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HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 36Onsite File ,,.��+_ � � ��.,z r«? ::�� ��' •� � � `� Kau < ,' �, � �s%. � � °�.:w� x 02O=m5O2 fry �' CJ 8136 IZ02,3 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221323 PID Number: 020-502-34 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name STEPHEN JELINEK & LESA HALL ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 15631 STANWOOD CIRCLE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. SOUTHPARK #2 3 36 Township Range Section Gravel width 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 FtZ Ft. Well 200'+ -- 25'+ TANK ® Septic ElS.T.E.P. El Holding 171 Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks DEEP -BURIAL HDPE TANK Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer MIKE N ANDERSON, PE (MNA) Drainfield CO/MT 3034 Inspector MNA & FWCS BENCH MARK (Assumed elevation) 100 ft Inspdection 15t 8/11/2023 02/07/2025 Location and description 2�d 3rd 4t TOP OF MANHOLE MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date . • •, Y Huffman '."O" r'"��" Septic System - 91 19Aw ,; •C»u"rtis" Q4no/2o2.•Approved 'Dat Aw } 0... - `�A Ze- approval does not include well permit require ents. i%0��,.��,,+e► (Rev 05/r) PID: 020-502-34 PERMIT: OSP221323 I LOT 37 ru BLK 3 0 � O I J (W // A -C=18.0' B -C=23.9' A -D=22.0' B -D=22.1' A -E=26.4' B -E=21,8' A -F=33,9' B -F=22.6' N87°22'13"E AL PAVED AVED D/W BM: MH TOP MH_ CO DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1,250 -GAL HDPE DEEP -BURIAL SEPTIC TANK W/ DCO & CO. VERIFIED & MAINTAINED 5'+ TO FIELD. LOT 36 BLK 3 LOT 35 BLK 3 231,09' ----------- b APPROX. WATERLINE LOCATED BY MNA PRIOR TO CONST. F "S �O d M1 N87°22'13"E Po fll �O 227,78' SEPTIC SECTION SCALE, NTS SOUTHPARK #2 BLOCK 3, LOT 36 PREPARED FOR: STEPHEN JELINEK & LESA HALL 15631 STANWOOD CIRCLE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com SUPPORT, SERVICES: OF ALS C* 9TI DATE: 4/10/2025 /+ rtis Huffman SURVEY: JLS ,s CE 128991 w Af DRAWN: FWCS , 04/10/25ew v SCALE: 1" = 30'\ 'OFESSIOo'*' n+ --A r In ionn O V, I O (U O W a APPROX. WATERLINE 1 � LOCATED PRIOR TO CONST. A -C=18.0' B -C=23.9' A -D=22.0' B -D=22.1' A -E=26.4' B -E=21,8' A -F=33,9' B -F=22.6' N87°22'13"E AL PAVED AVED D/W BM: MH TOP MH_ CO DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1,250 -GAL HDPE DEEP -BURIAL SEPTIC TANK W/ DCO & CO. VERIFIED & MAINTAINED 5'+ TO FIELD. LOT 36 BLK 3 LOT 35 BLK 3 231,09' ----------- b APPROX. WATERLINE LOCATED BY MNA PRIOR TO CONST. F "S �O d M1 N87°22'13"E Po fll �O 227,78' SEPTIC SECTION SCALE, NTS SOUTHPARK #2 BLOCK 3, LOT 36 PREPARED FOR: STEPHEN JELINEK & LESA HALL 15631 STANWOOD CIRCLE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com SUPPORT, SERVICES: OF ALS C* 9TI DATE: 4/10/2025 /+ rtis Huffman SURVEY: JLS ,s CE 128991 w Af DRAWN: FWCS , 04/10/25ew v SCALE: 1" = 30'\ 'OFESSIOo'*' n+ --A In ionn V, 1 ' Q Q 0 W a � 0 1 � r� A -C=18.0' B -C=23.9' A -D=22.0' B -D=22.1' A -E=26.4' B -E=21,8' A -F=33,9' B -F=22.6' N87°22'13"E AL PAVED AVED D/W BM: MH TOP MH_ CO DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1,250 -GAL HDPE DEEP -BURIAL SEPTIC TANK W/ DCO & CO. VERIFIED & MAINTAINED 5'+ TO FIELD. LOT 36 BLK 3 LOT 35 BLK 3 231,09' ----------- b APPROX. WATERLINE LOCATED BY MNA PRIOR TO CONST. F "S �O d M1 N87°22'13"E Po fll �O 227,78' SEPTIC SECTION SCALE, NTS SOUTHPARK #2 BLOCK 3, LOT 36 PREPARED FOR: STEPHEN JELINEK & LESA HALL 15631 STANWOOD CIRCLE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com SUPPORT, SERVICES: OF ALS C* 9TI DATE: 4/10/2025 /+ rtis Huffman SURVEY: JLS ,s CE 128991 w Af DRAWN: FWCS , 04/10/25ew v SCALE: 1" = 30'\ 'OFESSIOo'*' 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 http://wvAv.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221323 Work Type: SepticTank Upgrade Tax Code Number: 02050234000 Site Legal Address: SOUTHPARK #2 BLK 3 LT 36 G:3236 Site Mailing Address: 15631 STANWOOD CIR, Anchorage Owner: JELINEK STEPHEN K & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date �J�111CI1t .S JG, Cin ® � v llepai-tment Lot Size in Sq Ft: Total Bedrooms: 8/30/2022 8/30/2023 25863 ❑ 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 Special Provisions: • Waterline is to be located prior to construction to ensure the required separation is being met. 1. n II 7�6123 Greeff ��� k -{d he r �t . P5,tc<< e roce eco at Vpu r Own f , I Y fokn j wa.tcr iOkn ol�r �'rtq ex cg va �'o�l 0� ► ��eYrn/l fi _-alk I `s *> b e 1� 5t6 (sd . Received By: Issued By: (/U Date: 8/30/2022 Date: d 2 4 Development Services Department xj Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-502-34 Property owner(s) STEPHEN K JELINEK Day phone Mailing address 15631 STANWOOD CIR, ANCHORAGE, AK 99516 Site address 15631 STANWOOD CIR, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SOUTH PARK #2 BLK 3 LT 36 Legal description (Township, Range & Section) Lot Size 25,863 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) x❑ (w/wo ADU) Septic Tank M Upgrade M Duplex ❑ (D) Holding Tank ElRenewal ❑ 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 autnorizea agent) Permit/Rush Fees: 0225 Date of Payment: L3 /Z �2Z Receipt Number: O/2 / 70 Permit No. DSP 22132"' Waiver Fees: Date of Payment: Receipt Number: 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 August 10, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SOUTHPARK #2 BLOCK 3, LOT 36 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon steel tank out of precaution per the attached design to serve the existing 4-bedroom residence. Although the 6/4/1994 soils log #4 shows no groundwater to 18.5’—MOA sites other test holes on the opposite side of the house having groundwater. MOA has requested a steel tank in lieu of the HDPE tank due to these existing soils logs and potential groundwater at 8-10’ on the other side of the lot. The lot and area are served by public water and the waterline will be staked by a RLS prior to construction. 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 OSP221323, Deb Wockenfuss, 08/30/22 FIRST WATER CONSULTING NO WELLS WITHIN 200' OF PROPOSED SEPTIC TANK SOUTHPARK #2 BLK 3 LT 36 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221323, Deb Wockenfuss, 08/30/22 •�� > o aL-- Eu 7 0y tip a W n•••.'�'S �y 8'Z2 1� ww =m „��c,o Vpb O N N o 3 _p C3 ilrry C "h O o VN 0)W 0 o n O O - 2 ¢ - ark 112.0c), R) S 06.55,06.E ) 00 NN S 06.06.00"E 1 5 ELEC. ESMT. N Ih e •61 i3l yyN � _ 5y (M) 20.33 (P`! a 5 a0. (F! 20.33 (M. a = 51. I' (M) N 10 p03 �50 W .4059 .. ... n.. ' N n > o U 7 0y - ['81 W �y 8'Z2 � rs =m Vpb O N N o 3 _p C3 ilrry C "h O u'1N VN ry C o n O O - 2 ¢ - ark 112.0c), R) S 06.55,06.E ) 00 NN S 06.06.00"E 1 5 ELEC. ESMT. _ j 10' TELE. --- 1 ofLa 9' 77 -------------- ' __---- w � i3l yyN � _ 5y (M) 20.33 (P`! a 5 a0. (F! 20.33 (M. a = 51. I' (M) N 10 p03 �50 W .4059 .. ... n.. ' N n 7 0y ['81 ii 2 �y 8'Z2 � rs =m Vpb O N N o 3 _p C3 ilrry C "h O u'1N VN ry C NN 00 NN 1 mm j zz 1 ofLa i3l yyN � _ 5y (M) 20.33 (P`! a 5 a0. (F! 20.33 (M. a = 51. I' (M) N 10 p03 �50 W .4059 .. ... n.. ' N n Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: <~W~/69 PID Number: Name: L~ ,~e /~ Wastewater System: ~ New [] Upgrade Address: 7~/~ /~o,~-~o~- k/,,), ~'~ ABSORPTION FIELD p,-,cn~.: No. of B~.~rooms: J~ Deep Trench [] Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION soil Rating: Total Depth from original ~, 4~,.~' GPD/Sq. Ft. Lot: Block: Subdivision: 9epth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range! Section: Fill added above original grade: Gravel length: .... , ~ Ft. 7~' Ft. Number of lines: Distance ~etween lines: Gravel width: WELL: [] New [] Upgrade ~-.~' Ft. / "-'"'-" Ft. Classification (Private, A,B,C): ~'X'/E3Z, Total Depth: Cased To: Total absorption area: Pipe material: F~/0 ~>~'~.F'. ~43/4d~ ~,'XJ / 7'~ Ft. Ft. /i-~P~. ? SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set at: casing Height Above Ground: TAN.. GPM Ft. Ft. SEPARATION DISTANCES ,J~Septic [] Holding [] S.T.E.P. TO Septic Absorption Lift Holding =ublic/Pdvat¢ Manufacturer: Capacityin gagons: From Tank Field Station Tank Sewer Lines ~/U~.,~O~ [~.. ~ T'/=:~r.~ ~.. Material:~.7.~.E,/.. Number of Compartments: We~ /~ '-/- /Od ~ ~ - 2.~fl- Surface '~- '+ LIFT STATION Water /Od Lot Size in gallons: Manufacturer: Line /0 ~ "/" /a ~'~- ~ "-"----- ''Pump on" level a~off" level at; High water alarm at: Foundation / Curtain Drain Remarks: BENCH MARK 7~m~ 7~i> o~ ,~oo,,J~,~T~o,d /do .do Ft, ENGINEEB;S~ SEAL a & s ENGINEERING ~¢.,,~ ~ ~. ~.~ 17034 Eagle River Loop Road, No. 204 Inspections performed by: Eaale R~ver," Alaska 99577 Dates: 1st 77o/q4 .'~ Department of Health and Human Services approval ~ ' Reviewed and approved by'. ~_J~' -~ Date: 7- ~- 7* 72q)13 (Rev. 9/91) MOA 25 Permit No.Sw940169 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descriptic~nO:UTHPARK SUBD. ADD.#2; BLOCK 5, LOT 36 PID No.: 02005259 NEW NEW 1250 GAL (~o5~ qo6) =:~,80.6' NO WATER FOUND A 13 C FC-O 13.0~ ,~8.;6~-- COl 22.5 20.0 - C02 22.0 27.0 - CO3 21.6 29.0 - C04 22.0 36.0 - C05 36.5 49.0 - CO6 39.0 -- [2.0 MT1 29.0 [6.0 250 GAL. SEPTIC )BLCO 4 BD~M HOUSE NEEW PROPERT SERVED BY A i COMMUNITY WATER SYSTI{~VL 72-013 A (1/93) * N PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 0N-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940169 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HALL LESA ADELE & OWNER ADDRESS:7510 FOXRIDGE WAY #C ANCHORAGE, AK 99518 DATE ISSUED: 6/08/94 EXPIRATION DATE: 6/08/95 PARCEL ID:02005239 LEGAL DESCRIPTION: SOUTHPARK ADDN 2 BLK 3 LT 3 6 LOT SIZE: 25863 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PEILMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 AAID THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~ DATE: . JUN-~8-'94 WED 15:08 ID:S&S EN~INEERIN~ TEL N0:~94-1211 ~569 P02 June 08, lg~4 ROBERT ~:HAt~ER, ROGER SHAPELY, OIVIL ENOINEEI~ (907) 094-g979 PAX 094-13t I Italia wAmn ~=-~cE: Sout~park Sul~tvision W2; no~ 36; ~lo~k 3 Two test holes wera 14~ ~ ~rt ~igf~l on ~y 21, 1~ ~ ~e ~ S ~ S =ecen~ly. The si~ pl~. ~e ~nitorin9 t~s within ~e tes~ holes w~r~ ch~k~ o~ J~e 03, 19~ ~n on ~ at~ch~ site ~. ~e~ a~ ~ protec~ive wail This prope~cy is served ~ a Community Water ~yste~. We do not anticip&te ~¥ adverse effects o~ neighing pro~er~ies by tns~allation of ~he p~o~ ~ep~ic if you have any ~uestions, or r~/~ire a~itionnl information fo= your ~iew, pl~e ~n~ot ~. ~'~ S~, P.~, AITIWA~I~ 17034 NORTH EAGLE RIVER LOOP '~ SUITE 204 * EAGLE RIVER. ALASKA 99577 ST_~.A_NW~O_OD _ ___CIRCLE NV'ld 3IlS ,OCj =.,,L't- ,, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~----~;~-1~1~---- J~¢'~'~"~ Township, Range, Section: 1 6 7- ~M 9 -.~. WAS GROUND WATER 10 - ENCOUNTERED? SLOPE SITE PLAN 11 ~' IF YES, AT WHAT DEPTH? 12 13 Monitoring? G~ross ~ Net Depth to Net I --, ~: ~ ~H,A ~,1.,_" 7.4? ~ I "z..:~-/~ " (a" clX,, I ~:~ t~,~. ,~..~*.(~d.d~es/inch) PERC HOLE TEST RUN BETWEEN ~,, FT~A~ID FT / ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES [N'EFF~ON THiS DATE. DATE: 72-008 (Rev. 4/85} L~^L ~ / ~ ' I._.~T_~-.~-~~ , Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN PERFORMED FOR: LEGAL DESCRIPTION: L-"~! 8 9 10 11 15 (.f~J 16- 17- 18- 19- Gross Net Depth to Net Reading Date Time Time Water Drop i :o;;z ?,~ ~ 2 ,,,',r ,, - :],z lO q~'~ I" : ~,z to ,c,~" /,, 20 - ~' PERCOLATION RATE l0 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT ' ,. COMMENTS (4 PERFORMED BY' ~1~ pl... AI..I.. n~e~ I / ~ ~ CERTIFY 3HAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN E. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST , SLOPE SITE PLAN PERFORMED FOR: 1  WAS GROUND WATER 10 / ENCOUNTEREDZ ] 1 ~ IF YES. AT WHAT 14- 15- 16- 17 18 19 Gross Net Depth to Net Reading Date Time Time Water Drop ;io Io ~' '/;~ lS/~'' '. fig I0 '~" t//~'' COMMENTS TEST RUN BETWEEN .,,~T AND ,~ FT $ & $ ENGINEER,NG ~'/ JiM.J4 Eagle River Loop Road No. ~a /.,~'~,-~/ CERTIFY THAT THIS TEST WAS PERFORMED iN PERFORMEI~JJe ........... ~;a t1~,,~11 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUJDELINE~'~I'~yCT ON THI~ DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRmT,ON: l,....,~1//~'~l' ~_~,X./..j.~/~.- ~.,~ ~ Township, Range, Section: ~ SLOPE 1 2 SITE PLAN 5 6 7 8 9- 10- 11 12 13 14 15 16- 17- 18- 19- 20~ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~onilori~g? s L O P E Gross Net Depth to Net Reading Date Time Time Water Drop , i?~,.~ - ly~,, ~ : ~g ~ ~'/¢' ~,,~" '.~ % 4'/¢" ~/~" COMMENTS S & S 17034 ;~,1~ ACCORDANCE WITH ALL STATE AND MUNICIPAL MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 020 -502-34 Certificate of On -Site Systems Approval OSC251349 Expiration Date: 6/17/2026 Legal description SOUTHPARK #2 BLK 3 LT 36 Site address 15631 STANWOOD CIR Current property owner(s) JELINEK STEPHEN K & X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: Original Certificate Date: 8/19/2025 This rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject RIftern(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 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. 020-502-34 Complete legal description SOUTHPARK #2 BLOCK 3 LOT 36 Location (site address) 15631 STANWOOD CIRCLE ANCHORAGE, ALASKA 99516 Current property owner(s) JELINEK STEPHEN & HALL LESA 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑ Private Well serving # dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage F0 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 FNJ Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed M 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 $y� Waiver Fee $ Date of Payment 11)a0 Date of Payment COSA # OS J )34 Q 1 Waiver # COSA Application_Apr2025.doc COSA Checklist_May2025.docx COSA Checklist Legal Description: SOUTHPARK #2 BLOCK 3 LOT 36 Parcel ID: 020-502-34 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 58” Date of pumping 6/17/25 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) 8/14/1994 ALL standpipes present per record drawing Total measured depth from grade 14.4 ft (max) Measured depth to pipe invert from grade 5.3 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 6/17/25 Results Pass Fluid depth prior to test 38 in Water added 600 gal New fluid depth 50 in Elapsed time 1440 min Final fluid depth 38 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 115 in (MOA 9.6 ED) Effective depth used 38 in (Final Fluid Depth) Effective depth remaining 77 in Comments/Deficiencies: COSA Checklist_May2025.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 08/06/2025 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 & 08/06/25 LOT 37 BLK 3 N87°22'13"E 23 PAVED D/W SEPTIC • MH . PIPE • • (tm) �G A j 0 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. MAR 3, 2025 1 1"=40' Ischullerak0gni 25-012 r"W BY: CHECKED BY GRID NUMBER: BOOK A JLS SW3236 250116 1.09' V] 0 N V7 N87'22'13"E 227.78' LOT 35 BLK 3 O = FND 5/8" REBAR LOT 36 BLK 3 v`y ` o 0 ri 2 , . n 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 1" = 40' Ln N J N WALL p O J Cst M W L4 (31, CD N 0 .8' N1 N 41- pCD CD fO 0 U4 - 0 D � C) m ;Cl C7 '2 25, ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SOUTHPARK SUBD. ADD. NO.2 LOT 36 BLOCK 3 PLAT 83-213 LOT 37 BLK 3 N87°22'13"E 23 PAVED D/W SEPTIC • MH . PIPE • • (tm) �G A j 0 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. MAR 3, 2025 1 1"=40' Ischullerak0gni 25-012 r"W BY: CHECKED BY GRID NUMBER: BOOK A JLS SW3236 250116 1.09' V] 0 N V7 N87'22'13"E 227.78' LOT 35 BLK 3 O = FND 5/8" REBAR LOT 36 BLK 3 v`y ` o 0 ri 2 , . n 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (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 Parcel I.D. ff CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 0~o o5~ -~ 1. GENERAL INFORMATION Complete legal description Lot 36~ Block 3i Southpark Subdivision' 02 Location (site address or directions) Property owner Mailing address 15631 Stanwood Circle Anchora~% AK St~v¢ Jelin~k Day phone 7510 Fo;~ridge Way #2C Anchorage, AK 99518 243-8422 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 4 Individual well Community well XX× Public water 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: XXX 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~I 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 files and from my invest_~ation 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 $ & s ENGINEERING 17034 Eagle River Loop Road No, 204 Address ~.,.I. Rivar. AIn,d~'n Engineer's signature Phone Date DHHS SIGNATURE ; Approved for ,/ 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 Cedificates 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~, ~., ,~L~?'f/h-~¢'~)¢ ,-,~//D ~-2_ Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to If(~, B, or C, attach ADEC letter. ADEC water system number /"J//~ Date completed /~/: Driller ,AJh /~/'~ ' CaSi"g height Wires properly protected (Y/N) FROM WELL LOG / Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/hcldi~ej tank on lot Absorption field on lot Public sewer main Sewer service line /*"*//~ AT INSPE/CTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ,f~/'~' Petroleum tank ~//~ WATER SAMPLE RESULTS: Coliform d/,~ Date of sample: Nitrate /'///~ Other bacteria Collected by: B. SEPTIC/HO-' D:NG TANK DATA Date installed ~ -/~-/'~~ Cleanouts (~) High water alarm (Y/~ Date of pumping Tank size I ~r_.~ Compartments Foundation cleanout ~1) ,Y Depression (Y/N) hJ//~t Alarm tested (Y/N) /d/~4 /'~E~,~ Ti~ Pumper /~/h 2 SEPARATION DISTANCES FROM SEPTIC/H~)EDING TANK TO: Well(s) on lot /'~//~ On adjacent lots To property line /6 '~ Absorption field Surface water/drainage I(~0 ~ ~.0C~ ~/' Foundation ~ 4- Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. L!FT STATION ~j///~ ~ I-~,~2tsWa~eorAal~re (mt j~cV~,c c d e s (y/~ ) -"-~.. ~~Jes~ested SEPARATION~O~ TO: ~ Well o~J~ _On adjacent lots __ __ Surfa~r__ D~. AB"~ SORPT,ON FIELD DATA ., ,.,- ,"",-~ ~-'~'~~.,, Length Width Total absorption area /.~ 47 Cleanout present (~N) Date of adequacy test A~,/~/ ,/~..W ~.//.r. Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) ./%J/,~ Gravel thickness ~i¢" ' Total depth / ~' Depression over field (Y/i'~ /U/ for ~- Bedrooms After test ,/~//~ If yes, give date '"%//'~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~///~- To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~ o~ ~'~ Property line /0 "/- l6/ 'g' To existing or abandoned system on lot /"J//~ ~ {~ ")- Cutbank .~0 './ Water main/service line /0 ~ / 0d '¢ Driveway, parking/vehicle storage area /d ~.J E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ROBERT C. COWAN CE - 8801 HAA Fee $ Date of Payment 72-026 (3/93)" Back Waiver Fee $ Date of Payment Receipt Number