HomeMy WebLinkAboutHERBERT LT 2DHerbert
Lot 20
#010-115-02
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 010 115-02 -
1. GENERAL INFORMATION
Complete legal description HERBERT LOT 2b
Location (site address) 3706 Wilson
Current property owner(s)
Mailing address
Real estate agent
HOUt
2. TYPE OF DWELLING:
Fxj Single Family (w/ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Expiration Date:
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
❑
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑X
Waiver request tor: N O N E
9 Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Z eO
Date of Payment 5-11312- Z
Receipt Number CLl13 p
COSA # O SG 2212 D�
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal -affixed hereto -and -as of the validation date-shownbelow,-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 C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 5/6/22
q) -
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6. DSD SIGNATURE / • • . • • . ......
System #1 Approved for bedrooms ' ' ' ' . • • • ' 3
• CHARLES G BALZARINI
System #2 Approved for bedrooms r�� �F�u'.. CE -13854 ..&
Disapproved �11 TF�FOP ' • •SSION • ' P�11�—'"
ll ROFE
Conditional approval for bedrooms, with the following stipulations:
By U�)U_k �WXI 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 Checklist blue sheet
WATER AND
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By U�)U_k �WXI 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 Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade 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
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
Herbert Lot 2 D 010 115 02
11 1
5.1
UNK NA
UNK
+45
ND
22.1
12 C&M Engineering
4/28/22
14
5/2/22
Well may have been drilled c.1950.
COSA Checklist yellow sheet
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 ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No ft
Absorption Field > 5’ 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
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
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
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I certify that I 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.
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5/10/22
✔
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✔
✔
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Arsenic levels consistent with previous results. The sewer line passes near the well.
Recommend pumping and camera-ing the sewer line prior to occupying the home. Install
watertight caps. Consider encasement of pipe adjacent to well.
✔
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Arsenic Advisory
Certificate of On‐Site Systems Approval # OSC221209
Subdivision: Herbert, Lot: 2D
A water sample revealed an arsenic concentration of 22.1 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Information on arsenic is available from the On‐Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343‐7904.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
1
Carroll, Rebecca M.
From:CHARLES Balzarini <cgbalzarini@gmail.com>
Sent:Tuesday, May 24, 2022 9:58 AM
To:Carroll, Rebecca M.
Subject:Re: HERBERT LT 2D
Follow Up Flag:Follow up
Flag Status:Flagged
[EXTERNAL EMAIL]
Yes, well has a functioning seal.
The sewer CO inside the crawl space is capped, but it’s cobbled on.
On Tue, May 24, 2022 at 9:56 AM Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov> wrote:
Charles,
I’m looking at the resubmittal for the Herbert L2D COSA. Under Engineer’s Comments, you state “Install watertight
caps.” Is this in reference to the private sewer line cleanout(s)?
Becca Carroll
Onsite Water and Wastewater
Municipality of Anchorage
343-7908
From: eplans‐noreply@anchorageak.gov <eplans‐noreply@anchorageak.gov>
Sent: Tuesday, May 24, 2022 9:29 AM
To: Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov>
Subject: Onsite Well and Septic Department Review cycle #2 Assignment for OSC221209
Onsite Well and Septic Department Review cycle #2 Assignment
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Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 010-115-02
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA # i O
ExpirationDate: ,,2 .-7- //
Lot 2D, Herbert Subdivision
3706 Wilson Street Anchorage, AK
Current Property owner(s) Regina E. Herbert
Mailing address 2370 Kasmir Court Austell, GA 30106
Day phone
Lending agency
Day phone
Mailing address
Retal E'§t~te.~Ag,ent
Mailing Addr~.s
Unless;othen~',~se re~lbested, COSA will be held by DSD for pickup.
NUMBER OF'BEDROOMS: Two (2)
Day phone
TYPE OF.WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Pdnted Name Michael E. Anderson, P.E.
DSD SIGNATURE
'~"'~ Approved for
Disapproved.
Date 6/20/2011
't 'm~S..........?~ ~
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: 8 - ~- 7-~///
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Herbert Subdivision, Lot 2D
A. WELL DATA
IfA, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Well type Private
Date completed 1950+
Total depth >131 ft.
Cased to >40 ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: 25.7 ug/I
B. SEPTIC/HOLDING TANK DATA
Parcel ID: 010-115-02
g.p.m.
Nitrate .193 mg/L
Date of sample: 6/9/11
AWVVU Sewer System
Well Log (Y/N) N
Number of Compartments
Depression over tank (Y/N)
Pumper
Tank Type/Material
Tank size ~ gal.
Foundation cleanout (Y/N) ~
Date of pumping
C, ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth ft.
Date of adequacy test
Wires properly protected (Y/N)
Soil rating (g.p.d./ft2 or ft2/bdrm) ~
Width ft.
Eft. absorption area ft2 Monitoring tube
Results (Pass/Fail) __
in. Water added
Casing height (above ground) __
Fluid depth in absorption field before test
Elapsed Time: ~ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (YIN & type)
ATINSPECTION
6/17/2011
21.8 ft.
4.7 g.p.m.
Collected by: MEA
Date installed
Cleanouts (Y/N)..
High water alarm (Y/N)
Y
>12 in.
System type
Gravel below pipe ft.
Depression over field ~
For bedrooms
~ gal. New depth in.
in. Absorption rate >= g.p.d.
If yes, give date
Do
LIFT STATION
Date installed
"Pump on" level at~
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at~
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A
Absorption field on lot N/A
Public sewer main >75'
Sewer/septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >1oo'
On adjacent lots >1oo'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
>100'
>100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
N/A Property line N/A
Building foundation
Water main N/A
Wells on adjacent lots
Water service line N/A
N/A
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line N/A
Water Service line N/A
Curtain drain None Noted
Building foundation
Surface water N/A
Wells on adjacent lots
N/A
F. COMMENTS: Lot is Sewed by AWWU Sewer Main.
Absorption field
Surface water
N/A
N/A
N/A
Water main N/A
Driveway, parking/vehicle storage N/A
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 6/20/2011
COSA Fee $
Date of Payment
Receipt Number
lqo"
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 11105)
Municipality of Anchorage
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Arsenic Advisory
Certificate of On-Site Systems Approval # 111208
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
2D of Herbert Subdivision. This inspection revealed an arsenic
concentration of 25.7 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On-Site Water and Wastewater Program
website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
.......... SGS
SGS ReL# 1 112381001
Client Name Anderson Engineering Printed Date/Time 06/14/2011 8:01
Project Name/# Lot 2D Herbert Collected Date/Time 06/09/2011 10:45
Client Sample ID Lot 2D tterbert Received Date/Time 06/09/2011 11:10
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 25.7 * 5.00 ug/L EP200.8 C (<10) 06/10/11 06/10/11 NRB
Waters Department
Total Nitrate/Nitrite-N 0.193 0.100 mg/L SM20 4500NO3-F B (<10) 06/09/11 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 06/09/11 DLC
Total Coliform Negative I 100mL SM20 9223B A 06/09/11 DLC
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UNDER NO CIRCUMSTANCES SHOULD AN AS–BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONS181UTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY,
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
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IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
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UNDER NO CIRCUMSTANCES SHOULD AN AS–BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONS181UTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY,
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
LOT "WY SURVEY TYPE SYMBOLS
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PLOT PLAN ... As–Btwt . _ . LOT SURVEY ... TOPOMAPNY --`� 00 ASSUMED ELEV. IE-3t—k METAL FENCE LC1 L,+� W000 DECK
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON. THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICATION
PLAN
QA'®�
OF a��
PLOT
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hme fo.ma Q rtaeDNud allal the lot "mere
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b,aefedgo aM ovilm", all &" NNane hme bas,
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FOUNDATION AS -BUILT
••
t Raberl E Jols,e. Jr. hr'.by aMDy that I
ha•+ pateneee an An-Buft arwy d the
mW am the
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haven
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nonrAmanle &WUrAm
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FINAL STRUCTURE AS–BUILT®gig
Rata.rt It Jn hervby a Iyj Wel 1
• •, ,: • ,� 4
4 .IUnf,
he" pmfmrma A• -Dull n y of ,b.
all
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true awooUner,',H M•t Urdew
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ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN, FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED_
ALL DISTANCES ARE RECORD UNLESS OTHERVVISQ NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
cele: lit _A300RAGE, ALASKA 99500
Roo. Lot S.F, Rec. Piot File No.
ate sarieyed: 06/09/11 Drawn er• REJ Chocked 9WL
ate Drawn. 06/13/11 Gr'd`SW1729 "''0' 11-155
HERBERT LOT 2D
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
I ran a camera 45' down the well at 3706 Wilson Street and did not find any
holes/cracks in the casing or leaking around the pitless.
Beau Maxim