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HomeMy WebLinkAboutROVEL LT 1Onsite File Rovel Lot 1 #012-153-47 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211284 PID Number: 012-153-47 Dwelling: W Single Family (SF) F-1 with ADU [I Duplex (D) El Two Single Family Project: n New W Upgrade Name WOODS FAMILY 2001 TRUST ABSORPTION FIELD F-1 Deep Trench F-1 Wide Trench n B�ed;Zou n d Site Address 3550 WEST 75TH AVENUE -ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-227-5203 15 GPD/SF ; >1�4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grad :��Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ROVEL; LOT 1 Fill added above original gr a Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO! Septic Absorption I Lift Station Holding Sewer Total rption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well *55'+ TANK X Septic [3 S.T.E.P. El Holding 0 Other Manufacturer GREER TANK Capacity 1500 Gal, Surface Water 100'+ Material Number of compartments Lot Line 5'4 NA HDPE 2 Foundation 10'+ LIFT STATION , Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR *WR#OSV211045 Alarm location Electrical installed by PIPE MATERIAL House totank EXISTING/ Tank to EXISTING/ Installer A+ HOME SERVICES D3034 drainfield D034 Drainfield EXISTING CO/MT D3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 99.37 ft Inspectes:tion 15t 9/30/2021 Location and description da2' TOP OF MH 3rd - 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date C/) T ... .......... f A. Go 7 ness., Septic System Approved DateQuo Note: this approval does not include well permit requirements. 0 f S S #AECC884 DOpO krxt�v Uoluzi !0) PERMIT NUMBER: OSP211284 I A I B I DBLI 27.4 29.4 DBI -2 28.3 30.1 MH 29.8 31.2 ST1 33.7 34.5 DBI -3 35.3 34.9 DBI -4 35.9 34.4 RECORD DRAWING PARCEL ID NUMBER: 012-153-47 ISERVED BY PUBLIC WATER AND SEWER I WEST 75TH AVENUE - - - - - - -EL' RAV DRIVEWAY 4-4 A 01UTP9 W tffARNESS ENGINEERING GR Ltd ENGINEERING SALES, CONSULTING . ....... .. 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907)337-6179- FAX (907)338-3246 - WEBSITE: —.g--g—.-g.cam PREPARED FOR: HONE NUMBER: PAGE NUMBER: WOODS FAMILY TRUST 2021 --7907-227-5203 20F3 LEGAL DESCRIPTION: DRAWN BY: ROVEL; LOT 1 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 10/28/2021 it O Z m 0- m 0 w w co 0n, A.3 Hess . 0 ................ --, ....... # �e�ey A. �r ## LICENSE#44 #AECC884 GARAGE 55 2�AoA5 NEW 1500 GALLON HDPE GREER TANK ----\ I \ / EXISTING w HOUSE 2 w DBL3&4 04 U) B b APPROXIMATE LOCATION OF EXISTING EXISTING SEEPAGE PIT PER 1975 INSPECTION REPORT; PASSED A 5 BEDROOM ADEQUACY TEST ON 6/9/2021 HANSEN SAND LAKE; LOT 16A S / \ / / G 4-4 A 01UTP9 W tffARNESS ENGINEERING GR Ltd ENGINEERING SALES, CONSULTING . ....... .. 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907)337-6179- FAX (907)338-3246 - WEBSITE: —.g--g—.-g.cam PREPARED FOR: HONE NUMBER: PAGE NUMBER: WOODS FAMILY TRUST 2021 --7907-227-5203 20F3 LEGAL DESCRIPTION: DRAWN BY: ROVEL; LOT 1 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 10/28/2021 it O Z m 0- m 0 w w co 0n, A.3 Hess . 0 ................ --, ....... # �e�ey A. �r ## LICENSE#44 #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: ?SP211284 RECORD DRAWING 012-153-47 TOP OF MANHOLE = 99.37 98.8-98.9 MH1 ST1 left TOP OF TANK AT INTLET = 94.42 f TOP OF TANK AT OUTLET = 94.41 J INVERT OF BUNG AT INLET = 93.77 INVERT OF BUNG AT OUTLET = 93.58 NEW 1500 GALLON H.D.P.E. SEPTIC TANK F 44 O'W T; •�• T Ltd � �a .� ENGINEERING a. SALES -CONSULTING 91.Jx 'a.,v W �. r .......�. .......... ...... 00 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 33&3246' WEBSITE: w w gamessengneenng,mm • ................ . . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0",•, , s. ffrey ..i WOODS FAMILY 2021 TRUST 907-227-5203 3 OF 3 ���'i'' _795 �! AV AV LEGAL DESCRIPTION: DRAWN BY: YAV ROVEL; LOT 1 D.J.G. F.. I �.'••••'���• :.4' E OF WORK: DATE: LICENSE'11 "'1 TYPESS` ! SEPTIC TANK PROFILE 10/27/2021 #AECC884 �������� ------------- SHIPPING CONTAINER N -------------------- WEST 75TH AVENUE --------------------------- �n = GRAVEL 3 7' DRIVEWAY EAST 117.98' 24.2' ----- 28.0' LU ATTACHED SHED z' U. LOT 2 GARAGE I 0 0 I ~ IW SHED W Iw IQ w 28.0' Z O WELL I LL7 OI N CHIMNEY'"\ I o to co 26. ,50, gp 'T LOT 1I o 15,957 sq. ft. 8.00' I 04 cs, 8.°o, o 01 rn I 31.5' 2 -STORY 4.00' I o O FRAME � HOUSE LOT 17 SEPTIC i,',j-� ` p 0 I O STANDPIPES=� SEPTIC Cp M MANHOLE co I I LOT 3 10.00, DECK 47.5' 20.50' CANTILEVER I I I x x x x x x x x x x x x FENCE WEST 117.44' I� LOT 16A i *: 49 L . ; ... .; i �'• Buku S t o 0 10' 20' 1 J LS -14837 �J - �I�4F'•. AS -BUILT 1��8�202�.•' �,� ���t����FESSIONP 0� I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE LOT 1, ROVEL SUBDIVISION RECORDED SUBDIVISION PLAT (72-192) ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SHOWN IN RELATION TO THE PROPERTY LINES. SURVEY MAY DISCLOSE. DATED THIS 8th DAY OF NOVEMBER, 2021, AT UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE ANCHORAGE, ALASKA. USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. HEIGHT, FIXED HEIGHT LLC C.O. A. 122554 Land Surveying Services 907.290.8949 JOB # 21094B NO CORNERS SET THIS DATE SCALE 1 "= 20' 225 W 23rd Ave., Anchorage, AK 99503 WWW. FIXEDHEIGHT COM MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program POBox 1yO6o0 ^n0Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Permit Number: OSP211284 Work Type: SepticTank Upgrade Tax Code Number: O1215347OOO Site Legal Address: ROVELLf 1 G:2126 Site Mailing Address: 35G0VV75THAVE, Anchorage Owner: WOODS FAMILY 2UO1TRUST Effective Date Expiration Date 7MS/2O21 7/16/2022 Lot Size in Sq Ft: 15920 Design Engineer: GARNESSENGINEERING GROUP LTD Total Bedrooms: 5 This permit iefor the construction of: L] Disposal Field Septic Tank [] Holding Tank El Privy [] Private Well [1 Water Storage All construction shall bainaccordance 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 (i3AAC8U) J. The wastewater code requires inspections during the installation. The engineer shallnotifythe Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Municipality ®f Anchorage ur'rt I 1 %. P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997 http://www.riiuni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV211045 COSA#: Permit#:OSP211284 PID#: 012-153-47 Legal Description: Rove[ Lt 1 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 55.0 feet. This waiver approval applies to the proposed septic tank only. Any fixture upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: /� Z I Approved by: Name of Review **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department K„ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 012-153-47 Property owner(s) WOODS FAMILY 2001 TRUST (Catherine) Day phone 907-227-5203 Mailing address Site address 3550 WEST 75TH AVE *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) ROVEL; LOT 1 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank E Upgrade M (D) El Holding Tank ❑ Renewal F-1Duplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: WELL TO SEPTIC TANK Distance: 55 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees 22 Waiver Fees: - 18 U Date of Payment: `� r)_0 �L Date of Payment: Receipt Number: 09115 co Receipt Number: Permit No. 0,f) P Z 1128c -j Waiver No. _ 0.5U Z I I ouf .S G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211284, Deb Wockenfuss, 07/16/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211284, Deb Wockenfuss, 07/16/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211284, Deb Wockenfuss, 07/16/21 .9Z N N _ < LLi,99'9C AA ,OOZOoOO S ] I r C) -. 6Co LIJ W �0 cv !-- W r.: w x Q n cs u_ 1N3 3 V3 .kinun m t3 p a. " U?L ui >UJ a- ujLO w -ru� o < 00- O H U) • .'. o U- �""i "'*w i 0 (} iV LIJ IM 0 — 0 (L) 0 a £L D W W 0) W c ui 0w_ Di Z—) :E w m0 0 ZZZ e � �� tD 16.5 _ — U- -j < U) D < L J C,4 ,,• CN l -e111 Q LLuiW CV 0 ,.'313UON '00>,00 ui CO UJ UJ UJ U— cei 1 46.{x' W- • '.-'UJ . 19Z N < :4 0 -r t ---i %.0' #00 p 444 >LQ 3: LU W c6 o6 x �� ��. .► (1) F- D t t > c`+1 CC ,r ,-� to i F- > uj LL' t � • Qty .: L1J 0 0U- 0 F- 0 t �- - . . • a -= 0 W < < CL n > U) UJ W wz w00 W u N U � U) civ CL 00 0t� n CL 00 0 a. z Q ct3 x 0{ W Z W F- U W wa z 0 0 W 0 F- QW 0D W0� w © n N 99 199 W 135.56, a W0 co n> w®co w _n z U) 0 W t F- U) U) D W GREAT ANCHORAGE AREA BOROI' H Department3330°f EnvironmentaIc Street Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM PHONE LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL ~)~ ~ ~ NUMBER OF MANUFACTURER ~ V'~'~K' MATERIAL ~ '~(C E~ / COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~'O ~ GALLONS. SEEPAGE PIT: NUMBER OF PITS J DIAMETER __ LIN,NG MATERIAL c~'/~t3~ I BUILDING FOUNDATION ~t~~, ADDITIONAL ABSORPTION .OR WIDTH ~'0~. LENGTH'~'0~', DEPTH IN' CRIB SIZE: DIAMETER (0 DEPTH ~ DISTANCE FROM: WELL ~ ~ ~ TOTAL EFFECTIVE NEAREST LOT LINE ~ ABSORPTION AREA (WALL AREA) ~7 ~/. C) SQ. FT. WELL: TYPE AY" )1 e<:~ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED ~k/)/')~'~) ~2 ~C~ DEPTH DISTANCE FROM: NEAREST SEPTIC ~ SEEPAGE SEWER LINE TANK ~'¢ SYSTEM q0' REMARKS DISTANCES: ~ 0/'/"' HNST~LLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. ED-031 DIAGRAM Of SYSTEM I~, DATE GREATer ANCHOrAGe AREA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT iNSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD OTHER COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTIDE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SiZE ,//' ~'~ r ' ·' . ' SEEPAGE AREA SIZE TYPE /"'~ ...... -- DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ~0 SEPTIC TANK TO SE AGE PIT WALL J , SEEPAGE PIT TO NEAREST LOT LINE· DRAIN ~IELD DRAIN FIELD ., DRAIN F~ELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, /~ ~ , SEEPAGE PIT TO RIVER, LAKE. STREAM~ SEEPAGE PIT J~)~ , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND into CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 inCH DIAMETER CAST irON SIPHON PIPES ON EPTIC TANK AND SEEPAGEt/PIT I CERTIFY THAt,Am FAMILIAR WITH THE REQUIREMENTS Of GREATER AN~ORAGE Al OROUGH~O~A(~DD~NZNN~NO~/~'~//8/~ AND~HA~/T T2 T~T~HIg ABOVE Performed For Leaal Descrintion: LotJ3.__Block This form Re~orts Soils LoQ ¥E$ "On~ te~ is worth a th~sand o~Jn'ons ' Mr. Roger Woods Date Performed 3/3/75 Subdivision Rovel Subdivision Percolation Test oe~th Feet Soil Characteristics 5-- 7 . 8 9-- lO-- Foundation Grade Sand, well graded Clean Moist SW - 125 (Sand continuous through out depth'of test hole) /~;~i;.Bottom of test hole If Yes, At what De~th? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate t~inute Pronosed Installation: Seepage Pit YES Drain Field Deoth of Inlet Depth To Bottom Of Pit Or CNMgENTS: 125 square feet drainaqe area required per bedroom - No bedrock or water table encountered. Trench Sest Performed B¥CONSTRUCTTON TES~ T,nn Data Certified By:CONSTRUCTION ~T LAB 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 012N 0 74 sand and clay - no water ROVEL 238 23380 S 02 n -149.945521 233 SE 77 intermittent layers of sand, clay, and clay and gravel 61.15273000000002 1965 SWSE 233 233 CASED TO 233 FT. OPEN END, HOLE DEPTH 258 FT SW COTTEN DRILLING 18443 74 n 7 n n L01 8.7 250 ALLAN THOMPSON , fine sand 004W n 80 clay with some sand 238 258 sand, some clay 25 gravel w/water 250 OSOgoOIlO 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 OSC251026 Parcel ID 012-153-47 Legal description ROVEL LT 1 Expiration Date: 1/17/2026 Site address 7500 BLACKBERRY ST Current property owner(s) WOODS FAMILY 2001 TRUST X The On-site system(s) is/are approved for 5 bedrooms By: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject syster{(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, De`elopment 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. Conditional approval for bedrooms, with the following stipulations: Comments or conditions: ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory X MUNICIPALITY OF ANCHORAGE l 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. 012-153-47 Complete legal description ROVEL LOT 1 Location (site address) 7500 BLACKBERRY STREET ANCHORAGE, ALASKA 99502 Current property owner(s) WOODS FAMILY TRUST Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 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 4 - 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 / Waiver Fee $ / Date of Payment 2 �/ �Z 5- Date of Payment COSA # 05 C 2_5/ 0 2.6 Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: ROVEL LOT 1 Parcel ID: 012-153-47 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 7/25/65 Total depth 258 ft Cased to 233 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 1/23/2024 Static water level at beginning of test 75 ft. Well production at time of test 4 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 36.3 ug/L Arsenic less than MRL (ND) Collected by Date 1/17/25 Comments: High arsenic levels analyzed & would recommend point of use water treatment at kitchen sink. B. TANK DATA Measured operating fluid level in septic tank 68” Date of pumping 1/21/25 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/30/75 ALL standpipes present per record drawing Total measured depth from existing grade 13.8 ft (max) Measured depth to pipe invert from grade 4.8 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 2000 gallons 1/22/25 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 1/23/25 Results Pass Fluid depth prior to test 30 in Water added 750 gal New fluid depth 46 in Elapsed time 1440 min Final fluid depth 29 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 108 in (MOA 9’ ED) Effective depth used 29 in (Final Fluid Depth) Effective depth (ED) remaining 79 in Comments/Deficiencies: Approximate total measured depths from existing grade. Pipe invert calculated using apparent top of crib measurement. 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 *55 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 *SEPTIC TANK TO WELL, WAIVER #OSV211045. 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 1/30/2025 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 & 01/30/25 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite `- Arsenic Advisory Certificate of On -Site Systems Approval # OSC251026 Subdivision: Rovel, Block: , Lot: 1 A water sample revealed an arsenic concentration of 36.3 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.inuni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval.