HomeMy WebLinkAboutOLSON HEIGHTS BLK 2 LT 7
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPQSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
]Well ---- ,~1 JAbsorptionarea~
Liq. capacit Inside length
IF HOMEMADE: .~
Well Dwellin9
DISTANCE TO:
Manufacturer
Dwelling
NO, OF BFDROOMS
Width
No. of co~artments
Liquid d e,~p t I,~
PERMIT NO.
gallons
Well Foundation
DISTANCE TO: ~
No, of lines eacf Total length of I
Top of tile to finish grade
Material beneath tile
Length Width Depth
Trench width
Total effective a~;~tioa area
PERMIT NO.
Type of cri
TO:
Building foun(
~rest lot line
DISTANCE TO:
Driller
Sewer line
Distance to lot line
Septic tall k
PERMITNO. ~>7 90~f¢''(~) ('
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
WATZ[~ WELL LOG
FOSS DRILLING ASSOCIATED
909 CHUGACH DR. #3?
ANCHORAGE, ALASKA 99503
WELL OWNER Frank O. Bethard
USE OF WELL
WELL LOCATION Lot 7~ Block 2 _Olson Heights Suhd±vision
Domestic
SIZE OF CASING 6" DEPTH OF HOLE ]66 FTo
STATIC WATER LEVEL 1LI. O FT. Go P. M. 1~
REMARKS
CASED TO
WITH
]66 FT.
22 FT. OF DRAWDOWN.
DATE COMPLETE~ ?/~/??
. PUMP TO BE SET AT 165~
0 to ]0 Alluviumi brown color~ medium hardness
jo to 6_..Z
.65 to_Zi
Z~_.aoZL~.
J ~.o toLS_q
.LE.q. to~ 6 ~
,.1 6.~ t. ol 66
to
Till~ grey color and hard
Alluvium~ gr~¥ cQlor, m~d~.~.h_ar_dn~~
Alluvium~ blue-grey colo~, medium~ardness
Alluvium; gre~ color~ medium hardness
Alluvium; light brow~_~olor~ med~ium hardness
Sand; grey color~ with water
to
to
to
to
to
to
to
to
to
to
DEPT. OF HEALTtl &
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SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-222l'
SOILS LOG- PERCOLATION TEST
LEGAL DESCRIPTION:
DATE PERFORMED:
[] PERCOLATION
TEST
SLOPE SITE PLAN
lO
11
12
13
14
15
17
18
19
2O
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
S
.... ....
L
O
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
----. FT
72 008 (7/76)
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
OF ON-SITE SEWER AND NATER FACILITY
264-4744
GENERAL INFORMATION /MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision,'section, town~hip, range)
Location (address or directions)
(b) Property Owner '~ ~' ~1. [~)0::~-..Ul Telephone: Home
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent ~~ ~,~ ~ ~
Address
Business
Telephone
(e)
Mail the HAA to the followine address: or: Check here ~ if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family ~[
Number of Bedrooms
WATER SUPPLY
Individual Wellj~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite/~' Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 77-o25 fRev 8/,86/ Fronl
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MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Descriptig.,n,: /-,,~2 ~ "7; ~.~ ~ ,x~.
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ./'
Static Water Level
Cased to / ~
/¢?
Casing Height Above Ground ~ /.¢' i
Electrical Wiring in Conduit (Y/N) ,'/v/
Separation Distances from Well:
To Septic/Holding Tank on Lot J O ~
To Nearest Edge of Absorption Field on Lot _/
To Nearest Public Sewer Line ~t/~ Id
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A, B, C, D.E.C. Approved (Y/N) _
Date Completed c///,~/.~? ~) Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
;On Adjoining Lots
To Nearest Public Sewer
A~/~l "f- To Nearest Sewer Service Line on Lot ~ ~' O
'~ "'~ ; Date Ii/j ~J ~ 7
B. SEPTIC/HOLDING TANK DATA
Date Installed '~//?~'~)
Standpipes (Y/N) CDI~/~.' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N) __
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size ~ ~r¢--5'O No. of Compartments ~
y Foundation Cleanout (Y/N)
Date Cast Pumped "7/~.¢¢ /
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line i~-~¢~ c) '~'
To Water Main/Service Line
Course
To Building Foundation ! ~2
To Disposal Field -~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026 fray t~ 86! Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed '?/;/';7
Width of Field '~ ~'
Square Feet of Absorption Area
Type of System Design
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
i',,l O l,,l
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
;On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify tha~_.av~.c.h.e~ kc ~ ,d~.ve.r:~:c°r c°nf°rmed t° ill ~,O/A,~.nd HAA guidelines in effect on the date of this inspection.
Signed #- ~' Date ~ 0 / , / 1~7
MOA NO.
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
Engineer's Seal
72-026 (Bev 886) Back
DATE RECEIVED
INSPECTION APPOI NTM ENTS Ti M E~/~X)..,¢~
TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
llAUNIcIPALiTy OF ANCHoRAGij
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT, OF
825 L Street - Anchorage. Alaska 99501 E~VIJ~OIXIMENTA£
ENVIRONMENTAL SANITATION DIVISION ,JUL ~ 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE".~i~I_~..~D
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10} days for processing.
1, PROPERTY OWNER I PHONE
MAILING ADDRESS
PRQPERTY RESIDENT (If different from above) ' PHONE
2, BUYER PHONE
MAILING ADDRESS
;3, LENDING INSTITUTION PHONE --
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
-~ SINGLE FAMILY
[] MULTIPLI:- FAMILY
NUMBER OF.BEDROOMS
[] One [] Four
~ Two [] Five
L~ Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTI LI'FY
*ATTACH WELL LOG. Awell log is required for all wells dril ed
since June 1975, For wells drilled prior to that date, give well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON'SITE~'~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUI"ST BEFORE PROCESSING CAN BE INITIATED,
72-010 (Rev, 6/79)/I]"/,'~
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection
Verified
LOG
RECEIVED
3, SEWAGE DISPOSAL SYSTEIVI PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[] Septic T.%rt[( or [] Holding Tank
Size: i~L_~ ~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank 1Absorption Area Sewer Line [ Nearest Lot Line
Absorption Area to nearest Lot Line
5. COM[VIENTS
~//APPROVED FOR L.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompan/~tificate)
[] DISAPPROVED
DATE BY
MUNICIPALITY OF ANCHORAGE
(k
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC251072
Parcel ID 018 -231-11 Expiration Date:
Legal description OLSON HEIGHTS BLK 2 LT 7
Site address 4500 E 135TH AVE
Current property owner(s) KAYLOR RONALD W & JEAN K
X The On-site system(s) is/are approved for 5 bedrooms
By:
1/23/2026
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
According to the engineer the 2001 shallow trench was so full of liquid
that they didn't think it would pass the adequacy test. So they tested
the 1979 deep trench and found that it did pass the test, but was close
to 90% full. The life of this field my be limited.
C/- Original Certificate Date:
3/20/2025
This -Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
41stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory X Arsenic Advisory
Other
MUNICIPALITY 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. 018-231-11
Complete legal description Olson Heights Block 2 Lot 7
Location (site address)
4500 E 135th Ave
Current property owner(s) Jean & Ronald Kaylor Day phone
2. ON-SITE SYSTEMS SIZED FOR 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 23 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed g 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 $
Date of Payment -� )
COSA#
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
6.41
2/19/25 (A+)
N/A
(907) 522-7773
Benjamin Schiller, P.E.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ®. r 907-343-7904
On -Site Water and Wastewater Section ; Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC251072
Subdivision: Olson Heights, Block: 2, Lot: 7
A water sample revealed a nitrate concentration of 6.41 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.
Nitrate Fact Sheet
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.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC251072
Subdivision: Olson Heights Block:2, Lot: 7
907-343-7904
Fax: 343-7997
The septic tank for this property is 23 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
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LOT 6 C-
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- - - - - EAST 135th AVENUE
N 89053'00" E 165.00'
ASPHALT
DRIVEWAY
WELL
SHED
22.0' _
o r�
N
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CANT. 8.0'
8 9,
W 18.9' 2 -STORY
F FRAME
F_--�
U N HOUSE N
40.0'
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SEPTIC OJ
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82.2'
LOT 7
49,500 sq. ft.
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51
UTILITY ` — — — o
POLE O CEA & ATU UTILITY EASEMENT OVERHEAD UTILITY LINE
EO IIIA'r, EO EO EO EO EO EO EO EO EO �-
S 89053'00" W 165.00' REBAR
LOT 14
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (79-68) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION
SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED,
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I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 7, BLOCK 2, OLSON HEIGHTS SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 18th DAY OF MARCH, 2025, ATANCHORAGE,
ALASKA.
THE LIABILITY EXTENT OF THE FIR EPARER SHALL BE LIMITED TO THE AMOUNT OF FEES FIXED HEIGHT LLC
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. C.O.A. 122554
Land Surveying Services 907.290.8949
JOB # 23158 1 NO CORNERS SET THIS DATE I SCALE 1" = 40' 1 225 W 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM
