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Home My WebLink AboutNORTON PARK #2 BLK 4 LT 9Norton Park #2 Block 4 Lot 9 #016-211-55 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251058 Parcel ID 016 -211-55 Expiration Date: 2/7/2026 Legal description NORTON PARK #2 BLK 4 LT 9 Site address 400 W 123RD AVE Current property owner(s) SLYFIELD JUDY E X The On-site system(s) is/are approved for 2 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date: 3/5/2025 Thi/s,6tificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject tem(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 Arsenic Advisory X Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 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. 016-211-55 Complete legal description Norton Park #2, Block 4 Lot 9 Location (site address) 400 W 123rd Ave Current property owner(s) Judy Slyfield FOO' 2 2. ON-SITE SYSTEMS SIZED FORS"' BEDROOMS Day phone (206) 380-7683 3. TYPE OF WATER SUPPLY: 9 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 ❑■ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age N/A - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Well to Sewer Main Distance: 2 1 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 $ 2 -!?70 Date of Payment 2/zy/z s COSA # 0_5C2_510575 Waiver Fee $ Date of Payment Waiver # n.!E)U 2 5) n0,3 COSA Application_ June 2022 COSA Checklist_June 2022 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. 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. 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: 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) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/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 Absorption Field(s) on Lot to:(Please enter distances if less than required) Building Foundations > 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 > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private 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 Benjamin Schiller, P.E. �unr Municipality of Anchorage S P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV251008 COSA#:OSC251058 Permit#: PID#: 016-211-55 Legal Description: Norton Park #2 Block 4 Lot 9 Engineer: Forge engineering Your request for a waiver of the required 75 feet horizontal separation from the public sewer trunk to the private well has been approved. The approved separation distance is 20.0 feet. This waiver approval applies to the existing public sewer trunk only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Grant Date: _ — Approved Nam6 ot''Reviewer ...... ..................................................................... 1 **** VARIAN C E/WAIVER REVIEW **** March 3, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Norton Park #2, Block 4 Lot 9 – 400 W 123rd Ave Well to Sewer Main Waiver Request Dear On-Site Services Engineer: The property at the above address had a septic system permitted and installed in October 1969 , and the permit paperwork mentions the separation to the well. According to AWWU records, in July 1976 a sewer service connection was installed at the property, presumably in conjunction with a new sewer main in West 123rd Ave. The sewer main is shown on these records as 5’ from the north property line while the well is approximately 15.5’ from that same property line. Since that time the property owners have had no problems with contamination from the sewer main. There were no nitrates in the recent water sample, which indicates that there hasn’t been any leakage from the sewer main. There was also no bacterial contamination. According to the waiver requests for the neighboring lots of Norton Park #2, Block 4, Lots 6 & 10, the DEC knew that the wells would not have separation to the new sewer main. The separation distances are all clearly shown at less than the required minimums on the approved plans. Because of this waivers were implied to be in effect for the affected lots. For these reasons we request a formal muni waiver for 21’ from the well to the sewer main. Sincerely, Benjamin Schiller, PE WOOD FENCE -Z WEST 123 RD AVENUE FAST R3 nn a rn 4 �e THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD ,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON e O ONC WglKlylY WELL %EXIST OTHER THAN NOTED. 45 DETERMNE 25.8 DATED AT ANCHORAGE,ALASKA THIS 74 TH DAY OF PORCN 58 46.8 FEBRUARY , 2025 S/NG/EFgM/L 246 Y hoUSE 47. O.H. DECK 27.7 10' SCREENING EASEMENT N IN FENCE 10' UTILITYEASEMENT O O O WOOD FENCE — o OF A, . 49 TH oO °N SHANE A. HOLT ,d G Q4 OQ�P LS -6914 a , O a o '0fessionak foo HUFFMAN ROAD (UVDEV/EL OPED ) AS BU/L T SURVEY PI =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY L0T9 BLOCK4 NORTONPARKNO..2 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD ,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT %EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA THIS 74 TH DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. FEBRUARY , 2025 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON HOL TLAND SURVEY/NG THESURVEYDATA ON THIS DRAW/NG /S PREPARED FOR THE OWNER OFRECORD ONL Y. 9309 GRO VER DR/VE ANYCOPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 16207240-31 223-8615 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC251058 Subdivision: Norton Park #2, Block: 4, Lot: 9 907-343-7904 Fax: 343-7997 A water sample revealed an arsenic concentration of 15.6 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. 0 F dram} I IN 1 0 S' V I CONNECTION RECORD Lot a 9 MW loc � Lt ton0 - Ml 0 ftoperty Owner dross tri/ tor sr�w.r—0r/.L� t fj r A \.4.1a /Z �3 t4cjs X214�E�s� Date LUG Inspector Z/O- Aml4o7z;. am2.\Z 4Z v�lwzl A0,00, 0 AP lication. Yes No Applications Yea No IF L{ '#" 'N --" _ - - _ W -CIO ;.I--- Jk { -- _-tz' - _ - - _ +SIC t:�� • _ '�: _ _ _ 'fir # 4 t• � � '�� _ �� } f _ NL }tt'Y-_ `_ � `fix �+•_ 4�1�t'�� _} _� � � •�� _�'}-� -3 17 IL _ � ' = _ '�?_ T -'�-- ` � '`�� - ---r-'Y" -,�• T# 'rte' {+�� a - _ x� _ Vr - � jr - Ff ' � •+� "�' ~"' � _ • � -� f'.'` `dam a L - -- _ --' #= _ _ _ _ �- � •---��`r- f t - --ter" �4_'_a -.-;r T •' �; _ - �'+ _ -4tr _ _ - - __ _ � rim=•_ `!_ - __ , =r F .+f+'. _. �, Y" ..�},,; _ y.� MF fie __�_ •� C_� �_��___ -' - ` _ � ��'_ .�,1 �F J � _ '� � _ �'�-- '-•-� - .• _yam - - Y -_ • - +a - 4 � - - - � r _IQ 1 t:- ' sem`• �- �.�-��a`yy =-- �. %� I � S ' I j Lamas Ak . r +01 x 4 11 �rttuJiurY -3.�a� GRry 3'53 ro-am-Of � V�9F,/O'rS-3 4CmF&-W ; 140JOL—wo MUNICIPALITY OF ANCHOFtAGE —SEWER UTILITY Form No. S229(4-76 SEWER CONNECTION:On PrODertv Location RA-rnrei o,._...:.._ Name Subdivision Locati n .1 Z-1, k I ro 1 111 t 114vo Address Bo?L> A yE Acct., No. � phifK4f ;L Lot 9 Block_ Alley O Street ❑ 41 jjog4 4�, 'C' A. WA -V (Sketch on Back) Size Connect T y p e Depth at Stub Depth at Structure Size Main Type Approved El Riser Locate New Connection ❑ Replacement Connection ❑ % Grade Couplings ❑ Type Backwater Valve ID Type Bedding ❑ Type Compaction insulation El Type Cleanouts Type Location WATER: Municipal ❑ C.A.U. ❑ Private Residential ❑ Commercial El Industrial ❑ Control Manhole El Temporary Construction Rate Type No. of Units........... Type Type- Location Type-Elevation App roved, Comments: ASSESSMENTS Imp. Dist No. Sub. Agreement Latera! Assmt El Trunk Assmt, Ext. Agreement Trunk imp. Dist. ❑ Grid. Assessments Paid ❑ Comments Connection Made By: inspection By: D a t e I 3 Am mUMSCIPALITY OF ANCHORAGE WATER do WASTEWATER UTILITY x040 ARCTIC BLVD. PHONE: (907)564m2762 WASTEWATER CONNECT PERMIT DATE OF APPLICATION SCHEDULED COMPLETION DATE rim TA 1;� {� 08/21!97 12/31/97 BLOCKILOT/TRACT BLK 4LT 9 IX, SINGLE FAMILY SUBDIVISION NORTON PARK #2 � MULTI -DWELLING No. APT$ COMMERCIAL TAX CODE 1621155 GRID 2730 AS -BUILT STREET ADDRESS 400 E 123RD AVE OWNER BODDY JACKIE M II - -- PHONE — MAIL ADDRESS 400 W 123RD AVE ANCHORAGE, AK 99515 CONTRACTOR ASSESSMENTS Repair EAsting Service Main Line Extension On Property Only City Tap Have Been Levied �] Hydrant Only � 50' or Longer To Be Levied Main Tap - 1'a Property Line Only t Comments: [� MaInTap&OnPro erty Connect-- �] Disconnect --- R Y. R - Main Tap Only caner tom{ CONNECT SIZE 4 " ISSUED ackes INSPECTION FEES 104.00 *VAID CASH PERMIT FEES 35.00 CHECK # $ 0.00 BOTHER DEPOSIT ; 0.00 INSPECTED BY MIMBURSAS TOTAL $ 139.00 NUMBER -- - — DATE REMARKS PERMITTEE (please Print) "SAM NWILADDRESS SIGNATURE --MI %-& F - .---, - VN E R \) 19 C%I.1 v PHONEk,,;3yl %ZZ OST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR OdgInal GP~.TER ANCHORAGE! AREA BORG" HEALTH DEPARTMENT 327 '~GLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL, SYSTEM NAME MAILING 7/..,/'.,/ A'~/~//~//~.//~,Z/,.~../.~ PHONE ADDRESS./' / ~- SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY GALLONS. INSIDE LENGTH NUMBER OF /' /-~--~ (.,~ _COMPARTMENI'S /.,/ t LIQUID iNSIDE WIDTH -- DEP1H SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS // OUTSIDE DIAMETER --" OR WIDTH ,/ '~/ ! ~ LENGTH /' ~' , DEPTH LINING MATERIAL /~,' /'~/~/~ ~7-//'~'''~'~ ~J~. DISTANCE FROM WELL /~ ~ , BUILDING FOUNDAHON TILE DRAIN FIELD: DISTANCE FROM WELl NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDA ON ..~.~.~..~.~7"KIEAREST LOT LINE .DISTANCE BETWEEN LIi~IE'S'~' TRENCH WIDTH GTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE__ WELL: TYPE _~/'~ ~Z_.~Z.~-~ DEPTH ~ ~'~' LOT LINE 1~.., F NEAREST SEPTIC ~ SEWER LINE ~-~"' , TANK DISTANCE FROM WATER , BUILDING FOUNDATION -~/' SAMPLE .~ ~' (' SEEPAGE ~,~ S.-~" ," · SYSTEM ,CESSPOO[ DIAGRAM OF SYSTEM · NEAREST OTHER , SOURCES DISTANCES: DATE APPROVED AUIHORI[Y GAAB-H D-2 Case No. GRE.ATI~ ~. 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 9ROUGH 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~.k.~[~ RESIDENCE ADDRESS ,Kraft ~'i~ LEGAl_ DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK MAILING ADDRESS lq2(~ ~/AJgl/q'lJJ~l~ONE NO LOCATION OF INSTALLATION , SEEPAGE PIT. , DRAIN FIELD , OTHER TO SERVE THE FOLk0WING FACILITY ,~- FINANCED THROUGH ~'i~ TO BE INSTALLED BY PERCOLATION TEST RES~bTS ~ ~ ~ BELOWTO BE FILLED OUTBY HEALTH DEPARTMENT T.,S ,S TO. SERVE AS ~ C~k , PERM.T TO ,NSTALL A AS DESCRIBED BELOW. SIZE OFiUNITTO BE SERVED DIAGRAM OF SYSTEM DISTANCES: I/ / '- ~ealth Authority - q certi£y that I am £amiliar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the above described system is in accordance with said code.