HomeMy WebLinkAboutHIDDEN ACRES LT 4 E2 618910 77
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Certificate of On-Site Systems Approva °` 6 9 L '
Parcel I.D. 012-242-19 Expiration Date: / 2 -1q_J 7
1. GENERAL INFORMATION
Complete legal description Hidden Acres Lot 4 E2
Location (site address) 3624 W. 78th Ave
Current Property owner(s) Opsahl Richard Living Trust Day phone
Mailing address 6260 West Tree Dr. Anchorage AK, 99507
Real Estate Agent Kevin Sigafoos Day phone 907-244-3212
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
El Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well . [ Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer CI
WaiverNariance request for: Distance:
Received by: 140-0.1601:14-4-M11-- Date: q//q/1-7
COSA to be released to the engineer,unless otherwise requested by the engineer.-
COSA Fee $ 5. Waiver Fee $
Date of Payment 9�j5�1�/1'//r' Date of Payment
Receipt Number O J- X Receipt Number
COSA# 10- 1?1u6.6 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 1399 W. 34th Ave. Suite 203
Engineer's Printed Name Benjamin Schiller Date 08!31!17
6. DSD SIGNATURE
System #1 Approved for bedrooms :• - ••••»•
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System #2 Approved for bedrooms `4t '• _ - .,$ (h•C' -1.1,/p5-•Disapproved �r
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Conditional approval for bedrooms, with the following stipulations:
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By: rtiOriginal Certificate Date: 9 r `17
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_E '•
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- Hidden Acres Lot 4 E2 Parcel ID: 012-242-19
A. WELL DATA
Well type Private If A. B, or C provide PWSID # Well Log (YIN) Y
Date completed 11/11/75 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 276 ft. Cased to unknown ft. Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 11/11/75 08/12/17
Static water level 200 ft 67 ft
Well production 4 g p.m. 0.66 g.p.m.
WATER SAMPLE RESULTS:
Coliform 01 colonies/100 mL Nitrate 1. mg/L
Arsenic 5.05 ug/L Date of sample. 08/31/17 Collected by: Forge Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (YIN) High water alarm (YIN)
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 On adjacent lots >100'
Absorption field on lot On adjacent lots >100'
Public sewer main '75' Public sewer manhole/cleanout >100'
Sewer/septic service line '25' Holding tank '75'
>50'
>100'
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION :„.j '• ,Q, •'.4s �
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I certify that I have determined through field inspections and d
review of Municipal records that the above systems are in - .i . y
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conformance with MOA COSA guidelines in effect on this date. . ; .....
Benjamin Schiller °k ' 14 '" '�''� ' ,
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Engineer's Printed Name � �; -1 1 o
Date 08/31/170�ol' E-la &eta
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COSA brown sheet 10-10-12.doc
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Municipality of Anchorage
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Building Safety Division 4 S 4 E r r
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems Approval (COSA) # OSC171406
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 4 E2 of Hidden Acres subdivision, the
well's productivity was determined to be .66 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3-bedroom residence is .31 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
STATE OF ALASKA 18588
DEPARTMENT OF NATURAL RESOURCES
1 DIVISION OF MINING, LAND&WATER
Alaska Hydrologic Survey
*$' s'
"'�. a w, WATER WELL LOG Revised 08/18/2016
Drilling Started: 1 1 Completed: 11 / 11 / 1975 Pump Install: / /
City/Borough Subdivision Block Lot Property Owner Name &Address
Anchorage HIDDEN ACRES L04 MIKE BATEMAN ,
Well location: Latitude Longitude
Meridian S Township 012N Range 004W Section 11 , NE 1/4 of SE 1/4 of NW 1/4 of NW 1/4
BOREHOLE DATA: (from ground surface) Drilling method:❑Air rotary,Dable toolfOther
Suggest T.M.Hanna's hydrogeologic classification system* Well use:❑Public supply,❑Domestic,❑Reinjection,❑Hydrofracking
https://mv.nowa.orq/NC Product?id=a 185000000BYub3AAD
Depth Commercial Observation/Monitoring Test/Exploratory, Cooling,
From To 0 Irrigation/Agriculture,❑Grounding,❑Recharge/Aquifer Storage,
unknown 0.0 1.0 ❑Heating,❑Geothermal Exploration,❑Other
topsoil 1.0 3.0 Fluids used:
sand 3.0 70.0 Depth of hole: 276 ft Casing stickup: ft
Casing type: Casing thickness: inches
heavy in pipe 70.0 80.0
Casing diameter: inches Casing depth: ft
sticky clay 80.0 160.0 Liner type: Depth: ft Diameter: inches
sand w/water 160.0 182.0 Note:
heavy sand 182.0 189.0 Well intake opening type:❑Open end,❑Open hole,❑Other
Screen type: , Screen mesh size:
clay, sand, sticky 189.0 198.0 Screen start: ft, Screen stop: ft, Perforated❑YesElNo
heavy sand 198.0 225.0 Perforation description: Perf from: ft, Perf
clay and gravel 225.0 275.0 to: ft, Pert from: ft, Perf to: ft
medium gravel, water 275.0 276.0 Gravel packedElYes❑No Gravel start: ft, Gravel stop: ft
Note:
Static water(from top of casing): 200 ft on / / Artesian well fl
Pumping level&yield: feet after hours at 4 gpm
Method of testing:
Development method: Duration:
. Recovery rate: gpm
Grout type: __ _ Volume
Depth: From ft, To ft
Include description or sketch of well location(include road names, Final pump intake depth: ft Model:
buildings,etc.): Pump size: hp Brand name:
Was well disinfected upon completion?Q Yes ❑No
Method of disinfection:
Was water quality tested?❑Yes ❑No
Water quality parameters tested:
Well driller name: WAYNE WESTBERG
Company name: M-W DRILLING INC
Mailing address: PO BOX 110378
, City: Anchorage State:AK Zip: 99511
Phone number: (907 ) 345 _ 4000
AS 41.08.020(b)(4)and AAC 11 AAC 93.140(a)require that a
copy of the well log be submitted to the Department of Natural Driller's signature:
Resources within 45 days of well completion.Well logs may Date: 1 I
be submitted using the online well log reporting system Anchorage Municipal Code 15.55.060(1)and North Pole Ordinance 13.32.030(D) require
available at. that a copy of this well log be submitted to the Development Services Department/City
https:/ldnr.alaska.00v/welts/ within 30 days of well completion.
City Permit Number:
OR email electronic well logs to Date of Issue: / /
dnr.water.reports@alaska.gov Parcel Identification Number: - -
'Guide for Using the Hydrogeologic Classification System for Logging
Water Well Boreholes by Thomas M.Hanna NGWA Press
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PLAT NO. P-277
HIDDEN ACRES SUBDIVISION
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AS —B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE
GASTALDI LAND PROPERTY DEPICTED ABOVE AND THAT NO
SURVEYING, LLC ENCROACHMENTS EXIST EXCEPT AS INDICATED. �,,611‘11114,
FT IS THE RESPONSIBILITY OF THE OWNER TO ♦♦'��'•�F.. 4. ♦♦
JEFF A GAS/Al-DI' R.LS. r 4
DLit/NINE THE EXISTENCE OF ANY EASEMENTS, + /.�:'� sif-
2000 E. DOWIJNG RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT a 03: TH v
ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDMSION PLAT. �•*• 49 •••.� * 1
PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA 11:6(••2 , r
GRI2 DATE HEREON BE USED FOR CONSTRUCTION OR FOR o ..Je@ary A.Gastaldl •• n -
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ESTA8IJSHING BOUNDARY OR FENCE LINES. 0 ' ' -eo91 •
SW2226 7/25/2017 . '^^ ''••.......•••'•4'` 1
ANCHORAGE RECORDING DISTRICT, ALASKA 4,_.,,,A ro•.....itQr*4�
F,y, JOB NO. NOTE: NO CORNERS SET THIS DATE S191/111111111-
17702
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