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HomeMy WebLinkAboutT12N R4W SEC 10 LT 27 N2TI 21 1 R4W C · 10 Lot 27 N2 #011-161-16 Municipality of Anchorage Development Services Department Building Safety Division '~ ~.~ On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196659 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND]OR WELL INSPECTION REPORT Permit Number: OSP111223 PID Number: 011-161-16 Sharon Kellec Livina Trust Wastewater System: [] New [] Upgrade Address: 8608 Emerald Street ABSORPTION FIELD Phone: Number of Bedrooms: ~ [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: Soil Rating; Total Depth from original g~ade: LEGAL DESCRIPTION 1,2 27 N2 3Ft. 7 Ft 12N 4W 10 0,5 P~. 30 Ft. Well: [] New [] Upgrade e~ve~,~dth:2.5 Ft. Numberoflines:l IDistancebetweenlines:0 FI. Private (E) n~. P~.420 P~= 3034 PFC p,.A+ Home Services 8/3112011 Pl.TANK SEPARATION DISTANCES [] septic [] Holding [] S.T.E.P. [] Other: From~ Septic Absoqotion Lift Holding ~ublic/Private Manufacturer: Capacity: Tank Field Station Tank Sewer Line Anchorage Tank 1000 We, 100.8 105.8 N/A NIA 50' Steel 2 surf.~Water 100+ 100+ N/A N/A ~/ LIFT STATION Lot Line 26.0 29.5 N/A N/A Size: Manufacturer: Foundation 10+ 10+ NIA N/A 'Pur. p orf,*~o~ at: 'Pump offf level ah I High waMr alarm ah Curtain Drain NIA N/A N/A N/A / ~ Pump Make & Model Electrical Inspections performed by: Existing cesspool abandoned per code. BENCH MARK Basement F.F. 100,0 Pt. Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 8/30/2011 2"~ 813112011 Development Services Department Approval Reviewed and approved b /'~ ,~_~'~ Date: ~, ~' W LOT UNDEVELOPED NO WELLS OR SEPTICS ,. ,~ CESSPOOL " '- ~ ABANDONED PER CODE ' "\ ~ "~ ~, ' VERIFIED SIZE AND MArNTAINED I ~ I ~ I / I /~( .... ; ",%~'~ / - RESERVE DRAIN FIELD (P) WELL (E) ~,~ ,,, I A 57.5 ~1.0 SHARON KELLEC UVINC T~UST 8608 EMERALD STRBET ",~<{~¢ Sheet PLAN ANCHORAGE, AK 99502 ' " 20F5 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 5, SCOPE OF WORK: INSTALLED NEW 10009 SEPTIC TANK AND BOIL ABSORPTION SYSTEM. ABANDONED EXISTING CESSPOOL PER CODE. ,4. NO GROUNDWATER WAS OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.0 FEET BELOW EXISTING GRADE. 6.0 iNo §rGundwDter -1E.O ~_ mort toted 75.9 SECTION ~ __ ~ ;4"DRA,NPmE 92.6(NEW) - 92.5' ~1 / 91.9 (E) 81.9 DEEP TRENCH SEE DESIGN 81.9 PROFILE DESIGN PARAMETERS ABBREVIATIONS LEGEND PRIMARY/RESERVE SEPTIC SYSTEM CU COPPER W WATER LINE/ NO. BEDROOM: 5 (450 gpd) DIP DUCTILE IRON PIPE WELL RADIUS TANK SIZE: 10009 TH TEST HOLE PERC RATE = 1-5 MPI FC FOUNDATION CLEAN OUT ~ SS ~ NEW SEPTIC SOIL RATING: 1.2 GPD/SF T¢ TANK CLEAN OUT NO. AR~ RQD: 375 SF C~ CLaN OUT NO. SYS. ~PE: DEEP TRENCH 7.0' E.D. MIN LENGTH: 26.8 LF M~ MONITOR TUBE NO. RJ. RIGID INSU~TION USED: DCO DOUBLE CLaN OUT 30 LF X 2.5' WIDE, 7.0' E.D., DV DIVERTER VALVE 10.0' TD FS FLOW SPLICER TOTAL AR~: 420 SF SAS SOIL ABSORPTION SYSTEM 2/20/~4 RECORD P.O. BOX 100217 ANCHORAGE, AK 99510 ~.~ PHONE (907) 272-8218 FAX (907) 272-8211 ~.~_~ .r~ NTS T12N, R4W, Sec 10, Lot 27 N1/2 ~~~ 011-161-16 SHARON KELLEC LIVING TRUST ~ERMIT 8608 EMERALD STREET OSPl1122~ DETAILS ANCHORAGE, AK 99502 Sheet Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11223 01116116000 Septic 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 Upgrade Permit Effective Dates: August 29, 2011 to August 28, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: T12N R4W SEC 10 Site Legal Address: T12N R4W SEC 10 LT 27 N2 G:2324 Owner/Address: KELLEC SHARON LIVING TRUST 8608 EMERALD STREET ANCHORAGE AK 995025125 Site Mailing Address: 8608 EMERALD ST, Anchorage Lot Size in Sq Ft: 39441 Total Bedrooms: 3 Department This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N 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~91;l.~: ...... J ~ B. CoverejJ,,,~,~, and heated to pre'~l~Eezing. ~ ~ ~pecial Provision.s: The engineer is to verify the size of the cesspool and maintain a 14' separation'"~ the proposed field. Issued By: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On-Site Water & Wastewater Program 'RUSHY ~ Phone:907-343-7904 Fax:907-343-7997 Mayor Dan Sullivan , ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (~lJ- I~./~ !b Property owner(s) !('~L/~,ET'~ ¢ ..N, CC.O.,V' LJi/14/b Mailing address ~OC ,~-~¢--,~P E,/TCE-,~'~-; Site address ~'{~o~ ,~.,-~,'/E-,c_~z.z~ Legar description (Sub'd., Block & Lot) Legal description (Township, Range & Section) ~['~/?.-/f.); Lot Size ~'~;/.://./] Sq. Ft. Number of Bedrooms Day phone THIS APPLICATION IS FOR: ([~] all that apply) Absorption Field ~. Septic Tank ~ Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] 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. (Si~aft/r~of'~ro~¢ owner or authorizeO a~ent) Permit NO, Waiver Fees: 7~ Date of Payment: Receipt Number: Waiver No. 0 £'ll1' 31 G:\Building\On Site~Forms\Client Forms\Permit App_010411.doc (Rev. 1/11) Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 · (90D 343-7904 · Fax (907) 343-7997 http://www.m u ni.o r,q/Onsite Development Services Department On-Site Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW **** Waiveff4:OSPl11231 COSA#:__ Permit: OSPl11223 PID#: 011-161-16 Legal Description: TI2N R4W Sec 10 Lot 27 N2 Engineer: PES Applicant: Sharon Kellec Livinq Trust Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 26.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: Approved by: Namgof Reviewer- Rec#: 001802 Amount: $200,00 Date Paid: 8129111 **** VARIANCE/WAIVER REVIEW **** Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com August 29, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: T12N, R4W, Sec 10, Lot 27 N2 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The lot is served by a private well. The existing undocumented cesspool is in failure and shall be abandoned per code. A new drain field will be installed east of the existing cesspool and will be sized to handle a three-bedroom waste stream. The surrounding developed lots are served by private wells. The wells are located over 100 feet from the proposed soil absorption system. 1. Soils. One test hole was excavated by Pannone Engineering Service in August of2011. See the soil log attached. Ground water was monitored for seven days. No ground water was monitored to a depth of sixteen feet (16') below ground level after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used, using a conventional wastewater treatment system. Soil Absorption System Design. a. See Sheet 2 of the desi~ package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the proposed drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 8 to t 0 percent based on the survey information in the area of the septic system. There is a 35% slope within 35 feet of the reserve system. Page 2 of 2 5. Waiver: I request a drain field to slope waiver. See site section, sheet 4. 6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, ~.....~p~ ~Xa...~:,~......~......~ Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Ibla inii: [ O !}ox !0021~7 A~(;hora~}e, AK }95100217 ~ ysc } 61 as 82 A~,e~S~iiei}6 Ai~{:h{ ? } AK ie{ephene:{907) 2728218 }AK {907}2F28211 LOT UNDEVELOPED NO WELLS OR SEPTICS f 55' W. 86TH ~AVENUE ROW ~-~Q~ · 1OOOg SEPTIC TANK (P) GARAGE (E) WELL (E) NOTES: FOR CONSTRUCTION PLAN PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 T12N, R4W, Sec 10, Lot 27 N1/2 SHARON KELLEC LIVING TRUST 8608 LB STREET &K 99502 CESSPOOL (E) ABANDON PER CODE VER FY SfZE AND MAINTAIN ~//14' MINIMUM FROM EDGE -- / /[- RESERVE DRAIN FIELD (P) // ;OLF×2.~'W×7'ED× - DRAIN r ELD (P) 5OLF x 2.5'W x 7'ED x 10%D ~ ..... ~i~ 8/29/11 ~.' ~:~ 9, ~c~,~ ~"40~ ,~ "~ '. CE 8149 · ~-N~ -~-44 29.8 1 69.4' ~ , WELL (E) \ \ , SPECIAL PROVISIONS TO SPECIFICATIONS 1, ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2, ALL WORK SHALL BE IN ACCORDANCE WITH THE A~ACNED SPECIFICATIONS. 5. SCOPE OF WORK; INSTALL NEW lO00g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. ABANDON EXISTING CESSPOOL PER CODE. 4. NO GROUNDWATER WAS OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16,0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. TH-1 SM/ 7.0 ~.0 j No groundwater monitored = ~ SECTION  ~' MI~ -- _ I I ~ROFIkE DESIGN PARAMETERS A~BREVIATIONS LEGEND PRIMARY/RESERVE SEPTIC SYSTEM CU COPPER ~ W-~ WATER LINE/ NO. BEDROOM: 5 (~50 gpd) DIP DUCTILE IRON PIPE WELk RADIUS TANK SIZE: lO00g TH TEST HOLE PERC RATE = 1-5 MPI FC FOUNDATION CLaN OUT -- SS -- NEW SEPTIC SOIL RATIN6:1.2 OPD/SF T~ TANK CLEAN OUT NO. AREA ROD: 575 SF 0¢ CLEAN OUT NO. SYS. ~PE: DEEP TRENCH 7.0' E.D. MIN LENGTH: 26.8 LF M~ MONITOR TUBE NO. R.I. RIGID iNSU~TION USE: DCO DOUBLE CLEAN OUT 30 LF X 2.5' WIDE, 7.0' E.D., DV DIVERTER VALVE 10.0' TD FS FLOW SPLICER TOTAL AR~: &20 SF SAS SOIL ABSORPTION SYSYEM NOTES: 8/29/11 FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ~.~. ~... ~,~ ;... ~ ,Ts 4w, Lot :7 m/2 .... PJ.D, NO SHARON KELLEC LIVING TRUSTa-~l~". CE 8149 ...~ PERMIT NO. DETAILS ANCHORAGE, AK 99502 i~?go~¢¢~ Sheet SOILS LOG - PERCOLATION TEST TEST HOLE 1 1 OR ORGANICS Pi WAS GROUND WATER SLOPE ~4 -- ENCOUNTERED? N ~ 5 -- IF YES, AT WHAT TH DEPTH? -0-' X 17 -- DEPTH TO WATER AFTER MONITORING? -DRY- 18 DATE: 8124111 2 2:11:45 5.75 ~N ~DR~ 8.33 6.00 3 2:12:30 --- 2.33 --- 4 2:18:23 5,9 MIN {DR~ 8.33 6.00 S 2:19:00 --- 2.33 --- 6 2:25:00 6,0 MIN (DR~ 8.33 6.00 PEROLATIQN ~TE 1.0 (rain/inch) PERC HOLE DIAMETER 6 inches TEST RUN BE~EEN 4 FTAND 5 FT COMMENTS: Test ~o]e excavated by A+ ~OM~ SBAV[CgS. ~ec Aole was pteso~ed. Test ~u~ for o~e hour. bast 3 readings ~eported P~RYORM~D BY: Steve~ ~. P~o~e, P.~. [ C~R?~PY T~AT TH]S T~ST WAS ~RFORM~D ]N ACCORDANCE FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 F*X (007) 272-8211 ~"' SHARON KELLEC LIV}NG TRUST rj ~-. CE 8149 -'~ PERMT NO. SOILS LOG ANCHORAGE, AK 99502 Ii ~L~ Sheet WATER CLOCK READING DATE NET TIME LEVEL NET DROP TIME READING 1 8/17/11 2:06:00 --- 2.33 -- 2 2:11:45 5.75 MIN IDRY) 8.33 6.00 3 2:12:30 ... 2.33 --- 4 2:18:23 5,9 rdlN {DRY) 8.33 6.00 5 2:19:00 ... 2.33 ___ 6 2:25:00 6,0 MIN (DRY} 8.33 6.00 -50,0 26.0 ~ ? O~ 2.5 25~ ~ ~ ~  -- RESERVE F~ELD (P) PRIMARY FIELD (P) NO~S: P~O~ ~G ~C, L~ ~¢. OF AL.'~i, 8/29/11 Sc~e PHONE (907) 272-8218 FAX (907) 272-8211 ~" ~ .' ',,~ 1"=10' I12N, ~4W, Sec 10, ~t 27 S~/2 SHARON KELLEC LIVING TRUST ril,~..f¢ CE 8149 ..cw~"~ =ERMIT NO. 8608 EMERALD STREET ,~.%:. .~ 0SP~1223 SITE SECTION ANCHORAGE, AX 99502 MUMCWAUTY OF ANCHORAGE Development Services Department `r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-161-16 1. GENERAL INFORMATION Complete legal description T12N R4W SEC 10 LOT 27 N2 Expiration Date: J I— 11 - Z Location (site address) 8608 EMERALD STREET, ANCHORAGE, AK 99502 Current property owner(s) SHANE & JANA PERRINS Day phone Mailing address 4400 MANYTELL AVENUE, ANCHORAGE, AK 99516 Real estate agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5.90 Date of Payment Receipt Number COSA # 05C-2-1 11479 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for 8/12/2021 0F A\�li� ,.TH `�-• .....:..r�r ........... /� • •. Curtis Huffman PROFESSIONP�� bedrooms, with the following s`p``�P�\jY�OF(((��r�i�� ,..Q 4,' WATER ANn n r= Original Certificate Date: 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 s Legal Description: T12N R4W SEC 10 LOT 27 N2 Parcel ID: 011-161-16 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled CIRCA 1968 Well disinfected for coliform test? ❑ Yes ® Nc Total depth *109+ ft ® Coliform bacteria is Negative Cased to 60+ ft (PER MOA RECORDS) Nitrate mg/L ® Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic 25.3 ug/L ❑ Arsenic less than MRL (ND) ® Wires are properly protected WE Casing height (above ground) 24 in. Collected by .-- Date of flow test for COSA 8/5/2021 Static water level at beginning of test 99 ft. Date of Sample 8/5/2021 Well production at time of test 4.7+ gpm Comments *PER ACOUSTIC READINGS AT TIME OF TESTING. B. TANK DATA Age of tank(s) 10 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 8/5/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/31/2011 ® ALL standpipes present per record drawing Total measured depth from grade 14.1 ft (max) Measured depth to pipe invert from grade 7.3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.8' INTO THE 7' ED C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 8/5/2021 Results N Pass For 3 bedrooms Fluid depth prior to test 2 in Water added 450 gal New depth 11 in Elapsed time 1300 min ® Code -required soil cover over field Final fluid depth 1 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: F E. SEPARATION DISTANCES — PER OBSERVATIONS (8/5/21) & MOA RECORD DOCS From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' Water Main > 10' Water Service Line > 10' ® Yes if No ft ® Yes if No ft Community Wells > 200' ft ft ft ft 111 ® Yes if No ft ❑ Yes if No *85 ft ® 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' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER ISSUED. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. AIW TH • • Curtis Huffman • • •: R �����.• CE 128991 • ���� ROFESSiONA��.,� Municipality of Anchorage =4 q Development Services Department :z Building Safety 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 Arsenic Advisory Certificate of On -Site Systems Approval # OSC211479 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply at T12N R4W Sec 10 Lot 27 N2. This inspection revealed an arsenic concentration of 25.3 micrograms per liter (ug/L) for the property's well water sample. 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.or,g/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval.