HomeMy WebLinkAboutKASILOF HILLS BLK 8 LT 4A
Municipality of Anchorage Page
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
Permit Number: '~b'~c~CJo~'~ PIDNumber:
N~m~: ~ ~ Wastewater System: ~New O Upgrade
Address:
q,.o.~ ~ A~.~. ~fl ABSORPTION FIELD
Phone:~_ ~/~O~ JNo. of Bedrooms: ~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound DOther
LEGAL DESCRIPTION S°il Rsting: ~. ~ GPD/Sq. Ft. Total Depth fromm. ~°riginal' grade: _
Lot: ~ Block:~~%l~¢Rubdiv~i°n:~iLL~ Deplh to pipe bottom~ from original grade: Ft. Gravel depth~..~, cbeneath pipe Ft~
Township: Range: ~ Section: ~ Fill added above original grade: Gravel length:
~ I ~ - ~ ' Ft. Ft.
WELL: ,~ New ~ Upgrade Gravelwidth: ~ I Number of lines: Distance between lines:
~ '~ Ft. [ ~- Ft.
Classification (Private, A,B,C): Total Dept~: Cased TO: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: Pump Set at: Casing Height Above Ground:
~ ~.. d/K ~,. ) + ~,. TANK
SEPARAT)ON DISTANCES ~Septic ~ Holding ~ S.T.E.P.
TO Septic Absorption Lif~ Holding Public/Private Manufacturer: Capacity in gallons:
From Tan~ Field S~ation Tank Sewer Lines ~ ~ ~ ~
Well' J~O~ ~ [~l ~ ~ ~ ¢-I Material:%~L Number of Compartments:
Surfaca
Water [~'+- too!,- .~ -~ ~ LIFT STATION
Lot r ~ ~ ~ Size in gallons: lManufacturer:
Line ~5 ~ ~-~ / __
, "Pump on" level at: ~f~e, at: J High water alarm at:
Foundation ~l ~ O --~ ~
Pu~p Make~& M d~Electrical Inspections performed by:
Curtain
Drain ~
Remarks: BENCH ~ARK
Location and Description:
Assumed Elevation:
/~o
. 17034 Eage River Loop Road, NO. 204 %
I nspecbons performed~q; ~' ........ Dates: 1st ~-2~ ~
Department of Headman Services approval
Reviewed and approved by: Date:/2- 2/-¢%-
72-013 (Rev 9/91) MOA 25
Permit No. $W950752 Page ? of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AN[;) 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
LOT 4A, BLOCK 8, KASILOF HILLS S/D 01516115
Legal Description: PID No.:
ST1 98.2 ST2 1
do4~-
86.0'
~ FINAl GRADE-~
MT1
)3.6'~ I ,1250 (AL ,
[SEPTIC 'ANK
A B 77.7'~
FCO 6' 43'
&73.0' Np wATE~ FOUNI
ST2 52' 50'
CO1 55' 51 '
- CO2 57' 52'
CO5 93' 72'
MT1 134 96'
EW TRENCH-
L
,
72-013 A (Re','. 9/91) MOA 25
7
WELL L'
~t,attc Water LevelI 4OFt, feet
Oraw Down . ~/A .f feet
T_ype Material., ~F~
6 ft, tO
HEFTY DF
8540 AKL
ANCHORA
ILLING,
LA ORIVE
]E, AK 99516
-0593
Jackson Develop
~6 4a.r~k, 8
gallonls Per Minute
Total Feet
ng
RECEI\
DEO ?, 0
Municq)a[ity ol t
De ~t. Heal'~h & tqur
ED
~chorage
an Services
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950252
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:BURGESS V A DR
OWNER ADDRESS:10840 STROGANOF DR
ANCHORAGE, AK 99516
PARCEL ID:01516115
DATE ISSUED: 8/30/95
EXPIRATION DATE: 8/30/96
LEGAL DESCRIPTION:
KASILOF HILLS BLK
8 LT 4A
LOT SIZE: 28706 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION 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 (ISAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343 4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
RECEIVED BY:
DATE:
DATE:
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN E~TENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
August 18, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 4A, Block 8, Kasilof Hills S/D
Request you issue a permit to drill a well and install a
septic system to serve the four bedroom house on the
referenced property.
Two test holes were excavated and percolation tests
performed. The approximate location of the test holes are
located on the attached site plan.
At the time of excavation no water was encountered in test
holes ~1 & ~2 and after seven day ground water monitoring,
their monitoring tub~were found to be dry.
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, sep~tic systems or drainage patterns by the
installation of 'the proposed septic system.
There are no points of contamination within the proposed
well radius which can be seen on the attached site plan.
If you requ:Lre additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
Enclosure
MuNiCiPALI~D( OF ANCHOnJu'Qb
~.NVI?,oNMENTAL SERVICES DIVISION
AUG 2,5 995
RECEIVED
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
1" = 40'
$~ALE
SITEi PI. AN I DESIGN
UTILITY EASEMENT
~ ~ ~--mrqk j~ ii ~ ~
~ ~rq~
., 0
-~ PROPOSED 4
DRWC BEDROOM
HOUSE
z~z>~
~Om-~m~
oo
::~m0
-- C)--O 7-~
o-~
zO
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOIL~EST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
REFERENCE: Lot 4A, Block 8, Kasilof Hills S/D
August 18, 1995
GENERAL:
1.
0
De
The scope of this project includes the installation of
a 1250 gallon septic tank and leachfield trench to
serve the proposed four bedroom residence located on
the referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 4A, Block 8, Kasilof Hills S/D
August 18, 1995
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from 'the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
grave]. (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward°
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above fina].
grade. The portion of the monitorinq tube extending
through the gravel shall be perforated f~'om the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 4A, Block 8~ Kasilof Hills S/D
August 18, 1995
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic 'tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the ~200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 4A, Block 8, Kasilof Hills S/D
August 18, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etco Thus, the
inspecting engineer is 'to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.0.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 4A, Block 8, Kasilof Hills S/D
August 18, 1995
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
625 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED~¢j'~-~-/,~{. ;~'~'~
Township, Range, Section: ~~
PERFORMED FOR:
LEGAL DESCRIPTION:_
5
6
7
8
9
SITE PLAN
&-m
SLOPE
WAS GROUND WATER ~/ O
ENCOUN'FERED?
s
L
11 ~' ~' I1'~ ' IF YES, AT WHAT --- O
DEPTH? P
12 E
Depth to Water Aider / /~ .~
13 Monitoring? b/3,.7~_Oate: '7 ~l
14
15
16
17
18
19
Gross Net Depth to Net
Reading Data Time Time Water Drop
~,~¢..~4,,c /' ~ o ~7,, _
20 PERCOLATION RATE l, ~- ~ (minutes/incl,} PERC HOLE DIAMETER (~ ~..~--~
TEST RUN SETWEEN FT AND FT
COMMENTS
Municipality ol Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
(ENGIN F..~.~ L)
.....
Township, Range, Section:
1
2
3
7
8
9
10
11
12
13
14
15-
16
17
18
19
2O
0 ,t,(,,..4 ;vi ~- ~'
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES. AT WHAT '~ O
DEPTH? P
E
Depth Io Water Afler T) fl, '?/~l/q ~
Monitoring? ~/_ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
7/i;~/q~- o,.,; $ :~ ,,~,w 3, 'IS./' -
O' i~ q.?y~ I"
COMMENTS ~.- x c~.l~/4~ ~'~ ~ 8 ~
,ER,ORMED B'~ '' .N~N..~IN~ I ~/~ ~,'- CERT ,, THA, T, S TEST WAS
17~4Eagle River ~R~dN~2~ / '' ~' '
ACCORDANCE ~J~ ~IPAL GUIOEL~NES tN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERCOLATION RATE '~ (minutes/~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN [ ~/~' / FT AND FT
C /,. I ~.,'v ~'-' J' ~'T& I,~ I ~ L $ ,,./p ,'~ c' .-'L )'-
PERFORMEDIN
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EASEMENTS OF RECORD, OTHER THAN
,HOSE SHOWN ON THE RECORDED /
PV.i ARE NOT SHOWN HEREON. I /j 7 $·· p 5 ,-w
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• • • • • • • ·--•· I •• • • .•
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AS-BUILT NO CORNERS SET THIS DA TE
' I hereby· certl.fy · that I have .. performed-a Mortagee'a -in-
spection of the followin1 described property: L O f 4i A, Block 8 l<.a·s.-lof H/1/J Si;t,d.: I . . j I
Anchora1e Recording Precinct, Alaska,. and that the Improve-ments altuated theNon are within th111 property lines and do not overlap or encroach on the propert:y lylnc adjacent there-.. to, that no improvements on property lying adjacent thereto encroach on the premlsea In question and that there are no roadways, transmission lines or other visible easements on · aald property except a.s Indicated hereon. · • Dated at Anchorace, Aluka I
th'• 1 2 ..., d day of I N o V. 1
19 czs\
FRE_D WALATKA &· AssociATES Engineers and Surveyors . I .
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section - Fax: (907)343-7997
Parcel ID 015-161-15
Certificate of On -Site Systems Approval
OSC261199
Expiration Date:
Legal description KASILOF HILLS BLK 8 LT 4A
site address 10840 STROGANOF DR
Current property owner(s) CABIN CREEK TRUST
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
2 �.
In October 2018, the Municipality of Anchorage (MOA) published
Policy W.05 "Standard of Care Regarding the Inspection of Steel
Septic Tanks when Performing COSA Inspections." If this policy is not
attached to this COSA, please request a copy from the MOA On -site
Section. While this policy is not codified, it does describe the process
by which an engineer is to inspect a steel septic tank that is older than
30 years. The septic tank on this property is nearing 31 years old,
however, the engineering firm that conducted this COSA inspection
did not elect to follow this standard of care. The buyer is to be aware
that the physical condition of the septic tank (i.e. absence of holes
leaking, or corrosion) has not been verified.
l
By: Original Certificate Date: 6/26/2026
This Certificate of Ori-Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 01516115000
Complete legal description KASILOF HILLS BLK 8 LT 4A
Location (site address) 10840 STROGANOF
Current property owner(s) CaZort
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑■ Private Well serving # 1 dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK:❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 30* - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ L_ `' Waiver Fee $
Date of Payment '� Date of Payment
COSA # US, C_ 2 /i 9 9 Waiver #
COSA Application_Apr2025.doc
COSA Checklist_May2025.docx
COSA Checklist
Legal Description: Parcel ID:
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 Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D.DISPOSAL FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/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 Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 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/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
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 Phone
Engineer’s Printed Name Date
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: COSA for Kasilof Hills Lot 4 Block 8
Dear Reviewer,
The septic system on the subject property was installed in 1995, including a 1250 gallon steel septic tank.
The homeowner indicated that the system was very lightly used for the first 8-years after it was installed.
When we tested the system, the level in the tank measured 51-inches, which is the nominal tank level.
Typically with older leaking tanks, we find the level to be below 51-inches.
Corrosion is generally known to require an electrolyte and oxygen to occur. Wastewater has both and is
corrosive. There is localized wetting and drying along the waterline of the tank, as the tank is used and
the levels fluctuate up and down slightly. This is likely why we see can more corrosion holes right around
the tank waterline than at other areas of the tank. Sewage also emits gasses which corrode the steel. The
soil type, moisture in the soil, and quality of the coating will also play a factor.
A system that is lightly used for a long period of time is going to have a lower concentration of corrosive
elements and oxygen over that period of time which should result in less corrosion. We acknowledge that
it is impossible to determine the actual impacts of usage on the integrity of the tank, however the long
period of minimal use likely has some impact and believe the condition of the tank is going to be similar to
that of a tank which has been in service for 25-30 years.
Nitrates on this property are elevated and may be an indicator of a nearby leaking tank, or other factors.
We note the septic on the adjacent lot, lot 5 was installed in the 70s and is approximately 80-feet from
that property’s well. Many of the neighboring septic’s are in the 25-30 year age range.
Due to the exceptionally light use and nominal operating level, we are requesting that that the department
consider issuing a COSA for this 30 year old septic tank.
The tank is most certainly nearing the end of its useful service life, and we recommend it’s proactive
replacement in the next 1-5 years.
Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558
or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
6/16/26
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC261199
Subdivision: KASILOF HILLS Block:8, Lot: 4A
The septic tank for this property is 31 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
Steel septic tanks utilizing "Coal Tar Pitch" coatings are subject to corrosion as the
steel reacts to water and rusts. These tanks have a finite lifespan buried in the
ground. These tanks can become structurally compromised and pose a health risk.
They could collapse and/or leak untreated wastewater directly into groundwater.
In the interest of protecting public health and the environment, the Municipality of
Anchorage Development Services Department has issued Policy W.05 Standard of
Care Regarding the Inspection of Steel Septic Tanks when Performing COSA
Inspection. Please request a copy of this policy from the Department if interested.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address: P. 0. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC261199
Subdivision: KASILOF HILLS, Block: 8, Lot: 4A
A water sample revealed a nitrate concentration of 8.53 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
...... '~ 343-474:4 .......
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 0/,~'-I~/- I 5 ::" . .. 'HAA#_~.~,ct~L-~'"'t~
ERA INFORMATION ...... .~r~'; ;'~:-~ :~¢~ q~':'.; ~ ~'-~ ~7~;: ,'-'-'-
Complete legal description
Lot 4A; Btbbk'8;"'~a~ilo~"Hllls Subdivision
Locatio. 9_(site address or directions)
, NHN Stroganoff
.Prope~Ygwner,'-.James Cazort
Maili'h'gaddr;'ss'." P'.O..Box 241565 Anchorage,
Lending agency
- Mailing address: ......
Day phone 562.-5800 .... :-:..,
AK 99524
Day phone·
Agent ...... '~' '' Day Phone :"~;.:' .... ' "" ;3' .,;:;,,-~;
Address '"' "'":'"'" '"'
"'- ' -..- ,,-; ....... , .... ,.; ,; ...... , .............. , ............
. Unless othe~me requested HAA will be held for p~ckup. ·
":;~':: ;'-;'-"' ~':" ': '""~'-' "":'~-Indwidual well -7 ~'; '~"'~-~'~'~:~;: "' &" ~ L~'""'?' ":'-;~
"? .-" ~ '" ;-?,:'~:21-~,~.' ~:" :L '.'~,?_-:..-.'%: -'.':':. ~;,,.~' ?' '..' :,¢ *, ;." '-:,'; U.".';~,~:- , "¢,' ,~' '% ' .. ';.
Public water. ..... ....... ...,,' .... . _ . ....
NOTE: ff community well system, provide wri~en confirmation from Stale ADEC attest-
lng to the legality and status 0f system. . .... .,,,. ~,,(;,: ...... >.~,)/~/¢' '.-,
'. ' Individual on'site' . ~ ' -. : ,, ,' ,3 . ~ ', ..~
.:;; ~:.,; .':.7:,u'?,..-'.,' ': .' .-;;,.;Holding tank ;~. ¢;~.~-~.~?,:.,--,.-.?~ ~- . .. ,.,., ...,.,...,...,.--:. · ~ *; ~ "~ ...... ' ~' - ~ '~ '~'~¢ · ' ·
,~, .. . Community on-site .4., ..... .,;
.... "":" '" " ' Public sewer': - - '- "'''~ .... '""' "¢' .....
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and ~atUs O'f system.
72-025 (Rev. 1/91) Fronl MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER '
AS certified by my seal affiXed' hereto and as'~i the validation date shown below, verity that my
investigation of this Health Authority Approval application shows that the on-site water supply
an d/or wastewater disposal system is safe, functional and adequate for the number of bedroom~
and type of structure indicated herein. I further verity 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 wastewate~ disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this nspection.. '
S & $ ENGINEERING
Eagle River, Aia.~ka 99577.,
.... Address .. ' ¢;' ' .,t .
Engineer's signature '"': ' '
-~ - ' - ! '-*~.£:-.- ; ~,,t ....
.. ,., . . -.' ,.,,,.-'-,,."%0 OF
':': · ..... : ...... . ' ', ..
~ Approved for ~ bedrooms ............................ IL,, ,~ ......
· " ': t" 7-": ';: ' '~"" Cond t cna approva for. ,. ,' bedrooms, .w th the Jollowmg:2stlpulahons:"?.4?'
L.' ~: ?;;..J~'~;.,.:~-~:..,,,:.'.¢ ~ .;; ; .'~;.;-, : .7'.,..:'' ':' ,"' ." .' '"-' : '. "' , '. ' '": "'" '-" .....
· - -.,',: ~:',:',:'-2,~ ;: ¢-:,,.,Additlonal Comments ............ . ~ -'~
'~,The Muni~ali~,6,~nchorage Depadment of Hea~th and Human Se~ices (DHHS) i~ues Health Authori~
: ~:,,~proval,~e~if(~,~ased only upon the representations given in paragraph 5 above by an independent
:";~Sprof~ibhal en~ m~ registered in the State of Alaska; The DHHS does this as a courtesy to purchaeem of homes
(~gd.their lending institutions in order to ~tis~'cedain federal and state requirement, Employes of DHHS do not
conduct inspections or analyze data before a :ceAificate is issued, The Municipali~ of Anchorage is not
responsible for er~m or omi~ions in the professional ~ngineefs w°rk,' .........
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825'~[." Street. Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Legal Description: koTi
A. WELL DATA ]
Well type DR)v/~ £i
Health Authority Approval Checklist
1'1,4- 6L~<. j> KI~$a-~l'e' ht'L'C$ Parcell. D.:
ff A, B. or C, attach ADEC letter ADEC water system number
Log present
Total depth
SanitaW seal
Date completed
f
Cased to :3 ti
Casing heigbt (above ground)
Wires properly protected (~,~tN)
Date of test
Static water level
Well production
FROM WELL LOG
/ , ,r'
WATER SAMPLE RESULTS
Coliform O ' Nitrate
Dateofsample:'l'~/lY/"4- ~c~ ))'/'I/q
B. ~--~OLDING TANK. DATA
Date iustalled ~ / ;~ ~/q 5"- Tank size ]¢k $' 0
g.p.m.
AT INSPECTION
Other bacteria O
Collected by: S & S Et~61~EEE!NG
17034 Ea.qJe River Loop Road No. 204
Eagle River, Alaska 99577
Number of Compartments ~ Cleanouts ~q',l) ~ $
Foundafion cleanout C'~)'N) ~'~/~ 3' Depression
Date of Pu]nping ~'/4' ~tv¢,..,' Pumper ~
/,/o High water alarm (Y/~ ,v o
C. ABSORPTION FIELD DATA
/'ax, Soilrating ~orft2/bdrm) ]. ~L Systemtype "r~,,¢/4
Date installed q ~, / q J''' ' pr~e /'
Length ,~(o / ~
Width
Gravel thickness below p,pe ~ - ~ Total depth ~>. &-
Effective absorption area -,~ 0 q Monitoring Tube present~_~N) Y~$. Depression over field
Date of adequacy test N/4 ~ ,~w Results (Pass/Fail) Fei' ..._--~edrooms
Fluid depth iii absorpt~On field before test (ill.); [m gal. water added
Fluid depth ii~'~ Absorption rate =
Pm~rxid~ 12 months) (Y/N) lfyes, give date
g.p.d.
~ c
D. LIFT STATION
Date installed
Manhole/Access (Y/N) ~
Size in gallons
~'Pump ofF' level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~mlding taak oil lot ~ ~ 0
Absorption field on lot
Public sewer main W / h
Sewer/septic sep/ice line
/0 to q-
: On adjacent lots /o
.; On adjacent lots
Public sewer manhole/cleanout
Lift station Ar /
SEPARATION DISTANCES FROM ~HOLDING TANK ON LOT TO:
Building foundation 3 {, Property. line /4 3'- Abs?rption field
Water main/service line 3o ~- Surface water/drainage / 0 0 ~ Wells on adjacent lots __
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation '70 Water main/service line
t
Sur£ace water / o 0 4--
Curtain drain NOr~6_
Driveway, parking/vehicle storage area 70
Wells on adjacent lots / o o "/" Property line
F. ENGINEER'S CERTIFICATION
........
m con/brmance wtth MOA H/M guide~es m eJ/kct on thts date.
Iff,~ / // .5~c¢ "' ~ ", '~7 ',~
, t / a S
HAA Fee $ , ~ Waiver Fee $ "
Date of Payment [~ 0 ~ ~ Date
~ of Payment
Receiptmumber./~ :~3 Receipt Number
Rev. 8/95 OSS: haa.wk.doc