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HomeMy WebLinkAboutJO VON LT 4 Certificate of On -Site Systems Approval Parcel I.D. 014-131-35 Legal description JOVon Lot4 Site address 7511 Zurich St Current property owner(s) Pickering Expiration Date: 1-21-2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: BY: Original Certificate Date:10-21� This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE' li Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 014-131-35 Complete legal description Jo Von Lot 4 Location (site address) 7511 Zurich Street, Anchorage, AK Current property owner(s) Rodger Pickering Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ® Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ o Waiver Fee $ Date of Payment dp�' Date of Payment COSA # 65(_ _2a) Sn Waiver # COSA Application June 2022 Legal Description: Jo Von Lot 4 Parcel ID: 014-131-35 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.2 gpm Date drilled 1960 _Total depth 111+* ft Water storage tank volume - gallons Cased to 40+* ft Well disinfected for coliform test? ❑ Yes F,_/1 No W Sanitary seal is functioning correctly Z Coliform bacteria is Negative W Wires are properly protected Nitrate mg/L 0 Nitrate less than MRL (ND) Casing height (above ground) 21 in. Arsenic ug/L 0 Arsenic less than MRL (ND) Date of flow test for COSA 9/30/22 Collected by Areterra Consulting Static water level at beginning of test 53 ft. Date 9/30/22 Comments *Per previous COSA DATA Measured operating flue tic tank i Date of pumping ❑ Required maintenance completed, if AWWTS Comments: . BSORPTION FIELD DATA Which s m tested (date installed) ❑ ALL stand resent per record drawing Total measured depth fro rade ft (max) Measured depth to pipe invert fro rade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced __gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station_ m i ria+--_ . Comments: Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in 1 114 orption rate gpd FIELD US —POST RECOVERY Effective depth record drawings) Effective depth used in Effective depth remaining E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Building Foundation _ ' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft F,/1 Yes if No ft Neighboring Tank > 100' ✓0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Community We s — ❑ Yes if No ft Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' []Yes if No 68+/ -"ft ❑✓ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundation _ ' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft 'vate Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community We s — ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field is under driveway commen F. ENGINEER'S COMMENTS 'Per previous COSA well was installed in z1960, AWSU sewer connect permit indicates completion date of 8/30/84 G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Plione (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date z" h. LZ 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 AreTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 o -0 o QN o �• N R. 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C ` Lit 4 r O z ,O � D W So 00 0 a> m Z 1.J z m M 'a1 Art, r 0 (� D n v m D ; rD--ir-3 j D rI O O) C m az 5 ha my O 0 N m F* >> D ,^ D m '�e - sa�in�y�` 0 0� m F m O D z 0 M m z c m o m 0 D -a 0 -� m -a m > i z ❑ ❑ ❑ z ~ � D � 00 -{ m ° p m ti D n v m D ; rD--ir-3 j f O SUBDIVISION: 1 D ✓� I BLOCK: I LOT: 4- x-STRT50 (ox- STREET EET F- 0 I 0 w 41 cc S o v a J m w w U) INDICATE NORTH SEWER SERVICE LINE SKETCH SHOW LOCATION OF CONTROL MANHOLES/CLEANOUTS y � ;;IZE MAIN �_ TYPE MAIN: b. i.PCONNECT DEPTH AT MAIN 9/Z CONNECT DEPTH AT Prop. Line CONNECT LOCATION:._ O _ OF 5 _- 4.3 S -- COMMENTS: INSPECTED BY: 2 DATE: --I,, ti — - — - — - — — - — - --- — - — - — - — 9F I I- Q - = z a a cj; uj I I > Z Cl) rt D w r 3: M: cr < w W W > < 0' �, < In w u = w < < C� .1Z < 0 n LIJ -C 0 z ti Y w U, ti C3 0 F- C13 = ti ru 1+-= = w -zc uj w J 2 -i II W 0- m M 0 — co c uj a_ uj 19 > > F- C H < LJ w CG D 0 < -i m F I-- = cn . Ix H (n < N V F-GFn L'i -i cn QF -¢N UjC-9 F 0 F- IQ Z z w = L'iC) W -" rl >- 7 a a z z < >- W Li O > -1 S 0 :> F- :3: C-� 0 F - w 0 J LLJ CL uj -i Of CL w z 14 E: at: LU < >O W " W CZ wm 0 C) < dv F -i w w cr m = Ctt -, C) m LU F- ~ m CL F- = " uj 1 M O V In W H F - a - = X < 4'-" Q> F- UJ 1= I I- Q - = z a a cj; w 9 z U) Cl) I I- Q - = z a a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D~ws~on of Environmental Services On-S~te Services Section P O Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # ~L\ ~/-'~\~ ~.-~ I GENERAL INFORMATION Complete legal descr~pbon Lot 4; Jovon Subdrv~sron; Location (s~te address or d~rections) 7511 Zurrch Street Property owner _ Madmg address _ Lending agency_ Mailing address Agent Address Unless otherwise NUMBER OF BEDF 1-451-6199 TYPE OF WATER S Ind~v~L_i ?v, Commumty well Pubhc water NOTE If community well system, prowde written conhrmatlon from State ADEC attest- lng to the legahty and status of system TYPE OF WASTEWATER DISPOSAL. Individual on-s~te Holding tank Commumty on-s~te Pubhc sewer X× NOTE If commumty wastewater system, prowde written conhrmatlon from State ADEC attesting to the legahty and status of system 72 025 (Rev 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As cerbfled by my seal affixed hereto and as of the vahdatlon date shown below, I verify that my investigation of this Health Authority Approval apphcabon shows that the on-rote water supply and/orwastewater d~sposal system ~s safe, functional and adequate for the number of bedrooms and type of structure indicated herein I further verify that based on thelnformatlon obtained from the Mumclpahty of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system ~s in compliance w~th ali Mumc~pal and State codes, ordinances, and regulations m effect on the date of th~s ~nspect~on 5 ~, 5 ENGINEERING Name of Firm ----~Z(i34~2r¢~r gccp Rca~44o-,~O~. Phone Address Engineer's s~gnature Date. DHHS SIGNATURE ~ Approved for ~~bedrooms D~sapproved Cond~bonal approval for bedrooms, w~th the following sbpulatlons Additional Comments By The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cerbflcates based only upon the representations given in paragraph 5 above by an independent professional engl neer registered ~n the State of Alaska The DH HS does th is as a courtesy to purchasers of homes and their lending mstltu I~ons in order to ;atlsfy certain federal and state requirements Employees of DHHS do not ~'onduct inspections or analyze data before a certificate ~s ~ssued The Mumc~pahty of Anct~oraqe ~s not responsible for errors or omissions in the professional engineer's work Mumclpahty of Anchorage Department of Health & Human Serwces HEALTH AUTHORITY APPROVAL CHECKLIST A WELL DATA Log present (y/~ ~O Date completed U ~'~lfl~ Driller ~ Total depth ////~/ Cased to_ ~ ~ Cas,ng height_ Samtary seal ~N) ~S W,res properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~L /~__~ ~ ~ Stahc water level ~ r ~ ~ ~ Well flow gpm Septic/holding tank on lot Absorpbon field on lot _. ~ , On adjacent lots Pubhc sewer main ~ ~ ~ Pubhc sewer manhole/cleanout _. , Sewer sewlce ,,ne ~'~ Petro~m tank_ WATER SAMPLE RESULTS ~(~ ~ Cohform ~ Nltrate~O~ - ~~ Otherbacterla B. SEPTIC/HOLDING TANK DATA ~ ~ Date ~nstalled. ~ / ' ' Tank size ~ ~~(~ Compa~ments Cleanouts (Y/N) .... N) _ Depression (Y/N) High water alarm (Y/N) ~ ~arm tested (Y/N) Date of pumping SEPARATION DISTANC~EPTIC/HOLDiNG TANK TO Well(s) on lot., O~~ots. Foundation To property hne.., Absorpbon fleld~~ ~ ater mam/serwce hne. Sudace water/drainage 72 026 (Rev 7/91) Front ~ONTINUED ON BACK PAGE C LIFT STATION / . Date installed ]~/~f~- ~_ ~. Manufacturer Manhole/Access (Y/N) Size ~n gallons _ "um on" "Pump off" level at_ - Vent (Y/N) --- P P level High water alarm level Meets MOA electrical codes (Y/N) _ --- SEPARATION DISTANCE FROM LIFT STATION TO Well on lot ..... On adjacent lots ........... Surface water -~... ABSORPTION FIELD DATA Date installed W~dth t enqth - Total absorptton dtoa Depression over field (Y/N) Results (pass/fad) Peroxide troatment (past ~2 mollths) (Y/N) bEPAHAI ION [)IS F/ANCE FROM ABSORPq ION FIELD TO Well on lot _~J/4 _~ _On adjacent lots .... Sod rating ..... Systom type_ ~"_~<__ Gravel thickness I oral depth '~ Clednouts present (Y/N) - _~-~? of adequacy t( st _ _Prof)ertyh bodroolfl~ 1 o building foundation ~ __ To ex~stmg or abandoned system on lot Surface water ..... Driveway, p~le storaq~ area - (~U r[am dram ...... E ENGINEER'S CERTIFICATION date of I certify that I have checked, venfted, or conformed to all MOA and HAA gutdelmes m effect on the Signature -t ~ Hrl01f eers NdlRr~ -- -- -- HAA Fee $ ' Date of Paymem f~ecetpt Number Wmver Fee $ ..... Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX (907) 561-5301 ANALYSIS RESULTS for INVOICE t 59444 Chemlab Reft 92 5619 Sample ! 7 Matrix WATER Client Sample ID L4 JOVAN S/D Client Name S & S ENGINEERING PWSID UA Client Acer SNSENGP Collected OCT 8 92 ~ 18 O0 h~s E?Ot Received OCT 9 92 ~ 13 l0 hxs Req$ Analysis Completed OCT i2 92 Laboratory Super~so~ S~_T~N C EDE Send Reports to 1)S & S ENGI~ERING POS NONE RECEIVED Parameter Results Units Method Allowable Limits NITPaTE-N ND(O 10) m~/1 EPA 353 2/300 0 10 Sample ROUTINE SAMPLE COLLECTED BY J W Remarks I Tests Performed ' See Special Irmtructions Above UA=Unavailable ND- None Detected ** See Sample Remarks Above HA- Not Analyzed LT=Less Than, GT-Greatex Than Member of the SGS Group (Soc,~t~ G~n~rale de Surveillance) DEPT. OF ENVIRONMENTAL CONSERVATION / FACILITIES, CONSTRUCTION AND OPERATIONS ¢ BILL SHEFFIELD, GOVERNOR Telephone [90~ Address 274-2533 437 E. Street Suite 200 Anchorage, Alaska 99501 July 11, 1984 Ms. Ruth S. Eresman Assistant Administrator Anchorage Water & Wastewater Utilities 3000 Arctic Boulevard Anchorage, AK 99503 RE: Plans and Specifications Zurich LID #137 S82-12 Project #12750 Dear Ms. Eresman: Thank you for the opportunity to review the referenced documents. The project consists of some 1470 linear feet of 8 inch DIP with appur- tenant items (Including special manholes for well radius protect]on) and other features necessary to assure a properly functioning project. This project will provide sewer mains north from Lore Road ~n Bern Street, Zurich Street and O'Brlen Street. These plans and specifications are approved for matters of concern to this Department. Please forward cop]es of bid tabulations, bid award, signed construction contract and the notice to proceed with construction when avalliable. S1 ncerely, Gre~ ~gee~r~ Contruct~on Grants Engineer MM T/mmt CLOCK TIME .I ~0.34 Eagle Rivet Loop Roa~ LOCATION OF WELL (Legal Descrlptio~j DATE OF TEST. WELL DEPTH ~ F' ~~ CASING ~ DATE DRILLING ~MPLETED ~ ~ ZOF(EEN ~ STATIC WATER LEVEL (Top o! Casing) DEPTH TO DRAWDowNi WATER, IrT RECOVERy 0 1 20 ~5 30 35 5o ~0 15o ,Our) RECOVERY 0 ~0 DRILLER ~~ DATE~~.~~ PUMPING RATE, OpM REMARKs %?_ · ~ubse_quen_t Va riations