HomeMy WebLinkAboutHOLLYS HOLLOW LT EOnsite File
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Holly 1 5 Hollow
Certificate of On -Site Systems Approval
Parcel I.D. 075-061-39
Legal description Holly's Hollow Lot E
Site address 126 Iris Pond Circle, Girdwood
Current property owner(s) William Russel
Expiration Date: 1-26-2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By �-- Original Certificate Date: 16
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
MUNMPAUTY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 075-061-39
Complete legal description HOLLY'S HOLLOW; LOT E
Location (site address) 126 Iris Pond Circle *Girdwood
Current property owner(s) William Russel
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 230-1148
3. TYPE OF WATER SUPPLY: ❑■ 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
❑ Holding Tank ❑■ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
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 $ A 00 , -t I � O Kv�aiver Fee $
Date of Payment i O la u. /, a a Date of Payment
COSA # %3 9 1,5 -11 Waiver #
0- Oct �0-�3(-)
COSA AppllwBon June 2022
Legal Description: HOLLY HOLLOW; LOT E Parcel ID: 075-061-39
If more than 1 well and/or septic system on tot, provide separate checklist. Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled PRE 1983M Total depth *50 ft
Well production at time of test 5.0+ gpm
Water storage tank volume N/A gallons
Cased to 50+ ft Well disinfected for coliform test? ❑ Yes ❑ No
❑ Sanitary seal is functioning correctly On Coliform bacteria is Negative
On Wires are properly protected Nitrate 4.88 mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) 18+ in. Arsenic ug/L ❑ Arsenic less than MRL (ND)
Date of flow test for COSA 9/20/22 Collected by GEG, LTD
Static water level at beginning of test 37.8 ft. Date 9/20/22
Comments *PER AWPS CAMERA INSPECTION (RECIEPT ATTACHED) ON 10/13/22
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 fi not used for more
than 30 days prior to date o est)
Gallons introduced gallons date
Any rejuvenation tre ent (past 12 months)
If yes, enter to
COSA Checklist June 2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy to ate
Result Pass
Flui epth prior to test in
ater added gal
New 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
cv-
L-.
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' ( Community Sewer Manhole/Cleanout > 100' ❑Yes if No N/A ft ❑Yes if No 50+ ft
Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *5+ ft
Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' QYes if No ft
Ful Yes if No ft
Manure/Animal Excreta Storage > 100'
® Community Sewer Main > 75' [:]Yes if No x`50+ ft 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 th r • red)
Building Foundations > 10'
❑ Yes if No ft
Surface Wate _ ❑ Yes if No ft
Tank to Property Line > 5'
❑ Yes if No ft
ells on Adjacent Lots:
Field to Property Line > 10'
❑ Yes ft
Private Wells > 100' ❑ Yes if No ft
Water Main > 10'
❑ Yes if No ft
Community Wells > 200' ❑ Yes if No ft
ervice Line > 10'
❑ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*AWWU SEWER MAIN CONSTRUCTED PRIOR TO 8/10/79. CONNECTED TO PUBLIC SEWER ON 8/10/79,
SO IF WELL WAS DRILLED BEFORE 1983, THEN NO SEPARATION DISTANCE IS REQUIRED.
**MET CODE AT TIME OF INSTALL IF WELL WAS INSTALLED PRIOR TO 1983.
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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Gamess 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 fife 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.
COSA Checklist June 2022
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EASELIENTS OF RE CORD. OTHER THAN ;---------
THOSE SHOWN ON THE RECORDED � FRED WAL4-KA & ASSOCIAi ES, 1 -.LC
PLAT ARE NOT SHOWN HEREON'� ! Engineers and SUrve,asrs
UNLESS OTHERWISE i:CTED. FB 22-' pg 7" b _ i007 -248-143r,,6
This drawing is a r_prasenG?tion of corl0tions f✓ nd at the time !rice morgage ioraVon survey was per-I'Dn"ed. il,is decur-l; nt dceis net ca;rstrtUte a tulundar;
survey and is subject, io any ina .cura.'es thai a subseguerit bounder, survey may oisclose. The alio-i- ration G;nt2inAd On This c>ravatig :..hall nut be U5edt it
establish any fence. structs_ or other miprove^.eras. This drarnmg shpli only bti i'ed f^r ti single prop ir+y L ailsaction. Use Of this dTa"'ving by tr e nriginal
clieC.t cr by ethers at a taic.r d=,ic hi h.^:,E the cancyrt a' Elizanem L 'r'�ata�;<: is a vioian'cn of rederal . epi ht taw Lr:less rrosS ne*'inence is discovered.
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Dated at Artchorage, A!ask a
1 this St h daypf September,
EASELIENTS OF RE CORD. OTHER THAN ;---------
THOSE SHOWN ON THE RECORDED � FRED WAL4-KA & ASSOCIAi ES, 1 -.LC
PLAT ARE NOT SHOWN HEREON'� ! Engineers and SUrve,asrs
UNLESS OTHERWISE i:CTED. FB 22-' pg 7" b _ i007 -248-143r,,6
This drawing is a r_prasenG?tion of corl0tions f✓ nd at the time !rice morgage ioraVon survey was per-I'Dn"ed. il,is decur-l; nt dceis net ca;rstrtUte a tulundar;
survey and is subject, io any ina .cura.'es thai a subseguerit bounder, survey may oisclose. The alio-i- ration G;nt2inAd On This c>ravatig :..hall nut be U5edt it
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clieC.t cr by ethers at a taic.r d=,ic hi h.^:,E the cancyrt a' Elizanem L 'r'�ata�;<: is a vioian'cn of rederal . epi ht taw Lr:less rrosS ne*'inence is discovered.
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ANCHORAGE WELL & PUMP SERVICE, INC.
7640 KING STREET Invoice
ANCHORAGE, AK 99518
a{ PH. 907-243-0740
Invoice #: 20222869
Bill To:
Bili Russell
Box 428
Girdwood, AK 99587
Ship To:
Bill Russell
JOB: 126 Iris Pond Cir
Girdwood, AK 99587
SALESPERSON
YOUR NO.
SHIP VIA
COL
PPD
SHIP DATE
TERMS
DATE
PG.
TYLER S RIDGWAY
35123
Net 30
10/13!2022
1
TY.
I ITEM NO.
DESCRIPTION
PRICE
DISC %
EXTENDED
TX
PRICE
1
Service Call
CAMERA WELL FOR DETAILS
1
Field Service
10/12/22 - Check system. Camera water well,
$387.00
$387.00
gather information on pump set depth, static
water level, total depth of hole, pitless
adapter depth. Install customer provided
sanitary code well seal with conduit. System
ok.
WELL DIAMETER 6"
WELL INTAKE OPENING TYPE - OPEN
END
PITLESS ADAPTER @ 10' TOC. PITLESS
APPEARS TO BE IN GOOD CONDITION
STATIC WATER LEVEL @ 38' TOC
BOTTOM OF WELL @ SO' TOC
NO VISIBLE PERFORATIONS IN CASING
APPEARS TO BE A TRUE AQUIFER WELL
PUMP SET DEPTH @ 46' TOC
CASED TO BOTTOM OF WELL WITH
STEEL CASING
1
ST5-Tyler
Service Tech
1
ST19-Randy
Service Tech Helper
1
CAMERA
WELL CAMERA
$400.00
$400.00
2
FIT-ELC-CND-ENT-2
CONDUIT ENTRANCE -2" ELECTRICAL
$20.00
$40.00
1
FIT-ELC-CRL-MAD-1
MALE ADAPTER -1" CARLON ELECTRICAL
$3.00
$3.00
We appreciate your business. Thank you?
SALE AMT.
$830.00FREIGHT
$0.00
SALES TAX
$0.00
TOTAL AMT.
$830.00
PAID TODAY
$0.00
BALANCE DUE
$830.00