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Home My WebLink AboutBELLA VISTA #1 LT 26BBella Vista #1 Lot 26B #013-051-52 • '� Municipality of Anchorage a On -Site Water and Wastewater Program '� m (907)343-7904 .rr. Certificate of On -Site Systems Approval gem -1 5 c Parcel I.D. 013-051-52 Expiration Date: S-17—/3 1. GENERAL INFORMATION Complete legal description Bella Vista #1 Lt2613 Location (site address) 7839 Lumbis Ave., Anchorage Ak. 99518 Current Property owner(s) Alberta & Brian Porterfield Revocable Living Trust Day phone Mailing address 7839 Lumbis Ave. #A, Anchorage Ak. 99518 Real Estate Agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer Fx1 WaiverNariance request "Received by: / i✓�- ! �✓t /f r Date: S e COSA to be released to thep4gdineer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number COSA#— /2 S 7 f 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 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 Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for _�_, bedrooms System #2 Approved for _ bedrooms Disapproved Date %–Sr-/ 6 Conditional approval for bedrooms, with the following stipulations: By: /it0 : Original Certificate Date: The Vunic!Kalit;/ oj,,86chorage 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 X Well Flow Advisory Other COSA blue sheet E 7., c If more than 1 septic system is on the lot: COSA Checklist # Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Bella Vista #1 U26B A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Date completed 9/24/73 Sanitary seal (YIN) Y Total depth il1 ft. Cased to 110 ft FROM WELL LOG Date of test 9/24/73 Static water level 40 ft. Well production 3 g.p.m. WATER SAMPLE RESULTS: Coliform Absent colonies/100 mL Nitrate '0.1 mg/L Arsenic 14.0 ug/L Date of sample: 12/5/12 Parcel ID: 013-051-52 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 17 in. AT INSPECTION 12/10/12 31 ft 6.3 9 - p.m - Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments_ Cleanouts (YIN) Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area flz 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 "Pump on" level at Datum _ Size in gallons in. "Pump off' level at Cycles tested I4•94 9-11:711 1 [a] k, 111] 61 Va1: [y *1 WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption Feld on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain F. COMMENTS Building foundation Surface water Wells on adjacent lots Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ 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 / .�U�6 COSA brown sheet 10.10.12.doc Absorption Surface water Water main Driveway, parking/vehicle storage in. Parcel I.D. 013-051-52 Municipality of Anchorage L On -Site Water and Wastewater Program (907) 343-7904 S4 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Bella Vista #1 Lt26B Expiration Date: J - -�,) �7 — Location (site address) 7839 Lumbis Ave., Anchorage Ak. 99518 Current Property owner(s) Alberta & Brian Porterfield Revocable Living Trust Day phone Mailing address 7839 Lumbis Ave. #A, Anchorage Ak. 99518 Real Estate Agent 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well it Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer Q WaiverNadance request for: Received by:Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 010 Date of PaymentC- Receipt Number COSA# C�SC-j1�tS10 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 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 Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE 1/ System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Date /27"L/?- Conditional approval for bedrooms, with the following stipulations: By: L. Original Certificate Date:.!;,) -a 7— 42 Theunicip li orage 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 f .. 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: Bella Vista #1 U26B A. WELL DATA Well type Private If A, B, or C provide PWS ID # Date completed 9/24/73 Sanitary seal (Y/N) Y Total depth ii1 ft. Cased to il0 ft FROM WELL LOG Date of test 9/24/73 Static water level 40 Well production 3 WATER SAMPLE RESULTS: ft. Coliform Neg colonies/100 mL Nitrate N� mg/L Arsenic 14.0 ug/L Date of sample: 12/5/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Foundation cl ut (Y/N) Date of pumping. C. ABSORPTION FIELD DATA Date installed Length _ Total depth of Compartments Depression over tank (Y/N) Pumper Parcel ID: 013-051-52 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 17 in. AT INSPECTION 12/10/12 31 ft 6.3 9 - p.m - Collected by: PIES Date installed Cleanouts(Y/N) High water alarm (Y/N) Soil rating (g.p.d./ft2 or ft2/bdrm) System type ft. Width ft Gravel below i e ft ft. Eff. absorption Date of adequacy test Fluid depth in absorpti before test Pp ftp Monitoring tube _ Depression over field Results (Pass/Fail) For bedrooms _ in. Water added gal. New depth in. Elapsed Time: l 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 gal ae� "Pump on" level at Pump off' level at_ Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation P ine Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain F. COMMENTS Building foundayti n_ Surface water Wells on adjacent lots Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ LO -T– -5"V&'Q -)6-f iALOCU v SPS &� a— G. ENGINEER'S CERTIFICATION t certify that / 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 1-2-4 COSA brown sheet 10-10-12.doc Absorption field Surface water Water main Driveway, parking/vehicle storage in. Municipality of Anchorage Community Development Department =2 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 # 121571 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 26B of Bella Vista #1 Subdivision. This inspection revealed an arsenic concentration of 14 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 us -d 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. r. IRW 1 N 89 .SBl WHANE A. HOLT: 1n1LS-69114 AGmMT9ORV (NDOOMfMSETTFWDM) aay�r�u 1 F6♦BJ/ tRTfNTMAi I IrtVErfAgIMN A il7F11Q11�i ll WYili1170F•i11L (Ol{dM�4a RIA V6fAXW NO.1 I AMRMMrACOft,MMMC;T.AL4WAAM WAT WILIRTrfE 191OPDCTYIl1fi�;Sd"JEE64ldD VD VIIORF ifiillPRS OCV r>�!'! 4S ll6lm. MRDATA Q"DMWF.AL%SKATM IST MY 99 a1WY xi'. HOLT LOW A Rvold-noot h lao.tO rdWra+R6ABrrI�IT' Jr ----.— _ .-,-.— -.-- s, 11 �a a�now to ;I.!o ° + ,`��. r OAJViltltr . ..:;., EAST 79TH AiE1NLE' = i . WHANE A. HOLT: 1n1LS-69114 AGmMT9ORV (NDOOMfMSETTFWDM) aay�r�u 1 F6♦BJ/ tRTfNTMAi I IrtVErfAgIMN A il7F11Q11�i ll WYili1170F•i11L (Ol{dM�4a RIA V6fAXW NO.1 I AMRMMrACOft,MMMC;T.AL4WAAM WAT WILIRTrfE 191OPDCTYIl1fi�;Sd"JEE64ldD VD VIIORF ifiillPRS OCV r>�!'! 4S ll6lm. MRDATA Q"DMWF.AL%SKATM IST MY 99 a1WY xi'. HOLT LOW A Rvold-noot h lao.tO APPLI( NT FILLS OUT UPPER HK ONLY Time Property Owner CJ & je y C_._ ) l �. r f v Phone Time / �! Zip Code Mailing Address YK5 A)?, 04 e Buyer f 2ALkA D '�r' Address Zip Code Date nn _ Lending Institution %/� 1 4/� � C �, u Phone / 7 ! 7 �, Address Zip Code Inspector Realty Co. & Agent Phone Address Zip Code n n C Legal Description za S PGP n � Street Location L1.kU Field Notes: Type of Residence TY F ANCHORAGE ❑ Single Family Multiple Family No. of Bedrooms Other e, 082 Water Supply (So A Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( ) DISAPPROVED Sewer Disposal ( ) CONDITIONAL APPROVAL' ❑ Individual Year Individual Installed: Public Utility When Connected to Public Utility: Holding Tank DATE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time f�Lc�' Time -i l_SL� f 2ALkA D '�r' Date Date nn _ Date Date Inspector Inspector Inspector Inspector n n C n Field Notes: TY F ANCHORAGE ENVIk e, 082 (So RECEIVED (q) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' -3 K DATE BY: Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72023 (3/82) SENT TO POSTMARKV (See other side) OR DATE STREET AND NO. P.O., STATE AND ZIP CODE OPTIONAL SERVICES FOR ADDITIONAL FEES RETURN 1. Shows to whom and date delivered ..... 15¢ RECEIPT With delivery to addressee only ............ 650 : 1972 Oma- 460-743 f SERVICES' 2. Shows to whom, date and where delivered - 35¢ With delivery to addressee only ............ 852 Affadavit Attached: DELIVER TO ADDRESSEE ONLY --- ------ 502 SPECIAL DELIVERY — — — (extra fee required) .................................... PS Form 3800 NO INSURANCE COVERAGE PROVIDED— Apr. 1971 (See other side) NOT FOR INTERNATIONAL MAIL - t GPO : 1972 Oma- 460-743 f f Affadavit Attached: ) Letter Attached: C ) � C Approved: . Date: Disapproved: � � Date: t-- Department Worksheet: eve -09P yo ze61 oar 11VW 1VNOIiVN831N1 803 ION T L61 =dV (ep!s =ay/o gas) 0301AOdd 30V83AOO 33NVHnSNI ON 'u=od Sd Q .................................... (pe=!nbe= eef owe)_ A8008 a IV103dS - -- POS .......................:........ ATNO 33SS3HOOV Ol__U31AI130 a i _ OSB """""" Aluo aassaippe 01 F.Jan!IaP 431M S301A83S $SE " posoellap aseyM pue step 'woyM of sMoyS :L' $S9 """""" Alua aassaippe 03 A=an!IaP 41!M 1,113038 OSx PUBAII!ap etep pee woyM 01 SMayS _I SOA S301A83S 1ND�LdO N8013tl S331 1VN011100q 3000-d!Z ONV 31VIS "O'd 'ON ONV 13381S l 31V0 80 { NUVW1SOd 01 1N3S (93elsod snld) 00£-11M C131AI1a33 803 1d1303H } GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 6 . Legal Description : Lot 26B, Bella Vista Subdivision Location: 7839 Lumbis, Anchorage, Alaska _,9 02 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility No. 8drms. Four Individual xxxx If Individual, number of dwellings presently served ? If Individual, depth of well ? 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation EQ -03' X1/74) Individual (on - site) _xxx REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 'l 1 . Type of I nspecti on : C M R 0 VA .xxxXxx FHA CO`JV 2. Property Owner: Gary Sodergren Mailing Address : 7839 Lumbis, Anchorage, AK Day Phone 3. Name of Buyer: Clayton & Danielle Carr Mailing Address: 3642 W. 88th #207, Anch. , AK Day Phone 243-7841^ _ 4. Name of Lending Institution: Coast Mortgage Company Mailing Address: P.O. Box 1200, Arich, AK P h o n e 279-0665 5. N a m e o f R e a l t o r o r A g e n t: Beth Mack or Rusty Harrington - Tanner Ma owan Realtors Mailing Address: 3766 Arctic Blvd., Anch. , AK Phone 274-2521 6 . Legal Description : Lot 26B, Bella Vista Subdivision Location: 7839 Lumbis, Anchorage, Alaska _,9 02 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility No. 8drms. Four Individual xxxx If Individual, number of dwellings presently served ? If Individual, depth of well ? 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation EQ -03' X1/74) Individual (on - site) _xxx July 11,, 1(a73 Larry Yaij,,jjj.-j Luw1jus Driv- A)icoord(ju, Aldsfild 99,i .') 2 Re: Lot Bella Vjsca subd. !)�dr :Ir. Yait.-Ilio: ()jI su;,)JCCi t'.,roperty iii f i I I t1i t j i 1, 111pruVod Uri ti 1 t I -Y".rvious suit an -j L;,io we -1 tj(j,,j L dOOVe c(Isil)(1 if; Oro 6 I If Y" this MaLter, c S 0 f f i C�, t�L.,ast, coi ac t,- i Si 1ic,,,, rLly, Ruuu r c Pratt. LliVIROic!L,4'TAL jp�uL �)HlCLR RLPIk,u tilclosvre GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received %/4-C, 17,3 Time of Inspection S"00 Date of Inspection2 ZIE Z' REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 10 1. Approval Requested By: 4,tA�_.,..0-c�a Address; 3 Phone:9,�Z j —D.3 /70 2. Property Owner: Phones 3. Legal Description: 4. Location: 5. Type of F Number of Bedrooms: owl 6. Well Data: A. Type B. Depth % C. Construction D. Bacterial Analysis 7. Sewage Disnosal System: A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Size 2. Material E. Disposal Field: Total Length of Lines 8. Distances: A. Well To: Septic TankAbsorption Area , Sewer Lines Nearest Lot line Other Contamination B. Foundation to Septic Tank Absorption Area C. Absorption Area to Nearest Lot Line Request for Approval Individual Sewer & Water Facil" 'es Fuge Two g. Comments: Approved Disapproved �; Date Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date