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Home My WebLink AboutNORTH SLOPE #2 BLK 5 LT 11RV5H MUNICIPALITY OF ANCHORAGE Development Services Department � P � -� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-581-14 1. GENERAL INFORMATION Expiration Date: I — 6, ^z-CizZ Complete legal description NORTH SLOPE #2 BLK 5 LT 11 Location (site address) 30825 SAGWON AVE, EAGLE RIVER AK Current property owner(s) LESLIE & CHARLES ERWIN Day phone Mailing address SAME Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic F1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .6,y0 +32, 0 Date of Payment i O _q - 21 Receipt Number _ n 4 47(a COSA #_ 0,!�)G2.1 15a 2 Waiver Fee $ Date of Payment Receipt Number Waiver # b. 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Date 10-1-21 AWA • `f 49Th ` C JO �� MICHAEL N; ANDEPSCiJ•„_ . CE 969 with the following stipulation�� .. �T \IV” _— en �.. y: Original Certificate Date:il�� 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S _� e.2 (—k a,t„_ A+�OlenkPd Legal Description: NORTH SLOPE #2 BLK 5 LT 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 317/01 Total depth 183 ft Cased to 180 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 25 in. Date of flow test for COSA 8124121 Static water level at beginning of test 154 ft. Comments B. TANK DATA Age of tank(s) 21 years Tank type/material SEPTI6,SSEE Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 8/24/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 1012",2' ❑ ALL standpipes present per record drawing Total measured depth from grade 3.1/4.2 ft (max) Measured depth to pipe invert from grade 2.3/3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 050-581-14 Structure served by this system Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.89 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 8124121 l C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 812412' Results Q Pass For 3 bedrooms Fluid depth prior to test 5/0 in Water added 450+ gal New depth 6.511 in Elapsed time 1440 min 01 Code -required soil cover over field Fina! fluid depth 5/0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons if yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' Q Yes if No *5' Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ED Yes if No ft Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ] Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' 0 Animal Containment? 50' [✓ Yes if No ft 0 Yes if No ft Water Service Line > 10' IZI Yes if No ft Manure/Animal Excreta Storage > 100' comment below Community Sewer Main > 75' Q Yes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No *5' ft Surface Water > 100' 0 Yes if No ft Property Line > 5'✓Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' IZI 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' Q Yes if No ft Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS * PER THE OLD CODE, NO IMPACT FROM FOUNDATION G. ENGINEER'S CERTIFICATION 1 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 0Ft'e ® r/ •49TH fIl O : MICHA.t L N. ANDLUCH • CE- 9 �1�� • � fir• ��~� Septic Tank Advisory Certificate of On -Site Systems Approval #OSC211592 Subdivision: North Slope #2 Blk 5 Lot 11 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $9,000 to $12,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Madmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org Municipality of Anchorage gg On -Site Water and Wastewater Program (907) 343-7904 'VIL CERTIFICATE OF ON-SITE SYSTEms APPROVAL Parcel I.D. 050-581-14 Expiration Date: I - ��- ��2- 11 1. GENERAL INFORMATION Complete legal description NORTH SLOPE#2 BLOCK 5, LOT 11 Location (site address) 30825 SAGWON AVE., EAGLE RIVER, AK 99577 Current Property owner(s) T J NELSON FAMILY TRUST... — Day phone Mailing address Real Estate Agent 30825 SAGWON AVE., EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: �� Single Family (w/wo ADU) F-1 Duplex F-1 Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well- � I - i I - Holding Tank F-1 Individu , al Walter. Storage Community Com - munify'. Class'_ Well El Public Sewer F] Public Wa ter System 1-1 WaiverNariance request for: Distance: Received by: Date: COSA to be released f��4 eer, unless othemise requested by the engineer. COSAFee $ �52-co-00 Waiver Fee $ DateofPayment ioLe2yZat(y Date of Payment Receipt Number 053`43D Receipt Number COSA#_ 05 WW50 I 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 andlor 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/20/2016 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, AncTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF AZ encroachments, deficiencies or discrepancies exist. 10, , - 49iul* DSD SIGNATURE —Y System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the fo �,,M�NEIH p4 min M09�6 MIA A M W/,F "V4) C) 1 11-7 By: Original Certificate Date: d The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Syst ems 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAW�s�et 1010-12.cm 12 QECW. I �- Kim (Ty?) WHO *3� S*.O J/.O S4 G*9AF C, SUBMMMG 100. 8221 DEL STREET ANCIJOWE, ALASKA DM2 PAME 243 -AM 40 3/WO 1 As 9LmLT 50-29 9/30/00 PLOT PLAN 411-68 DATE MO. 8K. MCD. Fbm ts-.5m � NOTESL Ec*wnentz not appoaing on record subdvi3ion pkt ore not shown unke" description of ec�mt is provided by cEent. It is the tespormUity o( the owner or builder, prior to construction. to wiry proposed bWdng grGde reiatrm to fulish grate ond VIM" ond to datenn!" the existence of ony GQS�U. C�WA3. V reStl"OnS *rich 40 not 10 oppear on the recorded vAdivision plalt. Ele"Ctons bcred on csstIrr�d da"A unl� Otherwise indiccled, and becrings and d4lances as record doto, ALEX TAYLOR LEGAL DESMPTION LOT 11. El,= 5, NORTH SLOPE SUBMSION ADDinoN No. z PLAT NO. SCALE GRID T3-17 v-60 SE T03 00 1. INC Cy m - S4 G*9AF C, SUBMMMG 100. 8221 DEL STREET ANCIJOWE, ALASKA DM2 PAME 243 -AM 40 3/WO 1 As 9LmLT 50-29 9/30/00 PLOT PLAN 411-68 DATE MO. 8K. MCD. Fbm ts-.5m � NOTESL Ec*wnentz not appoaing on record subdvi3ion pkt ore not shown unke" description of ec�mt is provided by cEent. It is the tespormUity o( the owner or builder, prior to construction. to wiry proposed bWdng grGde reiatrm to fulish grate ond VIM" ond to datenn!" the existence of ony GQS�U. C�WA3. V reStl"OnS *rich 40 not 10 oppear on the recorded vAdivision plalt. Ele"Ctons bcred on csstIrr�d da"A unl� Otherwise indiccled, and becrings and d4lances as record doto, ALEX TAYLOR LEGAL DESMPTION LOT 11. El,= 5, NORTH SLOPE SUBMSION ADDinoN No. z PLAT NO. SCALE GRID T3-17 v-60 SE T03