No preview available
HomeMy WebLinkAboutWEST ADDITION KNIK HEIGHTS BLK 2 LT 5West Addition Knik H ight lock 2 Lot 017-371 -31 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231362 PID Number: 017-371-31 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name AMANDA & SCOTT DUNLAP ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 13001 ELMORE ROAD, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot WEST ADD KNIK HEIGHTS 2 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ __ 25',+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface water 100'+ -- GREER 1250 Gal. Material Number of compartments Lot Line 101+ __ _T7 NA HDPE 2 Foundation *8.5'+ __ LIFT STATION Manufacturer Capacity Remarks *Tank outside soil bearing prism & deck support Gal. Installed to bottom of new tank. Alarm location Electrical installed by Installer OWNER INSTALL — SCOTT DUNLAP PIPE MATERIAL House to tank 3034 d ainfi Id 3034 Drainfield CO/MT Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1" 11/06/2023 dates: 2„d 11/07/23 Location and description aro 4'h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL �� _or- Amw Conditional Approval: Date lie 49TM fir .. . ..... 0 •• •••• ••••••••••% rj Curtis Huffman % Septic Systepp A roved f G �`��, •. CE 128991 Date •.�low�/ `,F, 0PR0FESS10NA�'�-+,.. it Note: this approval does not include well permit require ent . 1117-1-1 PID:017-371-31 PERMIT:OSP231362 FIRST WATER CONSULTING WEST ADD. KNIK HTS. BLOCK 2, LOT 5 DECK-FOUNDATION PROFILE WEST ADD. KNIK HTS. BLOCK 2, LOT 5 LOT 5 EXISTING HOUSE 12/18/2023 MUNICIPALITY OF ANCHORAGE Development Services Department j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax907-343-7997 Septic System Owner -installer Agreement The On -site Water and Wastewater Section (On -site) may issue an approval for a homeowner to perform work on an on -site wastewater disposal system to serve that individual's owner - occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements: 1. The property owner and excavation equipment operator may perform work on no more than one owner -installation project in a 12-month period. 2. Owner's projected active involvement with the installation 3. The name of the excavation equipment operator: gco 4. 1 agree that there will be no monetary compensation for installation services rendered. 5. The name of the inspecting engineer: _FIRST WATER CONSULTING 6. 1 agree to discuss the following items with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On -site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7. 1 agree to have the project -specific On -site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional installation instructions and approval from the equipment distributor. As owner of (legal description) �,5 t f1,l ; a�;�,., k ni / 1 1� lazIt I agree that the information above is true and accurate. Owner's printed name: SGo AdA Owner's signature: Date: __L0 p -.[ 3 Mailing Address: P. 0. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org MUNICIPALITY OF ANCHORAGE „ -lit On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road i Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997� http://www.muni.org/onsite f De pa1,011ent On -Site Wastewater Disposal System Permit Permit Number: OSP231362 Effective Date: 10/25/2023 Work Type: SepticTank Upgrade Expiration Date: 10/24/2024 Tax Code Number: 01737131000 Site Legal Address: WEST ADDITION KNIK HEIGHTS BLK 2 LT 5 G:2836 Site Mailing Address: 1,3001 ELMORE RD, Anchorage Owner: DUNLAP SCOTT & AMANDA JOINT Lot Size in Sq Ft: 46098 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q 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: (S'su I` C_ Issued By: Date: Date: to, o 2 S� Z 2 3 so Development Services Department ", j Phone- 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-371-31 Property owner(s) SCOTT & AMANDA DUNLAP.... Day phone Mailing address 13001 ELMORE ROAD, ANCHORAGE, AK 99516 Site address 13001 ELMORE ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) WEST ADD KNIK HEIGHTS BLOCK 2, LOT 5 Legal description (Township, Range & Section) Lot Size 46,098 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade ❑ Duplex (D) El Holding Tank El Renewal El 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: 4 2 Z S Waiver Fees: Date of Payment: /01/z 3 Date of Payment: Receipt Number: 013 2 I Z Receipt Number: Permit No. _ OS PZ3 1 6Z Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! October 21, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: WEST ADDITION KNIK HEIGHTS BLOCK 2, LOT 5 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. A portion of the existing deck will need to be removed to install tank or a new 1500-gallon STEP tank will need to be installed outside the deck as noted on the design. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231362, Curtis Townsend, 10/25/23 FIRST WATER CONSULTING WEST ADD. KNIK HTS. BLOCK 2, LOT 5 DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK. VERIFY & STAKE AS NEEDED. WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231362, Curtis Townsend, 10/25/23 Development Services Department Building Safety Division On -Site Water & Wastewater Program o 4700 Elmore Road U P.O. Box 196650 4 Mark Begich Anchorage, AK 99507 S A E T Y Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 01'7-3'11-31 Legal Description Property Owner Name & Address: %*VL4A -'"Q Baal 6Q. -a" ao-It Pump Installation Date: -/3b f Pump Intake Depth Below Top of Well Casing: q(� feet Pump Manufacturer's Name: 4q ! a%C fl� Pump Model: 4YM -iv (2.,- Pump Size `/bhp Pitless Adapter Burial Depth: t Z feet Pitless Adapter Manufacturer's Name: r Pitless Adapter Installer: Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Comments: ?,t act �N°++ ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76TH AVENUE .,N ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. '"~AME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl.TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE SScf/-- 0 ?I © UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~oll I DISTANCE TO: Liq, cBpecit~ in g~llons - ~ I~ou _ DISTANCE TO: ] ~O ~ Top of tile to finish grade~ / ~ I ~gth Width ~ ~ Type of crib ~ IC'~, Deptb ~ ~ I DISTANCE TO: Building foundation lAbsorptio, n area /4;' Inside length Dwelling NO. OFBEDROOMS PERMIT NO, No, of compartments Liquid depth PERMIT NO, Liquid capacitv in gallons Foundation PERMIT NO. Total length of lines Material beneatb tile Depth Crib depth Bnilding foundation Driller IDwelling IWidtb Sewer line OTHER Distance between lines b l Total eff, egtive absorption area ~ PERMIT NO, Total effective absorption area Nearest lot line Distance to lot line I PERMIT NO. Septic tank I Absorpti~l~area(s) PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL E',O'F'FEIH Eq:::' THE: li~;;:'::(;;:l::l',,,'t:::l-I";!;I;;:~i"4 ':;;!;l",! I:::'E:I:ET;:'. 1.4 ;I; DTH ~!; :~i; O1:::' THE IE;:':;(;::!:::I',,,'I:::I'I" '_1; EIH ':; ;!; 1",1 F:%t!!i:T .'.',. COINSULTI NG GEOLOGIST BOX 476-M, STAR ROUTE A . ANCklORAGE, ALASKA 99507 · PHONE. 344-7071 SOILS LOG Performed for~~~ 16 18 20 Date Soil Type Water Level CoO Remarks Total Depth of Excavation Groundwat er ~Z~No t Reached Depth, if Reached Classification Method Visual ( ) Sieve Analysis () Material at Total Depth Bedrock ~Not Reached Depth, if Reached Gary F. Player, Consulting Geologist WATER ~ELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 SIZE OF CA~ING~DEPTH OF Hoz,¢I/Z..~. c~ To _!/{) ..... Fr. FEET OF DRAWDOWN. REMARKS DATE COMPLETED /; ~-~-- -- __ tom .t O__ __t O__ __to__ ____tO__ .__tO__ �\AUHMPDA U7Y OF A HCC OPO ;F �r 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. 017-371-31-000 Expiration Date: 12/1/2024 Legal description WEST ADDITION KNIK HEIGHTS BLK 2 LT 5 Site address 13001 ELMORE RD Anchorage AK 99516 Current property owner(s) DUNLAP SCOTT & AMANDA JOINTREVOCABLE TRUST X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: :J Original Certificate Date: 1/2/2024 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 ApprovaLiune 2022 MUHMPA UTY OF AHCHORAGE U 2€ -L�e 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. 017-371-31 Complete legal description WEST ADDITION KNIK HEIGHTS BLOCK 2, LOT 5 Location (site address) 13001 ELMORE ROAD, ANCHORAGE, AK 99516 Current property owner(s) SCOTT & AMANDA DUNLAP Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ 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 $ �� Date of Payment 1 �—ZII - COSA # Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: WEST ADDITION KNIK HEIGHTS B2, L5 Parcel ID: 017-371-31 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 4/5/1978 Total depth 110 ft Cased to 110 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10/17/2023 Static water level at beginning of test 79 ft. Well production at time of test 5.9 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate *14.3 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 12/1/2023 Comments SULLIVAN SCOPED WELL – SEE ATTACHED LETTERS. B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW TANK 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) 7/13/1978 ALL standpipes present per record drawing Total measured depth from grade 13.4 ft (max) Measured depth to pipe invert from grade 7.2 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 10/17/2023 Results Pass Fluid depth prior to test 53 in Water added 850 gal New fluid depth 68 in Elapsed time 1385 min Final fluid depth 48 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in (MOA 6’ ED) Effective depth used 48 in (Final Fluid Depth) Effective depth (ED) remaining 24 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per visual observations (sump invert), available record documents, elevation measured shots & appears sump depth is approximately 7.2’ below sump invert. COSA Checklist.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 *8.5 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 *Septic tank installed outside the soil bearing prism. 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 12/18/2023 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 & 12/18/23 13030 Sues Way Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com December 18, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: WEST ADDITION KNIK HEIGHTS, B2, L5 – EXISTING WELL / NITRATES Per our investigation of this well and the immediate area of the available water quality and well log information, recent scoping letter from a well professional, along with this letter indicating positive drainage away from the well,… it is our professional engineering opinion that the referenced well is not contributing to higher nitrate levels, but that the general neighborhood and natural characteristics is contributing to the higher nitrate levels and respectfully request issuance of the Certificate of On-Site Systems Approval (COSA). Per MOA records, a camera scoped the well casing integrity in 2009 and noted no issues and appears nitrates are coming from another source and not the water well of this property. As a precautionary approach, we also had the well rescoped by Sullivan to verify and no issues were found with the casing and there was no apparent action needed. As stated, the area in general has some increasing nitrates which could be contributed to increased density, lawn fertilizer, roads, drainage improvements, animal waste, …. We recommended periodic nitrate testing in the future of this property and perhaps installing a point of use (POU) water treatment system at the kitchen sink for drinking water. We did review and look at adjacent available MOA files and sites pertaining to water quality and to ascertain possible and visible contamination such as soils, agriculture, animals, septic, etc. We could not see any possible contamination to abate. The well and surrounding wells show confining soils of some silt/clay sands with some gravel above the bottom of the wells or water producing zones. The soils appear to adequately protect the well and aquifer from surface or shallow water flow. Based on this professional review, we request issuance of the COSA for the pending closing. Please contact us if you have any questions. Respectfully, Curtis Huffman, P.E. Date: 12/14/23 P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259. Brent Western , We found no issues during the well scope that would contribute to Elevated nitrate levels at : 13001 ELMORE ROAD - WEST ADD KNIK HTS B2 L5. Sincerely, Chancey Dietrich www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC231481 Subdivision: West Addition Knik Heights, Block: 2, Lot: 5 A water sample revealed a nitrate concentration of 14.3 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. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni,org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.'. 0~ .-_ ~,~1 ° 3 I 1. 6ENERAL INFORMATION Complete legal' description COSA# Expiration Date: Location (site address) 13OOt ~-~mo~.~ ~o~ · Current Propert~ owner(s) Day phone ~.t/2-- c/~o~/~ Mailing addrgss Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: z~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding Tank [] Community On-site E] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request Io homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As cedified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures oufiined 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 cf 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. Nameof Firm Sou~.~-I~n~ ~n~;nRecin~ Phone ' Address ~.o~ Engineer's Printed Name ~-~ZS ,,~r~-~,~c~ ' ~ Date DSD SIGNATURE L/'/ Approved for ? Disapproved. Conditional approval for bedrooms, t bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ,CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegaIDescription: ~{k ~rc! 5 ~SJ~ ¢1Y"2 Lo~5 A, WELL DATA Well typer ~ Date completed ~_~?j3(~ Totaldepth lib ft. IfA, B, or C provide PWSID # Sanitary seat (Y/N) Casedto II0 ft. : FROM WELL LOG Date of t~st ~l~ "~ Static water level ~ ' ft. Well production z{ g.p.m. WATER ~AM'PLE RESULTS: Coliform ~ ~ coloniesll00 mL Nitrate ~0. ~ mg/L Arsenic: B. SEPTIc/HoLDING TANK DATA Tanksize~ I~,-c'"',O gal. Foundation cl~anout.(Y/N) . Date of pumping C. ABSORPTION FIELD DATA well Lm (Y/N) Wires propedy protected (y/N) Casing height (above ground) AT INSPECTION~ g.p.m. Other bacteria ~" colonlesll00 mL Collected by: ~L A~.5 ..~'~u~,~la~ Number of Compartments ~, Cleanouts ~IN) r Depression over tank (y/N) ~/ High water*latin (WN) Pumper '~'5~O'c' $ Du m?~ n,..~ : Date installed -~tl;1"3'/~ Soilra~ting (g.p.d.lft'o~ Length ~5 ft. Width ,~ ft. Total depth 13,~ ft. Eft. absorption area ~) ft~ Monitoring tube . Date of adequacy test ~J 0<~ Results (Pass/Fail) Fluid dept~h in absorption field before test ~c~ in. Water added Elapsed Time: '~D min. Final fluid depth I~0 in. Absorption rate >= Any rejuvenation' treatment (past 12 mo,) (YIN & lype) ~DAt. ~Aot.d ~ If yes,: gi~e date. System type Gravel below pipe (o ft. D&~resslon over field For ~ bedrooms Newdepth ~ in. D. LIFT STATION Date installed / Size in gallons / / 'Pump on' levela/ in. 'Pump oft' level at/ in. / / Datum // Cycles tested / E. SEPARATION DISTANCES Manhole/Access (Y/N) / High water alarm level at / Meets alarm & circuit req~ents?. in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanl~ift station on lot Absorption field on lot IO0~+ Public sewer main ,,,4,,'/,,~ Sewer/septic service line Animal containment areas 50 On adjacent lots lC0 0+. On adjacent lots Public sewer manholelcleanout Holding tank ~/'/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots Property line .5't- Absorption field ~ ' Water service line SO t + Surface water ~CO ~- Curtain drain F. COMMENTS SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I0 t4- Building foundation JOt+ Water main ,/V/A Water Service line ~' Surface water ICO !~- ~ Driveway, parking/vehicle storage Wells on adjacent lots 7_S 't- I ce~ify that I have dete~ined through field inspections and review of Municipal recess that the above s stems are in Y confo~ance with MOA COSA guidelines in effect on this date. ~ / ~.~'~'~:~~ ~ ~ngineers ~rinted Name L~C~ ~[Ano COSA Fee $ ~ ~ ~ Waiver Fee Date of Payment Receipt Number (Rev. 11/05) Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 090365 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 5 of Knik Heights West subdivision. This inspection revealed a nitrate concentration of I0.1 milligrams per liter (mg/L) was reported for the property's well water sample. 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. SGS Ref.# Client Name Project Name/# Client Sample ID Matrix Samplc Remarks: 1095143001 Spurkland Engineering Knik Heights West B2,L$ Knik Heights West B2,L5 Drinking Water Results PQL Printed Date/rime Collected Date/rime Received Date/rime Technical Director 10/06/2009 12:26 09/22/2009 11:54 09/22/2009 16:15 Stephen C. Ede Allowable Prep Analysis Units Method Containe~ ID Limits Date Da~e Init Naeals I:T ICP/MS Arsenic Waters De,ar tment Total Nitrate/Nitrile-N Microbiolo~ Laborator~ Colony Count Total Coliform Fecal Coliform ND I0.1 5.00 ug/L EP200.8 C (<10) 10/02/09 10/05/09 NRB * 0.100 mg/L SM204500NO3-F B (<10) 10/03/09 LCE col/100mL SM20 9222B A (<200) col/100mL SM20 9222B A (<1) col/100mL SM20 9222B A (<1) 09/22/09 DLC 09/22/09 DLC 09/22/09 DLC Aarow Pump & Well Service, LLG P.o. Box 110496 Anchorage, AK 99511 OffIce: (907) 346-9355, Fax (907) 333-8970 Eaglo Rivet: (907) 622-9335 08491 CUSTOMER 13o01 dOB SITE -I I- -I. I L / QUANTITY, , DESCRi¢~JON PRICE AMOUKI' ~BOR HOURS RATE AMOU~ TOTAL MATERIAL TOTAL ~BOR WORK ORDERED BY~ DATE ~MP. 'OTAL ~OR Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of I~e Above Described Wo~ end agree that II above work Is not paid for in 90 days I agree to allow Aarow Pump & Well Sen4ce. LL.C. the right to remove unpaid for equipment and charge fo~ labor already performed & labor to remove unpaid for equlpmenl.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOIL.OWING PURCHASE, SERVICE CHARGE AT RATE OF 1,5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. Environmental Consulting and Design Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bmgaw Street Anchorage, Alaska 99519 October 7, 2009 Subject: Nitrate Levcls 13001 Elmorc Road Ladies and Gentlemen: The water quality was sampled for nitrate on September 22, 2009. The nitrate level in the sample is 10.1 mg/I. The well was seeped by Aarow Pump and Well on September 25~h, 2009. No pcrfomtions were observed Io a depth of 60 feet. The well casing has a proper seal on it. The casing extends 12 inches above grade and is graded to drain away from the well head. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Civil Engineer 203 West 15tb Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Municipality of Anchorage Development services DePartment Building Safety Division on-Site water and Wastewater Pro§ram 4700 SoUth Bragaw St. P.O. Box 196650 AnchOrage, AK 995'19-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O1'7- ~"/I-- ~1 1. GENERAL: INFORMATION Complete legal description HAA# bL[ ~'):2,j~ ~'' ' Expiration Date: /I- /I- 0 ~ Location (site address or directions) Current Property owner(s) Mailing address L e.~_cl~i~_g., agency Mailing address i i-= Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: Day phuJm~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [~ Individual On-site [~ [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given n paragraph 4 by an independent professional civil engineer registered in the State of Alaska Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 Health Authority 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/er wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm l---'~,~e~1 .~-V_\.~l~' ~ ~, Phone Address ~0~ ~ I~ ~%~U~[~_. Date Engineer's Printed Name 5. DSD SIGNATURE I~ Approved for ~ bedrooms. Disapproved. .............. ~_..-.~-.. _~Conditional approvahfo~ ..... ~ '~edmoms~with~the4eltowing~stipulati°ns~;~'~ - ON-aTE [ WAS EWATER ~ ~ PROGRAM .' o.'.. -' Additional Gomments ~.v~-... ... Note: ~e weii for mis proper~ meets ex~stmg State ano lVtunicipat Cooes. there are nitrates prcsc, l. It is suggcstcu tuat permute tc~ta g be performed i° h~surc ~ wefts coaii, ucd suiiab~iiy. . R~ch~e~ts; ..... 04 ~matmn on mtrates is aya~ab~ from the On-S~ Seduces Pr~rflm, at,343-7~ . H~ Checklist X ~a~ntenance ~greements Septic System Advisow Supplemental Engineer's Repod Well Flow Advisow Other Original Certificate Date: (Rev. 01/02) Develop .US¸ ft. __coloniesllO0.m ' Nitrate ~,~J rog. II. rog.II. Date Other bacteria,, ~,1_~"~ co~o~i~s/,?,~O mi. Number of C, )ression over tank (YIN Date installed High water a~arm [Y/N) Results ft2/bdrm) IIX) Gravel below pipe (e ft. M0nit~)'(ing t'dlS'b ~"/ Depression over field ~ Water added ~,,~ gal. in. __ bedrooms New depth ~ 0 in ;EPARATI~N DISTANCES Size in gallons ~; · ~' twanno~e/,~ccess (Y/N) ,. : "Purr ~) off" level av'/ n. Higr~ water alarm ~e in. orl r main fo6'ri~dat 6n ~ O r main Wells on adjacent o[s On adjacent lots Public sewer manhole/cleanout Holding tank ;EPT C/HOLD NG '¢~1( 6~ Lb? TO: Property line '~0 Absorotion field Water service une Surface water -':"~;'~ ;I O ~' Building foundation ~ ~ ~ Surface water ~'~D Driveway, parking/vehicle storage Wells on adjacent ~ots "~ [OO ~ With MOA HAA that t~e above systems are in ~ in effect on this date. Waiver Fee $ Date of Payment Receipt Number 07-~-04 08:35AM FRO~-CT~E ESi, SGS ENV SERVICES SGS Laboratory Analysis Report SCS Ret.# Client Name Project Nan./# Client Saraple ID Matrix Salnple Reraarks; 1043936001 Tobban Spurkland P.E. Kaik H~i~a*.s West KnikHetghts Wast ~Z I.T~" Drinking Water P.m,s,vt= Rer~l~.s PQL U~ All Dams/Times are Alaska Standard Tirae Printed Date/Time 07/12/2004 14:18 Collected Dete/Tlrae 07/07/2D0~1 !4:20 Reeelvefl Date/Tlrae 07/07/2004 15:15 Technical Director Ste~n C. Ede Allowable Piep ~al~..sis MetMM C?~taineF ID l.imtI~ Datc Date Init Nitra~e.N 9.11 0.100 rag/L EPA 300.0 A ~'<= lff) 0~37/04 JIB S 00'07'18" E 165.00' 10' UTILITY EASEMENT 40' NATURAL EXISTING HouSE 62.2 tRANSMiSSION SET BACK LINE S 00"05'00" 165.00' BRAGAW STREET APPLIC ",IT FILLS OUT UPPER HAL ONLY Buyer Phone . ),.y,:, ~:> J '/ Address Zip Code Lending Institution Phone Address Zip Code R~alty Co. & Agent/~-.~'~ [:~,:- ¢i')" t /'3~ "~ Phone Legal Description Street Location Address Zip Code I No. of Bedrooms f Type of Residence (~,'~n g le Family ~ Multiple Family (~ Other Water Supply [~"l'ndividual ATTACH WELl.. LOG. A well log is required for all wells drilled since June 1975. E3 Community For wells drilled prior to that date, give well depth (attach log if available). E] Public Utility Sewer Disposal (~2"'¢Fr~dividual Year Individual Installed: i '~ ~ {~::~ [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Date Date Date Date Inspector Inspector Inspeclor Inspector Field Notes: / ¢/2.....~ /..~/ MUNICIPALITYPERT. OF OFF~=/ANCHORAGE, ~.T, I & .~ ENVIRONMENI'AL PROT[~CTION '~APPROVED BEDROOMS RECEIVED 'CONDITIONS OF APPROVAL ) DISAPPROVED ) CONPlTJ~NAL APPRO.VAL" Soils Rating Date Sewer Installed '7 /. 77 72.023 (3t8~) Well To Absorption Area / ~.~.) / Well to-rank / g~--~¢ / Kc` Well Log Received f.'"5~ ~-~L~J~~ Septic Tank Size CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TEt. EPHONE: (907) 279-3916 Tony LaFramboise P.O.Box 110815 Anchorage, Alaska 99511 MUNICIPALITY OF ANCtlOIU,GE DEPT, £)F II~:/',Lilt A ENVII,~ONML-iq'i/;L Fbt©ficct ION ~:.., SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF TEST: TEST PROCEDURE: TEST RESULT LOT 5,BLOCK 2, KNIK HEIGHTS WEST 13001 BRAGAW TONY LAFRAMBOISE 4 BEDROOM, SINGLE FAMILY ON SITE WELL FROM MUNICIPAL RECORDS: TANK: 1250 gal. Greet Steel ABSORPTION SYSTEM: Trench,35 feet long,6 ft. of rocks. ABSORPTION AREA: 420 sq.ft. SOIL RATING: 100 INSTALLATION DATE: July 1978 DECEMBER 6. 1983 System was inspected on December 5,1983. Sump was 13 feet deep with 15 inches of liquid. 4-inch clean out was 3 feet deep and dry. Tank had 52 inches of liquid. Water flowing in could be heard. On December 6, approximately 300 gallons was added to the system at a steady rate of 6 gallons per minute. The water level in the sump rose 10.5 inches. After 4 hours the water level in the sump was below the level observed at the beginning of the test. The tank was pumped during the test. This system absorbed more than 300 gallons of water in a four--hour period. It meets the Municipal Require- ments. MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ' ENVIRONMENTAL ENGINEERING DIVISION ' Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILrTIES DIRECTIONS: Complete all parts on page 1, Incomplete reqnests will not be processed. Please allow ten (10) days for processing. MAILING ADDRES~ ' PROPERTY RESIDENT (if different from abo~e] PHONE 2. BUYER ' PHONE MAILIN~ ADDRESS 3~'~.ENDING INSTITUTION "~ ~ PHONE MAILING AD~R~8 ' ' 4. REALTOR/AGENT PHONE' MAI LING ADDRESS 5. LEGAL DESCRIPTION Z ,T 6-- '2. STREET LOGATI ON 6. TYPE OF RESIDENCE [~. SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A wel Icg is required for all wells drilled since June 1975, For wells drilled prior to that date, give well oepth (attach Icg if available,) 8. SEWAGE DISPOSAL SYSTEM "J~. INDIVIDUAL/ON-SITI?~ ~*lf individual/on-site, give installation date Z/._ 7Ct~ . If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING (;AN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONL DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS r~ SINGLE FAMILY [~j ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO I~'~O U R [] SIX PERMIT NUMBER 2. WATER SUPPLY DIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~I'~NDIVI DUAL/ON -SITE DATE INSTALLED [~] PUBLIC UTILITY Connection Verifiecl iNSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Rolding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: _ Absorption Area to nearest Lot Line [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ,~-~' ~_,-.- ~ -:~ ' LEG~- DESCRIPTION 72-010 {Rev. 3/78)