HomeMy WebLinkAboutUS SURVEY 3042 LT 97A-2GE $4
• '-c Municipality of Anchorage `r a
On -Site Water and Wastewater Orogram _
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 075-093-54
1. GENERAL INFORMATION:
Complete legal description USS 3042: LOT 97 A-2
Expiration Date: 10 ^LZ ?_ Z6
Location (site address) NHN AGOSTINO MINE RD *GIRDWOOD, AK 99587
Current Property owner(s) JIM KORPI Day phone 575-9610
Mailing address
Real Estate Agent
PO BOX 110694. *ANCHORAGE, AK 99511
Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or
Duplex)
^;.r
3. NUMBER OF BEDROOMS:
4�-
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:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment 7 1 % 1 bc)2 O Date of Payment
Receipt Number 6 a 0'7 (o G Receipt Number
COSA # _QSG W )33 a 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: 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 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 SIGNATURE
System #1 Approved for _q_ bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following
#AECC884
COF {(�rr�(�%
ON-SITE
WATER AND
r s..TEVVATER o
PROGRAM
Ire)_
Original Certificate Date: 7 -ZZ' �zo
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
(A.
Legal Description: USS 3042; LOT 97 A-2
If more than 1 septic system on lot: COSA Checklist # of
Parcel ID: 075-093-54
Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Well production at time of test 8+ gpm
Date drilled 4/797
Water storage tank volume N/A gallons
Total depth 160 ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to 160 ft
❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly
Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 18+ in.
Collected by GARNESS ENGINEERING, LTD.
Date of flow test for COSA 7/6/20
Date of Sample 7/6/20
Static water level at beginning of test 71 ft.
Comments THIS IS A VACANT LOT WITH A WELL ONLY ON IT.
THERE IS A DEPRESSION AROUND THE WELL HEAD, HOWEVER BECAUSE THE LOT NEEDS TO BE DEVELOPED IT
IS REASONABLE TO HAVE THE DEPRESSION ADDRESSED
WHEN THE WATERLINE IS RAN AT A FUTURE DATE.
B. TANK DATA
C. LIFT STATION
Age of tank(s) years
❑ Required maiint_en-ann-ce�
Tank type/material
Age of lifst^atl6n years
Measured operating fluid level in septic tank
p g �--'
Lift station material
❑ Standpipes/foundation motif per record drawing
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
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over feel
❑ System presoaked
(Required if vacant fo eater than 30 days prior to
date of test)
Gallo ntroduced gallons
_ ments/Deficiencies:
COSA Checklist yellow sheet
Adequacy test date
Results ❑Pass For bedrooms
Fluid depth prior st in
Waed gal
eth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
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)
Septic Tank/Lift Station on Lot > 100'
*
if No
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
2] Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' Eyes
if No * ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' Q Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' 0 Yes
if No ft
M Yes
if No
ft
If se tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distan
**
Manure/Animal Excreta Storage > 100'
❑ Yes
Community Sewer Main > 75' [] Yes
if No
ft
(v 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 ft
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 Is > 200'
❑ Yes if No ft
Water Service Line > 10'
❑ Yes
if No ft
If 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'
es
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
❑ Yes
if No
ft
Private Wells > 100'
❑Yes if No ft
Water Serv' ine > 10'
❑ Yes
if No
ft
Community Wells > 200'
❑ Yes if No ft
ace Water > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
*THIS LOT IS VACANT WITH ONLY A WELL ON IT (NO WELL PUMP INSTALLED).
**75+ FEET ASSUMED BASED ON AWWU RECORD DRAWINGS FOR SEWER MAIN
G. ENGINEER'S CERTIFICATION
l 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.
COSA Checklist yellow sheet
..................
teff y q.
CE -79x3
O�apro fession000
#AECC884
1'11EEFTY DRILLING
Well Wofer — it's nolurcmtly befferl
T
(. p
3540 AKULA DRIVE TELEPHONE:
ANCHORAGE, ALASKA 99516 (907) 345.0593
Permit Number 5 w 971)0 1 `% Date Of Issue__-_aY- Z7 Tax Identification Number-
Date Started __ Date Completed- -_% is well located at approved permit location? . tomes ❑ No
Legal Description
Block Lot
Property Owner Name & Address:
57a f C) C .y,
J, M
Cod 97
i1'�aRsIIQ
4123
Borehole Data: Depth
Method Of Drilling: r rotary ❑ cable tool
Soil Type & Thickness & Water Strata From To
uasing type: d J Wall I hicknessgRf0- inches
Diameter_inches, depth /l o feet
Liner Type: Diameter inches, depth feet
3 -
1 teasing SticKup Above Grouna: feet
Static Water Levet feet
W P- OZY10e. J
-o
Pumping Level: feet after hrs. pumping gpm
Recovery Rate: _X_gpm
Method Of Testing:
Well Intake Opening Type: pen End ❑ Open Hole
U Screened; Start feet Stopped feet
❑ Perforations Start feet Stopped feet
I
GroutType:.&.+._4ou)f4_ Volume
Depth; fromy feet, to .2=o' feet
11 Piimn intakes nanth• foot
A0 Jv o
f . �-- Pump Size hp Brand Name
Well Disinfected Uport Completion? es ❑ No
Comments:
0
Company
3540 AKULA DRIVE
Mailing AddressANr.NnRAG, g!( 9956
(907) 345-0593
City State Zip
I LOT 103-1
�OT, 103-2
<
��
I
o
a:
.;
,; -, -v
SANITARY SEWER
Q
<
LU
EASE.M
0
\,\�.OT 103-3
0
LOT 102 LOT 104
ti
0
Cx:
( I
Lo
0
LOT 103-4
STA, 50.82_0�, STA. 52�44�O
9'
C<L
M _9 pl-riA,
01
<
ITA 11 5DQ :1 H.. 10
5, C
COI R T
T ,z H. A. 4,42�5C
STA.
70°5'M,H..
5 67' 50' W" E
CONSTRL CT 11
a" c u�.— 189.29 L. r_i50` 8" D. 1. P. t.
T.H. 1p
It" =1\11
MI24750
INE
IT 05�.71=5TA75+25.0 0
EONSTRUT,�1J- 9
R
AI r-
`1
STA3
t' 94�01, 59.56'Rl,
WD STAKE
STA. 53-87.9
i
�9 1 LT99'1 1
/
ZST A #0=4i5*
LOT 99 LOT 98-4 LOT 98-3 LOT 97
LOT 9
7-:77
145
:1,43.",
-12
140
77=�
-
135
l—
125.E
130
7n
125
:7 77:
7— 1
120
�71.
=7.1= :1:20-
!JJLI
5
r
.4
9. NV:� +l
105
_170
�LOJE'
loo
—.:mo.
50-00 51 52-00 53+00
54+00 55-00 54,+00 55
GRAPHIC*
FIELD BOOKS RV DATE DESCRIPTION
BY TOM NO. I LOCATION
ELET — TAM NO.
3A SEE CCNTR2L_SKVCH fSH7. 31
63.79
G SEE CONlRrL SKETCHISHT. 3)
11195
SEE CONTROL SXETCnJSHT.31
49.68
SEE CONTROL SKETCII.(SHT.31-
M31
4 SEE CONTROL SKETCH(SHT
120.47
Cowmw t-egugia
L,'
,u,acg D. LU.Noesy 14IKH
00
M7
....,
s68 '02s�
E
40 66`
(87-146)
99
S
_7 A
41
Ov
CO
7 V3
1 A
r
8 00
99 A
9 7//-, A -
3
A
09
0
9, 0-1 S68.0
i`
I
CD
�00000pp� o
O •JO
G�����
°s
(L
o rq o°J :o N 0 U)
`r' o�p O
Q � �
rn �l 0'•
0-).
c n
` 0 et c' o
IV
10
��o Os M
> ; o0 9� 0
co
/ O \� 6 S
/. own �
,O s
Ob -
OZCc p
0,1: C
N
O£ Z o f o 8.Q'8.�'bo
' w w Q (T' Ln
CL
^
0 �
t
M � s
Ln
/
Q 9� 6Q(>
% � Cv
eI-)
t— (O d
Q
a
O O
J
00$
7
N
�Z x
o
w
0-
--I'
�L
O
x
N ®,
O
a
a
h(\
Q
U O
F
Z J Q
U
Y O
N s O
z m a i
¢ o w
:n �nmZ
za.n"w
D
J ri S ii
(L..1lo
> O O w C
O s U a w? W
O
U -
O N 7
O `
�cm
o
U co a.
o D c
ooz
v
`
�c
o 3�m w
N Q O O
U O O O
_00
oCL
<
W
o .N a
.c o 0 1 O
s c w
cn
VCOUI
W= •� O
N( ry
QV
O>7 aO
C
O
Q SO 0NC>SU
N
N o'2
'N
�
`
C O 0
O'Oo Z
Q
rJ
s Es��
a
o -' c U
aTi°E
t=- -o
me 0
o a
o"�2
`
0� �_
""ooh
/ n
eco
f-
0
lJj
O
o a -m o'
U c
w •- o-
c �'U
>
T.o -�
00 °
O
O t n�
v_. `'�
w a�oo
Z U O D
ZC C C
o Oa_,O)
w
(O
N
O.�! O
-0 U O
L'i
N
cD
Ln
tD
Z
XE
C7
N
a
w 3 !^ o+
7
CD
a
�N
.. l.L
r0m
WY
W
m
O
L'i LO Ln
1 x o
xo m
O
W �
7_
Z
I M �
U) 11
Ly ij: z
OM M u�
}OO u
> Ln
cy- 0) h o
rn
cn
om Q
F- Y
v
Z U, Q
"n J o
t- Z Q
(n W w Q
Z M m
C) O D 0
oN<NCV
��O o
Q= o
Z O O
Q d 7_ Y
J 4 Q mo 1T
� M
N
m
z
w
Y
m
m