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Home My WebLink AboutT12N R4W SEC 10 LT 68AOnsite File •t 0 MUNICIPALITY ;D Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-213-70 1. GENERAL INFORMATION Complete legal description T12N R4W SEC 10 LOT 68A Expiration Date: &Q - Z Z Location (site address) 9124 GLORALEE STREET, ANCHORAGE AK 99502-5137 Current property owner(s) UPSHUR M. SPENCE Mailing address Real estate agent Day phone 9124 GLORALEE STREET, ANCHORAGE AK 99502-5137 Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 7 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Waiver Fee $ Date of Payment S - Z' 21- Date of Payment Receipt Number_ 07 2 d 7 3 Receipt Number COSA # O` ZZ 1 1 7 7 Waiver # 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 - Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/29/2022 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 �+~ Or these various and dynamic characteristics and are outside the control of the evaluator of the �' •�f�i - '� well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•' discrepancies exist can be given by First Water Consulting & WS*' 4 lli '* r 6. DSD SIGNATURE % • • Curtis Huffman System #1 Approved for bedrooms II��FC/•• CE 128991 •.�� f lF,p'•.4/29/�2•'F�,.' System.#2 Approved for bedrooms i11F�PROFESS19Na Disapproved Conditional approval for bedrooms, with the following stipulations: l�tV U( Y 0F,c J ON—SIT `v WATER AND '1)))))1)11I%))II� By! Original Certificate Date: X7'2 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 a Legal Description: T12N R4W SEC 10 LOT 68A Parcel ID: 011-213-70 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1968 - Total depth 40+ ft (ASSUMED) Structure served by this system Well production at time of test 5+ gpm Water storage tank volume NA gallons - Well disinfected for coliform test? ❑ Yes ® No Cased to 40+ ft (ASSUMED) ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND) ® Wires are properly protected Arsenic 35.2 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 18+ in. FwI Date of flow test for COSA 4/22/2022 Collected by Static water level at beginning of test 44 ft. Date of Sample 4/22/22 Comments SULLIVAN EXTENDED CASING WITH NEW SEAL & CONDUIT. ADEC WELL SERVES THIS AND ADJACENT LOT. THERE IS A.VACANT-3- . UNDEVELOPED LOT & WILL FALL OUTSIDE MOA OVERSIGHT ONCE DEVELOPED B. TANK DATA - NA Age of tank(s) _ years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record. drawing Date of pumping D. ABSORPTION FIELD DATA - NA Which system tested (date installed) - - ❑ ALL standpipes present per record drawing Total measured depth from grade _ft (max) Measured depth to pipe invert from grade _ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth _ in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: NES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes if No Septic Tank/Lift Station on Lot > 100' If absorption field is under driveway comment below Property Line > 10' Community Sewer Manhole/Cleanout > 100' _ ft ❑ Yes if No NA ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells >100' _ El Yes if No ft Water Main >_1.0' . _...1`] Yes if No _ . ft Community Wells >.200' __ .❑. Yes . if No ft Water Service Line > 10' ❑ 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 If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells >100' _ El Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS SEWER SEPARATIONS APPEAR TO BE ADEQUATE PER VISUAL OBSERVATIONS WOR DATE WELL WAS DRILLED. ATTACHED AWWU SEWER CONNECT CARD & ASB SKETCH OF APPROXIMATE AWWU SEWER LINE G. ENGINEER'S CERTIFICATION l certify that l 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. AW TM•....':'.�: �..•..• ........t.......� �.. Curtis Huffman •.:� ,�0 5116/2� 1•��AW Arsenic Advisory Certificate of On -Site Systems Approval # osc221177 Subdivision: T14N R4W Sec 10 Lot 68A A water sampte revealed an arsenic concentration of 35.2 micrograms p-er liter- (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. "� 'Mailing Address ch P O Box 196650 *Anorage, Alas 99519 6650 *www muni org ; . ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: BUNT LOT 68A T12N R4W Sec10 S.M. PLAT 2003-166 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul< any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—gat APR 15, 2022 1"=30' schuller0ok.net 22-036 DRAM BY: CHECKED BY GMD NUMOE 800K pAGE: JLS SW2325 220162 LOT 68C = FND 518" REBAR SUlow OTAZAWR K.. .* .•• 49TH •� • � � � r' ... ......... yrs.. .fi.x .., � •.JT HN L. t SCHULLER: o` a Cr LS -10408 1831 Talkeetna Street aA Anchorage, Alaska 99508 � o (907) 227-1455 office r°fessiono\ (907) 274-4992 fax i DOCK N6"> LOT 68 44' S66°05'00"W 11.13' S89'59'10"W 117.06' --I 10.11 48.0' Y O Ld 2 7 aJ\' Q � V ( 4.0' 0 W z Q 60 LOT 68A c 16.5'Q DECK = Ld 6,2' UCO` 00 j LLJ Lv W 4 F— LOT 68B oo w U PAVEMENT JJ D K O W J 1 29.3' 2'.a Lr) Q 2' ---- j J DECK vii + L �z w O J ( 7 I (< ' v X X X as L`' 3 X X X X X n N89°55'544"W 100.00' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: BUNT LOT 68A T12N R4W Sec10 S.M. PLAT 2003-166 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul< any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—gat APR 15, 2022 1"=30' schuller0ok.net 22-036 DRAM BY: CHECKED BY GMD NUMOE 800K pAGE: JLS SW2325 220162 LOT 68C = FND 518" REBAR SUlow OTAZAWR K.. .* .•• 49TH •� • � � � r' ... ......... yrs.. .fi.x .., � •.JT HN L. t SCHULLER: o` a Cr LS -10408 1831 Talkeetna Street aA Anchorage, Alaska 99508 � o (907) 227-1455 office r°fessiono\ (907) 274-4992 fax AWWU / ASB WELL -SEWER SKETCH ' 1 f %/ 6� DOCK LOT 68 1g• 4pS „ w S66 05'00"W 11.13' S89 59'10"W 117.06'—•-I +� O5' CANT (ON P aa.o' qq � � o Q� SUBJECT SEWE CONNECT ° z PER A WWU / ASB 6.21 LOT 68A DECK w 06,y o w w �Ro LOT 68B 96+.n r w P4VEMLNT D K O W LJ 29.3.......... p � DECK F- (F- Z O x SUBJECT WELL z —X X X X X X N89 55'54"W 100.00' Lo V) LOT 68C DRAWING PER AWWU & RECENT SCHULLER ASB & PER CLI NT W/ o WELL SERVING TWO DEVE OPED o.. LOTS & ONE VACANT UNDE . LOT. Q -I-- L SUBJECT SEWER MANHOLE WEST DIMOND BLVD. PER AWWU / ASB SSMH LOT 68 T1 2N R4W SEC 10 PREPARED FOR: UPSHUR SPENCER 9124 GLORALEE STREET ANCHORAGE, AK 99502 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com SUPPORTOSERVICES: OFAA 4 T� H`Y M� DATE: 5/16/22 tis Huffman SURVEY: JLS 2022 �y, CE 128991 w DRAWN: FWCS 5/16/22 �� SURVEZ: 1 OF 1 "�?oFEssiovo TAX CODE No. 011-213-36 • MUNICIPALITY OF ANCHORAGE — SE' PROPERTY Name Address 9 L OV,4 . Plot No. Subd. ENURSi Residential ❑ Commerial ❑ Industrial ❑ No. of units CONNECT1SEE WlM Main Tap S On Property ❑ Permit No. Size—Type- izeTypeDrawing DrawingNO.,3123A Size Main Type Depth at Connect Insulation ❑ Cieanouts Type Connect Agent Inspector Date Comments Connect Location ASSESSMENTS: L.I.D. No. Private Dev. No. Subd. Agreement ❑ No. Sewer Agreement ❑ No. —RTE. ❑ Roll No. DYE TEST: Positive ❑ Negative ❑ N.S.A. ❑ Date Page No.—M.H. No. Billing Cycle Tested By Comments s;uawwoo i Z A31"7 V 133 ills - 8104vow 10Jiu00 ;o u0110001 nmgS yatayS Ag aoi4o3o-1 oui-1 aoiAJaS ,,kla3dOHd NO,, Le LV 6a �i J ` ../ _.. ... ....�:G.:.�nd,Y+i...n.�i..�`�. .,i:T,i:,.,.. n'.nv-:i"�-e1t: 3,wTE RECEIVED INSPECTION APPOINTMENTS :~IME TIME TIME DATE DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTr=J~i~i~IPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPt. OF R~ALTH ENVIRONMENTAL PROTECtiON ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 NOV 2 0 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~?V~~ DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. MAILING ADDRESS MAILING ADDRES~ 4. REALTOR/AGENT ~ PHONE MAILING ADDRESS 6. TYPE OF RESIDENCE [] SINGLE FAMILY ~-~ MU LTIPLE FAMILY [] One ~ Two Five ~ Three ~ Six Other 7. WATER SUPPLY [;~ INDIVIDUAL* * ATTACH WELL LOG, A well log is required for all wells drilled [] COMMUNITY since June lg75, For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** _~_YEAR ON-SITE SYSTEM WAS INSTALLED. J~ PUBLIC UTILITY NOTE: THE INSPECTION FEE IViUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '!THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 3ERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL E~] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEIVI PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING live dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line,I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E~APPROVED FOR ~ BEDROOMS r~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ 72-010 (Rev, 6/79}