HomeMy WebLinkAboutTURPIN #1 BLK 5 LT 5Turprin #1
Block 5
Lot 5
#006-096-05
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program :.
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING r, �1
Parcell.D. .00142-mte-D.5 COSA# W5g9
Expiration Date: 1-30-09
1. GENERAL INFORMATION
Complete legal descriptipn Trj7in
k1
Block 5 Lott 5
`. Location (site address) ' 6311 Ir -A-4
614 AgooVC
'Current Property owner(s) i21UA
BUCk 1_6-W Day phone
254-01/2
r,.
MaTng address
Lending agency
Day phone
Mailing address
Real Estate Agent ACAN
6K
-0 gf r, AX Day phone
25-4-0111-
5-4-OIIZMailing
MailingAddress
Unless otherwise requested, COSA will be
held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
f
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 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
Address
Engineer's Printed Name /_AQS5y kt4nd
5. DSD SIGNATURE
V�Approved for bedrooms.
Disapproved.
one 279-39/6
Date 1012710 pk
TW* 1(
. LAF S E. SPUR MhD.
11-00
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ��/— Original Certificate Date: % 0 — 3 D — Og
(R.v IM)
Municipality of Anchorage
Development Services Department
\ Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
T4r
Legal Description: oin Ili. glucFt 5 Lo� S ParcellD: 006-o qJA_() r
A. WELL DATA
Well type -ELA& If A, 8, or C provide PWSID # = Well Log (YIN) A/
Date completed Mnk^o.wm Sanitary seal (YIN) y Wires properly protected (YIN) y
Total depth hMu t. Cased to Casing height (above ground) { 16 in.
FROM WELL LOG AT INSPECTION
Date of test 4r+k+ow n i� Z o
i
Static water level u nk�own ft. 4 ft•
Well production g.p.m. 3.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 mL Nitrate NP mg/L Other bacteria /colonies/1,/00mL
Arsenic: N ug/L date of sample: _IC Woe Collected by: LAMS S�
J 76 k.mpl&a iolstilo0
B. SEPTICIHOLDING TANK DATA 5e_"cp.
Tank Type/Material �" Date installed
Tank size _ gal. Number of Compartments = Cleanouts (YIN)
Foundation cleanout (YIN) — Depression over tank (YIN) = High water alarm (YIN) --
Date of pumping Pumper
C. ABSORPTION FIELD DATA P��b is SEuE2
t
Date installed Soil rating (g.p.d./ft2 or ft2/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.) (YIN & type) — If yes, give date —
D. LIFT STATION
Date>on"
Size in gallons anhole/Access (YIN)
"Puin. 'Pump ;te
evel a in. High water alarm level in.
DatuCycles Meets alarm irc&tr uit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /V/A On adjacent lots
Absorption field on lot A/A On adjacent lots,
1
loo 1+
100 t-t-
Public sewer main –46+ Public sewer manhole/cleanout 100 i+
Sewer/septic service line 5 + Holding tank N/A
Animal containment areas So 1+ Manurelanimal excrete storage areas too It.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation — Property line Absorption field —
Water main Water service line Surface water
Wells on adjacent lots --
j
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line Surface water
Curtain drain
F. COMMENTS
Wells on adjacent lots =
Driveway, parking/vehicle storage I —
I
G. ENGINEER'S CERTIFICATION �Q� �,�):• s?9 i�
I certify that I have determined through field inspections and y 49T L�° .
10
review of Municipal records that the above systems are in 4
conformance with MOA COSA guidelines in effect on this date.% PVr.'4Fr(LA D
Engineer's Printed Name �j
SJariL�Ar1
LA�2S (l�'•'•FiiS5�����=�
Date 1o�2110B \\ FESS
COSA Fee $ Waiver Fee $
Date of Payment �2� Date of Payment
Receipt Number /7��J ✓ Receipt Number
(Rev. 11105)
SCS Ret#
1085602001
Client Name
Tobben Spurkland P.E.
Project Name/#
Turpin #I BS,IS
Client Sample ID
Turpin #11315.1-5
Matrix
Drinking Watcr
PWSID 0
Samplc Remarks:
Printed Date/time
Collected Date/Time
Received Datefrime
Technical Director
1022/2008 13:35
10102008 14:45
10/1012008 15:50
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQI. Units Method Comainer ID Limits Date Date Init
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitritc-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND 5.00 ug/L EP200.8 C (<10) 10/20/08 10.'21:'08 NRB
ND
0.100 mg/L.
SN1204500NO3-F
B
(<10)
10/14/08
dDZ
137
coL1100mL
SM20 92221)
A
(<200)
10/10/08
DLC
0
coVI00mL
SM209222B
A
(<1)
10/10:08
DLC
0
coVIOOmL
SM209222B
A
(<I)
10/10/08
DIX
SCS ReL#
1085827001
Client name
Tobben Spurkland P.E.
Project Dame/#
Turpin #1 B5,L5
Client Sample ID
Turpin #IB5,L5
!Matrix
Drinking Water
PWSID
0
Sample Remarks
Printed Daterrime
Collected Daterrime
Received Daterrime
Technical Director
10/28/2008 10:41
10,24.2008 15:45
10124/2008 16:25
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Microbiology Laboratory
Colony Count
Total Colifkwm
Fecal Coliform
0 col/I00mL
SM209222B
A
(<200)
1025'08
DLC
0 col.'100mL
SM209222B
A
(<I)
10/24/08
DLC
0 col,'100mL
SN1209222B
A
(<1)
10/25'08
DLC
EDWARD STREET
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