HomeMy WebLinkAboutT15N R1W SEC 18 LT 63
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231183 PID Number: 051-171-06
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
MANUEL & BOBBIE BELMUDES
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
19166 BIRCHWOOD LOOP, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
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.
63
Township Range Section
15N 1W 18
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Est. between trenches
From
Tank
Field
Tank
Line
Ftz
Ft.
Well
100'+
__
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
10'+
__
NA
Foundation
10'+
ILIFT
STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer JRS
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection
15` 8/17/23 �d 8/18/23
Location and description
ction 2
3rd 4'h
TOP OF MH / RISER
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
._
��
Conditional Approval: Date
A '•:tQ�l�
Curtis Huffman
Septic System
Approved
LC/ �t2�
�1�i�'S�lF��•..•�• �CE128991 �
,W rDate ,8/23/23X��'pROFEWN
Note: this approv nes not include well permit requirements.
(Nev u*luuiu)
PID:051-171-06 PERMIT:OSP231183
FIRST WATER CONSULTING
T15N R1W SEC 18 LOT 63
SHED
6.
1
LOT 63, SEC. 18, T15N R1W
Seward Meridian
113,256 Sq. Ft. +/-
19166 S Birchwood Loop Road
1 Story Wood Frame House With 1 Car Garage
LOT 36
50
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N90° 00' 00"E 393.03'
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33' PATENT R.O.W. RESERVE NO. 026496
8
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PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
August 25th, 2023.
Legend:
Scale 1" = 60'
Electric Meter Telephone PoleE
Lot 63, Sec. 18, T15N R1W, Seward Meridian
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Audry Mach
23-353 08/28/2023
77-211 1155
E Elec. Pedestal Tel. Pedestal
S T A T E O F ALA
S
K
A
49 TH
ROYEVRUSDNALLANOISSEFORP
DER
E
T
S
I
G
E
R Pierre M. Stragier
NO. LS-9812
09/05/2023
TWood Deck
Chain Link FenceGGas Meter
Over Head Utilities
SepticS
NOTE
1. Research could not find recorded legal description
of 50' and 100' easements, shown only for
informational purposes.SC Septic Tank M.H.W Water Well
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: OSP231183
Work Type: SepticTank Upgrade
Tax Code Number: 05117106000
Site Legal Address: T15N R1 W SEC 18 LT 63 GA 155
Site Mailing Address: 19166 S BIRCHWOOD LOOP RD, Chugiak
Owner: BELMUDES MANUEL EDWARD &
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date:
Ment S
�C G
EG �
o
Department
Lot Size in Sq Ft:
Total Bedrooms:
7/17/2023
7/16/2024
113256
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Received By: Date:
Issued By: Date:
5
MUNICIPALITY OF ANCHORAGE
CI-
ikov
Development Services Department _ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-171-06
Property owner(s) Manuel Edward & Bobbie Jean Belmudes Day phone
Mailing address 19166 S Birchwood Loop Road Chugiak, AK 99567
Site address 19166 S Birchwood Loop Road Chugiak, AK 99567
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T1 5N R1 W SEC 18 LOT 63
Lot Size 113,256 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) IN
(w/wo AD U)
Septic Tank
IN
Upgrade IN
(D) El
Holding Tank
ElRenewal
ElDuplex
Multiple
Multiple Dwellings ElPrivy
El
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: z
Date of Payment: 2�
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
June 28, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: T15N R1W SEC 18 LOT 63 – 19166 S BIRCHWOOD LOOP
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the
attached design to serve the existing 5-bedroom residence. No groundwater was noted in the
MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel
septic tank may be required. The lot and area are served by private water. The design will not
impact any of the neighboring properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231183, Curtis Townsend, 07/17/23
DESIGN DETAILS:
INSTALL NEW 1500—GAL HDPE
WELLS, 100' TO SURFACE WATER, 5'
INSULATION. INSTALL PER AMC 15.65
MATERIALS,...
APPROX. WELL
LOC. INSSIDE
41
0
Municipality of N dmr
On-site Water and Wastewater
REVIEWED FOR CODE COMWhA
OSP2311&3 Curtis TGMBWC 07117
TANK. MAINTAIN 10'+ FROM FOUNDATION, 100' TO
TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR
15.55, & MASS ... TANK BEDDING, SEPARATIONS,
FCO NOT SHOWN ON
— ASB. SHOW ON
\ FINAL ASB SURVEY.
STAKE 100' WELL
RADIUS PRIOR
TO CONST.
CO
APPROX. 100'
WELL RADIUS.
STAKE PRIOR
TO CONST.
DECOMMISSION EXISTING
S.T. & INSTALL NEW
1500—GAL HDPE SEPTIC TANK
WITH NEW DCO & RECONNECT
TO EXISTING SEPTIC FIELD.
VERIFY 5'+
FROM SX TO FIELD
C�
DCO CO
CO
NOT SHOWN ON
AS8. SHOW ON
FINAL ASB SURVEY.
CO
CO
NO WELLS WITHIN
1 00'OF PROPOSED
SEPTIC TANK. RE -VERIFY
PRIOR TO CONSTRUCTION.
-w— mu— mi,—ar _ mu— mu— mu—mn,—mu— M—tea,—M—M—ua,—mn,—m—am— w
BLM RES. ESMT. P.R!{i{V : PAD
T15N R1 W SEC 18 LOT 63 SUPPORT®SERVICES:
PREPARED FOR:
MANUEL & BOBBIE BELMUDES
19166 S BIRCHWOOD LOOP ROAD
CHUGIAK, AK 99567
FIRST WATER CONSULTING DATE: 6/28/23
SURVEY: FRONTIER
13030 SUES WAY DRAWN: FWCS
ANCHORAGE, AK 99516 SCALE: 1" = 30'
907-350-9566 FirstWaterAK@gmail.com PAGE: 1 OF 1
OF ALBA
* 9 TI
is Huffman
f� CE 128991 �`�
.6/28/23
onss1O0-'
Municipality of Anchorage Page /_of 2.--
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: %,:.~ c/ -~ol/,,,? PIDNumber:
Name: M,,~- ¢:, Po~-v,,~u.,~ ~ Wastewater System: ~ New ~Upgrade
· ~: )~l~U ~.o ~.~ ~¢/~, ABSORPTION FIELD
Phone ~_~1~ [NoofBe~oms ~DeepTrench ~ Shallow Trench DBed ~Mound ~Other
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION ~,~ ~/s~ ~
Lot: ~ 3 Block: Subdivision: Depth to pipe boltom ,ro~O~inal grade: Ft Gravel depth beneath~ ~"~Pi~e , Ft,
Township: [ Range: ~ Section: Fill added above original grade: Gravel length:
Number of lb]es: Distance between lines:
WELL: ¢~ l%~w U Upgrade Gravel w,dth: ¢% Ft G /¢ Ft
Classification (Private AB.C) Total Depth: Cased TO: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level:Fl Installer: ~ ~ Date installed:~//¢~ ,
Yield: OPM IPumpSetat: Ft ICasing Height Above Ground:F'. TANK
SEPARATION DISTANCES ~s~t~ ~ ~o~di.~ ~
From Ta~k Field Station Tank Sewer Lines ~ ~
Materiak Number of Compartments:
Surface ~Z~
w~t~ ¢¢0' '¢~*1 ~ LI STATION
LOt Size m gallons: IManufacture:
I
"Pump on' level at: I"pump off" level at: High water alarm at:
Foundation
//~
Curtal n Pump M~e & M0de~ [ Electrical Inspections performed by:
Drain
Remarks: BENCH MARK
Assumed Elevation:
ENGINE~ SEAL
Inspections performed by: ~ >~7~ Dates: 1st ~ /~~
Departmen~ of Health u ices approval~ ~?.... ......~
Reviewed and approved ~ Date: g~
72-013 (Rev 9/gt) MOA 25
Permit No. ~UO q ~t~,7 Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
PID No,:
E N aILIN~,~.,~8. SEAL
,,, co ..' ~:.y~, ....~,'~.
~'. ~ % David ~. Dayton
72-013 A (2/91) MOA 25
PAGE I OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PERMIT NUMBER:SW930167
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:BELMUDES MANUEL E
OWNER ADDRESS:lg166 BIRCHWOOD LOOP
EAGLE RIVER, AK 99567
DATE ISSUED: 6/21/93
EXPIRATION DATE: 6/21/94
PARCEL ID:05117106
LEGAL DESCRIPTION: T15N R1W SEC 18 LT 63
LOT SIZE: 113256 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
2. AL1, 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
Bo COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ALL PORTIONS OF THE SEPTIC SYSTEM MUST BE
WELL AND 10 LINE.
RECEIVED BY:~
ISSUED BY:~ ~
100 FT.
FROM THE
DATE:
FROM
, David R. Dayton P.E.
· ~- ie,~ Y~-~- ~ ~_._~ ~ ~d~o-,~ 20210 Donalar St.
Chugiak, Alaska 99567
MESSAGE
f SIGNED
RF.~.~F~I._, 4S 468 ~
POLY PAR (50 SETS) 4P468 k__J NO REPLY NECESSARY
~3 REPLY REQUESTED - USE REVERSE SIDE
D. R. DAYTON, P.E., R.L.S.
~)~~"Chugiak, Alaska 99567
20210 Donalar
[@o7) ~~
696-2417
Lot 63, Sec. 18, T15N, R1W.
Design Narrative
The proposed septic system up grade replaces a failed system
which was built in the 1960's. The system will be a 1500 gallon
tank with 2 80 ft. x-10~ft, trenches with 3 ft. cover.
The system is on a large lot, approximately Acres, which slopes
from Northwest to Southeast.
The system will not have any adverse affects on wells or septic
systems on adjoining lots. Drainage and reserved space, surface or
subsurface will not be affected.
20210 Don~l~r St.
Chuglak, Alaska 99567
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
LEGAL O ESDRIPT,ON:/~r ~.~ ~, n~ m~
2
3
4
5
6
7
8
9
10
11
13
14-
15-
16-
17-
18-
19-
20-
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Deplh to Water Alter. /.,,~
Monitoring? ,/L/~ ,',J ~ Date: ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
?: z.o 17 /~'" G"
PERCOLATION RATE ~ ~ (m~nutes/inch) PERC HOLE DIAMETER
TEST .UN BETWEEN ¢' ~ FT ^N~ ~Y~ FT
COMMENTS ~'~-
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / ~
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SLOPE
1
2
3
4
7
8
§
12
13-
~5-
~7
20-
DATE PERFORMED:
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~)
DEPTH? p
Monitoring?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
.,:,,-'/~..~/9~
/o.' oD 3o ~ ~/~ I~/~
/I., oz ~o ~ ~ llp
PERCOLATION RATE j~,'~ {minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'" FT AND ~ FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
i
'
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-171-06
Legal description T1 5N R1 W SEC 18 LT 63
Site address 19166 S BIRCHWOOD LOOP RD
Expiration Date: 12/15/2023
Current property owner(s) BELMUDES MANUEL EDWARD &BOBBIE JEAN
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Original Certificate Date: 9/15/2023
This 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 X
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. 051-171-06
Complete legal description T15N R1W SEC 18 LOT 63
Location (site address) 19166 S BIRCHWOOD LOOP RD, CHUGIAK, AK 99567
Current property owner(s) Manuel Edward & Bobbie Jean Belmudes Day phone
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
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 NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for: Distance:
Expedited review requested: ❑
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 $ 5 6_0
Date of Payment gA3�2:5
COSA # G 23 ) '� I y
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: T15N R1W SEC 18 LOT 63 Parcel ID: 051-171-06
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled UNKNOWN Total depth UNKNOWN ft
Cased to UNKNOWN ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+* in.
Date of flow test for COSA 6/22/23
Static water level at beginning of test 10 ft.
Well production at time of test 5+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 7.60 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 6/23/23
Comments: Well is located in the corner of the house in the bottom floor / half basement. Stickup is 18”+ above grade with
a sensor and accessible pump system. See attached services performed by AWPS well scoping letter.
B. TANK DATA
Measured operating fluid level in septic tank NA
Date of pumping NEW TANK
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) 7/6/93
ALL standpipes present per record drawing
Total measured depth from grade 9.25 ft (max)
Measured depth to pipe invert from grade 6.17 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 3.1’ & 2.2’
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 6/22/23
Results Pass
Fluid depth prior to test 2” & 14 in (N / S TRENCHES)
Water added 770 gal
New fluid depth 9” & 26 in
Elapsed time 1440 min
Final fluid depth 2” & 14 in
Absorption rate 750 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 51.6 in (MOA 4.3’ ED)
Effective depth used 16.4 & 39.2 in (Missing ED + Final
Fluid Depth)
Effective depth (ED) remaining 35.2” & 12.4 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximately 1.2’ of north trench & 2.1 south trench ED is missing. Southern trench is operating in the top 1’ of
the ED.
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 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
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 8/23/23
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 &
8/23/23
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC231314
Subdivision: T15N R1W SEC 18, Block: , Lot: 63
A water sample revealed a nitrate concentration of 7.6 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
ANCHORAGE WELL & PUMP SERVICE, INC.
7640 KING STREET
ANCHORAGE, AK 99518
PH. 907-243-0740
Invoice
Invoice #: 20235477
Bill To:
Remax Dynamic Properties
3350 Midtown Pl
Anchorage, AK 99503
USA
Ship To:
Remax Dynamic Properties
JOB: 19166 S Birchwood Loop Rd
Chugiak, AK 99567
SALESPERSON
Mark VanWingerden
YOUR NO.
37445
SHIP VIA COL PPD SHIP DATE TERMS
Net 30
DATE
8/17/2023
PG.
1
QTY.ITEM NO.DESCRIPTION PRICE DISC %EXTENDED
PRICE TX.
We appreciate your business. Thank you!SALE AMT.
FREIGHT
SALES TAX
TOTAL AMT.
PAID TODAY
BALANCE DUE
1 Service Call CAMERA WELL TO 40' FOR LEAK
INTRUSION. UPGRADE CASING TO MOA
CODE. CHLORINATE WELL FOR
DISINFECTION.
1 Field Service 08/09/23 - Remove well seal, camera well and
provide recording of results to Remax. No
intrusions found - see recording provided. Use
jack hammer around well to expose well
casing top and weld on casing extension.
Install new well seal. Re-plumb pressure tank
to accommodate raised exit height of pump
outlet. Add Bentonite seal and concrete patch
to floor around well casing.Paint well head.
Test system operation, normal at this time.
$2,337.00 $2,337.00
1 Field Service 08/11/23 - Install water on floor sensor/alarm.
4 ST2-Mark Service Tech
4 ST1-Dave Service Tech
2 ST16-George Water System Ops
1.5 WELL CASING 6" ASTM SCHEDULE 40 $35.00 $52.50
2 FIT-GAL-PIP-1 PIPE-1" GALVANIZED $9.00 $18.00
2 FIT-GAL-CPL-1 COUPLING-1" GALVANIZED $17.00 $34.00
1 FIT-GAL-S90-1 STREET 90*-1" GALVANIZED $19.00 $19.00
2 FIT-BRS-BSH-1X.75 BUSHING-1"X.75" BRASS NO LEAD $10.00 $20.00
1 FIT-BRS-NIP-.75XCLOSE NIPPLE-.75" X CLOSE BRASS $6.00 $6.00
1 FIT-DEU-.75 DIELECTRIC UNION-.75" AYM 5421-032 $35.00 $35.00
1 CKV-BRS-4201E/1-100E 1" CHECK VALVE
FLOWMATIC
$69.00 $69.00
1 FIT-BRS-NIP-1XCLOSE NIPPLE-1" X CLOSE BRASS $11.00 $11.00
1 FIT-ELC-CRG-.75 CORD GRIPS-.75" ELECTRICAL $25.00 $25.00
1 FIT-PVC-WVT-.5 WELL VENT-.5" NPT WELL SEAL VENT $8.00 $8.00
ANCHORAGE WELL & PUMP SERVICE, INC.
7640 KING STREET
ANCHORAGE, AK 99518
PH. 907-243-0740
Invoice
Invoice #: 20235477
Bill To:
Remax Dynamic Properties
3350 Midtown Pl
Anchorage, AK 99503
USA
Ship To:
Remax Dynamic Properties
JOB: 19166 S Birchwood Loop Rd
Chugiak, AK 99567
SALESPERSON
Mark VanWingerden
YOUR NO.
37445
SHIP VIA COL PPD SHIP DATE TERMS
Net 30
DATE
8/17/2023
PG.
2
QTY.ITEM NO.DESCRIPTION PRICE DISC %EXTENDED
PRICE TX.
We appreciate your business. Thank you!SALE AMT.
FREIGHT
SALES TAX
TOTAL AMT.
PAID TODAY
BALANCE DUE
2 FIT-CPR-90-.75 90*-.75" COPPER $6.00 $12.00
1 FIT-CPR-CPL-.75 COUPLING-.75" COPPER $3.00 $3.00
3 FIT-CPR-PIP-.75 PIPE-.75" COPPER TYPE M $7.00 $21.00
1 PRG-940070/0-100PSI 0-100 PSI PRESSURE GAUGE
MIDWEST
$18.00 $18.00
1 WLS-IRN-SPT-930782/6X1 6"X1" SINGLE PIPE WELL SEAL SPLIT TOP
MIDWEST
$110.00 $110.00
1 WELDER WELDER RENTAL $175.00 $175.00
1 EQUIPMENT EQUIPMENT DAILY CHARGES: JACK
HAMMER / ELECTRIC.
$238.00 $238.00
1 PARTS: CONCRETE REPAIR / GROUT. $90.00 $90.00
1 SHOP LABOR CUTTING WHEEL $6.00 $6.00
1 SHOP SUPPLIES GRINDING WHEEL $6.00 $6.00
1 CAMERA WELL CAMERA $400.00 $400.00
1 SHOP SUPPLIES PAINT $15.00 $15.00
1 Electrical Equipment: WATER LEAK ALARM. $265.00 $265.00
1 Freight: WATER DETECTORS UPS
1Z1Y63110222345408 ETA 8/7
$20.16 $20.16
$4,013.66
$0.00
$0.00
$4,013.66
$0.00
$4,013.66