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Home My WebLink AboutWINCHESTER HEIGHTS BLK 2 LT 11 Winchester Heights Block 2 Lot 11 #014 - 233 - 12 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. • • GE 9G •k Municipality of Anchorage On-Site Water and Wastewater Program 4 "®;til el ill '1 (907) 343-7904 SA E T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 014-233-12 Expiration Date: q ^ 1 7 1. GENERAL INFORMATION Complete legal description WINCHESTER HEIGHTS BLOCK 2, LOT 11 Location (site address) 3931 COVENTRY DRIVE,ANCHORAGE,AK 99507 Current Property owner(s) VERNON P. WRIGHTSON Day phone Mailing address 3931 COVENTRY DRIVE,ANCHORAGE,AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual El Individual Water Storage El Holding Tank ❑ Community Class Well El Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by: /��l v /- Date: / COSA to be released to the engineer,unless otheill uested by the engineer. COSA Fee $ - Waiver Fee $ Date of Payment ctn. Date of Payment Receipt Number 65Yia,) Receipt Number COSA# ,66C.1 7! o 7 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/1/17 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 r OF AL • encroachments,deficiencies or discrepancies exist. t 6. DSD SIGNATURE ; - 4 -�_a% System #1 Approved for bedrooms. # s�rw System #2 Approved for bedrooms. 4 a d # - r''F SSI00� iI Disapproved. w`-.4b--46-� Conditional approval for bedrooms, with the followi li5Gl itipp : ON-SITE WATFR AND �t FA WASTEWATER z --n PROUKAM By: - Original Certificate Date: r / 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 sre6>_iaiai2.doc 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: WINCHESTER HEIGHTS BLOCK 2, LOT 11 Parcel ID: 014-233-12 A. WELL DATA* Well type PRVT If A, B, or C provide PWSID# Well Log (YIN) N Date completed CIRCA 1955 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 63'+ ft. (Based on Measurements) Cased to 40+ ft. Casing height (above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test -- 5-26-2017 Static water level -- ft. 47 ft. Well production -- g.p.m. 4.2 _ g.p.m. WATER SAMPLE RESULTS: Coliform NElr colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L Date of sample: 5/26/2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER Tank Type/Material 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 ft? 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.) (YIN & 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 NA On adjacent lots NA Absorption field on lot NA On adjacent lots NA Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank NA Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS 'Well is located in basement I crawl space and sloped to sump pump basin. Nk,CS_ 61,OF ALS G. ENGINEER'S CERTIFICATION / 1 • "7 I certify that I have determined through field inspections and review of % _ !�� Ar Municipal records that the above systems are in conformance with MOA .. KENwo- - J , COSA guidelines in effect on this date. �:, 07++ / ' Engineer's Printed Name KENNETH M.DUFFUS f .s, ,o,?•‘' Date 6/1/17 `_�� COSA canary sheet 2-6-15.doc