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Home My WebLink AboutO'BRIEN ACRES LT 9AO' Brien Acres Lot 9A #014-063-22 ARCTIC PUMP & WELL INC. Jim Sullivan, CPI 111111 PO Box 770197 Oman = a am - Eagle River, AK 99577 (907)688-2510 (907)258-2510 anw@aci.net Decommissioning Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Arctic Pump & Well, Inc. Page 1 of I Legal Description: O'Brien Acres Property Owner Name & Address: Lot: 9A John Lindberg Block: 6751 Reedyke Cir Annhnraaa AK QQ507 Pump Installation Date: 5-2010 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Pump Model: Pump Size: hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Well permanently decommissioned by procedure 15.5 5.060L. c. Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of I ARCTIC Pump & WeLl INC. Jim Sullivan, CPI PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 apw,~ci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Legal Description:o'Brien Acres Lot:9a Block: Property Owner Name & Address: John Lindberg 6751 Reedyke Cir Anr'h A'K' QQq(}? Pump Installation Date: 6/28/2010 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Pump Size: Pump Model: hp Pitless Adapter Burial Depth: Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Arctic Pump & Well, Inc. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Well permanently decommissioned by procedurel 5.55.060L. c. Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 o fl Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. munLorg/onsite (907) 343-7904 Parcel I.D. O!/'/° O~".~['- ~ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING COSA # Ir~flO 10,7, , Expiration Date: /'/ '1. GENERAL INFORMATION Complete legal description Location (site address) ~,~51 /'~EF.~3Y~'E Cig. Current Property owner(s) Mailing address /.~o / Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~45A ~. C,,, CL Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] ~Jo .~r,=,~,~: Individual Holding Tank I--] Community On-site [] Public Sewer [] [] [] [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties sen/ed by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up Io one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmora Street P.O. Box 196650 Anchorage. AK 99519-6650 wwv.munLorglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: O'/~tE~'j /t~-E$ ~,Zt~'r' ~l~-~'~ A. WELL DATA Wel~ type Date completed Total depth I0~ ff. IfA, B. or C provide PWSID # Sanita~yseat (Y/N) Y' Cased to fL FROM WELL LOG Date of test - Static water level Well production WATER SAMPLE RESULTS: · Coliform ~ colonios/1oo mL Arsenic: .,,~.2,b ug/l- fL g.p.m. Nitrate 4 o. I mg/L date of sample: LI/aq]lO Parcel ID: OtLI - Well Log (Y/N) Wires properly protected (Y/N) Y ~asing helght (above graund) AT INSPECTION fL 6. ~ g.p.m. in. Other I~cte~ / ! colonies/tOO mL B~NK DATA Tank Type/Material Tank size ... gal. Foundation cleanout (Y/N) Date of pumping · C. ABSORPTION F~E~'o DATA' Depression over tank (Y/N) Pumper Date Installed .,gh wa,or Date in'stalled ' Soil rating (g.p.dJftt or ftt/bdrm) System type Le~gth"'~'~'~ ft.~lh i . fll Gravel below pipe · fL Total depth ft. Eft. absorption area ~(t~....., Monitoring tube Depression over field Date of adequacy test Results (Pa~.~. For bedrooms Fluld depth in absorption field before test in. Water added gal. ' --~e'~'depth~ Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & lype) If yes. give date D, LIFT STATION Date Installed Size In gallons 'Pump on' level at In. 'Pump off' level at Datum Cycles lesled E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot · Public sewer main ~ Sewer Iseptic service line Animal containment areas Jrt. Manhole/Access (Y/N) High water alarm level at Meets alarm ~ circuit requirements? On adjacent lots On adjacent lets Public sewer manhole/cleanout Holding tank Manure/animal excrete s'tomge sreas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~ : ; Build. lng foundation Property line Absorption field Water main Water sewice line sudace water in. ~/,55" Fe 'Wells on adjacent lets , SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:: Property line: , Water SeWiCe line Curtain drain Bui~ing foundation Sudace water Wells on adjacent lots COMMENTS ENGINEER'S CERTIFICATION I codify that I ha~o determined through field Inspections and review of Municipal records that the above systems are in r Water main : - D~.'eway, partdngNehide storage conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name ~'~ Date COSA Fee $ Date of Payment Receipt Number ; (Rev. '11/05) Waiver Fee $ Date of Payment Receipt Number Moxtgage Company' To the Municipality of Anchorage: Re: Date: The property at 6751 Reedyke Circle, Anchorage, AK 99507 Legal: Lot 9A O'Bden Acres April 27, 2010 Alaska USA Mortgage, as the lender on this purchase transaction, is asking for the COSA for the well and septic systems on this property. However, the well and septic will be decommissioned after the purchase transaction has closed. In order to guarantee the decommissioning process, we will collect and put into escrow funds in the amount of $10,500 at closing. The funds will be coming from the seller. This is 1% times the total bid; any funds left over after the decommissioning is complete will be returned to the seller. The engineer's bid is attached with this letter. Please feel free to call me if you have any questions. Best Regards, Catherine O Margolln Senior Loan OHginator (907) 689-3249 direct (907) 830-5456 cell c.mar.qofin~,alaskausamortqaqe.com /2:155 0Id Glenn Highway, Suite 101" Eagle River, Alaska 99577 Phone (907) 694-7030 · (800) 737-3033 outside £agle Rh, er * Fax (907) 694-7014 · www. elaskausamortgage.com Al adxa USA M~ge Company, U.C, · membe~ of the N~ka USA f~mll~ of flnan,'4al ,~_~¢a va ~7on DEAN CONSTRUC'I'ION & ~ ,~ DEVELOPMENT ~'~ Elkhom Cir~l¢ EaSe River, Ala~ka 99577 To"' Cken 6731 Reedyke Anchorage, Ak 9~;18 TOTAL DESCRIPTION of'WORK . - ·, ad ablution old w~er 7,000.00 W~erline connection to exihng A~ k~ · well to MO~EC ~egNOT in.de top~ ~ le~g NON ~ING TOTAL sT,~.~ CO~ONS ~222 ELK~ORrl ORCLE ° EAGt~. P~V~. AI.k.RKA 99577 -