HomeMy WebLinkAboutEAGLE RIVER HEIGHTS 1957 ADDN BLK 3 LT 2BEagle River Heights Biock 3 Lot 2B #050-281-64 MUNICIPALITY 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. 050-281-64 1. GENERAL INFORMATION Expiration Date Complete legal description EAGLE RIVER HEIGHTS 1957 ADDN. BLOCK 3, LOT 213 Location (site address) 10303 CHAIN OF ROCK STREET, EAGLE RIVER, AK 99577 Current property owner(s) JAY & TRUDY JORDAN Day phone Mailing address Real estate agent 10303 CHAIN OF ROCK STREET. EAGLE RIVER. AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System 4 Day phone TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 'Z'30 Date of Payment Z Ste` Z Receipt Number COSA # D.SG Z l l 3 5 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/24/2021 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, 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 system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWrS 6. DSD SIGNATURE System #1 Approved for qbedrooms System #2 Approved for Disapproved Conditional approval for Iime, 050u w TM ....... rIJ/ ... ..... �.~.'.- . • '. Curtis Huffman . •CE 128991 ��'/w l s� /24/ 9 �� OpROFESS0 bedrooms, with the following stipulations: OF r � Wp,TER N� z W AS�w _ a T i,/J lO GQ JJJ) FNT SERV JL -1';,' . By"_-- �,-� �� Original Certificate Date: -1 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: EAGLE RIVER HEIGHTS 1957 ADDN. B3 L2B Parcel ID: 050-281-64 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) *Date drilled 7/16/1984 *Total depth 100+ ft *Cased to 100+ ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/23/2021 Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 2.68 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWrS Collected by Static water level at beginning of test 71 ft. Date of Sample 3/24/2021 Well production at time of test 5+ gpm Comments `'PER MOA RECORD DOCS. B. TANK DATA - NA Age of tank(s) _ years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA - NA 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth -in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date FWrS Comments/Deficiencies: 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft Building Foundation > 10' ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Property Line > 10' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑ 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 Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I 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. At .. .... .......:.. JJ Curtis Huffman CE 128991 ROFISS oN F�FOP`�4.� T, ft `if ;'1.��, '?1,:S'ir`�:,."j F 2 "�`' 4+sv....-:.>..-'4"`i`-"._. "-•S eY.2•,i„•5:1'. .iC"�'.:"" t`•' ° Y�, ^,Y.a .a.. 'x.,•;��,.-,., r:aw. ;, Iq^•.'v Y'S`f.;�s%,7+; "+;w��t•:i;.. k�i, �'F-i�i�:t+�yv.Y�9t 7;'�<'•n k: ,?�sf, v h�t�';,5`�,}'' Y�SI. '1i .:sraz, tc'2+',L•�45"tkp'i4�i^;2.'S riWS.>Ar;:..^ A^,:,;.. .c•cu r-: ,. O= 2 m m cm Cmi•1 Z O ❑ ❑ p F 0 D D co C O = oD �® o< z �_ n KKM b Z 2�2� O NZ r Z r X p ODM O m m W W K m Z O D O D Z m —I m — n Z m 37 a� - nncHo C Km x m�- D O _< ,a, R, M m m m M -i n m D z D Z m Qo �) p 70 z p D m� fx o of , ..; {a m cn o oho ( mD p O m n N—* I �.. � =o CD O O Dn ?� D O vO D 7 , m D D m Z OZ -m-m m a-1 m p z 1 a)�o M �(� C!J Jt VO y {n m (A CD CD c �1 Nr� =O MO mo -� m Nm o of 3 0 m ::E -u `2 m O a- ozo CD co (:10 Z. D M Z mOm D 1 0c > Z D f't 3m�m �. U? z �m- ' C �_ m m '(7 o 0 -< D (— tib �p O m m m S C.0 r- �� m :z () -q m m m D i; 0:;,z O r 'ic C n - r O) Lam") a Z a O ^� _ O C) D Aio z f'` �, r� c 0 r �-- m m � C = o ✓ �� p O Cti (� m m m C!) K 'O D m m x c w v C) i i• 3 1�° _ n m r- a�ap--� CD I --iD cn a xrn mo mQCD D u rn O PO D nme Zm a ' — � sv O to CA $j m C i1. m O�`Q m m ❑❑ ❑ Z {, m D t m C n .m (1) Ej 1i M'z CD it m � .-« Z _ m m p ='( m,-^., i Cf) CD CD pmj ) p m 3 3 � >0Dmm is !/ o o° _ r --I z ui D t T. D t- "� m ' m SUBDIVISION: y� a O a. w z 0 F- 0 w CL Z cc w 3 w U) N — — INDICATE NORTH STREET I I I ( I I I e_*ljH341Q-J /,k ri BLOCK: LOT: 19/3 �---- -X� n rr, 1�09-Da ALLEY " I I I I I I I I SEWER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS SIZE MAIN: C7 TYPE MAIN: CONNECT DEPTH AT MAIN CONNECT DEPTH AT Prop. Line ls� CONNECT cLyOCATION:__lam— ©� fm�j� J J _ t -i1�r 1 1 a T Cmc S COMMENTS: INSPECTED BY:/fir- /� DATE: `v� Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St.' P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us ' (907) 343-7904 Parcel I.D. 1. CERTIFICATE OF HEALTH'AUTHORITY APPROVAL,, FOR A SINGLE FAMILY DWELLING 050-281-64 GENERAL INFORMATION Comple{e legal description Location (site address 'or directions) EAGLE RIVER HEIGHTS 10303 Expiration Date: 7'-' / JC~5'7 ADON SUBDIVISION; LOT 2B, BLOCK CHAIN OF ROCK STRE~ * ~GLE RIVER~ AK, 99577 Current Property owner(s) Mailing address Lending agency LOYD WILLIAMSON 10303 CHAIN OF ROCK STREET * Day phone 696-1890 EAGLE RIVER, AK 99577 Day phone Mailing address Real Estate Agent Mailing address BROOK STILTNER w/ REMAX PROPERTIES Day phone 694-4200 16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ,3 TYPE OF WATER SUPPLY: Individual Well I Individual water Storage F'l Community Class 'Well r-] Public Water System III TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site [--] Public Sewer I The Municipality of Anchorage Development services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only'upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may · be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my . investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the an-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedreoms 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 ins'tallation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough~ conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described th.e 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, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the e[~aluator 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. GEG, Ltd. can therefore not provide any warranty ?r future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. 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. 5. DSD SIGNATURE Phone 337-6179 Date Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: · Attachments: HAA Checklist Septic System Advisory · Well Flow Advisory (Rev. 12/01) . · -',a'-;,,-' Manitenance Agreements Suppl.emental Engineees Reort Other " Original Certificate Legal D, ,{ scdption: A. wEL~ D/~TA MuniciPality of Anchorage DeveloPment Services Department : : Building Safety Division . OmSite Water & Wastewater Program ' 4700 South Bragaw St. ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us . (907) 343-7904 HEALTH AUTHORITY ApPROvAL' CHECKLIST EAGLE RIVER HEIGHTS S/D; ,LOT 2B. BLOCK 5 :P~rcel ID: 050-281-64 , .,IfA, B,,~rCprovidePWSIO# N/A Wel! t~,P,e i"PR'VATE : · ;~ ' ' Date dompleted // 6//1984 - sanitary seal (Y/N) YES Total depth 100+ ft. D~ite of test sta{ic water level We!l. pro~ducbon WATER SAMPLE RESULTSi iform ~ Col : 0 colonies/100 mi. ~ I~N/A Arsenic: mg./L. SEPTI¢IHOLDING TANK DATA Tanl~ ]'yp~/Material Tar~k siz(~ gal. ~.:~ i~. . Fobndation cleanout (Y/N) :' Da}e~ of pumping ABSORPTION FIELD DATA Date in~t~iled Total d,epth ft. Da[e ~)f a~dequacy test ~ Fluid in abs( field Els Ca{;~dto! 100+ ft. FROM WEI'[ LoG 7/16/;~84//,~ r , ~ 75 EST. ft. ~ 4.0 'ESl'. ~ g.p.m. ;! ~ Nit~ate 1:89T mg./L. :II Date ofsamp~e:, , 3/31,/ 004 Numl:J~r of Compartments ' epress, lon over t~nk (Y/N) · Pumper rating (~.p.d./ft o rea ft~' :Results __ in. ~ Soil Eft. absor ;st Final fluid depth & typ ) -: ~, min, ion treatment (past 12 o.) (Y/N .... Well Log (Y/N) Wires properly protected (Y/N) Casing heigh~ (above ground), AT INSPECTION 3/30/2004 :5.13 g.p.m. -Other bacteria 0 Collectedl~ lby: Date in,tailed Clean0~Jtsf (y/N) High water a Y/N) YES YES 12+ in. colonies/100 mi. GEG, Ltd. ,s~St~m'type ' Gravel below pipe M°nit°,d ~ngtube !::i Water added · ' . :[ in. Absorption 'rate >= - ' !~ ~ If yes, give date Depression over field For bedrooms New depth in. g.p.d. D. LIFT STATION Ee Fi Date installed "pump on" level at ~, in. Datum ~ SEPARATION DISTANCES :,Size in gallons "~ "Pu~ ~ Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septictank/lift station On' lot N/A Absorption field 'on let' N/A Public sewer main 75'+ M a n h ole/Ac_.c, ess-(WN) High water alarm level at Meets alarm & circuit requirements?. · sewer/septic service line ' 25'+ On adjacent lots ,100'+ On adjacent lots ,100'+ : Public sewer manhole/cleanout ,100% ' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation' Property line ' :' Water main il .... water service line . ..-, surface~ , , Wells on adjacent lots COMMENTS ' . · ., G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and' ~review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printe~l Name 'JEFFREY A. GARNESS Date ~/~ ~o/0~.. HAAFee$ ' J~,~ 0 , :. , , Date of Payment J-.7L "//..~. -O1/1~ ' .., Receipt Nurnber- (~) ..~' '~ .~ :~).."~ -~ Waiver Fee $ Date of Payment Receipt Number ,, :,~ ' ' 04-02-04 12:55PU FROU-CT&E ESI, SGS EfiV SERVICES g075615301 T-902 P.02/03 F-273 SGS Ref.# Client Name Project Name/# Client Sample ID Matrix Sample Remarks: 1041536001 Gamess Engineering Group, Ltd. Eagle River Hts S/D, L2B, B3 Eagle River Hts S/D, L2B, B3 Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 04/02/2004 11:25 Collected Date/Time 03/31/2004 8:20 Received Date/Time 03/31/2004 10:30 Technical Dlrect0~''~- Stephen C. £de Released By ~ PQL Units M~hod Allowable Px,-'p Analysis . ._ Container ID Limit~ Da~'~ Da~e Init Waters Department Nitrate-N 1.89 0.100 mg/L EPA 300.0 B (<=10) 03/311O4 JIB Microbiology Laboratory Total Coliform col/100mL SM18 9222B ^ (<=1) 03/3 !104 DKC 04-02-04 12:56PM FROM-CT&E ESI, SGS ENV SERVICES 9075615301 T-g0Z P.03/03 F-273 SGSICT&E ENVIRONMENTAL SERvicEs 1041 536 200 W. POTTER DRI~/E ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 · · Fax: 907-561.5301 SAMI~I.E COLLECTION: · SAMPLE TYPE: ·. ~ o,~ Y,,, [] Repeat Sample Untreated Water.. ·?ran. p<~J ' ." tn Lab a~,' [] Same as collector Other. ~ Time: ' Temp: E] 4a ti~r~ Phone ~. ' ~ellvery Me{hod:./"'J . . · A a a s Record' '" eoo Ica Water in Iy ~ ~ I=BK .'UN ' ~ 'MembmneFilter · · ~ (PLA) ' e~e:- ~ Satisfad~ ~ { ~: ~ Unsatisfa~o~' . Drinking water Analysis R~port for T6tal Coliform Bacteria' READ IN~rRuC~rU3N$ ON ~. BIDE BEFORE COLLEGTING BAMPLE MUST BE COMPLETED BY WATER ~UPPLIER '.El puauc WATER SYS1T~ IO~ · .: ~ · -- I~.. tvA'rd WA~ SYST~ · ' ' LabRefNe. ' ' 6~ 2..?