HomeMy WebLinkAboutWOODLAND PARK LT 13EWoodland Park
Lot
#010-092-06
PG_E 8 vi
• Municipality of Anchorage
On -Site Water and Wastewater Program <r J
(907) 343-7904 S A E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 010-092-06 Expiration Date. -3-)v-2/
1. GENERAL INFORMATION
Complete legal description _WOODLAND PARK LT 13
Location (site address) _2233 WEST 34TH AVENUE, ANCH AK
Current Property owner(s) _TAMMY & MARK WONDZELL
Mailing address _SAM
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3. NUMBER OF BEDROOMS:
3
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: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2 Waiver Fee $
Date of Payment Date of Payment
Receipt Number d 15 3 y 7 Receipt Number
COSA # O '� c 211 `7 1(o 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 12/12/21
BY Original Certificate Date: 1 2 /
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.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory_
Well Flow Advisory Other
COSA blue sheet 1d-W-12.doc
�vr �' •e, w s 'V1
6. DSD SIGNATURE
'
System #1 Approved for
bedrooms. �� ^,� MICHAEL N
C, -.9
469
System #2 Approved for
bedrooms.�fy; .•IZf t��z( . ;°=
Disapproved.
Conditional approval for
bedrooms, with the follow`n�,G`Igibr(/i����i
S,TE
AST�:V A m
�0.O h AM a
T
BY Original Certificate Date: 1 2 /
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.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory_
Well Flow Advisory Other
COSA blue sheet 1d-W-12.doc
COSA Checklist
Legal Description: WOODLAND PARK LT 13E
Parcel ID: 010-092-06
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled UN
Total depth >40' ft
Cased to >40' ft
❑■ Sanitary seal is functioning correctly r�
Wires are properly protected` f`
t�
Casing height (above ground) iT
Date of flow test for COSA 12/3/21 e
Static water level at beginning of test 46 ft.
Comments
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA AWWU SERVICE
Which system tested (date installed)
9 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
Well production at time of test 2.0+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes No
X Coliform bacteria is Negative
Nitrate mg/L 9 Nitrate less than MRL (ND)
Arsenic 26.2 ug/L Q Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 1213/21
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'
❑ Yes
if No
ft
ED Yes
if No ft
Neighboring Tank > 100' 17/1 Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Water Service Line > 10'
❑ Yes
Animal Containment?i 50' 0Yes
if No ft
❑✓ Yes
if No
ft
_
Community Sewer Main > 75' ❑Yes
if No *50
ft
Manure/Animal Excreta Storage > 100'
0 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 fl
Property Line > 5'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑ Yes
if Na
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 > i Q
❑ 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
*HOME BUiLT IN 1949, REQUIRED SEPARATION 501
G. ENGINEER'S CERTIFICATION
l 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_
COSA Checklist yellow sheet
•.f� .;
l�A�'�•f a
. . f EWG v� • f . • . o Y (.
r'? + MICHAEL N. ANDERSCN
�F61
www.muni.org/onsite
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC211716
Subdivision: Woodland Park, Lot 13E
A water sample revealed an arsenic concentration of 26.2 micrograms per liter
(ug/Q. 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.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 * www murii org
TAX CODE No.ail-o22-�� GRID No.
MUNICIPALITY OF ANCHORAGE — SEWER UTILITY
PROPERTY
Name
Plat No. Subd.
Address f i�� g� �lE Ac10
� Al Lot—J Block
Residential ❑ Commerial ❑
Industrial ❑ No. of units
CONNECT:
Main Tap ❑ On Property ❑
Permit No. Size Type
Drawing No. Size Main
Type Depth at Connect
Insulation ❑ Cleanouts
Type
Connect Agent
Inspector Date
Comments
Connect Location
ASSESSMENTS:
L.I.D. No. Private Dev. No.
Subd. Agreement ❑ No.
Sewer Agreement ❑ No.
RTE. ❑ Roll No.
DYE TEST=
Positive ❑ Negative ❑
N.S.A. ❑ Date
Page No. M.H. No.
Billing Cycle
Tested By
Comments
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Mark Begich
Mayor
Development Services Deportment
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O, Box 1966§0
Anchorage, AK 99507
{9o7) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW
Parcel Identification Number: ~lC~'tPc[~.'O~
Date of Issue:
Legal Description
Pump Installation Date: ~/~/~
Property Owner Name & Address:
Pump Intake Depth Below Top of Well Casing: (~ feet
Pump Manufacturer's Name: A 'Y'
Pump Modeh '~'~/
Pump Size ~hp
Pitless Adapter Burial Depth:
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? YESes [~ No
Method of Disinfection:
Co m men t.%.~/2_ A
Pump Installer Name: A 0~)/05
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
KtiSfi
•
•11V- Municipality of Anchorage o"� E•
r31'
On-Site Water and Wastewater Program ;,,A1
(907) 343-7904 $A r E T
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 010-092-06 Expiration Date: I t — 2-1 — 1-0
1. GENERAL INFORMATION
Complete legal description WOODLAND PARK LT 13E
22_ 33 w 3y
Location (site address) _ , EAGLE RIVER AK
Current Property owner(s) _CHERYL ROURICK Day phone
Mailing address _22607 NORTHWOODS DR CHUGIAK, AK 99567
Real Estate Agent Day phone
h56789
2. TYPE OF DWELLING: �o
® Single Family (w/wo ADU) ' ;Nov
Q� 111
❑ Duplex AUG ;
❑ Multiple Dwellings (Single Family and/or Dupl-• , 1 2018
a
3. NUMBER OF BEDROOMS: 3 ' o
e` L9S1
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
Waiver/Variance request for: Distance:
Received by: Date: 24//7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 41 • co Waiver Fee $
Date of Payment . -1 Ii 2 Date of Payment
Receipt Number Receipt Number
COSA# OSC(2(42-1 Waiver#
�:�..4-
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 MIKE N ANDERSON,Y.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 8/21/18
ei jc.• OF
,/ `'
49'''4— a ar 'f
Cd n o It 9 f.'-1 C.�i.,} -•oa-
j!,0 0 0°x 0 0 0 o a p O°°L a 0 a
Coos a,a °
a .//I/a...
n a a a nae a o 0 0
6. DSD SIGNATURE e� =.,,"a �,;rcr,. r +ti�:zscN '
., a Ce 9:.159 .. ,1.
System #1 Approved for 3 bedrooms. 4 ,p -. at 1 �;
:.,C c �•• ,as-1
System #2 Approved for bedrooms. �k'�•;RO ESS1G '''
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
��kU `r_
iOff.
0/\/_80.
T
c
JwArERFy
IN'ISTSANu r
n pRAT
-). pGr-, '
1
1..,,`Ilr`re'
By: _ Gw. -.40 ' Original Certificate Date: Tz i r1
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 �C
Well Flow Advisory Other
COSA blue sheet 10-10.12.doc
• If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: WOODLAND PARK LT 13E Parcel ID: 010-092-06
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) N
Date completed UN Sanitary seal (Y/N)Y Wires properly protected (IN) Y
Total depth >40' ft. Cased to 40'+ ft. Casing height (above ground)f "+
FROM WELL LOG . AT INSPECTION
Date of test UN 4-19-2018
Static water level UN ft. 46 ft.
Well production UK g.p.m. 2.0+ g.p.m.
WATER SAMPLE RESULTS: 6
4,4
Coliform NEG colonies/100 mL Nitrate p mg/L
Arsenic: UK ug/L Date of sample: / Collected by: Mike Anderson
g• 71
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (YIN)
Foundation cleanout (Y/N) Depression over tank (YIN) _ High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA—
Date installed Soil rating (SF/BEDROOM) System type
Length _ft. Width _ ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft2 Monitoring tube_ Depression over field_
Date of adequacy test Results (Pass/Fail) 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.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in.High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot NA On adjacent lots 100'+
Absorption field on lot NA On adjacent lots 100'+
Public sewer main * 50'+ Public sewer manhole/cleanout 100'+
et U c .or S
Sewer/septic service line 4111* c4 �. � Holding
tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line Building foundation , Water main
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS r k q 51
HOME WAS BUILT IN 1949, REQUIRED 50' SEPARATION BETWEEN WELL AND SEWER MAIN OR MANHOLES. WELL IS
LOCATED IN THE BASEMENT
-;..,�� OF ALeNt
G. ENGINEER'S CERTIFICATION .`P.•'
I certify that I have determined through field inspections and o •
* . 49TH /' • *
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. /.
/
MICHAEL N. ANDERSON : P�
Engineer's Printed Name MIKE N. ANDERSON,PEr��•. CE 94 9
Date 812112018 , '1)(0 ' 7 a' E*�'.;'
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • .7e 907-343-7904
On-Site Water and Wastewater Section ' Fax: 343-7997
www.muni.org/onsite
Arsenic Advisory
Certificate of On-Site Systems Approval # 0SC181421
Subdivision: Woodland Park, Lot: 13E
A water sample revealed an arsenic concentration of 25.8 micrograms per liter
(ug/L). 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.
Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org
4 GRAPHIC SCALE: 1 Inch = 20 Feet
F c==1 1
t 10 0 10 20 40
• Q
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20 _ • - S89°55'54"W 142. 38
••,_. . . • . • . • . - • • • • • • • -
. - . . • . -
43.7 •
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O WELL • 0
ON ONE STORY CD
d WOOD FRAME O
CA HOUSE CJ-1
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S89°56'30"E 142.27
N N)
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W. 34TH AVE \ UE
The original plat recorded In 1947 shows this property
Date Scale Legal Description to be fifty foot by one hundred forty feet. A more recent
2-14-2018 1' = 20'
survey adjacent to this parcel was recorded in 2004, and .411:41101116,vik
Lot 13E the recorded dimensions as shown hereon. OF, ��\,
Grid Heavy snow cover at the time of this survey may r
SW 1628 AS—BUILT have covered minor items at ground level. `�
WOODLAND PARK i<S •••••
SUBDIVISION These structures were constructed in 1949, and may
Drawn byField Book `�
BFB ASB2018 PLAT I P-81 not have to comply with current Municipal building * TH ��.
setback requirements. / 4.9 �L�-.�
- ' •
*
I hereby certify that the property described hereon has been surveyed •• :". .-
BOBBY F. B URNETT by me, or at my direction, and that the improvements situated thereon /1 BOBBY F. BURNETT , /
are within the property lines and do not overlap or encroach on the LS-548f Al
2941 Carriage Drive property lying adjacent thereto unless otherwise shown. That no :d"-/y`/ •
Anchorage, Alaska 99507 improvements on the property lying adjacent thereto encroach on the Nc,
(907) 350-5541 premises in question and that there are no roadways, transmission ` ssioNAL
lines or other easements on said property except as shown. ‘vt‘..`4
907 Water Well Services O7 WA FE R �t
P.O Box 870475 / � r.0 L
Wasilla,AK 99687
(907)230-1868 RESIDENTIAL&COMMERCIAL WATER AND WELL SERVICES
johnnie.netherton1702@gmail.com 24HR EMERGENCY SERVICES AVAILABLE
FREE ESTIMATES
John Netherton
P.0 Box 210249
Anchorage,AK
995
21 907-230-7866
INVOICE
BILL TO INVOICE# 1613
Mike Anderson(Anderson Engineering) DATE 08/29/2018
4661 Natrona Dr DUE DATE 08/29/2018
Anchorage,AK 99516 TERMS Due on receipt
ACTIVITY QTY RATE AMC).,f
Well casing extension 1 1,375.00 1,375.00
Casing extended 24"+above grade
BALANCE DUE $1 ,375.00
90'7 16LI'z'k•ml- - WELL
RESIDENTIAL&COMMERCIAL WATER AND WELL SERVICES
24HR EMERGENCY SERVICES AVAILABLE
FREE ESTIMATES
907-230-T$6$
In regards to property 2233 west 34th Ave Anchorage Alaska 99517.
The components will need to be removed down hole and will be reinstalled after extension has been completed.The
pressure tank will be temporarily removed and reinstalled as well. Total cost will be $1375.00 and will be completed by
end of day 8/29/2018
If you have any question please call or text at 907-230-1868.
Thanks
John and Katie Netherton