HomeMy WebLinkAboutHIGHLAND TERRACE LT 7Highland
Terrace
Lot 7
050-3 ! 2
MUNICIPALITY OF ANCHORAGE
<i R! t �
Development Services Department �., % Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-312-14
1. GENERAL INFORMATION
Expiration Date
Complete legal description HIGHLAND TERRACE LT 7
Location (site address) 19235 High Bluff Dr
Current property owner(s) WILLIAMEE RAMONA
Mailing address
Real estate agent
Jeron Rose
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
J- 7 - 2-o z Z -
Day phone 907-351-9343
Day phone 907-351-9343
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
El
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of PaymentM2.q 17-1
Receipt Number O76?2
COSA#
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 9/28/21
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
Z bedrooms
bedrooms
bedrooms, with the following stipulations:
ON-SITE_
n
WATER AND
Original Certificate Date: ( (9 —7 -2.I
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:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA CtseckNA blue 3t a of
Legal Description: HIGHLAND TERRACE LT 7
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 11/87
Total depth 360 ft
Cased to 40 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 9/21/21
Parcel ID: 050-312-14
Structure served by this system
Well production at time of test 3+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L RN Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 9/21/21
Static water level at beginning of test 73.6 ft.
Comments 2 Pumps- Both Connected. Older well in house currently in use -Drilled 1969.
B. TANK DATA
Age of tank(s) 50 years
Tank type/material Cncrt
Measured operating fluid level in septic tank na
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 9/27/21
D. ABSORPTION FIELD DATA 7/19/78
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 2.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: Tank Level Normal
Tank Effluent Level Did Not Drop
Adequacy test date 921121
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 30 in
Water added 450 gal
New depth 36 in
Elapsed time 10 min
❑ Code -required soil cover over field
Final fluid depth 36* in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: " Checked the following day, under 24 Hrs, level returned to original level of 30"
COSA Checklist yellow sheet
I E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
CJ Yes
if No
Septic Tank/Lift Station on Lot > 100'
80+
Abscrption Field > 5'
Community Sewer Manhole/Cleanout > 100'
if No
M Yes
if No
ft
Oyes
ifNo-ft
ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 250 Yes
if No
ft
Abscrption Field on Lot > 100' Q Yes
if No
ft
Holding Tank > 100' Yes
if No
ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Yes
if No
ft
R/ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' S Yes if No ft Surface Water > 100' B Yes if No ft
Property Line > 5'
CJ Yes
if No
ft
Wells on Adjacent Lots:
Abscrption Field > 5'
P-1 Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Main > 10'
[D Yes-
if No
ft
Community Wells > 200' Q Yes if No ft
Water Service Line > 10'
El 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'
[D
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Warer Main > 10'
0
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Service Line > 10'
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water> 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / 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 Cnecklist yellow sheet
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,VlUNIClPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT
NAME , IPHONE ] ~JNEW
MAILING ADDRESS " ¢- _
LEGAL DESCRIPTION · ~1~,~¢~t~)~
LOCATION -~b 'k~
Well Absorption area Dwelling
PER~IT N07
f2 ~ DISTANCE TO: ~"~ f L
i~l- ~ Manufacturer f~ Material No. of compartments
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~ ~ DISTANCE TO: Wellb ~ ~ Dwelling PERMIT NO.
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~ No. of lines Length of each ~n~ Total length of lines Trench wid~ Distance between lines
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Length Width Depth - PERMIT NO.
~ ~ Type of crib Crib diar~et~r Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class (~ Depth Driller D~stance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(st
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PIPE MATERIALS / EX
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SULLIVAN WATER WELLS
P.O. BOX 67'0272, CHUG[AK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND ~{~,no,4j~ ~..J,,c/~ ~,L,r~_,q ~6,,~ .t~_~?~/,-,]
ADDRESS
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DATE - Started ~d~"-~ Ended
KIND OF FORMATION:
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MISCL. INFORMATION:
DRILLER'S NAME -"