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HomeMy WebLinkAboutBOB WELLS BLK 1 LT 2 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: ~ ~/G oo~.~ PID Number: o~-"/ - o ~ - o~ Name: c/o 1~1~ ~ R,~ L. + A~ p. ~ Wastewater System: ~New D Upgrade Address: ABSORPTION FIELD No. of BeSeems: Phone: ~ G I - ~ ~O ~ ~ Deep Trench D Shallow Trench D Bed D Mound D Other Total Depth from original grade: LEGAL DESCRIPTION So,,~n~:~. Z ~,O/Sq.~. Lot: Block: Subdiv~ion: Depth to pipe bottom from original grsde: Gravel depth beneath pipe ~ I ~w ~ ~ ~ Ft. ~ Ft. Township: ~I~ Range: ~I~ Section: ~ Fill added above original/-- ~grade: Ft. Gravel length: ~ Ft. WELL: ~ New D U pg rade Gravel width: Number of lines: ]Oistance be~een lines: ~' ~ Et. I I ~ Et. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~t~A~ / CO Ft. I00 .~ Et, ~OO Sq. Ft. Driller: ~'~ ~b~I~G Date~.~_~ ~Drilled: Static~.~Water Level:Ft.Installer: ~1 ~E~ ~e~s~ Date installed: Yield: ~ + GPM IPump Set at':~ ~ Ft. [Casing Height Above Ground:~ Ft. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding =ublic/Private IManufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ 0 ~ ~ ~ ~ /~ Material: Number of Compa~ments: su~c~ ~ LIFT STATION Water / o O /oo t + ~ ~ ~ Lot ~ ~ ' ~ ~ O l + -- -- -- S'ze 'n gall°ns: I Manufacturer: Line Foundation I ~ I j ~ "Pump on" level at: at: High water alarm at: Cu~ainDrain ~- ~,~g ~0~ . p~ [Electricallnspectionspedormed by: Remarks: Ao~.r,o~c p~,,~r/~ .~ ~ BENCH MARK , / Location and Description:  Assumed i OO, O ~, Elevation: 17034 E~gle River Le~ Road, No. ~ 2nd ~ - zz- q~ ............. - - -, Department of Heath and ~ah~ices approval ~- ~>~'.~. ~ ...., .;.,.. Date: ~ -.~,, ,,u.:~,~ Reviewed and approved b 72-013 (Rev. 9/91) MOA 25 2 2 Permit No. SW960023 Page of 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 LOT 2, BLOCK 1, BOB WELLS S/D Legal Description: PID No.: 06704202 EW SCALE = 40' CO; NO -MT1 A81' GROUND WATER 79' B.0.H. :72-013 A (Rev. 9/91) MOA 25 250 GAL. TANK = 100.1' = 96,5' ST2 = 93.1' = 93' NEW 1250 GAL ~.T. 85' DRIV Nf ROBE"T C. 'COWAN CE '~ .880] / / / / ,,_:,- 2S-96 FRI 09:02 AM M--W DRILLING 90? -~ .... ~,~*~-~'~'~ ...... ~.~,v,./-~.>.~;^>':,,". ~.,,' ,...~,~.,,.:.~..~_~','.~'~,w~'~,-~-. -..,",'~ .............. M"W DRILLING, Inc. P.O. BOX 110378 e 10~ O[~ ~eward Highway (,907) 349-85~ ANOHORAGE, ALA~ 99511 P.01 DI~ILLING tOe .... WELLS, ROB£R1- L..and ANNETI'.A. P__ _[l,e oi Well (address of: Township, R~ge, ~etion, if ~own; or distance m~n road BLOCK 1. BOB WELLS u~'.~,-.~ RIVER. ALASKA 6" 100 c~:~h~.g __ Depth o! Hole t. eet Cased to. 100.25 ~eet level. 53,2.~t. (above[ ~$~ l~d surface. Finish ot well (eheckone) open end ( X ); '~esm:ibe ~creen or perloratio~_} ~.,_~/A. ~umping test a~gaa~ns' ~ (~) (minute) t~t 1 ..~ours wi~ - :~x'a,.vdown from static ~gel. ~ 'mi AS BUIL% NOTES: wELL DRY GROUTED WITH 2 SACKS OF BENTONIT[ N0. 8 GRANULES. " WELt tOG mr face Give d~tls of formations ~netrated, size of material, color and hardness 2 C~$I~G STICK UP ...... 26 SI~.T:' ,~RE~. COBBLEY _ CLAY: GREY, SILLY, gTI,CKY' 100 WATER BEARIRG ~RAVEt: 'ANGULAR. COARSE 3 -- CONTRACTOR PERFORMED FOR: CIVIL ENGINEERS (907) 694-2979 I ~ ~O~"t C. COWAN /~ ~ F~(907)694-1211 I ~'. ~]~, cE-~oi ~-~'/::~ / ~ ~s ~ ~ '""'~',~.../,~_~-u~' .... '"; ..... LEGAL DESCRIPTION: ~OT' ~- 1 2 3 4 5 6 7 8 9 Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? P E Depth to Waler Alter Monitoring? Oaie: Gross Net Depth to Net Reading Date Time Time Water Drop '~-ZZ-e~ ¥:oo ------- 7'/z~ ~:o~ " ~ ',& " ~/~" PERCOLATION RATE _ TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND ~I ,FT COMMENTS BY: i ?034 E,,gle Riwr Leep Read Ne, 2u~ ' ACCORDANCE WITIIIi~Iii ~iTii~ ~I~i, Ii~ti.I~I~I~I~L GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: (; /~' ~ /6~ (0 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 ~,~C3 [/~2/~[ PERMIT NUMBER:SW960023 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WELLS ROBERT L & ANNETTA P OWNER ADDRESS:3111 C ST., SUITE #555 ANCHORAGE, AK. 99503 DATE ISSUED: 2/23/96 EXPIRATION DATE: 2/23/97 PARCEL ID:06704202 LEGAL DESCRIPTION: BOB WELLS BLK 1 LT 2 LOT SIZE: 50499 (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 (iSAAC80) . 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: DURING CONSTRUCTION, PEI{?ORM ADDITIONAL PERCOLATION TESTS AT THE 8-9FT. DEPTLtq AND SUBMIT SOILS PERCOLATION DATA WITH AS-BUILT/INSPECTION REPORT. REFER TO ENGINEER BULLETIN 91-6 REGAR~NG DEPTH OF PERCOLATION TESTS. RECEIVED BY: Z~"~// ~d.~_/~-~___ DATE: ISSUED BY: ~~~ f ~~ DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS Februay 8, 1996 (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 1, Bob Wells S/D Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole. The monitoring tube within the test hole has been checked and 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, septic 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 require additional information, please contact us. Sincerely, Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 SCALE 0 SITE PLAN / / DESIGN I-- mO Z-~ O0 / / / ,'--, / ~ / / ,.~ / / --Ira O'UO 0 ' --I © m o~___°r~ >~o~ '< ..q ~ 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~°'~" 1 2 5 6 7 8 9 10 13 14 15 16 17 19 2O WAS GROUND WATER ENCOUNTERED? I '". ;'4 ~ : t, 9. h ~:/" '~ "~ ] '¢i.%): CF. ~,an] /'.:'.:; ~f Township, Range, Section: SLOPE SITE PLAN Depth to Water AJ~qr.. Monitoring? T,~Tv~,y Date: ~...,-"'/~'~C~ ' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE "~.. D (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~' FT COMMENTS S & S ENGINEERING PERFORMED BY: I 17034 Eagle Riv~.'~ LOop ROad NO. 204 ACCORDANCE WITH ALEI~J~j~iI~ J~JL;~I~I~I~IDELINES IN EFFECT ON THiS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (907) 694-2979 FAX(907)694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 2, Block 1, Bob Wells S/D February 8, 1996 GENERAL: 1. e The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the 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 2, Block 1, Bob Wells S/D February 8, 1996 e e 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 gravel (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 final grade. The portion of the monitoring tube extending through the gravel shall be perforated from 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 2, Block 1, Bob Wells S/D February 8, 1996 Se 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. e 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). Be 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. All 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 2, Block 1, Bob Wells S/D February 8, 1996 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, etc. 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.O.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 2, Block 1, Bob Wells S/D February 8, 1996 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 MUWC�PAUTY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 067-042-02 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description BOB WELLS BLOCK 1, LOT 2 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: ( Location (site address) 26045 LOG CABIN CIRCLE, EAGLE RIVER, AK 99577 Current property owner(s) GARY & STACY WESOLOWSKI Day phone Mailing address 26045 LOG CABIN CIRCLE, EAGLE RIVER, AK 99577 Real estate agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Private Well Private Septic Water Storage ❑ Community Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Private Septic Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .5.0 Date of Payment 6Z/ IA J Receipt Number O08 f L{ O Waiver Fee $ Date of Payment Receipt Number COSA # OsG211-3 3°1 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/15/2021 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 4���1 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q:, • . �,9 ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWr.S . * 97H •'* �r 6. DSD SIGNATURE •Curtis Hutfman j System #1 Approved for bedrooms ��F��s•. CE 128991 ,-!,9 System #2 Approved for bedrooms PROF SS N �l ,a\N\\0.00_ Disapproved Conditional approval for bedrooms, with the following stipulations: CC15A resOlVed ct4iJ -re-move4 b- '(Re,becc,._ Qs rc 1L NoA Dns; q2p i ``1�Zi,4 OFc(A,_� 11/ J ON -SI m �VAVIATER AND =-o WAST` WATER C) V Original Certificate Date: PROGRAMJPO O�`� A,�I_ G �� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approv�al0m ff i1}vt�it�oli the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The � p;9I1 n�horage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisor Other -�e�� a1�Si0►-Y Legal Description: BOB WELLS BLOCK 1 LOT 2 Parcel ID: 067-042-02 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 4/2/1996 Total depth 100 ft Cased to 100 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/8/2021 Static water level at beginning of test 63 ft. Well production at time of test 1.2gpm Comments B. TANK DATA Age of tank(s) 25 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 4/26/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/22/2996 ® ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Measured depth to pipe invert from grade 5.6 ft (min) ❑ N/A — pressurized field Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 5.04 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Fwrs Collected by Date of Sample 4/23/2021, C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/8/2021 Results E Pass For 4 bedrooms Fluid depth prior to test 3 in Water added 600 gal New depth 7 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.4' INTO THE 8'ED Elapsed time 40 min ® Code -required soil cover over field Final fluid depth 3 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: F�_ 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 ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® 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 ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ 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 _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ 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' ® 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' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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. AJ Aw TH .. .... ..........� Curtis Huffman f CE 128991 • �c�� C� ���' • b125/21. • •ti\\v � Flo A— ft ft ft ft ft ft ft ft Septic Tank Advisory Certificate of On -Site Systems Approval #OSC211339 Subdivision: Bob Wells Block 1 Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 25 years old. Typical replacement costs range from $8,000 to $11,000 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. � £� '� Mailing Atldress P O Bax 196650* Anchorage, Alaska 99529 6650 *www muni org z a„x. �„�. .» r,:.�,. �.,� e.. ,3.,.ut �,�„�'�..,-. �', e,ua.� '..� .,,»_w e,.. �,..�...-�rsa,.>a�"`_, ;,.�....�.ar�-.,,..,,.-.��, ...�:i .,�.a.�:. se ✓.`;.r � s.f.,,�.,:,:� , .:.,� f....w..-o- w,�^_ ...�., ...aa�� MUNICIPALITY OF ANCHORAGE DEVELOPMENT SFRviOFS DEPARiMEl c / 907-343-7904 On -Site water and wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC211339 Subdivision: Bob Wells Block 1 Lot 2 A water sample revealed a nitrate concentration of 5.04 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. "� � Mai�mg Address �P -0 Box 196650*Anchorage, Alas�Ca 99519 6650 * www muni org 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. ��� � �.� �$ Mailing Address P O Box 196650 �`�Anchorage,�Alaska 9951 66i50�*� www Murn or � , i Lot 1 I Lot 6 S 89'51'49"E 280.00' i� 0 Lof 2 00 8.2'x16.2' SHED 50,499 S.F. o 41 -A: cn m Lot 3 EE NOVSE Lot 1 o -y SEPTIC PIPES 10' UTILITY ��_ �• f -WELL EASEMENT Cj 25' UTILITY— EASEMENT TILITY EASEMENT �° � 33„w•.12 .- Lo 2.0'x6.2' HOUSE DETAIL Scale: 1 "=30' MORTGAGE SURVEY _X_ SCALE _ 1=_= SO'_ GRID SW 0363 _ Project No. Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A S s o c i a t e S 9 inC, (907) 522-6476 Phone �p0���44 Professional Land Surveyors ken0lansury(907) 52gsurye y5 Fox com ©� OF A op jonathan®longsurvey.com I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 1, BOB WELLS SUBDIVISION (PLAT No. 79-32) Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other improvements. - _ Svt" `-- _, at Anchorage, Alaska Dated this the = 1__ Day of ________, _____ It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. '* 49TH*I KENNETH G LANG . a� 0 V�' R OFESSIONAI- a� AECC963 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 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 2; Block I; Bob W~lls Subdivision Property owner Mailing address Lending agency Mailing address Location (site address ordirections) NHN Lo9 Cabin Circle Anchorage., AK Robert and An~ta W~lls Day phone C/O Innovative Construction 3601 Raspb~.rry Road Day phone Anchorage, AK Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: If Community wastewater system, provide written confirmation from State ADEC · attesting to the legality and status of system. Individual on-site Holding tank Community on-site Public sewer XXX 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 Approval application 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 files 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 17034 Eagle River Loop Road No. 204 Address Eagle River, ~.laska~9577 / Engineer's mgnature ~/~//-~~ Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA#21 MUNICIPAUTY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of AnChOrage AUI 12 199 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist Legal Description: Z.~,7'Z z~/~,c,~ / A. WELL DATA Parcel I.D.: Well type .~,~-.~'~/,4 7'~~' If A, B. or C. attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected(~N) Log present (~/N) ~/~"~ Total depth / O~ / Sanitary seal ~N) ~-'"~ Date completed Cased to /4:~ (~ / // /-W FROM WELL LOG AT INSPECTION Date of test ~ "2 - ~'~ //./. ~, Static water level '~"~' / ,,/Z/. ,,~. Well production ~' ~'- ~ g.p.m. /I/. ,,~. WATER SAMPLE RESULTS: Coliform C3 Nitrate Date of sam pie: ~--~;[ ~- ~ °/ ,/? - ~q/~' Collected by: B, I~~OLDING TANK DATA Date installed -~"' Z. 7. -?~ Tank size/Z.~'c~ ~',~,' Number of Compartments Foundation cleanout ~N) 7'Z;'"~' Depression (Y/(~ Date of PumPing ~ -,"~' Pumper ,"u/-,'~' Other bacteria O ~-. Cleanoutsd~l).~-~-.ff High water alarm (Y~ ,'~ C. ABSORPTION FIELD DATA Date installed .~- Z Z -- ~>~ Soil rating {~~r ff~/bdrm) /" Length -~,' Width Effective absorption area~"~'~ Date of adequacy test System type ~'.~,~ Total depth Monitoring Tube present {~) Y[£ Depression over field Results (Pass/Fail) //,/'. ,'~f, For .-~/- "~' bedrooms Fluid depth in absorption field before test (in.); Fluid depth/Z,/. ~. (ins) Minutes later:, x~'. ,~. Peroxide treatment (past 12 months) (Y~ Immediately after~.,,~.gal, water added (in.): /~", -'~' Absorption rate = ~. ,'~' g.p.d. If yes. give date ,,'(-~, ~. 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* ///-/. ,,~. Cycles tested ,,~/..,~'. Size in gallons "Pump on" level at* /~- ,~. *Datum ,,~/, "Pump off" level at* ,,4./. ,,~. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: olding tank on lot Absorption field on lot On adjacent lots On adjacent lots Public sewer manhole/cleanout ~ ~'~ Lift station Public sewer main Sewer/septic service line SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: Foundation ~-' ~ '"- Property line ,-~ '~ '~' Absorption field Water main/service line //O ~ Surface water/drainage/'~O /-~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O/'/' Building foundation ,,,/~;::~ /'/'' Water main/service line Surface water ,,'/~(~ / ~ Driveway. parking/vehicle storage area Curtain drain /~,o,~' ,~,,,vo~,,~ Wells on adjacent lots /'4:~O /'-~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field.inspections and review of Municipal recor~ ~~l)~at~stems are Signature Engineer's Name Date HAA Fee $ ~43'~ -- ~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number