HomeMy WebLinkAboutCLEARVIEW LT 5
(Rev 05/02118) G
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page I of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 251386
PID Number: 015-242-44
Dwelling: X Single Family (SF) n with
ADU E] Duplex (D) [I Two Single Family Project: n New 01 Upgrade
Name
MATHIS
ABSORPTION FIELD
El Deep Trench n Wide Trench n Bed n Mound
Site Address
8100 ALATNA AVE
0 Other
Phone
Number of Bedrooms
Solt Rating
Total depth from original grade
14
GPD/SF1
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
CLEARVIEW LOT 5
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
Holding
Sewer
Total absorption area
Number of trenches
Dist, between trenches
From
Tank
Field
Tank
Line
FO
Ft.
well
100'+
50'+
TANK 51 Septic [I S.T.E.P. [3 Holding 0 Other
Manufacturer Capacity
GREERANCH TANK/ DEEP BURIAL 1250 Gal.
Surface Water
1001+
Material
PLASTIC
Number of compartments
2.0
Lot Line
101+
NA
Foundation
1+
F10
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 dTank to rainfield 3034
Installer
MIKE N ANDERSON
Drainfield CO/MT3034
BENCH MARK (Assumed elevation) 100 ft
Inspector MIKE N ANDERSON
inspection 10125/25
Location and description
nd
dates: 2
MANHOLE LID
3b 4m
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
E ine Stamp
Conditional Approval:
Date
TH[
1'� • MICHAZI N* At,
Septic System
V. CE - 9469
Approved
Date
No . this approval does
not include well permit requiremen
(Rev 05/02118) G
Permit No. OSP251386 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
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: CLEARVIEW LT 5 PID No.: 015-242-44
lU UIILIIY fS
ARK
A
B
TC01
23.5
13.3
TCO2
26.8
17.7
c01
30
21.9
CO2
31
23.2
LOT 5 NEW 12 GALLON PLASTIC
TAN K
BENCH, TOP OF MH
4 12' HI H DECK C01\ CO2
/ SMALL GROUND EVEL DECK LOT 6
TC01
Y B
1
I �
WELL
I � I
I I
I
10' UTILITY ESMT /
ASBUILT /
SCALE: 1"=50'
rcoz ."`��1
FCO TC01, BENCH MARK CO CO2 ..� F 11,
o .� ♦ �.......... .
i'• 49TH
•...,....,f.,..,,..,�...,....::.....�
SEPTIC SECTION
N.T.S.
;.MICHAEL N. ANDERSON; amu:
No. CE 9469
-1-25 •o
�•'••••......•••''��� ♦♦♦
Permit Number:OSP251386
Tax Code Number:01524244000
Work Type:SepticTank Upgrade
Effective Date:
Design Engineer:
Site Legal Address:CLEARVIEW LT 5 G:2740
Owner:MATHIS ALASKA COMMUNITY
Site Mailing Address:8100 ALATNA AVE, Anchorage
Lot Size in Sq Ft:50107
Total Bedrooms:4
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
Water 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. Coodinate with On-Site staff regarding preferred method.
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
10/20/2025
10/20/2026
HUBER ENTERPRISE
Expiration Date:
¨þ ¨¨¨¨
Issued To:
Issued By:
Date:
Date:
10/20/2025
10/20/2025
HUBER ENTERPRISE
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
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251386, Isatou Njie, 10/20/25
Clearview Lot 5
SepƟc Tank Replacement
Project NarraƟve/DescripƟon:
Clearview Lot 5, beƩer known as 8100 Alatna Avenue, in an exisƟng 4 bedroom residenƟal
property with an exisƟng sepƟc system. The System consists of a 1250 gallon Steel SepƟc tank that was
originally installed in 1990. The ExisƟng Drainfield for the property is a single 72 foot long deep trench
with 7 feet of effecƟve depth.
The exisƟng drainfields for the property we tested and are in proper working order. No new
drainfield is proposed.
The exisƟng private water well for the property is located near the SE corner of the site. A 100-
foot well radius is shown on the plans. No waivers are requested.
Design CalculaƟons
Flow Rate: 4 Bedroom Residence at 150GPD/Bedroom
- Design Flow = 4 bedroom X 150 GPD/bedroom = 600 GPD
SepƟc Tank Size: Minimum Tank Size shall be 1000 gallons plus 250 gallons for each bedroom over 3 per
AMC 15.65.205.
- 1000 + 250 = 1250 gallons Minimum Tank Size
AbsorpƟon Area: The exisƟng drainfield areas was designed as a Deep Trench type system that is 72
feet long with 7 feet of effecƟve depth. The soil test at the Ɵme indicated a percolaƟon rate of 0.6
GPD/SF. This is adequate for todays standards.
I am unaware of any adverse impacts this installaƟon would have on any wells or sepƟc systems
constructed in the adjacent area. Should you have any quesƟons or require any addiƟonal informaƟon,
please do not hesitate to contact me.
Sincerely,
Logan M. Huber P.E.
(772) 528-6287
Lhuber87@gmail.com
Feet
0 20 40
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251386, Isatou Njie, 10/20/25
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
I~---,./~/..,~ P-~ ~'d ATH. I ~ ~ SEPTIC ABSORPTION
Address TANK FIELD WELL
~ O. ~ O~Perm,tL~ 0 ~ ~ ~No. of Beerooms WELL
Phone(s)
CEGAL DESCRIPTION LOT LINE '
Lot I Block I Subdiwslon
Township, Range, Sect,on I g ~~ ~ FOUNDATION
AS-BUILT DIAGRAM (Show Iocahon of welt, septic system, property hnes, foundabon,
-- ~ L~N , ~ ~, ~ C ~ dnveway, water bodies, etc)
TANKS
~ SEPTIC g HOLDING /
Manulactu~er Capacity ~n gallons
Material No. ol Compa~ments
TYPE OF SYSTEM
Depth to p,pe bottom from I Total depth from original grade ~
or,gmal grade ~ FT I O ~ /
:dl added above origmat grade Gravel depth beneath p*pe a~
Gravel length' Gravel w~dth ~,,
7~ FT ~ FT
J
Total absorption ~re~ DIstance between Jibes
JOO~ SOFT FI/
Numberolhnes ]Sodrabng j P~pematerial
Installer ¢ - ,~ -~* Date ~
WELLS
~ PRIVATE ~ OTHER (Identify) J
~ ~ ~ FT FT /
tnstahei Date Installed:
REMARKS:
I ~ p ~ I ~O I Scale: "~,;ENGINEER'S SEAL
~ inspections PeHormed by; ~: ~
~ ~ ."'
I ~~ c~dily thai l~is i~pemi0n cas ~edorme¢ acc0rdin~ t0 all
¢ -
Health Depa~menl Appro~al: ~ - Date:
72-013 (3/85)
WATER WELl.: RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division-of Geological ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Pleole complelo either Io, lb or lc.) ' A.D.L. No.
T~:l. IBorough /)$ubdivieion ~ Lot Blook I-~.I . ~/4qlre. Soefion'No. Town~hlPNr~ Rongo' EI-~ Merldlort.~
~ DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ' $. ~WNER OF WELL;~
Street Addres~ end Area of Well Locetlo~
Material Type Top Bottom
~ ·. 0 .~ 6. . ~Cabl. tool' ~otary ~Driv.n~ .~ . . . ~Du,
t~ ".' /~ dium~ ' :'.1;. ID""': it. Depth Stickup ~ ft.
' .' ..' ~t ~t1~, ' ' ,:'.' fl. ,nd fl.
~ ' ~,~fllllnl~ ~r,~l p,~
· . ~ ',
' ,: .' I1: PUMP~'LEVEL bll~ I~nd ~,rfo~e ,nd YIELD
,,... .' . . ,... , , .: ,,.. ,- .~. :,., . , .,, . .. '..", fl,. uft~r hrs. ~umpl~j ~.p.m.
Othlr:
. . I~,P~IPJ (1t ~l~llo~l~)
HP
:. L~it~:~l D~p Pip~ fl, ~p~ll2 ' ~.~.m.
,. .. , · , '>:":. , ,' .... ,
. .' ' ." : ' "0:""-:0 c,,',,,,--, 0
16.. WATER WE~L CONTRACTOR'S CERTIFICATION:" ' ~' - --~ '" '
~ ,. . 15. Woler Temperature o ~ F ~ C
This well wos~drilled~de~ j.Or[~dlctlo~ ~ t~report Is true ~o the ~s~Of .~ knowledge and belief;
~egistered ~siness'Nam~ ~ '__.. '/ Contact LIcenee N~mber
Aulh~rlzed Rj~e sonic tl'~
Form OZ-WWR (11/81) .Copy D. istribulion; '~WHIT~-Sfol~ DGGS~ PINK-OHIle~ CANARY-Cuslemer
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
2
4
5
6
7
8
9
10
DATE
SLOPE SITE PLAN
~r~ ~r' e· A 'e
I".. ee.. o~.,,~='~'~'~e ..H~'. . · ~/
~~ ENCOUNTERED?
S
1
1
IF YES, AT WHAT
DEPTH?
E
Depth tO Water Aller
13 ~~ Monitoring? Oate~
14
15
16
17
A
I-
" Se.-" '(.
/' ,!?'
/
!,
~L
19
20
Gross Net Depth to Net
Reeding Date Time Time Water Drop
PERFORMED "¥:
^CCORD^NCE W~T~ ^LL ST^~E AND ~N~C,~AL ~U~DEUNES ," EFFEC~ ON ~H,S D^~E.
PERCOLATION RATE a~--.~ (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ / -'~' FTAND 7 F'r
DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEErS,SEAL)
DATE PERFORMED:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section:
SLOPE
WAS GROUND WATER . t
ENCOUNTERED? ~ (~)
S
L
IF YES, AT WHAT O
DEPTH? p
E
T ~.N:~-StY.,,, ..q~-.C_
SITE PLAN
Depth to Waler After
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
?.~/ - o - -. -- ? -- _
1.. iz. /: lz. ~ -.~ ~5_._
~:oo l:¥& 7
PERCOLATION RATE ~ (minutes/inch) PE~RC HOLE DIAMETER ~:
TEST RUN BETWEEN ~ FT AND ~-~ ~/~FT . ,
'7~.-z.. k./¢ · -., ' , ~ ·
PERFORMED BY: I ' -~ I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~-
WITH
ALL
STATE
72-008 (Rev. 4/85)
,:2'
EL~.GT UTTL t
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
, Tobben Spurkland P.E.
, Tobben Spurkland P.E.
.. W&TER WELl. RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Oivllio# of GIolo~Icol & Geol~hl~$1¢ol Survtyl
Orilll#g Permit Me.
'II~.IILL'';~ ;" (Pleele 4l~f4~e ell~ee lc, Il #le.) &.O,L. Ne. ' '
,""--"--~-- '0 '0
~'~d.&~..~r~v.1. brow.- ~.4o~t -'~t~, 1:'. ~0 ~a..., 0~ O~ 0o.~,~
.. .... ~ ~.,, -.. ~ om.= . ,
. ' . ' . '" - I. cIIme, ~.~ ~d~ ·
,,,,,, ,~m., .... u ~., ~ lt,7 .,h~,,, w,~pt 1~
I'~ ~o.. ~.~'. ~-~,:. ~'.~ ~ ,.,,.,,.o,.,~.,o~-. ~. ..
Y~:,
~d'~'~"C;r' vel: ~r~n, '~:Lt': 7~,te-.; :.~6 ~? ~t.,/u..h Sin: k.~:,,,
Oet.
I .:' ~ ~t~' 0 A~ ., O ~'.- I.~ ..,f.~
m _ :~, ' m ,, ~_ , ft. I1~ J ' LH' tllkl - I.l.l. *
' -' · II, ~M~ { If I~11111~{ Mt_
I ' ' D '""- D '"' ~ C.,r,,,., D
I 14. IIIlffll: .....
Ad~l~4 ~t~l~ ~ "-
.,,,~,,~. v
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~2~ L ~ A.~'k(mlge, Ah, Mm g~501 2~4-4720
SOILS LOG - PERCOLATION TEST
PF RCOLATION
TEST
HH
~'
DATE PER FORMED: ~.~..~
SLOPE
SITE PLAN'
i~ ~-,\
\
\
15.
~, 14
?.
16
19
SA,NI~
F
ENCOUNTERED?
O
P
IF YES. AT WHAT E
DEPTH?
Rmdk~ Dete Grme Net Del]th 1o Net
Ti~ Time WIltS' Droo
~'~" '
·
f, .~.e
~.~..., ..... ~ .... ..~..,
PERCOLATION RATI (~
TEST RUN BETWEEN , ,, FT AND FT
CERTIFIEDBY., ~, ~
4,4~/,~,~'1~g,..~ 4~A~,~//IF YES. AT WHAT
OEP, TH'~
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Pleoee complete either la,'lb or lc.) A.D.L. No.
'a.lleoroush S.~=di.i,ioa Lo, B,ock~ '/,qtre. S,,Io. No. To-,.hi,,l::3 R,O. Er-']
Street Address and Area of Well tocotlo.
~. W~LL LOG Feet Below
Surface 4. W~L~ DEPTH: (final) 5. ~TE OF COMPLETION
4,"~ ~'/ ~ ~'' /~ ~ ~ 7. USE:~DomesIIC OPubllc Supply
.~,/~.,*..-:6 .... ~'" ~- ~ ~/ O ~','"." O o.~.,: , _,"" "'
x ~ / ~ ,./ 9. FINISN OF WELL: ~ ~
~'~ ~'~ '~ Diameter:
~'~,;_~, ~+ e-~" ,~ ?') / ~.'~ /~ ,/ 0 ~ Slot/Mes'h Size: Length:
.~ ;.-~_ ~. ',~%~ ,. ~/.i,'~, {z~ .'/'/ /'l)~/ /(?. Z.~ Backfilling .... Gravel pack
· ~ , . ~x ~ /~ ~/ ;./ ~,/ ? , ~,,..~ IO. STATIC WATER LEVEL: ~' C./ ft.
,"~"'~'~ / 1~.:) t ~ 0
.,-.~ ........ * ~ II. PUMPING LEVEL below lend lurfGce Grid YIELD
'~'(:.'/ ~ ff. Qfltr hrs. pumping
,.?*' Moteriol: ~ Neqt Cement ~ Other:
· ~ .~.- -* I~. PUMP: Cif ovolloble) HP
Length of Drop Pipe ~ft. copocity ~O.p.m.
~- . ~ ~1 ,
16. WAT[R WELL CONTRACTOR'S C~'IFICATION: '--~"V~/O~_ 1'~-- //,~ ~
~5. W;ler TempeToture _ o ~ F ~ C
Thi& wetl ~ol drilled pn~e~ my ]u[isd~cl on ond Ibis reporl ts Irue Io the best of m knowled · on
~''~ .' · /Ii ~ -/ // ~ . ~ Y g d belief;
~,,,,,:.,.: <:... ~.~-~,.- //~/~ ~,~,~ _ ~ ~.:] .
Authorized Re~'~nta/ive . -- ~'
.Form O~-WWR (11/81) Copy Distribution: WHITE-State DOGS, PINK*Driller, CANARY-Customer
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10.
11
12
13
14
15
16
17
18
19
20
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
. Lro'"T
~ IL.T'
DATE PERFORMED:
SLOPE
Reading
SITE PLAN
u ~ ~ ~o~ ~4 WAS OROU.D WATER
ENCOUNTERED?
IF YES, AT WHAT
DE.T.;
PERCOLATION RATE
TEST RUN BETWEEN FT AND
COMMENTS
PERFORMED BY, CI:::RTIFIED BY: ~/,~
Net
Time
Depth to
Water
Net
Drop
(minutes/inch)
FT
72-008 (6/79)
DATE:
MUNICIPALITY OF ANCHORAGE
Development Services Department-7904Phone: (907)343
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251492
Parcel ID 015 -242-44
Legal description CLEARVIEW LT 5
Site address 8100 ALATNA AVE
Expiration Date: 10/30/2026
Current property owner(s) MATHIS ALASKA COMMUNITY
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
0
Original Certificate Date:
11/10/2025
This Ce icate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
syste (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.
ATTACHMENTS:
COSA Checklist X
Absorption Field Advisory
Tank Age Advisory
Other
Well Flow Advisory
Nitrate Advisory X
Arsenic Advisory
4. TYPE OF WASTEWATER L
ystems Approval Applic,
LT 5
n. ocr i m, i mnmm:;" oteei u riasur, U concrete " rwergiass
Age NEW - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWfS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for: Distance:
Expedited review requested: ❑
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 # C (�,. -6 I ` 4'� a Waiver #
COSA Application_Apr2025.doc
COSA Checklist
Legal Description: CLEARVIEW LT 5
Parcel ID: 015-242-44
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) Well production at time of test 2.6 gpm
Date drilled 10/8/90 Total depth 207 it Water storage tank volume 0 gallons
Cased to 123 ft Well disinfected for coliform test? ❑ Yes ❑ No
❑M Sanitary seal is functioning correctly N Coliform bacteria is Negative
❑J Wires are properly protected Nitrate 5.52 mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) 18 in. Arsenic ug/L 0 Arsenic less than MRL (ND)
Date of flow test for COSA 10/30/25 Collected by MNA
Static water level at beginning of test 58 ft. Date '10/30/25
Comments `NEW BACTERIA TEST FROM MATSU TESTING 11/5/25
B. TANK DATA C. LIFT STATION
Measured operating fluid level in septic tank NEW ❑ Required maintenance completed
Date of pumping NEW Age of lift station _ years
❑ Required maintenance completed, if AWWTS Lift station material
Comments:
D. DISPOSAL FIELD DATA
Which system tested (date installed) 10/9/90
0 ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
j] 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
Comments/Deficiencies:
COSA Checklist_May2025.doc
Comments:
Adequacy test date 10/9/25
Results ✓0 Pass
Fluid depth prior to test 72 in
Water added 600+ gal
New fluid depth 74 in
Elapsed time 1440 min
Final fluid depth 72 in
Absorption rate 600 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 84 in
Effective depth used 72 in
Effective depth remaining 112 in
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100'
Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No ft
Z Yes
if No _
ft
_
Neighboring Tank > 100' ❑✓ Yes
if No _
ft
Sewer Service/Septic Line > 25'❑✓ Yes
if No _ ft
Disposal Field on Lot > 100'[Z] Yes
if No _
ft
Holding Tank > 100' 0 Yes
if No _ ft
Neighboring Disposal Fields > 100'
Animal Containment > 50' ❑ Yes
if No _ ft
✓❑ Yes
if No
_ ft
Manure/Animal Excreta Storage > 100'
Sewer Line/Main > 100' OYes
if No
_ ft
❑ Yes
if No _ ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10'✓❑ Yes if No _ ft Surface Water > 100' ZI Yes if No _ ft
Field to Foundation > 10'
Tank to Property Line > 5'
Field to Property Line > 10'
❑Z Yes if No _ ft
0 Yes if No _ ft
QYes if No _ ft
Water Main/Service Line > 10' [D Yes if No _ ft
F. ENGINEER'S COMMENTS
Wells on Adjacent Lots:
Wells > 100'
Community Wells > 200'
❑/ Yes if No _ ft
❑� 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 Firm MIKE ANDERSON
Engineer's Printed Name
COSA Checklist_May2025.docx
SAME
Phone 727-8864
Date 11/3/25
��eelOZc.
INEEIi',
/.
,a' MICHAEL
CE -94G9
Wf �
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT,f0907-343-7904
On -Site water and wastewater Section~ Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC251492
Subdivision: Clearview, Block: , Lot: 5
A water sample revealed a nitrate concentration of 5.52 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.
Mailing Address P .4 Box 196650 *Anchorage, Alaska 99519 6654 * www:muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
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ANCHORAGE RECORDING DISTRICT, ALASKA
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LOT 5 PLAT 80-178
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SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the �� �`� . • " • 9s,1
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance shout / GJ:
any information on this drawing be used for constmerion of fences, ? * ; 49TE
structures, improvements, or for establishing boundary lines. /
EXCLUSION NOTES: It is the owners responsibility to determine ""
the existence of any easements, covenants, or restrictions which , 0 OHN L SCHULLER;
do not appear on the recorded subdivision plat. /+; � LS -10408
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1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 faa