HomeMy WebLinkAboutCALAIS BLK 2 LT 6 ·
Calais
Block 2
Lot 6
#009-035-07
Municipality of Anchorage •
On-Site Water and Wastewater Program o a
(907) 343-7904
Lill
$A r C T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 009-035-07 Expiration Date: 6 '5?--
1.
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1. GENERAL INFORMATION
Complete legal description Calais Block 2 Lot 6
Location (site address) 3003 Eureka St
Current Property owner(s) Cottini Day phone 727-9450
Mailing address Same
Real Estate Agent Wolf Day phone 727-9450
2. TYPE OF DWELLING: u5 6 7 8 g 70
® Single Family (w/wo ADU) ti
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) o ��� C 2U18
c ti
3. NUMBER OF BEDROOMS: 3 ��� 5n
w
6 8 L 9
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer
Received by: Date: .
COSA to be released to the engineer,unless • erwise requested by the engineer.
COSA Fee $ 'oZ( Date:
Date of Payment o2" 'S I ' Date of Payment
Receipt Number Oy oGjg Receipt Number
COSA# OSCE 103S 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.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724,Eagle River
Engineer's Printed Name Steve Eng Date 2/3/2018
•
6. DSD SIGNATURE �, ,;?
System #1 Approved for 3 bedrooms.
System #2 Approved for bedrooms. ^_• 55
Disapproved. r }
Conditional approval for bedrooms, with the following stipulatibrt-s�� -'
o
ON SITE ,,;
WATER ANDsal
WASTEWATER
PROGRAM
PDAn
6 /7-sFR\ric
B l C •
Original Certificate Date: 2. "-�"" /zS
The Municipality of Anchorage Devlopment 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 blue sheet 9-1-12.doc
1
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On Site Systems Approval Checklist
Legal Description: C/31- 41s ,3/3c.K. 2 4 d I`( Parcel ID: OCA Y6350 7
A. WELL DATA
Well type P If A, B, or C provide PWSID# Well Log (Y/N) /v
Date completed I 4:14.3 Sanitary seal (Y/N) ti/ Wires properly protected (YIN)
i
Total depth 4/0 1 ft. 1- Cased to 171 ft. t Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test. (/Nk 2 l / /f
Static water level (1 Alk ft. l 7.1 ft.
Well production JAJI - g.p.m. 7. 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform 1 colonies/100 mL Nitrate 1\i1:7 mg/L
Arsenic NI\ ug/L Date of sample: 27 , lI g Collected by: 11 6V'1ik 1`,iit
B. SEPTIC/HOLDING TANK DATA 1")(-1 B'-'c S6I.cJr a.
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts(Y/N)
Foundation cleanout(Y/N) Depression over tank(Y/N) High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA Pv6L(C S'Ewec j�
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION /1/A
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off'level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots /o0 'f
Absorption field on lot On adjacent lots /40 (t
Public sewer main So #. Public sewer manhole/cleanout . 50 4
Sewer/septic service line 2n -1- Holding tank /0 0 1-14-
Animal
fAnimal containment areas 50 +t Manure/animal excrete storage areas /
SEPTIC/HOLDING TANK ON LOT TO:/V 4
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO: Ai A
Property line Building foundation Water main
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
OF 41 %,
I certify that I have determined through field inspections and �� L4 1!
review of Municipal records that the above systems are in Co., ts
„ ••'° A0•• 0.-r
conformance with MOA COSA guidelines in effect on this date. s' iryr� :e `" •. ;7
Engineer's Printed Name
etv
2
Date /� sieve„ `V. Eng ,
PC6i56 ••�•��:
6 �J����r• oea• Q .�
COSA yellow sheet_2-6-15.doc
7
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ANCI.ORACC. ALASKA 99503 562-5291 (Toto 561-6626 .+s.y.r.....ts,c.wwwlo,r r.str.cla...s* .o A.1 ss.p..r w t . CRAM- C 1
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W012CO _L_207Aj 1'.20'I APR. 9. 2001 rIPJ 1630 I KEN _ 499/66 1.-sit M....M 0"4 r c...wsl..w i.r.wsnwt.• p..o«ir"WI- .A TEN SELL- 9
Municipality of Anchorage
Development Services Department
Bullding Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR .b, SINGLE FAHILY DWELLING
Parcel I.D. 009-035-07
1, GENERAL INFORMATION
3G
Expiration Cate: "~- ~ O - O [
Complete legal description CALAIS SUBDMSION; LOT 6, BLOCK 2,
Locatlon (site address or directions) 3003 EUREKA STREET * ANCHORAGE, AK 99503
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
RAY McDONALD
'~//,~ A
Dayphone 248-7530
Dayphone
RAM SZENOER w/ DYNAMIC REAL'fY Day phone
3111 "c" STREET * ANCHORAGE~ AK 99503
261-7657
Unless otherwise requested, I-/AA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~E]
Individual Holding tank
Community On-site ~E]
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations givan In paragraph 5 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for prope~es served by a single family on-site wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of HeaIth Authority
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 less than 30 days old. (Certificates may be reissued fora period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
welts or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the
professional engineer's woW,.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prlor
to dosing for tho englnsering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~'fied by my seal affixed hereto and as Of the validat/°n date shown below, I verify that my
invest/gat/on, based on procedures outlined in the Health Authority Approval Guidelines for this applica.tion,
shows that the on-site water supply and/or wastawater disposal system is(are) safe, functional and adequate
for the number of bedrooms and ~/pe of structure Indicated herein. I further verify that based on the
information obtained from the Municipali~y of Anchorage files and from my Invest/gab'on and Inspection, the
on-rite water supply and/or wastewater disposal system is(are) In compliance with all applicable Munidpal
and State codes, ordinances, and regulations in effect at the t/me of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504
Englneets Printed Name JEFFREY A. (;ARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducting this ~va/uetton, AWWC, In~ attempted to provide a thorough,
consdentious enginesdng analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Rogulalione. The repertsd r~ulta described the performance of the
~stem under the conditions encountered at the t/me of the test, and seperation
distances measured to readily Iden~able features. The operational life of all wells and
septic systems depend on the Iocal so~Ts cond'~on, groundwater levels that may ·
flucfuata dudng the year, and the water usage of the fatally being se/',,ed by the system.
These conditions are ¢~Jde the con,roi of the evaIuater of the s~fem. SatisfacteG, test
reautts do not guarantee fufure podormance of the system, nor do they guarantee that
there are no hidden defects or encroachmenta. AW1/VC, Inc. can therefore not provide
any warranty or future estimate of how long tho system will continue to meet the
operational requlrements of the ADEC or MOA DSD. The content of this report is for
the solo benefit of the owner ti$~d above. Any m/lance upon er use of this report by any
other person or parly is not author/zed, nor will it confer any legal dght v~alscover.
5. DSD SIGNATURE
[~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
'...
ON-SITE
. WATER AND
..... . WASTEWATER
bedrooms, w~ ~e fllowmg supu~on% PROG~M
~240~ _' '"
Attachments:
I-[AA Checklist
Septic System Advisory
Well Flow Advisory
Manitenanca Agreements
Supplemental Engineer's Reort
Other
O, ginal C,, ficate C)ate: Y'-/0
Municipality of Anchorage
Development Services Department
Legal Description:
WELL DATA
Well type .mVA~
Date completed 196,1 (?)
Total dopt~ 40'+ t~
FROM WELL LOG
HEALTH AUTHORITY APPROVAL CHECKLIST
CAI.NS S/D; LOT 6, BLOCK 2, Parcel ID:. 009-035-07
Static wate~ ft.
?1~ g.p.m.
C. ABSORPTION FIELD DATA
WATER 6AMPLE RESULTS:
Coliform 0 colonies/100 mi.
Date of sample: 3/21/'01
8EPTIC/tlOLDING TANK DATA
Tank Type/Mate~al
Ntlzate 0.5 mg./L. Other bactel~l 0
Collected by:. AWWC, INC.
I PUeUC SEWERI
Tank 81zo gal. Number of Co~
~:r tank ~/N) High --r alarm (Y/N)
Date Installed Soa rating (g.p.d./fl~or ~/bdrm) System type
Length It. Width lt. ~ lt.
Totaldopth ft. Eff. absorptlonama. ,~ ~ Depre~__Lonoverfleld
Date of adequacy test /~[~,~r~a/Fall) For bedrooms
Fluid depl~ In ebso~ptJofl_~~ Irt. Wa~r edded gal. New depth In.
Elapaed~ Final fluid dep~ In. ~ rate >=~ g.p.d.
nation treatment (past 12 mo.) (Y/N & type) Byes, gna date
Wen Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
3/2 /o
29 ,ft.
3.49 .g.p.m.
NO
12"+ In.
Date Installed
If A, B, or C provide PW$1D# N/A
D. UFT STATION
Date installed. Size In gallorm ~
· Pump ~' level at ~ Hlgh water aterm level at ._ In.
~ Cycles tested Meete almm & cimult requlremente?
SEPARATION DISTANCE8
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se~c tank/lilt station on lot N//A
AbSOI~I[Oll ~leld Orl lot N//A
Public sewer main 50'+
Sewer/septic se~ce line 25'+
On adjacent lots 100'+
On adjacent lots lOO'+
Public sewer mantmle/cteaneut
Holding tank N/A
50'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Buliding foundation Property line Absoq~on field ~
Water main ~.___~.~~
[PUBLIC SEWERJ
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main ~
Water ~em'lce line Surface ~y, paddng/Vehlde storage
F. COMMENT8
I cerUfy that I have determined through field Inspections and
revfew of Municipal records that the above m~en~ ere In
conformance ~ MOA HAlt guidelines In effect on this date.
Engines~ Pdn~ed ~lame JEFFREY A. GARNESS
HN Fee$
Date of Payment
Receipt Number ~,~
Walver Fee $
Date of Payment
Receipt Number
03-27-01 17:35 FROM-CTE ENVII~NL~NTAt.
CTIE
Environmental Servlcee Inc.
5615301
T-85T
P.02/03 F-699
CT&£ Ref. fl
Client Name
Project Name~
Client Sample ID
Matrix
Ordered By
1011400001
AK Water & Wastewater Consultants Inc.
Calais S/D
Lot 6 Block 2
Dri~dng Water
Client
Prlntrd Date~lme
Collected Datefflme
Received Date/Time
Technical Dlreclor
03/27/2001 14:42
03/21/2001 14:20
03/21/2001 1(5:30
Stephen C. Ede
I~WSID 0 Releasrd By - ~' ..~ ~,
Sample Remarks:
Al~owabh: Prep AnalysL~
Parameter Rmult~ PQL Units Method Limit3 Date Date Init
Watera Department
0.500 U 0.500 mg/L EPA 300.0 l0 max 03/21/01
SCL
Microbiology Labor&i:o~,~'
Total Coliform 0
co~lOOmL SMI8 9212B
03/21/01
~PR-09-2001 ~0~ 01:16 P~ FAX ~0. P. OI
S00'10'30'£ ?1,00'
71.00'
EUREKA STREET
03/14/01 11:21:09 AM
5
THIRTY FIRST
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