HomeMy WebLinkAboutGRAHAM LT 8
' ENVIRONMENTAL P~O [~ION
~~ JAN 8 1979
S~X INGM ~ATER W~LL DRILLED AND CASED OUT TO
DRILLED AT ~H~ RA~ O~ ~ ~o ~ P~R ~OO~.
DRILLER ~¢~ ~ O~ 2~'~p~ ~¢~-
WELL LOG:
0 .....21 ' S¢.azL.
21 ....45' ~e.t.
45 ..... 74' SZ.L.~. .~o~aZ. c.~.. __ :
74 ...... 75'
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~1425o00
THANK YOU VERY MUCH,.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATE OG,¢C. 21~&, 1978 ~e.~f'.__'¥-'.~.._,,
· SERVICE CHARGEOF 1~% PER MONTHIVFILL BE ASSESSED ON PAST DUE ACCOUNTS.
F'ERMIT NO. ,' '7806C14 )
RF'F'L :f- CFINT
LI3CRT I ON
LEGRL
E, RU_.E PRLMEF.:
E:RFINCHE DRIVE
L.,F: 6RFIHFIM .... E-
~:2::L E. 7~TH RNCH
LOT
'J¢tOO~ :.-':i;;]]I..IRRE F'EIET
MINIMUM DISI'RNCE BETHEEN R HELL RND RNY ON-SITE SEHRGE DISPOSFIL .'.':]Y:.-];TEM IS
:t6~0 FEET FOR R PRI',/RTE 14ELL.~ OR
:t50 TO 200 FEET FROM R PUBLIC: HELl... DEPENDING UPON THE T'./PE OF' PUBLIC 14ELL.
HELL LOG:S RRE REt:.:!UIRED FIND MUST BE RETURNE[." TO THE [:,EPRRTMENT H!TH!N
OF THE HELL COMPLETION.
OTHER RE6!UIREMENTS f'IR~" RPPL'¢. SPECIFICRTIONS FIND CONSTRUCTION DIRGI~:F!I'"!S
R~,,'RILRBLE TO IN,SURE PROPER INSTRLLRTION.
I
FORI"H B'¢ l"HE MLN_UIF'HL1T~ OF F~NC:HORRGE.
2: ~ HZt. L ZNSTRLL THE :,~.=,TEfl IN RCC:ORE:,RNCE H~TH THE E:OE:,E:5.
.........................
RF'F'L. ~ C~T BR~CE
............
..EF] IF ~ THRT
:f. RM FRMILIRR P.IITH THE REC..!UIREMENTS] FLF.. F~N-':;ITE SEHER5; RN[:, I.,]F]._LS t~'.:~; :~i;ET
Municipality of Anchorage A
UM
On-Site Water and Wastewater Program <
(907) 343-7904 S ETY
1101 6
Certificate of On-Site Systems Approval
Parcel I.D.012-181-14 Expiration Date:
1. GENERAL INFORMATION:
Complete legal description Graham Lot 8
Location (site address) 7311 Branche Circle *Anchorage, AK
Current Property owner(s) Russell and Jerri Knight Day phone 907-242-6449
Mailing address
Real Estate Agent Nate Baer Day phone 907-727-1130
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
F-1 Duplex
F-1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
.4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
❑
Individual Water Storage
D
Holding Tank
D
Community Class Well
0
Community
F71
Public Water System
1771
Public Sewer
WaiverNariance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 55D Waiver Fee $
Date of Payment 1.9 - q'A Date of Payment
Receipt Number' Oa5Receipt Number
COSA# QSC 101 157% Waiver #
ro
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 (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Gayness Date: z z
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s 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 systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, an
are outside the control of GEG. Satisfactory test results do not guarantee future performance of th
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance o
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 current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSQ SIGNATURE
System #1 Approved for _�_ bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms .
bedrooms, with the followi
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n 9' rC Gar ess:��
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ON-SITE
WAT' r AN
WASTE ! AT
FROG., -'AM
Original Certificate Date: l 2P 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 _ 6 Nitrate Advisory
Septic System Advisory Arsenic Advisory /110
Well Flow Advisory Other
Legal Description: Graham; Lot 8
Parcel ID: 012-181-14
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
C. LIFT STATION
OR Well log is filed with Onsite (or attached)
Well production at time of test 9.0+ gpm
Date drilled 101218
Water storage tank volume N/A gallons
Total depth 75 ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to 75 ft
❑ Coliform bacteria is Negative
FOR Sanitary seal is functioning correctly
Nitrate mg/L V Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic 75• $ ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 12+ in.
Collected by GEG
Date of flow test for COSA 17115/19
Date of Sample 71'14/19
Static water level at beginning of test 39.4 ft.
Fluid depth prior to in
Comments WELL LOG WAS NOT IN MOA RECORDS; SEE ATTACHED WELL LOG FROM "WELTS"
Water a gal
B. TANK DATA
C. LIFT STATION
Age of tank(s) years
❑ Re u' enance completed
Tank type/material , ®-"'Age
of lift station years
Measured operating fluid level in se
Lift station material
❑ Standpipes/fo cleanout per record drawing
Comments:
D pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed)
Adequacy test date
❑ ALL standpipes present per record drawing
Results ❑ Pass For edrooms
Total measured depth from grade ft (max)
Fluid depth prior to in
Measured depth to pipe invert from grade ft (min)
Water a gal
❑ N/A — pressurized field
w depth in
❑ Monitor tubes go to bottom of effective. If not, state
Elapsed time min
depth into effective
❑ Code -required soil cover over field
Final fluid depth in
❑ System presoaked
Absorption rate gpd
(Required if vacant fo ater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)
Gall troduced gallons
If yes, enter date
COSA Checklist yellow sheet
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'
NSA
Community Sewer Manhole/Cleanout > 100'
r7Yes
if No ft
M 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
❑✓ 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' i o ft
Property Line > 5'
❑ Yes
if No ft
Wells on ots:
Absorption Field > 5'
❑ Yes
if No
Private Wells > 100' ❑ Yes if No _
Water Main > 10'
es
if No ft
Community Wells > 200' ❑ Yes if No _
ervice 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 undercomment below
Property Line > 10'
❑ Yes
if No
ft
Well acent Lots:
Water Main > 10'
❑ Yes
if N
Private Wells > 100' ❑ Yes if No
Water Service Line > 1
Yes
if No
ft
Community Wells > 200' ❑ Yes if No
ater > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
*SEE ATTACHED EMAIL WITH AWWU REGARDING SERVICE TO ADJACENT LOTS
G. ENGINEER'S CERTIFICATION OF
1 certify that 1 have determined through field inspections and review D /�
of Municipal records that the above systems are in conformance with (,j • H I
MOA COSA guidelines in effect on this date..:.. 9 :.
COSA Checklist.yellow sheet
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Lega_l_Description (inctude lot, block, subdivision, section, township, range)
Location (address or directions) ~ _
~_~// ~;~ ~/~,z/~ / .~,4-/~',,%
(b) Applicant Name~>~¢'//~ ~/"¢/-"~'~ Te~p_b.9~: Home Business
Applicant Address /..? '~. ---
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution ~O/,-¢~ Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public,,[~ Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
5o
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of tl)i.i.i.i~[:ts~ection. ~
Name of Fi-~r~ ./~z~_~ ~~ ~-~ . Telephone -'~- ~
Address ~ ~-~7 ~; '~ ,/~'/~ /~'~
Approved for ./'~¢;~¢'~' bedrooms by
Approved ,~.~ DisapprOve~/? C°(~cl~/iti° hal
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent pro?essional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECT[Oi' I
WELL DATA
Well Classification
If A, B, C, D.E.C. Approved (Y/N)
Well Log PreserVe)
Total Depth ;~ /
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Date Completed
Cased to ~E-o~''''~ /
//~ - ~/-- ~'.b/ Yield
Depth of Grouting
Pump Set At ~-~
Sanitary Seal on Casing&N)
Depression Around Wellhead (Y~----?-
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
¢/ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
~ /~/-~:--/?.*/A.~/ ; Date ¢'"- ~
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Size No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(1~/84)
C. --ABSORP-T4EhN-'FtEL-G-Eh~-'FA J -%-' --¢./- × ~:
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hc~'e'~'h"~ked,/verifi~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~z~)* t¢~ Date
Company '~/'~'~'~E :-,~??; ¢.~27~( MOANo
Receipt No. 3 ~ ~ ~ S~
Date of Payment ~-I 3~ ~
Amount: $ '~ ~
Page 2 of 2
72-026 (11/84)
Location:
BESSE, EPPS & ~S
2220 EAST 88 AVENUE
ANCHORAGE, AK 99507
(907) 349-6451
WATER ~r.L TEST
Subdivision: ,/~ ~/~/ . :;~
Block:
Client's Name:
Tester:
Initial Reading m aeter: d'~/~ ~.~j~
TIME GPM /% VOLIJI~ TOTAL
Proch~ction Rate: ,~',?' GPM 24-Hour Ca[~-~city Gallons