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Home My WebLink AboutDORA #2 LT 19Lot lf) 014-251 -36 F'ERHIT NO. [)EPRR'f'ME:NT or:' HEF~LTFI FIND EN',,,'IRONMENTRL '"RO'FEC'TIFIN 825 264-,4720 #M EC L_ [ .... F' E£ I:;.:.". f-'l ][ '"'r ( 0iiO60 ) RF:'PI... I CFINT T. STE[,.If:IRT C:ONST. L. OCRT I ON I...EGFtL. Lt9 DORR 2. 84220 W ILL I I,,.IFt C I RCL. E LOT SIZE 2-':2?.]:-8684 ;;!~OO00 SQURRE FEET MINIMUM DIS"FRNC:E BETWEEN R WELL. AND RNY ON-SITE SEWRGE DISF'OSRL SYS]"EM IS :1.00 FEET FOR R PF..:I',?RTE WELL OR '1..50 TO 200 FEET FROM R PUBLIC NELL DEPENDING UPON THE T'¢PE OF F'UBLIC WELL MINIMLIM DISTRNCE FROM R PR I ',,,'RTE WELL TO R PRI',,,'RTE SEWER LINE IS 25 FEET RN[:, TO FI COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE [:,EPRRTMENT I.,.IITHIN ~:0 C,R?S OF TNE WELL COMPLETION. O"FNER REC..!LIIREMENTS MR"r' RF'F'L"r'. SPECIFICRTIONS RND CONS'f'RUCTION DI~GRRMS RRE FIVRILRBLE TO INSURE PROF'ER INSTRLLRTION. F:" t'Z F: 1"1 I T' E :='¢ F' I F.'.: E :5 [:' E C: E It'1 E: E ~: ".:';~: :.IL., :.t 9 :'.S,', :IL I CERTIFY THRT :1.: I FIM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELI._S RL:i; SET F'OF.'.TH B'Y' THE MLINICIPF~LITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM ID~CD]:~NC:E WITH THE COB, ES. SIGNE[:,: ~ .... ~~ ............ RF'F'L~NT "r. S'TEWRRT CONST. 1 :,:,UEE. ~ ..... E. H r E .............. ~ ....... V4. 0 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-251-36 GENERAL INFORMATION Complete legal description Location (site address) Dora Subdivision No. 2, Lot 19 8531 Rosalind Street Anchorage, AK 99507 Expiration Date: Current Property owner(s) Steve and Cheryl Sautel Mailing address 8531 Rosalind Street Anchorage, AK 99507 Day phone 440-0827 Lending agency Day phone Mailing address '2. Real Estate Agent Mailing Address Un/ess otherWi§e requested, COSA wi//be held by DSD for pickup. NUMBER O'F BEDROOMS: Three (3) Day phone TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] 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 private 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 o 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 vedfy 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. DSD SIGNATURE V" Approved for ._~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 10/10/2011 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other riginal Certificate Date: -// Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _' Dora Subdivision No. 2 A. WELL DATA Well type Private Date completed 4/29/81 Total depth 108 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 108 ft. FROM WELL LOG Date of test 4/29/81 Static water level 50 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate .122 mg/L Arsenic: 39.1 ug/I Date of sample: 9/30/2011 B. SEPTIC/HOLDING TANK DATA AWWU Sewer System Tank Type/Material Tank size ~ gal. Foundation cleanout (Y/N) ~ Date of pumping C. ABSORPTION FIELD DATA Number of Compartments Depression over tank (Y/N) Pumper Soil rating (g.p.d./ff2 or ~/bdrm) ~ Date installed Length ft. Width Total depth ft. Eft. absorption area ~ Date of adequacy test Fluid depth in absorption field before test Elapsed Time: ~ min. Final fluid depth Any rejuvenation treatment (past 12, mo.) (Y/N & type) Results (Pass/Fail) __ in. Water added Parcel ID: 014-251-36 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 10/10/2011 47.6 ft. 5.o g.p.m. Collected by: A. Harala Date installed Cleanouts (Y/N) High water alarm (Y/N) Y >18 in. System type ft. Gravel below pipe ft. Monitoring tube ~ Depression over field ~ For bedrooms ~ gal. New depth in. in. Absorption rate >= g.p.d. If yes, give date LIFT STATION Date installed "Pump on" level at~ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off' level at~ Cycles tested in. SEPARATION DISTANCES 'FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main >75' Sewer/septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage area{~ >100' >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line ~ Water main Water service line Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water Property line Water Service line Curtain drain Building foundation Surface water Wells on adjacent lots Water main · Driveway, parking/vehicle storage F. COMMENTS: Lot is Served by AWWU Sewer System. , G. ENGINEER S CERTIFICATION .... I ce~/~ that I have deter/ned through f/eld/nspectons and .... ..... ~nfo~ance w/th MOA COSA gu/de//nes /n effe~ on this date. En-ineer's Printed Name Mi~ael E. Ande~n, P.E. ~ Date ~ o/~ 1/2o~ ~ COSAFee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Community Development Department Development Services 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 Arsenic Advisory Certificate of On-Site Systems Approval # 111381 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 19 of Dora Subdivision. This inspection revealed an arsenic concentration of 39.1 micrograms per liter (ug/L) for the property's well water sample. 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. ~md that r~ encroacl-~mn~s exist except as indicated. Ex~lt~iom Note: It is the remponsibility of th~ owr~r to dmte~mir~ tl~ exister~e ~f any easements, ~ co~m~zts, or restrictions which do r~ appear on the recorded subd~vlmion plat. ~ Ur~_r no circ~msta~_es should a~y data hereon be used for construction or for ~..*. establishing boundary or fence liras. ~ .. CONI~ACTI~ ENGINEERS & '~ ASBUI LT A~r_No~-a~e, AI~sN 99502 ~ (907)349-2407 SGS SGS Ref.# 1114786001 ClientName Anderson Engineering ,~ Printed Date/Time. 10/10/2011 13:46 ~ ~ ~ ~ Collected DatefFime 09/30/2011 15:47 ' ~) ~ ~ ~' Received Date/l'ime 09/30/201 I 15:47 Client Sample ID Utility Sink ~' ~% ~ Matrix Drinking Water Technical Director Steohen C. Ede PWSID 0 Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 39.1 * 5.00 ug/L EP200.8 C (<10) 10/03/11 10/05/11 NRB Waters Department Total Nitrate/Nitrite-N 0.122 0.100 mg/L SM20 4500NO3-F B (<10) 10/05/1 I AYC Microbiology Laborator~ E. Coli Neo~ative 1 100mL SM20 9223B A 09/30/11 CR Total Colifbrm Negative 1 100mL SM20 9223B A 09/30/11 CR MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) (b) Property owner Mailing Address (c) Lending Institution Mailing Address Location (address or directions) (d) Real Estate Company and Agent A .~-~2_. )/4 TED Address Telephone .~"-~-'- % - ~-'~.~',~ Telephone'(home) t~,)p¢ Businessld'~ Telephone /IJ'2.~. (e) Mail the HAA to the following address: (or check here ¢~,if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family E~ Number of bedrooms 3. WATER SUPPLY Individual Well [~/ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm CC/¢'~/'~//k~ ¢ /Z:~~(--"Telephone Address /f~C'") ~::. D J AJ L) L_ V C? / '% '2__<:::) Date 6. DHHS APPROVAL Approved for ~bedrooms by Approved ~_ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval cerificated based only upon the representations given in paragraph $ above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) A. WELL DATA Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: v __ Date Completed JO5' Depth of Grouting Well Classification Well Log Present (Y/N) Total Depth i O(~ ~ Cased to Static Water Level ,q.o~ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line [00 ' To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) __ Yield '7. ~ ~ p ~ Pump Set At (.) h,.) ~ /k,) O [/O /k,) Sanitary Seal on Casing (Y/N) ~/ Depression Around Wellhead (Y/N) J~ ; On Adjoining Lots r~//~,_ ; On Adjoining Lots r~//~... To Nearest Public Sewer Cleanout/Manhole ':~J I0 ' ;Date &/Z Comments Date Installed ~ Size No. of Compartments Standpipes (Y/N) ~'~-- Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) ..... '""-. Date Last Pumped Pumping/Maintenance Contact on File (Y/N~'"-.._... ; for Holding Tank High-Water Alarm (Y/N) '--Z~orary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: "~.,%_ . To Water-Supply Well To Building Fou'nd~ _ To Property Line . To Disposal Field ""'--, To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course !.1 c. Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soling in Absorption Strata Date I nstat~d Width of Field~ Square Feet of Absortion~o~n ea Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPT~'IO~N FIELD: To Water-Supply Well To Building Foundation Lot Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoini ng~Cots~ To Cutbac~ ~if-.present) To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments \/ q-'--.. I ~ Date I ns'~ed Size in Gallons"~ "Pump On" Level High Water Alarm Level at Tested for -~- Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. /fi/ **Check Permit/t'ec~ Bedroom F)(ating Against HAA Request** I certify that )/ha/~/~h~e=ke~fied, or conformed to all MOA and inspection./ //~/~,// ~ Signed / //~// ~ MOA No. Receipt No. ~:~/~'-,,~ ~' Date of Payment Amount: $ // 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 on the lines ~n effec~ ~ ~-~.t. his Engineer's Seal APPLIf NT FILLS OUT UPPER HA;, ONLY Mailing Address "~0 ~:://4,~X ~df,)~'/C /. ' Phone Lending Institution / L~,~,~I~S ~ /,/~ ~/ZI~?~),) /gF)-// ~I~f.,D</'Z ~_, Address Z~p Code Realty Co.& Agent //2// //J>~,',~r~' / S Phone Legal Description /. ~:,/~ /d/ '~:)o/?/~ ._~r" ~..~, Street Location ~)",~ ~i' I ~ ~ 5 ~ L / ,~-! t~'~ T~po~of Residence ~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply ~;[/Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal [] Individual Year Individual Installed: ~'~ Public Utility When Connected to Public Utility: Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQtJEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date /-? Inspector Inspector Inspector Inspector~ Field Notes: ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL .(~) CONDITIONAL APPROVAL* · Well to Tank Septic Tank Size 72-023 (3182) ......... D/~£E RE~EI~/ED" -~ - ~ ' INSPECTION APPOINTMENTS TIME· . ' ~' TIME · TIME ' DATE DATE DATE MUNICIPALITY OF ANCHORAGE ~UNICIPALITY OF ANCHORAGE P CTI N DEPT O DEPARTMENT OF HEALTH & ENVIRONMENTAL ROTE O E · F HEA~TH & } 825 L Street - Anchora~, A~ska 99501 NVI~ONMENTAL P~.OTECTION ENVIRONMENTAL. SANITATION DIVISION OCT ~9 ;9 ~ . '; ~ Telephone 26~4720 DIRECTIONS: Complete all parts on page I. Incomplete reques~ wilt not be proc~d. Please allowten (10) days for processing. MA1 LING ADDRESS ' ' - PROPERTY RESIDENT (If different fr~m above) ...... PHONE '2. BUYER ,~ /~ _ , ,' '. , . PHON'E ..... MAIL NGADDRESS ' ~ -- ' ' 3. LfiNDING INSTITUTION ~ . / ~ ' ' '. ' ' ~ ! Ph6NE ' UA~L~N~ ADD~ESS ' ~ - ' = , , , ~ 'ih , , , , ~ , 4, REALTOR/AGENT~~y ~, ~ ~.--~1 PHONE- 5. LEGAL DESCRI TION ~ SINGLE FAMILY ~ TOwneo FF~ [] Other ~'1--1 MULTIPLE FAMILY [] Three [] Six 7. WATE R~UPPLY ..... J~ INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY dept~h (attach log if a, vailable.) 'I 8. SEWAGE D SPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~(.~ 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE I--I PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: , If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA ~. DISTANCES WELL TO: Absorption Area to nearest Lot Line ~. COMMENTS THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMIT NUMBER [] OTHER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE I NSTALLE D INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area ISewer Line Nearest Lot Lii3e DATE ~PROVED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ 72-010 (Rev. 6/79)