Loading...
HomeMy WebLinkAboutCALAIS BLK 3 LT 1Onsite File Calais Block 3 Lot 1 #009-034-38 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 Parcel I.D. 009-034-38-000 Expiration Date: 2 c a I, 2 0a 0 1. GENERAL INFORMATION Complete legal description Calais 133 L1 Location (site address) 401 W 31 st Current property owner(s) Susan and Mary Kiely Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: rx-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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 R Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2-1O (:0Q)0 Date of Payment qLe? LZO Receipt Number Oy Q 0C1 COSA # 0SCi2% ► y q."_ 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSD SIGNATURE "// System #1 Approved for __�_ bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date ZG'C%G C �E Steven .R Ponriciie ilCE 3149 ,ell TZ-* - Conditional approval for bedrooms, with the following stipulations: By: XJV o/) Original Certificate Date: I � `20 0 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: Calais B3 L1 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 unknown Total depth 80 ft Cased to Unknown ft NO Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/2012020 Static water level at beginning of test 22.7 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: COSA Checklist yellow sheet Parcel I D : 009-034-38-000 Structure served by this system 1 Well production at time of test 2.75 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 7.550 ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 7/21/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: 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 Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' P-1 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' I Yes Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q✓ Yes if No ft r,/J Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' , Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' j Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' —' Yes if No ft Community Wells > 200' _ Yes if No ft Water Service Line > 10' I 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 ft Water Service Line > 10' L! Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ,� Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF. AC ,Sj�� I certify that l have determined through field inspections and review �. 9 of Municipal records that the above systems are in conformance with I MOA COSA guidelines in effect on this date. 5te.Jen •R. ;�ar7none• 1. G F Q Js COSA Checklist yellow sheet A W N G) � v 0 X.N 3 ocn 0 O ro rt 4�S` C (D m CO � 1' am�°0 �mo.0 om (D < cn +m Qo N v < o iL F W O D n m om61o> you O c c < a) (D 3 v D -s C N rt%u (D 3m� '? (DN=(D u *to G to 3 (D 0 W `+, a300 t O c ,C y H f1 (D ' 1 rDc: /� CD (D (Np O Q 7 e-1( l'1 - rD r a p m f < cr vi 't l 7 CO Wa 0 (23w C 0 7 c m 3 :3 > n (D m n D O o< 6 2 N m 'D (D n 2q, _ 0 w � 0 (D D � (D S '✓r5 o a a " n O C M ()j (D (D, a 0 Q n > r+ 3 CL 3°o3 cr (n (D 3 (D o - ,o< ID v N o V1 Q (D 7 `G O ,... C0 (D Ul � Dia rt Q O an G(D 0' 3< N O 00 NOS (D 070 a v N (O_ a=•N O Co P FV (D (n (D 0 0 0 (D r Q 7 q 7 Dj 4 0 w a o` m = (P Cr _O (D Co 0CL 0 Un a 0 coor m w Q -v O 0 a <o K y a N a N (D � � m 0o n v Mton,Q o c � n N n =.Q 372 y (D r�F (D N O v O 0 w Zr a) Q O o, . i .p °:3 m n < m CL 0 3 w C a N a g o C)o2���0 'it .Q r` W O m N m o m rCt m 2s '' z�. o ` m n fD �s m < 3 a ID F co + n3.o< F D m 3mw3 0 ��(D �j oar v� N CD a N 7.3 A W N G) l DDm-{� C, O m -x �(D a3 G) m O o O (D v N I N n 0 C Q C (r (D n p 3 6, N `�� I N � m D 0 I20' (D N N O O (D O D O N C w CD m (DCL N (D p n 0 Q m n D o :3 n (D n 2q, N D (D TOE o o a a r _ S` (D, a (D -- -- m v < 6 N (A (n (D °i {F.M_B" I v 8,0 t 30.3 070 a v N (O_ a FV (D (n (D d (D r o` m o 0CL 0 Q j r1• Q -v O 0 a o_ y a (D �< a Q Dj s n Mton,Q � nN N N n (D r�F tp d: Zr a) Q O o, . i .p °:3 m O m CL w .tt A o C)o2���0 'it .Q r` W O (D O T N =r rCt m 2s '' z�. W T v3�TIQo v i" 0 O. (D < v a ID F co + N N 0 m 0 �j oar CD N 7.3 0 KD 0 m 0 T 0 O m -a (D I Q) Ii I N � I20' ALLEY O CL tD 0 A4'0"a S00° 10'30"E 65.00 TOE I �- -- -� _ Q -- -- >- -- X — v 10' UTIL. ESMT. (A < 8,0 t 30.3 O \ z z r \ 0CL f, Q j r1• Q a 3 �< a Z o � C,) �" tp d: Zr a) Q O o, . i .p o -Pb w .tt A o C)o2���0 'it .Q r` W O O m 2s '' z�. W T v3�TIQo v i" 0 a ID F co + N m zCD �P. o a O �j oar 7.3 m =� Z'£ I n PO co lD I IN NOW 10' 307 65.00 W N I O n®® SII 0 I u A O O +n I ---�-- -- -�--- --- EUREKA STREET - --- � - W *'`�� ms`s �1 pin } M. F LO 4� 00 ZS4,610 A C:) F + -' u i3em 10 J Cl LLj CL Ln e4) cpb L 0, 'a cn Z(L C:) Li %rz f �r� •• 0 • 0 7. Z CL C:) LU .� •z 0 0 z L) 0 uZ too 0 lzW 0 09 LU UJ H, z LuV) C) 0 a. CD C4 L x x 0 w Vol Ix Li w F Cl ri 0 i lu I 0 cr r 9L F Ld CL0 ix CL O { CL z CL y..t0 0 w 0 yiLLI El z o iN No LaW 0 i.i z u •. w z u A- 0 0 0 .. L o 0 w z Ej 0 cc s � lz W Ll > I 0 iN No LaW 0 i.i z u •. w u m 0 .. L o 0 ..CL w cc s � Ll Ix f) Li lip .■ LLI Ll 0 CL z CL t� LO Li J ca u Lliz 0 Q O u z .. CL W � 0 CL w z z C13 i w{.+yf ;j k: ��` t*i'Y ��'�'� �i+ i 3�' • .-r! • � ti'� .F t —� � +�tt �# i�x �`� + 3 � � � T � 1� } do f a v z LLY0 4 r— 1 z Li w J 0 Y u alu 30 $0 S cr a° a J C) Li u 0 u ME APPLIC ,~iT FILLS OUT UPPER HAL ONLY ~roperty Owner ~ .... ,;~,~: ;,~ ,,,~ ~-" ?[,- ~ ~,.~ ~ ~-~-- -/~/c:' /,// ',~'/ ~ ~ i"/ -~,'~(~ Phone Mailing Address ~ /,~C) ~;:' ~ t~.lj~-( J(.,L /}, .d'/~. J~, ]Z~,J~ ZipCode C~'~?F (_.~> Buyer Address Zip Code Lendinglnstitution ..!~.~.~ ..~.~>~.~ ~'(~.-~,/A, /"~'-ti2~/~l d'~-?~'/i'~"T' (.A.~.~ t'~b"t. Phone Realty Co. & Agent Phone Address Zip Code Street Locat~o~ -~ © C) ~, ~'~'. ~:' ~C )F ~. A ~C 1^, ,/~ E ; Type of Residence ~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply I~lndividual A'I-I'ACH WELL LOG. A well log is required for all wells drilled since June 1975. [][] CommunitYPublic Utility I~t ~,c_~- For wells drilled prior to~that~.~ ldate' ~give (~_well[ lepth (attach log if /~'5available)'L) z,'? Sewer Disposal [] Individual Year Individual Installed: ,. ~/Public Utility ,, O/~.~[en Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector M INICIPALITY/~: AI~t~HORAGE BEPT. Field Notes: ENVIRONM,':NTAL PROTECTION /-/.~ 4) AUG 1 0 lg83 RECEIVED { ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE ,~:- //~-~' ~3 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182) DATI~ RECEIVED INSPECTION APPOINTMENTS TIME TIME 'I~ME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPAL~ ~CHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL Pf;OTECTION  .~.A.m~.~ o..~A~. · ~.V,.O.M~.~A~ ..O~C~,O. 825 LStreet-Anchora~,Alaska99501 APR 3 1981 ENVl RONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E i V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be proce~ed. Please allow ten (10) days for processing. MAI LING ADDRESS 3. LENDING INSTITUTION ¢ PHONE MAI LING ADDR ESS STREET LOCATION un// 6. TYPE OF RE~I[~ENC,Ef ~ - [] SINGLE FAMILY iMULTIPLE FAMILY WATER SUPPLY 7. .~ INDIVIDUAL* ~ COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDRO~MS [] One ~ [] Other [] Three~ / * ATTACH WELL LOG. A wel/og is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE F-IPUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SIX [] OTHER Septic/Holding Tank IAbsorption Area [Sewer Line INearest Lot Line 5. COMMENTS ' PROVED FOR ~ BEDROOMS ~=~CONDITIONAL APPROVAL (letter mus~ adcompany certificate) [] °,SAP.ROVED 72-010 (Rev. 6/79)