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HomeMy WebLinkAboutSPERSTAD BLK A LT 15Onsite File ZF Y 4' y MUNICIPALITY OF ANCHORAGE Development Services Department p P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 010-342-30 Legal description SPERSTAD BLK A LT 15 Site address 903 W 53RD AVE Anchorage AK Current property owner(s) LISA & JAMES O'NEAL Expiration Date: z- 2.1 72-o 2— X The On -site system(s) is/are approved for 2 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 11/21/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA Approvdjune 2022 MUMUGAU7VOF _` HU--J0 F71�,GE Development Services Department =J Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel 1. D. 010-342-30 Complete legal description Sperstad Block A Lot 15 Location (site address) 903 W 53rd Ave, Anchorage, AK 99518 Current property owner(s) James & Lisa O'Neal 2. ON -SITE SYSTEMS SIZED FOR 2 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank 0 Community Septic or Public Sewer __-_—ee-- -�---���iaK:�����r-c:�a►G���Ri�tt��:aa:�����iiaii - - - Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ Z g J Waiver Fee $ Date of Payment COSA # U5 C_ ?, 3 ( y Y Date of Payment Waiver # COSA Application -June 2022 Sperstad Block A Lot 15 010-342-30 5.75 6/29/56 130.5 N/A >40 24+ 11.0 11/6/23 907 Water Wells 19 11/3/23 N/A Property is served by city sewer. N/A N/A N/A > Property is served by city sewer. Benjamin Schiller, P.E.11/9/23 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Property is served by city sewer. (907) 522-7773 Arsenic Advisory Certificate of On -Site Systems Approval # OSC231448 Subdivision: SPERSTAD , Block: A, Lot: 15 A water sample revealed an arsenic concentration of 11 micrograms per liter (ug/L). 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. r Mad�ng Address P O Box 196650 *Anchorage, Alaska 99519 6650'* www muni org MUNICIPALITY OF ANCHORAGE Development Services Department 7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 010-342-30 1. GENERAL INFORMATION Expiration Date: q A,v- 2 o 2_ Complete legal description Sperstad, Block A, Lot 15 Location (site address) 903 West 53rd Avenue Anchorage, AK 99518 Current property owner(s) Therese Landry Trust Day phone 563-0715 Mailing address 903 W 503rd Ave, Anchorage, AK 99518 Real estate agent 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 2 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 $ 1 -1 o Date of Payment b 1 74 026 Receipt Number (aj5q l0 COSA # Q J C 261-11;07 Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-7 9 255'0 DISCOUNT APPLIED 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, 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 Civil Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/3/2020 o 000©�E OF 44q °°o o �P,.•••••.... th 6. DSD SIGNATURE oa°'ii;°"'aY����7"`�::: o 0o�, ............................................ .... o System #1 Approved for % bedrooms PAICHAEI E. ANDERSON ft,' ©Q��''. No. CE -4381 System #2 Approved for bedrooms ©o®'6;•••.• 6/3/2020 ,.•••'���'o ' Disapproved 0p e0 "ROFESS1��®00®® ©®oam©0000 Conditional approval for bedrooms, with the following stipulations: illl��tl6%E' Bye,- Original Certificate Date: l0 -(1!7>"2 I�Z� 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 Legal Description: Sperstad, Block A, Lot 15 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/29/56 Total depth 130.5 ft Cased to '40 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 5/27/20 Static water level at beginning of test 31.7 ft. Comments B. TANK DATA Age of tank(s) NA years Tank type/material NA Measured operating fluid level in septic tank NA ❑ Standpipes/foundation cleanout per record drawing Date of pumping Lot served by AWWU Sewer System 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 Parcel ID: 010-342-30 Structure served by this system Well production at time of test 2.57 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.04 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 5/26/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: NA Lot served by AWWU Sewer System 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) NA 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' NA if No NA ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft 0✓ Yes if No ft Neighboring Tank > 100' ❑ Yes if No NA ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑ Yes if No NA ft Neighboring Absorption Fields > 100' F. ENGINEER'S COMMENTS Animal Containment > 50' ❑✓ Yes if No ft F-1YesYes 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 Foundations > 10' ❑ Yes if No NA ft Surface Water> 100' ❑Yes if No NA ft Property Line > 5' ❑ Yes if No NA ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No NA ft Private Wells > 100' ❑ Yes if No NA ft Water Main > 10' ❑ Yes if No NA ft Community Wells > 200' ❑ Yes if No NA ft Water Service Line > 10' ❑✓, Yes if No NA ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No NA ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No NA ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No NA ft Private Wells > 100' ❑ Yes if No NA ft Water Service Line > 10' ❑ Yes if No NA ft Community Wells > 200' ❑ Yes if No NA ft Surface Water > 100' ❑ Yes if No NA ft F. ENGINEER'S COMMENTS Lot is served by AWWU Sewer System. Sewer main is located at the back or north end of the lot. 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 �® °� ,.......... � anaaaia aatna nna aauavaa nate�( vaSutan to to 00 avnavvvavnvvvvuvavuvaaasvvenuvvaevvvevvave e MICHAEL E. ANDERSON tj ig NO. CE -4381 ,°°�.�do 6/8/2020 *0* P°°°� ® Fo +a0mb..aa. ay.v9Ot co ID R RPi to �C CS ° t0 e. '.S 1 — co %4 �a �.cm��rr�'toC M {h ° it A r m I-Q K�'!„dam m°Rm,dp„� cb pKRm" m m em+=C CD roR�o�q'o byaa126 aCD mo `< m CD RCD ohm R itR e+ CO p `�C3°mmo...�. R a ro m m y m m�c'Yo 0 m o m° �s m - CD R ry O Y (n C3 0 00 0' p1M CD r+ m co � m m �a M ►s I CO n rn n m ... U3 N (0 o 0 !b � � o•mb m rr v�• � o m 'NJte xo fDoa�� C 0 am��m a a 9D �a mp• .411.-Qk.N� i AWtd o �f; I�R- * � r► API III 00 1 O O O o' LJV O D . 00,09 P 4 b - n P � P D Y - A VM3A )CDI _ . " C/ �O 3WOH H L 10 3NVNJ DOOM ),dOiS 3NO 9 •-t (Ji (loom —— — -- I I I" —I , r —J V CJ 1 V Ot OZ Ol O Ol gJul I :37VOS 0IHdVVD Ar O M TAX CODE No. GRID No. MUNICIPALITY OF ANCHORAGE — SEWER UTILITY PROPERTY Name Address-`� Acct.No Plat No. Subd. _r .r t�C Y Lot ' Bloc 9tj Residential ❑ Commerial ❑ Industrial ❑ No. of units CONNECT, Main Tap ❑ On Property Q' Permit No. a Size _ Type t __ Drawing No. Size Main Type Depth at Connect Insulation ❑ Cleanouts Type Connect Agent Inspector Date Iq Comments D1,_71 ,Y 11::, 7twr ,_k Connect Location _ 1�"�}9 ASSESSMENTS: L.I.D. No. Private Dev. No. Subd. Agreement ❑ No. Seger Agreement ❑ No. PTE. ❑ Roll No. DYE TEST: --- Positive ❑ Negative ❑ N.S.A. ❑ Date Page No. M.N. No. Billing Cycle Tested By Comments Indicate North r w �C .c x Ct7 o C o jz- a ca O � �! O c C O 0 J v- O E 31 WC v a v Cf3 o U O J CC W O 0- 0 LC CL z O fd W x a� E < 0 tJ STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______ City/Borough Subdivision Block Lot Property Owner Name & Address Well location: Latitude Longitude Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna’s hydrogeologic classification system* https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD Depth From To Drilling method:  Air rotary,  Cable tool,  Other Well use:  Public supply,  Domestic,  Reinjection,  Hydrofracking  Commercial,  Observation/Monitoring,  Test/Exploratory,  Cooling,  Irrigation/Agriculture,  Grounding,  Recharge/Aquifer Storage,  Heating,  Geothermal Exploration,  Other Fluids used: Depth of hole: __________ ft Casing stickup: ___________ft Casing type: __________ Casing thickness: _________ inches Casing diameter: _________ inches Casing depth: __________ ft Liner type: _________ Depth: _____ ft Diameter: _____inches Note: Well intake opening type:  Open end,  Open hole, Other Screen type: _________, Screen mesh size: ____________ Screen start: ________ ft, Screen stop:________ ft, Perforated  Yes  No Perforation description: Perf from: ________ ft, Perf to: _______ft, Perf from: ________ ft, Perf to: ________ ft Gravel packed  Yes  No Gravel start: ______ ft , Gravel stop:______ ft Note: Static water (from top of casing): _______ ft on____/____/_____ Artesian well  Pumping level & yield: ______ feet after _____ hours at _____ gpm Method of testing:__________________________________________ Development method:______________ Duration: ____________ Recovery rate: _________ gpm Grout type: _________________ Volume __________________ Depth: From ___________________ft, To ___________________ft Final pump intake depth: __________ ft Model: _______________ Pump size: _____________ hp Brand name: __________________ Include description or sketch of well location (include road names, buildings, etc.): Was well disinfected upon completion?  Yes  No Method of disinfection: Was water quality tested?  Yes  No Water quality parameters tested: Well driller name: .................................................................................. Company name: ................................................................................... Mailing address: .................................................................................... City: __________________________ State: AK Zip: ___________ Phone number: (________) ________- ______ Driller’s signature: Date: ______/______/_________ Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: _____________________________ Date of Issue: _____/____/_________ Parcel Identification Number: ______-_______-________ *Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https://dnr.alaska.gov/welts/ OR email electronic well logs to dnr.water.reports@alaska.gov North 29 NE BERTIN LANDRY , DRILLERS COOP 82.0 101.0 124.0 127.0 128.0 130.0 004W 0.0 45.0 80.0 L15A NE 101.0 82.0 80.0 45.0 SE 130.0 130.0 128.0 127.0 NW 124.0 6 36 1956 n Clayey gravel "Hard pan" Gravelly sand-water Sandy clay Gravelly clay Sandy clay-bluish Gravelly clay Sand 130.5 394 Clayey gravel "Hard pan" Sand water Anchorage SPERSTAD n S 013N