HomeMy WebLinkAboutKNIK HEIGHTS BLK A LT 4KNIK HEIGHTS Block A Lot 4 #017-032-04 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251011 PID Number: 017-032-04 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name SCOTT &JANE BERGLUND ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 12540 BAINBRIDGE ROAD, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SF 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 2.5 Ft. Subdivision Block Lot KNIK HEIGHTS A 4 Fill added above original grade VARIES 0.94'— 2.11 Ft. Gravel length 2 @48' 96 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic 'Absorption 11 Lift Station Holding 1 Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field / STEP i Tank Line 750 Ft2 2 8 Ft. Well 100,+ 100'+ 1001+ 25°+ TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface water100'+ 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ 5'+ NA Foundation 10 + 10 + 10 + LIFT STATION Manufacturer GREER Capacity 1500 Gal. Remarks Deep-burial septic tank. Recommend retaining P P 9 final grade & adding 3"+ topsoil & grass in 2025 to Alarm location Electrical installed by maintain field cover. INSIDE FIRST FLOOR TOTEM ELECTRIC Tank PIPE MATERIAL House to tank 3034 dra 3034 Installer RED DOG MASONARY, INC nfield -- Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspeection 1" 2/19/2024 2�d 2/20/24 Location and description 3`d 2/21/24 4"' 2/24/2024 ITOP OF 1sT MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL rOF A Conditional Approval: Date �!,<Q•'� �,f-�� TH . / ..` ..... .. .... .... /� Curtis Huffman � - �?K;• CE 128991 .•�`�% �� ��JF�• Septic Syst Approved - Date` - . ,03/04/25, . Amw .. PR01E8S100`,:; Note: this approval does not include well permit requir , ments.\� (R r5/02/18) 24.3 24 . 0 16.1 36 . 2 40.2 60 . 2 10.7 9. 9 9.6 8. 7 12.2 19 . 9 PID:017-032-04 PERMIT:OSP251011 FIRST WATER CONSULTING KNIK HEIGHTS BLOCK A, LOT 4 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251011 Work Type: Septic Upgrade Tax Code Number: 01703204000 Site Legal Address: KNIK HEIGHTS BLK A LT 4 G:2836 Site Mailing Address: 12540 BAINBRIDGE RD, Anchorage Owner: BERGLUND SCOTT & JANE FAMILY Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: 1 /31 /2025 1 /31 /2026 Lot Size in Sq Ft: 43500 Total Bedrooms: ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: At Z) Issued By: Date: ON -SITE SEPTICIWELL PERMIT APPLICATION Parcel I. D. 017-032-04 Property owner(s) SCOTT & JANE BERGLUND Day phone Mailing address 12540 BAINBRIDGE ROAD ANCHORAGE, ALASKA 99516 Site address 12540 BAINBRIDGE ROAD ANCHORAGE, ALASKA 99516 Legal description KNIK HEIGHTS BLOCK A LOT 4 Number of Bedrooms Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable F0 APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field El Initial D Septic Tank El Upgrade El Holding Tank 0 Renewal El Privy D Well D THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: _k57q9 Date of Payment: 201 / 2- o z s'- Permit No. 0'C) k_ _e; / C/ I I Waiver Fees: Date of Payment: Waiver No. Distance: 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! January 30, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: KNIK HEIGHTS BLOCK A, LOT 4 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. The existing field is apparently encroaching groundwater and will be abandoned in place. We propose to install two shallow trenches with a 1500-gallon deep-burial HDPE STEP tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on January 23, 2025. No groundwater was observed at test hole excavation but was at monitoring. The area also shows groundwater levels and if deemed necessary the tank will be anchored for buoyancy concerns. The slopes are moderate at 0-5% 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 OSP251011, Curtis Townsend, 01/31/25 24.3 24. 0 16.1 36 .2 40.2 60. 2 10.7 9.9 9.6 8.7 12.2 19 . 9 FIRST WATER CONSULTING KNIK HEIGHTS BLOCK A, LOT 4 DESIGN CALCS: NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251011, Curtis Townsend, 01/31/25 24.3 24 . 0 16.1 36 . 2 40.2 60 . 2 1 0.79.6 8. 7 12.2 19 . 9 FIRST WATER CONSULTING NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM. DESIGN DETAILS: KNIK HEIGHTS BLOCK A, LOT 4 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251011, Curtis Townsend, 01/31/25 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 FirstWaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: KNIK HEIGHTS BLOCK A, LOT 4 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1/30/2025 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 SM/sp-gm 7 8 9 10 11 12 Silt & moisture increasing w/ depth 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 1/24/25 30 min 6” 5 14/16” 30 min 6” 5 13/16” 30 min 6” 5 13/16” PERCOLATION RATE 5.2 (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: 11.3’ DATE: 1/30/2025 TESTHOLE # 25-1 DATE PERFORMED: 1/23/25 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: SCOTT & JANE BERGLUND 01/30/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251011, Curtis Townsend, 01/31/25 FOUND REBAR THIS DATE; O CO 49 R `9 s SHANE A. HOLT �� G LS-6914 ,\,°fessiona� �-Qo N 89 58' E 300.00 o YARD LIGHT SEWER SYSTEM PIPE THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OFRECORD AS OF THEDATE OF THIS SURVEY. ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOD/ ANY CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHONN HEREON ( UNLESS INDICATED) NOTE, FENCELINES THAT MAY APPEAR ON THIS DRAYING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOGIN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNON ANDIOR ICE. roll, Nil AS --BUILT SURVEY I" = 30' NO CORNERS SET THIS DATE / HEREBY CERTIFY THAT / HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4 BLOCK A KNIK HEIGH TS SUB. A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENIS SITUATED THEREON ARE WITHIN THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 17 TH DAYOF JANUARY , 2025 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 16199 240-19 ~ '~ / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl_ INSPECTION REPORT /'~ I [] UPGRADE O~ DISTANCE TO: ~r ~'D Absorption area~ / ~elUngr~ ~ ~ Manufacturer~ ~ L iq. cT~n gallons IF HOMEMADE: Inside length Width Liquid depth  ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ Manufacturer Material Liquid capacity in gallons ~_ ~ ~ No. of Unes[ Een~th~line ~otal ~h~f lines Trench width~l, inches Distance be~es ~ ~ ~ Top ofltile to finish gra~ Materi~[ beneath tile - Total effective a%sorption area Length W~dth Depth ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~Well Building [oundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SO~L TEST RATING ~NSTALLER/ R EMAR KS APP~ ~~ DATE LEGAL 72-013 (Re~ ~8) ( E:;9_'THi::!F?.D ::::CH'.,IST. i NC L. 4 EF! I<i'.,!:[i< HEZCG-'I.,TS ]"H,E LEI'.,!C-i'TH D]:,~"I[EN'.::;IOI'..! IS i-'HE LENC'iTH (iiq FEET::, OF TI-..IE TREi'.,IE:H O1:;: DRFI!NF.:(EL.D. THE DEF'?TH OF R 'T'F.':E{NCH OR PIT IS THE Di'.-3TF~i'.,iC.~J: E:E]"HEE!",i THE '"-:";URFFiCE OF ]'HE !_--i!:~OUND Fil'.,l,r.)THI:'::: E:C!TTOM :.':),:: THE E;4CR',/FFi'tON ,:::i:!'.,t F"EET). 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THE E.;VSTEPi !N F:ICCOF:':DF!NCE HZ'T'H THF_' CO,(::,E:S. ]:: I UN!:)ERSTFii'-,IE:, THI::,'T THE Oi'..i-SI'!"E .'-2EHE:R S?'.E;TEM MF:i'.F RE(:':!LIiRiE Ei'.,iLFiR(::iEi',!E:NT :IF THE - PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5 6 7 8 9 ~'~10 ~ 11 12 13- 14. 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST kn'f- 4- BI,*. A ouec' b o r-c~. e q SLOPE SITE PLAN WAS GROUNDWATER I'~ (~) ~- ENCOUNTERED? , O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND~ ~T CERTIFIED B¥:~. ~~I 72-008 (6/79) ~ ~/WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8~ Geophysicol Surveys Drilling Permit No. LOCATION OF WELL (Please complete either lo, lb or lc.} A.D.L. No. io.]lSorough Subdivision Lot Block I'~.I '/4qtrs. Section No. TownehlPN~] Range EEl Meridian ;~.~ ~.C'~!., z ~ ': ]~. ~, --of--of--of -- S~ Ic.~]OISTANCE ANO DIRECTION FROM ROAO INTERSECTIONS ~. OWNER OF W~L~: ~- ~ ,~ ~=, ~,,~ ~.,?'~'~?~"~. , ~,~'t -~ ]~Y~I !~)(]c 'i '~ I ~ TestWell ~ Other: '..;~/:~.~.~ '. ~.'::E~Ef,~ ~. ~..t)..,- -. ....... ~, (,~' r~., :~i~g~:~ ~ ~,~; ~ ~C~ ~r~' 8. CASING: ~ Threaded ~ Welded ~ '''~ )'; ~bs./ft. · - -, ' ~C~ ~' ...... , ~ ~ .......... ' ~.';~:~;. 77' '~ '~" =~ ,'~ ~ ,.. ~, 11 ~1 ,.~ ~/C~/~ ~ ~ Above or ~ Below land surface Dote ~4" :~°~,/~,~.,~ ~HO~4~ ~ ~,~ ].: .~-. ~:~ - ,i~j c , ~ ~. ~ Equipment used: ....... ~ ~ ~ [ ~ ft. offer ~' hrs. pumping '. g.p.m. ~-CC~/ ] 1-- -- ft. after hrs, pumping --:~'~.V*~ [,.GROUTING Well Grouted: :~ Yes MoterJel: 0 NeGt Cement 0 Other: O Subm. O Jet O Centrificol O Other 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. # t~)~'-~ - ~).~ ~ ('~ ~--\ HAA # 1. GENERAL INFORMATION Complete legal description ' Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent ~-~c Address CRA~d~ WHITE A c.g. ,4k: Day phone Day phone /r~ ?¢~ ¢-~ Day phone /~ Ce..c o_3 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 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 verifythat 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~'LATTO P Address I u¢53o ECHo Engineer's signature Phone 3qS-- 135-5- Date d'/ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: 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 DHHS 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. 72~)25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo'T u,, I~LK Parcel I.D. A. WELL DATA If A, B, or C, attach ADEC letter. ADEC water system number Date completed '~/I(~ / 8~- Driller Cased to I-/C/ Casing height ¥ Wires properly protected (Y/N) Y FROM WELL LOG g.p.m. Well type Log present (Y/N) Total depth I ''lc/ Sanitary seal (Y/N) Date of test Static water level Well flow Pump level SEPARATION .DISTANCES FROM WELL TO: Septic/holding tank on lot [ 3 5' ~ Absorption field on lot ~ I ~5' ~ Public sewer main -> Ioo~ Sewer service line > t o or AT INSPECTION ; On adjacent lots >/'oo' On adjacent lots ~ Ioo Public sewer manhole/cleanout '~¢ co / Petroleum tank WATER SAMPLE RESULTS: Coliform 42 co( Date of sample: Nitrate Other bacteria f~o~ ~_ r~f,~r ~o( Collected by: F:fiT'to? T~c/J S~'¢~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size [o0 0 G/IL Compartments 2. Foundation cleanout (Y/N) ~ Depression (Y/N) Alarm tested (Y/N) N,A, Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [~5 On adjacent lots To property line > l0 Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front ~ Ioo~ Foundation 2, F~on C.O, Water main/service line ~ 5'0r CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~O' Width 3 Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating 15o ~'//$1~ System type Gravel thickness Total depth /0 rasP. ~P, Cleanouts present (Y/N) "/ Date of adequacy test ~'/2~/ for bluff K~,ow~' If yes, give date N,A. bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~- Iq.~ ~ Onadjacentlots ¢>~0o' Propertyline To building foundation ifc To existing or abandoned system on lot N,A. On adjacent lots ~' ~-0 ~ ' Cutbank N,A. Water main/service line Surface water ~-/oo' Driveway, parking/vehicle storage area ~ 30 Curtain drain E. ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~.'~,-~ Engineer's Name Date ,~.n~ l, 1¢¢~ ~~..~.~ Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 APPLIC ~IT'FILLS OUT UPPER HAL i, ONLY= ~';~ ~-- ,~) Phone Address Zip Code Lendinglnstitution {;' ~~ )"i~ L '~k~ ~, ~lTj}.' Phone Address Zip Code Phone RealtyCo.& A~nt ~,,.) /~ ~ j~ g~j ~-~ [~.: ~ ~ Address Zip Code Type of Resi~nce ~ Single Family ~2 ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A wall Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ Individual Year individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: /VIUNICIPALITY OF ANCHORAGE DFPT. OF HE/'I_TH & I:NVIR.~NM~NTA. P40. E'..Tt~ AUG ;J ~ ig82 RECEIV[D { 4,)-'A'~PROVED BEDROOMS ~,~ 'CONDITIONS OF APPROVAL ( ) D,SAP~OVED { ) CONDITIONAL APPROVAL' 8oils H~fing D~te ~wer Insfdled Well To AbsorpHon Area Well Log Heceived Well to Tank Septic T~k Size August 23, 1982 & ENGINEERS, INC. S 7125 OLD SEWARD HIGHWAY · ANCHORAGE, ALASKA 99502 Municipality of Anchorage Dept. of Health and Environmental Protection 825 "L" Street Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGI~ [""?q', C,? H,'~'~!'~'~ Gentlemen: The undersigned has inspected the well/septic system located on Lot 4A, Block 8, Knik Heights Subdivision. The following are my findings: The well casing is 6" O.D. 1/4" steel extending approximately 24" above grade. The top is capped with a water tight seal. The electrical wires are extended below grade within conduit. The well is located 140+ feet from the nearest point of the septic system. If you have any questions, please give me a call at 349-6561. TRS:dd EAGLE RIVER ANCHORAGE HOMER (907) 894-9848 (907) 349-6561 (907) 235-8179 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 OSC251073 Parcel ID 017 -032-04 Expiration Date: 3/5/2026 Legal description KNIK HEIGHTS BLK A LT 4 site address 12540 BAINBRIDGE RD Current property owner(s) BERGLUND SCOTT & JANE FAMILY X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date 3/24/2025 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 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 Development Services Department On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-032-04 Complete legal description KNIK HEIGHTS BLOCK A LOT 4 Location (site address) 12540 BAINBRIDGE ROAD, ANCHORAGE, ALASKA 99516 Current property owner(s) SCOTT & JANE BERGLUND Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 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 ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel 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 $ 2 250 Date of Payment _ 3,62 2 COSA# 05G25/07-5 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: KNIK HEIGHTS BLOCK A LOT 4 Parcel ID: 017-032-04 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 3/16/82 Total depth 179 ft Cased to 179 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 1/14/2024 Static water level at beginning of test 145 ft. Well production at time of test 3.5 gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.4 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 3/5/2025 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank ____ Date of pumping NA – NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DAT Which system tested (date installed) NEW FIELD ALL standpipes present per record drawing Total measured depth from grade 7.11 ft (max) Measured depth to pipe invert from grade ____ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) 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) N If yes, enter date Adequacy test date NA – NEW FIELD* 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 – NEW FIELD Effective depth (per record drawings) 30 in (2.5’ ED) Effective depth used 0 in Effective depth (ED) remaining 30 in Comments/Deficiencies: Approximate total measured depths from existing grade. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) 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 N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 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 > 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 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 03/20/2025 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 & 03/20/25 O FOUND REBAR THIS DATE; N 89 58'E 300.00 CO 49 R `9 s SHANE A. HOLT �� G LS -6914 ,\,°fessiona� �-Qo o YARD LIGHT SEWER SYSTEM PIPE THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OFRECORD AS OF THEDATE OF THIS SURVEY. ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROV/DED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOD/ ANY CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHONN HEREON ( UNLESS INDICATED) NOTE, FENCELINES THAT MAY APPEAR ON THIS DRANING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOGIN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNON ANDIOR ICE. roll, Nil QS --BUILT SURVEY I" =301 NO CORNERS SET THIS DATE /HEREBY CERTIFY THA T / HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4 BLOCK A KNIK HEIGH TS SUB. A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENIS SITUATED THEREON ARE WITHIN THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATEDATANCHORAGE,ALASKA THIS 27 TH DAYOF FEBRUARY , 2025 16199 240-19,45 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615