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HomeMy WebLinkAboutT15N R1W SEC 5 LT 9Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201202 PID Number: 051-032-10
Dwelling: X Single Family (SF) 171 with ADU El Duplex (D) n Two Single Family Project: n New N Upgrade
Name
LONNY RHUDE
ABSORPTION FIELD
n Deep Trench n Wide Trench INE Bed El Mound
Site Address
22627 MARAGRET MIELKE STREET, CHUGIAK, AK 99567
El Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-691-6916
4
0.7 GPD/SF
5 (MAX) Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
0.67 Ft,
Subdivision Block Lot
9
Fill added above original grade
SEE DWG. Ft.
Gravel length
58.5 Ft.
Township Range Section
15N 1W 5
Gravel width
16 Ft.
Beds: Number of Lines
3
Distance between lines
5 Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
936 Ft2
- Ft.
Well
1001+
1001+
—
—
25'+
TANK 9 Septic El S.T.E.P. E] Holding 171 Other
Manufacturer
INFILTRATOR SYSTEMS
Capacity
1530 Gal.
Surface Water
100'+
100'+
—
—
Material
Number of compartments
I
Lot Line
101+
101+
-
-
NA
PLASTIC
2
Foundation
10'+
10'+
'L�TION
Manufacturer
Remarks
Gal.
:!1a:rm!ccation�+1
i
Elects ailed by
PIPE MATERIAL House to tank ABS -F6278 drainfield Tank to D3034
Installer
OWNER
Drainfield D3034 CO/MT ABS -F6281
D3034
Inspector JODY MAUS, GARNESS ENGINEERING
BENCHMARK (Assumed elevation) 100.00 ft
Inspection im 10/7120 nd 10/12/20
Location and description
dates: 2
31d 10/14/20 41h 10/16/20 1
BOTTOM OF SIDING NEAR FCO
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stamp
Conditional Approval: Date
.......... .......
A. _G-0rr1_e'ss..*
CE7 79 300
coo
Septic System
Approved (-L/Z,/Z, Date 5131,20
Note: this approval does not include well permit requirements.
# ECC884 —rof ssiono\
Ikev ut)/uz/i?j)
PERMIT NUMBER: PARCEL ID NUMBER:
OSP201202 RECORD DRAWING 051-032-10
OLD SEPTIC SYSTEM NOTE: PER THE OWNER, NO DRAINROCK OR
PERFORATED PIPE WAS FOUND IN THE OLD DRAINFIELD. DISCUSSED
iWITH REBECCA CARROLL WITH MOA ONSITE DEPARTMENT AND SINCE
DRAINFIELD IS NON -CONFORMING, DRAINFIELD WAS ABANDONED IN
PLACE AND ALL STANDPIPES REMOVED FOR THIS DRAINFIELD, FLOW
DIRECTOR WAS CAPPED OFF ON WEST SIDE. OLD SEPTIC TANK WAS
DECOMMISSIONED PER UPC PER THE OWNER (CONTRACTOR)
z
w
GgRq �G
r
/ A
-NEW 58.5 FOOT LONG BY 16 FEET
WIDE DRAINFIELD. NOTE: TEST HOLE
EXCAVATION COMPACTED PRIOR TO
PLACEMENT OF SAND FILTER
/ , a 4 8F0 T/NG \
RP 134-
EXISTING WELL
A
100' WELL RADIUS
B f
FCO 22.4 30.7
MH1 34.1 41.6
STT 41.2 482ci
DBL1 44.2 51.1 J
DBL2 46.2 52.9
FD 53.5 59.9
MTI 63.5 84.2
C01 65.7 86.1
CO2 70.7 90.5
CO3 75.8 94.9
MT2 76.6 95.6 /
MT3 90.7 73.5
C04 90.6 74.1
C05 94.7 79.6
C06 98.8 84.9 /
\ MT4 100.0 86.5 /
\ r
_S1570 EASEMENT
ENGINEERING;tSALES -CONSULTING -- 3 .-..,,v „.. ....
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 - PHONE (907) 337-61T9 - FAX (907) 338.3246 ` WEBSITE: mw.gamessengineering.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
LONNY RHUDE 691-6916 2 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
Tl 5N, R1 W, SECTION 5; LOT 9 J.L.M.
TYPE OF WORK: DATE:
I� RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 4/29/2021
Aff
9
...... ...... ..............0
....
0 0
Gar ess�;'w
CE -79 3 ? s
/oil..
LICENSE M`t>t �5�,�♦•+`
#AECC884 ��`��`� J
INSTALLED FLOW DIRECTOR
Mh
(WEST SIDE CAP - SEE OLD
DRAINFIELD NOTE)
\ 2
NEW 1530 INFILTRATOR
HDPE PLASTIC SEPTIC TANK
/ , a 4 8F0 T/NG \
RP 134-
EXISTING WELL
A
100' WELL RADIUS
B f
FCO 22.4 30.7
MH1 34.1 41.6
STT 41.2 482ci
DBL1 44.2 51.1 J
DBL2 46.2 52.9
FD 53.5 59.9
MTI 63.5 84.2
C01 65.7 86.1
CO2 70.7 90.5
CO3 75.8 94.9
MT2 76.6 95.6 /
MT3 90.7 73.5
C04 90.6 74.1
C05 94.7 79.6
C06 98.8 84.9 /
\ MT4 100.0 86.5 /
\ r
_S1570 EASEMENT
ENGINEERING;tSALES -CONSULTING -- 3 .-..,,v „.. ....
3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 - PHONE (907) 337-61T9 - FAX (907) 338.3246 ` WEBSITE: mw.gamessengineering.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
LONNY RHUDE 691-6916 2 OF 3
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
Tl 5N, R1 W, SECTION 5; LOT 9 J.L.M.
TYPE OF WORK: DATE:
I� RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 4/29/2021
Aff
9
...... ...... ..............0
....
0 0
Gar ess�;'w
CE -79 3 ? s
/oil..
LICENSE M`t>t �5�,�♦•+`
#AECC884 ��`��`� J
PERMIT NUMBER: PARCEL ID NUMBER:
OSP201202 RECORD DRAWING 051-032-10
TOP OF MANHOLE
LID = 99.85
TOP OF TANK @
INLET = 95.27 -
INVERT OF PIPE
@ INLET = 94.72
MT1 Col
MT3 C04
FINAL GRADE
99.00-99-18
2" OF INSULATION
(PER OWNER)
BAFFLE
1530 2 -COMPARTMENT
IN F1 LTRATOR, SEPTIC TANK
CO2 FINAL GRADE CO3
C05 F = 97-59-97.98 C06
ILTER FABRIC
2.1-2.4' OF MOA FILTER SAND
RELATIVE ELEVATION OF GROUNDWATER ON 9128/2020 = 84.05
RELATIVE ELEVATION OF BOTTOM OF TEST HOLE = 83.05
1111, '11 i1q, lll�; Jim
- ENGINEERING - SALES - CONSULTING
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 - PHONE (907) 337-6179 - FAX (907) 338-3246' WEBSITE: www.gamessenineering.com
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
LONNY RHUDE
691-6916
30F3
PROJECT/LEGAL DESCRIPTION:
DRAWN BY:
T1 5N, R1 W, SECTION 5; LOT 9
J.L.M.
TYPE OF WORK:
DATE:
ill RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
4/29/2021
TOP OF TANK @
OUTLET = 95.29
INVERT OF PIPE @
OUTLET = 94.49
MT2 /—ORIGINAL GRADE
MT4 @ HIGHEST POINT
98,05 / @ LOWEST
m POINT = 96.95
INVERT OF DISTRIBUTION
LINE = 93.72
"'i OF FILTER
SAND/BOTTOM OF
DRAINROCK = 93.05
BOTTOM OF EXCAVATION
= 90.65-90.95
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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://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201202
Work Type: Septic Upgrade
Tax Code Number: 05103210000
Site Legal Address: T15N R1W SEC 5 LT 9 G:1557
Site Mailing Address: 22627 MARGARET MIELKE ST, Chugiak
Owner: RHUDE LONNY R & PAMELA A
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
© Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
�11�CI7C
n
IJehartm�nt
7/8/2020
7/8/2021
108900
❑ 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
Recei
Issue(
Date: _�TIP,I)- o
Date: 7���
M
MUNICIPALITY ANCHORAGE
Development Services Department _ ,i Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 051-032-10
Property owner(s) LO N NY RH U D E Day phone 691-6916
Mailing address 22627 MARGARET MIEKLE STREET, CHUGIAK, AK 99567
Site address 22627 MARGARET MIEKLE STREET, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) LOT 9
Legal description (Township, Range & Section) T15N, R1 W, SECTION 5
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
Q
Upgrade E
Duplex (D) ❑
Holding Tank
❑
Renewal El
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Au `16-- Waiver Fees:
Date of Payment: 6/_/_Zho Date of Payment:
Receipt Number: O y N L(7 G Receipt Number:
Permit No. 05P 20IWZ Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201202, Rebecca Carroll, 07/08/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201202, Rebecca Carroll, 07/08/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201202, Rebecca Carroll, 07/08/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201202, Rebecca Carroll, 07/08/20
The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner
to perform work on an on-site wastewater disposal system to serve that individual's owner -
occupied, single-family or duplex home if the homeowner meets and agrees to the following
requirements:
1. The property owner and excavation equipment operator may perform work on no more
than one owner -installation project in a 12 -month period.
2. Owner's projected active involvement with the installation:
layout, tree removal, supervise
3
The name of the excavation equipment operator: TBD/Self
4. 1 agree that there will be no monetary compensation for installation services rendered.
5. The name of the inspecting engineer. Garness Engineering
6. 1 agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.070.
C. Advance notice given to the On-site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
As owner of (legal description) T1 5N U G) SE -C, 5 L--1, 9
1 agree that the information above is true and accurate.
Owner's printed name: Lonny Rhude
Dlgirally signed by tunny Rh,de
Lo n n y R h u d e c,,P Lonny Rhude.o=Rockford
"nnnU=`Uel' September 28, 2020
Owner's signature: Dat,: 2020.09h80841::29 o8O"D5 Date: p
Date: 2020.09.2800:46:29 -08'00'
;a'-:� w':, z�v*rilz�t,�,'v.,<3d +�4 �„�.;, R r sem:..=-.p'gvy.tc ,>
1VIa�1�ng Ac�cress P Box 196650: AnciorageAaska 9951:9 5650 *"wuuuu mun�or t
m
D
o
c N
(D
bo
4
UTILITY
POLE
x ENE \ X
I
x SHo
SEPTIC I
STANDPIPES x c l I I
c_I I
DECK
95.8'
GApAGe
SATELLITE
DISH
5 00"06'00" E 330.79'
2 -STORY
FRAME
HOUSE
lWi WELL
LOT 9
2.50 ACRE
r
EDF+- EDFi-- ED! I
OVERHEAD UTILITY WIRE
0 30' 60'
i immi
UNLESS OTHERWISE NOTED, EASEMENTS OF RECORD, OTHER
THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT ARE
NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY
AND IS SUBJECT TO ANY INACCURACIES THAT SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
ED'
*; '4 9TH
�i
r
/ I
% .....A•.p'... .
i Buku Sali o
Iti s ' • LS -14837
J
l��pROFESS CS`
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
GOVERNMENT LOT 9, SECTION 5, TOWNSHIP 15 NORTH,
RANGE 1 WEST, SEWARD MERIDIAN.
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
'~ ~1 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
NAME . PHONE
L~ DESCRIPTI~
LOCATION NO, OF BEDROOMS
~ ~1 NO. o~yrtmen~s
~Oz DISTANCE TO:
~ ~ ~ ,o. of ,,nesf Lengtk~?~ line Total ~g~o~Jines Trench ~ inches
~ Top of tile t~i~h grade ~/~ inches
~ Length Width Depth PERMIT NO.
~ DISTANCE TO:
~ DISTANCE TO:
OTHER
REM~' S
APPROVED DATE LEGAL
72-013 (Rev.
/ '" " DEPFIRTMENT C"-'XHEFILTH RND EN',,,'IRnNi',IENTFIL '~'""'-dTECTION ~
I..-~EIL.. ~_ Ft~'-,I[-~ ij~q--_,--, ][ T;E ._.E.[,,,~EF-. F EE'E:Ffl I T
MFFL I_.HNT RICHBRD F SLORN F'O Bl_-I::.:: ~3:6 CHOG!FII<_.H._m,,Q-:"-'-" :~,*'."~,.'-b4 '.':;=::
LOCBTION ERGLE R I ',,,'ER/CHUG I F~K
LEGFIL T'iSNRiW S 5 L9 LOT ._,tz.E 99999'~ ._,t:.:UHRE FEET
TYF'E OF SOIL F~BSORPTION SYSTEM IS: DF~IELD
HB~<IMUM NUMBER OF BEDROOMS = 4 BOIL RFITING (SQ FT/BR)=
THE REQUIRE[:'_.~_q'~P- OF THE:,uIL¢- .E,c, uRFTI,_,N' '-- ' -,, -,TEh':' ":
[:"EF'T[4= E: LE~'~]'"~'F4= 5i G~qF~%."EL [:"EF"-F~-4-- 4
THE LENGTH DIMENSION I~ THE LENGTH (IN FEEq) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF B TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFBCE OF THE
GROUN[:, BN[:' THE BOTTOM OF THE E::':;CRV~TION. <iN FE~
TF~E T~]~-~[:Eq L-~ I D'T~q ~ ~ (5. Ei~Zl~2~ FEEl".
THE GRBVEL DEFTH IS TNE MINIMUM [:'EPTH OF GRFP,,'EE BETW~N THE OUTFBLL PIF'E
RND THE BOTTOM OF THE EXCB'¢BTION <IN PEET).
PERMIT RF'F'LICBNT PIP.., THE RE_,FuI~_,IE, ILIT'r TO INFORM THILq [:'EF'RRTMENT DURING THE
tN..TBLLHFIuN INSPECTIONS OF RNY WELL=, R[:,JRCENT TO THIS FF_FEFT'r FIND THE
Ni_IMBER OF R. Em, IE. EN_.E_-, THRT THE WELL NILL _,ER,E.
NINIMUM DISTFINCE BETI.4EEN Iq WELL BND RNY ON-SITE SENFIGE DISPOSRL S'.r'STEM IS
±E~E~ FEET FOR FI F'RIVFITE WELL OR 15E~ TO 20£~ FEET FROM R PUBLIC WELL DEPENDING
UPON THE T"r'PE OF PUBLIC klELL
MINIf'IUM [:,ISTF~NCE FRBM Fl PRIVBTE WELL TO Ft PRIVRTE SENER LINE IS 25 FEET RND
TO FI COMMIJNIT'-r' SENER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO 'THE DEPRRTMENT WITHIN _70 DR'CS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MBY RPPLY. SPECIFICFITIONB RND CONSTRUCTION DIRGRRI"IS RRE
B',,,'I'3ILF~BL.E TO INSURE PROPER INSTRLLFITION.
PER;F-'~ :I T E.---,F ][ R.E_ E:.EC:E~'-IBEF..: _z:l., ! .... :::¢_-
I
FORTH BY THE MUNICIPRLtTY OF RNCHORBGE.
2: I WILL INSTFIt_L. TFIE S¥S"FEM IN RCCORDFINCE WITH THE CODES.
2;: I UNDERSTFtND THRT THE ON-SITE SEWER SYSTEM NRY REQUIRE ENLFIRGEMENT IF THE
F.:EStDENCE IS REMO[:,ELED TO INCLU[:,E MORE THRN 4 BEE:,ROOMS. /
_,I,=NEr .............................................. !
FFL.__.HIq F RICHFIRD F SLC~Fd'-,I
,
.ERTtF% THFIT
t RM FRMILIFIR HITH THE ~'E'SLIREMENTS FZR ON-SITE _,EHEF._, RND b. IELLB RS _,ET
~E DEPTH GF R TRENCH O~ P~)' 3~ THE DIE. 7~NCE ~ET~4EEN ~HE ~URFRC:E OF THE
~tLLA~)Ot.( )NSPECTION~ 0F RNY NELL~ RDJROENT ~0 7HI~. PEOPEE~Y RND THE
:~ 'DF ~EDIDENCEE, THR~ IHE HELL HILL ~E~VE.
FILLING OF RN¥ -~.Y-c,%eH N~THOUT F1NRL IN~F'ECTION AN[) RPF'ROVRL DY TH]~
:TF'IENT HILL DE _C. LIEJ,JECT TO P~O~ECLIT]FJN.
'¢Ui~ D)g1RNC~ ~ETICEEN R HELL RND RHV DN-_c.I~E E.F, NRGE D]$POSRL ~.YSTEM IS
~E~T FOR' R F'R'iVR]E HELL OR ~5~ TO D~ FEE~ FROH R PUE:L]C NELL DEPENb~NG
T~ ]~'E OF PUE:LIC ~L.L.
~E ~LL COItPLET]ON.
[ F:E~U~REMENT~ MRS' RPPLY. 5F~CIF)CRT]ON~ RND CONSTRUCTION DIRGR~t~5 REE
~E:LE lO ]NEJ_IEE PFcOPE~ INE, TRLLRTION.
F.[ _K=: |"t 3' l' E ::-:: F' X !';: K ~c; £:'E CEI"IE: E R ~ ;1~ ,- 198~
3~ F Y THaT
k3LL IN~TRLL 3H~ 5YDTEH ]N RCCOR'DRNC~ ~]TH THE CODES.
~E~STR/.t[) TRRT THE ON-SITE REHE~' E&'S~EH ~IRS' RE,HIRE ENLRR:GEHEN'[ iF THE
- ~I~PL/CR~ ~/CHR~'D F ~LORN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, A~eska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ~OT' ~!
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
~lLr' TO/;' -~//--
WAS GROUND WATER
ENCOUNTERED?
DATEPERPORMED:
E / w., :,,/~.
SLOPE
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time ~.~,-~_~. ,'~ _~,_ Drop
.~.~..~'¢., .,,,,, II
~,,,,- ~ .~ ~.
PERCOLATION RATE
(minutes/inch)
COMMENTS ~-~ P~'
PERFORMED BY:
TEST RUN BETWEEN , FT AND , FT
72-008 (6/79)
MUNICIPALITY OF F ANCHORAGE
r -
Development Services Department J Phone: 907-343-7904
On -Site Water & Wastewater Section -� Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-032-10-000
Legal description T15N R1 W SEC 5 LT 9
Expiration Date:
Site address 22627 MARGARET MIELKE ST Chugiak AK 99567
11/4/2025
Current property owner(s) HAWKES JAMES WIDTFELDT &KARIN KEMPTON
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
M
Original Certificate Date: 11/20/2024
is 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. 051-032-10
Complete legal description
Location (site address)
T15N R1 W SEC 5 LT 9
22627 MARGARET MIELKE ST,CHUGIAK AK
Current property owner(s) HAWKES
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
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 $ �J� Waiver Fee $
Date of Payment 1/ �z Date of Payment
COSA # Waiver #
COSA ApplicationJune 2022
COSA Checklist
Legal Description: T1 5N R1 W SECTION 5 LOT 9
Parcel ID: 051-032-10
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 9/26/83 Total depth 81 ft
Cased to S1 ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 11/2/24
Static water level at beginning of test 32 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 3.6
Date of pumping 11/1/24
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/16/20
0 ALL standpipes present per record drawing
Total measured depth from grade 5 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
0 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 June 2022.
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate mg/L ❑Q Nitrate less than MRL (ND)
Arsenic ug/L 0 Arsenic less than MRL (ND)
Collected by MNA
Date 11/11/24
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 11/9/24
Results Q Pass
Fluid depth prior to test 0 in
Water added 600+ gal
New fluid depth 0 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 600+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 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'
❑o Yes if No _ ft
Neighboring Tank > 100' ❑o Yes if No _ ft
Absorption Field on Lot > 100' ❑� Yes if No _ ft
Community Sewer Manhole/Cleanout > 100'
Q Yes if No ft
Private Sewer/Septic Line > 25' g Yes if No _ ft
Holding Tank > 100' Yes if No _ ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ ft
❑o Yes if No _ ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑' Yes if No _ ft R 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' ❑E Yes if No _ ft Surface Water > 100' ❑� Yes if No _ ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
❑i Yes if No _ ft
❑� Yes if No _ ft
Yes if No _ ft
❑� Yes if No _ ft
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
Q Yes if No _ ft
❑� Yes if No _ ft
If tank or field is under driveway comment below
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 Im Ih e—GL /dcl.ers UN R l = Phone 727-8864
Engineer's Printed Name -7 4phC' Date ( t'
COSA Checklist—June 2022
°..
OW
0 x
avir
/.......
• MICHAEL N. ANDLUC•4
(+ �•, C9469 e
1
G �G
'Municipality ®f Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 F r Y
Certificate of On -Site Systems Approval
osk
Parcel I. D.M-032-10
1. GENERAL INFORMATION:
Complete legal description T15N R1W Section 5 Lot 9
Expiration Date: i 310�1
Location (site address) 22627 Margaret Miekle Street *Chugiak, AK
Current Property owner(s) Lonny Rhude Day phone 907-691-6916
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ —9 F-0
Date of Payment 513Lw %
Receipt Number d75()s
COSA#
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
S. 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 for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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 investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 44,29 k
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for bedrooms
bedrooms `
r
_ bedrooms, with the following �i latiWATAst SITE
ER AND
ST A vVATER o
PROGRAM J�
System #2 Approved for
Disapproved
Conditional approval for
#AECC884
�Q,1`�iC 1 jj
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
1t
COSA Checklist
Legal Description: T1 5N R1 W SECTION 5 LOT 9
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 926/83
Total depth 81 ft
Cased to 81 ft
FN Sanitary seal is functioning correctly
Q Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/5/2020
Static water level at beginning of test 29.8 ft.
Comments
B. TANK DATA
Age of tank(s) '1 years
Tank type/material SEMI DPI
Measured operating fluid level in septic tank
0 Standpipes/foundation cleanout per record drawing
Date of pumping N/A
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/16/20
V ALL standpipes present per record drawing
Total measured depth from grade 4.93• ft (max)
Measured depth to pipe invert from grade 3.9 ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 051-032-10
Structure served by this system
Well production at time of test 6.9 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes F Nc
F0 Coliform bacteria is Negative
Nitrate 0.70 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L R Arsenic less than MRL (ND)
Collected by GEG
Date of Sample
6/5/20 & 4/22/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station year
Lift station material
Adequacy test date NEW
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test - in
Water added - gal
New depth in
Elapsed time - min
ON Code -required soil cover over field Final fluid depth - in
❑ System presoaked Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO
date of test)NEW If yes, enter date N/A
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Q
Yes
Community Sewer Manhole/Cleanout > 100'
Q✓ Yes
if No
ft
2] Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' 2] Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Q✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' Q Yes
if No ft
0✓ Yes
if No
ft
Yes if No ft
Water Service Line > 10'
❑r
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' 0 Yes
if No
ft
❑✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Q
Yes
if No
ft
Wells on Adjacent Lots:
(l
Absorption Field > 5'
F-11
Yes
if No
ft
Private Wells > 100'
Q✓ Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'✓0
Yes if No ft
Water Service Line > 10'
❑r
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
P/1
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
(l
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
M
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
#AECC884
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.#
1. 'GENERAL INFORMATION
Complete legal description
HAA #
Lot 9: Sec 5: T15N: R!W
Location (s!te address or directions) 22627 Marqaret Mielke
~:iPioperty owner Di~k Sloan
- 'Mailing address ~,o. Box 6?0336
Day phone
563-1911 (wk)
' -Lending agency
,Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 -~
TYPE OF WATER SUPPLY:
Individual well ×
Community well
-Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
X
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~)25 (Rev. 1/91) Front MQA #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 verify that 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.
S & S ENGINEERING
Name of Firm !7-,,, :- *,.?. ~,~- [--p .~.a ~.,. se. Phone
Eagle River, Alaska
Address /~~/. /
Engineer's signature ~~~¢7~ 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 Certificates b~sed only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72.4)25 (Rev. 1/91) Back MOA~21
Legal Description:
· . · ~UNI~IPALITY OF
Munlclpahty of Anohorage JNVIRONMENTALSERVICE$~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division NOV 0 6 1997~:~'~--!'~i~
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
RECEIVED
Health Authority Approval Checklist
Lo-~o~ SP--~ T'l~[',J' RI~/ ParcelI.D.:
A. WELL DATA
Well type ~-,/RT~-
· og present
Total depth
Sanitary sea (~)
Date of test
Static water level
Well production
If A, B, or C, attach ADEC letter. ADEC Water system number
Date completed
Cased to ~ ~) ~
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed J(~/~.~/~ ~ Tank size
.Foundation clean0ut
Date of Pun~pinL-J
c. ABSORPTION FIELD DATA
Date installed /~/~/_~
Casing height (above ground)
Wires propedy protected(~N)
AT INSPECTION
Nitrate O- ~C'- ~. '7
Collected by:
Other bacteria O
$ & $ ENGINEERING
~'p,~/,~.,~ 17034 Eaqle River Leap I~a~l lU~,: 204
,--, v, '- ~ Eagle River, Alaska 99577
I~SOC~ Number of Compartments ~ Cleanouts 6N) 2~_
Depression (Y/~ ~ 0 High water alarm (Y/~ ~/~
Pumper
'Soil rating (g.p.d./fF or ff~/bdrm)
~"~' 1~ ~/l~'~.System type
Length. ~ ~' Width· :~ /t _~ /
Gravel thickness below pipe Total depth
2~ present ~N) ~ Depression over field (Y~) /~
Effective absorption area. ,~;)/~ Monitoring Tube
Date of adequacy test loll'/~' Results~Fai.) ~{~<~, For ~ bedrooms
Fluid depth in absorption field before test (in.); ~ Immediately after'~ gal. water added (in.):
Fluid depth ~../~ .~ (ins) Minutes later: J~,~ Absorption rate = ~)~' g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~07U~ ~V~W' If yes, give date
72-026 (Rev. 3/96)*
Manhole/Access (Y/N) ~"'"""Pu_ on" level at*
High water alarm level--at-- ~,,,~leve~ a~- * Datu m-'~-"~~
Cycles tested
E. SEPARATION DISTANCES
"Pump off" level at*
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot lbo / 1~-
,f
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~ ~ ¥ Property line Absorption field ~ iq_
Water main/service line rD' ~ Surface wateddrainage ~/jcd :p Wells on adjacent lots fO(.~ ~Jr
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line
Surface water
Curtain drain
Building foundation ib Water main/service line
Driveway, parking/vehicle storage area
Du,) rd Wells on adjacent lots I/~()
F, ENGINEER'S CERTIFICATION
I certify that/have determined thru field inspections and review of Municipal recor~t~¢¢, t,.,~,~,,l~..~.~tems are
in conformance with MOA HAA ~uidelin. es in effect on this date.
1 ,) /
Date
HAA Fee $ O~C~LD
Date of Payment \,\ Lo
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
~tK CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Name/#
Client Sample H)
Matrix
Ordered By
PWSID
976816001
S & S Engineering
Lot 9, Sec 5, T15N R1W
Lot 9, Sec 5, T15N R1W
Drinking Water
0
Sample Remarks:
Client PO#
Printed Date/Time 11/06/97 16:33
Collected Date/Time 11/03/97 10:55
Received Date/Time 11/04/97 09:10
Technical Director: Stephen C. Ede
Released B~
Results
PQL Units Method
Altowame Prep Anatysfs
Limits Date Date Init
Nftrate-N
Totat Coliform
0.527 0.100 mg/L EPA 300.0
0.00 co[/lOOmL SM18 9222B
10 max
11/04/97 GCP
11/04/97
APPLI( iNT FILLS OUT UPPER HAL ~ONLY
Buyer
Address Zip Code
Lending Institution /~,i/~ /~ ,.~. ~ / Phone
Address Zip Code
Phone
Realty Co. & Agent
Address Zip Code
Time Time Time Time ~. ¥~
Date Date Date Da~t~t ~
' ..~A,
inspector Inspector Inspector Inspector
F[eld Notes:
~_~ ~.. ~ ~UNICIPALiTY OF ANCHORAGE
NOV 3 ~ ~c,~
~'~ - ~-~~ - RECEIVED
*CONDITIONS OF APPROVAL
CONOITIONAL APPROVAL*
Soils Reting Date ~wer installed Well To Absorption Area l ~ ~ Well Log Received
? 5~ ' / o-