HomeMy WebLinkAboutEAGLE CREST #1 TR B LT 40agle Cees
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Lot 40
050- 291
-10
orm ,, Co. ,r) r,'//,' ,.,' .c . -3'-/.
Driller ~' ~]/'~ S ~
tqell O~,ner~ ' ' ~'~' Use of' ,ell ...
Location (a4dress of: Township, Range, ~ Section. (if l?o~n); distance from roi::
- ,, .__. l.. · ~1 t 6~q's,,c -- '
Static wat~ level eet (able) (bel ~d s~face. Finish of ~11
i (check one) Open end ( Screen ( ): Perforated ( ).
Des~lbe screen-or perforations: t/ : "
, t~e11 punping te~t at /~ gallons per (hr) (mxn) for ho~s ~ith
~ e fe~t of drm~o~m from static level.
Remarks
~ m~~LL LOG
~ Date co ~
~ ~ in ~eet fro~ Giv~tails o~ rotations pene~ed, size of.
i'~' ~ound s~face color, and hardness. . .
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Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-291-10
1. GENERAL INFORMATION
Complete legal description
COSA# 0~lt0
Expiration Date:
EAGLE CREST #1 TRACT Br LOT 40
Location (site address) 19040 FIRST STREET, EAGLE RIVER, AK 99577
Current Property owner(s) PAUL & HELENA CHALIFOUR
Day phone
Mailing address
20622 STARNER STREET, CHUGIAK, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
MATT DIMMICK
Day phone 865-6520
=
Mailing Address 101 W. BENSON, STE. 503, ANCHORAGE, AK 99503
Unless otherwise requested, O0$A will be held by DSD for pickup.
NUMBER OF BEDROOMS: 2
TYPE OF WATER,SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] IndividUal Holding Tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representatibns given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 verity 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 868-3792
Address 20~211 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 10/18/10
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 ~rom 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
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
[~//'* Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations, {
~: ON-SITE
~: WATFRAND
; WkSTEWATER .
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
By:
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: / ~ ~,~.- ~--/~)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE O'F ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: EAGLE CREST #1 TRACT B, LOT ~t0
WELL:DATA
Date completed t..3J12JIg')'2 Sanitary seal (Y/N) _
Total depth 1~8 ft. Cased to 1ff7 ft.
FROM WELL LOG
Date of te,~t 1Ii12/1972
ft,
g.p.m.
Collected by: AzcTerra
1.00 mg/L
Static water level 179
Well production I5
WATER SAMPLE RESULTS:
Coliform NE(; colonies/100mL Nitrate
Arsenic: ND .mg/I Date of sample: 10/I2/I0
B, SEPTIC/HOLDING TANK DATA- PUBLIC SEWER
Parcel I'D: 050-2~-I0-
Wires properly protected (Y/N) _
Casing height (above ground) 12+ in.
AT INSPECTION
Tank Type/Material Date installed ~
CleanOuts (Y/N) Foundation cleanout (Y/N)
High water alarm (Y/N) Date of pumping
178 ff.
2.3 g,p.m,
Tank size ~ gal. Number of Compartments
DepreSsion over tank (y/N)
~ Pumper
ABSORPTION FIELD DATA- PUBLIC SEWER
Date installed Soil =rating (g.p.d./ft~ or ft2/bdrm)
System type'-
__ ft. (bottom of effective)
ft. Total depth
Depression over field
Results (Pass/Fail)..
Length _ ft. Width _ ft.
Eft. absorption area ft2
Date of adequacy test
Fluid depth in absorption field before test
Elapsed Time: __ min. Final fluid.depth
in. Water added gal.
in. Absorption rate >=
Gravel below pipe __
Monitoring tube
Any rejuvenation treatment (past 12 mo.) (yIN & type) _If yes, give date
g,p.d.
For m bedrooms
New depth in.
LIFT STATION
Date inStalled
"PumP on" level at min.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off level at
Cycles tested
Manhole/Access (Y/N).
High water alarm level at,., in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NA
Absorption field on lot NA
Public sewer main 75'+
Sewer/septic service tine :tO<+
Aniffi~l~Ce~ifimentia~as ~
On adjacent lots :tOO'+
On adjacent lots :tOO'+
PubliC sewer manhole/cleanout
Holding tank NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: -- PUBLIC SEWER
Building foundation
Water main
Wells on adjacent lots
Property line
Water service line
Absorption field
Surface water
SEPARATION DISTANGE FROM ABSORPTION FIELD ON LOT TO: -- PUBLIC SEWER
~ ..................... D,.,;I~q;~'~L ~l, "~.1~.;~ ~
'Water Se~ice line Su~ce ~ter D~e~y, parking/vehicle storage
Cu~ain drain Wells on adjacent lots
F, COMMENTS
*Well encroaches 4' into ROW- ROW encroachment permit with utility letters of non-objection acquired.
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 10/18/1_0
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
AS-BUILT
I hereby certify that I have surveyed the fotlowin described
~'o e Lo '7-" ZZ-,-~ "~.-- -~ ,.- g
p~ p rty., - - , "
P~.-~']~ t7z' ~- c: ~.- ~:- ,,.~, ,/ ;' -- '-_.---~--'"-7 ';'=,-7-" --
Anchorage Recording Prednct, Alaska, and that the improve-
ments situated thereon are within the property lines and ~]o not
overlap or encroach on the property ]Ylng 'adjacent thereto, that
no improvements on property lying adjacent thereto encroach
on the premLse$ in q~estton and that there a.re no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at E~agle River, Alaska
· /~t"
th~s. ~--. day of
......
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No. ~80-LS
--;2~ Box 77-0456, Eagle River, zMaska 995??
Phone (907) 694-2543
SGS ReL# 1105516001
Client Name ArcTerra Engineering and Surveying Printed Date/Time 10/18/2010 8:08
Pro. iect Name/# Eagle Crest #1 Tr B Lot 40 Collected Date/Time 10/12/2010 15:45
Client Sample ID Kitchen Received Date/Time 10/12/2010 16:39
Matrix Drinking Water Technical Director Stel}hen C. Ede
Samvle Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/12/10 10/13/10 NRB
Waters Department
Total Nitrate/Nitrite-N 1.00 0.i00 mg/L SM20 4500NO3-F B (<10) 10/13/10 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM209223B A 10/12/10 DLC
Total Coliform Negative 1 100mL SM20 9223B A 10/12/10 DLC
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HF. ALTH ~ND ENVIROh,~ENTAL PROTECTION
APPLICATION F0K HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, towaship, range)
Location or
/~/address~TT. directions)
7/7
Applicants
(c)Applicant is (check one) Lending Instl~utiou ~ ; Owaer/builder~--~
Buyer [-~; Other ~ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TTpe of Residence
Single-Family_~
Number of Bedrooms
3. Water Supply'
Individual Well~_
Multi-Family~--~
Other (describe)
Community[--'"t Public~
Note: If community well system, must have written cm~trmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
OnsiteF--~ Public~ Community~--~ Holding Tank~--~
Note: If community well system, must have written confirmation from the State
Department of. Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
e
En~ineerin~ Firm Providin~ Inspectionst Testst File Seareh~ Data and Informatio~
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date
DHEP Approval
Approved for
Approved
(ENGINEER SEAL)
Telephone
bedrooms By
Disapproved
Conditional
Terms of Conditional Approval
CAFrION
THE Mb~IICIFALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON Tl~ REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFE~SIO~%L ENGINEER REGISTERED
IH THE STATE OF ALASKA. TH~ ]]HEP DOES THIS AS A COURTESY TO PURCHASERS OF H~IES
THEIR LENDING INSTITUTIONS TN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQUIRE-
MENTS. ~MPLOYEES OF ~IEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~NCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR ~IISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DIIEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY O~
HEALTH AU%TDRITY APPI~OVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHO~AG~
D£PT. OF H~ALT'~ &
[NVIRONM[N]AL P20[LCI'ION
AUG 2 3 'Jg~q4
RECEIVED
ae
Casing }{sight Abo~ Ground
Electrical Wiring in Conduit ~)N)
Sepa=atton Distances fucm Wsll:
To Septic/Holding Tank cn Lot ~/~
If A, B, ~ C, D.E.C. Al~=oved(Y/N)
Pump Set At
//--/~ - 7 Z Yield.
Pspth of G~outing
Sanitary Seal on C~_-ing
Pe~ession A~ound Wsllhead (Y~)
; On Adjoining Lots
TO Neammst Edom of Absouption Field on Lot ~'A ; On Adjoining Lots /Oo /~'
To Nearest Public SeweF. Line, ~%"' To Nearest Public
c~,~,.~t./~,-~le/~ I,~¢"~~ 'to Nearee~ Se.~ Se~vi~ ~.ine on Lot
Wate~ S~le Test Bssults -2)./~ ~. ~' ~W~¢ ~'~- %-
B. SEPTIC/~OLDING TANK II~TA
Date Installed Size
Standpims (Y/N) Ai~-tiCt C~
Holdi~ Ta~ Hi~t~ ~a~ (Y~)
~ati~ Dist~s ~ ~ptic~i~
To ~u~ly
To ~nty ~
To ~ter ~i~i~
C~
No. of Ccmpartmmnts
7/N) , fc~ foundation Cleanout (Y/N)
/ .~. Temporary Holdirg (Y/N)
Tank
Permit
Tank:
To Building Foundation
To Disposal Field
To Strewn, ~cnd, Lake, ~' Major Duainage
[Page 1 of 2]
2-15-84
C. ABSOR~-,'iON Finn I~TA
Soils Bering in Absc~ptic~ Stzata
Date Installed
Width of Field
'To Wate~-Su[~31y W~ll
To Building Foundation
Lot
~ of System Design
Length of Field
Lepth of Field
G~avel Bed Thickness
Squares Feet of Absc~ption A~ea, , ,~ Standpipes P~esent (Y/N)
Da~ession ova= Field (Y/N) , W ~atg/of Last Adsguac-f ~st
~sults of r*-t ~lsquaey 3~st_
Sepa~ation Distance f~cm Absczl~tion
To P~operty Line
To Existing c~ Abandoned System ca
; On Adjoining Lots
To ~ate= Main/Se=~ios Line To Cutbank(if [xessnt)
To St~eam/Pond/Lake/(x Majo~ ~ainsgs Course
To D~iveway, Pa~king A~ea, ~ Vehicle Stc~ags A~ea
D. LIFT STATION
Date Installed Di~nsions
Si~- in Gallons Manhole/A~eess (Y/N)
"Pump On" Le~sl at "Pu~ Off" Leal at
High Water m~ ~1 at ~ ~nt (Y~)
Ele~i~l ~s(Y~)
** Omok Be~d ~d=oo~ ~tirg .A~.ainst ~ ~st **
~ ~W~ A~S~ ¢~ . · ........~ ..,
2-15-84