HomeMy WebLinkAboutUS SURVEY 3042 LT 10 NW4USS 3042
Lot 10, NW4
#075-092-54
DATE SCHEDULED j
TIME INSPECTOR i cq
SUBDIVISION US SURVEY 3042
BLOCK/LOT/TRACT LT 10 NW4
INDICATE NORTH'
MR
f o . ed ,
house"
SIZE MAIN: 7
TYPE MAIN:
DEPT AT MAIN:
AT PROP. SINE:��
CONNECT LOCATION: :
!
COMMENTS: �
,DR
INSPECTED BY: ly
DATE:
m
0
q
m
0
Z*
'�t
t7
4
m
C)
0
m
z
U)
0
0
7z
m
m
T
0
D
(D
I
z
02
0
>
m
� I m 5 M -TI
-T, i
IT
I
I
I
*V
LOCATION Of WELL
HEFTY DRILLING
3540 AKULA DRIVE
AKCHORAGE, AK 99510 .
(907) 345-0593 •�
(Plasia complete either la. is or It.)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURALIRESOURES
Division of Geological 8 Geophysical Survey$
Drilling permit Nn S Lt) 6.061 j
E31 Borough Subdivision LalIb. 1/e r
41
Settler Ne. Township NO Range. SO M.Adlen
/oelect _e l_at_..I_
ap w0
e. DISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS
Lail
tis 5(,Pv�
S. OWNER OF WELLs� y/ // /�
•.3a4j. C . /� NW4t
�"4t�`WC1K+
AadrossJp Q.P 4) 7
Svaal Address and Arta of Well L ... lion
i
Cjl� /At E, V& tie k, 1-7
2. WELL LOO f3
Svface Aeo
a. WEL DEPTH: Ifinal)
S. DATE OF COMPLETION
Type M Top
M triol?'ff
B``ellllam
4• L fl.
� _ — ,S — �no
re O
/v
e. OCows goal F-Rolary ODIJveft ❑Dug
LAL
/
0Auger Qaalad' Qgared ❑Dlko,l
`
T'USE:N Domealla• O Public $.Poly Q Industry
Q Irryauan Ssehar s13 coone'lgal
[Test well ❑oihul
F ►^ 0
B. CASINat O Threaded ;& Welded
diem. —41A. le— fl. Depth w.lthg Ibs./ It.
nem. fn. Ia it. Depth 3110LYP 11,
~ r
-
•
C15
e, nnuH OF weut
Tyoet 014L�if n&L Diameter
SIH/Mash elsol length:
r I bu,SH
bHrson ft. and it.
Bachllilleg Olivet paab
_
10, STATIC WATER LtVELI / fl. -17 If
OA►eve at 0 Below one aweless oil$
E41110108111 Ass!•
-
of. PUMPINO LEVEL below lead sulfate and YIELD
fl. Aflor _hrs, ►uw6ing g,p, Ai,
it. allor hes. pumping I,p,m. '
-- - - -- - -- - -
- - -
-IE.ORGOTING Well Growled: Ys. rnNo
MelalH: CO Heat Csmsnl C3 Other. A�¢ncyl.
_
IS. PUMPS (if aralloblo) NP
-
Lengl► of Drop Plot fl. capacity
O Svbm. O del 0 Centrifleal ❑ Other
Ia, REMARKS
6 D p•�.
It. WAVER WELL CONTRACTOR'S CERTIFICATION:
1
IS. Walor TimpraluH ��a O F 0 C
TM calf We. drilled pAYaw my JnNfdiello. And loll report I. Nva to
•
IM btH at my hnerlad/t And billet;
�1
Ne poredBut e I Nam,
0
-
.� -
Contract �LiHnre Number
lt
AvlherNe r,Hnlorlre^
polo' -
Form
t
OY•WWR III/ell Csnr Ci•Idn..u..e
- - ,����� . +1 rmn-pruler, CANARY-CoHamo
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WATER SUPPLY PERMIT
Initial
Permit Number: SW000188
Legal Description: US SURVEY 3042 LT 10 NW4
Date Issued: Jun 22, 2000
Expiration Date: Jun 22, 2001
Parcel ID: 075-092-54
Design Engineer: 0000 None Required Site Address:
Owner Name: Richard & Belinda Cook Lot Size: 17430 SQ. FT.
Owner Address: PO Box 974 Total Bedrooms: 4 Permit Bedrooms: 4
Girdwood , AK 99587 -
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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 (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.
Receives
Issue(
Date: ?_ 10 1 7
Date: G -2- 3-0 0
Permit Number: SW980461
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WATER SUPPLY PERMIT
Initial
Legal Description: US SURVEY 3042 LT 10 NW4
Date Issued: Nov 19, 1998
Expiration Date: Nov 19, 1999
Parcel ID: 075-092-54
Design Engineer: 0000 None Required Site Address:
Owner Name: Richard & Belinda Cook Lot Size: 17430 SQ. FT.
Owner Address: General Delivery Total Bedrooms: 3 Permit Bedrooms: 3
Girdwood , AK 99587 -
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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
a �6 ()Ln
Received By: Date:
Issued By: f®� C t -WA Date: a -t � -98
w
".A
A
Rai, 6
A pAc
� ,W
s
fit ;>
1r
-, ti,
clt4h' �9Boo
yiG,yWq i-
00
'
t�r�
hV)
Od
M x
C!
r- 0
N�
Z
U
O w
O
".A
A
Rai, 6
A pAc
� ,W
s
fit ;>
1r
-, ti,
clt4h' �9Boo
yiG,yWq i-
00
'
t�r�
/
90�
4 "4
Municipality of Anchoral
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS AP
Parcell.D. 075-092-54
1. GENERAL INFORMATION
Complete legal description USS 3042; LOT 10 NW4
SEP 0 2 2016
Expiration Date: (e
Complete
_I
Location (site address) 658 SPROAT ROAD'GIRDWOOD, AK 99587
Current Property owner(s) BELINDA COOK Day phone 242-7765
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
658 SPROAT ROAD'GIRDWOOD, AK 99587
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 6
4. TYPE OF WATER SUPPLY:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well . -
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WeiverNenance request for.
Received
to the engirlW. unless othe ise requested by the englneer.
COSA Fee $ 5'R (e
Date of Payment
Receipt Number 5ai
COSA #
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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 ver' that based 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 l �6
Engineers Comments:
In conducting this evaluation, GEG pmvidedan engineering evaluation offhe welland/orseplk system in accordance m1h the 'w\\\\VjVA
guidelines amimqulagons establishedbyfhe MunicipalilyotAnchorage andindusfrypni ffces. The reportedresufts describe the -W**C Or / 4)►.
condition offhe systemrs on the dafa(s offhe evaluation. separation datences were measuredfo madllyidanfigaole features. �••,.......••• .,,q ♦
Hidden defects crencreachments mayexist that were not idenffied during the evatimi m.The operational life ofall affsand septic �♦
systems depend on a variety ofvadablesindudmg, but not limited to, sdl conddkns, 9mundwaferlevels (that may#uctuafe during 't
the yeao, quatkyotcansfnnikn(materials and workmanship), and the walerusage offhe family utilizing the systeMs. These
conditions can vary, and are outside the centmf at GEG. sagslactoryfest results do not guarantee future pedormams offhe'' ,4 „ „
,,,, ••,•••• ••••;;,•„•;
sydem4s,•themlore, GEG makes no mnardylexpmssorimpled)regarding thetutwe pedomiance ofthe wellorsepticsyslem. 0
GEGmakesnompmwnfegonwhelheran0emative welt orseplk system can be fastaAed on the pmpenyin the event eilherorfhe 0 ........... .. .........................0
cunemsystemsfail. The content of this repod is for the sole benerd offhe personfmay who retained GEG. Rdknce upon the
0/♦ y . ar ss : lu/
informationpmvidedin this report byany otherpenson orpany, including butnotlimifedfo subsequentpmpenypumhasers,,isnot �'
authorized. Inshod, GEGdisevowsanyiegaldulyto anyone otherthanthepesonipany whopaidkrthisrepod. ��.tf C 7 5
6. DSD SIGNATURE tcEn e4 '� ROFESSt'�����
#AECC884 \\\\\
System #1 Approved for bedrooms.'
System #2 Approved for bedrooms.
QPM `9Giii
Disapproved. V
-z pN RPNp z”
Conditional approval for bedrooms, with the following stip�t2 ons.
NWP�rMR O
a
\N N51 PM
NT0`
r+"�r1111111����`
By: t ti l `�� Original Certificate Date:
The Municipality orAnchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineerregistered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 10112112)
I
If more than 1 septic system is on the lot:
COSA Checklist # —Of—
Structure
fStructure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: US SURVEY 3042; LOT 10, NW4
Parcel ID: 075-092-54
A. WELL DATA *PER SUROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A
Well Log (YIN) YES
Date completed 7/5/2000 Sanitary seal (Y/N) YES
Wires properly protected (Y/N) YES
Total depth 166 ft. Cased to "40'+ ft:
Casing height (above ground) 18± in.
FROM WELL LOG
AT INSPECTION
Date of test 7/5/2000
8/15/16
Static water level 61 ft,
63 ft,
Well production 60 g.p.m.
3:9+ - g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L.
Collected by: GEG, Ltd.
Arsenic: ND ug./L. Date of sample: 8/15/16
B. SEPTIC/HOLDING TANK DATA
AWWU SEWER
Tank Type/Material
Date installed
ank size gal. Number of Compartments _
Cl tale ('fi
oundation cleanout (Y/N) YES pressi ver tank (Y/N) _
:ate
High water alarm (Y/N)
o ping Pumper
AWWU SEWER
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2orft'/bdrm)_
System type
Length _ft. , Width nLMonftoringtube
Gravel below ft.
Total depth - ft. Eff. absorption area ft2Depression over field
Date of`adequacy test Results.Forbedrooms
Fluid depth in absorption field before in. New depth _in.
Elapsed Time: Final fluid depth
rate >= g.p.d.
etuvenation treatment (past 12 mo.) (Y/N & type)If
yes, give date
D. LIFT STATION
Date installed Sim in gallons Manhole/Acoess (Y/N)_
"Pump on' level at in. "Pump ofl level at r alarm level at
Cycles tested Meats alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankiliR station on lot WA
Absorption field on lot WA
On adjacent lots fW+
On adjacent kits IW+
Public sewer main 754 Public sewer manhole/cleanout '
Sewer /septic service line 2'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas iw+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AWWU SEWS
Building foundation
Water main
Property
Absorption
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water n
Water service line Surface water
Wells on adjacent lots
F. COMMENTS
AWWU SEWER
storage
`FIELD TECHNICIAN COULD NOT PHYSICALLY LOCATE MANHOLE. THEREFORE SEPERATION DISTANCES COULD
NOT BE PHYSICALLY MEASURED. DISTANCE APPEARS VERY CLOSE TO iw SEE ATTACHED DRAWING
"LOCATION OF SEWER SERVICE LINE FOR PROPERTY TO THE SOUTH IS UNKNOWN. SEE ATTACHED AWWU
CONNECT CARD
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspectibns and
review of Municipal records that the above systems are in
conformance with MOA COSA guldelines In affect on this
date.
Engineer's Printed Nagle JEFFREY A. GARNESS
(Rev. MUM)
3
x
FjLL
�u
aS
3>r
E's lxe>, NC -.y x}A.'.h c Ci :.r}k4.«`i u'
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY
.%.sCsn"Gi"'�i%'./3G'1-��%h'l./%.,`✓c.'Crr/o ..
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH 00 NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR'CONSTRUCTIQN
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
*�No
�s
a w Hw
GRID: ° ,°
'l �a
D..n. Muway
BRAW
ll� kwr.
-tom.
is Ji c
s
sc �e
i
X.
L
A
�o-
4.,
p�qy A. N . Pt r
AwwJ Ntora
owl.
u>
-tom.
�4
fY
9U
c{J
r
A$13UfLT � ® SMARD &A SOCIATES LAND SURVEYING '694-08
HLgP.EBY CEftTlF`! THAT f HAVE SURVEYC:D THE
SCAT z.
FOLLOWINGDESCRIBED PROPERTY: ' : o()f Al%u4
wsv�rz DATE. r� .. .. A S'
H�6
AND AT NO FNCjOACHMENTS' EXIST EXCEPT AS
INbIGATED. IT IS, THE RE SPONSIBILITY OF THE r w ! r
OWN -M TO DETERM)NE THE E,,,CisTENCE OF ANY GRID.- °`}.aa `:10
EtSMENTS, COVEIUANTS, Aft RESTRICTIONS
WHICH DO NOT APPEAR ON THERECORDED SUSDI•- -- �a ouana Mork 54war
VISION PLAT. UNDER NO CIRC JMSTANCFS SHOULD FB:
ANY DATA HEREON :BEUSED FCiR'CONaTRU=ON
Of ENCS LINES, OR FOR ESABLISHlN6 80UND-
ARY:; LINES. DRAWN:
i
i
i
I