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HomeMy WebLinkAboutKWIK LOG BLK 3 LT 9} � ( ` . w \�� \ «�\ � � . . f m� \/�\ / mt .y \% m§ y���� %y. Certificate of On -Site Systems Approval Parcel I.D. 013-043-42 Legal description Kwik Log Block 3 Lot 9 Site address 646 East 72nd Ave. Anchoraqe, AK Current property owner(s) Frensley Expiration Date: 2-7-2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: By:. Original Certificate Date:J_7-'Z� 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 ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE I� 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 Parcell.D. 013-043-42 Complete legal description Kwik Log Block 3 Lot 9 Location (site address) Current property owner(s) 646 ast 72nd Ave. Anchorage, AK Alan Frensley 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: lZ 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 - 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: ❑ 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 11) late /a 2 Date of Payment COSA # 015 0-:2215-9-6 Waiver # Q x3016 COSA AppUcation_June 2022 Legal Description: Kwik Log Block 3 Lot 9 Parcel ID: 013-043-42 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 UNK Total depth 95+ ft Cased to UNK ft Q Sanitary seal is functioning correctly 2 Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 10/18/22 Static water level at beginning of test 26 ft. Comments H. ATA Measured operating -fluid Fit3-sep�ctank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: ABSORPTION FIELD DATA Which tern tested (date installed) ❑ ALL standp' s present per record drawing Total measured dept m grade ft (max) Measured depth to pipe inve om grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insula ❑ 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 _ COSA Checklist June 2022 Well production at time of test 3.2 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 _ Arcterra Consulting Date 10/12/22 C. LIFT STATION ❑ Required maintenance completed A e of lift station years Lift station~ made?tai-- Comments: Adequacy test date Results El Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd LD STATUS — POST RECOVERY Effec depth (per record drawings) in Effective dep sed in Effective depth rema g in 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' Community Sewer Manhole/Cleanout > 100' ./❑ Yes if No It 0 Yes if No ft Neighboring Tank? 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Fv� Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' F./I Yes if No ft R] Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F, -/]Yes if No ft Q Yes if No ft ❑ N/A - Served by Community Well (not on lot) or Public Water 3 Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundatior _ I R Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes i cam_ `~- ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft1_ ivate Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Weir0' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field is under driveway comme 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 Areterra Consulting Phone (9`U7)-696-6111 _ Engineer's Printed Name Kenneth Duffus Date _/-5,2,E-- 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 encroachments, deficiencies or discrepancies exist. 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Q c^ c •� 3 Z ti t o f d N ° Gin 0 M'j_+ �_ W Wo o �� rno�2o (n � 0 QN �a�c [Y g Lq d•r- r-aNg0 o aia Ual� c�� C7 W ( I cv LL �v_�N2 bA m v d p -Q q m E t7 � m ow .cac� O + O i p 'tea• a.W°� IW= W I �n a 17 >.�cco, -� o ui J '=tJo; 0 cq �o Z I �� C: -E N°�aE9 O m t ?cnaTi p @ u) N C CPO 0'94 = 6'4Z = 0 @ °c o coy =. w m o 3 O m s oo t \ \\ xLO - a@N�o of m i 00 -1 r_ 04 p m u v ElD vL N . O��a N'O V 7 m� Ti v C a^ 3 \ \ _ami v n3 c o @ Xs° `n O n �O Ln 3 13.8 v asi m a�y� Foca), Q J = om3 H w N ct ao ,L6't'£6 3„09 ,8Z oOS x m o T ° Ari' O —`j C 0 oQ Ca 0 CL J o- �c m N Q• Zd�/ Q a)2 :9 %LL. x :iso n� o O I ( N N N O. O z W i N +' N O O 4 i W =. L O w U riac'oEo I/ O CL Lu N Q) E 'rrlt,--: i aci ~ w Q ¢ riNAPOST IN A CONSPICUOUS PLACE SEWER CONNECTION APPLICATION & PERMIT a ti^sf GREATER ANCHORAGE AREA BOROUGH 3500 TUDOR ROAD. ANCHORAGE.pH. BOOK PAGE ALASKA gg507 LOT SUS Vi$lON 5'$ flika C RES LOT g e -CTION A f HLOC —»-__L9�5�. r CITY .. STATE ZIP CODE zee:.n • oiSt �,, LAT hY1p '_'---------. P-ROPERTY OWNER NAM PROP RTYW ERADDRE S CJT ST T 21P COD-E PHONE, I RES. A � CCktdEC7lCiN DATE '— NO. UNITS MO DAY � y SIZE COt,INECTtOPi . 'FORMA TiCiN CONNECT TO TRUNK .. INCH/c.0, REF. YES 0 -NO�a CONNECT TO LAT, CONNECTJON LOCATION YES NO LJ SERVICE STATU$ --- TRUNK SERV tCE PROVIDED HY (AGENCY)_ I LATERAL ASSp.lT.:-�,_,�- �_ _ , RUNK ASSMT.-;. '_'----� (jf' '<3N 'CTIOIL" PE "—. DATE RAID - _ CONNECTION FEE PAID By $DATE PAID F AMOUNT PAID C Et'TF ERECEtVEf O& _ G NCY NN CT NT -- a • AMOUNT a . ,.� D E POS tT TED } DAY YR PAYERNAME PAYER ADDRESS CIT' r'-------__.---- ----_._ _"----------.� STATE ZIP.CODE } -------- BASIC PREM_ -'TYPS HiLLCO . DE fJiLf. INDICATOR FILE I SILUNGAGENT IRATE CODE CUST6MER BILLING NO ACCT NO, TiCE � i DATE FWD.BILLING CORRE O !NG ADDR - ESS CORRE COMM - S TS=- SEWER MAINTENANCE DEPT, Apt 30 21 11:3 1 a Anoho age'NeI! & Pump Ser 9072420742 p.1 Development SeMces Department - Phone: 907-343-7904 ©n -Site Wa-:er & Wastewater Section � "_:.� Fay:: 907-343-7997 Well Drilling Pertnit Number- _ Parcel Identification Number; 413 - 0q Legal Description Block i Lot Lmo, 3 1 Pump Installation Date: - cY 7_9± - .( Date of Issue: - - Property Owner dame & Address: A t4 r— -rr't meq &6({e 1. �z` -. Pump Intake Depth Below 'rop of Well Cashing; // � � feet t J� If f V Pimp 11'lanutacturces Name: lump Model: G- �% _ TV � ti Pump Size: ��hp P itless Adapter Burial Depth: _� ' — fcer Pitless Adapter Manufacturer's Name: ✓�'" !::'A 1' ^-3 UI^- Pitless Adapter Installer: Well. Disinfected Upon Coni etlon? ErYes 10 No Method of Disinfection: �' "�f :j T-, - - -- Comments: Pump Installer _Mame: _ ANCHORAGE WEi i. & PUMP SERVICE 5K0 King Street Anchorage, AK 99518 Company:,�_---- PH: (907) 243-0740 tlalh[lg Address: - __-- City; —State, — 7!p - Attention: Tlha pimp installer shall provkic a pump insta lation ?o; to On-site wi-lin 30 daya of pump installation, V, L0 cy) D c\J cls �sl/�7 � flctobcr 4, 1971 Ti, o. a ;z s F - Tc, rk I s cl n S ' "L C': T, ,cher e c,; i-. iD 7j, i-, S L.c; rt 0 c 3 c o 'n V'-7 j t a r t n t N:rvjs!;oon ii -u r i 't 11 4, c+ Ci V'- sani 1.ar*, T f o u r ; c trs X C s Lt r f i. c iL, c L ary j i.r r!—L! i r c� f" I iss s r C.3!,j 4 c Zl V rt -D o L ."is off lc(. Z' , 0 contact t' r,- 5 t 4 RECEIPT FOR CERTIFIED MAIL -30(l (plus postage) SENT TO POSTMARK OR DATE STREET AND. NO. P.O., STATE AND ZIP CODE 14� OPTIONAL SERVICES FOR ABOITIONAL FEES RETURN 1. Shows to whom and 'ate delivered ............ 150 W I th delivery to addressee only ............ 650 RECEIPT 2. Shows to whom, date and where delivered .. 350 SERVICES With delivery to addressee only ............ 850 DELIVER TO ADDRESS EE ONLY .; .................................................... . 50d SPECIAL. DELIVERY (2 pounds or less) .......................................... 45¢ POD Form 3800 July 1969 NO INSURANCE COVERAGE PROVIDED— (See I ofher side) NOT FOR INTERNATIONAL MAIL GPO: 1970 0.397.4sa 73d 9 71 Tom Torkel son Subject: Block 3, BOO 9, KvAk tog Subdivision. Dear -°r. Torkel son Public sewer -is available. to your lot. To be in accordance. t.A th Crtater Anchorage "area Sorough Ordinance 28-68, Section a70, (A) , you -will need to connect. to the sexier. This letter is 'to serve as notice that connection to the pub- lic ub- 1ic sanitary sawer must be made ori thi n 31"' days of -J.-he receipt of this 1c:tt'er. if You have difficulty ii': connecting in the specifl;:!d period of time please contact this oil fice for a pos- sible eXtension of tire. Th(-# Property owner rust came in and apply -1-'(.wa connection permit from '14r. Bob Daniel, the permit officer for the Greater Anchorage. Area Borough. If you have any questions regarding the above, please do not hesitate to contact the permit officer at 279-SC86, extension 25'r, or the Department or €nvironriental Quality at 279-8685, IsUcer ely, Lynn S. Coad Environmental Specialist St Page 1 of 3 E A S E M E N T This agreement, made and entered into this day of ,by and between or Anchorage, Alaska, party of the first part, which expression shall include his, her, or their heirs, executors, administrators, agents, or assigns where the context so requires or admits, and tl j_ i JC 1� _. ) of Anchorage, Alaska, party of the second part, which expression includes his, her, or their heirs, executors, administrators, or agents where the context so requires or admits, witnesseth: Whereas, the party of the first part owns and has title to that real estate and real property located near Anchorage, Alaska, described as follows: �_� C) t'j e L And whereas, the party of the second part owns and has title to a parcel of property which adjoins the foregoing �and � described as L. U `T- q 1 -9 L K �) -d-a . desires to grant a perpetual easement for the purpose of [ 6 p v'J 1" � A uAe.I, �Y `e -t,. ) said well shall be located at (_S C,�; :�.�:.,� 1.,� o`���,.3 S�:,,, ... ) and the easement shall be within the radius of ( / )feet from the well site. Now, therefore, it is hereby agreed as follows: The party of the second part does hereby grant, assign, and set over to the party of the first part a perpetual easement for j.. Page 2 of 3 the purpose of installing and operating a community water system, said well shall be located at( I v w0- �- as located on that certain amended plat approved by the Greater Anchorage Platting Board and filed for record, such easement shall be within the radius of ( /-:1, 0 )feet from the well site. The party of the second part shall fully use and enjoy the aforosai.d- premises, except as to the rights herein granted. This agreement is subject to the following provisions: 1. Second Party shall: ``, a) Restrict the use of that portion of ( K o f �1 ) which falls within the ( 14 &- )foot radius of the well from all sources of contamination, and that portion of said tract which falls within the ( /,L"— 0 )foot radius shall have no sewer, septic tank, or disposal fields, except that sewer lines of cast iron pipe with leaded and caulked joints shall be permitted, and that portion which falls within the ( / )foot radius shall have no seepage pits, and that portion which falls within the ( IS 1) )foot radius shall have no cesspools, as regulated by the Greater Anchorage Area Borough health Department. To have and to hold the said easement, right, and right of way unto the party of the first part, successors, or assigns for a period of perpetuity and under the conditions, restrictions and considerations as set forth above. Page 3 of 3 It is expressly understood and agreed that this easement is a covenant running with the land. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed under seal as of the day and year first above written. STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) This is to certify that on the (4;t-( ) day of ( / r Lj before me, the undersigned Notary Public in and for a State of Alaska, duly commissioned and sworn, personally appeared ( ) known to me and to me known to be the individuals named in and who executed the foregoing instrument, and acknowledged to me, each for himself and not for the other, that they signed and sealed the same as their voluntary act and deed for the uses and purposes therein set forth. IN WITNESS WHEREOF, I have hereto set my hand and official seal the day and year first above writ'. Notary Public i and for Ala MY commission expires: cv P