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Home My WebLink AboutHILL LT 2Hill Lot 2 #017-112-39 Mark Begich Mayor DeveloPment ~rvices Department Building Safety bivision On-Site Water & Wastewater Peogram 4700 Elmore Road P.O. Box Z96650 Anchorage, AK 99507 www,muni.era/onsit¢ (907) ~53-7904 Pump Installation Log Well Drilling Permit Number: SW P~arcel Identification Number: (~lO.ll ~ '~.~ Legal Description Pump [nst~llation Date: Puml~ lnta ~k~ Depth.BelOw Top of Well Casing: ~5 feet Pump. Mangfacturerrs Name: ~~~ Model: Pump ~ize ~ bp Date of Issue: Property~Owner Name & Address: Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pifless Adapter Installer: Well Disinfected Upon Completion? ~es [] No Method of Disinfection: Comments: Pump Installer Name: ANCHORAGE WELL & PUMP SERV. 330 EAST 76TM AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall pmx~i~-a pump installation log to the DSD within 30 days of pump installation. 1897011 • • •_ Municipality of Anchors eFEB 2 VA * � 8V " - On-Site Water and Wastewater Progra . w 4.-ti I i ~ (907)343-7904 zc*h SAFETY 0168L9 Certificate of On-Site Systems Approval Parcel I.D. 010-113-45 Expiration Date: Sr 2_1 rl g 1. GENERAL INFORMATION Complete legal description Hill Lot 2 Location (site address) 1100 Wilshire Ave • Current Property owner(s) Even R. & Julie N. Evanson Day phone Mailing address 1603 Twining Dr Anchorage AK 99504 Real Estate Agent Mark Mandigo Day phone 223-8422 2. TYPE OF DWELLING: 0 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 0 Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 WaiverNariance request for: Distance: Received by: 0,I/1 o-RA,C4i Date: 2,4J//g? COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 51‘.0 Waiver Fee $ Date of Payment al 3Ir$ Date of Payment Receipt Number 0 /32,5a o Receipt Number COSA# 051.310q40 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 PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 2/ 8/18 4O ALA *5:Ivo 711 6. DSD SIGNATURE System #1 Approved for `r bedrooms •• f Rema n Schiller . System#2 Approved for bedrooms ��l�;s��: a�tq 2� •;;44`-.� Disapproved l \ `\,'NNIS Conditional approval for bedrooms, with the following stipulations: q� •\\1YOF `C' ON-SITE 59. •. WATER AND 51 tart WASTEWA I ER z "po PROGRAM! 0- F4 tSERV\C By ( �^ Original Certificate Date: 2 —2-1 I e 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: Hill Lot 2 Parcel ID:010-113-45 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log(Y/N) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth '63 ft. Cased to >40 ft. Casing height(above ground) 36 in. FROM WELL LOG AT INSPECTION Date of test Unavailable 2/04/18 Static water level ft. 42.2 ft. Well production g.p.m. 6.1 g.p.m. WATER SAMPLE RESULTS: Coliform Nec1 colonies/100 mL Nitrate ND mg/L Arsenic 0.5149 ug/L Date of sample: 2/2/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Public Sewer 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 N/A 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 Animal containment areas > Manure/animal excrete storage areas 50' >100' 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 *Well depth information taken from pump report. **Casing verified by camera to 40'. G. ENGINEER'S CERTIFICATION . Cq�I�, I certify that I have determined through field inspections and "4Y •• A �9 review of Municipal records that the above systems are in n,� �GV • 7 •conformance with MOA COSA guidelines in effect on this date. f. Engineer's Printed Name Benjamin Schiller, PE •, • 2/09/18 �', Bola4 Schilk*r :a Date �+ , •. C 12,592 .•ti Afr .140 xv ''4.w Ess. • .� COSA brown sheet 10-10-12.doc WILSHIRE AVENUE \ — _ .- N 89'58'05"E 50.03' . , • •: .•• •• ... . 10' T&E EASEMENT ' Lot 2. : ••. . 6,748 s.f. - GRAVEL.. WIRE FENCE co PARKING. ••N CHAIN—LINK FENCE : - 3.3'x3.5' • •PORCH • o dKIIIIINEiBIE®9111 o, i, al 4 WELL Lot 1 6.8' "- MN 0 Unsubdivided W 36.6' = N 0 m O In 0' 2 STORY 4.Z O '. I TRI—PLEX 00 • 4.4' 1.9' O co Z iD 10'4 °' ° 15'9 �CHAIN—LINK FENCE H1112.-- 10.3 0.3:�IIIIIillllllllll � 7.2'x6.6' COVERED DECK 15' SEWER EASEMENT N 8.8'x4.5' DECK 07 S 8956 00"W 50.00' / WOODEN FENCE Lot 3 / Lot 4 / / NOTE: DUE TO SNOW AND ICE COVER, THE LOCATION OF THE GRAVEL PARKING IS APPROXIMATE PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 1729 Project No. 18-035/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone 4oQ00000 (907) 522-4625 Fax o 0 F A L 0N0 Professional Land Surveyors kenOlangsurvey.com o ,9 jonathanOlangsurvey.com S Q nn I hereby certify that I have surveyed the following described property: Qo��Q' i\ 32- LOT 2, HILL SUBDIVISION (PLAT No. 83-456) i *•: 49TH �� . *OOH Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed Q .Q O KENNETH N o premises and that there are no roadways, transmission lines or other visible �, easements on said property except as indicated hereon. oo s� - '�!,(��4Q� . oO� 4p '�Fo ••.LS— 202.••' c. o Dated this the ,L' ' Day of i---41).-'0'''I , at Anchorage, Alaska ,o ''••-••• NO Go 400Ro SSIONA\-�., It is the responsibility of the owner to determine the existence of any easements, D• 4' 1 •• covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963