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Home My WebLink AboutSTRUEMPLER LT 1ruempler Lot I #017-421-14 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 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 Water System Permit Permit Number: OSP241013 Work Type: Well Initial Tax Code Number: 01742114000 Site Legal Address: STRUEMPLER LT 1 G:2840 Site Mailing Address: 12400 TURKS TURN ST, Anchorage Owner: FAIRBANKS MICHAEL & RACHEL Design Engineer: This permit is for the construction of: Effective Date: Expiration Date: �»ent S �° U � Cfi 1)epartmeut Lot Size in Sq Ft: Total Bedrooms: 1 /31 /2024 1 /30/2025 34432 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well Q 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: 5S �J W ` Date: Issued By: 1 3r 2 Date: 2`� GI Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 01742114000 Property owner(s) FAIRBANKS MICHAEL & RACHEL Day phone 432-260-5071 Mailing address 12400 TURKS TURN ST, ANCHORAGE, AK 99516 Site address 12400 TURKS TURN ST, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) STRUEMPLER LT 1 Legal description (Township, Range & Section) Lot Size 34,432 Sq. Ft. Number of Bedrooms 0 APPLICA T ION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial R Single Family (SF) El (w/wo ADU) Septic Tank ElUpgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage Fx] 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 C !A1 r/ (Signatur y owner or adhorized agent) Dyn14"O ffler4vd Permit/Rush Fees: Date of Payment: V /' In Receipt Number: Permit No. 05P 2- (f I o6 3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment ServiceslBuilding Safety\On Site Water and WastewaterTorms\Cllent FormsTermit Applicatlon.doc MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Development Services Department Building Safety Division "~ ~".,..,. On-Site Water and Waslewatet Program, 4700 S. I~fagaw St. P,O. Box196650 Anchorage, AK §951g-6650 Page ~' of_~ www.cl.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM ANO/OR WELL INSPECTION REPORT Permit Number: 5 ~'O 0 1C~'"~o~.0 pip Humber: SEPARATION DISTANCES ~ Septic D Holding Q S,T.E.P. ~ OlheE T~ Seplic Absorptior LEt ~olding Pub~bat~ s,.--w.. I~0~ jO0(+ ~ / LIFT STATION ,,,- .~1~ ~1' ~ "~'" BENCH MARK .... ,__,._--.. ..,--: 2~ ~-~7-0/ ' Development Services Department Approval ~e,~e~..~ ~o~ ~: ~ / ~: /~'~'~1 P£RMIT NO. SW010220 PAC£ 2 oP Municip. al. it oF .A.n£ h.o F a g.e. DEPARTMENT OF HEA~.THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ®Anchorage, Al~sko 99519-6650mTeJephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I..~CAL LOT 1, STRUEMPLER S/D P.I.D. NO. 017-421-14 UPPER HUFFMAN ROAD E~ I ~ ' 10' UTILITY EASEMENT /~NEW 1000 GALLON~DBL1 & DBL2 ~,¢~t~tc, SEPTIC TANK ~T2 ' ~L~ T 100' WELL RADIUS SCA~: I' PERMIT NO. SW010220 PACE 3 OP 3 Munidgo!.il of' .A.O_c h.o F a g.e. DEPARTHENT OF HEA~TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.a. Box 196650 JAnchor(ige, Al(iskJl 99519-6650e Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 1, STRUEMPLER S/D P.I.D. NO. 017-421-14 ST1 ST2 / 95.2' ---- .---' /11 FINAL O~ ~ ,~,,~/-2" INSULATION o'~o,.-"lNEW 1000 ~ '~'""- J GALLON .... J SEPTIC TANK CO1 C03 C02 A B FCO 2.5' 45.0' ST1 15.5' 54.5' ST2 20.0' 60.5' DBL1 21.5' 62.5' DBL2~ 25.0' 64.0' FS 48.5' 49.5' CO1 59.0' 48.0' MT1 46.5' 49.0' C02 88.5' 66.5' MT2 54.0 64.0' C05 48.0' 65.0' C04 91.5' 77.0' NO · WATER FOUND 80.8' B.O.H. Performed For:. Municipality of Anchorage Development Services Department Bullding Safety Division On-Bite Water and Waste#ater Program 4700 South Bragaw SL P.O. Box 196650 AAcflofage, AK 99519-6650 V.*#w.~,0 nchocaee, ak .us (9O7) 343-79O4 Soils Log - Percolation Test LegalDesc~ipfion: LOT" I ~7,.-~e,~f_.,~,~,~c~,,./E, '.~/i5 Slope 4-- 5- 6- 7- 10- 12- WAS GROUND WATER E.COUHTEaED? /V O IF yES. AT WHAT DEPTH? Monitoring? 13- 14o 15- 16- 17- 18- 19- 20- COMMENTS Reading Date Gross Time Net TimeDepth to Water Net Drop ?~.~-~,~/-d~/0 / o - 6 ,- _ ~,,~ ., ~" ~o e~- ~" PERCOLATION RATE / i.~o ~'- ~u~ut~o~) PERC HOLE DIAMETER TEST RUN BET~EN J~ '/,~. ItT AND ~ FT P E R FO RM E D I N AcC (;~_L~_~""~ ~,~i'~!l.? ~,~[. ~;t.~I~L:R~,~I I~N ~v:~,L GUI DE LIN E S IN E F F ECT ON THIS DATE. DATE: r~m KIV~ll Alaska ~577 88/89/2881 14:59 3453287 H W DRILLIHG, I~ PAGE 01 Job No.: P~rmit No.:. $W010120 Project No.: NIA M-W Drilling, ]:nc. tKO. Box l10378eA~choroge, AK 995lle ,907-345-4000 · 907-345-3287 · Wet· Owner: · l~gal Descr~ion: ,(~r,oundwater ~Fell ~ls-Built & Loc Brooks. Donald · Use ef Well: Lot I Sn'uemplcr Subdivision Domestic Anchora~et Aaska Construction · Hole DeptA: 446' · Casing Size: 6",,. · Cased To: 34.M', ,., · Matevlal: · DrllIM~bod: Air Rotary Pet/. · Well Comgleflon- O~en end X ~creen __ Perforated Metkod: · Screen/Perforatlen description: A 53 Steel · Grote· No·ts: ( I ) Sack- No. 8 b~ntonite granules · Well Development: Mefhod: Air suq~e Notes: · ~latlcwaterlevet(SWL) 39' (above) (~do~)topofc~stngflOC). · W¢llylddt~tat I gallons~,~min#te(GPM)/~w~-~l~'C~4)for with '10~/o of draw4own (DD) from smde tevet (SWg). · Me~&od:' Alt lift · t~te Of COmpleaon: D~pth In feet from top of etMn[. 0 TO _._._2__ 2 TO 28 28 TO 34 34 TO l I0 110 TO 136' i30 TO 25 0 250 TO 446 TO TO TO 03 Aul~uSt 2001 Well · P~mg ins·att: I~ib of formatloag penetrated, eLT~ of material? eolor and hardness. _ C_ _a_s.i ng _st ic~__l? ......... Silty gravel: brow~. .... __ Bedrock As above: dark ~_ay.. __A~._A: _p4'_a~y with white chips, very small water.seaps in fractures. A/A: gray, very_small water aeaps in fractures. . .MA'7 gray with white chips, very s_m_aU water seap$ in fi-actures. Date: rlOBERI' C. COWAI'I. P.E. rlODERT A. SI IAFEfl. P.E. cML ENGINEEI'~ {901) 694-2979 FAX (907) 694-1211 ' Municipality of Anchorage DEPARTMENT OF IIEALTll AND IIUMAN SERVICES 825 ~. Street P.O. Box 196650 Anchorage, Alaska 99519-6650 ~EFERENCE: Yhe septic tnspecttops for ?~le referenced property were performed on ~ and '~ ~17-01 · Prior to submitting tile On-site Wastewater tsposal System-and/.o,r Well Inspection Repor~ we are wai~ng for the ~~atV~ [o be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 11034 NOflll I EAGLE [qlVE fl LOOP ~' SLIIIE 204 · EAGLE fllvErl. ALASKA MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Wafer & Wasfewaler Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SiTE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jul 02, 2001 Expiration Date: Jul 02, 2002 Permit Number: SW010220 Legal Description: STRUEMPLER LT 1 Design Engineer: 0003 S & S Engineering Owner Name: Newby Construction Owner Address: 12929 Trecy Way Anchorage, AK 99516- Parcel ID: 017-421-14 Site Address: Lot Size: 34432 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must 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 Wastawater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction dudng freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Municipality of Anchorage Development Services Department Building Safety Dlvlslon On-Sile Water and Wastewaler Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us {907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SwOIO~.ZO,_ Property owner(s) Malling address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Lot Legal description (Section. Township & Range) Lot Size 0o~ ~,FL THIS APPLICATION IS FOR: Sewer Only ~ Sewer and Well Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub ~] Swimming Pool Therapy Pool [] Dayphone '3~J"'- I;ll ~ Zip Code ~ ¢1 .~,' ~ Number of Bedrooms Well Only ~]~ Water Storage Jacuzzi Water Softening Un'it I certify Ihat the above Information Is correct. I further certify that this application Is being made for a Single Family Dw~lllng and is In accordance with applicable Municipal Codes. S & $ ENGINEERING ~/Z ~""~'"'~ 17034 E.'. Rlv.r Loop Road No. 204 (Signature ol property owner or authorized agent) Permil Fees: Oa e of Paymenl: Receipl Number: {Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: June 19, 2001 ROBERT C. COWAN, P.E. CML ENGINEERS (907) 694-2979 FAX (907) 694-12 ! t MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Stmempler S/D It is requested that you issue a permit to install a proposed septic system and well to serve the three bedroom dwelling on the referenced property. A test hole was excavated and percolation test performed. The approximate location ofthe test hole is located on the attached site plan. At the time of excavation 5/6/96 water was not found. After ground water monitoring the test hole was found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCCroij Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RNER, ALASKA 99577 ~'~ LOT 1, STRUEMPLER S/D B.J.J. R.C.C. 6-19-01 1 OF 2 DESIGN C~ITE~IA: CONT~CTOR IS R[OUIR[D TO 5 BDRM = 450 GPD wo~ / SOILS = 0.45 GPD/SQ.FT.~ 450/0.45 : 1000 SQ.FT. REQ'D. PHONEi (907)6e4-2979 DRAINFIEI D CRITERIA: B.O' DEEP ~.o.~.~,v~ UPPER HUFFMAN ROAD ~ 3.0' WIDE I ~ T- M''CO-~FLOW SPUTTER ~' 5n n J/I.r ~MINiMUM SEPTIC TANK~/~ . CC*. / U; U / 3 BEDROOM 100' WELL RADIUS ' ~ LOT 2 DRAINFIELD 8.0' DEEP ~": LOT 1, STRUEMPLER R.C.C. DESIGN CRITERIA: 5 BDRM = 450 GPD 50ILS = 0,45 GPD/SQ.FT, 450/0.45 = 1000 SO.FT. REQ'D. CRITERIA: $.0' WIDE 72' LONG (2 0 3 EAc'~jppER HUFFMAN t I0' UTIUTY EASEMENT II II II II u LI ROAD PROPOSED 3 BEDROOM HOUSE I00' WELL RADIUS LOT 2 II II II I MUNICIPALITY OF ANCHORAGE oA i, Development Services Department' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 017-421-14 Certificate of On -Site Systems Approval Expiration Date: 1-13-2023 Legal description Struempler Lot 1 Site address 12400 Turks Turn St Anchorage, Alaska Current property owner(s) Brooks X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: . Original Certificate Date. 10-13-22 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 X Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE o 4( C l,:, M: 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. 017-421-14 Complete legal description STRUEMPLER LOT 1 Location (site address) 12400 TURKS TURN STEET, ANCHORAGE, AK 99516 Current property owner(s) DONALD & LAURA BROOKS TRUST... Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 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 21 - 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 $ '55"D Date of Paymentg I l- lad J"�- COSA # OSC22 I `� 83 Waiver Fee $ Date of Payment Waiver # COSA Application 2022.doc r Legal Description: STRUEMPLER LOT 1 Parcel ID: 017-421-14 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) Water storage tank volume NA gallons Date drilled 813/01 Total depth 446 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 35 ft (INTO BEDROCK) ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 0.998 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18++ in. FWH Date of flow test for COSA 9/23/2022 Collected by Static water level at beginning of test 49 ft. Date 9/26/22 Well production at time of test 0.8 gpm Comments DEEP WELL W/ NO WATER STORAGE PER CLIENT & OBSERVATIONS PER ACOUSTIC SOUNDER. B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 9/22/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/27/2001 ® ALL standpipes present per record drawing Total measured depth from grade 6.5 / 6.2 ft (max) Measured depth to pipe invert from grade 2.7 / 3.3 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® 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) N If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/22/2022 Results M Pass Fluid depth prior to test 1 / 13 in Water added 830 gal New fluid depth 10 / 17 in Elapsed time 1400 min Final fluid depth 3 / 11 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 42 in Effective depth used 11 / 3 in (final) Effective depth remaining 31 / 39 in Comments/Deficiencies: MTs/COs at arade. MT/CO East upper trench / MT/CO West lower trench 3.47' ED / 3.59' ED (effective depth). COSA Checklist 2022.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' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® 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 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 Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ®Yes if No ft Water Main > 10' ® Yes if No ft Water Service Line > 10' ® Yes if No ft F. ENGINEER'S COMMENTS Community Wells > 200' ® 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 09/30/22 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 & FWi 5 COSA Checklist 2022.docx dft--wOF A 9 7H pi . Z_� ..... Curtis Huffman �Fc % CE 128991 • k�c��i/ ��f'�F9• • . 9/30/2. •,s ��kF, PROFESS1120 Municipality of Anchorage rE A� Development Services Department <= Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Sheet P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage. ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC221483 During a recent COSA on-site inspection and test of the potable water supply well on, Lot 1 of Struempler subdivision, the well's productivity was determined to be .8 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Septic Wank Advisory Certificate of On -Site Systems Approval #OSC 221483 Subdivision: Struempler Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 21 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. V o OF•qtq�;4p �,,Q D O Sn� SHANE A. HOLT �p e LS -6914 �` O essiana� �oc UPPER HUFFMAN ROAD THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANYUSEOF THIS DRAWING BY THIRD PARTIESIS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHON ANY CONFLICTS SETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES ANDIOR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EAS£NENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHONN HEREON ( UNLESS INDICATED) NOTE. FENCELINES THAT MAY APPEAR ON THIS DRANING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOW HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNON AND/OR ICE. WALL WALL AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE / HEREBY CERTIFY THAT / HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT I STRUEMPLER SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENTS SITUATED THEREON AREW/THIN THE PROPERTY LINESAND NO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 12TIl DAYOF OCTOBER , 2022 15554 227-57 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 Municilmlif. y o1' Anchorage Development Services Department Budding Safely Division On-Silo Water and Wastewaler Program 4700 South Bragaw St. P.O. Box.196650 Anchorage. AK 99519-6650 www.cl.anch/:rag&ak. Us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMIL'{' DWELLING Parcel I.D.' O'f "~ v,,.~-.~./-- I ~ 1. GENERAL INFORMATION ExplralIon Date: Cbfirpiel~ legaldescnphon' ':" '.~.O,~" ; I ' $7"~ ~,~ f~t.~,~ ~]~ - Lo~:aliod(.~ite'addre~.~or~directions) tJPP¢'~ H~/=F~,4,,~. 2[- '/-,J~:j' T'u~.~' .,,Currefit Pr0Per,!.y o/,~r~e.'r(~) ~)g-, to 13 Y t:laili~g address ~ ~' '~' ~ c~ Lendi~ig agency Day phone ~3 ~'~"' ~; I I Day phone Maili~.(.l address Real Eslate Agent Day phone Maili~rg Address [Inlq,~ ~,t!mrwise requested, I IAA wi#be hem by DSD fcr pickup. 2. tlUMt-3EP, OF BEDROOMS: ~ 3. TYPE OF WA[ER SUPPLY: Individr ml Well IndMd~ral Water Storage Con nn~ miry Class ~ Puhlic Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding lank [] [] Community On-site [] [] Public Sewer [] 'lhe Municipality of Anchorage Developmen~ Services Deparb'nent (DSD) Issues Certificates of Health Authority Approval (t IAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer regi~lered In the State of Alaska. Certificates of Health Authority Approval ere required for tho transfer of lille (except belween spouses) for properties served by a single family on-site wastewater disposal and/or water s~pply system. DSD also issues HAAs upon request to homeowners. Cerli~cates of Health Aulhority Approval are wlid for 90 dnys from Ihe date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Cedificates may be reissued for a period of up to one year with valid water ~mples.) Certificates are valid for one year for properties served by Class A or 13 v/elis or a public :':ater synl,=,m. The Municipality of Anchorage is not responsible for errors or omissions in the prol'essional engineer's work. STATEMENT OF INSPECTION BY EJqGiNEER As certified by my seal affixed hereto and as o~' Ihe validation dale shown below, I verify Ihal my Investlgalion, based on procedures oullined In the I-tealth Au[horily Approval Guidelines for this application, shows Ihat the on-site waler supply and/or wastewater d~sposal syslem Is(are) safe, functional and adequale for file number of bedrooms and type of slruclure Indicated hereln. I ~'uHher verify Iha[ based on the Information obtained from Ihe Municipality of Anchorage files and from rny Investigation and Inspection, Ihe on-sile wa[er supply and/or waslewaler disposal system Is(are) In compliance i. vilh all applicable Municipal and State codes, ordinances, and regulations In eft~ecl at Ihe time of Inslellalion. Name of Firm Address Engineer's PrinIed Name DSD SIGNATURE . ~ Approved for Disapproved. $ & S ENGINEERING Eagle River, Alaska 99577 bedrooms. Conditional approval for. bedrooms, wilh Ihe following slipulations: Additional Comments Allachments: HAA Checklist Septic Syslem Advisory Well Flow Advisory X Malnlenance Agreements Supplemental Engineer's ReporI Other Original Cedificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South 6mgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (SO7) S43-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegelDescripfion:/...OT ) ~'~-Rvi..a.,eL./f:,~ parcel ID:. Ol '7 A. WELL DATA Well type ?~ V~ 7'rc. Data ¢omplat~ ~1:1° ~ Totaldepth.J'/q~)ft. Casedt~ **35' It. FROM WELL LOG Date of test ~/3/0 I Static water level ~ c} ft. Wall production /. O g.p.m. If A, B, or C provide PWSID # san~a~y s~ ~:i~N) yt .~ wa, Log~m) ¥~: $ w~s pmpe~ protected(~/N), Casing height (abeve ground) ~ [''/ in. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Date of sample: ~/~./la/e I Collectad by: B. SEPTIC/tlOLDINO TANK DATA Tank Type/Material Tank size ' ) 0 0 D gal.. Number of Compartments Foundation cleanout~/N) ¥~J Date of pumping N/A ~/~ ,t ~ C. ABSoRFrrlON FIELD'DATA Nll~ate ~)-"/~'~ mgJI. Depression over tank (Y~/u o Other bacteria O colonies/100mI. Soil rating (g.p.d./ft~ or ~/bdrm) ~' ° <~ System type 'r'~ ¢ ,-, c. u Length I0 ~ ~--z,,..lt. Wtdth ~ ft. Gravel below pipe "~-<~' ft. Total depth ~a ft. Eft. absorption area I · do fi2 Monitoring tube ¥&J Depression over field 7v ~ Date of adequacy test ~//'~' ' *'~-' ~'~ Results (Pass/Fail) / For ~ bedrooms Fluid depth in absorption field before tested gal. New depth in. Elapsed'rime: min. ~,.,~.u:.!~ .in. Absorption rate >=__ g.p.d. Any rejuvenation ~tt~past 12 mo.) (Y/N & type) If yes, give date O. UFT STATION Data installed 'Pump on" level at Datum Size in gallons ~ Cycles tested Meets alarm & ca,.dt requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot / 0 ~ Absorption field on lot Public sewer main Sewer/septic service line on adja'cei t ibte On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES F,ROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1,3 Property line ~' 7 Absorption field. Water main ,~ J,'~ Water service line ) o Surface water WellsonadJacentlets. /00 +' )~O .-F-- SEPARATION DISTANCE FROM ABSORPTION Fit=! I'~ ON LOT TO: Property line ~ ] Building foundatic~ 3 Water Service line / 0 '-~ Surface water j 0 O '~- Curtain drain ~'~. ~c,,,o~,~' Wells on adjacent lots Water main Dflveway, parking/veNcle sl~rage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date I o~/,~ 9/O/ HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 9875615101 T-114 P.02/03 F-142 CT&E Rcf.# 1018393001 Client Name S & _e £nginee~in§ Prolt~t FIame~ Lot I Stmempl.lr !ID Client Simple ID LOt I St~'ucmpl:r S/D Mstrtx Ddz:king Watrr Ordered By PWSID 0 Sample Rema~h: Client PO# Printed Date~ime 12/17/2001 9:31 Collected Date/Time 12/10/'2001 14:00 Received Dntefflme 12/10/2001 14:45 Technical Director Stephen C, Erie Relea~ed~~ pQ~. Method Allo~abl~ Pi,ap Analysis Limits Date D~te Init Nate~s Dep&ttment: NitTatc-N 0783 0.200 rng/L EPA 300.0 (<10) 17./10/01 SCI. Mie::'obiology Labo:at:o~T Teal Coliform 0 col/100mL SMI8 9222B 12/10/0t KAP