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HomeMy WebLinkAboutHYATT ESTATES BLK 1 LT 6Byatt E/D L� 61 4bL4io1 Io00 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 014 101 12 Certificate of On -Site Systems Approval Expiration Date: 6 1 / ^ Z( 1. GENERAL INFORMATION HYATT ESTATES BLOCK 1 LOT 6 Complete legal description Location (site address) 7051 HYATT Current property owner(s) Mailing address Real estate agent TCB INC 2. TYPE OF DWELLING: 0 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 5 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 0 Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 145 n Date of Payment oc Receipt Number 06 �y 9b COSA # OSC211041 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 2/7/2021 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for i bedrooms bedrooms OF Al_gk�k� ,co - 'o, *: 49 TH •.* �� r . :1• X'H rJ • CHARLES G BALZAR191 r�+_�01••, CE -13854 .•�`�� illF�PROFEB51CAP 1~ bedrooms, with the following stipulations: ,�tlllll(l(((ffr.,. B '.- Original Certificate Date: 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 COSA Checklist Legal Description: Hyatt Block 1 Lot 6 Parcel ID: 014 101 12 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 2 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unk Total depth unk ft Cased to +40 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 1/29/21 Static water level at beginning of test 64 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 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: PROPERTY IS ON PUBLIC SEWER COSA Checklist yellow sheet Well production at time of test +5.1 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 2.829 ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 2/3/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: PROPERTY IS ON PUBLIC SEWER 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 ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft 2] Yes if No Neighboring Tank > 100' El Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' Rl Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No Fv� Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [E] Yes if No ft [E] Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑ 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 Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No 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 Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS property is connected to public sewer. verified no septic system on property. standpipes shown on survey are cleanouts for connection to sewer. 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. 2/05/21 COSA Checklist yellow sheet "�.� �� of aLgs� Q TH '• �.. CHARLES G BALZARINI �P�G�•. CE-13854�Ail ••���� pROFE5S10NP .. ft ft ft M 0ry o (n o n 0 m o N = 0 m� C N w m m Z O m W � DC 0 G7 �+ C a:m tn�v z w r P to N Iry o> o P En r n r rr*�11 v1 '1 V Co z 4 m z �v O v- Z M= o g rnovA inn0om m O �o� ;d mm m Z rn O Z 9 m m M OO"3 � mmmm m );o oO m n m m -co) 0cv mmrnQN Cl)Z oMOCA904Q0-I ;a znm� ozcnvO o =crTl oo n C O m my -{ C3 Czoa v= m C C z v N=C� Z tn z v m o� z 0 m� n z -i T ;or. vvzm-i O� m D D O O o m v � m m 0 c c cn 0 z z A o v v m cn M - o M czn m o z m Av D S ta(rrt1 0 ;u < z D o r G v ? CA m CD v 0 z -I W O 00°25'44"W 36.00' r N 230 0 Z F — p S2 S8'F W Q 663. I o i N 00°25'44"W 59.00' N I 0 tD I m c I (n ts I n� 26.4' 26.1'co z co Ln x x I 000 i m m cZi 0 0 rou 0 z< 1� z 0 I m 1n <m m I x 25.6' 26.1' o00 - _ x I n0 16.0' 16.0' p O CSC I m z o Z N o N n == o 40.0' i I O I I � I I xm I NI 1z.a' ool x� I I I I x =4 x =x—x—x i x x= x x x x x—x—Y I I _ 10' UTILITY ESMT. N 00°08'50"W 155.67' r 0 Z p W Q 1n tD 0 0 0 O O m J O W Indicate North W SOA CO J _ J Q U N Y c oG T U Co p 0 U C- c � � o _j o i U O 1 L � � 7 CL � i O Q_ z (1 C O `� 0 W w x U) c o E U Indicate North Ld N (D 14 U) >1 (D m 76 C: r-- 0 O 0 C: 0 C) 0 -0 > U) Lij 0- 0 Of Cy a_ z =0 ui U) 2. -4L, SERVICE CONNECTION'RECORD Lot \ Date— Block— V) inspector Subdivision or AdditionYATi E5 -TA -TES :SUBE) IM 151 DN Property Owner T N1 7- Contr. —Fi—bninsula— Rxc-lay4l,-W Address Water Size Permit Yes No # Sewer Si ze 4 Permit Yes No # LOCATION SKETCH 14 1--/ —D, I wj V) A SERVICE CONNECTION RECORD Lot Block Date_ Subdivision or --------- Inspecto Addition Property Owner � ontr,- Address— C4 Water Size Sewer Permit Yes -------- No Size Permit Yes N 0 0 LOCATION SKETai GRE R ANCHORAGE AREA BOR ]GH Department of Environmental Qualitv 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH ~¢~(.~, ~O~t~.~ NUMBER OF MANUFACTURER ~ (~ ¢*~el MATERIAL Ce {A¢~ COMPARTMENTS I INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYiOO~) GALLONS, DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE_ TOTAL LENGTH OF LINES NUMBER Of LINES I DISTANCE BETWEEN LINES -- TRENCH WIDTH ~' IN. TOTAL EFFECTIVE ABSORPTION AREA ~ ~'' SQ. FT. LENGTH OF EACH LINE ~7 / ~-I DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE__ ~ ) II~. ABOVE TILE (O IN. WELL: TYPe_ ~ ~'\\~ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION -- O~ ~ F~-- NEAREST NEAREST OTHER SOURCES '7 ~" ' (X U¢ ~_,.~ DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK ~(7~/I SYSTEM t t ~)-- I DISTANCES: INSTALLED BY: SEWER LINE DEPTH: REMARKS: DI~IkGRAM Of SYSTEM ~' ) GRe:AtEr ANCHORAGE: AREA BOROUGH ~r~IFl~ ~ /~ / /DEPARTMENT OF ENVIRONMENTAL QUALITY ~ ~'~E"MIT ~ /~//fUll IIII IIII))~/I/A, ~. ~.,o ,,c,, STREET ANc. ORAGE~ ~- ~-~.~ ~.'~..,,-,,-.,-,,,-~'/z~./z'.~ ' SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMI~~ NAME OF APPLICANT I ~ / ~ 1 ~} ~ ~/ MAILING ADDRESS / [ z ~ ~ / PHONE INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK SEEPA E Pit. ~ ., ~ ~) OTHER FINANCED THROUGH TO BE INSTALg[D BY SO~L T[ST RESULTS--' NOT~ THI~ P~RMIT IS NOT VA~ID WITHOUT ~OIL COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES. REQUIREMENTS : DIAGRAM OF SYSTEM / FOUNDA~;ON ~O SEPT~O TAN~ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF FOUNDATION TO SE PAGE PIT . DRAIN FIELD SEPTIC TANK TO !S'E~:"~(~'E~PIT WALL SEPTIC TANK ¢'--~ . SEEPAGEP,T .. DRA,N E,~LD TO NEAREST LOT LINE. DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MA~N TO SEPTIC TANK ~ SEEPAGE PIT DRAIN FIELD , SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WiTH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. [ CERTIFY THAT I AM FAMILIAR WiTH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE GREATER ANCtlORAGE AREA BOROb~., Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 SOII, S I,OG - PEROI,ATION TEST Performed for~ Legal D e s c r i p t i' ~-n: ]?~_~]~__~____/z/~;~.~_-' This form reports: Soils log~ Depth Feet 2 3 -'~ ~ ~:// 10- ll ~, 12 - /~as ground water encountered? [)ate Perfon Percolation test If yes, at what depth? ............... Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. -Proposed i ns tal 1 a t~ on: Seepage P~ptl_i_~_d._U~t~_~__0~__pitDrainor trenci~Fi eld Depth of Inlet .............. · ............................. COMMENTS: :' V~q~-d-"~:-~ ~ ~.~_ Certi fi ed By: Date: n , is �' Y '� 7 ,� I °'�..+ s r — n $ 6 'O Y ANCHORAGE Development Services Department ~`E ` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014 101 12 1. GENERAL INFORMATION Expiration Date: 10 — 19— 20�!_O Complete legal description HYATT BLOCK 1 LOT 6 Location (site address) 7051 HYATT Current property owner(s) KI N S EY Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 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 El Waiver request for: N 9y E Distance: Received by: I Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $�A/ *33 Date of Payment OA 0 Receipt Number 0 6 511 b COSA# osc 20 ] Qct(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 Address 20182 TULWAR Engineer's Printed Name 6. DSD SIGNATURE CHARLES BALZARINI System #1 Approved for _� bedrooms System #2 Approved for bedrooms Disapproved Phone 8545558 Date 6/30/2020 OF A/- 49 TH rJJ • CHARLES G BALZARNI • � �F� • CE -13854 .••�`�� Imp, /�TFp•'••....•••���' ll OpROFEWVW C Conditional approval for bedrooms, with the following stipulations: ... VVht ilX n]av By- ti.r.. Original Certificate Date: © 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: Hyatt Block 1 Lot 6 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unk Total depth unk ft Cased to +40 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 6/26/20 Static water level at beginning of test 72 ft. Comments new cap and wiring installed 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 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: PROPERTY IS ON PUBLIC SEWER COSA Checklist yellow sheet Parcel ID: 014 101 12 Structure served by this system 1 Well production at time of test +3.2 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 6/16/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: PROPERTY IS ON PUBLIC SEWER 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' ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ✓❑ Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No F,71 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ft ft ft ft ft ❑ 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 Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No. 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 Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS property is connected to public sewer. verified no septic system on property. standpipes shown on survey are cleanouts for connection to sewer. G. ENGINEER'S CERTIFICATION -,q O � F , k I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with ��., • ' • ' • ' • S� MOA COSA guidelines in effect on this date. 6/30/20 .' . •3y COSA Checklist yellow sheet �• = m '• ....... ..... CHARLES G BALZAR191 c • • CE -13854 . • �`� s�F�FO ��� , , NP F ��Alow ROFESSO ft ft ft ft v m 0 HYATf STREET L4 0 N 00005'00"W 155.00'(R) N 00025'44"W 155.63'(M) x x- -x—x—x—xTx—x—x—x—x— • m z 0 z n n ti m � � X � � r v Z m N m v 0 n -a m a c,pfR m o OOVfRED STORAGE rn iv -i � SHED N (rte _ Oto . 18.3' O ai ai V 0101 N ro --A (A O tD m v O OtND I ami O O m i C Rim v m � -P 26.1' ® m cNo o W Z vCAD io I u m 00 O oWo 47)CA ca �'a z to [ryJ v j J m <v m L J rriW m 18E rmr < rnoorn m w 26.1'e _ r^ 000 0 16.0' 16.0' 16.0' 4J- m IfTa)m O p O A N CX N i o n a o zz o D U) D Z Z 0 O O a.o' 40.0' 15.9' x x o o _ m 12.0 O