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Home My WebLink AboutDORA #2 LT 20Z Z Apr 24 20 1 0:'_3a Anchoraci-e \Ne!! & Pirnp Ser 907/2430742 p 1 Legal Description Fr,.-Optrty wner INIrase & Address: —dwkrr� bo ro- 2- 1 20 ic:-- -19 Pump Installation Date. /'90 PLtmpt-Dtakel)tpt)kC-elowT4)ri>FWeUC'asin-,:63 feet Pump Manufactarer's NanteA Pump Model: �'fJ . 7v I Pump Size `s Adapter Barisal Y)Ppfh.. htless Adapter Manufacturer's Name: Pitless Adapter Installer: rR Well I)Lsinfected Upon Completion'? Yes 'l7 is"o, Method of Disinfection: Comments. Pump Installer Name: Attention: Thepuinp ilistallsr sliall vrov:;dc a pump Installation, lob; to the DSL) whh-In 30 days of puri; installation, S�e-V;Czs 0.0, B -,x 1966E.'O bfafk Begl:lh An ch c v c: cc,hti 99,507 pl,a)lcr Pump Installation Log Well Driltina Permit N timber; SW._.___ Date of Issue; Parcel Identification Number. Legal Description Fr,.-Optrty wner INIrase & Address: —dwkrr� bo ro- 2- 1 20 ic:-- -19 Pump Installation Date. /'90 PLtmpt-Dtakel)tpt)kC-elowT4)ri>FWeUC'asin-,:63 feet Pump Manufactarer's NanteA Pump Model: �'fJ . 7v I Pump Size `s Adapter Barisal Y)Ppfh.. htless Adapter Manufacturer's Name: Pitless Adapter Installer: rR Well I)Lsinfected Upon Completion'? Yes 'l7 is"o, Method of Disinfection: Comments. Pump Installer Name: Attention: Thepuinp ilistallsr sliall vrov:;dc a pump Installation, lob; to the DSL) whh-In 30 days of puri; installation, PERMIT NO. RF'PLICRNT 'T. STEWRRT C:ONS]'. LOCWF Z ON LEGRL L20 DCIRFt 2 8420 NIL..LINR CIRCLE LOT SIZE 3:":::3-8684 20000 SQURRE FEE'T MINIMUM DISTFINCE BETHEEN FI [;~ELL RND F~NY ON-SITE SEWRGE DISPOSRL. S'T'STEM IS lOEI F'EET FOR FI PR I ',,,'RTE WELL OR t50 TO 200 FEET FROM R PIJBLIC P.IELL DEPENDING UPON ]'HE T'¢PE OF PUSL. IC WELL... MINIMUM DISTf~NCE FROM R PRI'v'FITE WELL TO R PRI'v'BTE SEP.IER LINE IS 25 FEET 8ND ]'0 F~ COMMUNITY SEWER LINE IS ?5 FEET. t.,.IELL LOGS 8RE REQUIRED RN[:, MUS]' BE RETURNED TO THE DEPRF.'.TMENT 1.4ITHIN S":O DR'CS OF THE HELL COMPLETION. -I .... ~ ~-- ~-"" - ~" " · -'~. ~ ..... ' .... L IHEF.. REQLtIF~:'EMENTS MRY RF'F'L'¢. :.,FEL. IFICRTIUN:, RND L. ON_,TF..LIC[ILIN [ IMBRHtl..-.', FiRE RVRiL..RBL..E TO INSLJRE PROPER INSTRLLRTION I CER]' I F"r' THf:IT 1: I RM FF'tMIL. IBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS F~ND WELLS RS SE]" FORTH BY THE MLINICIF'BL. IT'¢ OF RNCH(~GE. 2: I I.,.tILL I~TRLL THE ~YS~'I ~IN ~:I~]IRDRNCE NITH THE CODES. ....... ~ ..... 7 .... ~ ..... ~ .................................................... RF'PL. IJ ~NT ]'. STEHRRT ]CNST. V4, 0 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC241.519 Parcel ID 014 -251-37 Expiration Date: Legal description DORA #2 LT 20 Site address 8521 ROSALIND ST Current property owner(s) JOHNSON EDWARD X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: zUe/— Original Certificate Date: 12/20/2024 This Certificate of O �te Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are i substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone:907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 014-251-37 Complete legal description DORA #2 LOT 20 Location (site address) 8521 ROSALIND STREET, ANCHORAGE, ALASKA 99507 Current property owner(s) EDWARD JOHNSON Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well E] Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units F Community Well or Public Fj Water Storage 4. TYPE OF WASTEWATER DISPOSAL: R Private Septic R Private Septic serving 2 dwelling units El Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: El Steel Fj Plastic F-1 Concrete F-1 Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: M AWWTS El Bed F] Deep Trench n Wide Trench El Seepage Pit Waiver request for: Expedited review requested: D Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment / Z_ 1171z_� COSA # 0S 2, Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist WELL ONLY.docx COSA Checklist Legal Description: DORA #2 LOT 20 Parcel ID: 014-251-37 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 4/30/1981 Total depth 100 ft Cased to 100 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 12/16/2024 Static water level at beginning of test 32 ft. Well production at time of test 4 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.200 mg/L Nitrate less than MRL (ND) Arsenic 14.2 ug/L Arsenic less than MRL (ND) Collected by Date 12/13/24 Comments __________________________________________________________________________________ B. TANK DATA – PUBLIC SEWER Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA - PUBLIC SEWER 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. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist WELL ONLY.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No NA ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No NA ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 12/19/24 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 12/19/24 MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT soi -343-7904 On -Site Nater and wastewater Section � Fax: 343-7997 www.muni.arg/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC241519 Subdivision: Dora #2, Block: , Lot: 20 A water sample revealed an arsenic concentration of 14.2 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. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Application Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) , . Applicant Name >G C~7 (~r~"f Telephone:Home ~F7-~~' applio~m is (oheok one): Lending Inmim{ion ~; Owner/builder ~; Buyer ~; O~her~ (explain); ~ E~ (d) Lending Institution Telephone Address (e) (f) Address telephone 5~-~2'- 9 ~ 5~ Mail the haa to the following address: TYPE OF RESIDENCE Single-Family.~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well~ ' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. '~" ,, SEWAGE DISPOSAL .. '-- . Onsite [] Public Bi Community [] Holding Tank'1~1 · Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page I of 2 72-025 01/84) 5. ENGINEERING FIRM PROVID,..,.~ INSPECTIONS, TESTS, FILE SEARCH, L,,-, FA 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. Name of Firm Address Date Seal Approved ~ Disapproved Conditional Terms of Conditional Approval · / ,,\ '., CAUTION The Muncipality of Anchorage Department of' Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP~doe,s~this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 L, ga Descrpt,on If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'/~?~"~/~/ Yield 7/-~ /'~/ Static Water L~vel Pump Set At' /2 /j Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) f Depression Around Wellhead Separation Distances from Well: To Septic/Holding Tank on Lot _~./~ . .~./..~_!~ ~; On Adjoining Lots To Nearest Edge of Absorption Field o~ Lot. / ~ ; O~ Adjoining Lots To Nearest Public Sewer Line ~[~. To Nearest Public Sewer Cleanou~Manhole /~'/'- -- To Nearest Sewer Service Line on Lot Water Sample Collected by~ ~/~/~~ - - ; Date ..... ' V'E' I. /J / Water Sample Test Results ~~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Su pply Well To Property Line To Water Main/Service Line Course Air-tight Caps (Y/N) Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified,~r conformed, to a~l MO~, and HAA guidelines in effect on the date of this inspection. Signed ~"~~ Date ~;~ _~/~ Company - - / M~OA No. - Receipt No. ~bb t - b~o~_ Date of Payment Amount: $ . Page 2 of 2 72-026 (11/84) Engineer's Seal ~ INSPECTION APPOINTMENTS ~ 'TIME TIME TIME -~//~ DATE ' DATE DATE iNSPECTOR INSPECTOR.. ' INSPECTOR \ ~~ DEPARTMENT OF HEALTH & ENVI RONME~AL PROTEETIO~~ ..... ~ ........ ~ ,~,,~,~ /~ ~% 8=s ~ st..t - ~.=hor,., n~,,k, ~0~ ' ~ Telephone 264~720 - ,, EEEEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page I. Incomplete requ~ will not be proc~d. Please allow ten (10) days for processing. 1. PROPERTY OWNER - -- I PHONE PROPER T (If di om above) ' PHONE 2. BUYER ' ' ' MAILING ADDRESS ~ ,/ / ' ~ . 3. LENDING~STITUTION ' ' I PHON~ " ' 6. TYPE OF RESIDENCE ' SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~_~Z/, 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) NUMBER OF~BEDROL0~$ [] One ~ Four [] Other. [] Two [] Five [] Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) T¥.E OF .ES DENCE [] S NGLE;F^ tLY [] MULTIPLE F~,MI [;Y 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC-UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I N DI VI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified I--ISeptic Tank or [] Holding Tank Size: , If Tank is homemade give dimensio ns: TYPE OF ~ANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO, [~, FOUR [] SlX PERMIT NUMBER [] OTHER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED "-INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area ISewer Line INearest Lot Lin~ 5. COMMENTS DATE APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~-~Y ~ 72-010 (Rev. 6/79)