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HomeMy WebLinkAboutTUNDRA JEWEL RANCH LT 6 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231087 PID Number: 051-193-11 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ® New ❑ Upgrade Name Wanda Blackburn Rev. Trust A 0RPTION FIELD Existing [E] De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22940 Sherman St. Chugiak, AK Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original g e F Gravel depth beneath pipe Subdivision Block Lot Tundra Jewel Ranch 6 . Ft. Fill added above original grade Ft. Gr I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr ches From Tank Field Tank Line Ft2 Well 100+ I I TANK 21 Septic ❑ S.T.E.P_ ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100+ I Greer 1500 Gal. Material Number of compartments Lot Line 10+ I NA Plastic 2 Foundation I 10+ I I L ATION Manufacturer Capacity Remarks Field Field verified 5' separation tank to leach field. Alarm location Electri tailed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield JR's Drainfield CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection 1n dates: 5/12/23 2nd 5/15/23 Location and description 31d 4`h Bottom of siding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp XV Conditional Approval: Date �. �A --r�!�t*400 a49111 ♦0 t KENNETH M. D S r �i`% CE 711 Date ApprovedSeptic ;NNrte-:thils approval does not include well permit requirem nts. MUNICIPALITY OF ANCHORAGE Ro!5)q r-c*.is Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-193-11 Property owner(s) Wanda Blackburn Revocable Trust Day phone Mailing address PO Box 670530 Chugiak, AK Site address 22940 Sherman St. Chugiak AK Legal description (Sub'd., Block & Lot) Tundra jewel Ranch 1,0t 6 Legal description (Township, Range & Section) Lot Size 15420 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑S Upgrade ❑X (w/wo AD U) Holding Tank ElRenewal ElDuplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Leach field to lot line Distance: V I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: 60 Waiver Fees: -Patio Date of Payment: x/23 Date of Payment: �5am e Receipt Number: 0c427.5G Receipt Number: Permit No. 05100';108-7 Waiver No. DSU 2_3)016( GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 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: OSP231087 Work Type: SepticTank Upgrade Tax Code Number: 05119311000 Site Legal Address: TUNDRA JEWEL RANCH LT 6 G:1159 Site Mailing Address: 22940 SHERMAN ST, Chugiak Owner: BLACKBURN WANDA W REVOCABLE TR Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Department 5/5/2023 5/4/2024 15420 ❑ 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 Special Provisions: • A provision will be added to the permit to locate the beginning of the field prior to installation to confirm that the 5' separation between the tank and field will be met. Install a cleanout or monitor tube so the field can be located in the future. I Reeei�:- L s f, u e J --ho A -c, lee rl-a Issued By: Date: Date: Z3 4 AS -BUILT SYSTEM DETAILS/SITE TUNDRA JEWEL RANCH LOT 6 PLAN Permit ❑SP231087 PID# 051-193-11 1500 S I A—C=12.7 � COMPUTED: BOUNDARY: N A 2 B—C=30.3 STMNG: N/A 100.19 99.7 Ln A—D=13.5' DATE. 15/1 DWG. FILE: B—D=30,9' ACRD FILE` FILE as a A—E=15.5' o J J i V B—E=31.9' LJWLJWI U U A—F=19,7' B—F=34.7' C A-15=23.3' 0 B-6=37.6' 1500 GAL A—H=24.2' y SEPTIC B—H=38.5' � �q TANK SCALES NTS ■ OF At 1 "or 00'* 491H *� �1N I ICENN *r�3 M. D E � � CE --7116 . • �'� 3 g� ■ Ar "mak 33ID Aw r5l ■���� EXISTING BUILDING �J i Y I wI NH13USE I FGUNDAIDN) . \ ov \ n� 4 - PREPARED FOR: WANDA BLACKBURN REV. TRUST P❑ BOX 670530 CHUGIAK, AK FIELD BOOKS COMPUTED: BOUNDARY: N A DR"": KSD STMNG: N/A CNECKED: KMD ASBUILT. BUKU DATE. 15/1 DWG. FILE: GRID: N W1 1 5 ACRD FILE` FILE 'IDB N- 23115 .L SCALEi 1' = 20' SCALE, NTS i I w I LOT 7 0 I N 00005'00" W 102.00' I �rLUTI LITY 15' POLE III I 0 KIWI wlol I WIN W l01 LOT 10 zI WI LOT 6 Of 13,464 sq. ft. LU1 SEPTIC NI WI STANDPIPES III Z IWI Cn cn 00 = �SEPTIC I I ;Uo MANHOLE 'S' 0 0 Ul _ IWI CA D (� CANTILEVER Z Oo O � O 30.7' 36.0' I W I - ;U IWI m W m _I N z D o O 3 -STORY o m. 0 o C m FRAME o IWI o HOUSE m I1 0 xCn 11 ASPHALT 13 0 91 I I 1 DRIVEWAY x CANT. O 0 DECK 1W1 LOT 11 x 0 00 N IWI I 0 Z IWI x r) m 23.0' x CANT. 33.5 1 IWI WELL CW L EAVE 15' 1 S 00005'00" E 102.00' W 0 CARGO TRAILER LOT 5 w OF C -D • 9 // *:49TH *; ......... ................... NOTE B u Sahz : �o DRIVEWAY LOCATION IS /// �J� LS -14837 0 10' 20' APPROXIMATE DUE TO SNOW AND ICE COVER. p ' • ... . .. OC� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE AS -BUILT RECORDED SUBDIVISION PLAT (P-581) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT I HEREBY CERTIFY THAT I HAVE SURVEYED THE BOUNDARY SURVEY MAY DISCLOSE. FOLLOWING DESCRIBED PROPERTY: UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR LOT 6, TUNDRA JEWEL RANCH SUBDIVISION ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE SURVEY STANDARDS. WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY DATED THIS 17th DAY OF MAY, 2023, AT ANCHORAGE, TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A ALASKA. VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES FIXED HEIGHT LLC COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. C.O.A. 122554 Land Surveying Services 907.290.8949 JOB # 23032 1 NO CORNERS SET THIS DATE I SCALE 1" = 20' 225 W 23rd Ave , Anchorage, AK 99503 WWW. FIXEDHEIGHT COM Municipality of Anchorage -- Ur.p;ntment P.O. Box 196650 • 4700 Elmore Road _Anchorage, Alaska 99519-6650 e (907) 343-7904 o Fax (907) 343-7997 http://www.rnuni.o,rq/0nsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231019 COSA#: Permit#:OSP231087 PID#: 051-193-11 Legal Description: Tundra Jewel Ranch Lt 6 Engineer: ArcTerra Your request for a waiver of the required 10 feet horizontal separation fiom the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 5 Z Approved by: Name of Reviewer ............................................................ ................. **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231087, Deb Wockenfuss, 05/05/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231087, Deb Wockenfuss, 05/05/23 i I w I LOT 7 0 I N 00005'00" W 102.00' I �rLUTI LITY 15' POLE IW III �-� SEPTIC o I STANDPIPES I W I wll I Wo IN WIo1 LOT 10 U.1 WI LOT 6 Of 13,464 sq. ft. U.11 VIII I Z1 w 1 cn 00 = � II 0 cr -0 CA(� CANTILEVER IWI D Z CD Cn Oo O O 30.7' 36.0' IWI - IWm I W mDI N z D o 3-STORYO o IT! o 0 o m FRAME 0 1 WI U HOUSE U) I1 0 xASPHALT 13.0' 91 1 Cn I 1 DRIVEWAY x CANT. O 0 DECK 1W1 LOT 11 x I 1 0 00 N IWI I 0 Z 1W1 x C m 23.0' x CANT. 33.5' 1 IWI WELL CW L EAVE 15' 1 S 00°05'00" E 102.00' W 0 CARGO TRAILER LOT OF C -D /i *: 9 4 T ..... ..... ............... NOTE % �'• B u Sahz �o DRIVEWAY LOCATION IS �// �J� LS -14837 0 10' 20' APPROXIMATE DUE TO // F � r SNOW AND ICE COVER. p ' • .. , . , .. �O EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE AS -BUILT RECORDED SUBDIVISION PLAT (P-581) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT I HEREBY CERTIFY THAT I HAVE SURVEYED THE BOUNDARY SURVEY MAY DISCLOSE. FOLLOWING DESCRIBED PROPERTY: UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR LOT 6, TUNDRA JEWEL RANCH SUBDIVISION ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE SURVEY STANDARDS. WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY DATED THIS 28th DAY OF APRIL, 2023, ATANCHORAGE, TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A ALASKA. VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES FIXED HEIGHT LLC COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. C.O.A. 122554 Land Surveying Services 907.290.8949 JOB # 23032 1 NO CORNERS SET THIS DATE I SCALE 1" = 20' 225 W 23rd Ave , Anchorage, AK 99503 WWW. FIXEDHEIGHT COM PERFORMED FOR: · EGAL DESCRI.ION: /--' 1 2 3 4 5 6- 7 9 10 11. 12 13 14 15 16 17 18 19 20- /~ SOILS LOG [] PERCOLATION TEST ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaske 99501 264-4720 SOILS LOG -- PERCOLATION TEST SLOPE SITE PLAN II II II I I~1 I I I~,~,1 II I)~ Ill [ I I 141111 A. 5kc~ Ho. 1457~. WAS GROUND WATER /~/"~ IS. O ENCOUNTERED? E IF YES, ATWHAT . DEPTH? ~ ~ Gross Net Depth to Net r ~R. eading Date Time Time Water Drop - ¢ PERCOLATION RATE Iminutes/inch) COMMENTS TEST RUN BETWEEN FT AND ~ FT CERTIFIED BY: DATE: 72-o08 (6/79) ~ MUNICIPALITY OF ANCHORAGE ~' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Manufacturer LOCATION ,/ IF HOMEMADE: DISTANCE TO: Manufacturer NO. OF BEDROOMS~. No, of compar :nts Inside length Width Liquid depth Dwelling PERMIT NO, Material Liquid capacity in gallons DISTANCE TO: Trench~t~ ~l~_/~h~ "'-- ~ inches ~ I ~ Total ef fecti~e absorption area inches Width ~rib diameter Type of crib Crib depth Building foundation Well DISTANCE TO: DISTANCE TO: ~DT,~ ~ Driller Build!ng foundation Sewer line OTHER ,' PIPE MATERIALS V.,~,' INSTALLER REMARKS 72-01~' (Rev. 3/78) ~' PERMIT NO. Total effective absorption area Nearest lot line · Distance. to lot line PERMIT NO. ISeptic tank I Absorption area(s) .............................MUNICIPALITY OF..ANCHORAGE -- DEPRRTMENT O~ HERLTH "RND ENVIRONMENTRL ~OTECTION , 825 '~' 'STREET, RNCHORAG6 AK. 9~ ~l /-~~ · - ' 2~4-4720 "' ON--SITE SEWER PERrIIT PERMIT NO. ( 820782 > RPPLICRNT JRM BLRCKBURN LOCRTION LEGRL ,' L6 TUNDR8 JEWELL RRNCH BOX 521CHUGIRK ~ LOT SIZE 688-220i 999999 SQURRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DEPTH= :1.0 LENGTH= :~4 GRRVEL DEPTHTM 6 THE LENGTH DIMENSION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND'~ND THE BOTTOM OF THE EXCRVRTION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET>. REQUIRED SEPTIC TRNK SIZE= 1250 GRLI Otis PERMIT 8PPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLflTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY ~ND THE · NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TWO (2> INSPECTIONS tiRE REQUIRED BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS · DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN 8 WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TVPE OF PUBLIC WELL. :iiMINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPEOIFICRTIONS 8ND CONSTRUCTION DIRGRRMS PRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERM I T EXP I RES DECEtlBER ~l.- I~$2 I CERTIFY THRT l: I tim FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET FORTH BY THE MUNICIPRLITY OF 8NCHORflGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. RPPLICRN~ JAM BLACKBURN ISSUED BY__ _DRTE___ V4.0 MUNICIPALITY OF ANCHORAGE Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-193-11-000 Expiration Date: Legal description TUNDRA JEWEL RANCH LT 6 Site address 22940 SHERMAN ST Chugiak AK 99567 Current property owner(s) BLACKBURN WANDA W REVOCABLE TR 8/24/2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Due to the rising concentration of Nitrates tested in this well, mitigation work may be needed in the future. In Original Certificate Date: 5/24/2023 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 Legal Description: _ COSA Checklist Tundra Jewel Ranch Lot 6 Parcel ID: 051-193-11 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 7/30/82 Total depth 110 ft Cased to 60+ ft ❑✓ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 13 in. Date of flow test for COSA 4/21/23 Static water level at beginning of test 60 ft. Comments *See Letter B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/21/82 R ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 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) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 4.6+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes 0 Nc ✓❑ Coliform bacteria is Negative Nitrate 25.0* mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L✓❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting.__ Date 4/14/73 . FT STATION ❑ Require tenance completed Age of lift station rs Lift station material Comments Adequacy test date 4/21/23 Results Q Pass Fluid depth prior to test 1 in Water added 600 gal New fluid depth 1 in Elapsed time 10 min Final fluid depth 1 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 1 in Effective depth remaining 71 in 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 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' F,71 Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 2]Yes if No ft 0 Yes if No ❑ 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' 0 Yes if No ft Surface Water > 100' 0 Yes if No Tank to Property Line > 5' F,/_1 Yes if No ft Field to Property Line > 10' ❑ Yes if No 1x ft Water Main > 10'✓❑ Yes if No ft Water Service Line > 10' Yes if No ft F. ENGINEER'S COMMENTS *Waiver##OSV231019 granted 5/5/23 Wells on Adjacent Lots: Private Wells > 100'✓❑ Yes if No Community Wells > 200' Q Yes if No If tank or field is under driveway comment below ft ft ft ft 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 Arcterra Consulting Engineer's Printed Name Kenneth Duffus Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra cannot give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist -June 2022 Phone (907)-696-6111 Date 237z, Q &m r� p! * 44]h 4 KINN'r}i M CittF CE 7116 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. 051-193-11 Complete legal description Tundra Jewel Ranch Lot 6 Location (site address) 22940 Sherman St. Chugiak, AK Current property owner(s) Wanda Blackburn Trust Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 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 V 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 $ .550 Waiver Fee $ Date of Payment Date of Payment COSA # 0 S C 3' Waiver # COSA Application—June 2022 May 23, 2023 ARcT r>KRA CONSULTING, INC 20441 Ptarmigan Blvd. Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: TUNDRA JEWEL RANCH, LOT 6 Well Inspection & Aquifer Concerns Per our discussion and to clarify the work effort completed prior to submission of our previously letter, please find the following: Prior to Sullivan's Water Wells conducting a well probe to identify potential sources of cross contamination, we initiated a review of the surrounding well logs, water samples taken on adjacent area properties and the historical MOA nitrate map. Based on that review we found that the MOA nitrate mapping indicates other high nitrate wells in the area with depths ranging from 40' to 254' and have shown all to be unconfined wells. Legal Nitrate Level Sample Date Well Depth Aquifer Subject Lot 25.0 4/14/23 110 Unconfined Tundra Jewel Ranch Lot 6 Tundra Jewel 9.91 9/29/19 254 Unconfined Ranch Lot 5 Skyline View 15.50 10/7/20 202 Unconfined Block 2 Lot 10 Skyline View 11.10 3/20/16 76 Unconfined Lot 1 Skyline View 9.12 8/14/22 81 Unconfined Lot 2 Skyline View 9.63 12/19/21 40 UNK — No Well Lot 4 log ' There was one well that did not have a well log to confirm if it was unconfined or not. However, based on the well's depth and the location to surrounding wells we believe this to be unconfined also. TUNDRA JEWEL RANCH, LOT 6 May 23, 2023 Page 2 of 2 As the high nitrate levels fall within the same unconfined aquifer as this well, we believe that all the wells are pulling water from the same aquifer and not different water producing zones. In addition, as the investigation from Sullivans indicates, there appears to be a perforation in the casing around the 60' level causing water to enter into the well casing. Given that there are area wells pulling water from either above or right below this level, it is my opinion that whether the wells in this area are drawing from above the 60' level or below the 110' level in this unconfined aquifer they are all pulling from the same water producing zone and there is no cross connection as they are all from the same aquifer. In light of the high nitrates, the owner is installing POV nitrate reducing reverse osmosis filters under the kitchen sinks. If you have any questions, please contact me at 696-6111/FAX 868-3793. Respectfully submitted, AreTerra Consulting, Inc. �. A>1zCT IER11A Y CONSULTING, INC 20441 Ptannigan Blvd. Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Ne FR rst rinc . 6�� L AK. W571-� May 15, 2023 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: TUNDRA JEWEL RANCH LOT 6- Well Inspection During our mid-April field inspection for a COSA approval for this property sale, we took water samples and submitted to SGS Laboratories for testing. The lab report on the nitrate sample came back at 25.0 mg/L. We immediately called Sullivan Water Wells and requested they scope the well to a depth below 40 feet and down to the static water level if possible, as suggested in the COSA Guidelines 2018 addition (8.c.i) Their report states four anomalies: at 51', 53'6", and 56'2" all as possible intrusions, rust bubbles or large dent inside the casing. At the time of the inspection there was no visible sign of water intrusion into the well. At 62' the inspection noted a possible hole which appeared to be obstructed by the drop pump pipe. Static water levels were found to be at 63'3" with water cascading on the surface possibly from the observations made at 62'. All of these observations are below the required casing depth of 40 feet. Our field inspection of the site shows the well casing extends above grade 2 feet and all the area around the well site drains away from the well, meeting the guideline 8.c.ii. The well was drilled in 1982 to a depth of 110 feet and meets the construction standards in place at the time of construction (guideline 8.c.iii). Historical records in the area as shown on the MOA nitrate mapping indicate other high nitrate wells in the area but with depths of over 200 feet. There is no reliable information that the water producing zones in this well are cross connected to other water producing zones at other depths. While this is the first time this well water has been tested for nitrates the residents of the property have not noted any adverse effects. To lower the nitrate level health risk, the owner is installing POV nitrate reducing reverse osmosis filters under the kitchen sinks. We are installing a new HDPE septic tank at this location, which should also help in reducing the current nitrate levels. . If you have any questions, please contact me at 696-611 1/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. gennethM. uffus, P.E. Attachments: Fixed Height As -built dated 4/28/23 Sullivan Water Wells Report dated 4/27/23 Date: April 27, 2023 P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Arc Terra Construction Scope review for 22940 Sheman Street, Chugiak, Alaska 99567 The following are observations from the well scope requested. +2-0: casing above grade. 9': pitless adapter depth. 51': possible intrusion, rust bubble. 53' 6": possible intrusion, rust bubble. 56' 2": possible intrusion, large dent inside the casing. 62': the view of the casing is obscured by the drop pump pipe, behind the drop pipe is a possible hole. Water is cascading on the the static water surface. 63' 3": static water level. Project #23115 Date 4/21/23 Legal Tundra Jewel Ranch Lot 6 Address Description Well Flow Test Time Arrived on Site Static Level 60' Read #Time Meter Read Chg. Meter Amt. of Water Chg. Time GPM Depth to Water 1 11:55 343 60' 2 12:05 387 44 44 10 4.4 60' 3 12:15 433 46 90 10 4.6 60' 4 12:25 479 46 136 10 4.6 60' 5 12:55 617 138 274 30 4.6 60' 6 1:25 755 138 412 30 4.6 60' 7 1:35 893 138 550 30 4.6 60' 8 1:45 943 50 600 10 4.6 60' 9 10 Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata --~~//~ Date Installed ~ '" ~' / '''''~ ~- Width of Field .~ t! Square Feet of Absorption Area Depression over Field,(~'~ Results of Last Adequacy Test · Separation Distance from Absorption Field: To Water-Supply Well ~ ~ ' To Building Foundation 7_. ~c~ t Lot ~J ~ To Water ~rvice Line Length of Field Depth of Field '~'~ ~ Gravel Bed Thickness Standpipes Present'gNy' Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y~N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.' ' Signed $ & S ENGINEERING Date .Jl_~_ I SRB 196X C°mpanj~13,1~iLE RIVER,.A,K 99577 MOA NO. _,,~5"'"" ~::~:~ Receipt No. ~ O~ I Date of Payment ~' ~ Amount: $ (~ ~'~ ~ Page 2 of 2 72-026 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA ~ND INFORMATION · As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & ~; ENGINI=;EING Telephone ~ ':~:~'~'~----~' [;;:~ ~' Address SRB 196X Date EAGLE RIVER, AK 99577 DHEP APPROVAL C~) Approved ~ DisapproveU ' Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11.,84) MUNICIPAUTY OF ANCHORAGE (MOA) ?~UTHORITY APPROVAL (HAA) MI.~K::IPAUTY OI= '"~'&~HECKLIST- FEBRUARY 1984 DEPT. OF HE. ALTH )JUL 2 t lgB6 Legal Description: A. WELL DATA RECEIVED' Well Classification S til~'' If A. B. C, D.E.C. Approved (Y/N) Well Log Present (~1'~,.-' Date Completed I'~ .,'~ ~ _ ~) '7_. Yield Total Depth [ [o I Cased to -L'IC)~' ~'' Depth of Grouting '""---' Static Water Level I'-I,~:~ I Pump' ,Set At Casing Height Above Ground J "Z--Y~ ~-- Senitary Seal on Cesing~WN~F Electrical Wiring i~ Conduit I~1~ Depression Around Wellhead ",Separation Distances from Well: '" i'o Septic/Holding Tank on Lot ~./..s~-.,s~ ,k.-' ~ On Adioining Lots To Nearest Edge of Absorption Field on ,Lot t.~) c~ ~'*"' ; On Adjoining Lots To NeareSt Public Sewer Line . To Nearest Public ,Sewer · · Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~li S ~1~,~ ~,..t~.-~_ ~ ~, ; Date ~7-' I ' Water Sample Test Results ;~ ,¢l.-~'/E=, ~-~,..,e"~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ -- 7..1.-'8Z. Size /~,..~r;> Standpipe~)/N')' Air-tight Caps Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '"--"-- Separation Distances from Septic/Holding Tank: To Water-Supply Well /C:X.~ · '" To Property Line /Z) I ~- To Water,Mei~#'Service Line ',.~O / ~' No. of Compartments ~ Foundation Cleanout (~4~ Date Last Pumped ?'/:::~-""~/' /u~ ; for ~ Temporary Holding Tank Permit (Y/N) To Building Foundation / ('/ / To Disposal Field ~, I Course Comments /""/4~-- To Stream, Pond, Lake, or Major Drainage Page .1 of 2 72-026(11/84) e MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264..4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) .Applicant Name ~"~--t ~l~l~l~l~l~l~l~l~l~~~Telephone:Home ~ Business -.-~~ ?pplicantAddress . ~:=,,"b~ ~o~-~ ~'~_~ J ~.1--I~1.~,,,~,~- ~ ~ (c) Applicant is (check one): Lending Institution I'1; Owner/builder ~'; Buyer []; Other [] (explain); (d) Lending Institution ] ~ ~A--"~[- "~A~-..t ~ Telephone Address ' ~tk,.t ~ (e) Real E~tate Company and Agent .F,,I.C;:)I,,J ~.- Address T. elephone (I) -~afl.~'t~e HAA to the following address: S & $ ENGINEERING 5R B ! 96X ~-.A. GLE RIVER, AK 99577 TYPE OF RESIDENCE Single-Family~ Multi-Family I-I Number of Bedrooms '~ Other ~ ' WATER SUPPLY Individual Well~ Community[] Publicr'l Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL · - Onsite~l~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 111/84) Page 1 of 2