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HomeMy WebLinkAboutUS SURVEY 3043 LT 68 A-2 T10N R2E SEC 18US Survey 3043 Lot 68A -2 #075 - 091 - 10 G Q� • '� Municipality of Anchorage ° On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 075-091-10 1. GENERAL INFORMATION: Complete legal description USS 3043; LOT 68 A-2 Location (site address) 131 BEIRNE #GIRDWOOD, AK 99587 Expiration Date: I ` L/— 2.02-0 Current Property owner(s) ALLISON BAKER Day phone 602-791-4740 Mailing address Real Estate Agent 131 BEIRNE'G_I_RDWOOD, AK 99587 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 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>' Waiver Fee $ Date of Payment %z. /ZD Date of Payment Receipt Number O((5gi7G Receipt Number COSA # Q_'5G Z0I _2�, C(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. Name of Firm: Gayness Engineering 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 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. 6. DSD SIGNATURE 4LSystem #1 Approved for _S_ bedrooms System #2 Approved for Disapproved Conditional approval for co C -A- -H n� c.©,M-m a-6 bedrooms bedrooms, with the �Q.,V- In91e me-+ coc e_ 1 �2- .5�, i�.'.. .'. ..1-1 ...... .......... #AECC884 SOF y `g ON-SITE g �'Tjt�Rn SAN D VAXLV.'!!, TER z g/,q/2D2 U SERv�G����,� 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_ Nitrate Advisory Septic System Advisory. Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: USS 3043; LOT 68 A-2 ParcellD: 075-091-10 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Adequacy test date ❑ Well log is filed with Onsite (or attached) Well production at time of test **4+ gpm Date drilled UNK Water storage tank volume N/A gallons Total depth *73.75 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to *40+ ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 0.431 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic u /L g ❑Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GARNESS ENGINEERING, LTD. Date of flow test for COSH 7/12/20 Date of Sample 7/12/20 Static water level at beginning of test **45.5 ft Any rejuvenation treatment (past 12 months) Comments *PER AAROW PUMP & WELL SERVICE RECEIPT DATED 1/3115. "RETURNED ON 7/28120 TO CHECK STATIC WATER LEVEL. **WELL DRAWDOWN COULD NOT BE MONITORED DURING THE WELL TEST BECAUSE THE WELL IS LOCATED Gallo ntroduced gallons UNDER THE DECK. ALL STORED WATER WAS PUMPED OUT AND THEN THE TEST WAS RUN. ments/Deficiencies: B. TANK DATA C. LIFT STATION Age of tank(s) years ❑ Required maintenance c4mpiet�8 — "`�— Tank type/material Age o atlon _ y 9 �� � years Measured operating fluid level in septic tank Lift station material ❑ Standpipes/foundation per record drawing Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) Adequacy test date ❑ ALL standpipes present per record drawing Results ❑ Pass For bedrooms Total measured depth from grade ft (max) Fluid depth prior st in Measured depth to pipe invert from grade ft (min) Water ed gal ❑ NIA — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state ew depth in depth into effective Elapsed time min ❑ Code -required soil cover over fiel Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant f eater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) _ Gallo ntroduced gallons If yes, enter date ments/Deficiencies: COSA Checklist yellow sheet 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' N/A Community Sewer Manhole/Cleanout > 100' *50 p Yes if No ft r7 Yes if No ft Neighboring Tank > 100' R/1 Yes if No ft Private Sewer/Septic Line > 25' F --,l Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' [3 Yes Animal Containment > 50' Q Yes if No ft F/� Yes if No ft ❑ Yes if No ft *50 Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Main > 10' [3 Yes if No ft Community s > 200' ❑ Yes if No. Water Service Line > 10' ❑ Yes if No ft If se' tank is under driveway comment below From Absorption Field on Lot to: (Please enter distan Building Foundation > 10' 1771Yes if ft Property Line > 10' ❑ es if No ft Water Main > 10' F-1Yesif No ft Water Serv' ine > 10' [F-1Yesif No ft ace Water > 100' ❑ Yes if No ft less than required) If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No _ Community Wells > 200' ❑ Yes if No _ F. ENGINEER'S COMMENTS PROPERTY SERVED BY PUBLIC SEWER. `HOUSE WAS ORIGINALLY CONSTRUCTED ON LOT IN 1967, IT WAS ASSUMED FOR PREVIOUS COSA'S THAT THE WELL EXISTED PRIOR TO INSTALLATION OF AWWU SEWER MAIN IN 1980. G. ENGINEER'S CERTIFICATION I certify that l have determined through held inspections and review of Municipal records that the above systems are in conformance with pig Hy MOA COSA guidelines in effect on this date. 0( ........ .l• • ,/.............. . COSA Checklist yellow sheet uA. .......�........ VO _Jeff' A. Gorn. ss. - E -. s, -E 7 'S` Opo �� �. • ��. dprofessio�°dam t#AECC884 �n0�pp0�c ft ft ft. ft po=R 'off, 4C usiricT i BfBDM SEMACK BCKL1Tq SETEACK / �� u V \ T \ u'0, O fi 'N p O• C.O.\ \EXISTING y HOUSE \ WELL 68A1 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE LOT SORWY SURVEY TYPE SYMBOLS FOUNDATION AS-BULT SET REBAR ❑ FINAL STRUCn$K AS -BUILT ORAINAGE t ASPHALT ❑ PLOT PUN ... AS -BMT ... LOT SURFEY ... TWOWAPtiY O FOUND REBAR �_e � FENCE :: CCNCRETE AS-BULT .. , o T)nCATM AS- LT ... NO CORNERS SET ASSUMED ELEV. 9 9 0 METAL FENCE ® 11CIOD DECK PLOT PLANS & LOT SURVEYS N0TF IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. CIIRUF'Y r`F'RTTFI(,ATIMI PLOT PLAN I e.•.or _h ewt i naw =1114 �+ + a,. w iW ., .,,e w.awe & th. aM e.ac I na. r.. a a ..wawa a a e» bt Law r =41 '..Mod wm .,b,. non ►.. FOUNDATION AS -BUILT �, Rce.•t.E Ja.r, r_ nawT• oaeY eel l hc.. prkm+.d .n Ar -suet sf W raxd.Um m w, Jot a.1 a AS e„ k -o-d « .ah( n«..L a•. w. a,d ro .nau.atvn.'I Fa ed,( ,na.f aew.:r. FINAL STRUCTURE AS -BUILT L Raul E Wm t„ n«..y.wtrT 0.4 I .a lar m."i.r o o V'.4 ra i cm.,aw sA Wxmoea, .. ,na.. n..,n a, w. a,a na rr:wdma,4. advt uVw AV 49th.. • ';®� ,.:...„. l ROBERT JOHNJ9P R. , • i � ®� °o, -4121—SAV • e'° 5 1 �6 411- roteaalono)'\ sOlcl ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. .FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, ALL DISTANCES ARE RECORD UNLESS OTHERVASE NoTF-n rrepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Wm ANCHORAGE, ALASKA 99504 Scala: _ 30' Ree. lot S.P. Rec. Plat F7e No. 1 "to 'Urycpa: 01/09/15 10-- by. REJ lChacIld IA 1 Date Ororm: 01/09/15 Grid: W,0 SE491 15-010 Lagai Description: Lot 68A-2 TION R9F :QFC'. IR I I.q Ct IRVr=v qnn� Municipality of Anchora On -Site Water & Wastewater Program (907) 343-7904 �4 a. AUG 092016 cle 4, CERTIFICATE OF ON—SITE SYSTEMS AP Parcel I.D. 075-091-10 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent US SURVEY 3043; LOT 68A-2 Expiration Date: 1) 4 0 — i o 131 BEIRNE STREET *GIRDWOOD, AK JASON & CAROLINE LANKFORD Day phone 131 BEIRNE STREET'GIRDWOOD, AK SHARNEE EPLY Day phone 351-0473 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. 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 WaiverNarlance request for N/A Distance: - Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date 8/(0/ id COSA Fee $ 6-24 Date of Payment / - 1S--- 1 s - Receipt , /r Receipt Number &7�`fb& COSA# °SCISM t2 - Waiver Fee $ Date of Payment Receipt Number 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: 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 Municipalityof Anchorage and industry practices. The reported results describe the condition of the systen✓s on the dates of the evaluation. Separation distances were measured to readiiyidenhriable features. Hidden defects or encroachments may exist that were not identified during the evafuation.The operational life or all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (mat may fluctuate during the year), quaf yofconstruction (materials and workmanship), and the water usage of the family razing 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/8; therefore, GEG makes no wanenly (express or implied)regarding the future performance of the well or septic system. GEG makes no representation whether an alternative welt or septic system can be installed on the property in the eventeftherofthe current systems fail The content of this report is fort he sole benefit of the person/pahy who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent pmperty purchasers, is not authorized. In short, GEG disavows any legal duty to anyone otherthan the person/party who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms. System -#2 Approved for bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date £3J'/6 • •,F 6 9 *. PROFESS\. O LICENSE ,,..\...... #AECC884 pY OFq bedrooms, with the following stipulations WAT -SITE ER AND R; WASTEr,NATEH Z: PROGRAM moo: • srmX. By: r -- e The Municipality or Anchorage Develop,emt 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. Original Certificate Date: g)— (.9 —( h 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10/12112) Nitrate Advisory Arsenic Advisory Other 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: US SURVEY 3043; LOT 68A-2 Parcel ID: 075-091-10 A. WELL DATA *PER ARROW PUMP & WELL SERVICE DOCUMENTATION Well type PRIVATE If A, B, orC provide PWSID# Date completed UNKNOWN Sanitary seal (Y/N) YES N/A Well Log (Y/N) NO Wires properly protected (YIN) YES Total depth *73.75 ft.Cased to *40+ ft. Casing height (above ground) 12+ Date of test Static water level Well production FROM WELL LOG AT INSPECTION 12/29/2014 OG/ NG�0�� ft g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate` 4 f g /L. Collected by: GEG, Ltd. 47 ft. 6.0+ g p m Arsenic: N Oug IL 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 Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2orft/bdr System type Length ft Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption ---a_ ft' Monitoring tube_ Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absor• field before test _ in Water added _gal New depth _in. Elapsed Ti � _ min. Final fluid depth _ in Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date Date of sample: 7/22/2016 PUBLIC SEWER D. LIFT STATION Date installed "Pump on" level atin. E. SEPARATION DISTANCES Size in gallons "Pump or level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main N/A N/A Sewer /septic service line 29+ Animal containment areas 50'+ Manhole/Access (Y/N) r alarm level at In Meets alarm & circuit requirements? On adjacent lots 1001+ On adjacent lots 100'+ Public sewer manhole/deanout Holding tank 751+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE PUBLIC SEWER Absorption field Water service line Surface water Property line B OT TO: Water main Driveway, parking/vehide storage undation Water service line Surface water drain Wells on adjacent lots F. COMMENTS *ASSUMED WELL WAS DRILLED IN 1967 WHEN HOUSE WAS BUILT. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date qg ins (Rev. 10/12/12) •��0• LICENSE f���t *****sem• SIAECC884 / / , /4:Ste.kA so,NNN Qv N ' `\sO 6' i. Ntir S0' 00, N. \ o N go o• c vo.\ $ EXISTINGN. HOUSE N. sti N. . �F G� ^• \F�% 68A1 NN MOM= MSC ROpI 'oAv"0T0�ATAxr BIONIC MeV MRO1T PALM SMACK SPX WOW SERIACK KAr UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARYFENCE LINES. THE SURVEYOR TAKES RESPONSIBUTY FCR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. r LOT BAWD* FOUNDATION AS -BUILT BIR ❑ FINAL S1RUCE AS o PLOT PLAN ... AB-dM.T ® AS -BUILT NO SURVEY TYPE SYMBOLS -BUILT ... LOT BURLEY ... TOPOGRAPHY CORNERS SET fl RECERWICA1IQN AS -BUILT NO CORNEAS SET • SET REBAR ° n O FOUND REBAR 4—EI-0 y DRAINAGE t' = � ASPHALT EMU Op FENCE CONCRETE ra ASSUMED ELEV. METAL FENCE F%IlJ WOOD DECK -X--X—R- ... PLOT PLANS & LOT SURVEYS NOTE: GROUND AND VISIBLE WILL BE SIDEWALKS. DRIVEWAYS, LOCATION, ONLY. SNOW FROM BEING SEEN AND LOCATED. UNLESS OTHERWISE NOTED. IT IS THE RESPONSIBIUTY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ONLY THOSE IMPROVEMENTS ABOVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, ETC.. ARE SHOWN IN THEIR APPROXIMATE MAY PREVENT SOME IMPROVEMENTS ALL DISTANCES ARE RECORD SURVEY CERTIFICATION \% 9f.. �*.•.�E•oF• •♦♦ • �P.• ♦ a •.•• ♦• ♦ as „i r . / {L: 9th. l'‘ •: ,• • �, •• ••L .,,;�, ....: ,� •• � .P •• ROBERT; JOHN JR. •••' oir s °: �. ♦♦ s '••. 4121—S 0• se ♦ leer •••••... ay 9.1�1'� ♦i�•ea Al„ •.......... aye .• ��� It% Prepared p by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 PLOT PLAN 1Meow IMapl - Area /bet 1 T y . ex M Imo esti AW ■ awl w r omen haw here . •Masi_•_ of at- s w ammokee me..a bv. tr. Rt FOUNDATION AS -BUILT seri '.. adM vw rely Not I e» = Scale: 1 n = 30' Rec. Lot S.F. Rec. Plat File No. Dote Surveyed: 01/09/15 Drown b: REJ Checked brAK J1V1f.IWN et c xNa. r. IOr..W, ^^'^a�^erl��°� WMWawl Mt!ex Date Drawn: 01/09/15 Grid: SE4913 W.O. 15-010 enw K e tt• Maslow slam FINAL STRUCTURE AS -BUILT L Robert E. AMA Jr.. Mosby Legal Description: Lot 68A-2 T10N R2E SEC 18 US SURVEY 3043 CC ltdnA that.71111:: av true Swan ...M (DMA' Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 075-091-10 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: US SURVEY 3043; LOT 68A-2 131 BEIRNE STREET *GIRDWOOD, AK JASON AND MAGGIE PORTER 131 BEIRNE STREET *GIRDWOOD, AK Day phone 240-8823 SHARNEE EPLEY 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ▪ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request for n/a 3 • Day phone 351-0473 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • Distance: — Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ S-02 ( Date of Payment I //– / C Receipt Number (J1718'&4 6- COSA# d S L /3—/ ) 2_ WaiverFee $ Date of Payment Receipt Number 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 017 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 Address GARNESS ENGINEERING GROUP, Ltd. Phone 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AIC 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: 10 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 listed above. Any reliance upon or use of this report by any other person or parry is not authorized nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for J bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for By. 72 337-6179 r f r A. Garnes-r Q �Oeo, mal VP saCf e 4 ,00 4�,,40Prof essione kiLuttll(1( \l‘{ OF tffrr, ON-SITE m. WATER AND a WASTEWATER oZ to <od PROGRAM O T l bedrooms, with the following stipulations: Original Certificate Date: 1— 2 The Munfe'. ality or orage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) Nitrate Advisory Arsenic Advisory Other 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: US SURVEY 3043; LOT 68A-2 Parcel ID: 075-091-10 A. WELL DATA *PER ARROW WELL AND PUMP SERVICE — SEE ATTACHED DOCUMENTS Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed UNK Sanitary seal (Y/N) YES Total depth *73.75 ft, Cased to *40+ ft FROM WELL LOG Date of test — Static water level — ft. Well production — g.p.m. WATER SAMPLE RESULTS: Coliform (--) colonies/100 ml. Arsenic: N B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Well Log (Y/N) NO Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 12/29/2014 47 ft. 6.0+ g.p.m. NitratJSang./L. Collected by: GEG. Ltd. Date of sample 12/29/2014 PUBLIC SEWER Number of Compartments Foundation cleanout (Y/N) Depression over tank (Y/N) Date installed Cleanouts (Y/N) High water alarm YES *12+ in. Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2orft2/bdr System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption . =a ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absor• '•n field before test in. Water added gal. New depth in Elapsed T min. Final fluid depth in. Absorption rate >= g.p.d. 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 : High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main *50'+ Public sewer manhole/cleanout *501+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Properly line Absorption field Water main Water service line Surface water Wells on adjacent lots PUBLIC SEWER SEPARATION DISTANCE FROM ABSORPTION FIELD • •T TO: Properly line Buii•'. : •undation Water main Water service line Surface water Driveway, parking/vehicle storage Cu ' rain Wells on adjacent lots F. COMMENTS *ASSUMED WELL WAS DRILLED IN 1967 WHEN HOUSE WAS BUILT G. ENGINEER'S CERTIFICATION 1 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 (Rev. 11/05) +p0o VA ness: E-7953 QQO professioi o0 PROPOSED FMRe RoOR BAv. Mme) PROPOSED BaaNa abase: MEV. (ASSAM) FRONT BUILDING SETBACK SIX a.MIC That REAR BUILDING mac UNDER. NO . cu.f- r: NC.:2 SHCCLC AN AS EUfLT BE USED FCR cats- UCDCP CR FCR ESTABLISHING BOUNDARY LIR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE $)RVEY. ISSIED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. L LOT SIRYEY ❑ FOUNDATION AS -BUILT ❑ FINAL STAUCIURE AS -BUILT 0 PLOT PLAN ... AS -BUILT ... LOT SLRVEY ... TOPOGRAPHY A AS -BUILT ... NO CORERS SET 0 REGERTIRCATION AS -BUILT . SURVEY TYPE 0 C0Rt4 S SET 0 DD II oryIea SYMBOLS `� SET REBAR w DRAINAGE FOUND REBAR g._o 0 WOOD FENCE ASSUMED ELEV. X X X METAL FENCE /fr11 ASPHALT CONCRETE WOOD DECK PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION PLOT PLAN I b.eby ..un Ma I Hew ob)eIay eew$a tlx IM Stem end CFV W Moan. aW NW I taw roma eF uveas s x the w maws isham sae •am am pus w F. . bort • lily me3.ye me dlSa a aMoubne Ma bat twang we and mlct. FOUNDATION AS -BUILT 1. Rabat E Alam A.. MFMy atfr Mat f haws "a� aaa. M anopW. as Menaotlan or Kam Masan an bus and no 3110 1.mb ewe ober` Nam -M.a4 FINAL STRUCTURE AS -BUILT I, Robert E Mom Mammas a.Wy that 1 M s yaMaM m M-e.R* any N Y Ottawa a1 sob. let .w that a M. amnion as M'a11Man m mem Sam Lord a,.. -.a .a .,scow,.-, Prepared by 'obert L. Johns, Jr. & Assoc. Professional Land Surveyors 1700 &ink Drive, ANCHORAGE, ALASKA 99504 Stole: 1" = 30° Rec. Lot S.F. Rec. Plat File No. Date Surveyed: 01/09/15 Drawn bY• REJ Checked by: .i lK Date Drawn: 01/09/15 crld: SE491 ° "°' 15-010 Legal Description: Lot 68A-2 TJ nit a'Y rt. et. ern F In r'YI afle /r\/ nn Af :• 09/15:2014 05:22 907-345-0202 $ - AAROIi! PUMP &WEE[ SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 • Fax (907) 345-0202 Eagle River: (907) 622-9335 ALPINE DRILLING PAGE 01/01 la 69'3 L 9�4/C i 9s. 27 .27 J06 SITE 6!S Scs.,As7 3®4� No. 10316 ic,4_2 nt, J L7rr3— INVOICE DATE II /-3 1 S _ _•-- WELLDEPTH 8WLl ry It CHLORINATED PUMrDEPhl Z f • `( _Y �/ // �/ (' I i pyo-rses--.. SALESPERSON,Y, :tQUANTiTY :_: ��i1; ��% �. .. 5'�r nr..v ��v //vim -t 1y •C , kyr t�07 —. fI Nrl/L Zj p ' iv�Y m� LABOR HOURS HATE AMOUNT TOTAL MATERIAL TOTAL LASOR WORK ORDERED BY TOTAL LABOR '1 PAY THIS AMOUNT S/O Thank You SIGNATURE. .13 J24 (i Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that If above work is riot paid for in 90 days j agree to allow Aarow Pump & Well Service, LLC, the right to remove unpaid for equipment and charge for labor already performed & 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. j smio•la —x le n o YO'I7e✓'hve a Js P 6 6