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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 rn_m o zo-� N: o I N00°05'30"E 118.34 oZrn 30 =m�z. Mo s o r- gI m o v w co a: .o T 0 Irn IS N00602'00"E 118.40 B D m � aq c CD r �to m1 Seo cn N cn °� t 1.6 o �� � . '.yit S•lajC•Hp��%^.• ) �'Cv.1:�.i.l"�'..1:: G r'. Y r / Vit;. �,..rS' y.1:'y,>�,6•Y• {[. •�3'.:;• 1;� N00°02'00'E 118.45 IJ mI cn r A ' N00°02'00"E 118.51 N O D w I I W O 8333X 0 co w w IMA