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HomeMy WebLinkAboutPETTIS LT 2Pettis Lot 2 #016-211-17 1 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 016-211-17 Expiration Date: 1. GENERAL INFORMATION Complete legal description PETTIS; LOT 2 Location (site address) 110 PETTIS *ANCHORAGE, AK Current Property owner(s) TIM WELBY Day phone Mailing address 110PETTts ___a_c yK ^ Real Estate Agent TIM KELLY Day phone 632-6205 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: Individualell ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver/Variance request for: N/A Distance: - Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5�.2 (7 f �l5'6///. % 0 Date of Payment 9 -!I - Receipt Number Z /V �+f COSA # r , Waiver Fee $ Date of Payment Receipt Number 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 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. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101, Anchoraoe AK. 99507-3246 f Engineer's Printed Name Jeffrey A. Gayness Date c1 /70�i 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 systems 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 on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality ofconstruction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; 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. The content of this report is for the sale benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIGNATURE _Z System #1 Approved for bedrooms in ON-SITE WATER AND System #2 Approved for bedrooms O WASTEWATER Oz � PROGRAM �� Disapproved Conditional approval for bedrooms, with the following stipulati�`y4� SE`G�SO�\ Original Certificate Date: t_" I —/ ok The Wunioipal/6# 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 9-1-12.dm If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: PETTIS, LOT 2 Parcel ID: 016-211-17 A. WELL DATA ji/ pf=Q- ID/30) 861 WL£iP7 F'zw �,oawSost pf4�c��it. it-( Hoa 9-r--cortoS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed UNK Sanitary seal (YIN) Wires properly protected (Y/N) _yf Total dept 61'4" g. Cased toy 61'4" ft, Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/31/2015 G Static water level �L LO ft, 12 ft NG Well production g.p,m. 2.12+ g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate , `63 mg./L. Collected by: _GEG. Ltd. Arsenic: "U ug./L. Date of sample: 8/31 /2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material PUBLIC Tank size gal Number of Compartments Foundation cleanout (YIN) _ Depression over tank (Y/N) _ Date of pumping C. ABSORPTION FIELD DATA Pumper. Date installed Soil rating (g.p.d./ftaor Length Width Date installed Cleanouts (Y/N) High water alarm System type Gravel below pipe ft. Total depth ft. Eff. absorptio a— ft' Monitoring tube_ Depression over field Date of adequacy test Results (Pass/Fail) For—bedrooms Fluid depth in absor n Feld before test _ in. Water added —gal. New depth _in. Elapsed T' : min. Final fluid depth _ in. Absorption rate >= g,p.d, rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump ofi level at—i . High water alarm level Cycles tested Meats alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/deanout 100'+ Sewer/septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: PUBLIC Building foundation Water main Wells on adjacent lots _ Property line Absorption Water service line - Surface SEPARATION DISTANCE FROM ABSORPTION Property line . Water service draln F. COMMENTS G. ENGINEER'S CERTIFICATION TO: Water main Surface water Driveway, parking/vehicle storage Wells on adjacent lots I certify that I havedete►mined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's PrInteq N me JEFFREY A. GARNESS Date 8J816 - (Rev. 17!05) 76� MQ . ................... e Garnessr m CE 7 53 ` m �40Q�p�0fess10��eo PETTIS ROAD { rl 0 r — _ — — _ — — s N 90'00' 0"E 70.00' ASPHALT:Lo 4, PAVEMENT., 1.7' ENiRVED `S yn��f� 22.3' / b a r e•7' .�WOODEN FENCE J 2.1' x 9.2' CANT � SINGLE 4 (n Lot 3 STORY N R Lot 1 RESIDENCE © _. ,8 D' 17.8' rn The location of the structure;s)as 2zJ b shown on this record drawing WOODEN FENCE 6,8' OECK (ag_ jcoml' 1 ' 1 21, AMC4.3' x 8.8' DECK By8.2' x 12.2' SHED 1 of 2 ��Date L5 -- ON SKIDS 1 L D' UTILITY IR 9,450 ss -f. — —EASEMEN7E -WE—O/E-0/E—D /E --0/E— O/C —WE—D/E—a/E-0/E-0 --t/----- rr- //--- N 90 0 00 70.00 Tr' /-.�'y- — T I WOODEN FENCE Lot 14 Lot 15 Lot 16 S14lELLY MARiE ESTATES' � I PLOT PLAN AS BUILT _y SCALE 1" = 30' GRID SW 2730 Project No. 15-257/Ai Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Registered Land Surveyors (907) 522-4625 Foxne kenOlangsurvey.com / janathanOlongsurvey.com I hereby certify that 1 hays surveyed the following described property: !...... Lot 2, PETTIS SUBD. (Plat No. P-680) �Q Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that + 49� Q4 no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. ..... .. .•••..••.f� V tKENNE:TH G. L Dated this the 2 v Day of Auf * c ?,c�" at Anchorage, Alaska �0- -, LS -5202 t / 3 It Is the responsibility of the owner to determine the existence of any easements, �`�A•�4�''--',��py �� covenants, or restrictions which do not appear on the recorded subdivision plat. DR�ggpNpt Qd 0 Ad Ytgx I ' I w 8 HE IM z 'tI a _ T � ' O p tg lae 6lBb- -$ 1004 - T iam _ - 9 ZOEE OAS. QL 5 / otla I a p 'Jtl0 } owl 6 Al we co O � N cu 4 OL{h L/ - cu IM o m _ o 4r c ey fi . _. a1 I i Ae m i > iae y R. n _B I O Kr N wCL at do co g: o cUB✓. Z 'o9v2 °�cn^2inL Eaa°rcv.: V .� O_ adu°vvu°ci u°o'w°vi >33z°n` moo_afzo _u o�w>ur oiowN � aauuuuuu aw Oxfnnrcv,r»33i. e N� Jy � ✓' r s µ5 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES1 e Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY! 1DWELLING 2 Parcel I.D.#L/V(0 I / _ Z'T HAA# #k)r(L'q,Jc;� 1. GENERAL INFORMATION Complete legal description PETTIS S IPDIVISION• LOT 2 Location (site address or directions) 110 PETTI5 ROAD ANCHORAGE. AK 99515 Property owner DON COLEMAN Day phone _(907337-8492 Mailing address 2221 MULDOON RD #515 ANCHORAGE AK 99504 Lending agency Mailing address Agent Day Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX Day NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer xxx NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer version 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 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 insggqqection, the on-site water supply and/or wastewater disposal system is in compliance with all Munici and State codes, ordinances, and regulations in effect on the date of this inspection. ,, r�F=012911 /_r1Rm? Phone (907) 337-6179 In conducting this evaluation, AWWC, IrJ�. retedtoWvide a thorough, conscientious engine'eririg analysis of the system in accordance with ADEC and I�jOAVDt1(¢fS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the usage of the family being served by the system. These conditions are outside the control c the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE Approved for 3 bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: r_rrlwem 0 Date % — 'A — d.n _ UA The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authoriiy Approval Certificates based only upon the representations given in paragraph 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. 72-025 (Rev. 1/91) Back MOA 921 Computer Version RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE�§EP A 5 200 Environmental Services Division 4 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 3`��NPALn OF ANCHSO ENVIRONMENTAL SERVICES DIVISION Health Authority Approval Checklist Legal Description: PETTIS SUBDIVISION; LOT 2 Parcel A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed PRIOR TO 1975 Total depth 61'-4"+ Cased to 61'-4" Casing height (above ground) 12"+ Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test Static water level QM Well production o g.p.m• WATER SAMPLE RESULTS: AT INSPECTION 8/22/2000 Coliform 0 Nitrate 0.892 mo/L Other bacteria 0 Date of sample: 8/22/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA CITY SEWER Date installed Tank size Number of Compartm Ieanouts (Y/N) Foundation cleanout (Y/N) n /N) High water alarm (Y/N) Date of P Pumper C. ABSORPTION FIELD DATA CITY SEWER Date installed Soil rating (g.p.d./f:2 orft2/bdrm) System type Length Width Gravel thickness below pipe o al depth Effective absorption area Monitoring Tube present — Depression over field (YIN) Date of adequacy For g.p.m. Fluid depth in absorption field befor m.); Immediately after gal. water added (in.):. Fluid depth (ins) Minutes later: Absorption rate (past 12 months)(Y/N) 72-o26 (Rev. 3196p Computer Verslon If yes, give Bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm Size level at* "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A ^_ Public sewer main 50'+ Public sewer manhole/cleanout 50'+_ Sewer/septic service line UNKNOWN Lift station 50'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Water mair Property line bserptiorrfleli I 1 T � • I i Q `I f z , W I o1Ga ® c ztz ,wo j y � L i i ^Ibl� F i I o= I z. SEP -05-00 TUE/16:10 KEN.JOHNSON.13RLG M7) 243.2282 KEN JOHNSON / 9072434852 KEN JOHNSON DRILLING CO. WATER WLL.L. DRILLING PUMP SALES AND SERVICE 36 Yo -us Alaska Drilling P.01 3163 LINDEN DRIVE ANCHORAGE, ALASKA 9950E MALs L j� DLK_J �'7<��- ,'Uiil_ ]h J.Ai fj� V7Tw PS ) PH A14PSiv)0DEL ES' C) L7IVPROLSt %cKq.s I^2��i�4q w u� IP1:' iE ;DEPTH s�� PIPE nus 1"•A�vK SIZE Cc PYP` 'G"W y is PLPERS & TYPE YELP i)nI':+s CIIVG .SIZE4.•_ DEr']'.Ii_�_/7 u,I,. `CrPP1_ - - llJ_� nflilEJ 4'IV .-iZPS _ OFF, 51PE P1'f1ESSs PYPF A" rop'p-m' %%�� vJT.'T.T. �:w nT.. Ab, .011 hp,: �,•, 08-29-00 15:37 FROM -CTE ENVIRONMENTAL '1L CT&E Environmental Services Inc. �ii�iw� rrw. wrwirrsrs� 5615301 T-388 P.02/03 F-545 CT&F Ref .# 1004892001 Client POs Client Name AK Water & Wastewater Cotisultants Inc_ Printed Date/time 08/29/2000 11:34 Project Name/n Pettis Lot 2 Collected Dawrrime OSJ22/2000 13:10 Client Sample ID Pettis Lot 2 Received Date/Tlmc 08/23/2000 11:00 Matrix Drinking Water Technical Direct Stephen C. 8 Ordered By PWSID 0 Relea zo Sample Remarks: Allo"ble Prcp Analysis paramiricr P. Alts PQL Units Method Litturs Dam Date Inst Waters Depari:aienr Nimate•N 0.892 0.500 m8/L EPA300.0 101nax 08/23/00 SCL Microbiology Laboratory Total Coliform 0 coUI00m1. SM18 9222B 08/23/00 ICRP