Loading...
HomeMy WebLinkAboutGIRDWOOD ORIGINAL TOWNSITE BLK 2 LT 26 PAGE 1 OF 1 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:SW950267 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:TUMEY MICHAEL OWNER ADDRESS:P.O. BOX 491 GIRDWOOD, AK 99587 DATE ISSUED: EXPIRATION DATE: PARCEL ID:07515251 9/o8/95 9/o8/96 LEGAL DESCRIPTION: GIRDWOOD ORIGINAL TOWNSITE BLK 2 LT 26 LOT SIZE: 6187 (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: 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: ~4~ ! ~%.~_.~ DATE: DATE: ,L GRID I Hereby c~rtify that I have surveyed tJaz followin~ dtscribtd property: Lot ~ ,Block ~ , ~~ ~K[~IW~ . ~H~ Rtcording District, Al~sk~, and ~t thg im~roy~mtn~ $i~ttd ~ton art within ~t property linis ~nd do not zncroech onto the prop~y adj~c~t ~etto, ~at ao that thtrg arm no roadways, transmission lint: or othtr visibls ¢asimgn~ on ~aid propt~ Ilci~t i$ indicatld htrton. It is the rtsponsibility of th~ owner ~o dz~trmin~ the ~xisttnct of any tas~m~nt~, covenant, or rtstrictio~ which do not appzar an thz r{corded subdivision plat. Andaora{% Alaska 99515 (g07~ 34.%§476 LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD ds Dw LOCATION/SKETCH: DEPTHS MEASURED FROM:~'casing top []ground surface BOREHOLE DATA: Material Type and Color Depth From To WELL OWNER: WELL DEPTH: Depth of hole: Depth of casing:. DATE OF COMPLETION ft DEPTH TO STATIC WATER LEVEL: · ,~ ft below~ top of casing Date: / / ground surface METHOD OF DRILLING: [] air rotary J~' cable tool [] other USE OF WELL: [~ domestic [] irrigation [] monitor [] public supply [] other CASING STICK-UP: ~t. Diam: ~ Casing type: ,<~/~ ¢ WELL INTAKE OPENING TYPE: [] open end [] perforated [] open hole Depths of openings: . to. in. to ft in. to ft [] screened SCREEN TYPE: x4~'~/(/~' Diam: Slot/Mesh Size: Length:... GRAVEL PACK TYPE: Volume used:. Depth to top: GROUT TYPE: Volume: Depth: from ft to DEVELOPMENT METHOD: Duration: L AND YIELD: ft afte[' ~-~ hrs pumping /4"~ gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? [] YES [] NO CONTRACTOR INFORMATION; ' , REMARKS: ~ ,'o~ ~_ ~~ //.. ~ PLEASE MAIL WHITE COPY OF LOG TO: ~g~ature of Authonzed RespresBntab~- ~ DNfl/DIVISION OF WATER PO BOX 772116 ~GLE RIVER AK 99577-2116 Tom Fink, Mayor Municipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1991 Michael A. Tumey PO Box 491 Girdwood, Alaska 99587 Subject: Lot 26 Block 2 Girdwood Original Townsite Permit #900349, PID #075-152-51 The subject permit, issued by this office for a singl~ family well and/or on-site wastewater system has expired as of December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system Dot installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. J~n Smith//P .~E.'' ~ ~/ogram Manager ~n-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" 10-'17- e/O e /0-/7- gO DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIO~ OCT 1 9 1990 RECEIVED SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown and de.  ~ scribed hereon and that the Improvement~situated thereon are within the property lines and ne  encroachments exist other than noted. PLEASE NOTE= It I! the contract LEGEND: SET FOUND ENGINEERB ' PLANNERS · SURVEYORS -or's responsibility to check top 5/8" REBAR ~ O of foundation In relation to HUB&TACK .~ ~ 440 WEST BENSON BLVD. finish grade and building set- MONUMENT ~ b.ck, In relation to lot lines AL-CAP ~ e ...... ANCHORAGE, ALASKA 99503 562-5291 and easements. PK NAIL X IRON PIPE ~ Gmo: LEGAL DESCRIPTION: j i= ELEVS, - DATUM ~. ~~ ~_: ~ss~D ...... ~- 8-/2'~0 In Parcel I.D. 075-152-51 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date: 8�// Z k , Complete legal description GIRDWOOD ORIGINAL TOWNSITE: BLOCK 2, LOT 26 Location (site address) 298 Main Street *Girdwood Current Property owner(s) Larry Palubicki Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 382-1406 Day phone o sarErr 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 51 1 202 % Date of Payment Receipt Number. 09q_3$ ,G Receipt Number COSA # 05 C Q I I 'a a $ Waiver # MAR 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. Garness Date: 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, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of 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. #AECC884 6. DSD SIGNATURE _/� System #1 Approved for 7i bedrooms System #2 Approved for bedrooms ON-SITE WATER AND m Disapproved J G WAST'_v)'ATER Conditional approval for bedrooms, with ttollo�'i r�QMtior 0 QJ By; Original Certificate Date: The Municipality ofhorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represent ions 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 0 COSA Checklist Legal Description: GIRDWOOD ORIGINAL TOWNSITE; BLOCK 2, LOT 26 01--\a. r Parcel ID: 075-152-51 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed wit Onsite (or attached) Well production at time of test 7.9+ gpm Date drilled1995 4 Water storage tank volume N/A gallons Total depth 42 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 42 ft 0 Coliform bacteria is Negative FE -1 seal is functioning 0.297 correctly Nitrate mg/L F-1 Nitrate less than MRL (ND) A-1Wires are properly protecte Arsenic ug/L X Arsenic less than MRL (ND) Casing height (above ground i Collected by CEG, LTD. Date of flow test for COSA 4/20/21 Date of Sample 4/20/2' A Static water level at beginning of test *3 ft. ��^^�,,a,c Comments 'PER HEFTY DRILLING - SEE ATTACHED RECEIPT FOR WELL REPAIRS AND'STATIC WATER LEVEL READING AWWU SEWER B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑Monitor tubes go to bottom of eff Ive. If not, state depth into effective ❑ Code -required soil cov ver field ❑ System presoake (Required if vac or greater than 30 days prior to date of test) Gallo ntroduced gallons L COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Xdequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' ft Property Line > 10' ❑ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'F� 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 M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑v Yes if No ft ❑✓ Yes if No ft Septic/Holding Tank Lot to: distances if less than required) AWWU SEWER From on (Please enter Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ❑ Yes if No ft Community > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If se p ' nk is under driveway comment below From Absorption Field on Lot to: (Please enter distanc Building Foundation > 10' ❑ Yes if N ft Property Line > 10' if No ft Water Main > 10' '0 Yes if No ft Water Servic ' e > 10' ❑ Yes if No ft Su e Water > 100' ❑ Yes if No It F. ENGINEER'S COMMENTS than required) If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft G. ENGINEER'S CERTIFICATION l certify that l 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. COSA Checklist yellow sheet #AECC884 AK RR 60 Lot 26 0- Lot 2 LOT 1 6�0 Block 2 'b Lot 24 4 LOT 2 Lot 23 AW OF . _ AW A4,qkk4 LOT -0 1 22 - .... .. ...... T 4 LOT 3 7, S-1 1.5 30 ojVVII - 71 XP 0 Sta 49r�l'% SM V Ing US SURVEY NOM FEET -All dimensions shown are grid bearings and ground distances, record boundaries are per Plat USS No. 1177. -49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no circumstances should any data hereon be used for establishment of property lines. -It is the ownexs responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed. GEND AS BUILT SURVEY LE49th Star Surveying LLC utility Pate 321 Fireoved Drive Lots 23-26, Block 2, Anchorage, AK 99508 US Survey No. 117 7, well (907)891-6111 Girdwood, Alaska z Tele-comm Pedestal leremy@49thStarSurveying.com MATE SCHEDULED 1 [ TIME INSPECTOR SUBDIVISION GIRDW€ OD ORIGINAL TOWNSITE BLKILTITRACT BLK 2 LT 26 tNDIC T R—ORTI i AIR ji f S K F 5 t SIZE MAIN, TYPE MAIN- DEPT AT MAIN: s � �` AT PROP LINE CONNECT LOCATION:c � a� i � E3(u MENTS 5. INSPECTED BY.&. DATE: ct, DATE SCHEDULED f I TIME INSPECTOR SUBDIVISION GIRD1 OOD ORIGINAL TOWNSITE Ll BLKJLTfTRACT BLK 2 LT 26 �1 DI" N RT z t � t $ SIZE MAIN.- � �» TYPE MAIN. DEPT AT IN: « ,. AT PROP. LINE: Zo 'c"U tc" CONNECT LOCATION: � �ffi � & x COMMENTS PL-y_ " INSPECTED Y-, DATE. �,