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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 1 LT 16 MUNICIPALITY OF ANCHORAGE Hea. ~ and Environmental Prote, on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 REPORT ON~SITE S~WAOE DISPOSAL SYS'FE2A Mrd- q7 ¢ SEPTIC TANK: NUMBER OF DISTANCE ?e°¢' I .~i[~;~.~c~%.~ COMPARTMENTS FP, OM WELL ___~ INSIDE LENGI'H_. '~ frHSIDE WlDI'H TILE DRAIN F1ELDi'7~--~-cq I DIS-FAINCE FROM WELL ~.0_¢~ ~.__FOUNDATION LIQUID DEPTH _.~__'~____ LIQUID CAPACITYJ~.)-~¢~'GALLONS. j TOTAL LE NGTH~c;, '$DI~.-NEAREST LOr LIME._._!.~£~_ .... OF LINE ¢ of Lines _[ _-- __ OIS'f ANCE BhTWEEN LINES ___.--~/_~--- TRENCH WID1 H_~-Q IN. TOTAL EFFECTIVE ABSOR?-TION AREA ~ ~ SQ, FT. LENG'FI4 OF EZACH LINE DEPTli OF FILTER DEPTIt: ~OP OF IiLK qO F:!bllStl GRADE . ~' ~ MATERIAl_. [~ENEAI't{ 'rILE ~ IN. ABOVE TILE ~ IN. SEEPAGE PIT: DIP, METER .... OR WIDTH ____ EENG'FId ., DEPTH Log Crib Rings BUIhDING F©UNDATIO W Crib Size: Dh'.\MEI'ER___DEPrH.-- DISTANCE FP, OM: WELL _ __ TOT,aL EFFECTIVE NEAREST LO]' LINE. ABSORPTION AREA (WALL AREA) SQ, FT. Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: Installer: .~.~. Remarks: ~.o~[ _$ON WELL DRILLil 1305 W, 45TH STREET ANCHORAGE, ALASKA 99..503 PHONE 2'72-9343 known; or distance main road ~O (..~1., '~--~c.g- L~ Loc(t~ion (addressp~: ,Township, Range, Section, if .. ~ , .. Size of casing ~" ? feet Cased to 8()' ? 1' Depth of Hole_~Or I* feet Static water level ~/ ft. (above) ~%~and surface. Finish of well (check one) open end ( ~); Screen ( ); Perforated ( ). Describe screen or perforation Well pdmping test at5% '~ gallons per (hour) C(~u~ for of drawdown from static level. hours with Jo I ft. Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness I"'{F:I',:.:',IHI,JM I'.~l.,.IMli~fliii3<~ CIF {ilifl!ii[>f;?.t]Oi'"lEi; .... :l. 'I'HI~Z I:;~:tiiii(~:!t,,J I RE[:. '.E; I ;;:!]!iil OF 'l'I.41L~ SO I I.,,. FIS~i.~;ORI:z'T I ON :!~;"r'S'I'I?ZH 1 5;: 'I'FIE L..lili},lt3-1'H I} I MEl'.,Iri:.i I ON I f.-:; 'THE I...,l~]'.,ll3"l'H ,:i I I",t FEE'T) O1::' '[ HE TRENCH Cfi;ir [:,F('I:::I ! I'.,IF I Ii!ilL[:,. 't"HE [:,IEEi]::;'I'H (IF I::t 'TI-;:'.EI'.,!CH Ol:;.'.' F'IT ill,El THE DIS'I'FINCti.il liii:l~C't"l.,.IEEl'.~ THE tE~URI:;;'FiC:Ii!:i OF 'IHE. GRCIUN[:, I::IN[:, THE t!~:OTTCIM Ol;:' THE E',:-:',CI::I',?f:I'T ]: ON 'I'Hli~}:'.E I'.E!i; I'.,IO ~i;E'T I.,-IIE:,'TH FOR t'I...11:~i C:iRI::I',,,'EL. t}EI:;:'"I'H I S:.; THE M I N I MIJM I>E;]-::'TH CIt;:' GI~!F:I',?EL. t:ii:E"l'l.,.IL:]~i:iM 'l"l...llli~: OU'T'I-;;'I::ILI... 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GF~iA,r.R ANCHORAGE AREA BOROUGH DEP/LR~,-~MENT OF ENVrRONMENTAL QUALITY Case 3330 "C" Street ANCltORAGE, ALASKA 99503' Performed For ~O~bL~/A~^ Legal Description: Lot IL Block This Form Reports Soils [Log_ Depth Feet Percolation Test Soil Tes~ Must Be l!ogged To 4' Below Proposed Seepage System Soil Chm~acteristics ~/kl Dated Performed ~,1,~.t-~?~ If Yes, At What Depl~h?? Ground Water Encm)untered? /kJ~ Reading Date / Gross Time Net Time Percolation Rate _~_/L~ MinuLe Proposed Installati(~)m: Seepage Pit Drain Field Depth of Inlet .................. ~.~ Depth to Bottom o}~-Pit Or Trenc~i' Test Performed BY ~jACC4f~r ~U~,~j~.~m_~ Date Cer. tified BY: Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 050 -641-19 Certificate of On -Site Systems Approval OSC261007 Expiration Date: 12/18/2026 Legal description MOUNTAIN VALLEY ESTATES BLK 1 LT 16 Site address 4527 BIRDSONG DR Current property owner(s) KOERNER KENT X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By:, Original Certificate Date: 1/20/2026 Th' Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other MUNICIPALITY CSF ANCHORAGE 7 Development Services Department Phone: 907-343-7904 On -Site UVater &Wastewater Section Fax: 9Q7-343-7997 Certificate of an -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05064119000 Complete legal description MOUNTAIN VALLEY ESTATES BLK 1 LT 16 Location (site address) 4527 BIRDSONG DR Current property owner(s) KOERNER Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY.0 Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA D Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: R Private Septic ❑ Private Septic serving 2 dwelling units Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete R Fiberglass Age 49 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed R Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ 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 $ W Waiver Fee $ Date of Payment l 113/14 Date of Payment COSA # ( 261(� 7 Waiver # COSA Apphcation_Apr2025.doc COSA Checklist_May2025.docx COSA Checklist Legal Description: Parcel ID: 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 Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA 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.DISPOSAL 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. 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: The home was not vacant for more than 30 days prior to testing, the precharge volume was just used to bring water into the monitor tube as described above. COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 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/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: 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 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 Phone Engineer’s Printed Name Date Septic Tank Advisory Certificate of On -Site Systems Approval # OSC261007 Subdivision: MOUNTAIN VALLEY ESTATES Block:1, Lot: 16 The septic tank for this property is 49 years old. Some previously installed fiberglass tanks have been replaced because they leak. Leaking septic tanks are a hazard to public health. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNICIPALITY OF ANCHORAGE MUNICIPALITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~P'F. OF I ;'~ALTi~ &  825 L Street - Anchorage, ENVIRONM£NI';kL Alaska 99501 I ENVIRONMENTAL ENGINEERING DIVISION FEB 1 197'9 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~l:l~=~dl~i~'~ I~ DIRECTIONS= Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, 1, PROPERTY OWNi~R PHONE -- William E. Johnston 694-9766 MAILING ADDRESS P. O. Box 334, Eagle River, AK 99577 ._ PROPERTY RESIDENT {If different from above) PHONE Sa_me 2, BUYER PHONE Cynthia L. German 694-3261 MAILING ADDRESS P. O. Box 1631, Ea~le River, AK 99577 _ 3. 'LENDING INSTITUTION J PHONE Alaska Mutual Savings Bank (Charles Steig~le) 6~4-9571 _ MAILING ADDRESS P. O, Box 1068, Eaqle River, AK 99577 4. REALTOR/AGENT J PHONE Myrna Johnston, AREA, Inc. RealtorsI 694-9555 MAI LING ADDRESS P. O. Box 249,..E..a.ql.e RiveT, AK ..9.957.7 ..... 5. LEGAL DESCRIPTION MoUntain Valley Estates Lot 16 Block 1 /~,~ ~ /-,~','//~,~,o/ /~ STREET LOCATION Birdsong Drive, Eagle River 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One ]~ Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six Other WATER SUPPLY Drilled Nov. 1977 :J~ INDIVIDUAL* 80 Feet * ATTACH WELL LOG, A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM J~ INDIVIDUAL/ON-SITE** **If individual/on-site, giva installation date 9/'15/77 . If system is over two (2} years old an adequacy test is required [] PUBLIC UTI LITY 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 I NSP ECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY 4"~ '~ "7 Connection Verified INSTALLER []Septic Tank or []Holding Tank ~'. ¢)./ Size: /~-~,~~1) If Tank is homemade SOILS RATING give dimensions: ~.~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line [~APPROVEDFOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (T~ LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ' ' 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 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 I PHONE William E. JohnstonI 694-9766 MAI LING ADDRESS Box 334 99577 PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE Same MAILING ADDRESS 3." tENDING INSTITUTION PHONE Alaska Mutual Savings Bank 694-9571 MAILING ADDRESS Post Office Box 1120 99577 4. REALTOR/AGENT Myrna Johnston, Area Realtors 69~-9555 MAI LING ADDRESS Post Office Box ~.4..9 9957,7. 5. LEGAL DESCRIPTION Lot 16 Block 1 Mountain Valley Estates Subdivision STREET LOCATION Mile 5.3 Hiland Road, dark green raised ranch on Birdsong Drive 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One ~ Four ~ ~INGLE FAMILY ~ [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For we s drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITF~ [] PUBLIC UTILITY **If individual/on-sit~ g~ve installation date If system is over two (2) years old an adeouacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAE BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY f'!L~ ~ ' DATE RECEIVED .... MENTS J~,~ DATE DATE DATE I NSPECTOB I NSP ECTOR ~NSPECTOR DIRECTIONB: 1. TYPE/OF RESIDENCE NUMBER OF BEDROOMS L~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [~"'FO U R [] SIX PERMIT NUMBER 2, WATER SUPPLY I~,/INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED NWAGE DISPOSAL SYSTEM PERMIT NUMBER DIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~;;~eptic Tank or []Holding Tank Size: {,,~'-'~ If Tank is homemade BOILS RATING give dimensions: ~i~ _.~~'- TYPE OF TANK MAhlJ. J.F. ACTUR ER. TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Rolding Tank ^bsorption Area Sewer Line I Nearest Lot Line 1 WELL TO: Absorption Area to nearest Lot Line [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate} [] DISAPPROVED DATE BY (T~ ~. ~ LEGAL DESCRIPTION 72-010 (Rev. 3/78) ]: .L,.th i~loor FROM '~ ;;; SUBJECT 'C,o'I?. ].6 ]~lock 3.. ~¢iou'o.'b. ain Valley },.;s-ba.~bs-o ,q-ctS¢ivisio~3 DATE 2 / MEB AGK : '.PI.ease make arrangements for a re.~und z'e~arding the a'ktachoc~ paporwork~ ~¢e haw:; d. one an inspection within a yemr¢ an~2{ this (rid no't require u.s doing anoeher inspection a't bhis .L~.c~.~pv. ,,~:70379 ~.4y~.na ~ohnston Post Office hex 2119 99577 $25.00 Sewer anrl ~,~ater other '~'hank you. SIGNED "~%~t t X Laura ; ~E~Y 2 6 4,-- 4 7 2 0 J~edJf~orm ~, 4S 471 SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY Poly Pak (50 sets) 4P471 DETACH AND FILE FOR FOLLOW-UP Municipality of Anchora% Environmental Protection 825 L S{reet Anchorage, Alaska 99501 REQUE.ST,FOR APPROVAL' OF INDIVIDUAL SEWER & WATER FACILITIES .'.]' Type of Inspectio. Q: .CMRO'__ VA FHA CONV .x' 2. Property Owner: William E. Johnston Mailing Address: Box 334, Eagle River, AK Day Phone694-9766 3. Name of Buyer: Wiliiam E..'Johns~on Mailin§ Address: Same Day Phone 694-9766 ,~me of Lending institution: Ak Mutual S.avings-Bank P. O. Box 1120 .- Mailing Add?ess: Eagle River, AK 99577' Phone 694-95'71 Name of'Realtor or Agent: Myrna Johnston, AREA, Inc. Realtors. P. O. Box.249 · ~iai]ing' Address: Eagle River, AK 99577 Phone 694-9555 Legal Description:' · M~ountain Valley· Est. Block 1, Lot 16 Location: Mile 5.3 Hiland Rd. Dark green raised ranch on Birdsong, Drive (left.side) .Type of Facility.to be inspect'ed: Water Supply . Type Of Supply: . Pub'li'c Utility Single 'Fam-.ily No. B. dr~ls. 4 Individual x: If' Individual,'number of dwetli'ngs, pre~ehtly served If Individual, depth of well 80 ft. Sewage Disposal'System Type,of S~stem: Public Utility "individual (on-site) X ....... ± ...... I.~ Individual,, date of installation September 1977