HomeMy WebLinkAboutHIGHLAND TERRACE #4 TR 3AHighland
Terrace #4
Tr
3A
#050-311-15
D Screened; Start '" feet Stopped "feet ,
u Perforations Start Cfe9t lopped feet
MM
Grout Type: A3t.�+.-,'I `rE Volume /ICI0413
Depth: from 0 feet, to sa feet
Well Disinfected Upon Completion? 46-Aes ❑ No
Method of Disinfection: CNA -4 /• JE
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 996650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Renewal
Date Issued: Sep 17, 2001
Expiration Date: Sep 17, 2002
Permit Number:
SWO10372
Parcel ID:
050-311-15
Design Engineer:
0003 S & S Engineering
Site Address:
011131 STEEPLE DR
Owner Name:
Brett Pearson
Lot Size:
81065 SQ. FT.
Owner Address:
19540 War Admiral Rd
Total Bedrooms:
3 Permit Bedrooms: 3
EAGLE RIVER , AK 99577-0000
This permit is for the construction of:
❑ Disposal Field
❑ Septic Tank Holding Tank
❑ Privy
Private Well 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: q / -0 /
C
a Date: —
Municipality of Anchorage
1�1'�pT6t BV' _
• Development Services Department o
Building Safety Division
On -Site Water and Wastewater Program F
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. h So - !j- 5 Permit NumberSWO/037r
Property owner(s)r- e - 14/{-t L &r.S d=7 Day phone ti y51- &V
Mailing address (1)(.cJa v— ZW 45!�. Ze Ael of
Mailing address
Zip Code 99577
Legal description (Lot, Block & Sub'd.) jgis rj T rrac t Lob 3h
Legal description (Section, Township & Range)
Lot Size J, 3 Acres/ q.Ft.
S O & S -�
THIS APPLICATION 1S FOR:
Number of Bedrooms
Sewer Only ❑ Well Only P1
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ' ` ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
re of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
r
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW970180 DATE ISSUED: 7/10/97
DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 7/10/98
OWNER NAME:PIERSON BRETT
OWNER ADDRESS:11131 STEEPLE DR
EAGLE RIVER, ALASKA 99577
PARCEL ID:05031115
LEGAL DESCRIPTION:
4.-,T��0UAND TERRACE #4 ;TR 3A
LOT SIZE: 80150 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: 7' L� '
DATE:
MoA COPY
�. PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW960115 DATE ISSUED: 6/12/96
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/12/97
OWNER NAME:PIERSON BRETT
OWNER ADDRESS:P.O. BOX 773224
EAGLE RIVER, AK 99577
PARCEL ID:05031115
LEGAL DESCRIPTION:
HIGHLAND TERRACE #4 TR 3A
LOT SIZE: 81065 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
REVISED PERMIT:
THIS PERMIT EXTENDS
CONSTRUCTION OF WELL
RECEIVED
ISSUED BY
PERMIT #SW950106 FOR THE
SYSTEM ONLY.
DATE:
DATE: 12 E
N
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Municipality of Anchorage Page I of a
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SA.)g50106 PID Number: 050-3//-/5
Name: p nT�
17QE7T �'2E O �
Wastewater System:%New ❑ Upgrade
Address:
Po bar -77_3=4 fl -;Aa PSuga�k %957
ABSORPTION FIELD
Phone:
61il 41 x)
No. of Bedrooms:
3
y{
)(Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: r
6
Total Depth from originalgrade:
%v
GPD/Sq. Ft.
ket! Block: Subdivision: #
T� TEa2ACE
Depth to pipe bottom from originfl grade:
Gravel depth beneath pipe
Cr .3)4 ZK -f )O
-S Ft.
qr6 Ft.
Township:
Range: Section:
Fill added above original grade:
/_.51
Gravel length: i
y0
Ft.
Ft.
WELL: *, j.)j❑ New ❑ Upgra
Gravel width: 5 /
Number of lines:
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C): Total D
Cased To:
Total absorption area: 1
Pipe material:
Ft.
Ft.
%av SQ. Ft..
A4 �_3a ��� F. q1C)
Driller: Date Drilled:
Static Water Level:
Ins )aller: / -
G.E.IJEPAL
Date installed: ;2
Ft. Ft.
4E6J7 urJT•
(�
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
❑ Septic ❑ Holding )S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:I _
4A)_1r1oeA6L- ��7.JK
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
1.250
Well-
A/R
'j4
N/ASurfac
Material:7 EEL
Number of Compartments:
160'+
!od'i-
LIFT STATION
Water
Lot
Line
r
10
Size in gallons:
4
Manufacturer:
AAjcm -TA,)ti 00ffA4s_e 5%trAF
Foundation
Al
,q/
"Pump on" level at: "Pump off' level at:
4ra rt .r
High water alarm at:
y11.t
Curtain
i 1
O
67 L
h
Pump Make6M)1
Electrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description: n
-
foP Of- I ETifT.VrAuCa WALL
f oiJJ T
Assumed Elevation: - -
/6 ep"
i�,!` 9*
Inspections performed bys S ENGINEERING tes: 1st
77034 Eagle River Loop Roe4 N4A
2nd `-1x-96
,ROBERT C. COWAN
�c
Eagle River, Aluka99STl = 7-17 -q7
:� CE -8601
Department of Hea i and Hu an Services approval
Reviewed and approved by: Date: 9_ 3
72-013 (Rev. 9/91) MOA 25
W
PERMIT No. SW950106
PAGE 2 OF 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, Alaska 99519-6650 • Telephone 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM ANO/OR WELL INSPECTION REPORT
LEGAL TRACT 3A, HIGHLAND TERRACE ##4 P.I.D. No. 050-311-15
� A �
A4'OA0
RETAINING
40' SEPARATION TO
SLOPE EXCEEDING 25%
NEW 1250 GAI
S.T.E.P. TANK
STI CO
96.8' MH
r NEW
1250 GAL
S.T.E.P. 92.1'
ALL SEP'T'IC PIPE LOCATIONS
WERE TAKEN FROM AN AS -BUILT
SURVEY PERFORMED BY
WILLIAM D. FLEMING
vh NEW PRESSURIZED TRENCH
IT C \ \
MT �
M \ RETAINING WALL
3 O'Ops \JJ
13:0
B� O
S4e
1"NA1301
MT1 = 103.3'
MT2 = 102.0'
SCALE I" = 40'
A ROBERT C. COWAN
'mac CE -8801
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE P(1\
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502 T
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950106 DATE ISSUED: 6/12/95
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/12/96
OWNER NAME:PIERSON BRETT lora
OWNER ADDRESS:P.O BOX 773224
EAGLE RIVER, AK 99577
PARCEL ID:05031115
LEGAL DESCRIPTION:
'14TGHL`AND T- RRRACE #4 TP 3A'
LOT SIZE: 81065 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PR
RECEIVED B
ISSUED BY:
DATE:
DATE: 1Z /V�
S&
25, 1995
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTHAUTHORITY MUNICIPALITY OF ANCHORAGE
APPROVALS Department o4 Heatth and Human Sen.vicea
P.U. Box 196650
Anchorage, AK 99519
SEWER&WATER REFERENCE: Lot 3A; Hightand Thrace
MAIN EXTENSIONS
Requebt you fAsue a pe&wi t to dkiU a weU and imtatt a aeWe system
SEWERB WATER
and issue a wai.vet to the n-equihement boa a 50' setback to a change .in
yipe q
INSPECTION 6topin ex"As a6 Y5%.
The maximum setback attainabte that witt allow development a4 this .tat
is 351. Att tots in this area ane tahge tots with steep stopels that
ENGINEERINGSTUDIES wehe subdivided pxiofL to current %egutatoiLy guidance. The only way
ANDREPORTS this tot can be developed is through the construction o6 a benched
ahea on the steep atope. The septic system wit.t be instatted at the
tae o4 the cutbank and witt be behind the house. At the bottom o6 the
absorption trench the honizontat separation distance wilt be
WELLWSPECTION approximatety 50'. UppeA po4tcon6 o4 the absorption area witt be
&FLOWTEST adjacent to a basement ahea that witt
preclude any potential ban
aun6aci.ng o6 e64tuent atong the steep scope. In addition zoita in
this area woutd not atiow migration o6 e64tuevt ba4 a distance o6
35'.
SITE PLANS
A test hate was excavated and a pencotation test per6onmed. The
approximate, tocation o6 the test Note is Located on the attached site
pian.
ROAD DESIGN
At the time o4 excavation no water was encountered and a6ter seven day
ground wate✓c monitoring, the moni-toning tube was bound to be dry.
SOILTEST This property has enough area bon. a 6uture septic upgrade which can be
,seen on the attached site plan. There are no points o4 contamination
within the proposed weft radius which can be seen on the attached site
pian.
PERCOLATION
TEST 14 you require additionat in6ormation, ptease contact us.
Sincerety,
STRUCTURAL&
MECHANICAL
INSPECTIONS Az //
Robtt
C. Cowan, P.E.
RCC/gk
ONSITE
WASTEWATER Enctosute
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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COMMENTS
Municipality of Anchoragee0e,9KAR
+
DEPARTMENT OF HEALTH & HUMAN SERVICES ,
825 "L" Street, Anchorage, Alaska 99502-0650
BERT C.COWAN
SOILS LOG - PERCOLATION TEST CE • 8801
m,
A/
'81101-1.
DATE
Section:
SITE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water 0.Rer�� C Z p
Monitoring? Date: v f O
17
Reading
Date Gross
Time
Net
Time
Depth todD
Water
,r
2
3:3�
d/V/N
8 3
ce-VIIeM/;j
%3�"
/o 04 i
7 g
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
/
TEST RUN BETWEEN s� _ FT AND FT
S & S ENGINEERING
17034 Eagle RiverE5-opIto—ad o.
PERFORMED BY: Eagle River, Alaska 99577 1 - CERTIFY THA THIS
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S—la- S-
72-008
72-008 (Rev. 4/85)
VST WAS PERFORMED IN
5-
Municipipity
®f
P00ri 6-650
ANCHORAGE.=1t-:;?:', 5,91.02-0650
(907)264-4111
�0 N ,., ,
VA ✓Oft
DEPARTMENT OF HEALTH AND i1r,'%IAL PROTECTION
<Permit #: 820649
January 31, 1983
TO: Permit Applicant
Tpr`
Subject: 3A Highland Terrace #4
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
I
-IF •-e° CIF F� rA C: F,! Fa i EF A t)
DEPARTMENT HEALTH AND ENVIRONMENTALOTE CION /�
82,5 'L' STREET, ANCHORAGE, A::. ` 9501
_,4-4720
i'l EE L L- a=i r -.I C Cl r -J -- =. I -T E E: t.,4 E F=' F° E _ Irl I -T
PERMIT NO, C 8206,49
APPLICANT BRETT PIER:SON Br. -=,'C:5 EAGLE RIVER-.. 99577 694-9+40
I OCATION- T/ lj i -
LEGAL LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH J���
MAXIMUM NUMBER LIF BEDROOMS ? SOIL RATIN i (SQ F BR')= 230 S' P (/"
fn flu,&
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Ap
ok IyiS
= L_ E_ P -A Ci `i " =
THE LENGTH DIMENSION IS THE LENGTH (IN FEET:; OF THE .TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DIETHNCE E:ETWEB'hd THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS. THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F;; -'E: -! i_1 I F., E C= ° !E:-: E F _T I C. -F FY P•41-7' !E-. I °� E - - el la el O FI L_ S r_Y" E
PERMIT APPLICANT HAS THE RESPONSIBILITY 'FO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELL'S ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RE_=+IDENC'ES THAT THE WELL WILL SERVE.
--- T"L-A ®: a_ :2" _- 11t4=.F°r=-C_T I ICA r-4:-=. F=1F?.E Fs'ELeU I F4 EELa ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I=
100 FEET FOR A PRIVATE WELL OR: 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC: WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT 141THIN 0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
Fit+AILABLE TO INSURE PROPER INSTALLATION.
F'EF= M I T
.I S
r CERTIFY THAT
1 I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEVERS AND WELLS AS SET tJ
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. �{o'
2: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF ,THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN = BEDROOMS.
RI r--
SIGNED:_ X4 SSR ----------------------- D de/t /
AP'P'LICANT BRETT PIER:SOtI
ISSUED B4'.JL�S1�Z------
Russell Oyster
694-2774
Performed for:
O & E EN&EERING & DEVELCICENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Mailinngg Address:
SOIL LOG
Legal Description:
rW lC�kLo roL
Depth (feet)
Soil Characteristics
0
1 NJL -
T✓P�o�c_ �A�, �s
_2
3
-4
�tz-7 f
5-
6 6
7LN TEs
_8
,L 3�
09 -
10 —
11
12
13— J�vr�—snit ®c �r
14
15
16
Earl Ellis
688-2280
Tel. No.o_ Z -1
PLOT PLAN
PERC.TEST
Fac♦ ` 2� /Hixf�rE
OF 44go�1®
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit_ Drain Field il�
No. 4286-E
0
Performed by:e:_' Q �� �I�u ��FiQ Date:5221 tsc
• Municipality of Anchorage^''�`'•�`
V3. gl ' fg;iiJX
On -Site Water and Wastewater Program <' v
(907) 343-7904 5A TLY
Certificate of On -Site Systems Approval
Parcel I.D. 050-311-15
1. GENERAL INFORMATION:
Expiration Date: ,-,
Complete legal description HIGHLAND TERRACE S/D #4: TRACT 3A
Location (site address) 11131 STEEPLE DRIVE EAGLE RIVER AK 99577
Current Property owner(s) RACHEL DARNELL-MILLER Day phone 417-712-4393
Mailing address 11131 STEEPLE DRIVE EAGLE RIVER, AK 995777
Real Estate Agent ROD STONE W/ BROKERS OF AK Day phone 727-9379
2. TYPE OF DWELLING:
® 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
ED
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for. Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $,i5[!
Date of Payment ,3l2 LIAP1GZ
Receipt Number �Lg?636
Waiver Fee $
Date of Payment
Receipt Number
COSA # (15(a6 1117 Waiver #
X330 KsYL -('ems 31a lmo (Oql%)
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 (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 3 '2.3 . 0
Qo�oo�0�4
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o�
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the p O
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or P
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, • • • • • • • • • • • • • • • • • • • • • • • • • • •
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ........ .........
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the J f y A. Hess•
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of E 7953 e G
the well or septic system. GEG makes no representation whether an alternative well or septic system VV� s �'�
can be installed on the property in the event either of the current systems fail to perform adequately in i1 .P .. • 23 f - �� o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to �Q dproFession&
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
AECC884
6. DSD SIGNATURE `���1`\'(YtOF (,q��i����
System #1 Approved for bedrooms Q y�����
System #2 Approved for bedrooms WATER AND m
Disapproved WAS TI=V ATER o
Conditional approval for bedrooms, with the followingpu IalfliC'RAM
���111J1i1}1111'��
�-�`— Original Certificate Date: 25 r6u
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_ Nitrate Advisory
Septic System Advisory ArsenicAd\L[sory
Well Flow Advisory Other.
COSA blue sheet 10-10-12.dx
COSA Checklist
Legal Description: HIGHLAND TERRACE S/D #4; TRACT 3A parcel ID: 050-311-15
If more than 1 septic system on lot: COSA Checklist #, 1 of 1 Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 9124101
Total depth 260 ft
Cased to 51 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 3/19/20
Well production at time of test 2.16 gpm
Water storage tank volume *300 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 6.33 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG, Ltd.
Date of Sample 3/11120
Static water level at beginning of test 71.5 ft.
Comments "GEG PERFORMED NO INSPECTION/EVALUATION OF THE WATER STORAGE OR DISTRIBUTION SYSTEM/S
NOTE: THE TANK IS ATTHE END OR NEAR THE END OF ITS USEFUL LIFE EXPECTANCY.
B. TANK DATA C. LIFT STATION
Age of tank(s) 24.8 years
❑ Required maintenance completed
Tank type/material STEEL Age of lift station 24.8 years
Measured operating fluid level in septic tank "11.5" Lift station material STEEL
❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping *10/30/2019
`NOTE: OWNER LIVED IN HOUSE SPARSELY FROM END OF OCTOBER TO MID -JANUARY. HOUSE HAS BEEN VACANT SINCE (SEE ATTACHED LETTER FROM OWNER).
ON 3/19/20, LIQUID LEVELS (L.L.) IN TANK WERE CHECKED AND FOUND ONLY 11.5". "GEG DID NOT PHYSICALLY FIND FOUNDATION CLEANOUT. FCO IS BELIEVED TO
BE UNDER WOOD BLOCKING (FROZEN IN PLACE) IN DRIVEWAY - SEE ATTACHED PHOTO. FCO PRESENT PER PAST COSA/HAA.
D. ABSORPTION FIELD DATA PRESSURIZED DEEP TRENCH
Which system tested (date installed) 6/12/96 Adequacy test date 3119/20
- - ❑ ALL standpipes present per record drawing Results [ZPass For 3 bedrooms
Total measured depth from grade 14.8 ft (max) Fluid depth prior to test **0 in
Measured depth to pipe invert from grade ft (min) Water added "2,451 021
❑ N/A — pressurized field New depth **0 in
Al Monitor tubes go to bottom of effective. If not, state **0
depth into effective Elapsed time min
❑ Code -required soil cover over field Final fluid depth **0 in
❑ System presoaked Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced 2000 gallons if yes, enter date
Comments/Deficiencies: '"IN NORTHWEST MT (MT2) ONLY. ADDED WATER TO SOUTHEAST MT (MT1). NO RISE IN MT2 DURING
ENTIRE TEST MT1 HAD A MAXIMUM RISE OF 11" INCHES OF L.L. WHILE WATER WAS BEING INTRODUCED INTO IT AND BECAME
DRY SHORTLY AFTER WATER HAD STOPPED BEING INTRODUCED INTO IT. TIM EKLUND FROM MOA ONSITE APPROVED
PRESOAK AND SEPTIC ADEQUACY TEST TO BE PERFORMED ON THE SAME DAY ON 3/19/2020.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Q
Yes
Community Sewer Manhole/Cleanout > 100'
ft
0✓ Yes
if No
ft
Q Yes
if No
ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No
ft
Absorption Field on Lot > 100' Q Yes
if No
ft
Holding Tank > 100' E] Yes
if No
ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q✓ Yes
if No
ft
Q✓ Yes
if No
ft
Water Service Line > 10'
❑
Yes
Manure/Animal Excreta Storage > 100'
ft
If septic tank is under driveway comment below
Community Sewer Main > 75' 0 Yes
if No
ft
0 Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q
Yes
if No
ft
Surface Water > 100'
Q✓ Yes if No ft
Property Line > 5'
0✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
F✓
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
71
Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
ft .
Water Service Line > 10'
❑
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
✓V
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
❑
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft .
F. ENGINEER'S COMMENTS
`PER 2016 KENNETH DUFFUS, P.E. COSA AND 2001 ROBERT C COWAN, P.E. HAA,
\►>1►/���\\RI�I�[•Yi[���Z�7►����\�,��l'��G7T7t11�1�i\���c7xe�\�717�L�Si�i\:113'
G. ENGINEER'S CERTIFICATION
1 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.
COSA Checklist yellow sheet
0
:.:....'I 1 . ...............
J �CC—,79
rr ess
\%o, ro f e s
#AECC884
Lift Station/Pump Vault
ii ,, :� nt =
Owner_JP�('�.? �- I� I'U",.L Street Address t 4 4,{ ,x, 2
Septic Tank: I
-Sludge level () inches -Pumping: required Yga r o -Pumping completed te no
Lift station:
-Pump basket cleanedr\'5� no -Effluent filter cleanedQ,`e no
-Control floats cleaned no -Proper float settings confirmedt \ e no
-Operation satisfactory _,.'&s no
Alarm System:
-Dedicated electrical alarm circuit no -Audible and visual alarm inside dwelling no
-Alarm system operation, sa for not satisfactory
Manhole Riser
-Groundwater intrusion at riser to tank connectioneV s g
-Groundwater intrusion around pipe penetrationsey s (nn -Weep hole functional no
-Manhole lid: Functional'-y2"no Insulate - e no Properly Secured `mss no
Other
r
-All manufacturer required inspections and maintenance completed,xg no
Qualified Maintenance Provider:
Technician Date of maintenances7 0
L)
Company DRx 1r1)
Signature . ! Date -4,
L
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC201117
Subdivision: Highland Terrace #4 Tract 3A
A water sample revealed a nitrate concentration of 6.33 milligrams per liter (mg/Q.
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.
r Mailing AddressP O Bcx 196650 *Anchorage, Alaska 99519 6650 * wuvw rnunLorg`
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
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC201117
Subdivision: Highland Terrace Tract 3A
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 24.8 years old. Typical replacement costs range from $8,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
.S" rt ii
�° r MaiUng Address P� O Box 196650 * Anchorage,�Alaska 99519 6650 *www muni org
• Municipality of Anchorage
On -Site Water and Wastewater Program K
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-311-15
1. GENERAL INFORMATION
Expiration Date: 6,/
Complete legal description HIGHLAND TERRACE #4 TRACT 3A
Location (site address) 11131 STEEPLE DRIVE, EAGLE RIVER, AK 99577
Current Property owner(s) BRETT & GAIL PIERSON Day phone
Mailing address 11131 STEEPLE DRIVE, EAGLE RIVER, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless
COSA Fee $
Date of Payment 12P,
Receipt Number O550-IoA�
COSA# CY5C-ILo1+5q
3
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Date: /D
by the engineer.
Waiver Fee $
Date of Payment
Receipt Number
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 ARCTERRA CONSULTING INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 9/23/2016
Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen r OF T\
encroachments, deficiencies or discrepancies exist. v "L
,101
* 44-
6.
4
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the
? KENNETH; 1Z�+
lre 4Air
�v
eAV
tEsswr''� i
stipulations:
Uttrr�;,
BW -_
=it Original Certificate Date: 1
The Municipality of Anchorage Development Services Division (DSD) issues Cerifcates of Onsite Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the Stale of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory L�
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA b1m sheet ta10-12.dm
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: HIGHLAND TERRACE #4 TRACT 3A Parcel ID: 050.311.15
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID #
Date completed 912412001 Sanitary seal (YIN) Y
Total depth 260 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test 9/24/2001
Static water level 60 ft.
Well production 1.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 6.12 mg/L
Arsenic: ug/L Date of sample: 9/712016
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 387TIC12MI. S'1'j _ F
Tank size 1250 gal. Number of Compartments 2
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
91712016
ft.
Collected by: ARCTERRA
Date installed 611211996
Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) Y
Date of pumping 91712016 Pumper JRs
C. ABSORPTION FIELD DATA
Date installed 611211996 'Soil ratingg.p.d. or fe/bdrm) 0.6 System type DEEP TRENCH
Length 40 ft. Width 2.5 ft. Gravel below pipe 9.5 ft.
Total depth 14.6 ft. (Measured suis) Eff. absorption area 760 ftz Monitoring tube Y Depression over field N
Date of adequacy test 917/2016 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 7 in. Water added 900 gal. New depth 24 in.
Elapsed Time: 40 min. Final fluid depth 7 in.
Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date
D. LIFT STATION
Date installed 6112/1996 Size in gallons 1250 Manhole/Access (Y/N) Y
"Pump on" level at 42 in. "Pump off' level at 32 in. High water alarm level at 44 in.
Datum BOTTOM OF TANK Cycles tested 2 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 1001+
Public sewer main 751+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 54 Property line 51+
On adjacent lots 1001+
On adjacent lots 1004
Public sewer manhole/cleanout 1004
Holding tank 1004
Manure/animal excrete storage areas 1004
Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 104 Building foundation 104 Water main 104
Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 104
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 1001+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 9123!2016
COSA canary sheet 2.6-15.doc
/OFALJ.
r
P
104N K
F'E9510''-y AV AV
Municipality of Anchorage ,96.a
Development Services Department s � `" °
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 # OSC161454
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
Tr 3A of Highland Terrrace #4 subdivision. This inspection revealed a
nitrate concentration of 6.12 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.
-
Municipality of Anchorage
o
+l
Development Services DepartmentF
e`'a
Building Safety Division
'
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
RV. GER l Irl{ ASE (�F ��EfiL�Fl !1U 1 11C�R1 1 Y AI NKUVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-311-15 _ HAA # _i� �>0 � I
Expiration Date:
1. GENERAL! NFORMATION
Complete legal description _ Trait IA- Highland Tex—r——r_ 94
Location,`(steaddress ordirections) 11131 Steeple Dr.
Current Property owner(s)Brett & Gail Pierson __ Day phone _694-8910 Y.
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
same EagleRiver. AK 99577
(lay phone
Day phone
Unless otherwise requested, NAA will be held by DSD for pickup.7 /��� 3
Y
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL:
Individual Well U
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Individual On-site
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Aoproval 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 Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system i s(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.
^J>me of Firm S & S Engineeri
P. none 694=2979
Address 17034 N. EagleRiver Loop Ste 204 EagleRiver, AK 991577
Engineer's Printed Name Robert C. Cowan i Date� 0 3
5. DSD SIGNATURE
V Approved for
/ Disapproved.
Conditional approval for
Additional Comments
bedrooms.
Pr, 5 ROBERT C. COWAN
g-+ CE -8801
3t �T� •.
bedrooms, with the following stipulations:
,,::Z: WATER AND
1
9A?ApT QA1ATCR
,!. PROGRAM ,(Qj
VIE
J11)T bt N
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: `(J, / _ Original Certificate Date: 7_a. - O 3
(Rev.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water& Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ZA4Ct"3.#, Y/z-#coNo 7e— S10 ParcellD:05'd 311 -Ir
A. WELL DATA
Well type SJ�-_ If A, B, or C provide PWSID # = Well Log (Y/N) y
Date completed 4410a
/ Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth -ZL/0-6ft. Cased to 4-0 ft. Casing height (above ground) /8 f in.
FROM WELL LOG
Date of test zni Dl
Static water level (o d ft.
Well production % g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 14. W' mg./I.
Arsen' mg./I. Date of sample: 6h;1/01 1,
B. SEPTICIHOLDING TANK DATA 7a-3
lo -3
Tank Type/Material z'-rr1r1C' SiEft,
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) . Depression over tank (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
AT INSPECTION
Other bacteria
ft.
g.p.m.
r' colonies/100 ml.
Collected by: 5¢G'
Date installed
Cleanouts (Y/N) y
High water alarm (Y/N) S
Date installed /2 / Soil rating (g.p.d./ft2 or ftZ/bdrm) System type T. &I fc 71 /
Length _ 40 ft. Width Z , S ft. Gravel below pipe %, S ft.
Total dept) /9�' ft. Eff. absorption area �&Lcft2 Monitoringg� tube ' Depression over field N
Date of adequacy test IV&ti✓ Results (Pass/Fail) 45S For 3 bedrooms
�_t,'Juf6-13
Fluid depth in absorption field pefore test _ in. Water added_ gal./e>
New depth_ in.
Elapsed Time: _ min. // Final fluid depth _ in. `Absorption r= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) s(/ If yes, give date
D. LIFT STATION
Date installed _� Size in gallons ZSD Manhole/Access (Y/N)
"Pump on" level at 4-1, in. "Pump off' level at 3 Z in. High water alarm level at in.
Datum 407rir 1 Cycles tested Ne" Meets alarm & circuit requirements? `7
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /00 + On adjacent lots i 0O I r
r
Absorption field on lot 1 r On adjacent lots _ 0 �
Public sewer main N � Public sewer manhole/cleanout N A
Se r /septic service line 2 S �- Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation + -r- Property line J C/ 4 Absorption field_
Water main OJ A- Water service line 10 !P- Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/ (00 "f—
Property line 10 / Building foundation 101— Water main Nlq
+
Water Service line t Q f Surface water iO® I +- Driveway, parking/vehicle storage
Curtain drain A)9Ne- %1'i-/O&Ar Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and j , ,; „
review of Municipal records that the above systems are in
conformance with MOA NAA guidelines in effect on this date. dV,' p tz
wN e C
Engineer's Printed Name JQd 6W- C. caw4.
Date b/3710 3
HAA Fee $ 3 -75,
7` / O.
��� r //
Waiver Fee $
Date of Payment
/S
//
G ! 3 6 0 3
Date of Payment
Receipt Number 3 7 J' o Receipt Number
(Rev. 12/01)
AV
J /
0G
QJ
/
/
/
/
/
0
6/13/03
FINAL AS BUILT
59-12
7/17/97
AS BUILT SEPTIC
39-60
5/17/95
PLOT PLAN
33-18
DATE FLD. BK.
NOTES: Easements not appearing on record subdivision
plat are not shown unless description of easement is
provided by client. It is the responsibility of the owner
or builder, prior to construction, to verify proposed
building grade relative to finish grade and utilities
connections, and to determine the existence of any
easements, covenants, or restrictions which do not
appear on the recorded subdivision plat.
Elevations based on assumed datum unless otherwise
Indicated, and bearings and distances are record data.
W-nisi=a!p
40 '� 3&3 Engineering
�4�11- to 17034 EAGLE RIVER LOOP ROAD
' '� EAGLE RIVER, ALASKA 99577
' (907)694-2979
LEGAL DESCRIPTION
LOT 3A
HIGHLAND TERRACE
ADDITION NO. 4
PLATSCALE GRID
75-120 1"'50' NW 155