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HomeMy WebLinkAboutKASILOF HILLS BLK 1 LT 6BOnsite File #015-161-51 1982 Drainfield is sized for up to 3 bedrooms Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211167 PID Number: 015-161-51 Dwelling: 9 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New I Upgrade Name MIKE HAWKER ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 11001 GLAZANOF DR ❑ 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 Gravel depth beneath pipe Subdivision Block Lot KASILOF HILLS BLK 1, LOT 68 Ft.Ft. Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches Tank Field Lift Station From Tank Line Ftp Ft. Well 100,+ 50r+ TANK ® Septic ❑ S. T. E. P. E Holding ❑ Other I Manufacturer Capacity Surface Water 100`+ GREER TANK 1250 Gal. Material Number of compartments Lot Line ! 10'+ NA PLASTIC 2 Foundation !!!! 10,+1 LIFT STATION Manufacturer Capacity Remarks TANK DEMO PER UPC, Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield DENALI Drainfield CO/MT 3034. Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed eievation) 100 ft Inspection 1� 7/12121 2�a Location and description dates: 3`" 4111 TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval:Date `�� O F .4t k\1l . 49TH ............. / Septic System �C� n � /� � � •. MICHAEL N. ANDERSON ; � r Approved 1� l X Date 7 a1 D21 CE 14 9 Note: this approval does not include well permit requirements. �t ROFFSSIOK���� (Rev 05/02/18) t `4 -6tJ*oo m o�T p ru v a..4 +0-��2 , Permit No. OSP211167 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: KASILOF HILLS BLK 1, LOT 6B MARK A B TC01 18 30 TCO2 22 30 CO3 25 34 C04 25 35 i DRIVEWAY \ F -C J PID No.: 015-161-51 BENCH. TOP OF LID NEW 1250 GALLON PLASTIC TANK 2 TC 02 8' BETWEEN TANK AND FIELD WELL ASBUILT SCALE: 1"=30' SEPTIC SECTION N.T.S. MICHAEL N. ANDERSON: L No. CE 9469 * 0 4 ............ �� OF A�q�;�p �. 49 TH* a SHANE A. HOLT LS -6914 44a a o ���°Iessiona� Loo THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW AN' CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS-BUILTSURVEY I" =30' NO CORNERS SET THIS DATE /HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT6B, BLOCKI, KASILOFHILLSSUB (PLAT69-233) 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 ATANCHORAGE,ALASKATHIS 13TH DAYOF JUL Y 2021 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 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.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211167 Work Type: SepticTank Upgrade Tax Code Number: 01516151000 Site Legal Address: KASILOF HILLS BLK 1 LT 613 G:2641 Site Mailing Address: 11001 GLAZANOF DR, Anchorage Owner: HAWKER MICHAEL C Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: �ti»�nr DeI)IrtIII ell t 5/28/2021 5/28/2022 30113 ❑ 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: �p Date: Issued By: Date: ';b S49 0'� t 4 UNUP LITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-161-51 Property owner(s) Michael Hawker Day phone Mailing address 11001 Glazanof Dr. Anchorage, AK 99507 Site address 11001 Glazanof Dr. Anchoral4e, AK 99507 Legal description (Sub'd., Block & Lot) Kasilof Hills Block 1 Lot 6B Legal description (Township, Range & Section) Lot Size 30,113 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ■ Upgrade 0 (D) F1 Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: J`w Z6 202 Date of Payment: Receipt Number: 41 2-7 % Receipt Number: Permit No. D SI? 1 / % 6 `] Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211167, Rebecca Carroll, 05/28/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211167, Rebecca Carroll, 05/28/21 % MUNICIPALITY OF ANCNORAGE DEPARTMENT OF HEAl_TH & ENVIRONMENTAl.. PROTEC'rlON ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WEI. L INSPECTION REPORT ...... [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION / il;fir ~OCATION NO. OF BEDROOMS~ Well Ab~orptio~ ~w~Hing , PERMIT NO. DISTANCE TO: //O ~ / ~ea ~ ~ Manufacturor Moterinl ~/ ~o~ of compartments ~ ~ Liq. capaciW in gallons Inside length Width Liquid depth ~ /,~ IF HOMEMADE: ....  ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer .... Material Liquid capacity in gallons ~=~ DISTANCE TO: Well//~) + / FounOation~r/ Nearest,otlh,)¢[ PERMITNO. ~ Ne. of lines Length of each line / Total length of lir~ / Trench width Distance between lines ~ ~ ~ Top of tile to f~h grade/ Materia~ ~eneath tile Total effective absorptioQ aAea Length Width Depth PERMIT NO. ~ ~ Ty~e of crib Crib diameter Crib deptl~ Tota~ e~fective obsor priori a~ ea ~ Well Buildh~ foundation Nearest lot line ~ DISTANCE TO: ~ Class , Depth Driller Distance to l6~ line PERMITNO. ~ DISTANCE TO: Building foundation Sewer line//O.~_ Septic tan~/o-m Absorption area(s).~ INSTALLER REMARK ~PPROVED DATE LEGAL I !"!r;:¢::l"r' 1; '"dq J,:::;::!;5 ;( L. 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"., '~"~..~:: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~SO ILS LOG ~RCOLATION TEST SLOPE SITE PLAN DEPTH 5 WAS GROUND WATER 15 16 17 18 19 2O COMMENTS PERFORMED BY: 4~~/~ 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 2~''~ (minutes/inch) TEST RUN BETWEEN ~"-~' FT ANO -~' ~PFT CERTIFIED BY: II SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF jZ% 00 DRILLED AT THE RATE OF PER FOOT, PROPERTY OWNER LOCATION OF WELL SITE DRILLER WELL LOG: 0 ......... WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THe SUM OF COST INCLUDES ALL, LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. ,:,:/,'/,' OO ~ O0 THANK YOU VERY MUCH, DATE BERNIE CLAUS OF RAMPART DRILLING WORKS ~VI~ GHA~G~O~ I~% P~R MONTH WILL B~ ® 'I [I- C) VJ ^D ^Vl m M O O Anp o l�"!I O LLL �t- C Q � U N E o � >W © o i a)U) r/N C,6v) L E Q L- O > C/) o0 W, L N O N LO N Co ai O coQ X W C) 0 0 LO r r V d O m U O LO CY) Q m 0) J � � U ry C/) oW J LL J_ O 2 LLQ 0 Q <C—/) � Y O O c � O �• Q O U N m � c� CD v J (n co X c E O � O � L � N O) C (Y) O O N U) u o O W W C O Q L O^ U^) O Q Q N �L O C U) O > cu O L U 0 cn c a� E O U . q. O 0 O .Q >, W Q. Q O N �-+ MCD ai N s N U L U U N tm 0 fn O iQ. - L O O >, L O 4+ U N 70 U) (n -0 N fn N +' O Q Q U Q �. 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H MI O a- ��' >, aW ami O N M ui CO > W m a) LL > m i m 0 LL Q 0 N ca a O a) cu 0 0 0 U Q 0 0 U COSA Checklist.docx COSA Checklist Legal Description: KASILOF HILLS BLOCK 1, LOT 6B Parcel ID: 015-161-51 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 5/15/1982 Total depth 200 ft Cased to 200 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/2/2024 Static water level at beginning of test 60 ft. Well production at time of test 5.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.66 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 3/25/24 Comments: A well cap is on top of the sanitary seal. B. TANK DATA Measured operating fluid level in septic tank 59” Date of pumping 3/28/2024 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) 5/5/1982 ALL standpipes present per record drawing Total measured depth from grade 10.6 ft (max) Measured depth to pipe invert from grade 4.3 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 5.5’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 4/1/2024 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 4/2/24 Results Pass Fluid depth prior to test 0 in Water added 1300 gal New fluid depth 0 in Elapsed time 0 min Final fluid depth 0 in (18” missing ED) Absorption rate 450+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in (MOA 7’ ED) Effective depth used 18 in (Final Fluid Depth + Missing ED) Effective depth (ED) remaining 66 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate with 5.5’ ED. No water appeared in the MT/Sump during the presoak & subsequent adequacy test. 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 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 4/10/2024 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 & 04/10/24 '*R US R MUNICIPALITY OF ANCHORAGE Development Services Department -` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel LD, 015-161-51 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: 0 a 4� 1 t� o l KASILOF HILLS BLK 1 LT 613 11001 GLAZANOF DR, ANCH AK Current property owner(s) Mailing address Real estate agent MICHEAL HAWKER SAME 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Z Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $_!��G04 J3y rtA5, 1 Waiver Fee $ Date of Payment 7/11/2 � D 2 1 Date of Payment Receipt Number 01 9 5b ( Receipt Number COSA # 0 S C2) Waiver # Distance: 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. 1 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. 6. DSD SIGNATURE r1 System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Date 7-15-21 OF Atowl 49TH +� �� �• MICHAEL N. ANDERSCN -v / CE 9 IN - with the following stipulati000i OF WATER AND o WAS - OrzPAM-� rN T SER4pl,\. By:aI Original Certificate Date: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: KASILOF HILLS BLK 1 LT 613 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 5/15/82 Total depth 200 ft Cased to 200 ft ❑Q Sanitary seal is functioning correctly X Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 5-19-21 Static water level at beginning of test 37 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material Measured operating fluid level in septic tank NEW Il❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 5/5/82 ❑ ALL standpipes present per record drawing Total measured depth from grade 10'-5 ft (max) Measured depth to pipe invert from grade 3'-5" ft (min) ❑ N/A — pressurized field FE Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-161-51 Structure served by this system Well production at time of test 7+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes X No 0 Coliform bacteria is Negative Nitrate 6.78 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/LN Arsenic less than MRL (ND) Collected by Arc Terra Eng. Date of Sample 5/19/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5119/21 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 1 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth n ❑ 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)If yes, enter date 0 Gallons introduced gallons 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) Septic Tank/Lift Station on Lot > 100' ❑Q Yes Community Sewer Manhole/Cleanout > 100' v❑ Yes if No _ ft ❑v Yes if No ft Neighboring Tank > 100' M✓ Yes if No _ ft Private Sewer/Septic Line > 25' ❑v Yes if No _ It Absorption Field on Lot > 100' ❑v Yes if No _ ft Holding Tank > 100' Yes if No _ ft Neighboring Absorption Fields > 100' ❑✓ Yes if No _ It Water Main > 10'❑ Animal Containment > 50' Yes if No _ ft ❑v Yes if No ft Yes if No _ ft Water Service Line > 10' Q✓ Yes _ Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' v❑ Yes if No _ ft M 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 _ It Property Line > 5' ❑ Yes if No_ It Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No _ ft Private Wells > 100' ❑✓ Yes if No _ It Water Main > 10'❑ ft Yes if No—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' ❑Q 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'v❑ Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Service Line > 10' Yes if No _ ft Community Wells > 200' ❑✓ Yes if No _ ft Surface Water > 100'❑ Yes if No _ ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I 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. COSA Checklist yellow sheet _��®waav0 *:49TH `fr • MICHAEL N. ANDERSON 1 �• CE -94 9 ••z% 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 # OSC211404  Subdivision: Kasilof Hills, Block: 1, Lot: 6B  A water sample revealed a nitrate concentration of 6.78 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.          MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '1. GENERAL INFORMATION Complete legal description Lot 6B; Block 1; Kasilof Hills Subdivision Location (site address or directions) 11001 Glazanof, Anchorage, Alaska Property owner Mailing address Hawker Day phone 272-2025 2600 Cordova, Suite 206, Anchorage, Alaska 99503 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holdin9 tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91} Front MOA #21 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 of this Health Authority Approvalapplication shows that the on-site water supply and/or wastewater disposal system is 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & s ENGINEERING Phone ~ 2.J.~4. ~-ag~e River Loop Road No, 204 Address 1=~''i~ }?iver. Alaska 99577 Engineer's signature Date DHHS SIGNATURE Approved for Disapproved. /-~//'-~('/'~./~b e d r o o m s. Conditional approval for bedrooms, with the following stipulations: Additional Comments /7 / _ , . /,/ By: ...... Date ,//g~ _, The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DJ-IHS do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage Js not responsible for errors or omissions Jn the professional engineer's work. 72q)25 IRev 1/~1) Back MOA ~21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-O'T '~/~; ~ I/Y~%/&oF ,,Z/¢~¢.~ ~f--Parcel I.D. ~/~}~- A. WELL DAT,~.. Well type t tL~UPc~f~£ Log present (~N) Total depth Sanitary seal CN) If A, B, or C, attach ADEC letter. F~::~ Date completed o~,Oo Cased to ADEC water system number ~(-'//~ -'~-IK-~- 8'~ Driller I~Pt~p4czT- /~RIu-t,Wo Casing height /~¢r Wires properly protected (~N) ~- Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION /O/6 /~2-MUNICIPALITY OF ANCHORAGE , / lcNVIRONMENTAL SERVICES DIVISION OCT 1 $ 1992 II- 's RECEIVED Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /00 /- /oo ; On adjacent lots _ ,'/(~(~ ~ 'On adjacent lots /~,/d ~ Public sewer manhole/cleanout /U///¢ P etrole u m tank _~_F¢~.. WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: \c¢~ '~ - ~ ~-' Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~E'~ - U-'o- ~ ~- Cleanouts ~/N) Jv¢o High water alarm (Y/~ Date of pumping Tank size ./{..J(~0 ¢4-(-- Compartments _ Foundation cleanout(~'~N) ~"~ Depression (Y/~)~ Alarm tested (Y/~ /O/~/Cz Pumper &~ ~ ~16~% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: t Well(s) on lot /(~ ~ To property line /(.j t/. Surface water/drainage On adjacent lots /~) ~ Foundation /'~ / Absorption field ~¢ Water main/service line c~.~ ~ /¢0 '/ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~--~ Length ~"~" ~ Width Total absorption area Depression over field (Y~? R esu Its.~;~ail) ~/'~ Peroxide treatment (past 12 months) Soil rating Gravel thickness Cleanouts presentd~zt~) Date of adequacy test for "~ '4'~1~ ~[ If yes, give date System typ~ f Total depth \~ ~-~---- ¥ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~ ~ ~;>~ "~ On adjacent lots To building foundation To ex¢isting or abandoned system on lot On adjacent lots .¢/~,t~__. Cutbank Surface water \ f=;:>~' Curtain drain f.~O~.z:u E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 5 & 5 ENGINEERING 1703~'~ E~.gle River Loop Roa¢~ No, 204 Signature Engineer's Name Date HAA Fee $ / Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99516 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 59444 Chemlab Rof.# 92,5619 Sample # 1 Matrix: WATER Client Sample ID : DRINKING WATER L6B B1 KASlLOF HILLS $/D PWSID : UA Collected : OCT 8 92 @ 16:15 hrs. Received : OCT 9 92 @ 13:10 hzs. Pzesexved with : AS REQUIRED Analysis Completed : OCT 12 92 Laboratory Super~.~e~?HJN C. EDE Roloasod By ', ~ C~..~-~ Client Name :S & S ENGINEERING Client Acot :SNSENGP BPO~ : Roq~ : O~dexed By :R. SHAFER Send Repo~t~ to: l)S & S ENGINEERING 2) PO~ :NOllE RECEIVED Pazamater Results Units Method Allowable Limits NITRATE-N 3.8 ~/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: J.W, Remarke: 1 Tests Pezformod ' Soo Special Inetructlons Above UA-Unavailable ND- None Detected "See Sample Remazke Above WA- Not Analyzed mT-Less Than, GT-Greatez Than Member of the SGS Group (Soci~t~ GOnbrale de Surveillance) MUNICIPALrPf OF ~%NCH£)IlaGE DIVISION OF I~IRONMENTAL HF. AL'I}I DEPARTMENT OF ~L'i'H ~D E~IRON~NTAL P~ECTION APPLICATI~ ~R HE~TH J~UTHO]~]%~ APPROVAL CEIYK[FIO~-ITE I. ~ hera 1 infomm~t ion Appl ication Date __ff_}/~3~/__8~. ...... (a) I~gal [~sc~ipt],on (include lot, blc~xk, subdivision~ ',mct ion~ to~ship~ range) Lot 6B. Blk l~i~f H~~j~zi~Qn ................................. Loc~tion (ad.ess or directions) 11001 G]azanof Drive (b) App.licants Name William Devine 7%l~nho~ Applicants Address 11001 Glazanof DuJve (c) Applicant is (check one) I~nding Institution (d) Lendinw Institution Alaska PacLfic Bank Liiii F Owner/buj.!c~..r [121; Te ].e_phone 562-6100 Adck'ess 101 Benson Blvd. (e) .Peal Estate Co. & Agent Address 1205 E. Telephone 561-1667 2. _%[lipe of Resi. d~nc~ N~r of ~edr~.n~ Individual )~11 ERA Kitt~ Devine Internatienal Air~ort Rd. Other (doscrite) Note: If ccnmunity v~ll system, must have v{citten cr3nfiFn~ticn fz~c~n the ~pa~nt of E~vironnental Conservation attesting to the legality a~d statts~ Is ~e v, ell adequate for' the n~]e~r of ~cN~s s~cified in this HA& J_~zQJA_! 4. ~.~.g~_~gs a 1 Is the wastewater dis~sal system adequahe for th~} Eum~? of hidro~s !Y~h_~ [PaGe 1 of 2] 5. E._~qineerin~j Firm Provj:_din__lcL Inspections, 1bsts~ r~.ta and [nformntion I ~ertify that I have cn~cked, verified, or cxonforn~-~d to ~1i ~Y3A H~A Juid~lir'~s i~ effect on the date of this~' no~c~. ~'"c.ton. Signed / '," .... > . - Date Na~ of Firm / ' '. '> ~,':: ' Te.leohone Address Sigmd by Date ~,N~IN EI~R SEAL) DHEP Approved for 'ihe Municipality of Anchorage l~p~rtm?.nt (of I-}e.a].th al'.d Envi£on~renta] Prchccti,..r: not guarantee the ccntinued satis'!:.actory i~:formano:~, c,f the water' supply ar:d/or wastewater dis[~osal syshemo Tills approval i~tdicates hhatr a~ cf thc valJ. daLion shc~n above, based cn t.~ data and :i. nforn~tiou furnished bf an ec, gin. ee~,? r,?.giste::e: the Stalze of ~taska, the water supply and ~ra. shewater dist:osa], system is saft~ and t.tonal for the rtt.'.mbe~ off ~eclrocm'~ and type of struct.u~e Jndicated~ ( DHEP .>E,kr., ) '7. Mail the H~:\ tc the follcwing address: KB2/d5/s [Page 2 of 2.] ae MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8, ENVIRONMENTAL PROTECTIOI~ UNZCZP ZTY OF HEALTH AUTHORITY APPROVAL (HAA) MAY 1 lg84 CHECKLIST - FEBRUARY 1984 Well Classification Individual Well Log P~esent (Y/N) Y Total Depth 200' caSed to Static Water Level 30' Casing Height Above G~ound 12" + Electrical Wiring in Conduit (Y/N) Y Separation Distances f~om Well: To Septic/Holding Ta~k on Lot 110' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N/A C leancut/Manhole N/A Wate~ Sample Collected By Wate~ Sample Test Results Comments RECE! ED LEGAL: Lot 6B, Blk 1 Kasilof Hills If A, B, or C, D.E.C. Approved(Y/N) N/A Date Completed 5/15/82 Yield 200' Depth of GroutinG --- Pump Set At 105' 3 gp~ Sanitary Seal on Casing (Y/N) y Depression A~ound Wellhead (Y/N_ ).N___ ; On AdjoiniJg Lots 1'00' + 100'+ ; On Adjoining Lots 100' + To Nearest Public .Se~r To Nearest Sewer Service Line on Lot .... N./A Duane Mane¥ ; Date 4/30/84 ~ Satisfactor~ for Total Coliform B. SEPTIC/HOLDING TANK DATA Date Installed 5/5/82 Siz~ 1000 No. of Compa~tn~nts 2 Standpipes (Y/N) Y Air-tight Caps (Y/N) Y Foundation C]~anout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped~_~ Pumping/Maintenance Cont~act on File (~Y/N) N/A ; fo~ --- Holding Tank High-.Wate~ Alarm (Y/N) --- Temporary Holding Tank Permit (~/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well 110' To Building Foundation 12' __ To P~operty Line 13' To Disposal Field . 8' To Water Main/Service Line 10' + To Stream, Pond, Lake, c~ Major Drainage CourSe None Noted Connmnts [Page. 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 5/5/82 Width of Field 3' Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test 230? Sq. ~ft/Be~ Type of System Design Trench Length of Field 52' Depth of Field 10' Gravel Bed Thickness 7' 728 Standpipes P~esent (Y/N) Y N Date of Last Adequacy Test --- system installed 5/5/82 Separation Distanoe from Absorption Field: To Water-Supply Well 100' + To P~operty Line 14' To Building Foundation 36 1/2' To Existing or Abandoned System Lot None ; On Adjoining Lots None TO Water Main/Service Line 10% To Cutbank(if present) None TO Stream/Pond/Lake/o~ Major D~ainage CoL~se None Noted TO D~iveway, Parking Area, o~ Vehicle Sto~age Area Co~u~nts LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dircensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bed~c~om Rating Against HAA l~equest I certify that I have' checked, verified, or conformed to all MOA HAA Guidelines in effect on the date ~f this ins?ection. / Signed //~/,/z'f/?',:~--'-'__ _~./-2~j_3~'~,~? ' ~-N<--. Date ~ . ',/~_ ~/-4~/''~//' [Page 2 of 2] NT FILLS OUT UPPER HAl APPLIf ONLY Lending Inslqution ,~/ _ l/ .... -- ~ // Realty Co. & A~nt .::~ - -. l":~ ....... ~' /' '~ X' ' .. ~r~,, :, ~/ ~ /~/,¢ ;:~.~ ~ ~:/ ~"~,>~ ,. ~ Cod, Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~, ,) _ ~ Olher Phone Phone Phone Water Supply .~' Individual ATTACH WELL LOG. A we~l Icg is required for all wells drilled since June lg75. [] Community For wells drilled prior to that date, give well depth (attach Icg if available), [] Public Utility Sewer Disposal .~ Individual Public Utility [] Holding Tank Year Individual Installed: .,/,z~ When Connected lo Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ,~..~(.-'~'"~---./'~-. ~.~ 7 ~4:~ / Date Date Inspector Inspector Inspector Inspector ~('g)) APPROVEDDisAPPROvEDBEDROOMS-- ~ ~ 'CONDITIONS OF APPROVAL ( ) CONDITIONAL APPROVAL* -J SoHo ~atin 72-023 (3/82) July 19, 198° Pe je.,3 Do. velo~ment 6917 Old So. ward Highwoy A~c'hor ago., A'i:~ 09502 Lot 6B Dlock 1 ~(asJ.].o:l:' }{' ].1~ A[n)roval :for the individual sewer and wa'~ker 'facilities cannot be granted until, the, following it. ems have been completed: ~ we.1.], log submit%ed %o 'this office for our files and ~/~phe 'tot) of the well (::af:J. ng seal. e({ with a sanitary :~eal sc) that it is water tight, :?!~.e depre~'~si, ou or pit around tl~e we].l casinq need~-~ to be fl]_]_ed with impervious type soil so tb~t]'_"',_ ,s]or)es, away~_ from the well cas.i.l~q, ~t-)osed electrical wires to the well head are in violatioF~ of 'che Nur~J. cJ. pality o:[ Al]C!oorage codes a~c'l mi]st been(,"a~,' cotldU ]_ ,.. h~. ,~.tte[ ana].ysl~,~ report needs to Ne submitted to thj, r~ ~)offin~ ................. 'From 'th[, ('h,~m Lab, ~633 B Si:.reet, :flor our review. Please notify t'bis Department :F. or D. relnnpe¢.tlon who. n the noi:ed di;$crepancies h. av~ been corrected, I:[! the. re are any further questioDs, ~].o, ase call this office at 264-4720, Sincerely, Robert C, A~r~o(-~iate