HomeMy WebLinkAboutKWIK LOG BLK 3 LT 20Certificate of On -Site Systems Approval
Parcel I.D. 013-043-37
Legal description Kwik Log Block 3 Lot 20
Site address 647 E 73rd Ave Anchorage, AK
Current property owner(s) Stone
Expiration Date: 1-21-2023
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Original Certificate Date:
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
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. 013-043-37
Complete legal description KWIK LOG BLOCK 3, LOT 20
Location (site address) 647 E 73RD AVENUE, ANCHORAGE, A 99518
Current property owner(s) JASON L. STONE 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 - 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 (r Waiver Fee $
Date of Payment %%lll2Z -7)1 Date of Payment
COSA # a?6"/� 1 Sbk Waiver #
COSA Application—July 2022.doc
Legal Description: KWIK LOG BLOCK 3 LOT 20 Parcel ID: 013-043-37
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) Water storage tank volume NA gallons
Date drilled *UNKNOWN Total depth 71+ ft Well disinfected for coliform test? ❑ Yes ® No
Cased to *40+ ft ® Coliform bacteria is Negative
® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND)
® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND)
Casing height (above ground) 24+ in. FWIrs
Date of flow test for COSA 10/6/22 Collected by
Static water level at beginning of test 23 ft. Date 10/6/22
Well production at time of test 3.9 gpm
Comments *PER MOA DOCUMENTS IN FILE. *CIRCA LATE 1960S. PER ACCOUSTIC READINGS & AUDIBLE
OBSERVATONS BOTTOM OF WELL OR PUMP APPEARS TO BE APPROXIMATELY 71' TOTAL DEPTH SEE
ATTACHED SEWER SKETCH AND AWWU CONNECT CARD.
B. TANK DATA — PUBLIC SEWER C. LIFT STATION
Measured operating fluid level in septic tank ❑ Required maintenance completed
Date of pumping Age of lift station years
❑ Required maintenance completed, if AWWTS Lift station material
Comments: Comments:
D. ABSORPTION FIELD DATA - PUBLIC SEWER
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
Comments/Deficiencies:
COSA Checklist 2022 WELL ONLY.docx
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)
Effective depth used _ in
Effective depth remaining in
in
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'
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No NA
ft
® Yes if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes if No ft
Absorption Field on Lot > 100' ❑ Yes
if No NA
ft
Holding Tank > 100' ® Yes if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes if No ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes
if No
ft
® 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
Surface Water > 100' ❑ Yes if No ft
Tank to Property Line > 5' ❑ Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10' ❑ Yes
if No
ft
Private Wells > 100' ❑ Yes if No ft
Water Main > 10' ❑ Yes
if No
ft
Community Wells > 200' ❑ Yes if No ft
Water Service Line > 10' ❑ 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 10/14/22
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, Wi; . • • • • • : ;ryW��
local soil characteristics, groundwater levels that may fluctuate during the year, quality of AedtV•
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 �/� • TM •• ,
these various and dynamic characteristics and are outside the control of the evaluator of the �/ , , ... . , . , . , . , i.
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory j®O w %®
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & flvi s
j Curtis Huffman . II"
�Fc •. CE 128991
�i �cf'l�% 10/14/22 .'���Aw
COSA Checklist 2022 WELL ONLY.docx
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October 9. 1968
My. Peter K. gaplund
c/o Hughes, Thorness ~ ~owe
Anchorage, ^la,ks 99501
SUBJECT~ Well Reserve Easement
Lot 20, Block 3, Kwik Log Subd.
Dear Mr. Asptund:
We understand that you hesitate to grant the subject easement ~o
the ¢~nera of the Kwik Log Subdivision as you feel the easement
will detract from your property val~s.
This let'kev is to explain the necessity of the easement and to
~ie you to assist the owner of the system and this office in our
efforts to bving the water supply into compliance with applic~)le
codes.
The ^laske Administrative Code setahltshes protective radii around
all semi.-puhltc and public water supply systems. It ts against
the law to install various portions of sewerage systems within
these radii. The well involved is a Class As Semi-public and the
protectiv, radii a~e as follcws~
(2)
(~)
0-~0 feet ~ No source of potential contamination
~0-80 feet - Only cast iron sewer pipe with leaded and
caulked Joints
80-120 feet - Enclosed portions of sewage disposal facilities,
f. e., septic tanks, A/C pipe, eta.
beyond 120 feet - Seepage pits, drain fields, and other
seepage systems may he installed.
I~egard.less of the existence or the nonexistence of the required
easement, it is illegal to violate the protective radii established
in the code.
The easement is merely a method of assuring that the well is not
encroached upon without requiring continued surveillance by the
Department.
Mr. Peter, K. Asp:Lund
Page 2
October 9~ 1968
We are su.~e that you OaR appreotate this need if you ~onsids~ that
mm%y of these small subdivisions' wells stay in use for 20 year~ or
more. Re~o~dlnZ of the easement p~ov~das a pmrmanent reoord a~d an
effective method of preventing enomoach~mnt.
As the situation stands today~ we a~ unable to approve the watem
system for service to additional hom~s; consequently~ if you
to develop your p~operty, water fmom the ~iat~g system would not
be available.
Again, wa urge you to provide the necessary easenmnts at this
so that this matter can be permanently dispat~hed.
Sincerely,
DAVID R. L. DUNCAN, M. D.
Medical Director
BY:
SanitarASn
RRS / E~,~o
! i'"-1 S ow to whom d~te, and r-~-] ueliver u ~. /
/ L_.J ~ddress whore delivered L-J to addressee /
: o RECEI PT
Rece~ed~e nmnbered article d~scribed below.
kSIGN^TURE OR NAME OF ADDRESSEE (Must always b#.~ll~d ~n)
[$S~E'S AGENT, IF ANY
RECEIPT FOR CFRTIJ:iED
CITY, STATE, AND ZIP CODE
EXTRA SERVICES FOR ADDITIONAL FEES
Heturil Receipt Deliver to
deDvered deDvered ~ 50~ fee
[~ 10¢ fee [] 35¢ fee
POSTMARK
OR DATE
/
~/~t:/~ E A S E M E N T
~g~ 1 of 3
This agmeement, made and entemed into this ~ ........ )day of
.,by and between '
or Anchomage~ Alaska, party of the first part, which expression shall
include his, her, o~ thei~ heirs, executors, administPato~s~ agents~
om a~¢~p~m whem~ the context so Pequi~es
)~ of Anchorage, Alaska, party of the
see~d part, which expression includes his, her, or their heirs,
executors: administrators~ oP agents where the context so mequiPes
om admits, witnesseth:
Whereas, the party of the first part o~rns and has title to that
Peal estate and real property located near Anchorage, Alaska,
desemibed as follows
And whereas, the party of 'the second par~ owns and has title to
a parcel of p~operty which adjoins the foregoing and described as
desires to grant a per~tual easement for the purpose of ( ~>~.~' ~ ,'~ [
located at ( ~ F ( o ~ ,~,c,~ ~-('~ ~(~ ill ~ ' ~.'~u V ,"':') 5o [,~,~;,
and the easement shall be within the madius of ( I> t> ) feet
fmom the well site.
Now, themefome~ it is hereby agreed as follows:
The party of ~he second part does hePeby gmant, assi~, ~d
set ovep to the party of the first part a pe~tual ease~nt fop
Page 2 of 3
the purpose of installing and operating a community water system,
said well shall be located at ( ~\~ ~i~'l~ ~ ~ i~.~ ~
as located ~] that certain amended plat approved by the Greater Anchorage
Platting Board and filed for record, such easement shall be within
the radius of ( /~? u )feet from the well site.
The party of the second part shall fully use and enjoy the
~for~a{d premises, except as to the rights herein granted.
i This agreement is subject to the following provisions:
1. Second Party shall:
a) Restrict the use of that portion of ( ~- ¢~-( ? ~3 )
which falls within the ( ~]O )foot
radius of the well from all sources of contamination~
and that portion of said tract which falls within
the ( ~(~ )foot radius shall have no sewer,
septic tank~ or disposal fields, except that sewer
lines of cast iron pipe with leaded and caulked
joints shall be permitted, and that portion which
falls within the ( ~3 ~) )foot radius shall
have no seepage pits, and that portion which falls
within the ( / ~ ~ )foot radius shall have no
cesspools, as regulated by the Greater Anchorage Area
Borough Health Depamtment.
To have and to hold the said easement~ right~ and might of
way unto the party of the first part, successors, or assigns for a
period of perpetuity and under the conditions, restrictions and
considerations as set forth above.
It is expressly unders~:ood and agr~eed that this easement is a
covenant running with the land.
IN WITNESS WHEREOF, the parties hereto have caused this
agreement to be executed under seal as of the day and year first
above written.
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
This is to certify that on the ( ) day of ( )
before me, the undersigned Notary Public in and for the State of
Alaska, duly commissioned and sworn~ personally appeared (
) known to me and to me known to
be the individuals named in and who executed the foregoing instrument~
and acknowledged to me, each for himself and not for the other,
that they signed and sealed the same as their voluntary act and deed
for the uses and purposes therein set forth.
IN WITNESS WHEREOF, I have hereto set my hand and official seal
the day and year first above written.
Notary Publ[~ in and :for Alaska
b~y commission expires:
JOHN C. HUGHES
DAVID H, %HORSNESS
ROBERT C, LOWE
R]CHARD O. GANTZ
ROBERT C, ERWIN
JAMES M. POWELL
HUGHES. THORSNESS. LOWE, GANTZ & CLARK
ATTORNEYS AT LAW
807 G STREET
ANCHORAGE, ALASKA 9950~
October ll, 1968
Mr. Rolf R. Strickland, R.S.
Sanitarian
Greater Anchorage Area Borough
Health Department
327 Eagle Street
P. O. Box 968
Anchorage, Alaska 99501
TELEPHONE 272-5477
RE:
ASPLUND Property
Lot 20, Block 3, Kwik Log Subdivision
Our File No. 6845
Dear Mr. Strickland:
You realize, of course, that Peter K. Asplund is now deceased
and that the only person who can act for the estate is the Exe-
cutrix, Genevieve L. Nichols, of 5401 41st Street S.W., Seattle,
Washington.
Under these circumstances, you can understand that the Executrix
who holds the property as a quasi officer of the Court is, or
may be, reluctant to bind the property for a period beyond the
course of her administration. The three-page document which you
have prepared purports to have the Executrix enter into an
agreement with Kwik Log Subdivision, Inc., restricting the use
of the property in question according to certain formula or a
pattern based upon -40-, --80-, -120-, and -150- feet radius
provisions.
The mere fact that I suggest that the Executrix would be somewhat
reluctant to execute this document, under the circumstances, does
not mean that she will not execute the document, provided that
she understands fully what it means.
Mr. Rolf R. Strickland, R.S.
October 11, 1968
Page Two.
If you could prepare a plat of the area in question and could
demonstrate to us in a graphic manner where the various radii
would fall upon the property known as Lot 20 of Block 3, it
would at least be more understandable, and the limitations on
the property would be graphically illustrated and made a part
of the agreement.
If you will please prepare such a graphic illustration, I will
submit the document in question to the Executrix for her deter-
mination.
If you have any questions, please advise.
Very truly yours,
HUGHES ~ THORSNESS, LOWE~ GANTZ
Hughe _~
JCH:f
cc: Genevieve L. Nichols
5401 41st St., S.W.
Seattle, Washington
