HomeMy WebLinkAboutT12N R3W SEC 4 LT 23
'-� Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 , A P E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 014-091-10
1. GENERAL INFORMATION
Complete legal description T12N R3W Sec 4 Lot 23
Location (site address) 2728 E 68th Ave, .Anchorage, AK
Current Property owner(s) Robert A. Frasher
Mailing address
Real- Estate Agent
Expiration Date: ZdaZ
Po Box 1623 Seward AK, 99664
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex.
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
WaiverNariance request for:
2
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
❑
Holding Tank
❑
Community
❑
Public Sewer
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ d 9z
Date of Payment V2q/ 20 a 2
Receipt Number 0 5156
COSA# OSCaa 10 1 G
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
istance:
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.
Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111
Address 20441_ PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name. KENNETH M. DUFFUS Date e zy-
_ /_2K---
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 01'' 4.
encroachments, deficiencies or discrepancies exist. _. _._ ._._. _ _ _ /�= L^f6' 1
T1-1 I�
6. DSD SIGNATURE _
System #1 Approved for bedrooms. KENNETH M. M; R; I6 =�
System #2 Approved for bedrooms. 11 n"�; ✓ Z�����s
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet -10-10-12 doc
Legal Description:
♦, I A ^1
T12N R3W Sec 4 Lot 23
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled UNK
Total depth 50.4+ ft
Cased to UNK ft
Sanitary seal is functioning correctly
01 Wires are properly protected
Casing height (above ground) 28 in.
Date of flow test for COSA 1/20/22
Static water level at beginning of test 35 ft.
Comments
ANK DATA
Age oft years
Tank type/materia
Measured operating flui�Ievi
❑ Standpipes/foundation cleanout
Date of pumping
tank
t-&QLd drawing
ABSORPTION FIELD DATA
Which s tested (date installed)
❑ ALL standpipes ent per record drawing
Total measured depth from ft (max)
Measured depth to pipe invert from gr ft
❑ NIA — pressurized field
❑ Monitor tubes go to bottom of effective. If not, st
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
(min)
Parcel ID: 014-091-10
of Structure served by this system
Well production at time of test 3.4 gprn
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes No
Coliform bacteria is Negative
Nitrate 0.402 mg/L ❑ Nitrate less than MRL (ND)
Arsenic 7.78 ug/L ❑ Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 1/13/22
'FT STATION
❑ Requi aintenance completed
Age of lift station 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 rat _ gpd
Any rejuvenation treatm ast 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'
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
NA ft
® Yes
if No
ft
Neighboring Tank > 100'
® Yes
if No
ft
Private Sewer/Septic Line > 25'21 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
ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
®Yes
if No
ft
® Yes
if No
ft
Ff Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundatlo _ lQ;r
❑ Yes
if No
ft
Surface Water > 100' ❑ Yes
if No
ft
Property Line > 5'
❑ Yes
'
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑ Yes
if No
�ft
"�►�., rivate Wells > 100' ❑ Yes
if No
ft
Water Main > 10'.
❑ Yes.
if No
. ft
Community ti — 00, , M Yes
if No
ft
Water Service Line > 10'
❑ Yes
if No
ft
If septic tank is under driveway comm
w
FfQja Absorption Field on Lot to: (Please enter distances if
less than required)
Building Founda i .3Q'
_ 1'`�-•
❑ Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ e
o
ft
Wells on Adjacent Lots:
Water Main > 10'
❑ Yes
if No
ft ``^�•.,�
Private Wells > 100' ❑ Yes
if No
ft
Water Service Line > 10'
❑ Yes
if No
ft
Commune s > 200' ❑ Yes
if No
ft
Surface Water > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that l 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
a
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APPLIC tlT FILLS OU ' UPPER HAL ONLY
~a[ling,?ddre~
Buyer
Address /)r /-) Zip Code
Lending Institution Phone
Address Zip Code
Realty Co. & Agent Phone
Address /t/' W~ Zip CO~O
Street Locati~ ,¢' ;2~¢ /¢ ~¢
Type of Resigned
Single Family
~ Multiple Family No. of Bedrooms~_/~ ~
Communityl¢ - -- For wells drilled prior tothat date, give well depth (attach Iogif available).
~ Public Utility
Sewer Disposal
~ Public Utility When Connected to Public Uti~ty:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST REFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time . ·
Date Date Date Date
Inspector Inspector Inspector Inspestor
( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
.'.<,.iTt.tonal Go
Ancho~:aoe, AK 99507
5u}.',ject~ T],2b, I<3W~ Section 4~ Lot 23
the well Lot our im;pcction to doLer~:~ine propel:
The sopti<: t;Mlk pmql)e<] wit{~ a t~ecoipt submittod to this
on the r<>c¢:Lpt mM verJ. iiied by a registered eng.[noo~7 a~ to
size <)~ the septic tank.
ti £<)uE (4) inch c].eat~,¢>uL nor2dS to bo imsta[LLo(i to the SeL¢"-
Lic tank,
o /k todr ( 4 ) in¢:P~ <:J.{~itI~ot/t lle~:<i:i t<) l)e~ instaJ, ler, i to tho
p~:ivate firms {)~2rlk}rming iht: t{:,~t in ollc].os~2d. This repo):t
the eas~me~lt di. roc',t].y to the west. Th:[~ i,,3 not a 1.'~2~.lt~:i.l;'<~~-
fh.~rther <[{w~;t:iom';, pi. oas0 call, this office att 264--4720.
Rob(.~.~:t Co Pt'att
AsLociat~} i]:nviro}u,'~cntai 'Ji?ecia.LIsL