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Home My WebLink AboutALPINE VILLAGE BLK 3 LT 12Certificate of On -Site Systems Approval Parcel I.D. 014-133-30 Legal description Alpine Village Block 3 lot 12 Site address 7325 Basel St Anchorage, Ak 99507 Current property owner(s) Young Expiration Date: 1-24-2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: r - Original Certificate Date: 10-24-2022 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 Other COSA Approval_June 2022 KOS# MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 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. 014-133-30 Complete legal description Alpine Village, Block 3 Lot 12 Location (site address) 7325 Basel Street, Anchorage, AK 99507 Current property owner(s) Douglas & Kathleen Young Day phone (907) 744-6958 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: X 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 X 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: ❑E 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 Waiver Fee $ Date of Payment Date of Payment COSA # 5 C ag 15 -OL Waiver # a i0091,90 COSA Application—June 2022 COSA Checklist Legal Description: Alpine Village, Block 3 Lot 12 Parcel ID: 014-133-30 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA FOR Well log is filed with Onsite (or attached) Date drilled 8/30/82 Total depth 97 ft Cased to 97* ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 10/5/22 Well production at time of test 8.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc FOR Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 5.42 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Static water level at beginning of test 18 ft. Date 10/4/22 Comments *Assumed; depth of casing not actually specified in the well log B. TANK DATA Meas. �operatlinguid level in septic tank Date ❑ Required maintenance com if AWWTS Comments: D. ABSORPTION FIELD DATA system tested (date installed) ❑ ALL sic pipes present per record drawing Total measured dep om grade ft (max) Measured depth to pipe inve grade ft (min) F1N/A — pressurized field. 1771 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 N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date C. LIFT STATION fired maintenance completed Age of lift station years Lift station material Comments: Adequacy test date _ Results ❑ Pass Fluid depth prior to test Water added gal New fluid depth in Elapsed time min in Final fluid depth in Ab tion rate gpd FIELD STA — POST RECOVERY Effective depth (per r-ec drawings) Effective depth used in Effective depth remaining in Comments/Deficiencies: Property is served by AWWU Sewer COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) if No NSA ft Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' if No NSA ft F-1 Yes if No ft EYes if No ft Neighboring Tank > 100' ❑ Yes if No NSA ft Private Sewer/Septic Line > 25' FM-] Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' [:]Yes if No NSA ft Neighboring Absorption Fields > 100' NSA Animal Containment > 50' QYes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft [E 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 NSA ft Surface Water > 100' ❑ Yes if No N/A ft Tank to Property Line > 5' ❑ Yes if No NSA ft Field to Property Line > 10' ❑ Yes if No NSA ft Water Main > 10' ❑ Yes if No NSA ft Water Service Line > 10' ❑ Yes if No N/A ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No NSA ft ❑ Yes if No NSA ft If tank or field is under driveway comment below 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 Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. COSA Checklist—June 2022 Phone (907) 522-7773 Date 10/6/22 TH �.. .....o Benjark6ySchiller �� F� •. CE 12592 • �w�� • +pROFESS14*0ti�� 2-0 z E rn -0 -:0 C-3 X - C=2 S:p -P g -84 m Aj I C> FR m q <--> - �co m C'7 d Cj> C> ag rn::4 0o o0 Fn CO C:) mCD 83 rn C13 M E3 EDE- z E -0 -:0 C-3 S:p -P g -84 c, 2= m ag rn::4 0o o0 Fn mCD m >< ag rn::4 Fn mCD coIrl ZE: co C-> M C-) --I m e rri czi C> 00 co T rTl Pa L21, SUBDrvISION: L pV11-1 9GtE oc a 5 Z � 0 v w a z ' INDICATE rr NORTH w 1 VJ BLOCK: LOT: SIZE MAIN: 8 TYPE MAIN 2),J- CONNECT DEPTH AT MAIN l� /z CONNECT DEPTH AT Prop. Line CONNECT LOCATION:-SCS� COMMENTS: T_t��itwrgccorl CD37rq,.-J-4 INSPECTED BY: TREET ALLEY � � I SEWER SERVICE LINE SKETCH I SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS SIZE MAIN: 8 TYPE MAIN 2),J- CONNECT DEPTH AT MAIN l� /z CONNECT DEPTH AT Prop. Line CONNECT LOCATION:-SCS� COMMENTS: T_t��itwrgccorl CD37rq,.-J-4 INSPECTED BY: :2-0 C> w=E -r- § D - -4 (Z) - AN, L tiJ ci cn M cn M C--> C5 O CO 0 C3 0 rri W t ---u lox GJJsf-/33-30 ✓ 80�� -- — S U B D W I Si O N: STREET 4 t-- I CF ca f\ z o U Z , INDICATE CA NORTH i Cn I LOT: SEWER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS ALLEY 1 SIZE MAIN: TYPE MAINS CONNECT DEPTH AT MAIN CONNECT DEPTH AT Prop. Line � CONNECT LOCATION: Q l y�� COMMENTS: c� INSPECTED BY: DATE: C �� 6 PERMIT NO. t'lLIl~.l I C: I PAL I T"T" CIF RI'-.ll]:F' -'RRL3E DEPARTMENT HEALTH AND ENVIRONMENTAL /..'OTEC:TION ,- ...."L STREET., RNCHC'RAGE., AK. 99501 264-472~:i L~IELL PEl~-'t'l I T ( 820904 ) APPLICANT LOCATION LEGAL BILL TAYLOR DBA COLONY B3 L±2 ALPINE VILLAGE 2601 LRHONDA 99503 LOT SIZE 277-9387 999999 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET, WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EE:t'I I T E:=<P I [;.:ES [)E~]Er. IE:ER _---<~t.. -1982 I CERTIFY THAT 1: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2' I WILL INSTALL THE ~T'STEM IN ACCORDANCE WITH THE CO[:,E~ blG'~F ',' ~~ RF'PLIE~F~ 6iE[ TRYLOR DBA COLONY BLDRS I ~_,UE[, 8, ....... DATE___ ~, V4. 0 MUNICIPALITY OF ANCHORAGE - -,' - ' DEPARTMENT OF HEALTH & HUMAN SERVICES ...... Division of Environmental Services On-Site Services Section 'P.o. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ~ - 1~''3 -- ~ 1. GENERAL INFORMATION ' Complete legal description ?- E~cation ..(Site. address or directions) 7525 B~.~ ..... ~ ¢ ,, David ~ J~dy ;;!~Maiii~'gadd'm~''~ ~ 7325 S~ Anchoraq¢, AK Lending agency Ma~hng address Agent,-~. S~b E~&~/ FZSTA ~EAL E~TATE ~::A~'dres's' ~' ~"'~-'4241 "B" S~ .Angora, s, AK St~ Anchora,~c/ AK Day phone 344-7371 99507 Day phone Day phon,e ~73-7~69 99503 :..,~;.3.'.;',-'-TYPE OFWATER SUPPLY:_: .... ~ ........ :'~;.'r.~.' .... ~ .................... ~,~ ...................... Individual welL: .................... xx× .................. ~ ~ Community well ~- "~ ~ ~ ~ ' Public water .;:.,.: ~ '~; ' ~- ':;:~:;~;NOTE:~ ~; If commUni~ welI system, provide Wri~en confirmation from state ADEC ing to the legali~ and status of system. 4. ~PE OF WASTEWATER DISPOSAL: ~' ....... Individual on-site ........ '~ .... H;"di';'~u, .~ ,,~'~;;n~' ............... '- 'Community site ' .......... on- :,: ...... Public sewer NOTE: If communi~ wastewater system, provid~ wri~en confirmation from State ADEC a~esting to the legali~ and status of system. (R~, 1/91) Front MOA ~1 .~" 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 of this Health Authority Approval application shows that the on-site water supply and/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 invest, i_gation 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. .... Name of Firm s & s ENGINEERII~ Phone (; ',/'''( - 2- ~/ '7 ~ 17034 E~gle River Loop Road No, ~4 Address Engineer's signature Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent Professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not -cOnduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not rsspons~ble for errors or omissions in the professional engineer's work. T2-O25(Rev. 1,/91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist A. WELL DATA Well ~e/,-,'~ Log present (Y/N) Total depth Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed ff-°2 49 -O¢ ~ Cased to 62//~7' Casing height (above ground) Stmita~ seal (Y/N) y e J FROM WELL LOG Y-zo- z Wires properly protected (Y/N) AT INSPECTION >_r- Date of test Static water level / Well production /~-' Nitrate WATER SAMPLE RESULTS: Coliform ~ Date of sample: 0c-//'- . /tS? Other bacteria Collected by: --~ ~'~-°'/ ~( ~?-'~q,~',~ _Date i, stalled ~ Tank size~ ~ Cleanouts (Y/N) ~ Pumper Date inst-'~ i Soil rating (g.p.d./ft2 or ft2/bdnn) ~,,~ffystem type ~ngth.~__~ Gravel thickne~ Total depth ~ffecti~e ~bs~rption, area,_.~~~sent(Y/N)__ Depression over field (Y/N) _D~ty.ol adeq. uacy test ~~~1~ ~sa~~~ For bedrooms Fl.ui.d depth in absorption~ test (in.); __ ImmerSe__ gal. water added (in.): ;lerUio~idde~~past 12 months) (Y/N) If yes, give date ~...~,~g.p.d. Date installed -~ Manhole/Access (Y/N) .~~l'~llff level at* "Pump off" level at* High water.~~evei at'~'~'~'-~*Datum ~ ~Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot -A/'~//~ ; On adjacent lots Absorption field on lot ~/~,/,/~ ; On adjacent lots Public sewer main Public sewer manhole/cleanout ! oO r ~ ! Sewer/septic service line ;t 5'- Lift station SEPA~OM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ Absorption field ~¢aternnl~nT~rvice line Surface wa~ Wells on adjacent lots Fe SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~""~'"'~-- ~ent lots ENGINEER'S CERTIFICATION ~ I certify that I have determined thrufield inspections and review of Municipal rec in conformance w~ gu~delines~effect on this date. Signature :~& ~/~. ~ Engineer's Name //~b ~ i ,4 ~ ~"~ Ca t/-, d ~-~ Date c6'- Jr' t. / q 5-- HAA Fee $ ~-44.), Date of Payment are Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date "~/~7//'/'~g GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 12, Block 3, Alpine Village Location (address or directions) 7325 Basel Street (b) Applicant Name Fern McMahan Telephone: Home 349-8061 Business N/A Applicant Address 7~25 Basel Street ~ Anchorage ~ AK (c) Applicant is (check one)'. Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution Alaska Mutual Bank Address .~6 & Minnesota, Anchora;~e, (e) Real Estate Company and Agent N/A Address Telephone Alaska 264-2787 Telephone (f) Mail the HAA to the following address: pickup by applicant TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/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 investigation 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. Name of Firm .................................. Telephone L;/-~L1L, r" I~lvErl r'l~Lllflr-r'rtll~lO Address EAGLE RIVER, AK 99577 "~/l.~/~, P. 0. BOX 773294 Date 694-519§ Approved ~/ Disapprovea[-j Cond't'onii a/ ) Date Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCH~'~o~; DEPT. OF HEALTH ~?EJI%~FH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTIONCHECKLIST - FEBRUARY 1984 264-4720 APR Legal Description: )... om RECEIVED Well Classification ~R =.~ ~'r~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ¥ Date Completed A~,~, & o ~ I~ Z" Yield Total Depth ~ 7' Cased to ~ '7 C~~-; Depth of Grouting Static Water Level W H ' =.~' 4;,,,~. o~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /~/^ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y · On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~//~ · On Adjoining Lots l~a TO Nearest Public Sewer I DO 'f To Nearest Sewer Service Line on Lot ,~. 5- £//' ~, ~ 6 ; Date 3- i ~'- ,P~ B. SEPTIC/HOLDING TANK DATA / Date Installed ' Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Air-tight Caps (Y/N) Foundation Cteanout (Y/N) Date Last Pumped for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~~--~ Date MOA No. Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) APPLI ' NT FILLS OUT UPPER HA, 'ONLY P,operty Owner ~ ~\~ v~d ~__p ,,.D , / C~C' ~'" ~,, ...~ V~_ Phone Buyer ~ ~ ~ ~_~ ~ Address ~ ~~ ~ Zip Code Lending Institution~. ~ .... ~(< ~ ~ ~[ ~~ Phone Address Zip Code Realty Co. & A~nt Phone Address ~ ~ ~ ~ Zip Code Ty~ o~si~nce ~ingle Family ~ ~ Multiple Family No. of Bedroo~ ~ Other ~lndividual A~ACH WELL LOG. A wall 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 Indiv~ual Installed: ~ubllc Utility When Connected to Public Utility: ~ / ~ ~ ~ Holding Tank ~--~ ~--~ ~ ~~" ~'>--~/ > ~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED, Time Time Time Time ~ Date Date Date Date - S-Ez Inspector Inspector Inspector Inspector Field Notes: ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ( )DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE / -- / ~ -- '~ ~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3/82)