No preview available
HomeMy WebLinkAboutUS SURVEY 3043 LT 11 NE4 T10N R2E SEC 18US Survery 3043 Lot 11 NE4 #075 - 092 - 29 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 075-092-29 1. GENERAL INFORMATION Complete legal description US Survey 3043 Lot 11 NE4 COSA# hiOL4IDn� Expiration Date: #3 '7 - O Location (site address) 114 Telemark Way, Girdwood, AK • Current Property owner(s) Michael & Faye K Montoya Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1284 8th St., Los Osos, CA 93402 Day phone Day phone Sam Daniel/ Glaser City Realty PO Box 550 Girdwood, Alaska 99587 Day phone 783-1910 Unless otherwise requested, COSA 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 ❑ ❑ ❑ ❑ 0 Individual Holding Tank 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 served 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 to 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. 4. 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 Watkins Engineering, Inc. Address PO Box 110443, Anchorage, AK 99511 Engineer's Printed Name Cindy W. Ellis 5. DSD SIGNATURE ✓ Approved for .2. bedrooms. Disapproved. Phone (907) 349-1851 Date 12- r -c17 Conditional approval for bedrooms, with the following s `CI kkl NesTYl• • e res L J ON-SITE .: t) ` ' WAIENAND • m= WASTEWATER . PROGRAM : tel•.. .. ` `, Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By: ), (Rev tvos) by,/ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 0:. 7-07 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O.Box 198850 Anchorage, AK 99519-6850 www.munLorglonslte (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description; USS 3043 Lot 11 NE4 A. WELL DATA Well type Private K A, B, or C provide PWSID B Date completed 1977 Sanitary seal (YM) Yes Total depth 155 ft. Cased to 155 ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Conform 0 colonies/100 mL Nitrate <0.1 mg1L Arsenic: 40.005 mg/I Date of sample: 9/5/07 B. SEPTIC/HOLDING TANK DATA Ta Tank size gat. Foundation cleanout(Y/N) Date of pumping C. ABSORPTION FIELD DMA Date mala Length of Compartments Parcel ID: 075-092-29 Well Log (YM) No Wires properly protected (YlN) Yes Casing height (above ground) 21 in. AT INSPECTION 91512007 53 ft. g.p.m. Depression over Pumper t Other bacteria 1 colonies/100 mL Collected by: Rocky Trainor Date installed Cleanouts (YIN) High water alarm (Y/N) S00 rating (g.p.dJlt2 or ft'/bdrm) System type ft. Gravel below pipe Total depth ft Eff. ebsorpnon area Date of adequacy test ft. Monitoring tube _ Depression over field Results (Pass/Fa For _ bedrooms Fluid depth in absorption field before test in. Water added New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. UFT STATION Date install - • Size in gallons Manhole/Access (YIN) "Pump on' level at _ in. 'Pump off' leve High water slam level at Datum Cycles tested Meets alarm & E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAifi station on lot NA Absorption field on lot NA Public sewer main 110+ On adjacent lots NA in. On adjacent lots NA Public sewer manhole/cleanout 100'+ Sewer /septic service line 301+ Holding tank NA Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �ittOROrty line' Water main Water service line Wells on adjacent lots TION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line uilding foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Absorption field Surface water Curtain drain Wells on adjacent lots F. COMMENTS: O. ENGINEER'S CERTIFICATION 1 certify that I 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. Engineer's Printed Name Cindy W. Blis Date 12/04/07 COSA Fee $ 7 30 Date of Payment /210570 /- Receipt Number /002g/1 (FW. 11105) Waiver Fee $ Date of Payment Receipt Number SEP -14-e007 02:28P FROM: TO:3491934 P.1 Pump Installation Log mane eielelmeik Rd. 1.-ctws3c4 50-w► D :c 1 /o7 ABOVE GROUND CASSIG NAYS:. OA1E: ACAIVAM Pitless Adapter Manufacturer's Name: %//t Places Adapter Installer: n //1. MP PUTTP( Su lw+e rs'. hte E MAKE A c -r ri o 4-J r ISM 1 13- SO 31f;vL SEIlAI. t R.Np Mott DROP TIM Type 64:1 v • sm. COMFr,ics, GoocL 11 PD.O csac: TWO "Pa *vied f t- lass, cttc>atx: vsts P -3a Amp. Cr • WATER TANTO TTP. 1410/ 1.19-0 fats WELL CAC Sr. CASED HOLE Aon BOAC SLAJCWRE: bp. Aim OPER NDIC nom 7 Ota TTp. oI To t7 onot To — 5{*e 1 I 545 To CONSENTS well was disinfected upon completion. method: calcium hypochlorite. • ��oaoZ N 0 at tei :a .', e0 b. CI `t4. P ©COG" 0 3 z• w g o W 3 .cy;-'�k N ro/ \ \\a J 0 0 • M S N.< N to b W d r < CO 1- 0 cc 4 1.- Y .5 co ccz z cck { cL z z ti O C.) W K 0 a I0 N O N O z W z J 01 0) A Y 2 J 0 O n N J N n h n 0 h O G at N z 4. N O b n N J W 8 O b b N 8 'D J W Q N O z 1 J J 0 2 J 0 W sc F - •U cn __I cc at_ =o< 0 Oz( fl` -. Q 0 e � Or Zap WI Fe rNQ • °Via - Q IL O W .L; 1°C O 4P' E: m 01 oa fic (0, ow =caw bw i OZ06 JC< Mtinicipality olAnchorage epartm.ent'o_f Health and Human 'Soh,.ices Building Safety Division 1 On -Site Water.and Wastewater Program = • 4700 South Bragaw Street -' P O; BoX 196650, Anchorage; AI<,99519-650 w.ci.a wwnchorage; ak us ' (907) 343-7904 `CERTIFICATE OF:HA EALTH UTHORITY APPROVgL •••••:(..6R'A'.SINGLE FAMILY. DWELLING t; Parcel I.D:.0 '75` '0•`f �= i • • -HAA# :Npl 4004 " Expiration Date`• 1. GENERAL INFORMATION i;= .. Complete legal description -Lot 11A, USS 3043, NE4,•T10N Rat S18 Location (Site address ordirections)iAlveska Highway,1st Left past Rulein Road Current Property owner(s) - Angela & Perry Mollan • ' Day phone 745-1364 ;Mailing address ' P.O. Box 211, Mile =7-Alveska Highway, `Girdwood,99587 Lending agency ": Day phone • Mailing address • Real Estate Agent Day phone Mailing Address •s Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ® _ Individual Water Storage ; ❑ , Community Class Well 0 Public Water System 0 1 • TYPE OF WASTEWATER DISPOSAL: Individual Onsite ❑ Individual Holding tank 9 Community On-site . Public Sewer IRI ;FtrI 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 properties served by a private.orClass C well and may be reissued with new water sample results less than 30 days old. 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. (Rev. IMO) „:,r 5. STATEMENTOF INSPECTION BY:ENGINEER ±y;; As certified by my seal affixed hereto and as of the validation'date show9below,1 verify thalmy investigation based on' procedures outlined in the Health. AuthorityApproval Guidelines for this Health Authority'Approval application showsithat!the on-site water supply and/or wastewater disposal system' is'info; .functional land adequate for the number of bedrooms and type of'structure indicated herein. t further,venfy 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 was tewaterdisposal system is In compliance With -ail applicable Municipal and State codes,'ordinances;and regulations in effect at the time of installation Name of Firm Pannone Erin. Svc: Address'P.O. Boz 102954, Anch; AK 99510. Engineer's Printed Name Steven R: Pannone, P.E Date %`•311212001 =` Engineers Comments In conducting an adequaq fist, I attempt to provide a thorough, conscientious Q4,*!*t!!�1 cnengineeringanalysis of the systeni'in accordance siith MOADHHS Guidelines &.'Regulations The ;c.".•': OFta • reported results describe the performance of the system under thc conditions encountered at the time of the ♦��Q` i'•, test, and separation distances measured to readily identifiablcfcatures. The operatwrul lift of all wells and i GJ r ,,•� septic systems depend on die 1oca1 soil condition; ground water levels' that ria) puetuatc dunn,; the year .• and the water usage of thc twilit);beingserved by the S stcni. These conditionsthe control of,. the evaluator of this 5)stem: All systems eventually fail and satisfactory. test results do not guarantee : , ' future performance of the systcrn, nor do 'they guarantee that therdare no hidden defects or encroachincnts • PES can therefore not provide any warranty for future performance nor give any estimate of how long the '' j (41 system Will continue to meet the operational requirements of the ADEC or MOA DIIIIS. The content of , •♦fit this report is for the sold benefit of the ollncr listed abet a Art) reliance upon or use of this report by any • othcr person or party is not authorized nor will it confer any legal right whatsoever? 6: DHHS SIGNATURE Steven R.. Pannone; /ha NO CE 8149 O(O3 r'Z `4 Approved for I bedrooms vt a �▪ tttiuttfrrriii�� Disapproved \vwt ��(Y OF q�yCii�� _ ' Conditional• approval for bedrooms with the following stip4 's .' 1 '. .�y� •'I , -,-eJ •; ONSITE', c-^ . -.Z WATFR AND •' mom Additional Comments' • WASTEWATER PROGRAM Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: do�� W. Expiration Date: (o - o 1 (Rev. 1199) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 3- / S-0 / Reissue Date: • iv unicipaiity of Anchorage Department of Health and Human Services 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 Legal Description: Lot 11A USS 3043. NE4. T1ON. R2E, S10 Parcel I.D.: Q 7S O q a - at) A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Well Log N Date completed _ Sanitary seal YES Wires properly protected YES Total depth UNKNOWN ft Cased to 40+ ft Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION 3/3/2001 Date of test Static water level ft 53 ft Well production g.p.m 4.7 g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate 0.5u , mg/I Other bacteria 0 colonies/100 ml Date of sample: 3/4/2001 Collected by: Steven R. Pannone. P.E. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Public Sewer System Date installed Tank size gal Number of Compartments Cleanouts Foundation cleanout Depression over tank _ High water alarm _ Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Length ft Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type Width ft Gravel below pipe ft Total depth _ ft Effective absorption area 1t2 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 (Rev. 11/99) n 1 ICT CTr1,TION Date installed Size in gallons 'Pump on level at _ in"Pump off" level at _ Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ManhnlelArraec in High water alarm level at _ in Meets alarm & circuit requirements? 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 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 50' Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation N/A Property tine Absorption field Water main Water service line Surface water Drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain F. COMMENTS Building foundation Surface water Wells on adjacent lots Water main Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION t certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. RE. Date 3-12-01 � . 49S"_ ■ • i 1 in %Steven P. Pannone. �•Pannon e ; ai•-• I, No. C 8149.7 ` q b• ,i.%•• 'i:%' HAA Fee $ 30 O •QC) Date of Payment 3- / 7-n / Receipt Number /7 Cr (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number