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HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 4 LT 4Abbott Loop MQnor lock 4 Lot 4 014-181 -41 Jun 30 11 05:01p Beau Maxim 19073391985 Mark Begich Mayor Development Sevvices Department Building SafeVy Division On-Site WateP & Wostewater 4700 Elmore P.O. Box Anchorag6, AK 99507 www.m u ni,orq/o~sit¢ (907) 343-7904 Pump Installation Log Well Drilling Permit Num bet: SW Date of Issue: Parcel Identification Number: Legal Description ABBOTF LOOP MANOR BLK 4 LOT 4 Pump Installation Date: $/~e/~ 1 Pump Intake Depth Below Top of VCell Casing: 40 Pump Manafacturer's Name: GP. UNDFOS Pump Model: 15 SQE 07 150 Pump Size 1/2 hp Pifless Adapter Burial Depth: lO feet Pitless Adapter Manufacturer's Name: O_.AMBEL Pifless Adapter Installer: BRIAN WILLE Well Disinfected Upon Completion? ~ Yes [] No Property Owner Name & Address: IMARIT HOMES Jlg20 W. DIAMOND BLVD, SUITE F A. NCHORAGE, AK 99515 feet Method of Disinfection: RECIRCULATED USING CHLORINE PELLETS Comments: Pump Installer Name: BEAU MAXIM Attention: The pump ingmlter shall provide a pump installation log to the DSD within 30 days of pump installation. FROM :Alpine Drillin9 FAX NO. :907 345 0202 Jun. 03 2011 09:$?AM Pl Alpine Drilling & Enterprises Well Log Permit Number:. #SWOSP 111011 Date of Issue: 2-14-11 Parcel Identification Number: 0_1__418141000 Date Stattad: 5-25-11 Date Completed: 5-15-11 Is well located at approved permit location? x Yes [] No Legal D~crip#on: Abbott LoOP Manor BIk 4 Lot 4 Property Owner Name & Address: Brown R Hutton & Wencly- Brown George R & Alice 2213 Foraker Drive Anchorage, Alaska 99517 Borehole Data: Depth (ft) Method of Drilling x air rotary [] ~able tool Soil Type, Thickness & Water Strata From To b'tick-up 0 2 Organics & silt 2 4 Silty gravel 4 11 silt 11 19 gravelly silt 19 34 water sand & gravel $4 36 gravelly silt 36 42 water sand &.gravel 42 44 Casing type: steel Wall Thickness: .250 inches Diameter: _6 inches Depth: 44 feet Liner Type: ~ Diameter: ~ inches Depth: ~ feet Casing sflckup above ground: _2 feet Static water levd (from ground level): 15 feet Pumping level: 4..~O_feet af~er _2 hours pumping/0 gpm Recovery Rate: ~ gpm Method of Testing: ~ Well Intake Opening Type: x Open End [] Open Hole [] Screened Start ........ feet Stopped, feet [] Perforations Start feet Stopped ~ feet Grout Type: Bentonite ~_ranules Volume: I b~ Depth: Start 0 fext Stopped. ? feet Pump: Intake Depth ~ feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes ["] No Method of Disinfection: ~ablets Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 ,4nchorage .4K 99511 06/03/2011 09:58 No.' R075 P.001/001 Jul 08 11 03:45p Beau Maxim 19073391985 p.2 n4ark eegich M~yor Development Services Deportment Building $ofety Division On-Site Woter & Wc~stewnter Program 4700 Elmor¢ Rood P.O. Box 196~50 Ancho~g¢, AK 99507 www.muni.orq/orsite (907') 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description ABBOTD LOOP MANOR eLK 4 LOT 4 Pump Iestailation Date: Para p Intake Depth Below Top of Well Casing: 4o feet Pump Manufacturer's Name: GRUNDFOS Pump Model: ~s SOE 07 Pump Size v2 bp Pitless Adapter Burial Depth: 10 feet Pirie. ss Adapter Manufacturer's Name: CAMBEL Pifless Adapter Installer: BR~,",~ WILLE Well Disinfected Upon Completion? [] Yes [] No Method of Oisinfecfion: RECIRCU LATED USING CHLORINE PELLETS Comments: Property Owner Name & Address: JMARIT HOMES 1920W. DI/U~tOND BLVD, SUITE F ANCHORAGE, AK 99~,5 Pump Installer Name: BEAU MAXIM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days o£pump installation. SGS Ref.# 1112935001 Client Name Anderson Engineering Printed Date/Time 07/08/2011 14:59 Project Name/# Abbott Loop Manor Lot 4 Blk 4 Collected Date/Time 07/06/2011 9:35 Client Sample ID Abbott Loop Manor Lot 4 Blk 4 Received Date/Time 07/06/2011 10:30 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 9.37 5.00 ug/L EP200.8 C (<10) 07/06/11 07/07/11 NRB Waters Department Total Nitrate/Nitrite-N 0.104 0.100 mg/L SM20 4500NO3-F B (<10) 07/07/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 07/06/11 CR Total Coliform Negative 1 100mL SM20 9223B A 07/06/11 CR Permit Number: Tax Code Number: Work Type: Permit Effective Dates: Design Engineer: Subdivision: Site Legal Address: Owner/Address: Site Mailing Address: On-Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 OSPl11011 01418141000 Well Initial February 14, 2011 to February 14, 2012 ANDERSON ENGINEERING ABBOTT LOOP MANOR ABBOTT LOOP MANOR BLK 4 LT 4 G:2233 BROWN R HUTTON & WENDY 50% & BROWN GEORGE R & ALICE T 50% 2213 FORAKER DRIVE ANCHORAGE AK 995171151 7720 Hacienda DR, Anchorage Lot Size in Sq Ft: 11900 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: · , ~ Date: Date: Feb. 9. 2011 2'OOPM ~nderson engineering No, 9254 P. 1 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 995'19-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-181-41 Property owner(s), Merit Homes, Inc. Mailing address ?.0. Box 111982 Anchorage, AK Site address Hacienda Drive Legal descriptio~ (Sub'd., Block & Lot) Abbott Loop. Manor Subdivision, Block 4, Lot 4 Legal description (Township, Range & Section) Lot Size 11,90o Sq. Ft. Number of Bedrooms Four (4) Day phone 334-9233 Zip Code 99511 Zip Code 99507 THIS APPLICATION IS FOR ([~] all that apply): AbsorptionI Field [] , Septic Tank [] HOlding Ta,nk [] [] Private Well [] Water Storage [] THIS'APPLICATION IS AN: Initial Upgrade Renewal Waiver Fees: Date of Payment: Receipt Number: (Signature of prop:'erty Permit/Rush Fee~: Receipt Number:' (Rev. 11/05) I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes, / / / / / / / / / / / / ? MUNICIPALITY OF ANCHORAGE Development Services Department c P p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approvalql� Parcel I.D. 014-181-41 Expiration Date:C 2 Legal description ABBOTT LOOP MANOR B4 L4 Site address 7720 Hacienda Dr Anchorage Current property owner(s) Amanda and Owen Tittle X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 2/14/2023 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 Approval_June 2022 M UHMP A UTY OF A HCHORAGE 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. 014-181-41 Complete legal description Abbott Loop Manor, Block 4 Lot 4 Location (site address) 7720 Hacienda Drive, Anchorage, AK 99507 Current property owner(s) Owen & Amanda Tittle 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank Q Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age N/A - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit 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 Waiver Fee $ Date of Payment Date of Payment COSA # O's C ;a3 % 03 r Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: Abbott Loop Manor Block 4 Lot 4 Parcel ID: 014-181-41 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 5/15/11 Total depth 44 ft Cased to 44 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 2/8/23 Static water level at beginning of test 10.4 ft. Comments B. TANK DATA lis edoperating fluid level in septic tank Date of pumping El Required maintenance comp if AWWTS Comments: D. ABSORPTION FIELD DATA system tested (date installed) ❑ A standpipes present per record drawing Total me ured depth from grade ft (max) Measuredde to pipe invert from grade ft (min) El N/A — pres rized field. ❑Per recorddra gs, field is insulated. ❑ Monitor tubes go to bo m of effective. If not, state depth into ❑ Presoaked required if (Required if house vacant or field n used for more than 30 days prior to date of test) Gallons introduced N/A gallons N/A date Any rejuvenation treatment (past 12 months) N If yes, enter date Well production at time of test 4.5 9 p Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.01 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 01/23/23 C. LIFT STATION Age ired maintenance completed of lift station years Lift station material Comments: equacy test date esults ❑ Pass Fluidth prior to test in Water add gal New fluid dept in Elapsed time min Final fluid depthin Absorption rate g FIELD STATUS — POST F Effective depth (per record draw%in in Effective depth used in Effective depth remaining Comments/Deficiencies: Property is served by AWWU sewer. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) if No N/A ft Field to Property Line > 10' ❑ Yes Septic Tank/Lift Station on Lot > 100' N/A Community Sewer Manhole/Cleanout > 100' Water Service Line > 10' ❑ Yes Yes if No ft DOE Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ❑ Yes if No N/A ft Neighboring Absorption Fields > 100' N/A Animal Containment > 50' ❑ Yes — if No N/A ft ❑ Yes if No ft Community Sewer Main > 75' ME if No ft Manure/Animal Excreta Storage > 100' ❑ Yes if No N/A ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No N/A ft Surface Water > 100' ❑ Yes if No N/A ft Tank to Property Line > 5' ❑ Yes if No N/A ft Field to Property Line > 10' ❑ Yes if No N/A ft Water Main > 10' ❑ Yes if No N/A ft Water Service Line > 10' ❑ Yes if No N/A ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No N/A ft ❑ Yes if No N/A ft If tank or field is under driveway comment below 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 Firm Forge Engineering Phone (907) 522-7773 Engineer's Printed Name COSA Checklist June 2022 Benjamin Schiller, P.E. Date 1/23/23 -�, OF AC'q�l� r { • �.• rvS Benjarrchiller CE 12592 •�c4�.® �� F�PROFESSIOO�o'� 9.1)5Pu; MUNICIPALITY OF ANCHORAGE 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. 014-181-41 Expiration Date: ©' DZ 0 1. GENERAL INFORMATION Complete legal description Abbot Loop Manor, Block 4, Lot 4 Location (site address) 7720 Hacienda Drive, Anchorage, AK 99507 Current property owner(s) Terry Helmueller Day phone Mailing address 7720 Hacienda Drive, Anchorage, AK 99507 Real estate agent Day phone 2. TYPE OF DWELLING: n Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic. ❑ Water Storage ❑ Holding Tank ❑ Community Well ElCommunity E ❑ Public Water System ❑ Public Sewer 0 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �� Date of Payment Receipt Number COSA# 05C11?15594:� Waiver Fee $ Date of Payment Receipt Number 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 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 12/19/19 6. DSD SIGNATURE System #1 Approved for _Y_ bedrooms System #2 Approved for bedrooms Disapproved —walknu— Conditional approval for bedrooms, with the following stipulations: By: �— Original Certificate Date: 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 Stati 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 Legal Description: Abbott Loop Manor, Block 4, Lot 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/15/11 Total depth 44 ft Cased to 44 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 12/17/19 Static water level at beginning of test 11.5 ft. Comments B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Public Sewer D. ABSORPTION FIELD DATA Public Sewer Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 014-181-41 Structure served by this system Well production at time of test 3.75 gpm Water storage tank volume 0 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 of Sample 12/16/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Public Sewer Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) - Public Sewer Septic Tank/Lift Station on Lot > 100' NA if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 0 Yes if No ft ✓❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) - Public Sewer Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ 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) - Public Sewer 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' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS Lot is served by AWWU sewer system. G. ENGINEER'S CERTIFICATION I 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 '''., 12/27/19,�w'�C� RuSH Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 EImore 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. 014-181-41 Expiration Date: GENERAL INFORMATION Complete legal description Let 4, Block 4, Abbott Loop Manor Subdivision Location (site address) 7720 Hacienda Drive Anchorage, AK Current Property owner(s) Merit Homes, LLC Day phone 334-9233 Mailing address 1920 W. Dimond Blvdl, Suite F Anchorage, AK 99515 Lending agency Day phone Mailing address Real, Estate Agent Mailing A~idress Unless'othem/iso:!'Poquested, COSA will be held by DSD for pickup. 2.: ,NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Well Public Water System Day phone 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 vedfy 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/orWastewater disposal system is(are) in compliance with all applicable Municipal and State codesl ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/12/2011 DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other MuniciPality of Anchorage Development Services Department Building Safety Division On-Site Water & 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 CHECKLIST Lot 4, Block 4, Abbott Loop Manor Subdivision Parcel ID: 014-181-41 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) __ IfA, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 44 ft. Legal Descr!ption: A. WELL DATA Well type Pdvate Date completed 5/15/2011 Total depth 44 ft. AT iNSPECTION g.p.m, g.p.m. Nitrate .104 mg/L, Date of sample: 7/6/2011 FROM WELL LOG Date of test 5/15/2011 Static water level 15 Well production 10 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: 9.37 ug/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material AWWU Sewer System Tank size ~ gal. Foundation deanout (Y/N) Date of pumping C, ABSORPTION FIELD DATA Number of Compartments Depression over tank (Y/N) Pumper Date installed Length ft. Total depth ft. Date of adequacy test Fluid depth in absorption field before test Elapsed Time: ~ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) Y >18 Collected by: B. Hippe Date installed Cleanouts (Y/N) High water alarm (Y/N) Y in. Soil rating (g.p.d./~ or ~/bdrm) ~ System.type Width ft. Gravel below pipe ft. Eft. absorption area ~ Monitoring tube ~ Depression over field Results (Pass/Fail) __ For ~ bedrooms in. Water added~ gal. New depth in. in. Absorption rate >= g.p.d. If yes, give date LIFT STATION Date installed. "Pump on" level at~ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump oft" level at~ Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot NIA Public sewer main >75' Sewer/septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? iN. On adjacent lots N/A On adjacent lots N/A Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas >100' >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots Property line ~ Water service line Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain Building foundation Surface water Wells on adjacent lots F. COMMENTS: Lot is Served by AWWU Sewer System. Water main Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer s Printed Name Michael E. Anderson, P.E. Date 7/12/2011 COSA Fee $ (~ '~ '~~¥4~{[ ~- Waiver Fee $ Date of Payment ~ - ~ ;~ -' ~ I Date of Payment Receipt Number (~ ~ ,~ L'I (~ Receipt Number (Rev. 11/05) PLAT NO. P -64-7A ABBOTT OOP MANOR SUBDIVISION LOT 4, BLOCK i +/— 12,147 S.F. kb '00-6 y tOO,G t i N � Le Nm shown on this record drawing (as ui) c0m Ii i h Title 21, AMC. 1 "=20' NOTE: LOT DOES NOT MATHEMAMALLY CLUSE. AS —B U I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E. DOWUNG RD., SUTE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR GRID DATE 2233 7/8/2011 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. 20tj-03 AT M944 NOTE: NO CORNERS SET THIS DATE. C21 OF 44 sem♦ AV co 49TH �• s.6• 'LCL LO345 A/4 .e • etfery F. Gastald� � � � 'O LS -6 t 1