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HomeMy WebLinkAboutT10N R2E SEC 18/19 LT 26 PART 8T1ON R2E Sec 18/19 Lot 26 Part 8 #075 - 061 - 31 MUNICIPALITY OF ANCHORAGE o 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. 075-061-31 Legal description T1 ON R2W Sec 18/19 Part B Site address 155 My Road Current property owner(s) Todd & Monique Jackson Expiration Date: 11-1-22 X The On-site system(s) is/are approved for 2 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Based on MOA Mapping sewer line enters center of the lot while the well is on the right Thus separation is assumed to be meet By- Original Certificate Date: ZS 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 ApprovMjune 2022 MU�'� U LffY OF HC HORAC E Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 075-061-31 Complete legal description T1 ON R2 Section 18/19 Lot 26 Part 8 Location (site address) 155 My Road Current property owner(s) Todd & Monique Jackson Day phone 2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑Q Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage [P Andffdm • r\�J\MW1���17�I�\��i�r�+�n���ilii���� off%.�:fi►:fi������n:•�u:�i•:iG��� i.�:•yl.;i:��•• 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 $ '?, !?_0 % Date of Payment 120.22 COSA# ()SC2.213�Y Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: T1 ON R2E Section 18/19 Lot 26 Part 8 Parcel ID: 075-061-31 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) Date drilled 7/31/08 Total depth 51 ft Cased to 51 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/15/22 Static water level at beginning of test 20 ft. Comments K DATA Measured bPekiting fluid level in septic tank Date of pumping ❑ Required maintenance Comments: RPTION FIELD DATA Which s m tested (date installed) ❑ ALL standpip resent per record drawing Total measured depth fro radeft (max) Measured depth to pipe invert fro rade 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/Deficiencies: COSA Checklist June 2022 Well production at time of test 6.6 qpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 7/15/22 STATION ❑ Require ntenance completed Age of lift stationras Lift station material \� Comments: Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in orption rate gpd FIELD TUS — POST RECOVERY Effective depth record drawings) in Effective depth used in Effective depth remaining E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Building Foundations _ Septic Tank/Lift Station on Lot > 100' ft N/A Community Sewer Manhole/Cleanout > 100' ❑Yes if No ft ❑® Yes if No ft Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' FE -1 if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' FNI Yes if No ft FmI Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' DYes if No ft ❑ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water Prc eptic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations _ ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft ivate Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community e ❑ Yes if No ft Water Service Line > 10' ❑Yes if No ft If tank or field is undecomm ow Mriveway 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 Finn Forge Engineering Engineer's Printed Name Beniamin Schiller, P.E. COSA Checklist—June 2022 Phone (907) 522-7773 Date Aw ,r •' 49 iii ' 7-- .. .. . . nja ' ."Schiller i �F� •. CE 12592 ���`�dPROfESS1* �eJ D1�i��inc�, Inc. lt'atrr heir Drilling and Turn; Service 'Audioatlr,'Af zsCa 0'7) 445-t',t City Botuugh. .Su1><hvision. I DL(Xt Girdwood Meridian Township JON Range .2E Well Log Dolling Started: 07'31 2008(•0mptc1cd:07/31 +2008 Properly Owner Name A Address: Darren Mattingley P.O. Box 950 Site: My road Girdwood, AK 99587 BOREHOLE DATA(from top of casingpepth Material: 'type, Color & wetness% Prom To &action 18/19 _ %a of _ V. _ _ 'A or ✓"' Drilling method: (X ) Air rotary. ( 1 Cable tool, Other Well use: ( ) Public supply. (x I Domestic. Other stickup 0 2 fill 2 4 Depth of hole: 51 11. Casing stickup: _2—ft Casing type:steel_ _ _ ihicknc's: .250 inches Casing diameter: 6 inches Casing depth: 51__ ft Liner type: - Diameter: _inches Depth: - 11 silty clay w/ gravel 4 8 silty gravel 8 34 Static water (from top of casing). 20_ ti on OZ31_ 2008 Punyting level S. yield: _ fxt after _ hours at _ gpin Recovery rate: 50+ gpnt htcthod of testing: airlift Development method: airlift Duration: 1 hour moist silty gravel 34 38 wet clay & gravel 38 41 gravel w/ 1120 41 51 Well intake opening type: ( X1 Open end. ( 1 Opcn hole. Other _ Screened: Start: - It. Stopped __-__—._..._ It Screen type: - Slot mesh sive: - Pcrlbrated: Stan: - n. Stopped: n Stan: - I. Slopped: n Note: Grout type: __ bentonite_ Volume Depth: from-g9Un.41$u):f_a_Qe . to Pump intake depth: fi Pump site: hp. Brand name: _FA .9A DE R f�ERES DEPT. AUG 05 tong —1SITE-w wasltwATER t . Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Section 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 Was well disinfected upon completion' (X 1 \'ts. ( ) No Method ofdisinfection:CaICiUm.1iypochlorite..(Chlorine)... Driller comments: disclaimers - Well driller name: Johnny Company name: Hefty Drilling, Inc. Mailing address- 3540 Akula Dr. cit:_Anchorage_ Phone number: ( 907 Drillers signature: State: LE zip 99516 34 - 0593 fax345-4700 Attention: Property owner shall provide a well log to the DSD within 60 days of well completion. Permit Number: SW080139 Date or issue: X411 /23 /200$ Parcel Identification Number. f175 -0R1 -31 Is well located at approved pemut location? ( x) Yes or ( 1 No APR -24-2009 02:55P FROM: TO:3437997 P.1 Pump Installation I .o. c = Tap CASNG 1 Mfg OA. (..a4;‘9 G;rawea /My o Log T/o u e tic. I8Lit 8 NAME Du ereIVO Nl AftiNg MP3/ DATE I0(JP T/O T A Pitkss Adapter Manufacturer's Name: 4. ,4 t.,�h *A j B u Pitless Adapter Installer: ilea/ 04145 ;IL KIM Twc StAbneits bie. MAC - Ma 10 54E05— 160 SOIAL R NNW 96/ (I 0 iv Mote $1a�( ,t gDROP TM: Tp. XII 7L/ PVC p . • 1" cams, new' i i PONES S CATp. /W;'I4t& SW 141 1416 bid- condo. a1l rl 'SEC,RhCAl: Moil. /15 [ Amp. /O. 9 WARR TAMC: Tips We1114raI sh. 2f01 t CASH& 9n 4, / " Db. Tips 5 ler( ' 5 / ' O To (9ytfti Eno( '------ To CAPD ICL• from MTANE STa)C1UfE: Type from OPEN HOLE• Nun To COMMENTS: well was disinfected upon completion. method: calcium hypochlorite. Water Weir anti Pumy Service Anchorage, %Casks (907) 345-0593 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW080139 Legal Description: T1 ON R2E SEC 18/19 LT 26 PART 8 Design Engineer: 0000 ZZ - NONE NEEDED Owner Name: DARREN MATTINGLEY Owner Address: PO BOX 950 GIRDWOOD , AK 99587 - Date Issued: Jul 23, 2008 Expiration Date: Jul 23, 2009 Parcel ID: 075-061-31 Site Address: Lot Size: 7796 SQ. FT. Total Bedrooms: 1 Permit Bedrooms: 1 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank 0 Privy ❑✓ Private Well 0 Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date:—9/72Aftf Municipality of Anchorage Development Services Deparinnent,.. Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 7 5 0 �' 1 3/3S!_�q& cost) Property owner(s) • Oct (rein Al ci r vie/ �/ Day phone 5 6 3 3 8 L/ �, Mailing address ?C `i `S o 6 t rcl we c+c� Zip Code 95 Site address Ay et 4 d Zip Code 9 9S 9 7 Legal description (Sub'd, Block & Lot) —r1 d N iCoSe c / 8 / 19 Lf ac Par% 8 Legal description (Township, Section & Range) Lot Size_ g,t1, Sq. Ft. Number of Bedrooms 1 1 THIS APPLICATION IS FOR (®all that apply): THIS APPLICATION IS AN: Absorption Field 0 Initial Septic Tank 0 Upgrade Holding Tank 0 Renewal Privy ❑ Private Well /114-- Water ®Water Storage 0 certify that the above information is correct. 1 further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Q9 x— 4r �- (Signature of property owner or authorized agent) Permit/Rush Fees: II's` Waiver Fees: Date of Payment: 11 IIA Date or Payment: Receipt Number. a 1 billIS Receipt Number: (Rev. 11/05) Lot 26 ca / N s cp. ct�4 s- seon\ Lot 26 6 ii k e LOT 25C LOT 25D N NOTE: 1) Bearings and distances are as Deed Description Provided by Client N SENTEC Surveying • Engineering 2525 Gambell Street, Suite 200, Anchorage, Alaska 99503 Tele: (907) 563-3835 Fax: (907) 563-3817 PLOT PLAN OF: LEGAL DESCRIPTION Portion of Lot 26 U.S. Survey No. 3034, Alaska SURVEY CER IIF ICATION: SENTEC has condutted .r physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no encroachments exist other than noted. Will OMR. MY.• 08-5037 MY 11.2007 130' ..,,w.. Kms.,. ME MJH %I10 SSA WA coy' /A.s. Wet EXCLUSION NO ES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. NOTE: Undcr no circumstances should any data hereon be used for the construction or for the establishing of property lines. LEGEND © CAKE TV TELECOM. PEDESTAL ® BECIRIC TRANSFORMER D4 WATER VALVE ,Q WATER HYDRANT O SEPTIC VENT ''O, EIEC POLE Ma 'in�%ey Darren J Pc( red 075 061 3 Lejq/ Priv N Z° (/V e /l M9no/e. /4).4/ se wet. frvhlc lin e - Pr; ken *e. V l i C 4-r v vt k- 35/-'v6Z LI- 2.6' ate# My Rog q/ 6 ,ecit-i/00 c/ 2 s / 7s -1-