HomeMy WebLinkAboutT15N R1W SEC 9 LT 58BT15N R1W Sec. 9 Lot 58B #051 -103 -38 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201064 PID Number: 051-103-38 Dwelling: ❑ Single Family (SF) ❑ with ADU ® Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JUSTIN & CHAELENA STUBBERS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20713 STARNER STREET, CHUGIAK, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 6 GPD/SF 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. 58B Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. T1 5N R1 W 9 SEPARATION DISTANCES To! ( Septic Absorption I Holding Sewer Total absorption area Number of trenches Dist. between trenches Lift Station From Tank Field Tank Line Ft' Ft. Well 1 OO -- �+ i 25' + TANK ® Septic ElS.T.E.P. El Holding [I Other Manufacturer ANCHORAGE TANK Capacity 2000 Gal. Surface Water ( 100'+ -- Material STEEL Number of compartments 2 Lot Line 101+ -- NA Foundation 5'+-- LIFT STATION Manufacturer Capacity Gal. i Remarks Tank insulated per owner. Tank installed W/out permit. One pos-tank CO sweeps towards exist field. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Owner — (MAY 2017) Drainfield CO/MT 3034 Inspector FWCS — (Visual post construction) BENCH MARK (Assumed elevation) 100 ft Inspection 1s` 4/7/2020 ntl Location and description ection 2 3I 4`" BOTTOM OF DOOR SILL ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date ��•,•'' 1 '•,,��� �AW l... . fH ....�...��� `." "" ""'":"� Curtis Huffman Septic System Approved -�'c�,,•.� / a j CE 128991gir Date D �?D D `J .,2 1 �4117/202Q. .,�� s �� (� 1. X11, � F�PROFEON SSI� Note: this approval does not include well permit requirements. �NN,_4001 (Rev Ub/U1/18) 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com April 17, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT - DOCUMENTATION LEGAL: T15N R1W SEC 9 LOT 58B The owner has requested that we obtain a COSA and document the non-permitted septic tank install from 2017. Attached are the inspection report, copy of tank purchase and other corresponding COSA documents. These documents are based on recent visual observations and information provided by the owner. The tank was installed in the same location as the previously existing one and does not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. MUNICIPALITY OF ANCHORAGE SAI Development Services Department On -Site Water & Wastewater Section ON-SITE SEPTICMIELL PERMIT APPLICATION Parcel I.D. 051-103-38 RNs Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) JUSTIN & CHAELENA STUBBERS Day phone 2085533684 Mailinq address 74-5555 KAIWI STREET, KAILUA KONA, HI 96740 Site address 20713 STARNER STREET, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 5N R1 W SEC 9 LOT 58B Lot Size 48,150 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank El Upgrade El Duplex (D) Q Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ e THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this iso in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: jd'51a'y'-"6 Waiver Fees: Date of Payment: 11&190,26 Date of Payment: _ Receipt Number: .3/616 .� Receipt Number: Permit No. /�5%J Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc T15N R1 W SEC 9 LOT 58B APPROX. WATERLINE LOCATION WELL ON ADJ. PID: 051-103-38 PERMIT: OSP201064 GRAVEL LOT 58A MT 100'+ x � 00 X 2.0'x48.3' CANT EXISTING FIELD NEW 2000—GAL 3.0'x12.0' DECKS 4.2' SEPTIC TANK }- A F°° •°° �° Lot 58B 10 8.3' cn c co D E 48,150 S.F. cv BM 24.2' 2.0'x20.0' CANT RAVEL B 00 N 89 59'00"W 300.68' 8.3'x12.3' SHED A—C=9.3' B—C=32,1' A—D=20.8' B—D=35.4' A—E=24.2' B—E=36.3' SCALE: 1' = 30 JI. HL L; IV 1 J SUPPORT$SERVICES: \\ T15N R1W SEC 9 LOT 58B � / �� 4F AL�S \� PREPARED FOR: 1 JUSTIN & CHAELENA STUBBERS 20713 STARNER STREET * CJ TH CHUGIAK, AK 99567 / FIRST WATER CONSULTING DATE: 4/20/2020 rtis Huffman / SURVEY: KGL 1f� CE 128991`Of 13030 SUES WAY DRAWN: FWCS ' 4/20/2020�'� ANCHORAGE, AK 99516 SCALE: 1" = 30' 1 \ FESSI��Py 907-350-9566 firstwaterAK©gmail.com \� I � I 30.0 15' UTILITY EASEMENT Lot 58A � I S 89'59'00"E 301.22' Lot 58B 48,150 S.F. PIPES NOTE: THE LOT IS SERVED BY A COMMUNITY WELL LOCATED ON LOT 58A. V) Lot 57 Lot 1 PLOT PLAN ___ AS BUILT _X_ SCALE _1___50__ GRID __NW 1359__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone oQ000pO� (907) 522-4625 Fax oo p�4 Professional Land Surveyors kenOlangsurvey.com c F A yjonathan®langsurvey.com 00 5440 I hereby certify that I have surveyed the following described property: LOT 58B, A SUBDIVISION OF BLM SMALL TRACT 58 (PLAT No. 79-261) o * 49TH'•� �� Anchorage Recording District, Alaska, and that the improvements situated thereon are �' "' .'6 within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed �'�i ...... ENNETH &ANG premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. O F G L,, 4� �Fo ..�5—S 02. ' 'AJ Dated this the --- __—_ Day of ___1�___—_—__, _L° _, at Anchorage, Alaska Q ,o NOo 40oR�FfSSIONA� �o It is the responsibility of the owner to determine the existence of any easements, DOOD000� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 z to M Z � o 0 24.2' N U - GRAVEL O X O W n 2.0'x79.7' CANT a- m 2.0'x48.3' CANT 0_ C m / O 6.0'x12.0' DECKS ^. } 4.2' c O / p O 108.3' I 2.0'x20.0' CANT GRAVEL 242 00 N 89'59'00"W 300.68' I I 8.3'x12.3' SHED I Lot 75 Lot 58B 48,150 S.F. PIPES NOTE: THE LOT IS SERVED BY A COMMUNITY WELL LOCATED ON LOT 58A. V) Lot 57 Lot 1 PLOT PLAN ___ AS BUILT _X_ SCALE _1___50__ GRID __NW 1359__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone oQ000pO� (907) 522-4625 Fax oo p�4 Professional Land Surveyors kenOlangsurvey.com c F A yjonathan®langsurvey.com 00 5440 I hereby certify that I have surveyed the following described property: LOT 58B, A SUBDIVISION OF BLM SMALL TRACT 58 (PLAT No. 79-261) o * 49TH'•� �� Anchorage Recording District, Alaska, and that the improvements situated thereon are �' "' .'6 within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed �'�i ...... ENNETH &ANG premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. O F G L,, 4� �Fo ..�5—S 02. ' 'AJ Dated this the --- __—_ Day of ___1�___—_—__, _L° _, at Anchorage, Alaska Q ,o NOo 40oR�FfSSIONA� �o It is the responsibility of the owner to determine the existence of any easements, DOOD000� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 3(4$ov. 3/78) r i-, \\ 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 `/ `/ K I �A ptr--.i. I % /�7p -l/ ' `� NEW UPGRADE MAILING ADDRESS t,112- 7 ` LEC�A1D ESCRIP( N rV',L ---anmo5�e / (hI 5 ��. / TI i ki 1 Z 1 U J LOCATION NO. OF BROOMS SEPTIC TANK DISTANCE TO: 102W lief ut ,+Absorption�ei 041 Dwelling , . PERMIT N`/00-�7q c C^-O4t / l7 Manufacturer 2C2.r 9 Material 1 Q , \G-' c -V No. of compaptments Lig1capaCtyje gallons IF HOMEMADE: Inside length Width Liquid depth-- 6 �' J02 0! 4 1Wellf DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: rvt'� dant oundation Nearest lot line PERMIT NO. No. of lines / Length of ea line g Total len of/lues g ` Trench h 0 inches Distance bgtyve Ines K/ Top of tile to finishgrade Li.I Material beneath tile T gel ! inches Total effect absorption area t la SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption weals/ OTHER PIP MATERIALS T1'' ao-31.4 50 L TEST RAGg,— INSTALLE SOLD aTefprl3e3 - G' REMARKS --71115) C-re6f 8 Svrn r lltt k ttttttlk rt I' 1' do' `1, PPR, 7. DATE LEGAL A {9St)>C1 J t46/7 9 3(4$ov. 3/78) r ���� '����+DJ»"' Pl#DEPARTMENT OF; 825 'L/ :SO/^ �`m-, `����� �� ��� ����� �m �4 HEALTH AND ENVIRONMENTAL vrolTECTION STREET/_HNCHORHGE, HK. 99501 ` Lic, [»/ ��b4-4(2m ����I�� �E��JR PERMIT NO. ( 790504 ) APPLICANT RICHARD WEIS LOCATION LEGAL BLM L58 S9 T15N R1W `�^'.[� �\`| ����."1"- et n'/` o���"',�u 5924 CHMROSE DR Z]I 0796 LOT SIZE 109000 SQUARE TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 6 SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E> 14-0.,- *3 1_ r— 1"413114-1 =. et (3 FR IF1 "./ 0 IF- F'.° == FEET THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS Ni SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). I PlET> SAE: ��I c7...] 1 -Form< S5 I 2:17= n PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. __ 1- [kJ ��> r4 EE 1- I ND R1/44 !=, EE BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND DEPARTMENT WILL BE SUBJECT TO PROSECUTION. DEPARTMENT DURING THE PROPERTY AND THE TA .... E> APPROVAL BY THIS MINIMUM DISTANCE BETWEEN H WELL AND ANY ON SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. thf917"— I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT T ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I-7REMOTO INCLUDE MORE THAN 6 BEDROOMS. SIGNED PFtj CF ISSUED B' --- RICHARD WEIS ' DHTE V].2 0 Et E GEOTECHNI CAL Ft DEVELOPMENT CO. Russel Oyster 694-2774 Soils 6 Foundations Box 90, Davis St., Engle River, Alaska 99677 694-2774 or 688-2280 50IL LOG Est Ellis 6987280 Land Development Performed for: Name: 42/cK o644- ,Cg/Sxckcn4/,e' Tel. No. Mailing Address: Legal Description: !1O7 Depth (feet) 0 sB SEC. q, 77rv, ,ziw, "/. Soil Characteristics 1 Alt 5/cr % r /l.2742e»7e,t 41,9, /06 x, • 2 , 6P, 5P l.en✓Eu 0 5400 coaace. S >z ,Ffar%cp6KS '771 /4_ 4 5 6 7 �ia T /1/Ea DEAwS, t 8"4 CP -i9 41 9 Go.B/.3Geis §c An/co/sal to /a mom, C'cEA,t/ Zeta se- 1 ase- 10 - 11 12 13 14 15 16 PLOT PLnA/ Al. SC/nc Ground Water Encountered: YesNo ✓ If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments 52 5 0nT 3 1979 p/ ,rformed by: � .f / f' Date: a/1/4? It rn (Y) rn (Y) M CO M I— rl- O O () (3) LO N O N m N ti 6 cu C O m Q x W O O O ao co I co O LO O a� U r— CoCO rn M Q co cu LO C) U W� Cw O w _ z Q z ~ Lf') C'7 O O N Q O U O O a a ca a) � J CO I N IS, N N Q) C: 0 O Q O C1 C: a) U 9701 0 N O Q CU a) L cu D In0 cn O cn c O Cu L X 0 O CL C2 ca ca C 0 c O Al E 0 A N O N c) O r WE C O O a) -� Q. Z -a a 3 .2- C) y V N C t CD ~ cn O ~ a) 'a U L O = O +0+ o a) r -N •a Rf N a) O N o C a) CL ,U ^m Q a) > a O O cn j .E o Cl) c Q > aQ NN = O U Q O OL N O = N CU �- N N p 3 C m Q. .N z Q U E +, N r � L � -0 •� o > o C Ma: Q = L Q. •Q CL N CLE a) i N U o E a� x �•��o 4- N + Ci) m o fn fn y E 'a O Q _ ' Q. > aZ N U) O cn O O N O a) Q 0 N 0 � c: O (1) v ui O (R F QCI- Q L r Z W O-�e ami E U Q H O U t w t U N v Q v 1 - C) OD m O O d7 O (1) X rLU -r- 0 a U- � V NQ 0 V Z LL .. \\ 0 1} F— J Q C ^ C O I.i U E °) V � � Z a� U � ai C,6 L E CL O C O ca U 0- 0 O r� v! W 4 - CO N C O O N m co M M O r LO O ❑ L co .I u a u ., FA Z Ti A U U ° C' _ a) (n 0 (o N 3 ° C O U N Q_. •�% 0) L E D 7 cn .) U C E O U L �. NO ❑ C _0 a) Q U _� M Ll d (nn 0) CL O U u) T C El ElD 2) o a) a LL L v > •L M ra^) LL� r ElQ Q) � // V) a - VJ a)❑ N lz cu a = .a a) �, cu ® E] O C) >, oN m o C Q. W o m a? CO J El C ❑ Q. =p > N U -C U)++ a_ L ca O (n L ~ S R �. o ❑ ❑ n 0- c w U.o >- ❑ a) Qa) ❑ J N d W ❑ _0 E d w a a a) O cn cn cn J a) d A L1J ® W a U) 0 W W H F. cn -0 Z m Q Q Y o co >I^- O 0 cn Q Q) W LL LL I— fn G. > d O O fnW/� W I- L�� a) a. a M a) �0 cn O �" co Q Q > Q O X 9+ N M �t L6 (0 W O m 0 ° a) LL a) co CL 4t o .! cu cu ❑ J � S E a) co LL d *k O O coo O U ❑ U COSA Checklist.docx COSA Checklist Legal Description: T15N R1W SEC 9 LOT 58B Parcel ID: 051-103-38 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA (PRIVATE (Class C) on adjacent Lot 58A) Well log is filed with Onsite (or attached) Date drilled 6/19/1979 Total depth 63 ft Cased to 63 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA NA Static water level at beginning of test NA ft. Well production at time of test NA gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.64 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/10/24 Comments: 2 STRUCTURES SERVED BY THIS PRIVATE WELL. B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 7/23/24 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/10/1979 ALL standpipes present per record drawing Total measured depth from existing grade 8 ft (max) Measured depth to pipe invert from grade 4 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 9/10/24 Results Pass Fluid depth prior to test 17 in Water added 900 gal New fluid depth 23 in Elapsed time 1440 min Final fluid depth 12 in Absorption rate 900 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 48 in (MOA 48” ED) Effective depth used 12 in (Final Fluid Depth) Effective depth (ED) remaining 36 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *5+ ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *Septic tank to foundation met code at install. 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 09/20/2024 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 & 09/20/24 Epuhts M uNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Section Phone: 907-343 -7944 Fax: 947-343-7997 Expiration Date: J "lq 10 , IC!.C Day ghone 6 Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic X Holding Tank I Community I Public Sewer I Distance: XI Tf Certificate of On-Site Systems Approval Parcel l.D. 051-103-38 1. GENERAL INFORMATION Complete legal description T15N R1W SEC I LOT 588 Location (site address) 207 13 STARNER STREET, CHUGIAK, AK 99567 Current property owner(s)JUSTIN & CHAELENA STUBBERS Mailing address Real estate agent 2. TYPE OF DWELLING: I Single Family (w/wo ADU) X Duplex n Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: 74.5555 KAIWI STREET, KAILUA KON Received by:Date: COSA to be released to the engineer, unless otherwise requested by the engineer. cosA Fee $ 55D f Ll tA ,5D Lt I tbleoaoDate of Payment Receipt Number dwta Waiver Fee $ Date of Payme Receipt Num Waiver #cosA # }aCADil5b 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, based on procedures outlined in the Certiticate 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 veriry that based oh the information obtained from the Municipality of Anchorage fites and from my investigation and inspection, the on-site water supply and/or wastewater Oisposit system is (aref in compliance with all applicable Municipal and State codes, ordinance,s, and regulations in effect at th; time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Address 13030 SUES WAY. ANCHORAGE. AK 99516 Engineer's Printed Name CURTIS HUFFMANJE 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 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 U ISp' 6. DSD SIGNATURE//V System #1 Approved for b bedrooms System #2 Approved for Disapproved Conditional approval for Phone 907-350-9566 Date 4t1512020 bedrooms bedrooms, with the following stipulations:ffi" -€N-st+E wWATER AND =y16g:rLv\qTgp 5F --FROG[r*M oq?=Sffi ,r,'Prlr** h,il orisinar certiricat "o^t", 4' 21" )" The Municipatity of Anchorage Development Services Division (DSD) issues Certificates ot On-Site Syst€ms Approval (COSA) bas€d only upon the rspr€sentations given in paragraph 5 by an indep€ndent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errorg or omis€iong in the professional engin€e/s work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: T15N R1W SEC 9 LOT 58B Parcel ID: 051-103-38 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA – WELL LOCATED ON LOT 58A Well log is filed with Onsite (or attached) Date drilled 6/19/1979 Total depth 63 ft Cased to 63 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 4/9/2020 Static water level at beginning of test 44 ft. Well production at time of test 7.7+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.75 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 4/7/2020 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) 3 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50” Standpipes/foundation cleanout per record drawing Date of pumping 4/6/2020 C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/10/1979 ALL standpipes present per record drawing Total measured depth from grade 8.1 ft (max) Measured depth to pipe invert from grade 4.1 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 4/9/2020 Results Pass For 6 bedrooms Fluid depth prior to test 4 in Water added 920 gal New depth 16 in Elapsed time 40 min Final fluid depth 4 in Absorption rate 900+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No 5’+ ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No 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. 4/17/2020 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 • CERTIFICATE OF ON-SITE SYSTEMS APPROVAL / Expiration Date: - / - F Li Parcel I.D. 051-103-38 1. GENERAL INFORMATION Complete legal description T15N R1W SEC 9 Lot 58B Location (site address) 20713 STARNER ST, Peters Creek, AK Current Property owner(s) McDuff Mailing address Real Estate Agent same Day phone 563-7620 Gene Cod Dall Property Day phone 563-7620 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) m Duplex IP1 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System MAY 1 4 2014 TYPE OF WASTEWATER DISPOSAL: ❑ Individual ❑ Holding Tank ❑ Community ❑ ❑ Public Sewer n Received by: COSA to be released to the engineer, unless otherwi a engineer. COSA Fee $ 6 `—Ca Date of Payment 6//51/9 tip Date of Payment Receipt Number 015(4Q Receipt Number COSA # 05G141‘. i5C0 Waiver # Date: 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, 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6. DSD SIGNATURE System #1 Approved for (p bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for 5/13/2014 bedrooms, with the following stipulations: \`UUIIUU I rr f . &? OF AA/(11-0L_:- \N- Lay i G\ OA�ii ON-SITE WATFR AND ?;•.0 WASTEWATER o PIROGRA\c„,?5,M y �0 / /• Original g. _ fit=� B : LC/0 nal Certificate Date: / The Municipality Anchorage Devlopment 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 Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12doc X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: TIE Al le/W SEC 71 of" Se,$ Parcel ID: 0 51- / 0 3- 32 A. WELL DATA — &ELL is C oCetrs_D ON Lon' S&A Well type CI -4g s C. If A, B, or C provide PWSID ft Well Log (Y/N) Date completed G 1( `(1 71 Sanitary seal (YIN) y Wires properly protected (Y/N) Total depth 63 ft. Cased to 6 3 ft. ( Casing height (above ground) 2'1 . in. FROM WELL LOG AT INSPECTION Date of test c/ 11/7 9 47/12 7/%7 Static water level 2 0 ft, y8 ft Well production / S g.p.m. /04 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 5. 8 5 mg/L Arsenic ©• 31( ug/L Date of sample: 2/ 4 Collected by: 42r.V, B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5 PTre-I s reE 1. Date installed //o /7 Y Tank size / 750. gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Depression over tank (Y/N) AI Hiah water alarm (Y/N) N Date of pumping 5/7// Pumper S/1-AJIT4-tr 7d'"F42 .3 C. ABSORPTION FIELD DATA Date installed 9 0 71 Soil rating (g.p.d./ft2 or ft2/bdrm) g'S System type 7Rai. i c tf Length 7/ ft. Width .3 ft. Gravel below pipeLieft. Total depth g ft. Eff. absorption area 5(0 ft2 Monitoring tube y Depression over field A r For 4. bedrooms Fluid depth in absorption field before test 0 in. Water added 100 gal. - New depth ? in. Elapsed Time: C 0 min. Final fluid depth 0 in. Absorption rate >_ 7CO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) //it/� If yes, give date Date of adequacy test L//29//[` Results (Pass/Fail) //1SS D. LIFT STATION tJ Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOTTO: 'e' 1,1/642 °Ai Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: CI' Building foundation 5 "' Water main NA Wells on adjacent Tots / 5a r" ABSORPTION FIELD ON LOT TO: Property line /0 te Building foundation Goy" 58A1 Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Property line / 0 'f Absorption field /a `4 Water service line lD f Surface water / 0 o 11- / 0 't Water main NA Water Service line /0 't Surface water /00 41- Curtain 'Curtain drain r/A-M. Wells on adjacent lots / 50 F. COMMENTS *"" S efidi.z4Tr0N Ad 60a g ,9,01/4) Aor. s84 Driveway, parking/vehicle storage 50 rF G. ENGINEER'S CERTIFICATION I certify that t 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. 5 T/vC EN G Engineer's Printed Name Date 5�r3/iy COSA brown sheet_10-10.12.doc ' INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECT .' DEPARTMENT MUNICIPALITY OF ANc-HORAOC MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & OF HEALTH & ENVIRONMENTAL PROTECT RONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 SANITATION DIVISION OCT9 190 Telephone 264-4720 RECEIVED OF INDIVIDUAL WATER AND SEWER FACILITIES \• /'. ENVIRONMENTAL \ / REQUEST FOR APPROVAL DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing. 1. PROPS TYOWNE i�µM IG LO El S PHONE 937 o77G MAILING ADDRESS C-7 C -41M /0 5 e Di_ PROPERTY RESIDENT (If different from above) rag ,v,V» 5rt,t,/vn s r PHONE 2. BUYER X l e-nin 'ted; - iC4'i I 5— `MAILING PHONE MAI LINGADDRESS 3. LENDING INSTITUTION//�w,n /l/ C3 /9 ©O "I,' V�04-itike PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION—�. _ �J 1 c/ 6-8/6 sec 9 rick, R I I/ -J SJV\ STREET LOCATION Film sr -#/1) AiGz---. s 7--- 6. TYPE OF RESIDENCE NUMBER OFkBEDROOMS • One • Four IN Other ❑ SINGLE FAMILY IN Two • Five M MULTIPLE FAMILY • Three 12 Six 7. WATER SUPPLY IN INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled IW COMMUNITY since June 1975. For wells drilled prior to that date, give well le PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM R1 INDIVIDUAL/ON-SITE** /77% YEAR ON-SITE SYSTEM WAS INSTALLED. IN PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS • SINGLE FAMILY • MULTIPLE FAMILY • ONE • THREE • FIVE • OTHER ■ TWO ■ FOUR ■ SIX 2. WATER SUPPLY PERMIT NUMBER • INDIVIDUAL DEPTH OF WELL C COMMUNITY • PUBLIC UTILITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER • INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY DATE INSTALLED Connection Verified • Septic Tank or • Holding Tank INSTALLER Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL. 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS • CONDITIONAL APPROVAL (letter must accompany certificate) • DISAPPROVED DATE BY 0 72-010 (Rev. 6/79)