HomeMy WebLinkAboutT14N R2W SEC 12 LT 14 REMAdopmw 4
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MUNICIPALITY OF ANCHORAGE
Department of Health end Human Services
On-Site Services Program
825 L Street, R~om 502
P.O. Box I~6550, Anchorage, AK ~519-6~50
(gO7) 343-4744
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Oct 09, 2000
Expiration Date: Oct 09, 2001
Permit Number: SW000431
Legal Description: T14N R2W SEC 12 LT 14 REM
Design Engineer: 0000 None Required
Owner Name: Aiaina Anderson
Owner Address: 17520 Northgate Park
Eagle River, AK 99577-
Parcel ID: 050-273-05
Site Address: 016832 FOOTHILL AVE
Lot Size: 23047 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
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. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 end 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.
Date:/~) --~"0~
Municipality of Anchorage �^ .
On -Site Water & Wastewater Program_
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-273-05 Expiration Date: J
1. GENERAL INFORMATION
Complete legal description T14N R2W SECTION 12 LOT 14
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
16832 FOOTHILL AVE *EAGLE RIVER
ADAM GALINDO Day phone 830-0085
16832 FOOTHILL AVE *EAGLE RIVER
Day phone
0 Single Family (wlwo ADU) ,ori
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) b L
NOV 12 2014
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF;WAI�STEWATER DISPOSAL:..
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
WaiverNadance request for: n/a
Distance: —
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52-f�_ Waiver Fee $
Date of Payment I1 f 121)q (ice- Date of Payment
Receipt Number i�bt�JG Receipt Number
COSA# 0(�I%3 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. l 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 _ lb J$ /14
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the o00��44
system under the conditions encountered at the time of the test, and separationo` O F A 4p
distances measured to readily identifiable features. The operational life of all wells and ®�'.. • .....•� S40
septic systems depend on the local sods condition, groundwater levels that may �� Q'.• / /r QO
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test * —H/ '* OO
results do not guarantee future performance of the system, nor do the OX
9 p y they that �: ,P .. ..,.fj. ......... .......�
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide (,
any warranty or future estimate of how long the system will continue to meet the' . ' "
operational requirements of the ADEC or MOA DSD. The content of this report is for OO J f f . Ga rn ss: QO
the sole benefit of the owner listed above. Any reliance upon or use of this report by any Q s. ' — 5 om Q
other person or party is not authorized, nor will it confer any legal right whatsoever
6. DSD SIGNATURE 4�Qd Professlonoo�
444400�a
System #1 Approved for bedrooms.
��AlltlihllOt4h/
`�
System #2 Approved for bedrooms: ��(OF AIVCW rrrr
Disapproved. `,AQP
Conditional approval for bedrooms, with the following stipularia wAjER AtyD z
Jo WASTEwATM o=
J
Original Certificate Date:
he unicipality or Anchorage 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 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. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 1IM5)
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: T1 4N R2W SEC 12 LOT 14 REM
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 1.0/10/2000 Sanitary seal (Y/N) YES
Total depth 122 ft. Cased to 121 ft.
FROM WELL LOG
Date of test 10/10/2000
Static water level 85 ft.
Well production 30 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: ND ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) Depression over tank (Y/N) _
Parcel ID: 050-273-05
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 18+ in.
AT INSPECTION
9/23/2014
87
Nitrate 0.62 mg./L.
Date of sample: 9/23/2014
PUBLIC SEWER
5.33 g.p.m.
Collected by: GEG. Ltd
Date installed
Cleanouts (Y/N) _
High water alarm
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft or ft/bdrSystem type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption a ft' Monitoring tube_ Depression over field_
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor ' 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 oti level High water alarm level
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main 75'+
Sewer /septic service line *25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank
Animal containment areas_ 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation
Water main
Wells on adjacent lots
Property line Absorption
Water service
SEPARATION DISTANCE FROM ABSORPTION
Property line
Water service line / Surface water
Wells on adjacent lots
F. COMMENTS
Surface
Water
Driveway, parking/vehicle storage
*ASSUMED PER AWWU RECORD DRAWING, AWWU CONNECT CARD AND AS—BUILT SURVEY
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
raview of Municipal records that the above systems are in
conformance with MOA COSH guidelines in eyed on this
date.
Enginsers Printed Name JEFFREY A. GARNESS
Date 10) by
(Rev. 11105)
Cerfifirrtttttlg
by
DOC CO. doa
IV
SULL AN TER WELLS
P.O. BOX 670272, CHUG1AK, ALASKA 99567 a TELEPHONE 688-2756
OWNER OF I AND:1,34' fl . 14-4,q ty:Dv z=
ADDRESS:
LEGAL DESCRIPTION: T1yy +`4L 4 ,AJ' ; a-'�
DATE: 4$ is ...- —
PERMIT NUMBER: LL1)4k) '1 -3 : DateoflssuelC
TAX IDENTIFICATION NUMBER:
Is well located ata approved permit location? t.�s � No
n
Method of Drilling: L�-<i rr otary :J cable toot
Depth of well: _Lx I
Casing (Yp e 2 r 64 Wall Thickness " ; '`d inches
cr
Diameter' _ inches, depth 1 � _,_feet
Liner Type:
Casing Stickup Above Ground:—•NS feet
Static Water Level: ��a�_-. feet
Recover Rate:--' gpm
Method of Testing: 6`r a
Well Intake Opening Type:n fiend L7 open hole
Screened, Start.--- feet Stopped feet
J Perforations Start f@Qe topped feet
Grout Type:, 1-lj _Volume
Depth: from
p—�feet, to feet
Well Disinfected Upon Completion? s _3 No
Method of Disinfection:`i�t
Comments:
CSvrry S T1
Driller's Name {
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. Matsu Borough:
Department of Environmental Conservation.
Lam' F
u�',=r1=iiHW e S' 1/4, SEC710H 12, -HAND R2W, S.M., ALAS
r JJO nEr rl rcOiv IrVcl FOttT101� CONVEYED 10_i9E-9PATE-3FALASW,. -_— -. .•�
DEFA�IWENI OF HIGHWAYS BY WARRANTY DEED RECORDED MARCH 6, 1978, IN BOOK 8, AAT. PAGE BP..- - --- � -
v�Y
a§
..g
WILL
BUILDING DETAIL
SCA -E: V=20'
NOTE: @FARINGS AND DISTANCES BASED ON BREAKDOWN OF THE
SW 1/4 SW 1/4 SEC. 12, T12N, R2W, UNLSS NOTED OTHERWISE,
FINAL STRUCTURE AS-BJILT
AS -BU I LT I HEREBY CERTIFY THAT r HAVE SURVE171) THE
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PROPERTY DEPICTED ABOVE AND THAT NO
G;S,i J� LhtiO SJR�rTNG
EENCROACHMEWIS EXIST EXCEPT AS INDICATED.
JETrr A GASTAL DI, R.LS.
R IS THE RESPONSIBILRY OF 71fE OWNER TO
472E !i_, BS7r, A:�NjE
DcE7RASIVE T- �::�-✓ C- n:.' - - -
ANCHORA.^.E, ALASi.A E-3502 1
=VENAh a OR RZE-MI,T,ONS WnICH DO NOT
PHONE 24u-5454
APPEAR ON THE RECORDED S'JBD."O SION PLAT,
UNDER NO CIRCUiJTANC� SHOULD f}.T DATA
GRID I DATE I
HEREON BE USED FOR CONSRr UCTION OR FOR
HWO052 II 7/27/2001
ES7ASuSriiivG BOJNDARY OR FENCE UNES.
ANCHORAGE RECORDING DISTRICT, ALASKA
F.^o. J09 kO.
0S -D7 Li4SEC12
NOTE: NO CORN' -ERS SET THIS DATE.
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