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HomeMy WebLinkAboutUS SURVEY 3042 LT 87 SW4G� B` • Municipality of Anchorage =A On -Site Water and Wastewater Program (907) 343-7904 5 A F E, Y Certificate of On -Site Systems Approval Parcel I.D. 075-132-64 1. GENERAL INFORMATION: Expiration Date: �� l r2 0 2 Complete legal description US SURVEY 3042 LOT 87 SW4 Location (site address) 148 Jewel Mine Road *Girdwood 99587 Current Property owner(s) Patricia McDonald Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 227-4179 Day phone 3. NUMBER OF BEDROOMS: 3 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 $ 2 g0 Waiver Fee $ _ Date of Payment T� 2 Date of Payment Receipt Number 06 Clq 2 G Receipt Number COSA # -0S G?.2 I I W Waiver # W< 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 Engineerinq 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: Z 1*9 i 2,7— In 7 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 6. DSQ SIGNATURE System #1 Approved fora__ bedrooms ��.•' �. TSI � •� a C? -7 G or slo, #AECC884 System #2 Approved for bedroomstOF((r��/i�, Disapproved ```\`\��QP Conditional approval for bedrooms, with the followlnulatip:SITE \NATER AND By: �� Original Certificate Date: 1 "1 —20ZZ 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 engineer's work. 7. ATTACHMENTS: COSA Checklist X— Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: US SURVEY 3042; LOT 87 SW4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled '980M Total depth *61.2+ ft Cased to UNKNOWN ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/18/22 Static water level at beginning of test 60.8 ft Comments *PER GEG INSPECTION 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 of ective. if not, state depth into effective ❑ Code -required soil er over field EJ System pres ed (Required if nt for greater than 30 days prior to date of t introduced ,gallons COSA Checklist yellow sheet Parcel ID: 075-132-64 Structure served by this system Well production at time of test 4.4+ gpm Water storage tank volume N/A gallons Well Id'sinfected for coliform test? F-1Yes No ®,Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L El senic less than MRL (ND) Collected by GEG, LTD. Date of Sample 3/18/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: 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 and Any rejuvenation treatment (past 12 months) If yes, enter date 8 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' if No ft ❑ Yes ElYes if No ft Q Yes if No ft Surface Water > 100' ❑ Yes �N,---ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' Q Yes if No ft G Neighboring Absorption Fields > 100' ft Animal Containment > 50'(✓ Yes if No ft -s 0 Yes if No ft ft Water Service Line > 10' ❑ Yes if No n If s c tank is under driveway comment below Manure/Animal Excreta Storage > 100' s if less than required) r 0 Community Sewer Main > 75' [D Yes if No ft nv Yes if No ft Building Foundation > 10' Property Line > 10' Water Main > 10' Water Sere' ine > 10' ace Water? 100' F. ENGINEER'S COMMENTS El Yes #N6' ft if No ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes From Septic/Holding Tank on Lot to: (Please enter distances if less than required) AWVVl1 SEWER Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes �N,---ft o Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: D Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑Yes if No ft Water Main > 10' ❑ Yes if No ft Communit ells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If s c tank is under driveway comment below From Absorption Field on Lot to: Please enter dista s if less than required) Building Foundation > 10' Property Line > 10' Water Main > 10' Water Sere' ine > 10' ace Water? 100' F. ENGINEER'S COMMENTS El Yes #N6' ft if No ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft 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 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. COSA Checklist yellow sheet . F . . �r. ............... .... ... ....... ...... ....... J f A. Gorn ss,- • �ceG l�,d _'ro f essionoo` #AECC884 S. Portion Lot 86 N ' 68 9"9.3 98Is, S.. ]P'o Italolmt, W,,(90, Lot 87/ 2s 2 -Story 1,?� House �; ..,O�,�filr 384 `y�� 3 •'� M Portion, W. 98' Lot 87 Neighbor's Shed Encroachments ti /k) 2nd Fir OHI X381 'o Lot 2 49d N /Starr Surv(ey ng I 0 1� 30 US SURVEY FEET -All dimensions shown are grid bearings ground distances; record boundaries are per USS 3042 and Plat No. 94-69. -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 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. AS BUILT SURVEY South Portion, Westerly J8` Lot 87, USS 3042, Girdwood, Alaska 0 well p Property Corner 49th Star Surveyingv wC' 321 Fireoved Drive Anchorage, AK 99508 (907)891-6111 Jeremy@49thStarSurveying.com W.O. 2142 I DATE 2/24/22 SCALE: 1"=30' LEGEND QS Sewer Manhole Comm. Pedestal 0 well p Property Corner 49th Star Surveyingv wC' 321 Fireoved Drive Anchorage, AK 99508 (907)891-6111 Jeremy@49thStarSurveying.com W.O. 2142 I DATE 2/24/22 SCALE: 1"=30' M HIHON 31VOICINI i L' Vl it w C3. R 'illi /C�' �f,,�•� `+U W ¢ U Q O z CL w � O w CL I` � ( Q > _ 2 E- U cry U HIHON 31VOICINI 00 5A 2A 7511 a 75t. r � . Legend - Constntctsd and Design AdmiNstmtlon FodFty to 0 Mwout.AWWU O ® Metering Stffilon Y ii poanad. PrNam 19 0eanou11nh1entwle,AWWU © Utl Stettin 80' AToe. AWWU ® SoDtapo R—Ming Station *17696 J � ^ Max nholu,AWWU FEE %V ata WrTr�atment Fadiy O Madwlo. Pdva,a *27606 Dangerous Merlhda GiRC'::CCC ® Disdnergo PomL AWWU - IftD U5lftlrl:. PARK ® AIR.Ile(AWWU �Q\ ® AhVawom.AWWtI � 4 P Conatrudotl Pips Das n 4e '. ®® Maln.AWWU Casing and Outer Pipe. All Q+mers P"� Main. Privato AWWU ® F—Maln,AWWU nw1AWWU `"' '®` Force Main. PrMafe PWUnod Plpe �{ Abandoned In Placa. All Owners Raced Dmwirg Limh ®®' Baron ® MOAGrid 0®' 62A.,�. rl INFORMATION AND DATA CONTAINED ON THIS DOCUMENT 1� IS NOT TO BE CONSIDERED ACCURATE AND THE MUNICIPALITY OF ANCHORAGE ASSUMES NO LIABILITY FOR DAMAGES OCCURING AS A RESULT OF USING THIS DOCUMENT. FOR THE LATEST AND MOST UP TO DATE - I INFORMATION YOU ARE URGED TO CALL THE ro c RDWOOD - = .ry ANCHORAGE WATER & WASTEWATER UTILITY )LD GIRDWOOD TO N'Slr_. 's uss,n;a , . . AT (907) 554-2725 BEFORE STARTING OPERATIONS. 2-6475 Ction System Grid Number SE5012 I-lu 'AD ®MUNICIPALITY ANCHORAGE ' DEPARTMENT OF HEALTH $HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6e50 343-4744 APPROVALFORHEALTHCATr= OF FOR A S GLEFAMI Y DWELL NG Parcel I.D. #— _ 1 I. GENERAL INFORMATION 4z lk� N F J99� ��Y'cF HAA ti_q&ql �� Complete legal description Portion of Lot 87, U. S. Survey No. 3042, Alaska Location (site address or directions) NHN Jewel Mine Road, Girdwood, AK Property owner Tom Wilson Day phone N/A Mailing address PO Box 112362, Anchorage, AK 99511 Lending agency N/A Mailing address N/A Day phone N/A Agent George McCoy, Jack White Co. 783-2937 Address 3201 C Street Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer X NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M51R" 1A11) Front MOA 121 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 of this Health Authority Approval application 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 furtherverify that based on the Information obtained from the Municipality of Anchorage tiles 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 Criterium Alaska Engineers Address PO Box 111 Anchora AK 99511-1790 Phone 349-1003 Engineer's signatu 6/7/96 Date __ 1t • Ps: T�eaCoreKJcutica :a 6- DHHS SIGNATURE (�' pf •< Approved for bedrooms. Disapproved. By: Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health authority Approval Certificates 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 engineers worx. 72-75 (RW IMI 6• MOA 171 Municipality of Anchorage • DEPARTMENT OF HEALTH & HUMAN SERVICE 8250L" Street, Room 502 •Environmental services Division E C E I V E D Anchorage, Alaska 995019 (907)343-4744 JUN 12 1996 gjans Health Authority Approval Checklist Municipality of Anchorage Dept. Health & Human Services Legal Description: Portion of Lot 87, U. S. Survey No. 3042, Alaska Parcel I.D.: A. WELL DATA Well type PrivateIf A. B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/1) -In Date completed 1980 Total depth 81.5 Casio hcl ht above round 2 Cased 60_ s g ( ground) — Sanitary scat (Y/N) Yes Wires Properly protected (Y/N) ^ FROM WELL LOO Date of tat Unknown Static water level Unknown Well production Unknown g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 0•396 Date of sample: 5/28/96 & 6/3/96 Collected by: B. SEPTIC/11OLDING TANK DATA AT INSPECTION 7.1 &p -m. Other bacteria 0 Eric M. Johnson Date installed N/A Tank size �— Number of Compartments C[eanatts (y/N) Foundation cleanout (YIN) Depression (Y/N) High water alarm (Y/N) Date of Pumping pumper C. ABSORPTION FWLD DATA Date installed N/A Soil rating (g.p.d/(t= or 8r/bdrm) System type Length Widal Gravel thickness below pipe Total depth Effective absorption arca Monitoring Tube prment(Y /M_ Depression over field (Y" Date of adequacy test Results (Pass/Fail) For \ bedrooau< Fluid depth in absorption field before test (in.); Immediately after I , ` water gal. ter added ,([n.): Fluid depth Minutes later. (in.) . Absorption rate ----_Sp.d. Peroxide treatment (past 12 months) (Y" If yes, give date D. LIFT STATION t y Date installed ' ManholetAcce s (Y/N) a L' High water alarm lcvcl nN Cycles tested E. SEPARATION DISTANCES F. Size in gallons "Pump on" level at* "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/ltolding rank on lot N/A ; On adjacent tots Absorption field on lot N/A ; On adjacent lots Public sewer main 103' Sewer /septic service line 64' "Pump off" level at* N/A NIA Public sewer manholelcleanout Lift station N/A 103' SEPARATION DISTANCES FROM SEPTIC/HOLDINO TANK ON LOT TO: Foundation N/A Property line Absorption field Water maintservice line Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation N/A Water main/service line S rfnce ler u tva Curtain drain CERTIFICATION rrveway, in. rking/ve c e storage arca Wells on adjacent lots , 1 certify that 1 have fixed thru Jleld inspectionsand review In conformance MO 1nUA guide! es /n effect on this date. Signatu Engtncc s Name Theodore . Johnson, P.E. Date HAA Fee S " — ' Waiver Fee $ _ Dato of Pnymcnt 7 /� Date of Payment Receipt Number 5�'y��/ Receipt Number Rev, 8/95 OSS: haa.wk.doc TheodorerJohnscn lA systems are