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Home My WebLink AboutUS SURVEY 3042 LT 88C T10N R2E SEC 19U 3042 T10N R2E ,Sec. 19 Lo1' 88C #020-113- 55 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw 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. 075-132-40 t. GENERAL INFORMATION Expiration Date: 7- ,/~ - /,~. Complete legal description Location (site address) TION, R2E, SEC 19, LOT 88C (~/~" ,~'~"~J~YF:'/~/ 116 JEWEL MINE ROAD *GIRWOOD~ AK 99587 Currant Property owner(s) Mailing address Lending agency Mailing address RICK & DEBRA COLEY Day phone C/O AGENT 116 JEWEL MINE ROAD *GIRWOOD~ AK 99587 Day phone Real Estate Agent SAM DANIEL W/ GLACIER REALTY Day Phone 783-1910 ~,;~,Malingaddress 174 HIGHTOWER'S RD *GIRDWOOD ROAD 99587 Un/ess othen~sa ~quested, COSA will be held by DSD for pickup. 2. NUMBER OF 'BEDROoMs: 3. 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-sita [] [] 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 f~om the date of issue for properties served by a pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates ara 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 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 ENGINEERING GROUP, Ltd. Phone 337-6179 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 eva/uafion, GEG, LtD. attempted to provide a thoreughj conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results descdbed the pedormance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operafionat fife of all wails 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 evaluater of the system. Satisfactory lest results do not guarantee futura perfarmanoe 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 wi//continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for' the sofa benefit of the owner listed above. Any reliance upon or use of this report by any other person or parly is not authodzed, nor wifi it confer any legal right whatsoever. 5. DSD SIGNATURE ~/" Approved for bedrooms. Disapproved. Conditional approval for __ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate 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 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us {907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegalDescription: TION, R2E, SEC 19, LOT 88C A. WELL DATA Well type PRIVATE Dote completed UNK Total depth 84 ft. IfA, B, orC provide PWSID8 N/A Sanitary seal (Y/N) YES Cased to 60+ ft. ~, C~/{ ~/~'y13arcel ID: 075-132-40 Well Log (Y/N)/V' ~ wires pmpedy pmte~ed ~/N) YES Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test NO WELL LO0 4/2/12 Static water level ~ ft. 73 ft. Well production ~ g.p.m. 5.52 .g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate __mg./L. Arsenic: i® ug./L. Date of sample: 4/2/12 B. SEPTIC/HOLDING TANK DATA Collected by: GEG, Ltd, PUBLIC SEWER Tank Type/Material Date installed Tank size.__ gal. Number of Compartments __ ~ Foundation cleanout (Y/N)__ De~ High water alarm (Y/N) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ~/bdrm).__ System type Length ft. Width ft, Grav~. Total depth ft. Eft. absorption area ft2 Monitoring tube.~ / Depression over field. ~ Date of adequacy test R~ For_ bedrooms Fluid depth in absorption fiel~ in. Water added_ gal. New depth in. Elapsed T'~ Final fluid depth in. Absorption rata >= g.p.d. ~/y~nation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT sTATION Date installed Size in gallons Manhole~ "Pump on" level at_ _in. "Pum~ High water alarm level at in. Datum -- Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A 75'+ Public sewer main Sewer/septic service line Animal containment areas. On adjacent lots N/A On adjacent lots N/A Public sewer manhole/cleanout 100'+ 25'+ Holding tank 75% 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water ~ Wells on adjacent lots ~ SEPARATION DISTANCE FROM ABSORPT~OT I?:' . Water service Iine~ .~ s~n'veway, 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 Pd.nts¢ Name JEFFREY A. GARNESS Date uc/,,/Iz COSA Fee $ q q6 Date of Payment q/tl] tZ Receipt Number 6 I ~--~)~'~'~ (Rev. tl/05) Waiver Fee $ Date of Payment Receipt Number SGS Reft# Client Name Pro.iect Name/# Client Sample ID Matrix 1121020001 Gamess Engineeriag Group, Ltd T10N R2E Secl9 L88C USS Survey T1 ON R2E Sccl9 L88C USS Survey Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 04/09/2012 17:51 04/02/2012 15:15 04/02/2012 16:15 Stephen C. Ede Sample Remarks: 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) 04/04/12 04/05/12 ACF Waters Department Total Nitrate/Nitrite-N 0.515 0.100 mg/L SM21 4500NO3-F B 1<10) 04/05/12 LCE Microbiolo91; Laboratory E. Col/ Total Coliform Negative 1 100mL SM2I 9223B A 04/02/I2 DLC Negative I 100mL SM21 9223B A 04/02/12 DLC 2 of 4 Aarow Pump & Well Service, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 · Fax (907) 333-8976 Eagle River: (907) 622-9335 No. 9329 CUSTOMER -1 [- JOB SITE "QUANTITY DESCRIPTION PRICE AMOUNT / LABOR HOURS RATE AMOUNT TOTAL MATERIAl / / / / WORK ORDERED BY DATE COMP. TOTALLABOR ThankYou SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, bEC. the right to remove unpaid for equipment and charge for labor already per[ormed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. 0 / / / / 0 0 DATE: TO: FROM: SUBJECT: MEMORANDUM 91-010 (5~78) . US~ Date ~ ' ZONE ROVED (lo,~e as sllotDll ~ccl be changerl, ~t ]ir~ ob~nt~ t