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Home My WebLink AboutFAIRFIELD LT A f • � Municipality of Anchorage a On -Site Water and Wastewater Program < (907) 343-7904 <:, F E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 075-093-32 1. GENERAL INFORMATION Complete legal description Fairfield Lot A Location (site address) 258 Hottentot Mine Rd. _ Expiration Date: __ 9/-1/2 Current Property owner(s) _Timothy Denuptiis Day phone Mailing address P.O., Box 351 Girdwood AK 99587_ Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _ Well Public Water System Waiver/Variance request for: Day phone ,3"q TYPE OF WASTEWATER DISPOSAL: Individual ❑ ® Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. stance: COSA Fee $250 Waiver Fee $ Date of Payment �`7� Date of Payment _ Receipt Number02- 6 Receipt Number COSA # 0562.1125 S 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. Name of Firm ARCTERRA CONSULTING, INC. _ Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AIC 99577 -- Engineer's Printed Name KENNETH M. DUFFUS _-- Date e Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ��®\ occupants or can ArcTerra guarantee that no unseen i OF encroachments, deficiencies or discrepancies exist. c r / 1 6. DSD SIGNATURE // System #1 Approved for H bedrooms. ` rcEvnErEi :N. fur�� s Y Pp j S System #2 Approved for bedrooms. ,c'\ ��' �'``Aw Disapproved. Conditional approval for bedrooms, with the foll l�t�ti tti�ons: Pp �`V�� F ��r�� ``. V\�� - -- - _ pN-SITE z Wp,TER AN R __ _ �j-pTE o WAST ppoGfSPM r, JJJI��N T)S)EF>>>�1, By: Original Certificate Date: 6/Z/2 1 The Municipality of Anc7ge velopment 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 blue sheet -10-10-12 doc Text * Field verified that the sewer FCO is approximately 25’ from SW corner of house and 36’ from well casing. 5/30/21 dea L EXCLUSION NOTES: It is the owners' responsibility to determine LEGEND: SET FND ORDERED BY: the existence of any easements, covenants, or restrictions 5/8"RB W/CAP* 5/8" RB TIM & SHEILA D E N U P TI S which do not appear on the recorded subdivision plat. NOTE: 3.25° AL.MON. q� MONUMENT Under no circumstances should any data hereon be used for HUB & TACK p - construction or for establishing property lines. FENCE-x— x— SURVEY CERTIFICATION: A.L.S. has conducted a OVERHANG— � physical survey of this property as shown on this WOOD DECKS— A. I, A. �I,/, A, I, A, h I,I?, //A�\ III//A�\ IUr(/�//A�\ ILI�//A�\ �II�yIJIILI�I\ here �I, I,I�n\, /J�� drawing and that the improvements situated there—CONCRETE— IVI`JIJIIIJ �IL�� on ore within the property lines and no encroach— on CONCRETE— 0 ASPHALT— 0 ASPHALT— ments exist other than noted. GRAVEL— SEPTIC STANDPIPES— ❑5 WELL - LAND, CONSTRUCTION 8c MINERAL SURVEYORS 04 GIRDWOOD? ALASKA 99587 L LOT (907) 783-2212 0T 9 9 A WORK ORDER NUMBER:DATE: SCALE: 4/3/99 1"B(fox) 783-3455 F A R E I E L D S U B D V S O N DRAWN BY: {NECKED pY• GRID rNUBER: ER; BaaK PAGE; 1 and dd 327/72 SUBDIVISION: z yl ---I- �--lk � BLOCK: -- I ----:S-- MAIN: 'TYPE IMAIN: DEPT AT MAIN: CONNECT LOCATION: COMMENTS: INSPECTED BY: LOT:WA -�o . . . ......... ......... ...... <--4 -4 AT PROP. LINE: -7 ':Z DATE: 5T HEFTY DRILLING 3540 AKULA DRIVE TELEPHONE: ANCHORAGE, AL^$KA 99516 (907) 345-0593 Date Dril.led : 7-9-93 WELL LOG Tim Demup Girdwood Static Water';'LeYel 75. Feet Draw Down N/A. Feet Type Material Drilled: 0 ft. to 3 ft. Overburden Gallons Per Minute_30 Plus Total Feet of casing _]57 3 ft. to 70 ft. Cemented hardpan w / streaks of sandy clay 70 ft. to 100 ft. Brown sandy~ravel 100 ft. to 142 ft. Clay & rock w~et ~treaks 142 ft. to 155 ft. Clay 155 ft. to 157 ft. Sand & rock wLH20 to to to HEFTY DRILLINI~' 3540 AKULA DPdVE ANCHORAGE° AK (907} 345-0593 [ aii[¥ o4 Anchorage Dept. Health ~,,' '"' .... S PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930053 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:DENUPTIIS TIMOTHY D OWNER ADDRESS:8607 VERNON ST. NO.3 ANCHORAGE, AK 99515 DATE ISSUED: 4/07/93 EXPIRATION DATE: 4/07/94 PARCEL ID:07509332 LEGAL DESCRIPTION: FAIRFIELD LT A LOT SIZE: 17919 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS.'~ ISSUED BY: ~ / DATE' DATE: ~'" APPROVAL FOR A SINGLE FAMILY _____ _DWELLIN~ Corn lete le al descnptio - - Lending agency ': :, NOTE: If comm~Uni~ well system, provNe ~ri~en confirmation from State ADEO a~est- :~<.t ,, ':~, lng to t~e legali~ and status of system.?:~' : attesti(~g to the 72-02~(Rev. 1/91) Front MOA~21 _ .,> , . ..:' .' - - 5. STATEMENT OF INSPECTION BY ENGINEER As certified bY my seal affixed hereto and as of the vel!dafi'°n date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply anct/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 inves.t~atlon 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. Nameof Firm J~--~ ~--~/:~/'(~//~-//,~/~ Phone ' ~--~ '~-~ e DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for ~-.. ,,~ ,.. , '" b~rooms. ¢.,~,% ~ ,~,- - - . b~room~, with the' following'~pulntions: Comments ' "<' ' Department of Health and Human Services (D~ISi issues Health Authority only upon the representations given in peragrept~ 5 above by an independent Istered in the State of Alaska. The DHHS does ~his as a courtesy to purchasers of homes and uirements. Employees of DHHSdo not or analyze data before a certificate is issued. The Municipality"of Anchora,ge is not · '~sp0nSi~le for errors 0~ omissions in the professional enginee'r's ~0rk: "" ' ' 'J'",~!~,~Ji'~:~i?~ ,~, ~-'':''' Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) ~PiL,')~/~-~~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed 7 '-~-'-~' .~ Driller Cased to / :~ 7 Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION . SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~]//~ ; On adjacent lots .~ /~-C_-~ f Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform {~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA ;On adjacent lots ~ / ([~?O Public sewer manhole/cleanout '~*~ /''~ / Petroleum tank /'%) O/~-> Collected by: Other bacteria Date installed Tank size Compartments Cleanouts (Y/N) '~-~ Foundation cleanout (Y/N) .~De~r. ession (Y/N) High water alarm (Y/N) ~ Alar~33-tes ed~) Date of pumping ~ ~mper SEPARATION DISTANCES ~ANK TO: Well(s) on lot ~ On adjacent lots ~ Foundation To properly li~e/ Water m~'m~a~/service line Absorption field Surface water/drainage 72-026 (3/93)° Front CONTINUED .ON BACK PAGE C. LIFT STATION Date installed D. ABSORPTION FIELD DATA Date installed Length Width Total absoq3tion area Manufacturer Size in gallons Manhole/Access (Y/N) Veto (Y/N) .... ~P4J~m~ on" level at ."..PjJm, pofl" Level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTA~7~-"F'-F~'(~M LIFT STATION TO: Well on~~-~j On adjace~nt lots Soil rating (GPD/Ft2) Cleanout present (Y/N) Date of adequacy test Results (pass/fail) Wat~:-Ie~1~'eLin~.absorption field before test ..... Peroxide treatme~ ~pasLl.~2 months).(¥/N~ ~ ~ __ __ SEPARATION DIS.T.~NGE~ROM A-E~SO~:IPTJ~IEL~D TO: Well on 10t~ ~-'"'~ On adjacent lots ~ To I~lilding foundation On adjacent lots Cutbank Surface water .Sy e my pe Gravel thickness ~. ?-~Total depth ~. ~' Depression over field (Y/N) for After test If yes, give date Property line To existing or abandoned system on lot Water main/service line Bedrooms Surface water Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HM Fee $ ~3/~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number # 1517 72-026 (3/93)* Back