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Home My WebLink AboutT13N R3W SEC 13 LT 3 OF GAAB TR97/AKA BLM L107 (TR 97 BEING SW4SE4SW4NW4) 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 OSC261179 Parcel ID 006 -063-23 Expiration Date: 5/26/2026 Legal description T1 3N R3W SEC 13 LT 3 OF GAAB TR97/AKA BLM L107 Site address 520 PATSY ST Current property owner(s) WELLS GARY L The On-site system(s) is/are approved for bedrooms Conditional approval for bedrooms, with the following stipulations.- Comments tipulations:Comments or conditions: By: /� 'L.�' Original Certificate Date 6/8/2026 This C ificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject systkm(s) 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 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 Parcel I.D. 006-063-23 Complete legal description T13N R3W SEC 13 LT 3 OF GAAB TR97/AKA BLM L107 JR 97 BEING SW4SE4SW4NW4) Location (site address) 520 PATSY ST Current property owner(s) GARY WELLS 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ■❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit 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 $ Date of Payment COSA # S C- L Waiver Fee $ Date of Payment Waiver # COSA Application_Apr2025.doc COSA Checklist Legal Description: T13N R3W SEC 13 LT3 OF GAABTRW/Ax BLM L107(TR97 BEING SW4SE4SW4NW4) Parcel ID: 006-063-23 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 PRE 1947 Total depth +40 ft Cased to 40+ ft ❑Q Sanitary seal is functioning correctly H Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 5/26/26 Static water level at beginning of test 16 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. DISPOSAL 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. ❑ 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 gallons date Any rejuvenation treatment (past 12 months) If yes, enter date COSA Checklist_May2025.docx Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes X No H Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/LArsenic less than MRL (ND) Collected by MNA Date 5/26/26 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date Results ❑ Pass Fluid depth prior to test _ in Water added _gal New fluid depth _ in Elapsed time _ min Final fluid depth _ in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) _ in Effective depth used _ in Effective depth remaining _ in E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' E] 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' R] Yes if No _ ft Sewer Manhole/Cleanout > 100' ✓❑ Yes if No _ ft Sewer Service/Septic Line > 25'Q Yes if No _ ft Holding Tank > 100' ❑✓ Yes if No _ ft Animal Containment > 50' ❑✓ Yes if No _ ft Manure/Animal Excreta Storage > 100' 0 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 Surface Water > 100' ❑ Yes if No _ ft Field to Foundation > 10' ❑ Yes if No _ ft Wells on Adjacent Lots: Tank to Property Line > 5' ❑ Yes if No _ ft Wells > 100' ❑ Yes if No _ ft Field to Property Line > 10' ❑Yes if No _ ft Community Wells > 200' ❑ Yes if No _ ft Water Main/Service Line > 10' ❑ Yes if No _ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS * AWWU SEWER SERVICE, G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 MIKE ANDERSON Engineer's Printed Name SAME COSA Checklist_May2025.docx Phone 727-8864 Date 6/5/26 OF. Ail S I ;-n .• •MICHAEERSCN ��•• CE -9469 ��'„� ,r. 1 " = 20' S89054'007W 140.00' 15' 40.0' x Ln PAVED m m D/W 0 0 O X//X X- X X ---I O I— X 0 / X 0 LLJ Q0 20.0' CD Li Li 32.0' X �— WELL ® ;� O PAVEMENT Y 0 i- v X o EXISTING o o x V) N N HOUSE N LOT 3 N Q 0 X o z z 52.0' 8.0' X M SHED c6 x 1.1 1. 5L4 S89°54'00"W 140.00' x ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: GARB TRACT 97 (PART OF BLM LOT 107) LOT 3 PLAT P-367 � � A .." 0F Lv °SURVEY CERTIFICATE. I Have a 11 r, AW oU� s�1 physical survey of this property as shown on this drawing and that the /' . • • . ;� 1 �� G� improvements situated hereon are within the property lines and no �,•. , enchroachments exist other than noted. Under no circumstance should low .' 4TH '•'`� , -� ,� any information on this drawing be used for construction of fences, , ; • • ... . • ... • . • . .. .. structures, improvements, or for establishing boundary lines. / Cn a % n low P g rY / EXCLUSION NOTES: It is the owners responsibility to determine FA .. ' : ' ' ' ' ' ' ' ' . ' ' ' . ' ' ' : OR t the existence of an easements covenants or restrictions which co '.J N L. SCHULLER.• do nota ear on the recorded subdivision plat. �' LS -10408 pp e p ' � Lor . • �J / 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE. E-MAIL: t 100, ' ' •' Z� •i ' a i Anchorage, Alaska 99508 MAY 29, 2026 1"=20' schullerakogmail.com Ar 4� — DRAWN BY: CHECKED BY GRID NUMBER: BOOK PAGE: �\ �feS na\ \' �� (907) 227-1455 office 26-054 JLS SW1240 260216 \�\� s`�_�� (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 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. # (~"~"~l~, - (~'{D '2h- ~ ~ HAA # ~.~ 1. GENERAL INFORMATION Complete legal description L~'-T'.~ ~ 'T~-&C-T- /¢':7/ ~CT/¢~' /9/ -Y/~/,-'~ Fb..~ ~ Location (site address or directions) Property owner Mailing address Lending agency Day phone Mailing address Address ~ £ ~A ~ ~ '-~L-~-"'~ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1/91) Front MOA#21 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 flies 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~'~¢'~)~¢c~ ~- ~¢J~.. S~J(- Phone Address ~,~ ,k~;~or,, 1 ~{~_o~'-~ ~,~fl Ol~L A F- Engineer's signature_ Date S G.^TU.E Approved for '~-~ '?-g~ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 DH HS 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. Municipality of Anchorage 6 E I V E DEPARTMENT OF HEALTH & HUMAN SERVICES ' Environmental Services Division ·1 1998 825 L Street, Room 502 · Anchorage Alaska 99501 (907) 3,+o-,+74,+ : Municipality Of Anchorage ·. . Dept Health & Human Services Health Author ty Approval ChecKds~ Legal Description: /-,~;j t--"p_ I~ ':7- / -.~c- t~ -T'~,-~t]~,,;~ ~ Parcel I.D.: A. WELL DATA Well type '~c2 Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) /~/ ~ Wires properly protected (Y/N). ~ Date completed Cased to z.¢o-~- ' FROM WELL LOG AT INSPECTION Date of test ~/! q (' ~ Static water level ! ~ ! Well production g.p.m. -~' ~ f' g.p.m. WATER SAMPLE RESULTS: Coliform ~ C~ ~ Nitrate Date of sample: ,~//,~/?~ [ :~,/2~,[~'~ ¢~.IC~.P F-t~-~_ Other bacteria " ' Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size ~ments Cleanouts (Y/N).__ Foundation cleanout (Y/N) ~ ._.---~e~e/s/~,on (Y/N) High water alarm (Y/N) D te~plng Pumper C. ABSORPTION FIELD DATA Soil rating (g.p.d./ft~ or ft=/bdrm) System type Gravel thickness below pipe Total depth ~ent (Y/N) Depression over field (Y/N) Effective absorption area Date of adequacy test ReSult{ (Pass/Fa~TF'--.. For bedrooms Fluid depth in absorption field before test (in.); Immediate. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = ~ Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pum~m~l~ High water alarm leveJ.a *t~-~,'-~ *Datu.r;n .~Cyel s6rC~e sted "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,,4//~ A~O~(J Absorption field on lot ,.&2/¢. Public sewer main //d::~ ~ Sewer/septic service line ~."T' '~ 5- ~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line Absorptio.~~ Water main/service line Surface water/drainage ~n adjacent lots SEPARATION DISTANCE FROM A_~.S, ~T TO: ~.ai~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conformance with MOA HAA guidelines in effect on this date. Signature. ~ ------ Engineer's Name Date '~ are HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, Alaska 99514 (907) 272-8218 WATER SUPPLY SYSTEM ADEOUACY TEST Legal: Owner: Residence: Lot 3 Tract 107, Sec 13, Township 13 N, Range 3 W Ms. 520 Patsy Road Anchorage, AK 99504 Date of Test: 3/14/98 Well Flow Only Test Procedure: A well log was not found. From information provided, the well was drilled in approximately 1947 and is cased to greater than 40 feet. The well cap did not meet the sanitary seal requirement of the MOA, and the wires were not properly protected. The well cap was upgraded to meet Municipal requirements. The static water level in the casing was discovered to be approximately 17 feet below the top of the casing. During the test we pumped a total of 777 gallons of water from the well at the rate ofT.0 gallons per minute (GPM), which caused the water level in the casing to be drawn down to 27 feet, but no further. Based on our test data, we determined that the total yield of the well is in excess of 7.0 GPM, which exceeds the Municipal criteria for approval of a single family residence. This well also meets the FHA lending criteria that a well be able to supply a minimum of 720 gallons over a four-hour period. Water samples collected on March 15, 1998 are being analyzed by CTE Environmental Test Lab at this writing and will be forwarded as the results become available. TESTS RESULTS: This well production meets the code requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells depend on the local soil condition, ground water levels tbat my fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee tbat there are no hidden defects or encroachments. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State.