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HomeMy WebLinkAboutKASILOF HILLS BLK 7 LT 20 Municipality of Anchorage Page I of "5_ 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 .ama: ~¢, /--~^ DoF./z Wastewater System: ~ New [] Upgrade ~No. of Bedrooms: ~ ' Phone: 3~-Z&~y I ~ D~ ~DeepTrench U Shallow Trench UBed UMound UOther Total Depth from original grade: LEGAL DESCRIPTION so,,,~,,.,~.~ ¢ GPD/Sq. FI. ~¢¢nDX Loh Block: Subdlv~lon: Oeplh Io pipe bollom from odglnal grade: Gravel depth beneath Townghlp: J Range: Socllon: Fill added above original grade: Gravel length: Cla891flc8flon (Private, A,B,C}~ Total Deplh:~ Cased To: ~ Tolal absorpUon area; ~ Pipe material: Yield: ~ ¢ GPM I Pump Set et: ~t.ICs'lngHelghtAb°v~r°und:'~ I ~ ~ Ft. TANK SEPARATION DISTANCES ~s..,o u Holding B S.T.E,P. To Sepllc Absorption Llil Holding 'ubllc/Prlv8le Manufaclurer: ~ Capacity In gallons:  Malerlah Number of Compndments: Surface ~ Lot ~ ~ Size in g~llons: ~ CurtatnDrain ~0¢~ ~o~ _~ ~ ~ Pump Make & Model i Electrical Inspection9 performed by: Remarks: ~,~¢ D6sl~ , /fl~Pgcr¢'~ * BENCH MARK Loc~flon and Dogcrlpllon: I Aegumed Elevation: ENGINEER'S SEAL Inspechons performed by: -o ..... ' Dates: 1si ¢¢¢5 ' · Department of He man Se~mes approval ~e~!,2.~ "' '¢-V~7/~¢" RECEIVED MAY 18 1993 Municipality of Anchorage Dept. Hea/lh & Human ~3er~ice$ ~Y~73 ;(9 q6, o W~r-rr~ ~t:, ~) ?0,7® D~vld R. Dayton 2{Y'~ I 0 Don~ler Chugl~k, FAX MEMORAND[ JM TO: Dept. of Health & Human Services FAX NO.: 343-6740 ATTENTION: Dan Roth SUBJECT: lot 20, blk 7 Ka$ilof Hills Subd. DATE: 12'~21\94 W.O, NO.: 94173 NO. OF PAGES: 1 Including this cover sheet) x FOR YOUR INFORMATION: Original Disposition: [] Mailed [] Call for Pickup D Flied [] For Your use [] For Review&Comment X As Requested [] For Approval MESSAGE: Dan, As a follow up to our phone conversation, I have reviewed our records on Mr. Daytons files. It appears that Mr. Dayton was on site on May 23, 1993 to inspect the installation of the tank; May 28, 1993 when he inspected and surveyed the bottom of the trench. His survey notes indicated that the bottom of the trench is at the design elevation; Oct. 27, 1994 when he inspected and surveyed system after completion. It appears Mr. Dayton was on site to see the system installed. Concerning your second questiorl, Mr. Radofr has indicated to LIS that this is to be his personal residence. Concerning the depth of the monitoring tube, I don't know if the tube is a the bottom of the trench. Our survey indicates that it is about 1.5 feet above what should be the bottom of the trench. The owner and Mr. Daytons notes indicate that the trench was dug to depth. In my opinion, it appears the length and depth of the system were constructed substantially in accordance with the perrnit. I hope this additional information answer's all your concerns. Please call if you have any more questions. SENT BY: Dee High DHI CONSULTING ENGINEERS P.O. BOX 1113~,9 AI,~CHORAGE, ALASKA 99511-1349 PHONE: (g07) $45-'1385 FAX; (907) 345-138B MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930129 DESIGN ENGINEER:'DAVID R. DAYTON, P.E. OWNER NAME:RADOFF GEORGE R OWNER ADDRESS:6684 FAIRWEATHER DATE ISSUED: 5/27/93 EXPIRATION DATE: 5/27/94 PARCEL ID: 01513225 LEGAL DESCRIPTION: KASILOF HILLS BLK 7 LT 20 LOT SIZE: 30000 (SQ. FT.) NUMBER OF BEDROOMS: /~ THIS PERMIT: /4' THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DURING CONSTRUCTION I~NGINEER MUST EXTEND TEST HOLE TO DEPTH // RECEIVED ,JUN 1 6 199,3 Mumc]pal~Y ot Anchorage Dept. Health & I-luman Services David R. Da,/~on P.E. 20210 Donalar St. Chuglak, Alaska 99.q67 O~w~ R, Dayton P~. '21~i 0 Donil. r St. ~//~/~ x,.~ ..... .~g!i:k, Al~skl 99567 / / / RECEIVED MAY 1 B 1993 Municipality of Anchora ,e Dept. Health & Human 8er~/gi~.~s David R. Dayton P.E. 202,10 Donalar St. Chuglak, Almmk199567. David R. Dayton P.E. 20210 Donalar St. Chuglak, Almskm 99567 PERFORMED FOR: LEGAL DESCRIPTION: 10 11 12 13 14 15 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Del]Ih to Waler Alter Reading Date Gross Net Depth to Net Time Time Water Drop _//.' ~ ~ ~ PERCOLATION RATE TEST RUN BETWEEN . [minules/inch) PERC HOLE DIAMETER __ _ FT AND --"~.__ FT PERFORMED BY: .~ '~¢~'~ F-~ I z ~ CER~'IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~-"//~ x"~.~ Municipality BI Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~'~7-~2 LEGAL DESCRiPTiON: ~'T ZO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O f2~c~--')~ ~)/'¢cs/,o~F JCvCf, Township, Range, Seclion: si'ri [CLAN SLOPE WASGROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? p E Bepth lo Waler AIle~,A,O~ Moni~orinll? Bale:. Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 1EST RUN BETWEEN . /' (m~nutes/inch) PERC HOLE DIAMETER Y FT AND .,~-- FT COMMENTS · ~ CER'flFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DA~fE: ~'~/~¢/' ~' PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 7~./~ //¢,~ ~ :~ ,; LEGAL DESCRIPTION: LOT- ZO ./~k.: y k,~c'/.¢~-//~[,rTownship, Range, Section: ~,. } ~, ,/'-'-/~.,k.), t2 ~ ~ 5 8 9 10 11 12 13 14 15 16 17 18 19- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, ATWHAT O DEPTH? p E Depth Io Waler Aller ,, / f~onilori.g? /1~ tr~' Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~*'7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _, FTAND '~ _FT COMMENTS PERFORMED BY: ' _~"~. ¢~- J'"'P~T'~,'~) ~¢~C~' I /,~L&~ CER11FY THAT TNIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINESlNEFFECTON~HISDA~E. DATE: ~.~'~ Q' STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER LOCATION OF WELL WATER WELL RECORD BOROUGH SUBDIVISION LOT BLOCK SECTION QTI~S SECTION TOV~q~SHIP RANGE MERJDIAN  DN DE 7 Ds Ow LOCA'rlON/SKETCH: WELL OWNER: DEPTHS MEASURED FROM:[]casing top []ground surface w~J. DEPTH: DATE OF COMPLETION Depth of hole:___.~__¢~__~, ft BOREHOLE DATA: Depth Depth of casing: ~¢.~ft .~ /.~ ~ / Material Type and Color From To - DEPTH 'TO STATIC WATER LEVEL: ft below ,L~] top of casing I-] ground surface / /z/~/'~ ~./ USE OF WELL: /J~' domestic r-] irrigation [-I monitor --G?'~.,~-"~,-"-~.,.- ,-~-,'~ ? ~'~ V'I public supply [] other / CASING STICK-UP: _ft. Diem: ~_~ in. to ~" ~'t~ -~~ .~_ ~ ~7/~>~ Casing type: ~'~,,-"~----- ~ in, to WELL INTAKE OPENING TYPE:/{[~'.opBn end [] screened [] perforated ,/~ open hole .... .//' '~2 ¢.../..~"0,~ z,./,70 Depths of openings: to ft SCREEN TYPE: ~>~___~ Diem: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE.'.~ Volume used:'~ Depth to top: Depth: from ft to ft JU~ ~ ~cj~ DEVELOPMENT METHOD: ~,' Duration: ~ _~_ Murlic:lrdah[y ol /M~OI1C Dept. Health & Human S ~rvices PUMPING LEVEL AND YIELD: ~/~ ¢ft after z't/ hfs pumping ~.~ gpm. PUMP INTAKE DEPTH: ____ ft Horsepower: WELL OI$1NFE-43TED UPON COMPLETION? [] YES [] NO CONTRACTOR INFORMATION: REMARKS: Regist, e/ed Business Name )- -"':?~ .~.~/¢ "7 //_.,,.._., :V . PLEASE MAIL WHITE COPY OF LOG TO: Si~a., ,'" .~; ,. ,', ¢--- , '//%.. _~ ~j ~'.~ g ture or Authorized Respre~intative Date~' DNR/DIVlSION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 Municipality of Anchoral On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 015-132-25 1. GENERAL INFORMATION Complete legal description Kasilof Hills Block 7 Lot 20 Location (site address) 10081 Stroganof Drive Current Property owner(s) William Alquire Mailing address 10081 Stroganof Drive 70 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: SEP Go 2114 Individual Individual Well z Holding Tank VAL U/ 6 8 L Ct El Expiration Date: 12--1,3-1 Day phone Real Estate Agent Debbie Mumma Day phone 907-242-024 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex 0 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well z Holding Tank ❑ Individual Water Storage El Community ❑ Community Class _Well ❑ Public Sewer ❑ Public Water System. ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55-6 Date of Payment L149 Receipt Number COSA # Waiver Fee $ Date of Payment Receipt Number 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 9 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future +��\ occupants or can ArcTerra guarantee that no unseen or '4'X encroachments, \ encroachments, deficiencies or discrepancies exist. rAc� 10,/� Q T11 y;111 `I- 2 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved. Conditional approval for KENNET T 00 bedrooms. ` ,I,/6 bedrooms. bedrooms, with the following stipulations: Original Certificate Date: — 3 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory' Arsenic Advisory Other��,�,� �o.;S-Co/' I COSA Checklist Legal Description: Kasilof Hills Block 7 Lot 20 Parcel ID: 015-132-25 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 5/27/93 Total depth 470 ft Cased to 30 ft IN Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/26/19 Static water level at beginning of test 38 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 11 Standpipes/foundation cleanout per record drawing Date of pumping 9/3/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/23/94 IN ALL standpipes present per record drawing Total measured depth from grade 10 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 Well production at time of test 2.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform bacteria is Negative 16 Nitrate 7.mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 8/26/19-8/30/19-9/9/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/26/19 Results Q Pass For 3 bedrooms Fluid depth prior to test 12 in Water added 450 gal New depth 24 in Elapsed time 185 min Code -required soil cover over field Final fluid depth 12 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) If yes, enter date Gallons introduced gallons Com ments/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' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [I Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No ft 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' 0 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' ® Yes if No ft Private Wells > 100' 0 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 / certify that 1 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 DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191418 Subdivision: Kasilof Hills Block 7 lot 20 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 26 years old. Typical replacement costs range from $6,000 to $9,000. 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 20 year old steel tank MAY look like. g, WIN X111 C�l95Ss? =O}f 9665f1" t1CiOCagBdS 966 ItT iii O!g Nitrate Advisory Certificate of On -Site Systems Approval # OSC191418 Subdivision: Kasilof Hills Blk 7 lot 20 A water sample revealed a nitrate concentration of 7.16 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. 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. 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. GE At Municipality ®f Anchorage On-Sit6 Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. 015-132-25 I Complete legal description KASILOF HILLS BLOCK 7, LOT 20 Expiration Date: 10- 11 -.] 7 Location (site address) 10081 STROGANOF DR, ANCHORAGE, AK Current Property owner(s) ARIS & RACHEL SOPHOCLES — Day phone Mailing address Real Estate Agent 10081 STROGANOF DR, ANCHORAGE, AK 99507 2, TYPE OF DWELLING: Z Single Family (w/wo ADU) F-1 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual N Individual Well z Holding Tank El Individual Water Storage El Community El Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by:..L4 2 Date: COSA to be released to the engineer, unless 'othe4fse requested by the engineer. COSA Fee $ — Date of Payment . 7712-01-7 Receipt Number COSA# I 3 I Q Waiver Fee $ Date of Payment Receipt Number Waiver # 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. Name of Firm 'ARCTERRA CONSULTING INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 3/3/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS (ENGINEERING, SURVEYING, CONTRACTORS, ETC... ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ` encroachments, deficiencies or discrepancies exist. OF 41 /A n TP-'t� System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, rr KEl\NTTH1`—tri' Fof 16 tt� f. 0 01 n� C\ 0; with the following stipulations: �r Drnr,ATR �� By: 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. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory Arsenic Advisory _ Other If more than 1septic system ismothe lot: COSAChecklist # —of Structure served by this system k: K III IIIIIIJ: Legal :Pan:e ID: 05.132-25 A. WELL DATA Well typePRV7 Date completed 5/27/1993 Total depth - 470 -ft. Date of test Static water level Well production Sanitary seal (Y/N)y Cased to FROM WELL LOG 5127/1993 35 WATER SAMPLE RESULTS: Cn0bnnNEG-__co|oniea/ OOnnL Nitrate ft. um Arsenic: Date oysample: 71712017 Wires properly protected (Y/N)Y Casing height (above ground) _16in. AT INSPECTION 53* ft� RM Collected by: ARCTERRA Tank Date installed 8120193 Tank size _i250_gal. Number ofCompartments 2 C|eanouhe(Y/N) Foundation cleanout (YYN)y Depression over tank (YYN)N High water alarm (YYN) Date of pumping Pumper Northland Pumping Date installed S/23194 Soil rating (g.pd/ft2m*2 /barm)8.8_ System type DEEP TRENCH Length ft. Width ft. Gravel below pipe 5.2* ft. Total depth 10*,ft. Eff.absorption area vrn* *e Monitoring tube y Depression over field N Date ofadequacy test Results (Paoa/Fai|)_PASS* For 2_bedrooms Fluid depth inabsorption field before test _12*in. /24"Measured 7/7/17> Water added 500+* gal. New depth 20*in. Elapsed Time: 24 HRS* min. Final fluid depth 11* in. (24^Measured rf7/17) Absorption rate >=50X0+°g.pd. Any rejuvenationtreatment (past 12mo.)(Y/N&type) |fyes, give date________ D. LIFT STATION Date installed "Pump on" level at__in Datum Septic tank/lift station onlot Size in gallons "Pump off level at — in Cycles tested Absorption field onlot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK [)NLOT TO: Manhole/Access (Y/N)__ High water alarm level at Meets alarm & circuit requirements? On adjacent lots (]nadjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas ral 8ui|dingh»undation Property line _S'+° Absorption field ' Water main 100Y Water service line `101+* Surface water 100'+* Wells onadjacent lots _1DQ'+*_-__' ABSORPTION FIELD ON LOT TO: Property line Building foundation _10,+*Water main Water Service line _1U'+*_____ Surface water Driveway, parking/vehicle storage _�0��_____ Curtain drain Wells on adjacent lots_100Y__ F. COMMENTS *Septic adequacy test and well flow test performed by MN Anderson 10/1312015. Site ins ection and new water sArnpipswere performed by ArcTerra Consulting 7/7/2017 with changes noted on report. G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review ofMunicipal records that the above systems are /nconformance with MOA COS4guidelines /neffect onthis date. Engineer's Printed Name KENNETH M. DUFFUS Date 712012017 COSxcanary oheet-2-6-15dn �KENNETH M. D T IS � � � Ar 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 = - Certificate of On -Site Systems Approval # OSC 171310 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 7, Lot 20 of Kasilof Hills subdivision. This inspection revealed a nitrate concentration of 5.83 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. 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.