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HomeMy WebLinkAboutFIRE LAKE BLK 1 LT 12Akr%cv VU/UZJ ion Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221177 PID Number: 051-361-09 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name RACHEL WHITE ABSORPTION FIELD Deep ❑Wide Trench ®Bed ❑ Dee Trench Al❑ Mound Site Address 13817 MALASPINA STREET, EAGLE RIVER, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 817-707-7582 4 0.7 GPD/SF JTotal SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 0.51 Ft. Subdivision Block Lot FIRE LAKE 1 12A Fill added above original grade SEE DWG. Ft. Gravel length 60+ Ft. Township Range Section - - Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 900+ Ft2 - -Ft. Well *1001+ *100'+ - - 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 1001+ 1001-+• - - Material Number R compartments Lot Line *51+ *10'+ - - NA PLASTIC 2 Foundation 10'+ 10'+ - - L ct )N Manufacturerer Capacity Remarks *WELL RADIUS AND LOT LINES WERE STAKED Gal. BY A REGISTERED LAND SURVEYOR Alarm location _ _� Electn c fled by Installer PIPE MATERIAL House to tank D3034 Tankto D3034 NORTHERN EXCAVATION Drainfield D3034 CO/MT D3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 103.78 ft Inspection ection 1s' 8/10/2022 2�e 8/11/2022 Location and description aro 8/12/22 41h 8/12/22 GARAGE SLAB (RIGHT DOOR / RIGHT SIDE) ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �o60pO4� o QFIq oaQ Conditional Approval: Date o �� " f • �5,0� �� o� ��� 7 *_ 4 tH , P Septic Sys m '. fray A. Gdrness;' Q 1009 l�E Approved / Date "� �_Z 795y3 Note: this approval does not include well permit requirements. paprofess"°"°oma #AECC884 kr%cv VU/UZJ ion PARCEL ID PERMIT NUMBER: RECORD D RAW I N V 051-361-09 NUMBER: OSP221177 / i I A B C i ( ' \ FIRE LAKE; \ BLK 1, LOT 14A / NOTE: THE NORTH & WEST LOT LINES AND THE 100 -FOOT NEW DRAINFIELD, WELL RADIUS WAS STAKED BY A REGISTERED LAND i SURVEYOR PRIOR TO CONSTRUCTION. I ' i ` Lx_x_x_X_X_X_X_X_K_X EXISTING SEEPAGE ' DBL1 59.1 55.4 68.6 DBI -2 59.5 562 69.4 MH 76.7 75.2 83.6 ST1 81.0 79.7 87.1 DBI -3 82.8 81.1 87.8 DBI -4 83.5 81.6 87.8 FD 94.2 84.7 81.2 C01 97.7 88.0 83.7 MT1 87.3 81.0 82.4 CO2 86.3 79.5 80.9 CO3 81.7 74.8 77.2 C04 77.4 70.1 73.6 MT2 76.1 69.5 74.0 MT3 120.1 94.5 66.3 COS 117.9 92.2 64.4 C06 115.0 88.3 59.4 C07 111.4 83.8 54.0 MT4 112.0 83.9 53.3 nc ®® Ilia � 9�1 .......... ...jam./.........:�.,,.c....., ENGINEERING,- SALES - CONSULTING. _,.. �_ /ll1 1j 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA' PHONE (907) 337.6179' WEBSITE. www.gamessengineering.com �. .. .. ..5. ....�amess PREPARED FOR: PHONE NUMBER: PAGE NUMBER: � el ey A.••� * Ar RACHEL WHITE (817) 707-7582 2 OF 3 ®0�'�s,°... C 79 3 ' \�� PROJECTIL.EGAL DESCRIPTION: DRAWN BY: ®®® • �j � j9 �� �•.•' ®� FIRE LAKE S/D; BLOCK 1, LOT 12A J.L.M. 0 Fp •`'•••.......••,••�`'� a TYPE OF WORK: DATE: ®� ® RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 8/3112022 LICENSE #AECC884jut PIT. TO BE USED AS SCS ' NOTE: PIPE LOCATIONS ARE 1 , A RESERVE SITE ( SHOWN PER GEG SHOTS TAKEN ° WITH LEICA DISTO 5910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. \ '' INSTALLED FLOW �/ a / • TH#1 _ �::� EXISTING ' ED I DIRECTOR (FD) % .t ,:_. , . ' GARAGE p '`• INSTALLED ��' • +- :- tiry / ��,}• .l ti� i ' DBL CO'SL :" �/ "�! •:' �� �o I _ � (DBL3 & DBL4) y .: q� ? p� I ' a ! •' B • f ' {� I.LI NEW 1250 GREER I APPROX. LOCA ZTEM.ION W PLASTIC SEPTIC INSTALLED EXISTING ' � OF SEPTIC SYS TANK DBL CO'S q 4 -BEDROOM f I (DBL1 & DBL2) HOUSEco I ' i NOTE: OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC I \ PER THE CONTRACTOR. II SCALE: \ ' 1' = 40' i nc ®® Ilia � 9�1 .......... ...jam./.........:�.,,.c....., ENGINEERING,- SALES - CONSULTING. _,.. �_ /ll1 1j 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA' PHONE (907) 337.6179' WEBSITE. www.gamessengineering.com �. .. .. ..5. ....�amess PREPARED FOR: PHONE NUMBER: PAGE NUMBER: � el ey A.••� * Ar RACHEL WHITE (817) 707-7582 2 OF 3 ®0�'�s,°... C 79 3 ' \�� PROJECTIL.EGAL DESCRIPTION: DRAWN BY: ®®® • �j � j9 �� �•.•' ®� FIRE LAKE S/D; BLOCK 1, LOT 12A J.L.M. 0 Fp •`'•••.......••,••�`'� a TYPE OF WORK: DATE: ®� ® RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 8/3112022 LICENSE #AECC884jut PERMIT NUMBER: PARCEL ID NUMBER: OSP221177 RECORD DRAWING 051-361-09 1 TOP OF MANHOLE FINAL GRADE (MH1) = 98.63--\ = 98.47-9862. TOP OF TANK @ INLET = 94.47— INVERT OF BUNG @ INLET = 93.76 FILTER 0.51' OF EFFECTIVE T NEW 1250 -GALLON GREER PLASTIC SEPTIC TANK FINAL GRADE 97.13-98.55— TOP OF TANK @ OUTLET = 94.47 INVERT OF BUNG @ OUTLET = 93.56 —ORIGINAL GRADE @ HIGHEST POINT = 97.60 8 -FOOT MAX. DEPTH —INVERT OF DIST. LINES = 92.38 \—BOTTOM OF DRAINROCKJ TOP OF FILTER SAND =91.87 15 FEET WIDE \_ LIMITS OF EXCAVATION = 89.60 RELATIVE ELEVATION OF BOTTOM OF HOLE = 81.60 (TH DRY ON 5/19/202 1-4 A UARNESS ENGff INEI-11ERINk"ff GROUP, Ltd ENGINEERING* SALES i: CONSULTING 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, ALASKA -PHONE (907)337.6179'WEBSITE: www.gamoss"inearing.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: RACHEL WHITE (817) 707-7582 3 OF 3 PROJECTILEGAL DESCRIPTION: DRAWN BY: FIRE LAKE S/D; BLOCK 1, LOT 12A J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 8/31/2022 OF 4 ............. lw AV r 4. 4q 9 ......... .... .......... ....... ...... A . 10 @79r �l A 4 Fp <Pop . ........ 4W 4,��ESSO LICENSE IlIkjkVj #AECC884 I .00'08L M.,04'. L0.,00 N .UUUUL MjiUktWcUU N O i338iS VNIdSVIV w 0 0 < zo 0-0, 0 0;5 6 Ix V) �z z L �e 8 6 � o w m: z =1 0 — SOCW) e-- S Cl) 52 3: 0 D z cnoaw Br. 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U) r- 0 cd LL: MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PoBox 1oosno 4rnnElmore Road Anchorage, Alaska oyme-6oso Phone: 904 Fax: (oor)a*o-7ny7 oopmwmw.mum.ong/onu}te Permit Number: OSP221177 Work Type: Septic Upgrade Tax Code Number: 05136109000 Site Legal Address: FIRE LAKE BLK 1LT12A Q:0453 Site Mailing Address: 13817MAL&SP|NAST, Eagle River Owner: WHITE RACHEL LYNN Design Engineer: GARNEGGENGINEERING GROUP LTD This permit is for the construction of: 0Disposal Field R) Septic Tank [] Holding Tank [3 Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Depirtment 8/28/2O22 8/2882O23 n Private Well 171 Water Storage All construction shall behmaccordance 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) _ The wastewater ,code . ,inspections during,=,."=,."""" The engineer shall notify the Development Services Department per AMC 15G5.Provide notification by calling (907) 343-7904 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed omthe same day, mr b. Covered, sealed, and heated toprevent freezing _ Received By_ Issued By: 0 �b Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221042 COSA#: Permit#:OSP221177 PID#: 051-361-09 Legal Description: Fire Lake Block 1 Lot 12A Engineer: Garness Engineering Group Applicant: Rachel White Your request for a waiver of the required 18.0 feet horizontal separation from the proposed absorption field to the existing seepage pit has been approved. The approved separation distance is 10.0 feet. In addition, your request for a waiver of the code requirement that a bed be installed on a slope no greater than 10% has been approved. See engineer's waiver request and field section drawing for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: aS a4a2 Approved by: f (?WUB Name of Reviewer **** VARIANCE/WAIVER REVIEW **** unacipakAty of LA: August 10, 1987 P.O. (M` X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Robert A. Shafer, P.E. S&S Engineering 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 Subject: Lot 6A Block 1 Fire Lake Alaska Subdivision Waiver Request WR87-044 Dear Mr. Shafer: Your request for a waiver of the 100 foot separation required between the seepage pit on the subject lot and a private well located on the neighboring lot (Lot 12A Block 1 Fire Lake Alaska S/D) has been granted. The required distance has been waived to feet. A letter of non -objection from the owner of the well on Lot 12A was written in 1978 at the time of the seepage pit installation. 9`0- - You have submitte a risk analysis to this department that indicates that there is no possibility of bacteriological contamination of the well from the encroaching seepage pit. You have shown that there are elevated background levels of nitrate levels in the area. It is unlikely that these elevated levels are the result of this single well -to -seepage pit encroachment. This waiver is valid _for the existing seepage pit only. Should Ze t—require upgrade, the upgrade will be require to meet applicable setback standards. Sincerely, Stephen S. Morris civil Engineer On-site Services cc Gus Andress, P.E. Manager, On-site and Water Quality Programs MUMCIPALITY OF ANCHORAGE r..r Development Services Department � ' p p / Phones. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-361-09 Property owner(s) RACHEL WHITE Day phone 817-707-7582 Mailing address 13817 MALASPINA STREET, EAGLE RIVER, AK 99577 Site address 13817 MALASPINA STREET, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) FIRE LAKE; BLOCK 1, LOT 12A Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field 0 Initial ❑ Single Family (SF)x❑ Septic Tank Q rade X Upgrade (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 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: 9 5 Waiver Fees: 4-1q5 Date of Payment: 3 Date of Payment: -27-202� Receipt Number: 7 1 G Receipt Number: 0*ua) a of 5 6 Permit No. 03P 2-2-1177 Waiver No. ()SV 9 a 1 b 9 a GADevelopment ServicesOuilding Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221177, Rebecca Carroll, 06/28/22 Page 2 of 2 6. BED TO SEEPAGE PIT WAIVER REQUEST: On the proposed design, we are showing the new bed will be 10 -feet from the perimeter of the existing seepage pit. Based upon the MOA records, the seepage pit has 9 -foot of effective depth. We are requesting the required separation of 18 -feet between this seepage pit to the proposed bed type drainfield be waived to 10 feet. Justification for granting this waiver is the fact that the porous soils (<1 minute/inch) will allow for rapid downward migration of the effluent and result in minimal lateral migration ............ limiting the influence between the two drainfields. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistarAe. Sin Jey "Gar ems P.E., M.S. Pre .di t 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221177, Rebecca Carroll, 06/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221177, Rebecca Carroll, 06/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221177, Rebecca Carroll, 06/28/22 GPeATER ANCHORAGE AREA BOROI'-~H HEALTH OEPARTMENT ~"O. 5 4 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2~iI I INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: D~STANCE FROM WELt ?,:7' uqu~D CAPACITY /,,.Z.~ ~,,~,~sO~X~,~/...z.~ ~./,~~~ PHONE/..~/.c" LEGAL DESCRIPTION ,/~..~T.)~'"-,,__/-~ _~'./_~/_. _~~~ MATERIAL GALLONS. INSIDE LENGTH NUMBER OF / COMPARTMENTS INSIDE WIDTH ~ / LIQUID~,,i DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: /1 / , LENGTH J'"'~ / ~ / NUMBER OF PITS OUTSIDE DIAMETER .OR WIDTH /.~ / ., DEPTH / ..~' ,,~-"~.i~,/ BUILDING FOUNDATION LINING MATERIAL ~~2j'~'~}'/~r'''~'~-'''~ /'J~/'/L'/~":"$ DISTANCE FROM WELL /~"~ ~:~ / " , L/3-)- so. ET. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL __ ~.~'~ON NEAREST LOT LINE OF LINES , DF~H.. TOP OF TILE TO FiNiSH GRADE ~DC-'I~T"~FILTER MATERIAL BENEATH TILE IN ABOVE TILE WELL: TYPE~, DEPTH ~'~,~ '/ DISTANCE FROM ,~ X WATER · BUILDING FOUNDATION.. SAMPLE ,'/J'/~" NEAREST SEPTIC ~/ SEEPAGE ! ~ OTHER ~ NEAREST /,,.,/ TANK SYSTEM ./~.. 7 CESSPO0~ SOURCESE LOT LINE //~2 ! ~ , SEWER LINE " DISTANCES: c;~/..-~g: =/..z'7 ' DIAGRAM OF SYSTEM DATE ////",,~,~APPROVED ~ ~ ~ - ' HEALTH AUTHORITY GREATEF tNCHORAGE AREA r -~ROUGH CaseNo.~'6~- HEALTHDEPARTMENT 2792511 327 Eagle St. Anchorage, Alaska 99501 ' ~ sEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT -- NAME OF APPLICANT~ a ES~ DEN CE AC O REdS ~ ~,~"~-#Z,~ ;~,~, LEGAL DESCRIPTION~ APPLICATION TO INSTALL: SEPTIC TANK~ TO SERVE THE FOLLOWING FACILITY_ FINANCED THROUGH~ PERCOLATION TEST RESULTS ~_~.~ ~___~__ . To BE ,NSTALLEO BY__ ~" ~-' ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT MAILING ADDREdS ~rJx'/'~!~'°/'' /~;t''4''~'~ . PHONE NO.~~'?¢)-/5-/'~'- _ LOCATION OF INSTALLATION ~-'-/'~' /-~/~"' . _,OTHER__ THIS IS TO SERVE AS /~/~/~ ~' -, PERMIT TO INSTALL A _As DESCR'BE~ RELOW. S,ZE O~ UN,T TO BE SERVEG_ ¥ ~"~"-~ /~? ' .TYPE '- SEPTIC TANK SIZE [~-0 TYPE ~d/~()~"'~"-SEEPAGE AREA _ _. - DIAGRAM OF SYSTEM Io~ 07~t ~ ~ bd~(:~f~ DISTANCES: HI~'a'LTH {~RTIqORI ~ / ~O ' ~ -inance No 28-68 and, that the u~s~ ~?,o.~,.~ .... the re,,uirements of Greater Anchorage Area Boro.u. gl~ Ufa I certify that I am tammar wmt q w~th said code ~ - ' t-'5 ' above describes system is in accordance ' . ~t~t~[ ~~ ~ ZREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE # Performed For ~+ O~ra~,A Date Performed Legal Description: L, otj.~Block ]'' Subdivision ~-,'re This Form Reports a. Soils Log Z~--- .Percolation Test ..... ',",', .... ' ' Depth Feet Soll Characteristics Was Ground Water Encountered? /~ If Yes, At What Depth_ Reading Date ' -I ' ate" l~,/' r~olat 1 on Gross Time " ' 'M~nute' Net Time Location Sketch J ! I.l I Z'Li__J___J I il.. I I _l Ti:~i' i,lI il I Depth To H20 Drain Field Net Drop Proposed Instal~'~'tion:' Seepage Pit Depth Of Inlet .~ '~ , Depth To Bo~'~om Of Pit Or !rench _ COMMENTS: (',;Ir'. £e',~,,c,~.~' ~>rC~ '.- 10~' /~P~ .... '7/ /2.~ / 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 Parcel I.D. 051-361-09 Legal description Fire Lake Block 1 lot 12A Site address 13817 Malaspina St, Anchorage, Ak Current property owner(s) White Expiration Date: 1-17-2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: _ % 7 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 ApprovaLJune 2022 1 �LJr" `IPALITY O ANCHORAGE Develo menf Se-vic.as Department _ h P p - - �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL 4INFORMA i iON Parcel I.D. 051-361-09 Complete iegal descrip±ion FIRE LAKE; BLOCK 1, LOT 12A Location (site iddres , 13817 MALASPINA STREET, EAGLE RIVER, AK 99577 Current property owner(s) RACHEL WHITE 2. Old -SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 817-707-7582 3. TYPE OF V ATER SUPPLY: 0 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steei 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request [or: 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 $ � F 0 Waiver Fee $ Date of Payment /a 1131 as Date of Payment COSA # /J Sc a2-1'!�_y 9- Waiver # -/�d153g6-2 COSA Application June 2022 Legal Description: FIRE LAKE; BLOCK 1, LOT 12A Parcel ID: 051-361-09 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 3/16/1970 Total depth 92 ft Cased to LINK ft R Sanitary seal is functioning correctly MR Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/30/2022 Static water levet at beginning of test 81.8 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 8/10-12/22 © ALL standpipes present per record drawing Total measured depth from grade 6.7 ft (max) Measured depth to pipe invert from grade 4.8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 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) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 7.1 qpm Water storage tank volume N/A gallons Welldisinfected for coliform test? ❑ Yes R No [ ]'Coliform bacteria is Negative Nitrate �•�C mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L arsenic less than MRL (ND) Collected by GARNESS ENGINEERING GROUP Date 9/29/2022 STATION ❑ Requi e -C-- j Age of lift station Lift station matef Adequacy test date NEW SEPTIC Results [Pass Fluid depth prior to test NEW in Water added NEW gal New fluid depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate NEW gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used NEW in Effective depth remaining �-" in nA E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Yes if No ft Septic Tank/Lift Station on Lot > 100' Q Yes if No ft Tank to Property Line > 5' Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Ful Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' [E Yes if No ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' * 90 Animal Containment > 50' QYes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ME Yes if No ft Q 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 Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' © Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *EXISTING WAIVER GRANTED. SEE GEG 2022 INSPECTION REPORT. 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 Gamess Engineerinq Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system 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 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 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 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or parry (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 OF.4CIgN 9 ...:... .....7 ........ ..... .................... �J f Gorness* ''•t6�I.Z��"���o L11 ENS �rofes 5io ld% .1 ECC864 f-INI1I' Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221502 Subdivision: Fire Lake Block 1 lot 12A A water sample revealed a nitrate concentration of 5.2 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. "Mailing Address P Q Box 1`96650 *Anchorage, Alaska 99519 6650 *www mum orgy �� 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. IVladmg Address P O Box 650,,,* Anchorage, Alaska 99519 6650 *www rriuni org No.3 0 6 5 Name Address I'�" L%zA Zi WATER WILL LOG PATRICK DURPND FIRE LAKE AREA 0 - 20 Ft Cemented gravel 20 - 38 FT Cemented gravel 38 - 54 ft hard pan 54 - 90 Ft hard pan 90 ft - hit water 90 - 92 ft - Sand & gravel_ _ Bail tested well - 10 gallons per minute . BROTHERS, INC. P.O BOX .700 m PALMER, ALASKA 99645 OWen 16loffftf .- PH. 745.3700 _.. . 22% CEJ STATE OF ALASKA 13813 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 03/18/2016 Drilling Started: I / Com leted: 3 / 16 / 1970 Pump Install: City/Borough Subdivision Block I Lot Property Owner Name & Address Municipality of Anchorage F1 RE LAKE B 1 Ll 2A 9 Well location: Latitude Longitude Meridian S Township 015N Range 002W Section 36 I SE 1/4 of NE 1/4 of NE 1/4 of SE 1/4 BOREHOLE DATA: (from ground surface) Drilling method: it rotary, able tool,QOther Suggest T.M. Hanna's hydrogeologic classification system* https://my.ngwa.org/NC Product?id=a185000000BYub3AAD Well use:E]Public supply,ODomestic, E]Reinjection,[]Hydrofracking ri Commercial, []Observation/Monitoring,[]Test/Expioratory,FlCooling, 11 Irrigation/Agriculture, []Grounding, []Recharge/Aquifer Storage, 0 Heating,OGeothermal Exploration, []Other Fluids used: Depth From To Depth of hole: 92 ft Casing stickup: ft Casing type: Casing thickness: inches Casing diameter: inches Casing depth: ft Liner type: Depth: ft Diameter: inches Note: Well intake opening type:: Open end, pen hole,.D Other Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, PerforatedOYes M No Perforation description: Perffrom: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packedQYes QNo Gravel start: ft, Gravel stop: ft Note: Static water (from top of casing): ft on / / Artesian well Pumping level & yield: feet after hours at gpm Method of testing: Development method: Duration: Recovery rate: gpm Grout type: Volume Depth: From ft, To ft Include description or sketch of well location me u e roa names, buildings, etc.): Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion?Lj completion?'Yes E No Method of disinfection: Was water quality tested?QYes RNo Water quality parameters tested: Welldriller name: .................................................................................. Company name: MOFFITT BROS ............................................................... Mailingaddress: .................................................................................... h City: State: AK Zip: Phone number: (� AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Driller's signature: Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https:Hdnr.alaska.gov/welts/ Date: Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. OR email electronic well logs to City Permit Number: Date of Issue: t / dnr.water.reports na.aIaska.gov Parcel Identification Number: - - 'Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press