Loading...
HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 5 LT 96lock Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221438 PID Number: 015-001-43 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name ERWIN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 9301 BUDDY WERNER DR,ANCH ❑ Other Phone of Bedrooms Soil Rating Total depth from original grade TNumber GPDISF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot PROSPECT HEIGHTS # 1 BLK 5 LT 9 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ ! 50'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCH TANK 1000 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10'+ NA PLASTIC 2 Foundation 10'+ I LIFT STATION Manufacturer Capacity Gal. Remarks TANK DEMO PER UPC, Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer MIKE N ANDERSON, P.E. Drainfield CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection1st 11/2/22 Location and description dates:2nd TOP OF MANHOLE 100 3rd 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL En ineer's Stamp A T�Tva Conditional Approval: Date.P;.• r \�' •.•. a'9r `tit .: 491! .....•• .......• .�.: .,. /•.es� e .•.. .. Septic System Approved �yr 6r✓n r"Oge-r •• MICHAEL N. ANDLRSC;rq CE -94 9 ' _ l Date �5 Z 2'rr�'•. � 2 Note: this approval does not include well permit requirements.�- (Rev 05/02118) WELL ►• ;�. 49 TH* y SHANE A. HOLT m G LS -6914 o`O LOT 5 THEINFORMATION HEREONIS FOR THE USE OFLENDING INSTITUTIONSSPECIFICALLYTO SHOWANY CONFLICTS BETWEENEXISTING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS,'AND IS NOT TO BE USED FOR POSITIONINGADDITIONAL STRUCTURES, IMPROVEMENTS, ORFENCELINES. EASEMENTSOFRECORD, OTHER THAN THOSEAPPE4R/NG ON THERECORD PLAT, ARENOTSHOWN HEREON ( UNLESS INDICATED) NOTE.FENCELINES THATMAYAPPEAR ON THISDRAW/NGARENOTTO BE USED TODETERMNE PROPERTYLINESORPOSITIONADDITIONAL IMPROVEMENTS. ANYPAV/NGSHOWNHEREONMAYBEAPPROXIMATEDUETO EI(CESSIVESNOWAND/ORICE. 'SURVEY 1"=50' THIS SATE /HERESY CERTIFY THAT/ HA VEPERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 9 BLOCKS PROSPECT HEIGHTS SUB. ADD'N. I ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENTS SITUATED THEREONAREWI7HIN THEPROPERTYLINESAND NO VISIBLE ENCROACHMENTS EXIST 07HER THAN NOTED DATEDATANCHORAGE,ALASKA THIS 201h DAYOF DECEMBER , 2022 75646 227-44 229-67 9309GROVERDRIVE 9NCHOk9GFAK 99507 223-8615 3751060 NET G:\Deveiopment ServicesXt3utid /nguutetyvunbite vvann ano,"nmewainnrwnx,==°vt""=^"Ili "=VI".IV=".."^ Well Decommissioning Log Legal Address: Subdivision PROSPECT HEIGHTS #1 Block 5 Lot 9 T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommissioning: Name: Signature: MIKE N ANDERSON. P.E. SAME Well decommissioning date 11/2/22 Method of decommissioning: AMC 15.55.06OLl a. b. C. Location: Use the space below to provide a drawing of the property showing the following items: • North arrow • Decommissioned well location Location of other water wells on ffii, property Two separate swing -tie distances for each well shown on the drawing Note: The swing -tie distances shall be measured from either permanent structures or the property comers. G:\Deveiopment ServicesXt3utid /nguutetyvunbite vvann ano,"nmewainnrwnx,==°vt""=^"Ili "=VI".IV=".."^ MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221438 Work Type: SepticTank Upgrade Tax Code Number: 01509143000 Site Legal Address: PROSPECT HEIGHTS #1 BLK 5 LT 9 G:2441 Site Mailing Address: 9301 BUDDY WERNER DR, Anchorage Owner: ERWIN DUANE A & SHERRY D Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date Expiration Date �,»ent n J Department Lot Size in Sq Ft: Total Bedrooms: 10/25/2022 10/25/2023 : @I ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing - J Special Provisions: • The well is to be decommissioned prior to IR approval. Please submit the Well Decommissioning Log. l Received By: Issued By: Date: Date: _ �� A z 3 Development Services Department �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-091-43 Property owner(s) EDWIN Day phone _ Mailing address 9301 BUDDY WERNER DR, ANCH AK Site address SAME Legal description (Sub'd., Block & Lot) PROSPECT HEIGHTS #1 BLK 5 LT 9 Legal description (Township, Range & Section) Lot Size 88000 Sq. Ft. Number of Bedrooms/3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) 0 (w/wo ADU) Upgrade 0 Duplex (D) ❑ Renewal F-1Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 360D Waiver Fees: _ Date of Payment: l U �a! 2 Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Oct. 20, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: PROSPECT HEIGHTS #1 BLK 5 LT 9 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). The existing dry well (see stie plan) will be decommissioned per the MOA codes. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221438, Deb Wockenfuss, 10/25/22 WELL 1"=50' EXISTING LEACH FIELD MT TH#1 NEW 1000 GALLON PLASTIC TANK W/ 20" RISER 30' WELL DRIVEWA Y EXISTING HOUSE EXISTING WELL 100' RADIUS Xref .\Williams_TB.dwg PROSPECT HEIGHTS #1 BLOCK 5, LOT 5 SCALE: DJRDRAWN: DATE: PROSPECT HEIGHTS #1, BLOCK 5, LOT 9 Anchorage, Alaska DUANE & SHERRY ERWIN 10/5/2022 DRIVEWA Y-BUDDY WERNER DR-PROSPECT HEIGHTS #1 BLOCK 5, LOT 8 PROSPECT HEIGHTS #1 BLOCK 5, LOT 10 PROPOSED DRAINAGE FIELD EXISTING DRY WELL TO BE DECOMMISSIONED PER THE MOA CODE EXISTING STEEL TANK TO BE DECOMMISSIONED PER THE UPC PROSPECT HEIGHTS #1 BLOCK 5, LOT 6 CONCRETE PATIO, AT GRADE BOTH WELLS ARE OVER 100' FROM THE PROPOSED SITE, NO CONFLICT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221438, Deb Wockenfuss, 10/25/22 ►• 49 TH y SHANE A. HOLT m G LS -6914 o`O LOT 5 THEINFORMATION HEREONIS FOR THE USE OFLENDING INSTITUTIONSSPECIFICALLYTO SHOWANY CONFLICTS BETWEENEXISTING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS,'AND IS NOT TO BE USED FOR POSITIONINGADDITIONAL STRUCTURES, IMPROVEMENTS, ORFENCELINES. EASEMENTSOFRECORD, OTHER THAN THOSEAPPE4R/NG ON THERECORD PLAT, ARENOTSHOWN HEREON ( UNLESS INDICATED) NOTE.FENCELINES THATMAYAPPEAR ON THISDRAW/NGARENOTTO BE USED TODETERMNE PROPERTYLINESORPOSITIONADDITIONAL IMPROVEMENTS. ANYPAV/NGSHOWNHEREONMAYBEAPPROXIMATEDUETO EI(CESSIVESNOWAND/ORICE. 'SURVEY I" = 40' THIS SATE /HERESY CERTIFY THAT/ HA VEPERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 9 BLOCKS PROSPECT HEIGHTS SUB. ADD'N. I ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENTS SITUATED THEREONAREWI7HIN THEPROPERTYLINESAND NO VISIBLE ENCROACHMENTS EXIST 07HER THAN NOTED DATEDATANCHORAGE,ALASKA THIS 57H DAYOF OCTOBER , 2022 7564622744 9309GROVERDRIVE 9NCHORIGFAK 99507 223-8615 3751060 NET i~ ,MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I [~] NEW Wayne Erwin 243-5664 []UPGRADE 'MAILING ADDRESS 7154 Linden Court, Anchorage, AK 99502 LEGAL DESCRIPTION~t~ Lot 9 Blk ~ Prospect Heights LOCATION Buddy Werner Drive ND. OF BEDROOMS 3 Well Absorption area Dwelling P El~ZM IT ~ ~ DISTANCE TO: 178 10' 7 ~ Manufacturer Greet MateriaIs~ ,o..~par~ Liq. capacity in gaUons Inside length Width Liquid depth 1~000 IF HOME,DE: ~ ~ DISTANCE TO: Well DweUing PERMIT NO. O Z ~ Manufacturer · - ~ Material Liquid capacity in gallons  Well Foundation Nearest lot line PERMIT NO, DISTANCE TO: ~25 ~ 25 ~ 80 ~ 780275 ~ No, of lines Length ~each line Total length of lines Trench width Distance between lines - ~ 43 3 6 inches ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area m 4 1/2 ' - 6 ' 72 inches 516 m Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well DISTANCE TO: Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ ~ ~Ok~ ~ Cast to PVC drain SOIL TEST RATING 125 SF/B.R. ~ ~k~T INSTALLERJ A.A. REMARKS ~ ' 1" x 2' wide styrofoam insulation over pipe. Vis-queen over washed rock. End vent was 8" perforated ~ ~ pipe wrapped w~~ueen. ~-- A~ROVED¢ / < 7' DATE , LEGAL ' FIPPL I CANT SCOTT SELL LOCA'I"ION B-~,~YY HERNER LEGFtL L'=9 B5 PROSPECT FI'T'S LINDEN (71' 99502 4529 S6!LIflF.:E FEI:iT TYF:'~: OF SC.IlL. RBSORBTION SYSTEM II~;: TRENCH HRXIMUM NUMP, ER OF B~DROOMS .= ~ SOIl.. RATING <S6! FT/E,'R>~ ~.2r5 THE REC!UtF:ED SIZE OF THE SOIl. ABSORPTION SYSTEM THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF' THE TRENCH OR DRf~INFI~,ZLD. THE: DEPTH OF a TRENCH OF: PIT IS~, THE ,P,tSTRNCE BETNF=EN THE SUF.:FACE OF THE GROUND AND THE BOTTOM OF THE E~',CAVATION ,::IN FEET::,. , THERE .IS NO SET NIDTH FOR TRENCHES. THE GRRVE'L. DEPTH IS; "rile M]:NIMUM DEPTH (:iF GRAVEL DETHEEN 'H'4E: OI.,.tTFfiLL PIPE: FIND TH[.:: BOTTOM OF' THE ENCflYFtTION (IN FEE:T:.L PERMIT FIPF'LICRNT HaS 'THE RESPONE:;IBILII'Y 'FO INFORM THIS DEPARTHS:NI' Dt.,IRIN6~ THE IIqE;TALLR'FION INSPECTIONS OF ANY ME',LLS ADJACENT TO THIrd; PROPERTY FiND THE NUME]E:R OF RE:SIDENCES THAT THE NELL MILL SERVE. BFiCKFILLINCi OF ANY SYSTEM NITHOUT FINFIL. INSPECTION RN[~ aPPROVAL BY THIS [:.EPRRTHENT HILL BE 5LID.]EOT TO PROSECUTION, MINIMUM DISTANCE DE'TNEEN A HELl.. aND ANY ON-SITE SEHf~GE DI~;POSRL SYS'I"EI~t IS J. O0 FEET FOR a PRIVATE NEL, LJ OR t50 TO 200 FEEl' FROH R PUBLIC NEI,,L DEPENDINO UPON THE TYPE OF PLI~LIC HELL. NELl,. LOGS ARE REC!UIRED AND MUS'T' BE RETURNED TO THE DEPARTMENT HI'Il-tiN E~O DRYS OF' THE NELL COMPLETION. OTHER RELqU~REHENI'S MAY APPLY. E;P~C~F'~CRT~ONS AND CONSTRUCTION D~RGF:RME; ARE AVAILABLE TO ~NSURE PROPER :INSTALLATION. I CERTIFY THAT ~.: I RM FAMIL.!RR NITH THE REC!UIREMENTS FOR ON--,SITE SEHER, S FIN[,'.', HELLS AS SET FORTH BY 'THE MUNICtPFtLITY OF ANCHORAGE, 2: I MILL tN2;TRL.L THE ~YSTEN IN RCCORDI~NCE NITH THE CODES:. Z: I UNDERSTAND THAT Tt4E ON.-E;ITE ~SEWER SYS'I"EM blAY RELTtUIRE ENLRROEHENT iF THE ¢:E:5IDENCE I$ REMODELED TO INCLUDE MORE: THAN ~: BEDROOMS;. ......... .%:s~"L_ , ..' ¢ - ........... ¢= ~L.-~~ ~PL., t UHNl :~UF F :)ELL ...q .~, / - . g , Alaska 99503 ~'er~ormed For Sherry Erwin ~ ......... Date Performed ll- Lenal Oesgr~ption, Lot 9 ~__. ....... ___16-77 · ~ _ ~uur. 3 bUD~V1SIO~ Prosl~ect He~ .hts Thts ;orm Re~orts Soil~ Lo~ f'~s ~--~ ~. . ~ .- Subdiy]fitor werco~at~on iest Feet So~l Characterist{cs Peat 4 Brown Silty Gcave.lly Sand 6 .... (SM) Brown Sandy Gravel 10 ~ (GP) 14__ 162_ 20~ Brown Silty Gravelly Sand (s~) Bottom of Test ltole I~as ~round Water Encountered? No I~ Yes, At what Depth7 Read,hq Date Gross Time Net Time De.nth to H20 Net Drop L Percolation Rate ~lfnute Proposed Insti'T'l-~-t--~-6~': Seenaoe Pit Drain F~eld Oeoth of Inlet Oep~h~---~-o~tom Of P~t OF:Trench .... Cn~PENTS:~ 13~ S~, ~ r~i-uaif, a_n_Lan__r~~~ from minus 6.0 feet to 13 feet. Date: //- ~-?? Drilling Contractor Mailing Address , Property Owner Mailing Address Location o[ well site: Depth .in Footage Under Certification That This Log Is True aL~Q~orrect Signature oJ Driller ,',~/'~/Z,¢.o~ ,., ,- ~ .~. ,,~.:~~, , , Date #"~ ~'fj~ 1.~ 7~ ~ ?~ ~ 7w~ ~ ~ h~ ~. ~. MUNICIPALITY OF ANCHORAGE 0 t Development Services Department 1 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-091-43 Certificate of On -Site Systems Approval Expiration Date: Legal description PROSPECT HEIGHTS #1 BLK 5 LT 9 Site address 9301 BUDDY WERNER DR Current property owner(s) ERWIN DUANE A & SHERRY D X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: 11/18/2023 bedrooms, with the following stipulations: By: , 1 Gf� 1% / JP.t1 C_00Q (' r Original Certificate Date: 8/18/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services 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 work. ATTACHMENTS: COSA Checklist X Well Flow Advisory _ Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory _ Other COSA Approval_June 2022 MUHMPAUTY OF Development Services Department On -Site Water & Wastewater Section ANCHORAGE A• 4A Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-091-43 Complete legal description PROSPECT HEIGHTS # 1 BLK 5 LT 9 Location (site address) 9301 BUDDY WERNER DR„ ANCH AK Current property owner(s) EDWIN 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑® 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 ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑® AWWTS ❑ Bed 0 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 Date of Payment COSA # 05G 23121, i Waiver # COSA Application—June 2022 COSA Checklist Legal Description: PROSPECT HEIGHTS # 1 BLK 5 LT 9 Parcel I D: 015-091-43 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 UN Total depth ft Cased to ft ® Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9/23/22 Static water level at beginning of test 112 ft Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: NEW PLASTIC TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) 6/16/78 ❑01 ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade 4.4 ft (min) ❑ N/A —pressurized field. ❑ Per record drawings, field is insulated. ❑E1 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 Com ments/Deficiencies: COSA Checklist June 2022 Well production at time of test 3+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 No © Coliform bacteria is Negative Nitrate 5.14 mg/L ❑ Nitrate less than MRL (ND) Arsenic Collected by Date 7/26/23 _ ug/L M Arsenic less than MRL (ND) MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 9/23/22 Results Q Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 6 in Elapsed time 1440 min Final fluid depth 2 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 2 in Effective depth remaining 72 in 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' OYes if No _ ft Neighboring Tank > 100' ❑m Yes if No _ ft Absorption Field on Lot > 100' E Yes if No _ ft Community Sewer Manhole/Cleanout> 100' 0 Y✓rs if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100'❑ Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No _ ft 0 Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No _ ft O 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' 7 Yes if No _ ft Surface Water > 100' ❑� Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' ❑i Yes if No _ ft R Yes if No _ ft 0 Yes if No _ ft ❑� Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑� Yes if No _ ft 0 Yes if No _ ft If tank or field is under driveway comment below 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 Finn Mi /?G Al -.4.7 r1 e t 44. N R t✓ Engineer's Printed Name Sn K+C Date Y��`�Z3 OF A �`eea.AAr,q OW it INffE ".- • �,� �+�/ /. .. : s-.-..........� �•� •MICHAEL N. ANDERSCN r�++lf9 CE- 469PRO Phone 727-8864 COSA Checklist—June 2022 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC231291 Subdivision: Prospect Heights #1, Block: 5, Lot: 9 A water sample revealed a nitrate concentration of 5.14 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. 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. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~IEPT, O;' ', ;?,'\LI';! &  825 L Street - Anchorage, Alaska 99501 E;~[ViR©N[¢,~iqTAL i ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~[~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1, PROPERTY OWNER MAILtNG ADDRESS PROPERTY RESIDENT (If different from abo.e) PHONE 2, BUYER MAILING ADDRESS PHONE 3, LENDING INSTITUTION · MAILING ADDRESS  PHONE ~, REALTOR/AGEnT MAILING ADDRESS 5. LEGAl1 DESCRIPTION STREET LOCATION 6. TYPE OF RES|DENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three I~] Six [] Other~ 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] 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.) ** i f individ ual/on.site, g~i~n, stalb, t~on d~e NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 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 [] INDIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: ] (~)(~) (:~ If Tank is homemade SOILS RATING give dimensions: j TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DiSTANCESwELL TO: S e p t i c ~H ~..~di n~:~a n k A b s o ;pt~_n~ r e~a lSewer Line Nearest Lot Line Absorption Area to nearest Lot Line [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~ DISAPPBOVED DATE BY {Tide) LEGAL DESCRIPTION 72-010 (Rev. 3/78)