HomeMy WebLinkAboutLAKE HILL ACRES LT 1rtiS
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Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231055 PID Number: 051-053-26
Dwelling: ® Single Family (SF) ® with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade
Name
FINIS & SHARON SHELDEN
ABSORPTION FIELD
® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
24330 SUNNYSIDE DRIVE, CHUGIAK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.6 GPD/SF
9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision Block Lot
LAKE HILL ACRES 1
Fill added above original grade
Gravel length
Township Range Section
VARIES 1 Ft.1
84 Ft.
Gravel width
2
Beds: Number of Lines
e ben lines
SEPARATION DISTANCES
Ft.
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
[Dis:t.b:etwe:entrenches
From
Tank
Field
Tank
Line
1000 Ft2
2
12 Ft.
Well
100'+
100'+
25'+
TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface water
100'+
100'+
GREER
1250 Gal.
Material
Number of compartments
Lot Line
51+
10'+
NA
HDPE
2
Foundation
10'+
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks 4BR SEPTIC. SERVICE LINE, TANK &
LOWER TRENCH INSULATED.
Alarm location
Electrical installed by
Installer JRS
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield 3034 CO/MT 3034
Inspector FWC
BENCH MARK (Assumed elevation) 100 ft
Inspdda{ sn is t 4/27/2023 2„d 4/28/23
Location and description
3`d 4/28/23 4d' 4/28/23
SHOP DOOR SILL
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
..,,�in A4
Conditional Approval: Date
•' ' • •,RQ,��
TH ••��
All•• .•••• ••••.....• d
Sep ticSys te
Approved -
Curtis Huffman : 4
Date �Z
�� • CE 128991
�• �`� .•�'
�s�F�•
• 5/6/2023 . •C�,p
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S0kV�
�kkF�SI4NA ,�
Note: this approval does not include well permit requirements.
`'pROFES'���.
fPow nFun11uN
iC:
Lot 2
Lot 14
SUNNYSIDE DRIVE
N 89'55'10"E 210.00'
— 5.9'
3.5'x4.0' DECK 38.8' n
o' 1 STORY e N
N RESIDENCE8.0' m
ZI 41
n `8.1'x12.1' SHED
x
3.2'x6.3'
8.0'x12.1' SHED DECK
SEPTIC}
PIPES x
7P -p G \ MANHOLE x
N
2R e� . TSFPTIC—
8.0•x12.0'
SHED
17.1'
OQ o
N
Lot 15
I
LOT 1
31,500 S.F.
Lot 16
Lot 17
370
00
coo
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o
/
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m
0
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O
1 II
30.0'
I
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I
PLOT PLAN ___ AS BUILT _x_ SCALE _1" =_40__ GRID _ NW 1561__ Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
kenOlongsurvey.com
Professional Land Surveyors jonothanolangsurvey.com �OF•Aqkkl
irav(sOlangsurvey.com ��Q�.• 'A•,s�„1,
I hereby certify that I have surveyed the following described property:
LOT 1, LAKE HILL ACRES (PLAT No. P-374) / *: 49 T
Anchorage Recording District, Alaska, and that the Improvements situated thereon are � • • • • • • • • • • • • • • • •
within the property lines and do not encroach onto the property adjacent thereto, that 0
no improvements on the property lying adjacent thereto encroach on the surveyed / ••••• •••• •••••
premises and that there are no roadways, transmission Imes or other visible KENNETH G. LANte
easements on sold property except as Indicated hereon. �j,�"��f, a pOp .•��A
Dated this the __ 51__ Day of ___w]j ___—___, __` __, at Anchorage, Alaska ffft F9F0 • rJ' S�Q�
� �l` PROFESS IONA� �Pa�
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
FIRST WATER CONSULTING
PID:051-053-26PERMIT:OSP231055
LAKE HILL ACRES LOT 1
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: OSP231055
Work Type: Septic Upgrade
Tax Code Number: 05105326000
Site Legal Address: LAKE HILL ACRES LT 1 G:1561
Site Mailing Address: 24330 SUNNYSIDE DR, Chugiak
Owner: SHELDEN FINIS J
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
mcnt. 'S,
�° 6.
1
DP.pai,tn eiit
4/26/2023
4/25/2024
31500
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
S -Ulm u L
Date:
Issued By:
I
Date:
Z 2,sL
M
Y OF H C H 0 R A GE
Development Services Department
Phone: 907-343-7904
On -Site Water & Wastewater Section — Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 051-053-26
Property owner(s) FINIS & SHARON SHELDEN Day phone
Mailing address PO BOX 671087, CHUGIAK, AK 99567
Site address 24330 SUNNSIDE DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) LAKE HILL ACRES LOT 1
Legal description (Township, Range & Section)
Lot Size 31,500 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) 0
Septic Tank
Q
Upgrade
(w/wo AD U)
Holding Tank
ElRenewal
ElDuplex
(D) El
❑
Multiple Dwellings ElPrivy
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
ignature of property owner or authorized agent)
Permit/Rush Fees: 1595 Waiver Fees:
Date of Payment:� 0 20 Z 3 Date of Payment:
Receipt Number: 5 O0 Receipt Number:
Permit No. f3SP2�/055 Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
!
!!
April 14, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: LAKE HILL ARECE LOT 1
The property owner has requested we obtain a permit to upgrade the failed septic system of the
above referenced lot. We propose to install two deep trenches and 1500-gallon HDPE septic
tank to serve the existing 3-bedroom residence and proposed 1-bedroom ADU. If groundwater is
encountered at construction a 1500-gallon epoxy coated steel septic tank may need to be installed
and/or the septic absorption field redesigned. The design is based on the recent test hole
conducted on April 3, 2023 . No groundwater was observed at test hole excavation or
monitoring and will be re-verified at construction.
The slopes are moderate at 5-10% at the proposed upgrade location. The lot and area are served
by private water. The design will not impact any of the neighboring properties and required
separations are to be staked by a professional land surveyor prior to construction. Please contact
us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231055, Curtis Townsend, 04/26/23
FIRST WATER CONSULTING
LAKE HILL ACRES LOT 1
DESIGN CALCS:
NO PRIVATE WELLS
WITHIN 100' OF PROPOSED
SEPTIC SYSTEM
NO SLOPES >25% WITHIN 50'
OF PROPOSED FIELD.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231055, Curtis Townsend, 04/26/23
FIRST WATER CONSULTING
DESIGN DETAILS:
LAKE HILL ACRES LOT 1
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231055, Curtis Townsend, 04/26/23
13030 Sues Way - Anchorage, Alaska 99516
Tel. 907-350-9566 FirstWaterAK@gmail.com
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LAKE HILL ACRES LOT 1
PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 4/12/2023
DEPTH
FEET OG
SOILS
1
ORG/OL
2
3
4
5
6
7
8
GM- w/ cobbles to 1
9
10
11
12
13
14
15
16
BOH
17
18
19
20
Reading Date Gross
Time
Net Time Depth
to
Water
Net Drop
4/4/2023 30 min 6 1 13/16
30 min 6 1 14/16
30 min 6 1 13/16
PERCOLATION RATE 17 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 4/11/2023
TESTHOLE # 23-1 DATE PERFORMED: 4/3/2023
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: SHARON SHELDEN
4/12/2023
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231055, Curtis Townsend, 04/26/23
Lot 2
M
Lot 14
SUNNYSIDE DRIVE
- _ - 5.9'
3.5'x4.0' DECK J'q38.8'
1 STORY
SEPTIC PIPES RESIDENCE
26.5'
89.5'12
3.9'
\8.0'x72.1' SHED 3.2'x6.3' DE
Z
0
O 8.,'x12.1' SHED /
GF-
GP�P
8.0'x12.0'
SHED
5�GQ o
' n.r
o
N
Lot 15
C
� x
\ o
0
0
� m
Lot 1 0
31,500 S. F. 0
CHAIN-LINK FENCE
Lot 16
Lot 17
370
30.0'
I
I
PLOT PLAN ___ AS BUILT _X_ SCALE 1= __ 40__ GRID _ NW 1561 Project
No.
11500 Daryl Avenue, Anchorage,
Lang & Associates, inc. (907) 522-6476 Phone
Alaska 99515-3049
kenOlongsurvey.com
`\\\
Professional Land Surveyors jonathanolangsurvey.com
travisOlangsurvey.com
OF Aq kj
qsL�
,
I hereby certify that I have surveyed the following described property:
LOT 1, LAKE HILL ACRES (PLAT No. P-374)
*: 48 TH
Anchorage Recording District, Alaska, and that the improvements situated thereon are
/ • • • • • • • • • • • • • • 0
within the property lines and do not encroach onto the property adjacent thereto, that
improvements the lying thereto encroach the surveyed
;WA 0,
no on property adjacent on
premises and that there are no roadways, transmission lines or other visible
/ KENNETH G. LANG ; o
,+,``cJf,
easements on said properly except as indicated hereon.
No. 5202
Dated this the 1`_\ _ Da of----`Abr_Lt ;,_r:.'-; 9
Day _______, ______, at Anchorage, Alaska
itl PROFESSIONPL�Pa��
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
State of Alaska AECC963
t, - GRER ANCHORAGE AREA BO'GH
.0110, Department of Environmental Quality
3330 C Street
r Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 0. i 144SrDEN MAILING ADDRESS 143 ( Com.(. too< A lc PHONE
LOCATION ;1-c 2:0-z. LEGAL DESCRIPTION LerT ( LA [L(( 5(4 to
SEPTIC TANK: / L 7$/
DISTANCE i nf.! _ NUMBER OF
FROM WELL I lig MANUFACTURER ✓rkj( c C L MATERIAL_ Teed- COMPARTMENTS _I- - .,.
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY WO GALLONS.
4
SEEPAGE PIT: U
NUMBER OF PITS _. DIAMETER 5 I OR WIDTH 111 , LENGTH 1S , DEPTH
LINING MATERIAL `-0 CRIB SIZE: DIAMETER �r DEPTH W/ DISTANCE FROM: WELL 130 '
TOTAL EFFECTIVE 7-7 l I
BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 32 T SQ. FT.
ADDITIONAL ABSORPTION
WELL: C
TYPE.141�e0 CONSTRUCTION rANOk12V DEPTH 21i DISTANCE FROM:
BUILDING
DDATION t-' I LOTNEAREST LIINE I r SEWERST LINE TANKSEPTIC i I , SYSTEM106, SEEPAGE I i 30 1.
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES: DIAGRAM OF SYSTEM
INSTALLED BY:
le,. _..„.Trlia,
Illi
r� .05.4.k.. 4B' IP' `''
PIPE MATERIAL: C6S; ie2�l y f - I�o4se IL{L -�j
Rt 4 it 4.
LOT SLOPE: LQ -
NET T
REMARKS:
Mkt;p pai-ek m
, l
, I
DAT. 1� APPROV"1 A'
G.A.A.B.
IlkForm No. EQ-031
• lilt
„ �„4 GREATER ANCHORAGE AREA BOROUGH
,' ,•'�'o DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
.ir
li,G,
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
.,..o Ao '.•, SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OF APPLICANT / u MAILING ADDRESS 01 l'?/ , -- �. PHONE
INSTALLATION LOCATION ` i- - r ..-1/ti ("7 "11-- '
,\
LEGAL DESCRIPTION r/`�` � �
INSTALLATION OF: SEPTIC TANK /��� SEEPAGE PIT DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED r
FINANCED THROUGH TO BE INSTALLED BY G___ 1 __Q
J�
SOIL TEST RESULTS NOTE: THIS P RMIT IS NOT VALID WITHOUT SOIL TEST
-
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION./ �
SEPTIC TANK SIZE /eV°`� TYPE 'r� SEEPAGE AREA SIZE /1' •/�//4ct TYPE Selfrle -
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
r
FOUNDATION TO SEPTIC TANKc ,
FOUNDATION TO SEEPAGE PIT 20 r . DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /f( ,
2Zf
SEPTIC TANK , SEEPAGE PIT 2 DRAIN FIELD '
TO NEAREST LOT LINE.
/161-1) -
WELL TO SEPTIC TANK_/l SEEPAGE PIT —. ,
DRAIN FIELD __—_ . ALSO CONSIDER AREA WELLS. `_
WATER MAIN TO SEPTIC TANK . SEEPAGE PIT ' .
DRAIN FIELD _ —. `
/� ! r� ! - .
SEPTIC TANK. SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF — '
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TA NKND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH '• . LATIONS REGARDING INSTALLATION.
Al , ' /
G.A A.B.
OR
LICENSED DESIGNER I
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIB ID YSTEM IS IN ACCORDANCE WITH SAID CODE. /JTI
DATE ` /3 l 'It/ APPLICANT'S SIGNATURE C----61A--"VV/
"ORM NO. -016
4111 41111
., GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
� �roJA9Y 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 7/31/74
Time of Inspection 10:00 am
Date of Inspection 7/31/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
1 . Approval requested by: Betty Fields
Mailing Address: Lox 1065 Eagle River Phone: 694-2112
2. Property Owner: Arlie Hasten Phone:
Mailing Address:
3. Legal Description: Lot 1 , Lake Hill Acres Subdivision
4. Location:
5. Type of facility to be inspected Single No. of bedrooms
6. Well Data:
A. Type grilled B. Depth 21Y
C. Construction Standard D. Bacterial Analysis Satisfactory
7. Sewage Disposal System:
A. Installed 1974 B. Installer Polefeko
C. Septic Tank: 1 . Size 1000 gal 2. Manufacturer Stam StPPI
D. Seepage Pit: 1 . Absorption Area 12x16 2. Material jog
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank 10;' , Absorption area 130 ' , Sewer Lines ,
Nearest lot line , Other contamination
B. Foundation to septic tank 16' , Absorption area 42' •
C. Absorption area to nearest lot line 21 ' •
EQ-034 (1/74) Page 1 of two pages
age 2 of two pages - Ret for Approval of Individual Illkr & Water Facilities
.
Legal Description 1.07 1 LiQkc k // ,4ce1;
Comments
Approv / 4_________ Disapproved Date Ve0PP/71
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
j:/;;
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
GREATER ANCHORAGE AREA BOROUGH
fil Ill
Department of Environmental Quality
I)
} „ — 3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 7/26/74
Time of Inspection
Date of Inspection 7/29/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
VA
1 . Approval requested by: Selective Realty
Mailing Address: Phone:
2. Property Owner: Arlie Pastan Phone:
Mailing Address:
3. Legal Description: Lot 1 Lake Hill Acres 0-‘
4. Location: 1 1iie 23 1/2 Old Glen otiwax Highway
5. Type of facility to be inspected Single No. of bedrooms 1
6. Well Data :
A. Type Drilled B. Depth 219 '
C. Construction Standard D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed 1974 B. Installer Polyefko
C. Septic Tank: 1 . Size 1000 gal 2. Manufacturer Stack Steel
D. Seepage Pit: 1 . Absorption Area 12/15' 2. Material Loq
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank 106' , Absorption area 130' , Sewer Lines ,
Nearest lot line 91 , Other contamination .
B. Foundation to septic tank 13' , Absorption area 42 ' .
C. Absorption area to nearest lot line 21 '
EQ-034 (1/74) Page 1 of two pages
ge` 2 of two pages - Rest for Approval of Individual •r & Water Facilities
Legal Description Lot 1 Lake fill Acres
Comments Approval is for sewer system only:
dill! /
APP e 'rovr etc Disapproved Date 8/1/74
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
MUNICIPALITY OF
o
Development Services Department "
On -Site Water & Wastewater Section
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Y*
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-053-26
Complete legal description LAKE HILL ACRES LOT 1
Location (site address) 24330_SUNNYSIDE DRIVE, CHUGIAK, AK 99567
Current property owner(s) SHARON & FINIS SHELDEN 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 ® 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 $ P �i n Waiver Fee $
Date of Payment 5 /� 13 Date of Payment
COSA # 0S 7, 3 111 g Waiver #
COSA Application 2022.doc
Parcel I.D. 051-053-26
Certificate of On -Site Systems Approval
Expiration Date: ?(/312..� 13
Legal description LAKE HILL ACRES LT 1
Site address 24330 SUNNYSIDE DR Chugiak AK 99567
Current property owner(s) FINIS & SHARON SHELDEN
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
M
Original Certificate Date: ✓ ,Zo Z
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
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
COSA Checklist 2022.docx
COSA Checklist
Legal Description: LAKE HILL ACRES LOT 1 Parcel ID: 051-053-26
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 CIRCA 1974 Total depth 219 ft
Cased to UNKNOWN ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 3/23/2023
Static water level at beginning of test 169 ft.
Well production at time of test 3+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 3/24/2023
Comments
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NA – NEW SEPTIC TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) NEW SYSTEM
ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 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
Adequacy test date NEW SYSTEM
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/6/2023
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 &
5/6/2023