HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 8 LT 5 N2Eagle River Heights
Block 8
Lot 5 N2
050-281-20
This is a duplex!
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
1
Parcel I.D. 050-281-20 Expiration Date: �y' z 41 —�
1
1. GENERAL INFORMATION
Complete legal description Eagle River Heights Block 8 Lot 5 N2
Location (site address) 10135 Lee St, Eagle River AK
Current Property owner(s) Clarke Janet Day phone 230-5441
Mailing address same
Real Estate Agent Owner Day phone 230-5441
2. TYPE OF DWELLING: 1 susmiTTAL
® Single Family (w/wo ADU) t 07 td I
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class C Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
®
Individual
❑
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
Received by :/� -r Date
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ '52-& �-t � 00(D Date:
Date of Payment_.. C D Date of Payment
Receipt Number
Receipt Number.
COSA # C�`J ) Ih_ 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
Date 8/1412,014
<< v F
CN i"!
ova
6
6. DSD SIGNATURE
System #1 Approved forbedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following sti
By. Original Certificate Date:
The uniclpality of nchorage Devlopment 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
COSAbluesheet 9-1-12.d=
If more than 7 septic system is on the lot:
. COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: EA64 E telV612C tY'S S NZ Parcel ID:r7 50 ^28/ -26
A. WELL DATA
Well type P If A, B, or C provide PWSID # _
Date completed-Zab=f= % Sanitary seal (Y/N)
Total depth _/--ft. Cased to
FROM WELL LOG
Date of test - /A JA
Static water level OAlk ft.
Well production f%N6C g.p,m.
WATER SAMPLE RESULTS:
Coliform d colonies/100 mL NitrateZ•?y.mg/L
Arsenic O. 26s ug/L Date of sample:
Well Log (Y/N) 5"u/2 ✓Er
Wires properly protected (Y/N)V
Casing height (above ground) _lin.
AT INSPECTION
8 ft.
?-t- g.p.m.
Collected by:
B. SEPTICIHOLDING TANK DATA A114
Tank Type/Material Date installed
Tank size gal. Number of Compartments_ Cleanouts (Y/N)
Foundation cleanout (YIN)_ Depression over tank (Y/N) _ High water alarm (Y/N)
Date of pumping
Pumper
C. ABSORPTION FIELD DATA AIA
Date installed Soil rating (g.p.d./f:2 or ftZ/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft2 Monitoring tube _ Depression over field_
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION Nuc}
Date installed _
"Pump on" level at
Datum
Size in gallons
Manhole/Access (Y/N) _
in. "Pump off" level at in. High water alarm level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested Meets alarm & circuit requirements?
Septic tank/lift station on lot 'IVA
Absorption field on lot AIA
Public sewer main
i
Sewer /septic service line zs i
r
Animal containment areas �0 7'
SEPTICIHOLDING TANK ON LOT TO: ^JA
Building foundation
Water main
Wells on adjacent lots
On adjacent lots /Dd
On adjacent lots lDQ "r -
Public sewer manhole/cleanout sof
Holding tank /V -f
Manurelanimal excrete storage areas / 00 ft
Property line Absorption field
Water service line Surface water
ABSORPTION FIELD ON LOT TO: /V,4
Property line Building foundation
Water Service line
Curtain drain
F. COMMENTS
Surface water
Wells on adjacent lots
Water main
Driveway, parking/vehicle storage
G. ENGINEER'S CERTIFICATION
I certify that f have determined through field inspections and d4qi�,.•N••••:.
review of Municipal records that the above systems are in'�;°• �'•.�F�Q®
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name '::�;% �U,: Eit)io•qs
Date _ 4 / t' 7 /IT 01 Fti+ Steven W. ng ;
n.
dC`F •• 7
COSA brown sheet_10-10-12.doc
Municipality of Anchorage
• -- Development Services Department
Building Safety Division
On -Site Water and Wastewater Program s A' p
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 20 HAA #
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. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties 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 properties served by a private or Class C well and may be reissued with
new water sample results. (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.
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot
5, Block 8.
Eagle River Hta_ a„hdiviaioa
Location (site address or directions)
10135 Lee
Street
Current Property owner(s) Arthur Saltmareh.
Sr. Day phone
696-0119
Mailing address 10135 LAP
St_ - Eagle
Pluer, AL 99577
Lending agency
Day phone
Mailing address
Real Estate Agent Jed Weingarten/Dynamic
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
KX
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
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. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties 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 properties served by a private or Class C well and may be reissued with
new water sample results. (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 verify that my investigation,
based on procedures outlined in the Health Authority 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
S 5 S Engineering
Phone 694-2979
Address 17034 Eaele River Ln gA — Ra¢lo [livor_
Akl
99577
/is
/or
Engineer's Printed Name Robert C. Cowan
Date
g
p II *&T C. COWAN
5. DSD SIGNATURE �", CE -8801
Approved for bedrooms. �f��; •......�..�; �f
Disapproved. (t`ti�tiiev+�►r
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
M
(Rev 01102)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
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
HEALTH AUTHORITY APPROVAL CHECKLIST
v
Legal Description:®T �'? t�Lpcat Q� c � 2 jm-Aarcel lD:
A. WELL DATA
Well type�tVR115.1 If A, B, or C provide PWSID ff
!4•io�iz(79
Date completed ' �f Sanitary sea]ON) j'`3
Total depth Cased to eft.
�( FROM WELL LOG 404
MgA:e'u mit!
Date of test 44141? 1
Static water level
ft.
Well production 4 C.P.M.
WATER SAMPLE RESULTS:
Coliform --a—colonies/1 00 ml. Nitrate fsq mg./I.
Arsenic: — mg./l. Dale of sample: -EIiJOS
B. SEPTIC/HOLDING TANK DATA OF"L I e- S I✓t4�-
Tank Type/Material
6VV-0Y
WeII.ImeSrV)N)
Wires properly protectedON) %%
Casing height (above ground) I e4 -in.
AT INSPECTION
8 e5
tot'
ft.
M e (o g.p.m.
Other bacteria colonies/100 ml.
Collected by: S4 -g �Ir>6rruZ�12tK7r;,
Date installed
Tank size gal Number of Compartments_ Cleanouts (Y/N)
Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water al Y/N)
Date of pumping
Pumper
C. ABSORPTION FIELD DATA �vgLIG S1t'2 • /
Date installed Soil rating (g.p.d./ftp or ft'/bdynr System type
Length ft. Width
Total depth _ ft.
Date of adequacy test
ft. Gravel below pipe ft.
Eff. absorpf rea ft2 Monitoring tube _ Depression over field
Results (Pass/Fail) For _ bedrooms
Fluid depthin asorp ' fi
beld before test _ in. Water added_ gal.
Elapsed Tim min. Final fluid depth _ in. Absorption rate >_
New depth_ in.
treatment (past 12 mo.) (YIN & type) If yes, give date
...
D. LIFT STATION
Date installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
(Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/lift station on lot 0 A On adjacent lots I t+
Absorption field on lot IJ A- On adjacent lots 1004-
Public sewer main Public sewer manhole/cleanout rJ o 1+
Sewer /septic service line 25 r+ Holding tank to p
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: POF51-1 C-
Building foundation
Water main
Wells on adjacent 0t'r
Property line
Absorption
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pois (C. S. - C4Z.
Property line Building foundation Water main
Water Service line Surf Driveway. parking/vehicle storage
Curtain drai _
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Wells on adjacent lots
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HA/A� guidelines in effect on this date.
Engineer's Printed Name C . eOw�,�
Date g /11 los
HAA Fee $ y zu "D
Dale of Payment
Receipt Number 7sa'T'f Y
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
qo 1 ROBERT C. COWAN
'^O�'•� C: - 8801
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258.2510 sf � ��" 911577
%45-9;10 1
►;m 680.2543 r1WWA ctmriml) PUMP INSIAI-1.17.11
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9349
-f,u>lomr'r Orden No. mono fl. r; , clioo
Name
Oly--- r)nscriplion I'1ir.0 Anmmwl
71-f
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• r'leme pay by hrvolce. All account pant hue will b^ chmnnd 11/71..
$25 second billing rhagin
TIIANK YOU
08-11-05 08:52AM FROM-CTSE ESI, SCS ENV SERVICES
—sw
SCS Ref#
1054848001
Client Name
S & S Engineering
Project NameNi
L.5 BI.8 Eagle River His. S/D
Client SampleTD
L.5 BI.8 Eagle River His. S/D
Matrix
Drinking Water
PWSID 0
Sample Remarks:
9075615301 T-676 P.02/04 F-610
All DatesMmes are Alasira Standard Time
Printed DateMme
08/092005 9:05
Collated Date/Time
08/02/2005 12:30
Received Date/time
08/02x2005 16:52
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Pannctcr Px=ls PQL Units Method Conm4mID Limits Due Dato left
Waters Department
Nitrate -N 4.34 0.100
Kir-robiology Laboratory
Total Coliform 0
mg/L EPA 300.0 D (< Ia) 0810=5 1EM
col/100ml. SM209222B A ("1) O&Q=S TLF