HomeMy WebLinkAboutUS SURVEY 3042 LT 75BUS Survey
3042
Lot 75B
#075 - 132 - 77
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o A- Copy
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW950350
DESIGN ENGINEER:
OWNER NAME:MURPHY DENNIS H
OWNER ADDRESS:P.O. BOX 214
GIRDWOOD, AK. 99587
PARCEL ID:07513277
LEGAL DESCRIPTION:
JUS SURVEY 3042 LT 75B
LOT SIZE: 14599 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED:10/18/95
EXPIRATION DATE:10/18/96
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS(:
RECEIVED BY:
ISSUED BY: (ha
DATE• /O/27//
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LOCATION OF WELL (Please compl•I• either �1e, Ib Of lc-)
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lc D(STANCr AND O,NECTION FROM ROAD INTERSECTIONS
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WATER WELL RECE1RO
STATE OF ALASkA
DEPARTMENT OF NATURAL RESOURES
0lvloton 01 GetIoglca! Q G•opl.y•Ic01'
011 ling P•rmlt No.
A.D.L. No.
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3 OWNFre CF WELL' Uoj.fl t-ALLfPho
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A *CLL DEPTH. (tln•1)
11.
6. �Coble tool
0 Au9.r
t.OSE 0 Opm•Ulc
IME •Ilan
CI Test Well
5 DATE OF COMPLETION
QPo asy Ortven
Q Jarred ❑ Bond
Q Pant Supply 0 Induoty
0 Ree korg• Q Cemm.(1C61
OIA4t'
Tnr•adsd ❑ Welded
Io _ t• D•Pln Violet
10
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9. 11141511 OF WELL'
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Bock IlJmg _ __ Gravel pock —
10. STATIC WATER LEVE -L1'. _�el.
0 Above 0,`J R•'a• land ..riot.
Egelpm•nl 4141
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I1. PUMPING LEVEL bele./ lend button end YIELD
11 0110( nn Pumping
1t 13111, lira. penp'ng
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00:h.,:
1O. WATER WELL CONTRACTOR'S C£NTIFICAT10N'
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Mal•vtel' O Meet CO •n•
13. PUMP. (i1 snowy) NP
L.ngln •I Drop Pig.
0 Sob,. 0 dal
REMARKS
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
COSA # 010473 1
Expiration Date: —.2, tj - 0
Parcel I.D. 075-132-77
1. GENERAL INFORMATION
Complete legal description us survey 3042 Lot 75B
Location (site address) 103 Jewel Mine Rd., Girdwood, AK
Current Property owner(s) Dennis Mushy
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
PO Box 214, Girdwood, AK 99587
Day phone
Day phone
Sam Daniel, Glacier Oty Realty
174 Hightower Rd, Girdwood, AK 99587
Day phone 783-1910
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
with Accessory Dwelling Unit
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
4
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding Tank
❑ Community On-site
❑ Public Sewer
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 sample results. (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 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 Watkins Engineering, Inc.
Address PO Box 110443, Anchorage. AK 99511-0443
Engineer's Printed Name Cindy W. Ellis
6. DSD SIGNATURE
i/ Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 907449.1851
Date g- /9 -as
bedrooms, with the following stipulations:
ttttUlrrr r "
ft
•• •
:ate. ON-SITE •:�c1=
WAIEHAND ; r'1-
• WASTEWATER • =
• PROGRAM '
.,'•. • .
f.�o)))mii SV'
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: //e/ (l l Original Certificate Date: 8 -� 08
(R« 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVALCHECKLIST
Legal Description: us Survey 3042 Lot 75B Parcel ID: 075.132-77
A. WELL DATA
Well type private If A, B, or C provide PWSID p= Well Log (Y/N) Yes
Date completed 10/19'95 Sanitary seal (Y(N) Yes Wires properly protected (Y/N) Yes
Total depth 80 ft. Cased to 80 ft. Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 10/19/95 7/26/2008
Static water level 71 ft. 70 ft
Well production 9.0
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
g.p.m.
Nitrate 0.461 mg/L
6.9 g.p.m.
Other bacteria 0 colonies/100 mL
Arsenic: 0 mg/l Date of sample: 7/27/08 Collected by: Cindy Ellis
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material NA - public sewer
Tank size
Date installed '
gal. Number of Compartments _ Cieanouts (YM)
Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed NA Soil rating (g.p.d./ft2 or ft2/bdrn) 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 NA Size in gallons Manhole/Access (Y/N)
'Pump on' level at _ in. 'Pump off level at _ in. High water alarm level at
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NA On adjacent Tots NA
Absorption field on lot NA On adjacent lots NA
Public sewer main 75« Public sewer manhole/cleanout 100'«
Sewer/septic service line 25'«
Animal containment areas 100'+
Holding tank NA
in.
Manure/animal excrete storage areas 100'«
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation NA Property line _ Absorption field
Water main Water service line Surface water
Wells on adjacent Tots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line NA Building foundation
Water Service line Surface water
Curtain drain Wells on adjacent lots
F. COMMENTS:
Water main
Driveway, parking/vehicle storage
G. ENGINEER'S CERTIFICATION
1 certify that 1 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 Cindy W. Ellis
Date $
COSA Fee $ I'M ��
Date of Payment �g
Receipt Number l% %1n 2 c
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
B
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