HomeMy WebLinkAboutALPINE VILLAGE BLK 3 LT 4Alpine Village
Block
Lot 4
#014-133-04
. lJMUPA UTY OF ANCHORAGE
Development Services Department `"' .I4 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel 1. D. 014 133 04
Certificate of On -Site Systems Approval
Expiration Date: -ars -zo Z 2
1. GENERAL INFORMATION
Complete legal description ALPINE VILLAGE BLOCK 3 LOT 4
Location (site address) 7236 BERN
Current property owner(s) Chaney Rentals
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
❑
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
Waiver request for: N ON E
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2 C6O t .0 1
Date of Payment
Receipt Number 058'0 �t
COSA # OSG 2 210 7 7
Waiver Fee $
Date of Payment
Receipt Number
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 C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 3/2/22
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6. DSD SIGNATURE T% r�CE-13854
_
.S stem #1 Approved for bedrooms
HARLES G BALZARINI j
System #2 Approved for bedrooms +F�.CE-13854s�
Disapproved 'ili'PROFESSIONA
Conditional approval for bedrooms, with the following stipulations:
WATER AND
f
Original Certificate Date: —/ 0 -2% Z %
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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: ALPINE VILLAGE 63 L4
If more than 1 septic system on lot: COSA Checklist # 1 of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 9/7/2016
Total depth 101 ft
Cased to 101 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) +24 in.
Date of flow test for COSA 2/24/22
Static water level at beginning of test 33 ft.
Comments Pump Set at 92' per pump install log
B. TANK DATA
Age of tank(s) years
Tank type/material Steel
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 014 133 04
Structure served by this system 1
Well production at time of test +4.5 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate ND mg/L ❑ Nitrate less than MRL (ND)
Arsenic ND ug/L ❑ Arsenic less than MRL (ND)
Collected by C.BALZARINI
Date of Sample 2/24/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
If absorption field is under driveway comment below
❑✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100'
M Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100'
M Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' Yes
if No ft
M Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
[D Yes
if No
ft
FVJ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water > 100' ❑ Yes
if No ft
Property Line > 5'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑ Yes
if No
ft
Private Wells > 100' ❑ Yes
if No ft
--Water Main > 10'
❑ Yes
if No
ft
Community Wells > 200' ❑ Yes
if No ft
Water Service Line > 10'
❑ Yes
if No
ft
If septic tank is under driveway comment
below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
❑ Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
❑ Yes
if No
ft
Private Wells > 100' ❑ Yes if No ft
Water Service Line > 10'
❑ Yes
if No
ft
Community Wells > 200' ❑ Yes if No ft
Surface Water > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / 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. 3/06/22
COSA Checklist yellow sheet
c OF ALgsl
TH
49
d. ......... ..
CHARLES G BALZARINI�
6'CE-13854
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Permit Number: OSP161`133
Tax Code Number: 0`14`13304000
Work Type: Well
Permit Effective Dates: May 27, 20'16
Design Engineer:
Subdivision: ALPINE VILLAGE
On-Site Water System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Initial
to May 27, 20`17
Site LegalAddress: ALPINE VILLAGE BLK 3 LT 4 G:2133
Owner/Address: P,~I~R ~-6- ~.~t'~- (~Ve~[~'- ~'~O/"P'~"'~ "~"H~-'-
Site Mailing Address: 7~ge ~' ~ ~ '7' Lot Size in Sq Ft: 8450
Total Bedrooms: 3
)artment
This permit is for the construction of:
N Disposal Field N SepticTank N Holding Tank N Privy Y Private Well N Water Storage
All construction must be in accordance with: `1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: .
MUNICIPALITY OF ANcHOAA ,,-
DC°mmunity Devel°pment Departmenm~~l~~~ ~TM· '"' ~ :.~ ' ' ¢"~
On-Site Water ~ Wastewater Program ~
~ '
Prope~owner(s) ~ (~ ~~
Site address 7 ~ O~(~ ~rh % ' ~
Legal description (Sub'd., Block & Lot) ~ I~'1~. Vi
Legal description (Township, Renge & 8~ctio~ '
Lot Size ~ Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN:
([~ all that apply)
Absorption Field [] Initial ~
Septic Tank [] Upgrade []
Holding Tank ' [] Renewal []
Pdvy []
Private Well ~"
Water Storage []
TYPE OF DWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D).
Multiple Dwellings (SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
¢~f~ agent)
(Signature of pro~thodzed
Permit/Rush Fees: ~;ZI$ ,~-.-~
Date of Payment:
Receipt Number: 'Zo
Permit No,
Waiver Fees:
Date' of Payment:
Receipt Number:
Waiver No.
SET MON. MK'D ALP.: V.
650-S 196~'
rq
MDNICIPAUTY OF ANCHORAGE
WASTEWATER
CONNECT PERMIT
3090ARCTIC *BI:VD.
PHONE:(907)564-2762
DATE OF APPLICATION: 05/27/2016
SCHEDULED COMPLETION DATE: 12/31/2016
BLOCK/LOT/TRACT: BLK 3 / LT 4 ~
SUBDIVISION: ALPINE VILLAGE
TAX CODE: 01413304000 GRID: SW2't33
STREET ADDRESS: . AK
OWNER: 'PIPINO MICHAEL J & SHARON R
MAILADDRESS: 7237 BASEL STREETANCHORAGE, AK 995070000
[] SINGLE FAMILY
[] MULTI-DWELLING No. APTS
[] COMMERCIAL
PHONE:
CONTRACTOR Dimond Masonry ' ASSESSMENTS
[] Repair Existing Service [] Main Line Extension
[] OnPmperl*Y Only [] CityTap [] Have Been Levied
[] Hydrant Only [] To Be Levied
~ -[] Main Tap - To Property Line Only Comments:
[] Main Tap& On Property Connect Row No.
[] Disconnect
. [] R&R-MainTapOnly bwner Istaff _~
CONNECTSIZE 4in ISSUED WWSAP
-- INSPECTION FEE $ 103.00 J~PAID [] CASH
72.00
PERMIT EEE$ [] CHECK#
$ 0.66 [] OTHER
REIMBURSABLE DEPOSIT $ 0.00
NUMBER TOTAL $. 175.66 INSPECTED BY
DATE
REMARKS
SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
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