HomeMy WebLinkAboutUS SURVEY 3044 LT 41BUS Survey
3044
Lot 41B
#075-061-80
LOCATION OF WELL
(Please, complete e ther lo, Ib or lc.)
')WATER. WELL RECORD
STATE OF ALASKA
DEI?ARTMENT OE. NATURALRESOURES,
Division of Geological a Geophysical Surveys
Drilling Permit No.
A.D. L. No. ,..,
Toll Borough
Anch
Subdivision
Lot
41B.
Bieck Ib.
USS 15OiJaf-or_of—
1/4gtre.
Section No.
Township N❑
s
Range El
w❑
.Meridian
El DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address and Areo of Wait Location
3. OWNER OF WELL: -- - - "
Mr. Dave Siefert
Address: `Box 116". -
GirdW Odf Ak 99587
2. WELL LOG - -
Feet Below
Surface
4. WEl45DEPTI MP
(final) 5. DATE OF COLETION�b0
`J 1111
Material Type
Top
Bottom
- _ Clay - ..
0
5 -
6, ❑Coble tool - a'Rotary'❑Driver: . Dug
Clay and gravel
5
38
0Aug9r ❑ Jetted ❑Bored " ❑other'::
Gravel. silt. water -
38
48
7; USE: [�omestiq Rabllc Supply, �.❑ In Juetry_
- - -
-9,!4!)'11,-°,,l':;,..
❑ Irrigation a ❑ Recharge `❑ Commerical
0 Test Well ❑ Other: '
8 CASING: • Threaded -
j'. Welded '
- - -- - -
hd
atom. 6 In. to '-.45 'ft. Depth‘'' Weight l7 " lbs. ft.
-
-
diem. Into ft. Depth S, ft. •:-
„,,
`.' 9 FINISH OF WELL.
Type: - Dlameter['-
Slot Mesh Slut: Length:
- -
-
Set between - ft. -and ft..
- - -
Backfilling Gravel pack
.
,`
10. STATIC WATER LEVEL
❑ Above
.
Below Ianq
or
Equipment
surface
.
used:
I1. PUMPING LEVEL. below land surface and YIELD.
.
-. ...- ._ ..
-..-.
.. ..
ft. _. ofterr . hrs.—pumping '' 9.p.m
.-.
,_. ft after hrs, pumping`__ g.p.m... ...
-'-- - -'-'
-
12. GROUTING Well Grouted: Yes '❑No
-
Material' ❑ Neat Cement ❑ Other:
--- - "'
-
13. PUMP: (if available) HP 1/3 '---''"'�'-'
Length of Drop Pipe 21 ft. capacity 5,
_gd,...
- -
- - -
®) ubm. ❑ Jet ❑ Contrition! . - ❑ Other
_ ..
- 14. REMARKS:..._
Production of 5 GPM
16. WATER WELL CONTRACTOR'S CERTIFICATION:
- -
_
--❑ F ❑ C
15. Water Temperature
_a
This well was drilled under my jurisdiction andthis report is true to the best of my knowledge and belief;
Magnudon Drilling AA 5385 ' ''
Registered Business Name Contract License Number -
Address: P.O. :ox 770504 Eagle River, Ak. 99577
Signed:
/ . �L_ - Sept. 16, .1985.
• �� e t _ f Data:
Authorized- Representaliv.
Form 02-WWR (11/81) Copy Distribution: WHITE- Stale DGGS, PINK -Driller, CANARY' Customer - - -
NUN A C I F,c11_ I "°-e i � f= 1=B N a_ =1--1 2 F_ BR C3 EE
DEPARTMENT 0 HEALTH AND ENVIRONMENTAL f JTECTION
825 /L.' STREET. ANCHORAGE: AK. 99501
264-472A
4" EE LA` F=" E= F IA 1 t
PERMIT NO. 1,265
APPLICANT DAVID J SEIFERT
LOCATION
LEGAL L418 USS 3.044 GIRE:'NOOD
E:0< 116 GIRDWOOD 995E:7
LOT SIZE 999999 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS
±00 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 LOG_ ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETIONd.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F=" 1= _IIF. S= "= - C=a ®__ t^ 1 E= l= FS' - _c—D1'
I CERTIFY THAT
1: I AM FAMILIAR I.IITH THE F:EPUIF:EMENT'_ FOR ON—_ITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED:
APPLICANT DAVID J _EIFERT
ISSUED BY H7-10
0
DATE
-2z.--t3
V4. 0
ret 19 I 0 I F•aL L. 1 'T''r' 'JF nr-J+. H+J>GriC.;c
DEPARTMENT OF HEALTH AND ENYIRONMEN AIL PRO TEC TION
925 'L- STREET: ANCHORAGE: AK.. 99501
254-4120
id airt_ FEF:P1 I T
PERM j T N0. ( 830265 )
APPI ICANT--0AM d- -ttERT— - 80h lib i.3INVAUQO55.37 re3-2411W
LIJLATION
LEGAL L416 UJS5 3044 0[ROWO'}D
ZE 939999 9I'JRRE FEE
INIMUM 015 TRICE BETWEEN A WEL.I_ HND ANY ON-5ITE _SEWAGE DISPO'St3L SYS TEN L.
1c10 1'£€ r I OR A PR I','RTE 1.1&L OR 150 TO X00 FEET FROM H PUL IC WELL DEPEND INCt
UPON THE TYPE OFF PUBLIC WELL,
MZNENUM IS TAME FROM R PRIVRTE WELL TO B PRIVHTE SEWER LINE [ S 25 FEET AND
to- `-A Ci3HMUN [ TY SEEDIER L INE 15 75 FEET.
£JELL L ;3S ARC REQIJ[REO ANO 1 E RE TURNED TO THE DEPARTMENT WITHIN 30 DAYS
31,e' THE WELL COMPLETION,
7TFIER REQUIREtJENTS MAY APPLY, SPEC IFICATIONS AND CON'S TRIJCT ION DIf'3RAPtS ARE
AVAILRRLE TO INSURE PROPER MSTALLAT[e1N-
eE r M I T E. -Xi I F?E`5S G.0:t 1iSCR i J+
Pr' THAT
4 PPM IL EAR 14 (TH THE REQUIREMENTS FOR ON-SITE SEWERS t1NG WELLS tis SE T
TH OY THE 1.11JP! IC I PAL [ TY OF ANCHORAGE
I 14 ILL Lt STALL rH£ SYS TEM EN .+:5 DH";.E WITH THE CODES.
HPPLICANT DAVID J 'SE LFERT
RTE---��L_r
V
January 31, 1984
David J. Seifert
Box 116
Girdwood, Alaska 99587
._SK
Subject: Lot 41-8, USS 3044, Girdwood
Approval for the individual sewer and water facilities cannot
be :_;ranted until the following items have been completed:
A welllog submitted to this office for our files and
review.
° The top of the well casing should be sealed so that it is
water tight.
° The well on your property is located too close to the com-
munity sewer. You are in violation of 15.55.030.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If .there are any
further questions, please call this office at 264-4720,
JR2.5/ej/E1
Attachment 15.55
cc:
Jack Vandenberg
Jack white Realty
"C" Street
Anchorage, AK 995
Sincerely,
Jim ' obert s
Associate Lh4ironmental Specialist
e,
MunicipaUty of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 075-061-80
1. GENERAL INFORMATION:
Complete legal description US SURVEY 3044; LOT 41B
Location (site address) 183 Crow Creek Road *Girdwood
Expiration Date: 11' a q _ 2-C)
Current Property owner(s) Eric Schnider Day phone 598-3742
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or. Duplex)
Day phone
3. NUMBER OF BEDROOMS:
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:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 33 (-,0 U f P Waiver Fee $
Date of Payment
Receipt Number
COSA# Q5C2.0152_L(
Date of Payment
Receipt Number
Waiver #
Ni
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: Gamess 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: , ci02 L2,0
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 datels 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.
6. DSD,,S(GNATURE
System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
Pa --o
bed norns(f
#AECC884
�� N° -q
�.sc: mak. F L -ow
r
cC'
_
OleRnW, With thefiollowing stipulations:
\n�eST� �'11'`TER
0—
tAl(� Original Certificate Date:
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 engineers work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other
' A &5 Sv(Lvv& 7 3 f) 4L `41IR
COSA Checklist
Legal Description: DS SURVEY 3044; LOT 41B Parcel ID: 075-061-80
If more than 9 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
N 11M Well log is filed with Onsite (or attached) Well production at time of test- *6.0 gpm
NDate drilled 9"'/83 Water storage tank volume NIA gallons
Total depth 48 ft Well disinfected for coliform test? ❑ Yes ON No
CS'
Cased to 45 ft X Coliform bacteria is Negative
Q� nitary seal is functioning correctly Nitrate O•hOng/L ❑ Nitrate less than MRL (ND)
[Rires are properly protected Arsenic 17 -IL ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 12+ in. Collected by HEFTY DRILLING INC.
Date of flow test for COSA 8/94120 Date of Sample 8/14/20
Static water level at beginning of test *40 ft
Comments *WELL TEST PERFORMED BY HEFTY DRILLING
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 (m
Measured depth to pipe invert from grade
❑ N/A — pressurized field
(min)
❑ Monitor tubes go to bottom o ective. If not, state
depth into effective
❑ Code -required soil er over field
❑ System preso ed
(Required if v ant for greater than 30 days prior to
date of to
introduced gallons
COSA Checklist yellow sheet
C.. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
11,
:44
s
Adequacy 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'
N/A
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100'
❑✓ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No *13 ft
Absorption Field on Lot > 100'
❑ Yes
if No N/A ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields
> 100'
Animal Containment> 50' Q Yes
if No ft
✓❑ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
M Yes
if No
ft
F/1 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' ❑ Yes
if 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
Commun' ells > 200' ❑ Yes
if No ft
Water Service Line > 10'
❑ Yes
if No
ft
'44 If is tank is under driveway comment below
From Absorption Field on Lot to: (Please enter dist
s if less than required)
Building Foundation > 10'
Yes
ft
If absorption field is under driveway comment below
Property Line > 10'
es
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
❑ Yes
if No
ft
Private Wells > 100' ❑ Yes
if No ft
Water Se ' ine > 10'
❑ Yes
if No
ft
Community Wells > 200' ❑ Yes
if No ft
ace Water > 100'
,
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
*PER S&S ENGINEERING HAA DATED 3/30/00
G. ENGINEER'S CERTIFICATION
1 certify that J 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'/''
U v SSP �
#AECC884
0
Lot 41A --_ • S�O5�Z1�"
Garden Q&
Beds
"I
Lot 41 C
i%
-..Wood
.'Shed
C6
"IT Lot
C
49th' N Star
Surveying
\z
0
30
GravelO
0
V
US SURVEY
FEET
NOTES Asphalt
All dimensions shown are grid bearings and ground distances, record boundaries per Plat No 82-447.
-49th Star has conducted a physical survey of
distan ari are
f the Property and all details shown on this Asbuilt
Survey are correct. Under no
circumstances should any data hereon be used for construction or the establishment of property lines.
-It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed.
Lot 41B,
US Survey No. 3044,
Girdwood., Alaska
LEGEND
@ Well
0 Tele -comm. Pedestal
(E) Electric Pedestal
49th Star Surveying LLC
321 Fireoved Drive
Anchorage, AK 99508
(907)891-611:1
leremy@49thStarsurveying.com
10� Utility Pole I W -0200-F SCALE: r=3O
Fire
o Pit
;_3 1ptJ
-z-
-77 ca
CV
Q 2 -Story
House
5'0
V1.
CO
"I
Lot 41 C
i%
-..Wood
.'Shed
C6
"IT Lot
C
49th' N Star
Surveying
\z
0
30
GravelO
0
V
US SURVEY
FEET
NOTES Asphalt
All dimensions shown are grid bearings and ground distances, record boundaries per Plat No 82-447.
-49th Star has conducted a physical survey of
distan ari are
f the Property and all details shown on this Asbuilt
Survey are correct. Under no
circumstances should any data hereon be used for construction or the establishment of property lines.
-It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed.
Lot 41B,
US Survey No. 3044,
Girdwood., Alaska
LEGEND
@ Well
0 Tele -comm. Pedestal
(E) Electric Pedestal
49th Star Surveying LLC
321 Fireoved Drive
Anchorage, AK 99508
(907)891-611:1
leremy@49thStarsurveying.com
10� Utility Pole I W -0200-F SCALE: r=3O
N8Uj'v�C� ` ALt 7 V0 I PlkHCV�0Ri ,��E
DEVELOPMENT SERVICES DEPARTMENT ( �
1
On -Site Water and Wastewater Section
www.muni.org/onsite
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC201524
Subdivision: US Survey 3044, Lot: 416
907-343-7904
Fax: 343-7997
A water sample revealed an arsenic concentration of 17.2 micrograms per liter
(ug/Q. 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.
"e y Drilring C ,
, In
Hefty Drilling Ine.
3540 AMa Dr. Anchorage, AK 99516
830-9985
3454700 Fax
heftydrillingQ
,aol.coin E-mail
www.heftydri lling.com
test pumping & drawdown
Well Depth: z47 I-)"
Cased: L17"7 "
Well intake opening type: Dpe*`
Test pumped @:
Static water level: qO
Pumping level: Li
Drawdown: 5 1 to
Comments: lAft
N6�
Test completed by : .......................................
Date: Pj_ ILI_ ;0
Name: S (j �oc.,
Site: / T5 (,,r*w •
Q� S..Yte" 30qq
L,A- L11
RUSH!
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 075-061-80
1. GENERAL INFORMATION
Expiration Date: 1. - 2. 9- /tZ
Complete legal description USS 3044 LOT 41B u.S SLArve1
Location (site address) 183 CROW CREEK ROAD *GIRDWOOD, AK
Current Property owner(s) GREGG AND TERESA BENOLKIN Day phone C/0 AGENT
Mailing address PO BOX 376 *PALMER, AK 99645
Real Estate Agent JEFF GOYETTE W/ PEAK REALTY Day phone 232-3537
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well E Individual On-site ❑
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer 1.
Received by: Date'
COSA to be releasee to the engineer, unless otherwise requested by the engineer.
t�
COSA Fee $ —1�'1O — CAL', q_ Qt t50 Waiver Fee $
Date of Payment Gt I? I h ? Date of Payment
Receipt Number en—n 1 G 000 Receipt Number
Waiver #
COSA# YEC '(10 (
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 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.
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
system under the conditions encountered at the time of the test, 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
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
Date
'ea 912-
.,.
���r1ows�
410Wl2• oUOFAN et
ON-SITE ) r
WATER AND
- WASTEWATER g^
PROGRAM,•
SEW w‘tv
llfl))))1ltli,
bedrooms, with the following stipulations: pili
The Municipality 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
Septic System Advisory
Well Flow Advisory
By:
Nitrate Advisory
Arsenic Advisory
Other
(Rev. 11/05)
Original Certificate Date: 9 - 2 % - / 2_
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 416
Parcel ID: 075-061-80
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 9/11/83 Sanitary seal (YIN) YES Wires properly protected (YIN)
Total depth 48 ft. Cased to 45 ft. Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test 9/11/83 9/8/12
Static water level UNKNOWN ft, 40 ft,
Well production 5 g.p.m. 5.05 g p m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 511mgg./L. Collected by GEG. Ltd.
Arsenic: s• 5 ug./L. Date of sample: Ill fo/ 12
B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER
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. absorption - -a ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor. 6 field before test in. Water added gal. New depth _in.
Elapsed Ti.•-: _ min. Final fluid depth in. Absorption rate >= g.p.d.
ejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off' level
Datu Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
N/A
N/A
75'+
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line *13' TO FCO
Animal containment areas 50'+
Manhole/Access (Y/N
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
N/A
N/A
Public sewer manhole/cleanout 100'+
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main Water service line
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIEL
Property line
Property line
Water service line
Absorption field
Surface water
OT TO:
Buil • : • undation Water main
Surface water Driveway, parking/vehicle storage
C - rain Wells on adjacent lots
F. COMMENTS (('P
*PER S&S HM DATED 3/30/00. PER GEG INSEGIONS THE SEWER LINE ENTERS THE HOUSE IN
THE CRAWL SPACE, 25' FROM THE WELL.
G. ENGINEER'S CERTIFICATION
1 certify that I 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 Printe Nan)ee JEFFREY A. GARNESS
Date `N/r'-
(Rev. 11ros)
Lot 41A
Garbage
Rock
PLAT NOTE:
1. COMMON VEHICLE ACCESS FOR
LOTS 41A ANO 418 OFF CROW
CREEK HIGHWAY.
-rtrZ\N
`-', ----- -4
,r•S,..- - .?LZ
;Kt' --1-Qo
0
0
David M. Dreyer
I. LS -10392
°essionn'
Z1\ Cic
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT
PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH.
Legal Description:
AS -BUILT
Lot 412,
U.S. Survey #3044
&dwelt OR Jeff Gayettefreak Realty TLC
Legend
Seen Sto dpip
Water Well e
Fence—X—X—
MfrlitValt
LantaCill
LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS
440 West Benson Boulevard, Suite 200 Rhone: 562-5291
Anchorage, Alaska 99503 Fox: 561-6626
Plot 82-447
Grid: 4814
SURVEY CIETIIFICATON: LANIECH has conducted a physical survey of the
property of shown on this drawing and certifies that the improvements
situated thermn are within the property Mem and no WICroOdirnent rete
other than noted.
EXCLUSIONARY NOTE: It is the ownersresponsibility to determine the
existence of any easements, comments, restrictions er right—of—way
takings which do not appear an the recorded subdivision plot Under
no circumstances should any dot hereon be used for construction,
for establishing property tines, er fen Plot—Pion PutPuseah,,,
Datm August 29. 2012
Drawn 8s PL
Work Orden 2012—L-173
Ret 2000-L-110
Soaks 1"m30.
Checked Sy. DM
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Grid Number SE4814
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Parcel I.D.
«5
Municipality of Anchorage
Development Services Department:
Building Safety Division '
On -Site Water & Wastewater Program
4700 South Bragaw St..
P.O. Box 196650 Anchorage, AK 99519-6650
www. d.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH.AUTHORITY_ APPROVAL.
FOR A SINGLE FAMILY DWELLING
-
_ - PA 010319
075-061-80 HAA# 4+A698143-
1. GENERAL INFORMATION
Complete legal description U.S-SURVEY' 3044LOT '41B'
Location (site address or directions)
Current Property Owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
• Mailing address
Expiration Date: 9 '2'6 ^ 0
-CROW CREEK ROAD, GIRDWOOD,' ALASKA
RON WILLIAMS
C/O RE/MAX OF ALYESKA'
Day phone
Dayphone
DAVE BAUER.w/REMAX OF ALYESKA
Day phone 783-2010
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
•
3. TYPE OF. WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
• Individual On-site
❑ Individual Holding tank
❑ Community On-site
❑ Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or.Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the
professional engineer's work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $600.00 at, or prior
to closing for the engineering seMces provided.
4. 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 Health AuthorityApproval 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 supptyand/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 . AKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
consdenfous engineering analysis of the system m accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational fife 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 famllybeing served by the system.
These conditions am 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. AINWC, Inc. 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 parry Is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
I/ Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Date
642.10 I
WATER AND
bedrooms, with the fllowing stipulations:: ; WASTEWATER
PROGRAM •
�Jit •• ,ryf<••
J'lJl�o%))CFW
111
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
By:
(Rev.izm)
O
Manitenance Agreements
Supplemental Engineer's Recut
Other
Original Certificate Date* 6 " 2 6 - 0 /
Legal Description:
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 188850 Anchorage, AK 99519-6850
www.d.andarage.akus
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
U.S. SURVEY 3044 LOT 418
A. WELL DATA
weft typeSAT
Date completed 9/11/83
Total depth 48 ft.
Date of test
Static water level
Well production
If A, B. or C provide PWSID# N/A
Sanitary seal (WN) YES Wires properly protected (YIN) YES
Cased to 45 t
Parcel ID: 075-061-80
Well Log (Y/N) YES
FROM WELL LOG
9/11/83
UNKNOWN ft
5 ppm
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Date of sample* 6/18/01
Nitrate 0.5 mg./L.
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matertal
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) _.
Casing height (above ground)
AT INSPECTION
3/21/00
41 ft.
5.6 gpm
12"+ in
Other bacteria 0 colonies/100 mi.
AWWC, INC.
Date installed
/N)
over tank (Y/N) _ High water alarm (WN)
g Pumper
C. ABSORPTION FIELD DATA
Date installed Soli rating (g.p.dJft'or ft'/bdrm)_
Length
Total depth
Date of adequacy test
Fluid depth in abso
ft Width ft.
System type
Gravel pe
ft Eff. absorption area ft' Monit Depression over field
ft.
(Pass/Faft) For bedrooms
fore test in Water added _gal. New depth _in
_ min. Final fluid depth _ in Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type)
If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/
"Pump on level at in. "Pump ofl" n High water alarm level at in.
Datu Cycles tested Meets alar & drcuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/Iift station on lot N/A
Absorption field on lot
N/A
On adjacent lots
On adjacent Tots
N/A
N/A
Public sewer main 75'+ Public sewer manhole/deanout 100'+
Sewer /septic service line • 13' TO F.C.0 Holding tank
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption ti
Water main Water
We
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Surface water
Property line Building foundation Water main
Water service line Surface = - Driveway, parking/vehide storage
Wells on adjacent lots
F. COMMENTS
*PER S&S HAA GATE 3/30/00. PER OUR INSPECTIONS. THERE IS NO F.C.O Sc THE SEWER LINE
ENTERS THE HOUSE IN THE CRAWL SPACE. 25' FROM THE WELL.
G. ENGINEER'S CERTIFICATION
I codify that 1 have determined through held inspections and
review of Municipal records that the above systems are In
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Na e JEFFREY A. CARNESS
Date 6/Z
40
A. Gorness:•
—7953
W,s••........ ••'��Qo
HAA Fee $ 2,00•°
Date of Payment ti / pt
Receipt Number ttoJ apt
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
JUN -21-01 08:31 FR011-CTUE ENVIRONtENTAL SRV
GCC CT&E Environmental Services Inc.
.
Cf&E Rete
Client Name
Project Namern
Client Sample ID
Matt
Ordered By
PWSID
1013473001
AK Water & Wastewater Consultants Inc.
US Survey 3044 Lot 4I B
US Survey 3044 Lot 41B
Drinking Water
0
9075615301 7-072 P.02/03 F-948
Client POR
Printed Date/time 06/20/2001 18:28
Collected Date/time 06/18/2001 14:00
Received Date/time 06/18/2001 16:30
Technical Director Stephen C. Ede
Sample Remarks:
Released By'gia,y1.7
'�r�'�//�
Parameter
Results
PQL Units Method
AOowsbk Prep Analysis
linin Date Date Init
Waters Department
Nitate-N
Microbiology Laboratory
Total Coliform
0.5000
0
0.500 mg/L EPA 300.0
0 col/100mL 8M18922213
(<10)
06/18/01 SCL
(<1) 06/18/01 KAP
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On -Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343 -4744 --
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel '7"* -.;,0W k —ZJ0 HAA# nOgnIA5
` y ,. -,` �' - ,. Expiration Date:
1.,, GENERAL INFGFIMATION O
i i U. S. Lot 41B
Complete.le'gal,tlesc[iptionSurvey,
Location (site ddres or directcons) Crow Creek Road
Current Propertyawner(s) Albert Hicks Day phone 783-2605
M: 7fl:Pril ailingadddress PO Box 928, Girdwood, Ak 99587
Lending agency Day phone
Mailing address
Real Estate Agent Remax Alyeska/Judy Bauer Day phone 783-2010
Mailing Address PO Box 1029, Girdwood, AK 99587
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 2xj Individual On-site ❑
Individual Water Storage 0 Individual Holding Tank ❑
Community Class Well ❑ Community On-site 0
Public Water System
❑ Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 01/00)'
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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. 1 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm S & S ENGINEERING
17034 Eagle River Loop Road, No.204
Address
Phone c94 -z979
age v ,
Engineer's Printed Name Date
6.. DHHS SIGNATURE
I/ Approved for
Disapproved.
Conditional approval for
bedrooms.
-
r -4t ..f• 414 en,
f tI GINair
.`')\ •9
• * ,
I ��• �: W 0
I l : Collin K. Williams , .,. ;,
D+, flF CE.9S67 • ,•�y�r
•t
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Expiration Date:
75-025 (Rev. 01/00)'
R
(o- 3o-po
Original Certificate Date: 3 " 3 / -O 0
Reissue Date:
Municipality of Anchorage `/ frt&
DEPARTMENT OF HEALTH & HUMAN SERVICER
3n 2000
Environmental Services Division '" vc;'M
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)4( 'f4s7O4
.SFkVrcp h°1QE
L04
Health Authority Approval Checklist
��77
Legal Description:
% /6; 1.1 is' ;044 Parcel I.D.: i9-76 Oho 1
A. WELL DATA
Well type * ✓4 -
Log present (Y/N) OS
If A, B, or C, attach ADEC letter. ADEC water system number
Total depth
Sanitary sea
Date completed 9fr/e%3
44-- Casing height (above ground) 2
«65
Cased to
/� FROM WELL LOG
Date of test 9/��/e3
(.7N E_
Static water level
Well production S g.p.m. �� 6
WATER SAMPLE RESULTS: Q
Coliform Nitrate a8 Other bacteria
Wires properly protected/N)
AT INSPECTION
3/2(/av
4/
g.p.m.
Date of sample: 3 / Z/ / u
B. SEPTIC/HOLDING TANK DATA
Collected by:
Date installed Tank size Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N)
Date of Pumping, Pumper
C. ABSORPTION FIELD DATA
Date installed boil rat i • • (g.p.d./ft2 or ft2/bdrm) System type
Length Width Gravel thickness below pipe Total depth
Effective absorption. area 4•S' Monitoring Tube present (Y/N) Depression over field (Y/N)
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption '-Id before test (in.); Immediately after gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate g.p.d.
Peroxide treatment' past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
"Pump on" level at*
*Datum
Septic/holding tank on lot
Absorption field on lot
Public sewer main
AVA-
Sewer /r Fic service line /3 r `q
o
On adjacent lots
On adjacent lots It//A-
Public sewer manhole/cleanout
"Pump off" level at*
Af 7k
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Property line
Water main/service line Surface water/drainage
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field
ent lots
Property line Building foundation Wa er main/service line
Surface water Driveway, parking/vehicle storage area
Curtain drain Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal recorgeetiateAlio stems are
in conformance with MOA HAA guidelines in effect on this date. ........sari
Signature
Engineer's Name
all/k1 W,LL/ KmS
Date 3- 5'0-Oo
ot to:
#1*:491"
�.....
i' rJ
.....?
ra
d
Collin K Williams : w /
fJ'�!,, ' CE -9857 •�����\�
%%%% POLO- --
HAA Fee $ 9, 00 Waiver Fee $
Date of Payment 1 J CODate of Payment
Receipt Number ;(.0-I'6 L rl"1 , `l 3 Receipt Number
72-026 (Rev. 3/96)*
03-25-00 15:36 FROM -CTE ENVIRONMENTAL
£tL
CT&E ReL#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
CT&E Environmental Services Inc.
1001174002
S & S Engineering
N/A
L418;4SS 3044
Drinking Water
0
5615301 T-838 P.03/05 F-833
Client POn
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
03/24/2000 15:53
03/21/2000 18:30
03/22/2000 15:55
Stephen C. Ede
Sample Remarks:
Parameter
Results
POL
units Method
Allayable Prep Analysis
Limits Date Date Inst
WATERS DEPT
Nitrate -8
MICRO LAB
0.844
Total Coliform 0
0.500 mg/L EPA 300.0 (c10)
col/100a SM18 92228
03/22/00 SCL
03/21/00 KAP
APPLI+:NT FILLS
OUT UPPER HA' ' ONLY
1.4-2 0 D J Zip Code 115 �j 7
Phone 1�
(703----M-,
P:ipnrly Owner ``fly 1 b S �
Mailing Address 1 0")<- { t 1,, y.>
Buyer
Address 3 Zip Code
Lending Institution
Address - Zip Code
Phone
Realty Co. & Agent j t15C. r L,j A I -VC tra. ` A L'( o 3 ,4 G p l; A 6e P IS c it Cj—
Address 4 °ji - Zip Code
Phone
Legal Description bo r 4-1 - 3 lJ59 30t 4- %,,., zi)y„.) 00 5
Street Location ��Z_aJ C /LEEK_ GO vet 6t.�(c p� v 4 1 00 1 Is • --iv
r0✓1
tM A Ives %r9 14 ,(.0,0
Type of Residence
Single Family
❑ Multiple Family No of Bedrooms
)
❑ Other
Water Supply
l Individual
❑ Community
❑ Public Utility
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal
❑ Individual -% 0 !�
$ Public Utility / rZ / >7CL
0 Holding Tank 7
Year Individual Installed' `c 5
When Connected to Public Utility' 1 ! 5 3
2fi Qr>.o�
/H�J`
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Q 1-e
Time
Time
Time
Time
t
11
c� `=+- L L% uYk
Date
Date
Date
Date
/
CC
Inspector
Inspector
Inspector
Insp t r
Fiel//d Notes:
I7"�
72 .x rreec „a_ac p--c_r204
ex,9'Sl-e--- . per fr
2fi Qr>.o�
/H�J`
1'rL/
/2 tP , . .
Ce
ONDITIONS OF APPROVAL
- -
r>7.� W
`j�`
APPROVED BEDROOMS c
x) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE 5 /- r
/-i4
BY. i"^ "..--(0.
Sons Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
72023131821
rt-•
'rte .,�
`s- '