HomeMy WebLinkAboutSCIMITAR #1 BLK 3 LT 6Onsite File
ARE
tf A(@ IZI �'- W#VfflWfA I
Per 2021 COSA, ydrofracked
and produc ugh w to support a
3 -bedroom house.
Onsite File
Scimitar #1
Block 3
Lot 6
#051-132-34
Per 2021 COSA, well was hydrofracked
and produces enough water to support a
3-bedroom house.
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 3437997
http:/Iwww.muni.org/0nsite
p a i- r in (1-1 11 t
On -Site Water System Permit
Permit Number: OSP221318 Effective Date: 8/22/2022
Work Type: Well Upgrade Expiration Date: 8/22/2023
Tax Code Number: 05113234000
Site Legal Address: SCIMITAR #1 SLK 3 LT 6 G:1261
Site Mailing Address: 19866 TULVVAR DR, Chijgiak
Owner: GRAVESTREV," R T LotSize in Sq Ft: 43953
Design Engineer.- Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field 0 Septic Tank 13 Holding Tank El Privy 1:1 Private Well 2 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 we2ther
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provis
ions:
Water tanks and installation are to meet all AMC 15-55 Water Storage Tank requirements.
. . ........
i -J
Received By-,■
�ssued By:
Date:
Date:
_ F
Development Services Department
Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051 132 34 000
Property owner(s) TREVOR T GRAVES Day phone 907-600-9807
Mailing address 19866 TULWAR DRIVE, CHUGIAK, AK 99567
Site address 19866 TULWAR DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) SCIMITAR #1, BLK 3 LT 6
Legal description (Township, Range & Section) N/A
Lot Size 43,953 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
(® all that apply)
APPLICATION IS AN:
TYPE OF DWELLING:
Absorption Field
❑
Initial ❑
Single Family (SF) 0
Septic Tank
❑
Upgrade X
pg
(w/wo ADU)
Holding Tank
❑
Renewal ❑
Duplex (D) ❑
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
0
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above in
applicable Municipal
on is correct. I further certify that this is in accordance with
Zh
(Signature of property owner or authorized agent)
Permit/Rush Fees: 1160 Waiver Fees:
Date of Payment: 5/6h22 Date of Payment:
Receipt Number: 76( --
Receipt Number:
Permit No. 05)922/3 g Waiver No.
GADevelopment Services\Building Safetyl0n Site Water and WastewaterTorms\Client Forms\Permit Application.doc
alai 0 NmAparal,
AL,g ?2 ;?0 12 44.. Anchw-age V110! -& °unip .Sei— 9072430742 p.1
Pnrnp ]Irtstallation Dater
PInrnp lntalce Depth Relow'rap of Well Casing. q feet
Pump Ma►nufac:turer`s ranee: :114 CT)
Pump -Madel: ✓ G �I tab vz
Yulnlr size lip I
Pirlesc Ada Burial Depth: 146'eet
Pitless Adapter Alanufactus•er�s Name.:
Pitless Adapter Installer:
Well Disinfected Upon Compietion?
Mi efliod of Disi;nfcelioa:
Comments: `e7ae6�
r
Pump In0aller flame:
Attention: The pump :nsialler snc+li p-ovide z. puz;Ip insta'.la?ion log :o the DSD within 30 days of punip installation_
� i)QES'aG}u.... t
fy n
�.I!'r St3
..
`C ..
.�.�.:.i. ��. A: `1S .D4wC:re'-.,'.%' Pi'wrcrc:rii
.';
:.
4700 Ecienc e RUor
c
r'. oG:. 966JliUkA
f4arx-9BCgich
��--:3�!"iC�"+1��, AK 99-1'07
� L r
payor
nvw n m;.o-calor,n e
\h fes/
Purnp Installation Log
Well Drilling Permit Number: S'iVDate of Issue:
Parcel idendfication ltiumber: 05
Legal Description
Property Owner Nme & iiddr�ess:
Z-,,,*��---
�W
Scam # 1
�3 L lv � - —'
Pnrnp ]Irtstallation Dater
PInrnp lntalce Depth Relow'rap of Well Casing. q feet
Pump Ma►nufac:turer`s ranee: :114 CT)
Pump -Madel: ✓ G �I tab vz
Yulnlr size lip I
Pirlesc Ada Burial Depth: 146'eet
Pitless Adapter Alanufactus•er�s Name.:
Pitless Adapter Installer:
Well Disinfected Upon Compietion?
Mi efliod of Disi;nfcelioa:
Comments: `e7ae6�
r
Pump In0aller flame:
Attention: The pump :nsialler snc+li p-ovide z. puz;Ip insta'.la?ion log :o the DSD within 30 days of punip installation_
Municipality of Anchorage
Development Services Department Y''=' '
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 5cjogOOS3 PID Number: 0371-13.-? .3
Name: �o 1LVJI � 1 e
Wastewater System: (g New ❑ Upgrade
Address*
$66TUlw br v Ie Kiv 567
ABSORPTION FIELD
Phone:/ .� I FE Number of Bedrooms:
AUC �
[11 Deep Trench 61 Shallow Trench ❑Bed ❑Mound ❑Other:
LEGAL DESCRIPTION
Soil Rating:
U
Total Depth from original grade: /J
GPD/Fly
/ FI.
Block: 3 Lot: Subdivision: `/ .
I
Depth to pipe bottom from original grade:
Gravel depth beneath pipe: '
JC Im; Y•
Ft.
/ FI.
Township: Range: Section:
Fill added above original grade: /
Gravel Length:
LO
s 6 FI.
FI.
Well: New ❑ Upgrade
Gravel width:
Number of lines:
Distance between lines:
Fl.
Fl
Classir ation( Private, A, 8, C):
r 5 Vae
Total Depth:
2100 Ft.
Cased to:
1 oZ7 Ft.
Total absorption area:
O Flz
Pi a Mnlerlal: �y/�2 �9/
5e O_T 9
Driller:
Dale Dr'lied:
Static Water Level:
Installer, r
T
�/
Dale Installed:
L+I[
Ft.
/ ze i:C t/ki A
Yield:
Pump Sol at:
Casing Height Above Ground:
TAN K
� GPM
FI.
Fl.
SEPARATION DISTANCES
10 Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
From
Septic
Absorption
Lift
Holding
ubiic/Private
Manufacturer ` J
Capacity:
Tank
Field
Station
Tank
Sewer Line
rem / e r Tic$
ICAO Gal.
Well
113'
13 f t
��
� r +
J
Material; , / D P
`('�
Number or Compartments
Surface Water
(�I
LIFT STATION
Lot Line
�
�
�Li
ize:Manufacturer:
Gal.
Foundation
1
f
"Pump on' level at: 'Pum ave
nigh water alarm al:
Curtain Drain
o /1�
now
Pump Meke odot Electrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description: // 1
0 o wrid eTiorl
., sl Assumed Elevation:
Olnr
'ITI Ft.
Engineers Stamp
u,
S & S ENGINEERING
17034 Eagle River Loop Road, No. 204 5l
Inspections performed by: Dates: 1 � 7- VT
Alaska 9957-7
....o sseoset aWs�so9c�xe
Las!e River,
Ll
2nd —17-0q
Development Services Department Approval��
�a �.�s ee�. .: e000«s.snys.�erto f3,
A. Odaaar`
�e
Reviewed and approved by: �a Date: l0 $ 0?01
/• s" h1a. 14517.8 J ,-
h° Ji
��.,,�. dw
(Rev. 12/00)o��
..
i'�j eaw K, .aocm ,,,�„ s9/
) hc S L p -{ern CLl9PrDVCj o W
�E �a W I,Q o w t,�QQ s► be �e d
W
PERMIT NO. SW040053
PAGE 2 OF 3
MunicipaUt of Anchora e
DEPARTMENT OF HEALTH AND HUI`UN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 3, SCIMITAR S/D #1 P.I.D. NO
LOT 5
051-132-34
goo ,
C /
9 / �
t� 3 HOUSOOM
V /
B A TBM
FCO
TMT /� / A'
\ \
ST o NEW 1000 GALLON / /
\ \
ST 2 ° HDPE SEPTIC TANK
\ \ CO1 DBL1 & DBL2
MT1
�? / // LOT 16
/ J /
\ F \ CO2 MT2 10' MIN.
SCA 1" = 50'
SEPTICAV�a@s3c, as c' sa
c AREA
'
�
✓
LOT 7
\ / S7 a G+Zi Ooi ^+D ^Je96499Y900.. JJ D..
OpOO�DO.Om'00
100' WELL RADIUS% -a
/
/
/
/
/
/
/
LOT 5
051-132-34
goo ,
C /
9 / �
t� 3 HOUSOOM
V /
B A TBM
FCO
TMT /� / A'
\ \
ST o NEW 1000 GALLON / /
\ \
ST 2 ° HDPE SEPTIC TANK
\ \ CO1 DBL1 & DBL2
MT1
�? / // LOT 16
/ J /
\ F \ CO2 MT2 10' MIN.
SCA 1" = 50'
SEPTICAV�a@s3c, as c' sa
c AREA
'
�
✓
LOT 7
\ / S7 a G+Zi Ooi ^+D ^Je96499Y900.. JJ D..
OpOO�DO.Om'00
100' WELL RADIUS% -a
PERMIT NO. SW040053 PAGE 3 OF 3
MunicipaUt of Anchora e
DEPARTMENT OF HEALTH AND HNAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Tet hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 6, BLOCK 3, SCIMITAR S/D ##1 P.1.D. N0. 051-132-34
ST1 ST2 — 98.8'
FINAL GRADE
NEW
95.1 ' 1 000 GALLON
POLYETHYLENE
SEPTIC TANK
2" INSULATION
C01
MT2 CO2 MT1 C01 = 98.9'
CO2 = 97.0'
FINAL GRADE
2" INSULATION
C01 = 94.3'
I-
7j-i
CO2 = 94.4'
MT2 = 90.4-//MT1 = 90.3' N. T. S.
NO WATER FOUND
83.3' B.O.H.
J -J
AS -BUILT
I hereby certify that I have surveyed the following described
property: -----
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no improvements on property lying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this 7�" day of 1' 200
ROBERT C. JOHNSON r {
SCALE: Registered Land Surveyor No' 880 -LS
Box 77-0456, Eagle River, Alaska 99577
Phone (907) 694-2543
01/25/2006 11.11 9073436599
JF11����2�86 e3t52 PH EH.SG
907 7CE 2636
ATTN; Marilyn Thorsness
24 January 2006
REFERENCE parcel k 051-132.34.000.05
7'hia is a "Orn statement aw the property at 19866 Tulwar Drive does not have a
functioning source of water. The well, at a cost ofS11,500.00 is dry. Itis not
economically viable for the try and Of a new well. A well pump was not installed
since thele was no waxer in it. t,
Rater is waled from the Eagle River fire station to my house via 150 gallon tank in the
back of my pickup. This trip's made dailey (except weekends).
Attached Is a copy of the well log indicating there was no flow at the time the well was
drilled. Also attached is proof that I would like a municipal water system.
If you have any questions, please contact me at 244-3210 or my father at 753.2693.
Sincerely
Ro rtlrShafer -
PAGE 04
9• -es
01/25/2006 11:11 9073436599
JPN-'1�-2006 eat3• PM EN.8G
MOA PROP APPRAISAL.
907 T83 2636
Mrilliniri T Og
PAGE 02
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Apr 13, 2004
Expiration Date: Apr 13, 2005
Permit Number: SWO40053 Parcel ID: 051-132-34
Legal Description: SCIMITAR #1 SUBDIVISION BLOCK 8 LOT -6
Design Engineer: 0003 S & S Engineering Site Address: 19866 TULWAR DRIVE
Owner Name: Bob Shafer Lot Size: 0 SO. FT.
Owner Address: 19866 TULWAR DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
EAGLE RIVER. AK 99567 -
This permit Is for the construction of:
❑Q Disposal Field ❑� Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By.
Issued By.
Date,26.
Date: / O
PY),
W
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.enchorage.ak.us
(907)343-7904
OiJ-.MITE SEWER/WELL PERMIT-r".PPLICATICIN
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 057 —AW — 0 Permit Number SW 040653
Property
Day phone A �f
Mailing address (1) ::;v- -"3 '
5#e4i�g address (2) mo66 TUL WA// I? 0/ i rMY6/RR
Legal description (Lot, Block & Sub'd.) 5141 ULQ,-&
Zip Code flEA7
Legal description (S� tioprwnship & Range)
Lot Size'" 4 y Acre Sq.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well I® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that th ove in rmation is correct. I further certify that this application is being made for a
Single Famy Dwellin nd is in accordance with applicable Municipal Codes.
owner or authored agent)
Permit FeeAwoslso— f /7s -0—v RMjAvaiver Fees: _
Date of Payment: 41 O4 Date of Payment:
Receipt Number: 5-114o& Receipt Number:
(Rev. 12100)
12461
01410VW
1E'ALTNA ftHOSITY
APPPgJAy
SEWER 6 WATER
MVPEETEPSIOPS
SEWER 6 WATER
NSPEM ON
ENCNEERNGSTUOIES
ANO REPORT!
WELLNSPEMON
A PLOW TEST
WE PIANS
SOILTEST
PEACOlAT104
TEST
BTRUCRAIALS
WCNANrAL
INSPECTIONS
ONSRE
WASTEWATER
0SPOSALSYSTEY
OESIGN
April 12, 2004
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 6; Block 3; Scimitar # 1 Subdivision
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907)694.2979
FAX(907)694-1211
It is requested that you issue a permit to install a well and a septic system to serve the
proposed three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test performed. The approximate location of
the test hole is located on the attached site plan. At the time of excavation 4/02/04, no
water was found. After monitoring, ground water was not found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas'or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Enclosure
Cowan, P.E.
17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
1" = 40' DESIGN SITE -PLAN
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Municipality of Anchorage
Development Services Department
Building Safety Division
y� On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650
Www d anchorave.ak.us
(907) 943-7904
Performed For.
Legal Description:
2-
3-
4-
5-
6-
7-
8-
9-
-3-4-5-
s-
8-
9- L7
10-
11- "N.
12-
�Il
13- 0
14
15-
1
, s-
SoI Lo Percolation Test " 14
1 /ph�c-� Date. Performed:
G �i7 F6,3 �L A-gLZNrf 34- Townshi
0R ism
Ic7/-� <P�t-T
aha Co 66)er
B, 0, 14
s
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT DEPTH?
Depth to Water After
Monitoring?
Oate: 1
bb,,rt A. Sfax
Pb. 1477•f {� �
oc
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
/
Iz If
A04
—'
it
_
0 il0/i
/O
Ar
G"
n:13A
/o
Iv;30A
�o
�•,
S •,
PER CATION RATE Li• lm+wie✓+NI renu rnxc uwn+c,cn
TE RUN BETWEEN =FT ANDFT
COMMENTS
PERFORMED BY: ! CERTIFY THAT THIS T S WA
PERFORMED IN A ANC ITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: OZ
MUMUPA\U TY OF A HC HOR%AGIF
Development Services Department p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-132-34-000
Expiration Date: 2/8/2024
Legal description SCIMITAR #1 BILK 3 LT 6
Site address 19866 TULWAR DR Chugiak AK 99567
Current property owner(s) GRAVES TREVOR T
XThe On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 11/8/2023
)Phis Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory X
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approvaljune 2022
MUNICIPALITY OF ANCHORAGE
0
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. 051-132-34
Complete legal description SCIMITAR #1 BLOCK 3, LOT 6
Location (site address) 19866 TULWAR DRIVE, CHUGIAK, AK 99567
Current property owner(s) TREVOR T GRAVES Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
® Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age 19 - 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 $S (� Waiver Fee $
Date of Payment J 1 2 / Z 3 Date of Payment
COSA # O S& 13 l Lf 3 Z Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: SCIMITAR #1 BLOCK 3, LOT 6 Parcel ID: 051-132-34
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 2004 Total depth 400 ft
Cased to 127 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10/30/23
Static water level at beginning of test 228.4 ft.
Well production at time of test 0.06 gpm
Water storage tank volume 1000 gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 1.79 mg/L Nitrate less than MRL (ND)
Arsenic 5.092 ug/L Arsenic less than MRL (ND)
Collected by Sullivan Water Wells Date 10/30/2023
Comments See Sullivan well flow report of marginally producing well.
B. TANK DATA
Measured operating fluid level in septic tank 41”
Date of pumping 9/5/2023
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) 4/17/2004
ALL standpipes present per record drawing
Total measured depth from grade 8.4 ft (max)
Measured depth to pipe invert from grade 2.7 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
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 9/6/2023
Results Pass
Fluid depth prior to test 4 in
Water added 600 gal
New fluid depth 5 in
Elapsed time <15 min
Final fluid depth 4 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 48 in (MOA 4’ ED)
Effective depth used 4 in (Final Fluid Depth)
Effective depth (ED) remaining 44 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate.
COSA Checklist.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 11/01/2023
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 &
11/01/23
Date: 10/30/23
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259.
TO: Brent Western, First Water Consulting
The flow test has been completed at 19866 Tulwar Dr., Chugiak. The flow test results are as
follows:
STATIC : 228.4
DRAW-DOWN: 150’
YIELD: .06 gpm
Sincerely,
Chancey Dietrich
Well Nater Advisory
Certificate of On -Site Systems Approval # OSC231432
Subdivision: Scimitar #1, Block: 3, Lot: 6
This well's productivity was determined to be .06 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the well
production does not meet this requirement, water storage has been provided to
meet minimum code requirements.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P O Box 196650* Anchorage, Alaska 99519 6650 *www mum org
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. 051-132-34
1. GENERAL INFORMATION
Complete legal description SCIMITAR #1
Location (site address) 19866 Tulwar Dr
Expiration Date: "- C
ZO 2
BLK 3 LT 6
Chugiak AK 99567
Current property owner(s) PUTASKI STEPHEN & PATIENCE
Mailing address
Real estate agent
19866 Tulwar Dr Chugiak
-Hila-ry Lockhart—
2. TYPE OF DWELLING:
Fx� Single Family (w o AD
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
AK 99567
Day phone 907.343.8817
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $__/ q 5 Waiver Fee $
Date of Payment _q - Z (%ZZ Date of Payment
Receipt Number Of 6� -7 i Receipt Number
COSA # QS G 22 1076 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 Eklutna Engineering, LLC
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE
6. DSD SIGNATURE
System #1 Approved for 3— bedrooms
- System #2 Approved for
Disapproved
Conditional approval for
bedrooms
Phone 907.406.1058
Date
^= A I 1k,
�•.• TM.........:..
.. .eL.T ,e .....
�'• Date 2'
No. C 11. D4
1���� PROFESSION���
STAMP
bedrooms, with the following stipulations:
.,itW(('(((w1"
WASTE-v,'ATER z
PROGRAM c�
)>>)))))w1
r
BY Original Certificate Date: 3 ^ [ –zo
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
COSA Checklist blue sheet
Legal Description: SCIMITAR #1 BLK 3 LT 6
If more than 1 septic system on lot: COSA Checklist # of
Parcel ID: 051-132-34
Structure served by this system
A. WELL DATA
-rF 3,F �'t A s -� Z �rz
❑ Well log is filed with Onsite (or attached)
Well production at time of test 1.3 gpm
Date drilled 2004
Water storage tank volume 500 gallons
Total depth 400 ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to 127 ft
❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly
Nitrate 1.99 mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected A--
Arsenic 3.27 ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 24 in. j;5 i
Collected by Curtis Townsend
2
Date of flow test for COSA 129'2021 -7 o
Date of Sample W812022
Static water level at beginning of test 91 ft.
Final fluid depth 0 in
Comments water well has been hydrofracked, well production is based on well recovery rate
B. TANK DATA
Age of tank(s) 17 years
Tank type/material septic plastic
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping Mar 7, 2022
C. LIFT STATION
❑ Required maintenance cam
Age of lift station vearti
Lift station material
Comment
D. ABSORPTION FIELD DATA
-rF 3,F �'t A s -� Z �rz
Which system tested (date installed) 2004
Adequacy test date 112912021 q�Cj
❑ ALL standpipes present per record drawing
Results [Z Pass For 3 bedrooms
Total measured depth from grade 8.6 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 2.6 ft (min)
Water added 517 gal
❑ N/A — pressurized field
2
New depth in
FOR Monitor tubes go to bottom of effective. If not, state
400
depth into effective
Elapsdd time min
❑ Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate X450 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies: 2" insulation over tank and field according to inspection report
COSA Checklist yellow sheet
E. 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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
F✓ Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' 0✓ Yes
if No
ft
Private Sewer/Septic Line > 25'✓Ej Yes
if No ft
Absorption Field on Lot > 100' M✓ Yes
if No
ft
Holding Tank > 100' 0✓ Yes
if No ft
Neighboring Absorption Fields > 100'
✓/ Yes if No.
Water Main > 10'
Animal Containment > 50' R✓ Yes
if No ft
F71 Yes
if No
ft
0 Yes if No.
Water Service Line > 10'
M
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' Fv Yes
if No
ft
n,/ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
P✓ Yes if No.
Property Line > 5'✓lam
Yes
Yes
if No
ft
Wells on Adjacent Lots:
n✓
Absorption Field > 5'
✓M
Yes
if No
ft
Private Wells > 100'
✓/ Yes if No.
Water Main > 10'
M
Yes
if No
ft
Community Wells > 200'
0 Yes if No.
Water Service Line > 10'
M
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' 121 Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No
Water Service Line > 10'
n✓
Yes
if No
ft
Community Wells > 200' QQ Yes if No
Surface Water > 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
Feb 28, 2022: SWL 305', water level in septic tank 40", 0" water in field
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
-s�
.......,
COSA Checklist yellow sheet'
`.CEI
PRQFES51
ft
ft
ft
ft
10
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 Sept `i aO 1 tel(
Parcel I.D. 051-132-34 Expiration Date:
1. GENERAL INFORMATION
Complete legal description SCIMITAR #1 BILK 3 LT 6
Location (site address) 19866 Tulwar Dr
Chugiak
Current property owner(s) ROBERT SHAFER
Mailing address
Real estate agent
19866 Tulwar Dr Chugiak
Matt Baxter
2. TYPE OF DWELLING:
Fx_1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
AK 99567
Day phone
AK 99567
Day phone 907.227.5412
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Private Well
El
Private Septic
R
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 $ 55 O Waiver Fee $
Date of Payment 01.2 0 Date of Payment
Receipt Number Receipt Number 1
COSA # 0 SC a H I 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 Eklutna Engineering, LLC Phone 907.406.1058
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE Date J`
r �
6. DSDSIGNATURE
V/ System #1 Approved for \3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
.201
4� OFAL�s';
_ " '
.o seed mos-... •........ €�}
•eem° irtis.. .....
Date
No.
bedrooms, with the following stipulations:
.�ittttttt(Ui�,_
By: Original Certificate Date: Q Z1 � bCQ 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
COSA Checklist blue sheet
Legal Description: SCIMITAR #1 BLK 3 LT 6
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
Rs �
Parcel ID: 051-132-34
Structure served by this system
❑ Well log is filed with Onsite (or attached)
Well production at time of test 1.3 gpm
Date drilled 2004
Water storage tank volume 500 gallons
Total depth 400 ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to 127 ft
Al Coliform bacteria is Negative
IN Sanitary seal is functioning correctly
2.0 4'''D,55 cmL
Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic 3.7 ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 24 in.
Collected by Curtis Townsend
Date of flow test for COSA 1/29/2021
Date of Sample 112712021
Static water level at beginning of test 91 ft.
Comments water well has been hydrofracked, well production is based on well recovery rate
B. TANK DATA
Age of tank(s) 16 years
Tank type/material septic plastic
Measured operating fluid level in septic tank 4011
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 1/26/2021
D. ABSORPTION FIELD DATA
C. LIFT STATION
❑ Required maintenance com
Age of lift station /y a ',4
Lift station material/
Which system tested (date installed) 2004 Adequacy test date 1/2912021
❑ ALL standpipes present per record drawing Results a Pass For 3 bedrooms
Total measured depth from grade 8.6 ft (max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 2.6 ft (min) Water added 517 gal
❑ N/A — pressurized field
New depth 2 in
❑ Monitor tubes go to bottom of effective. If not, state
Elapsed time 400 min
depth into effective
❑ Code -required soil cover over field Final fluid depth 0 in
❑ System presoaked Absorption rate '450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: 2" insulation over tank and field according to inspection report
COSA Checklist yellow sheet
E. 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'
[D
Yes
Community Sewer Manhole/Cleanout > 100'
0 Yes
if No
ft
r1/ Yes
if No ft
Neighboring Tank > 100' rv-� Yes
if No
ft
Private Sewer/Septic Line > 25' F-/� Yes
if No ft
Absorption Field on Lot > 100' 0✓ Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
P/ Yes if No ft
Water Main > 10'
Animal Containment > 50' Rl Yes
if No ft
0 Yes
if No
ft
El Yes if No ft
Water Service Line > 10'
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' Q 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'
[D
Yes
if No
ft
Surface Water > 100'
Q✓ Yes if No ft
Property Line > 5'✓0
Yes
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
M
Yes
if No
ft
Private Wells > 100'
P/ Yes if No ft
Water Main > 10'
Q✓
Yes
if No
ft
Community Wells > 200'
El Yes if No ft
Water Service Line > 10'
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
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l 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.kNGIEER'S
.... ..........`..
.aa.a
�y Curtis L.
............vnzse1`
COSA Checklist yellow sheet o . Date 4
.No. CE 11 904 a�
�����PROFESSIGt1P��,
�¢' ry ROCK AND
,^] WIRE
RETAINING NG
WALL
•�o` f GRAVEL
�.. DRIVEWAY
2 -STORY —�'
NOTES
1. DIMENSIONS ARE RECORD PER PLAT 74-186.
2. UTILITIES OTHER THAN THOSE SHOWN MAY EXIST.
N ss.
,S
2 I.
Lor 5
"rs
.0j,
CHAIN-LINK
FENCE
SOIMI TAR
FRAME HOUSE
SUBDIVISION
WITH LOFT
.
8' x 8'
PLAYHOUSE
Lor 6
BLOCK 3
W/ DECK
� Ss.
s
LEGEND s?)� •.
0
FOUND REBAR rye;
ss,'
cw
WELL
i S"
SEPTIC VENT
,L
ELECTRIC PEDESTAL
LOT 7
[ ; -
GUY WIRE
POWER POLE
� -7
-- OVERHEAD U11UT Y
NOTES
1. DIMENSIONS ARE RECORD PER PLAT 74-186.
2. UTILITIES OTHER THAN THOSE SHOWN MAY EXIST.
N ss.
,S
2 I.
Lor 5
"rs
.0j,
CHAIN-LINK
FENCE
SOIMI TAR
SUBDIVISION
UNIT NO. I
Lor 6
BLOCK 3
PLAT 74-766 /
715.0' x 8.7'
SHED UNDER
2ND STORY
DECK
OF ALojkk�
491H
Dayna M, RumfeR
�� ���; • No. LS13322•
i1►' R;f�SSloskA A ARW
3. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY
AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES
SHOULD ANY DATA SHOWN BE USED TO ESTABLISH ANY FENCE,
STRUCTURE OR ANY OTHER IMPROVEMENTS.
4. ALL VISIBLE ABOVE GROUND FEATURES OF THE EXISTING
SEPTIC SYSTEM WERE LOCATED AT THE TIME OF SURVEY AND
SHOWN HERE ON.
LA ENDER
SURVEY & MAPPING
2890 S. BARNYARD CIR., WAS LLA. AX 99654
DAYNAQAVENDERSURVEY.COY
SCALE 1" = 50'
ASBUILT - NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED
A SURVEY OF
LOT 6, BLOCK 3, SCIMITAR SUBDIVISION
UNIT NO. 1, PLAT NO. 74-186, ANCHORAGE
RECORDING DISTRICT, ALASKA,
AND THAT THE IMPROVEMENTS AS DEPICTED
HEREON EXIST AS SHOWN IN RELATION TO
THE PROPERTY LINES. EASEMENTS OF
RECORD OTHER THAN THOSE SHOWN ON
RECORDED PLAT No. 74-186 ARE NOT
SHOWN HEREON UNLESS OTHERWISE NOTED.
DATE: 2/7/2021 FB: 2020-03
GRID: NW 1261 DRAWN: DMR
SCALE: 1" = 50' FILE: 21-006AB