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HomeMy WebLinkAboutGLENNPHILL LT 2Onsite File Glennphill Lot 2 #006-055-04 ��E eLi Municipality of Anchorage On -Site Water and Wastewater Program a (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 006-055-04 1. GENERAL INFORMATION Complete legal description Glennpnill Lot 2___-_______ Expiration Date: _� Z Location (site address) 316 Eklutna St. Anchorage, AK_99504 Current Property owner(s) Penny Hanson Day phone Mailing address Real Estate Agent 316 Eklutna St. Anchorage, AK 99504____ 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well IR Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ Waiver/Variance request for: Received by: 3 Day phone TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community ❑ Public Sewer COSA to be released to the engineer, unless otherwise requested by the engineer, Date: COSA Fee $ a 3- Waiver Fee $ Date of Payment l `�Oiz Date of Payment Receipt Number 0 10 716 Receipt Number COSA # O 5C2'1156 5 Waiver # Distance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441_ PTARMIGAN_ BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH_ M._DUFFUS Date ji7 .z 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\\\� �.�Y OF �(I system will function satisfactory for current or future \\ occupants or can ArcTerra guarantee that no unseen fl� �1 encroachments, deficiencies or discrepancies exist. ` J� ON-SITE WATER AND *1 TH } m WAST'-] VATER 6. DSD SIGNATURE J� PROGRAM System #1 Approved for ���� �' KENNETH M. 'rr• Y PP oms. '� O. 71 System #2 Approved for bed#oSSER\J��,1 '�kn,�, d `"Ar � 1kr asto`;�� Disapproved. tl Conditional approval for bedrooms, with the following stipulations: (UVVLb . W -e -CL r By: Original Certificate Date:_ 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 blue sheet10-10-12.doc 1 Legal Description: GlennPhill Lot 2 Parcel ID: 006-055-04 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1995 Total depth 122 ft Cased to 122 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 23 in. Date of flow test for COSA 9/15/21 Static water level at beginning of test 31 ft. Comments ANK DATA Age of'ta years Tank type/material Measured operating fluid leve tic ❑ Standpipes/foundation cleanout per Date of pumping tank drawing BSORPTION FIELD DATA Which Sy tested (date installed} ❑ ALL standpipes ent per record drawing Total measured depth from ft (max) Measured depth to pipe invert from gra _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 Structure served by this system Well production at time of test 6.8 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 9/15/21 IFT STATION ❑ Requi aintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Fina depth in Absorption ra gpd Any rejuvenation treatm ast 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'FO Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ❑ Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building o s >> 10' ❑ Yes if No ft Surface Water? 100' [:]Yes if No ft Property Line > 5' . No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No t Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community. 00' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comme From Absorption Field on Lot to: (Please enter distances if less than required) Building Foun 1�0' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' •.. o ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft rivate Wells >' 100 _ ❑Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community _ ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft..�_ F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 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. COSA Checklist yellow sheet W Q -J U (r LLI Q3 W ujH J 3," "J W cd ot{ u. v� ZW Z) Q m U n m m MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907) 564-2762 BLOCK/LOT/TRACT LT 2 SUBDIVISION GLENNPHILL TAX CODE 605504 GRID 1241 AS -BUILT -'I_4 U'AES 3 ='ja CONNECTWASTEWATER 0988 DATE OF APPLICATION 08/24/95 SCHEDULED COMPLETION DATE 12/31/95 ® SINGLE FAMILY MUTT -DWELLING No. APTS F1 COMMERCIAL STREET ADDRESS 318 EKLUTNA ST OWNER HANsoN PENNY PHONE MAILADDRESS ANCHORAGE,AK 99514-1802 CONTRACTOROWNER n Repair Existing Service ® On Property Only Hydrant Only Main Tap - To Property Line Only F] Main Tap & On Property Connect Disconnect R&R - Main Tap Only n City Tap El 50' or Longer Main Line Extension !c © Have Been Levied To Be Levied Comments: LID Oerner St CONNECT SIZE 4 ISSUED BY BIK INSPECTION FEE $ 104.00 ® PAID CASH PERMIT FEE ,$ 35.00 CHECK# 3 $ INSPECTED BY REIMBURSIBLE NUMBERDEPOSIT $ 0.00 �' TOTAL $ 139.00 DATE � /? /5' S� REMARKS PERMITEE (Please Print) PHONE MAIL ADDRESS SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOE SITE AWWU INSPECTOR original 77- CACD 21 - -, Of DATE SCHEDULED I/ TIME INSPECTOR SUBDIVISION GLENNPHILL BLK/LT/TRACT LT 2 I INDICATE NORTH ,r fCr %i ,n I 1 � F, c SIZE MAIN: TYPE MAIN: DEPT AT MAIN: AT PROP. 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A s•• �rlLLl oVV•® -Y m Z Z `r-)NlQ-I313 VSS113VV 6661 -Z 0 d3 OUR I vil'w 19•.Vt 3A18a 13AVND (66'r—d 'ON 1Vld 213d) ONINV313 30 SISbB (S`d3W) .*,S'S£ l (0321) X V92 l 31100,tgo6 o H 0 3mNa 13n"o ,�" A 0 3fiI�9® `I mw o .09 6 ,o•a 10,6 Wawa ONIlSIX3 °' r ' e ozs o o ; B UA 16'9£ .0'061 >030 i o 1 1 30V8VO E a3SOdO8d i M 57 0'Z£ 1 1TTM 1 .-------------v jxOUR o ® ,0'06 ('XdV) 33N3-4 -� (03N) GZ`9(2 � 300®0,*Mg N ( N) XV92 � 3o1Zta9iro6S N tr� i3ritting i[og by DOC Co. tlba SULLI"N WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND DEPTH OF WELL ADDRESS STATIC LEVEL OF WATER FT. LEGAL DESCRIPTI DATE. - Started — PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Ft. to From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft.. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin—Ft. From Ft. to Ft. Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From MISCL. INFORMATION: Ended DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin—Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From Ft. to.Gr G I \l F Q From Ft. to Ft. juN 11995 From Ft. to Ft. From MUCipali,y ul AnChOrage Ft. tort caith no.`UMan SeryiCeS From Ft. to Ft DRILLER'S NAME I til L� PAGE 1 OF 1 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:SW950024 DATE ISSUED: 3/01/95 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 3/01/96 OWNER NAME:HANSON PENNY OWNER ADDRESS:P.O. BOX 141802 ANCHORAGE, AK 99514 PARCEL ID:00605504 LEGAL DESCRIPTION: GLENNPHILL LT 2 LOT SIZE: 8111 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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: THIS LOT MUST BE TIED INTO PUBLIC SEWEW BEFORE THE WELL IS CONNECTED TO THE -DWELLING. RECEIVED B ISSUED BY: DATE p �s DATE: J i cd. 0 A.1 tr 9.9 VIA f = 01 0 A.1 9.9 f = 01 31. 10 0 A.1