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Home My WebLink AboutBENITO BLK 3 LT 4enito lock Lot 4 050- 272 -20 Parcel I.D. 050-272-20 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Benito Block 3 Lot 4 Location (site address) 10028 Genora St. Expiration Date: Current Property owner(s) Hope Community Resources, INC Day phone Mailing address 540 W. International Airport Rd. Anchorage, AK 99518 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 - VXfN C� ,4'� 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 ❑ Waiver/Variance request for: Distance: U Received b�. ��? \ L Date: r} COSA to be released to the engineer, unless o erMse requestedythe engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number_ 01110(7 Receipt Number COSA # _ 8 4001W U 319 Waiver # 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. In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Phone (907) 272-8218 Date 5/4/2018 WN M. DSD SIGNATURE , b System #1 Approved for bedrooms ..S even R. E3arin6rie : System #2 Approved for bedrooms CE -8149 Awr Disapproved Conditional approval for bedrooms, with the following stipulations: RA[W By: `"� �`— Original Certificate Date: �J 7 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet—E � c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Benito Block 3 Lot 4 Parcel ID:050-272-20 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N Date completed 1972 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 100+ft. Cased to 40+ ft. Casing height(above ground) 16+ in. FROM WELL LOG AT INSPECTION Date of test UNK 4/26/2018 Static water level UNK ft 94 ft. Well production UNK gpm 5.1 g.p.m. WATER SAMPLE RESULTS: Coliform e-lolonies/100 mL Nitrate I =�. ' mg/L Arsenic N ug/L Date of sample: 4/27/2018 Collected by: PES \�' B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts(Y/N) Foundation cleanout(Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation 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 off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION • ' SOF 4"kk I certify that / have determined through field inspections and P • 4 review of Municipal records that the above systems are in p*; TH / conformance with MOA COSA guidelines in effect on this date. ••••• •• •• 9 Engineer's Printed Name Steven Pannone •••• ••••j 9� •••��i;veri�. annane Date 5/4/2018 ��g• CE-8149 �1�0�o�s's7o�P��= COSA canary sheet_2-6-15.doc Municipality of Anchorage - Development Services Department Building Safety Division On-Site Water and Wastewater Program' 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-272-80 GENERAL INFORMATION Complete legal description Location (site address) Current Properly owner(s)' Mailing address Expiration Date: / ~.. - j ~ -/0 Beni-I;o S/D, BLock 3, Lot' 4 10028 Genorc Si;ree-I; P(tut & June Cordc~$ci 10028 Genora S~cree~ Day phone 694-7632 Lending agency Day phone Mailing address Real Estate Agent Mailing Address. Tim Rii;-t:cd RE/HAX Day phone 257-0134 unless otherWise .requested, COSA will., be held by DSD for pickup. NUMBER OF BEDROOMS: ~ ' ~ 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 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 sample results. (Cedificates 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 theprofessional engineer's work. 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 Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal syst. em 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. N.o~thRim Engineering P,D, Box 770724 Name of Firm Address Phone Engineer's Printed Name DaD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. 694-7028 Si;eve En9 Date 9/9/10 · ,~.~ ..'" ' ,. ~ : . ~-~ ~.~ :7~ · bedrOOms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well .Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other . {Rev. 11105) Mun~ipa~tyof Anchorage Development SerVices Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box196650 Anchorage, AK 99519-6650 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 3eni-I;o S/D Brock 3 Lo't: 4 Parcel ID: 050-272-20 A. WELL DATA Well type , ,.P. 'If A, Bi or C provide PWSID # , Date completed 1972 Sar~a~ seal', (Y/N), Y Total depth 100'fit. -es't; Cased,to 40+ ff. rER~ WELL LOG Date of test unk Well Log (Y/N) N Wires properly protected (WN) Casing height (above. ground),, AT INSPECTION 8126110 Y in. Static water level Well production g.p.m. 93,0 ft. 5+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 coloniestl00 mL Nitrate<HRL mg/(~,5 Arsenic: 0,171 ug/L date of sample:8/25/10 B. SEPTIC/HOLDING TANK DATA H RL(~her bacteda Collected. by: 0 'colonies/100 m L NRim Eng Tank Type/Material Tank size '~ ~ ~-~ ~ ' '~ , ~- .gal;, . ..-., Number of.C0mpartments Foundation ~;m~lt~Yin) ~.i ~i;~';::~ePression over.t.t~X(~'lN) , Date of~U~ping .~ ~:~ >' ''' , ". '.,.' ,:';~ ~-; Pu%~ c. a Date installed ' Soil~g (g.p.d./~ or ~/bdrm) Len~h ff. ~:'' Width Total depth ~ ff. Eft. absorption area Monitoring tube__ Date installed C'leanouts; (Y/N) High water alarm (Y/N) System type Gravel below pipe Depression over field . Date of adequacy test Results (Pass/Fail) __ For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min, Final fluid depth in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= If yes, give date g.p.d. D. I~IFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES PubU¢ Sewer-AWWU Size in gallons "Pump off" level at in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ,~!~ Absorption field on lot NA Public sewer main 75'+ Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manholelcleanout Holding tank Manure/animal excrete storage areas. ,, !00' + I nnl_,. N~ 100' + SEPARATION DISTANCES FROM. SEPTIC/HOLDING TANK ON LOT TO: Building foundation NA Property line NA Water main Water service line ;,iA ;,iA 'Wells on adjacent lots .,~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water NA Property line N A Building foundation N ,", Water Service line ,~, NA . Surface water Curtain .dr, aiii NA Wells on adjacent lots COMME~TS- , . 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 ~-'c,:,v,= Fno Date 9/9/[0 Water main NA Driveway, parking/vehicle storage COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ,-~ ~c ~:~,~ BEAR PAW Cl RCLE N89° 58' 25"W 150.00' I I I I w ~ ~ 26.0 ~z o ~ m 5 w > I ~.~:..~,~ ~ o c 4.0: I ' I ~L 22.0 :: 'L" .' .' . .'.'-' ''- 25' S8~° 58' 25"~ mE SUR~YOR T~ R~PON~BIUW FOR mE INI~AL mANSAC~ON ONLY ~D A~MES RNANCI~ U~IU~ ~LY FOR mE COST OF mE SURLY. US~ DISTANCES PREVNL O~R SC~NG, REPRODUC~ON MAY CAUSE ~RORS IN SCA~. ~ LOT ~ SURLY T~E SYMBOLS ~ F~A~ ~-BUET ~ ~ ~ ~ ASPHALT ~ RN~ S~C~ ~-B~LF SET REB~ ~ ~ DRNNA~ ~ PLOT P~ . . . A~BUILT... LOT ~, . . T~Y O FOUND REB~ ~ ~ ~ WO~ ~NCE ~ CONCRE~ ~ ~-BU~LT NO ~N~S ~ ~ ~RCA~ A~mLT... NO ~ ~ ~ A~UMED E~V, X X X MET~ ~CE ~ WOOD DECK PLOT PLANS ~ LOT SUR~YS NO~: IT IS ~E RESPONSIBILITY OF ~E BUILDER OR O~EE, PRIOR TO ONLY ~OSE IMPRO~EN~ ABO~ GROUND AND ~SIBLE ~ BE CONS~UC~ON, TO ~RI~ PROPOSED BUILDING GRADE RELA~ SHO~. ~NCES, ~LLS. SEP~C C~ANOU~, SIDEWAYS, DRI~WA~, TO FINI~ED GRADE AND U~LI~ CONNEC~ONS AND TO DE~RMINE ETC., ARE SHO~ IN ~EIR APPROXIMA~ LOCA~ON, ONLY. SNOW ~E EXIS~NCE OF ANY EASEMENTS, CO~NANTS OR RES~IC~ONS MAY PRE~NT SOUR IUPRO~MENTS FROM BEING SEEN AND LOCA~D. ~lOH DO NOT APPEAR ON ~[ RECORDED SUBDI~SION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURLY CER~FICA~ON _.~mm)mmm._ Prepored by _.'~2 OF zT'%. Robert E. Johns, Jr. & Assoc ................ Pro¢ io,ol Uo d S, wyor ~ORAGE. ~A ggs01 ~¢~th s~,~: 1" = 30' ,.~. ~ot s.r. ~,.~. ,,.t F,. ,~. FOUNDA~ON ~-BUILT ~ ' ' RNAL~:~'~ "~'" ~" ~.~S~UC~RE~ ~, *...~,AS-BUILT~e ,¢, ~¢~G,2~X '".. ~~~' / *~ LegolDate Dra~:Des~iption:7/13/10 ~": N W52 w.°. 1197 .~."- ~" ' ~-~" ~ ~ ~... ,.,., ~,., .. 'e;?-¢ .... ............-o=~-*'~;¢%~' LOT 4 BLOCK 3 ,~.~ -q~ BENITO SUBDIVISION