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HomeMy WebLinkAboutT12N R3W SEC 15 LT 126Onsite File #015-482-01 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191389 PID Number: 015-482-01 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: Deryl Titus ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 10201 Elmore Rd, Anchorage ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot 126 Fill added above original grade Ft. Gravel length Ft. Township Range Section T12NR3W 15 Gravel width Ft. Beds: Number of Lines Distance between lines FL SEPARATION DISTANCES To Septic ' Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank ( Field Lift Station Tank Line FP Ft. Well 100'+ 100'+ TANK ® Septic [IS.T.E.P. C1Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. i Surface Water 1100'+ i I Material Plastic Number of compartments 2 Lot Line 10'+ NA LIFT STATION _ Foundation 10'+ I ! Manufacturer Capacity Gal. Curtain Drain NA Pump on level at Pump off level at High water alarm at Remarks TANK INSTALLATION ONLY in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tankTank to D3036 drainfield D3036 Installer Eagle Glacier Excavating Drainfield CO/MT D3036 Inspector ;lrcterra Consulting BENCHMARK (Assumed elevation) 100 ft Inspection 1t Location and description dates 10/12/19 2"° __.._..........._. 3f—__.___._..........�. 4 th u Garage door slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL �► 1t�0 OF tt + +� t Conditional Approval: Date ;,►GjFt 49Iti • - r i KENN r ` OF -us i ---...... ......_......_._—__.._.......... ---..__._...._._ Approved �/1LG� �rt,�'� Date CE--T11,6,r �E+ raw inspection Report_9-1-1L.000 A -C=32.0' B -C=16.6' A -D=34.8' B -D=21.8' A -E=70.1' B -E=42.5' A -F=67.6' B -F= 36.8' A -G=36.9' B -G=21.9' A -H=38.0' B -H=21.8' A-1=38.7' B-1=21.6' AS -BUILT SYSTEM DETAILS/SITE PLAN Tl 2N R3W SEC 15 LOT 126 N89'56'37"E (N90'00'00"E 279.93 Ra100' Permit:OSP191389 PID# 015-482-01 280.33' 279.93' R) N OU) p > 0 ® FCO DIVERT 24.0' DECK N—a O') ��m .� u z� —+ E F MTiCO nom -w -on NOTES ON SITE INSPECTOR VERIFIES TANK ISAMINIMUM 5 FT SEPERATION FROM FIELD < OF `� 49rru KE D S CE— ryeAof jj.. sslo 9.50 99.23 1000 GAL SEPTIC PREPARED FOR: DERYL TITUS 10201 ELMORE RD. ANCHORAGE, AK (907)-351-5051 FIELD BOOKS Compulm: MMDARY' A DRA" : I( STAKING: N A CHECKED: KMD ASSUILT: JLS DATE: 11/04/ Dvr_ ML IGmD: 2536 ACAD.FILE: FILE "e Na: 18-185 SCALE: V= 30' SCALE: NTS E+ c <'r' SIN, Aw, 2 Pon � , t•' f H # 9 Z � 3" i siVn r a _ Y Un h (NOT SULT) E N 0 { 0'0,'(-J f,,) ,_ ---- .-......_ _.,.._ w` 4 3 Ira ��C � y ..m Pm q z C 4 ci. �CD f c <'r' SIN, Aw, � , t•' f H # 9 Z � 3" � siVn r r� s ? Y nrzxvw � �'.raxi h (NOT SULT) YL swm; f^e e f � � I r m�.as4mna»au�zcsau'mam�w.�„ ? Y nrzxvw � �'.raxi h (NOT SULT) E N 0 { 0'0,'(-J f,,) ,_ ---- .-......_ _.,.._ 4 Ira ��C � y ..m Pm q YL swm; f^e e f � � I r m�.as4mna»au�zcsau'mam�w.�„ aroma- eu�as+easv�rs�.,mwmv..� rna�vax H,-zvmaaeav+:'��raa� ma wz.w.m m+xww�,��ut�'uxam�a+mkr.HIm. awau meu:samwreureau»aemwoss.�e. �n.<w, x�.evaantmswawsvvmaraeaz+xr'hn �m�.� «�«sw�asm-mvc~�*�m'+ew�nva�aw»m mmrr. .m,.w.se� �<sxwes,'.erv. EASJ.- -1101ST AVE nrzxvw � �'.raxi (NOT SULT) E N 0 { 0'0,'(-J f,,) ,_ ---- .-......_ _.,.._ z C 4 ci. �CD f E E z I f( N .,0ler(YO E 28a,„' (0190' , 7 i b i € 3 f f 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: OSP191389 Work Type: SepticTank Upgrade Tax Code Number: 01548201000 Site Legal Address: T12N R3W SEC 15 LT 126 G:2536 Site Mailing Address: 10201 Abbott Loop RD, Anchorage Owner: TITUS DERYL A & KELLY J Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 1.)epartment 10/9/2019 10/8/2020 32200 ❑ Disposal Field D 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 Received By: 46 Z� t Issued By: A'ectk Date: Date: �� 4 / 3 MUNICIPALITY OF ANCHORAGE 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. 015-482-01 Property owner(s) Deryl Titus Mailing address 2110 Meander Dr, Anchorage AK 99516 Site address 10201 Elmore Day phone 351-5051 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12NR3WSec 15 Lot 126 Lot Size 32,200 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Q Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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: V07 S: d Date of Payment: 8130 0 � nn Receipt Number:ffi pp SV Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc o �FtCTERR,y ,,p x AncTr:111ZA CONSULTING, INC � 20441 Ptarmigan Bld, Eagle River, AK 99577 ... _ 0 TINGOffice (907) 696-6111, Fax (907) 868-3793 '(e'�G'YSUL� � Fq AK. 995]]-gl�fi August 29, 2019 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Sox 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit — T12N R3W SEC 15 Lot 126 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3 -bedroom house. The adjacent lots to the east and north are undeveloped and the lot to the south is served by a private well as more than 100' away. There is no surface water within 100' of the proposed tank. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 696-6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. D fu , P.E. Attachments: On -Site Sewer Application Wastewater Absorption System Details/Site Plan 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 — SYSTEM DETAILS/SITE PLAN T12NR3W SEC. 15 LOT 126 -- 51 �o J m 30 1 VACANT 0 50 279.93 1P7 EAST 659.86 B.L.M. Permit:OSF N1389 PID# 015-482-01 (96-143) 4.96 126 SCALE: 1" = 100' 20' Gas. Tele 32.18 S89' EAST 329.93 B.L.M. EAST 114.93 1. DECOMMISSION EXISTING SEPTIC TANK PER CODE. 2.INSTALL NEW 1000 GALLON SEPTIC TANK WITH TWO POST -TANK CLEANOUTS PER CODE 3. INSTALL CLEANOUT AT CONNECTION WITH SEPTIC LINE. 4. TANK TO HAVE MIN. 20" MANWAY RISER. 5. MAINTAIN 10'+ FROM FOUNDATION & EXISTING FIELDS. 6. MAINTAIN 100'+ FROM PRIVATE WATER WELLS. NOTES NO WELLS ON ADJOINING LOTS ARE WITHIN 1 00'OF PROPOSED TANK PLACEMENT. NO SURFACE WATER NOTED WITHIN 100' OF PROPOSED TANK PLACEMENT. OF AZt PREPARED FOR: -1U' DERYL TITUS �� 10201 ELMORE RD. * ,1 T * ANCHORAGE, AK `t (907)-351-5051 �1 KENNNETILM. D S FIELD BOOKS COMPUTED: l$ty/ tCl 15-1 Afr BOUNDARY: N A DRAWN: KSD STAKING: N A CHECKED. KMD F'ESSIO�-AV ASBUILT: _ DATE: 9/5/ 1 DWG. FILE GRID: S W25; ACAD RLE: FILE JOB No.: 1818.55 mes/ArcTerra Shared/Storage/WELL & SEPTIC — Filed By Leqal/Seward Meridian/T12N, F 15/Lot 126/18185 TANK REPLACEMNET 8.19.dwq SYSTEM DETAILS/SITE PLAN Permit:OSP I(13,� T12NR3W SEC. 15 LOT 126 PID# 015-482-01 279.93 DRIVEWAY 1: REMOVE AND REPLACE EXISTING TANK WITH 1000 GAL. INFILTRATOR TANK UNDER BRIC WALK WAY, OUTSIDE OF WELL RADIUS & 10' FROM BUILDING 2:INSTALL 2 POST TANK CLEAN OUTS 3:INSTALL BARRIER TO PROTECT TANK FROM DRIVEWAY l MT. ! , 5 f7GtirGZT v"nn. +"o Pr 4-0 to e Co�1 - a . k ,,, e- Pl �. v`rrA4 i R=1 COs mlo EXISTING PREPARED FOR: DERYL TITUS 10201 ELMORE RD. ANCHORAGE, AK (907)-351-5051 FIELD BOOKS COMPUTED: BOUNDARY: N A DRAYN: KSD STAKING: N A CHECKED: KMD ASBUILT: _ DATE: 9/5/1 DWG. FILE GRID: 255.36 ACAD FILE FILE 10B NO'' 18185 SCALE: 1" = 20' BUILDING PORCH 1 i MUNICIPALITY OF ANCHORAGE ii'/~',,~ ~ I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION '~'~!~' L~/ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ . PHO~ ] ~NEW LEGAL DESCRIPTION -- V NO. OF BEDROOMS~ Well Absorption area - b-Z Manuf~cturer~ L'"' ' ~,~(~ Materia3¢~l N°' °f c°mpaltmonts 2 L q capacity in gallo~s ~ Inside ~ength Mdth Liquid depth [Z~O~ Ih HOMEMADE: · ~ Well Dwelling PERMIT NO. DISTANCE TO: O ~< Manufacture~ - ~' Material Liquid capacity in gallons ~ ~, DISTANCE TO: WeH~ ~ Foundation gl Near's{ ,~t line tel ~ Irr~ _ ~ No. of lines Lengthofea ~dine I Total lengthofline ~ Top of ,ile to fb, ishgrade --- Material beneath tile ~ - ~ q' 601' inches Totaleffoctiveab,~(] -- LenGth Width Depth PERMIT NO. ~ ~ Type of crib ~rib diameter Crib depth Total 0ffective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE ~ '~ Class Depth Driller Distance to lot lin~ P~RMIT NO, ~ Buildin9 foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: PIPE MATERIALS ,-- so . T ST ...... REMARKS / ~ __ fl_ } // ~ .... / / ~_ . ~-~ ,.~ ~PPROVED DATE LEGAL 72-013 (Rev. 3/78) Permit ~ Applicant: ~c~- Location: Legal Description: ~/~ ~j ~2.~ ~ Type of Soil Absorption System Is: MUNICIPALITY OF ANCHORA6E Department : Health and Environmenta? Yotection 825 ~ Street, Anchorage, AK. ~)501 264--4720 * * * HANDWRITTEN PERMIT * * * ~O-~'~ WELb AND/OR ON-SITE SEWER PERMIT Mailing Address: Phone ~,/A~ C/~k~Lot Size: Trench: Drainfield: Seepage Bed: ~ Holding Tank: Maximum Number of Bedrooms: _~ . Soil Rating(sq.ft/br) ~%/ The Required Size of the Soil Absorption System Is: DEPTH ~ LENGTH ~ ~/ GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of grave]L between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(H(~L-DI~G-)- TANK SIZE = /~-~ © GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department. will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * * I certify that: (1) I am fami].iar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more t~7 3 b~ooms. SJ. gne~: ~ Issued by: -~ SWP/024(1/81) /0<:' c, [; a Departmen+ of Health 825 L Street, Permit ~t Applicant: Location: and Environment~l Anchorage, AK. 264-4720 '~ ~ ~ HANDWRITTEN PERMIT WELL AND/OR ON-SITE SEWF-R PERMIT <:-/~-~ ~: ,~ Mailing Address: Phone Number: Protection 99501 Legal Description: /£ < ~, , ~ C .... ~/ ~' E /-~ l; Lot Size Type of Soil Absorption System Is: Trench: Drainfield: ..... Seepage Bed: . ~ _ Holding Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) Tank: ..... The Required Size of the Soil Absorption System Is: DEPTH _ } LENGTH "&C~ ~._")_/__. GRAVEL DEPTH C-" WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet:). There is no set width for trenches. The gravel depth is the minim]lin depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * ~ REQUIRED SEPIIC(HObD-?NG-) TANK SIZE = /~-c, C3 GALLONS '~ * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * s~ckfilling of any system without final inspection and approval by this departmen wi1.1 be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon tile type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 o° 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 begrooms. Signe~: App 1,/~ c an t Issued by: Date: SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTI-! AN[) ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Aiaska 99501 2.64-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST LEGAL DESCR'PT'ON:__q--lzN¢ / 3tJ,, 15- 1 SLOPE SITE PLAN 2 3 4 5 6 7 8 ~0- 13 14 15 16 17 18 19 20 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IE YES, ATWHAT _ DEPTH? Gross Reading Date Time AbD ~l~.~J #: z 5:15 Abb ~o Net Depth to 'rime Water '~O ~OM~ · ~0 .2.5 .20 ,2o PERCOLA FION IRATE (S (minutes/inch) TEST RUN BETV~EEN __~.~-- FT AND ~ FT [ef~b~!~;T A:T It~0~ l~u,e 'Th 4~ I{ d~'T~'N-'i-, CERTIFIED BY:. DATE: SOILS LOG 1 2 3 7 10 ~2 17 ~8 2O MUNICIPALITY OF ANCFIORAGE , DEPARTMENT OF HEALTH AND ENVlRONMEN'FAL PROTECTION 825 L, Street, Anchorage, Alaska 99601 264-4720 SOILS LOG - PERCOLATION ]'EST PERCOLATION TEST SLOPE DATE PERFORMED: WAS GROUND WATER ENCOUNTERED? AJO SITE PLAN IF YES, AT WHAT DEPTH? Reading f (}ate Gross Time /p,'~? Net /~--~ Depth to Time Water ,~ [; 1'7 /o 'q ~' ~ /,,z? 10 ,q~ +HzO ~,'3¢ ,Sz PER~ATION IRATE f J~ ~,~)lO (minutes/i~ ./ TEST RU~BE~WEEN __~__ FT AND ~ FT --/ Net Drop ~L/~$1t/~ I~II'"'~UIIlII~IllAL UUIIIHUL 3Ul~U" ':3, Illb. ~lill~rmq [ {~nuironmtnlol SN~I~ PERCOLATION TEST DATA SHEET ADDRESS ZIP CODE LEr~L LOCATION ~. [~-~ .~-/L,'~)_~ (..~-C~-OF'I..../~ L~'~ {'~-~1:, -- TOTAL DEPTH OF HOLE_ d_ ~ft. ZONE TESTED - c~ 1/~ .ft TO </ ft TH ~..-.--.L. TEST HOLE DIAME'FER__~O_._" READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (rain/in) DATUM FINAL PERCOUNTION RATE PERFORMED BY_ MOA 5183-024 SQUARE FOOT/BEDROOM .(mtn/in) WATER WELL RECORD STA'rE OF: ALASKA DEPARTMENT OF NATURAL RESOURES Oivision of Geologicel ~ GeophysieDI Surveys LOCATION OF WELL (Please complete either la~ lb or lc,) BOrough Subdivision/ Lo, IR,oe L.r, '/,,.,r.. I ~DISTANCE ANO DIRECTION FROM ROAR ~NTER~ECTIONS Section No. TownshiPN0 RanGe EEl Meridian sE] wE] I S. OWNER OF WELL: Address: 2. WELL LOG Material Type ,t/ ./~ IS. WATER WELL CONTRACTOR'S CERTIFICATIOR: Feet Delow Surface TOp BOttOm / ~ ~Z;~- 4. WELL REPTH: (flnol) 5. DATE OF COMPLETION 6. z~'Cable tOOt [~]Rotory L-~Drlven /~]'Oomestic [] Public Supply [] Industry 7'OSE~C~lrrigallon []Recharge [~] Comn, erlcal ~-] Telit Well [] Other: 8. CA,~INO= [] Threaded ~ Welded dlar~._~ In IO..~/,'Z~. Depth Weight _,/ .~-/__.lb$./fL diam. in Io - fl, Depth Sllckup '~..,. ft. 9. FINISH OF WELL: ft. s'rAYtC WATER LEVEL= /Z/:S~ ft. // ~-~/~>,:~ [] Above or ~ Delow land surfooe Date /. e / -~ II, PUMPING LEVEL below land surfaoe and YIELD IE.GBOUTINB Well Grouted: [] Yes ~.No Municipality of Anchorage ` On -Site Water and Wastewater Program (907) 343-7904 S A ` T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel l . D. 015-482-01 Expiration Date: —2 ^ 2026 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 15 Lot 126 Location (site address) 10201 Elmore Rd Anchorage, AK Current Property owner(s) Deryl Titus Day phone 907-351-5051 Mailing address Real Estate Agent 10201 Elmore Rd Anchorage, AK 2. TYPE OF DWELLING:--. ® Single Family (w/wo•ADU) ❑ Duplex_,..,,' ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well El Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer - '9 -2_5_ —.ZQZ�Q L) W D0 <7 ,ao1y51 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of thevalidation.date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,..and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AI< 99577 Engineer's Printed Name KENNETH M. DUFFUS Date !�44e Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future +r► `�\ occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE M.System #1 Approved for bedrooms. �� xL.iaE1 7 `'s .Ae System #2 Approved for bedrooms.�n Disapproved. Conditional approval for bedrooms, with the following stipulati s: .`��\�Y OFAA,n4 sl�W V — r WATER AND WAST`-v�'ATER oz A s e J� `O!t _ �1 By: i V.V\ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: T12N R3W Sec 15 Lot 126 Parcel ID: If more than 4 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 11/27/83 Total depth 215 ft Cased to 215 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 26 in. Date of flow test for COSA 8/4/20 Static water level at beginning of test 153 ft. Comments B. TANK DATA Age of tank(s) 10/12/19years Tank type/material Se_ ptic/Plastic Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 11/1.4/83 ALL standpipes present per record drawing Total measured depth from grade 14 ft (max) Measured depth to pipe invert from grade 9 ft (min) ❑ NIA — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet 411 G_dRI_til Well production at time of test 4.7 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative Nitrate 7.76 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 8/4/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/22/19 Results ® Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 33 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES ® Yes if No ft Surface Water > 100' From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes Septic Tank/Lift Station on Lot > 100' ft Wells on Adjacent Lots. Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' If septic tank is under driveway comment below Animal Containment > 50' ® Yes if No ft ®Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10` ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots. Water Main > 10' Absorption Field > 5' ® 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 septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line >10' ® Yes if No ft Community Wells > 200' ®Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 1 -Titrate Advisory Certificate of On -Site Systems Approval # OSC 201451 Subdivision: T12N R3W Sec15 Lot 126 A water sample revealed a nitrate concentration of 7.76 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 O Box 196650;* Anchorage„Alaska 99519 6650 *,www muni org 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. MU~I[CIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEAL'fI-I DEPA[~I'MENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION ~)R HEALTH ~iITHORIR~f APPROVAL CERTIFICATE 1 .C~..ne~al Information Application Date __/_-~_i/_2't!' L (a) Legal. Description (include lo~, block, subdivision, section, tcvmship, range) Location (address or directions) (d) ! Applicant is (c~ck one) Landing Institution R~ lep!f~q_ne~ Lending Institution Address (e) F~al Estate Cx>~ & Agent Address Y~].ti-Fanily~--~ Other ( de scri~.~ ) otate Note: If ccanunity ~11 system, must have written ccnfirnr~tion fr~n tfi~e Department of 5wironrmntal Conservation attesting to the legality ~d status. Is ~e ~11 adequate for the nu~r of ~dr~ms s~cified in this ~ ~) 4. Is the wastewate~' dis~sal system adequate f~ the nem~r [Page 1 of 2] 5. E~%gi_~neerin_.q Firm Pr_qo_vidi_n.~L~gspeet~__~ipn__s, Tests, Data and Information I ce~.tify that I have ch~cked, verified, or confor~f~d to all Y~A [~ ~i~li~s in effect on t~ ~te of ~%is inspection. Signed by (ENGINEER 6. DItEP Approval Approve d fo~__~ ...... h~dr oc~rfl Appro~d ]~ .... Disappr~oved C: l'ern~ of Conditional Approval %he Municipality of Anchor_age [~p~:tx~nt of Health and Environnental Protection dces not guarantee the continued satisfactory performance of the. wate~r supply and/or tile wastewater, disposal system. %his approval indicates that, as of the validation dat~. shcwe ebon, based on t~%9 data and inforrmntion ful:nished by an ehxjir~er registered in the State of Alaska, the water supply and wast-ewater disposal system is safe and func- tional for the n~2mber of bedrc~Jms and type of structuee indicated~ ( E(tEP SE~d3) 7. Idail the HAA to the ~o].lcm;ing adduess: KB2/d5/s [Page 2 of 2] 2-15-84 ae Well Classification _~(~l~r0~Cj Well Log P~esent ~) ~,~.5 __ Total D~pth ~' 0 ~d to Static Wate~ ~1 /~ Casin~ ~ight ~ G~nd ~' Elee~ical Wi~in~ in ~nduit ~) (~.~ ~p~ation Distan~s f~ ~11: ~ To ~ptic~oldin~ Ta~ ~ ~t ~' ~ To ~a~est ~ of ~so~ption Field on ~t MUNICIPALITY OF AN~:' MUNICIPALITY OF ANCHOI~GE (MOA~ DEPT. OF HEALTH & ·- ']-'NVIRONMEN/AL PROTECTION' HEAL]~ A[YfHORITY APPROVAL (HAA) CF~ECKLIST - FEBRUARY 1984 If A, B, c~ C, D.E.C. Approved(Y/N) ~/~ [late Cc~pleted _ ~/-~7 ' 2..1~~ Depth of G~outing ~]/A Set Sanitary Seal on Casing · Depression A~ound Wellhead '~ __; O~ Adjoining Lots ~/~ d otntng Lots TO Newest ~blie ~ Line ~/~ _ To ~est Public Clean~t~anhole ~/~- ~o ~est ~ ~vi~ Li~ on ~t ~/~ Wate~ S~p].e Collected By ~' 0~ ~ , ; ~te . Wate~ S~]~ Test ~su%ts~ <3 ~a~l~ ~q¢'l~W . , , , ~ "~ B. SEPTIC/HOLDING TANK DATA Date Installed _JL/-_L~b~__ size /~5c3 No. of Compartments ~ Standpi~s (Y~) Hf.~ Alit-tight Caps (Y~) ~,~.f~ _ Foundation Clean~t ~Y~) ~5 ~p~ession o~ Tan~ (~) ~6 ~te ~st Pt~__ .,P~ing~intenan~ Con~a~ ~ File (Y~) ~/~ ; fo~ ~ Holding Ta~ High-Wate~ ~a~ (~) ~//~ ~a~y Holdil~ Tank ~mit ~} ~p~ation Distan~s ~ ~ptic~olding Tank: To Building Foundation ~ To Disposal Field .. ~ To Stream, Pond, Lake, c~ Majo~ [krainage [Pa~ 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /l o/4/.~8~ Width of Field ~ '~0~f~ Square Feet of Absorption A~ea Depression Over Field (Y/N) Results of last Adequacy Test Length of Field., _ Depth of Field Standpipes P~esent (Y/N) Date of last Adequacy Test Type of System Design, Separation Distancs from AbsorpLion Field: To Water-Supply Well /0~~ To P~operty Line To Building F, oundation ~! To Existing o~ Abandoned System Lot ~/~ ; On Adjoining Lots To Wate~ Main/Service--~' nine .~0' To Cutbank(if present) ~/~ To Stream/Pond/Lake/o~ Major Drainage Course ~/dO / To Driveway, Pa~kipg A~ea, c~ Vehicle Storage Area ~' Cormr~nts D.. LIf~f STATION Date Installed Size in Gallons "Pump On" I~vel at High Water Alarm Level at Tested fo~ Electrical Codes(Y/N) Dinensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~nts ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, or confo~msd to all MOA HAA GuideliP~s in effect' on the date of this inspection. K l/dS/s [Page 2 of 2] 2~15-84 D~PT. OF ENV~RON~NT~L ~O~§ERV~T~ON SOUI'HCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 ! BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274.-2533 June 25~ 1984 Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Sir: Subject: ~2N, R3W, Section 15, Lot 126 ~.le have reviewed your letter of June June 25, 1984 regarding a waiver to 96 feet between the septic tank and the private well. This request is approved. Sincerely, Anchorage/Western District Supervisor JCA/msm cc: Robbie Robinson (MOA)