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Home My WebLink AboutTURNAGAIN BLK 2 LT 4 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 Parcel I.D. 016-122-32 Expiration Date: )® - Z e 2 e z Z- 1. GENERAL INFORMATION Complete legal description Turnagain Block 2 Lot 4 Location (site address) 1109 Ramona Street Current property owner(s) Benedict Living Trust Day phone (907) 632-3935 Mailing address 1109 Ramona Street, Anchorage, AK 99515 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Waiver Fee $ Date of Payment 7 1 a0 Date of Payment Receipt Number 0 g $ ("A Receipt Number COSA # 05C P,�Z 13 y 3 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 7/11/22 OF A :4� 1 tl j*'49TM� /• • �• 6. DSD SIGNATURE � '.' . .. ... . . System #1 Approved for bedrooms / Ben)arrl* chiller System #2 Approved for bedrooms �1*1, CE 12592 .�. Disapproved `�lF�pROFESSIOO Conditional approval for bedrooms, with the following stipulations: 4 OWSirF ATE -- _R -AND . mrn �- - r- e— m m PRO`G66 o� Original Certificate Date: -7,2 C`zz 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 _(K Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Turnagain Block 2 Lot 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UNKNOWN Total depth '41 * ft Cased to- ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 7/7/22 Static water level at beginning of test 21.9 ft. Comments *41' Max draw down during well test B. TANK DATA Alf tank(s) years Tank type/ m�dte I Measured operating flui in septic tank ❑ Standpipes/foundation cleanout p or drawing Date of pumping D. ABSORPTION FIELD DATA system tested (date installed) ❑ ALL stan '�nspresent per record drawing Total measurrade ft (max) Measured depth to pipe invert fro de ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, sta depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 016-122-32 Structure served by this system Well production at time of test 2.9 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 17.7 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/29/22 C. LIFT STATION uired maintenance completed Age of lift sta years Lift station material Comments: Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Fina depth in Absorption rate gpd Any rejuvenation treatmen t 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' [D Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NIA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes if No ft ❑✓ Yes if No ft c/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations Property Line > 5' Absorption Field > 5' Water Main > 10' Water Service Line > 10' LJ Yes if No ft ❑ Yes i ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft Surface Water > 100' Wells on Adjacent Lots: []Yes if No ft Wit@ Wells > 100' E] Yes if No ft Community W'e'l�below s >._ Yeft If septic tank is under driveway comme F+oMAbsorption Field on Lot to: (Please enter distances if less than required) Building Foundatio ' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' LJ Yes "ff _ ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft[Irvate Wells > 100' Water Service Line > 10' ❑ Yes if No ft Community Wel s Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I 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 Checklist yellow sheet ❑ Yes if No ft ❑ Yes if No ft f4,9 R �% • Benjarr Schiller �� c •. CE 12592 �� Jl�• , 7/11/22 �C�®� \ ��FppROFES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft M 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 NSA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ✓0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MV Yes if No ft ✓❑ Yes if No ft Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations _ `❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes i ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation _ ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes i ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft . ate Wells >' 100 _ ❑Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wel s _ ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I 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 Checklist yellow sheet lap : 49 H Benjarr giSchiller 6V3% CE 125927/1 www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC221343 Subdivision: Turnagain, Block 2, Lot 4 A water sample revealed an arsenic concentration of 17.7 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. �ailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org ; M --------- ALLEY---------- RAMONA STREET THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. THESURYEYDATA ON THIS DRAWING IS PREPARED FOR THE OWNER OFRECORD ONLY. ANY COPYING, OR UTIUZNG THE D I TA HfREONIS PROF1I817-ED UNDER COPYRIGHT LAND OFASPHALT o OF AC�4p 49 TH* . o. :o N� SHANE A. HOLT a G LS -6914 o`O fesS1Ona� ASBUXTSURVEY p, =30r NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4 3LOCK2 TURNAGAIN SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 13TH DAY OF 2022 HOLT LANDSURVZ-YING 930961?OVET7 DRIv/E ANCHORACE,AK 99507 223-8575 MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BOULEVARD PHONE 786-5557 SEWEROC71 iO PERMIT r► OF APPLICATION rt• jMw •, SCHEDULED COMPLETION DATE 1989 O SINGLE FAMILY O MULTI -DWELLING No. APTS LOT/TWT BLOCK 2 O COMMERCIAL SUBDIVISION `wmd TAX CODE ~ GRID 263 - AS -BUILT No. STREET ADDRESS 1109 ltma St OWNER 01 a AM bmie� PHONE MAIL ADDRESS R=MMv CONTRACTOR: ❑ ON PROPERTY ONLY =MAIN TAP—TO PROPERTY LINE ONLY (MOA or State ROW Permit Required) ❑ MAIN -TAP & ON PROPERTY CONNECT ❑_�MOA or State ROW Permit Required) -O-W NO E ❑ Main extension agreement ffl:Improvement District ❑ Extend connect agreement ❑ Pending CONNECTION SIZE CHARGE $ INSPECTION FEE $ PERMIT FEE $ REIMBURSIBLE NUMBER DEPOSIT $ /C TOTAL $ ❑ PAID O CASH ❑ CK#_ INSPECTED BY: r� FiCMAHKS: I'M #9484.464--3%4 PERMITTEE (Please Print) C&d + h•fa�47 PHONE MAIL ADDRESS I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE TO COMPLY WITH THEM. POST IN A CONSP16—U 80-021 (Rev. 11/86) PERMITTEE SIGNATUREUS PLACE AT THE JOB 88 1 MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BOULEVARD PHONE 786-5557 SEWER 87 Z CONNECT PERMIT DATE OF APPLICATION I , I SCHEDULED COMPLETION DATE G.SINGLE FAMILY 0 MULTI -DWELLING KI A M'rQ1 'j, LOTITRACT BLOCK 0 COMMERCIAL SUBDIVISION7"F6 TAX CODE GRID AS -BUILT No. STREET ADDRESS OWNER MAIL ADDRESS CONTRACTOR: 'WON PROPERTY ONLY 0 MAIN TAP—TO PROPERTY LINE ONLY (MOA or State ROW Permit Required) 0 MAIN TAP & ON PROPERTY CONNECT (MOA or State ROW Permit Required) 0 R -O -W NO. - PHONE ASSESSMENTS • Main extension agreement • Improvement District 0 Extend connect agreement 0 Pending 1-111 4 PERMIT ISSUED, BY: CONNECTION SIZE-- 1-3 —CHARGE $ INSPECTION FEE $ 0 PAID 0 CAS n PERMIT_ FEE $ 0 CK#_ REIMBURSIBLE INS EC D BY: NUMBER DEPOSIT $ TOTAL $ DATE: REMARKS: PERM177EE (Please Print) PHONE MAIL ADDRESS f f I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE TO COMPLY WITH THEM. PERMITTEE SIGNATURE POST IN A -CONSPICUOUS PLACE AT THE J SITE 80-021 (Rev. 11/86) A sjknA#ne SUBDIVISION:-ruiqP119 c A IAS STREET w INDICATE NORTH c BLOCK: LOT: SEWER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS ALLEY SIZE MAIN: TYPE MAIN: CONNECT DEPTH AT MAIN I / CONNECT DEPTH AT Prop. Line CONNECT LOCATION: COMMENTS: INSPECTED BY: DATE: SUBDIVISION: Ira BLOCK: I LOT: 7-r I INDICATE NORTH STREET SEINER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS YLt-/ ALI EY i SIZE MAIN: �' TYPE MAIN: t2-7—_ CONNECT DEPTH AT MAIN CONNECT -DEPTH AT Prop. Line g CONNECT LOCATION: �1 • �� f /Z-4 ,,Xg K I_ COMMENTS: INSPECTED BY: DATE: lZd'�9 DEPT. OF ENVIRONMENTAL CONSERVATION March 15, I974. Mr. Rolf Strickland Dept. of Environmental Quality Greater Anchorage Area Borough 3330 C Street Anchorage, Alaska 99503 SUBJECT: Lot 4, BIk 2 -Turnagain Subdivision Dear Mr. Strickland: This office has no objection to the waste disposal system on the subject property as long as it meets Borough Requirements which were in effect before the promulgation of the Alaska Department of Environmental Conservation Wastewater Disposal Regulations. This waiver is given because the system was constructed prior to the effective date of the regulation. Yours truly, Ky]K~I J~. Che~rr~ Regional Environmental Engineer