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HomeMy WebLinkAboutSPENARD HEIGHTS LT 19AOnsite File Spenard Heights Lot 19A #012-052-65 Job No. 19-128 Drilling, Inc. o P.O. Box 110389 ♦ Anchorage, AK 995110 0907-345-4000 0 GROUNDWATER WELL LOG Well Owner: ANTHC / Magdalene Irrigoo Use of Well: Domestic Site Description: 3818W.63 ` Avenue, Anchorage, Alaska Legal Description: Spenard Heights Subdivision, Lot 19A, Anchorage, Alaska CONSTRUCTION Drill Method: Air Rotary Hole Size: 6" Hole Depth: 180.74' Casing Size: 6" Cased to: 171.98' Material: A53B steel Wall: .250" Well Completion: Open end Screen X Perforated Method: Screen/Perforation Description: 5" riser pipe & K -packer: 169.33' to 171.95', 5" ss 0.010 slot well screen: 171.98' to 177.16', 5" tail pipe & butt plate: 177.16' to 178.19' Grout Notes: 4 Sacks (50#ea) of Bentonite. 10" casing installed from 10' to ground surface, bentonite chips installed in annulus between 10" casing & 6" casing as 10" casing removed from well. Well Development: Air Surge Well Disinfected: Yes Method: Bleach Yield Test at 6 GPM for 4 hour(s) with 72.7' of drawdown (DD) from static level(SWL). Method: Submersible pump Static Water Level (SWL): 97.3' Start Date: 8/13/19 Completion Date: 8/16/19 Test Pump Date: 8/16/19 Final Pump Install Date: 8/16/19 WELL LOG Depth in feet from top Details of formations penetrated, size of material, color and miscellaneous details. of casing. 0 TO 3 Casing Stick Up 3 TO 90 Silt & Sand: grey, dry, some gravel 90 TO 169 -------------- . Silt & Sand: grey, wet, some gravel .._ .. _...._.__.._ . __ 169 TO 180 Water Gravel. medium, some fine silt & sand mommalm 0 11 t �� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Well Drilling Permit Number: Parcel Identification Number: 012 - 0526 - 5000 Date of Issue: - - Legal Description Block Lot Property Owner Name & Address: Spenard Heights 19A Magdalene Irrigoo 3818 W 63rd Ave Anchorage AK 1199502 Pump Installation Date: 8 -16 -2019 Pump Intake Depth Below Top of Well Casing: 175 feet Pump Manufacturer's Name: Goulds Pump Model: 10HS10412CL Pump Size: 3/4 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: Hayward Pitless Adapter Installer: Travis Denevan Well Disinfected Upon Completion? 0 Yes 0 No Method of Disinfection: chlorine pellets Comments: I Pump Installer Name: Travis Denevan I Company: Pioneer Peak Industries LLC Mailing Address: 4394 N Farm Loop Rd City: Palmer State: AK Zip: 99645 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. --- -- -- ---W63rdAVE- N 89055'50" E 96.23' ALUMINUM O CAP 10' ROW, SEWER & WATER EASEMEN- 0--'-------- ---------------- w Ivti o I zI GRAVEL o I DRIVEWAY o mI O I r -I m oD I .CONCRETE 0 (m KI 51.01 .. 2 -STORY FRAME o HOUSE 51.0' CONC. U1 Vt 23.2' om Q°I O SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY t> m LOT 19A �I omI I p i m o 8,707 Sq. ft. N -P ( m D THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION m m m m THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY o -zi I I cr1 FENCE VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE N ( I — x 15' LLC C.O.A. 122554 JOB # 21154 1 NO CORNERS SET THIS DATE I SCALE 1" = 20' Land Surveying Services 907.290.8949 ! WELL 2 -STORY FRAME o HOUSE 51.0' CONC. U1 Vt 23.2' Uj DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS O SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY O SURVEY MAY DISCLOSE. C) = UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE = USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR N ESTABLISHING PROPERTY BOUNDARIES. m -D THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION m SURVEY STANDARDS. m THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY Cn TRANSACTION, RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR cr1 ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE N ( I LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. 15' S 89°57'41" W 116.20' - I LOT 19B OF ��,`����♦\1\ttttl .H i'• $uku Sali o LS -14837 +�AR��44-- I{1ttttts i�� EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (92-7) ARE NOT SHOWN HEREON. THIS AS -BUILT DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS I HEREBY CERTIFY THAT I HAVE SURVEYED THE SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY FOLLOWING DESCRIBED PROPERTY: SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE LOT 19A, SPENARD HEIGHTS ADDITION SUBDIVISION USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION WITHIN THE PROPERTY LINES AND NO VISIBLE SURVEY STANDARDS. ENCROACHMENTS EXIST EXCEPTAS INDICATED. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY DATED THIS 11th DAY OF AUGUST, 2021, ATANCHORAGE, TRANSACTION, RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ALASKA. ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. FIXED HEIGHT LLC C.O.A. 122554 JOB # 21154 1 NO CORNERS SET THIS DATE I SCALE 1" = 20' Land Surveying Services 907.290.8949 225 W 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHT.COM X DO B A I 4 F A UJtN: JttLLUN1N FNUUUUI: AUtoaeSK I;IVII .JU LUI'J- - togiisI PILL: \\CIOSkO.ITIS.gOV\OtS\FrOTIles\)eeiiorin\UeSKLOP\ANI;-U-�,IFLAN.CW9 LATUU1: JIIt-FLAN-Ll,U FNIIVILU: L/-IU-/LUIU- IU:LJ:26 AM NOTE: LOCATION OF SEWER SERVICE LINE TO THE RESIDENCE AT 3818 W. WELL TO CLOSEST CORNER "A" = 16' WELL TO CORNER "B" = 40.2' SS 63RD AVENUE WAS APPROXIMATED FROM 1975/76 MUNICIPALITY OF SS — — — ANCHORAGE SEWER CONNECTION APPLICATION AND PERMIT / / WELL TO CORNER "C" = 62.5' Pioneer Peak Industries LLC - 4WellAs47ulit LOT 17 `' LOT 16 LOT 15 V) / I ' 105' PROPOSED WELL BUFFER of Environmental Health and Engineering Health 4500 Diplomacy Drive Anchorage, Alaska 99508 (907)729-3600 flame- Magdalene Irrigoo 3 feet Dat$: 13AG/2019 Grourod level SUrfaolasea Total Depth -_ n e ` Casing Depth � � B p Static Level 97 Liner depth WA 171-177 fi" steel well casing 4 RECORD DRAWINGS CERTIFICATION THESE DRAWINGS REFLECT RECORDED AS -BUILT INFORMATION OBTAINED DURING CONSTRUCTION. I (OR AN INDIVIDUAL UNDER MY DIRECT SUPERVISION)J1 HAVE CONDUCTED A POST CONSTRUCTION OBSERVATION OF THE FACILITIES AND REVIEWED AS-BUILT1 INFORMATION RECORDED BY OTHERS. TO THE BEST OF MY KNOWLEDGE ALL WORK THAT HAS BEEN INSTALLED. IS IN ACCPRDANCIJ WITH THESE DRAWINGS. p NAME: DATE: PRINTED N ME: KURT SAUERS 171 FitF] _INeIISCrren 177 Feet i *' 49°1 *,0j 44 • .1.a ..; KU CE-10280ER5. �i�'^o!9���= t���i�� �I�•. WEST 63RD AVE. _ _ S C[ SY9SWJ ... i o I` ii — MIH ,_,C N89 55 SO E 96.23 �� 31.3g^III / 1 Ln � ' ' I 100' SEWER Ln 1 o LOT 197A-)(-:: SETBACKBAR O — LOT 18 75' - f f P I ' e fV SETBA SEWKER � EXISTING A. 75' SEWER MAIN o HOUSE `n C SETBACK o wII z SS W ` �/ � s o 0 5 M1 Gi PROPOSED WELL o SITE LOCATION f ,N89 5A' 41 "E 116.20 0 OUFF�P O / `, 25' SS o �S �f��•�- 75 SEWER MAIN 1 ` �SpSV ` SETBACK 75' SEWER MA � ` J,� 0 APPROXIMATE SETBACK i 100' SEWER LOCATION SETBACK .S` 75' SERVICE 0 ' `; LOT 19B/ SIH ` 0 100' SEWER / oo SETBACK z 0 — \ i ` O , _ SSv ` [V 1 s S LOT 21 r / �?� f _ f LINE LOT 22 oSCreer� IS ONE INCH ON ORIGINAL DRAWING, IF NOT ADJUST SCALES ACCORDINGLY 0 CD zA r Y N a Q J W W C (� � (- J 0 a m U z Ch z W Q Q G cc W O U W °G 0 a N w S$9° �%I 41 IIW 11,6 19 ' LE®ND PROPOSED WELL\ ��� LOT 20 SEWER MANHOLE SETBACK R \ �SSPOSSIBLE WELL LOCATION\,v ---- PROPOSED WELL BUFFER LOT EASEMENT LINE GAS AND OTHER UTILITY LOCATIONS ARE APPROXIMATE. 0 = M PLAN SET: AKA -I8 -ANC Batt4m ole 180' CALL 811 FOR LOCATES PRIOR TO DRILLING. -- SEWER LINE SETBACK th - S - - SEWER LINE SEPERATION DISTANCES AND SETBACKS PER -��- -UNDERGROUND GA5 LINE AMC 15.55.060TO BE VERIFIED BY DRILLER 0 m' 20 4o w,a„hPROJ CoW-rrW.0 PROJ MGR: M. LANDON ENG: K. SAUERS DRUMS ENG: DRAWN BY: ? SPENARD HEIGHTS SUBDIVISION DRAWN BY: PS SHEET TITLE CHECKED BY: SC SITE PLAN - LCG All measurements from toll of Cash LOTS 19A -19B DATE: 0410SJ2016 HOT DRAM To SCALE Submitted y: Tra+ris Denelran Inc °`O""®' �'9'^�'¢'0�''"�'$ 250 H Street Anchorage, AX 99501 F*07) 29 F csD .I z4s-s62s ,nwv,.lcgak-mn, JOB NO: 15064 WELL SITE PLAN PARCEL# 012052650000 SCALE: 1 "= 20' SHEET NO: v l , 14-1 C-1 01 �./ SHEET 1 OF 4 UJtN: JttLLUN1N FNUUUUI: AUtoaeSK I;IVII .JU LUI'J- - togiisI PILL: \\CIOSkO.ITIS.gOV\OtS\FrOTIles\)eeiiorin\UeSKLOP\ANI;-U-�,IFLAN.CW9 LATUU1: JIIt-FLAN-Ll,U FNIIVILU: L/-IU-/LUIU- IU:LJ:26 AM """rr MUNICIPALITY OF ANCHORAGE �pH �__..,..�o `ill l'1]�. On-Site Water&Wastewater Program `:.%,.,S ,,� PO Box 196650 4700 Elmore Road _ i-. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r; r. http://www.muni.orgtonsite t .- 4, iii Department 4"r c;; P O' On-Site Water System Permit Permit Number: OSP191028 Effective Date: 2/25/2019 Work Type: Well Initial Expiration Date: 2/25/2020 Tax Code Number: 01205265000 Site Legal Address: SPENARD HEIGHTS LT 19A G:2026 Site Mailing Address: 3818 W 63RD AVE, Anchorage Owner: IRRIGOO MAGDALENE Lot Size in Sq Ft: 8707 Design Engineer: Total Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: To close this permit please submit: 1. Well Log 2. Pump Install Log 3. Water sample results Received By: __,LDate: 21'251 15 Issued By: /' AA, Date: Z/2-5,/ " �UIUHIU A UTY OF ANCHORAGE 0;1; -�- - Development Services Department `?7 Phone: 907-343-7904 On -Site Water & Wastewater Section F 8 -7997 u .7o -o ON-SITE SEPTIC/WELL PERMIT APPLICATION Q FCg 13 2019 Parcel I.D. 012052650000 ';�_ZZ 0Z Property owner(s) Magdalene Irrigoo Day phone (907) 248-0 8 L 9 Mailing address 3818 West 63rd Ave., Anchorage, AK 99502 Site address Same Legal description (Sub'd., Block & Lot) Spenard Heights Addition Subdivision - Lots 19A & 19B Legal description (Township, Range & Section) NW 1/4 of Sec 2, T12N, R4W, SM, AK Lot Size 8,707 & 8,656 Sq. Ft. Number of Bedrooms .$ 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial FI Single Family (SF) 0 (w/wo AD U) Septic Tank 11Upgrade ElDuplex ElHolding (D) Tank ElRenewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ED Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: o u Se er o est Av 8ft) & igh-13cue R1'latecal.(9�Distance: 8 I certify that the above information is correct. I further certify that this is in accordance with appli ble Municipa Codes. ®,�,,�-�/hElff Aaspjpe -rr'64 Dr. nature of property owner or authorized agent) CP�� L �Zi-t$� e•ii'Ps ��.��'�C• DP@ (Sig Permit/Rush Fees: Waiver Fees: 1 /' Date of Payment: allgl a Date of Payment: .I�f I Receipt Number: -� 3LI LI 0 I Receipt Number: v y LJ � ® I Permit No. 0s,50qIO ag Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc 1 I 2 I 3 I 4 NOTE: _ LOCATION OF SEWER SERVICE LINE TO THE RESIDENCE AT 3818 W. e �,S 63RD AVENUE WAS APPROXIMATED FROM 1975/76 MUNICIPALITY OF Sj ss -ANCHORAGE SEWER CONNECTION APPLICATION AND PERMIT ler-,O�� s 41 D LOT 17 c� LOT 16 LOT 15tin tn Division of Environmental Health and Engineering 4500 Diplomacy Drive Anchorage,Aloka 99508 ,-105' PROPOSED • (907)7294500 WELL BUFFER • /' i `�9m b3RD ... .. ........ . . ........... ..... .. . . / '-i . I.V,: KURT D.SAUS .,,i N89° 55' 50E 96.23 _S •*,.. CE-10280 .4/- , •zi9 !9s�i a �,1� FFSSW's 4• •--100'SEWER — _ _ — o LOT 19A \- 1---) D ,- 'II / SETBACK y ~ rf \ O _ J BAR IS ONE INCH ON ii 75' Lh Q - - ORIGINAL DRAWING, IF NOT LOT 18 ( R \ , I - - ADJUST SCALES ACCORDINGLY a C SEWER R d- I EXISTING „` z SETBACK 1 f 75'SEWER MAIN- o - HOUSE C) 1 r SETBACK 8 ' ,�, I J — w� LOT 21 Y N = ��- i s �:� S C' 4 S N t I a-I Gc PROPOSED WELL-- r1 !r' .. W W N \ I.: t \--'r ''N89° 5 '41' E 116.20 l Qz SITE LOCATION ° J O UFFGP O � �� / 25 O: Q U '^ ,NN���g r /,I ,! / 75'SEWER MAIN = GCI- u. �OSC` / �/i SETBACK z W �' ri/ APPROXIMATE Q G/75SEWERMA / 100'SEWER- .. LOCATION W W' / SETBACK OF SEWER GC n rr' I 75. i . 1 SERVICE LINE N '.'; LOT 19B/- �'. \ i�\ / 0E0r // 1---- = ^ B A 589° 57' 41"W 11.8.19 0 1 .� .% LOT 22 \ \ S.;' U :h W LEGEND: ® -PROPOSED WELL LOT 20 ' e -SEWER MANHOLE 100'SEWER n i�SETBACK '4,.//.//- -POSSIBLE WELL LOCATION\ N ' Vro /7 — --- PROPOSED WELL BUFFER \• ; Y ----LOT EASEMENT LINE GAS AND OTHER UTILITY LOCATIONS ARE APPROXIMATE. g CALL 811 FOR LOCATES PRIOR TO DRILLING. PLAN SET: AKA-18-ANC A •-:.:5-- -SEWER LINE SETBACK 0 '" 20' wmil PROJ MGR: M. LANDON - -SEWER LINE SEPERATION DISTANCES AND SETBACKS PER eelaa PROJ ENG: K. SAUERS AMC 15.55.060 TO BE VERIFIED BY DRILLER Dir msA• DRUMS ENG: --UNDERGROUND GAS LINE �� -- _ J DRAWN BY: ? LCG . SPENARD HEIGHTS SUBDIVISION DRAWNPS SHEET TITLE CHECKEDED BY: SC 1 Inc LOTS 19A-19B DATE: 04/05/2016 SITE PLAN-LCG lintiaCr j JOB NO: 1SO64 ""•` `� WELL SITE PLAN 1�,H ��r SCALE: C-101 AnMoraEe,AK 99501 SHEET No. „ PARCEL# 012052650000 1"=X., 014 SHEET 1 OF 4 USER: JEELLORIN PRODUCT: Autodesk Civil 3D 2019 - English FILE: \\alcsxa.Ihs.gov\dfs\Profiles\Jeellorin\Desktop\ANC-C-STPLAN.dw9 LAYOUT: SITE_PLANICG PRINTED: 2/19/2019 10:25:28 AM 2 OF 7 TOTAL SHEETS .,..._ ....•.,...r ,a...—.. .w-.n:•-Ydv,,,,,,;£::..w: .vcn9."+-`i3 5,,,...w �a r (v(2�J ly1�v'i� �'VrracK"-hgti .Y�� TAX CODE No. a/2—OSS-23 GRID No. 4'Zy.-Z MUNICIPALITY OF ANCHORAGE — SEWER UTILITY PROPERTY. '' Name P/91//.0 I 4'E Address 3P/7 w 6 3 4ele" Plat No. Subd. SPE/r/A.PD I/E/Gy7s ACct.No Lot !- Block Residential Commerial 0 Industrial 0 No.of units /efl' 'E CONNECT: Main Tap Er On Property //722 Size 'i" P Y 0 Permit No. Type ,I Drawing No. Size Main Type Depth at Connect !1!1 Insulation 0 Cleanouts Type Connect Agent Bi9€C6 jie. Inspector Date g-7 -76 Comments G'av ''cre.e To 7 't4t1e /*de& .Z•as,ECTED Connect Location d'•D. /�'..E. elf 41,9e.(•Po,P«r — cCA' ite .Pe ar yon-,, eve Mom, ,'433eeo:,53 • :( ASSESSMENTS: L.I.D. No. Private Dev. No. Subd.Agreement 0 No. Sewer Agreement 0 No. P.T.E. 0 Roll No. DYE TEST. ' Positive 0 Negative 0 N.S.A. 0 Date - Page No. M.H. No. Billing Cycle it Tested By S Comments 4 . m UH CC F Lu V OF /\ NCE — ll U RAL, GE 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. 012-052-65 1. GENERAL INFORMATION Expiration Date: Complete legal description Spenard Heights Lot 19a Location (Site address) 3818 W 63rd Ave, Anchorage, AK 99502 Current property owner(s) Magdalene Irrlgo0 Day phone 907-230-8622 Mailing address 3002 W 32nd Ave, Anchorage, AK 99517 Vanna Deevanna --- - 907-720-4663 Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑E Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ A �V Waiver Fee $ Date of Payment Date of Payment Receipt Number nZ�31� Receipt Number COSA # d S C 2 11 T a '7 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date -rH 6. DSD SIGNATURE • • j`�y'' E System #1 Approved for .S bedrooms / Benjamtry5chiller / �� 9F'• CE 12592 ••`� System #2 Approved for bedrooms_ �sj'•._ 10/6/21 .'•v�`�r Disapproved i�PROFESSION.�w Conditional approval for bedrooms, with the following stipulations: LITY OFA/i ON-�'►Tr � 1I/a Tc /)1))l►IIi%))))) " Original Certificate Date: —2J1� ��� It 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 j Legal Description: Spenard Heights Lot 19a If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ®❑ Well log is filed with Onsite (or attached) Date drilled 8/16/19 Total depth 180.74 ft Cased to 171.98 ft Q Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 10/6/21 Static water level at beginning of test 74 ft. Comments B: —TAA DATA Age of tank(s) _ Tank type/material Measured operating fluid level in septic tank ❑. Stand pipes/fou ndation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) present per record drawing Total measured depth3r—OT";:a._e ft (max) Measured depth to pipe invert from grade ----_.ft (mir ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 012-052-65 Structure served by this system 1 Well production at time of test 3.7 gpm Water storage tank volume NSA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 52.8 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 10/5/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal depth in Elapsed time--- imein Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft © Yes if No ft Neighboring Tank > 100' 2 Yes if No ft Private Sewer/Septic Line > 25' F/ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' F/ Yes if No ft 91 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft [✓ Yes if No ft Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundation _ 0 Yes if No ft Surface Water > 100' F/ Yes if No ft Property Line > 5' ✓1 Yes i ft Wells on Adjacent Lots: Absorption Field > 5' Q✓ Yes if No ft rivate Wells > 100' ✓1 Yes if No ft Water -Main > 10' _ - F71 Yes if No ft Community e _ 00' F✓ Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft If septic tank is under driveway comme w Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > ®✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes i�ltia _ ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft rim Wells > 100' Yes if No ft Water Service Line > 10' M✓ Yes if No ft Community Wells > ✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I 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. COSA Checklist yellow sheet low COW �� • Benjarr chiller CE 12592 6' 10/18/21 �(d�`� PROf ESSIONP� �-�� DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC211627 Subdivision: Spenard Heights Lot 19A 907-343-7904 Fax: 343-7997 -A water sample revealed an arsenic concentration of 52.8 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 muni org