HomeMy WebLinkAboutSPRING BROOK VISTA #1 BLK 1 LT 7Onsite File
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COSA Checklist
Legal Description: SPRING BROOK VISTA #1 BILK 1 LT 7 Parcel ID: 05009122000
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
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Static water level at beginning of test ft. Date
Comments Public Water No well located on the property
B. TANK DATA
Measured operating fluid level in septic tank 50"
Date of pumping 5/29/23
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/23/03
❑■ ALL standpipes present per record drawing
Total measured depth from grade 5-5.5 ft (max)
Measured depth to pipe invert from grade 3 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
Comments/Deficienci
COSA Checklist June 2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/21/24
Results M Pass
Fluid depth prior to test 0
Water added 600 gal
New fluid depth 2 in
Elapsed time 30 min
Final fluid depth 0 in
in
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 30
Effective depth used 0 in
Effective depth remaining 30 in
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 ft ❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No na ft Holding Tank > 100' ❑Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No
El Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No
❑ 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 5'+* ft Surface Water > 100' ■❑ Yes if No
Tank to Property Line > 5'
Yes if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑■ Yes if No
ft
Private Wells > 100' EC 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 tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
* Tank @ 5'+, Field
@ 10'+
T
ft
ft
ft
G. CERTIFICATION & STATEMENT OF INSPECTION BV 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.
Dame of Finn NorthRim Engineering Phunc 694-7028
Engineer's Printed Name Steve Eng Dalc 5/22/24
4W OF
AV * .49TH�r
;
�
........................
Steve Eng k- �
CE -6256 ? AV
5/22/
COSA Checklist—June 2022
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234.21 Ri
I hereby certify that I have surveyed
the following described property: Lot 7,
Block 1, Spring Brook Vista Unit 1, Eagle
River, Anchorage Recording District,
Jk
``
Alaska and that no encroachments
49TH s
exist except as indicated heron. This
A'•*
As—built will only show the easements,
D
covenants, or restrictions that appear
on the recorded subdivision plat.`
t
Anthony P. Donets
Under no circumstances should any data
hereon be used for construction or for
:`. No. 10393 'a`a
s,� .,
establishing boundary or fence lines,
�,,;••••..•,,,•,,,, ....
go/aiiohs
Dated at Eagle River, Alaska
3103
This day of 20 03
As—built Survey Lot 7
SCALE: 1" =40'
18008 Meadow Creek Drive
Prepared by:
DATE:10/13/03
Eagle River, Alaska
Anthony P. Boneta
DRAWN BY: APB
99577
DEPARTMEN
825
MUNICIPALITY OF ANCHORAGE
IF HEALTH AND. ENVIRONMENTA PROTECTION
L Street, Anchoracr~. Alaska 99501
264-4720
Date Received: ~ovember 8,1977
~1: Time _~_~U~]~_ #2: Time
#3: Time
Date 1]_-9-77 Wednesday Date
Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: ~ecurity National Bank
Mailing Address: 800 H Street 99501 Phone:
2. Property Owner: Arthur Sayles Phone: 277-6505
Mailing Address:
3. Legal Description: Lot 7 Block 1 Sprinqbrook Vista Subdivision
4:
Single Family Residence: (x)
Multiple' Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
Well System:
Permit #
Construction
Individual well (x~ Community/Public System ( )
Depth of Well 105 Well Log on File (
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x) Public Utility ( )
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Request [:lor Ai.}prova] o£ IndJ. vidual. Sewer and Water Fac ii i ties
Legall>c,,~s'~'c x,~- Lot 7 Block 1 Springbrook Vista Subdivision
Affadavit Att;ached: ~ Letker Attached: ( )
A ~oved Dahe /~
D'i sanproved: I'ake:
Del}ar %mel~ 'lA W_~ . k~>}le ~ t:
,~UNICIPALI'PF OF ANCHORAGE
I! , ,?,;'Pr ! . , , ~ ' - ~ '
~s;?2'~-:~{equest for Approval of Ind].v~.d~aA Sewer anct Naker Facilities
1. Proper'Ly Owner: ......................................... ~ .........
Realtor/Agent.
Multiple Family J{esi(lence:
( ) Number o[ Bodrooms
Water Supp].y: * Indi_vidua] We]_]_ C~) Public/Commun Ly SysLem
If Individua~ WelL]_, well depth .............
( )
If CommunJ.ty System, name of system
Sewage Disposal System: ~n-sit;e System (-~) Public System ( }
*NOTE: A well log is required on ALL we].ls drilled since 6/75.
** If on-sil;e sewer system J.s over two(2) years old, an ade(luacy
tesh is requJ_red by this departmenL.
A fee of $25.00 must accompany each request befere processing
can be in'il.:ial;ed.
3/77