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Home My WebLink AboutT12N R4W SEC 2 LT 17T12N R4W Section 2 Lot 17 #012-131-32 bevelopmcnt Services Department Building Safety Division On -Site Water $ Wastewater program ,* / 4700 Sragew Street P.O. Sax 196650 " ` _ Mark5egich Ancharaae, AK 99519-6650 ` Mayor.. .w muni aro/nntife (90Tj 343.7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: _ Legal Description 4 W S�.a Z l.. -t / Property Owner Name g Address: 5_Ky( lv1`Robe.- s a Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 1)3 feet Pump Manufacturer's Name: ?ej jtq&AZr — Pump Model: &V7$G Pump Size by Pitless Adapter Burial Depth: /Q feet Pitless Adapter Manufacturer's Name: i Pitless Adapter Installer. n//p Well Disinfected Upon Completion".,j Yes ❑ No Method of Disinfection: Comments: Pump Installer Name:Q�'t1 -T 1 AWRs,J �4V Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Page: 1 Document Name: ENTERPRISE SERVER PARCEL: 012-131-32-000-99 CARD: 01 OF 01 RESIDENTIAL OTHER BUILDINGS STATUS: RENUMBERED TO/FROM: 000-000-00-000-00 REBISCHKE TIM JAMES T12N R4W SEC 2 LT 17 LOT SIZE: ZONE : TAX DIST: GRID : NOTES : PO BOX 3954 NINICHICK AK 99639 3954 SITE 27,225 ---DATE CHANGED ....... DEED CHANGED--- Ri OWNER : 01/05/98 BOOK : 3172 PAGE: 003 ADDRESS: 10/23/98 DATE : 12/23/97 HPJt # : 000000 PLAT : 000000 .................................. ASSESSMENT HISTORY ...................... ---LAND .... BUILDING .... TOTAL--- FINAL VALUE 1996: 39,100 9,300 48,400 FINAL VALUE 1997: 39,100 2,000 41,100 --EXEMPTION FINAL VALUE 1998: 39,100 2,500 41,600 ..... TYPE-- EXEMPT VALUE 1998: 0 0 0 STATE EXEMPT 1998: 0 FINAL VALUE 1998: 41,600 -COMM COIINC SAND LAKE Date: 2/3/99 Time: 10:35:52 AN Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 012-131-32 Expiration Date: 6-'2-0—Zo �® 1. GENERAL INFORMATION Complete legal description T12NR4W Sec 2 Lot 17 Location (site address) 6902 Carlin PI Current Property owner(s) Tim James Rebischke Day phone Mailing address Real Estate Agent Day phone 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 ❑ WaiverNariance request for: Received by: 5 TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community ❑ Public Sewer COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 916 Date of Payment oZ`%QI�Do�D Receipt Number COSA # 65 rC t 61059 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # istance: 5. STATEMENT OF INSPECTION BY ENGINEER 6. 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, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 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 .. Or T \ encroachments, deficiencies or discrepancies exist. System #1 Approved for System #2 Approved for Conditional approval for By:! I ' 4--1 J= �_ ... TI X bedrooms, with the following Original Certificate Date: % —Zd 207 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: o COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Adviso � ; �N Well Flow Advisory ther r; of .�i-2 COSA blue sheet 10-10-12.doc COSA Checklist T12NR4W Sec 2 Lot 17 Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA 012-131-32 ❑ Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm Date drilled 1957" Water storage tank volume gallons Total depth 123 ft Well disinfected for coliform test? ❑ Yes No Cased to ft U Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate ND mg/L ❑ Nitrate less than MRL (ND) 8 Wires are properly protected Arsenic 10.ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12 in. Collected by Arcterra Consulting Date of flow test for COSA 2/9/20 Date of Sample 2/7/20 Static water level at beginning of test 28 ft. Comments x: House originally built in 1957. Xx: Depth taken from Pump installation log. B. TANK DATA Age of tank(s) years Tank type/material Septic/Steel 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 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' 0 Yes if No ft 5z Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No 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_ Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ft Community Wells > 200' Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No _ Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No_ Water Service Line > 10' ❑ 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' Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. COSA Checklist yellow sheet ft ft ft ft ft ft ft ft ❑ Yes if No ft ❑ Yes if No ft Arsenic Advisory Certificate of On -Site Systems Approval # OSC201059 Subdivision: T12N R4W Sec 2 lot 17 A water sample revealed an arsenic concentration of 10.8 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. S89053'41'W 165.30 Date. scale cEription DeI s' 874 --,—gal 2-1-02: Lot 17 45.1 Vanguard Drive, SWU203 grid 212'7 I AS-BUILT 2200202 BL)4 SEC 2"T12N.A4W9330 Anchorage' Alaska00$07. 04 Reffboo SUBDMSION (907) 562-6060-RkIB , e'TiRAv I hereby certify that the proper"t desuribed hereon has:bepn-surveye d y me, or at my direction, that improvements A OF A4� and, --thin, situated thereon are in the property lines; an �. A 2� Xz, j o.mc encroao not overlap or -b 6jx :,the properlylyLul adjacent theret6..unless otherwise Ai .:,7!i f - 01m a ` 6.) improvements' om the properly 1ping ad7acenl thereto: en -Proac, on the ans=sslan HOUSE 1&0 4.4 It is the responsiisility of ,the oder o2bttilders priorto COW otian .............. tKARLES E: FO ftse -e * 732& , - lu- di -I " ti over s6AH rig ,:j t0A, stances pr' ail U0 rte.kC- 00 v 41 kp. V4 4k, %VEUL HOUSE At, �7: mm. STAIRS 93 LU O LU C> 71 N891400T 165.46 ;7 GRAR0 SCAM I Inch =Fftf, 4o 10: 6 '16 A 80 FOR: SALTY DOG CHARTERS ,:: Date. scale cEription DeI s' LanMrk --,—gal 2-1-02: Lot 17 , BIocka Vanguard Drive, SWU203 grid 212'7 I AS-BUILT 2200202 BL)4 SEC 2"T12N.A4W9330 Anchorage' Alaska00$07. Dtawn, by Reffboo SUBDMSION (907) 562-6060-RkIB , S.M. ALASKA ,, I hereby certify that the proper"t desuribed hereon has:bepn-surveye d y me, or at my direction, that improvements A OF A4� and, --thin, situated thereon are in the property lines; an �. A j o.mc encroao not overlap or -b 6jx :,the properlylyLul adjacent theret6..unless otherwise Ai .:,7!i f - 01m a ` 6.) improvements' om the properly 1ping ad7acenl thereto: en -Proac, on the ans=sslan 4.4 It is the responsiisility of ,the oder o2bttilders priorto COW otian .............. tKARLES E: FO connections end; to determfne: the 0, of ani* eas:emen i "co,ventnt% or res 0 onshdo not e recorded iOdlvi P. -e * 732& , - lu- di -I " ti over s6AH rig ,:j t0A, stances pr' ail U0 rte.kC- 00 v 41 kp. V4 4k, Q on, may,caus q 'o At, �7: