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HomeMy WebLinkAboutFIRE LAKE LT 4 TR NFire Lok¢ ction Lot 4 T act N #051-332-23 Municipality of Anchorage : Development Services Department ~'~ ~:: Building Safety Division '~ ~ On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: PID Number: Na me~'"'~I (,/'7../~/ /'~/~ D OF"L~- Id Wastewater System: [] New [] Upgrade ~- [] DeepTrench [] ShaltowTrench [] Bed [] Mound .~/~,~.t~.~O ~i~t/h;r~ ~"' Ph°ne:d 7~~h''- 3 / '70/' :' Numbe, of Sedroor~:_~ : LEGAL DESCRIPTION Soi,.,ng: A ~ GPD/Ft' T°taiDepth'r°m°~g'nalg'de:7 Ft. Bloc~: Lot: Subdi~sion: Depth to ~ bottom ~om o~ Ft. To.ship: Range: Se~ion: Fill added above o~ginal grade:~ '~ Gravel Length: Well: ~ New ~ Upgrade G~v~ ~d~: ~Ft. Number/D/,~oflines: Distance be~eo. Classifl~tion (Pnvate, A, B, C): Total Dep~: ~sed to: To~l ab~Qon area: Pipe Material: Dnller: * DateD,lied:., ~ Sta,ic ~r Level: Installer: Yield:~ GPM~ Puget at: Ft.~ Casi g Height Above~ Ground:Ft. TANK ' SEPARAIION DISIANCES ~Sep~c ~ Holding ~ S.T.E.P. D Other: To: Septic Absorption Li~ Holding ~ubli~Pdvate Manufa~uren Capa*ty: ~ Tank Field Station Tank Sewer Line ~~ /O O q~ GaL Material: Number of Co~nts: Curtain Drain ~ ~ ~' bY4/ / Electd~p.i~s in'l / J Re~rks: ~ ~ ,/W~/~'~O~ ~0~'~ BENCH MARK Lo~tion and Descd¢on: ASSU ~d Elevation: En~n~; Sta.mp inspections performed by: / ~ . Dates: 1st % ~ ....... = , Development Se~ices Depa~ment Approval ¢; ,:'. .. ' .... : .... ~'~ 'G'~, ~ ';: ,5.: ~ :~ i Reviewed 8nd approved by' .? -'? ~' ' ,?'"~: / Date: ,~ ~',, ,',:'. ...... " THRIM I.?EERING NorfhRim Engineering June 15, 2005 MOA On-Site Water & Wastewater Program JeffPoet 4700 Bragaw St Anchorage, AK 99519 RE: Certificate of HAA; Fire Lake S/D, Tract N, Section Lot 4 Dear ~ I have spoken with you several times concerning the subject property. We located the original application & permit which stated that the permit was not valid without a soils test; so we excavated a soil pit adjacent to the seepage pit. The soil test is included. The seepage pit performed very well for an old system. This is likely due to the very clean sandy material, virtually no silt. Please review the information for the single family home. I have included additional information for this submittal. If there is need for additional information or clarification please give me a call. Sincerely, HAA Enclosures THRIM I~NEERING SOILS LnG - PERCOLATION TEST ]3ate Performed: 5/P5/05 Performed For: Carol McDonald Legal Description: Fire Lake Tract N Section Lot 4 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - DEPTH (FEET) ..";: :.. · '.',..~ · ..:: :...-.'"';. GP T,H, Location: Adjacent to amd Betow Seepage Pit Groundwater? No Depth -- Water Depth AFter Monitoring,None Date: 6/3/05 Date Gross Time Net Time Depth Net Drop 5/25 0 -- 3- __ 5/25 1 1 min, 4' 1' 5/25 3 3' __ 5/25 4 1 mir, 4' 1' 5/25 5 -- 3, __ 5/25 6 1 min, 4' 1' Percolation Rate 1 min,/inch Perc Hote Diameter Test Run Between 4' and 5' Comments: 1]ry, qandv ~olt, ~nmy e×cavn-hlrl~l, Performed ByNo~thRim Erg, I~_/~ - CERTIFY THAT THIS TEST WAS Performed in Accordance with--~[[ S-~te/Municipa[ Guidelines in Effect ON THIS DATE, DATE: 6/15/05 NOF8 THF~IM EN GINEERIN 17237 Bear Paw gogle Ri~, AIo~o ~577 907. 694. 7028 TESTHOLE LOG GEOTECHNICAL T, H, 1 6/15/05 Well Ownen LoCation ~V~ 'W DRiLLiNG, inc, P. O. BoX 4-1224 o 1310C In:ternational AirpOrt ROad (907} 2:74~461 l ANCHORAGE, AL~KA 99509 DRILLING LOG 2~m Langl$~ ~Use of Wet} Dom taddress of: Township~ Range, Section, if known; or distance main road Size of eamng. Static water level .20 ft. (~ Screen ( ); Perforated ( Describe screen or perforation .Depth of Hole__ - 7o ~-feet Cased to__~ .... 'feet (below) land surface. ). Well purr:ping test at_ ~. gallons per (~) of drawdown from static level. Date of completmn__~ ~ 0 Jun Finish of well (cheek one) open end ( × ); (minute} for~__2k~_hours witb~_.~ ft. WELL LOG Depth in feet from g~ound surface 0 _iC 20 _TO 22 ~ ,._TO }}:a .TO~__~_ t .TO ~TO TO ........................ TO .TO Give details of formations penetrated, size of material, color and hardness ~ilt./ ~ravel brown I --CUSTOMER GREATER ANCHORAGE AREA BOROUGH D,EPA~T~,,4ENT ¢O,F E~V~RONME~TAL ~UAL~T'¥ DISPOSAL SYSTJ~M -- APPLICATION AND PEAM)T l NSTALLAT!©N LOCATION '~ RA'V;EL BAC,~ ?~LL Address Realty Co. & Agent Phone Address /{d ~/~:' //~ ~ Zip Code Type of Residence LJ Multiple Family No. of Bedrooms [] Other Water Supply ~ Individual ATTACH WELL LOG. A well 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  Individual Year Individual installed: Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Tim~ Date Date Date Inspector Inspector Inspector Inspector Field, Notes: -'~f.~'~ pc,& ,~.'~ .::p ~. ,-:? vt,.-'... >" ~ /, ( ~f~'-PROVED BEDROOMS -5--- ~'~ --~ 'CONDITIONS OF APPROVAL (~) DISAPPROVED ( ) CONDITIONAL APPROVAL* By:DATE ~_.~..¢,,~ '~~ ,~ ,~k~ ~'~ Soils Rating Date Sewer Installed Well To Absorption Area ,.,' / Well Log Received Well to Tank r Septic Tank Size 72-023 (3182) EXCAVATION ROBERT A. SHAFER WORK May 21, 1983 CIVIL ENGINEER 694-2979 ['4r. ?~cmonald Box 108.~_~lsn'""' ' Hatchery Road Eagle River, Alaska 99577 Dear [fir. F!cDonald, Reference: Lot 4; Block N; Upper Fire Lake Subdivision A sewer system adequacy test~ was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The septic tank was also exposed to verify that a steel tank did exist. The seepage pit was charged with 1000 gallons of fresh water and after a period of 24 hours all the water which had been added to the crib had percolated out. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. If we may be of further service, please do not hesitate to call. Sinc,e~y, /~:'~' cc: Mun±cipaiit¥ of Anchorage Department of Health and Snvironmental Protection SRB 196X EAGLE RIVER, ALASKA February 25, i983 .Harry J.- MCDonald BOx 108 Fish Hatchery Rd. Eagle River, AK 99577 Subject: Lot 4 Block N_~Upper Fire Lake Subdivision Approval for t~e individUal sewer and water facilities cannot be granted until the following~..items have been completed: ~1 .The water analYsis ,report needs to be submitted to this , ..... ,'~~ffice from the chem Lab, 5633 B Street,-for our review. " The septic tank pumped with a receipt submitted to th~s department. The total~number of gallons pumped needs to be on the, receipt and verified by a registered engineer as to the actual number of ~allons pumped. ThiS'is to verify the size of the septic tank. " Expose the septic tank man'hole to verify its existence. Please notify this-Department-~°r a reinspection when the ~noted discrepancies have been corrected, ~ If there are any .~urther questions~ please cal!~,this of'~ice at 264-4720. Sincerely, Jim'Roberts' AssOciate Environmental-Specialist JRi 15/p/E1 lizt • e fp) I,_ _. z;.ti p • t Municipality of Anchorage r4,"7..,. r. . _6_11c. Municipality On-Site Water and Wastewater Program < '-IAV I i `— (907) 343-7904 SA ETY Certificate of On-Site Systems Approval Parcel I.D. 051 332 23 Expiration Date: IO d aO 1`� 1. GENERAL INFORMATION Complete legal description Fire Lake Tract N Lot 4 18851 Fish Hatchery Location (site address) Current Property owner(s) Michael Niemi Day phone Mailing address 18802 Fish Hatchery Real Estate Agent Nathan Jabaay Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:Well To Septic l rc+tn-c;z k IrcJn-cielA -1-o Sux- t-ce t'3"D stance:" g8r/ci 0 V Received by: _(- --1, Date: I(//l/ COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5-2-- Waiver Fee $ 1123 Date of Payment II J 811? Date of Payment 1([2 117 Receipt Number 02017 b Receipt Number 02.4/2b COSA# 0 5C I ' 1511q Waiver# as V 1'31642 ' cGIGP-1.toi 4P -4 - Plitd" I'llg Irv- o m+- h 4 117 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 C&M ENGINEERING Phone 907-854-5558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 10/30/18 OF ACotrokk 6. DSD SIGNATURE y1r; t STH • fir 4 System #1 Approved for 3 bedrooms _ . P_r System #2 Approved for bedrooms �� HARLES BALZARiI r V.• CE-13854 ��• a�° Disapproved isTF•• '%v�� irrP Conditional approval for bedrooms, with the followings �F� iik k„ttz � • ON-SITE WATER AND o WASTEWATER -c-41-- PROGRAM PROGRAM 'VT SEW\C' • By: JA-A/Q9.. CSOtit-A Original Certificate Date: 10\) 09) Q O 1 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 blue sheet r . c If more than 1 septic system is on the lot: COSA Checklist# 1 of1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Fire Lake Tract N Lot 4 Parcel ID:051-332-23 A. WELL DATA Well type private If A, B, or C provide PWSID# Well Log (YIN) yes Date completed 6/20/74 Sanitary seal (Y/N) y Wires properly protected (Y/N)y Total depth 176 ft. Cased to 22 ft. Casing height(above ground) +12 in. FROM WELL LOG AT INSPECTION Date of test 6/20/74 10/25/18 Static water level 20 ft. 53 ft. Well production 1 g.p.m. 1.22 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2.17 mg/L Arsenic ND ug/L Date of sample: 10/24/18 Collected by: C&M Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC** Date installed 7/1974 Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) yes Foundation cleanout(YIN) yes Depression over tank (Y/N) no High water alarm (Y/N) nO Date of pumping 5/11/18 PumperJRs C. ABSORPTION FIELD DATA Date installed 7/1974 Soil rating (g.p.d./ft2 o &rn) 1.2 System type pit Length 8 ft. Width 8 ft. Gravel below pipe 4 ft. Total depth 8.2 ft. Eff. absorption area 200 ft2 Monitoring tube yes Depression over field no Date of adequacy test 10/25/18 - Results (Pass/Fail)pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added +450 gal. New depth 0 in. Elapsed Time: <144 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) none known If yes, give date na D. LIFT STATION 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 WELL ON LOT TO: Septic tank/lift station on lot +100 On adjacent lots +100 Absorption field on lot 88'* On adjacent lots +100 Public sewer main +100 Public sewer manhole/cleanout +100 Sewer/septic service line +100 Holding tank +100' Animal containment areas +100 Manure/animal excrete storage areas +100 SEPTIC/HOLDING TANK ON LOT TO: Building foundation +5 Property line +5 Absorption field +5 Water main +10 Water service line +10 Surface water +100 Wells on adjacent lots+100 ABSORPTION FIELD ON LOT TO: Property line +10 Building foundation +10 Water main +10 Water Service line +10 Surface water +* Driveway, parking/vehicle storage +5 Curtain drain +50 Wells on adjacent lots +100 F. COMMENTS *See supplemental information letter regarding tank condition and septic to well separatioy G. ENGINEER'S CERTIFICATION �'� or A � L vok / certify that I have determined through field inspections and �r review of Municipal records that the above systems are in el C9 • -- :571- conformance with MOA COSA guidelines in effect on this date. fit:�4 9 T H -* , Engineer's Printed Name Charles Balzarini174 _ u Date 10/30/18 CHARLES G BALZARINT f'F j•, CE-13854 ,• IkPROFESSION - COSA canary sheet_2-6-15.doc 1p C11 Municipality of Anchorage P.O. Box 196650 e 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.orq/Onsite Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181092 COSA#: OSC181589 Permit#: PID#: 051-332-23 Legal Description: Fire Lake Lot 4 Tract N Engineer: C#(1.) q n9.-" r► Applicant: Michael Niemi Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 88.0 feet. In addition, your request for a waiver of the required 100 feet horizontal separation from the absorption field to surface water has been approved. The approved separation distance is 90.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. • Waiver is Granted: X Waiver is not Granted: Date: d 7/9 0 1 SApproved by: Gkitfi Name of Reviewer **** VARIANCE/WAIVER REVIEW **** C&M ENGINEERING SERVICES Ph:907-854-5558 Municipality of Anchorage Onsite Water&Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Existing Septic System at Fire Lake Tract N Lot 4 Dear Reviewer, The above referenced property is currently served by an older 3 bedroom septic system installed in 1974. An adequacy test was performed on the septic system in late Oct 2018 and it was determined to be functioning and adequate. Upon inspection of the property and review of available documentation, it appears that there two observed discrepancies and issues which require attention beyond minor repairs. 1. The seepage pit system is within the 100'well radius and just over100'from surface water. 2. The tank is documented as a steel tank installed in 1974, indicating significant age. We are requesting approval of the existing tank and approval of a waiver from the seepage pit to the well and surface water. It is important to note that pit was over 100'from surface water at time of inspection, however it appears that at high water conditions, the seepage pit may encroach on surface water. The requested waiver distances are: 88 ft well to pit and 90 ft surface water to pit. The waiver is justified for the following reasons: • This system has a history of COSA/HAA approval and has been in operation since the 70s with no discernable adverse impacts. • The nitrate levels are low and were measured as 2.17, see attached. • The area is lightly developed an unlikely to become heavily developed over the life of the system, given the lot size and topography. • The well log shows 20' of soil and 134' of bedrock above the water producing zone. • Bedrock topography makes it extremely unlikely that any effluent could migrate towards the well casing. • • Though the well casing is shallow, it is not perforated and extends into the bedrock Based on those points, we believe approval of the waiver is justified and in the best interest of the property buyers and future owners. The existing septic tank installed in 1974 was documented as steel and a single chamber. The records appear to be poorly documented and the accuracy may be disputed as they are not original to construction. We believe the tank currently in use is original construction concrete tank with a cast iron riser pipe. It is possible that the inspecting engineer in the 80s exposed the steel riser and assumed the entire tank was steel. We camera'd the tank through the cleanout pipe and based on our observations in the air gap area, the tank appears to be made of concrete material and a square corner was observed. While it is impossible to determine if this is the original tank, the long operational history of the system and materials used point to this being the original concrete tank. Replacement of this tank due to issues with documentation would not benefit the buyer or public health. Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558 or by email cqbalzariniqmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 11/9/18 °F'14'l1l �4 49 ;*Int i *fie , cam '_ 2___ CHARLES G BA.LU,.RINI f CE 13354 \ate r 1�`Fc taa��1� Age AO*:*: 49 TM /\ ..*94 , • CHARLES G BALZARIC 4 V7 p('•• CE-13854 • (cr t4�`TF,p'.. /2s.'•, e. �‘ "PROFESSIO�P�� 4 TANK HOUSE DRAINFIELD SL•• - - - - REQUESTED WAIVER DISTANCE FOR CREEK FLOW VARIATIONS /SLOPE / O 90 11 SLOP / \�/ / V \ / \ 100'CREEK OFFSET DRIVEWAY / / \ \120' \ f \ \ ciS `I i ---.„,_ a WELL I I \ / i NOTE: / THIS PLAN DEVELOPED BASED ON AVAILABLE SURVEY INFORMATION / AND FIELD MEASUREMENTS RELATIVE TO HOUSE LOCATION. / ANY OVERFLOWING EFFLUENT FROM THE SEPTIC SYSTEM / WOULD TRAVEL DOWNHILL AWAY FROM BOTH THE WELL / AND SURFACE WATER. / \ / /i , \ // - - - -� - - WALE 1"a 40' LEGAL DESCRIPTION: FIRE LAKE TRACT N LOT 4 C&M ENGINEERING SERVICES OWNER: kin NEMdEI ]DATE:Io/3O/14 REV: I DRAM: Cbl REF: 907-854-5558 WAIVER PLAN Municipality of Anchorage • • G6, B Development Services Department �: Building Safety Division On-Site Water and Wastewater Program S A ET 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-332-23 COSA# SC \\\ C-D CD Expiration Date: 9 -17- 1. GENERAL INFORMATION Complete legal description FIRE LAKE LOT 4,TRACT N Location (site address) 18851 FISH HATCHERY ROAD, EAGLE RIVER, AK 99577 Current Property owner(s) JONATHAN & WENDY CHIN Day phone Mailing address 18851 FISH HATCHERY ROAD,EAGLE RIVER,AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE Of WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Irdivic(ual vvelK Individual On-site )r)div dual`Water Storage ❑ Individual Holding Tank ' Community Class Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ 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 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 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 06/13/2011 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 * "'I16 "10 occupants or can ArcTerra guarantee that no unseen ter- encroachments, deficiencies or discrepancies exist. ' y t 7�. _S__ 5. DSD SIGNATURE , , J •Approved for bedrooms. 4 G1 _ ,d' Disapproved. " ;+, "' " Conditional approval for bedrooms, with the following stipulations: \ fit•'. .'ti0 J`� ON-SITE •,,• 0 `4;, WATER AN©- : m= WASTEWATER : PROGRAM- : -::".-..tV• ..*.$Attachments: • COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements __ Well Flow Advisory A Supplemental Engineer's Report Nitrate Advisory Other By: . / ../ , .._ ....., Original Certificate Date: — (Rev.11/05) C� _ �[ t • ET:Tr-} Municipality of AnchorageDevelo ment Services Department Building Safety Division On-Site Water& Wastewater Program fel 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: FIRE LAKE LOT 4,TRACT N _ Parcel ID: 051-332-23 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/20/1974 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 176 ft. Cased to 22 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 6/20/1974 5/12/2011 Static water level 20 ft. 40 ft. Well production __ 1 g.p.m. 0.57 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate 1.69 mg/L Arsenic: ND mg/I Date of sample: 6/1/7/2011 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 07/1974 Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 5/12/11 Pumper jRs C. ABSORPTION FIELD DATA Date installed 07/1974 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type Seepage Pit Length 8 ft. Width 8 ft. Gravel below pipe 4 ft. Total depth 8.7 ft. (Measured 5/12/11) Eft. absorption area 200 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/12/2011 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 730 gal. New depth 4 in. Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date--- D. LIFT STATION 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: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1001+ _ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ _ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION +0'0' 01k Ot1.441Z I certify that I have determined through field inspections and -F.c \N1' review of Municipal records that the above systems are in ": .. "` conformance with MOA COSA guidelines in effect on this date. /� _ " 's r Engineer's Printed Name KENNETH M. DUFFUS tit: ate Iso /O Date 6/13/11 s4 COSA Fee $490.00 — _ Waiver Fee $ Date of Payment ' I5 - I I Date of Payment Receipt Number c;55)b C. Receipt Number (Rev. 11/05) • Municipality of Anchorage GE 8 PY ° S r �i3�°f Development Services Department • - Building Safety Division SA ETY On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # 111200 During a recent COSA on-site inspection and test of the potable water supply well on Block Tract N, Lot 4 of Fire Lake subdivision, the well's productivity was determined to be 0.57 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. 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.org/onsite · (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. DS-I- GENERAL INFORMATION Complete legal description /~/,~'/~ /_._~_. Location (site address) ,/(~-~:J~ 2-- ,,,~"/'0~/¢ Current Property owner(s) /¢~ ~ ¢..~, ' COSA # Expiration Date: Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone ."~,.5"1 '- ~--~'~Z 7 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ = TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: J~ Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer 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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined iR 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 /4,/d:)C"C-~//r~t~ct. Address ,~O ~::~,,'.k:2 77~:::~ Engineer's Printed Name~ Phone Date DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. ~ ~:,',,, bedrooms, with the following stipulations: Additional Comments Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~~,~' Original Certificate Date: (Rev. 11/05) Municipality of Anchorage 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: WELL DATA Well type Date completed ~'/,2<3./7//// Total depth / 7'g" ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Cased to FROM WELL LOG ,bo! 7,/ If A, B, or C provide PWSID # Sanitary seal (Y/N) __~ f · g~ ff. ft. g.p.m. Well Log (Y/N) y Wires properly protected (Y/N) '~/ Casing height (above ground) 2 ~/ AT INSPECTION 7 in. Coliform ~ colonies/100 mL Arsenic: Z~..~ a~j/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material --~7'~'/...- Tank size ,/O0' 0 gal. Number of Compartments /' Foundation Clean°ut (Y/N) y Date of pumping ~//t/¢..~ 7 C. ABSORPTION FIELD DATA Date installed /~ "7/7,/d/' Length ~P ft. Nitrate ~ mg/L Date of sample: 7/;25'/0 7 Depression over tank (Y/N) Pumper ~'-~ ~, Soil rating (g.p.d./ft2 or ft2/bdrm)'~, ~ Width ¢~ ft. Other bacteria 4~ colonies/100 m L Collected by: ,~o~'~/'~--~,x,~ ,~-~, Date installed (:~ Cleanouts (Y/N) y High water alarm (Y/N) System type ~'~_e_~,,~ ~' Gravel below pipe ~ ft. Total depth 7 ft. Eft. absorption area ,~ ft2 Monitoring tube Date of adequacy test 7//~.~_ _~/(5 ~ Results (Pass/Fail) ,~:),,~,J"J' Fluid depth in absorption field before test (~ in. Elapsed Time:,~'(:~ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Depression over field For ..~ bedrooms Water added ~gal.'/' New depth // in. . in. Absorption rate >- /,,,/,_~'(~ "/" g.p.d. ~/~r(~,~' If yes. give date D. LIFT STATION Date installed / "Pump on" leve/ in. Datum / E. SEPARATION DISTANCES Size in gallon~/ "Pump off' I/e(,el at __ CyclesAed in. Manhole/Acce~Y~) High wate~rm level at Meets/alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot ./~'~ Public sewer main /'/'//~ Sewer/septic service line Animal containment areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation .? f+' Property line Water main ,X'/'//~ Water service line Wells on adjacent lots /~,~' ~ On adjacent lots ,/~:~g ~' On adjacent lots /0~ G, Public sewer manhole/cleanout Holding tank /(,//,,~ Manure/animal excrete storage areas Absorption field /,~ '/~"- Surface water /~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~ /''/' Water Service line /4:::l' ~- Curtain drain /~/~/~'~'~ Building foundation //'~' ~'' Water main /~'/-~ Surface water ~'~ /'f' Driveway, parking/vehicle storage Wells on adjacent lots /~/~' F. COMMENTS in. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name ..~-'7-~--~"~/'~'~ Date COSA Fee $ ? Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ";~ ~ ~" :~:~' ' Expiration Date: GENE~:" ~FoEI~ATION- Location (site address or,.~ir~g~i~ns) ~o~ /o ~ ~¢~'A ~-~.~.¢~ Currefit. PrbpedYowner(~)C¢'~6[ /X¢ j~[~ Day phone Mailing"~aO'flte'ss· ~... ~: ~' Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone o'~,2--//g¢-O ~_ Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: ,~ Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD)Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 ,,'~6¢'¢~ f~r,"~"~ Address / .~,:-,~..~ 7 _/~,~:,~ Engineer's Printed Name DSD SIGNATURE / Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 01/02) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST ' Legal Description:/¢,Ce- /--~-(~/.~-.- -%//-) WELL DATA Well type P Date completed Total depth /7~/ ft. Date of test Static water level Well production If A, B, or C provide PWSID # __ Sanitary seal (Y/N) ~ Cased to ~--- ft. FROM WELL LOG ft. g.p.m. Parcel Well Log (Y/N) y Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ~O ft. g.p.m. Y WATER SAMPLE RESULTS: Coliform (~ colonies/100 mi. Arsenic: mg./I. Foundation cleanout (Y/N) ~_. Date of pumping /~/yO~{ C. ABSORPTION FIELD DATA Nitrate O, ,~ mg./I. '~'/'¢~)LOther bacteria~ Date of sample: ~'/~;/0 S Collected by: (~ colonies/100 mi. SEPTIC/HOLDING TANK DATA Tank Type/Material ~~lli~- ..~'-~'~'~/_... Tank size ,/OG O gal. Number of Compartments Depression over tank (Y/N) Pumper Date installed I~/,/,"~? Cleanouts (Y/N) High water alarm (Y/N) Date installed <~7'/'/'~.~ Soil rating (g.p.d./ft2 or~ Z ~--- { I Length /'F ft. Width 0c~ ft. Total depth ~ ft. Eff. absorption area~--~E5 ft2 Monitoring tube_.~ Date of adequacy test ~~,/d ~ Results (Pass/Fail) /O¢,,~,j, Fluid depth in absorption field before test O in. Water added¢5'fSgal¢- ~ f Elapsed Time: g'~ min. Final fluid depth ~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN & type) System type.-.-~c,c,p~ ~ _ /~( Gravel below pipe ~ ft. Depression over field For-~' bedrooms New depth ~ in. ~'~- ~ g.p.d.'/' If yes, give date D. LIFT STATION Date installed i~. "Pump on" level at __ Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at __ Cycles tested Manhole/Access (Y/N) / High water alarm level at /' Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /(~ d ~ '/~ Absorption field on lot / d d, / ¢' Public sewer main /¢/.,,¢'- Sewer/septic service line /¢5/¢- On adjacent lots /'~' "Y-- On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation .-~/¢- Water main ,,4/~/4¢ Wells on adjacent lots/¢~ ~¢' Property line /¢ Water service line //'~ Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,/¢ Water Service line Curtain drain Building foundation Surface water Water main ,,4//~- Driveway, parking/vehicle storage Wells on adjacent lots COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date ~"4"-5"/°'''¢ HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number hereby certify that I ]lave ~uy~_~ f~l~ing ~inct that~ ~ ~e