HomeMy WebLinkAboutLAKE 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
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