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HomeMy WebLinkAboutDORA #2 LT 17DORA Loi' 17 014-2§1 -34 U Z Z ! i 0 d o'd o o o o o o d o o o o o cD 0 o o o o o © F'ERMIT N0. DEF'FIRTME:NT L HEFI[...TH AN[:, ENYIRONMENTFIL .OTECTION 825 "L'" STF..'EET., FtNCHORRGE., R~::;. 264-4720 1.-I E: L b. F" E-_-.' ~". f'l I "T" ( 8:1.:2058 F1F'F'LICRN].' 'T'. STEWFtRT CONST. LOCFIT I ON LEGRL L:.t7 [."ORR 2 8420 WILLII4R CIRC:LE LOT SIZE 200000 S~;!UFIRE; FE:ET MINIMUM DIS'TRNCE BETWEEN 8 LqELL RND FIN¥ ON-SITE SEI.,.IRGE [:,IS;POSFtI_ S"r'S'I"EM ±00 FEET FOR FI PF.'.I',,,'FtTE WELL OR &50 TO 200 FEET FROM Ft PUBLIC FIELL [:..'EPEN[."ING UPON THE T"r'PE OF PUBLIC WELL.. MINIMUM DISTFINCE FF.:OM R PRIVRTE WELL. TO FI PRIVRTE SEWER LINE IS 25 FEE"[ FIN[) ].'0 Ft C:OMMLINIT'¢ SEWER LINE I~"; '75 FEE]''. WEL. L LOGS; F4RE RE6!UIRE[.', RND MLIST BE RETURNED TO THE DEF'FtRTMENT 1.4tTHIN Z'.':O OF THE WELL COMPLETION. O]"HER REC..!UIREMENTS MA"r' FIF'PL'¢. SPECIFICFtTIONS FIN[:, CONSTRUCTION DIFIGRRMS A',,,'FIILRBLE TO INSURE PROPER INSTI=ILLRTION. I CEF.:T I F'"r' THR'f' :1.: I BM FRMIL_IRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS FIS SET , ,," 'FIF';:-II~*T ' T. 2;TEWFtF.:T. C:ONST. , /~) V4. 0 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. 014-251-34 GENERAL INFORMATION Complete legal description Location (site address) Dora ~ 8551 Rosalind Street Anchorage, AK 99507 COSA Ct- (~.2~.~._... ~ \\ ~-"') 0 Expiration Date: //'~) - ~ ~ -//[ I Current Property owner(s) Alex and Mary Gerrard Mailing address 8551 Rosalind Street Anchorage, AK 99507 Lending agency Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address Uniess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Three (3) 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 vedfy 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DS.D SI~;NATURE Approved for ~2 Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 7/25/2011 bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other X Original Certificate Date: (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 Lot 17, Dora Subdivision No. 2 Parcel ID.' 014-251-34 IfA, B, or C provide PWSID # Well Log (Y/N) Sanitary seal (Y/N) Y Wires properly protected (WN) Cased t0116 ft. Casing height (above ground) FROM WELL LOG AT INSPECTION 4/29/81 7/22/2011 49.5 ft. 51 ff. 10 g.p.m.. 4.97 g.p.m. Legal Description: A. WELL DATA Well type Private Date completed 4/29/81 Total depth 116 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: 86.1 ug/I B, SEPTIC/HOLDING TANK DATA AWWU Sewer System Tank Type/Material Tank size ~ gal. Foundation cleanout (Y/N) Date of pumping C. ABSORPTION FIELD DATA Nitrate N/D mg/L Date of sample: 7/18/2011 Number of Compartments Depression over tank (Y/N) Pumper Date installed Length ft. Total depth ft. Date of adequacy test Fluid depth in absorption field before test Elapsed Time:__ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) Other bacteria o Collected by: a. Hippe Date installed Cleanouts (Y/N) High water alarm (Y/N) Y Y >18 .in. colonies/100 mL Soil rating (g.p.d./ft2 or ft=/bdrm) System type Width ft. Gravel below pipe ft. Eft. absorption area ft2 Monitoring tube Depression over field Results (Pass/Fail) __ For bedrooms in. Water added gal. New depth in. in. Absorption rate >= g.p.d. If yes, give date 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 Absorption field on lot. 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 On adjacent lots Public sewer manholelcleanout >1oo' Holding tank N/A Manure/animal excrete storage areas >lOO' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots Property line Water service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain Building foundation Surface water Wells on adjacent lots F. COMMENTS: Lot is Served by AWWU Sewer System. Absorption field Surface water Water main Driveway, parking/vehicle storage I certify that l 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· · ' N e Michael E Anderson, P.E Engineers Pnnted am · Date 7/2s/2011 COSA Fee $ C.~ ..-- Date of Payment -~ ) I II Receipt Number (-~"} ~ ~ ~ (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number 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 # 1 11270 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 17 of Dora #2 Subdivision. This inspection revealed an arsenic concentration of 86.1 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. SG,$ SGS Ref.# 1113228001 Client Name Anderson Engineering Printed Date/Time 07/21/2011 16:35 Project Name/# Dora #2 Lot 17 Collected Date/Time 07/18/2011 15:25 Client Sample ID Dora #2 Lot 17 Received Date/Time 07/18/2011 15:49 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 86.1 * 5.00 ug/L EP200.8 C (<10) 07/19/11 07/20/11 NRB Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (< 10) 07/19/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 07/18/11 DLC Total Colifom3 Negative I 100mL SM20 9223B A 07/18/11 DLC MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date March 10, 1987 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 17; Dora Subdivision #2 Location (address or directions) 8551 Rosaland Street (b) Applicant Name Dorothy Gra~./ Telephone: Home Applicant Address (c) Business Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution Northland Mortqa.qe Telephone Address Anchoraqe, Alas~/ATTENTION: T~Jwm~ (e) Real Estate Company and Agent Col~ Ba~ker//~{art~...~e Pejojoer Address 4105 T~do~ C~ ~v&, A~cho~&, ~ Telephone 56 I- 2488 ~O, LD (f) A4xa~the HAA to the following address: S ~ S ENGINEERING 17034 Eagle River Loo'.~ Road. Eagle River: Alaska 99577 TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Number of Bedrooms 3 Other Suite ~04 , , i ~,, ordered by Martel,~e Peppe~IRealtor WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public I'~ Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDII~ ,~ISPECTIONS, TESTS, FILE SEARCH, DX AND INFORMATI~rgN ,. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health' Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Telephone ~ ~ ~'4'"',~. ~"~ ~: 17034 Eagle River Loop Road No. 204 Address ~:.,,.,I,, ~wv.~. Alsek,,, qq~77 DHEP APPROVAL Approved for bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~..i i~uNtCIPAL%'I'Y OF AHCHO~LTH AUTHORITY APPROVAL (HAA) Et~tRO~N.~.^~' $~.R¥~CF-$ DIViSiOI;tHECKLIST264.4720- FEBRUARY 1984 MAR 1 4) !987 Legal Description: ?- R£C£ IV rr..g Well Classification ~. ~,, Well Log Present'N) Total Depth / )(_,--/ Cased to If A, B, C, D,E.C. Approved (Y/N) Date Completed ~ -~' - P~/ Yield / / ~ Depth of Grouting - Static Water Level ~_e Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: Pump Set At Sanitary Seal on Casing Depression Around Wellhead To Septic/Holding Tank on Lot,~Ul'~Z'/~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '~5- /~ Cleanout/Manhole /"~q:,~ ~ '/' D~/~--"~:. ; On Adjoining Lots ~"~/.~- ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by .~-d- <~ ~ ~ L~'&,~"~-i~.Z~..- ; Date Water Sample Test Results ~,,;>,.--..=--~-...~ ~ r'a.... ~7' Comments "'X..,.~L~.__ \/,,-'L,5 2l~'~-'J:~Off'~-~L-~J~ 3-/)-,~.~ B, SEPTIC/HOLDING TANK DATA Date Installed '-~ Stand pipes (Y/N) Depression over Tank (Y/N) , Size No. of Compartments Air-tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments --~ Foundation Cleanout (Y/N) Date Last Pumped  ; for rary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~_../...~x./.x_/~_~r ?~"~ '~ I"~U,~/C_ Type'of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date/of Last Adequacy Test /~//~T~°Perty Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERIN~ 17034 Eagle River ~eoP R~a~114a' 'J~llte- 3 ComoaD.v ....... Receipt No. / Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) · '~ _. . ' " r DATE RECEIVED ~ -" INSPECTION APPOINTMENTS 'l:iM E TIME .... TIME ' ' ' DATE DATE ~'~ t ~- ~' DATE / J - MUniCIPALITY OF ANCHORAGE MUNICIPALITY OF~ANCHO.~,. '.-.  825 LStr~t-Anohora~,Alaska99~l :NVIRO MLNTA ~ Telephone 264-4720 REQUEST ~OR ~P.ROVA~ O~ ~ND~V~DUA~ W~TER AND SE~~[~ DIRECTIONS: Complete all parts on page 1. Incomplete requ.~ will not be proceed. Please allow ten (10) days for processing, , MAILING ADDRESS ' ~9~o ~ 1/, ~a ~ . PROPERTY RESIDENT (If different fro~ .bo~} ' PHON~ 2.' 8~YER ~ ~ ~__ . . ~ PHONE ' 3, ~ENDING INSTITUTION '. ~ ~ ~ ~ -- _ -- I PHONE MAILING A~DRESS ' ' 4. ~A~YO./Ao~N~ I~"O~ ,- , , ., MAILING ADDRESS 5,~LEGAL DESCRIPTION .... STREET ~),~.TI 0 N 6. TYPEOF R~SlDENCE ' NUMBER O~EDROO~ ' ' 7. WAT?R:~UPPLY ,~ INDIVIDUAL* ~ [] COMMUNITY [] PUBLIC UTILITY 8. 'SEWAGE DISPOSAL SYSTEM SINGLE FAMILY MULTIPLE FAMILY [] NDIVI DUAL/ON-SITE** PUBLIC UTILITY ~ One [] Four [] Other ~l~ Two [] Five I/--I' Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ' 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified. 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: ' If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AR EA 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area [Sewer Line INearest Lot Line DATE ~'~APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)