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HomeMy WebLinkAboutTURPIN #1 BLK 6 LT 9"1' ®m 11 -- a , mOEM I if ry LIM* Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 006-096-17 1. GENERAL INFORMATION Complete legal description TURPIN #1 BLOCK 6 LOT 9 Expiration Date: T-17 —1 Location (site address) _6323 MARKSTROM DRIVE ANCHORAGE AK 99504 Current Property owner(s) STEVEN C. BERGER Day phone Mailing address Real Estate Agent 6323 MARKSTROM DRIVE, ANCHORAGE AK 99504 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by: � 9�in p Date: `J COSA to be released to the engineer, unless other i of A ested by the engineer. COSA Fee$ �Waiver Fee $ // Date of Payment ! l 2J ��° Date of Payment Receipt Number 60 (�;)� i Receipt Number COSA# 0;L1 to 1� g 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 Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 5/9/2016 Engineers 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 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 ® �F d r® \ encroachments, deficiencies or discrepancies exist. ,rs ®* 44�Tii 4. 6. DSD SIGNATURE System #1 Approved for bedrooms. 9 '� E` i 6 ° ee System #2 Approved for bedrooms. ® �' aessrorA� r Disapproved. Conditional approval for bedrooms, with the following stipulations: SITE ON B (% Original Certificate Date: 5^17-14 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Cosa bim sbwer_10-ro-i2.dw If more than 1 septic system is on the lot: COSA Checklist # sof _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: TURPIN #1 BLOCK 6 LOT 9 Parcel ID: 006.096.17 A. WELL DATA Well type PRVr If A, B, or C provide PWSID # Date completed 0111963 Sanitary seal (Y/N) y Total depth 75 ft. Cased to 75 ft. FROM WELL LOG Date of test 01/1963 Static water level 35 ft. Well production 11 g.p.m. WATER SAMPLE RESULTS: Coliform Ncolonies/100 mL Nitrate 3.33 mg/L Arsenic: ug/L Date of sample: 5/312016 B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER Tank Type/Material Tank size _ gal. Number of Compartments Foundation cleanout (YIN) Depression over tank (Y/N) Date of pumping Pumper. C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires property protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 53.2016 ft. 10.6 g.p.m. Collected by: ARCTERRA Date installed Cleanouts (YIN) High water alarm (Y/N) Date installed _ Soil rating (g.p.d.W or fe/bdrm) _ System type Length ft: Width ft. Gravel below pipe _ Total depth -ft. Eff. absorption area f? Monitoring tube Depression over field ft. Date of adequacy test Results (Pass/Fall) For bedrooms Fluid depth in absorption field before test _ in. Water added_gal. New depth_ in. Elapsed Time: _min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) _ If yes, give date _ D. LIFT STATION Date installed "Pump on" level at_ in. Datum Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main 754 Sewer /septic service line 251+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line _ Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Building foundation Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots NA On adjacent lots NA Public sewer manhole/cleanout 100'+ Holding tank Manure/animal excrete storage areas 1001+ Absorption field Surface water Water main Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name KENNETH M. DUFFUS Date 0510912016 COSA canary shaet_�-6r15.doc s�� OF� /-n \KW v w�� AV astose" .i I=ASI�h/?E=J�JT A Loi r 2- STORY f7!2. 42.1 R R. —r—R f, ft Dom VE CERTIFICATE OF SURVEY �M LEGEND �} s F-M:X 5/501 m Anchorage Recording District. Alaska, and that the improvements situated thereon are within the property lines and do trot overlap or encroach an the property lying adjacent thereto, that no improvements an property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon, Dated at Andtorage, Alaska, this !� ' day of Sj9?_ �.._, tg ,.., BARNARD ENGINEERING 203West 25thAve. Anrhwage, Af**A Mat 274-5235 rOR: r RookNo. --72— Drawnlr 4. REALTOR/AGENT MUNICIPALITY OF ANCHORAGE DEPT. ©7 .... DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~;~[I~N},,'~ENTJ\L FLo~CTION~.~  825 L Street- Anchorage, Alaska 09501 q979 ' ENVIRONMENTAL ENGINEERING DIVISION ( tlAY 1 5 , - Telephone 264-4720 RECEI ED REQUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SEWER FACILITIES 1. PHONE PROPERTY RESIDEN~If different fro~ove} ~ ~t1' ~K PHONE IPHONE 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY ' / 'NUMBER OF BEDROOMS [] One ,~ Four [] [] Two t~l Five [] Three [] Six Other 7. WATER~JPPLY INDIVIDUAL' LJ COMMUNITY [] PUBLIC UTILITY 8. SEWA~ GE DISPOSAL SYSTEM [] iNDIVIDUaL/ON-SiTE**  PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) /~' **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED ', INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Coonection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~'~PROV ED FOR y BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION ; ~/ ~' - (~ 72-010 (Rev. 3~78)