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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 8 LT 11'-� Municipality of Anchorage ° On -Site Water and Wastewater Program (907) 343-7904 5`A F C t Y. Certificate of On -Site Systems Approval Parcel I. D.019-102-14 1. GENERAL INFORMATION: Expiration Date: g12-1 /Z ( Complete legal description SKYWAY PARK ESTATES; BLOCK 8, LOT 11 Location (site address) 1520 SHORE DRIVE *ANCHORAGE, AK Current Property owner(s) Mailing address Real Estate Agent Day phone GORDON SLOAN Day phone 907-313-7966 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 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 WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ZW Date of Payment 9 —� Receipt Number COSA # SGZ I ) 2 I Waiver Fee $ Date of Payment Receipt Number Waiver # (A 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 (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 System #1 Approved for _� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, #AECC884 c0Ft<<������( ON-SITE with the followeg stipt i�i� AND a WAST WA oz m By: Original Certificate Date: Z 1 2 The Municipality of Anch ge 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 Legal Description: SKYWAY PARK ESTATES; BLOCK 8, LOT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 71311987 Total depth 62 ft Cased to 56 ft Q Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/7/21 Static water level at beginning of test 43.1 ft Comments AWWU SE WER B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date 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 Parcel ID: 019-102-14 Structure served by this system Well production at time of test 6.4+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Q Nc 01 Coliform bacteria is Negative Nitrate `l mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 'Arsenic less than MRL (ND) Collected by Date of Sample 5/6/21 C. LIFT STATION ❑ Required maintenance Age of lift station Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in (min) Water added gal ❑ Monitor tubes go to bottom of ective. If not, state depth into effective New depth in Elapsed time min ❑ CZ d soil co over field Final fluid depth in ❑ Soa Absorption rate gpd (Reqfor greater than 30 days prior to Any rejuvenation treatment (past 12 months) date If yes, enter date Guced gallons Comiencies: 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' NSA Community Sewer Manhole/Cleanout > 100' ft ❑ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *34' ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' if No Animal Containment > 50' Yes if No ft Q Yes if No ft if No ft If se ' ank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [ZI Yes if No ft M 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 ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' F-1 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ❑ Yes if No ft Community s > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If se ' ank is under driveway comment below From Absorption Field on Lot to: (Please enter distant less than required) Building Foundation > 10' ❑ Yes if ft If absorption field is under driveway comment below Property Line > 10' es if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Se ine > 10' ❑Yes if No ft Community Wells > 200' ❑Yes if No ft ace Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS *PER 2006 COSA BY CINDY W. ELLIS, PE G. ENGINEER'S CERTIFICATION OF I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with O q TI yam' MOA COSA guidelines in effect on this date. �....:'. , .. - .. i .. , , ,. , , - , , ; - - - COSA Checklist yellow sheet J ff±' Gar — hess. CE79 3 see 5F .. o �� d��. e .�� o 0,a pro f e s slo�000 #AECC884 p,. ? c.;, () ~.1 :J!; ]. ~) [ I}i',J",l I:i D ' I STATE OF' ALASKA DEPARTMENT OF NATURAL RESOURES Oivlsion of Geological ~ Geophysical Surveys ~uNiCiPAU~ nF ANCHOIAGB -- .~0 ft. ~lter~. hr,. pumpl.~ ~.p.m. DEPT. C ~EAL~H & ~f ofler ~.hrs. pumpln~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMA'rlON (MUST BE COMPLETED PRIOR TO SUBMITTAL) {a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner '~.~'e ~d~ev~,.5 Mailing Address. ~ ~ ~'~ '"'~¢ (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone: Home _Telephone Business 3/ Telephone (e) Mail the HAA to the followina address: or: Check here~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public/~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 fRev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below1 I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~O~.S..~, --t~.4~'f'~;, ,.-~c..- Telephone _ Date ~-~ O- ~? ¢ ,-.. :.' Engin,eer'e -Seat · ; .,;:;,, -.., :.'* , · DHHS APPROVAL Approved for m/~c'"'~ 6'"~_ bedrooms by Approved u'~' Disapproved Conditional Terms of Conditional Approval Date /~-/- :~ '7- CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paregraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 fRev 8,861 Back MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALI1;' OF/~NCHo2H~ALTH AUTHORITY APPROVAL (HAA) I~NVI?,ONMI N1AL SLk'¢I!~:S D ..... I/I-,k)~¢HE(,,KLIST - FEBRUARY 1984 264-4720 r';! ,, .: o ]987 L II WELL DATA L ~e~g al Description: Well Classification "~ Well Log Present (Y/N) Total Depth ~ Static Water Level _ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) / Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed 7~ '~'--~7 Yield Depth of Grouting Purr p Set At ~O ' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~u~,fzc 5.~.~e ~-'; On Aaioining LOtS / To Nearest Edge of Absorption Field on Lot ,4.///,,~ , On Adjoimng Lots '¢' /~¢ · To Nearest Public Sewer Line ¢'/¢ ~" To Nearest Public Sewer Cleanout/M~mhole ¢'/¢~ ' To Nearest Sewer Service Line on Lot ¥. Water Sample Collected by ~¢. ~ Water Sample 'rest Results ~.,~..-.-.~¢~.,~ ¢-o.,~ -- Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ Separation Distances from Septic/Holding TanK: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Comoartmen£s Air-t ght Caps (Y/N) Foundation Cleanout [Y/Nj Date Last Pumeed ; for _ Temporary Holding Tank Permil (Y/N) To Building Foundation To Disposal Field To Stream Pond, Lake. or Major Drainage Page 1 of 2 72-026(11/84} C. ABSORPTION FIELD DATA - /,/'07 ~"'5~'.~ Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance lrom Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~/~ O/~/~ ~/ /,5' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION -- ,4/07" Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t .~ ,~ e,,~,~,,~_, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Receipt No. ~--~ O/ ~ O O ~ ~ Date of Payment ~- 3 O-- ~ 7 ':': Amount: $ ~ ¢ O Page 2 of 2 ': :' NE)R'EHEHN TESTING LAB0 :U-tTOR ES, INC. 600 LINIVEI~SlTY I~I_AZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115 2505 I:AIRSANI(S STFIEEiT ANCHORAGE, ALASKA 99503 90L277-O378 Quality Control Report Client: Constructing Engineers ID~: A092487-8 Listed below are quality control assurance reference samples with a known concentration prlor to analysis. The acceptable limits represent a 96% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at ];he same time as your sample, ensuring the accuracy of your results. Sample# Parameter Unit Result Acceptable Limit EPA WS378-6 Nitrate-N mg/L 0.93 0.84 1.02 = ..... ====== ~ ~/~~rriSOn =vice_president~~ , .... ====== ..... === ......