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Home My WebLink AboutT12N R3W SEC 15 LT 138T12N R3W Sec 15 Lot 138 015-484-15 COMMUNIY SYSTEM • Municipality of Anchorage On -Site Water and Wastewater Program a (907) 343-7904 s A E T Y Certificate of On -Site Systems Approval Parcel I.D. 015-484-15 1. GENERAL INFORMATION: Complete legal description T12N, R3W, Sec 15, Lot 138 Expiration Date: ':1 )e C J , 0"? 0 f Location (site address) 4721 E. 104th Avenue *Anchorage, AK 99507 Current Property owner(s) Ken & Heidi Schulz Day phone 502-387-7596 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: 6 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 $ J�SD Waiver Fee $ Date of Payment g 2(,o IN 44 Date of Payment Receipt Number 0'b < < G Receipt Number COSA # 05C,11 19 -DR -1 Waiver # 0 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: Garness 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 19 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 whatsoever. #AECC884 6. DSD/ SIGNATURE J System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedro\m+>(tftK6yag stipulations: � \Q �' ON-SITE WATER AND --mEWATERo� PROGRAM By: -2 116-94) 3 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: T12N, R3W, Sec15, Lot 138 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑E Well log is filed with Onsite (or attached) Date drilled 6/25/06 Total depth 266 ft Cased to 266 ft ❑ Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 817/19 Static water level at beginning of test 195.5 ft Comments B. TANK DATA Age of tank(s) _ Tank type/material Measured operatin ❑ Stand ' /foul e of pumping _ years E{uitTlevel in septic tank ation cleanout per record drawing D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for er than 30 days prior to date of test) Gallons ' oduced gallons Co nts/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-484-15 Structure served by this system Well production at time of test 6.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ Nc ❑■ Coliform bacteria is Negative Nitrate mg/L [% Nitrate less than MRL (ND) Arsenic ug/L J)J Arsenic less than MRL (ND) Collected by GEG Date of Sample 8/12/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station yea Lift station material Comment Adequacy test date Results ❑ Pass For rooms Fluid depth prior to to in Water adde gal N epth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Eli 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' P Yes if No ft FV1 Yes if No Neighboring Tank > 100' 121 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' ❑v Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' W rvice Line>0' ❑ Yes Animal Containment > 50' ❑✓ Yes if No ❑r Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E] Yes if No ft ❑✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' es if No " Property Line > 5' ❑ Yes if No ft Wells o • ent Lots: Absorption Field > 5' ❑ Yes if No Private Wells > 100' ❑ Yes if No. Water Main > 10' Yes if No ft Community Wells > 200' E] Yes if No. W rvice Line>0' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under drivewa n I Property Line > 10' ❑ Yes if No ft Wells on A • ots: Water Main > 10' ❑ Yes if No Private Wells > 100' ❑ Yes if No Water Service Line > 10' es if No ft Community Wells > 200' ❑ Yes if No ater > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS No evaluation or testing was performed on the community septic system. G. ENGINEER'S CERTIFICATION I certify that 1 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 ft ft ft ft ft ft ft ft ft ft �. Qp •"Je r A. Gorne -)3 VQO 9, '• s E 79 •mac O e � o Profess -to °aa #AECC884 ft ft ft ft ft ft ft ft ft ft Jeff Garness From: David Harper <dlharper2@gmail.com> Sent: Wednesday, August 21, 2019 5:54 PM To: Jeff Garness Subject: 4721 E 104th Ave Jeff, the well seal at the above location has been brought up to current MOA code requirements. David Harper Aarow Pump & Well Service, LLC Sent from my iPhone LOT 136A I Windowwell �U 00 m O C'7 O co O Well �— CV T O O C`7 co Mo 00 0 0 C:) 0 to Z Z 0 O LCA LOT 117 S89058'31 "E 1330.18 (C) EAST 329.87 (131- 280.18 BL 280.18 (C) 280.32 (M) M 8 e S :Flame Ret. wall (lyp) LOT 116 LOT 138 Septic vent (typ) U Do 0 / \ Ln 0 O e Ge�cae��e� J� 2.3 OH Gravel dfiveWaY N 280.18 (C) S89058'31 "E 330.18 (P 2002-178 EAST 329.87 (BLM) There exists an AGREEMENT TO PROVIDE ACCESS recorded 6-28-2006, Serial No. 2006-042848-0 LOT 139 0 0 o Road Reservation LO CE E. 104th Avenue EAST 329.87 (BLM) LEGEND S89058'25"E 329.89 (C) (BLM) Record per BLM survey dated 1-27-1965 (R) Record per Plat No. 2002-178 (BLM Lot 136A) (C) Computed per Plat No. 2002-278 Note: There exists a variance from AMC 21.40-080.G3 in the R-6 District to allow both house and deck to encroach into the 50' rear yard setback recorded 2-25-10, Serial No. 2010-008852-0. as o D SCALE: 1"= �, EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED. FB 19-3, pq 70-73 �.N\\\%,1 OF • A4,1 100 +I 49th -7 00 / iza6eth L Walatke . 10 �� siF • 8036 - LS 7839D r c 0 .8I U . . Oca r 0 Ilf pco Z O CO m I o U U ~o C) w 0 0 L6 I r- Z 0 Z Z Q — — 50.00 0 0 0 Ln AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the follov"ng described property. BLM LOT 138. SECTION 15, T12N. R2W. S. M. AK Anchorage Recording District Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission fines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 1st dayof AUGUST .2019. FRED WALATKA & ASSOCIATES, LLC. BE907-248-1666 Engineers and Surveyors