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HomeMy WebLinkAboutNORTON PARK LT 2ANorton Park Lot 2A #016-151-61 r Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program j C' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING L.S. Parcel l.D._016—)51-GI COSA # NA06D12q Expiration Date: :7— 7 — O Ce 1. GENERAL INFORMATION Complete legal description Lot a¢. dor[on Pont, Location (site address) 170 w. kj( .* Current Propertyowner(s) L,ff Day phone Mailing address _Pl7 nox wm)l Qq Stl Lending agency Day phone Mailing address Real Estate Agent MtA 11 7arce-4 Day phone at ST 01 5 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 tille (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 verify that based on the information obtained from the Municipality of Anchorage riles 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 Address 203 W. ISIS` Engineers Printed Name 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Phone Ml"391(0 of Date u 12 10 Lo OFA( �11l 49T��.qS�9�t� // T ,To EliSPLIEKLAND: �r G� CE 2225 ��1► b/�r»ncS����� bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other By.�i / 1/7/, 6 -yl Original Certificate Date: qz 17-06 (Pe .Itm) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lok 19, YpAon Park SID Parcel ID: A. WELL DATA 1 Well type Pri vc `r Date completed 4K Total depth LOD-L"ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) y Cased to 4t) I r FROM WELL LOG UK u K ft. N K g.p.m. WATER SAMPLE RESULTS: Coliform —.(2—.(2mL Arsenic: UO mg/I B. SEPTICIHOLDING TANK DATA Tank Type/Material _ Tank size — gal. Nitrate ND mg/L Date of sample:5 o r. Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) �5 in. AT INSPECTION 12 0 9t3 ft. y g.p.m. Other bacteria _'9L colonies/100 mL Collected by: jars Date installed Number of Compartments — Cleanouts (Y/N) Foundation cleanout (Y/N) — Depression over tank (Y/N) — High water alarm (Y/N) Date of pumping C. ABSORPTION FIELD DATA Date installed — Pumper Soil rating (g.p.d./fe or fe/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/Faiq — 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 >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) — g.p.d. If yes, give date Fow, &%4eyk �or Appro✓at of Inlvict,k Sew" 4 We-._II/iilT(v D. LIFT STATION Date installed 'Pump on' level at = in. Datum Size in gallons "Pump off" level at in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tank/lift station on lot '— On adjacent lots Absorption field on lot — On adjacent lots — Public sewer main F SDI Public sewer manhole/cleanout + 100 Sewer /septic service line +ZS Holding tank Animal containment areas "' Manurelanimal excrete storage areas '— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line — Absorption field '— Water main '— Water service line — Surface water Wells on adjacent kris SEPARATION DISTANCE FROM 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 kris F. COMMENTS 1 L * t.r.11 S. Intltr) Dr;or o lot e>!) G. ENGINEER'S CERTIFICATION OF A'.4,.1 11, 1 certify that I have determined through held inspections and�; Co •' `- :12 1 review of Municipal records that the above systems are in / { : 4 TH conformance with MOA COSA guidelines in effect on this date. i........ . . Engineer's Printed Name Toh6c.. -Sourkl enA � �'.•7066 ! SFUFXLAP;D ill s . CE 2225 V:'r Date Apr;l 12_ , zooco COSA Fee $ 41* L�30 'UU 4 rfS -Cc Date of Payment�t 3 �O(o Receipt Number • �� (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number 04-14-06;14:20 ; ;907 561 5301 # 2/ 4 SGS Rer.9 1061645001 All Dates/filmes are Alaska Standard Time Client Name Tobben Spurkland P.E. Printed DAte/Time 04/132005 16:17 Project Name/# Norton Park Lot 2A Collected Datr/Plmc 04/052006 12:15 Client Semple M Norton Park Lot 2A Received Datell'Ime 04/052006 1234 htatrls Urinitjn); Water Teehplcal Director Stephen C. Ede PWSiD 0 Sample Remarks: Allowable Prep Analysis P-mtneur Results POL Units Method Container in umits Dort Date tail Metals by TCP/MS Ammic ND 5.00 ua EP200.8 C (o-10) 04/07/06 04/12/06 SCL waters Department Nitntc•N ND 0.100 Mierobielogy Laboratory Total Coliform 0 mWL EPA 3532 D (o-10) 04/05/06 ALR coV100mL SW209222D A (o-1) 04/0$/06 TLF n CERTIFICATE of SURVEY DOUR OF RiCORD ILL rsIl1 ET11P.J.l��` �NCtioXq(,g ,/,k�J� ur sten 1 Lsr•W ./rtIFF 1L.1 A* f•Iloelp d.sntl.d M•F•rtF Les L.r. wnry►d ►t / p •edw wF ..►w• .itw, ...J Mel L►.+w.wU sll.Nrd Ilww• J. eet •eer.e<L w odl•e.er w.►.•M. H.1 L.F+w.e.M/ •. .dl.r..l FMrrtF d...t eev..L M IM nrpTd ►nets.., eej dLlt Iter. •r. .. �►..• Ife./. AeessJ"lm W./ of slLw vi -r-1- es.e•.A w rl•Lu-•t-eFF M<.►t .s sloe.. L•nw. . re•sm..Ie,Ir... t I •.LOT '-LA... I , .�v° Wlvg- • I IA ..L„TLd7,r.>Qd4AWi7; 'p Q W '� g �.4 weLi. V ..LOT 25 M. OF 4C -hi tb s I I P. f 7P /n L /rCl. aR3La ` P I Pi T�Aa zeDW S 42 Its l! . IRA+ VIFK �• • • L po • CND• - LOT.a�, BLOCK IM I L.M. Ir.ss C.► M.e.e.et F.J. ® I•sss Cop Y«eeret. I.t,F.L-.- p I•" A►•, 5.1,P64— J40 a 30" A-&-. s-l—.pftj.2L .1—.F.d—s4e.30"A-&-.3.l—.FnJ.2L D 3ww M6 a3..L. Ut—N.J._ I RRC%DINO FRFGINR.A[•SXA asgulur SUNY F=IC,3C st LL sw�,-r MLM UNWIN & SCHESEN `°"" G401ADE C3 F.LLM/l.Mw°3 MUNICIPALITY OF ANCHORAGE AaL • '� DEPARTMENT OF HEALTH & HUMAN SERVICES MMA Division of Environmental Servicescam On -Site 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. # ° 6 ` HAA # 1. GENERAL INFORMATION Complete legal description Loi: 2A • Noncan Panfz Subdivision Location (site.address or directions) iv' 4e •tir,., Property owner N°'crr'an' J. Mailing address 'T70 w• Lending agency', - Mailing address Agent" 170 W. Klatt Road Roxanne, S.toWeA Day phone 349-7084 Qac Road Anchonaoe., AK 99515 Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest 72-025 (Rev. 1/91) Front MOA M21 O ,�... UA p 1n �( :> W CL _ z & NOTE: If community well system, provide written confirmation from State ADEC attest 72-025 (Rev. 1/91) Front MOA M21 5. 6. 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 of this Health Authority Approval application 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 Phone 17034 Eagle River Loop Road No. 204 Address Engineer's signature •30C- DHHS SIGNATURE __Approved .for .� Disapproved. Conditional approval for Additional Comments Date 1I / ; r `f r 0� ..� 1 ROBERt C. COWAN f �Q/ ��l `c�;•.� Cc - 8801 f�''s ��• Clew,, •••.,,..• n\ � ti - bedrooms. bedrooms, with the following stipulations: By: Date :;a 1IITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-4744 Health Authority Approval Checklist Legal Description: /0'r- Parcel 1. D.: C71 tO Y S`/ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/& N 0 Total depth /0 o Sanitary seal (6)/N) Y'el S Date of test Date completed -" / "i 7 S` Cased to 0 FROM WELL LOG U / K Static water level U1 u Well production WATER SAMPLE RESULTS: Coliform 0 V/� Date of sample: ID / 3o /9 5- B. B. SEPTIC/HOLDING TANK DATA Date installed Tank sir. Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area _ Date of adequacy test Nitrate _ Casing height (above ground) I / + Wires properly protected &N) Y � S AT INSPECTION l0/30/6iS- i yy g. p.nt. / g.p.m. nZ iu O J / Other bacteria O n o C" u Collected by: S & 5 ENGINEERING 17034 Eagle River Loop Road Nob2FA <� : ;Ile rover, Alaska 99577 c> a e Number of Compartments _ Cleanouts (Y" Depression (Y/N) High water Pumper Soil rating (g.p.d./ or fr'/bdrm) ravel thickness below pipe Monitoring Tube present(Y/N)_ Results (Pass/Fail) _ System type Total depth Depression over field (YM) For bedrooms Fluid depth in orption field before test (in.); Immediately after gal. water added (in.): Fluid th (ins.) Minutes later: Absorption rate = __ eroside treatment (past 12 months) (YIN) if yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) :i --"Pump on' "Pump off' level at* High water alarm level at* *Dat un Cycles teste E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /A ; On adjacent lots Absorption field oil lot _ /. ; On adjacent lots 1 o v Public sewer main / Public sewer manhole/cleanout d / Sewer /septic service lice `� S 4- Lift station v 1A U$LIL $ 51 wt, iL jM5T.4«j4 441d/L T,Q t°i �_3 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main/service line Surface water/drainage Wells or cent tots SEPARATION DISTANCE FROM ABSORPTION FIEL OT TO: Building foundation _ Water main/service line Surface water Driveway, parking/vchicle storage arca CujcLa drain _ Wells oil adjacent lots _ Property line F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal records that tins are in con/brmance with ild A IL= 1 guidel es in effect on this date. �" ""�� OF Al„ N ,, ,,........ 1 �e•S,' Q, Signature j1,, y �A e sy: �aQF; Engineer's Name c lC© a✓9i✓ —7 Date ROURr C. 'COWAN CE - 8801 r`411 • �J -{74i. HAA Fee $ ?2Q01 Waiver Fee $ Date of Payment H-62-75 Date of Pavment Receipt Number 3N Receipt Number Rev, 8/95 OSS: baa.wk.doc CT&E Environmental Services Inc. Laboratory Division rii�®®rrrarr®isirrroeo®®ror�®s-a®s®®®�r�som�®®s®® CT&E Ref.# 95.4864-1 Laboratory Analysis Report Matrix WATER Client Sample ID L2A NORTON PARK Client Name S & S ENGINEERING WORK Order 19308 Allowable Ext. Anal Ordered By R. COWAN Printed Date 11/01/95 Q 14:50 hrs. Project Name Collected Date 10/30/95 ® 09:15 hrs. Project# Received Date 10/30/95 ® 09:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Released Byy--�_--K�^_`_��,(' Sample Remarks: SAMPLE COLLECTED BY: BOB C. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------- Nitrate-N 0.10 U mg/L EPA 353.2 10. — ---- 10/30/95 CMR ------===__-=.====_no_====--------------- See Special Instructions Above UA - Unavailable *� See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D,= Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 4 'MW Aor aPfA $J a 0`1 yi Y �n/tF0 jau1.41 �. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received November 4, 1976 Time of Inspection M O ® a.m. Date of Inspection 11-5-76 Friday REQUEST FOR APPROVAL OF Pratt INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Alaska Bank of Commerce Mailing Address: Pouch 7-012 Phone: 279-5641 2. Property Owner: William H. Snethen Phone: 349-5352 Mailing Address: Star Route A Box 156A 3. Legal Description: Lot 2A Norton Park 4. Location: Corner of Klatt Road & Ellen Road 5. Type of facility to be inspected Single Family No. of bedrooms 3 6. Well Data: A. Type Individual B. Depth 100, C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed Public B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Absorption area Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines , EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rer t for Approval of Individual S Legal Description Lot 2A Norton Park Subdivision Comments Approved Disapproved r & Water Facilities 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 subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date MUNICIPALITY OF ANCHORAGE (*j DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 v U� REQUEST FOR APPROVAL OF \O. INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO�VA FHA CONY l 2. Property Owner: AkifiW Mailing Address:/9/u�'/fo�'T°° 9- Day Phone: - 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: ,5 /� C' i &z -C f p X'e. Mailing Address:f0'lD� �O>„� 9SiD Phone: 5. Name of Realtor or Agent: Mailing Address: Phone: J �1 � 6. Legal Description: /// Or ��/1 %/c' f i O��'J /`j�/�'/� /s �r al/1151Q k= / Location: ( llole �C C� / /C Fel �i�t1 ¢ 6L�'D✓ .Z'cx 7. Type of Facility to be Inspected �s Nry�E= / /J�li No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well )00/ 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation -5,opNe/Z / %' %-S 6n.T -S/fir'. 72-003(3/76) �o'