HomeMy WebLinkAboutKNIK HEIGHTS BLK F LT 14Onsite File
Knik Heights
Block F
Lot 14
#017-371-14
Municipality of Anchorage 99
On -Site Water and Wastewater Section - (907) 343-7904 OCT "I�ge�3 of 3
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221237 PID Number: 017-371-14
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New O Upgrade
Name
ALFRED BAGLEY ABSORPTION FIELD
Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ound
12941 ATHERTON ROAD 'ANCHORAGE, AK ❑ Other
Phone Number of Bedrooms Soil Rating Total depth original grade
907-250-8147 4 GPD/SF
Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot
KNIK HEIGHTS; BLOCK F, LOT 14 Ft. Ft.
Fill added above original gr Gravel length
Township Range Section
Ft. Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Lift Station Tank Field Holding Sewer Total orption area Number of trenches Dist. between trenches
From Tank Line Ftz Ft.
Well 100,+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Surface Water 100,+ GREER TANK 1500 Gal.
Material Number of compartments
Lot Line 51+ NA H D P E 2
Foundation 10,+ LIFT STATION
Manufacturer Capacity
Remarks TANK INSTALLED IN SAME HOLE AS OLD TANK Gal.
Alarm location Electrical installed by
PIPE MATERIAL House to tank EXISTI Tank to
Installer EXIST�I
6 drainfield
A+ HOME SERVICES Drainfield EXISTING cO/MTD3034
Inspector GEG AND MOA BENCH MARK (Assumed elevation) 96.00 ft
Inspection 1st 9/23/2022 2�a - Location and description
dates: TOP OF M H
3d- 4`h_
ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp
006� O
Q F
Conditional Approval: Date
_ a
0o A �a> ness;•
Septic System e rey
,,
Approved Date 2 0�09 CE-79.53
Note: this approval does not include well permit requiremen s. 4��a ro f ess!0t1 dam
#AECC884 O�O�Q�00
(Rev 05/02/181
PERMIT
OSP221237 RECORD DRAWING PARCEL 10 NUMBER:
017-371-14
I I A I B
DBL1
Tl00.8
105.3
DBL2
101.2
105.9
MH
102.5
107.3
ST1
106.9
112.2
DBL3
108.8
114.2
DBL4 1109.7
1
115.1
KNIK HEIGHTS; BLOCK F,
LOT 15 - VACANT
® I NEW 1500 GALLON HDPE GREER T
Q11
0 I GENERAL LOCATION OF EXISTING FIELD PER
CO AND MT LOCATION AND MOA RECORDS (40
Qf I FOOT LENGTH PER MOA RECORDS) -7
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KNIK HEIGHTS; BLOCK F, )
LOT 13 - VACANT I
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- ENGINEERING � SALES CONSULTING -�
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE 19071337-6179 • FAX (907) 335-3246 - WESSITE: — 0ameucnp� n9 cam
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
ALFRED BAGLEY
907-250-8147
2 OF 3
LEGAL DESCRIPTION:
DRAWN BY:
KNIK HEIGHTS; BLOCK F, LOT 14
D.J.G.
TYPE OF WORK:
DATE:
SEPTIC TANK RECORD DRAWINGS
10/412022
10' UTILITY EASEMENT
IN
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PE NUMBER: PARCEL ID NUMBER:
O�,tj221237 RECORD DRAWING 017-371-14
TOP OF TANK AT INTLET =
INVERT OF BUNG AT INLET =
TOP OF MANHOLE = 96.00
FINAL GRADE = 95.75-95.83
Mw ZZE
NEW 1500 GALLON GREER TANK SEPTIC TANK
V)11:: V I o� ^_ 1)""j L—,—(,o -) L
2-of
1111r, xli'll I�'i liq 11''i lj� q r
TOP OF TANK AT OUTLET = 99,91-
INVERT OF BUNG AT OUTLET = 89,22
T "I'll 11 -�f'E I , -,�
11 . . . . . . . . al ENGINEERING, SALES, CONSULTING
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK99507 -PHONE (907) 337-6179- FAX(907) 339-3246-WESSITr:w garne engmenng�
—TP907-250-8147
PREPARED FOR:
PHONE NUMBER:
C
PAGE NUMBER:
ALFRED BAGLEY
3 OF 3
LEGAL DESCRIPTION:
DRAWN BY:
KNIK HEIGHTS; BLOCK F, LOT 14
D.J.G.
TYPE OF WORK:
DATE:
,. SEPTIC TANK PROFILE
10/7/2022
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#AECC884 0%vilk%z"**
I
OCR A L It,
"CH a a I,
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:t/wvAv.muni.org/onsfte
Permit Number: OSP221237
Work Type: SepticTank Upgrade
Tax Code Number: 01737114000
Site Legal Address: KNIK HEIGHTS BLK F LT 14 G:2836
Site Mailing Address: 12941 ATHERTON RD, Anchorage
Owner: BAGLEY ALFRED R & CAROL A
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
E3 Disposal Field RI Septic Tank 11 Holding Tank El Privy
Effective Date:
�-T �-# I Z
Lot Size in Sq Ft:
Total Bedrooms:
iLiNent
Department
715/2022
715/2023
43500
11 Private Well El 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 (I 8AAC72) and Drinking Water Regulations (1 8AAC80)
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
0
Special Provisions: Prior to future COSA approval, a Right -of -Way encroachment permit is required for the well
in the Utility Easement.
Received By:
Issued By:
Date:
Date:
MUNICIPALITYF ANCHORAGE
Development Services Department = j Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICIWELL PERMIT APPLICATION
Parcel I.D. 017-371-14
Property owner(s) ALFRED BAGLEY Day phone 907-250-8147
Mailing address 12941 ATHERTON ROAD *ANCHORAGE, AK 99516
Site address
Legal description (Sub'd., Block & Lot) KNIK HEIGHTS; BLOCK F, LOT 14
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial 0 Single Family (SF) Q
ADU)
Septic Tank
Q
Upgrade(w/wo
❑
(D) El
Holding Tank
❑
Renewal ElDuplex
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)
ermi us ees:WaiverFees:
Date of Payment: 7767c) aa Date of Payment:
Receipt Number: Receipt Number:
Permit No. 051'22123'1 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Cllent Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221237, Rebecca Carroll, 07/05/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221237, Rebecca Carroll, 07/05/22
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MUNICIPALITY OF ANCHORAGE
(~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I~.O/k S'~ ~ '?~
ENVIRONMENTAt. ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON.SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE L ~EW
MAILING ADDRESS
LEGAL DESCRIPTION
Well AbsOrption area Dwel'l~ng PERMIT NO, c~
O ~ Materia~k No. of c~partments
~ ~ Manufacturer ~ C~ Width
Liq, capacity in g~ns IF HOMEMADE: inside length Liquid depth
tr~% U D~elling ' PERMIT NO.
Well
DISTANCE TO:
~ ~ ~ Manufacturer - Material Liquid capacity in gallons
~ ' Wel'l Foundation ~earest lot line PERMIT NO'~
~ ~ DISTANCE TO: ~'~- ~ ~ ~ ~ .~ ~ ~ O ~
~ -- O - Total length of/~n~ Trench~th Distance between lines
~ ~ ~ No. of lines Length of each line , inches
~ ~ ~ I ~0 Material beneath tile Total effective absorptiol) area
~ ~ Top of tile to finish grad~ ~ :~ ~ inches M~
~ De~th PERMIT NO.
.... Length Width
~ Type of crib C~ib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
----~ Class Depth D~ller Distance to lot line ~ERMIT NO.
-J ~ Absorption area(s)
~ Building foundation Sewer line Septic tank
~ DISTANCE TO:
OTHER
SOIL TE~T RATING ~
NSTALLER ~
F:IPF'I.... ~CF:INT
LIJC:FtT Z Ot",1
I..EIZiI:tL.
SOL.,.FIF.: I- L.L .:, I i'.,IC
HEFtI_TH F:IND Ei'.~'v'IF:ONHE, NTFIL. i-,...CIT[~:CTi'Ot',!
S T 17 F..'.' E T., FI I'.,I C:H O F.-'.FI(3 E., FIl.(. ~i~9 Dl;i:.t::l..
26 d.--.d.'? 2~?.1
CJ lb.,fl ....... :.%; iii: T E: ~;; E~: II..-~ ~E E:E.". F" IE==.: F,;_" I1".11 :lE qF'
SF:~Ft E:O::':: ';L.~56±IJ FII"JCFIOF~::F:lCqiE '~'-:;~t~-"l;Jl~ ~-:,::l.,::l.-[52::Ld.
LOT SIZE '9 '..'i '9 'i? '9 :5~ 'E;(i:!UFIF.:E FF.....E"I"
.:, :IE.II IS' ""-'" I-'
"I"'~"F'E OF i~,O l L FIE:E;OF.:F'TZ O1'.,! -' "- .........I [;.El ,I_.H
I"IFI::-::!HIjH I'-,IUHBEF:: OF' E',EI:::,F.:C~OHS .... 4. SOTL F:FITII",IG
THE RE:i!. :I:F:EE:, SIZE OF' THE :E;OIt... FIE~SCIITF"FICII",I .:,'r.: l:[:ll ]:S'
TFIE L. EiI'.,IGTH I)IHEI'.,IE;ION IS 7'HI:E LEt'.,IG7'FI ,::t1'.,1 FEE"[':) [)F 7'HE TREiNC:FI OR [:,F::FIII'.,IFIELI}.
'T'IdE [::,E.:I::'t'H OF' FI 'T'F:EI'.,ICH OF:: F'IT ]::i.:, THE [:,I'.E;TFII'.~CE BETklE[.:iI'.,I TIdE SIJF'.FF~IC:E OF THE
GI:~:CIUI'.,I[::, FIi'.,IIi:, THE: E:CF['TOH OF THE E',:.::C:FI',,,'FITICli'-,I ,::ll'.,I FEET::,.
THEF.'.E IS NO Lkq£T I,.II[:,TH FOR TF..:Ei'.,IC:HE:i.:;.
THE: CJF~:FI',,,'EI... [:,E:F:'TH :IS "['ldl:.~: I',t]:N:[HIJH [:,[EF'TId OF GRFI'v'EL. E:E7'I,.IEEN THE CII...ITFFILI_ I::'II:::'E:
FIN[::, THE E',Ct7'TOH (iF TIdE E::.~;CFI',,,'FIT I ON ,:: I I'.,I F'EET :.',.
[.. [:F. dF... FI IE.i'! 1 E:,I_IR'. I I'.,l(:ii THE
F'EI:~:H]:T I::IPF'L. IC:FIi'.,IT FIFI'L:; THE .E=,F_i',I:,IE, II...].7~ TO INF'OF. fi'"I 7'HIS ..... '-' .......
:f: IqrBTFILLFFI' ]: Olq ]: NSI::'ECT I Oi'.,!S OF I=11'.,t? I.,.IELLS I::I[,3FICENT 7'FI 7'H.T. :5 F F. F El:. 1 t FINB, THE
:, E.F.. ,E.
NUHE~ER OF' RE';E;]:[::,ENCE'J~.; THFI7' TI..~iE I.,.IELL I.,.IIL. L ' ..... "''
E:FICI::::FILI...II",IC:; iF' FIN"r' .:, ::~IE. II I.,.t:[TIdCILIT FrlHFIL.. INSF'ECTICIN PIN[:' MI:FF. ~IL. "1"1'"1]::.:.,
[::,EF'FffT:SH"tEi",IT I,.tlL..L E.:E SUBJE:C:T TO F'F."Z'~E: TICIH.
I'"lll'.,lll"llJl"'l [::, I S 7' Fl iq C: E E:Ei'F!.,IEE:I'-,t l::l I-,.I[::LL d=ff',l[:' FIi",l"r' CIN-SITE SEI.,.IFIGE E:,ISPI3:E;FtL S'~r'S"['E:I"'I
:lJi'JEI F'EIET FORt I::t PF~::['v'FtT'E 14EL.L. O17 :.t. DE1 TO 212)El FEET FI:;.tOH Fl F'UE:L. ]: C: I.,-IEL.L I::,EPENDII",fG
UPOI',I THE 'TYPE OF F'UE:I.... ]1 C: I.,.IEL[ ....
I'"IiNIHLIH DISTF:INC:E I:::F'.OH Fl F'I:~tI',,,'F¥I:"E F!ELL TO FI PRI',,,'FITE ~:E!.,.IEI:;it LIi",IE :i:S 2..=.., FEET FIND
TO I:~ CCfl"tI'"iI..Ii",IIT'~'' S[:.:I,.IER LINE IS '7~ FEET.
FIELL L. OGS F~F. tE F~:EL:.!LIII:REB, Fil",ll:J HLI:-3T E:E F.'ETIJF.".t",tED 'I-F~ 7'HE D[:_'PFIRTHEI",I'I' !.,.IITHIN i!i:~:L:~ DFI'~"S
OF THIE I.,.IEI._L. CFIHF'LET'ION.
O'I:'FIEFi: 'F.'~E(i:!Lt:[REHEiqT'L-: HFI¥ FIF'F'L"r'. SF'EC:IFIC:FITIOI",IS FIN[i:' COBISTF.:UC:T:[CII",I E:'IFtGF'.I::tI'"tS FtR:E
FI',/FI ]1LI=tE',LE TO t I",tSLIF.'.E: F'I:ROF'EF: ]: NS"I"F:ILLFtT :[ ON.
I I."i:ER:T ]: F"r' THFIT
::L: I F:IH F'I:~i'"I ]: L. t FIR'. kl I TH THE REE!Lt I F.'.Eit'iENTE; FOR Oi",!'-S :[ TIE "L":EI4EI:~'.S Ffl",tD I,.IELL. S FtS SET
FOF.".TH B'~" TIdE HI..II",I.I: C:]: F'FIL. ]: 7'V Cfi:' FIIqC:HOFi:FIGE.
2: :t: 1411....L :[ I",IE;TI=IL.L. 7'FIE S'~"'.:.~7'EH I N FICCOI:~iI)FINC:E 141 't"H THE COE:'ES.
3:: Z UNDE:I:R:ii;TFff'~D THFIT THE OI",I--':!SITE SEI4EF: F:;"r'STEH I'"lFl"r' RE~S!LJTRE ENL. FIF.':CiEHEt",IT IF THE:
17E'.=:;TI.)EtqC:I~: IL=; RIEHOt::'ELEF..:' -I"O ]:I",tC:LLtE:'E I"tOF~:E 7'ldFIIq d. I~:E£:,l:~:C~Oi'"l~.'5,.
WELL LOG
Date Drilledl
6-1 ~ ~.S~ 3
Static Water Level S2 feet
Gallons Per Minute
Draw Down ~/A feet
Total Feet of Casing ll2
Type Material DrilledI
110 Feot
to IJ2 Fool;
to
to
to
Hefty Drilling
S.R.A. Box 1553 H
Anchorage, Alaska
99507
APPLI- FILLS OUT UPPER. HA ': ONLY
,, ~ ~,, .~:t ,", f ~ .;r.- /'~~..~ ' "
Mailing Address
Buyer
Address
Lending Instilution ,,/_'? //~.~ ¢
Address
Zip Code %/:.?:
Zip Code
Zip Code
Phone
Realty Co. & Agent /~,/, ,/,'
Address Zip Code
Legal Descriplion
Street Locatio(~ /2-
Type of Residence
,~ Single Family
~ Multiple Family No. of Bedrooms.
~ Other
Phone
Phone
Water Supply
[~ Individual
~~ Community
(Ti Public Utility
ATTACH WELL LOG. A well Icg is required for all wells drilled since .June 1975.
For wells drilled prior to that date, give well depth (attach Io9 if available).
Sewer Disposal
[~]' Individual
~ Public Utility
[] Holding Tank
Year Individual Installed: _'/' ''2~' '//~' --~
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
(Date
inspector
Field Notes:
/~ ~
Date
Inspector
Date
Inspector
Time
Inspector
MUNICIPALFrY OF ANC!IORAGE
DEPT. OF W:/',LTil ~'
ENVIRONM2~I AL FAO [r-CHON
RECEIVED
(") APPROVED BEDROOMS
( ) DISAPPROVED
~ )CONDITtONAL APPR0VAL
DATE I /? ' ' ' ::' ' ;%
*CONDITIONS OF APPROVAL
Soils Rating
Dale Sewer Installed
72 023 (3i82)
Well To Absorplion Area
Well to Tank / ~) O
Well Log Received
Septic Tank Size // ~-'
MUNICIPALITY OF ANCHORAGE
Development Services Department i
p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 017-371-14
Legal description KNIK HEIGHTS BLK F LT 14
Expiration Date: � y Z,02- 5
Site address 12941 ATHERTON RD Anchorage AK 99516
Current property owner(s) BAGLEY
The On -site system(s) is/are approved for bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
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Original Certificate Date:
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory x
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
MUNUPAUTY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-371-14
Complete legal description KNIK HEIGHTS; BLOCK F, LOT 14
Location (site address) 12941 ATHERTON ROAD ANCHORAGE, AK
Current property owner(s) ALFRED BAGLEY Day phone 907-250-8147
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER 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: [_E� Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel FW� Plastic ❑ Concrete ❑ Fiberglass
Age <2 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed Fo� Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ C) S 2 L1 2, 2- Waiver Fee $
Date of Payment 2 % 2,, 2 y Date of Payment
COSA # so
Waiver #
COSA Application —June 2022
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If more than 1well and/or septic system onlot, provide separate checklist. Structure served by this system
A. WELL DATA
0�Well log is filed with Onoitekn
Date drilled 8M4/1983 Totaldooth 112 ft
Cmaadbo 112 ft
�� Sanitary seal is functioning correctly
NWires are properly protected
Casing height (above ground) 12 in.
Date offlow test for CO8A 6/8/2022
Static water level mtbeginning mftest 907 ft.
Comments
/q mr
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B. TANK DATA I
Measured operating fluije in septic tank____
Date ofpumping.
Fl Required maintenance completed, if/4/VVVTG
Comments: NEW SEPTIC TANK INSTALLED |N2O22
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1S83
UN ALL standpipes; present per record drawing
Total measured depth from grade 114 (max)
Measured depth topipe invert from grade 49 ft (min)
El N/A - pressurized field.
El Per Perracord drawings, field in insulated.
FlMonitor tubes gotmbottom ofeffective.
Knot, state depth into effective 3-"*9'
FlPresoaked required if
(Required ifhouse vacant orfield not used for more
than 3Odays prior todate of test)
Gallons introduced '`QaUona date
Any rejuvenation treatment (past 12months) N/A
If yes, enter date -
Well production at time oftest 8.8+ ==
Water storage tank volume N/A gallons
Well disinfected for cm|Ubnntest? FlYes No
kB"Co|ifommbacteria imNegative
Nitratemo/L R Nitrate less than K4RL (ND)
Arsenic __uo/L W'"enicless than K8RL(ND)
Collected by &C--
C'LIFT STATION
Fl Required maintenance
Age oflift station
Lift station weer
Adequacy test date 6/9/2022
Results gPaso
Fluid depth prior totest 25 in
Water added 615 gal
New fluid depth 42 in
Elapsed time 120 min
Final fluid depth 30 in
Absorption rate 600+ gpd
FIELD STATUS - POST RECOVERY
Effective depth (per record } 72 in
Effective depth used om in
Effective depth remaining 18 in
COSA Checklist -June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
M Yes if No ft 0 Yes if No ft
Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft
Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 9 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft
❑i Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' M Yes if No ft Fs-1 Yes if No ft
❑ NIA — 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'
Q Yes
if No
ft
Surface Water > 100'
0 Yes if No ft
Tank to Property Line > 5'
❑n Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑o Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
[E Yes
if No
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
PORTION OF DRAINFIELD MAY BE UNDER DRIVEWAY (SEE ATTACHED RECORD DRAWING)
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 Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Gamess 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 systems; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an altemative 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.
COSA Checklist June 2022
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Nitrate Advisory
Certificate of On -Site Systems Approval # OSC241032
Subdivision: KNIK HEIGHTS, Block: B, Lot: 14
A water sample revealed a nitrate concentration of 5.83 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
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.
