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Home My WebLink AboutLEWIS & CLARK LT 13Onsite File Lewis & Clark Lot 13 #017-074-77 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211177 PID Number: 017-074-77 Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade Name Randall & Lela Walker ABSORPTION FIELD Site Address ❑ Dee p Trench ® Wide Trench ❑ Bed ElMound 8410 Cox Drive, Anchorage ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 4.0 GPD/SF 0.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 0.0 Ft. 0.5 Ft. Lewis &Clark 13 Fill added above original grade Gravel length Township Range Section + � O V 1? Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Z7 i Ft. n/a n/a Ft. To Septic I Absorption I I Holding I Sewer Total absorption area Number of trenches Dist. between trenches II Lift Station From Tank Field Tank Line 120 F121 n/a Ft. Well1 100'+ 1001+ 100'+ 25'+ TANK ElSeptic ElS.T.E.P. El Holding 9Other Manufacturer Capacity Surface Water 100'+I 100'+ 100'+ ORENCO 1500 Gal. Material Number of compartments Lot Line 51+ I 10'+ 51+ I I NA ADVANTEX ffOQE 2 Foundation I 19+ 10'+ 10'+ I LIFT STATION Manufacturer Capacity Remarks FIELD IS MOUNDED ORENCO 250 Gal. M1500-AX20-MODE 3B TANK Alarm location Electrical installed by House PIPE MATERIAL House to tank 3034 Tank to3034 Installer drainfield Brownson Bros., LLC Drainfield 3034 co/MT3034 Inspector PES BENCH MARK (Assumed elevation) 100.0 ft Inspection�5, Location and description dates: 11 ��a� 2d 3'd ll 130 %2l 4'h Ia a South East Corner Of House, Garage FF ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF AC4kk A TH S ® Steven . Panner:_' Septic Systerrv\ CE 8� Q Approved _ DateIZ1312-7- y' Note: this approvales not include well permit requirements.��`��`�`��`� tRpn�in�i�Q� y co Z"c'ZDN O --� >0'�DIZO 0O y E o O C z� z z Ill m�z c/) m;moo z gg z D r O z r m Omp D r Nm � C m —i m C 0(n�OF, 0 n D (n -O —i Z ;O W -< -<X>OMDOm z(n —I c m —I -q Ocn�O — (n Dm (nD� m DF �� m IC DIT -I) >00 < 'S r.. <r..0 r X { m =m mm0 U) m N - UY N ro z n O O x 0 0 x U O I O W O� O O `x O x moDmcp pi zmoKCorn CD W N N x 0 + o m m z a W W O (Jn W . 0 O 0 co w co 00 °' 0 J D 0 / 0� / =morn i O U)D0�10 D / > 00 m mlin=D 0 0/ X O -uD D D m W J / O Cr CJt CD Zcm O cmz0 / � C m —i m C 0(n�OF, 0 n D (n -O —i Z ;O W -< -<X>OMDOm z(n —I c m —I -q Ocn�O — (n Dm (nD� m DF �� m IC DIT -I) >00 < CD X r.. <r..0 �r�r �0rJDDNOm 0z D�JW4A�DN.. 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LEWIS AND CLARK L13 '"' " " ""' P.I.D. NO DRAWN EJC RANDALL & LELA WALKER Steven R. "'""""' = 017-074-77 i', Pannone ; PERMIT NO. SITE: 8410 COX DRIVE 's, r OSP211177 SITE PLAN ANCHORAGE, AK ISHEET 2OF4 D O N Z i cn Z m z cn cn a (o C) o� D z -+ r rn Z r i90 03O (n C � N m * f O G7 4+ O N O f t -i Y� 0 0 Ul >.. off. m O >o _ N OD n <Z m p Z Ln 0 D p m O mX 0 D D 7 Z 20) < Z T rn Z � -1 0 cn wC� Kt NOTES: PANN®NE ENG SVCLLC (C.'. 1088) P.O. BOX 1807 PALER, AK 89645 PHONE (907) 745--8200 FAX (907) 745-8201 """` , .�? 5F, -'4 - = ........ = � .St@ven ceR. a Pannone fes= REVISIONS DATE 01/07/2022 RECORD DRAWINGS LEWIS AND CLARK L13 RANDALL & LELA WALKER SITE: 8410 COX DRIVE SCALE- NTS P.I.D. NO 017-074-77 DRAWN LJC PERMIT NO. OSP211177 DETAIL ANCHORAGE, AK a,P SHEET �.....,, 3OF4 Job No. 21-116 Permit No: OSP21117 Drilling, Inco s P.O. Box 110389® Anchorage, AK 995110 0907-345-4000* GROUNDWATER WELL LOG Well Owner: Brownson Bros., LLC Use of Well: Domestic Site Description: Parcel #017-074-77 Legal Description: Lewis & Clark Subdivision, Lot 13, Block 1, Anchorage, Alaska Well Coordinates: CONSTRUCTION Drill Method: Air rotary Hole Size: 6" Well Depth: 122' Casing Material: A53B steel Casing Size: 6" Wall: .250 Cased to: 96.63' Gravel: cobbly, silty 82 To 86 — _Water gravel: very silty Well Completion: I Open end: X Screen: Liner: Perforated: Method: Screen/Perforation Description: — water fractures from 94'-110' 7-10 gpm -- — __—_-- ___!_ iu3�dfi, id'PLLjI!)Itl4, .2{ . —�_.-- NGWA, Certified baster Groundwgter Co it ntor Grout Notes: 2 Sacks (50#ea) of Bentonite granules WATER QUALI TESTING--- -Colliform — --Eotf 4E?6r► Nitrates q :22 Arsenic Mo -- -- ----- — ------ ---- Well Development`. Air surge Well Disinfected: No I Method: Yield Test at 7-10 GPM for 1 hour(s) with 100% of drawdown (DD) from static level (SWL). Method: Submersible pump Static Water Level (SWL): 33.27' Start Date: 7/23/21 Completion Date: 7/23/21 Test Pump Date: n/a Final Pump Install Date: WELL LOG Depth in feet from top of casing. Details of formations penetrated, size of material, color and miscellaneous details. 0 To 3 Casing stick up 3 TO 82 Gravel: cobbly, silty 82 To 86 — _Water gravel: very silty _86 TO 94 Gravel: medium, silty, dry 94 TO 122 ---Bedrock: — water fractures from 94'-110' 7-10 gpm -- — __—_-- ___!_ iu3�dfi, id'PLLjI!)Itl4, .2{ . —�_.-- NGWA, Certified baster Groundwgter Co it ntor A Gen Contr Lic No 1000 WATER QUALI TESTING--- -Colliform — --Eotf 4E?6r► Nitrates q :22 Arsenic Mo -- -- ----- — ------ ---- fjqAa. , MUNICIPALITY OF ANCHORAGE 907-343-7904 Development Services Department Phone. #n -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number-, 0 Parcel Identification Number, 017 -074-77' Date of Issue: Legal Description Block Lot Property Owner Name & Address: HULTQUIST HOMES, INC. L`L`___W[1S <s CLARK 13 12570 OLD SEWARD HWY STE 204 I r 1ANCHORAGE, AK 99507 Ra a �jje" 08 03 2021 Pulm�p InLtaafllke Depth, aip 0, f C?,�10fhm'g- EPURIMP MIX01kP,1, T)n R 21 e " 75 1, 13mp 0 hi P E ALd %ptesurR"%ItEe Ipt Ph�, �J S 0 �`�� jh\/AARTH,� rrhIL, iso 11�!'T Ma E tu rer! ANCHORAGE WELL 8't PUMP SERVICE up"am"I omplleffon?o Yes 0 No Me-jzfted, olf' PELLETS 0 �C�1 RT'T_e' n t3 0 Punmap COM102, ny-0 CR O'Lyo �L 0 ANCHORAGE VY'ELL cr PUh0W SERVvICE 7640 MING STREET ANCHORAGE, AK 99518B 907-241'3"'-0740 AU'emiff'on.- The pump installer shall provide a pump installation log to On-site vifthin 30 days of pump,installation. Dr. I �b .0 '7"i-91ing Gravel — Agreement to Provide Shared Access.... Document #2021-009395-0 �f-- Existing Gravel Lot 13 334,022 sf 7.868 oc N89'02'50"W 585.97' Tract A Lot 16 -"\ Lot 18 Lot 15 C1 C2 b n Trailbiaze Ci 110' T&E Easement 0' T&E ZEasement CV Cd II cc Lot 14 'ri� Lot 12 2.8' dia. Manhole t� 2.2' dia. Manhole Vault \— Vent c Detail 30' 4" dia. PVC Curve Table Survey Certification: I hereby certify that a Mortgagee's Curve # Length Radius Delta Chord Chord Bearing ci 31-30 50-00 035'51'47- 30.79- S88.05'31"w C2 44-80 380-00 006*45'16* 44.77' S77-21'1 YE Survey Certification: I hereby certify that a Mortgagee's Legal Description: Inspection was performed on the described property. 124 E 7th Avenue Notes: It is the owner's responsibility to determine the As—built Legend: Anchorage, Alaska 99501 existence of any easements, covenants, or restrictions which are not on the recorded subdivision plot. Document "Agreement Well (907) 306-8104 #2021-009395-0 to Provide Shared Access" mail@S4AK.com doesn't specify dimensions for the Shared Access Area. Said Lot 13Septic G AEC#1730472 access area is plotted as shown on Appendix "A" of said s Gravel I ........ I ....... Document. Lewis & Clark Subdivision Overhang F7777-7� F Checked by. CB Scale: 1" = 150' Drawn by. AR Grid: SW2941 Wood Deck Job: 2014-55 Plot: 2020-56 Field Book: 150 Date: 12/27/2021 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://mvrv.muni.org/onsite Permit Number: OSP211177 Work Type: WellSeptic Initial Tax Code Number: 01707477000 Site Legal Address: LEWIS & CLARK LT 13 6:2941 Site Mailing Address: 8410 COX DR, Anchorage Owner: WALKER LELA A & RANDALL Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: � 4X3 ..cuyxg,: I�r;partn�enr 6/9/2021 6/9/2022 334022 Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy Q 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 1 _ / Received By: --~-19 — Date: i Issued By:ML �Date: 3 UNICC4ALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-074-77 Property owner(s) Randall & Lela Walker Mailing address 1630 Dimond Dr Anchorage, AK Site address NHN Messinia St Day phone Legal description (Sub'd., Block & Lot) Lewis & Clark L13 Legal description (Township, Range & Section) Lot Size 334,022 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field X❑ Initial FK Single Family (SF) X❑ (w/wo ADU) Septic Tank ElUpgrade ❑ (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well X❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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: Date of Payment: ..5 2 7 L l Receipt Number:O `79 % 2 G ,r� Permit No. OS 1' lIq 1 r7l Permit App_.;- :- ; ..:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211177, Rebecca Carroll, 06/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211177, Rebecca Carroll, 06/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211177, Rebecca Carroll, 06/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211177, Rebecca Carroll, 06/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211177, Rebecca Carroll, 06/09/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211177, Rebecca Carroll, 06/09/21 MUNICIPALITY OF ANCHORAGE I'll THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this L4 Day of J-IAVV, of 20 A (_, by and between UJO- WakktY � (2AAA�_t Werein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as L"" 4 -x located at (legal description) I,- UL 13 2. Maintenance, Repairs and Alterations. V1Owner is required to read, understand and initial each section) 10 Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement, (rev. 05/18/2018) Page 1 of 3 W4) Owner acknowledges that the Municipality may request records of maintenance and V4repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term, The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: %� aY� (signature) cLh[ui (print name) STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument was acknowlec 20ZI ,by, =e,�G...A(ZLvnCt0,lk NN(,. ss. Date: 0 L' ,.!'t,+� P 0'9-1 before me this 4""day of cJV V 2- MUNICIPA.L,ITY: By: �C � ea- Ly cu (signature) URCCCAQ- act r- o ((- (Print name) (rev. 05/18/2018) L�: Title: Page 3 of 3 'Ros�_ � MUNHUIPALITY OF Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 D Certificate of On -Site Systems Approval Parcel I.D. 01774 77000 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lewis and Clark L13 Location (site address) 8410 Cox Drive Current property owner(s) Randall Walker Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Q 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 $ %5 + $ y 5 Waiver Fee $ Date of Payment I /12/'2_z- Date of Payment Receipt Number 017'31 Cr Receipt Number COSA # _ QS C 2 7 ) 006 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. In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. .6. DSD SIGNATURE Phone (907) 745-8200 Date 2zeG � �: 49.1-I —•_� I System #1 Approved for _� bedrooms '"s eve :tea none' Fc. CE 814,9 Ems` System #2 Approved for bedrooms ti •tv Disapproved � Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: / ZZ The Municipality of Anc �ageDevelopment 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 X_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Lewis and Clark L13 parcel ID: 0177477000 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA HE Well log is filed with Onsite (or attached) Date drilled 7123121 Total depth 122 ft Cased to 96.63 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA new Static water level at beginning of test 33.27 ft Comments B. TANK DATA Age of tank(s) 11111'1202 years Tank type/material Ad,"' DP Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 1122/2' ❑ ALL standpipes present per record drawing Total measured depth from grade :5� 3®ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective On Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced HES Waallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 7 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes R No ❑ Coliform bacteria is Negative Nitrate 9.29 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by PES Date of Sample iss=om, ins C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material HDPE Comments: Adequacy test date new Results [D Pass For 3 Fluid depth prior to test — Water added New depth Elapsed time gal in min bedrooms H Final fluid depth in Absorption rate 450 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) L,�J Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'r-71 Yes if No ft Absorption Field on Lot > 100' F,/] Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' If septic tank is under driveway comment below Community Wells > 200'[]✓ Yes if No ft Animal Containment > 50' C]✓, Yes if No ft ❑✓ Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft s if No ft From Septic/Molding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' ®✓ Yes if No ft P roperty Line > 5 L,�J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Water Main > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' 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' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200'[]✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION pF Akvl o I certify that l have determined through field inspections and review 0V c.• sy l of Municipal records that the above systems are in conformance with : 49 TH MOA COSH guidelines in effect on this date. ... �C Steven R Pannone* CE 8149: COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC221006 Subdivision: Lewis & Clark, Block: , Lot: 13 A water sample revealed a nitrate concentration of 9.29 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval.