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HomeMy WebLinkAboutARNETT BLK 1 LT 2A rnett
Block i
Lot 2
#015-471-22
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw Sl.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.cienchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSP111239 PID Number: 015-472-20
Name'.
April Anne Arnett
Wastewater System: ❑✓ New ❑ Upgrade
Address
3504 Heartwood Place Anchorage, AK 99503
ABSORPTION FIELD
Phone: Numberof Bedrooms:
Four
V Deep Trench 11 Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grams:
.6 GPDVp'
11.7-12.1
Block: l Lot, Subdivision :
Arnett
Depth to pipe bottom from original grade:
Gravel depth beneaN pipe:
3.7-4.1 FL
$ Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
0-1 Ft.
63 Ft.
Well: ZNew El Upgrade
Gravelvidth:
Number of lines:
Distance between lines:
3 Ft
1
Ft
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Private
106 Ft
74 FL
1,008 Ft'
ASTM D3034 PVC
Driller
Date Drilled
Static Water Level:
Installer
Data Installed:
Alpine Drilling
9/27/11
33 Ft.
Red Dog Excavating
9/7/11
YieldPump
Set at
Casing Height Above Ground,
6 GPM
Ft.2
Ft_
TANK
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublic/Private
Manufacturer.
Capacity:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1,250 Gal,
wet
>100'
>100,
N/A
N/A
>25'
Material:
Steel
Numberof Compartments:
Two (2)
Surtace Water
>100•
>100'
N/A
N/A
LIFT STATION
Size:
Manufacturer
Lot Line
>5.
>10'
N/A
NIA
Gal.
Foundation
>5'
>10'
N/A
N/A
"Pumper"level at:
in.
'Pump off' level at
in.
High water alarm at'
in.
Curtain Drain
None
Noted
Pump Make & Model
Electrical Inspectrons performed by:
Remarks:
BENCH MARK
Location and Description:
Garage Slab.
Assumed Elevation:
100.00 Ft.
Inspections performed by: A. Harala Dates: 1a' 9/7/11
�.® ..,q..' u�+
Intl 9/7/11
0 e •S °�
s (owl
Development Services Department Approval
•go 4918*
Conditional Approval Date:
.
p
fr.�1�•l��t�F�
'
•.NMlH1NlON..........•
:MICHAEL &ANDERSON
-..
E. 81
!� SEP•., � �-.if ,•�a�e
�//��
Reviewed and approved by: 0 Date:
Z
N 00'04'20"E 164.93' Q
(D
10' UTIL. ESMT.
_______________________
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP111239
93.55
N
1,250 Gallon
Septic Tank
98.4
N UU
U)
Page 3 of 3
PID No. 015-471-22
8126/11
49th
PROFILE AS -BUILT ;�
MICHAELE. CEQ 438RSON
No Scale
93.1
u
Alp, -.,e Drilling & Enterprises
Well Log
Permit Number: #SWOSP111239 Date of Issue: 9-2-11 Parcel Identification Number: 0154722000
Date Started: 9-27-11 Date Completed: 9-27-11 Is well located at approved permit location? x Yes ❑ No
Legal Description: Arnett Block .I Lot 2
Property Owner Name & Address: Arnett April Anne
3504 Heartwood Place
Anchors e, Alaska 99503
Borehole Data: Depth (ft) Method of Drilling x air rotary ❑ cable tool
Soil Type, Thickness & Water Strata From To
Pump: Intake Depth _ feet
Pump size _ hp Brand Name
IIWell Disinfected Upon Completion? x Yes ❑ No II
Method of Disinfection: chlorine tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
a
r
l�
Casing type: steel
Stick-up
0
2
Wall Thickness:.250 inches
silt
2
5
Diameter: 6 inches Depth: 74 feet
gravelly cobbly silt
5
11
Liner Type:
Diameter: —inches Depth: feet
silty gravel
11
14
_
Casing stickup above ground: 2 feet
sandy silt
14
33
Static water level (from ground level): 33 feet
silt
33
50
Pumping level: 106 feet after
silty sandy gravel H2O
50
54
4 hours pumping 6 gpm
sandy gravelly silt
54
64
Recovery Rate: 6 gpm
Method of Testing:ir li
a
—�
silty water sand & gravel
64
66
Well Intake Opening Type:
gravelly silt
66
73
❑ Open End ❑ Open Hole
bedrock
73
106
❑ Screened Start _ feet Stopped _ feet
x Perforations Start 51 feet Stopped 54 feet
Grout Type: bentonite Volume: 1
Pump: Intake Depth _ feet
Pump size _ hp Brand Name
IIWell Disinfected Upon Completion? x Yes ❑ No II
Method of Disinfection: chlorine tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
a
r
l�
Development Services Department
Building Safety Division
On -Site Water & Wastewater program *AE
4700 Elmore Road
P.O. Box 196650
Mark Begich Anchorage, AK 99507
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW OSP111239 Date of Issue• 9/2/11
Parcel Identification Number: 0154722000
Legal Description
Arnett Block 1, Lot 2
Property Owner Name & Address:
April Anne Arnett
3504 Heartwood PI.
Anchorage, AK 99503
Pump Installation Date: 12 21/11
Pump Intake Depth Below Top of Well Casing: 94" feet
Pump Manufacturer's Name: Grundtos
Pump Model: 1-SOE-07-200
Pump Size 314 hp
Pitless Adapter Burial Depth: NA feet
Pitless Adapter Manufacturer's Name: NA
Pitless Adapter Installer: Red Dog Masonry
Well Disinfected Upon Completion? 0 Yes ❑ No
Method of Disinfection: chlorine tablets
Comments:
Pump Installer Name: John Netherton
Aarow Pump & Well Service, LLC
P.O. Box 110496, Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
On -Site Water & Wastewater System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP111239
Tax Code Number: 01547122000
Work Type: WellSeptic Initial
Permit Effective Dates: September 02, 2011 to September 01, 2012
Design Engineer: ANDERSON ENGINEERING
Subdivision: ARNETT
Site Legal Address: ARNETT BLK 1 LT 2 G:2640
Owner/Address: ARNETT APRIL ANNE
3504 HEARTWOOD PL ANCHORAGE AK 995033902
Site Mailing Address: 11020 HIDEAWAY TRL, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
49683
4
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: •; 3 iy , Date:
/ 9
Issued By:� (if/ �_�y Date:
y
ON-SITE SEWER/WELL PERMIT APPLICATION RL, %�
FOR A SINGLE FAMILY DWELLING �'
Parcel I.D. OP5 - `f 7i ` Z L
Property owner(s) cii A epi Day phone
Mailing address 3-:>_04 dc-Awr& o o o P6 i -c 4jL-- cmgo3
Site address 110 7 -re- t, Av (:,,ot26'L,/4 c A-%- -? i s7 i I.
Legal description (Sub'd., Block & Lot) AIA&
Legal description (Township, Range & Section)
Lot Size q1 � f' 3 Sq. Ft. Number of Bedrooms 1
THIS APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
a
Holding Tank
❑
Privy
❑
Private Well
Water Storage
❑
THIS APPLICATION IS AN:
Initial 9
Upgrade ❑
Renewal ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
1
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GABuilding\On Site\Forms\Client Forms\Permit App_01 041 1.doc (Rev. 1/11)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
August 27, 2011
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2, Block 1, Arnett Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 2, Block 1, Arnett Subdivision intends to construct a new four-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to accommodate the home. The attached
Site Plan and backup documentation identify the location and configuration of the
proposed well and septic system along with the alternate site. Also identified on the
plans are the existing wells and septic systems on surrounding lots. No conflicts exist
between the proposed well and septic system and wells or septic systems on adjacent
lots. Drainage arrows are shown on the site plan showing the grade and direction of
flow on the lot. The drainage pattern will not be changed as a result of this project.
The test holes placed on the lot in the area of the absorption trench and alternate site
indicates silty sand (SM). The percolation rate of the soil was determined to be
between 12 and 17 minutes per inch. No groundwater was found during the placement
of the test hole and none was noted during the monitoring period. An application rate of
.6 gallons per day per square foot was used in the design of the absorption system.
We are proposing to place a new 1,250 -gallon septic tank and a 63' long by 3' wide by
8' effective depth absorption trench to treat and dispose of the effluent generated in the
house. The elevation of the distribution line in the absorption trenches will be 4' below
the surface and the total depth will be 12'. A minimum of 3' of fill or 2" of insulation and
2' of fill will be placed over the absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the northeast at
a 10% grade. The new trench will be constructed parallel with the contours of the slope
as much as possible in conformance with Municipal requirements. The new septic
system will be constructed a minimum of 100' from all wells and any surface water and
Lot 2, Block 1, Arnett Subdivision
August 27, 2011
Page Two
10' the proposed and existing water services in the area.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
2
4�
)63 Existing Well
I
I
C:1
-744
..c��P�E OF /1< q •���i
49th
4
.MICHAEL E. ANDERSON : 4
P • NO. CE-4381AN
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/
N89'56'10"E 301.20
Proposed Well
1
1 �1\ Existing Well
VA\9
1 �
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,
�II Existing Well
AREA MAP
SCALE 1" = 100'
no
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HIDEAWAY TRAIL — —
umrxsox sro�xssww
LOT 2, BLOCK 1, ARNETT SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 12-17 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .6 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1,000 SF Absorption Area
1,000 SF/16 SF/LF = 62.5 LF Trench Length
THEREFORE: Construct A 63' Long x 3' Wide x 8' Effective Depth Absorption Trench at the
Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth
to be 12' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
Drainfield Rock
3'
L �
r
TYPICAL DEEP TRENCH SECTION +
(NO SCALE) �R�+�E
...............
��.,
.41C
NOTE: Grade Area Over Trench to Drain Away. ,
Minimum 6' Separation From Bedrock. 49th
■.....:..................,
Minimum 4' Separation From Groundwater. i..
.............
Minimum 100' Separation From Wells in the Area. s 0 MICHAELE ANDERSON
Minimum 100' Separation From Surface Water or Streams: A� NO. CE4381
••♦♦� FESS\tl�i�:=ice
Natural
Backfill
3'6"
Geotextile
Fabric
6"
O
4" Perforated
PVC (Holes Down)
Drainfield Rock
3'
L �
r
TYPICAL DEEP TRENCH SECTION +
(NO SCALE) �R�+�E
...............
��.,
.41C
NOTE: Grade Area Over Trench to Drain Away. ,
Minimum 6' Separation From Bedrock. 49th
■.....:..................,
Minimum 4' Separation From Groundwater. i..
.............
Minimum 100' Separation From Wells in the Area. s 0 MICHAELE ANDERSON
Minimum 100' Separation From Surface Water or Streams: A� NO. CE4381
••♦♦� FESS\tl�i�:=ice
Municipality of Anchorage
Development Services Department
Building Safety Division
0 On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorage.ak.us
(907) 343-7904
Soils Log - Percolation Test
Performed For: Red Dog Masonry
Legal Description: Arnett Subdivision, Block 2, Lot 1 Town:
Slope
�,/
f It
'r.5 1=
fGXZ- �6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
zl
0
2
COMMENTS TH # 1
# 4918 •Y�
Y
MKHAK
�,•,�•Y.' ....UIIY YON
•
L ANDSWN � Or0
CE , 4381
AW
tre•••i s•:•'•t �014*
Date Performed: ?� ZO 11
WAS
WAS GROUND WATER
ENCOUNTERED? No
S
IF YES, AT WHAT DEPTH? xxx L
Depth to Water After O
P
Monitoring? No Water E
Date: R' ( (0 1I
Nan.- 9�//// Y)tr P'1E/}
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
Aug 24, '11
g s9
� 1
®M+►VS
f "
1. 6 U
y
rijOKI Ak,,
it'd
PERCOLATION RATE 1 -V (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -6.0 FT AND -6.5 FT —+—
Perc Cavity was pre-soaked on Aug 23, 2011
PERFORMED BY: A. Harala i CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
L_
i
Municipality of Anchorage •. �� �R' •)�©
Development Services Department �� ® ���
Building Safety Division ; 4918 �
On -Site Water and Wastewater Program ✓ • • N
* 4700 Elmore Road g / • , •• •••••• F
P.O. Box 196650 Anchorage, AK 99507 • ,• •�S
www.ci.anchorage.ak.us r^ ; a ANDERSON �•� rr
(907) 343-7904 i� CE • 4381 �� rr
AW
Soils Log - Percolation Test ♦�,e p•FES
: �• r����`r,`
Performed For: Red Dog Masonry Date Performed: Aug73%2"%%
Legal Description: Arnett Subdivision, Block 2, Lot 1 Township, Ranqe, Section: T12N,R3W,SEC 24
Slope
N
i
De t
1-�
2-I�' I �/
3 0 �
WAS GROUND WATER
ENCOUNTERED? No
S
IF YES, AT WHAT DEPTH? XXX L
Depth to Water After O
P
Monitoring? No Water E
Date: 8/26/11
A;C,lL q/l/I/ dor n��f
Reading
Date
7 M
Net Time
Depth to Water
Net
8-
Aug 24,'11
��:1'�
9-
�j•yj r
-Drop
/
10-
11-
,
5,19 "
12-
13-
1----
14-
15-
16-
11, I
30 M►�l5
��
��
17-
18-
19-
r'
20-
t'
WAS GROUND WATER
ENCOUNTERED? No
S
IF YES, AT WHAT DEPTH? XXX L
Depth to Water After O
P
Monitoring? No Water E
Date: 8/26/11
A;C,lL q/l/I/ dor n��f
Reading
Date
Gross Time
Net Time
Depth to Water
Net
Aug 24,'11
��:1'�
�j•yj r
-Drop
/
SVA+
15a MtV4
5,19 "
I.�� �►
1----
1
11, I
30 M►�l5
��
��
t'
I', Iv''
PERCOLATION RATE_ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN - 5.5 FT AND - 6.0 FT
COMMENTS TH # 2 Perc Cavity was pre-soaked on Auq 23. 2011
PERFORMED BY: A. Harala I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
a 4700 Bragaw Street
e P.O. Box 196650
R
Anchorage, AK 99519 6650 www.muni.org/onsite
(907) 343-7904
ZD
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. b 15g71 a.O COSA # OSC I a 1 ON
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 2, Block 1, Arnett subdivision
Location (site address) 11020 Hideaway Trail Anchorage, AK 99503
Current Property owner(s) April Anne Arnett
Mailing address
Lending agency
Mailing address
Real Estate Agent
3504 Heartwood Place Anchorage, AK 99503
Mailing Address
dlnless otherwise 4pquested, COSA will be held by DSO for pickup.
2. -NUMBER OF BEDROOMS: Four (4)
Day phone
Day phone
Day phone
3. TYPE ORWATERSUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well.✓❑
Individual On-site
✓❑
Individual Water'..Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 fro tk9•fviunicipality of Anchorage files and from my investigation and inspection, the on-site water
supply 0 tater disposal system is(are) in compliance with all applicable Municipal and State codes,
orcregulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 1/4
/2012
®� OF
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5. DSD SIGNATURE 4I�c'i CSE` •( ...���aa
/ Approved for bedrooms. +4 AR `�5H-laO dw
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
rnacnrnencs:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory_
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By; , �� Original Certificate Date: 1 i' 12
(Rev. 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
\_ on -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lott Arnett subdivision 0 1, � k -'
Parcel ID: 015-472-20
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Well Log (YIN) Y
Date completed 9/27/11 Sanitary seal (YIN) Y
Wires properly protected (YIN) Y
Total depth 106 ft. Cased to 74 ft.
Casing height (above ground) >18 in.
FROM WELL LOG
AT INSPECTION
Date of test 9/27/11
Static water level 33
Well production 6 9-p m
g.p.m.
WATER SAMPLE RESULTS:
---
Coliform 0 colonies1100mL Nitrate � mg/L
Arsenic: 2U mg/I Date of sample: 112/12
Collected by: A. Harala
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SeptiriSteei
Date installed 917/11
Tank size 1,250 gal. Number of Compartments Two
Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN)
N High water alarm (YIN) N
Date of pumping New construction Pumper
C. ABSORPTION FIELD DATA
Date installed 917111 Soil rating (g.p.d./ftz or ftzlbdrm).5 GPD15F System type Deep Trench
Length 63 ft. Width 3
ft. Gravel below pipe 8 ft.
Total depth 12 ft. Eff. absorption area 1,006 ftz Monitoring tube Y Depression over field N
Date of adequacy test New const. Results (Pass/Fail)
For _ bedrooms
Fluid depth in absorption field before test in. Water
added_ gal. New depth in.
Elapsed Time: min. Final fluid depth in.
Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
If yes, give date
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
"Pump on' level at _ in. "Pump off' level at_
in. High water alarm level at in.
Cycles tested
Meets alarm & circuit requirements?
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot > 100'
acent lots >100'
adjacent On
J
Absorption field on lot >100'
On adjacent lots >100'
N/A
Public sewer manhole/cleanout N/A
Public sewer main
Sewer /septic service line >25'
Holding tank N/A
Animal containment areas >50'
Manure/animal excrete storage areas >1004
SEPARATION DISTANCES FROM SEPTIC/HOLDING
TANK ON LOT TO:
>5' Property line >5_
Building foundation P Y
Absorption field >5'
Water main N/A Water service line
>10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation
>10' Water main >19
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS:
Or
r,cF e .:4��4Q•
G. ENGINEER'S CERTIFICATION"LJ,• d
0 49� * v6
l certify that / have determined through field inspections and 00.:.,•..ry »y •-•• � � '®
review of Municipal records that the above systems are in i7 F .........
conformance with MOA COSA guidelines in effect on this date. / zo .�r,AtcHnsl-F.
" • "GE• 4381 ;
Engineer's Printed Name Michael E. Anderson, P.E. ,Isli,� _y_/I•�•.•�a�'s
Date
COSA Fee $ I�
Date of Payment C �12—
Receipt Number U— /
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 121004
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 2 of
Arnett subdivision. This inspection revealed a nitrate concentration of 6.81
milligrams per liter (mg/L) was reported for the property's well water
sample. 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. 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.
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SGS Ret.#
1120016001
Client Name
Anderson Engineering
Project Name/#
Water Samples
Client Sample ID
Arnett Subd Lot 2 Block 1
Matrix
Drinking Water
Sample Remarks:
Parameter Results LOQ
Metals by ICP/MS
01/06/2012 13:13
Collected Date/Time
Arsenic
251
* 5.00
Waters Department
Stephen C. Ede
B
Total Nitrate/Nitrite•N
6.81
0.100
Microbiology Laboratory
E. Coli
Negative
1
Total Coliform
Negative
1
Printed Date/Time
01/06/2012 13:13
Collected Date/Time
01/02/2012 14:15
Received Date/Time
01/03/2012 12:00
Technical Director
Stephen C. Ede
Allowable Prep Analysis I
Units Method Container ID Limits Date Date Init
ug/L
EP200.8
C
(Q0)
01/03/12 01/05/12
SCL
mg/L
SM20 4500NO3-F
B
(<10)
01/03/12
CMA
100mL SM20 9223B A
100mL SM20 9223B A
01/03/12 MEM
01/03/12 MEM
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