Loading...
HomeMy WebLinkAboutJACKSON'S CORNER LT 1Onsite File • '~� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 008-051-A' ,`k Expiration Date: 1. GENERAL INFORMATION: Complete legal description Jacksons Corner, Lot 1 Location (site address) 4510 Grumman Street *Anchorage, AK Current Property owner(s) Brian & Kandy Broderick Day phone 907-748-4900 Mailing address Real Estate Agent 4510 Grumman Street *Anchorage, AK 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 WaiverNadance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ I `I 5 Date of Payment Receipt Number COSA# ()SCS)'1 a7 8 Waiver Fee $ Date of Payment Receipt Number Waiver # 0A 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 IGNATURE System #1 Approved for -Z bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fo f I !� 1.2-1 �Wjrlffl r A. �:. ..�5.'.. ... ' E-7953 �1�aFr0tessic #AECC884 0))))))11111 Original Certificate Date: n —� 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: Jacksons Corner, Lot 1 Parcel ID: 008-051-15 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) Well production at time of test 2.6+ gpm Date drilled 1969 ? Water storage tank volume N/A gallons Total depth *120 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to *62+ ft 0 coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L 0-11itrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L tW'Arrsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, Ltd. Date of flow test for COSA 1/28/21 Date of Sample 5/25/22 Static water level at beginning of test 41.7 ft. Comments *Per AWPS receipt in MOA records dated 7115/08 B. TANK DATA C. LIFT STATION Age of tank(s) years ❑ Required maintenance Tank type/material �Ae�f.1i€t s iot�F — years Measured operating fluid level in septic tankl. -- Lift station material ❑ Standpipes/found efe2i'out per record drawing Comments: Date-af'�umping D. ABSORPTION FIELD DATA Which system tested (date installed) El 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 ❑ Monitor tubes go to bottom of effective. If not, s depth into effective ❑ Code -required soil cover over fi ❑ System presoaked (Required if vacant reater than 30 days prior to date of test) Gall introduced gallons COSA Checklist yellow sheet Adequacy test date Results ❑Pass r bedrooms Fluid depth r to test in added gal New depth in Elapsed time min Final fluid depth in Absorption rate and Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes Septic Tank/Lift Station on Lot > 100' n�a Surface Water >' 100 _ Community Sewer Manhole/Cleanout > 100' rl Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No n/a ft Holding Tank > 100' S✓ Yes if No ft Neighboring Absorption Fields > 100' Communit ells > 200' ❑ Yes if No ft Animal Containment > 50' E✓ Yes if No ft 0 Yes if No ft AWWU Sewer Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' S Yes if No ft P 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 N ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ❑ Yes if No ft Communit ells > 200' ❑ Yes if No ft Water Service Line > 10' ❑Yes if No ft (f se ' tank is under driveway comment below From Absorption Field on Lot to: (Please enter distan if less than required) Building Foundation > 10' ❑ Yes if ft If absorption field is under driveway comment below Property Line > 10' s if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Servic ' e > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Su e Water> 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS AWWU Sewer G. ENGINEER'S CERTIFICATION o� OF 1 certify that l have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. „ _ • . , , . ff y A. ness,, OQ49, E-79 3 `� COSA Checklist yellow sheet 440 p iii �o 0 a \ o ��_rofessio _o #AECC884 O ® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 008-051-15 Expiration Date: 1. GENERAL INFORMATION: Complete legal description T13N R3W SECTION 33, LOT 25 Location (site address) 4510 Grumman Street *Anchorage 99507 Current Property owner(s) Southcentral Foundation Day phone Mailing address Real Estate Agent 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 $ 280 Waiver Fee $ _ Date of Payment 2 6 0? d� Date of Payment Receipt Number 0 5 2 2 G Receipt Number COSA # OSC211044 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 hype 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 descrioe 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 systemis; 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 _0 System #1 Approved for .3 bedrooms System #2 Approved for Disapproved Conditional approval for la bedrooms bedrooms, with the foll #AECC884 OF ON-SITE WATER AND �'-- tigP)AVPsVV`ATER �. PROGRAM ,1j"V1_1SER\1,V fill - Original Certificate Date: z. - 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 omis: ions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: T13N R3W SECTION 33, LOT 25 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1969I?I Total depth x50.4+ ft Cased to UNKNOWN ft FE -1 Sanitary seal is functioning correctly [®j Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 1/28/21 Static water level at beginning of test 41.7 ft. Comments 'PER GEG INSPECTION B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid levet in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Parcel ID: 008-051-15 Structure served by this system Well production at time of test 2.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes A No Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic ug/L MArsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 1/28/2' LI -Z Ji /7" C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material 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 (ma Fluid depth prior to test in Measured depth to pipe invert from grade ft (min) Water added gal ❑ N/A — pressurized field ❑ Monitor tubes go to bottom o ective. If not, state New depth in depth into effective Elapsed time min p ❑ Code -required soil er over field Final fluid depth in ❑ System pres ed Absorption rate gpd (Required if ant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of t G ons 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' N/A if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25' 0 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' ❑ Yes if No Animal Containment? 50' 0 Yes if No ft M Yes if No ft if No ft ,I- 'Nf se ' ank is under driveway comment below 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 fit Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ 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 ,I- 'Nf se ' ank is under driveway comment below (—V From Absorption Field on Lot to: (Please enter distant if less than required) Building Foundation > 10' ❑ Yes ifW 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 ' Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft race Water > 100' ❑ Yes if No ft F, ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION w� CiF 1 certify that l have determined through field inspections and review �d�� • j " . `i - t of Municipal records that the above systems are in conformance with Q p� MOA COSA guidelines in effect on this date. 7.1 . ....... ........ CE 7,19p • r_G' �� FF COSA Checklist yellow sheet'T'o f ess+ono ..AECC884 ���Qa`�� (1 J, N 6 D N D -- N = 0 0 j z > C) -tom m m ? Z o � D> D C � = D N a Z r� � C ;00 a n z z O� -C m C D m N CO ;q >c CO CD r 07r D> W om 0 -i D Ni n c f sm 07 p 3 S x NCO m t0 • .p« ®? tD r C Orn noo 13 «0 Z W CO O p 7 Z co =rp,oz Do a. -o Cn pn0 Ln Zi CD m CDp°�C 3 ,o t°mU3o�j -00 •'C 3 _ S�Aro rrl C_p. �so02;0m O 3 _am" oo�o000004 m -i =� m 0 v p o" m p �z vr9 0 03-0 Zo�c�o0-0 � maa�m Daa,D :tQ 4�O rt OL pm 1 .fr -, . ©=< m Z p c w O m N X- (_ a53Ka moaw� rn:` - N) Q Q m o�oo mwov �j OD (A Da� fA to 7 3�"' OO '�W �• � o Cr 0 DO l Qa m o �n mo o 007 _a N': Q to m p: C C ('• 0 a 44 s •. ��'J\(\� y rn m np.pm Q.Z7m 4GlL ••••. • f J y 00 =5 3 CLOD C7 Z �m p o � gym`° a m> f 0 0 i m < z= Z 'ovzo r,0co LL GI 2 0 o A ZI n m O Z I I r` a m W Ln D I l m z n y\ 0 W �® r-- r z W I x a n I I o ? a Om ' ^ x 0 v, ( z Z N p. x Z�u o 0 GRUMMAN STREET M0Dr 1 m m -< 0 pr -0 .Zrn1DZ I z 33' Co X 18.0 z tO 24.0 ITl -P 0 cn O `'- D Z C m jt — 3L4XJ —