HomeMy WebLinkAboutUS SURVEY 3044 LT 41A1U55 3044
Lot 41 A-1
#075-061-99
M-fJ'DRILLING, INC.
TEL No.9073453287 Dec. 3,90 10:08 P.01
M -W DRILLING, Inc.
P.O. Box 10-378 • 10300 Old Seward Highway
(907)369.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Job # 83-107
Well Owner Ralph Ror 10 Use of Wen Dtt•ang'Jc
Location (address of: Township, Range, Section, if known; or distance main road
Lot O14 U S 5orvoy 3044 rird..,ond
Size of casing-_b—._Depth of Hole 61' feet Cased to_. 60.6' feet
Static water level z0' ft faima&3 (below) land surface. Finish of well (check one) open end ( x );
Screen ( ); Perforated ( ).
Describe screen or perforation NIA
Well pumping test at 20 gallons per fthouo) (minute) for
of drawdown from static level.
Date of completion December 21 , 1982
WELL LOG
1
hours with__} —ft
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO 2 Casing Stick-up
2 TO 4 Fill Gravel
4 TO 6 _Qxgflntc
6 ___TO.-_ 18 Gravel 6 Clay
_ 18 .TO 54 Silty Gravel
_TO r—
TO
TO
TO
TO
.TO
H2O Gravel
(Zed r
NWwY%1 ut, ..�f
req fh ,4 5.,, t'Cc(-..- 15
h11 R, Gi.9
1 -CUSTOMER,
M 'DRKONG; inc. 'tel
' P.O. Box 10-378"•103- O0Id. Seward Highway •
'(907)-349-85$5.:':. •
ANCHORAGE, ALASKA_ 99511
a\n°
Owner ttnlph ttnretn
Location (address of:Township, Range, Section, -if known; or distance main road
tot 41 A ny8 S"r"ey 101.4 Girdmood
Job 83=407,,
'Us'e-of Well napes* in'
Size of casing 6" t)epth of -Hole
Static water level 4oft - x
Screen ( ); Perforated ,(
Describe screen or perforatio
W"al -umpmg test•at=22—ga
of drawdown• from static
Date of completio December
meet: Cased to In 6r feet
1
low) -land surfaces, Finislr of well (check one) open end (
Depth in feet from
groundsurface ,
0
TO
TO
TO
18 TO
54 TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
WELL LOG
rmatiops penetrated, size of material, color and hardness
•
3 —CONTRACTOR
MUNICIPALITY OF ANCHORAGE
Department;') Health and EnvironmentaY )rotection
825 L Street, Anchorage, AK. _7)501
264-4720
# * * HANDWRITTEN PERMIT * * *
Permit # q;,j ()CA
Applicant: 6 67c
WELL ANDAR-Oft—S-I-T.; PERMIT
Mailing Address:
Location: Phone Number:
[S Mot\ LLQ/ 0'F - Pr (DO 5.c., 41)
9955)7
Box 3(7 grrP :VD
Legal Description: L L / -4•09 ti e 5 30(( -Ci Lot Size:
Type of Soil Absorption System Is:
Trench:
e
t'epsge—Bed
Maximum Number Number of Bedrooms: c53 Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:'
DEPTH LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* # * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet',
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 u 2 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
thence is remodeled to include more that 3 bedrooms.
Signed:
Applicant
SWP/024(1/81) 0j6.0.:
Issued by.
Date:
02 V
do 2.--
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 075-061.n *It
Expiration Date: 9 - _30 / S •
1. GENERAL INFORMATION
Complete legal description USS 3044; LOT 41 A-1
Location (site address) 171 CROW CREEK ROAD *GIRDWOOD, AK
Current Properly owner(s) KEVIN MYERS
Mailing address
Real Estate Agent
Day phone NIA
171 CROW CREEK ROAD *GIRDWOOD, AK
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
Day phone -
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well M Individual
Individual Water Storage 0 Holding Tank
Community Class Well ❑ Community
Public Water System 0 Public Sewer
WaiverNariance request for WELL HEAD TO SEWER SERVICE LINE
Distance:20 FEET
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date: / 7iq / I S
COSA Fee $ 5260 -
Date of Payment tp 0.4115
Receipt Number 87512 70
COSA# 85C(5/3Glo
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
f2115A
Wail (5
(15V/ 5! d7 -O
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 Gayness Engineering Group, Ltd. (GEG)
Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259
Engineer's Printed Name Jefirey A. Garness
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 systems 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 on 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. The content of this report is for the sole benefit of the
person/party who retained GEG. Reliance upon the information provided in this report by any other
person or party, including but not limited to subsequent property purchasers, is not authorized. In
short, GEG disavows any legal duty to anyone other than the person/party who paid for this report.
6. DSD SIGNATURE
[/System #1 Approved for bedrooms
System #2 Approved for b
Disapproved
Conditional approval for
Phone (907) 337-6179
Date b/44/!s"
ON-SITE m�
WATER AND
o WASTEWATER oz
bedrooms PROGRAM
i�O,,00,,�� O,`�
bedrooms, with the following stipulato�4,9;N �SER�}G�l��,,
By: /it1 Original Certificate Date:
Th anic iality 5f Att horage 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12 loc
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: USS 3044; LOT 41 A-1 Parcel ID: 075-061-n X19
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# .N/A Well Log (Y/N) YES
Date completed 12/21/82 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 61 ftCased to 60.6 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 12/21/82 6/12/15
Static water level 40 ft. 41.7 ft,
Well production 20 g.p.m. 7.40 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mi. Nitrate nt(7i img /L. Collected by: GEG Ltd.
Arsenic: ug./L. Date of sample: 6/12/15
B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (YIN) _ High water alarm
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2or ft2/bd System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption - -a ft2 Monitoring tube_ Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in abso r • field before test in. Water added _gal New depth in
Elapsed T min. Final fluid depth _ in. Absorption rate >= g.p.d.
rejuvenatipn 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 or level = High water alarm level at in
Datu Cycles tested Meets alarm & drcuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
N/A
N/A
75'+
On adjacent lots
100'+
On adjacent lots 1001+
Public sewer manhole/cleanout 100'+
Sewer /septic service line *10' Holding tank
75'+
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 FIELD • •T TO:
Property. line Buil. • , • ndation Water main
Water service line Surface water Driveway, parldng/vehide storage
Cu
n Wells on adjacent lots
F. COMMENTS
*SEE ATTACHED WAIVER REQUEST. SEPARATION DISTANCE BETWEEN WATER AND SEWER SERVICE
LINES ARE UNKNOWN *WWu tong irarpgrb re P2oCke 13S ¢ loyev��� GQa`
Fat- £ER..rrc5 UWE.
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field Inspections and
review of Municipal rocoris that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date %lZg//r
(Rev. 11/05)
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http:llwww.muni.orglOnsite
Development Services Division
OnSlte Water and Wastewater Program
oenr S
No e
n
Q f.
U
epa� rrinent
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV151070 COSA#: OSC151306 Permit#:
PID#:075-061-99
Legal Description: USS 3044, Lot 41 A-1
Engineer: Garness-Engineering Group
Applicant: Kevin Myers
Your request for a waiver of the required 25 feet horizontal separation from the
sewer service line to the private well has been approved. The approved separation distance is
10.0 feet.
This waiver approval -applies to the existing sewer service line only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver:
Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
Adjacent properties are not affectedby this waiver.
Waiver is Granted: X * Waiver is not Granted:
* The waiver is only valid, in effect and in force if the well water auaii t stays below 5 ma(L Nitrate.
Date: , 6 do
Approved by:
ame of Reviewer
■L■.■■.■ •■.■......■f■.■■....■■.■■■■■■■.I
GARNESS ENGINEERING GROUP, Ltd
June 24, 2015
CIVIL& ENVIRONMENTAL ENGINEERS, e
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Waiver Request from Well to Sewer Service Line on USS 3044; Lot 41 A-1
To whom it may concern:
The existing 3 bedroom house and 1 bedroom ADU is served by a private well and public sewer. The
well is located within 25 feet of the sewer service line serving the house and ADU. The measured
distance between the well head and the foundation cleanout serving the ADU is 22 feet and what
appears to be the closest assumed distance between the well and sewer service line serving the house
is 13 feet. We are requesting your department issue a waiver of 10 feet for these encroachments.
Justifications for this waiver are as follows;
• The encroachment has existed for approximately 23 years.
• Per recent water sample results it appears that aquifer has not been adversely impacted.
We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems.
If you have any que ions, please contact us at 337-6179. Thank you for your assistance.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
TR—A
42A
UTILITY EASEMENT
FOLLOWS FOOTPRINT
OF GARAGE
40
�4�•OFaq pre
W 491H lY U
:Kenneth L. Dreyer.
LS -8202
X44)ayesamno.t'oab"�
=
ppp0000s
do
\\A
ORDERED ev,
KE'/1 N MEYER2
EXCLUSION NONE& ft Is the owners' responsibility to determine
the exstent of my comments, oen4 Or restrictions
wtYch M
do n appear an e dedeubdiM&on plat NOIE:
Under no c wmatoncee should any data hereon be used for
constrvotlon or for wtabllablg property Mw.
LantaCill
LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS AS—BUILT OF: LEGAL OESdiW1WN;
440 WEST BENSON BLD. # 03
ANCHORAGE. ALASKA 99503 (907) 562-5291
'dCBN ComEB NWBtR: scslG
SURVEY CERTFoCATON: LANIECH has conducted a
physical sunny of This property as sham on 1b&
droning and thol The improvements e{Wcted There-
on ere the property /nee and no encroach-
ments edet other then noted.
95S20ASB
MAR 28, 1996
40'
(fax) 561-6626
rMSF M�M�am
DMD. I t
O0 Matt
4814
sosNApo
271\9
LEGEND: SET END
SATS Vi/CAPS a/V M 0
aro' ALMCN. Ip1WKNT
HUB & TAOCai
FENCE-. —x— x —
OIQnNNe-
8000 DECKS
COMM-
ASPHALT- ISIENIMIE
MAWS-
SEPlIC
N6 ElE-
A9 1ALT-
MAWS-
Sf111C STNICVifs'
ISMER 'MU --
LOT 41 A1,
U.S. SURVEY NO. 3044
ACCORDING TO PLAT 95-124
Parcel I D #
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
7- 06/ - 79,
HAA #
/ gc0s
1. GENERAL INFORMATION (Must be completed prior to submittal) ENV!RL,NMENTAL SERVICES DIVISION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 41A; U S S #3044
Location (address or directions)
(b) Property owner
DEC 3 1990
RECEIVED
.The. & SheManhuba Telephone : (home) 783-2815 Business
Mailing Address P.O.Box 686 G.Lndwood, Ataafza 99587
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent VISTA REAL ESTATE ATTN• Judy watch
Address 3000 C S.th.ae$ Anehonaga, Atahfza 99503
Telephone 783-2010
(e) Mail the HAA to the following address: (or check here 1 xif hold for pick up.)
List contact person and day phone number below:
e F gNG':NEERING
17034 Eagie River Loop Road No. 204
^zi!e River, :%lasica 99577
2. TYPE OF RESIDENCE
Single -Family CPx
Number of bedrooms
3
3. WATER SUPPLY
Individual Well.R3; Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 0 Public L1K Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88)
Page 1 of 2
5. 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 this inspection.
Name of Firm
Address
Date
17034 River Loop r.oaCi 1'•;p. 204
Telephone
g7'-2-9.7 9
6. DHHS APPROVAL
Approved for 3 bedrooms by
Approved pt-`- Disapproved
Date /2/00
Conditional
Terms of Conditional Approval
CAUTION!
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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.
72-025 (Rev. 7/88) Back
Page 2 of 2
C ID
J%P,\5
pc
'GAS
ie
S��$� cy/ f, <e
A. WELL tb47+0t
Well Classification .-)! n)4 k1- o4M) I� If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Li Date Completed /2 -2-/ -02
Total Depth_g_1Cased to (0O L ' Depth of Grouting
Static Water Level I/ 3 Pump Set At V K
Casing Height Above Ground / 2 /t -t- Sanitary Seal on Casing (Y/N) 9
Depression Around Wellhead (Y/N) /J
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description.
Z44i„A•"� 03 S.
.6o4 Lf
Yield 8. IP
(iN2/- o)
Electrical Wiring in Conduit (Y/N) 11
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot k3/49 ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots / 00 4
r 111
To Nearest Public Sewer Line 7 S % To Nearest Public Sewer Cleanout/Manhole / 00 �f
To Nearest Sewer Service Line on Lot 2 ' '-/
Water Sample Collected by 5 4 S rid ;MCC isI /05 ; Date / / - 2 /� q o
Water Sample Test Results ' - • P £ArtairuA 4 N J I}
`S
Comments
B. SEPTIC/HOLDING TANK D • TA
Date Installed Siz- No of Compartments
Standpipes (Y/N) Ai -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) j( ► Date Last Pumped
Pumping/Maintenance Contact on Fte (Y/N ; for
Holding Tank High -Water Alarm (Yll/N) Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDI •. TANK:
To Water -Supply Well To =uilding Foundation
To Property Line To Di 'osal Field
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments 4c.�bI(t✓ Sai.ueo'
72-026 (Rev. 7/88) Front
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorp '.n Strata Type of System Design
Date Installed Length of Field
Width of Field Depth of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION E
To Water -Supply Well
To Building Foundation
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
D:
To Property Line
To Existing or Abandoned System on
Lot • On Adjoin i . Lots
To Water Main/Service Line To Cu
ack (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments tk) \ tc- ,Set.AJ of
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at I "Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect 9.Q he date of this
inspection. €i ' ;t
Signed
5 & :i LN(yliTE tttNG
Company 17n2/1 i agie River Loop Road No. 9o4
Date
Eagle River, Alaska 99577
MOA No.
CG Qv -c0 3
Receipt No. .4-ll.v
via+
Date of Payment 0-3 - 70
Amount $
72-026 (Rev. 7/88) Beck
Receipt No
a A.:Aoki
No. 14.57..}5
Waiver Fee• $
Date of Payment
Page 2 of 2