Loading...
HomeMy WebLinkAboutBRENNER LT 2Brenner Lot 2 #075-061-83 Mark Begich Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 vwwVnunl orq/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Legal Description 13RENNER L. -z Property Owner Name & Address: L Mai Mr FICE PETEesE") 138 I3Rt&NEie ci'eclC eieb wood / /Q K 94587 Pump Installation Date: l9. -I? ^/41 Pump Intake Depth Below Top of Well Casing: /I 0 feet Pump Manufacturer's Name: /4y 71c DoNIL P Pump Model: /4101 SO It 3/i -'7 v /2. Pump Size %/ _ hp Pitless Adapter Burial Depth: /0 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: / Well Disinfected Upon Completion? es ❑ No Method of Disinfection: CLOP hc eaters Comments: s Pump Installer Name: Anchorage Pump & Well Service 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW950126 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:MEYER MELANIE OWNER ADDRESS:601 EAST 74TH AVENUE #B ANCHORAGE, ALASKA 99518 PARCEL ID:07506183 LEGAL DESCRIPTION: BRENNER LT 2 LOT SIZE: 13500 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/20/95 EXPIRATION DATE: 6/20/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: d DATE: DATE: 6--2a-as Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 20, 1995 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 2 Brenner Subdivision Waiver Request #WR950024, PID #075-061-83 Dear Mr. Moore: Your request for waiver of the required 75 foot separation to a public sewer main and/or 100 foot separation to a public sewer manhole has been approved. The approved separation(s) are 77 feet from the well to the sewer cleanout. This waiver approval applies to the existing well and public sewer manhole only. Any future upgrade will require all separation distances be met or another approval from this department. Sincerely, -1?"--zz Daniel J. Roth Civil Engineer On-site Services DJR.ljm MUNICIPALITY OF ANCHORAU, Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#h \P cC, ;e; - A PID# 075-061-83 HA# Permit #j\1 Date Received: June 12, 1995 Legal Description: Lot 2 Brenner Subdivision Engineer: Ted Moore, P.E., Flattop Technical Services 14530 Echo Street, Anchorage, Alaska 99516 Applicant: Melanie Meyer Waiver Requested: Private well to public sewer cleanout to 77 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for. above: SEE 1l/-9-( f/ 9 Date: 6 -- 2v_ ?5 By: Q ( C7/ Name of Reviewer Rec #: 00975/452 Amount: $ 920.00 Date Paid: June 12, 1995 LOT 3 /.33./"7/ // 69' /9' a Of- C_.,EA/ ; //x.10 (83 -. 75) / �G)1 /r/()1 / LOT ,rGv ((1/ I1 IS thr, rrspot rihility of the owner or ruildor, prior to construction, to verify propcwed f)uildint,l rtrra<la rcic+five to finish�'rl aro<tP and utility con_ nrz(lions and In deforn,infa fly! o:islence .,f tiny cov-i oats, cc:vr:nenrts, or rc"trielionl whiril dry not nl-.lwnr ott Ihcr lied ctilr(livisinn Hot Lot, Block !._!I,.e>(_ner L5c-Jtz /V/s/ot Anchorage Recording District, Alaska LOT SURVEY CERTIFICATION 1 hereby certify that I hove surveyed the property shown and described hereon, and that the Improvements situated thereon are within the prop- erly lines and do not overlap or encroach on od lucent property and that no improvements on adjacent property overlap or encroach on the premises In Question and that there are no roadways, utility Ilnes,,or other visible easements on said property except as indicated hereon. \O r, Easements of record other than those shown on the plot of record are not shown hereon unless otherwise noted. LEGEND Q!) Brass or Aluminum capped monument recovered O Iron pipe and/or rebar recovered 0 2 x 2 hub 61 tack recovered • 5/8 t x 30" rebar set this survey Li5'/S OF v&4T/CA( L7?.. -/M /927 N.G. 5. /972 9t : on A v it 9' LS -11922`` 9� Scale b,Date Ref.4.F. B. No. i ) �� ,� Prepared by: RL.BUTTON Registered Land Surveyor (907)279-6200 .5/9 W Eighth Ave. Anchorage Alaska 9950/ Property of: Mortes 77T/E..- M -VV DRILLING, Inc. P.O. Box 10-378 • 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner RON LEVINE Use of Well DnmPst-i r Location (address of: Township, Range, Section, if known; or distance main road Lot 2 Brenner Sub Size of casing h" Depth of Hole 1 'i 5' feet Cased to 1 11. 1 n feet Static water level 24 ft (abcfut* (below) land surface. Finish of well (check one) open end ( XXX ) ; Screen ( ) ; Perforated ( ) . //�� Describe screen or perforation /"7A Well pumping test at 5 gallons per (HMI (minute) for 1 hours with 100% a[tc of drawdown from static level. Date of completion November 13, 1983 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness nTO 9 2 TO 4 4 TO 12 12 TO 21 21 TO 78 78 TO 82 82 TO 130 130 TO 135 TO TO TO TO TO TO TO CnGing stickup Organics Gravel with silt & rl a Gravpl with nrr _ rnbhl p Gravel with silt Gravel with silt (damp) Silt with gravel Waterbearin_g gravel i LSA t:..�.. RECEIV n�lunir.iu=zi�ty 1,\f1r_ho gage Dept, Nenith & Homan Services NWWA Certified Contrart.T Certificate No's. 814 ez 973 1 — CUSTOMER ASSESSMENTS Main Line Extension Have Been Levied El To Be Levied Comments Owner Staff UMBER'cx'_. parr. •r ENVIRONMENTAL CONSERVATION / nom,on.: awn 274-2533 Addme: 437 E Street Suite 200 Anchorage AK 99501 Arctic Ingineers Inc. 1306 W. 36th Avenue Aaakorags, Alaska 99303 Dear Sirs Subjects Brenner SID (Oirdvood) Sewer Improvements (8421 -DA -136) We hove reviewed the plant and specifications for the subject project. the project to hereby approved for construction for the items with which this Dsp rtta*t ie concerned. This letter constitutes the permit required by A.B. 46.03.720(6) for approval of sewerage systesu. Sincerely. Wfi/iE?tF(7/.te"s'r FL. or 2 ofi'Fitfs'E,Swop/ LJ,5/04,, r v/t? q u i ,i irA1 D E lti (15 04) 2 kThvER RYqu 5-r F0Y1 Pl?!vrirF= w LI ro Pr-tr.3ric C/-f.gao r or 771'447 L 14/E 09714 1(E rx i, 64C) 1- r AI E/( t_ e, v o u r / 4' L E s 7f0A- r/- S r" n f T Ii / c T C/J /,{i j"/f6' S ur+.0 /? //q4. THE /',-//,vf Rtvlrw /9M/ ,9PPi? v t,, �rJ c _" (-04, fir i 7//> d I 4( C DM PLI1HE'/ / d1 t E ✓'T, nF / 9173 L NFA, T11r SuB f ,2 r / U U .5" P F_ C / �. Tw 6 � v 5r� r1 f a �� S >'k � c �I �� A, 7 -lc c r-! ds I c�, u � ' � 6 %' �' ,9 t/NG coN,r, t ' EO cN.d.9T-CT- StI-<ry LlA,F Ix, Lt- fiI) N0T- F ers7'; 00 A/ w / rw rfrt 4 CIG S r /,t +A 5S 77,,A,/ S 77 ` -moi fir`? %'-iris?F_ /s 49 /i1 0.9-p P/ Tc i r C 4? i / re:/ (sulef,9-CrE) 8 kr-1-1-Eta SELL WE C'LtfiN Oi T, r /-t i 4 1,4-. 14- Pi`s T P6TE r161 - CP < 1- C/•4, 7C'f $ r? Fn. cA4rA/79-rrcyt- OF EA,T Fra'aA-I to.-r1no r/(E wEL.L, 1& ELL }/7 Tit tr-151.c /t. cem,,Esr/ov if 13, reFr S", L r s 6ivi,iel,s fi-/? F pte/v/9-r'r2 rt-T.E t I -u R-. rr-i ORift105-1 , FA.c&K•/T a lir Iia Ft r ofiER 15 Z 4 FF6r /ev,prCLt/FeN f /5 Co i F/I,& P. It F L iia 6.c a 7- 11-16"1-17A..- ph-EP. `r(,/f /A_- phEFP, /1/WME c'ttr Y,t5ief r7 -e /4- rF r? a 4,1r,' / /e G{ -OLP if /9/? b5: s' e PE. 4'- P 5. OF / . P [. C. 5, p k/, 6, Tel'r s; R, ?, 1'f TI/? 77T" 13 O ' - ' /v' /� !_ _ x /70 2o 5.0/i. 50HeritYi AJ I -TE f )4 I 6 I?fi- ?,-- 77 21' b81- C,AJCL tt /CSN 6 f?161-4/T 1-71/VEfr ./ 4.6 2,3 2. C. FLATTOP TTOP TECH-INICAL SERVICES CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE T. MOORE, P.E. PH: (907) 345-1355 June 12, 1995 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 MUNICIPALITY OF ANCHUkrcit ENVIRONMENTAL SERVICES DIVISION ,'U'N 12 1995 RECEIVED By means of this letter we are requesting issuance of a separation distance waiver for Lot 2, of Brenner S/D in Girdwood. The requested waiver would reduce the required separation distance from 100 feet to 77 feet between a private well and a public sewer cleanout, thereby allowing a permit to be issued for the existing well. A site plan, copy of the sewer line as -built drawing and copy of the driller's log for the well are enclosed for your review. According to the driller's log, the well was completed in November of 1983, shortly after the required separation distance between a private well and a public sewer cleanout was increased from 50 to 100 feet. The well has a total depth of 135 feet and a yield of 5 gpm, with the aquifer being located first encountered at 130 feet. The static water level is reported to be at 24 feet. The topography in the area slopes down towards the south at approximately 5%, meaning that effluent from a leaking sewer would not flow directly towards the well. As can be seen from the well log, the material overlying the aquifer is predominantly silt, which could be expected to have a percolation rate of slower than 50 minutes per inch. The fact that the static water level is at 24 feet indicates that the aquifer is confined and artesian, virtually guaranteeing that no contamination originating in the vicinity of the well could make its way into the aquifer being drawn upon by the well. Because the well does not have a pump or electricity available, it was not feasible to obtain a water sample at this time. Of course, water samples will be collected and a flow test conducted. at such time as a HAA certificate is requested. All that is being requested at the present time is the separation distance waiver and issuance of the well permit (for which an application has already been filed by the present owner of the property), so that he can obtain his building permit. The following is a breakdown of how waiver analysis points could be assigned using the 1985 "Separation Distance Waiver Guidelines for SCRO". '�= ' /17 ki ,j )('G"' Category Points Water table (130 below ground level to aquifer) 7.15 Soil Sorption (predominantly silt) 3.5 Per neability (predominantly soil with perc rate > 50 min./inch) 3.0 Water table gradient (assume -5%) 2.0 Horizontal separation (77 feet) 2.08 Total 17.7 Based on this waiver point analysis it appears that the requested waiver can be granted. without concern over potential contamination of the well by wastewater associated with the location of the sewer cleanout. This conclusion agrees with our opinion based on field observation and analysis. In light of the fact that we are already well into the construction season, we are requesting that you expedite issuance of the waiver and well permit so as not to cause undue delay in issuance of Mr. Tingle's building permit. Thank you for your attention to this request, and please feel free to give me a call if you have any questions. Sincerely, E,..f 1144, Ted Moore, P.E. cc: Marcus Tingle 601 E. 74th Ave., Suite B Anchorage, AK 99518 SEWER CLEANOUT 8" DIA. SEWER-- LINE ��� / �� QOv N/ 8" DIA SEWER— LINE 5% -\ \ \9 \e9Fti ti 90 N16 LOT 3 (VACANT) c" PROPOSED HOUSE `, --EXISTING WELL EXISTING WELL HOUSE LOT 1 N // / LOT 2 10% ./ / / / / / / 1x0,000 . MOORL: LOT 2, BRENNER SID GIRDWOOD, ALASKA EXISTING WELL SITE PLAN FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 1 INCH = 50 FEET DRAWN BY TFM JUNE, 1995 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. M -VV DRILLING, Inc. P.O. Box 10-378 • 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner RON . '•VTNE Use of Well mmnpRr i c Location (address of: Township, Range, Section, if known; or distance main road Lot 2 Brenner St'b- Size of casing 6" Depth of Holes 135 ' feet Cased to 1 3 3 ..1 R feet Static water level 74 ft (above (below) land surface. Finish of well (check one) open end ( XXX Screen ( ); Perforated ( Describe screen or perforatio ); Well pumping test at 5 gallons per NW) (minute) for 1 __hours with. 1S1Q. xtc of drawdown from static level. Date of completion November 13, 1983 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ❑TO 7 2 TO 4 4TO 12 12 TO 21 2110 78 78 TO 82 82 TO 130 130 TO 135 TO TO TO TO TO TO TO CAGin8 stickup Organics Gravel with sj It & rl ay Gravp1 with nrr_ rnhhle Gravel with silt Gravel with silt (damp) Silt with gravel Waterbearing grav- NWWA Certified Contrantnr -Certificate No's. 814 & 973 1 --CUSTOMER AVMFIJIH VAS -JA -1V 44 .1 r 1.1 Ll N \ J•1 O'll r 141 1 1 .1 I I 1. U) .J J rn U J J ✓ Q O 1.)1, 1 r) JI 111 , 1 .! IJ Vi ,A `1 .1 .l' f J 1 1.. 1u fJ • 11 1 I) 14 ) 11111 I I •I z W J u ) NAT TONAL V) Ir1 0 z 0 1' U U) z 0 1,1 r vl 1 U1 '1 141> 11. (1 1.) W V. Q U VI 1. U1 11. t) IJ 111 IL 111 V. l,) i c1 .1 (2 V 41 _ ) FY ft r 1 .1 1 t1 .1 1.) 1,;41.J .i J 0 V) ;l 11 (1 LJ 14-1 V) to 1'1 1.1 in 0 0 C' C a a Q, (J 0 ;r () tr n: 1.) n- o, Q v Q GENERAL MUNICIPALITY OF TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑ Development Services Department On -Site Water & Wastewater Section Parcel I.D. 075-061483 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 1 f d " 2©ZO Complete legal description Brenner, Lot 2 Location (site address) 138 Brenner Circle Anchorage, AK Current property owner(s) Lawrence Petersen & Sue Liebner Day phone (907) 223-9921 Mailing address P.O.Box 565, Girdwood, AK 99587 Real estate agent 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four (4) Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑■ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 210 CAVI o Date of Payment. 1?QfZo Receipt Number ��8222J� COSA# 0-GLW 3G 3 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/28/2020 ®�P�� OF • AV ®�®m 4-9 th 6. DSD SIGNATURE A"""'"""' ""' ® I2V l C ® ........................ ... .. . _< System #1 Approved for bedrooms MICHAEL E. ANDERSON ; O m No. CE -4381 =a System #2 Approved for bedrooms ®o®'F�;'•.,.f/28i20 •,,.••'���'® Disapproved �� ®mE®m ES tee®®®®® Conditional approval for bedrooms, with the following stipulations: J= ON -ITP WATER AND m Original Certificate Date: R ^ ( —2-0 r?c 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 Checklist blue sheet COSA Checklist Legal Description: Brenner, Lot 2 Parcel ID: 075-061-83 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Al Well`log is filed with Onsite (or attached) Date drilled 11/13/83 Total depth 135 ft Cased to 133.10 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 7/27/20 Static water level at beginning of test 26 ft. Comments B. TANK DATA Lot served by public sewer Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 3.5 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 7/27/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material Comments: Lot served by public sewer. Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES Lot served by public sewer. From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes Septic Tank/Lift Station on Lot > 100' NA Surface Water > 100' Community Sewer Manhole/Cleanout > 100' 77 Yes if No ft 1`7 Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' iD Yes if No _ Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑✓ Yes if No _ Neighboring Absorption Fields > 100' Community Wells > 200' ❑ Yes if No _ Animal Containment > 50' ✓❑ Yes if No 0 Yes if No ft _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓D Yes if No ft E] Yes if No _ From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Lot served by public Sewer. Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No _ Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No _ Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No _ Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Lot served by public sewer. Building Foundation > 10' EJ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS Lot is served by public sewer system. G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet OF 14;h A T- 49 th `. MICHAEL E. ANDERSON •s i IJ 8O No. CE -4,381 ffi ' ffi �� j1�Da,,• 7/28/20, X444 � FESS\' �' ft ft ft ft ft ft ft ft ft ft A O m O Tm N 23 0 0 Z m 0 I v �� 1y a O O �O > I 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.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING coSA # 1 00667 Parcel I.D. 075-08183 1. GENERAL INFORMATION Complete legal description LOT 2; BRENNER SID Expiration Date: 6-2C-10 Location (site address) 138 BRENNER CIRCLE, GIRDWOOD AK. Current Property owner(s) MARCUS A. TINGLE Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. BOX 101832, ANCHORAGE AK. 99510 Day phone 440-8966 Day phone BRYAN EPLEY W/REMAX OF ALYESKA P.O. BOX 1029, GIRDWOOD AK. 99587 Day phone 223-9799 Unless otherwise requested, COSA Will be herby DSO for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:__ Individual Well Individual Water Storage Community Class Well Public Water System 4 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer 0 0 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 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 S b S ENGINEERING Address 15861 S. BIRCHWOOD LOOP RD. CHUGW(, AK 99567 Engineer's Printed Name ROBERTA SHAFER 5. DSD SIGNATURE I/ Approved for Disapproved. Conditional approval for bedrooms. Phone 907-694-2979 Date .3//7//.7 bedrooms, with the following stipulations: r• .QF J` r OU-SRE •s�63 '•• VVAm t AIN EW •_EWATER PROGRAM• 1 . SWT lF,0 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: L& I Po Original Certificate Date: 3 -.2 St / C7 (Rev 11/05) • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL fCAT Well type -MOTE If A, 8, or C provide PWSID # Date completed I) i' - /eh Sanitary seal(cNN)E'3 Total depth 13S r ft. Cased to /S3.1 ft. FROM WELli LOG Date of test It'13 S3 Static water level 024' I ft. Well production 5• g.p.m. WATER SAMPLE RESULTS: Coliform i:7 colonies/100 mL Nitrate 0/37 -mg/ Arsenic: N`b ug/L date of sample: 3)/2k, B. SEPTIC/HOLDING TANK DATA' j7Q fd Q JC _ Tank Type/Material I Tank size tov6e 5Parcel ID: ClIS-a, - 83 gal. Number of Compartments WellL••� ) ,I Wires properly protectec N) YC -5 Casing height (above ground) iP 4 in. AT INSPECT/ON 3/IaD is Foundation cleanout (Y/N) _ Depression over tank (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 o bdrm) System type go' ft. 4,6 g.p.m. Other bacteria 0 colonies/100 mL Collected by: S'S 5 //tArCa,Q6 Date installed Cleanouts (YIN) High wate Length ft. Widt Total depth _ ft. Eff. abso • on area Date of adequacy test Results (Pass/Fail) Fluid depth in abs • • ion field before test _ in. Water added_ gal. ft. Gravel below pipe ft. Monitoring tube Depression over field _ Elapsed T e: _ min. Final fluid depth _ in. Absorption rate >_ A ejuvenation treatment (past 12 mo.) (Y/N & type) For bedrooms New depth_ in. g.p.d. If yes, give date D. LIFT STATION obi Date installed Size in gallons 'Pump on' level at _ in. 'Pump off' level at Datum c es tested E. SEPARATION DISTANCES Manhole/AccesUY/N)— igh water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIR- On adjacent Tots N /1} Absorption field on lot ttJr T.S. On adjacent Tots Nle Public sewer main Ito 1 1- 1s-4 , Sewer /septic service line c2.S + Animal containment areas in. Public sewer manhole/cleanout r31 Holding tank N /R i Manure/animal excrete storage areas /00 /" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TOTP uc rc c Building foundation Property line Absorption field Water main Water service line Surface water Wells on ad' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TOj3uc czwcc. Property line Building foundation Water Service line Surface water Water main Driveway. parking/vehicle storage Curtain drai, Wells on adjacent Tots F. COMMENTi�i Fr.av ?nit" nit" P145-021CTEt 8y P0144-1 PLAWIT5PO4 • u)rw rCao 12.tiTE Porr 60ritealu!tcb= -3citC611,001 vifiziccriat,S cn1S cc -0e . G. ENGINEER'S CERTIFICATION � ., F„ N( 1 certify that I have determinerough field inspections and review of Municipal records that above sys s are conformance with MOA COS . uid nes 1 e t Engineer's Printed Name Date 3—17"-/0 COSA Fee $ glq V Date of Payment 'J` 2-1-1110 Receipt Number 055 16D (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number LOT 3 i0a.)c • cc- •" 1. 1 ` • • • WELL C' /Gin/ /33./7' ,v 89'/9' 32"w OF 8E&c&A10 (83'275) / ij/ • /• // LOT 4' 1 Lot 2 , Block Bremer- Sub /iw.,ion Anchorage Recording District, Alaska LOT SURVEY CERTI.FICATION 1 Pre0y certify Ihol shave 4w.eyed the property Shan and described nom, and that IM ITp.ov.AMte Woofed ther.On Oro within the pop- trty hop and do not overlap or .n<rooch on adlotenl property and Mot 0 Potot.rn.nts On odtocnt properly Overl0p Or .010a0h on the pr.ntl.e, 0 toenail Ond 11101 there Ore n01000.0 ., utility linos, Or other YI.la11 t0sement. on .old property .seep. Oe indicated hereon. 1 o' • • / 1(U' / i • eae.ntente of record Ocher than 111014 shown on the plot of Mord ar. not .no.n hereon unrest otheralis 001.4. LEGEND Q Brass or Aluminum copped monument recovered O Iron pipe ond/or rebar recovered O 2 x 2 hub 6 tack recovered • W8" 30" rebar set this Survey B4S/S OF VeArrCAL. .J477 -.A /927 N.G. S. /972 AO✓UjT- 'Scale Ref. /' 3 45/4 Date © 05-30-95 Prepared by. R L. BUTTON negrsre/ea Lone Sofveyor (907/279.6200 5/9 W Eighth Ave. Anchorage A/osgo 9950/ F. B. No. ?^ Property of: Nk:lrcus /7/!C7/e