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Home My WebLink AboutT13N R3W SEC 13 LT 1 OF GAAB TR97/AKA BLM L107 (TR 97 BEING SW4 SE4 SW4 NW4)T13N R3W Sec. 13 Lot 1 of GRAB TR97 #006-063-21 Municipality of Anchorage On -Site Water and Wastewater Program sem^ .(907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D._ 006-063-21 Expiration Date: 1. GENERAL INFORMATION Complete legal description T13N R3W Section 13 Lot 1 0� e,#12, % Act7 Location (site address) 500 Patsy Street, Anchorage, AK Current Property owner(s) Mark Reid Mailing address Real Estate Agent 500 Patsy Street, Anchorage AK 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ® Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ Waiver/Variance request for: 3 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment -lot Receipt Number -J 4 6 0 G COSA# 0 5 C_ �,)b 1'19 2- Coviv Waiver Fee $ -Date of Payment Receipt Number Waiver # istance: 5. STATEMENT 8IF44ECTION BY ENGINEER As certified by my seal affixed hereto and as of thevalidation 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 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AIG 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/-Ac., Engineer's Comments: This investigation .vas completed in compliance with ADEC and MOA regulations. The assessmentoftthe 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 �, �F7 encroachments, deficiencies or discrepancies exist. /.' ;1 O.Tir 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By=Original Certificate Date: 6 w The Municipality of Anc ge 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 X Nitrate Advisory Septic System Advisory _ Arsenic Advisory Well Flow Advisory Other COSA blue sheet -10-1 0-12.dr Legal Description: T13N R3W Sec 13 Lot 1 Parcel ID: 006-063-21 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.4 -q PM Date drilled Water storage tank volume gallons Total depth 59.7* ft Well disinfected for coliform test? ❑ Yes 0 No Cased to 40'+* ft ❑ Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate 0.830 mg/L ❑ Nitrate less than MRL (ND) Wires are properly protected Arsenic ug/L 0 Arsenic less than MRL (ND) Casing height (above ground) 35 in. Collected by Arcterra Consulting Date of flow test for COSA 8/14/20 Date of Sample 8/14/20 Static water level at beginning of test 31 ft. Comments *Information from previous COSA years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA system tested (date installed) ❑ ALL stan s present per record drawing Total measured depth rade ft (max). Measured depth to pipe invert fro de ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective71fnot, s depth into effective ❑ Code -required soil cove_ r 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Com Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min F7Tb6U1Lid depth in Absorption r gpd Any rejuvenation treat ast 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' Surface Water > 100' ❑ Yes if No NA ft ❑ Yes if No 50+x 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 NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ❑ Yes Animal Containment > 50' Yes if No ft V1 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No 50+ ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Buildln Lations ? 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' if No if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No Water Service Line > 10' Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Commun > 200 ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway cam w From Absorption Field on Lot to: (Please enter distances if less than required) Building on >10' _ ❑ Yes if No ft if absorption field is under driveway comment below Property Line > 10' if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community 0' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft. F. ENGINEER'S COMMENTS x Approved per code at time of drilling. Y Information from Previous COSA G. ENGINEER'S CERTIFICATION ! 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. COSA Checklist yellow sheet Parcel I.D. Municipality of Anchorage On-Site Water(907) & Wastewater343_7904 Program CERTIFICATE OF ON-SITE SYSTEMS APPR 006-063-21 GENERAL INFORMATION Complete legal description Location (site address) Current Proper~y owner(s) Mailing address Real Estate Agent Expiration Date: T13N, R3W, SECTION 13; LOT1 ~ ~4~ ~ ,~ ~L~ 500 PATSY STREET, ANCHORAGE, AK, 99504 MANUEL & ANDREA SOARES Day phone C/O AGENT 3101 E. COTTLE LOOP, WASILLA, AK, 99654 MARY JO CUNNIFF W/KELLER WILLIAMS Day phone 317-3187 2. TYPE OF DWELLING: [] Single Family (wlwo ADU) · Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. 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 Waiver/Variance request for: N/A Received by: COSA (o be released to the engineer, unless~ Date: COSA Fee $ Date of Payment Receipt Number COSA Cf Waiver Fee $ Date of Payment Receipt Number Waiver Cf $. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea/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 Guidetines 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A, GARNESS, P,E. Date 337-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD ~tlempted to provide a thorough, 6, DSD SIGNATURE t-//' System #1 Approved for System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. ~ ON-SII E '~ bedrooms, with the following stip~ns:wATE The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other If more than I septic system is on the lot: COSA Checklist fi: of Structure served by this system __ Certificate of On-Site Systems Approval Checklist Legal Description: T13N, R3W, SECTION 13; LOT 1 Parcel ID: 006-063-21 A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION. SEE A~q-ACHED. Well type .PRIVATE If A, B, or C provide PWSID# __ Date completed UNKNOWN Sanitary seal (Y/N) YES Total depth *59.7 ft. Cased to *40+ ft, N/A Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. FROM WELL LOG Date of test Static water level / ft. Well production J g.p.m. AT INSPECTION ~"¢ ..8'/25/2014 14 .ft. 5.63+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 0.988 mg./L. Arsenic: ND ug./L. Date of sample: ¥.g/22/2014 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA I PUB.C SEWER I Tank Type/Material Tank size __gal. Number of Compar[ments __ Foundation cleanout (Y/N) __ Date installed Cleanouts (Y/N) Depression over tank (Y/N) High water alarm~N~ Pumper Soil rating (g.p.d./ft2or ft~em type Width / ft. Gravel below pipe Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft, Total depth ft. Eft. abs ft Momtonng tube Depression over field__ Date of adequacy test ,/" Results (Pass/Fail) Fluid depth in/before test in. ~on~rea~nt (pa st ~i2n amlofl, i i~yil~ P~htype) For bedrooms Water added __ gal. New depth in. in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Size in gallons Manhole/Access (Y/N) "Pump off" level a~ ~va er alarm level at Cycles tested Meets alarm & circuit requirements? on adjacent lots N/A Absorption field on lot N/A Public sewer main *50+ Sewer/septic service line 25'+ Animal containment areas. 50'+ On adjacent lots Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A *50+ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ~ SEPARATION DISTANCE FROM ABSORPTION FIE~.D~L~T TO: Property line ~on_ Water main Water service line~.~~''~ Surface water Wells on adjacent lots. PUBLIC SEWER Driveway, parking/vehicle storage F. COMMENTS *APPROVED PER CODE AT TIME OF DRILLING (PRE-1983) NOTE: ALL SURROUNDING PROPERTIES SERVED BY AWWU SEWER, 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 JEFFREY A. GARNESS a,e (Rev. 10/12/12) I~]~]N.Lc3 XS.L¥,d ~8 Aarow Pump & Well Service, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 · Fax (907) 345-0202 Eagle River: (907) 622-9335 No. 10133 buan~rltv D~cR~PTDn Pmce AMOUNT LABOR HOURS RATE AMOUNT TOEAL MATERIAL TOTAL LABO~ / WORK ORDERED BY TOTAL LABORI PAY THIS ~OUNT Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completiorl of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump &Weli Service, LLC. the right to remove unpaid for equipmenf and charge for labor already performed & labor to remove unpaid for equipment) TERMS: ACCOUNTS PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDLIE ACCOUNTS.