG Date of test 10/14/2005 Static water level 31 ft. Well production 30 g.p.m. WATER SAMPLE RESULTS: Coliform kY colonies/100 ml. Arsenic ug./L. n110 1 B. SEPTIC/NOLDING TANK DATA Tank Type/Material Tank size gal. Foundation cleanout (YM) _ �tsv ng C. ABSORPTION FIELD DATA Date installed Length Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 4/30/2007 25 ft, 4.25 g.p.m. NitratsQ. la mg./L. Other bacteria -e- colonies/100 mi. Date of sample: 4/30/2007 Collected by: GEG Ltd. PUBLIC SEWER Date installed Number of Compartments over tank (Y/N)_ High water alarm (Y/N) Soil rating (g.p.d./ftror h'/bdrm)_ System type ft. Width Total depth ft. Eft. absorption area_ ft' Date of adequacy test ft. Gravel b ft. ingyrh _ Depression over field Fluid depth in absorption field be eSf _ In. Water added _gal. New depth _in. Elapsed Time: n. Final fluid depth _ in. Absorption rate >= g.p.d treatment (past 12 mo.) (Y/N 8 type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at —in. "Pump off" le . E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankA tft station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots :9 Public sewer manhole/cleanout 100'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation _ Water main Wei lsal10a—cent lots Property line Absorption SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water, Building foundation Water Wells on adjacent lots- 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. Engineer's Printed Name JEFFREY A. GARNESS Date (;JI Q & 7 parking/vehicle storage COSA Fee S, -2,n 4 176 t�(%S 14 Waiver Fee $ Date of Payment sI//o /O/ Date of Payment Receipt Number 9 a (, 31 Receipt Number (Rev. 11105) SGS Refq 1071768001 Client Name Garncss Engineering Group, Ltd. Project Name/# USS 3044 Lot 36 Client Sample ID USS 3044 Lot 36A Matrix Drinking Watcr PWSID 0 All Dates/Times are Alaska Standard Time Printed Date/Time 05/09/2007 15:53 Collected Datelrime 04/30/2007 13:45 Received Datelrime 04/30/2007 15:00 Technical Director Stephen C. Ede Sample Remarks: Atiossable Prep Analysis Pantmeter Results POL Units Method Contaim ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 Haters Department Total NitmteNitritc-N 0.106 0.100 Microbiology Laboratory Total Colifunn 0 ug/L EP200.8 C (<10) 05/08/07 05/09/07 TK mg/L S1120 450ONO3-F D (<10) 05/05/07 1DS coVI00mL SM2092220 A (<I) 04/30/07 DLC d3Certificate of On -Site Systems Approval 064- 85 Parcel I.D. 075 - Expiration Date: 1. GENERAL INFORMATION Complete legal description USS 3044 Lt 36C, T 10 N R2 E, Sec 17 Location (site address) 1853 Alyeska Highway Current property owner(s) Mailing address Real estate agent West Alta Holdings LC Day phone 801-304-5930 10011 S Centennial Pkwy #275, Sandy, LIT 84070 Erin Eker, Ski to Sea Properties 2. TYPE OF DWELLING: i� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907-783-3493 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Z Private Septic D Water Storage ❑ Holding Tank 0 Community Well ❑ Community ❑ Public Water System ❑ Public Sewer E Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-56 Date of Payment. 9LVLq Receipt Number & 1 *76 8 COSA # 66 C'm 43ke Date: Waiver Fee $ Date of Payment Receipt Number 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 Restoration Science & Engineering, LLC Phone 907-278-1 D23 Address 911 West 8th Ave, Suite 100, Anchorage, AK 99501 Engineer's Printed Name Neil Waggoner, PE Date 7/30/2019 � OF qtlk ;9�� .�. .... �"�: X49 TM+ • .� �� 6. DSD SIGNATURE •n••�e•a•.o••a •••..... System #1 Approved for bedrooms •1..,...%'"' :.;; ,. System #2 Approved for bedrooms NEILDW� BONER Disapproved ROFESStd Conditional approval for bedrooms, with the following stipulaa i�3'''°� By: i �--- '/)JlI11�... NNN111. Original Certificate Date: �? 13 1 1 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 Checklist blue sheet A 0 .::. ,; iT- •� 710 Legal Description: USS 3044 Lt 36C, T10N R2E, Sec 17 Parcel ID: 075-064-53 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 9 gpm Date drilled 10114105 Water storage tank volume gallons Total depth 128 ft Well disinfected for coliform test? ❑ Yes FOR No Cased to 128 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 32 in. Collected by Neil Waggoner, PE Date of flow test for COSA 7/29/19 Date of Sample 7/29/19 Static water level at beginning of test 23.88 ft. Comments Well flow tested at —9GPM for one hour, 510 gallons pumped. Well will easily produce 600 GPD. 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 Residence on City Sewer 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: COSA Checklist yellow sheet 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) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'El Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' F/� Yes if No ft Neighboring Absorption Fields > 100' ft Water Main > 10' Animal Containment > 50' 0 Yes if No ft ❑✓ Yes if No ft _ Water Service Line > 10' ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' R Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft 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) 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 ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS At time of testing, well flow test shows the well can easily provide the daily flow rate. G. ENGINEER'S CERTIFICATION I certify that / 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 ►.aE st m f 491i -1 a. saam►ao►asa seam ♦►►►►mesas s►a a►esm NEIL D. WAGGONER e CE 14704 a°�'r Tract A /� \ C3S V1 \ \ o ORS` Rp Lot 36A 'o. 0 \ EXISTING o HOUSE 9Unt"\ �e r, 0 \\ Lot 1 \\ Lot 36C Hs64sbp • � s.>. ps 8 p \ \ Lot 36B N \ Wm, Lot 36D, \ ' Lot 2 \ - �y QOF \ b AC��oo N66 PIS .... QQ ' n, ,0`Q QQ o •:A tin ny H LS-9020 Q4 4p kqe .,(o 4 rO res SiOna\ ao P� 0*��D0000000 (\Cc AS-BUILT NOTE: TNtS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. Legal Description: ordered By Kevin McDermott Lot 36C, US Survey 3044 Legend: Septic Stondplpe 50 :.':."::AiPhall%>`: `•::: Water Well o .: '�°^�•la :;: Farce—X—x— i"i O.erhonq?j:;Sej_ Wood SURVEY CERTIFICATION: LANTECN has conducted o physical survey of the property as shown on this drowing and certtfles that the i provemenle LZ situated thereon are within the property lines and no encroachments exist Other than noted. LAND k CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS EXCLUSIONARY NOTE., it Is the owneri responsibility to determine the existence of any easements, co~onts, restrictions or right—ol—way takings which do not appear on the recorded subdNislon plot. Under 440 West Benson Boulevard. Suite 200 Phone: 562-5291 Anchorage. Alaska 99503 Fax: 561-6626 no clrcumstonces should any data hereon be used for construction, for establishing property lines, or for plot—plop purposes. Piot: 2006-141 crld: 4814 Date: May 4, 2007 Drawn By. NRB Work Order. 2007—L-052IM/Po: 682/71, 72 Scale:1"-40' lChockod By. APH Tract A 9g �� 2 Lot 6C 20.482 JL a' Lot 36A PFG :-• • • : . b i `� � � I •'. may. 1'= •Y ' _ L J . I Q9 $O' ••�.� ` Lot 36B Lot 35' Lot 36D o � ti Q �•. o................................. 7171 . � -.. .Michael LJoketa Ztri1� Q�°' L5-7839 p /� Sep 20 06 02:C2p Kevin McDermott -- � , cam• ---a `r'�� (907) 703 -COGS p.-2 STATE OF ALASKA DEPARTMENT OF \AIVRAL RESOURCES DIVISION OF i%1ININC:, t AND & !WATER 'V%'AT£R WELL LOC Drilling Started: %Q -3 2-095t<ompleted: 10,14.-'200-5 Cit. I3r+nwLh: Sutxli-, i.iun: 13LOi-K t.OT rropc•t•n' cJ«,tcr game & Addresa: Allen Cornelison & Kevin Moder P.O. Box 1148 Girdwood, AK 99587 i I Girdwood US Survey 3044�J36c titcridian TowitshipRank ticction _ _ t/<or _ _t•V Or of BOREHOLE DATA: (from T.O.C. ) Depth Drilling method: (X ) Air rutar•. t ) Cable toot. Other Material: Type. Color b, wetness. from T° Wcll usw:: ( ) Public supply. 1 (X ) Domenic. Other overburden 0 3 Depth oi'hole: x,28 ti. Cu>ing stickup: 2 ft Casing trpt::,,,r. tee Thickness: 0,2m inches Casing diameter: 6 inches Casing depth: _ 128 _ ft t 1 grey sift & gravel 3 24 Liner type: Diameter: - inches Depth: - It sand & gravel 24 53 Siatic water (from top of easing): _ I on 1Q°4:2X,5 Pumping level & yield: feet after hours at — gpin Recovery rate: 30 _ spm. %tethod of testing: airlift wet gravel &sand 53 55 th vctopmcnt meters!: airlift Duration: 1 hour silty gravel w/ some H2O 55 58 Well intake opening type: (X) Open end. ( ) Open hole. Other Screened: Start: ft. Stopper) li i clay & rock 58 100 Screen type: Slot'mcsh size: Perforated: Starr. `_ _ „ _ A. Stopped' tt Stan: ` _ ti. Stopped: - ft wet clay & rock 100 110 Note: silty gravel w/ H2O 110 123 Grout r; -Pc: _betftonjte Volume Depth: from f2. to 20 ft 1 - - coarse gravel w/ H2O 123 128 Pump intake depth; ft Pump size: , hp. Aranri narnc: Was well disinfected upon complctitm? ( X)'!'cs, i ) No Method ofdisinfeetion:... Cillorin..e .................................................... tDriller comments..'discizimcrs:............................................................ t .........-................................................................................................ ............................................................................................................. Well driller name: -Johnny -Kay .................................................... Company name: ... Rof y.DrillingJO.rr............................................. ; Mailing nddrc%s:..�S O,AkUi2.Dr. ..................................... City: Anchorage_ State: A K 'Lip 99516 Phone nurnicr : 907 ) _ 345- _ 0593 Drillers signature- Alaska mate law requires that a copy of this well tog be x^ni to the EX-parimcnt ot'Nuntral Rcsourccs within 45 days: +:'very tttt ucccntahle. (AIC>srpate.3li.US.U30.3:e.U5.03t.•11.Utr.U�U. .54.1 i_U3t1 and AK rcgulatiwt,t i I AAC 9}.I.iQ). D14R Division of Putting. Dull and %%atcr. ;tp 1fi 7th Avg nuc. Shite 1 Z)20 Anchorage. AK 9950 1- Phutx ('lU7)^(,9.1<fal9 on . tax Within the Citv of AqJ orage. i 1 ' equired that a copy of the well log be sent to the appropriate city off ice within 60 days and that another copy of the vett for be Ecnt to the well:propeny owner within 30 days. Permit Numbcr: !pyygW�67 Dare of Issue: _SeR% 2g_;20Q5_ Parcel Identification Number. Is well located at approved permit trwtilion'? ( )() Yes or ( )\o August 7, 2019 MOA Onsite Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99507 907-343-7904 RESTORATION SCIENCE & ENGINEERING, LLC 911 W. 871 AVENUE, SUITE 100 ANCHORAGE, AK 99501 VOICE : 907-278-1023 FAX: 907-277-5718 EMAIL: NWAGGONER@RESTORSCI.COM URL: WV'NN.RESTORSCLCOM Subject: COSA Well Testing and Submittal - 1853 Alyeska Highway, Girdwood, AK — MOA Parcel ID 075-064-53 Dear MOA Onsite Water and Wastewater Program, Restoration Science & Engineering, LLC (RSE) is pleased to provide the following Certificate of On-site Systems Approval (COSA) evaluation and submittals to meet Municipality of Anchorage requirements for the onsite drinking water well located at 1853 Alyeska Highway in Girdwood, Alaska. The property has a legal description of US Survey 3044 Lot 36C and MOA parcel ID 075- 064-53. RSE engineer, Neil Waggoner, PE travelled to the site on July 29, 2019 and inspected the on-site drinking water well, performed a water well adequacy (flow) test, and collected a water sample to meet MOA COSA requirements. RSE inspected the well casing stickup, sanitary seal, and wiring connection. At the time of inspection, the lower casing ring of the well sanitary seal was cracked, and the conduit connection to the sanitary seal had become disconnected. RSE subsequently recommended the owner hire a licensed plumber or a well driller to replace the sanitary seal and repair the electrical wiring conduit. As a result Aarow Well and Pump was replaced the sanitary seal, and repaired the electrical wiring conduit connection, and sent photos of the repairs to RSE (see attached photos). The casing stickup is approximately 32 inches above ground level, and the ground surface is sloped away from the well. The initial well static water level was 23.88 feet below the top of casing (TOC), and the well log shows that the total well depth is 128 feet. RSE conducted a flow test of the drinking water well pumping a total of 510 gallons of water from the well at approximately 9 gallons per minute for an hour. A sensus 5/8" PMM series NSF - certified flow totalizer was connected to the pressure tank bypass line sample tap to allow for collection of flow meter readings. Well drawdown stabilized at approximately 34 feet below top of casing. The flow test indicates that the well can easily provide 600 gallons per day (based on 150 gallons per day/bedroom) for this four-bedroom house. After conducting the well flow test, RSE collected a water sample from the well. The sample was analyzed by SGS Environmental Services, Inc for coliform bacteria, total nitrate/nitrite-N, and arsenic. Sample results were negative for Total Coliform and E. Coli, and not detected at the laboratory detection limit for Total Nitrate/Nitrite-N and Arsenic. 1853 Alyeska Highway, Girdwood, AK August 2019 COSA Well Testing and Submittal Please contact me via email or at 907-278-1023, extension 108, if you have any questions regarding this COSA evaluation. Best Regards, Neil Waggoner, PE Attachments: COSA Checklist Blue Sheet COSA Checklist Yellow Sheet Property As -built Well Log SGS Environmental laboratory report 1194199 Site Inspection Photos « « 49 H O •+p0°A.«a°«�f««owe®W«a Yio«4 i NEIL D. WAGGONER : �¢ E 14704 RESTORATION seen« a ¢oy:ncedn?, ILC