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Home My WebLink AboutGALATEA ESTATES BLK 3 LT 9UM SIHl NO 1SI� aV3Hmw ON --AON (dui wniv�o a3wns~;v woau n3 3nuv-oa A•�s 1 N � ) lbt Ar'lun .00'OZ L &.00.£5.69 S Eg 0 � _ � � � (trld 83 g/du� — v " MSOMW s 0NUSoa „w0 oY x .oz c ! -X .0,00i O Z .vfa i ! cag ' ' I Z w86 X o_r x a� 8 Z Aricp .0� -OTOt = -t3 6 101 i o 'VU 'Nle 311R10;'�1l i ONIQ11f18 I �p Q3SO Dad ( V p i i ori Qi -- 'r' Wo Joow X A' l0t I — .0.0£ ! 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J N ,o •OO'OZ t A%,OO.£5.69 S A'S OoVs 1.0-9011 c A0018 '6 10- NOISIAIC]8nS S31` IS3 V31V-Jd0 96 t —ZL Parcel I.D. 014-103-14 p TCf BG'` Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s F E T Y Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Expiration Date: Galatea Estates Block 3 Lot 9 Location (site address) 7010 O'Brien St Current Property owner(s) John & Patricia Hoffman Day phone Mailing address 7010 O'Brien St. Anchorage, AK 99507 Real Estate Agent Edward Davidson 2. TYPE OF DWELLING: F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907-947-2311 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 WaiverNariance request for: Received by: Date: 411 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ _ Date of Payment�� 2 Date of Payment Receipt Number C22 L2 Receipt Number COSA # r�cj HCl d I o 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 Forge Engineering Phone 907-522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 1/08/18 4 �t of• t �} /*:49T •* / 6. DSD SIGNATURE System #1 Approved for bedrooms •• r gen.-r"n Schiller System #2 Approved for bedrooms �9� 1" *.„ c�1259.2 Disapproved 184 ��r`��?0�=55:�'�^''� Conditional approval for bedrooms, with the following stipulations: ON-SITE �'c :, WATER ANI -. o rpp WASTEWPtT 0: PROGRAM itg6NT SER By: Inti ` 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 blue sheet_i" c 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: Galatea Estates Block 3 Lot 9 Parcel ID: 014-103-14 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 8/7/03 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 82 ft. Cased to 82 ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 8/7/03 1/05/18 Static water level 36 ft. 17.1 ft Well production 12 g.p.m. 3.9 g.p.m. WATER SAMPLE RESULTS: Coliform hco colonies/100 mL Nitrate IID mg/L Arsenic 1. ID2.. ug/L Date of sample: I IyII E Collected by: Forge Eng. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Public Sewer 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 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 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 N/A Animal containment areas >50' Manure/animal excrete storage areas 100 SEPTIC/HOLDING TANK ON LOT TO: Building foundation N/A Property line N/A Absorption field N/A Water main N/A Water service line N/A Surface water N/A Wells on adjacent lots N/A ABSORPTION FIELD ON LOT TO: Property line N/A Building foundation N/A Water main N/A Water Service line N/A Surface water N/A Driveway, parking/vehicle storage N/A Curtain drain None Noted Wells on adjacent lots N/A F. COMMENTS G. ENGINEER'S CERTIFICATION ',��-NiNkk OF ACq�1Z1 I certify that I have determined through field inspections and .:�Q` ' , ' -.:9 � review of Municipal records that the above systems are in *• �Fi '*�ir, conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name Benjamin Schiller, PE • •• •��•,• .• 1/08/18 /j :• Ben Schiller i Date ( ..• C,� 2592 ....4%-.% COSA brown sheet 10-10-12.doc