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Home My WebLink AboutUS SURVEY 3044 LT 59BMUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 075-061-65-000 Expiration Date: 6/25/2025 Legal description US SURVEY 3044 LT 59B Site address 116 BEAVER VIEW WAY Girdwood AK 99587 Current property owner(s) ELSON MICHAEL D X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: a bedrooms, with the following stipulations: Original Certificate Date: 7/12/2024 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 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 075-061-65 Complete legal description US SURVEY 3044 LOT 59B Location (site address) 116 BEAVER VIEW WAY, GIRDWOOD, AK 99587 Current property owner(s) MICHAEL D ELSON Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 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 $ 2.50 Waiver Fee $ Date of Payment 5 2e 2 y Date of Payment r COSA # 05 G 2Ll 12 �1 1 Waiver # COSA Application.doc COSA Checklist Legal Description: US SURVEY 3044 LOT 59B Parcel ID: 075-061-65 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 7 gpm Date drilled Circa 1970s* Total depth **40'+ ft Water storage tank volume NA gallons Cased to **40'+ ft Well disinfected for coliform test? ❑ Yes ® No ® Sanitary seal is functioning correctly ® Coliform bacteria is Negative ® Wires are properly protected Nitrate 0.700 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 6/25/24 WS Static water level at beginning of test 23 ft. Collected by Date 6/25/24 Comments *DATE PER MOA TAX RECORDS. & AWWU CONNECT CARD. **PER AVAILABLE AREA WELL LOGS & NITRATE RESULTS. SULLIVAN EXTENDED CASING WITH NEW SANITARY SEAL & CONDUIT. B -,,TANK DATA — PUBLIC SEWER C. LIFT STATION Measured operating fluid level in septic tank ❑ Required maintenance completed Date of pumping Age of lift station years ❑ Required maintenance completed, if AWWTS Lift station material Comments: Comments: D. ABSORPTION FIELD DATA - PUBLIC SEWER 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 field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficie COSA Checklist WELL ONLY.docx Adequacy test date Results ❑ Pass Fluid depth prior to test _ in Water added _ gal New fluid depth _ in Elapsed time _ min FinaiJ, uid depth _ in Absorption -rate _ gpd FIELD STATUS 7POST RECOVERY Effective depth (per record drawings) Effective depth used 11, Effective depth remaining ra 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' ft If tank or field sinderdriveway comment below Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® 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 than required) Building Foundationis_> 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' j �e ` ❑ Yes if if No ft f o ----ft Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft —Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field sinderdriveway comment below F. ENGINEER'S COMMENTS 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 71512024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, �``�\\ and best industry practices / methods. The assessment of the condition of the well and septic �� applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, A • " • • :1� �, local soil characteristics, groundwater levels that may fluctuate during the year, quality of /�`-• • • • construction (workmanship & materials), the water usage of the family being served by the g '• '.� fl/ system and maintenance. The operational life of all well and septic systems are subject to *; •� TM these various and dynamic characteristics and are outside the control of the evaluator of the .... .... .. ......... I well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or , , , , , , • ,v ,~ discrepancies exist can be given by First Water Consulting & FWCS /� • CUflIS Huffman cCE 128991 �1Vsl�c�• • 07/05/24 •��v�� PROFESSO COSA Checklist WELL ONLY.docx rVI i r (f� w O 2 a s 2 w LL Z 0 C J F c - � E r• Z E m LU m m � F - v to rom �Z a� m � lA m o N c o U3 :3 No Q O C C U< d X N d m �a a�i :A8 03103dSN :S1N3WW0: :NOUV001103NN0: auli -dwd 1`d H1d34 103NN00 —Q -j NIdW ld Hld3r7 103NN00 CjjQ :IN`IVVl 3dAl--g� WVV4 3ZI' L v V sinON`d310/S31OHNVW IOH1NOO 30 NOIIVOO1 MOHS HO13YS 3N11 301AH3S H3M3S /4o rA /0 ° n In F � s-, A311V h 133HiS H1HON 31VO10 N I I� O :101 h02- S :10018 pe0 O� �(�� S :Nolslnlaer ,goo 9"Yrt' !''f'y y=u�u� °�7'r�'p .t - c^ n� r 3. ,�. "'w: ,�-c�•w.�:>.,. rhr u.r.p.: ,,� :1 r `!Lf' t ' f x ' •.N J' . t i H ., � , ro + _ 1 TAX CODE No. U*75-o6l -yg GRID No. 55 l00 Sem 171 (0 AJ MUNICIPALITY OF ANCHORAGE — SEWER UTILITY PROPERTY: Name Address AcctNo Plat No. Subd. rs d — ood �n .i` Lot /%% Block rac �d Residential ❑ Commerial ❑ Industrial ❑ No. of units CONNECT: �% �r Main Tap ❑ On Property ❑ Permit No. Size Type Drawing No. Size Main Type Depth at Connect Insulation ❑ Cleanouts Type Connect Agent It4p Inspector k k Date )e -?-10-7'7 i Comments S' Connect Location z �� 17LI /2x`9 / S' //T?�ia.� ASSESSMENTS: L.I.D. No. Private Dev. No. Subd. Agreement ❑ No. Sewer Agreement ❑ No. —RTE. ❑ Roll No. 1 DYE TEST: Positive ❑ Negative ❑ N.S.A. ❑ Date Page No. M.H. No. Billing Cycle ;t o Tested By 0 Comments ;' o y�; z;?�^'v�...}%'"s�' � � ��v.�'' ._ �'�"� �4'� "`��c",�9'� .,id � .-� '� •1 �.�.�'(� -.S i�,•. r 7�i�,irn.�;. �.I �� :i :r. 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