HomeMy WebLinkAboutCREST VIEW BLK B LT 43Crest View
Block B
Lot 43
#010- 232-10
RUSH
Mumclpahty of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904
Certificate of On-Site Systems Approval
Parcel I.D. 010-232-10 Expiration Date:
//-//-/¢
1. GENERAL INFORMATION
Complete legal description Crest View, Block B, Lot 43
Location (site address) 2202 W 45th Ave.
Current Property owner(s) Kathy Hardin
Mailing address 2202 W 45th Ave.
AUG 7 2014
Day phone
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: 6
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class __ We!! []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual []
Holding Tank []
Commun.ty []
Public Sewer []
Waiver/Variance
.Distance
Received
unless otherwise requested by the engineer.
Date:
COSA Fee $
Date of Payment
Receipt Number
COSA #
05E / q /3q/
Waiver Fee $
Da~ of Payment
Receipt Number
Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my~se&'l 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 Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
bedrooms
bedrooms
DSD SIGNATURE
~ System #1 Approved for _
System #2 Approved for __
Disapproved
Conditional approval for
Phone (907) 272-8218
Date 8/7/2014
~¢~.-. 0E-8149 .:~,~-~/~
bedrooms, with the following stipulations:
By:
The ~'c¢~/l~e 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.
ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
X
Nitrate Advisory
Arsenic Advisory
Other
X
COSAbluesheet_.r - .~ c
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: Crest View, Block B, Lot 43
A. WELL DATA
Well type Private ifA, B, or C provide PWSID #
Date completed t~'~--tlL-,UE~Ld.-~Sanitary seal (Y/N)%
Total depth 48 ft. Cased to 48 ft.
FRQM WELL LOG
ft.
g.p.m.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~-~'(.¢' colonies/100 mL
Arsenic ~, ;~ ug/L
Nitrate ,100 mg/L
Date ofsamp,e
Parcel ID: 010-232-10
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
8/4/2014
28 ft.
5.6+
g.p.m.
Collected by: ¢¢S
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date installed
Tank size __ gal. Number of Compartments__ ~
Foundation cleanout (Y/N) ~ High water alarm (Y/N)
~ Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type ~
Length ft. Width ft. Gra~ ft.
Total depth ft. Eft. absorption area .ft2 Mon~.__ Depression over field __ _
Date of adequacy test __ ~~)__. __ For __ bedrooms
Fluid depth in absorb___ in. W ta er added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
~eatment (past I2 me.) (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
Cycles tested
'wa er alarm level at
Meets alarm & circuit requirements?
in,
E. SEPARATION DISTANCES
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+
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
100+
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
Property line Absorption field
Water servi ' Surface water
ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line Surface water ~-~Driveway, parking/vehicle storage
C~J~~--~Wells on adjacent lots
F. 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.
Engineer's Printed Name Steven R. Pannone
Date 8/7/2014
COSA brown sheet_10-10-12.doc
Mnmcipality 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
w~wv.muni.org/onsite
(907) 343~7904
Arsenic Advisory
Certificate of On-Site Systems Approval # 141391
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block B, Lot 43
of Crest View Subdivision. This inspection revealed an arsenic
concentration of 29.2 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.
DocuSign Envelope ID: 036FFADA-92F5-46F1-9FF5-96CA77E452C0
The IocaSon of tha structure(s}
as shown on this reoord drawir~8
LEGEND
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