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Home My WebLink AboutKING (PLAT 67-87) BLK 1 LT 3Parcel I.D. 014-252-25 Muntc,paht7 of Anchor/{ On-Site Water and Wastewater Progr~ (907) 343-7904 ~ CeKificate of On-Site Systems App~~f E ¢ration GENERAL INFORMATION Complete legal description King (Plat 67-87), Block 1, Lot 3 Location (site address) 2920 E. 84th Avenue Anchorage, AK 99507 Current Property owner(s) Joy Guest Day phone 632-6681 Mailing address 2920 E. 84th Avenue Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Six 4. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual [] Holding Tank [] Community [] Public Sewer [] WaiverNariance request for: Distance: unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA# Waiver Fee $ Date of Payment Receipt Number Waiver Cf 5. STATEMENT OF [~ii~TION BY ENGINEER As certitied 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.-S[te 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 vedfy that based on the information obtained from the Municipality of Anchorage tiles 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. DSD SIGNATURE '~ System #1 Approved for ~ bedrooms System #2 Approved for __ bedrooms Disapproved Conditional approval for Phone 522-7773 ,':,,'Date ~_ ~ ~1,. ' ~*~ 49TH~ ~.~ bedrooms, with the following stipulations: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Apprevai (COSA) based only upon the representations given in paragraph 5 by an independent profess!oriel 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. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory X Nitrate Advisory __~ Arsenic Advisory Other 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: King (Plat 67-87), Block 1, Lot 3 A. WELL DATA Well type Private Date completed 8/1/63 Total depth 98' .ff. Date of test Static water level Well production IfA, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to >40' ft. FROM WELL LOG 8/1/63 Unknown ft. Unknown g.p.m. WATER SAMPLE RESULTS: Coliform Arsenic 0 colonies/100 mL Nitrate 5.38 . mg/L ND ug/L Date of sample: 7/1/16 Parcel ID: 014-252-25 Well Log (Y/N) ~ ~/ Wires propedy protected (Y/N) Y Casing height (above ground) >12 AT INSPECTION 7/11/16 39.8 ft. 5.2 g.p.m. Collected by: And. Engineering in. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size __ gal, Foundation deanout (Y/N) Date of pumping Number of Compartments __ Depression over tank (Y/N) __ Pumper Date installed Cleanouts (Y/N) High water alarm (Y/N) C, ABSORPTION FIELD DATA Date installed Length ft. Total depth ft. Date of adequacy test Fluid depth in absorption field before test __ in. Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) Soil rating (g.p.d./ft2 or ft2tbdrm) Width Eft. absorption area __ft2 Monitoring tube __ Results (Pass/Fail) Water added in. System type Gravel below pipe ft. . Depression over field __ For bedrooms gal. New depth in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at __ Datum in. Size in gallons "Pump off' level at in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in, E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main >75' Sewer/septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain Property line Water service line Building foundation Surface water Wells on adjacent lots On adjacent lots >100' On adjacent lots > 100' Public sewer manholeldeanout >100' Holding tank >75' Manure/animal excrete storage areas >100' Absorption field Surface water Water main Driveway, parking/vehicle storage F. COMMENTS Lot is served by AWWU sewer system. 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 7/14/2016 COSA brown sheet._10-'10-12.doc Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 161291 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 3 of King Plat 67-87 subdivision. This inspection revealed a nitrate concentration of 5.38 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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 fi'om private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. N 'i :~ S% '7 0 Iii City/Borough: Subdivision: Anchorage KING Latitude Meridian S STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISIONOFMINING, LAND& WATER 343 WATER WELL LOG Drilling S~arted: I 1 Block Lot Property Owner Name & Address: B1 L03 ,IMM/ HYLTON Longitude Township 012N Range 003W Section Completed: 8 /1 I1963 9 , NE.~.__l/4of NE 1/4of NW 1/4of SW 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna's hydrogeologic classification system * httos://info.ngwa.om/servicecenter/shoooerlProductDetaillcfm? ProdCompar)yPassed=nqw&ProdCdPassed=nqw-t 1030 Depth From To gravel clay medium clay gravel, hard, blue clay gravel, brown, medium clay grave[, blue, hard unknown sand and gravel, water clay gravel, blue, hard sand and gravel w/water AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be forwarded to the Department of Natural Resources within 45 days of well completion. Please email well logs to: dnr. water.reports(D,,alaska.qov oR send to Alaska DNR, MLW, Alaska Hydrologic Survey 550 West 7 Avenue, Suite 1020 Anchorage, AK g9501 Drilling method: ~ir rotary,~able tool,D Other Well use: public supply, DDomestfc,DReinjection,DHydrofracking Fluids used: [] Other Depth of hole: 98 It, Casing stickup: It Casing type: Thickness inches Casing diameter: inches Casing depth Liner type: Diameter: inches Depth: ft Static water (from top of casing): ft on / Pumping level & yield: __ feet after houm at Recovery rate: gpm, Method of testing: Development method: Duration: gpm E]Screened; start: screen type: DPerforated; start: Start; Gravel packed []Yes [] No Well intake opening type: DOpen end, ~Open hole ,DOther fi, Stopped It Slot/mesh size it, Stopped it, Stopped From fi, To. It Note: .................................................................. Grout type: Volume Depth: From it, To ft Pump intake depth: ft Pump size hp Brand name Was well disinfected upon completion? []Yes Method of disinfection: .......................................................................... Was water quality tested?Des Bo Water quality parameters tested: .......................................................... Well driller name: .................................................................................. Company name:.~.w. ~.F..F..O..R..O...D..R.~.L..L!.N. ~. ..................................................... Mailing address: .................................................................................... City: State: AK Zip Phone ~umber: ( ) Driller's signature: Date: / f Anchorage Municipal Code 15.55.060(I) requires that a copy of this well log be forwarded to the Development Services Department within 30 days of well completion. City Permit Number: Date of Issue: / / Parcel Identification Number: * Guido for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press s wel located at approved permit Iocation'~ ~'"~ Yes