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HomeMy WebLinkAboutT13N R3W SEC 33 LT 25 S PTNOnsite File !iection ® Municipality of Anchorage On -Site Water and Wastewater Program < (907) 343-7904 5 ., Fc T Y Certificate of On -Site Svstems Approval Parcel I.D. 008-051-14 1. GENERAL INFORMATION: Expiration Date: ^ 36 — Z� Complete legal description T13N R3W SECTION 33: LOT 25 S PTN Location (site address) 4530 Grumman Street *Anchorage Current Property owner(s) Southcentral Foundation Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 5 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: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .2 W Date of Payment 2-2G z 1 Receipt Number 03"2- (9 Z G COSA# 21113% Date: 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.- 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 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 Date: Conditional approval for bedrooms, with the following o� 0I .... ........ e fr y H. cu ss: t (� ! CE 70 3 G ECC884 �llll`l(�`i0F K�� ON-SITE m WATER AND to,atllkSTI. /V ATER o PROGRAM JJJJ Original Certificate Date: Z-30-2/ 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. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: T13N R3W SECTION 33 LOT 25 S PTN Parcel ID: 008-051-14 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1972(?) Total depth *35.6+ ft Cased to UNKNOWN ft Al Sanitary seal is functioning correctly Fil Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/25/21 Static water level at beginning of test 31.1 ft Comments" B. TANK DATA >operatin tank(s)years rial tin evel in septic tank oundation cleanout per record drawing D. ABSORPTION FIELD DATA Well production at time of test 3.1+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No Fil Coliform bacteria is Negative Nitrate 0.757 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Fil Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 2/25/21 � • I 1 _ 1 C C. LIFT STATION ❑ Required maintenance com Age of lift station Lift station materi Comme Which system tested (date installed) Adequacy test date ❑ ALL standpipes present per record drawing Results ❑ Pass For edrooms Total measured depth from grade ft (max) Fluid depth prior tot in Measured depth to pipe invert from grade ft (min) Water ad gal ❑ N/A — pressurized field depth in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective ❑ Code -required soil cover over field 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) Ga introduced gallons If yes, enter date mments/Deficiencies: AWWU SEWER 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' ❑ Yes if No ft Q Yes if No — Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No _, Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑✓ Yes if No _ Neighboring Absorption Fields > 100' EJ Animal Containment > 50' ❑✓ Yes if No Q Yes if No ft ElYes El _ ft If sep ' nk is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ❑✓ Yes if No_ 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' 1771Yes if No ft Private Wells > 100' Yes if No Water Main > 10' EJ if No ft Community W > 200' CEJ Yes if No Water Service Line > 10' ElYes El if No ft If sep ' nk is under driveway comment below From Absorption Field on Lot to: (Please enter distanc_�Iess than required) ft ft ft ft ft ft ft ft 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 *ASSUMED - AWWU CLEANOUT ON E 46TH AVE. COULD NOT BE FOUND (SEE ATTACHED AWWU RECORD DRAWING). **NO REQUIRED SEPERATION AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION I certify that 1 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. 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