HomeMy WebLinkAboutT15N R1W SEC 30 LT 78AT15N R1W
Sec 30
Lot 78A
#051-302-42
Certified Drilling Log
BILL & COLE OC CO dba
*n Box 670269, g
ULLIVANWATER WELLS
OWNER OF LAND: Bob Ross
ADDRESS: 15315 Darby Road Eagle River, AK 99577
LEGAL DESCRIPTION T15N R1W SEC 30 LOT 78A
DATE: 6-17-16
PERMIT NUMBER: 05P161137 DATE OF ISSUE: 6-10-16
TAX IDENTIFICATION NUMBER 05130242000
Is well located at approved permit location: MYes ❑No
Method of Drilling: ®air rotary ❑cable tool
Depth of Well: 100'
Casing Type: Steel Wall thickness .250
Diameter: 6 inches, depth 44
Liner type
inches
feet
Static Water Level: 12
Recovery Rate 1
Method of Testing Air
feet
gpm ❑ gph
Well Intake Opening Type: ❑ open end ®open hole
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 Ibs
Depth: from 2 feet, tIoo� r�7 42 feet
Well Disinfected Upon Completion: yes I no
Method of Disinfection: Chlorine 50 PPM
Comments:
Well flow after hydro -frac.
Shallow bedrock surface seal completed to MOA code.
WATER QUALITY TFRTING
Arsenio IMP uyL
Bore Hole Data
Depth
From To
0
2
2
4
4
5
5
49
49
87
87
100
Casing Stickup
Overburden
Silty Sand & Gravel
Bedrock Gray
Bedrock Dark Gray w/ Fractures
Bedrock Green Hard
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
D
,—BILL Sc COLE OC CO tl6a
*ULLIVANPO. Box 670269,giakWATER WELLS
, AK 99567 688-2759
www. s u l l iva nwate rwe l l s. com
Pump Installation Log
Well Drilling Permit Number: SW OSP161137
Date of Issue 6-10-16
Parcel Identification Number: 05130242000
Legal Description
T15N R1W SEC 30 LOT 78A
Property Owner Name & Address
BOB ROSS 15315 DARBY RD EAGLE RIVER, AK 99577
Pump Installation Date: 7-3-16
Pump Intake Depth Below Top of Well Casing: 90 feet
Pump manufacturer's Name: FLINT & WALLING
Pump Model: 4F07P05301S
Pump Size: 1/2 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Installer: SULLIVAN WATER WELLS
Disinfected Upon Completion? ® yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: MARTINSON
Pump Installers Name: Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
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: OSP161137
Tax Code Number: 05130242000
Work Type: Well Initial
Permit Effective Dates: June 10, 2016
Design Engineer:
Subdivision: T15N R1VV SEC 30
to June 10, 2017
Site Legal Address: T15N R1 W SEC 30 LT 78A G:0654
Owner/Address:
ROSS ROBERT A & KAREN L TRUST
ROSS R A & K L/TRUSTEES 15315 DARBY ROAD EAGLE RIVER AK 995779211
Site Mailing Address: 15315 DARBY RD, Eagle River
Lot Size in Sq Ft: 49582
Total Bedrooms: 2
This permit is for the construction of:
N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N 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 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 By:
Issued By:
Date: //7/
Date: (�
MUNICIPALITY OF ANCHORAGE 12\`4/
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Parcel I.D.
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
O.r- I — — <12 - 0 I &
Lc+i8A l/6N rwS3
Property owner(s) % , t" is , p0 5S Day phone 901 2.3o tote
Mailing address par„,r) 9 /z'3q Ect j /e k,i,,{ Ak 993'i'
Site address ! 5 31 5 P&'r% Q_ / C. 2t der AP -9 99 s y�
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size /, / 2 wre Number of Bedrooms
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
0
0
APPLICATION IS AN:
Initial
Upgrade
Renewal
TYPE OF DWELLING:
Single Family (SF) N
(w/wo ADU)
Duplex (D) 0
Multiple Dwellings 0
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
415
s cp// Cs
06815 b
Permit No. C059V.U31
A991 t,.5h (QO M>s
Permit App_9-1-12.doc ch, 12,4k(Jt-g-ll>
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
tJ t$er 04-0 roqR'
ecto v.. /47t -Ln
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C1)4ld ( 500.+A-ce
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72-013 (Re /78)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NA -
„ �' e ,, (. Z4 -45)d -`C , y
PHONE 1p
6 qz- ok
[EW
■ UPGRADE
MAILILII���lM AD/DD, E_SS'1
v0 t J cr1G a 41 I fie.
LEGAL DESCRIPTION
7-/,c e 1 S< 3 o 4-44- 78-A
N n,✓t4�^/^�� ^ `�
NO. OF BEDROOMS
6
SEPTIC
TANK
DISTANCE TO:
Well
y/4 Ay
Absorptionarea et
tom—
Dwelling
/ 8
PERMIT NQS 90-7 (
/
Manufacturer
Materi ^ n
No. of c,Lpartments
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
/ 5-oo
o
J2Z
2 Z FQ-
Well
Dwelling
PERMIT NO.
DISTANCE TO:
,
Manufacturer
Material
Liquid capacity in gallons
J
w
-Z
=
DISTANCE TO: .(�--�,i(��
VI/1H, I
Foundation
.�. c, p r
Nearest lot line
/ 0
PERMIT NO.
7 to; t � �
No. of lines
Length of each line
/.� frn
Total length of lines
Trench width rr
0 ,
Distance hetween
(c'
H
Top of tile to finish grade
�, 5
Material beneath tile
a, 3 inches
Total effective absorgtj»,n aJea
SEEPAGE i
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
amet
Crib d e
Crib depth \
Total effec " • absorp 'on area \-f/- \
DISTANCE TO:
Well
\Bui 'ng foundation
`N-arest lot line
w
w
) •
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
i_.Ail it./ t I 11L_
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■■'rfi'L�ID{`L��IY�il
■■".�'65y5W.
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'llWS
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SOIL TE
T RATING 1
INSTAL ,EJ �V_�
o.(((�ry�`ry/�f `� /
REMARKS
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EAS
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APP OVED DATE LEGAL
e'l ' / 43CAX- ' /6167 79 1.78 -E T/5 -A1 RI w -'-fit
72-013 (Re /78)
APPLICANT ROBERT F:C!E5 C/O C. C. E:RE PFJ BOX 541 EAGLE RIVER 694 90:t0
LOCATION OLD GLENN HWY
LEGAL 1_2B -R S30 T15N RIN A
LOT SIZE 55000 SQUARE: FEET
TYPE. OF OIL AB'SORBTION SYSTEM IS: DRAINFIELC'
MAXIMUM NUMBER OF BEDROOMS -. SOIL RATING(SG! FTe'ER)=_ 325
THE REQUIRED SITE OF THE "_OIL ABSORPTION SYSTEM I5:
Dia @-"'LrE-Y--. L55 @__@::c@" -"@C3 l@"El= --="<-n_.4.. _ E:_@..._ F:="E.-e_ - 11-4==
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DE AINFIE:LD.
THE: DEPTH OF A TRENCH OR. PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE:
'ROUND AND THE BOTTOM OF THE EXCA'V'ATION IN FEET).
' R--1 E_: 1.- P: Fes. @"-•1! e__ & @ E.".5 :5,_ E'::" r B - -T I r _ r: 'ia C„ A na F 1 _ _ _@...
THE GRAVEL DEPTH IS THE: MINIMUM DEPTH OF•GRAV'E.L BETWEEN THE: OUTFALL.. PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
.C. F:6_ 0.:P e " L.c r_- tl :ll_ 9._ -' E RI tl "J f. S 1 2.E 4:._ =': _.h... 75 C E) L. B_. -A P-4.
PERMIT APPLICANT HAS• THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO TI -IIS PROPERTY AND THE
NUMBER OF RESIDENCE'S THFIT THE WELL WILL SERVE.
----- ""-' 17tr-1 O C -:" --u 1 PA ES F— F.:"_ u_: T' I A.- _A t"ql�"-'� ft .' �:=:.. �".': E GOA LJ I F"." F. ': @.:n
BACKFILLING OF ANY 'SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS
DEPARTMENT WILL BE. SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A !:.!EL.L.. ANIE:, ANY ON-SITE SEWAGE C:'ISPOSAL. SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM Fi PUBLIC WELL DEPENDING UPON THE•'I YPE OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
a = G m^ M :F -Y" t_:.- -" F=" :F' FE:P =: SF ='" F=-:: C' EMU € _ _: a.: :'it. S=tl o - °--tl
I CERTIFY TI -IAT
AM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS AND WELL, AS SET
FORTH Et' THE MLUNICIPALITY OF ANCHORAGE.
I WILL. INSTALL THE SYSTEM it+! ACCORDANCE WITH THE CODES.
- UNDERSTAND THAT THE OP-SITE SEWER SYSTEM
MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS.
'mIGNED:__
HPPLIC:;,Qf► ROPE.f T R -SS C/O c.!_. BFiEeb
;SUED E:
.DATE
Steven A. Johnson
P.O., 'Sox 76
C,hu.ak, AK 99567
Phone: 907-688-3085
--` 0 SOIL1S too
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Robert Ross
LEGAL DESCRIPTION
Lot 78A Sec 30 T15N R1W SM
0'-1' red sandy silt .w/
organics(ML)275ft2/bm
1'-2' gray sand w/
some silt(SM-SW) 225
perc tested 2.5° to 4.5'
water table at 9'
COMMENTS
SLOPE
&1 PERCOLATION
TEST
DATE PERFORMED: 1 0/10/78
WAS GROUND WATER
ENCOUNTERED?
total depth 12' IF YES, AT WHAT
DEPTH?
YES
9'
s
L
0
P
E
i" = 1 DO/
Reading
Date
Gross
Time
TeJ
al
la
1
10/10/78
60
2.5
2
1
6o
1.75
3
60
1.50
4
Act'
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Na
Drop
1
10/10/78
60
2.5
2
6o
1.75
3
60
1.50
4
60
1.25
5
60
1.25
PERCOLATION RATE
48 Iminutos/inch)
TEST RUN BETWEEN 2' 5 FT AND 4°5 FT
JDiL slopes gently to F'
PERFORMEDBY: Steven A. Johnson
72.008 (7/76)
CERTIFIED 8Y:
ATE: 10/11/78
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-302-42 Expiration Date: / / ' 30 IC"
1. GENERAL INFORMATION
Complete legal description T15N R1W Section 30 Lot 78A
Location (site address) 15315 Darby Road
Current Property owner(s) Ross Day phone 230-6018
Mailing address Same
Real Estate Agent Owner Day phone 230-6018
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by:—
COSA to be released to the engineer, unless erwise requested by the engineer.
Date: Ac4,07/ 1'
COSA Fee $ 624 - ^ Date:
Date of Payment Wf 3-31 rt, (j'`+ _ Date of Payment
Receipt Number Oa JStcl b. Receipt Number
COSA # 05U Cr 1 k 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 NorthRim Engineering
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
By:
System #1 Approved for bedrooms.
Phone 694-7028
Date
8/22/2016
System #2 Approved for bedrooms. - fmc
Disapproved. `/4j45
Conditional approval for bedrooms, with the following stipuidtions,:ra -
1ltlltt ((l ((((!r
TY OFCy
(fi0P,�i
:11:o WWAPOATNTOEEGSRWIRAENTMDRmoz%
Original Certificate Date: g- 3 Q --/
Municipality of Anchorage Devlopment 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12.doc
X
Nitrate Advisory
Arsenic Advisory
Other
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: 775At ) i N' SEC 30 47,4 Parcel ID: csi 3oe-'j 2
A. WELL DATA
Well type P If A, B, or C provide PWSID # Well Log (YIN) y%
Date completed 0 -rh/Sanitary seal (Y/N) 7' Wires properly protected (WN) 7'
Total depth Loot Cased to 419 ft. Casing height (above ground) 2 y in
FROM. WELL LOG AT INSPECTION
Date of test ‘1/47//4- New
Static water level / 2 ft. ft.
Well production 0.7 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrated- 5'S2( mg/L
Arsenic > /Va�ug/L Date of sample: �rt Collected by: .1//et •'h_,C),
B. SEPTIC/HOLDING TANK DATA
tank Type/Material SEI r C/ST6(L- Date installed iie7`!
'Tank size /54j9 gal. Number of Compartments.. Cleanouts (Y/N)
Foundationcleanout (YIN) 7 Depression over tank (Y/N) ,t/ High water alarm (YIN) / N
Date of pumping 372 S Pumper 7/0(
C. ABSORPTION FIELD DATA
Date installed/a/6/79- Soil rating (g.p:d.Ift2 o ft2/bdrm 3 Z 5 System type 7Aa
Length /'-si FO ft. Width S ft. Gravel below pipe c • SN e..
Total depth y ft. Eff. absorptio2 area /fit/& Monitoring tube y Depression over field At
Date of adequacy test 81/2//` ;i Results (Pass/Fail) f For a bedrooms
Fluid depth in absorption fiek! beforet t 6 in. Water added 50o gal: New depth f' in.
91i.
Elapsed Time: ea min. Final fluid depth 4 in. Absorption rate >_ :30Cf + g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1/ If yes, give date
D. LIFT STATION AM
Date installed Size in gallons Manhole/Access (YIN)
"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 /00 'r"' On adjacent lots /00 err
Absorption field on lot - /00 `f Qn adjacent lots /00'1-
Public
06'`1
Public sewer main
/00 Cr Public sewer manhofe/cleanout /a.' <'r.
Sewer /septic service line 5 1i-
Animal
*Animal containment areas �c
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S '� Property line
Water main
Holding tank /64 T-
Manure/animal excrete storage areas
/00
Absorption field ` s 74 -
dr
dr r Water service line / 0 ,F Surface water /0C 1 --
Wells on adjacent lots /06'4 -
ABSORPTION FIELD ON t LOT TO:
e
Property line / 6 4" Building foundation /d f Water main Qt y`
v'r`g storage
Service line. / 6 f /a 0 Driveway, Surface water parkin /vehicle Stora e
Curtain drain ///S/f Wells on adjacent lots 0 0
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipalrecords that the above systems are tn.,
conformance with MOA COSA guidelines in effect on this date.
date.`
Engineer's Printed Name S%6dt E,V bP 2-77
Date
COSA yellow sheet 2-6-15.doc
Se
tee�e .,i . i$. •., J
Stair W.
4INN
4.114 o
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anehorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # OSC161381
During a recent COSA on-site inspection and test of the potable water
supply well on Block T15N R1W Sec, 30, Lot 78A of subdivision,
the well's productivity was determined to be .9 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
2 -bedroom residence is 0.20 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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