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HomeMy WebLinkAboutUS SURVEY 3043 LT 2 OF 65BU.S. Survey 3043 Lot 2 of 65B #075-061-58 fiF. F~' DRILLING ~"° ~ °~'~' R E C E I V E D ANCHORAGE. AK 9951G (907) 345-0593 .1 . . JUN 18. 2001 WATER WELL RECORD STATE OF ALA$1CA DEPARTMENT OF NATURAL R[$OURES Division of GeOIoglccI ~ Geophysical Surveys Munlcipality.o. f Anchorage o,,,,,.o ,,,,.i, N,. ~t,lbr~ I C~ ~ OCoble loci ~Rol,ry r'JDrlve~ Fl*.., I-I~,,,.' O,,,. g Tell Will g Giber: . 8. CA~ING~ ~ Threoded ~ Welded II. PUMPINO LEVEL halo. lend lurfeee cad YIELO 16. WATER WELL CONTRACTOR'S CERTIFICATION: - '"~': ~'~/,rt~,-, ,'",",,,.-.-, ,.,, ,.,.,,,. ,,-,0,,,....,., ,...,.,,.., ,.,,., J ~ ' '""'"'~;~,"-,..- ............ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jun 27, 2000 Expiration Date: Jun 27, 2001 Permit N umber: SW000198 Legal Description: US SURVEY 3043 LT 2 OF 65B Design Engineer: 0000 None Required Owner Name: Richard Randall c/o David Seifert Owner Address: PO Box 116 - ' Girdwood, AK 99587- Parcel ID: 075-061-58 Site Address: Lot Size: 12332 SQ. FT. Total Bedrooms: 1 Permit Bedrooms: 1 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By:~ Date: Z 0 (.,4 0 F I I I I I I CERTIFICATE FOR A Municipality of Anchoracje Developme=n Services Department ,.,uiMng Safety Division ,/ >~/ On-Site Water & Wastev~¢ater Program // . 4700 Etmore .~.oad P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 OF ON-SITE SYSTEMS APPROVAL SINGLE FAMILY DWELLING O Parcel I.D. 075-061-58 1. GENERAL INFORMATION COSA# ~ 0(~ \/\ Expiration Date: fi' 3 i:~ '- / / Complete legal description U.S.S. 3043; LOT 2 OF 65B Location (site address) 148 BURSIEL CIRCLE * GIRDWOOD, AK * 99587 Current Property owner(s) RICHARD RANDALL Day phone 346-2338 Mailing address 2876 JACKIE CIRCLE * MINDEN, NV * 89425 Lending agency Day phone Mailing address Real Estate Agent Day phone r, ,. Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2..UMBER.o .BEOROOMS: 3 3. TyPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer · The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 samples. (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. 4. STATEE{ENT OF !NSPECT!©N BY ENG!NEER As certified by my seal affixed hereto and as of the validation date shown below, I verify t,bat my investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guidelines for this application, shows '~' z,,~ ,,,~ on-.~,e water suDp!v, . ~,,~,~.,.,,~/. ..... ,.~,~.,~.~. ..,~.~,~o~,,.,~,~r H~o~,~l ~z~-~...ev°f~ .~ie t(are).~ safe, functional and ~dequate for the number of bedrooms and type of structure indicated herein. I fu,ff,fer verify t,Sat based on the infomTation obtained ~m the Municipality of Anchorage files and ~m my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compfiance with all appficable Munic(~al and State codes, ordinances, and regulations in effect at the time of instaflation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 Eo TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date ~/2.._~//I 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 t,~is report by any other person or party is not authorized, nor will it confer any legal right w,~atsoever. DSD SIGNATURE '~J Approved for bedrooms. Disapproved° Conditional approval for bedrooms, with the following stipulations: ~vS,-, Checklist Sepd¢ System Adviso~ Well Flow Advisory (Rev 11t05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other _O.dgi_n_ a! _C~rtEiga~e D~; ~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: U.S.S. 5043; LOT 2 OF 65B Parcel ID: 075-061-58 A. WELL DATA *UNSPECIFIED. ASSUMED BASED UPON SURROUNDING WELL LOGS. SEE ATTACHED. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/11/2000 Sanitary seal (Y/N) YES Total depth 60 ft. Cased to *40+ ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. Date of test FROM WELL LOG 7/11/2000 AT INSPECTION 6/15/2Oll Static water level 50 .ft. Well production' 50 g.p.m. 53 ft. 6.8+ g.p.m. WATER SAMPLE RESULTS: Coliform (~ colonies/100 mi. Arsenic:-~' J ~ ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 0.'~1 ,-,~rng./L. Date of sample: 6/15/2011 Collected by: Tank Type/Material Date installed Tank size __ gal. Foundation cleanout (Y/N) ~ Date of pumping ABSORPTION FIELD DATA Date installed Length ft. Total depth ft. Date of adequacy test Eft. abs ft Mon~tonng tube ,/" Results (Pass/Fail) GEG, Ltd. I PUBLIC SEWER Number of Compartments ~ Cleanouts (Y/N) Depression over tank (Y/N) __ High water alarm,~(,Y,/~ Pumper Soil rating (g.p.d./ft2or em type Width / ft. Gravel below pipe Depression over field__ Fluid depth in~ before test in. Water added Ela~: ___min. Final fluid depth in. A~y rejuvenation treatment (past 12 mo.) (YIN & type) Absorption rate >= If yes, give date .ft. For__bedrooms New depth in. g.p.d. D. LIFT STATION Date installed "Pump on" level at in. ~ Cycles tested. E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access (Y_._~N~ "Pump off" leve~ High water alarm level at Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas. 50% ,in. Meets alarm & circuit requirements? On adjacent lots N/A On adjacent lots 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: I PUBLIC SEWER Building foundation Property line. Absorption field Water main Water service line Surface water ~ Wells on adjacent lots ' ~ SEPARATION DISTANCE FROM ABSOR~OT TO: Property line _~ ~ ~ B~.~j,~oundation Water main Water serv~ Surface water Driveway, parking/vehicle storage ~n drain Wells on adjacent lots. F. COMMENTS G. ENGINEER'S CERTIFICATION I 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 Printed Name JEFFREY A. GARNESS Date COSA Fee $ (~C~ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 0 4' ~o F- Frl -q 07O "'el 1-- 1 1 I I' / / I LANTECH / / / :%. / / / / / TO: Municipality of l%nchorage Water and Sawer Section This is to notify your office that I plan to build a 16' x 20' wood freeze cabin on ~ lot near Girdwood (Lot 65-2~ U.S. Survey No. 3043). Since I only plan occasional overnite and weekend use of the cabin, I don't intend to connect it to running water. I will haul my own drinking water. Waste ~ater from cooking, dishes, etc. will be hau!~d back to ~nlchorage. A chemical type toilet will be used to dispose of human waste. No further development is planned until co~munitywater and sewer becomes available. I also understand that legal action can be taken against me if I violate my above stated intentione of providing for w~ter and disposing of waste. Richard C. Randall 5306 Cope St. ~%~chorage, ~laska 99503