HomeMy WebLinkAboutEARLES LT 3"I.y.
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
TOR A SINGLE FAMILY DWELLING P
Parcel 1. D. 012 - 2 Y 2 - I l COSA # �0 o 1p q
1. GENERAL INFORMATION
r
• ,Y
i
SA 9TT
Expiration Date: ? - a S- 0 S
Complete legal description t e F -7EArlvl S /b
Location (site address) 76'36 NNc k l f l ev--y -CIL
Current Propertyowner(s) Roff Glog., Dayphone `/. S-2-9-MO2
Mailing address
Lending agency
Mailing address
Real Estate Agent
410 ri fer t6 -
Day phone
l fu�icrnne 6:�mF Piu,_ eec� t�G� Day phone S2-9 -d'60 2
Mailing Address 3,601 relylrf�7ove
rnf Drr, /nen +bc 9950.1
Unless otherwise requested, COSA will be held by DSD for pickup. Pl ecNe Cu Il Ha rlQnnP Jr�M,07j`
@ S29 - d60 Z zvAeA larA .ru
2. NUMBER OF BEDROOMS: �_ Yeady kr pick -q4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class t_ Well
®
Community On-site
❑
Public Water System
❑
Public Sewer
91
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
As certified by my seat 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 _Flal-fai, TicAn r ca«/ Ser'v,eei Phone 'JyX- /3.S,y-
Address 1N5"30 FcAo !unO.on Rocaci A.+cAci,-c 2t �;.k 39Ti4<
Engineer's Printed Name -gleodo7 F l-i000r Date 'A// 2/ / 2 ooe
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
a4. tttt V `i • y'+ t
...•Y•i..•:• •..
Ms : HE000RE F. I400RE ; 1
o : C[ - 358
.ee
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: / �-�Original Certificate Date: _ O8
(Rw.11105)
Municipality of Anchorage
C Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: l,a F 3 E a r �t1 S �D Parcel ID: O r Z— ZY 2- I/
A. WELL DATA
Well type �C 4 If A. B, or C provide PWSID #_g1kor60 7 Weil Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of lest '
Static water level
Well production
WATER SAMPLE RESULTS:
ft.
g.p.m.
Coliform p.. colonies/100 mL Nitrate 40-1 mg/L
Arsenic:f0,e�S mgll Date of sample: YI8/06
B. SEPTIC/HOLDING TANK DATA /J. A,
Tank Type/Material
Tank size gal. Number of Compartments _
Foundation cleanout (Y/N) _ Depression over tank (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA N - A.
Date installed Soil rating (g.p.d./fe or felbdrm)
IS -w wK. SG w � r
ft.
g.p.m.
Other bacteria colonies/100 mL._
Collected by: P 7'!CA Svc
Date installed
Cleanouts (Y/N)
High water alarm (YIN)
j
System type
ft
Length It. Wiatn It. Gravel below pipe
Total depth_ ft. Eff. absorption area _ftp 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
j
D. LIFT STATION N• /4.
v 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
SEPARATION DISTANCES FROM WELL ON LOT TO: N• A,.
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: P-4.
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N• A•
Property line Building foundation Water main
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION y r
int,;; ^,•.,
I certify that I have determined through field inspections and s• ... ....... ..
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. i'......• • • • • • • •:
-`�•'Ra-U_'^0.5 `f. NOOFc"• li'
n.
Engineer's Printed Name _ %Aror/o-e f= Moo,?.
Date IGpr,f 2 1.9
COSA Fee $ S7 Waiver Fee $
�3wbDate of Payment Date of Payment
Receipt Number ()g Receipt Number
j (Rev. 11/05)
M raMa enr+t
2
N 8945400" W
E
cARACE 24.0' p
w
0
!`� E70STINa
O HOUSE_,
S 89'54.00" E
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SURVEY CERTFWATION
PLOT
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ASI"MIYM reMI` �,, •0reeebRd
180.00'
43.2'
0
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
642 E. 12 AK
AND#M"X. ALASKA 1eE0t
UCKRec lel Af. Pat Fp No.
i^ = 30'
u wn ymo. ' 1e.el OI CnealleE ey.
10-09-08 PF.T JUIIC
Dole DPG": "" 2226 •.o. 855
Leo ofwavtlm:
Lot 3 •
Earles
0 WT SUR.ET SURVEY TYPESYMBOLS
Q PammVm AS-oxy a SET MAR 'PR� D1WNAOEASPHALT
(1 Art W"AM UIK p1. v O POUND RE3AR MOOD MCE �.::... CONCRM
D RAI RMI ... As -Nal ... lot K*V" ... T Pea ArN1 fo—o-Q ASSUMED My. *4-1F METAL
PLOT PLANS h LOT SURVEYS NOTE:
R is THE RLSPONSBIUTY OF THE WILDER OR OYANER. PRIOR TO ONLY THOSE IMPROVEMENTS MOVE GROUND AND NOBLE "LL BE
CONST UCMON. To VCM,, MorOSCD *1 LDINO CIIADE RELATIVE 9NOWN. rENCEs. W[L63. 3EW"c CLEANOUTS, 310LW^LNs. DMVPWATS.
TO MS ED GRADE AND UTIUTY CONNECTIONS AND To DETERw1NE . CTC.. AMC ONOWN M MVV ArPROMNATC LO6AMO . DNLY. e040
M EASTENCE Or ANY EASEMENTS. COVENANTS OR RESTNICTIONS MAY PFtFVENT SONE W~VCMENT7 PROM /EIND SCr-N AND LOCATED.
WHICH O NOT APPfAft ON THE RESSLR000Art ►LAT. N
UNDER NO OR"STANCCS SMOAD AN AS-QULT BE USED FOR CONSTRUCTION OR ►OR ESTARUww MMARY OR PENCE ONES.
INC SURVEYOR TAKES RMONSORM rrOORR THE IIeTIAL TRANSACTION ONLY AND ASSUMES FINANCAALL �UAVRIUTY ONLY FOR TRE COST Or TNN 9URKT.
WTF.0 DI1_TMIw Y1'[t YAK GIt" iVMJ.••.• K�nWVFn i SW CAW'lic Lam.—.+ w• M..l
SGS ReEN
1081410001
Client Name
Flattop Technical Srv.
Project Name/N
L3 Earles SO
Client Sample ID
1.3 Earles S/D
Matrix
Drinking Water
PN SID
216807
Sample Remarks
All Dates/rimts are Alaska Standard Time
Printed Date/time 04/182008 7:56
Collected Datelrime 04/08!2008 11:20
Recehed Date rime 04,108.2008 12:00
Technical Director Stephen C. Fade
Allo%ahlc
Prep Analysis
Parameter
Results
PQL Units
Method Conuiner ID
limits
Date Date
Init
Metals by ICP/M3
Arsenic
ND
5.00 ug/L
EP200.8
C
(<10)
04/15/08 0411WOR
NRB
Waters Department
Total NitmtcMitritc-N
ND
0,100 m8/L
S%1204500NO3-F
B
(<10)
04/16/08
LCI'
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
0
0
0
coVi00mL
co11100m1.
col/100ml.
SN1209222B
SN1209222B
SS1209222B
A
A
A
(<200)
(<I)
(<I)
04.08'08
04.'08A8
04/08/08
DI.0
DLC
ULC
STEVE COWPER, GOVERNOR
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
DEPT. OF ENVIRONMENTAL CONSERVATION FNVIRONMENTAL PROTECTION
%;.1^r o�D nmnD7=7',T1,n
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?Ct S ,`; ,mSUI-I'271 SUI -I'271 37.2
99503
'.'_r. Robe --t A. Shafer, P.".
S & S engineering
1-7034 7agle river Loop, ^uit- 2.0,1
`agle River, Alaska 99577
RECEIVED
December 25, 1.990
5G3-5775
17T.l }ii T.."i: Lots 2 & 3 Earles Subdivision, Anc go Class
C Public llator Sys t"e:a, .hD :^ Project ;`?um'aer
Tlaiver Rec,u^st Re-viesr
Dear _.'.r. Shafer:
Tfhi3 is in response t0 your cu!D:ittal, receive-', in this office on
Decc aber 19, 1990, in Which you request-';] the De.)artrac t t0 Chant
CieD,,aration distance 'waivers LOA"' the 11.0 foot separation :Dei:FJe"en tf-Ie
eXisting Class C Public 'dater System Source Tlell and tle sc�Dtic
Lan'," and the 120 foot sei)aration between the -_]:_-sting -source i•7c�_1
and tna soil absorot-ion System. 1 s a r -salt of �y r -vi t, of your
GUb a7.t'ta1, til- De iDart ment clas iounCi the inforIiIation :Drovi 10 ] to be
satisfactory for allO ling a teia-norary wa ]ver, ter,Miriating On.7Uly
30, 1991, in accordance with 1f, T1 C 72..035 of the State T7aste;�ater
DisooSal "egulations. `Pile s-;Daration distances are Waiv-red Co til-
Lollowing:
11
aali ut-rOLIrC -11 �O 1 -)tic ,.ari. 1..0 feet
Public "later Source 7'7ell to Soil Absorotion Sj7stoai,- 1-').() fee t
i.a ap ,Yova1 is only valid Lor tae wastewater disposal systa;a
-s-rVing the -structure or, Lot 2, Earles Subdivi-sion, �,ny Chances
t0 "t - efiSth'� 'DUC water Sytei, tlEFe't?Y 570Sa1 Sv3tc t,i�ila11ai
(tile elel',intion is tae Connection to the Co;ti[lUnity Sewer Col'_''Ction
tiystc;n) o incraascd demand is L laCC=d on the ;;a' c j>ste::i t: i -tLou .
pr- >>1an a-,) royal of this De -,,)L ':7ili 11Val i .dt t l' `:: ]1Je?Y
_n regards to the Conn-Ction t0 the Coi aunity sewer ^.01..CCt401-,
SyS teiil, V -r ilCaL iOih that the :`I c-...'3 teS7dt2I "'1-spOShc Sj StC:ll :�erV l.nCj
file LrIICtUr' lOCdtci on 0t �,dYi-S SUD1Vas On ii__
":Oroparly a':)an(2on ariJ tilt necessary service connection naz been
Co'ir)Iet.^_d will neeCl t0 e sub-ai"C_ted to lis Office by .7u I1/ ;l
1991.
2=. : Gert A. :safe:, 2.3.
December 23, 1900
Page 2
At this time, the Department is assigning Pu51:= -later Sy:te«
Identification ( SID) 9uzsers to all Public Water 37:2«9 in 2
State. As a :aselt, the 2wszo xcr e: assignee to this system is
21;2:7. ?be present s=ate )rjnEing Sate= go:at:on: 20 not
}eg\ire any routine Ovate= sa riling for =lass c Public Qate:
Syetazs; however, if the regulations change, the Jeg:ztzeet o1:1
notify your clients.
=sane you for your coordination wits this oega:amen:. :: you Rale
any Gee tions, please do not he::tate to contact
Sincerely,
44"-1 /�
Revon =, "12wano
7nvirons ntal Engine=:
cc: Jobs Smits, oma
= 01/pf
WALTER J. NICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
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OF r"F STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
r
CONSTRUCTION AND OPERATION CERTIFICATE
OF P
ALASh for
PUBLIC WATER SYSTEMS
A. APPROVAL TO CONSTRUCT 11 ,L�aAeBB
Plans for the construction or modification of �g s--
�i.L�S C, __ public water system located
in Alaska, submitted in accordance with 18 AAC 80.100
by have been revievAed and are
a.5 a 5:;,,_�� t�rw J�/�i�rr✓:�fc/
❑ approved. �c�, P c W c �/ ! / — 1-75 ,
❑ conditionally approved (see attached conditions).
BY
TITLE
DATE
If construction has not started within two years of the approval date, this certificate is void and new plans and
specifications must be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Change (contract order no. or descriptive reference) Approved by Date
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
is made available to the public.
The construction of the___�O� 2�d e J� public
water system was completed on �l
/ q( q� _ (date). The system is hereby
granted interim approval to operate for 90 ays following the completion date.
DATE
BY TITLE
As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed
the system was constructed according to the approved plans. The system is hereby granted final approval to
o "te.JJpe},tC — — L_/
DATE
BY TITLE
DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C)
2. YELLOW - WATER SYSTEM FILE (Complete Section C)
3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C)
4. GOLDENROD - MUNI -BOROUGH (Complete Section A)
16-0407 (Rev. 11/83)
Sk a F L (I S I WALTER J. NICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
7�7, '7j
091 C STREET, 111077 322,
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