HomeMy WebLinkAboutCALAIS BLK 4 LT 3
J APPLIF-NT FILLS OUT UPPER HA! ONLY
Phone
Property Owner (~,. :.,...~. ~. .~?...~/./
Lending Institution :,/5' ¢ ~>~,:::;~:~,/ {:~/:'b / ~.) :~, Z.:>r~.~: Phone
: ~ Zip Code
' '" '/ Phone
Address Zip Code
Legal Description Z '~ /~ ~ /~ 4~,-', :
Street Locati~ ~I(5/~ ~-:.- ~ ~ ~"::- :, ~ /
Type of Resi~nce
~ Single Family
~ Multiple Family No, of Bedroo~
~ Other
Water Supply
~ Individual ~ A~ACH WELL LOG, A wal 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~ ~-. ~ .... / ~7 ' .-
~ Individual ~ Year IndivMual Installed:
~ Public ~'lity When Connected to Public Utility: /
Holdi~ankn~T OTE THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time J ,,¢?,/~ 7~ g /D/c?', Time ~/~/./~. Time
Date,,,3 ~ :~ Date
Date~ ~~ Date~ ~ ~~
Insp~tor Insp~tor
Insp~tor
MUN~C~PAL',T',
~// ~oo io~ (~") ¢~/~..;~~ ~¢// AUG ! O 1983
RECEIVED
(~ APPflOVED BEDflO0~8 ~ 'CONDITION8 OF APPROVAL
( ) DISAPPROVED ~-~_ 0~,
( )CO~D,T,O~*L ~PPROWL' ~;~.. A
so.s .a,~n. ~a,e ~wer ,.s,~,~ We, =o *~o,.,~on *~ea ~ We, Lo. Re~ei~e~ ~//~
~~ / ¢~ ~ ~ Well to Tank ~. Septic T~k Size
72-023 (3/B2)
MUNICIPALITY OF ANCHL)XA~=
MUNICIPALITY OF ANCHORAGE DEPT. OF t!-~ALTH &
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENG NEERmG DW S O. JAN 1 5 lgTg
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER j PHONE
PROPERTY RESIDENT (If different from above) PHONE
2. BUYE~ . ~' PHONE
MAI LIN G AD~R ESS
3. LENDING INSTITUTION
MAI~ING ADDRESS
4. REALTOR/AGENT PHONE'
MAI LIN G ADDR ESS
LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~'~ ~r~OlNGLE FAMILY [] One [] Four
[] Two [] Five
[] MULTIPLE FAMILY ~"~'Three [] Six
[] Other
7. WATER SUPPLY
~INDIVI DUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~'~U B LI C UTILITY
* 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.) ¢..~.'~'~' ~4~'~ J~
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF REsIDENcE NUMBER OF BEDROOMS
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER 'SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
I--ISeptic Tank or i--IHolding Tank
Size: If Tank is homemade
give dimensions:
[] oNE [] THREE '1--1 FIVE []
[] TWO [] FOUR [] SIX
PERMIT NUMBER
-DEPTH OF WELL , .. -,
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
,Absorption Area to nearest Lot Line
OTHER
Septic/Holding Tank
IAbsorption Area ISewer Line
Nearest Lot Line
5. COMMENTS
[Z~"'APPROVED FOR -.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
lBY (Title)
BOUNICIPALITY 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. 009-034-40-000
Expiration Date: 3/18/2025
Legal description CALAIS BLK 4 LT 3
Site address 3102 EUREKA ST Anchorage AK 99503
Current property owner(s) VILLASENOR ANTONIO &EVANGELINA
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories: Engineer recommends a point of use arsenic treatment system
at the kitchen sink for drinking water.
M
Original Certificate Date: 3/21/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory X
Other
COSA Approval_June 2022
MUMUPAUTY OF ANCHORAGE
ment Services Department f
Development p 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. 009-034-40
Complete legal description CALAIS BLOCK 4, LOT 3
Location (site address) 3102 EUREKA STREET, ANCHORAGE, AK 99503
Current property owner(s) ANTONIO & EVANGELINA VILLASENOR Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ® Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
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 $ 2 �D
Date of Payment l -L �-2,!22
COSA # 0502 3
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist WELL ONLY.docx
COSA Checklist
Legal Description: CALAIS BLOCK 4, LOT 3 Parcel ID: 009-034-40
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 *1963 Total depth UNKNOWN ft
Cased to UNKNOWN ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 3/15/2024
Static water level at beginning of test 14 ft.
Well production at time of test 5.7 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.305 mg/L Nitrate less than MRL (ND)
Arsenic 27.5 ug/L Arsenic less than MRL (ND)
Collected by Date 3/6/2024
Comments *1963 date per MOA file that also shows >400’. Area has higher arsenic levels and would recommend
a point of use (POU) arsenic treatment system at kitchen sink for drinking water.
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
The sewer serves the site from the back side of the property, no separation issues were noted at inspections
and appears the private well and public sewer have been installed per code at time of installations. Attached
are obtained AWWU documents.
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 3/18/2024
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 &
3/18/2024
Received Date/Time 03/06/2024 11:20
03/06/2024 11:00Collected Date/Time
1240876001
Matrix
SGS Ref.#
Client Sample ID Spigot
Client Name
Project Name/#
Printed Date/Time 03/13/2024 16:34First Water Consulting Services (FWCS)
Technical Director Stephen C. Ede
Calais B4, L3
Drinking Water
Sample Remarks:
Parameter Results LOQ Units Method
Allowable
Limits
Prep
Date
Analysis
Date InitContainer ID
Metals by ICP/MS
HGS03/13/24EP200.8ug/LArsenic 03/08/2427.5 5.00 (<10)*B
Waters Department
EBH03/07/24SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 0.305 0.200 (<10) C
Microbiology Laboratory
PHK03/06/24SM21 9223B100mLE. Coli Negative 1 A
PHK03/06/24SM21 9223B100mLTotal Coliform Negative 1 A
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DRIVEWAYEXTENT SHOWN HEREON ESTIMATED USING PHOTOS
PROVIDED BY THEOWNER. DUE TO EXTENSIVEICEAND SNOW
AS -BUILT SURVEY SCALE 1 ^ = 20
SHANE A. HOLT O�
LS -6914 5o`�O NO CORNERS SET THIS DATE
aA oa 0
�OrOfessional0'_ I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
O�OOoo�� OF THE FOLLOWING DESCRIBED PROPERTY
LOT3 BLOCK 4 CALAISSUB (PLATP522)
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN EXIST OTHER THAN NOTED.
HEREON ( UNLESS INDICATED) DATED AT ANCHORAGE ALASKA THIS 6TH DAY OF
NOTES FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE ANCHORAGE,
ALASKA
LINES OR POSITION ADDITIONAL IMPROVEMENTS• MARCH , 2024
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE•
ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON
HOT T LAND SURVEYING
9309 GROVER DRIVE
1600.% 235-146 ANCHORAGE,AK 99507
907-223-8615
Arsenic Advisory
Certificate of On -Site Systems Approval # OSC241063
Subdivision: Calais, Block: 4, Lot: 3
A water sample revealed an arsenic concentration of 27.5 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.
Mailing Address : -O Box 196650 Anchotage, glaska 99M 6650 * win►w muni org