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Home My WebLink AboutKING (PLAT 67-87) BLK 1 LT 4King (Plat 67-87) Block 1 Lot 4 #014-252-30 MUNICIPALITY OF ANCHORAGE Development Services Department Aw Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 014 252 30 Certificate of On -Site Systems Approval Expiration Date: cl r q- 2,0 2 d 1. GENERAL INFORMATION Complete legal description KING (PLAT 67-87) BLOCK 1 LOT 4 Location (site address) 2921 E 85TH Current property owner(s) CASH ALASKA Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer El Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 00 ^ ';2lU Date of Payment & l '? la0 a 6 Receipt Number COSA # OS C gli !a3 S Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-19 25% DISCOUNT APPLIED 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. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 6/5/2020 *�P 49 TH / TH 6. DSD SIGNATURE "' ""' W System #1 Approved for bedrooms "' "' " " CHARLES G BALZARINI System #2 Approved for bedrooms �Fc��.._.CE-13854 r Disapproved ,iiF�PROFESSIONPl� \\zIr0Z ` Conditional approval for bedrooms, with the following stipulations: ."urlri.,_ A I� "))))) I11)W), % Original Certificate Date: -2 021- 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 State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: KING (PLAT 67-87) BLOCK 1 LOT 4 If more than 1 septic system on lot: COSA Checklist# 1 of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1980 Total depth 90 ft Cased to 90 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test'for COSA 6/1/20 Parcel ID: 014 252 30 Structure served by this system 1 Well production at time of test +5.25 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 6/120 Static water level at beginning of test 55 ft. Comments Well Data from previous COSA. OVER 600 GALLONS PUMPED. 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 D. ABSORPTION FIELD DATA 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: PROPERTY IS ON PUBLIC SEWER COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: PROPERTY IS ON 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) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ❑ Yes Animal Containment > 50' ❑✓ Yes if No ❑✓ Yes if No ft WELL ONLY, PROPERTY IS ON PUBLIC SEWER. Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ❑✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No 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) 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 Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS WELL ONLY, PROPERTY IS ON PUBLIC SEWER. G. ENGINEER'S CERTIFICATION l certify that l 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. 6/5/20 COSA Checklist yellow sheet '��'• OF A1,,4 .. . ............. �j CHARLES G BALZARII CE -13854 •�� PROFESS0 ft ft ft ft 8364M LOT 3 LOT 3 LOT 4 r.o ~ 0 LOT 5 EAST 99.70 ,,/'-Chain link fence 10' UTILITY EASEMENT ~_~ LOT 4 Wood fence-,,~ fence J/-Satelllte dish Well o ~, - co LOT 5 I_ z ~ Turnaround - ~-' ~ ..'.."' ~(;~'~ I' -.o EAST 99.68 fi. 8§th Avonuo SGALE: 1"= 30~ .... ~,.'4g~_ ' '-.~ Il ~''' NO 3255 S '"~ ,~2. ' ' .'L~ ~1 ~ "'. ...... "~ EASEMENT8 OF REOORO, OTHER THAN THOSE SHOWN ON THE RECORDED P~T ARE NOT SHOWN HEREON. JLS, Fb 1~6, pg 55 AS-BUILT NO CORNERS SET THIS DATE I hereby cedify that I have performed a Mortgagee's Inspecfior of the following described property: LOT 4, BLOCK 1, KING SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the promises In question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 20th day of September ,2011 FRED WALATKA & ASSOCIATE~ Engineers and Surveyors (907-248-1666) 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. 014-252-30 Expiration Date: GENERAL INFORMATION Complete legal description King Subdivision (Plat 67-87), Block 1, Lot 4 Location (site address) 2921 E. 85th Avenue Anchorage, AK 99507 Current Property owner(s) Roddy and Marilynn Ainge Mailing address 2921 E. 85th Avenue Anchorage, AK 99507 Lending agency Day phone Day phone Mailing address Real Estate. Agent Mailir~g Addr(~,~'s .Unless Otherwise reqUe'sted, COSA will be held by DSD for pickup. 2.. NUMBER OF BEDRoOMs: Four (4) Day phone ¸3. 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 engineeCs 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ Approved for J7L DiSapproved. Conditional approval for bedrooms. Phone 522-7773 Date 10/7/2011 bedrooms, with the following stipulations: WATER AND ! tm: WASi"EWATER ' _: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X By: (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .. 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 Legal Description: A. WELL DATA Lot 4, Block 1, King Subdivision (Plat 67-87) Well type Private If A, B, or C provide PWSID # Date completed 8/5/1980 Sanitary seal (Y/N) Y Total depth 90 ft. Cased to 90.5 ft. FROM VVELL LOG Date of test .. 8/5/80 Static water level 65 g.p.m. · Nitrate N/D mg/L Date of sample: 9/21/2011 AWWU Sewer System Well production 5 WATER SAMPLE RESULTS: Coliform · 0 colonies/100 mL Arsenic: N/D ug/I SEPTIC/HOLDING TANK DATA Tank Type/Material Number of ComPartments Depression over tank (Y/N) Pumper Tank size ~ gal. Foundation cleanout (Y/N) ~ Date of pumping ABSORPTION FIELD DATA 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.) (Y/N & type) Soil rating (g.p.d./ft~ or ~/bdrm) ~ Width fl:. Eft. absorption area ~ Monitoring tube Results (Pass/Fail) __ in. Water added Parcel ID: 014-252-30 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 9121/2011 61 ff. 3.5 g.p.m. Other bacteria o Collected by: A. Harala Date installed Cleanouts (Y/N) High water alarm (Y/N) Y Y >18 in. colonies/100 mL System type Gravel below pipe ft. Depression over field ~ For bedrooms ~ 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 off" level at~ Cycles tested in. SEPARATION DISTANCES FROM VVELL ON LOT TO: Septic tank/lift station on lot .. Absorption field on lot 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 On adjacent lots 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 Property line ~ Water main Water service line Wells on adjacent lots 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. Absorption field Surface water Water main Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that I 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 10/7/2011 COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 11105)