The URL can be used to link to this page

Home My WebLink AboutERIN LT 14BErin Lo1' 14B #016-152-63 Municipality of Anchorage On-Site Water and Wastewater Program (907) 343'7904 Certificate of On-Site Systems Approval Parcel l. D. 016-152-63 Expiration Date: ~:~//~//~ GENERAL INFORMATION Complete legal description ERIN LOT 14B Location (site address) 11820 ELLEN AVE., ANCHORAGE, AK 99515 Current Property owner(s) LEE PULLIAM Day phone 360-441-5062 Mailing address Real Estate Agent DEBBIE HIGBEE Day phone 748-7375 2. TYPE OF DWELLING: [] Single Family (w~vo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual [] Holding Tank [] Community [] Public Sewer Ixl WaiverNariance request for: NONE Received by: ._ '/,/~',~~' COSA to be released to the engineer, unless otherwise requested by the engineer. Distance: Date: ~:~'~/~"Z-/[~--'~ COSA Fee $. Date of Payment Receipt Number COSA # 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. Name of ¢irr~ s~URKLAND ENGINEERING Phone 279-3916 Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND Date 4/24/13 DSD SIGNATURE System #1 Approved for __ System #2 Approved for __ Disapproved Conditional approval for ..... h bedrooms / :; bedrooms ~j ~'. .1~.0~ .;~ ~ bedrooms, with the followin stip~: B Original Certificate Date: - ( ~'' Th~rvlunicipality 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. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: ERIN LOT 14 B Parcel ID: 016-152~3 A. WELL DATA Well type PRIVATE IfA, B, or C provide PWSID # -- Date completed UNK Sanitary seal (Y/N) Y Total depth >88 f. Cased to unk f. FROM WELL LOG Date of test UNKNOWN Static water level Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) >12 AT INSPECTION 11/15/12 UNKNOWN f. 46 Well production UNKNOWN g.p.m. 6.8 ~ -- Coliform C) colonies/loo mL Nitrate O,O~o~'~',mg/L '~ (~,Arsenic ~.~ ug/L Date of sample: ~L~ ,~_,-~'~ollectedby: g.p.m. ANSON MOXNESS Tank Type/Material --- Tank size -- gal. Foundation cleanout (Y/N) -- Date of pumping -- Number of Compartments Depression over tank (Y/N) Pumper Date installed -- Cleanouts (Y/N) --- High water alarm (Y/N) -- C. ABSORPTION FIELD DATA Date installed '- Soil rating (g.p.d./~ or ft2tbdrm) -- Length -- ft. Width --- Total depth -- ft. Eft. absorption area -- ft2 Monitoring tube -- Date of adequacy test -- Results (Pass/Fail) -- Fluid depth in absorption field before test --- in. Water added -- Elapsed Time: '- min. Final fluid depth -- in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) --~ System type --- ft. Gravel below pipe --- ft. Depression over field --- For -- bedrooms gal. New depth --- . in. Absorption rate >= -- g.p.d. If yes, give date -- LIFT STATION Date installed --- "Pump on" level at --- Datum -- Size in gallons --- __ in. "Pump off" level at -- Cycles tested -- in, Manhole/Access (Y/N) '-- High water alarm level at '- Meets alarm & circuit ~:luireraents? -' in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot --- Absorption field on lot -- >75' Public sewer main Sewer/septic service line >25' >50' Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation -' Water main Wells on adjacent lots -- ABSORPTION FIELD ON LOT TO: Property line -- Water Service line -- Curtain drain '- Property line -'- Water service line -' Building foundation -- Surface water -- Wells on adjacent lots -- >100' On adjacent lots >100' On adjacent lots Public sewer manhole/cleanout >100' Holding tank NA Manure/animal excrete storage areas >100' Absorption field --- Surface water -- Water main -- Driveway, pa~king/vehicle storage '- F. COMMENTS 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. I_ARS SPURKAND Engineer's Pdnted Name 4/24/13 Date COSA brown sheet_10-10-12.doc ~/?/V~A V /Vg 7 7~