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WEST ADDITION KNIK HEIGHTS BLK 1 LT 4
West Addition Knik Heights Block 1 Lot 4 #017-035-23 suwrr,i ';L CCD 2 R , Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page ( Of ON-SITE WASTEWATER INSPECTION REPORT Permit Number. S w 013'0 1761 PID Number: 49t? - OK' — 2_3 Dwelling: Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade Name: C-01 Lot i C 0, ABSORPTION FIELD [Deep Trench El Shallow Trench ❑Bed El Mound Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 6),6'f r qGPD/SF A Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.K (60 Ft. Gravel depth beneath pipe {7r 0 Ft. Subdivision Block Lot - IL Fill added above original grrade (. O Ft. Gravel length W & Ft. Range Sezti Townnship ._ WfAdAj is Gravel width Z,0 Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. / / Ft. To Septic Absorption Lift Station Holding Sewer Total absorption a a Number of trenches Dist. between trenches From Tank Field Tank Line 3 (0 Ft' l 1_1� Ft. Well ��f� (�f+. 1'� ,/ TANK eptic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer / /' !n f k GNI 14, Capacity 1 t 2.rO Gal. 1(• Surface Water /Vrf (f/Or� Material en, %Y2'i Permit No. SW050179 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 4, BLK 1 KNIK HEIGHTS WEST ADD S/D PID No.: 017-035-23 MARK A B GRND. PIP LEV. / FCO 7 43 101 90 / C01 38 10 92 8 / 37 10 / TCO2 25 91.8 / CO2 2219 91.6 / CO3 22 0 91.6 / 18 25 91.6 89 / C05 64 100 89 MT 80 91.5 I f f v BENCH, CONCRETE SLAB I I HOUSE 1 l 1 THS _ \ FCO TH1 \100' WELL RADIUS I 11 T/tO2 TCO' �� f I 1 - CO3/ C01 � t ------ I -_ \ COS _--_- MT- ------C04/CO2 ASBUILT SCALE: 1"=30' ol CAINEMMN OM TANK Cd1 .��•' OF "It czr11Tcw mo' col coz CO, r �(�.................... . /�/ 91.R Mil / 91.< .. ' ...... . ♦%%%♦ 49 .O OR i •.� OR / R ... 3 iIL1ER fOBRIC k Y MYIAIION , ,,, .. E# 1.250 GRLLON gy.� ' "" "' / 9R[EL TANK °°` ♦� °. MICHAEL N. ANDERSON: N KM �IC�s° No EX •'•`•''VA'.�'`�i SEFnC SE00 ��f,,I1 E N.T.S. 7z< MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade lZ�v�/VW64 3ivop.4 Date Issued: Jun 17, 2005 Expiration Date: Jun 17, 2006 Permit Number: SWO50179 Parcel ID: 017-035-23 Legal Description: KNIK HEIGHTS WEST ADDITION BLK 1 LT 4 Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 012701 ELMORE RD Owner Name: GUY GREER Lot Size: 45982 SO. FT. Owner Address: P.O. BOX 110553 Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99511 - This permit is for the construction of: Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: .(/ Issued By: 'IBJ'' Date: G 17 Ar Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. d(:7 — 60 '515 _ z 3 Permit Number SW Property owner(s) t7 to W Z, r•e r r, Day phone 3 44S - k o 0 ( Mailing address_ P, 0- PDX L Zip Code `l 9 S / / Site address .E7&0)65E Rh Zip Code Legal description (Lot, Block & Sub'd.) f , `t. 14, s /i 4.s k-. Ts 4-,,� t J G t L o t` 11i Legal description (Section, Township & Range) Lot Size 49488 f• :res q.FL Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only 19- Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade $ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) PermittRush Fees: 0 Date of Payment: _/irVfr7 -q— Receipt Number: U (Rev. 09/04)— Waiver Fees: Date of Payment: Receipt Number: Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4640 Shoshone Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 9, 2005 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Knik Heights West Addtion S/D Lot 4 Block 1 To Whom it may concern: This is a request for a septic upgrade permit. A test hole was excavated at the southwest comer of the lot and found silty sand for the complete I8' depth. My pert was 20 minutes per inch after a 4 hour pre-soaking. No water was observed during excavation or after the 7 day monitoring period. The soil log consisted of silty sands with some silty gravel mixed throughout the entire depth. An application rate of 0.45 gallons per day per square foot will be used for the design. A new garage is proposed which will require the removal of the old system that is the reason for this upgrade. The slope of the lot is 5 to 6 percent for most of the lot, then flattens out to 2 to 3 percent along the southwest comer. No pounding of water has been observed near the site or in the surrounding area. None of the surrounding lots will be impacted by this new system upgrade as the overall plan shows for 200' radius. If you have any question please call me at 345-3377 Sincerely Mich�N Andel s k*v DESIGN CRITERIA: .4'BDRM X 150 = 600 GPD APPLICATION RATE: 0.45 GPD/SO. FT. 2.0' WIDE TRENCH 600/0.45 = 1.333 SO. FT. REOURIED 1,3333 SO FT./18 = 74.0' USE 75' TRENCH TRENCH: D < 12.0' DEEP 9.0' EFFECTIVE 2.0' WIDE (1) 75' LONG —3.0 —6 5M —12.0 1 1 —7' 2.0' -a' 3.5' 18• Q NO WATER 6-09-05 TH# I SOIL LOG OVER TER FABRIC '0 PIPE EWER ROCK W W I G D < O 0 m\ 200' RADIUS O \ i / \ I i ' EXISTING HOUSE < I • / Vis==sem I I EXISTING WELL — —4 00' RADIUS PROPOSED -Iii NFIELO _ �.� -I ` \ PROPOSED ' `. / sEPnc TANK \ T A F A I R M 0 N V E N U E— Septic Design Prepared For I�� U4, ♦�'��OF ,,qG��,,00 LOT BLOCK 1 = �j�P''...........'••♦.0 KNIK HEIGHTS WEST ADDITION SUDIVISION 497—H Prepared By.....i ....... ...... ............1.... MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE :.: /°;MICHAEL N. ANDERSON: (907) 345-3377 / FAX (907) 345-1391 ♦� '�'• SCALE: 1"=200' JUNE 9, 2005 "5.. 4�0 1. ��� DRIVEWAY 1 � t � � PROPERTY LINE i \ i \ DRIVEWAY / \ / i \ `j SHED i i t 1 I DRIVEWAY i — — —���� 0 1 WELL EXISTING SEPTIC TANK TO i EXISTING BE REMOVED ENTIRELY HOUSE XISTING DRAINFIELD TO 1 BE REMOVED ENTIRELY 11 0 GAS L1NE�• k ` 75.0' :E TH/1 i PROPOSED 1,250 GALLON SEPTIC TANK — DOUBLE CO co TANK CO DOUBLE CO/ Septic Design Prepared For GUY GREER LOT 4, BLOCK 1 KNIK HEIGHTS WEST ADDITION SUDIVISION Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSIIONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' JUNE 9, 2005 ` 10' UTILITY EASEMENT 100' EXISTING WELL RADIUS �;•' 4y:s 49TM IAEL N. ANDER No. CE 9469 53 Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: U &1 ' C7 r-, -r r'. DATE LEGAL DESCRIPTION:_h1Nl K IMe%I>f✓< (,,! /�/T �r Township. Range. Section: Bt9011ie I ltifK R/k/ 1 2 3 4 8 /5 �rnGi 7 C7 rAvr�`Iy rr S 8 9 10 WAS GROUND WATER ENCOUNTERED? O 0 11 S IF YES. AT WHAT L O 12 DEPTH? P E DepM to Water Mr 13 monitoring? A&C Oats 14 15 1121 17 18 I�CI�OM 14t6i 20 COMMENTS G SG C9-4{ i* 49TH* ... S_ -A -a b• 9A..L. '� sell ...•..,...... ....... MICHAEL N. ANDERSCN CF. 9JA9 41 It rLAN ®=m®ml �r��ffaW"M,1Warz�A rmIi PERCOLATION RATE 40 (minutesnnch) PERC HOLE DIAMETER G TEST RUN BETWEEN -- FT AND G FT PERFORMEDBY: /�.r�°f�^��� l ertv/1 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCCRDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 1 '� <- 72-008 (Rev. 4/851 Municipality of Anchorage DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6.650 ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL NAME Leo MAIe-r ADDRESS °j9U z • czv. iLl 1 c{q5-p ll PHONES) �1 LOCATION 'ZP_f,6AW LEGAL DESCRIPTION I 1 �� �1 ��� k �s West AdG -77411 PERMIT NUMBER #OF BEDROOMS SEPTIC TANK TILE DRAINFIELDh� SEPTIC MANUFACTURER (�Pmx CAPACITY IN GALS. NUMBER OF LINES LENGTH EACH �� NJ& MATERIAL #OF COMPARTMENTS INSIDE DIMENSION DISTANCE BETWEEN LINES LENGTH WIDTH DEPTH SEEPAGE SYSTEM TILE DRAINFIELDh� SEPTIC _ SEEPAGE SEWER NUMBER OF LINES LENGTH EACH FOTAL LENGTH NJ& SYSTEM LINE CESSPOOL DISTANCE BETWEEN LINES TRENCH WIDTH 3 ( DEPTHS` 1 1 00 f- 1 _ TILE TO GRADE FILL BELOW T:i:ABOVE TILE ❑ SEEPAGE TRENCH OR ❑ PIT WIDTH LENGTH DEPTH ❑ LOG CRIB I ❑ RINGS -DIA. FILL MATERIAL DEPTH TOTALEFFECTIVE ABSORPTION AREA: �� SO. F1'. WELL CLASSIFICATION DEPTH PIPE MATERIAL INSTALLER REMARK NIZssh ��" • >eils V i��.o4 a'vca � a.15 DISTANCES TO SEPTIC _ SEEPAGE SEWER FROM TANK SYSTEM LINE CESSPOOL WELL WELL f ©I I 1 1 00 f- 1 _ --�• ME LOT (v I LINE. FOUNDA- TION V SYSTEM DIAGRAM ,ld Cpl. Ll 11c'u,.ss DATE �O_ '�_ APPROVED BY- �3a� LOT:4 BLOCK: '_SUBDIVISION: ��•��� Wb weioai1 C [YPE OF SOIL H8SURBTION SYSTEM IS� TRENCH �HXIMUM NUMBER UF BEDROOMS � 4 SOIL RHTING (SQ FT/BR)= 165 THE REQUIRED SIZE OF THE SOIL 1 1BS8RPTl1-)1 .1 SYSTEM IS: ���1 - H ��� y I . I ,.U�E C , A 'I ��il 11`��' ::: 11 ii�:: I F � W, 1 M 1 E I .- U������ Is � THE LENGTH 1 )IMENSION IS THE 1ENGTH (IN FEET) UF THE TRENCH OR DRI INFIIl' LD, THE DEPTH OF H TRENCH OR PIT I�5 THE DISTRNCE I ETWEEN THE SURFHCE OF THE GROUND HNTHE 8OTTOM OF THE EXCHVHTION (IN FEET) THERE lS NO SET WIDTH FOR TRENC|IES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFALL PIPE HND THE BOTTUM Al THE EXCRYHTI0N (IN FEET) Ili ;:?, Coi � K���jo:: � L_:." !:��rr jj::: �: !I l , li Ji � H , �- �P�milhsU< AN K aSE— 7 A W t A Q)� ���' .U-��. 11� �11 .,Uill j �;' !l 0 x I ", TV �!; - w- 1: W- u h v! AS 1TV F? 17 OREIVAST j J, li,�'!F��� —~�~ GHCKFJLLING OF HNY SYSTEM WITHOUT KlPAPAL. INSPECTION HND RPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROUVUTION. HlNIHUM 1 iISTRNCE BETWEEN H NELL 1: 1N|) f: 11, ClN-SlTE SEWHGE DISPOSHL SYSTEM lS 100 FEET FOR H PRlYHTE WELL OR 208 FEET FOR H PUBLIC WELL WELL LOGS HRE REQUIRED HND MUST BF RETURNED TO THE I �EPHRTMENT W/THIN ]0 �HYS OF THE WELL COMPLETION OTHER REQUIREMENTS MRY HPPLYSPECIFICHTIONS HND CONSTRUCTlON DIHGRHM� HRE HVRILHBLE TO INSURE PROPER INSTHLLHTION WISR1411mv XT V>00" I uYuk !?" d,F� "D W N If? If 1� KQ �JL ^ �li' w.:' �ZOV •uN ova ZSOZ95 � _ .([am�M GxH3 Q_ ywa i ,£�„T ��vos SL~Z®OT Alva IOs,UiJss-[v 4gvuaogouv nvianr Olsv'ly sNaveaive �ovaor+oav 1aTOH as01 30 20q 'auk 94UD41nsuoj 2LDOWNHDal NVHDO arluvi 21H,ZVM ON SL - L -UL 9 -Hi TOV mulsuTQ uo umogs se I uo7:auooT sluasajdaa Boa �^»u.�pr S) laiS UKOS GNvs xZqUnt+H9 ('Bo QNvs zovu i is 'A . O ;O: S) ,zriis mios (Ulvs xgglAvuf) : o Q ,o. 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M H ri M ri H cr'1 1 O r -i r^1 r-1 H r -i r-1 M M M /d i.i H O 'C3 Gl W O r-1 :7 O r-0 ri ri r-1 r -i r -i r-1 r -i r-1 r -i W V1 In In Y-4 v-1 r -i H �o © r.-1 N M it V'1 W (' CO CT O (n O V1 Q Q O O U') to to In to In 1n In tri un Ci C7 r{ 'i N M --t In N N N N N N N N N C+1 ri H H H H r-1 r -i r-1 r-1 ri H r-1 ri H H H r-'1 H 00 IT CD r•1 \ \ t- 1 \ \ \ \ \ H ri H \ PI H - \ H N 0 M M M M M M M In[r1 M r^i r-1 M 2.1 w r- FOI IV w 41 a� a I O r -i rl ri r -I r -i r-1 r -i rl I-1 rl to I11 In In O O O ,'T• ITi ri ri �I H O O ri N M w -t In %D ry 00 O% O to O In O C9 Q O r -i r-1 •-1 ri ri H r-1 r^i rl r -i N N M M �Y Vl <7 r -i N N N N Cl N N N N CV N N N N N N H H Pl ri t-: H ri H r-1 I -i H r-1 ri H r -i r -i ri r-1 .7 at N N .f N I7 vim' C0 ri l\rl ri 1• Il M .-i M r -i r-1 M H PI ri r -i H M Mw O 41 1-1 N N r-11-1 NH I r-1 N H W O QJ m OD 1 O r•i H ri r-1 r=1 ri r -i r-1 ri H W to In Vl O O H H r-1 t -i FI O " N M +f to �o r`. 00 m O to 0 In O O O O ' Cl) M M M nl M M M M M -'f --7 to to O r -i N M I-4 ri 60 rA --, ri ri H H rA H H H ri H -^i N N N N r -i H ri I -i r-1 H ri r -i r-1 H H r -i r -i d r-1 CO Q �, �: -. ,`!'u ( .. ........:�L/12L, .... �......� .�Q���..... `i T_: 11�� UH�C0 P A TY 0F " GHCH0RvAG, FF Development Services Department ~'Ii Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel 1.9- 017-035-23 Certificate of On -Site Systems Approval Expiration Date: 12/14/22 Legal description WEST ADDITION KNIK HEIGHTS BLK 1 LT 4 Site address 12701 ELMORE RD Current property owner(s) LEATHERS AMANDA SUE X The On-site system(s) is/are approved fe-r 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/29/20 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 Approvaijune 2022 By: Original Certificate Date: 9/29/20 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 Approvaijune 2022 1�1.I�I UHMP A UTY OF A HC HO OE 0/, 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. Complete legal description 12701 ELMORE ROAD, ANCHORAGE, AK 99516 Location (site address) 12701 ELMORE ROAD, ANCHORAGE, AK 99516 Current property owner(s) AMANDA SUE LEATHERS Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE_OF_WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units 131 LLj ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 17 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® 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 $ 5 tf Waiver Fee $ Date of Payment g a3 as q ZGlZZDate of Payment COSA # o o Waiver # c r��� COSA Application—July 2022copy.doc COSA Checklist_July 2022 copy.docx COSA Checklist Legal Description: WEST ADDITION KNIK HEEIGHTS B1, L4 Parcel ID: 017-035-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/11/1977 Total depth 135 ft Cased to 135 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/10/2020 Static water level at beginning of test 84.7 ft. Well production at time of test 2.5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 9.4 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/14/2022 Comments NITRATE LEVELS AS NOTED IN MOA FILE W/ MOA ADVISORY. CONDUIT FIXED AT WELLHEAD. B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 9/23/22 – ONE STOP Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/25/2005 ALL standpipes present per record drawing Total measured depth from grade 11.6 ft (max) Measured depth to pipe invert from grade 2.6 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective *9.85 ED 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 If yes, enter date Adequacy test date 9/10/2020 Results Pass Fluid depth prior to test 32 in Water added 600+ gal New fluid depth 61 in Elapsed time 1440 min Final fluid depth 32 in Absorption rate 600+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 108 in Effective depth used 32 in Effective depth remaining 76 in Comments/Deficiencies: MT/COs ARE AT GRADE WITH PLASTIC CAPS. *9/2022 SHOTS SHOW 9.85’ ED AT THE WEST / LOWEST END OF THE FIELD. MAJORITY OF THE FIELD HAS 3’ OF COVER & NO KNOWN FROST ISSUES. WEST MT 2022 MEASUREMENTS SHOW 82” OF FLUID OR 36” OF “FREEBOARD” FROM EXISTING FLUID LEVELS & INVERT LATERAL. WELL / SEPTIC TEST DATA IN FORM PER MIKE N. ANDERSON, PE – SEE LETTER. COSA Checklist_July 2022 copy.docx 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/23/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 9/23/22 Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 September 22, 2022 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: West Addition Knik Heights Block 1, Lot 4 To whom it may concern: I, Mike N Anderson, PE installed and inspected the septic system on the above referenced lot in 2005 and subsequently conducted tests and a MOA COSA in September, 2020. We know it has been a rather wet 2022 fall. Based on the septic adequacy and well flow tests and results we conducted and shown on the currently submitted COSA by First Water Consulting we approve the use of our testing data. Please call me if you have any questions. Sincerely, Michael N. Anderson, P.E. 4661 Natrona Anchorage, AK 99516 Phone 727-8864 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC221479 Subdivision: West Addition Knik Heights, Block: 1, Lot: 4 A water sample revealed a nitrate concentration of 9.4 milligrams per liter (mg/L). 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. UNMPAUTY OF ANCHORAGE a GE i Y 1 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. 017-035-23 1. GENERAL INFORMATION Expiration Date: 2 —�� Complete legal description WEST ADDITION KNIK HEIGHTS BLK 1 LT 4 Location (site address) 12701 ELMORE RD, ANCH, AK Current property owner(s) Guy & Lisa Greer Mailing address SAME Real estate agent 2. TYPE OF DWELLING: Day phone Day phone Fx� Single Family (w/wo ADU) E71 Duplex '�'V❑ Multiple Dwellings (Single Family and/or Duplex)''` 0 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic F Water Storage ❑ Holding Tank ❑ Community Well ❑ - Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. Waiver Fee $ Date of Payment Date of Payment Receipt Number COSA# OS C Receipt Number Waiver 4 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_ i acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 9-5-20 6. DS SIGNATURE � �: 49TH ,• r r System #1 Approved for 4 bedrooms �. , , , , . , ; ... • .. _ J System #2 Approved for bedrooms rp ��' MICHAEL N. Ar�DEtScu•:=;� %'. CE- 4 Disapprovedt�Gj���ti; t\ 1r, fSSI �t'�= Conditional approval for bedrooms, with the following stipulations: o0�e���� .,trtttrrr.,. By: Original Certificate Date: C/ -2c{ 20 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: WEST ADDITION KNIK HEIGHTS BLK 1 LT 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well tog is filed with Onsite (or attached) Date drilled 1011177 Total depth 135 ft Cased to 135 ft Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 15"+ in. Date of flow test for COSA 9/10/20 Static water level at beginning of test 84.7 ft. Comments B. TANK DATA Age of tank(s) 15 years Tank type/material * Measured operating fluid level in septic tank 48" Standpipes/foundation cleanout per record drawing Date of pumping pumped 9/9120 D. ABSORPTION FIELD DATA Parcel ID: 017-035-23 Structure served by this system Well production at time of test 2.5+ qpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ yes ❑ No 0 Coliform bacteria is Negative Nitrate 9.73 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by MNA Date of Sample 9/10/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: * steel septic tank Which system tested (date installed) 6/2e/o5 Adequacy test date 9110120 ALL standpipes present per record drawing Results [✓ Pass For 4 bedrooms Total measured depth from grade 11.5 ft (max) Fluid depth prior to test 32 in Measured depth to pipe invert from grade 2-6 ft (min) Water added 800+ gal ❑ N/A — pressurized field n Monitor tubes go to bottom of effective, if not, state New depth 61 in depth into effective sed time 1440 min Ela p Code -required soil cover over field Final fluid depth 32 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Yes if No Septic Tank/Lift Station on Lot > 100' If absorption field is under driveway comment below Property Line > 10' Community Sewer Manhole[Cleanout > 100' if No Q Yes if Na ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No— ft Private Sewer/Septic Line > 25' Q Yes _ if No_ ft Absorption Field on Lot > 100' 2 Yes if No ft Holding Tank> 100' Q Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' Q Yes if No ft ED Yes if No ft Community Sewer Main > 75' Q Yes if Na ft Manure/Animal Excreta Storage > 100' — ✓[] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100'[]✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' []✓ Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Yes if Na ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' Q 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: Water Main > 10' Q Yes if No_ ft Private Wells > 100' []✓ Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' [✓ Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION dF. Afly 1 certify that / have determined through field inspections and review 4, �' E of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.l .. • • • ,•; f yD • MICHAEL N. AhDERSGN :.a4'� CE 9474 low aC f COSA Checklist yellow sheet DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section — www.rnuni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC201527 Subdivision: West Addition Knik Heights, Block: 1 , Lot: 4 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 9.73 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. 00 • O — 0 C 0 D I i 4h, N (D 7 C C0 01) ay O M1 m Cfl rn O (Dn N ((D r Ni •° 7 O GO 0 N (D N S 1 CO OS 3�0•fi ------ N 7 7 cr O m r+ CD o 0- M ° to S 7 =� A Oo 0 OCG 00 CO Om CL Er On -O'° .+rt F ------ 0 7 N ? Do o (D (M CD i3 S (D 3N 1 O `< a EA c CL a 0-0 7- Crt N Cr ° N• r_ n.a. CLCL o O (D _ opON ! (7 7 73 5. < (n p (D p -`C .Ny. rt ---0 D N (Da a i r,, CD �« X, O N O N — 7 rt :3 0 3CD o O 0 O 7 O_ -n N V _ O Ul ! 7 N O CO 7' CD CD O co M�� MM NCD . 7 0 (A m O (ND O o (D C '+ S N =o_ --------------------------- Elmore -------------------------- Elmore Road N00'05'00"W p ki 30.0' I i 4h, ''• 9',. C0 01) 1 I / o Cfl rn O C r Ni i 16.2 GO 0 rnl 1 CO CP p ki w sD.3 14 4. i i I ti =rJ �� I I CX n Z f —(z0 Ij LnN� m (n I I� COC=C I I I I C5. in C3 I I 10' Utility Esmt. S00'07'18"E 165.00' I i 4h, ''• 9',. 01) co �m - m M: Cfl Ut C r 0 �• 6Z _ m 3 CO w sD.3 14 4. i i I ti =rJ �� I I CX n Z f —(z0 Ij LnN� m (n I I� COC=C I I I I C5. in C3 I I 10' Utility Esmt. S00'07'18"E 165.00' Ln 0 I i 4h, ''• 9',. co �m - m M: I r Ln 0 [|T� 0F ��O0�A(�F PK0T[�TT0N , Aucboca«p. Al 99�O1 Z64-�I72O Date kcoeivcJDecember 1977__�__ #I: Time 30 a.0.�2� ��m� �3� ��mo _-~-~--~-__ Da12-15-77 Thursday JoLo DuLo Iosp Buchholz [uF� Innp kEQ�JBST FO)! &_!'PDDoViU, OF IQDIVIUD7\L, 5C#N'D AND Fi\CIIiI'j.lIFS I. Len -,Jing Alaska Stotebaob % Bevezll, ��ailio� �ddzeos� 310 East Northern Lights Blnd____ 2Dcopert7 Owner: _Leo _A~ Miller In 11 333-4369 5901 East 6th Avenue Space 141 99504 3, I,cgal Dcooriyiioo: Lot 4_Dlook l Koik Heights West Subdivision 4single Yumily DeoWenoe: (X) Number o[ JR,dromns Mn�t��lc ynmily Du,id000u: S. Well. system: Individual (X) �onmonit7/�uhl�o S�atnm ( ) � Permit.- � Dept -0 of Well ��5� wellDrg nu yzlo --`-^------- -----------~ ' )'aotczial 6. Sewage Dj.nposal Syxtrm� 0o~s�tc SyStcm (X)Pobl�t � '77 4t Pe" mit U y� v�-�� Iustollc6 1977 Iu�tzll:r ScDtio 'Yank Size, 0ano[aotucnr 7Distauoey: Wall to Septic !.'auk 'tn Abnorptiou /\zca to Scvvec 1,:i/x! Lot ljuc /|bsVcptioo /\roa to NcazcnL �oL Line MUNICIPALITY OF ANCHORAGE. Department of Health and Envi_ronmenLal Prol,_ec-1—Jon 825 L Street, Anchorage, Alaskr\ ` 9501 264-4720 1 quest for Approval of Individual Sewer and Wftr Fac -lit,ies i 1 . P.r. oiler. Ly Owner : C%_ ___��• -_ /1 �1�t/z____-__-_--_-- .- MailingAddress. 2. Name of Buyer: --- �� r -i it ----- -- ---- ----- —-------- - Mailing Address: Phone: 3. Lending Institution: 131�_s_k_�--.�i�---A9���• Nailing Address:���.-e>k--_---- _--------- -- Phone: 4. Realtor/Agent: Mailing Address: Phone: 5. Legal Description: k /v��%���h% Street Location: /�cc��'/✓���Jyf' ��i�/�G_'`2� _-----_ _ _ _ _ 6. Single Family Residence: ("j' Number of Bedrooms: - CZ Multiple Family Residence: ( ) Number of Bedrooms: 7. Nater Supply: Individual_ Well Public/Col-amunit�7 System ) If Individual Well, well depth / E If Community System, name of: system B. Sewage Disposal System: r'On-site System (Or Public System ( ) If On-site System, date of installation: I(Ior> /y'7'i *NOTE: A well log is required on ALL wells dri-7-led since 6/75. **if on-site sewer system is over two(2) years old, an adequacy test .is required by this department. A fee of $25.00 must accompany each request before processi-nc7 can be initiated. 3/77 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4 Block 1 Knik Heights West Subdivision _ Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved Disapproved: Department Worksheet: Date: Date: