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ARGYLE LT 3
Onsite Argyle Lot 3 #015-141-18 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 Community Development Department Development Services Division C* On -Site Water & Wastewater Program k Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-141-18 Property owner(s) LESZEK KULIGOWSKI (Builder) Day phone Mailing address Site address Legal description (Sub'd., Block & Lot) ARGYLE LT 3 Legal description (Township, Range & Section) Lot Size 44519 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field x❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑x Water Storage ❑ APPLICATION IS AN Initial Upgrade Renewal THIS APPLICATION INCLUDES A VARIANCE / WA TYPE OF DWELLING: ❑ Single Family (SF) (w/wo ADU) El Duplex (D) El Multiple Dwellings (SF and/or D) 4, / A)n v tER REQUESj FOR: !n� I certify that the above information is correct. I further certify applicable Municipal Codes. (Signature of property owner or Permit/Rush Fees: 5A 4 Date of Payment: Receipt Number: 2022 Permit No. 0--TIii' Permit App__-:- .:..,:c. agent) _„I�>iZr`�a Waiver Fees: Date of Payment: Receipt Number: Waiver No. nce with 1 0 0 0 LO Ld 0 0 Q 0 LOT 3 ARGYLE SUBDIVISION 44,519 SF EAST 296.79' I I I I I I I I I I 1 I i I I W I m I I N I I � I m TH2 0I U) i TH 1 I I I I I I i EAST 296.80' ale Locations Not SITE PLAN SCALE 1' = 40' 0 0 0 W 0 0 0 a 0 DEPTH (feel) I- 2- 3 - 4 - 5 - 6 - 7 - R — 9 10— N- 12- 1 J- 14- 15- 16- 17 18 1c 2® MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 3, ARGYLE SUBDIVISION PERFORMED FOR: JOHN Cl ARE DATE: PROJECT No.: PARCEL ID#: TECIIMCIAN:yy, ROBERTS rtrt��T7��77TT TEST HOLE 2� IIIIIIIIIIIIII OB/OG COMMENTS: a SILTY SAND n, ° WITH GRAVEL SW/SM a BOH @ II WAS AROUND WAI ER HNCOUNTERI D, Ila ...._... 49th _ NEL E RNBmuN No. CE -4381 Ofa'TII OP WATC;R APT'GR MUN N2 UATE or MONITORITORING. 2% DATE READING GROSS TIME NET TIME DEPTH Tp (talNu7e5) (MINUTES)- WA I ER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 8/14 1 10:24 0.63" 2 10:54 30 6.75" 6,1P 3 10:55 0.50" 4 11:25 30 6.63" 6.13" 5 11:26 0.75" 6 11:56 30 6.88" 6.13" PERCOLATION RATE: 4.9 (MIN/INCH) PERC. HOLE DIA.. 6!—HNCHES) TEST RUN BETWEEN:: 2_0 FT. and 3.00 FT. TEST PERFORMED BY ANDERSON ENGINEERING. I. MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DA'Z'E: DEPTI I (lect) 2 - 3 4 - 5 - 6- 7- 8- 9- 10- 11 12- 13- 14- 15- 16- 17- 18- 19- 20 - MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: -_LOT 3, ARGYLE SUBDIVISION PERFORMED FOR: JOHN CLARE DATE: 8/13/15 PROJECFNo.: PARCEL ID#: TECHNICIAN: W. ROBERTS TEST HOLE l OB/OG a o. d a 4 a SILTY SAND WITH GRAVEL d SW/SM n SLOPE i. 49th HrCH L E. PNDERSON SITE PLAN SET SNE PIAN k i a G a WAS GROUND \VATF.R ENCOUNTERED' IF \'ES rt WHAT DEPTH" DEPTH OF WATER AFTER MON11ORING DATE OF hION1TORING: fNG BOH @ 13' DATE No 2% GROSS TIME NET TIME READING (MINUTES) (rolNurFs) DEPTH To WATFR (INCHES) MET DP,OP (INCH) O TEST HOLE PRESOAKED PRIOR TO TESTING: 8/14 1 10:09 L75" 2 10:39 30 7.25" 6.50" 3 10:40 1.50" 4 11:10 30 7.00" 6.50" 5 I:II 1.50° 6 1:41 30 7.00" 6.50" PERCOLATION RATE: 4.6 (MM/INCH) PERC. HOLE DIA.6 (INCHES) TEST RUN BETWEEN- 2=5 FT. and 3.5 FT. COMMENTS: TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 8/31/15 Performed For: Legal Description: Depth (Feet) 5- 6- 7- 8- 9- 10- 11- 1 2- 13- 14, 15- 16- 17- 18- 19 - COMMENTS y P/C p /'l % �v tfvW rf Ce" Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraoe ak-us (907) 343-7904 Soils Log - Percolation Test z 1, 1 �y'�PBlGINEER' EA'L{`�'{aej' / y} .' ; k 49TH 01 A! MICHAEL N�•AKDi RSC.•,•• �t+r�q.• CE -9469 PROcrc� ;YDate Performed U ri L u{. 3 Township, Range, Section: WAS GROUND WATER ENCOUNTERED? N If' Gross Time Net Time Depth to Water 5 IF YES, AT WHAT DEPTH? Ir 1� t Depth to Water Aker IO P P Monitoring? t J V tet— E Date: 1) 1 S )1 (7JG Site Plan D.v .A. k - Reading Date Gross Time Net Time Depth to Water Net Drop Ir 1� tam IO PERCOLATION RATE (rrinntesrinch) PERC HOLE DIAMETER 4_ TEST RUN BETWEEN FT AND_FT PERFORMED BY: I�/j ' I I CERTIFY THAT THIS TEST WAS, PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 1 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. 015-141-18-000 Expiration Date: 9/4/2025 Legal description ARGYLE LT 3 Site address 10901 LIPSCOMB ST Anchorage AK 99516 Current property owner(s) TIULANA ELIZA G & CHARLES K X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/15/2024 Thrs Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject dystem(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 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 t Certificate of On -Site Systems Approval Application Y PP PP 1. GENERAL INFORMATION Parcel I.D. 015-141-18 Complete legal description ARGYLE LT 3 Location (site address) 10901 LIPSCOMB ST, ANCH AK Current property owner(s) TIULANA 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: X 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: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 8 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 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 Date of Payment Clz a�Z y a COSA # 05C 7,�1 137 Z Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: ARGYLE LT 3 Parcel ID: 015-141-18 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 1/12/17 Total depth 240 ft Cased to 240 ft Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9/4/24 Static water level at beginning of test 212 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 9/4/24 ❑ Required maintenance completed, ifAWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/5/16 ❑ ALL standpipes present per record drawing Total measured depth from grade 9.5 ft (max) Measured depth to pipe invert from grade 3.5 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) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5.5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑0 No ❑N Coliform bacteria is Negative Nitrate mg/L Q Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Date 9/4/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 9/4/24 Results QPass Fluid depth prior to test 2 in Water added 600 gal New fluid depth 1 in Elapsed time 1440 min Final Fluid depth 0 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 2 in Effective depth remaining 72 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' Qi Yes if No _ ft [E Yes if No _ ft Neighboring Tank > 100' ❑s Yes if No _ ft Private Sewer/Septic Line > 25' ❑� Yes if No _ ft Absorption Field on Lot > 100' [j] Yes if No _ ft Holding Tank > 100' ❑E Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑� Yes if No _ ft ❑i Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Fm—] Yes if No _ ft Q 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' ❑Q Yes if No _ ft Surface Water > 100' ❑� Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS Mm Yes ifNo_ft 0 Yes if No _ ft ❑E Yes if No _ ft ZYes ifNo_ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' E Yes if No _ ft ta❑ 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 Mr 4v t; t.( 4,%4 rr 4yvr P$, Engineer's Printed Name COSA Checklist June 2022 Phone 7_27-8864 Date �y%(�24f T _ d OF • 44 Sd %' fit• ' �^°� r; a± • ' 5�• MICHAEL N. ANDERSGN ��� CE -9469 • •-6.-"r Municipality of Anchorage On-Site Water and Wastewater Program . . wil' (907) 343-7904 SAMT c T r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-141-18 Expiration Date: §-1 2 ( 1 1. GENERAL INFORMATION Complete legal description ARGYLE S/D LOT 3 Location (site address) 10901 LIPSCOMB ST, ANCHORAGE, AK 99516 Current Property owner(s) Day phone Mailing address 10901 LIPSCOMB ST,ANCHORAGE,AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLJNG: \1-3 4 5 g 70 ® Single Family (w/wo ADU) e4' 490 s,0 ❑ Duplex z 41- 0 Multiple Dwellings (Single Family and/or Duplex) �1 -/ 3. NUMBER OF BEDROOMS: 4 4RA mai I \ 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: /414 Date: S 2 COSA to be released to the engineer, unless otherwise requested by the engineer. Cg COSA Fee $ dl DI 'i,( — U( I , to Fr. Waiver Fee $ Date of Payment 5) I/I 1 Date of Payment Receipt Number -2. 11 E a b Receipt Number COSA# 7SC.l't (Ill 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. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 05/9/17 .Q--,- - '4;‘:::%‘':-..•°•e e o•% '''• 1 F .e _:wr • y '.i 1f e '• 49I7....!K 1.---',$: jfaa 4oceeo o o on 0 • aal/. vd 6. DSD SIGNATURE `,• Ce * aeleGoov•e -Oe•• • r re• •;7?....,!••MICHAEL N. ANDERSCr. , " r;: 7( System #1 Approved for V bedrooms. .4 --"1•• CE-9469 :�...�.';r System #2 Approved for bedrooms. I.i? �1.�'fi: 5/0//F-. ,\.•'J`'" Disapproved. 1h':_v-,.-,=--�=-- Conditional approval for bedrooms, with the following stipulations: `y© ON-SITE -'y WATCR AND m j WASTEWATER z m PROGRAM —4/7..Crr'1 f,f FS C = -- 4 Original Certificate Date: 2 -/ 7 The Municipality of Anchorage Development Sees 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 COSA blue sheet 10.10.12 doc .f If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: ARGYLE S/D LOT 3 Parcel ID: 015-141-18 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 1-9-17 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 240 ft. Cased to 240 ft. Casing height (above ground) 18 FROM WELL LOG AT INSPECTION Date of test 1-9-17 NEW Static water level 214 ft. NEW ft. Well production 10 g.p.m. NEW g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1,98 mg/L Arsenic: ND ug/L Date of sample: 41412017 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 1215/2016 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NEW Pumper NEW C. ABSORPTION FIELD DATA— 1985 SYSTEM TESTED Date installed 1215/2016 Soil rating .p.d./f .r ft2/bdrm) 1.2 System type DEEP TRENCH Length 44 ft. Width 2 ft. Gravel below pipe 6.0 ft. Total depth_at', Eff. absorption area 528 ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) NEW For 4 bedrooms Fluid depth in absorption field before test NEW in. Water added NEW gal. New depth NEW in. Elapsed Time: NEW min. Final fluid depth NEW in. Absorption rate >= NEW g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) UNKNOWN If yes, give date • D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off level at in.High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 50'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 5'+ Water main 100'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS • • G. ENGINEER'S CERTIFICATION • : c,�t.+ ?, ' 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in yr' • ; ,4�g T H ` conformance with MOA COSA guidelines in effect on this date. � �I I. • s4'ltl.!` d Engineer's Printed Name MIKE N. ANDERSON, PE �! MICHAEL N. Ftvr'CRS:'J • • J' 946 Date 0519/2017 er ��,��▪.. I/�?• .•.t.; ••� ‘‘OiNN--•:%- COSA canary sheet_2-6-15.doc • PLAT NO. 66-83 ARGYLE SUBDIVISION LOT 3 44,520 S.F. N 90°00'00"E 296.79' I I 108.0' I I b i I GRAVEL DRIVE b n n I I I I � * I I o I I o o inI I 0 m I I gU���NG l 0 33' o I I gX50 . • • •• o (/) M I I WELL SEPTIC SYSTEM ,M 00 I I • oo Z I La I 111 z WI Z° I O ; I ?YI -e I mea I 1 " =40' b I NP I • I I •1 1 l IN N 90"00'00"E 296.80' WELL LOT 4 S40 se 'ut t8,5' tp U `' U 15.0' acs. 81' 35.2. T. IA it .r Ado ill I BUILDING DETAIL SCALE: 1"=20' AS —B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING. LLC IT IS THE RESPONSIBILITY OF THE OWNER TO ***x•111+ JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 4 cc, OF ,i,w*, 2000 E. DOWUNG RD., SUITE 8 • .••""••• 4 COVENANTS OR RESTRICTIONS WHICH DO NOT ♦ P; . S ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. coar • PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA 49TH ••• * • • GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR SW2636 • • •46.447S-rvvrr.-.1111 4/7/2017 ESTABLISHING BOUNDARY OR FENCE ONES. • - a • Je ery A. Gastaldi : o ANCHORAGE RECORDING DISTRICT, ALASKA ♦: •..• ��� ,91� a'• .��,• F.B. JOB NO. NOTE: NO CORNERS SET THIS DATE ,eaj0, ••• �� SJ•� °,esslona1 k . 1 7-02 ARGYLES web+,"'.�� •