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HELLUVA LT 49B
Onsite File Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161059 PID Number: 051-104-24 Dwelling: ❑N Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: # New ❑ Upgrade Name: Troy Davis Homes ABSORPTION FIELD ❑ Deep Trench X Shallow Trench ❑ Bed ❑ Mound Address 1689 Knik Goose Bay Rd. #400 Wasilla, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 357-9394 4 1.0 GPD/SF 7.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot 49 Fill added above original grade 0-1 Ft. Gravel length 45 Ft. Township Range Section T1 5N 1 W 9 Gravel width 5 Ft. Beds: Number of Lines Distance between lines FL SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 450 Ft? 1 Ft. Well >100' >100' >100' >75' >25' TANK ❑JI Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,000 Gal. Surface Water >100' >100' >100' NA Material Steel Number of compartments Two Lot Line >5'10' >5' NA NA Foundation >5. >10' >5' NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D2665 TanktoD drainfield 3034 Installer Northern Excavation Drainfield F810 CO/MT Inspector MEA BENCH MARK (Assumed elevation) 100.0 ft Inspection1" 5/3/16 5/3/16 Location and description dates: 2- 3rtl 4 t Garage Slab. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL %MID %4 ®oaW OF AC Conditional Approval: Date .440 .... ...... .. }.. ......................10 AAlCHAR E. ANDERSON p CE - 4381 : w Approve �' Date'I�Z'� t,lip�OpROFESSI�®:'�� 9®s®c0 Inspection Report_9-1-12.doc Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP161059 V U � 95.2 Finished Grade Original Grounc Geotextile Fabric Drainfield Rock N S H 98.7 Page 3 of 3 PID No. 051-104-24 91.2—/ II 91.2—/ — 82.7 No Groundwater 4-15-i6 PROFILE AS -BUILT No Scale 95.2 sM N N M Original & inishad Grade 2' Insulation 1,000 Gallon Septic Tank .45 a ¢ Finished Grade Original Grounc Geotextile Fabric Drainfield Rock N S H 98.7 Page 3 of 3 PID No. 051-104-24 91.2—/ II 91.2—/ — 82.7 No Groundwater 4-15-i6 PROFILE AS -BUILT No Scale 95.2 Permit Number: OSPI61059 Municipalityat nc orage DEVEOPMENT SERVICES DEPARTMENT Page 2 of 3 4700 South Bragaw Street Anchorage, AK. 99519-6655 — 343-7904 PID No. 051-104-24 Lot 2 m Lot 44—A Lot 44—B Lot 1 r S 89'59'54"E 30.48' r c D TE Existing Septic System (n Decommissioned in Accordance with Municipal Code. Lot 48A m 52 S1W11A73.2' CdBLM Mt O ¢ m C5 108,882 s.f. M2 ' 's Z L4 � Ln Lot 50 0 ir1 Three Bedroom � jv Home c, N u1 11 � Foe Sn S2 Well 5 \CCl/ VI q� Lot 48B aIt. Site ' "' ?�•�P = �' '• 1 i` 49th•• GENA� ` M7 - Monitor Tube .....: ....... ..... ........... ....... ./ 51 -Septic Tank Vent � / """"""""""';- �'/ MICHAEL E. ANDERSON C FCO - Foundation Clean Out TH - Test Hole C4 Clean Out •• I NO. CE -4381 •v'J,, - 2CO - Double Clean Out p�•.�, �•� V�'� •�. 'Cf)•(O�r �4\: �(���� ESSI N 90'00'00"W 330.24' PLAN AS BUILT AURORA BOREALIS SCALE I' = 60' MAY -23-2016 08:09R FROM: 70:19073579395 P.1/2 Development Services Department 0 Building Safety Division On -Site Water 6 Wastewater Progrom m 4700 Elmore Road < P.O. Box 196650 Anchorage, AK 99507 s • r Mark Begich www mwl am/onsita Mayor (907) 343-7904 Well Log Permit Number.OSPI61059 Date of Issue: May 02, 2016 Date Started -QS -12-16 Date Completed: 05 16-16 Is well located at approved permit location? Yes U No Legal Description: 115N RSW SEC 9LT 49 G:1358 Site:20815 Helluva St Chugiak Property Owner Name & Address: Troy Davis Homes, Inc. uuuoe Day nu n-..,.. { 99654 Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To stickup 0 2 overburden 2 4 silt & gravel` 4 10 wet sand & gravel,boulder at 20' 10 25 clay 25 30 moist gravel w/ clay 30 60 sand & gravel w/ little H2O 60 65 dry silt & gravel _ 65 100 Nitrates FC, nM L Ptrsenic _IN \ Water Sample Results: Arsenic: _ ug/L Nitrates: _ mg/L Total Coliform Bacteria: _ colonies/100mL Other Bacteria: _ col/100ml, Method of Drilling Ox air rotary ❑ cable tool Casing type: steel Wail Thickness: .250 inches Diameter: 6 inches Depth: 100 feet Liner Type: PVC Diameter: 4.5 inches Depth: 40_to 100' Casing stickup above ground: 2 feet Static water level (from ground level): _ 13 fee[ Pumping level: feet after hours pumping — gpm Recovery Rate: 2 gpm Method of Testing: airlift n Open End U Open Hole ❑ Screened Start _ feet Stopped _ feet n Perforations Start 60 feet Stopped 65 feet Pump: Intake Depth_ feet Pump size _ hp Brand Name Well Disinfected Upon Completion .9 n Yes (_ No Method of Disinfectlonlchlorine tablets Comments: Well Driller: Hefty Drilling, Inc, 3540 Akula Dr. Anchorage, AK 99516 Attention: The well driller shall provide a well log to DSD within 30 days of completion. OCT -20-2016 09:27A FROM: RECEIVED 10/20/2016 10:24AM TO:19073579395 Development Services Department Building Safety Division ° On -Site Water & Wastewater Program 'e 4700 Elmore Road P.O. Box 196650 Mark Begkh Anchorage, AK 99507 Mayor www mum.ora/onsste (907)343-7904 Pump Installation Log �n1 Well Drilling Permit Number'9W %(7/05 el Date of Issue: Parcel Identification Number: P.1/2 Legal Description�5+, / c- e PropertI LT yper Name & Address: Krtt$( li7 tA�9tra G C Pump Installation Date: ail I LO Pump Intake Depth Below Top of Well Casing: "lS feet Pump Manufacturer's Name: WeAcykro' Pump Model: wv oA f5ac,3 Pump Size J�PMhp Y2- Pitiless ZPitless Adapter Burial Depth: I I feet Pitless Adapter Manufacturer's Name: UC Pitless Adapter Installer. LtC K Well Disinfected Upon Cro`m1_pletion?R] Yes © No Method of Disinfection:br; Comments: Pump Installer Name: S%"n Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Lot 44—A Lot 44—B II I I 10.7'x12.6' PORCH 1.3'x8.3' CANT Lot 1 Lot 50 --I- "Z' I � I � I � HOUSE DETAIL SCALE: 1"=30' 1 STORY rf--moi-8.1'x10.3' DECK RESIDENCE /( 2.0'x30.2' CANT PLOT PLAN AS BUILT X SCALE —!L= 100' GRID NW 1355 Project No. to—VJJ/a.7 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone o0�4 O (907) 522-4625 Fax OF A Z 4 Professional Land Surveyors kenOlongsurvey.com eo ......... 9 p jonathanOlangsurvey.com S I hereby certify that I have surveyed the following described property: 0* LI --- %A BLM LOT 49, SECTION 9, T1514. R1W, S.M., ALASKA Anchorage Recording District, Alaska, and that the Improvements situated thereon are �•' within the property lines and do not encroach onto the property adjacent thereto, that •• no Improvements an the property lying adjacent thereto encroach on the surveyed 0'p : kKEMJETH• LA premises and that there are no roadways, transmission tines or other visible easements on said property except as Indicated hereon. 00 ..I,S-5202.•' S�aG Dated this the 25w Day of at Anchorage, Alaska pp pRa ��p 0 N, F£SSIONA� v It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Irn I r Lot 2 I< ID I� Im Lot 48A I z o 100 0 I o C4 N Ut I Lot 48B — J I I Lot 44—A Lot 44—B II I I 10.7'x12.6' PORCH 1.3'x8.3' CANT Lot 1 Lot 50 --I- "Z' I � I � I � HOUSE DETAIL SCALE: 1"=30' 1 STORY rf--moi-8.1'x10.3' DECK RESIDENCE /( 2.0'x30.2' CANT PLOT PLAN AS BUILT X SCALE —!L= 100' GRID NW 1355 Project No. to—VJJ/a.7 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone o0�4 O (907) 522-4625 Fax OF A Z 4 Professional Land Surveyors kenOlongsurvey.com eo ......... 9 p jonathanOlangsurvey.com S I hereby certify that I have surveyed the following described property: 0* LI --- %A BLM LOT 49, SECTION 9, T1514. R1W, S.M., ALASKA Anchorage Recording District, Alaska, and that the Improvements situated thereon are �•' within the property lines and do not encroach onto the property adjacent thereto, that •• no Improvements an the property lying adjacent thereto encroach on the surveyed 0'p : kKEMJETH• LA premises and that there are no roadways, transmission tines or other visible easements on said property except as Indicated hereon. 00 ..I,S-5202.•' S�aG Dated this the 25w Day of at Anchorage, Alaska pp pRa ��p 0 N, F£SSIONA� v It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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: OSP161059 Tax Code Number: 05110424000 Work Type: Welseptic Initial Permit Effective Dates: May 02, 2016 to May 02, 2017 Design Engineer: ANDERSON ENGINEERING Subdivision: T15N R1W SEC 9 Site Legal Address: T15N R1 W SEC 9 LT 49 G:1358 Owner/Address: TROY DAVIS HOMES INC 1689 KNIK GOOSE BAY ROAD #400 WASILLA AK 996540000 Site Mailing Address: 20815 HELLUVA ST, Chugiak This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank 5 3 bl� d3UK Lot Size in Sq Ft: 75794 Total Bedrooms: 3 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: Issued By: =J/ MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program e., Phone: 907 Fax: 907 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-104-24 Property owner(s) Troy Davis Homes Day phone 310-2501 Mailing address 1689 Knik Goose Bay Road #400 Wasilla, AK 99654 Site address 20811 Helluva Street Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 5N R1 W Section 9 Lot 49 Lot Size 75,794 Sq. Ft. Number of Bedrooms Three APPLICATION IS FOR: (® all that apply) Absorption Field ❑X Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑X Water Storage ❑ APPLICATION IS AN: Initial ❑X Upgrade Renewal ❑ 7 MAR 31 2016 TYPE OF DWELLING: Single Family (SF) ❑X (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. �� property owner or Permit/Rush Fees: +215 = 79Li Waiver Fees: Date of Payment: ! / ('0 Date of Payment: Receipt Number: or)ob2-G) Receipt Number: Permit No. OS PI to 165q Waiver No. Permit App_::-;L,:c. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX March 28, 2016 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: BLM Lot 49, Section 9, T1 5N, R1 W Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The owner of BLM Lot 49 intends to construct a new three-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. No existing wells are closer than 100' from the proposed septic system. Drainage arrows are shown on the site plan showing the grade and direction of flow on the lot. No slopes in the area of the proposed septic system exceed 25%. The drainage pattern will not be changed as a result of this project. A shallow (approximately 20') well point was found on the lot which is no longer in service. It will be decommissioned in accordance with Municipal Code and a decommissioning report will be filed. In addition, a single cleanout was noted near one of the old structures on the lot. This area will be investigated to determine the extent of the possible septic system. The entire system will be decommissioned in accordance with Municipal Code. The test holes placed on the tract in the area of the absorption trench and alternate site indicated poorly graded sand with gravel (SP) material. The percolation rate of the soil was determined to be less than 1 minute per inch. The gradation completed on the material indicated it is similar to the sand filter material required by the City. We therefore request this in situ material be allowed to act as a sand filter. No groundwater was found during the placement of the test holes and none was noted during the monitoring period. An application rate of 1.0 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,000 -gallon septic tank and a 45' long by 5' wide by 4' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in BLM Lot 49, Section 9, TI 5N, R1 W March 28, 2016 Page Two the absorption trench will be 3' below the surface and the total depth will be 7'. 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 absorption trench slopes from the southeast to the northwest at shallow grades. The new bed 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 10' from the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: 1. 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, p Q Michael E. Anderson, P.E. Attachments -0 D Z T 10.00 N N L6'6Z£ Np.- gi oo ~ O r 0 D '1S `dAnll3 H �;u cn F71 O (f) m <� Z C co G O N co o m ®voM- Z '0-m n' 00 Ow (o O W N AA vi n'1 �O —h O Z to 3„ L L,Z0.00 S -m Z .R.� cpmn �no� r Fnoao m £ S Q mo .o ag N f oma OT F� 3.. E o m i 3 O 9 =Sm 38 oV / i N L6'6Z£ Np.- gi oo ~ O r 0 D '1S `dAnll3 H �;u cn F71 O (f) m <� Z C co G O N co o m ®voM- Z '0-m n' 00 Ow (o O W N AA vi n'1 �O —h O Z to 3„ L L,Z0.00 S -m Z .R.� Z r m £ S Q m, Mp foo N Q OT p o o � Mm r- 0 co BLM LOT 47 TI 5N R1 W SECTION 9 DESIGN FACTORS: 3 Bedroom Home Perc. Rate: <1 Min./Inch Application Rate: 1.0 GPD/SF (Sand Filter) SYSTEM REQUIREMENTS: 5' Wide Trench System 1,000 Gallon Septic Tank 4' Effective Depth 3 Bedrooms X 150 GPD/Bedroom = 450 Gallons Per Day (Design Flow) 450 GPD/1.0 GPD/5SF/LF*.5 LF (Red. Factor) = 45 LF Bed Length THEREFORE: Construct anew 45' long x 5' wide x 4' effective depth absorption trench at the location shown on the Site Plan. Distribution pipe to be placed 3' below the existing ground surface. Total depth to be T. Place a minimum of 4' of cover over septic tank or 2" of insulation and 2' of cover. Insure that all components of the septic sytem are 100' from the well on this and adjacent lots. SP TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) �J 04 NOTE: Grade Area Surrounding Bed to Drain Away. is Minimum 6' Separation From Bedrock. a.....t Minimum 4' Separation From Groundwater. i 11 s ..... Minimum 100' Separation From Private Wells in the Area. fA Minimum 100' Separation From Surface Water or Streams. A`8 Minimum 10' Separation From Water Service Line. VV Michael E. Anderson W 0 DEP (feet) 1- 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 49B, BLM LOT 49 SUBDIVISION PERFORMED FOR: TROY DAVIS HOMES DATE: 2/19/16 PROJECT No.: PARCELID#: TECHNICIAN: A. HARALA Tx TEST HOLE 3 mTmmmn 1"010 0 d a d O 'd. SILTY SAND t' WITH GRAVEL SM SLOPE SITE PLAN SEE SITE RAN WAS GROUNDWATER ENCOUNTERED? NONE IF YES @ WHAT DEPTH? DEPTH OF WATER AFTER MOMTORING: 2% DATE OF MONITORING: c�:r - 1-1 DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 2/19 1 12:58/1:08 10 7.63"/11.38' 4.25" 2 1:09/1:19 10 7.25"/11.38' 4.13" 3 1:21/1:31 10 .50"/11.75' 4.25" 4 1:32/1:42 10 7.12"/11.44 4.32" 5 1:43/1:53 10 7.6311/11.38' 4.25" 6 1:55/2:05 10 7.63"/11.38' 4,25" PERCOLATION RATE: 235(MIN/INCH) PERC. HOLE DIA. 6f INCHES) TEST RUN BETWEEN: 4.0 FT. and 5.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 3/23/16 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1- 2 3 4 5 6 7 8- 9- 10- 11- 1 011 1 16 17 18 19 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 4913, ELM LOT 49 SUBDIVISION PERFORMED FOR: TROY DAVIS HOMES DATE: 2/19/16 PROJECT No.: PARCEL ID#: TECHNICIAN: A. HARALA TEST HOLE 4 LM OB/OG d a a A a a a d. SILTY SAND a WITH GRAVEL I d d 0 a 0 a 0 BOH @ 16' SLOPE 0 NEL E. ANDERSON No. CE -4381 SITE PLAN SEE SITE PLAN E WAS GROUND WATER ENCOUNTERED? NONE IF YES@ WHAT DEPTH? S DEPTH OF WATER AFTER MONITORING: NONE IS 0 2% DATE OF MONITORING: 4/15/16 DATE READING GROSS TIME NET TIME DEPTH TO WATER NET DROP (MINUTES) (MINUTES) (INCHES) (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 2/19 1 3:05/3:15 10 .13"/16.25" 12.12" 2 1:09/1:19 10 .25"/16.38" 12.13" 3 1:21/1:31 10 .25"/16.38" 12.13" 4 1:32/1:42 10 .13"/16.25" 12.12" 5 1:43/1:53 10 .25"/16.38" 12.13" 6 1:55/2:05 10 .13"/16.25" 12.12" PERCOLATION RATE:<l (MIN/INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN: 4.0 FT. and 5.5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE- 4/25/16 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 - 2- 3- 4- 6- 7- 8- 9- 11 12 13 14 15 16 17 18 19 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 49B, BLM LOT 49 SUBDIVISION PERFORMED FOR: TROY DAVIS HOMES DATE: 4/8/16 PROJECT No.: PARCEL ID#: TECHNICIAN: W. ROBERTS TEST HOLE 5 OB/OG d d a d G . n a ' d. SEW SAND 'd. WITH GRAVEL � d a O d d a BOH @ 16' SLOPE N 0 SITE PLAN SEE SITE PLAN $ 11 WAS GROUND WATER ENCOUNTERED? NONE IF YES @ WHAT DEPTHS DEPTH OF WATER AFTER MONITORING: NONE 2% DATE OF MONPFORING: 4/15/16 DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 4/8 1 9:14/9:24 10 .75"/11.00" 10.25" 2 9:25/9:35 10 .50"/10.75" 10.25" 3 9:36/9:46 10 .50"/10.75" 10.25" 4 9:47/9:57 10 .75"/11.00" 10.25' 5 9:58/10:08 10 .50"/10.75" 10.25' 6 10:09/10:19 10 .7s°nl.00" 10.25" PERCOLATION RATE: < 1 (MIN/INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN: 4.0 YT. and 5.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS nATR- 4/25/16 NORTHERN GEOTECHNICAL ENGINEERING, INC./ TERRA FIRMA TESTING PROJECT CLIENT: Anderson Engineering PROJECT NAME: BLM Lot 49 PROJECTNO,: 4386-16 SAMPLE LOC.: T15N RIW Section 9 NUMBER/ DEPTH: TH#5 / 4. Below Grade DESCRIPTION: Poorlygraded sand v/ gravel DATE RECEIVED: 3/14/2016 TESTED BY: 3A REVIEWED BY: RC 100 90 So 70 N 60 50 ro 40 30 20 10 0 %GRAVEL: 42.2 %SAND: 57.3 % SILT/CLAY: 0.5 USC: SP USACOF PC: .02 mm: ASTM )1557 (uncorrected) pcf ASTM D4718 (corrected) pelf OPTIMUM M.C. corrected) % NATURAL M.C. 2.3 OA PARTICLE SIZE ANALYSIS ASTM D422 / C136 Me I" �■�Ilnor■tlum■■ ii�iu �nnr�i■� nn ■ iim�■■ ■ � ■ ili0r■i 111■II�� r■■�iii�i��ilo�i�{iini■u�Iiiirr■ 1 ■���un� ■■ i1■■ � m n■ gqlen rll�r■rrrri� nn ■■ nl ■ so III III I'�Cu■'� �9m�.��ll MEMIM Im InIICC� nu■�nnm■mnunu� nn ■ nu nr■� �ur■ u in ■ III nn m n � �un��rliir i n n ■ ■ u11���■nil ill m l ■ III nil I in InrQi■■ i 1 ■{■� �■■��Ir■■� DEGRADATION 152.40 6" PLASTICITY DVDEX 76.20 NEW 38.10 1.5" 100 19.00 145 140 1" a 135 z 131) q 125 q 120 115 MOISTURE -DENSITY RELATIONSHIP ASTM D 15 57 0 2 4 6 8 10 12 14 16 MOISTURE CONTENT (5) SIEVE ANALYSIS RESULT SIEVE SEE(mm) SIEVE SIZE(U.S.) TOTAL% SPE=CATION PASSING DEGRADATION 152.40 6" PLASTICITY DVDEX 76.20 3" 38.10 1.5" 100 19.00 3/4" 84 12.70 1/2" 75 9.50 3/8" 70 4.75 #4 58 2.00 910 42 0.85 #20 21 0.43 #40 8 0.25 #60 3 0.15 #100 1 0.075 11200 0.5 HYDROMETER RESULT ELAPSED DIAM M TOTAL% TIME QMN) (mm) PASMO 0 0.5 1 2 4 s 15 30 fi0 250 1440 HYDRAULIC GOND. (ASTM D2438 DEGRADATION (ATM T-13) PLASTICITY DVDEX ASTM 4318 The testing services reporledherein have been performed t0 recognized i A LI standards, unless otherwise noted. No o0rer warranty is made. Should engineering interpretation or opinion be mgnhed, NGE-TFT will provide upon written request. 11301011ve Lane - Anclwrage, Alaska 99515 • Phone: 907-344-5934 - Far: 907-344-5993 - wrnnnge-60.ronr GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVTRONMFNTAI_ QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 C a s e P NoWiNen Performed For Earl SQWVQY, Dated Performed -y-73 _ 9 TIS/U Rlw Legal Description: Lot�_Block Subdivision cc. _ This Form Reports Soils Logation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth -fir ee e z Date Gross Time Net Time Depth to H2O Net Drop w�er�e.aes — 3 1 �' ry5M:7-So 4 5114Y 5" -4 a 6 3 - +0 f OPfit � C�64h 9- 10— I I — 12— - 13- 1 Y - Was Ground Water Encountered? ES If Yes, At What Depth? S� 010 — - - F Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate—_minuLe Proposed Installation: Seepage Pit Drain Field Depth of Inlet_—_—_ _—_Depth to Bottom o1 Pit or Trenc rn MMCAITC • "--' Test Performed BY Date Certified BY: Date: • Municipality of Anchorage On-Site Water&Wastewater Program ,�:�g'. (907)343-7904 Sok ETY Certificate of On—Site Systems Approval Parcel I.D. 051-104-80 Expiration Date: l 3 d LE 1. GENERAL INFORMATION Complete legal description HELLUVA SID; LOT 49B Location (site address) 20815 HELLUVA STREET,CHUGIAK,AK 99567 Current Property owner(s) JAYSON&YVONNE MINIO Day phone C/0 AGENT Mailing address 20815 HELLUVA STREET,CHUGIAK,AK 99567 Real Estate Agent BROOKE STILTNER W/REMAX Day phone 748-0156 2. TYPE OF DWELLING: 111 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: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. N/A Distance: - G� 9 /y/ 9?Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ Sr Waiver Fee $ Date of Payment e7/2 ‘1( Date of Payment Receipt Number 0S-9 51, 4) Receipt Number COSA# a C (RI tt33 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD,SUITE 101 "ANCHORAGE,AK, 99507 Engineer's Printed Name JEFFREY A.GARNESS, P.E. Date Engineer's Comments: 1 In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the 116,63iiiil D.11 1+�, guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the condition of the system/s on the dales of the evaluation.Separation distances were measured to readily identifiable features. ,••\ O '••• ,1 Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic / I / \••••;7��. systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during yyy the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system/s.These I l/ % * • conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the i : \ 49, i1/ • system/s;therefore,GEG makes no warranty(express or implied)regarding the future performance of the welt or septic system. \°• GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the ..641' it current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the •� , A. p me f S = information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ♦ 0 I l authorized.In short,GEG disavows any legal duly to anyone other than the person/party who paid for this report. • ,f��,�j• j DE-7953 +� 6. DSD SIGNATURE +,<4.,b pR• ...... • •�O • NP� LICENSE ,�1�01`S``,* System#1 Approved for 3 bedrooms. #AECC884 System#2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: '< ON-SITE WATER AND • ; WASTEWATFR -� PROGRAMS By: `'— Original Certificate Date: 3 I IF The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev.10!12112) If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: HELLUVA SID; LOT 49B Parcel ID: 051-104-80 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 5/16/2016 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 100 ft. Cased to 100 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 5/16/2016 8/16/2018 Static water level 13 ft• 12.8 ft. Well production 2.0 g.p.m. 1.9 g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 ml. Nitrate 7 91 mg./L. Collected by: GEG, Ltd. Arsenic: <5 ug./L. Date of sample: 8/14/2018 B. SEPTIC/HOLDING TANK DATA NOTE:1.5"TO 2"OF LIQUID LEVEL IN DOUBLE CLEANOUTS.BELIEVED TO BE BELLY IN LINE. Tank Type/Material SEPTIC/STEEL Date installed 5/3/2016 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NO p Date of pumping 7/23/2018 Pumper ALASKA QUALITY SEPTIC, LLC C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT BOTH MT1 AND MT2.MAY BE SHY OF COVER. SEE ATTACHED EMAIL STATEMENT FROM OWNER. Date installed 5/3/2016 Soil rating P•d./for ft2/bdrm) 1.0 System type 5-WIDE Length 45 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth *7.2+ ft. Eff. absorption area 450 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/16/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 478 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NO If yes, give date - D. LIFT STATION Date ins . . Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' leve .ice High water alarm level at in. Datum Cycles tested Meets alarm & circuit req - - E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ 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 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALLATION. G. ENGINEER'S CERTIFICATION .__41-.4. �P�.............. ♦. Air AI % �• ♦ % • I certify that I have determined through field inspections and 49 I. ''‘ '• • review of Municipal records that the above systems are in •• • conformance with MOA COSA guidelines in effect on this - •••• •• •:•_.• • date. ♦ - f A. Game : ♦ �'•, 1 a Engineer's Printed Name JEFFREY A. GARNESS ♦♦ fj, CE- •. l cp A Date `8 f 30 / ��i,�Fp•P• . R • 4iROFESS\ ,••• LICENSE i* 's #AECC884 (Rev. 10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT i • ( -"" ) 907-343-7904 On-Site Water and Wastewater Section / Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # 0SC181433 Subdivision: Helluva, Lot: 49B A water sample revealed a nitrate concentration of 7.91 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. 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. Mailing Address: P.0. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen,which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650*www.muni.org ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) March 20, 2017 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 49A, Helluva Subdivision Pit well decommissioning Dear Onsite Services Engineer: The approved permit for the septic system on Lot 49A of the Helluva Subdivision makes note of a shallow well within the area of the septic trench. The well is described as being 'cased down to 20 feet'. I understand that this well was also mentioned on the permit for the neighboring lot as requiring decommissioning. I have been to the site to inspect this well. It is not an actual well- it is a shallow, open pit inside a small concrete 'bunker' partially buried in the ground. There is no casing, simply a concrete cover on the pit that needs to be removed in order to get access to the well. Although the bunker has not been demolished, this pit has been filled in with soil, so that there is no access to water, and no surface water. For all intents and purposes the 'well' has been decommissioned. r�.sJ,AuC 4n • or Sincerely, . •e4 .s1-se# Jr. Asa AVP Benjamin Schiller, P.E. ' 1 US; i .r .... a, c•� 1 133d1S YAfl113H W 0 •0 ') 41, „$L'96 M"l ,00.00 N 00 O� \ I / o Z\ A y. J \ C 0 0,0.. rn �i o \ / :1:1:;) s 0 ` Cm rO Dj w xi.,/ Rl C CO I ; IOa Z D <T_ /4444 > Z �`' D �, ')0 m \ u4 �C" ` O p ' / O U A O 20.0'•c^'i .0'0Z XJ \W p u co" 4 rq 4) W ;p - (D _ 57.4' _ m^' - D D N 12.0 0_4 O8 3 r m o.o'Z 1 m 0 N N 0-< U/ 0) 0 rn iu cp v) , 56.0• .f&N —I .\1.A N XI I 01 m Pm _ / _ v N 0 op op O (,i (!1 xx_ - N 0o W I TI(A N cfrl n---I o Z 0 x 30.0' S 00'02'27"W 158.58' I-- 0 0 1 t • / PLOT PLAN AS BUILT X SCALE 1" = 50' GRID NW 1358 Project No. 16-053/B6 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone (907) 522-4625 Fax 0 F q?"‘, Professional Land Surve ors k.nOIongsurvey.cam o!y jonathanOlangsurvey.com ' `''• '• •: 5, '11 I hereby certify that I have surveyed the following described property: �P . I i LOT 498. HELLUVA SUBDIVISION $ �'' 49� �, �� Anchorage Recording District, Alaska, and that the improvements situated thereon an within the property lines and do not encroach onto the property adjacent thereto, that Q _ / i / no improvements on the property lying adjacent thereto encroach on the surveyed . 4 ..* ay promises and that there are no roadways. transmission lines or other visible -0, '• KENNETH easements on said property except as indicated hereon. 1416•0 ,.-4-4' �{,� .4.5-520%. �� Dated this the Day of = 02 >-�- L� i at Anchorage. Alaska 4% A� Oo It Is the responsibility of the owner to determine the existence of any easements. covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 ® Municipality of Anchor On -Site Water and Wastewater Progr (907)343-7904 I� Certificate of On -Site SystemsF Parcel I.D. 051-104-24 Expir 1. GENERAL INFORMATION Complete legal description T1 5N R1 W Section 9 Lot 49 Location (site address) 20815 Helluva Chugiak, AK 99567 Current Property owner(s) Troy Davis Homes, Inc. Day phone 357-9394 Mailing address 1689 Knik Goose Bay Road, No. 400 Wasilla, AK 99654 Real Estate Agent 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well FX] GE 6G �( Ll GOA I t �l �• o ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer LrI Ll�iij IS pproval ; 1 atinn-Data 1. GENERAL INFORMATION Complete legal description T1 5N R1 W Section 9 Lot 49 Location (site address) 20815 Helluva Chugiak, AK 99567 Current Property owner(s) Troy Davis Homes, Inc. Day phone 357-9394 Mailing address 1689 Knik Goose Bay Road, No. 400 Wasilla, AK 99654 Real Estate Agent 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well FX] Individual iX Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance requ est for: —Distance: Received by: V� /lne., Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ I • IDS Waiver Fee $ _ Date of Payment I ��2 I�aIO Date of Payment Receipt Number �a 5 "J�C1 Receipt Number COSA# WAO� 5010 Waiver# OSCMWOIO 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. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE 4— System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for 522-7773 Date 10/25/16 =MICGAEL F ... Ai"ERSON CL -t4,^81 a .; bedrooms, with the following stipulations: B/ �v 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r ': c TH =MICGAEL F ... Ai"ERSON CL -t4,^81 a .; bedrooms, with the following stipulations: B/ �v 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r ': c If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of Ora -Site Systems Approval Checklist Legal Description: T1 5N R1 W Section 9 Lot 49 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 5-16-16 Sanitary seal (Y/N) Y Total depth 100 ft. Cased to 100 ft FROM WELL LOG Date of test 5-16-16 Static water level 13 ft. Well production 2 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 6. 31 mg/L Arsenic ug/L Date of sample: 1 O/24/16 B. SEPTIC/HOLDING TANK DATA Tank Type/Material- Septic/Steel Tank size 1,000 gal. ; Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Const. Pumper C. ABSORPTION FIELD DATA Parcel ID: 051-104-24 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION ft. 16aau>! Collected by: And. Engineering Date installed 5-3-2016 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 5-3-16 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.0 GPD/BDRM System type 5' Wide Length 45 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7.5 ft. Eff. absorption area 450 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For 4 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.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off" level at Cycles tested _ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer /septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5Property line >5' Water main >10, Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 10/25/2016 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100' Water main >10, Driveway, parking/vehicle storage > 10' in. Municipality of Anchorage Development Services Department 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 Nitrate Advisory Certificate of On -Site Systems Approval # OSC161506 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 49 of T15N R1W Sec9 subdivision. This inspection revealed a nitrate concentration of 9.39 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. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.