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Home My WebLink AboutSAND LAKE #2 BLK 2 LT 12E. 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 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 *8 ft Property Line > 10’ Yes if No *0 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 *PREVIOUS MOA WAIVERS. 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. 7/8/2022 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC221308 Subdivision: Sand Lake #2, Block: 2, Lot: 12 A water sample revealed an arsenic concentration of 58.1 micrograms per 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. I ADEC PWSID#216156 ASSUMED WATERLINE EPCPAIS 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 Parcel I.D. 011-133-37 Expiration Date: L(-2 1 -2O 2 D 1. GENERAL INFORMATION Complete legal description SAND LAKE#2 BLOCK 2, LOT 12 Location (site address) 8149 SEAVIEW STREET,ANCHORAGE,AK 99502 - Current property owner(s) NICHOLAS&BRITTANY KUKA Day phone Mailing address SEAVIEW STREET,ANCHORAGE, AK 99502 Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex E Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well - CLASS C ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 551) Waiver Fee $ Date of Payment s 18 lig _ Date of Payment Receipt Number 6?AO b Receipt Number COSA# aS aq u55 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 ANDERSON CONSTRUCTION &ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 5/7/2019 i � OF. l* '49TH /4/41;. .* .� 6. DSD SIGNATURE 2 System #1 Approved for ___7 bedrooms / MICHAEL N. axnExso y p p / No. CE 9489 / System #2 Approved for bedrooms 1 5/7/19.. $� Disapproved "116.:1010-441PIP Conditional approval for bedrooms, with the following stipulations: 014_sVT P. �� WIPSIA EWA�ER pROGRAM By: :CO Original Certificate Date: S— `1 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 otAA/V 'DJ /it COSA Checklist blue sheet COSA Checklist Legal Description: SAND LAKE#2 B2, L12 Parcel ID: 011-133-37 If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system A. WELL DATA— PRIVATE CLASS C ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes ® No Cased to ft ® Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate ND mg/L ® Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic 66.8 ug/L ❑ Arsenic less than MRL (ND) Casing height(above ground) in. Collected by FWCS Date of flow test for COSA Date of Sample 4/30/2019 Static water level at beginning of test ft. Comments B. TANK DATA— 10/28/1998 - 1000-gal C. LIFT STATION - NA Age of tank(s) 21 years ❑ Required maintenance completed Tank type/material STEEL Age of lift station years Measured operating fluid level in septic tank 50" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 4/29/22019 D. ABSORPTION FIELD DATA—42'L x 2'W x 7.5'ED—0.8 GPD/SF = 630 SF Which system tested (date installed) 10/28/1998 Adequacy test date 4/30/19/2019 ❑ ALL standpipes present per record drawing Results El Pass For 3 bedrooms Total measured depth from grade 11.5 ft(max) Fluid depth prior to test 21.6 in (Missing ED-Dry) Measured depth to pipe invert from grade 5_8 ft(min) Water added 880 gal ❑ N/A—pressurized field New depth 56.6 in ® Monitor tubes go to bottom of effective. If not, state depth into effective 5.7' Elapsed time 1260 min ® Code-required soil cover over field Final fluid depth 21.6 in (Missing ED Dry) ® System presoaked Absorption rate 450+gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) N date of test) Gallons introduced 1500 gallons If yes, enter date Comments/Deficiencies: Pipes located in the SE corner of the lot for the 1982& 1998 systems were not found. The 1982 system MT was found in the NE corner and had 97"of fluid. 1998 system presoaked and tested and diverter switched to 1998 system. Adequacy measurements include the missing 21.6"of effective depth. COSA Checklist copy 2.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well)CLASS C WELL ADJ. LOT Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> s ® Yes if No ft i es if No ft Neighboring Tank> 100' ® Yes if No ft Private S- . - eptic Line>25' ® Yes if No ft Absorption Field on Lot> 100' ® Yes if No f Holding Tank> 100' ® Yes if No ft Neighboring Absorption Fields > 1 ' Animal Containment> 50' ® Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' CsImmurriver 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 Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® Yes if No ft Water Main > 10' ® Yes if No ft Water Service Line> 10' Community Wells> 200' ® Yes if No ft ® Yes if No ft If septic tank is under driveway comment below Surface Water> 100' ® Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) `Building Foundation > 10' ❑ Yes if No 8 ft If absorption field is under driveway comment below *Property Line > 10' ❑ Yes if No 0 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Waivers A''' , OF AZ;‘ G. ENGINEER'S CERTIFICATION Air ` I certify that I have determined through field inspections and review 4*49 TH iN of Municipal records that the above systems are in conformance / with MOA COSA guidelines in effect on this date. / 4 MICHAEL N. ANDERSON. 41�� No. CE 9469 w / COSA Checklist copy 2.docx 5,819 4' FESSION1.' Air 1,`__t Municipality of Anchorage • • Development Services Department Building Safety Division SAP ETV On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # OSC 191155 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 12 of Sand Lake #2 Subdivision. This inspection revealed an arsenic concentration of 66.8 micrograms per liter (ug/L) for the property's well water sample. 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 informationand 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. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT + • , .. 907-343-7904 On-Site Water and Wastewater Section l i Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval #0SC191155 Subdivision: Sand Lake #2 B2 lot 12 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. 4'. HSM r *,-i .1 i ; a .+E I f1111 11411' - 1!' { - :fir . — ` art' yO,�,y� ,, 'r:+ .-41"4 .1 r, `':, ' ' SI\ ,t• e f r ,.. 2 6 Mailing Address: P.O. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0//-/35-37 Expiration Date: GENERAL INFORMATION Complete legal descri~){io? ._/-O'/'/2_ Z¢/~/-~ 2 -.~¢,0,,;'J"~/¢~/v/E~ Location (site addr. es.s..or, directions) Current P~(~[3~rty'owner{s) C,~)i"/,.~ Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: -,~ TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System . [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority Approval Guidelines ,for this application, shows that the on- site water supply and/er 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. Eng neer' Pdmed Name DSD SIGNATURE i/ Approved for Disapproved. Date bedrooms. Conditional approval for bedrooms, with the folllowing stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other J Original Certificate Date: (Rev, 01/02) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P,O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Parcel ID:~ If A, B, or C provide PWSlD # ~ Well Log (Y/N). /4V/' Sanitary seal (Y/N) Y' wires propedy protected (Y/N) Cased to __ff. Casing height (above ground) FROM WELL LOG AT INSPECTION in. Date of test Static water level fl. fi. Well production , g.p.m. WATER SAMPLE RESULTS: Coliform {~ colonies/100 mi. Ameni=: /{//~ mgJI. B. SEPTIC/HOLDING TANK DATA Nitrate ?~.._ mg./I. Date of sample: Other bacteria ~ colonies/100 mi. Co, ed by: ,5. Tank Type/Material ~ Tank size ~ gal. Number of Compartments Foundation'cleartout (Y/N) ~y Depression over tank (Y/N) Date of pumping ~ Pumper ~1~ ,/-?/~t~ . ~',~'U'/~,~' ABSORi:rilONFIELDOATA'. ' ' Length '~,::i'~':~.:~;': ' Width ~- ft. Total depth // ft. Eft. absorption area ~z,~Oft2 Monitoring tube '~/ Date of adequacy test ~ Results (Pass/Fall) Fluid depth in absorption field before test .~.7,~f"/ Water added~l~ gal. Elapsed Time:/-~mln. Final fluid depth ~.~ lm'~l~ Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) Date installed ~ Cleanouts (Y/N) High water alarm (Y/N) System type ~ Grovel below pipe ~ ft. Depression over field ]~u/ For ..~ bedrooms New depth ~,~j~, ~,~'(::~) g.p.d. If y~s, give date LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES Size in gallons 'Pump off' level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line in. Manhole/Access (Y/N) High water alarm level at Meet~ alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout in. Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main ~ Wells on adjacent lots Property line /~- Absorption field Water service line ~ Surface water. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line, Water Service line Curtain drain F. COMMENTS Building foundation J,~ / Water main __~_~_ (~ Surface water A~/')~ Dniveway, parking/vehicle storage Wells on adjacent lots ~/"/O5~'~/.~// Date of Payment ~- ,~ "~' {~) :~ Date of Payment Receipt Number "~ '~ 0 ~ O Receipt Number (Rev. 12/01)