HomeMy WebLinkAboutMICA'S MEADOW LT 1Mica's Meadow
Lot 1
#075-091-19
., `.
o'd 3..s ..1 4Sv
January 10, 1986
TO: Permit Applicant
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY k\:OWLES.
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Subject: Permit # 850668 2
USS #304p -Lot 69
rAiod
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
»^ 1A=.." F-
,DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825.L STREET, ANCHORAGE, AK 99501
264-4720
lERMIT NO:
)ATE ISSUED:
�PpLICANT:
DDRESS:
�ONTACT PHONE:
850668
1O/10/85•
JONNIE LAZARUS
BOX 421 GIRDWOOD
GIRDWOOD, AK 99587
783~2242
^ u
�
SUBDIVISION: USGS SURVEY #30
SECTION: 10 TOWNSHIP: 10N'
27102 (SQ"FT. OR ACRES)
.EGAL DESCRIP:
.OT SIZE:
certify that:
•1` I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of• Alaska.
2" I will install the system in accordance with all MOA codes and regulations,
and in'compliance with the design criteria of this permit. •
3. I wi1] adhere. to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
DATE: \i�/��|\��\ �/ `
LOT: 69 '
RANGE: 2E
BLOCK: NA
3IGNED
•
J��NIE~.AZA
;PP LICANT: J���IF�.AZARLS
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:SSUED B"
DATE:
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MUNICIPALITY OF ANCHORAGE SEWER 85 03148
NIERE g
CONNECT PERMIT
T
,tv ANG
WATER &WASTEWATER UTILITY
3000 ARCTIC BOULEVARD
PHONE 7.8S.,554O
DATE OF APPLICATION ./'= Jr/ z�,'
SCHEDULED COMPLETION DATE/ /2'
SINGLE FAMILY
❑ MULTI -DWELLING
No. APTS
D COMMERCIAL
O INDUSTRIAL
LOT/TRACT / BLOCK
SUBDIVISION /ii,iz i) 1- /.//7
TAX CODE ( ,- i RID / ': DRAWING No.
PHONE
MAIL ADDRESS
CONTRACTOR: r
(License & Bond required)
ON PROPERTY ONLY
. ❑ MAIN TAP—TO PROPERTY LINE ONLY
(MOA or State ROW Permit Required)
O MAIN TAP & ON PROPERTY CONNECT
(MOA or State ROW Permit Required)
ASSESSMENTS
❑ Paid previously
❑ Main extension agreement
❑ Subdivision agreement
❑ Extended connect agreement
❑ Pending—AMOUNTS
CONNECTION SIZE r ` CHARGE$
INSPECTION FEE $ f/'•
PERMIT FEE $ _
REIMBURSIBLE
NUMBER DEPOSITS
TOTAL $
REMARKS: -.
/ %'' f r ' .. /2/ A/) / 4 i -f/ -"
yl, d ..
PERMIT ISSUED BY:
CA -PAID C3 CASH
GqCK#/- l7
INSPECTED BY:
PERMITTEE (Please Print) \, d ;I r / 74 , AL(12 PHONE l -' r
MAIL ADDRESS � /'. ''fir.. /� /-
7
.I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE
-'.TO COMPLY WITH THEM.
PERMITTEE SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JO
8o-021 (10/84) CUSTOMER
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 075-091-
1. GENERAL INFORMATION
Expiration Date:
Complete legal description MICA'S MEADOW S/D; LOT 1
Location (site address) 162 MICA'S MEADOW, GIRDWOOD, AK, 99587
Current Property owner(s) WILLIAM & JONNIE LAZARUS Day phone 783-2263
Mailing address P.O. BOX 421, GIRDWOOD, AK, 99587
Real Estate Agent SAM DANIEL W/ GLACIER CITY REALTY Day phone 227-4626
2. TYPE OF DWELLING:
▪ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 1
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well • Individual On-site
Individual Water Storage ❑ Individual Holding tank
Community Class Well n Community On-site
Public Water System ❑ Public Sewer
•
Received by: /
COSA to be released to the engineer. unless otherwise requested by the engineer.
Date:
COSA Fee $ Lilo —
Date of Payment b5113
Receipt Number 067611 N
COSA #
05C %%12-I�
Waiver Fee $
Date of Payment
Receipt Number
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. t 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. Phone337-6179
Address
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LfD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSO Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered of the time of the fest, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
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
results do not guarantee future performance of the system, nor do they guarantee that
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
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for ( bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Date b l Zie h.?
40
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ess.•
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5 d
fr e,
\��O000006`t11(i((flitff,
20" OFANn�ff4
ON-SITE
WATER AND
WASTEWATER
:id 4— PROGRAM ,
?IA
Arr
-.Oh j"�I)SI G`,
By:
l
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Original Certificate Date: iii ' A ! g
The Municipality o/Ane6ef ge 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
Septic System Advisory
Well Flow Advisory
(Rev. 11/05)
(z.
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: MICA'S MEADOW S/D; LOT 1 Parcel ID: 075-091-0 / 9
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 5/22/1986 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 55 ft. Cased to 55 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 5/22/1986 6/10/2013
Static water level 30 ft 33 ft.
Well production 8 g p.m. 5.55+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate NO mg./L. Collected by: GEG, Ltd.
Arsenic:D8•LI ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date installed
Tank size gal. Number of Compartments _ Cleanouts (Y/N)
Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water alarm
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2or ft2/bdr System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorptio . ea ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor. '.n field before test in. Water added _gal. New depth _in.
Elapsed T -: _ min. Final fluid depth in. Absorption rate >= g.p.d.
y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
Date of sample: 6/10/2013
PUBLIC SEWER
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at . wa er alarm level at
in
Cycles tested Meets alarm & 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
75'+
Public sewer main
Sewer /septic service line 25'+
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout 100'+
Holding tank
N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIE • . 1 LOT TO:
Property line B • oundation Water main
Water service lin Surface water Driveway, parking/vehicle storage
in drain Wells on adjacent lots
F. COMMENTS
PUBLIC SEWER
G. ENGINEER'S CERTIFICATION
I certify that f 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.
Engineer's Printed Name JEFFREY A. GARNESS
Date bl2Y/t3
(Rev. 11/05)
Well pwiier
•.- :. nignway
(So7) 349-tics5 G u
ANCHORAGE, ALASKA 28511.
DRILLING. LOG
Lay lirt1A D ill /PG : Jur/ ce kick_ /14,-.
;SDS VD3
Use of Wall . Dci s tic
Location (address of; Township, Range, Section, if known; or distance main .road.
USGS Survey L 69, Mica's. Meadow L1
Size of casi'g.__.61 _.:Depth of iioi- eet Cased to S5 _._feet
Static water level 3 l_ ft,
Screen ( ); Perforated h
Describe screen or pertxtt
Well pumping teat at_e._.g
of drawdown from static
rface.. Finish of well (check one) open end ( ) ;
(minute
rcr Ltours with__— _ft.
Date of completiot.i
Depth in feet from
ground surface
C TO. 2
2 _To 6
B
to 16
-1dTo..52
.2 TO 55
TO
TO
TQ __
TO
TO
— TO
_
WELL LOG
rmations penetrated, s
terial, color and hardness
• 11.WWA Certifitid Con.tronter
Certificate No's. ,sla err tetS
i —STATE
PROPOSED MIFFED FLOOR
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LJABIIJTY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT 91JRAEY
I❑ FOUNDATION AS -BUILT
FINAL STRUCTURE AS -BUILT
I--!
IJ PLOT PLAN ... AS -BUILT ...
0 AS -BUILT ... NO CORNERS
SURVEY TWE
o DRAINAGE SET REBAR
SYMBOLS
LOTIRESURVEY ... TCPOORAPXY
—1
SET ' 1 RECIRPRCAIN)N AS -BUILT ... NO CORNETS SET
C""'-"" 1 ASPHALT
0 FOUND REBAR {)--e—e-{)--e—e-__OA .. :. { CONCRETE
FENCE [2r4-
WOOD
00 A ASSUMED ELEV.
FENCE L/.!')/1 WOOD DECK
X X X METAL
PLOT PLANS & LOT SURVEYS
NOTE:
,
GROUND AND VISIBLE WILL BE
SIDEWALKS, DRIVEWAYS,
LOCATION, ONLY. SNOW
FROM BEING SEEN AND LOCATED.
UNLESS OTHERWISE NOTED.
IT I5 THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ONLY THOSE IMPROVEMENTS ABOVE
SHOWN, FENCES, WELLS, SEPTIC CLEANOUTS,
ETC., ARE SHOWN IN THEIR APPROXIMATE
MAY PREVENT SOME IMPROVEMENTS
ALL DISTANCES ARE RECORD
SURVEY CERTIFICATION
••+,�`i«',,
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' �Ili�
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
PLOT PLAN
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Fg1NDARON AS -BUILT
s) •
•• •••� ,� ••0
Scale: 1
1"= 50
Rec. Lot S.F.
Rec. Plot Fite No.
h 4patert E a Aea.&I<moray
Mn. mamba m Ii -8,11
fanafle. m ua 101 ma act
am• me nw ac
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" L ROBERT Fgt OHNS, Jr.- - j
••9.'°•" 4121-s
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Surveyed: 4115(13
Drawn by RE J
Chocked by
awl
1
Dote Drawn:
4/15/13
Grid:
8E4913_
W,O.
13-121/11-215
00
aro cwwee.aw memwnml.
FINAL STRUCTURE AS-8UILT
Legal Description:
1
MICA'S MEADOW
1,, sawn c +chis. Jr.. hardy
certify that
way of the
a IM
nam Naim
"a
w.. p.'na.f o. -a,.1
.baton m mw a1 ma Ind
twm. me Manna -Nan m
.amaB:k:m'°°" mw`"
SGS
SGS Rcf.#
Client Name
Project Name/#
Client Sample ID
Matrix
PWSID
1132270001
Gayness Engineering Group, Ltd
Mica's Meadow Lot 1
Mica's Meadow Lot 1
Drinking Water
0
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
06/21/2013 15:42
06/10/2013 10:55
06/10/2013 11:58
Stephen C. Ede
Sample Remarks:
Parameter
Results
LOQ
Units Method
Allowable Prep
Container ID Limits Date
Analysis
Date Init
Metals by ICP/MS
Arsenic
Waters Department
28.0
Total NitrateMitrite-N ND
Microbiology Laboratory
E. Coli
Total Coliform
Negative
Negative
* 5.00 ug/L EP200.8 C (<10) 06/17/13 06/20/13 ACF
0.100 mg/L SM21 4500NO3-F B (<10) 06/13/13 AYC
1 100mL SM21 9223B A 06/10/13 SDP
100mL SM2I 9223B A 06/10/13 SDP
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 131276
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
1 of Mica's Meadow Subdivision. This inspection revealed an arsenic
concentration of 28 micrograms per liter (ug/L) for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On -Site Water and Wastewater Program
website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.