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Home My WebLink AboutGLACIAL LT 3Glacial Lot 3 #075-091-13 ALPINE DRILLING & ENTERPRISES Permit Number: #SW050370 Date of Issue: 9 27-05 Parcel Identification Number: 075-091-13 Date Started: 10-18-05 Date Completed: 10-18-05 Is well located at approved permit location? ® Yes ❑ No Legal Description: Glacial Lot 3 Property Owner Name & Address: Kirk Hoessle & Gabrielle Markel PO Box 917 Girdwood, Alaska 99587 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling ® air rotary ❑ cable tool Casing type: steel stick-up 0 2 'Wall Thickness:.250 inches silt 2 8 Diameter: 6 inches Depth: 80 feet silty gravel 8 21 Liner Type: gravelly silt silt gravelly silt 21 55 67 55 67 72 Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 34 feet Pumping level: 80 feet after water sand & gravel 72 76 2 hoursum in 30+ m P P g.gP silt 76 78 Recovery Rate: 30+ gpm water sand & gravel 78 80 Method of Testing: airlift Well Intake Opening Type: ® Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite granules Volume: 1_g Depth: Start 0 feet Stopped 7 feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & Enterprises PO BOx 110496 Anchorage AK 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property . -.1 . _.. I. A..".. A.11 ......•J. .....111.....1 . tl._.. 0. . .... 1........ n ...... .......:.I •. .N A.... .f ......�..�... MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SWO50370 Legal Description: GLACIAL LT 3 Design Engineer: 0000 None Required Owner Name: KIRK HOESSLE & GABRIELLE MARKEL Owner Address: PO BOX 917 GIRDWOOD . AK 99587 - Date Issued: Sep 27, 2005 Expiration Date: Sep 27, 2006 Parcel ID: 075-091-13 Site Address: Lot Size: 8188 SQ. FT. Total Bedrooms: 1 Permit Bedrooms: 1 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 Date: Z ::Z F:Q5� Issued By: 11! Date: 77 lour �\ Municipality of Anchorage 1 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. Permit Number SW P � j� 1�7LIy'6 Z'? Property owner(s) K t ry' oe55if L6Jo ne I e, /' ' Day ph, one _ 703 7 Mailing address Vo UX 2 17 '�l�r NW OcA t Zip Code 1 CI159 Site address G cl-C-�/eC� ?J��li2,( WWouhip,Code Legal description (Lot, Block & Sub'd.) Lar��U�c� SU4XJ11 U S �Ofl Legal description (Section,Township & Range) Lot Size 3X Acre Sq. . 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 Simile Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: �i5'� Waiver Fees: Date of Payment:q�?/o' V36 Receipt �7 Date of Payment: Receipt Number. 'f `f36 Receipt Number: (Rev. OWN) 09/12/2005 '09-20 LOT -L Neil s 5625427 Awku A[„♦n.r. bt�ir �� .r Nn. .,t.t.tm., PAGE 01 I M11,11U.1 OR V4 PGG IT1UN111_ �Ui?.�^-Jl PROPERTY OWER VIN -Y Oc65� !LMESSY6 ��GeGtGI`��ill��......• .. . 4+4'wu C«ting " �,=Imj� ollrk 'y . Cornec-oF C,.a1m:� 'iti Lot•• ; — 7z7cl 793-�667R+ K 1 rye LOT 4 a tiS 2. r o r �� dQ, o 4y � AD�ry� 3, o ;- LOT 2 EXISTING ---- _ '-- --BUILDING LOT 3 `<< s 09/27/2005 08:21 FAX 9077835558 Gabrielle Markel 1?1002 •AAWNICIPALTIYOF ANCHORAGE qel d NO WATER dr WASTEWATER CONNECT PERMIT 05-4037 WASTEWATER UTILITY DATE OF APPLICATION 09/22/2005 PHONE: (9064 2762 ' ARCTIC BLVD. SCHEDULED COMPLETION DATE 12/312005 ' 'PHONE: 18LOCK10TIfRACT -LT 3 [� SINGLE FAMILY SUBDIVISION GLACIAL ❑ MULTI -DWELLING No. APTS ❑ COMMERCIAL TAX CODE • 7509113 GRID SE4913 AS -BUILT STREET ADDRESS OWNER HOESSLE KIRK PHONE MAILADDRESS POBOX389 GIRDWOOD,AK 995870389 CONTRACTOR CONRAD ❑ Repair Existing Service ❑X On Property Only ❑ City Tap ❑ Hydrant Only ❑ SW or Longer ❑ Main Tap -Yo Property Line Only ❑ Main Tap & On Property Connect Row No. ❑ Disconnect ❑ R & R - Main Tap Only CONNECT SIZE 4 - (REIMBURSABLE NUMBER ,�ggr•g7:•d INSPECTION FEE $ 64.00 ,•PERMITFEE S 38.00 S 0.00 DEPOSIT $ 0.D0 TOTAL $�1102.00 ASSESSMENTS ❑ Main Lino Extension ❑X Have Been Levied ❑ To Be Levied . Comments: ISSUED spa AID ❑ CASH ❑ CK 0 ER l`J NSPECTED BY VOTH DATE / ! PERMITTEE (Please Print) PHONE . MAIL ADDRESS , SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE CUSTOMER COPY Original MUNICIPALITY 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. 075-091-13 Expiration Date: 1. GENERAL INFORMATION Complete legal description GLACIAL LOT 3 Location (site address) 156 RAVENWOOD CIRCLE, GIRDWOOD, AK 99587 Current property owner(s) JOHN & JULIE SCHLABACH Day phone Mailing address Real estate agent 156 RAVENWOOD CIRCLE, GIRDWOOD, AK 99587 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 1 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 Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ / 1/5 Waiver Fee $ Date of Payment S'— 5''_ ZZ Receipt Number COSA # DS c ZZ I 1 S 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/4/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to �Sl�� these various and dynamic characteristics and are outside the control of the evaluator of the l` well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• • •Z_n:� •;1 �) for current or future occupants or guarantee that no unseen encroachments, deficiencies or g••••9 fr discrepancies exist can be given by First Water Consulting & FWCS * • 49 •'* rs A ...6. DSD SIGNATURE " / • • Curtis Huffman System #1 Approved for bedrooms CE 128991��/� fF�FOp�l4/2z. System #2 Approved for bedrooms >> ROFESSVP� Disapproved Conditional approval for bedrooms, with the following s IR�(Iriit�gs�� p,_ITY OF rrOj, AT o R WA 0, AND m PROD ATER SERVIGF� �\\\ By: Original Certificate Date: 23'22 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 Legal Description: GLACIAL LOT3 - - Parcel ID: 075-091-13 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA 9 Well log is filed with Onsite (or attached) Date drilled 10/18/2005 Total depth 80 ft Structure served by this system _ Well production at time of test 5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc Cased to 80 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) 18+ in. F' S Date of flow test for COSA 5/3/2022 Collected by Static water level at beginning of test 33 ft. Date of Sample 5/3/2022 Comments MAX WELL DRAW DOWN 35'. PRESSURE TANK AND VALVE IN OUTSIDE HOUSING ON CABIN NEAR WELL. B. TANK DATA - NA 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 - NA 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 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 ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date FS Comments/Deficiencies: > E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes if No Septic Tank/Lift Station on Lot > 100' If absorption field is under driveway comment below Property Line > 10' Community Sewer Manhole/Cleanout > 100' if No ❑ Yes if No NA ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® 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' Animal'Corntainment > 50' ® Yes if No ft ® Yes if No ft 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) 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 >,_1.0' _ ❑ 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 Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS ASSUMED SEPARATIONS PER VISUAL OBSERVATIONS & MOA RECORDS... G. ENGINEER'S CERTIFICATION 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. TM ....�: ` .•.. .... ....�'..... • Curtis Huffman �� ' •.• CE 128991 -\0�� O��F�Fa oFEss oN�`ti-�,.� MUNICPALITY OF ANCHORAGE r . Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 075-091-13 1. GENERAL INFORMATION Complete legal description Glacial Sub, Lot 3 Location (site address) 156 Ravenwood Circle Expiration Date: -S-- ! ( - Z I Girdwood, AK Current property owner(s) Tyler Cresswell Day phone (907) 312-0498 Mailing address P.O. Box 788 Girdwood, AK 99587 Real estate agent Stuart Greene 2. TYPE OF DWELLING: ❑Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 782-7276 3. NUMBER OF BEDROOMS: 1 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 lJoKI Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2.130 Date of Payment- - 14 2-1 Receipt Number 031 n 3 8 _D COSA # C0-2-1 2- I 1016 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller P.E. Date 2/9/2021 49— *� 6. DSD SIGNATURE � :�'��" ..-..!�- System #1 Approved for bedrooms r% Benjam'rn5chiller % System #2 Approved for bedrooms �� F��s . CE 12592��rr� ��illF, �ZPROFESSO Disapproved Conditional approval for bedrooms, with the following stipulations: ``.,rx tALITfrr��rr GIigT �SyTF o ; =M J o pR • �;� �O m^ JlJiis VICES �)' s Original Certificate Date: 2- —11-2—t 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 COSA Checklist Legal Description: Glacial Sub, Lot 3 Parcel ID: 075-091-13 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) Date drilled 10/18/05 Total depth 80 ft Cased to 80 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 28 in. Date of flow test for COSA 1/26/21 Static water level at beginning of test 33.2 ft. Comments B. TANK DATA Age of tank(s) years Tank type/material AWWU SEWER Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA AWWU 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 Well production at time of test 8+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate •548 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 1/27/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments.- Adequacy omments: 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) if No NSA ft Septic Tank/Lift Station on Lot > 100' ❑ Yes if No NSA ft Community Sewer Manhole/Cleanout > 100' Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Neighboring Tank > 100' ❑ 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' Animal Containment > 50' ❑✓ Yes if No ft M Yes if No ft Community Sewer Main > 75' � Yes if No ft Manure/Animal Excreta Storage > 100' ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No NSA ft Surface Water > 100' ❑ Yes if No NSA ft Property Line > 5' ❑ Yes if No NSA ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No NSA ft Private Wells > 100' ❑ Yes if No NSA ft Water Main > 10' ❑ Yes if No NSA ft Community Wells > 200' ❑ Yes if No NSA ft Water Service Line > 10' ❑ Yes if No NSA 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 NSA ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No NSA ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No NSA ft Private Wells > 100' ❑ Yes if No NSAft Water Service Line > 10' F-1Yes if No NSA ft Community Wells > 200' ❑ Yes if No NSA ft Surface Water > 100' ❑ Yes if No NSA ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION! 0 Amw 1050, I certify that I have determined through field inspections and review / 7 of Municipal records that the above systems are in conformance with lli 4 �ir 0, MOA COSA guidelines in effect on this date. 7;enja chiller �00� PFS CE 12592219/21 A" �l�F�f'ROFESSI4NP�,�� COSA Checklist yellow sheet •�_ Municipality of Anchorage A 1,,,1. et, •/. f.. . .. _'r.:lilil i lililf Ili 0 _ On-Site Water&Wastewater Program • WA 1101 (907)343-7904 /:<;- 'L j i.� r�Iry ti � w CERTIFICATE OF ON-SITE SYSTEMS APPR6•iAL T ' Parcel I.D. 075-091-13 Expiration Date: 1 1. GENERAL INFORMATION Complete legal description GLACIAL;LOT 3 Location (site address) 156 RAVENWOOD CIRCLE'GIRDWOOD,AK Current Property owner(s) GABRIELLE HOESSLE Day phone 907-229-6927 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: 1 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well U Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer WaiverNariance request fon. N/A Distance: - Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ �O Waiver Fee$ Date of Payment 10—.I-1 Date of Payment Receipt Number 065‘11pa Receipt Number COSA# alg l 5Zt 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 GARNESS ENGINEERING GROUP,Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD,SUITE 101 *ANCHORAGE,AK,99507 Engineer's Printed Name JEFFREY A.GARNESS,P.E. Date I olt /1 Engineer's Comments: in conducting this evaluation.GEG provided an engineering evaluation of the well and/or septic system in accordance with the ,0001i1111.%i I guidebhes and regulations established by the Municipality of Anchorage and industry practices.The reported results describe fire •4`.( OF a 4 condition of the systems on the dates of the evaluation.Separation distances were measured to readily identifiable features. •� \ Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic ••, •`` '.,•1 ♦fit systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels pat may fluctuate during 1'•--the year),quality of construction(materials and workmanship).and the water usage of the familyubliing the system's.These I' ;• 9 r� 1\ �� •• *• • conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the ■ 0 system/s;therefore,GEG makes no warranty(express or implied)regarding the Allure performance of the well or septic system. • • GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the % 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: GLACIAL, LOT 3 Parcel ID: 075-091-13 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/18/2005 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 80 ft. Cased to 80 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 10/18/2005 9/16/2018 Static water level 34 ft. 33.1 ft. Well production 30+ g.p.m. 5.3+ m 9p . WATER SAMPLE RESULTS: Coliform CCcolonies/100 ml. Nitrate\- mg./L. Collected by: GEG, Ltd. Arsenic: N (ug./L. Date of sample: 9/16/2018 B. SEPTIC/HOLDING TANK DATA AMU SEWER Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption . -a ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorp field before test in. Water added gal. New depth in. Elapsed Ti ••. min. Final fluid depth in. Absorption rate >= g.p.d. 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 •• a er alarm level at in. - _ •• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A - On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main *75'+ Public sewer manhole/cleanout *100'+ Sewer/septic service line `25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AWWU Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ••• •T TO: Property line Build'._ sundation Water main Water service line Surface water Driveway, parking/vehicle storage Cu ..• . ain Wells on adjacent lots F. COMMENTS 'ASSUMED BASED UPON AWWU RECORD DRAWINGS AND CONNECT CARD; COULD NOT PHYSICALLY VERIFY SEE ATTACHES SURVEY WITH ASSUMED LOCATIONS OF SEWER LINE,SEWER MAIN AND MANHOLES .•,� _ OF ,., G. ENGINEER'S CERTIFICATION :� .. is t.* . 0. I certify that I have determined through field inspections and 9 i' .�_ review of Municipal records that the above systems are in 4 •• conformance with MOA COSA guidelines in effect on this ••• �•• date. ♦ .. J •• i A. e. ass:: Engineer's Printed Name JEFFREY A. GARNESS •• S,• CE-7 53 ...icTalr • ��t.. .•••1 p'( -1's—,\D\-' `x.4 Date i 0 1 i// .44•/'ROPE S\U:•4 LICENSE ,11 ' *�� #AECC884 (Rev.10/12/12) • . N/ il ..., .....:. •.••.. . s,.s, 0 '... . . • DRi k0 • • . .\\•. • . • . . • do • .• \\ � . :. •• • . ... • : .rta• CULVERT (TYPICAL) • _•. : -ice•: LOT 4 ' O N52° 36'W tiS2° 15.00 u' COVERED- �4 1� ' y STORAGE '` , LOT 2 . . ,,,"��• 1. OUTHOUSEmir (NOT FUNCTIONAL, < USED FOR STORAGE) 1 11‘ 1�. CA l‘ t. cls` el;051 ti -� �� . -•.•. LOT 3 ( :c 1,+\ •WOOD:STa - •GE `1'' �� 1 \ O .//1)-,6,,,N fcr LOT 68-A-1 F T N G X 9,1 N `: \)••• TRACT H N. 000ppp `� 4 49TH i %•• * 0 r 1'41 6,1,4. -cit ‘1444((—C41,,k* v 0 .. STEVEN CAN. �� v":" '•, pLS-12034 •'' p 11 44 SDA �a " °,asslono\ „at, NOTE: �ODOpoo�� THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. \ ORDERED BY: GABRIELLE HOESSLE PARCEL#: 075-091-13-000 SURVEY CERTIFICATION:LCG LANTECH,INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE LEGAL DESCRIPTION: ADDRESS: 156 RAVENWOOD CIRCLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO AS-BUILT ENCROACHMENTS EXIST OTHER THAN NOTED. EXCLUSIONARY NOTE:IT IS THE OWNERS'RESPONSIBILITY TO DETERMINE THE LOT 3 EXISTENCE OF ANY EASEMENTS,COVENANTS,RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO GLACIAL SUBDIVISION CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION,FOR ESTABLISHING PROPERTY LINES,OR FOR PLOT-PLAN PURPOSES. LEGEND: 250 H Street SEPTIC STANDPIPE oco ' Anchorage, Alaska 99501 WATER WELL Q Overhang .::.•Asphalt::::.:. FENCE x \� Wood Deck\ Concrete 0 Survey Department DRAWN DATE: 09/20/2018 WORK ORDER: 18125 Phone 562 5291 - "C~. Inc Mainline DRAWN BY: ADS PLAT: 66-28 Phone 243-8985 CHECKED BY: SC GRID: SE4913 G'/lu'I�t�QCtt[/1 Q,' en yu•t e.P/un.�.'AuA.veytn J. SCALE: 1"=20' FB/PG:811/28 REF:2005L249