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Home My WebLink AboutT13N R3W SEC 33 LT 43 W2TI3N W 43 W2 #008-071-35 Municipality of Anchorag On-Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS A~ Parcel I.D. 008-071-35 Expiration Date: 1. GENERAL INFORMATION Complete legal description T13N R3W SEC 33 LOT 43 W2 Location (site address) 2608 E 48TM AVENUE, ANCHORAGE, AK 99507 Current Property owner(s) Mailing address Real Estate Agent GLORIA PARRET Day phone 2608 E 48TM AVENUE, ANCHORAGE, AK 99507 Day phone TYPE OF DWELLING: [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: WaiverNariance request for: COSA to be reteased to the othen,v],~l~cl by the engineer. Individual [] Holding Tank [] Community [] Public Sewer [] Distance: Date: COSA Fee $ Date of Payment Receipt Number COSA Cf qlttl/6 Waiver Fee $ Date of Payment Receipt Number Waiver # STATEMENT OF INSPECTION BY ENGINEER As certified ffixed 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 vedfy 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 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/25/15 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations, The assessment of the 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 vadous and dynamic characteristics and ara 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 currant or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~'" System #1 Approved for System #2 Approved for __ Disapproved. ..~ bedrooms. bedrooms. Conditional approval for bedrooms, with the following stipulations: ON-SITE WATER AND rn '~.'~ PROGRAM Original CeKiflcate Date: ff W ~ -/~ 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 t s[eptic syS~m is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: A. WELL DATA Well type PR~I' Date completed CIRCA 1965 Total depth Unknown ff. T13N R3W SEC 33 LOT 43 W2 IfA, B, or C provide PWSID #__ Sanitary seal (Y/N) Y Cased to 40+ ff. Pamel ID: 008-071.35 FROM WELL LOG Date of test .. Static water level -- ft. Well production -- g.p.m, Well Log (Y/N) N Wires properly protected (Y/N) _Y Casing height (above ground) 18 AT INSPECTION 8/1412015 84 ff. 3.9 g.p.m. in. WATER SAMPLE RESULTS: Coliform t~4~ colonies/lO0 mL Nitrate /I/'/~ _mg/L Arsenic: ]~, ~ ug/L Date of sample: 8114i15 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA - PUBLIC SEWER 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 Length Total depth ft. Date of adequacy test Soil rating (g.p.d./ft2 or ~/bdrm) _ ff. Width Eft. absorption area _ft2 Monitoring tube Results (Pass/Fait) Fluid depth in absorption field before test __ in. Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type Gravel below pipe Depression over field Water added gal. in. Absorption rate >= If yes, give date For bedrooms New depth in. g;p.d, D. LIFT STATION Date installed "Pump on" level at __ in. Datum Size in gallons "Pump orr' level at __ in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas On adjacent lots NA On adjacent lots NA Public sewer manhole/cleanout 100'+ Holding tank NA Manure/animal excrete storage areas IQO'+ SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line __ Water service line ABSORPTION FIELDON LOTTO: PUBLIC SEWER Property line Water Service line Curtain drain Building foundation Sur[ace water Wells on adjacent lots Absorption field Surface water Water main Driveway, parking/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. Engineer's Printed Name KENNETH M. DUFFUS Date 08/25/'15 COSA canary sheet..2-6-15.doc EAST 48th AVE~E Roberl E.~:~e:~s, Jr..~::Assoc. Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastewatcr Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 w~vw.muni.org/onsit¢ (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # 151502 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 43 W2 of T13N R3W Section 33 Subdivision. This inspection revealed an arsenic concentration of 14.7 micrograms per liter (ug/L) for the property's well water sample. 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.