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HomeMy WebLinkAboutBROADWATER HEIGHTS TR H LT 6 GAAB-HD-I GR' 'ER ANCHORAGE AREA BOROU ~1 DEi~,,,,RTMENT OF ENVIFIONMENTAL QUALfl , 3500 TUDOFI FIOAD ANCHOFIAGE, ALASKA gg§07 27g-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILINGn ADDRESSL~~ LEGAL DESCRIPTION L. oJ, (~ -rr~r-~zrt- ~4 PHONE~ SEPTIC TANK: DISTANCE FROM WELL /C2~- f LIQUID CAPACITY_ l) (~)~C) __.GALLONS. MATERIAL t~'tm)/~ INSIDE LENGTH. NUMBER OF COMPARTMENTS INSIDE WIDTH / LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS j LINING M A T E R 1A LCr~J~/'~_ -/~£~ NEAREST LOT LINE .... ~,-(~./ OUTSIDE DIAMETER ~ OR WIDTH ,J Co / _~/.'/2~ DISTANCE FROM WELL J' ~),_~ t TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH /~, t , DEPTH BUILDING FOUNDATION sQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL ~ , F~L,LNDAI'ION , NEAREST LOT LINE , OF LINES ABSORPTION A~__ __ -- SQ. FT. LENGTH OF / DEPTH: TOP/OF TiLE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH T LE IN. ABOVE TILE__ WELL: LOT LiNE DISTANCE FROM WATER TYPE -~"~-~.?-i ! J ~:~CJ-r , DEPTH '~ ., BUILDING FOUNDATION. -- SAMPLE -- NEAREST NEAREST SEPTIC SEEPAGE ~ OTHER ~ , SEWER LINE '.~ , TANK Jt(~-~,_~ / , SYSTEM. {~)~ , CESSPOOL '-- , SOURCES~ DISTANCES: /4-/~ CC~ ~- fo iD= DATE DIAGRAM OF SYSTEM APPROVED G.A.A.B. GR rER ANCHORAGE AREA B( DUGH 13EPARTMENT OF ENVIRONMENTAL QUAL. ITY 3SOO TUDOR ROAD POUCH 6-680 ANCHORAGE, ALASKA 99802 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK f SEEPAGE PIT .... ~ TYPE AND SIZE OF FACILITY TO BE SERVED ~Jf ~!_ _ . ~1,~__ FINANCED THROUGH SOILrTEST*RESULT$ COMPLETION DATE ANTICIPATED. PERMIT NO. ....... PHONE DRAIN FIELD OTHER NOTE, THIS PERMIT IS NOT VALID WITHOUT BOll. TEST FINAL INEPECTION, 14 HOUR NOTICE REQUIRED. BACKFILLING OF ANY BYITEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROIBCUTION. SEPTIC TANK SIZE TYPE SEEPAOE AREA SIZE TYPE MINIMUM DIITANCEB, REQUIREMENTS FOUNDATION TO SEPTIC TANK 6"-' FOUNDATION TO SEEPAGE PIT ~) //~ . DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /.~"- / SEPTIC TANK TO NEAREST LOT LINE. ~ELL TO 8E~IC TANK DRAIN FIELD WATER MAIN TO "EPTIC TANK ~ / . SEEPAGE PiT DRAIN FIELD · '~IG TANK, . ~ ~ .~SEEPAGE PIT ~ DRAIN FIELD -- TO RIVER, LAKE, STREAM. SEEPAGE PIT ~ DRAIN FIELD . """,AGE PIT //--~g> / ALSO CONSIDER AREA WELLS. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTo CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. QRAVEL IACKIflI,A. CONFORM TO BOROUGH REGULATION8 REGARDING INSTALLATION, DIAQRAM OF SYIT[M HEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF C~REATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-88 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE g ~TER ANCFIflRAGE AREA BOROU, DEPARTMENT OF ENVIRONMENT'A[. QUA[.ITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For '~ ~ol~__ Wo~s'o~ Date Performed Lec~al BescriP, tion: Lot ~ ...... ;~',- M Subdivision -~[-_~.___~__--~_-~-- This Form Reoorts Soils [~g~-~-l---~/)~ Percolation Test v r)e~th Feet 1 5-- 6~ 7-- 8-- 9__ 10~ S0il Characteristics Was Ground Water Encountered? I~ If Yes, At what Depth? Readin~ Depth to H20 Date Gross Time Percolation Rate Minute Proposed Installation: Seepage Pit Demth of Inlet Depth To Net Time Drain Field Net Drop Bottom Of Pit O.r Trencjq Data Certified By: Date · DAVID A. SLENKAMP ROBERT A, SHAFER MECHANICAL ENGINEER 694-9055 Auqust 26, 198'1 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL pF, OTECT ON Mr. Glen Greeley P.O. Box 1088 Eaqle River, Alaska 99577 ~,~,,~ Dear Mr. Greelev, Reference: Lot 6t ~cck ~ Broadwater Heights Subdivision RECEIVED A sewage system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was charged with 1000 gallons of fresh water and after a period of 24 hours all the water which had been added to the crib had percolated out. It can be concluded from this test that the waste water disposal system servinc the three bedroom residence located on this property is currently functioning adequately. However, it cannot be guaranteed against subsequent failures. If we may be of further assistance, please do not hesitate to call. Sincerely, BERT A. SN3 .~ER, P.E. cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA Municipality Anchora e 825 "L" Si'REET ANCHOR/LGE, ALASKA 99S01 (907) 2644 111 MAY()H AN[) ENVIF1ONMFNT-At. PF~O [ F:~,tl'ION August 18, 1981 Glen/Betty Greeley Post Office Box 1088 Eagle River, Alaska 99577 Subject: Lot 6 Tract tt Broadwater Heights Subdivision In addition to our letter of July 30, 1981, the following will also need to be corrected prior to approval from this office: (1) (2) Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. The seal on the well head needs to be tightened so that it is water tight. Please notify this office for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw Mu cipali of Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907') 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION July 30, 1981 Glen/Betty Greeley Post Office Box 1088 Eagle River, Alaska 99577 Subject: Lot 6 Tract H Broadwater Heights Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water anlaysis report needs to be submitted to / this office from the Chem Lab, 5633 B Street, for our review. (2) The standpipes to the sewer system need.to be located and exposed for our inspection. ,~ The septic tank pumped with a receipt submitted to this office. , An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. , If there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/1 j w CC: Betty Greeley % Century 21 - Heritage Homes /~ 207 East Northern Lights Boulevard_~._! 99503 ii' . -DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME DATE DATE DATE INSPECTOR ~' INSPECTOR~', --c INSPECTOR '~'),l"~, ~[~ MUNICIP/LITY OF AN~'H'ORAGE ' DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMI~NTAL PROTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street-Anchorage, Alaska 99501 JUL 2 ? 1981 t ENVIRONMENTAL SANITATION DI VI SION Telephone 2§4-4720 .RE C Ei V ED I::JEQUEST FOIl APPIIOVAL OF INDIVIDUAL WATEIl AND SEWEIl FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY RESIDENT (if different from above) ,/' ~ PHONE' 2. BUYER PHONE MAI LING ADDRESS 3, 'LENDING INSTITUTI'ON PHONE MAILING ADDRESS ' ... 4. REALTOR/AGENT ~ -> ,~, ,~/ /7 PHONE 5. LEGAL DESCRIPTION ~,~ STREET LOCA.IO.N 6. TYPE OF RESIDENCE ~h' NUMBER OF~BEDROOMS /~ [] One SINGLE FAMILY []/Two [] MULTIPLE FAMILY ~d' Three 7. WATER SLOPPLY /~ INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY . Four Five Six [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well"- depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM /~IN DI VI DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FF~ MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ~.2 . , ~:,:~. :~ ' , ~:::~ ,::-':' ~:' ~ ~' ~'~W~~' - '", ..... ~ .... 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' ,~t el ~' o o ~ ""' ~ ii1~pro¥~';11(':'1~ ~iltt;It~'(l lh~'l'(~(,l~ ~l'e ¥.'111~11~ the l>rol~ert)' .~- .-, ,. n'o~ .~ v ~hlq (,a,cmet~ts on s~itl prol)crt)" excepi '. ,./:.':. ~, · . · ' "'%' ' ' "' ~'' "F/~'~'?~%~f': . :'4: '-"~:;I>'~~'~ ��I�UHMFAUN OF A HCHOiA GE o Development Services Department `- c cud Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-081-50 Legal description BROADWATER HEIGHTS TR Site address 12226 W Skyline Dr Eagle River Current property owner(s) Booker Expiration Date: 5/13/2023 H LT 6 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 3/2/2023 This Certificate of On -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 Services 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 work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 MUHMPA UTY OF ° HC HOAOC 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. 050-081-50 Complete legal description BROADWATER HEIGHTS TRAC H LOT 6 Location (site address) 12226 W SKYLINE DR, EAGLE RIVER 99577 Current property owner(s) BOOKER 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 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 52 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed FE� 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 Waiver Fee $ Date of Payment !3 1A0 A 3 Date of Payment COSA # Q e IQ 310 J Waiver # COSA Application_June 2022 Nitrate Advisory Certificate of On -Site Systems Approval # OSC231032 Subdivision: Broadwater Heights, Track H, Lot: 6 A water sample revealed a nitrate concentration of 5.9 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. 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. COSA Checklist Legal Description: BROADWATER HEIGHTS TR H, LOT 6 Parcel ID: 050-061-50 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 circa 1970 Total depth '114 ft Cased to '40+ ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/13/21 Static water level at beginning of test 69 ft. Comments 'Assumed based on acoustic readii B. TANK DATA Well production at time of test 1.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes K No N Coliform bacteria is Negative Nitrate 5.9 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L H Arsenic less than MRL (ND) Collected by . Date 2/15/23 and well scope (see MOA file) Similar as noted for 2019 test MNA Measured operating fluid level in septic tank 74 Date of pumping 10/3/22 ❑ Required maintenance completed, if AWWTS Comments: single compartment tank, pump annually D. ABSORPTION FIELD DATA Which system tested (date installed) 5/10/70 0 ALL standpipes present per record drawing Total measured depth from grade 9 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 5.6 ❑ 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/13/21 Results Q Pass Fluid depth prior to test 53 in Water added 500 gal New fluid depth 66 in Elapsed time 1330 min Final fluid depth 52 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 52 in Effective depth remaining 20 in Comments/Deficiencies: System operating in the upper one-third of the 6 foot effective depth, same as 2019 COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' MYes if No X95 ft Neighboring Tank > 100' Q Yes if No _ ft Absorption Field on Lot > 100' i] Yes if No ft Neighboring Absorption Fields > 100' ❑o Yes if No _ ft Community Sewer Manhole/Cleanout > 100- [j] Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' QYes if No It Animal Containment > 50' [E Yes if No_ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Q Yes f No _ ft rm Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' g Yes if No _ ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' ❑i Yes if No _ ft Field to Property Line > 10' Q Yes if No ft Water Main > 10' Yes if No _ ft Water Service Line > 10' Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Yes if No ft Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS "Septic tank met separation code requirements of 50'at time of construction. 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 Engineer's Printed Name COSA Checklist June 2022 Phone 727-8864 ± UMCM UTY of ANCHORAGE Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 050-081-50 1. GENERAL INFORMATION Complete legal description B Expiration Date: 0-' - 167 -2-1 ATER HEIGHTS TRACT H LOT 6 Location (site address) 12226 W SKYLINE DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) JAMES & CINDY LILLY Mailing address Real estate agent Day phone 12226 W SKYLINE DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55O Waiver Fee $ Date of Payment Date of Payment Receipt Number a 9 d7 Receipt Number COSA # 0SC;W Y6.3 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 8/7/2021 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 + 1 due to subsurface conditions that may not be observed from the surface, changes in land use, • ' Yin ' • % ��Q ` local soil characteristics, groundwater levels that may fluctuate during the year, quality of O,�g��' • �� �) construction (workmanship & materials), the water usage of the family being served by the 0* • w� TM • ••*r`r system and maintenance. The operational life of all well and septic systems are subject to % "ta these various and dynamic characteristics and are outside the control of the evaluator of the • ' ' ' ' ' ' ' ' r/l well and septic system. Therefore, any estimate of how long a system will function satisfactory . for current or future occupants or guarantee that no unseen encroachments, deficiencies or ' •' discrepancies exist can be given by First Water Consulting & �j Cultis Huffman Fes, (� �'F•• CE 128991 •���� d'T -.8/7/2021 • . • �2�� 6. DSD SIGNATURE �1,�1 PROFESSIONP,`'4' System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: ``,nk llTYrrrr����� �/AT SITE I VV AS,T-: V' AT - M o -o 'AUGA Altrj 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 Nitrate Advisory Arsenic Advisory Other Legal Description: BROADWATER HEIGHTS TRACT H LOT 6 Parcel ID: 050-081-50 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) Well production at time of test 1.5 gpm Date drilled CIRCA 1970 Water storage tank volume NA gallons Total depth *114+ ft Well disinfected for coliform test? ❑ Yes ® No Cased to *40+ ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 9.16 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by FWCS Date of flow test for COSA 5/13/2021 Date of Sample 5/20/2021 -- Static water level at beginning of test 69 ft. Comments *Assumed based on acoustic readings and well scoping (see MOA file) Similar as noted for 2019 tests. B. TANK DATA Age of tank(s) 49 years Tank type/material CONCRETE Measured operating fluid level in septic tank 74" ® Standpipes/foundation cleanout per record drawing Date of pumping 5/12/2021, D. ABSORPTION FIELD DATA Which system tested (date installed) 5/10/1970 ® ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade _ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5_6' C. LIFT STATION - NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: Recommend pumping annually due to single compartment. Adequacy test date 5/13/2021 Results M Pass For 3 bedrooms Fluid depth prior to test 53 in Water added 500 gal New depth 66 in Elapsed time 1330 min ® Code -required soil cover over field Final fluid depth 52 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: System operating in the upper one-third portion of the 6' effective depth as it was at 2019 tests. COSA Checklist copy.docx 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 *95'+/- 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' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft 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 Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Absorption Field > 5' ® Yes if No ft Water Main > 10' ® 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 If septic tank is under driveway comment below ® From Absorption Field on Lot to: (Please enter distances if less than required) ft ft ft ft ft ft ft 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Septic tank met separation code requirements of 50'+ at time of construction is down hill from well and is concrete G. ENGINEER'S CERTIFICATION l 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 copy.docx �- ... ...t..._:� Curtis Huffman , �F, CE 128991 .•�`��� /��Fq•' 81a2G21 . •��c�� ��)k p, ROFESSIONP�� Nitrate Advisory Certificate of On -Site Systems Approval # OSC211463 Subdivision: Broadwater Heights Tract H Lot 6 A water sample revealed a nitrate concentration of 9.16 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. *aa A"3�'.t t""', ��� z��� _ MaiUng Address aP O Box 196650 * A�ichorage,{laska 99519 6650 *www murn or , � � � 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. f ,e s��� ��m�R� MailmgAddress P sD Bo 966�O��AncMorage� Alas�a 99519 6650 '� r�vww muni org��"� �$ � EPI -ANS MUNICIPALITY OF ANCHORAGE Development Services Department j Phone: 907-343-7904 On -Site Water & Wastewater Section —' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-081-50 1. GENERAL INFORMATION Expiration Date: 2'—z d— l? Complete legal description BROADWATER HEIGHTS TRACT H LOT 6 Location (site address) 12226 W SKYLINE DRIVE EAGLE RIVER AK 99577 Current property owner(s) KAREN MULLHOLLAND Day phone Mailing address Real estate agent 4978 HIGHLAND DRIVE BLAINE WA 98230 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5b—b Date of Payment y12 57/ 9 - Receipt Number 050'76D COSA# 05CAi0d Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON PE Date 4/24/2019 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for A1111111110 Sftqh OFA #0* 49M *+ bedrooms `A MICHAEL N. ANDERSON: � ) T� No. CE 9469 bedrooms �DFESSIot�At' bedrooms, with the following stip`lati�kkavlffw�rrr� r— e By• — Original Certificate Date: S- Q The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: BROADWATER HEIGHTS TRACT H LOT 6 Parcel ID: 050-081-50 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1970 Total depth *114+ ft Structure served by this system Well production at time of test 1.74 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No Cased to *40+ ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 6.54 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by FWCS Date of flow test for COSA 4/17/2019 Date of Sample 4/18/2019 Static water level at beginning of test 73 ft. Comments *Assumed based on acoustic readings and well scoping (see attached letter). B. TANK DATA — 5/10/1970 - 1000 -gal C. LIFT STATION - NA Age of tank(s) 49 years ❑ Required maintenance completed Tank type/material CONCRETE Age of lift station years Measured operating fluid level in septic tank 73 Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Thick 6" solid laver — recommend Date of pumping 4/17/19 pumping annually due to single compartment. D. ABSORPTION FIELD DATA — 18'L x 16'W x 6'ED — 0.8 GPD/SF = 408 SF Which system tested (date installed) 5/10/1970 ® ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade _ft (min) ❑ N/A — pressurized field Adequacy test date 4/17/2019 Results Z Pass For 3 bedrooms Fluid depth prior to test 54 in Water adde d New depth 450 gal 64 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5_6' Elapsed time 1400 min ®Code -required soil cover over field Final fluid depth 51 in ❑ System presoaked Absorption rate 450 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: System operating in the upper one-third portion of the 6' effective depth. COSA Checklist.docx 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 *95'+/- 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' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft 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 Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Absorption Field > 5' ® Yes if No ft Water Main > 10' ® 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 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 *Septic tank met separation code requirements of 50'+ at time of construction is down hill from well and is concrete G. ENGINEER'S CERTIFICATION l certify that l 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.docx ft ft ft ft ft ft ft ft Lot 22 WOODEN FENCE 10' UTILITY EASEMENT PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 0253 Project No. 19-176 A 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & A S 5 o C i a f e n (907) 522-6476 Phone (907) 522-4625 Fax Q�OF A���� Professional Land Surveyors ken®longsurvey.com o Jonathan®langsurvey.com 0'`Q p � • 's �0 1 hereby certify that I have surveyed the following described property: LOT 6 of Tract H, BROADWATER HEIGHTS SUBDIVISION (PLAT No. 71-156) 0 49TH*'*do Anchorage Recording District, Alaska, and that the improvements situated thereon are""""""" .. ... ........... within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed Q ; G premises and that there are no roadways, transmission lines or other visible Q ,,,� KENNET G. o G easements on said property except as indicated hereon. �, 0 'P •'' J p Dated this the 6 Day of ��`�► at Anchorage, Alaska S-5202. �4FOA -• �Oo© 4�QR��SSIONAG �a It is the responsibility of the owner to determine the existence of any easements, 04oppo�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 TELL .2� C i '� oy 0 PLOT PLAN AS BUILT X SCALE 1" = 40' GRID NW 0253 Project No. 19-176 A 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & A S 5 o C i a f e n (907) 522-6476 Phone (907) 522-4625 Fax Q�OF A���� Professional Land Surveyors ken®longsurvey.com o Jonathan®langsurvey.com 0'`Q p � • 's �0 1 hereby certify that I have surveyed the following described property: LOT 6 of Tract H, BROADWATER HEIGHTS SUBDIVISION (PLAT No. 71-156) 0 49TH*'*do Anchorage Recording District, Alaska, and that the improvements situated thereon are""""""" .. ... ........... within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed Q ; G premises and that there are no roadways, transmission lines or other visible Q ,,,� KENNET G. o G easements on said property except as indicated hereon. �, 0 'P •'' J p Dated this the 6 Day of ��`�► at Anchorage, Alaska S-5202. �4FOA -• �Oo© 4�QR��SSIONAG �a It is the responsibility of the owner to determine the existence of any easements, 04oppo�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 907 Lt 1 Ll' t RESIDENTIAL & COMMERCIAL WATER AND WELL SERVICES 24HR EMERGENCY SERVICES AVAILABLE FREE ESTIMATES '-7 907-22 5/24/2019 Regarding property 12226 Skyline Dr. Eagle River AK 99577, a 4" PVC liner was installed and grouted extending the well casing to a depth of 40' to meet municipality requirements. If you have any question, please feel free to call or text Katie at 907-203-0565. Katie Netherton E f � 9(,)7 � J RESIDENTIAL & COMMERCIAL WATER AND WELL SERVICES 24HR EMERGENCY SERVICES AVAILABLE FREE ESTIMATES 4/29/2019 Regarding property located at 12226 West Skyline Dr. Eagle River AK 99577, a well camera inspection was conducted and the results are as follows: Cased to 10' 10" Pitless at 7' 8" Static water level at 42' Casing stick up 3' 7" Total depth of the well 300'+ The water level was drawn down from 42' to 60' with no incoming water shown in the top 60'. If you have any questions please feel free to call or text John at 907-230-1868 or Katie at 907-203-0565. Thanks Katie and John Netherton Nitrate Advisory Certificate of On -Site Systems Approval # OSC191130 Subdivision: Broadwater Heights, Tract H, Lot: 6 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.54 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. 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. Ma�lmg Address P O Box 196650 *Anchorage, Alaska 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. Werecommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. t � Mailing Address P O� Box 19665Q *Anchorage, Alaska 99519 6650 � www mun�'org � ram