HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 3 LT 11
Mountain Park Estates
#2
Block 3
Lot 11
#017-022-23
QGRE-' :R ANCHORAGE AREA BO '-'!JGH
Department ~3~n~ir~er~ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/'~'~'~'~Z/1/ MAILING ADDRESS ~-! f~-~ ~'~ /~/'q'~L ~' PHONE
LOCATION ~E~'~//;8'/"*-" .¢,C¢ ¢-h'~/X3/*'{/ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL MANUFACTURER [:~//c.~ ~.A/~' MATERIAL
INSIDE LENGTH ~' INSIDE WIDTH ~ LIQUID DEPTH
NUMBER OF
COMPARTMENTS //
~"I_IQUID CAPACITY ///~4-~¢-¢') GALLONS.
SEEPAGE PIT:
/
NUMBER OF PITS DIAMETER -'
LINING MATERIAL/'.¢.~/¢? /~/~'¢/?~A"~CRIB SIZE:
BUILDING FOUNDATION ~'P
ADDITIONAL ABSORPTION
OR WIDTH //~,/ LENGTH //~i/ DEPTH
DIAMETER ,~¢ DEPTH~--~, ~ DISTANCE FROM: WELL
," TOTAL EFFECTIVE '
NEAREST LOT LINE /,(2~ . ABSORPTION AREA (WALL AREA) .._~7~/ .SQ. FT.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
CONSTRUCTION
NEAREST / NEAREST
LOT LINE /~'~¢,~(~/SEWER LINE
OT'ER SOURCES ,'~('¢'/f/g;'
APPROVED DISAPPROVED REMARKS
DEPTH ~/- ~X~'~ /
DISTA. NCE FROM:
SEPTIC SEEPAGE
TANK ~ ,SYSTEM ,/(/Z//'-J '
DISTANCES: ,-~,4z,'~f'/J /~/
INSTALLED B Y: .~/////~?¢4//~
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
~~~ l l'.i~'''
G.A.A.B.
GREATEr ANCHORAGE AREA Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM. -- APPLICATION AND PERM.IT
'NST^LLAT,ONLOCAT,ON AU'UD££S oF ' Az
INSTALLATION OF: SEPTIC TANK / SEEPAge PIt / DRAIN FIELD , OTHER
NOT~ THIS P~lf IS NOT V~LI~ WITHOUT SOIL
FINAL INSPECTION: 2~ HOUB NOTICE REQUIRED. BACKFILLING OF A~Y SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPABTMENT OF ENVIRONMENTAL ~UALITY AUTHORITY WILL BE SUBJEOT TO PROSECUTION,
MINIMUM DISTANCES, REQUIREMEN~ /
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIt ~:~ U , DRAIN FIELD
/
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
· DRAIN FIELD
. SEEFAGE P,T I 00/
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK ~ , SEEPAGE PIT ~
DRAIN FIELD ¢
SEPTIC TANK· . SEEPAGE PIT _, DRAIN FIELD
TO RIVER· LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
DIAGRAM OF SYSTEM
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
Gr :ER ANCHORAGE AREA BOROUGIt
· ' -~, - Depar'~ment of Environmental Quality
~ '~ 3330 "C" Street
<$"'-~ Anchorage, Alaska 99503
This form reports: So---]~'~g ~ ',~ ] Percolation test
Depth
Feet
I -
2-
11 -
13-
Was ground water encountered?
If yes, at what depth?
Date
"Reading Net Time
Gross Time
Depth to H20
Net Drop
Per'col a ti on :F~ te mi nu te: . . .................................... L
Proposed installation: Seepage P'it Drain Field
Depth of' Inlet
CO~'~'F,-i ~' -, . ->~ . ~ ' -' . ~ . ' ' ,' -- - ..' ~ '
. ......... .......
..~/ //~ / ~ z...
., , DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 0CT $ 1980
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
D £FI\/EB
)1RECTIONS: Complete al] parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing,
1. PR/q~E~RT'~ OWNER~ PHONE
PROPERTY RESIDENT (If ~Jifferent from above) PHONE
2, BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
MAILING ADDF~ESS
MAI LING ADDR ESS
STREE~ffLOCATION
6. TYPE OF RESIDENCE ~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
~ Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVI DUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER ( / ' '
[]Septic Tank or ~Holding Tank
Size: } O ~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTA~OESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~DISAPPROVED -- ~/
~ CONDITIONAL APPROVAL (letter must ~ ;c~mpany certificate)
72-010 (Rev. 6/79)
Tobben Spurleland P.E.
8155 Cranberry St.
Anchorage, Alaska 99502
Phone (90?) ;243-5302
Mr. Richard Davis
P.0.Box 10-2224
South Station
Anchorage, Affaska 995~4
November 5, 1980
SEWER ADEQUACY TEST
Legal
Location
Qwner
Residence
Water
Sewer System
Date oi' Test
Test Procedure
7;;, ........
Test Result
Lot 11, Block 3 Mountain Park Estate No 2.
Off deArmond
Richard Davis
Three Bedroom Three Storeys
On Site Well
From Municipal Records
Tank 1000 gal. Espinoza, concrete, one compartment
Absorption System Log Grib with gravel backfill
Total Absorption Area 374 ft. sq.
October 30 and 31 1980
System was inspected on Oct. 29, 1980. 17 inches of liquid was
measured in the crib. Liquid ~s heard trickiling into crib.
On October 30th, the tank was pumped with approximately 1000
gal. removed. The crib was charged with water and the following
measurements of the licuid level taken.
~Begin Test 18.75 inches
Add 500 gal 33.50
Add 5OO g~ '51.5
24 hours later 11.00
A total of 1200 gal of liquid was absorbed during the 24 hour
test period. This sustem surpasses the municipal requirements.
MUNICIPALITY OF ANCHORAGE ....... - ' :..:
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEGTION
825 L Streot - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (i0) days for processing.
1. PROPERTYOWNER ~ H±s work #276-1322 *Her work #276-5676 PHONE
Richard L. Davis Jr. and Jean G. Davis 344-5383
MAILING ADDRESS i
SRA Box 377 C, Anchorage~ Alaska 99507
PROPERTY RESIDENT (If different from above)
PHONE
U/A
N/A
2, BUYER PHONE
Refinance N/A
MAILING ADDRESS
N/A
3. LENDINGINSTITUTION PHONE
Peoples Bank & Trust Co. 279-7511
MAILING ADDRESS
Pouch 7-007, Anchorage, Alaska 99510 ,
4. REALTOR/AGENT
N/A
MAI LING ADDRESS
N/A
5. LEGAL DESCRIPTION
Lot 11, Blk. 3, Mountain Park Estates
~TREET LOCATION
NHN Saunders Road, Anchorage, Alaska 99507
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
[] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
PHONE
N/A
7. WATER SUPPLY [] INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE*'~
[] PUBLIC UTI LI~:Y
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING cAN BE INITIATED.
72-010(3/78)
J~UNICIPALIIY OF ANC[';'i?
DEPT. OF HEALTH
ENVIRONMENIAL pROI
jUL. 1 0 i978
pFcF[VED
(SL/~ '^aU) O ~ ~-~.L
NOI.LclIMOSOQ 1'/933
_._(all!J_) AI3~
d~AOWddVSIQ ~
(a).eo!j!:lJao AuedLuoooe :~snLu Jo~,~Ol) 9VAOWddV 9VNOI±IONO0 E~I
SiAJOOHQO~] ~.,ff~.Z-~ HO-J ¢]3AOWddV-~j
3±VO
S±NO~IAIOO 'G
ou!-I ~o'"1 ],seJeeN ]
WOH10 []
eaJ~/ uo!~dJosq'~
~ueJ. 6u!PlOH/O[~daS
:OJ. 9-13~
SODNVI$1Q 't,
-IVIHO.LV!AI VOHV NOI.LdHOSI~IV qV,J-O±
~-JO~Jr'~±OVOFINV~ )lNVJ. 30 3dAJ.
ONI±VU SqlOS
~J38V~nN ±I1R bi3 d
C]OAIOOOU 909
(]39q IHC]
-193M 30 H±dOQ
XlS ~ ,WflOJ F_3 OM± []
3AIJ E.'~ 33UH.L [] qNO {~
-- :suo!suauu!p a^!6
apetuau.~otI s! >lU%L Jl :az!s
>lUe± 6u!ploH [] ,Io >luejL oi:~das[]
pa[~.!JaA uopaauuo3
A.LI9 IJ-Q 9118 r'ld [Z]
311S- NO/OVQQIAI(JNI
lAI31SAS 'IVSOd"'Q 3DVM3$ 'g
paB!JaA uo!!oauuoo
A±I9 I.Lfl OI98Qd []
Ali NI~IAIRO3 ~-j
9VQ(31AI(]NI []
A'lddFl$ HO/VM 'g
A9 IIAJVJ 39dl±919[N []
A9 IRV-t 3~IDNIS []
33N3QISO~J -I0 3dAJ. 'L
HO.L03 dSN I HO..LOOdSN I
3±VCI 3J. VO
3WI/
3~NIJ_
S±NO~J_NIOdd¥ NOIJ. 33dSNI
QOAI303~J 3J-VG
AONO 3S~ 9VIOI-J~O WO-J _OQIS SIHI
:9NOIIOO~IQ
HO103dSNI
3F~I.L
Richard L/J~an G Davis
~o~ 377~C
Lot 11 Block 3 ~ountain Park
r~-ipt sul~itted to ~his of fica.
If there is not a s~D~ tank, one will. need to be
~n th~ ~vent the [~rcolation test fails an up~rade ~ilI
Prior to th~ upgrad~ a soil~ t~sB must bm obtained and
if there ar~ any question~, p!~as, oont~ct this office
at 264-4720.
Pouoh 7-007 99S10
PEOPLES BANK I TI:lUST
August 14, 1978
· Municipality of Anchorage
Dept. of Health & Environmental Protection
825 "L" Street
Anchorage, Alaska 99501
Attn: Robert C. Pratt, R.S.
Re: Lot 11, Blk. 3, Mountain
Park Estates Subdivision.
Dear Mr. Pratt,
In reference to your letter dated July 26, 1978, copy
attached, I am enclosing a copy of the Adequacy Test done
by R&M Consultants, Inc. pertaining to the above referenced
property.
Mr. Davis informed me today that he has had his sewer
pumped to verify the size by Isaacs Vacuum Cesspool & Septic
Tank Cleaning, the size was verified as a 1,250 gallon tank,
evidence of this will be forwarded to your office.
Please advise us if this information is adequate, or if
you will need to reinspect.
Thank you for your assistance.
Sincerely,
Mortgage Loan Processor
Encl.
MEMBER FEDERAL DEPOSIT INSURANCE CORPORATION
TO
ISAAC.~' PIJ'MPING'SERV
Norm Tibbetts (Owner)
6218 Quinhagak
ANCHORAGE, ALASKA 99507
Phone 344-0].14
PLEASE REPLY ~NO REPLY NECESSARY
August 2, 1978 R&M No. 851579
Mr. Richard Davis
SRABox 377-C
Anchorage, Alaska
Subject: Adequacy Test on Existing Sanitary Sewer System; Lot 11, Block 3,
Mt. Park Estates Subdivision~ Anchorage, Alaska
Dear Mr. Davis:
At your request of August 1, 1978, we conducted a test of the septic system
on the above described property.
During the test the liquid level in the septic tank was monitored as water
was added to the system. The measurements are summarized in the following
table:
Liquid Level Below Top Total Gallons
Time of Standpipe Adddd
9:55 10.1 0
10:05 ]0.1 25
10:15 9.3 75
10:30 9.0 125
10:40 9.1 175
10:50 9.9 175
11:00 10.1 175
The meter used during the test was a Rockwell 5/8" standard water meter which
had previously been calibrated by R&M Consultants, Inc.
If the 3 bedroom residence on the property is to house 6 people, the average
load on the system can be expected to be 450 gallons per day or .31 gallons
per minute. During the test, the system accepted 175 gallons in 65 minutes.
This indicates an average effluent acceptance rate of approximately 2.7
gallons per minute at the time of the test.
Because the house on the lot is occupied, we assmne that the leach field was
at its normal degree of saturation. We can therefore conclude that the
system is disposing of effluent at an adequate rate for a 3 bedroom
residence.
August 2, 1978
Mr. Richard Davis
Page -2-
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions concerning this test or if we can be of additional
service.
Very truly yours,
R&M CONSULTANTS, INC.
Lynne Kos±kowsk±
Staff Geologist
JMB/kky
3330 "C" Street, Anchorage, Alaska
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
99503 274-4561
Date Received June 8, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
9:30 a.m.
~-9-76 Pratt
Wednesday
Approval
Cony.
i~l~ka Bank of the North
Mailing Address: 4th and E Street
2. Property Owner: David W. Roden
Phone:
e
Phone: 344-5383
Mailing Address: Star Route A Box 377-C
Legal Description: Lot 11 Block 3 Mountain Park Estates~7
Loca ti on:
Corner of Saunders Road & De Armoun, see map
Type of facility to be inspected Single Family No. of bedrooms 3
Well Data: Individual
A, Type ~
B. Depth 266'
C. Construction
D. Bacterial Analysis
Sewage Disposal System:
A. Installed 1974
C. Septic Tank': 1. Size
D. Seepage Pit:
E. Disposal Field:
][~ On-site system
B. Installer ~J'~ ~---
RP~(D 2. Manufacturer ~-~i~
1. Absorption Area 2. Material
Total length of lines '
Distances:
A. Well to: Septic tank /~£, , Absorption area
;
Nearest lot line [~ , Other contamination
B. Foundation to septic tank &~ , Absorption area
C. Absorption area to nearest lot line
, Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
~er & Water Facilities
Page 2 of two pages - Re'~:st for Approval of Individual '
legal Description Lot 11 BlocI 3 Mountain Park Estates
Comments
Approved
iDisapproved Date
Approval ,Valiid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF-SYSTEM
certify that the information cot
accurate representation of the su~
are operating satisfactorily.
tained in this request for]aPproval to be a true and
ject sewer and water facilities and these facilities
SIGNED
EQ,034 (1/74)i~'
Date
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner:
Mailing Address:
3. Name of Buyer:
Mailing Address:
FHA
CONV ~/
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
DaY Phone:
Phone:
Phone:
Type of Facility to be Inspected:
No. Bdrms.
Water Supply
Type of Supply: Public Utility Individual
/
If Individual, number of dwellings presently served
If Individual, depth of well ~:~- ~ ~'
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
72-003(3/76)
£ 6WiTY
. i
4.1 ~
o 0
.l-} 0 ~ ~..
Fl rd 0 md_..
~ O~ ~ 0
~ 0 0 ~ ~
MUNICIPALITY OF ANCHORAGE
Ahme
Development Services Department Phone: (907)343-7904
On-Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 017 -022-23
Certificate of On -Site Systems Approval
OSC251054
Expiration Date: 1/29/2026
Legal description MOUNTAIN PARK ESTATES #2 BLK 3 LT 11
Site address 13120 SAUNDERS RD
Current property owner(s) FONTAINE MARY L
X The On-site system(s) is/are approved for 3 bedrooms
BY'v
This rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
s�stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
a
Well Flow Advisory
Nitrate Advisory X
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
Development Services Department `. , Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-022-23
Complete legal description Mountain Park Estates #2, Block 3 Lot 11
Location (site address) 13120 Saunders Road, Anchorage, AK, 99516
Current property owner(s) Mary Fontaine
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic X Concrete ❑ Fiberglass
Age 50 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑■ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ Waiver Fee $
Date of Payment 2 LZ 0/ z 5 Date of Payment
COSA # 10-5 C 2.510Waiver #
COSA Applicalion_June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to:(Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Tank to Property Line > 5’Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date Benjamin Schiller, P.E.
Lot 10
S 89*45'00" W 183.00'
LoiL is
0
C
3,
.32.3
1<
M
0
Home
04
81.2'
CA
z
06
24.31
F_
0
N
6 0'
S 89*45'00" W 183.00' ROW
Lot 12
•
OF
0 is 30
4
;1011
US SURVEY
FEET SluorveylungrJ Jer • ;A. 0 jrs
14";•
1 79§
/N Aie
AdW
Adw
A1W
NOTES
-All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. P-561
-49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no
circumstances should any data hereon be used for construction or the establishment of property lines.
-It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed.
AS BUILT SURVEY LEGEND 49th Star Surveying
Lot 11, Block 3, ro_) Power Pole PO Box 738
Girdwood, AK 99587-0738
Mountain Park Estates ® Clean Out (907)891-6111
No. 2, Anchorage, AK Jeremy@49thStarSurveying.com
X Valve Box WO Well
W-0. 2506 _FDATE_ 2?17fl
SCALE 1"-30'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ' r
On -Site Water and Wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC251054
Subdivision: Mountain Park Estates #2, Block: 3, Lot: 11
907-343-7904
Fax: 343-7997
A water sample revealed a nitrate concentration of 5.53 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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
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.