HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 16I/Vynter Pork
Block I
Lot 16
#051-491-37
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-491-37 Expiration Date: ~ ..~.LP.. _~"-] 7
Complete !egal description
L~cation (site address)
Current Property owner(s)
Mailing address
GENERAL INFORMATION
Wvnter Park#1 Block I Lot 16
21014 Sparkle Drive, Chu§iak, AK
Schwartz
Day phone 242-9750
Real Estate Agent
Steven Cavin, Windermere
Day phone 244-1210
2. TYPE OF DWELLING: [] Single Family (w/woADU)
[] Duplex
[] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class C Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual []
Holding Tank []
Community []
Public Sewer []
Received by: : _
CQSA to be reieased to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ ~-2'~
Date ¢ Payment
Receipt Number
Date:
Date of Payment
Receipt Number
Waiver #
~~ OFINSPECTIONBYENGINEER
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 NorthRim Engineering
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
Phone 694-7028
Date 7/2/2015
6. DSD SIGNATURE
\j System #1 Approved for
System #2 Approved for
Disapproved,
Conditional approval for
bedrooms.
bedrooms.
bedrooms, with the following stipule
The Municipality of Anchorage Devlopment 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 blue sheet_9-1-12 doc
X
Nitrate Advisory
Arsenic Advisory
Other
If more than '1 septic system is on the lot:
COSA Checklist # of,
Structure served by this system __
Certificate of On-Site Systems Approval Checklist
Legal Description:
A. WELL DATA I°MSL~C:
Well type
Date completed
Total depth
IfA, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
ft.
g.p.m.
mg/L
Parcel ID: (::)'S'(- 5/~'/'- ,3 7'
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
Collected by:
Date of test.
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform .__colanies/100 mL Nitrate
Arsenic ug/L Date of sample:
in.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material ;~_ ~'7-/c...//~,.~
Tank size 2~00 gal. Number of Compartments
Foundation cleanout (Y/N),7;~ Depression over tank (Y/N)
Date of pumping ~'/(:~'/~ ~" Pumper
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
C. ABSORPTION FIELD DATA
Date installed (:~/~.~' Soil rating (g.p.d./ft2 or ft2/bdrm)
/
Length ~ 7 ff. Width 3 ft.
Total depth' //,?Z' ft. Eft. absorption area,/,/Z5 fi2 Monitoring tube .
Date of adequacy test ~,/~---P.~'I/.S' Results (Pass/Fail) /O/~,,J',~' For ~ bedrooms
Fluid depth in absorption field before test (:~ in. Wateradded Z-tt,.~'O gal. Newdepth. Z in.
Elapsed Time: ,_~O min. Final fluid depth O in. Absorption rate >= Z./,/,5'O g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) /"(,,/'~_--~ If yes, give date
System type
Gravel below pipe /t~ ft.
'-/' Depression over field
D. LIFT STATION ,,~/~
Date installed
"Pump on" level at __
Datum
Size in gallons
"Pump off" level at
Cycles tested
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main t/ d'/~--
We/Is on adjacent lots /~ ¢'~'
ABSORPTION FIELD ON LOT TO:
Property line
Water Service line
Curtain drain ~j'-<2
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Property line /(2 t.¢. Absorption field ,~' ~-'
Water service line / ¢ ,¢'' Surface water /¢:2' ¢ ~
Building foundation
Surface water
Water main
Driveway, parking/vehicle storage
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the ebove systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name ~'~"L/",~-~'
Date 7~/~f/~'
COSA yellow sheet_2-6-15.doc
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