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Home My WebLink AboutLAKE OTIS HEIGHTS BLK 1 LT 2Onsite File Lake Otis Heights Block 1 Lot 2 #014-102-31 Parcel I.D. Municipality of Anchorage ra? $U On -Site Water and Wastewater Program a ; (907) 343-7904 s , r Er Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 102-31 1. GENERAL INFORMATION Expiration Date: Puk�Z Complete legal description Lake Otis Heights Block 1_Lot 2 ~t i y f -- Location (site address) _?`_Stella Place, Anchorage, AK Current Property owner(s) Julian_& Briana Koerner, Day phone Mailing address Real Estate Agent 4374 Chatterton Ave Sm -Port -Orchard, WA, 98367 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ® Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: Received by: N Day phone TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community ❑ Public Sewer COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $< 0? _. .. _ Waiver Fee $ -- Date of Payment , _a _ _i _ 1 p 2� Date of Payment Receipt Number 0 �, o� L1 G Receipt Number COSA # 0 S _C. 2 1 f 7�2 1 _ Waiver #_ stance: 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 ARCTERRA CONSULTING, INC. _ _ Phone 696-6111 Address _._20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. UUFFUS ......... -_.__ Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system, Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future �•�. ®.� occupants or can ArcTerra guarantee that no unseen OF encroachments, deficiencies or discrepancies exist.. 6. DSD SIGNATURE 0 10 .� System #1 Approved for bedrooms.:' KENNETH M. r"_ -11s c= System #2 Approved for bedrooms. fb t /61�! 1:- AV n, 'stoti�` _-- Disapproved. Conditional approval for bedrooms, with the following st`ioQ&S: C��,.rr/ `J= ON-SITE ....p --- W ER AND v 6LBy _____.___ ___ Original Certificate Date: t_1f7 202i 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 10-10-12.doc Legal Description: COSA Checklist Lake Otis If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UNK Total depth 50* ft Cased to UNK ft E Sanitary seal is functioning correctly FOR Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 12/7/21 Static water level at beginning of test 33 ft Comments DATA Age of tank(s) Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5,.413SORPTION FIELD DATA Which sy tested (date installed) ❑ ALL standpipes nt per record drawing Total measured depth from gr ft (max) Measured depth to pipe invert from gra ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Block 1 Lot 2 Parcel ID: 014-102-31 _of Structure served by this system Well production at time of test 6.3 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes X No 01 Coliform bacteria is Negative Nitrate mg/L 0] Nitrate less than MRL (ND) Arsenic ug/L IEI Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 12/7/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years t t -slab _n material Comments: Adequacy test date Results []Pass For bedrooms Fluid depth prior to test in Water added gal New depth in apsed time min Final th in Absorption rate gpd Any rejuvenation treatment t 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' Property Line > 10' ❑ Yes if No NA ft [0 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No ft m Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building dations > 10' Yes if No ft Surface Water > 100' El Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if Building Foundation > 10' ❑ Yes if No ft Property Line > 10' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS required) If abso ' n field is under driveway comment below Wells on Adjace ts: Private Wells > 100' Community Wells > 200' G. ENGINEER'S CERTIFICATION 1 certify that / 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. COSA Checklist yellow sheet ❑ Yes if No ft if No ft * 49111 * �f ■ i xEa.NNE iD FUS At ♦!/�s'f CE AF •Z 1L �i� ♦�' -M(0)FESS� �+