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HomeMy WebLinkAboutT12N R3W SEC 27 LT 8/0 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: OSP191523 Work Type: SepticTank Upgrade Tax Code Number: 01705110000 Site Legal Address: T12N R3W SEC 27 LT 8 G:2937 Site Mailing Address: 5010 GRIFFIN RD, Anchorage Owner: ALASKA AFL-CIO Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: ,l"C17( mot IV? J 111 f Departlllent 2/24/2020 2/23/2021 1:•11 ❑ 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 Special Provisions: 1. This property transferred title without a COSA. Prior to the expiration date of this permit, a COSA shall be obtained. If a COSA is not obtained, the On-site systems will be deemed out of compliance and an NOV will be issued. Received B) Issued By: Date: v U Date: 1 Municipality of Anchorage S.n: P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 O (907) 343-7904 A Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section x* x x VALIANCE/WAIVER REVIE``V x x x x Waiver#: OSV201009 COSA#: Permit#:OSP191523 PID#: 017-051-10 Legal Description: T12N R3W Section 27 Lot 8 Engineer: Garness Engineering Group Applicant: Vince Beltrami Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance is 90.0 feet and 80.0 feet, respectively. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field and proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. .............................................................................. 1 Waiver is Granted: X Waiver is not Granted: Date: Approved by: pp- _ Name of Reviewer .................................................................. 0 ........... I **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAG /6789 3 70 DEC 0 ° zarq _ Community Development Department Phone: 907-34,-79� 04 Development Services Fax: 907- 3 On -Site Water & Wastewater Program s L 9 Mayor Dan Sullivan On -Site Sewer/Well Permit Application 6N� For A Single Family Dwelling Parcel I.D���-051-10 Property owner(s) VINCE BELTRAN Day phone 907-224-6852 Mailing address 5010 GRIFFIN ROAD *ANCHORAGE, AK Site address 5010 GRIFFIN ROAD *ANCHORAGE, AK Legal description (Sub'd, Block & Lot) T12N R3W SECTION 27; LOT 8 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 1 APPLICATION IS FOR: ( ISI all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION PPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: PrODnCPd -nnL `i 4-D 1,1 TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 80-4 9 0 411 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: zat&ld Date of Payment: ab 202 0 Receipt Number: n Q9XYC161 Receipt Number: �� 52(,G Permit No. 45AP91523 Waiver No. O '�> � ab -1 0 09 (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd ENGINEERING o SALES- CONSULTING: --_— December 1711, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for T12N, R3W, SECTION 27, LOT 8 To whom it may concern: The subject lot is served by a private well and septic system. Per MOA records, the existing steel septic tank is 30+ years old. Per MOA memorandum, a septic tank of this age must be physically inspected and/or replaced prior to COSA approval. Based upon this fact, we are proposing to replace the septic tank. We are proposing to decommission the existing septic tank per UPC and install a new 1000 -gallon HDPE Greer tank rated for 10' burial. As can be seen on the attached design drawings, the proposed septic tank is approximately 80 feet from the existing well and the existing drainfield is approximately 90 feet from the existing well. We are requesting that your department issue a variance from drainfield to well and tank to well down to 90 and 80 feet respectively. Justifications for granting these waivers are as follows: • Water samples were pulled on 11/26/2019 and the nitrates were found to be 4.86 mg/L • The exact orientation of the drainfield is unknown. During construction, the south end of the drainfield must be located for the installation of a cleanout and monitoring tube. If the drainfield is found to be outside the 100' well radius, the waiver can be voided. • The existing septic tank encroaches on the well. Replacing the existing tank with an HDPE septic tank will be an improvement in terms of potential sources of contamination. • The home is located between the well and proposed septic tank and existing drainfield. If effluent were to overflow, it would not travel directly towards the well head. See attached design drawings for tank location and other MOA requirements. 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 assistance. A Sincerely, E., M. S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com HILL -N -DALE; TRACT A SCHUMACHER;LOT 9B - VACANT PER MOA RECORDS 1 0 I I 1 SCHUMACHER;LOT9A Tl 2N R3W SECTION I 27: LOT 32 II M CSEPTIC — >1 ! A CURRIN; LOT 1 00' WELL W'DIU CURRIN; LOT 41 GRIFFIN ROAD `\ / ---------- ----------.'------ / 1 1 I 100' WELL RADIUS I I 1 1 / Tl 2N R3W SECTION 27; LOT 33 % I I 1 \ \ \ \ GARNESS ENGINEERING GROUP, Ltd( c -- ENGINEERING SALES o CONSULTING —-� --- 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE. AK 99507' PHOjZIE (907) 337-6179' FAX (907) 338-3246 • WEBSITE: ww .gamessenginee6ng.com PREPARED FOR: VINCE BELTRAMI PROJECT/LEGAL DESCRIPTION: Tl 2N R3W SECTION 27 LOT 8 TYPE OF WORK: I- SEPTIC SYSTEM DESIGN UPGRADE PHONE NUMBER: 907-224-6852 PAGE NUMBER: 1 OF 2 DRAWN BY: D.J.G. DATE: 12/6/2019 T12N R3W SECTION 27 LOT 7 / / / / / I I _ 100' WELL RADI T12N R3W SECTION \ 27; LOT 34 1" = 100' of �`tit 4W • j .I AV a] E: �# ;.- CE- 3 ' _= J • . Zl.`.g. k ROFESSI�`:�� LICENSE #AECC884 GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER NOTE: THE CONTRACTOR I THAT PERTAINS TO THIS DESIGN. BY PROCEEDING SHALL HAVE ALL WELL RADII FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND FLAGGED BY A REGISTERED PROPERTY OWNER AGREE THAT THEY HAVE LAND SURVEYOR PRIOR TO READ THESE SPECIFICATIONS AND AGREE TO CONSTRUCTION. ACCEPT THE TERMS AND CONDITIONS OUTLINED. GRIFFIN ROAD 4 \ 50' Roadway & Utility Reservation \ 'T I : •S '•i \ APPROXIMATE LOCATION OF EXISTING TRENCH: INSTALL CLEANOUT AND MT AT SOUTH END OF TRENCH '•- \ •:.' PROPOSED 1000 GALLON HDPE GREER TANK RATED FOR 10' BURIAL; INSTALL DOUBLE CLEANOUTS BEFORE AND AFTER TANK OAPPROXIMATE LOCATION OF EXISTING SEPTIC TANK TO BE fy DECOMMISSIONED PER UPC j I •.. / \ O I ST1 O H' \ A. \ \\ w _• � EXISTING 1 O I / BEDROOM HOUSE �IN INFIELD I (A W I I I 90, WELL TO D� I � I I WAIVER REQUEST I 06 (D 'oo / ' I QIN I o of \\ � I \ S ALE: ���P • • ;-�10 GARNESS ENGINEERING GROUP, Ltd - I •....... W:..••.� - ENGINEERING c SALESo CONSULTING - -- �] �• �: 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK99507• PHONE (907)337 -6179 - FAX (907)338-3246•WEBSITE:www.gamessengineedng.com / ,a� ••••11��••• •••••••••• •••••.• , PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0%u % J,effr y�. Game s W ■ VINCE BELTRAMI 907-224-6852 2 OF 2 �jG'i / Cta`�9. ?s .� PROJECT/LEGAL DESCRIPTION:DRAWN BY: •S: �'• �I b���� AV T12N R3W SECTION 28 LOT 8 D.J.G. 1� c�Q pp'•••• •.•••••''P�, s� TYPE OF'WORK: DATE: '1� 11ROFPELICENSE k DESIGN OF SEPTIC TANK UPGRADE 12/17/2019 #AECC884 I 11D 'e MWIR" -j 'J7 0 _j (paindwoo) (INle) 96*8ZC MAC30.00N co 22.() P F_ 28.0 0 Z -ci Z! � 1 4 3) (1.) = .2:, P OE :5 C LO — M 0 Co 0 (1) - 1: cc U_ N 28.0 C8 0 0 V, Lq o (WE abed 'LZZZ X009) lu9w9se3 f4min 'Em v3:D,06 ------------ -------------------- L MC abed 'LZZZ MOOO) IuGwese3 Aam *E)*n v3om uo4eAjese�4mmg Aempeo�,oq MIS) LZ6ZC M.00.Z0o0ON of ci -j 'J7 0 _j (paindwoo) (INle) 96*8ZC MAC30.00N co 22.() P F_ 28.0 0 Z -ci Z! � 1 4 3) (1.) = .2:, P OE :5 C LO — M 0 Co 0 (1) - 1: cc U_ N 28.0 C8 0 0 V, Lq o (WE abed 'LZZZ X009) lu9w9se3 f4min 'Em v3:D,06 ------------ -------------------- L MC abed 'LZZZ MOOO) IuGwese3 Aam *E)*n v3om uo4eAjese�4mmg Aempeo�,oq MIS) LZ6ZC M.00.Z0o0ON z ci c 0 0 W Qa: z o cr m 0 CL co C s21 Ix 0 m 3: LL Z U) (r c LLJ j F- zCO:r w o < 2ago N too ci U) w CO d R � wz r t c c QS c SF0 O c c 2 o .0 r tw cc c rn x 0 E_ W :s (D 2 .(n 07 mm 2 c E cL E T 0 J m WX z e 2D cc 0 a) 5 2 cl a) 2 0 u 2 CLY a ) w -ED �3 -0 1% 0 OZ > a) M C -- M Wa 0 L) M ' ja co LL co -, ! .5 2 zac 76 0 JTO 0 C', C: 0 NCL 81,5i z O o 0 C) 0 0 mE Uw CD y r a) c to (0 co (n < C'4 c 2 0 W N it o > 0 (D N CN Om co cm ;F i6 mh co <c m m > Z: D:s CD z w 0 z =moo 0 0 W Qa: o www o cr m 0 IX 1: w 0 z z 3: w 6 1- w z 0 co Ix 0 m 3: LL Z U) (r 0 �: w � 0 m 0 Z LLJ j F- zCO:r w o < W cr 0) mw< (fj ci U) w CO d R � wz w t-- 0- D '~-'% 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 DISTANCE TO: UPGRADE Absorption area ~ I~ Dwelling Inside length I Width Dwelling NO, OF BEDROOm]vIS IF HOMEMADE: Well PERMIT NO, DISTANCE TO: Manufacturer Material Liquid capacity in gallons No. of compartm~ Liquid depth Foundation DISTANCE TO: No. of lines / Total length Distance betwem es Top of tile to finish grade ,~_~ ~) htile ~! 7¢i.¢hes Length Type of crib Width Depth Crib diameter Crib depth Well Building foundation DISTANCE TO: Class Depth Driller DISTANCE TO; Euildlng foundation Sewer line QTHER PIPE MATERI/ Total effective absorption area Nearest lot line Septic tank AbsorpBon area(s) Distance to lot Pine PERMIT NO. DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. ( DEPARTMENT t,, HEALTH AND ENVIRONMENTAL ~...DTECTION 825 "L" STREET., ANCHORFIGE, AK. 9950± 264-4?20 82:8786 ) RPPLIC:AN'r LOCATION LEGAL ARTHUR R. RLMON T±2N RSW S27 L8 PO BO)< iii2 995ii 995i2 274-2740 LOT SIZE i08900 SQUARE FEET TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH MAXIMUM NLIMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL AE,=,_EFTI_N _,~_,TEIt IS: [:, [---- F' 'T ~-i = -I ~_--~ L. Et'-tlS T H = 4]: ~3 F--." R %," E L [:,E F']-H == 4- THE LENGTH DIMENSION IS TNE LENGTH (IN FEET) OF THE TRENCH OR DRRINFiELD. 'THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AN[:, THE BOTTOM OF THE E,XCAVATION ,.'.'IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE FIND THE BOTTOM OF THE E,XCAVATION (IN FEET). PERHiT 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 NELL WILL SERVE. BACKFILLING OF ANY SYSTEM NITHOUT FINAL INSPECTION AND APPROVAL B'¢ THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i.£~E1 FEET FOR A PRIVATE WELL OR ±50 TO 200 FEET FROM ~ PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WINIt"IUM DISTANCE FROM A PRIVATE NELL TO R PRIVATE SEWER LINE tS 25 FEET AND TO ~ COMMUNITY ~ENER LIHE IS 75 FEET. OTHER REQUIREf'~ENTS ["lAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT ~: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS AND WELLS BS SET FORTH BY THE MLINtCtPBLITY OF ANCHORAGE. 2: I WiLL INSTALL THE SMSTEM IN ACCORDANCE WITH THE CODES. 3:: I UNDERSTAND TH~3T THE ON-SITE SEWER SYSTEM 1"1B9 REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. RPPL. ICRNT ARTHUR R. RLMON ISSUE[. E,T :__DATE V4. 0 , I EN~ONMENTAL ENGINEERING DIVISION ~ ~ 825L Sire' ,,n~or... Alaska .501 Telephone 264-4: ' ~ ~' ' ON~ITE SEWAGE DISP~AL SYSTEM AND/OR WELL INSPECTION REPORT LOCATION Liq.~Hons IF HOME.DE: Insid. lenglh Width L~quid d~pth Z -- ~ Material Liquid capacity in ~llons n 7~ inches Total efe~bs~r~ti~ =~--~ Ty~ of crib Crib d, ,er ~J'~ ~ib depth Total eff~,i~ absorption area ~~, --,~ . ,. ~ Class ~,h;~ ~ ~iller Distance to Jot line PERMITNO~~ m Bud ng foundation ~ ~r line ~tic tank ~ DISTANCE TO: ~ ~,~ OTHER / . DATE LEGAL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SO~LS LOG [] PERCOLATION TEST SLOPE DATE PER FORMED:~2~ SITE PLAN --10 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 72-008 (6/79) ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: {minutes/inch) FT AND -- FT ALASKA EIiUIROIlmEF1TAL CODTROL SE!F4uICE!$, J~n§in~erinq 6 ~nuironmcnlcd $1urJi~ InC. Mr. Keith Bandt MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 March 7, 1984 Dear Mr. Bandt: ./z In regards to the sepr~ sy em ~nspect~on of Art Almon s property at Tract 12N, Range 3W, S.Mo, Sectio~[27,/Lot 8. The septic tank was placed at a distance of 85 feet from the well. \To/~l~place the septic tank 100 plus feet from the well the tank would have to be reburied on the West side of the driveway on an embankment falling to Dearmoun Road, or it would have to be placed Northwest of the buildlng (labeled shack on the inspection form) and ~ast of the trench on a declinlng slope. This same falling slope limlts the length of the ~orth end of the trench. Either area is difficult to construct in, because it is on steeply sloping land (over 25%) and the fall of the septic system would be less than recommended due to long pipe runs from the house to the septic tank, and from the tank to the trench. Also, to clear up a few other minor points. The shack is built on a permanent block foundation. The soil log is incorrectly labeled. The North arrow should point to the right side of the paper. This would place the location of the soil log at approximately 10 feet from the cleanout at the North end of the trench. During the first inspection I examined the soil and found it to be a (GW) sandy gravel rated at 85 sq. ft/bedroom throughout the entire area the trench was constructed. At the North end of the trench the GW layer began at 4.5 feet and extended to 14.5 feet. At the South end of the trench (the ground was 4 foot higher here than at the North end) the GW layer extended from 7 foot to 14.5 feet, the bottom of the trench. Sincerely, Geotechnical ~.ngineer JG/caj 1200 LUesI 33rd Aucnu¢. SuiI¢ J~eAncJ~ora§¢. Alaska 99503,(907) 561-5040 FIELD PUMPING TEST DATA SHEET LOCATION OF WELL (Legal Description): ~,/~ WELL DEPTH: /~K~ FT. CASING: /F~r~ FT DATE DRILLING COMPLETED: /~,4 DRILLER: STATIC WATER LEVEL (Top of Casing): ~7,~- FT DATE OF TEST: _..~.~F.~_~ o~'' J?. 27 SCREEN: .......... C1 ock Time Elapsed Time Since Pumping Started/ Stopped, Min. Depth to Water, ft. /,.~ 5"29 o _ 1 5 10 15 20 25 30 35 4O 45 50 55 9O ~2D (2 15o 180 (3 210 240 RECOVERY 0 5 10 15 20 25 3O 35 4O 45 50 55 6O ~U 12U Drawdown/ Recovery Pumping Rate, GPM Remarks Start unicipality of Anchorage � �3 On -Site Water and Wastewater Program `(907) 343-7904 S>A F E T Y Certificate of On -Site Systems Approval Parcel 1. D. - 51-10 Expiration Date: 1. GENERAL INFORMATION: Complete legal description T12NR3W SECTION 27 LOT 8 Location (site address) 5010 Griffen Street *Anchorage Current Property owner(s) Vince Beltrami Day, phone 244-6852 Mailing address Real Estate Agent Day phone 2. TYPE OF'DWELLING: Single Family (w/wo ADU) ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual' Individual Water Storage ❑ Holding Tank Community Class Well ❑- Community Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by:; Dater COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment �G f mad Date of Payment Receipt Number 051-12� (,i Receipt Number COSA # QSf a otoq q Waiver # O 5. 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 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 16-1_2,v 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 party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD IGNATURE System #1 Approved for .3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the J � i ....... ... .......... ......... �ffr 5:... CE -795 0, ° f e s Sion°6o #AECC884 r ng t'r g r r�! S�L;�i %I,,I�CNW-X- 1��! Original Certificate Date:�'2� 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_ Septic System Advisory Well Flow Advisory Nitrate Advisory_ Arsenic Advisory Other COSA Checklist Legal Description: T12N R3W SECTION 27, LOT 8 Parcel ID: 071-051-10 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1983 (') Total depth *149.3+ft Cased to LINK ft VSanitary seal is functioning correctly [+Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 11/25/19 Static water level at beginning of test 146.2 ft Comments *PER GEG INSPECTION B. TANK DATA Age of tank(s) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NEW © Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA' *AT SUMP Which system tested (date installed) 11/14/83 ❑ ALL standpipes present'per record drawing Total measured depth from grade *12.6+ft (max) Measured depth to pipe invert from grade *6.8+ ft (min) Well production at time of test 6.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No 0 Coliform bacteria is Negative Nitrate 5.01 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG LTD. Date of Sample 11261198 31*1zv C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 11!25/19 Results ❑✓ Pass For 1 bedrooms Fluid depth prior to test 0 in Water added 532 gal ❑ N/A — pressurized field New depth 2 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 15 min depth into effective '6.8' p FE-1Code-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate .450+ gpd / (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) If yes, enter date N/A Gallons introduced .2025 gallons Comments/Deficiencies: "PRESOAK AND TEST PERFORMED ON SAME DAY COSA Checklist yellow sheet N E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes �Ci-ft # Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ❑✓ Yes ❑✓ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Rd ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft R] 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' Ul Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: '-k Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' R/Yes if No ' ft Water Main > 10' ✓1 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'✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ✓❑ Yes if No ft Wells on Adjacent Lots: qV Water Main > 10'✓❑ Yes if No ft Private Wells > 100' [W yes if No + ft Water Service Line > 10'✓❑ Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *WR#201009 G. ENGINEER'S CERTIFICATION I certify that 1 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 #AECC884 000 ✓�yi 3)111 1� 03105/2020 14:36 8686770 APLUS PAGE 01 GHT mF�ra A FULL NaJ� X HOME SERVICES 7501 E. 140th Avenue Anchorage, Alaska 99S 16 (907) 345-1890 Ntarch .% 2M To: Garness Enoneering Re: SMO Griffin Road We at A+ Home Services, Inc, Wil fill in the depression around the man We riser this spring Once the ground has dried) +hen we c;a�mplete the final regrada If you have any questions or concern please do not hesitate to contact us at the number listed above. A+ Home Services, l nc Michael Makeslee Your Septic System, Holding Tank, Excavation Professional Service Company www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC201094 Subdivision: T12N R3W Sec27, Lot: 8 A water sample revealed a nitrate concentration of 5.01 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 AddressF O ,Bost 196650 Anchorage, Alaska 99519 6650 *wwwmum,org .z K� . 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. r � Mailing Address P O r8ox 196650 * Ancfiorage, Alaska 99519 6650 * wwwYmum org � MUNICIPALITY OF ANCHORAGE DIVISION OF ~qVIRON~tEN~fAL HEALTH/ 1. C-~ne~al Information Application Date ~/~7/~ (a) LeGal Description (include lot, block, subdivision, section, township, r~nge) Location (adck~ess or directions) ~r (c) Applicant is (check o~) ~nding Institution ~ '; ~r~r,~uil~r ~; Buyer ~; ~e= ~ (exTlain); (e) ~al Estate ~. & Agent __~ Add~ess Telephone ~T,.~pe of ~sidence Single-Family Number of ~drccms .Multi-Family Other (describe) 3. Wate~ Supply .Individual W~li ~ Cc~waunity ~ Public ~-~ ~ -~-/~.~- Note: !f ~unity ~11 system, must ha~ %~it~n ~nf~tion ~ ~e State ~p~nt o~ ~virop~ntal Conservation attesting to t~ legality ~d status. Is ~e ~11 adequate fo~ the n~r of ~ s~cified in this ~ . ~ ~wage Disposal OnsiteF~ Publict 7 Co~munity~ HoldingTank{--~ Is the wastewater disposal system adequate fc~ the nt~ber of t~dr~ns (Y/~)~-~ [Page 1 of 2] 2-15-84 6. DHEP Approval Engineering Firm Providing Inspections, Tests, E~ta and Information I certify that I have ~cked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Name of Firm ~_~_ ~_~ Telephone Signed by -- t O,' ( ENGINEER SEAL) ~' ~.. ~oy ~.~' Approved for . Approved ~ ~/___ bedr crams Disapproved Conditional Terms of Conditional Approval %he Municipality of Anchorage Department of Health and Environr~ntal Protection dces not guarantee the continued satisfactory performance of the water supply and/or the wastewater disDosal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the %~ater supply m%d wastewater disposal system is safe and func- tional for the pzmlber of bedrooms and type of structure indigated. ( Eff~EP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL E~TA Well Classification Well Log P~esent (Y/N) ~> Date Completed Total Depth ~%~c~a~ Cased to ~.%s~%~A Static Water Level k~,~j~ Pump Set ~t Casing Height Above Ground ~.~_ 7~x~a~k~ ~ Electrical Wiring in Conduit (Y/N) ~ Separation Distances frcm Well: ~ To Septic/Holding Tank on Lot ~-~ ~==-U ~ If A, B, c~ C, D.E.C.'Approved(Y/N) ~, 'k.~ ~% ~-~c~--~ Y~eld ~3~ Depth of G~outing ~'~b~ Sanit~y ~al on ~sing (Y~)'J~ ~essi~ ~nd ~l~ead (Y~) ~ ; On Adjoining Lots ~- \(~ To Nearest Edge of Absorption Field on LOt..\~ To Newest ~blic ~ Line ~/~ To ~est Public ~r C lean~t/Ma~ole ~/~ Wate~ S~le Collected By Wate~ s~le Test ~sults C~m'ents ~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed '\~/~ Size. k~>~ Cc~.~- No. of Cc~pa~tments ~__ ... Stan~i~s (Y~) ~ ai~-ti~t ~ps ~)~ Foun~tion Clean~t (Y~)~. ~pression ove~ Ta~ (Y~) ~Q . ~te ~st P~d ~./~ (~ ~~ _ P~in~intenan~ ~n~act ~ File (Y~) ~; for Holding Ta~ High-Wate~ Ala~ (Y~) ~ . ~ra~y Holdi~ Tank ~r~t (Y~) ~/~ ~p~ation Distan~s ~ ~ptic~olding Tank: To Water-Supply ~11 ~ ~~ To ~ilding F~ndati~ ~A~ = ~/ To ~o~rty ni~ ~ ~ -~ TO Dis~sal Field ~ ~ To ~ter Main/~vi~ Li~ ~/~ To S~e~, Pond, ~e, ~ ~jo~ ~aina~ Corm~nts [Page 1 of 2] 2-15-84 ~8-ST-~ [~ ~o 'g s~,ueu~uoD ¥C:~ s~oe~l (N/X) :IUOA ~e TaA~q ,,~D dar~a,, (N/A) ssaaaV/~Ioqu~N suoII~D u! ~zIs PSII~]suI o~G g NOIIVIS J~llq ¥~ (Iq[Ia NOIJA'~O$'B¥ 'D