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HomeMy WebLinkAboutKARELLA LT 20AOnsite File Karella Lot 20A PID# 015-141-59 Only the 5 bedroom system may be tested for any future COSAs. Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201255 PID Number: 015-141-59 Dwelling: X Single Family (SF) 0 with ADU El Duplex (D) [I Two Single Family Project: ❑ New N Upgrade Name JAMES & ERICA CASE ABSORPTION FIELD [:1 Deep Trench M Wide Trench F-1 Bed ❑ Mound Site Address 11000 LIPSCOMB ST, ANCORAGE AK 99516 ED Other Phone Number of Bedrooms Soil Rating depth from original grade 1.2 GPD/SF ITotal 5.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade A.4a 3, 0 Ft. Gravel depth beneath pipe 2.0 Ft, Subdivision Block Lot KARELLA 20A Fill added above original grade 1.0 Ft. Gravel length (2EA)44 Ft, Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank I Field Lift Station Tank Line 625 Fe 2 6.4 Ft. Well 102.6 120.3 i 50+ TANK H Septic El S.T.E,P. E] Holding E] Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100+ 1 100+ Material Number of compartments Lot Line 30.8 14.0 NA POLY 2 Foundation 10+ 10+ I LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House totank 3034d Tankto 3034 rainfield Installer BCX Drainfield 3034 COIMT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 405 ft int 20200811 nd 20200812 Inspdates: Location and description 2ection 3" 20200813 4th SOUTH HOUSE TRIM ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date em *49 TH e annoy® CE 8149 Septic System Approved _Date Note: this approval does not include well permit requirements/ (Kev ubwz/i 6) Qv -=CD cz) £ ;:a M >ozz O D 0(n = -I c m? O G) m O O C 0 z O m Z Wxo z ::E o D r m . z o U) D r O Z n cm (f) "I 3. NOO 00M 2.01— o-�C o�----6.D O" OO O N K: 0 NOTES: RECORD DRAWING DRAWN I JRL SITE PLAN CLEAN OUT p Z \ y�D.. 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( v O N —{ O O m O N r) �II A_ r I 0 � m cn r V) \ N f O� D I` CO m z ro fir' 4 \ OD W;u`J vN OT \V __-V \ y m t.� v �z `\ O m0, ( 0 rtl vA \ 0 0 ( \ L M Z U) .Ln I -J u m <�\ U) < \ 0 x m \ \ O � ZNZ Ocn> —Nim0D z (m r N \ �\ \ 0rri0 D0 � Ox Oi \ OR TUB ZD1-11 �O Ln\O J OUT\ o o z O C7 =x I I m mrn I cn x z0pZ 'J' -DiNO 00 3 U > - - - - - - - - - - - - -� m O - - - = 0' UTIL ESMT \.- LIPSC�QMB/ STREET PANNONE ENG SVC LLC (C.I. 1088) REVISIONS DATE P.O. BOX 1807 PALLIER, AK 99645 ,� OFAl 8/31/2020 PHONE (907) 745-8200 FAX (907) 745-8201 p. ' REV: 20200909 SCALE KARELLA L20A •... • ......• P.I.D. NO JAMES & ERICA CASE "fi!e`en PEERMITRMIT N0. annope 1-59 CE 8149 N 11,000 LIPSCOMB STREET OSP201255 ANCHORAGE, AK 99516 ti SHEET 2OF2 z z t O N \ -I I \ O \ N f O� D I` CO m z ro fir' 4 \ OD W;u`J vN OT \V __-V \ y m t.� v �z `\ O m0, ( 0 rtl vA \ 0 0 ( \ L M Z U) .Ln I -J u m <�\ U) < \ 0 x m \ \ O � ZNZ Ocn> —Nim0D z (m r N \ �\ \ 0rri0 D0 � Ox Oi \ OR TUB ZD1-11 �O Ln\O J OUT\ o o z O C7 =x I I m mrn I cn x z0pZ 'J' -DiNO 00 3 U > - - - - - - - - - - - - -� m O - - - = 0' UTIL ESMT \.- LIPSC�QMB/ STREET PANNONE ENG SVC LLC (C.I. 1088) REVISIONS DATE P.O. BOX 1807 PALLIER, AK 99645 ,� OFAl 8/31/2020 PHONE (907) 745-8200 FAX (907) 745-8201 p. ' REV: 20200909 SCALE KARELLA L20A •... • ......• P.I.D. NO JAMES & ERICA CASE "fi!e`en PEERMITRMIT N0. annope 1-59 CE 8149 N 11,000 LIPSCOMB STREET OSP201255 ANCHORAGE, AK 99516 ti SHEET 2OF2 o '°F . A �s40 49 TH* SHANE A. HOLT G LS -6914 v O 44©h��fessioaai ��o i • • Q N 199 sT 08" F 2!)t 50 m 0 • • NOT HF SURt%FJ' I90NU1441 VT_S FOUNQ ��Al FE ASTER,ti f30- N ,1/1 Y AS -BUILT SURVEY 111 = 30' /-/A !/F BEEN SFT A 17HE 33'I'll TEN7" RIGHT OF 1*1 YE)ISTAIVC E. T1-1EPiAIINDICATT530, tiYN/C,HAPPFARST sr-INLRr'OR. NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY THESURVEYDATA AND MEASUREMENTSHEREON AREPREPARED FOR THE OWNER OFRECORD AS OF THEDA TE OF THIS SURVEY. OT20 A, nV4 EILA JUt9. ANY41SEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRIMENPERAI/SS/ON ISPROV/DED. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOY ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS CONFLICTS BETYEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS EXIST OTHER THAN NOTED. NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELIN£S. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOUN DATED AT ANCHORAGE, ALASKA THIS 217th DAY OF HEREON ( UNLESS INDICATED) 1106667 , 2020 NOTE= FENCELINES THAT MAY APPEAR ON THIS DRAUING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHONN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOY AND/OR ICE. F13,205 4' -108 , HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5523 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muhi.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201255 Work Type: Septic Upgrade Tax Code Number: 01514159000 Site Legal Address: KARELLA LT 20A G:2636 Site Mailing Address: 11000 LIPSCOMB ST, Anchorage Owner: CASE JAMES H & ERICA G Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date Lot Size in Scl Ft: Total Bedrooms: tjlenr .moo llc.partment 8/6/2020 8/6/2021 49436 Q 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: Issued By: Date: Date: 6 2C> 5 MUNICIPALITY OF ANCHORAGE Community Development Department '- Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-141-59 Property owner(s) James & Erica Case Mailing address 11000 Lipscomb St Anchorage, AK 99516 Site address same Day phone Legal description (Sub'd., Block & Lot) Karella L20A Legal description (Township, Range & Section) Lot Size 49,436 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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: X46.2 rl Uv)n Waiver Fees: Date of Payment: 7�/6�zr Date of Payment: Receipt Number: Receipt Number: Permit No. OSP2-01255 Waiver No. Permit App_:- : ._.,.c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201255, Deb Wockenfuss, 08/06/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201255, Deb Wockenfuss, 08/06/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201255, Deb Wockenfuss, 08/06/20 N 5'9, ,,1 ,3" /- OF A4„gs�0 �D.. 49 TH J w” SHANE o o s� SHANE A. HOLT G 14P LS -6914 O 0 0 Les sionak NOTE THE SL: :!E!'lit7Ni;;L•1E.tV7_SFO(1f�1 tJ,1%T.h'c!45Tfii;^?Bl )CIti/7�fiY /-11111E SEFh15b 1 A i HEP/AT 1AIDIC A TF> 3, (J; +. t l ,'lOI APPFAl?, TO 6E IN F_R.�?Or^r- THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANYUSE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICAIL Y TO SHON ANY CONFLICTS BETdI£EN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASENFNTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, INPROVEIIENTS, OR FENC£LINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOIVN HEREON ( UNLESS INDICATED) NOTE: FENCELIN£S THAT MAY APPEAR ON THIS DRAVING ARE NOT TO BE USED TO DETERNNE PROPERTY LINES OR POSITION ADDITIONAL INPROVEMENTS. ANY PAVING SHONN HEREON NAY BE APPROXIMATE DUE TO EXCESSIVE SNOU AND/OR ICE- " l o AS-BU/LT SURVEY i " = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY 0'26 L ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS `}TI' DAY OF JULY , 2020 Fif e'Q> -li 1 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 ,/'"//~]1~ ;'~'/~% MUNICIPALITY OF ANCFIORAGE i~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT "~,M E ....... [PHONE L~ NEON MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS Well Absorption area Dwelling PERMIT ~O. Material No. of compartments ~ Manufacturer ~ t~(~ (¢~¢  Liq. capacity in gallons Inside length Width Liquid deptl~ ,i ~-~] IF HOMEMADE: ~ - ....... PERMI~NO. Well Dwelling  ~ DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid caoaciW in flallons ~ Well Foundation . Nearest lot line PERMIT NO. ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~: ~ ~ Top of tile~'~ finish grade Material b~heath tile Total effectiv ' on area .~j Length Width Depth PERMIT NO. ~ p Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to-lot line PERMIT N~ Building foundation Sewer line Septic tank Absorption area(s~ ~ DISTANCE TO: OTHER -- PIPE MATERIALS ])&~ J¢ 0¢~ SOl L TEST RATING INSTALLER ~ k ~EMARKS ~ E 9VI~ ~ ,- .. ,. ~PPROVED DATE LEGAL ./, , 72-013 (Rev. 3/78) 14LI~I,] I ~ ~-- · ]'~ OF IFt~CHL~:F~,BIE DEF'RRTMENT OF HERL]'H AND ENVIRONMENTAL PROTECTION 825 L STREET., ANCHORAGE., RE 99501 264-47~0 PERM I T NO: DATE I'--';SUED: 84042:~ 06,.."E~5,.'84 :~'; EE I.,-I E R PER I'-1 ][ 'l' APPLICANT: CaDDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: IdA~ BEDROOMS: DEARMMOUND EXC:AVRTIN 5~44 RIVERTON AVE ANC:HORFIGE., AK ~D5~.6 ~45.-~629 SUBDIVISIBN: KRRELLR SECTION: 22 TOWNSHIP: ~2N 4D4~6 (S~.FT. OR ACRES) 4 LOT: 20 A RANGE: ~W BLOCK: NB LISTED BEL. ON ARE THE OPTIONS FIVAILFIBLE TO YOU IN DESIGNING YOUR SEPTIC SVSTEM. C:HOOSE THE OPTION THAT BEST FITS YOUR SITE. [:'EPTH TO PIPE BOTTOM (FT, ::, GRFI',,,'EL DEPTH (FT.) TOTAL DEPTH (F'T.) GRAVEL WIDTH (F"'T..':, GRAVEL. LENGTH (F'T.) GF.'.RVEL ","OLUME (CU. YDS. ) TANK SIZE (GALS) SOIL RATING (Sm]). FT. /BR) TRENCH E:E[], 14. [:,RRZ~4 4.0 4.0 4.0 6.0 0.5 ~.5 20.0 4.5 7.5 2.5 22.0 5.0 50. 0 4~.0 65.0 3:0.0 ~. 4. 48. ~. ±50 &50 ,+:.~.: TANK MUST HAVE A'f LEAST TWO COMPARTblENTS I BERTIFV ±. I BM FAMILIAR WITH THE RE.f;..:!LIIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY ]'HE MLINICIPFILITY OF' ANCHORAGE (MOA) AND THE STFITE OF ALASKA. 2, I WILL INSTALL ]'HE SYSTEM IN FICCORDANCE WITH ALL MOI=I CODES AND REGULFtTIONS., AND IN COMPLIANCE WITH THE DESIGN CRITERIFI OF THIS PERMIT. 3:. I WILL ADHERE TO ALI_ MOR FIND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WFISTEWRTER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR FINY FIDJRCENT OR NERRB'¢ LOT. 4. I LINDERSTFIND THAT THIS F'ERMIT IS '¢ALID FOR R MFI',,<IMUM OF 4 BEDROOMS AND FIN'¢ ENLRF,:GEMENT WILL REQUIRE FIN FI[:,DITIONRL FERi'IIT. IF FI LIFT STATION IS INSTALLE[:, IN RN RRER COVERED BY MOA Bt]ILDING CODES., THEN (1) AN ELECTRICAL PERMIT AN[:, INSPEC'rlON MUST BE OBTRINE[:u (2) RS-BUILTS WILL NOT BE APPROVED WI]"HOUT R[,,I ELECTRICAL INSF'ECTION RERORT~ FIND (2:) THE ELECTRICAL WORK MLIST BE [:,ONE BY R LICENSED ELECTRICIAN. ~PF L I ..PIN r: ND E>:iCRVRT I N I =,=,UE[. B"r' ~~_ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99901 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST 2 3 4 5 6 7 8 9 10- 1 12 13 14 16 17 18 19- 20- SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN P E Reading Date Gross Net Depth to Net Time Time Water Drop 72-008 (6/79) PERCOLATION RATE TEST R U N,,..B)TWE E N (minutes/inch) FT AND FT 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 Parcel I.D. 01514159 1. GENERAL INFORMATION Complete legal description Karella L20A Expiration Date: _b, e- c 10 ) 1), 0� -6 Location (site address) 11000 Lipscomb St Anchorage, AK Current property owner(s) James Case Day phone Mailing address 11000 Lipscomb St Anchorage, AK Real estate agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER 0 FBEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 1XI Private Septic Water Storage ❑ Holding Tank ❑ Community Well El Community ❑ Public Water System El Public Sewer Waiver request for: Distance: MEMMM.M.-, Received by: Date: COSA to be released to the engineer. unless othen-fise requested by the engineer. COSA Fee 0 cct� Waiver Fee $ Date of Payment III bwn / Date of Payment Receipt Number Receipt Number COSA411' 0 SC oC Q Waiver # 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their`own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for 5 System #2 Approved for Disapproved Conditional approval for =11 •.u - bedrooms Phone (907) 745-8200 Date 20200831 bedrooms, with the following stipulations: By: Original Certificate Date: Aa d 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 r� AN, 'e dT. By: Original Certificate Date: Aa d 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: Karella L20A If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth unknown ft Cased to unknown ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/17/20 Static water level at beginning of test 214.7 ft Comments B. TANK DATA Age of tank(s) new years Tank type/material poly Measured operating fluid level in septic tank n/a ❑ Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA new field Which system tested (date installed) new ❑ ALL standpipes present per record drawing Total measured depth from grade 6 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 01514159 Structure served by this system 1 Well production at time of test 3.8 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes M No ❑ Coliform bacteria is Negative Nitrate 5.3 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 6/17/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date new Results ❑ Pass For 5 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' LL] Yes Community Sewer Manhole/Cleanout > 100' M✓ Yes if No ft `✓M Yes if No ft Neighboring Tank > 100' F/1 Yes if No ft Private Sewer/Septic Line > 25' F-V� Yes if No ft Absorption Field on Lot > 100' [Z] Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' M Yes if No ft 0 Yes if No ft Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5 LL] Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' P� Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓J Yes if No ft If absorption field is under driveway comment below Property Line > 10' F✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓[] Yes if No ft Private Wells > 100'�]✓ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 20200831 COSA Checklist yellow sheet 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 # OSC201478  Subdivision: Karella, Lot: 20A  A water sample revealed a nitrate concentration of 5.34 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.                                 Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org  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 medi a 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.          ~ MUNICIPALYTY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEAL%~I DE1)AR~I74ENT OF HEAL'D~ /kND ENVIRONMENTAL PROTECTION APPLICATION ~I)R HEAL'I~-! AL~HORITY APPROVAL CEW£IFICATE 10 General Information Application Date ._.~'./...,.~_~!l .~ Y (a) lagal Descr,iption (i~c].UCk{ lot, block, subdivision, ~ction, township~ ~'ange) Location (add~ess or ,directions) (b)Applicants -~.~- Applicants Ad~,ess (d) ~ndi~ Institution Address " Address NL~ of ~dr~n~ .......... fl_ 3. ~nter Note: If ~r~m],ty ~all system~ must have w~d~tten e~nfir~tion ~a ~Te State P~pa~nt of ~virom~ntal Conservation attestinG to tl~ legality and status~ !s ~e v~ll adequate fo~z the n~ber of ~,~ s~cified in this ~ .~) Is the wastewate~, disposal system adequate f~ [Page 1 of 2] 5. En_q~neerinq Firm Provid~n~j~n__s~_cti.9_ns, Tests, ~tta and Inforn~ation I certify ttR%t I have checked, verified, or conforf[~d to ali. YOA HAA Guidelirms effect on the dat~ of this inspeetio~ 6. DHEP Approval~ in Tern~ of Conditional Approval . %he Municipality of Anchorage Depat, tn~.nt of[ Health and Environ~cental P~otection dc~s not guarantee t~ continued satisfactory ~for~n~ of t~3 wate~ supply and/or the wastet~tel, dis~sal system~ ~is appl, oval indica~s that~ as of t~ validation ~te sh~n'~ ~o~, ~d on the c%qta and infor~tion furnished [~ ~ encjir~eer registered in the State of ~.aska, ~e ~ate~ supply aad wastewater disposal system is safe and rune~. tional fo~z the ~nber of ha~r~ and ty~ of s~uctt~,e indicated~ Al . the [~tA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ~UN~C~PAtlTY OF ANCHORAQ~- DEPI, OF HEALIH & I]NVIRONMENTAL PROT5CTIOb~ JUL g 1984 Well Log P~es~ent (Y~//' ' Date Completed /~72~' Yie~d~/~<'y3/~ Casing ~ight ~ G~nd/~ /~ ~ / Sanitary ~al on Casing~ Elee~ieal Wi~ing in Conduit ~) ~p~ession .~ound ~l~ead'~_ ~p~ation Distan~s f[,~ ~11: To ~a~est ~ge of ~so~ption Field on ~t~[~/~ ; ~ Adjoining [~ts ~/~ B. SE~IC/HOLDI~ T~ ~A ~p. ession ove. Ta~ (Y~7. ~te ~st Pu~d ~/~ ~ /~ Holding Ta~ .igh-~a~e,, Ala~ (Y~7~/~.a~y Holdi~ Tank Per~t (,Y/N: Separation Distan~s ~,~ptic~olding Tank: TO Water-Supply ~].1- ~'O"~/~,, .TO Building Foundation TO ~ter Main/Se~yi~ Li~ /~/~' To S~e~, Pond, ~ke, ~ Major Draina~ 7 Co~ [Page 1 of 2] 2-15-84 qoe;~e u! seu~,IaPTn9 YYR YO~ ~ o:~ pa~o~uoo ao 'paT.3~.aa~ 'pexaeqa e~eR I :~eq:~ Z~!:~aeo I :l~enBe~ ~ ;~ut~by bu!~e~ ta~o~pe~ pe4;~a~zec~ ~aeuD ple!,~ ~o q~bu~/ NOI,T,~S J~I~/ Y[BW(] Gq~I~ NOIJZt~ 'D ALASKA iIUIROFlmeI TAL COrlTBOL S RUICeS, Irlc. ~nqJnecrinq 8 I~nuiro~menlrJ Studies 4/25/84 BARBARA PARKER ANCHORAGE Ali 99501 SELLER - MITCHEL BUYER - SUBDIVISION - KARELLA BLOCK - 0 IDT - 20A ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA, THE SYSTEM IS CAPABLE OF ACCEPTING 180 GALLONS OF WA}ER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 252 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS. THE SEPTIC TANK ~AS PUMPED ON 4/26/84 . FLOW TEST ON WELL THE WELL FLOW RATE WAS 2.7 GPM FOR 4.0 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE.