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HomeMy WebLinkAboutT12N R4W SEC 10 E2/5 S3 N2 NW4 NW4 NW4 AND S20 E2/5 N2/3 N2 NW4 NW4 NW4Onsite File T12N R4W SEC 10 E2/5 S3 N2 NW4 NW4 NW4 AND S20’ E2/5 N2/3 N2 NW4 NW4 NW4 PID# 011-112-05 Previously known as Parcel 2A Municipality of Anchorage - On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221107 PID Number: 011-112-05 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DOUG ROBUCK & SUK MYONG ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7634 WANDERING DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 1.2 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot PARCEL 2A Fill added above original grade VARIES 1-1.1 CUT Ft. Gravel length 60 Ft. Township Range Section T12N R4W SEC 10 Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 720 Ftz 1 NA Ft. Well 100'+ 100'+ 25'.+. TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks EXISTING UNDOCUMENTED CRIB SYSTEM DECOMMISSIONED. MOA ON SITE. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer PCN Drainfield 3034 ___ _CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1M 5/10/2022 5/11/22 Location and description 2nd da 3`d 5/11/22 4" 5/12/22 TOP OF MANHOLE / RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL - -kk Conditional Approval: Date '' TH 00 " " " "' �� ••• Curtis Huffman Septic System Approved - Date 51,3 `. 9 F -CE 128991 w'o' 5/20/22 • . •'�yc��.� �'ROEESSiflNP- Note: this approval does not include well permit requirements. (Rev 05/02/18) PID: 011-112-05 PERMIT: OSP221107 PRIOR CONST. ERFIED 1-00'+ TO WELL — Parcel 2 WITH OWN R & WE IS / WAS NEAR HOUSE APPROX. LOC. "E 89 59 00 E(C) 3.49 (C X/1 WOODEN FE CE2 WE 12.4' RETAINING WALL 0 u -i 8.0' Parcel 2A N 34,263 S.F. 2'x20.2' SHED o W SPHALT \ RIVEWAY O 5BR RESERVE W/LS TH22-1 SYST 2GPD+ 513RADVANTEX O RESIDENCE =32L X 2'W X 6'ED "i Ln 4 �W 0 co ` 13.7' pFG� <B MT OVERHEAD POWE LINES A RETAINING ALL H MT E D C POWER P LE G F CO * DFCO DCO CO MH WELL RADII DECOMMISSIONED STAKED / VERIFIED EXISTING SEPTIC SYST. PRIOR TO CONST. & INSTALLED NEW BLUFFING SAND LAKE 1500 -GAL HDPE SANDY MATERIAL BUILT TRENCH ACCORDINGLY. SEPTIC TANK W/ FDCO &DCO. EDGE OF ASPHALT ROAD S 89 57'34"W(R1) 264.10'(R1) A -C=13.5' B -C=23.2' DFCO �`'�H CO -DCO MT / A -D=16 5' l *BM 99.95 yy 1 100.0 ORIGNAL GRADE 99.0 B - D = 2 3.1' FINAL GRADE ORG/OL A—E=20.3' 95.90 2' B -E=23.7' FILTER FABRIC A -F=25.1' � sw/� B - F = 2 4.1' 95.32 1,500 -GALLON 95.15 HDPE TANK 94.0 94.0 A -G=31.5' NEW FIELD B—G=24.1' 88.0 88.0 A -H=34.5' BOH B -H=241' SEPTIC SECTION 18' 82•oi A -I=83.9' SCALE: NTS DRY - 5/10/2022 B -I=66.1' T1 2N R4W SEC 10 PARCEL 2A SUPPORTs SERVICES:'_ PREPARED FOR: OF �\\ � YONG D7634 F� � � ��� WANDERING DRIVE ANCHORAGE, AK 99502 � C * 9 TH* 0` Huffman / FIRST WATER CONSULTING DATE: 5/20/22 rtis 13030 SUES WAY SURVEY: KGL DRAWN: FWCS k CE 128991 w 11 5/20/2022�10, ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com SCALE: 1" = 30' PAGE: 1 OF 1 \ '°hDFESSIO�Pti �``'� SkYLARK C/RCLE Lot 2A M O O O 10' T&E Z EASEMENT 10' UTILITY EASEMENT 10.2'x20.2' SHED Parcel 2A 34,263 S.F. Parcel 2 WOODEN FENCE v N 89'59'00" E(C) 263.49' C) 2.0'x7.3' CANTS 1 10.0'x10.0' 1.0'x2.3' 0 2 STORY n RESIDENCE w/ WALKOUT BSMT.�. Al3.7'OEO�/ STAIRWELL- MANHOLE-� PIPES / I \ \ I Lot 5 i \�20' ROAD EASEMENT WELL W \ \ -RETAINING WALL - , \ M a Z M W Co 6 LLJ N Z �a m Lot 4 OVERHEAD POWER RETAINING WALL POWER POLE EDGE OF ASPHALT S 89.57'34"W(R1) 264.10'(R1) / 10' T&E _ _ _ _ — _ _ / EASEMENT — ' — A Tract B3 / WANDERING 'D 0 10 25 50 100 SCALE: 1`30' cll c o a 0 x ° m a E m 0, O NN m C,4 N C CI to U) C O O11.2 n 0, c nooc vvY -0 (R1) = RECORD FROM PLAT No. 2004-160 (R2) = RECORD FROM PLAT No. 2021-97 (C) = COMPUTED NOTE: THE LOT (PARCEL 2A) IS DESCRIBED AS THE COMBINATION OF PARCEL No. 1 & PARCEL No. 2 IN A QUIT CLAIM DEED RECORDED ON AUGUST 6th, 2002. (Doc. No. 2002-052724-0) M 10 A U U W a p Y m o 0 �t o+ a m m m O m 9 C m U C > m m + > a U oz may 0 +O ax z O 3 a C. oE0 Epy p U m 0 az> 0. 55 ° `poamocc i aFxE:E"i.2°m I 9W. m y 1 0)�mCwEL I 03L�Uam 0 0" U T N p ° 'a m m C p 0< o «3� mrn9O �Y 1 0 m e a , Z CNJ O t 0 U O m NFav ac r v o m o >��000t o__ m mm 1 L O o C `m ° - �o1=c�a'yl OUCTO V :E Lw) 2EIityoo c) T 0 mc— r N m O m V C m maE 50 « U J m > m 0 0 TU M= 01 C LCL dym ma�LEEmm m L < 3 c a m a NOTE: THE LOT (PARCEL 2A) IS DESCRIBED AS THE COMBINATION OF PARCEL No. 1 & PARCEL No. 2 IN A QUIT CLAIM DEED RECORDED ON AUGUST 6th, 2002. (Doc. No. 2002-052724-0) M 10 A U U W a MUNICIPALITY OF ANCHORAGE 0n -Site 11'Ifatar & Wastewater [Program PO Box 19 H 4700 ErrnOre P=d Ae horlga, Alaska 99519436M PhD e' (907) 343-7904 Fax= (907) 343-7997 h1 tea; ijv,+ wW.nwnk4 m �o ns iW Un -Sita Wastewater Disposal System Permit Perm It Number: 0$P2211(17 Work Type; Septic Upgrade Tax Code N umbe r, 0 1111205000 Site Legal Address, T12N R4W SEC 10 PARCEL 2A 0=2224 Site Mailiing Address: 7 4 WANDERING DFS, Anchorags Owner; ROBUCK DDUGLAS LYNNE & Deign Engineer: FIRST WATER CONS ULT IN0 This permit is for tho C-Onstructlon of, Effei"Vve Date: Expiration Date-, Lot Size in S -q Ft Tota) Bedrooms, SM 02 &1&2Q23 ;33$CIQ RI Disposal Field 10 Seplls Tank ❑ plulding Tank 0 PNvy 0 Private Well ❑ VVater Storage All wnstruction shall be in accordance with; 1- The a11arhed appToved design. 2_ All requirements Specified in Anchorage Municipal code Chapters 15-55 and 15.65and the Sl!ete of Alaska Wastewater Disposal Regulations J 18AAC72) and Drinki rig Yater Regulations J 18AAC$Q) 3- The weislewnter coda requires i 175pe{.t1w is dui ii iy ll ie ii wlal la liuri. Thu englnver shell note+ tMe l7evelopme rkI Services De pertrrient per AMC 15.6.5. Provide notification by calling (207) 343-7904 (24)7). 4- From October 15 to April 15. a subsurface salt absnrptlon system Under construction durlrng freezing wea€her shall be eiih er- a. Opened and Closed on 11h a Same doy, or b. Covered, sealed, and heated to prevent Freezing Received By: Issued By - 5/1W22 Dais- y � UMU a��� UT ' Y O� NCHORAGF Development Services Department ' r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-112-05 Property owner(s) DOUGLAS ROBUCK & SUK MYONG Day phone_ Mailing address 7634 WANDERING DRIVE, ANCHORAGE, AK 99502 Site address 7634 WANDERING DRIVE, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 2N R4W SEC 10 PARCEL 2A Lot Size 33,800 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E all that apply) Absorption Field Fx-1 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade Q (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Ignature of property owner or authorized agent) Permit/Rush Fees:95 Waiver Fees: Date of Payment: 5 Z — 2 Z Date of Payment: Receipt Number: 2e© 3 Receipt Number: Permit No. OSP 22. / ID7 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com May 2, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: T12N R4W SEC 10 PARCEL 21 – 7634 WANDERING DRIVE The property owner has requested we obtain a permit to upgrade the failed and unknown septic system from the “Borough Days” of the above referenced lot. We propose to install one deep trench and 1500-gallon tank to serve the existing 5-bedroom residence. The design is based on the recent test hole conducted on April 25, 2022. Soils encountered were typical Sand Lake sand with a little silt and no groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 15%+/- at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221107, Deb Wockenfuss, 05/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221107, Deb Wockenfuss, 05/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221107, Deb Wockenfuss, 05/10/22 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : T12N R4W SEC 10 PARCEL 2A PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/2/2022 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 7 8 9 10 SW/sm 11 12 13 14 15 16 17 18 BOH 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 4/5/22 10 min 6” 4 8/16” “ 6” 4 8/16” “ 6” 4 7/16” “ 6” 4 6/16” “ 6” 4 716” “ 6” 4 6/16” PERCOLATION RATE 2 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 5/2/2022 TESTHOLE # 22-1 DATE PERFORMED: 4/25/22 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: DOUG ROBUCK & SUK MYONG 5/2/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221107, Deb Wockenfuss, 05/10/22 S/(YLARK CIRCLE F1 10.2'x20.2' SHED Lot 2A W O M 0 0 O Z 10' T&E EASEMENT 10' UTILITY EASEMENT — N Parcel 2A 34,263 S.F. Parcel 2 WOODEN F b0"E(C),263.49',(C) 2.0'x7.3' CA 10.0'x10.0' DECK 1.0'x2.3' CANT 5.1'x5.5' STAIRWELL SEPTIC I \ \ I Lot 5 \� 20' ROAD EASEMENT I \ \ WELL W I \ \ -RETAINING WALL \ rvi Q _ 8.0' o .' ry0' N o a Z ` ASPHALT 2 STORY DRIVEWAY. RESIDENCE w/ A - - - N W N WALKOUT BSMT.A. N_ 0 I Lot 4 \�\ 48.9' W GK CN OVERHEAD POWER LINES -VI O rn a RETAINING WALL POWER POLE EDGE OF ASPHALT S 89'57'34"W(R1) 264.10'(R1) 10' T&E __--__ EASEMENT — — — — i � / o Tract 133 i o i WANDERING 0 0 10 25 50 100 SCALE: 1"=30' it =II J Q U N U 1n L. _ O N L TN U 0 D N J N _ Q C3 C: O N �� to c tr �O J CL (R1) = RECORD FROM PLAT No. 2004-160 (R2) = RECORD FROM PLAT No. 2021-97 (C) = COMPUTED 0 'O O Y m L m E m m O L m Q O ° oc a t ° m m 0 m o U L •. 2 3 C m Cc C C fn m C Q 0 N O t ° ° h O 0.2 m ,S.I m a O1 O m E aZovmwE `a-c- 2312v- - 1 m I o.mc� I 012.2 0 H- ° wON wE� N t.V� i m C m 3o3co+ OE m TAY am Tw m m O N N Q C O m w T mpg=s�o c > a m o 0 Tn00_ cL Z`p U U> -yl _O m� °.0 YI N m m m T O O m J 0 a t" w 0 9 m- m v mwMa0 0 m L C O m j m m0m0� 9 00-= L 00-2 +°C a NOTE: THE LOT (PARCEL 2A) IS DESCRIBED AS THE COMBINATION OF PARCEL No. 1 & PARCEL No. 2 IN A QUIT CLAIM DEED RECORDED ON AUGUST 6th, 2002. (Doc. No. 2002-052724-0) ui M-W Drilling, Inc. P.O. Box 110389 Anchorage, AK 99511 907-345-4000 907-345-3287 Fax Job No. 13-122 GROUNDWATER WELL AS-BUILT & LOG Well Owner: Doug Robuck Use of Well: Domestic Legal Description: 7634 Wandering Drive, Anchorage Parcel 2A, Sec10, T12N, R4W CONSTRUCTION Drill Method: Air rotary/casing hammer Hole Size: 6” Hole Depth: 193’ Casing Size: 6” Cased to: 192.45’ Material: A53 Steel Wall: 0.25 Well Completion: Open end X Screen Perforated Method: Screen/Perforation description: None Grout Notes: ( 2 ) Sack(s) of Bentonite Well Development: Air lift/surge Well Disinfected: Y/N Method: Yield test at 30 GPM for 1 hour(s) with 100% of drawdown (DD) from static level(SWL). Method: Airlift Static Water Level (SWL): 95.5’ Start Date: 8/20/13 Completion Date: 8/22/13 Test Pump Date: Final Pump Install Date: WELL LOG Depth in feet from top of casing. Details of formations penetrated, size of material, color and miscellaneous details. 0 TO 3 Casing Stick Up 3 TO 93 Sand: brown, medium 93 TO 95 Clay 95 TO 97 Boulder 97 TO 153 Clay 153 TO 156 Gravel: small, sandy, wet 156 TO 173 Sand: medium, silty, small coal layer 173 TO 192 Water gravel: medium to large, slightly sandy, clean, good saturation TO TO TO TO TO Wayne E. Westberg TO President, M-W Drilling, Inc. TO NGWA Certified Master Groundwater Contractor TO Ak Gen Contr Lic No 1000 On-Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131126 Tax Code Number: 01111205000 Work Type: Well Permit Effective Dates: June 28, 2013 to June 28, 2014 Design Engineer: Subdivision: T12N R4W SEC 10 Site Legal Address: T12N R4W SEC 10 PARCEL 2A G:2224 Owner/Address: ROBUCK DOUGLAS LYNNE & MYONG SUK 7634 WANDERING DR ANCHORAGE AK 995021931 ~artment Site Mailing Address: 7634 WANDERING DR, Anchorage Lot Size in Sq Ft: 33800 Total Bedrooms: 4 This permit ia for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: d ~ MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program R US H! i Parcel I.D. 0////~. Properly owner(s) Site address Legal description (~'d., Block & Lot) ~//~I Legal description (Township. Range & Section) ~o~si~ ~,~ s,.,~. .~.ror,~oo~s ~ Phone: 907-343-7904 Fax: 907-343-7997 'APPLIC~'~t~/f Day phone ,'~'°O'"~~''~ APPLICATION IS FOR: APPLICATION IS AN: ([~ all that apply) Field [] Initial [~. Absorption Septic Tank [] Upgrade [] Holding Tank [] Renewal [] Privy [] Private Well ,~ Water Storage [] TYPE OF DWELLING: Single Family (SF) (w/we ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: , cedify that the above information is correct., further certify that this is in acco. r.da.~.c¢ v)/i~h~/~//.. applicable~Municipal,1( ~-~C°des't ~~"' ~(~-~, (Signature of prope'rty-owner or autt~orize~ent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_9-1-12.doc Cq ,00'0~' I, 3.00,O0.OON E 2[2 0 ~°~ 0.. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251220 Parcel ID 011 -112-05 Expiration Date: 5/28/2026 Legal description T12N R4W SEC 10 E2/5 S3 N2 NW4 NW4 NW4 AND S20 Site address 7634 WANDERING DR Current property owner(s) GEST MARCIE E& DARREN X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments 0 Original Certificate Date: 6/10/2025 This,,C'ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject stems) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcell.D. 011-112-05 Complete legal description T12N R4W SEC 10 E2/5 S3 N2 NW4 NW4 & S20' E2/5 N2/3 N2© Location (site address) 7634 WANDERING DRIVE ANCHORAGE, AK 99502 Current property owner(s) DARREN & MARCIE GEST 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: RN Private Well serving # 1 dwelling units El Other Non-public well as regulated by MOA El Water Storage R Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: � Private Septic R Private Septic serving 2 dwelling units R Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: R Steel RE Plastic R Concrete R Fiberglass Age 3 _ See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: n AWWTS n Bed nE Deep Trench n Wide Trench n Seepage Pit Waiver request for: Expedited review requested: n 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 Date of Payment COSA # Waiver Fee $ Date of Payment Waiver # COSA Application_Apr2025.doc COSA Checklist_May2025 copy 2.docx COSA Checklist Legal Description: T12N R4W SEC 10 E2/5 S3 N2 NW4 NW4 & S20' E2/5 N2/3 N2 NW4 NW4 NW4 Parcel ID: 011-112-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/22/13 Total depth 193 ft Cased to 192.45 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/30/25 Static water level at beginning of test 96 ft. Well production at time of test 3+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 11.2 ug/L Arsenic less than MRL (ND) Collected by Date 5/28/25 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 67" Date of pumping 5/28/25 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 5/12/2022 ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 4.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 5/29/25 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/30/25 Results Pass Fluid depth prior to test 4 in Water added 810 gal New fluid depth 9 in Elapsed time 1440 min Final fluid depth 2 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 2 in Effective depth remaining 70 in Comments/Deficiencies: COSA Checklist_May2025 copy 2.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 06/04/2025 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 06/04/25 Arsenic Advisory Certificate of On -Site Systems Approval # OSC251220 Subdivision: T12N R4W, Block: Section 10, Lot: E2/5 S3 N2 NW4 NW4 and S20 E2/5 N2/3 N2 NW4 NW4 NW4 A water sample revealed an arsenic concentration of 11.2 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. Certificate of On -Site Systems Approval Parcel I.D. 011-112-05 1. GENERAL INFORMATION Complete legal description T12N R4W SEC 10 PARCEL 2A Expiration Date: ��tlQ d Location (site address) 7634 WANDERING DRIVE, ANCHORAGE AK 99502 Current property owner(s) DOUGLAS ROBUCK & SUK MYONG Day phone Mailing address 7634 WANDERING DRIVE ANCHORAGE, AK 99502 Real estate agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: 5 TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ olao Waiver Fee $ Date of Payment Jr`d-0 1 AZ ©Q � Date of Payment Receipt Number 310./21 14 Receipt Number COSA # O '� Ca � 1 a 25 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 .Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 5/20/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the - system and maintenance. The operational life of all well and septic systems are subject to �! e���� these various and dynamic characteristics and are outside the control of the evaluator of the '`+� well and septic system. Therefore, any estimate of how long a system will function satisfactory g��: • • • •9 �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or.M ' •• discrepancies exist can be given by First Water Consulting & FWC S . / d .. ... 6. DSD SIGNATURE • "' "' �"�'~ • • • Curtis Huffman System #1 Approved for 5 bedrooms r¢�'Fcs•, CE 12/92- ®,�® System #2 Approved for bedrooms ���F�pROFESStoNP Disapproved _ Conditional approval for bedrooms, with the following stipulations: �ttcrrrr WATER ANn n ''i))))))))mW I,* By: `P�mk ca_r� Original Certificate Date: J31 ac a a 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 Legal Description: T12N R4W SEC10 PARCEL 2A Parcel ID: 011-112-05 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/22/2013 Total depth 193 ft Cased to 192 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 3/25/22 Static water level at beginning of test 94 ft. Well production at time of test 4.5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic 6.77 ug/L Arsenic less than MRL (ND) Collected by Date of Sample 3/25/2022 Comments B. TANK DATA Age of tank(s) NEW TANK - 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank * Standpipes/foundation cleanout per record drawing Date of pumping *NEW TANK C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ALL standpipes present per record drawing Total measured depth from grade 10.4 ft (max) Measured depth to pipe invert from grade 5 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 Adequacy test date NEW SYSTEM Results Pass For 5 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) N If yes, enter date Comments/Deficiencies:MT / CO AT GRADE. 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 Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS 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. 5/20/22