Loading...
HomeMy WebLinkAboutUS SURVEY 3044 LT 37 W99' MUNICIPALITY OF ANCHORAGE o Development Services Department - Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 075-061-08 Expiration Date: Legal description US SURVEY 3044 LT 37 W99' Site address 147 GLACIER CREEK DR Current property owner(s) BROKAW DANIEL A &BASHAW ERIN K XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: 11/14/2023 bedrooms, with the following stipulations: By: v" Original Certificate Date: 8/14/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 UP-41CIPAUTY FmCHO §CRE Development Services Department `, Phone: 907-343-79104 On -Site Water & Wastevvater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 075-061-08 Complete legal description US SURVEY 3044; LOT 37W 99' Location (site address) 1893 AlyeSka Highway *Girdwood Current property owner(s) Dan Brokaw Day phone 540-2337 2. ON-SITE SYSTEMS SIZED FOR �• BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units q,0 I rl 23 ❑ Holding Tank 11191 Community Septic or Public Sewer 5. SEPTIC TA ❑ St el El Plastic El Concrete 171 Fiberglass Age See advisory if steel older than 20 years 6. ABS P ION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2, Waiver Fee $ Date of Payment 7/Z O/Z —Z, Date of Payment COSA # 0 12- GWaiver # COSA Application—June 2022 R�•��SF./i � i�II COSA Checklist Legal Description: US SURVEY 3044; LOT 37W 99' Parcel ID: 075-061-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or atta ed Date drilled "PRE 1970 depth *38.5 ft Cased to UNKNOWN ft Sanitary seal is functioning correctly ;RWires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/12/23 Static water level at beginning of test 36.2 ft. Comments *PER GEG TESTING **PER MOA RECORDS B. TANK DATA Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or fiel of used for more than 30 days prior to date of t) Gallons introduced gallons date Any rejuvenation tre ent (past 12 months) If yes, enter to COSA Checklist June 2022 Well production at time of test 5.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes M No n Coliform bacteria is Negative Nitrate 0' ('o �mg/L [:]Nitrate less than MRL (ND) Arsenic ug/L ❑Arsenic less than MRL (ND) Collected by GEG, Ltd. Date 7/12/23 4" DIAMETER WELL CASING C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ass Fluid de prior to test in W r added gal ew fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in f`,' E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No NSA ft Community Sewer Manhole/Cleanout > 100' M Yes if No ft Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *UNK ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' ❑i Yes Community Sewer Main > 75' FmFl Yes if No ft if No ft Animal Containment > 50' [E Yes if No ft Manure/Animal Excreta Storage > 100' Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required fes Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Adjacent Lots: Field to Property Line > 10' ❑ Yes if ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ❑ Yes if No ft Wa Ice Line > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *NO REQUIRED SEPARATION DISTANCE AT TIME OF INSTALL (PRE -1982) G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gayness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gayness 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 o6Q� O practices. The reported results describe the condition of the system/s on the date/s of the evaluation. o�OF Separation distances were measured to readily identifiable features. Hidden defects or encroachments may v exist that were not identified during the evaluation. The operational life of all wells and septic systems depend �oP� . • G� upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate Q during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing Q� 49 the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not • • . • • • • • • • • • . • • ... • 3uarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardin t 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 e r Gorn es G adequately in the future. The content of this report is for the sole benefit of the persontparty that retained GEG �Q?o CE-7� 5� z p to perform the evaluation. Reliance upon the information provided in this report by any other person or party Q 9 ;ce4 (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. LICENSE a �� rofess+ o COSA Checklist June 2022 4AECC884 0400�0�� ? 9d w C3 Uj Ar Co AL # �� o NS AW x l!? GZ AV tn Ln ni. N ..: 4* �w r •.# a r- e a s W m 4- tv C) LO 441C� co40 Ln I 9 ul U- uj +. J +mD W uju ► Va X ?z uj .r > 0 w 9 uj f%i uj e --i ~ 3 �- 3 0 v �v © a c a to me a UJ I.- w -- w w ��+wa ir LA- vV) M - UJ m tau U. r- 0 u d � < Lu a -i in z� LL !E uj uj W�<M4wW c ; CL 9L v' s % 362.74' N 23'36'00' W CREEK co 44 . Iq .4 .4W 23.A 32.3` .8.3' a Com! GRAVEL M►E 4 , 40 a 4. 4 f° 4 20 362.74` N 23.36,00" W w C3 Uj Ar Co AL # �� o NS AW x l!? GZ AV tn Ln ni. N ..: 4* �w r •.# a r- e a s W m 4- tv C) LO 441C� co40 Ln I 9 ul U- uj +. J +mD W uju ► Va X ?z uj .r > 0 w 9 uj f%i uj e --i ~ 3 �- 3 0 v �v © a c a to me a UJ I.- w -- w w ��+wa ir LA- vV) M - UJ m tau U. r- 0 u d � < Lu a -i in z� LL !E uj uj W�<M4wW c ; CL 9L v' +t ,'tt+1 PROJECT JOB NO. PAGE ~ [-. Oo~ L-., c, ~ DATE DATE ~o l~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~ ~ ~){O~ - ~)~ HAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my sea[ affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address Engineer's signatu _ DHHS SIGNATURE ' "' -'~' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ~'- 2/- ~'..~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 72-025 {Rev. 1/91} Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I,D. A. WELL DATA Well type t~ t~-~ Log present (Y/N) Total depth /~t Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number ~/Ct I~ ~ Date completed Oh~L/'-~[o~'~.l · Driller I)~[ I~.l,.J~ u.~.~ Casedto VD ~ Casing height [~.l, FROM WELL LOG Wires properly protected (Y/N) Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot IkJ/ field on lot Absorption Public sewer main Sewer service line g.p,m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~/'~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA ~/~ Date installed Tank size Compartments Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line On adjacent lots Absorption field Foundation Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE: C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Width ' Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTrON FIELD TO: Well on lot To building foundation On adjacent lots Surface water Surface water Curtain drain Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for System type Total depth If yes, give date bedrooms On adjacent lots Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signatur~ ~--~ _~_ I,.......~_.. Engineers Name Date HAA Fee $ ? 7 Date of Payment Receipt Number 72-026 (Rev, 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number