HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 1 LT 4Prospect Heights #5
Lot 4
Block 1
#015-135-04
'" Municipality of Anchorage Page I of
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: -~.t~c~ O~-O~ PID Number: Ot~ --|'~5 'Out
Name: CO~'~h~ I~ '~1~0~,}' Wastewater System: ~New D Upgrade
Address: ~ ~0 I
~o ~e~ 7~ ~zoo n~,.~. ABSORPTION FIELD
Phone: ~ -- ~ J No. ofB~rooms: ~ DeepTrench ~ShallowTrench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION So,.~,n,: ~.~ GPD/Sq. Ft. Total Depth fro~o~iginal grade:
Subdiv~ion: ~ ~ Depth to pipe bDt/em Irom original grade: Gravel depth beneath pipe
Township:I Ran~e=I ,o,,on: Fill added above original grade: ~el~gt;~t~ ~01
Ft.
WELL: ~ New ~ Upgrade Gravelwidth: ~t Number of lines: Distance between fines:
Ft. ~ I O Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: ~tat~cWater Level: Installer; Date installed:
Yield: j ~ GPMII Pump~Set at: Ft. Casing Height~Above Ground:Ft. TAN K
SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding ~ubilc/Pdvate Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~E~ ~O O
J Number of Compartments:
Sudace
w~t~ ioo~+ idol+ ~ ~ ~ LIFT STATION
Lot Size in ga'o"s: I Manufacturer:
Foundation ~ I ~0t ~ ~ ~ ~ "Pump on" level at: ~at: High water alarm at:
Curtain
Drain
Remarks: BENCH MARK
Location and Description:
I Assumed Elevation:
~ I '~ ~
EagleEIver, Ala~kag~57? 2nd ~-Zz-~l ~,~ ,o.,~ c. cOWAN
Department of Health and Human Se~ices approval ~,~t-: .............. ~:~
Reviewed and approved bz:/~ Date:
72-913 (Rev. 9/91) MOA 25
~ 1~0, SW960307 :P*G~ 2 OF 3
. iVlun~i_cip. 9_[it.y_o.F Anchorac~e
DEPARTMEN/ UI- HI:::AL/H AND HUI~AN SERVICES
ENVIRONIVlENTAL SERVICES DIVISION
P.g. Box 196650 ~,Anchor-age, Alaska 99519-6650eTe[ephone'. 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOT 4, BLOCK 1, PROSPECT HEIGHTS NO. 5 P.I~.NO. 015-135-04
A B
'-CO 45.5' 3.5'
F7 F'/ CO 49,0' 5.5'
I I
i i i / ST1 49.5' 8.0'
i i / I ST2 49.5' 17.5'
'' ~/ / DBL1 51.0' 24.0'
I I
' I ~' ,/ ! )BL2 56.5' 33.0'
I I' / FD 59.0' 39.0'
/ / NEW TRENCHES C01 50.0' 35.0'
I
/
co4 MT1 70.0' 67.5'
ALT. SITE ~,21JI '77/ C03 67.0' 43.0'
//,, ~,,,,,,// co,~ 90.0' 82.5'
MT2 85.0' 75.5'
/1i
I
iNSTALLED// OBL2' CO~
~LO~V mvm~ (~)
NEW 2000 GAL~ sn I r
NEW
6 B D R M I DRIVEWAY
HOUSE~
~ .~,.. "SC~E t" = 40'
~ ~~ ~r...'"' '"'x"'.~A.
~ NO~ SW960307 ~a,G~ ,3 0~'
Hunicipo, ti-'c o£ AnchoPo. Qe
DEPARTMENT OF HEAETHAND HUI"1AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 OAnchor'(:zge, A[o. sk0. 99519-66500~retephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LOT 4, BLOCK 1, PROSPECT HEIGHTS NO. 5 P.I.D. NO. 015-1,55-04
ST1 ST2 -FINAL
5~-~ NEW Ix. ,
90. 20~?T GAL. I 90.3
GRADE
CO1 C01 = 94.5' C03 CO3 = 89.3'
· MTI 002/C02 = 90.6' MT2 C04/C04 = 88.0'
MT1 = 90.6~..~// MT2 = 88.7L--~.~~
MTI = 81.2'~ MT2 = 80.1'~
·
NO WATER FOUND
70.6' B.O.H.
N.T.S.
From : ALPINE DRILL 987:345 0202 Nov, 20. 1997 10:40 PM P01
STATE.OF-AU~,SKA :'
· .. DEPARTMI}NT OF N~O~L-R~URCE~' .
~ * ' D~V~SION. QF MINING.~,WA~ MG~T '
~:. .. [~ATtON .OF WE~E ' WATER~WE~k RECORD
.8~REHOLE DAT'A: Depth
Color *' ~dm TO
WI;L[ DEPTH: ' * DATE OF COMI?LE~rlON
Depth of hole:~ft . ·
DEPTH TO STATIC WATE~"L~EL . . ....'..
USE'pF WELL ~'qJom~sti~; · O";r¢il~atlon D 'mi)nl~o~
-CASING .STICK.U~ fL plato:
Casfng typ~
perforated ~en hope
Oupths of Openings: , :tO It ' .
SCREEN TYPE:
Slot/Mesh Size:..
GRAVEL PACK TYPE:
Volume used:
· GROUT TYPE:
Depth: from~
DEVELOPMENT METHOD:
Oepth to top:
ft to
LEVEL.AND YIELd:
ft
PUMP'INTAKE DEP'i~: * fl Hori~opuwer:' :.
WELL DISINFECTED UPON COMPLETION?
INFORMATION;
.' Authorized Re~ptesentati~ ~: 0NR/01VISION OF MINING & WATE8 M~MY
' ' 3601C St, Suite B00 ," '
RECEIVED
DEC 19 !997
Municipah[y ol Al~c;nora§8
Dept. Health & Human Services
MUNICIPALITY OF ANCHORAGE
D PARTM NT OF AND UMAN S VIC S
a~CHO~AG~, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960307
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:ONEY JOHN ANTHONY & RITA GAE
OWNER ADDRESS:10241 NIGH RD
ANCHORAGE, AK 99515
DATE ISSUED: 9/24/96
EXPIRATION DATE: 9/24/97
PARCEL ID:01513504
LEGAL DESCRIPTION:
PROSPECT HEIGHTS #5 BLK
1 LT 4
LOT SIZE: 49624 (SQ. FT.)
NUMBER OF BEDROOMS: 6 THIS PERMIT: 6
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:
RECEIVED BY: /~/~/J~~
ISSUED BY :~~~~'~
DATE:
DATE:
ROBERT C. COWAN, RE.
ROBERTA, SHAFER, RE.
Date: ~/'¢i. / 9 7
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
SEWER&WATER
Iv~dN ID(TENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE pLANS
ROADDESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTtONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH ~qD HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lo
RECEIVED
JUN 9 1997
Municipality of Anchorage
Dept, Health & Human Services
The septic in~pe, ctions for the referenced property, were
q-/.~3./¢;? . P~ Lor to submitting
performed on ~/-z, [ q 7 and ~
the On-site Wastewater Disposal System an¢' r. Well Inspeqtion
Report we are waiting for the~6?~,__c ?~/~3d~-.~r *.-~'~ be
completed.
If we may be of further service please contact us.
Sincerely,
Robert C. Cowan, P.E.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
HEALTH AUTHORI'fY
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
D~SPOSAL SYSTEM
DESIGN
September 12, 1996
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 4, Block 1, Prospect Heights S/D
Addn. #5
Request you issue a permit to drill a well and install a
septic system to serve the proposed six bedroom house on
the referenced property.
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 and after seven day ground water monitoring, the
monitoring tube in the test hole was 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.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/g :
Enclosure
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
17034 NORTH EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER, ALASKA 99577
'"
FI]
---t
('DOll 'XO~ldclV)
.~fllGV~[ 'lrllEli ,OOI
SITE PLAN
-o
mO
'-qm
n" Z
DESIGN
DRIVE
ROBERT C, COWAN, RE.
ROBERTA. SHAFER, RE.
HEALTH AUTHORIIY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
P~RCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 4, Block 1, Prospect Heights S/D Addn. %5
September 12, 1996
GENERAL:
1.
e
e
De
The scope of this project includes the installation of
a 1750 gallon septic tank and five foot wide
drainfield to serve the proposed six bedroom residence
for 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. On all
leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation
growth over the mounded area.
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:
me
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
e
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
e
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 4, Block 1, Prospect Heights S/D
September 12, 1996
Addn. $5
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.
m
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.
0
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.
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.
Page Three
Lot 4, Block 1, Prospect Heights S/D
September 12, 1996
Addn. %5
MINIMUM MATERIAL SPECIFICATIONS:
me
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
e
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pip~
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.
7e
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements, which ever applies.
Page Four
Lot 4, Block 1, Prospect Heights S/D
September 12, 1996
Addn. $5
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.
e
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.
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/OWNER
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
LEGAL DESCRIPTION: ~--OT /'/ 8£ ~' '1
DATE
" Township, Range, Section:
8
9
10
11
12
13
14
15
16-
17-
18-
19-
20-
COMMENTS
8,o.
WAS GROUND WATER ~ O
ENCOUNTERED?
S
L
IF YES, AT WHAT ~
O
DEPTH? p
E
SLOPE SITE PLAN
Depth lo Water After. A.
I/
Monitorin§? O.,~y Date. ~/l"//C~f~
Reading Date Gross Net Depth to Net
Time Time Water Drop
ql~/eG O : oo ,- G '/;,'' -
O: o t t '~,~; 7 Y~ " I"
o:.c ~ ~7~" I"
o: e~ t 7" I"
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '~ FT AND ~ FT
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
Township, Range, Section:
1
2
3
4-
5
6
7
8
9
10
11
12
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
-T-£ $ rr
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Alter
Monitoring?
SITE PLAN
1
N
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE "~' 7
7
TEST RUN BETWEEN __
__ (minutes/inch) PERC HOLE DIAMETER __
FT AND ~> FT
S & $ ENGINEERING ,
PERFORMED BY: ~.~ Eag;" ~iver L~p Road No. ~ ...... ; CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ~~~GUIDELINES iN EFFECT ON THIS DATE. DATE: Cl /17 / q C
72-008 (Rev. 4/85)
COSA Checklist
Legal Description: PROSPECT HEIGHTS #5 BLOCK 1, LOT 4 Parcel ID: 015-135-04
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 4/9/1997
Total depth 205 ft
Cased to 120 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 8/27/2020
Static water level at beginning of test 96 ft.
Well production at time of test 5+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 6.95 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample 8/28/2020
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) 23 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50”
Standpipes/foundation cleanout per record drawing
Date of pumping 8/27/2020
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 4/22/1997
ALL standpipes present per record drawing
Total measured depth from grade 8 / 10 ft (max)
Measured depth to pipe invert from grade 4.9 / 6.18 ft
(min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective (0.1-.32’ deeper per inspection vs IR)
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date 8/27/2020
Results Pass For 6 bedrooms
Fluid depth prior to test 0 / 0 in
Water added 900 gal
New depth 0 / 7 in
Elapsed time 1210 min
Final fluid depth 0 / 0in
Absorption rate 900 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Comments/Deficiencies: NE field cleanout could not be located with digging & appears buried a few feet below grade.
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
ft
Neighboring Tank > 100’ Yes if No
ft
Absorption Field on Lot > 100’ Yes if No
ft
Neighboring Absorption Fields > 100’
Yes if No
ft
Community Sewer Main > 75’ Yes if No
ft
Community Sewer Manhole/Cleanout > 100’
Yes if No
ft
Private Sewer/Septic Line > 25’ Yes if No
ft
Holding Tank > 100’ Yes if No
ft
Animal Containment > 50’ Yes if No
ft
Manure/Animal Excreta Storage > 100’
Yes if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *7 ft
Property Line > 5’ Yes if No
ft
Absorption Field > 5’ Yes if No
ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No
ft
Community Wells > 200’ Yes if No
ft
If 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
Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No
ft
Water Service Line > 10’ Yes if No
ft
Surface Water > 100’ Yes if No
ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No
F. ENGINEER’S COMMENTS
*PER MOA IR.
G. ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
9/15/2020
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Nitrate Advisory
Certificate of On‐Site Systems Approval # OSC201482
Subdivision: Prospect Heights #5, Block: 1, Lot: 4
A water sample revealed a nitrate concentration of 6.95 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a medi a with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC201482
Subdivision: Prospect Heights #5 Block:1, Lot: 4
The septic tank for this property is 23 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 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 30 year old steel tank MAY look like.
Parcel I.D.
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
01 5 - 1 3 5 - 0 4 HAA# ,(J//t~"C'~,~
Expiration Date:
GENERAL INFORMATION
Complete legal description Lo t 4, B:lcok 1, Prospect Heights
Location (site address or directions) 10200 Schuss Dr±ye
Current Property owner(s) Harold Snow
Mailing address
Day phone
10200 Schuss Drive, Anchorage, AK 99516
346-1705
Lending agency
Mailing address
Day phone
Real EstateAgent Dynamic/Karen Foster
Day phone 261-7670
Mailing Address 3111 C Street, Suite i00F Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ~/~/2 ~,~.-~
NUMBER OF BEDROOMS: 6
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
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 Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and /or wastewater disposal
system is safe, functional and adequate for the number of bedrooms and type ot 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 wastewater disposal system is in compliance with
all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation.
S & S ENGINEERING
17034 Eagle River Loop Road No,
~:~gle River, Alaska 99577
Name of Firm
Address
Phone ~ ¢1 ':7' - ')- ~? 7 ¢/
Engineer's Printed Name Robert C. Cowan
DHHS SIGNATURE
1,~ Approved for ~ bedrooms.
Disapproved,
Conditional approval for
Date /]/¢
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
72 025 iRev 01
Municipality of Anchorage _ j~
Department of Health and Human Servic~l~ E C E ! V E
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650 NOV 0 7 ~2000
www. ci.anchorage.ak.us
(907) 343-4744 MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: La~- ~ ¢Lo~.~ '1 P,~orP~.cT- N¢.,¢..-~4~'~' 4~'
A. WELL DATA
Well type ~
Date completed ~/'~/~/7
Total depth ~' o .5 ft
Date of test
Static water level
Well production
Cased to
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform O colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material J~.~ r, c /
Date installed
If A, B, or C provide PWSID # __
Sanitary seal ¥~/- '¢
logo ft
ft
g.p.m
Parcel I.D.:
Well Log. ~//Z _r
Wires properly protected .V~ .r
Casing height (above ground) '~" in.
AT INSPECTION
Io/3o/oo
¢" ,~-. 5 -)- g.p.m
Nitrate 3.~7 mg/I Other bacteria O colonies/100 mi
Collected by:
$ & S ENGINEERING
'17034 Ea~ie [~ver Loop Road No. 204
Eagle River~ Alaska 99577
gal Number of Compartments
High water alarm
System type
__ Depression over field ~v o
For ~ bedrooms
Tank size
Cleanouts ¥~' Foundation cleanout ¥~.3 Depression over tank
Date of pumping I~ / 7/~o Pumper
C. ABSORPTION FIELD DATA
Date installed L~/,).~/ ~? Soil rating~r ft2/bdrm)
Length c40 ff r~,~ Width ~ ft Gravel below pipe
Total depthS- I-~ fl Effective absorption area~'~(, ~' ft~ Monitoring tube
Date of adequacy test/~/¢~/~, Results ~Fail) ?,~
Fluid depth in absorption field before test ~&Y in Wateradded ~1 '~ gal. Newdepth_ ~'~/;z in.
Elapsed Time: ~-O min Final fluid depth ~- in Absorption rate >= ~ o o g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ ~,"~ ~ ,,, o ,, ,~ .If yes, give date --
72-026 (Rev. 01/00)*
D. LIFT STATION
Date installed Size in gallons __
"Pump on" level at ~
Datum ~ Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ) O o ' +-
Absorption field on lot
Public sewer main ~v
Sewer/septic service line
High water alarm level at __ in
Meets alarm & circuit requirements
On adjacent lots
On adjacent lots
/06 -P
t
Ioo'+
Public sewer manhole/cleanout
Holding tank N ,/4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Building foundation -/ ' Property line /o
Water main N//J Water service line
Drainage ,',,'/4 Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~'/0 -+ Building foundation 3 5' 4-
Water Service line !o !+ Surface water / o o '4-
Curtaindrain~',~,,~. ~:~o,~,,, Wells on adjacent lots /oo
Absorption field / o +-
Surface water ) o o -~
Water main
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date h/~,
Driveway, parking/vehicle storage
HAA Fee $
Date of Payment
Receipt N.mber
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
11-02-00 lf:29 FROM-CTE ENVI RON~ENTA1
,a~ CTIE EnvironmentaIServlceslnc.
5S15301
T-233 P.02/03 F-471
CT&E Ref.# 100676200l
Client Name S & B Engineering
Project Name/g L4 B l Prospect Hts #5
Client Sample ID ~ ~ l Prospect Hts ~5
Matrix D~ng Water
Ordered By
PWSID 0
Sample Remarks:
Client POg
Printed Date/Time 11/02/2000 15:36
Collected Date4Time 10/30/2000 10:45
Received Date/Time 10/30/2000 12:35
Technical Director Stephen C. Ede
Allowable Prep Analysis
Paramete* Re~tdts PQL Units Method Liners Date Date Init
Waters Deparhment
3.1t7 0.500 mg/L EPA 300.0 10 max 10/30/00 SCL
Microbiolo~y Laboratory
Total Coliform
col/100mL SM18 9222B
10/30/00 KAl)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343:4.744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
ParcelI.D.# 015-135 -oq
1. ~GENERAL INFORMATION
Complete legal description
Lot 4;
Block 1; Prospect Heights #5
Location (site address or directions)
NHN Schuss Drive
Anchorage, AK
· Prope~y oWner Connie Snow
, Mailing address 550 West 7th
, ..Lending agency "
Mailing address
41200 Anchorage,
Day phone 345-8359
A~ 99501
Day phone
.Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
XXX
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 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.
5'Z $ EN61NEERiN6 Phone. (~ ¢/' ¢ -~-~ '7 ¢
Name of Firm ~7e~,4 Eagle ~,iver Loop Rea8 No. ;zu4
~, ate River, Alaska 99577
Address /,..~_._
Engineer's signature . _ Date ? ,z./! S'/¢/~
D~/~ SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
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 DH HS 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 MOAI¢21
:,.ONMENTAL SERVICES DIVIS',,.
Municipality of Anchorage 0[(~ i (~ [99'i~
DEPARTMENT.OF HEALTH & HUMAN SERVICES
Environmental Services Division [~ E C E J V J~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description: L.o-r
A. WELL DATA
Well type
Log present (~/N) ~/E-~
Total depth ,,~,o
Sanitary seal
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform O
Health Authority Approval Checklist
FROM WELL LOG
If A, B, or C, attach ADEC letter. ADEC water system number ~ //~
Date completed ur / % /97
Cased to ) :~o Casing height (above ground) ~
Wires properly protected ~N) ~ ~- -J
AT INSPECTION
/ o-~ ///-/
g.p.m, g.p.m.
Nitrate ~. ~ ~ Other bacteria
Collected by: S & $ ENGINEERING
Eagle River, AlasEa ~9577
Number of Compartments
Date of sample: , ~L [1~'/~
B. SEPTIC/HOLDING TANK DATA
Date installed ~q~/ Tanksize
Depression (Y/~) ~ o
Pumper
rating Or fF/bdrm)
Soil
High water alarm (Y,~
I. ~. System type
Gravel thickness below pipe Total depth 8
Monitoring Tube present (~}'N) h/E-~ Depression over field (Y/~)
Results (Pass/Fail) ~ For
Immediately after -- gal. water added (in.):
~ Absorption rate = .g.p.d.
If yes, give date
bedrooms
Foundation cleanout (~N) ~s
Date of Pumping /~%.W.~
C, ABSORPTION FIELD DATA
Date installed ur - 'z'~- ~i -/
Length('~ (~ 5~St') qo1%i%~h
Effective absorption area -77 ~,
Date of adequacy test /~ F_ ~
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed _
Manhole/Access (Y/N)
High water alarm level at?
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Size in gallons _
ff" level at* _
On adjacent lots _
IOo~-~
On adjacent lots _
Public sewer manhole/cleanout _
~oo~-t.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sewer/septic service line ~- -~ t ~ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Property line _ 1o5 ~ Absorption field
Water main/service line _ I o14' Surface water/drainage _I°o~'f Wells on adjacent lots.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ~o ' ~ Building foundat on ~o
Surface water
18
Curtain drain
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
ENGINEER'S CERTIFICATION
certify that I have determined thru field inspections and revi~
Inconformance/.~wi~7~ .l~g~linesineffect°nthisdate'
Engineer's Name
Date
are:
Date of Payment
Receipt Number
7P-026 (Rev. 3/96)*
Waiver Fee $ _
Date of Payment _
Receipt Number
~/~tk CT&E Environmental Services Inc.
· 'J~J~,~'J~'~'all~J~J~l~'J~'~'.
CT&E ReL#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
977528002
S & $ l~ngineering
N/A
Lot 4 Blk 1 Prospect Hts #5
Drinking Water
Sample Remarks:
Client POg
Printed Date/Time 12/19/97 09:40
Collected Date/Time 12/15/97 13:45
Received Date/Time 12/15/97 14:15
Technical Director: Stephen C. Ede
Released By~ ~ ~.~//~
Parameter
ResuLts PQL Units
ALLowabLe Prep AnaLysis
Hethod Limfts Date Oate Init
~trate-N
Waters Department Analyses
Total Co[fform
3.66 0.100 mg/L
EPA 300.0 10 max 12/15/97 RNV
0.00 co[/lOOmL s~18 92228 12/15/97