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Home My WebLink AboutEAGLE CREST #1 TR A LT 72a le Crest T act A Lot 72 ¢ 050- 304 -39 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 Permit Number: OSPl11347 Tax Code Number: 05030439000 Work Type: Well Initial Permit Effective Dates: December 07, 2011 Design Engineer: Subdivision: EAGLE CREST #1 to December 06, 2012 Site Legal Address: EAGLE CREST#1 TR ALT 72 G:0055 Owner/Address: MILLER CLELLIS E & K M 1733 CROSSON AVE FAIRBANKS AK 997010000 Site Mailing Address: 19237 EAGLE RIVER RD, Eagle River Lot Size in Sq Ft: 15180 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N SepticTank 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. Special Provisions: The private sewer line shall maintain a minimum 25' separation from the well. MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax:.907-343-7997 On-Site Water & ~astewater Program S H! Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION ~Oq- %C~ FOR A SINGLE FAMILY DWELLING ParcelI.D. Z~'/~ t¢'7~_ ~,,,~l,~_c,,~..~ff L~...;.,,,,.~ %4" Prope,y owner(s) ~'~ ~ ~ C~~~ Day phone Mailing address Z~~ ~~j ~, Site address /~1 ~ ~~ kogal doscdption (Sub'd., Block & Lot) ~~.~q~*~~ '~" ke~al description (lownship, Banjo & Section) Lot Sizo Sq. Ft. ~umbor of Bodrooms ~ THIS APPLICATION IS FOR: ([] all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [~ Upgrade .[] Renewal [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. (Signature of property owner or authorized agent) ~\b-~- Permit/Rush Fees: ~L~ - rd&\\ ~\.ff Waiver Fees: Date of Payment: ~.!~ ~ \ / C~-~ Date of Payment: Receipt Number: tL~<~'~ \ Receipt Number: Permit No. (2%¢P ~ \ \\ ';b"'-~'-'~ Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11) )o )0 PLOT PLAN . 7... ASBUILT _ SCALE Lan,, .~ Aem~_l~ 1150.0 Daryl Avenue, Anohora e, Alaska' 99515 .., - ...v...le,, Inc. ,x~........ _. g .... . Registered Land Su~eyom (907:) 522-4625 Fax ; ~~.~..~~t I hereby oe~ ~d I ha~ mu~d ~e 'following d,oH~.p~ . ~..~ -2.. ~'~.. ~onomg, Ke~o~mg Died, MasKa, arid thd t~ imp~me~ ~ ~? ~ ~Tu~ '.:~ th~on.a~ wl~l~.~e p~pe~ lines ~nd do not enoroaoh aalaeen[mer~, mat no.:mp~menm on the pmpe~ ~o~aon ? m? ,u~a p~mm~ and ~at ~ I1~, or ~r ~,lble ea~menh on ,aid p~pe~ exae~ ~ Indio~d heNon. ~~~~..~-.~ ~,emenh. oovenanb, or re,~dlon, whioh do nM appear on Bubdi~Blon pl~. -- '--- ' ~~t. 1 t= I .; , GRID ~'~'~, Prolecf No. ~,~.. MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE:(907)564-2762 WASTEWATER CONNECT PERMIT DATE OF APPLICATION: SCHEDULED COMPLETION DATE: 12/06/2011 12/31/2011 BLOCK/LOT/TRACT: LT 72 / SUBDIVISION: EAGLE. CREST #1 TAX CODE: 05030439000 STREET ADDRESS: , AK GRID: NW0055 [] SINGLE FAMILY [] MULTI-DVVELLING No. APTS [] COMMERCIAL OWNER: MAIL ADDRESS: 1733 CROSSON AVE FAIRBANKS, AK 997010000 PHONE: CONTRACTOR Sanders & Sanders Repair Existing Service On Property. Only Hydrant Only Main Tap - To Property Line Only Main Tap & On Property Connect Disconnect R & R - Main Tap Only CONNECT SIZE 4 in REIMBURSABLE NUMBER Row No. [] City Tap ASSESSMENTS [] Main Line Extension [] Have Been Levied To Be Levied ~omments: ~)wner I Staff INSPECTION FEE $ 98.00 PERMIT FEE $ 63.00 $ o.oo DEPOSIT $ 0.00 TOTAL $ 161.00 ISSUED VWVKMM [] PAID [] CASH [] CHECK # [] OTHER INSPECTED BY DATE REMARKS PERMITEE (Please Print) Sanders & Sanders MAIL ADDRESS P.O. Box 231541 Anchorage, AK 995231541 PHONE (907)522-1997 SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE CUSTOMER COPY 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. 050-304-39 1. GENERAL INFORMATION Expiration Date: ZS —,K-- 2 ® Z 0 Complete legal description Eagle Crest #1 TR A L72 Location (site address) 19237 Eagle River Road Current property owner(s) Keith Wllken Mailing address Real estate agent 1000 W Salina Lane 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 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 Q Waiver request for: Distan Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ rRS61 "llo Waiver Fee $ Date of Payment 5`16-1;t6M Date of Payment Receipt Number 60gg36 Receipt Number COSA # l3 5�-M( 1179 Waiver # sCOVID4 9 2570' 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Phone (907) 745-8200 Date ZC>,5-eP ( Aw ,f f 6. DSD SIGNATURE .. —4— System #1 Approved for bedrooms Steven R'. •PC 'nn cne. �Fc. CE 8149 System #2 Approved for bedrooms Disapproved Conditional approval for pp bedrooms, with the following stipulatio?s�:� 1__ tn�41ASIIy,VATER PROGRAM Original Certificate Date: JS_- S'--- 2C2ZO 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory 2C Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Eagle Crest #1 Tr A L72 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Fil Well log is filed with Onsite (or attached) Date drilled 1130/12 Total depth 312 ft Cased to 310 ft N Sanitary seal is functioning correctly W Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 412012020 Static water level at beginning of test 276.1 ft. Comments B. TANK DATA Age of tank(s) n/a years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA n/a 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 i Parcel ID: 050-304-39 Structure served by this system Well production at time of test 3.13 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑✓ No [M Coliform bacteria is Negative Nitrate mg/L IN Nitrate less than MRL (ND) Arsenic i Me ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample � W '7-O .- C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 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' ❑✓ Yes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) 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) 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 G. ENGINEER'S CERTIFICATIONOF A�%!k�......certify that lhave determined through field inspections and review �oj9 of Municipal records that the above systems are in conformance with TH MOA COSA guidelines in effect on this date. Steven f'ainore ' 8149 � COSA Checklist yellow sheet Q r 1 ooe ft ft www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC201174 Subdivision: Eagle Crest #1 Tr A, Lot 72A A water sample revealed an arsenic concentration of 11.6 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650 *Anchorage, AIRS laska 99519 6650 *www muni org