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Home My WebLink AboutWAKELAND LT 1Onsite File 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/onstie (907) 343-7904 CERTIFICATE OF ON.SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-472.01 Expiration Date: 1. GENERAL INFORMATION Complete legal description Location (site address) 10012 Debbie Drive Eagle River, AK 99577 Current Property owner(s) RobertA. Sharmr Mailing address P.O. Box 7704.53 Eagle River, AK 99577. Lending agency Mailing address Real Estate Agent Mailing Address Unless othe~vise-requeafad, COSA will be held by DSD for pickup. T14N, RIW, Section 8, SE4, N2, SW4, SE4, SE4, Remnant Day phone 903-9134 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] Three (3) Day phone Day phone 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 representations 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 pdvate 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 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 veri~ 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer'S Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 5/28/2012 DSD SIGNATURE / ^pp ovedfor 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev 11105) 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 OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T14N, R1W, Section 8, SE4, N2, SW4, SE4, SE4, Remnant A. WELL DATA Well type Private Date completed 1967 Total depth unk ff. IfA, B, or C provide PWSID # __ Sanitary seal (Y/N) Y Cased to >40 f. FROM WELL LOG g.p.m. Nitrate .862 mg/L Date of sample: 4/o3/12 Number of Compartments Two Depression over tank (Y/N) N Pumper Sanitary Pumpers Soil rating (g.p.d./ff2 or ft21bdrm)142sF/BDRM Width 3 ft. Eft. absorption area 432 ft.z Monitoring tube __ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: N/D mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Foundation cleanout (Y/N) Y Date of pumping 5/29/2012 C. ABSORPTION FIELD DATA Date installed 10/4/s4 Length 36 ft. Total depth 10 Parcel ID: 050-472-01 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 5/27/2012 0 ft. 4.9 g.p.m. Collected by: MEA N Date installed 1975 Cleanouts (Y/N) Y High water alarm (Y/N) N Date of adequacy test 5/27/2012 Results(Pass/Fail) Pass Fluid depth in absorption field before test 13 in. Water added 451 gal. New depth Elapsed Time: 1,440 min. Final fluid depth 13 in. Absorption rate >= 450 Any rejuvenation treatment (past 12 mo.) (YiN & type) N If yes, give date >12 System type Deep Trench Gravel below pipe 6 Y Depression over field N For 3 bedrooms 32 Y in. il3. gp.d. D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at __ in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tank/lift station on lot >lOO' Absorption field on lot >100' Public sewer main N/A Sewer/septic service line >25' Animal containment areas >50' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main N/A Water service line >10' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: On adjacent lots >1o0' On adjacent lots >1oo' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' Absorption field >5' Surface water >1oo' Water main >1o' Driveway, pad(lng/vehicle storage Property line >1o' Building foundation >1o' Water Service line >1o' Surface water >1oo' Curtain drain None Noted Wells on adjacent lots >1oo' >25' F. COMMENTS: Well Casing Inspected and No Perforations Found < 40' Below the Surface. 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 Michael E. Anderson, P.E. Date 5/28/2012 COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Dat~ of Payment Receipt Number ARCTIC PUMP & WELL INC. PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 (907) 745-2510 apw¢~gci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: ILegal Description: Lot: TI4N R1W SEC 8 SE4N2SW4SE4SE4 Property Owner Name & Address: Robert Sharrer PO BX 770453 Pump Installation Date: 3-27-12 Pump Intake Depth Below Top of Well Casing: Pump Manufacturer's Name: Pump Model: Pump Size: hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: UK Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Casing 40'+ with no perforations Feet Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of l 0 a 0 -1 0 < - CD (D (A Q :r 0 = 0 3 -- -- =r (A 0 = ,=r a :3 o rn :3 (D cr 0 (a C) r- 0 -1 "O =r 0 (D :3 CL *1 za o a) (D C) 0 0 =r (Do 0 0 :3 -3CD =r m+ 'a x, CD O R 0 (D 0 CD :s -0 < -1 :3 0 CD 0 > 0 o o- m -0 :I o :r 0 CD — (0) X (D 0. C (a w iQ V) :E C) 0 o Q A c 0 0-:3 0 0 0 CD 0 =1 X, �< 0 :3 0 o -tea CL :3 n 0 (o 0 5 o =of r --i- -0 10 CL CL (D U) CD eaQ C) e =0 -P, 5' o 0- :% — Z —0 0 3� :j . =r =r =r CD 0 0, C, CD 0 Z)* CD (D Z 0 W"O L4 X . In -1 rn 0 CD 0 m :3 < :3 0 Z :j ID cD 0 0 3 00- CO to a 0 Ln m - 0 0 z .0 -4-4o �,� o CL 'o 0, 04 o G -0 °n 0 to CD 0 iv N =r= —at = -1 3 < 0 C: l< —0 a CD 09 � > 0 > = =014 0 :3 < cil CD a) 0 =r 0 3 CDC CD -n _°® 0 :r Q —0 X O> CLp :I a 0 Ova: -u r- 0 4 —C, (D 0 I - z 0 I I r— r- 0 --I 0) r- 0 q -4 I co to ED -u r- 0 4 —C, (D 0 I - z 0 I I r— r- 0 --I 0) r- 0 q -4 I