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HomeMy WebLinkAboutTRANQUILLITY HEIGHTS BLK 1 LT 42T onquility Height Block Lot 42 #014-151-22 4 ment Services Department f cf Development p ��--' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014-151-22 Expiration Date: 1-11-2023 Legal description Tranquility Heights Block 1 lot 42 Site address 3520 East 72nd Anchorage Current property owner(s) Miller X The On-site system(s) is/are approved for 3 bedrooms Conditional approval l for bedrooms, with the following stipulations: Comments or advisories: �lJ sr/I [ Gm -p C G, �,A 6,P I% S BY Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUMCPALITY OF AmcHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 014-151-22 Complete legal description TRANQUILITY HEIGHTS; BLOCK 1, LOT 42 Location (site address) 3520 East 72nd Ave. *Anchorage Current property owner(s) Colton Miller Day phone 719-649-5660 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑■ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee Date of Payment Date of Payment COSA # n.SCy� $ Waiver # COSA AppllcaUon_June 2022 I vl Legal Description: TRANQUILITY HEIGHTS; BLOCK 1, LOT 42 Parcel ID: 014-151-22 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 4+ t ft N/A Qpm Date drilled uNKN Total depth 80+ Water storage tank volume gallons Cased to '80+ ft Well disinfected for coliform test? ❑ Yes ❑ No ❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative ❑ Wires are properly protected Nitrate /L m g ❑Nitrate less than MRL (ND) Casing height (above ground) 18+ in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 9/28/22 Collected by GEG, LTD. Static water level at beginning of test 27.2 ft. Date 9/27/22 Comments "PER AAROW WELL & PUMP 3/27/2002 REPORT IN MOA DOM IMPNT.0, B. TANK DATA , 1N SEWER° Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or fiel of used for more than 30 days prior to date of t) Gallons introduced allons date Any rejuvenation tre ent (past 12 months) If yes, enter e COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test d Results ass Fluid de prior to test in W r added gal ew fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) ❑ Yes Septic Tank/Lift Station on Lot > 100' F� Yes NSA if No ft Community Sewer Manhole/Cleanout > 100' if No ft Field to Property Line > 10' FC Yes if No ft Neighboring Tank > 100' © Yes if No ft Private Sewer/Septic Line > 25' nM 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' [Yes if No *31 ft Fol Yes if No ft Community Sewer Main > 75' ©Yes if No ft Manure/Animal Excreta Storage > 100' ® Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than Building Foundations > 10' ❑ Yes if No ft Tank to Property Line > 5' Yes if No ft Field to Property Line > 10' ❑Yes if_Na7:�:�ft r Main > 10' Yes if No ft Zervice Line > 10' ❑ Yes if No ft Surface Water > 1 Lots: Yes if No ft Private Wells > 100' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *APPROXIMATELY 31 FEET FROM WELL TO NEIGHBORING CHICKEN COOP HOUSING 3-4 CHICKENS (SEE ATTACHED PHOTO). EXISTING WELL HOUSE APPEARED TO HAVE BEEN USED IN THE PAST AS A CHICKEN COOP. -= G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER L As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gayness Engineering Group LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date oy j td2,Z- In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 OF � 91"1 A �................ O) f e .. Garness: —795 1.3 LICENSE �+`� �o(essionove AEC 884 O�Op00 Municipaii of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Pa l .D. H A# Z..P 2Ol/& ~piration Date: ~ ~ 1. GENE~LINFORMATION Complete legal description Lot 42~ Block 1 Tranquilli~ Heiqh~ Lo~tion (sEe address or dim~ions) , End of 72~ Ave, off Aboff Loop Road Current Property owner(s) John Goins Mailing address 2419 East 86"' Ct1 Anch~ AK 99507 Day phone 349-5804 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHH~ for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Wetl Individual Water Storage Community Class Pubtic Water System Well TYPE OF WASTEWA~'ER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for prcperties served by a private or Class C well and may be reissued with new water sample results less than 30 (Jays old. Certificates are valid for one year for properties served by Class A or B wells cra public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professiona! engineer's work. 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En.q. Svc. Phone Address P.O. Box t02954~ AnchT AK 995'10 Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adcqua? [cst, ! attempt to provide a thorough, conscientious enginccring a~alysis of[he ~'stcm in accordance with MOA DHHS Guidelines &: Regulations. Thc reported results dcacfibc [he performance of [he s:,.,$tcm tmdcr [he conditions c~countcrcd at [he time of thc test, and scparalion dislunccs mc~sLm:d to ga(lily identifiable fcatarcs. Thc operational life of all ~*'clls and s~tic ~*stcms dclx'ad on thc local soil condition, ground v,'atcr Icvcls [hat may fluctuatc during thc)*car. and thc ',rater uscgc of thc family being sca'cd b.,,' thc ~'stcra. These conditions arc outside thc control of thc cvalualor oft. his s:,.'stcm. All s:,.~tcms eventually fail and satisfacto~,, test rcsul~s do not guaruntcc t'uturo pcrformuncc et' thc ~'stcm, nor do [he:,.' guaramcc [hat [hcrc are no hidden defects or cncroachments, PES can [hero£orc not provide aay,,~'arrunty for future pcrt'ormuncc nor give am,.' estimate of how long thc s.vstcm ~,ill continue to meet thc' operational requiremenU o£[hc ADEC or MOA DHHS. The content of this report is for thc sole benefit of thc m~=cr listed above. Am.' rcliunco upon or usc et' this report by un.',' other pcrson or pa~.' is not authorized nor will it confer am.* legal right x~'hatsoc','cr. 272-8218 4/612002 5. DHHS SIGNATURE I~ Approved for O Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory fixpiretio~ Date: X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Reissue Date: Legal Description: A. WELL DATA Well type Private Date completed ~ Total depth 82' ft Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650' www. ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Lot 42, Block 1 Tranquillit~ Heiqhte IfA, B, or C provide PWSlD # __ Sanitary seal YES Cased to 80+ ff FROM WELL LOG Date of test ' Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 3/22/200~2 B. SEPTIC/HOLDING TANK DATA I, JN KN0~-'VN ft UNKNOWN gp.m Tank Type/Material Date installed Cleanouts Date of pumping Parcel I.D.: 014-.151-22 Well Log NO Wires properly protected YES' Casing height (above ground) 24 in. AT INSPECTION 3/;~712002 29 12+ g.p.m Nitrate 0.394 mg/I Other bacteria 0 colonies/100 mi Collected by: Brian Wllle Arsenic , · mg/I gal Number of Compartments Depression over tan. k ~ High water alarm Tank size Foundation cleanout Pumper Water added in System type n/a Gravel below pipe ft Monitoring tube Depression over field __ For bedrooms gal. New depth Absorption rate >= If yes, give date C. ABSORPTION FIELD DATA Date installed Soi,I rating (gp.d./ftt or ft2/bdrm) Length ft Width ft Tota~ depth ft Effective absorption area ft2 Date of adequacy test .~ Results (PasS/Fail) Fluid depth in absorption field before test in Elapsed Time: rain Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) (Rev. 11~9) in. gp.d. Date installed. "Pump on" level at. Datum .. S?e ' ~ tn gat ..... N/.,'~ in"Pump off' level at Cycles tested. E. SEPARATION DISTANCES · in High water alarm level at. in Meets alan & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldlift station on lot NIA Absorption field on lot. NIA Public sewer main. 100+ Sewer/septic service line 35' On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout. 100+ Holding tank . 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING'TANK oN LOT TO: Building foundation NIA Water main Drainage Property line. Water service line. Wells on adjacent lots Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ' Property line NIA Water Service line Curtain drain. F. COMMENTS · ' Building foundation Surface water Wells on adjacent lots Water main. DHveway. parking/vehicle storage . *-Wires not installed. Seal Dluoaed Lot served b,, AWWU S~;'c;' r.,..,A _, ................ [,~1~ ~.~ _~-w -~-~ ....... .;-~Z~, · . uam u.w~. u~mlnqls unknown, no Ioq I certify that l have determined through field inspections and revfew of Municipa/ records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Eng,neer's Pr,nted Name ~teven R. Pannone, P E Dale of Payment ~. !~/0'~- Receipt Number, I~aO~0 ~:~. (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number ,j~. CT&E EnvimnmenbM SMvk)e~ in.. Aarow Pump & W~II Service L42, BI T, Inqm3~y 0 ~ D~e/Tlme 03/~2/2002 14:35 itKdved Ds~'l'lm c 0_.0...00. Nim~N O,394 0.200 ~o~ OOmL SMI{ 97~n FROM 9075615301 TO 3/22/2002 6:01 PM ?aoe 2 WATER'iVELL o TEb-f YLI~P REYOR'F ..~,.~.,,.,~ EAST 72 ND AVENUE N 90'00'00" W 63.10' j, 43 ~ 42 ~ 41 I 10' U~L. ESMT. d , S PLOT P~NS ~ LOT ~R~ ~~~, _~ ....... ~e. Professional Land Surve~rs ~ APRIL 10, 2002 2135 22036 Tom Fink, Mayor Municipality of .Anctxorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-8650 343-4744 October 7, 1992 Norma Jean Goins 3520 East 72 Avenue Anchorage, Alaska 99507-2820 Subject: Lot 42 Block 1 Tranquillity Heights Subdivision Permit ~SW910323, PID ~014-151-22 The subject permit, issued October 7, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of October 7, 1992. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, ~/ / enc: Copy of Permit PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW910323 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:GOINS NORMA JEAN OWNER ADDRESS:3520 E 72ND AVE ANCHORAGE, AK 99507 DATE ISSUED:10/07/91 EXPIRATION DATE:10/07/92 PARCEL ID:01415122 LEGAL DESCRIPTION: TRANQUILLITY HEIGHTS B 1 L 42L T12N, R3W, SEC 4, SM LOT SIZE: 8469 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY: DATE: DATE: ,?