HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 1 LT 11Abbott Loop
Mano
lock I
Lot 11
014-181
-11
MUNICIPALITY OF ANCHORAGE
f.
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel 1. D. 014-181-11
1. GENERAL INFORMATION
Expiration Date: Se p o2i�
Complete legal description Abbot Loop Manor B1 L11
Location (site address) 7641 Adobe Dr
Current property owner(s) ,Jared T. BOerger
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
❑
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
n
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ f Waiver Fee $
Date of Payment 5 7 2 1 Date of Payment
Receipt Number o y y G Receipt Number
COSA # O S C -I 2 2— Waiver #
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.
In conducting an adequacy test, I 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSD SIGNATURE
J System #1 Approved for q bedrooms
System #2 Approved for bedrooms
Disapproved
Date
OF Al -,q
Steven P. Pannone f
cE 814_
Conditional approval for bedrooms, with the following stipulations:
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By:`��� 9t �� 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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Abbot Loop Manor 131 L11
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled unk
Total depth unk ft
Cased to unk ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 25 in.
Date of flow test for COSA 05/18/21
Static water level at beginning of test 45.4 ft
Comments
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured opera . fluid level in septic tank
❑ Sta pes/foundation cleanout per record drawing
of pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (rr
Measured depth to pipe invert from grade
❑ N/A - pressurized field
❑ Monitor tubes go to bottom of effecti . f n,
depth into effective
❑ Code -required soil cove er field
❑ System presoak
Ae
(Required if va t for greater than 30 days prior to
date of to
G ns introduced gallons
C ments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 014-181-11
Structure served by this system 1
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test
Res Pass For bedrooms
luid 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
a ALES."
Well production at time of test 3.90
-�
"
Water storage tank volume NA
gallons
Well disinfected for coliform test?
❑ Yes No
❑ Coliform bacteria is Negative
Nitrate •439 mg/L ❑ Nitrate less
than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by PES
Date of Sample 5/18/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test
Res Pass For bedrooms
luid 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 > 10
❑ Yes
Community Sewer Manhole/Cleanout > 100'
Yes,% f talr�
ft
Q Yes
if No ft
Neighboring Tank > 100' ❑✓ Yes if No
ft
Private Sewer/Septic Line > 25'✓Q Yes
if No ft
Yes
Property Line > 5'
Yes
if No
Absorption Field on Lot > 100' J Yes tNo
ft
Holding Tank > 100' [✓ Yes
if No ft
Neighboring Absorption Fields > 100'
if No
Animal Containment > 50' ❑✓ Yes
if No ft
M Yes if No
ft
❑ Yes
if No
ft
Community Wells > 200'
Manure/Animal Excreta Storage > 100'
er Service Line > 10'
Community Sewer Main > 75' ❑✓ Yes if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enterdistances if less than required)
Building Foundations > 10'
❑ Yes
o
ft
Surface Water > 100'
® Yes if No ft
Water Main > 10'
Yes
if No ft
Water Service e > 10'
Yes
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 Mai _ 10'
❑ Yes
if No
ft
Community Wells > 200'
❑ Yes if No ft
er Service Line > 10'
❑Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distanc
Building Foundation > 10'
LJYes
if No ft
Property Line > 10'
if No ft
Water Main > 10'
Yes
if No ft
Water Service e > 10'
Yes
if No ft
Su Water > 100'
❑Yes
if No ft
F. ENGINEER'S COMMENTS
Well only. Public sewer
less than required)
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
l 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. t 0�5206
COSA Checklist yellow sheet
OF A(,q>�
TH
ate reri��� Pannone
CE 8149 4e
:
u567897O •
• Municipality of Anchor. A/ 1i ° '`-
On-Site Water and Wastewater Progr.ff JAN
(907) 343-7904
� � 2 018� ., iJ kNIETy
Q �
Certificate of On-Site Systems App • 8 L_g
Parcel I.D.
014-181 -11 Expiration Date: `� Z Z- k
1. GENERAL INFORMATION
Complete legal description Abbott Loop Manor, Block 1 Lot 11
Location (site address) 7641 Adobe Dr
Current Property owner(s) Robert & Bobbyjo Edwardsen Day phone
Mailing address 7641 Adobe Dr, Anchorage, AK 99507
Real Estate Agent Patrick Walgomuth Day phone 227-3735
2. TYPE OF DWELLING:
H Single Family (w/wo ADU)
I Duplex
n Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual ❑
Individual Water Storage n Holding Tank ❑
Community Class Well n Community n
Public Water System ❑ Public Sewer
WaiverNariance request for: Distance:
Received by: 1),p(ma ;mpOy14 Date: ,
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5 oZ Waiver Fee $
Date of Payment //c2, 413 Date of Payment
Receipt Number 002e-130Receipt Number
COSA# 0 C,/$/Q(9 Waiver#
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 Forge Engineering Phone 577-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 1/17/2018
of 4.14.1,;ilki
*: 491
6. DSD SIGNATURE I
System #1 Approved for >~ r•••
y pp bedrooms • Ber4a i Schiller •: ;e
System #2 Approved for bedrooms ������'• C';125°2 -..4 ,40e
Disapproved 1l��4/Y,?O,: SS'G'�"`4
Conditional approval for bedrooms, with the following stipulations:
-\QP��ZY 'OF
AlAi,h
� w O
ON-SITE
WATER AND ":-
c�n WASTEWATER o
PROGRAM c;.
c
Original Certificate Date: hZ 2--
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
COSA blue sheet_f. . c
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: Abbott Loop Manor, Block 1 Lot 11 Parcel ID: 014-181 -11
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth >111*ft. Cased to >40**ft. Casing height(above ground) X2411 in.
FROM WELL LOG AT INSPECTION
Date of test 12/23/17
Static water level ft. 18 ft.
Well production g.p.m. 5. g.p.m.
WATER SAMPLE RESULTS:
Coliform
ND colonies/100 mL Nitrate 0.408 mg/L
Arsenic ND ug/L Date of sample: 1/3/2018 Collected by: 907 Water Well Srvcs
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material N/A 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 N/A 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 N/A On adjacent lots >100'
Absorption field on lot N/A On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
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
*Per inspection by 907 Water Well Services
**Per previous camera inspection by Aarow Pump & Well Service
G. ENGINEER'S CERTIFICATION �+~~�"k�tl
I certify that I have determined through field inspections and "4:. 9t#1
review of Municipal records that the above systems are in *_�. �[�! ',•*j4
conformance with MOA COSA guidelines in effect on this date. , v,___.,,,r2..„YvIAEngineers Printed Name Benjamin Schiller, PE gDate1/17/2018 /0 -P Beniller •<� fief
.rte•. •C 1292 .y`/'
All
'� slF,a:• Ltt a,•• ar
COSA brown sheet 10-10-12.doc
CERTIFICATE
FOR A
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
470.0 B!:ag.a .w_ Si~reet ..
P.O. Box 196650 ."
Anchorage, AK 99519-6650
www.muni.org/onsite ~ /
(907) 343-7904 t-'
OF ON-SITE SYSTEHS APPROVAL
SINGLE FAHILY DWELLING
Parcel I.D. 014-181-11
1. GENERAL INFORMATION
COSA
Expiration Date:
.,
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing~address
ABBO'FI' LOOP MANOR S/D; BLOCK 1, LOT 11
7641 ADOBE DRIVE * ANCHORAGE, AK * 99507
NIELS NIELSON Day phone 546-5678
4351 ZODIAK DRIVE * ANCHORAGE, AK * 99507
Day phone
ED JACOBSON W/ PRUDENTIAL' Day phone 563-5500
3801 CENTERPOINT DR, # 200 * ANCHORAGE, AK * 99505
Unless'.otherwiSe requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
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. STATEMENT OF INSPECTION BY ENGINEER
~r,xeo he~eLo and as o~ u,e validation date ~' ....
As certified by my seal ......... ~ '~' .... w,, ~,~,~,,v, I verify,,,~, ,,,.v*~*"* '""'
investigation,, based on procedures outlined in the Certificate of Qn-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 ENGINEERING GROUP, Ltd.
Phone 557-6179
Address 5701. E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
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 fisted 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.
DSD SIGNATURE
ApprOved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
"'"~'* Advisory
Arsenic Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage,
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bmgaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www;muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
Legal Description: ABBOTT LOOP MANOR S/D; BLOCK 1, LOT 11
WELL DATA *PER GEG INSPECTION. **PER AAROW PUMP AND
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed ,,,1965 Sanitary seal (Y/N). YES
Total depth *85+ ff. Cased to **40+ ft.
Parcel ID: (~ .~/~- I ~ I "' i I
WELL INSPECTION. SEE ATTACHED.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
NO
YES
12+ in.
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
12/2/2010
45
7.2
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~:"~> colonies/100ml.
Arsenic:~ug./L.
B. SEPTIrC/HOLDING TANK DATA
Tank Type/Material
Tank size __ gal.
Foundation cleanout (Y/N) __
Date of pumping
C. ABSORPTION FIELD' DATA
Date installed
U,trat~ mg./L.
Date of sample: 12/1/2010
IPUBLIC SEWERI
Number of Compartments
Depression over tank (Y/N)
Other bacteria~rO, ' ' Colonies/100 mi.
Collected by: GEG Ltd,
Date installed
Cleanouts (Y/N)
High wa~
Pumper
Soil rating (g.p.d./ft2or ~tem type
Length .ff.. Width / ft. Gravel below pipe ft.
Total depth ff. Eft. abs~ ft~ Monitoring tube Depression over field
Date of adequacy test _..--"~ Results (Pass/Fail) ~ ,For_ ~bedrooms
FlUid depth in~d before test~ in. Water added gal. New
depth
-~Elapsed~: ___ min. Final fluid depth in. Absorption rate >= g.p.d.
Affy rejuvenation treatment (past 12 mo.) (Y/N & type) If yesl give date
D. LIFT STATION
Date installed
"Pump on" level at__in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons Manhole/Access ~ J
"Pump off" leveJ.a~ High water alarm level at
Cycles tested. Meets alarm & circuit requirements?
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main *50'+
Sewer/septic service line 25'+
Animal containment areas. 50'+
.in.
*50' REQUIRED Prior TO 198,5
On adjacent lots N/A
On adjacent lots N/A
Public sewer manhole/cleanout *50'+
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: IPUBLIC SEWER J
Building foundation Property line Absorption field
Water main Water service line Surface water
on adjacent lots
Wells
SEPARATION DISTANCE FROM ABSORPTION FlEeT TO:
Property line ~ation. Water main,
Water service line~ Surface water Driveway, parking/vehicle storage
~ 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
COSAFee$ /~
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number.
<~
>o ~
~o~
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
7641 Adobe Drive
Well was inspected by camera to 45'. No perforations or leaks were found.
Brian R. Wille
Aarow Pump & Well Service LLC
SGS Ref.# 1106369001
Client Name Garness Engineering Group, Ltd Printed Date/Time 12/10/2010 9:57
Project Name/# Abbott Loop Manor B I,L 11 Collected Date/Time 12/01/2010 10:45
Client Sample ID Abbott Loop Manor BI,L11 Received Date/Time 12/01/2010 11:00
Matrix Drinking Water Technical Director Stephen Co Ede
Saml~le Remarks:
4500NO3-F ~ Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements°
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/03/10 12/08/10 NRB
Waters Department
TotaINitrate/Nitrite-N 0.164 0.100 mg/L SM20 4500NO3-F B (<10) 12/02/10 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 12/01/10 DLC
TotalColifonn Negative 1 100mL SM20 9223B A 12/01/10 DLC