HomeMy WebLinkAboutYOSH LT 1Yosh
Lot I
051-063
-95
MUNICIPALITY OF ANCHORAGE
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~ddress~~ r~ ~~ ~ ~0 SEPTIC ABSORPTION WELL
~ TANK FIELD
Phone(s)r'O'~ ~ ~¢~ermi~No~,~1`°'~~l°f B~ms WELL X ~ / ~ [ ,
~ - ~1~ J ~ ~ LOT LINE
LEGAL DESCRIPTION
Township. Range, Section ~'~ ~t~ ~ ~ ~ AS-BM,ET DIAGRAM (Show location of well, septic system, prope~y I,nes, foundation,
~. ~ ~ ~' ~~ , ~~ driveway, water bodies, etc.)
· . N
E PTIC ~ HOLDING ~ ~'
Manufacturer Capacityingallons ~i '
/
/
Material No. of Compa~ments
TYPE OF SYSTEM
ENCH ~ BED ~ W. DRAIN ~ OTHER
Depth to pipe bottom from Total depth from origina, grade
obgina, grade ~ FT ~ ~ FT
Fill aCde¢ a~ove original ~ra¢e Gravel ~epth boneath p~pe
0 FT ~ FT ~
Gravel length Gravel width
Total absorption area Distance between lines ~ ~
Pipe material ~ ~( ~"~ ~ ~ ~..
Number of lines ~ S°il rating
Installer ~ ~ ~ Installed
WELLS
~PRIVATE ~ OTHER (Identify)
Installer Date Installed:
REMARKS:
~a~e: ~ ,~.~, E .
/ ~ ~a~e: ~ ~_ ~
I : ?: :_- =__:_: :_ __: .... cedily that t~ inspe~n was ped0rmed according l0 all
Health Depadment Approv~
72-013 (3/85)
i....c,'L i....ega ]. :: Sub d :i. v .:'..-. s :i. c,n ~: !',IA Lot: NA B 1 oc k: NA
Section: ~!; 'T'ownship: 15N Flange: 1W
SOUTHERN PART Of'" F'Ttq S2,i',IE:4,SE4
t....u)l.'.. .~::i 'i z (.9 ............( '.-E. cj ,, ',' ~ ............
Max E~,:.~:,,'.::! r' ,'::;,,:::,ms r, Th :i. e; l:::'e ~- m .i.t. ',~ 3 Tota 11. L';ap ac 5. t y :', :1~
(:;~r' 'i' :, }:!'; ......... I¥[L.u"i :i. c: . '"" :i. ty Ar'ich,.';:)p age ........
' ' .,... ! ~ ,::# :i. p ~..,. ,::.'. f' ( Mr': .~:':.'. '., a n ,:J .t: h ,:e ::::;i. a i- ,.= {::~ '! A 1 a s I.:: a ..
:i. nsto:Li the ,:.::yste,':,:~ in accor'dari,:::e i^.~ith all i"IOP~ cc, cie!!:, and r"egu].atic:,r"~s,
ar':..cl ;i ............ '", (::; cu"¢q:¢ ]. ~..ar"~ce ,,,,,~ ;i.'~ h '~'" -, (;;l(.:.~:.s i.:;.ir-.,, ct' i"i'.. ~'.;.:.;,~-
ac:!h(::;:,.r'e 'i._,::~ a:l.:t. NEiA and !?La'L(.:.::: o.i' A:l.a~i.::a p*:.:.:q,'...,'.;i.r'em(..?:,r'~'ts ¢.,:::)r- t.h,:.;.:.;, .::.::.;.5~t. t:::, .:,. ,:;:: k
stanc:,:.:,s .!' P C:h",.~ &i'",.V ,:~5::.'.( .i. ,~iit :i.i]c.] I..,i ¢:.:, ]. ]. ~, ~,.',';as'.l;..E,i',.~a'!:.¥T.-.'.p (:l :i. si:.',c:..~ia I sys!'..em c:~r'- i:;:,ul:;', i :i. c
!!!iE-}~,',/~':~':'i" E~', (:,I (':(,? ".z,i~')I'~EY~-,i:.;,~'fTi C:)i'] 'i:,.h ii. iii:, C)l" at"!."),' i~G.::Ij ac:,~,,~i"lt..:::it" r'l,:.:.:.).:':.."~r' l::)'y' ].
under'stand that 'Lh i. s per'.m:i.t :Ls valid
,--:::J..:F.;c:) L.U"! (::I (.;':':' P ':.~::'I:.. .:[t Fi ,;::I that 'Lb(.:-:-:, cal:::,ac::i.t¥ c;f 'Lh-~..'.:.: tc,",:.a:L s':,,'s'L,',-:.?-m :i.s 3 i::)(~:.:,(::i'~"~:::.,.(::;,.'r'~.~ ar'~.-':::i
y ,'..:.z, n ]. e r'. g e,'fi,:...'-n t ~.,¢ :i. ;I. :I. r' e "-::t u :L p e a n a ,::.'1 d :L t ;i. {::'~ n a 1 t:::'
l:::: ,.... ,ii!: l::::l ..::f ,, ,::) ,./ ~...~.1~ ..,~'. ............. S./.~:- .., ..................
PERFORMED FOR:
LEGAL DESCRIPTION:
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,COPY
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
TownshiP,sLoPERange, Section- '-T-'~ ~iSlTEtEt?P LAN~ ~ I ~'~--~ ~
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT / O
DEPTH? p
E
Depth to Water Afle~.~..~r .
Monitoring?
Date:
-I
N
---1. / 8'
'f;, ~' ~ 1~'
-'
Reading Date Gross Net Depth to Net
Time Time Water Drop
-~ ~¢,~ ~:;~ ,~-¢~ r:c~~/e," ,,~
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~" FT
PERFORMED BY: ........ .. .......... //I/ /~ ~ CERTIFY THAT THIS
I su~ ~agBu ~l,vur ~ ~O ~O, 2~/ TEST WAS PERFORMED IN
ACCORDANCE WIT~ ~ ~~L GUIDELI~~ECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
04/13/2009 12:01
Jan 01 09 01135p
9076941211 SNSENG I NEER I NG PAGE
SuIlivan Water Wells 907 688 2759
SULLIVAN WATER WELLS
p.o. gOX67027'?.~ CHUGIAK, ALAgKA g956'7 · TELEPHONE t~d&275g
03/05
OWNER OF LAND C~o._./.'~O ¢'4'.~
DATE - St~ed Ended
PE~Ii~ HU~ER
DEI"['H OF WELL
ST.\TIC LEVEL OF WATER l--r.
KIND OF FORMATION:
From~-O-~Ft. to '~ ....... Ft.. CA.i, ,¢ C '~...'¢-,_g'~/' ~ From ~. Ft.
r~-~~, r~.,o ~g ~t. x,~Cr X~,,~ ~~> r,,.,~,.,,,
F~om Ft. ~ ' ' ' ' . From ~'t.
Fromm-Ft. 1o. Fi.~;~& --~'~'i~ ~¢~ From ~Ft. t~,Ft.
~rom-- Ft. ,* FL ~ ~-- C~ From
From_ Ft, to~F~ Fr~ ~Ft.
From.~Ft, to.~Ft Frm ~_Ft. ~
Fmm~Ft. to ..... Ft. ~ From
Ft, to
Ft. to
...... Ft. to
DRILLER'S NAME 1-.~*~. ~
Municipality of Anchorage
Development Services Department
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-063-95
GENERAL INFORMATION
Complete legal deScription
COSA# O£c/s
ExpiratiOn Date: / - /--/ '- / /
YOSHLOT1
Location (site address) 21636 OLD GLENN HWY, CHUGIAK, AK 99567
Current Property owner(s) WILLIAMSON & ASSOC., LLC Day phone
Mailing address PO BOX 3538, MONTGOMERY, AL 36109
Lending agency Day phone
Mailing address
Real Estate Agent CAROLINE STREANO Day phone
Mailing Address
Unless otherwise requested; COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER,SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
2
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
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 Firm ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 09/28/2010
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,
ArcTerra 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
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory .X'
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
M kipality of Anchorage
DeveloPment se i, ces D epa ent
Building. Safety Division
On-Site Water &: Wastewater program
4700 Bragaw Street
P.O. Box 1'96650
Anchorage, AK 995.19-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal: DescriptiOn: YOSH LOT 1
WELL .D~/?A
seal (YIN)Y_
Total depth 200 ft. Cased to 131 ft.
FROM WELL LOG
Date of test 10/I984
Static water level SS.. ft.
Well production 25 g~p.h.
Parcel ID: 051-0{~,95
wires (Y/N) _Y
Casing height (above ground) ..24 in.
AT INSPECTION
/20/z010
0~392 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100mLNitrate 2.31 mg/L
Arsenic: ND mg/I Date of sam pie: 09/17/2010 Collected by: Al,¢Te~za
B. SEP13C/HOLDING TANK DATA
Tank Type/Material S~q~Steel Date installed 10/'1989 Tank size 1000 gal.
Number of Compartments_2 Cleanouts (Y/N) _ Foundation cleanout (Y/N) Y_. Depression over tank (Y/N) _.N
High water alarm (Y/N) N Date of pumping 9/20/2010 Pumper IRs
C. ABSORPTION FIELD DATA
Date instaiied 10/1989 Soil rating (g.p.d./ft2 or ft2/bdrm) 225 System type Trench
Length 61 fl. Width ~ ft. Gravel below pipe 4__ft. Total depth 12.33 ff. (Measured 9/20/10)
Depression over field _N_
Results (Pass/Fail) Pass For 2 bedrooms
Water added 700 gal. New depth 40 in.
Eft. absorption area 488~ Monitoring tube X
Date of adequacy test 9/20/2010
Fluid depth, in absorption' field before test 0 in.
Elapsed Time: 1410 min. Final fluid depth 0 in. Absorption rate >= 300+ g.p.d.
Any rejuvenation-treatment, (past 12mo.) (Y/N & type) N__lf yes, give date --
D,
LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at __in:
Cycles tested
Manhole/Access (Y/N).
High water alarm level at in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankJlift station on.lot 100'+
Absorption field on lot II~Y+
On adjacent lots loo'+
On adjacent:lots
Public
Building foundation $'+
Water main 10'+
Wells on adjacent lots 180'+
Animal'containment areas 50'+ ManUre/animal excrete storage areas :tOO'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line 5'+ Absorption field $'+
Water service line 1.0'+ Surface water :tOO'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line :to'+ Building foundation 3.0'+
Water Service line :tO'+ Surface water :tOO'+
Curtain. drain 50,+ (No~e Kaew~)
COMMENTS
Water main :tO'+
Driveway, parking/vehicle storage
Wells on adjacent lots .. 100+
10'+
G. E.Sm. ER'S
I certify that, have determined through field inspections and
review of Municipal records that the above systems are
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Y~NNET~ M. D~S
Date 09/28/2010
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
0
N89'55'OO"E (R&:H)
105.92' (106.00'
77.4'
GRA¥~L
LOT 1
SF~P TIC
~ V~NT$
LOT
/
?
0
g
/
ANCHORAGE RECORDING DISTRICT
// N 8~7~-6'~2;' E
(N89'57'10"E
ASBUILT OF:
YOSH SUBDMSION
LOT 1 PLAT 2009~4
SURVEY (~TJl~TION: ], John L. Schuller, have c, ondu~ a
physical survey of this ~ as abown on this drawing and that the
WORK ORDER NUMBER: IO~TE ISCALE: E:-UA~U
IsE~-r 5, 2o~o I ~"=5o' I
1 0 ..... ~'.~ 5 '~ ~ORAWN BY: ICaE:CK£D sYlC, mO NUMB[R: / I~OK/PA.~F_.:
/ JLS NW1460 100520
I I I
0 - I~]D S/~" REBAE W/Ym.~row I~_,A~T~C CA~
.
1831 Talkeetna Street
~chorage, ~aska 99508
(907) ~27-1455 offioe
(907) 274-4992 fax
SGS Ref.# 1105011001
Client Name ArcTerra Engineering and Surveying Printed Date/Time 09/27/2010 8:15
Pro.iect Name/# Yosh WT 1 Collected Date/Time 09/17/2010 13:40
Client Sample ID Yosh WT 1 Received Date/Time 09/17/2010 14:27
Matrix Drinking Water Technical Director Stephen C. Ede
Saml~le Remarks:
4500NO3 - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/21/10 09/23/10 KDC
Waters Department
TotalNitrate/Nitrite-N 2.31 0.100 mg/L SM20 4500NO3-F B (<10) 09/18/10 AYC
Microbiology Laboratory
E. Coil Negative 1 100mL SM20 9223B A 09/17/10 DLC
Total Coliform Neeative I 100mL SM20 9223B A 09/17/10 DLC
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. ci. anchorage, ak.us
(907) 343-7904
Water Well Advisory
During a recent
supply well on
Certificate of On-Site Systems Approval (COSA) # 101229
COSA on-site inspection and test of the potable water
Block , Lot 1 of Yosh subdivision, the well's
productivity was determined to be 0.392 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 2-bedroom
residence is 0.2 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
, COSA# U/'I.
Expiration Date:
1. GENERAL INFORMATION
Complete legal description w 1/2; S 1/2; SE 1/4; NE 1/4; Sec. 3; T15N; R1W; SM
Location (site address) 21636 OLD GLENN HWY, CHUGIAK AK. 99567
051- 0[ 3-17
Current Property owner(s) WILLIAMSON AND ASSOCIATES Day phone 907-726-1778
Mailing address 22243 LAKE VIEW DRIVE, EAGLE RIVER AK.99577
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
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 Firm s & s ENGINEERING
Phone 907-694-2979
Address 15861 S. BIRCHWOOD LOOP, CHUGIAK AK. 99567
Engineer's Printed Name ROBERT A. SHAFER
Date 4-3-09
DSD SIGNATURE
~ Approved for ,~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipul~
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory ~'
Nitrate Advisory ~
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ]7L -/-~ - O ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
470~0~EImore Street
p.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Well type p
Date completed//~(~/-'/
Total depth ,~ ft. ft.
Date of test
Static water level
Well production
Parcel
IfA, B, or C provide PWSID # ~
Sanitary seal (~N)
Cased to/3 /
FROM WELL LOG
ft.
E
,Well Log0N)
Wires properly protectec~(Y~N)
~ /-- /r
Casing height (above ground) Z/-7L in
AT INSPECTION
~, ~ g.p.m.
B=
Co
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 4~), ~,-~mg/L
Arsenic:
SEPTICtHeEDtN~ TAN K DATA
Tank Type/Material ~~/- 67~e~-~ f
Tank size/~ gal. Number of Compartments ~--
Other bacteria (~) colonies/100 mL
Date installed / ~/~
Cleanouts~) /
Foundationcleanou~) ,~ Depressionovertank~_N~~/,~ High water alarm (Y/N)
Date of pumping ~/~ ~t70 ~ Pumper ~, ~ ~ ~ ~ ~ ~.
ABSORPTION F~LD DATA ~- ~ /
~ate installed ~ ~ Soil ratin~ System type ~*C
ken,th ~ ] ft. Width ~ ~ ~. Gravel below pipe
Total depth /~ ft. Eft. absorption are~ ff2~onitoring tube~r~
Date of adequacy test / ~0/0 ~ Result~(Pas~Fail) .~
Fluid depth in absorption field before test~T in. Water added~ /gal.
Elapsed Time////~ ~min Final fluid depth ~ in. Absorption rate
Any rejuvenation treatment (past 12 mo.) (~ type) ~~ ~~
~L ft.
Depression over field
For ~ bedrooms
New depth ~ in.
,-~ "J"- g.p.d.
If yes, give date ~ ....
D. LIFT STATION
Date installed Size in gallons ..----~~ole/Access (Y/N)
"Pump on" level at ~ in. ~t in. High water alarm level at
Datum ...---~-J Cycles tested Meets alarm & circuit requirements?
in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
SePtic tank/lift station on lot /x'~(~ ~/_
Absorption field on lot /~) '7z'
Public sewer main ~ /Y'Or' /
Sewer/septic service line
Animal containment areas
!
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank ~.~
/-
Manure/animal excrete storage areas ~/~
Absorption field ~ /'
Surface water ,,/~ 17/--
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~-"Z.~. ~ _
Property line/~~'- ~/
Water main ,AJ //~ Water service line ~) '7/--
Wells on adjacent lots //tS~O ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /~"-
Water Service line
Curtain drain
Building foundation
Surface water
Wells on adjacent lots
Water main ~//'~
Driveway, parking/vehicle storage ,~ ~
F. COMMENTS
I ce,ify that/ have determ/~e~u h field ,~s ectibns and
g P ~ ~.~
review of Municipal records~at ~e above systems are in
conformance with MOA CO~ g~in~ iG e~n thi~ate. ~~~ ~'. ~ ~
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
~,~.~,~.,,,~'
Waiver Fee $
Date of Payment
Receipt Number
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.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
During a recent
supply well on Block
SE4 NE4 subdivision,
gallons per minute.
Department (AMC
Certificate of On-Site Systems Approval (COSA) # 090082
COSA on-site inspection and test of the potable water
, Lot of T15N R1W Section 3 W2 S2
the well's productivity was determined to be 0.8
The minimum well productivity required by this
15.55) for a 2-bedroom residence is 0.2 gallons per
minute. Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the production capacity of
the well may fluctuate. Restriction of non-critical water uses such as
washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
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
Nitrate Advisory
Certificate of On-Site Systems Approval # 090082
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
of T15N R1W Section 3 S2 NE4 SE4 PTN subdivision. This
inspection revealed a nitrate concentration of 8.85 milligrams per liter
(mg/L) was reported for the property's well water sample. The
Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Please see the attached "Nitrate
Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
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EKLUNTA HEIGHTS, STEWART ADDITION
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