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 • Ld• 0 • :. ui • .� CL ui 0 i w0 w L) LLJ UJ s 160 •w . w „uj i <• • LLJw i • 0 w� .. i wCO z., ui i • ,,, LLJ i w0- .w •2 z • uj w • 0 w Ix 0w r i . iLu w CO 0 ico z i i co 0 Cort w C13 i i y� • w Z W w i i • 0 + w i i • +! • i t i i i i W i i CO z_3 nw �i • i � w • w ' ,. i s 5 • Di z ! • D Ai LLsw i 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-