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HomeMy WebLinkAboutKIJIK LT 2Onsite File Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number- f3SSP2312.7& PfD Number: 013-092-23- Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: [:)New 0 Upgrade Name LITTLE SU TRUST ABSORPTION FIELD X Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6301 EAST 142ND AVE ❑other tie - ber. of Bedronms. •I: Rating Total. deptb-from, oro rtat grade 4 0.8 GPD/SF 7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft Gravel depth beneath pipe 5 Subdivision Block Lot KIJIK LT 2 Ft Fill added above original grade 2 Ft Gravel length 75 Ft Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 Ft2 1 Ft. Well 100'+ 100+ 50'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 100'+ Gal. Material Number of compartments Lot Line 10'♦ 101+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks * TWO ALARMS, INSIDE & OUTSIDE ANCH TANK 50 Gal. Alarm location *NW CORNER BLDG Electrical installed by BRICKWELL Installer PIPE MATERIAL House to tank Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100.2 ft Inspection ectio1�' 8-29-23 8-30-23 Location and description 2� 3'd d'h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL �1En1gFgVtamp OF A Conditional Approvai: Date „^,` ;�•'• �° t;� i=1 :' ° •; 17 ` • 49TH .i ........... ......... ' ..... Of MICHAEL •• MICHAEL N. ANDENSON•: P •, Septic System Approved Date_��5'Z CE-949 .4 ��qf�'• , ���•-��?` ;��-� Note: this approval doe not include well permit requirements. Permit No. OSP231278 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN 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 Description: KIJIK LT 2 MARK A B C01 37 22 CO2 38 23 BASIN 40 25 MT1 35 38 MT2 97 85 ��--SN, P MT2 II // o CO CO2 TC01 I' WELL I PID No.: 017-092-23 I I I I I APPROX V I I I I I I 1 1 / NEW 50 GALLON PLASTI PUMP BASIN 1 / BENCH, TOP OF MH, I EXISTING CONCRETE TJANK 1680 GALLONS, W/ BAFFLE EXISTING FCO UNDER STAIRS I I / � I � I � I � I ASBUILT SCALE: 1 "=�50' I I I l I \ SEPTIC SECnoN N.T.S. WATER ® 87 AUG. 2023 OF 49TH :. MICHAEL N. ANDERSON: ' No. CE 9469 9-5-23 0 (P cq O 0 ro M�7~ a F=- � w r W cy- : Q� Y D AW O J � \ > f Emy D L -Z a D U O O't y as \z CII E Q (n W W Li Unsubdivided LITTLE LANE S 00'00'25"E 300.53' N `` CII o1q 0 Ch 9 a U a N N 00'00'37"W 300.55 I� J J ,.r LO �q C I� CD �p N1 1a CD �C O O G Z t "iD E oat °D E a maEm° � D t 9 CD n 3i m co 0I " ° m ni Q ro-® O V)I L a® G•O rvm Y0+L- d U N L W n NU) •0 V U O0 U _ a� 86 f •V VV) cy)4- C: O 0 p J W Q U N M I Z a M�7~ F=- � w a cy- : Q� Y D AW LJ 0 \ > f Emy D L -Z a D U O O't y CD \z y E Q i=3 m o aTco a a'o m H C p m Bytom a� Q"- O V m V O E -'I CN 3 .2 N E ala i I c a O Com' m rnv y E m Ih m .QSZ J c°ro 1 ) I I O Cli O'F 7 ,uuI W 013k I ms°C�a?.� 01 m o op33E� aZ6+0 V'IC O Q c t a C I ,m ° JJ�Q y m C Q L 7 m y C t y. U vva—y`cca Ln O O ct O c D �mrnm .00 D O C C� D O m 3 0 O D a C m o IT 'CYC O� y� � L uQi O U m a rr y N �Na1 it y 3 t Lri I r o y y a m D C p m V o m No Cmsso C O U Q I I i r i ,o-oc I ,o-oC T T I I 0 � I ,.r LO �q C I� CD �p N1 1a CD �C O O G Z t "iD E oat °D E a maEm° � D t 9 CD n 3i m co 0I " ° m ni Q ro-® O V)I L a® G•O rvm Y0+L- d U N L W n NU) •0 V U O0 U _ a� 86 f •V VV) cy)4- C: O 0 p J W Q U N Z a F=- � w a cy- : Q� Y D AW 13 a Y m t y Emy D L -Z a D U O O't y m m m p 0.t p m a y E Q i=3 m o aTco a a'o m H C p m Bytom a� Q"- O V m V O E -'I y O 3 .2 N E ala i I c a O Com' m rnv y E m Ih m y O Z m r� I m mt c°ro 1 ) t� C m m m D O'F 7 ,uuI m Q 013k I ms°C�a?.� 01 m o op33E� aZ6+0 V'IC O Q c t a C I ,m ° JJ�Q y m C Q L 7 m y C t y. U vva—y`cca Ln O O ct O c D �mrnm .00 D O C C� D O m 3 0 O D a C m o IT 'CYC O� y� � L uQi O U m a rr y N �Na1 it y 3 t m I r o y y a m D C p m V o m No Cmsso C O U 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: OSP231278 Work Type: Septic Upgrade Tax Code Number: 01709223000 Site Legal Address: KIJIK LT 2 G:3038 Site Mailing Address: 6301 E 142ND AVE, Anchorage Owner: LITTLE SU TRUST Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date went S �o G G Q � ,a Departmeiit Lot Size in Sq Ft: Total Bedrooms: 8/29/2023 8/28/2024 Q Disposal Field ❑ 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 �-� � I�eC,�es1 n �t�te � �,5her��ot,tncl Gva�P�• 0/3v/z- Re9ei]r-ed=By: —L5.5 U ca to Issued By: Date: Date: S Zq 7 4 MUNICIPALITY OF ANCHORAGE Development Services Department -T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION± Parcel I.D. 017-092-23 Property owner(s) LITTLE SU TRUST Mailing address 6301 E 142ND AVE Site address SAME Day phone Legal description (Sub'd.., Block & Lot) KIJIK LOT 2 Legal description (Township, Range & Section) Lot Size 90,000 Sq. Ft. Number of Bedrooms / L -I APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Receipt Number: 023V(j Receipt Number: Permit No. (95'P Z 3 1 2 �' Absorption Field Fx_1 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ❑ Upgrade El (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (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. (Signature of property owner or authorized agent) Permit/Rush Fees: 9 S- z Waiver Fees: Date of Payment: Date of Payment: Receipt Number: 023V(j Receipt Number: Permit No. (95'P Z 3 1 2 �' Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc CC) _-z:LrI August 30, 2023 Municipality of Anchorage Development Services Dept. On -Site Water & Wastewater Section Anchorage, Alaska 99519 Phone 343-7904 Re: Septic permit CHANGE ORDER Legal: KIRK LT 2 To Whom it may concern: This is a request for a CHANGE ORDER on the approved septic permit for the above referenced lot. The soils were silty sand SM for the entire 18 -foot depth, BUT the water table has raised to 13 feet due to the very heavy rains this week. Per the code for seasonal ground -water we need 6 feet separation therefore the bottom of the new system is 7 feet. The perc rate was measured at 8 minutes per inch. A small pump basin has been designed to lift the effluent above the elevated water table. The slope at the leach field area is 5 percent with no cut banks or open water within 100 feet of the site. The existing was tank was exposed and found to be concrete, -a valve, nn This CHANGE ORDER will not impact any of the surrounding properties. Sincerely Michael N. wnaerson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS = 750/0.8 = 750 GPD 750 GA/10 = 75 (1) TRENCH 7.0' DEEP 5.0' EFFECTIVE 2.0' WIDE 75' LONG (TH#1) 16. 1.0ORG ISM/GM ND OVER FILTER FABRIC EE 1.25"0 PIPE -2.0 0.25" 0 HOLE @ 48" SEWER ROCK -7.0 -, "01 18 WATER @ 13' AUG. SEPTIC FIELD SECTION I I II II ----J I --------------- ----I I-----------,---- PROPERTY LINE WET LA I II I II � 1 I R EXISTING HOUSE II 1 PROPOSED �I II o \ DRAINAGE FIELD i I all 11 I I SEPTIC L\\I I EXISTING WELL • \�_I �� 100' RADIUS II II I \ I I- 142nd A Septic Design Prepared for LITTLE SU TRUST KIJIK LOT 2 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-1391 SCALE: 8/23/2023 DJR 1 "=200' w z w J J ---� L ------------------------------ I I I I I I I I I I I /I /I / I I 1 I I I I I I I I I 1 F --------------------J--------- I I I ' I APPROX. WETLANDS I BOUNDARY AREA � I ADVANTEX TRENCH, I 1 APPLICATION RATE 2.0 � GPD/SF, 25'X6'X2' TYP. 1 1 I 1 10' UTILITY EXISTING CRIB TO BE I EASEMENT DECOMMISSIONED 1 1 II MT 5% 1 II I II 250 GALLON PUMP II 5% �� BASIN II 1 I HE �I I O 5% \ I II I II EXISTING 1680 GALLON 1 PROPOSED NEW ��— CONCRETE TANK W/ FIELD MT 0 BAFFLE MAINTAIN 5' 1 GNELL E. 142nd TANK TO FIELD TYP. I 1 1 1 I I I I AVENUE Septic Design Prepared for LITTLE SU TRUST KIJIK LOT 2 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-1391 SCALE: I I I I I I I I I I I I I I \ 8/23/2023 1 "=50' Municipality of Anchorage Development Services Department C� On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AIC 99519-6650 (907) 343-7904 Soils Log - Percolation Test r • • • esee o. a dd I'. L•ia.w-e• � O • MICHAEL N. ANDLRSCN •. CE W974 Performed For: t �� !� ^� ft.,4 —l" Date Performed: Legal Description: ' (� �j L 2 Township, Range, Section: 0 V'C� • 0 4- -5-6-7- Date rocs Time 5- 6- Depth to Water 1 Net Drop 7- ,—Ott s- l 7 4� /_,4 - 9- 10- 10- 69 11- 11- 12- 12- 13- 13- 14- 14- 15- 15- 16- 16- 17- 17- 1s- 18--'_ ��v►,� 19- � 20- Site Plan WAS GROUND WATER ENCOUNTERED?_ s IF YES, ATWHAT D Depth to Water fter o r ARonitori t `2j E Date: 2 Reading Date rocs Time Net Time Depth to Water 1 Net Drop l 7 3 �� 69 OC D!`nt ATIl1.n � — - . - • • — n pn...... ncn) rtKL; HULL DIAMETER f TEST RUN BETWEEN _ r ^ FT AND( FT COMMENTS -� i PERFORMED BY: L%_ j fyy�_ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 20 z a Q J 0 Unsubdivided ----------------------------- LITTLE LANE S 00'00'25"E 300.53' O J XI W w D V) W C) a c� O cn 0 y W I �v• g N � ° Ln ra. ory rn /`�• =I z � ��Q ° ��••. W Y •D' O in o It J � m r sa J Q a U cm E c ° a N •°°o m 3 L O O H Q° m O Z Unsubdivided ----------------------------- LITTLE LANE S 00'00'25"E 300.53' O J XI W w D V) W C) a c� O cn 0 y W I �v• g N � ° Ln ra. ory rn /`�• =I z � ��Q ° ��••. W Y •D' O in L o m r sa h ��° a cm E c ° a a Q A •°°o m 3 L al p m E m 3 O O H Q° m O Z C c a m. a ?.m O o ELD u� � c 3 I O® 3,.?,•_ Q m m c °N rn �O O LO C u— c . C q O H.2 ° a.._ •`O 0nFm, a ism�cm I �v3r L kndccv m vY.°� J�m°> a Z, 1 mm Vm! E L `-.� C� m L Q v-0 0E �I 0 p hm V/ U V) L3 m N O L C L 'cc I m L X 0 0o I m c°moo I t •— M y D >. •� I c o �� C 0 3N-m .+ ] p�rLo I Em V! 6 O; a y� O 3 � Z 6 � ° E I O O �— -0 3, -0-0 .40 0U I mq m ° O ° aa m °� C r N q11 t O V/� O'L > a o U) O tD tmo N._rnCL C CNON Q .0mO- UC —73 O C�N -C V)-0 c m h 8V 0V O O-0 h� L h O N cros mom3H m mN N T 6 H 3 m C c O m~LHa►vm O° +v L L m D m J V L-.!2 � mt D m C N m o J c Lc it Co v GRE/ 'itER ANCHORAGE AREA BORb--ClGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME L~\i ~-- ~ul~ls/~fzil:l~ MAILING ADDRESS'~'~' ~)g~;I SEPTIC TANK: DISTANCE J~'l ~" ~.~ MATERIAL FROM WELL MANUFACTURER / '' ' ' - INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /OC} o GALLONS. SEEPAGE Pit: i, ~L~,! Cs, NUMBER OF PITS -- DIAMETER OR WIDTH ig LENGTH DEPTH LINING MATERIAL ~('2~) g~c)'u~'~ CRIB SIZE: DIAMETER ~ DEPTH ~/ DISTANCE FROM: WELL I ~-~' . TOTAL EFFECTIVE ~.~--(.~ L/ BUILDING FOUNDATION__ NEAREST LOT LINE~g'-~ . ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: ~ TYPE ~J~¥~'-L)~-~ CONSTRUCTION DEPTH DISTANCE FROM: BUILDING q~.~i NEAREST NEAREST SEPTIC l SEEPAGE [~ FOUNDATION LOT LINE SEWER LINE TANK t~ , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: PiPE MATE RIAL: ~--~.q C{t,~'- LOT SLOPE."-- REMARKS: DIAGRAM OF SYSTEM DATE APPROVED G.A.A.B. PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY /~'~0 -- 3330 "C" STREET ANCHORAGE, ALASKA 99503 °- TELEPHONE :~?/~-4 S~ ~ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT /~/ DRAIN FIELD OTHER TYPE AND SiZE OF facILItY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS TO BE INSTALLED BY NOTE: THIS PERMIT 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 TYPE SEEPAGE AREA SIZE - MINIMUM DISTANCES, REQUIREMENT~=~-- FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ~ 0j' SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT NEAREST LOT LINE. ~ TO WELLTO SEPTIC TANK 100 DRAIN FIELD ~ WATER MAIN TO SEPTIC TANK SEEPAGE PIt DRAIN FIELD SEPTIC TANK, ~'~S~AGE PIT , DRAIN FIELD DRAIN FIELD ~0 /. DRAIN FIELD ',SEEPAGEP'T 100I ALSO CONSIDER AREA WELLS. 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 TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REG~ARDING INSTALLATION. DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-§8 AND THAT THE ABOVE ~JDepartment of Environmental Qu~/ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed fo r_~x/(~ ~/_ Legal Description ~ This form reports: Soils log Date Performed Percolation test Depth Feet lO- j 13 - 14 - / Was ground water encountered? .... /kO _ If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. -Proposed installat-16-n? Seepage Pit Drain Field ........................ Depth of Inlet Depth to bottom of pit or trench COI.IMENTS: ........................................................ /~:Y ? .-~ /~ - ~ .............. EQ-040 (6174) (907) 243-7893 KEN JOHNSON KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE 3163 LINDEN DRIVE ANCHORAGE. ALASKA 99502 · J~iU NiCI PALITY OF DEPT. OF ·HEALTH Larry & ~ry Weisheim P.O. BOX 0189 S. S. Anchorage, Alaska 99511 ( 345.I181 ~)Vi~.ON~./,ENTAL PROTECTION RE8 Lot 2 ( No block No. ) KiJik Subd. WATER ,WET~L LO,~, ...... RECE V[D 0 ft to 2 ft 2 ft to 4 ft 4 ft to 10 ft 10 ft to 18 ft 18 ft to 25 ft 25 ft to 2'~ ft 29 ft to 34 ft 34 ft to ~8 ft 48 ft to 5! ft 6~ ft to 69 ft. ft to 80 ft B0 ft. to 8t-6 f% 81-6 ft to 84-6 ft 84-6 ft to 89 ft 89 ft to 93 ft 97 ft to .~00 ft 100 ft to 110 ft 1~0 ft Brown silt Fins gravel &light brown'silt Medi,,~grav & It brown sllt..j ' Course gray & brn silt .~. Med. gray & it brn silt Brn silt with some med gray, Med gray & brn silt Brn silt with some med gray:- Water beari~ sand and gravel.. X2 ft. head: Aprox. 2 to 3 GPM ( d~ty ) Gravel and clay ( dry ~ Courase gray & gray silt ( tight ) S~me but weeps H2o .,Bails dry..poor recovery Water bearing Snd & gray. i5 ft. head..No test Med gray & gray stl~..Weeps N2o,. 35 ft. head Bails dry..poor recover¥~.:.-~ Course g~av &gray sllt..dr~_. Heaves..1i ft. Med. and Course gray & gray sl~t Same but weeps H2o,. Clean medium sand & med gray.. Water bearing.. Static Water level 3~ ft. (.?2 ft in well ) Test bailed at !5 GPM} hr.~ ( very clean ) 22 ft. drawdown ( good recovery ) Bottom stable .~ Set pump 85 to 90 ft. Took,water Sample to Chemical &Geological Laboratories of Alaska, INC. for Iron test Results inclosed. / MUNICIPALITY OF ANCHORAGE Development Services Department ` ` Phone: 907-343-7904 �7 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-092-23 Legal description KIJIK LT 2 Site address 6301 E 142ND AVE Expiration Date: 12/15/2023 Current property owner(s) LITTLE SU TRUSTWEISHEIM LARRY EDWARD & MARY X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 9/15/2023 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 Tank Age Advisory Arsenic Advisory X Other COSA Approval_June 2022 MUNICIPALITY Development Services Department rl 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. 017-092-23 Complete legal description KIJIK LOT 2 Location (site address) 6301 E 142ND AVE ANCH AK Current property owner(s) LITTLE SU TRUST 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑■ Concrete ❑ Fiberglass Age 1985 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed K 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 $ )6 Waiver Fee $ Date of Payment 5---- 3 Date of Payment COSA # 0 S C Z 3 /3 a Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: KIJIK LT 2 Parcel ID: 017-092.23 If more than.1 well and/or septic system on tot, provide separate cheeklist_ Structure served by this system A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled 8-7-82 Total depth 110-7" ft Cased to 110-7" ft ® Sanitary seat is functioning eorrectty ❑ Wires are properly protected Casing height (above ground) 16 in. Date of flow test for COSA 3/14/23 Static water level at beginning of test 41 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 66_' Date of pumping 8/30/23 ❑ Required maintenance completed, if AWWTS Comments: EXISTING CONCRETE TANK D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑0 ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade ft (min) © N/A —pressurized field. ❑ Per record drawings, field is insulated. ❑E1 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 COSA Checklist June 2022 Well production at time of test 3+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? ❑ Yes a No ® Coliform bacteria is Negative Nitrate mg/L I] Nitrate less than MRL (ND) Arsenic 20.1 ug/L ❑ Arsenic less than MRL (ND) Collected by Date 8/24/23 M NA C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: 50 GALLON PUMP BASIN INSTALLED Adequacy test date NEW Results Q 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) 60 in Effective depth used 0 in Effective depth remaining 60 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' QYes if No _ It Neighboring Tank > 100' Q Yes if No _ It Absorption Field on Lot > 100' 0 Yes if No _ It Community Sewer Manhole/Cleanout> 100' TYes ifNo_It Private Sewer/Septic Line > 25' Q Yes if No It Holding Tank > 100' QYes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ It 0 Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' EYes if No _ It riiYes 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' M Yes if No _ ft Surface Water > 100' Yes if No _ ft Tank to Property Line > 5' Q Yes if No _ It Wells on Adjacent Lots: Field to Property Line > 10' ❑E Yes if No _ it Private Wells > 100' Yes if No _ ft Water Main > 10' Q Yes if No _ ft Community Wells > 200' Q Yes if No _ It Water Service Line > 10' Yes if No _ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS DOCUMENTED EMS TING CONCRETE TANK, MOA RECORDS REVISED 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 NCI AP_ n( X,4,otr w-1 01A, Phone 727-8864 Engineer's Printed Name 4#t^e— Date ee.�a'R5-y: *• , Frr f A • MICHAEL N. ANDIRSCiV �'. CE 94 9 � s Ill RCFfSSIOH'`�4H COSA Checklist—June 2022 Arsenic Advisory Certificate of On -Site Systems Approval # OSC231340 Subdivision: Kijik, Block: , Lot: 2 A water sample revealed an arsenic concentration of 20.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650` Anchorage, Alaska 99519 6650 *www mum org