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HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 2 LT 10 Buyer Address Zip ~e Address Zip ~e ~ Other Water Supply Comm~ity For wells ~llled prior to that date, give well depth (attach I~ if available). Sewer Disposal ~¢~~~~' ' NOTE; THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Inspector Inspector Inspector Inspector ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAl. MUNICIPALITY OF ANCHORAGE Development Services Department cF Phone: 907-343-7904 On -Site Water & Wastewater Section - -- Fax: 907-343-7997 Certificate of On -Site Systems Approva Parcel I.D. 014-181-23 1. GENERAL INFORMATION Expiration Date: 1 '_l Complete legal description Abbott Loop Manor Block 2 Lot 10 Location (site address) 7651 Rancho Drive Current property owner(s) Kenneth Karl Herbert Trust Day phone 480-390-6392 Mailing address P.O. Box 3032 Apache Junction, AZ 85117 Real estate agent 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic. ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number © SIZ,�g©J p Receipt Number COSA # n c L t 0 I Is -'s L IWaiver # 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 Forge Engineering Phone 907-522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 10/3/18 O ` F ,4�q�l�l� 6. DSD SIGNATURE System #1 Approved for S bedrooms Benjarrlin.5chiller System #2 Approved for bedrooms �;��slFq. X10 3598 ,•����'����/ Disapproved i1,F�pROFESSI* Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 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 Well Flow Advisory Other COSA Checklist blue sheet 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: Abbott Loop Manor Block 2 Lot 10 Parcel ID:014-181-23 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth ft. Cased to ft. Casing height (above ground) 14 in. FROM WELL LOG AT INSPECTION Date of test Unknown 9/20/18 Static water level ft. 58 ft. Well production g.p.m. 2.15 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 9/21/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material N/A 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 Date installed N/A Soil rating (g.p.d./ft2 or ft2/bdrm) System type N/A 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 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 N/A On adjacent lots >100' Absorption field on lot N/A On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >100' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: 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 A�gtkk I certify that I have determined through field inspections and ��Q"�`.•' .cm_g review of Municipal records that the above systems are in /�' . `,� :•1-:9‘t conformance with MOA COSA guidelines in effect on this date. 0 *:•�TH )\ • *V/ Engineer's Printed Name Benjamin Schiller, PE � •• 10/3/18 „jar.. ' . . . . ... . e Date /� • Benja chiller '. CE 12592 •4 c�Jj�'. 10/3/18 ,.'•v (kk PROFESSIO- COSA brown sheet 10-10-12.doc N r ,\ 10' UTILITY EASEMENTS / ' 30.0' Lot 11 RETAINING WALL I Lot 2 4.0'x8.0' 10.2'x9.7' SHED ' / ' DECK CV 7.0'x5.0' SHED • ASPHALT N 90'00'00"E , 127.40' -- — L4.1 _ 30.8' r \._._ . — • — —— Z \96 Ilk 11.9'x12.0'—7 V9*-- IX A-FRAME C:..1 -VS•t SHED / O '...� GRAVEL'• : o % WELL" li .:i ►�i x 0 rya t • x try Q r Y 5.o'x18.5' V0" .50 p\ ; ;n 1 Lot 3 et DECK O� WOODEN G� l RETAINING WALL 0. "pp WALKWAY I . * Lot 10 f. -� ' 12,824 s.f./I / CHAIN-LINK FENCE : GRAVEL DRIVEWAY`-.. ' ` _ J — N 90'00'00"W 107.87' 1 / Lot 9 I I Lot 4 / I I PLOT PLAN _ AS BUILT X SCALE 1" = 30' GRID SW 2233 Project No. 18-523/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lana & Associates Inc• C . (907) 522-6476 Phone J (907) 522-4625 Fax o�ooODOpp 4 Professional Land Surveyors kenOiangsurvey.com v( F A °4 jonathanOlangsurvey.com V-\ . I I herebycertifythat I have surveyed the followingdescribedproperty: • Go�P �' ( Y pC�: s �j\ • OI LOT 10, BLOCK 2, ABBOTT LOOP MANOR SUBDIVISION (PLAT No. P-647A) e• . 4 ' Anchorage Recording District, Alaska, and that the improvements situated thereon are D D within the property lines and do not encroach onto the property adjacent thereto, that D no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible 'V c" , BONA A LANG •: o easements on said property except as indicated hereon. A� �I T'Z J.b.• �� � *' '••.LS-9944.•'' J G Dated this the Ilam\ Day of pc-Z-.4 �c'- , "t,\� , at Anchorage, Alaska ��`�pR '• Of'd� 40Q O�SSIONAI-�fv' It is the responsibility of the owner to determine the existence of any easements, °Opppdoa covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963