HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 1 LT 7
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage Page °-~---~ of
DF_PARTMENT 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.,d ~w"¢-4~? OL¢"t,("")(~/~ [~ PID Number: __OJS'
' Name:
~ ~ r ',// ~r4 C¥ t~¢ ?~ B~- Wastewater System: j~ New [] Upgrade
Address~:) ';~'('~O ~vn~I Cs<~m Dr,'v~ ABSORPTION FIELD
Phone: ~ ~¢_, ~DeepTre.ch ~ShallowTrenoh ~Bed ~Mou,d ~Other
LEGAL DESCRIPTION ~ SoilRat[*g: / GPD/Sq. Ft. Total Depth from original grade:
L~t: Block; Subdiv~ion: Depth to pipe bo~om from original grade: Gravel depth beneath pipe
Fill added above original grade: Gravel length:
WELL: ~ New ~ Upgrade Gravelwidtb: Number of lines: Oislancebehveealines:
~ ~t.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
)riller: Date Drilled: StaticWater Level: installer:
Pump Set at: Casing Height Above Ground:
,-- ¢ GPMI *' ~ Ft.I *.* Ft. TANK
SEPARATION DISTANCES ~ Septic U Holding
TO ~ Absor¢ion Lift Holding =ublic/Privale Manufacturer: Capacity in gallons:
Fro~ Field Stadon Tank Sewer Lines ~ C~ erq ¢ a %~ ~
~ Material: ~1
We~ 1~3~ ~2 ~ 54-e ~ Number of C~pa~ments:
SudaCewater ~ ~/~ LIFT STATION
~ Lot I I Sizein gallons: Manufacturer'
Pump Make & Model Electrical Inspections pedormed by:
~ ,.,.~. BENCH MARK
Location and Description:
A~umed Bevat[on;
Inspections pedormed by: ~ ~ Dates: lsL¢/Z¢/? ~_
Depadment of Health and Human Se~ices approval
Reviewed and a~roved by: ~ ~ ~ )~ Date:JO~/~'~ ~'~"~"~'~'"~'~'~
72-013 (Rev. 9/91 ) MOA 25
19/ P~c.
o 4- ., ¢~--,'V-- ) /"~' '
...... ~0°
_ I,°~/
Municipality Anchorage
Dopartmollt of H~--a?'h'uz~ "L' ~reo?tlldt Humall Sorvicos
p.o. Box 100050 Anehora0o,'Alaska 00510-0650
Rick Mystrom http://www.ci.anchorage.ak,us
Mayor
Permit Number: #SW 990064 Date of Issue: 4-20-99 Parcel Identification Number: 015-735-07
Date Started: 6-11-99 Date Completed: 6-1-99 Is well located at approve.d permit location? [] Yes [] No
Legal Descriptioli~ Prospect H,qhts #5 blkllt 7 ('bi
Property Owner Name & Address: Gary Cartwright
6700 Gunnison Drive
Anchorage, Ak 99516
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Stick up 0 2
organic silt 2 4
gravelly silt 4 39
sandy silt 39 77
silty gravel 77 91
gravel 91 107
gravelly silt 107 145
water sand gravel 145 148
silty water sand & gravel 148 152
Bedrock 152 245
RECEIVFD
JUL 7 1999
Municipality of Anchorage
Dept, Health & Human Services
Method of Drilling [] air rotary [] cable tool
Casing type: steel
Wall Thickness: .0250 inches
Diameter: _6 inches Depth: '/5_8 feet
Liner Type:
Diameter: ___ inches Depth: __
Casing stickup above ground: 2 feet
feet
Static water level (from ground level): 139 feet
Pumping level: 245 feet after
_2 hours pumping _4 gpm
Recovery Rate: _4 gpm
Method of Testiug: air
Well Intake Opening Type:
[] Open End [] Open Hole
[] Screened Start___ feet Stopped
[] Perforations Start.___ feet Stopped
_ feet
feet
Grout Type: bentonite
Depth:
Volume: ] bag
Start_0 feet Stopped ? feet
Pump: Intake Depth feet
Pump size ___ hp Brand Name
Well Disinfected Upon Completion? [] Yes [] No
Method of Disinfection: clorox
Comments:
Well Driller:
Alpine Drilling & Enterprises
P.O. Box
Anchorage Ak 99511
~r ~ ;':e~ .,an, ,-]Jer skal~.pre.Adea-well~ogto-tt*epropm%'owrecr ~¢,4thi~ 30days of completion and the property
Aarow Pump & Well Service, LLC
P.O, Box 110496
Anchorage, AK 99511
Office: (907) 34.6-9355 · Office (907) 34,5-0202
Cellular: 244.-3541 · F~x 333-8976
RECEIVED
OCT '19 199!)
Municipality Gl ,~\ncl~orage
5129
Oept, Health & Human Services
- QUANTITY DESCRIPTION PRI~'~'-- ..'~.. AMOUNT
~BOR HOURS RATE AMOUNT TOTAL MATERIAL
~ORK 0~5~R~9 ~Y DATE COMP,
~EOR
rhank You.
'/'ERMS: ACCOUN3'e PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE.
$1~RVICE CHARGE AT RATE OF 1,~% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
June 30, 1999
Muuicipality of Auchorage
Department of Health & Human Services
825 "L" Street
Anchorage, Alaska 99502~0650
Attention: Douna C. Meats, Civil Eugineer
Subject:
On-Site Wastewater Disposal System, As-Builts
Lot 7, Block 1, Prospect Heights Subdivision
Permit Number SW990064
Dear Ms. Meats,
The purpose of this letter is to submit the on-site wastewater as-built for tile subject property.
Attached are the following items:
1. On-Site Wastewater Disposal System report
2. Site as-built for subject property
I have attached a copy of the well logs for your review. I have not reviewed the well logs, nor
inspected or tested the water. The well does have a sanitary seal. I have as-built the well casing
in for your records.
Please call if you have any question or need addition information, at 694-2332 or 250-7574 and
my address is:
Christopher M. Kinney
11244 Lower Sunny Circle
Eagle River, Alaska 99577
Sincerely,
her M. Kinney, P.E.
cc: Gary Cartwright
Attachments
MUNICIPALITY OF ANCHORAGE
Department of Health end Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box '196650, Anchorage, AK 99519-6650
¢07) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Apr20, 1999
Expiration Date: Apr 19, 2000
Permit Number: SW990064
Legal Description: PROSPECT HEIGHTS #5 BLK
Design Engineer: 0809 Christopher M. Kinney
Owner Name: Gary Cadwright
Owner Address: 6700 GUNNISON DRIVE
ANCHORAGE , AK 99516-3718
1LT 7
Parcel ID: 015-135-07
Site Address:
Lot Size: 114751 SQ. FT.
Total Bedrooms: 6 Permit Bedrooms: 6
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date:
April 5, 1999
Municipality of Anchorage
Department of Health & Human Services
825 "L" Street
Anchorage, Alaska 99502-0650
Attention: Mr. Jim Cross
Subject:
On-Site Wastewater Disposal System
Lot 7, Block 1, Prospect Heights Subdivision
Dear Mi'. Cross,
The purpose of this letter is to submit the on-site wastewater application for the subject property.
Attached are the following items:
1. MOA On-Site Sewer Permit Application,
2. Original Soils Log - Percolation Tests for TH #1 & TH #2,
3. Site Plan and typical trench detail,
4. Calculations,
5. Septic/Lift Station Catalog excerpts.
An existing well is located 15 feet fi'om tile subject lot on each adjacent lot. Tile new absorption
field is located up hill of the well located north of the subject lot. The new absorption field,
however, has been placed approximately 110 feet from this well. The new well for the subject lot
will be located approximately 105 feet southwest of the septic tank.
The wastewater systern will consist of a 2000 gallon septic tank with lift station, 130 lineal' feet of
absorption trench (5 feet wide), and I ~A inch HDPE force main. The absorption field will be
located at the east end of the subject property approximately 40 west of Schuss Drive.
A reserved space or alteruate absorption field site has been selected toward the west end of the
property at tile base of the bluff crossing the lot.
Surface drainage generally flows across the site to tile northwest, reference site plan. There will
be no apparent impact to the adjacent properties.
We request your review and approval to construct tile subject improvements. Please call if you
have ally question or need addition information. .. ~....:..!%.: .... .. . . .
Very truly yo/.n's, //
Christopher M. Kinney, P.E.
Attachments
SCHUSS DRIVE
-Z
Munlcil:allty o! Anchorage
DEPARTMENT O" '~EALTH & HUMAN SFRVICF_S
825 "L' Street, '~m:horage, Alaska 99502-0650
SQILSLOG., PERCOLATION TEST
PERFORMED FOR:
LEGAL DBSCR IPTION:
1
2
3
4
5
6
7
8
9
lO-
11
13
14
15
16
17
18
19
20
ENCOUNTEF[ED?
DATE PERFORMED!
Township, Range, S.~ction:
SLOPE
SITE PLAN
Peadin9
O~3[e
· p~/~
Time Time
Depth to J Net
Water .~ Drop
PERCOLATION RATE <' ~/~"~ (m~nutos/mch) PERC HOLE DIAMETER ..
TEST RUN BETWEEN ,~'Z,- FT AI~D ~ I FT
DISCLAIMFR: C~rnumdwater__c~Q_d_itiR~s indicated are fnr the dates
P~st and future presence and/or depth of groundwater can not be
ACCORDANCE WITH ALL STATE AND MUNICIPAL GDI[ ELINES IN EFFECT ON TNIS DATE.
72-008 (Rev, 4/85)
shown oqly.
predicted
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: _ l a/~/~,~
PERFORMED FOR:
LEGAL DESCRIPTION:
4
5
6-
7
8
10-
12
13
14
15
16
17
18
19
20
Municil:a[Ity o! Anchorage
DEPARTMENT OF *~EALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG- PERCOLATION TEST
/::i ' (ENGINE~!'8 S~/~L) · ---. ; :'.
Township, Range, Section:
SLOPE
W/IS GROUND WATER
Et';COUNTER ED?
SITE PLAN
P':~COLATION RATE ~ ,~::~ (m,m~ms/,nch) PERC HOLE DIAMETER ~ if'
~FST RUN ~ETWEEN
DISCLAIMER: GrolJndwat, er~.onditions indicat.~,d~re for the dates shown only.
Past and future presence and/or depth of groLndwater can not be predicted
' from these o~serva%lons.
PERFORMED BY:
I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIEELINESIN EFFECT ON TNIS DATR, DATE:
72-008 (Rev. 4/~5)
Date Gross Net Depth to Net
Time Time Water Drop
'-~ ~.~.V~ ...... 11~ ~,~.~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASE REVIEW WORKSHEET
ON-SITE SERVICES SECTION
CASE NUMBER: I DATE RECEIVED: COMMENTS DUE BY:
I
89-036 I July 6, 1989 July 24, 1989
SUBDIVISION OR PROJECT TITLE:
A request to rezone approximately 2.63 acres from R-9 to AF.
(Lot 7 Block 1 Propsect Heights #5)
( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE
( ) COMMUNITY WATER AVAILABLE
COMMENTS:
CASE:
PETITIONER:
REQUEST:
TOTAL AREA:
LOCATION:
CURRENT ZONE:
89-036
Michael S. Castro
Rezone to AF (Antenna Farm District)
2°63 acres ~
Prospect Heights #5, Block 1, Lot 7; located
north of Upper O'Malley Road and west of
Schuss Drive.
R-9 (Rural Residential District)
HILLSIDE EAST COMMUNITY COUNCIL
/'.~'% ?~ f~~? ?~ ....?~??-/~'~.'~.~"?.~:~ ~:~ .. "~.. ~ ~. -".' ~z~ .." ' .~:.?,';,-':~.~.,,:',/':/~',:.~,~ ' ....
'. .... =.~.~_=~;-~ P;O,;~x~...-'-- v~oW~.. '' '.
ZOning M~ ~.mi~mum,~:~ ~'o~ ~d M.a ~un~ comm~ t° the r~u~t~ Zoning'di~
.... .'-. ..
~ ~'. Do ~ w~e in the ,had~ ~
Parce~
· I~ I hereby certify that (I ira) (I haVebeen b'Ot~birT,~<tt6:~ for) theown~bf
rwone in m M.wah
the b~ic r~oning ~ ~ nonr~unda~e ~d M tO:c~he.~ -~ w~h
not ~ure ap~ of the r~oning;~l ~ Un~d'~:addition~ f~may ~ ~s~ if the Municip~i~s costs to
proc~s th~ a~li~on ex~ the ~of~ I fu~he~ und~s~nd ~ ~ig~ being dat~ ~e tentative and may
have to ~ ~t~n~ ~ Pl~ning S~ff. Pl~nin
......... g Com~on~r the ~y du~to admin strative r~~T
,- ,., . - ~:~:; . : ... 'A~ m~,~ ~ ~:or ~on.
Please check or fill in the following:
1. Comprehensive P~an -- Land Use Classification
Residential
Commercial
Parks/Open Space
Transportation Related
2. Comprehensive Plan --? Land Use Intensity
Special Study
3. Environmental Factors (if any):
a. Wetland.
1. Developable
2. Conservation
3. Preservation
Marginal Land
Commercial/Industrial
Public Lands/Institutions
Alpine/Slope Affected
Industrial
Special Study
Dwelling Units per Acre
Alpine/Slope Affected
b. Avalanche
c. Floodplain
d. Seismic Zone (Harding/Lawson)
D. Please list any attachments:
1. Location Map (Required)
2.
3.
E. Proposed Special Limitations: (Use separate sheet if necessary.)
1.
2.
3.
F. J u sti f i ca~'~"~_,t,h e r ezo n i n g;
1 ¢"~E~Plai~ ~lublic neeO,,~'~ation for the rezo%ing.
.2~ /"ExPlain~il~e positive'e~eci of'~heX'fezoni¢~] on the ~v~nd/~he surroqnd~prope~y.
/~~oseO r~ni~ ¢l ~he~g;a,~ o~e compreh~iCe~ian.
/ ~ Q~mify t~unt o ' avl ' as u
G. Please indicate below if any of these events have occurred in the last three years on the prope~y.
Rezoning Case Number
Subdivision Case Number
Conditional Use Case Number
Zoning Variance Case Number
Enforcement Action For
Building/Land Use Permit For
H. The full legal description for legal adve~isement (use separate sheet if necessary).
20-002 Back (Rev. 3,'85)
posed special limitations will mitigate any advers'e
effects.):
a. Environment;
b. Transportation;
c. Public Services and Facilities;
d. Land Use Patterns.
Note:
Surrounding neighborhood = 500-1000'
General area = 1 mile
Community = Anchorage as a whole
o
Quantify the amount of undeveloped (vacant) land-in the
general area having the same zoning or similar zoning as
requested by this application. Explain why you feel the
existing available land is not sufficient or is not ade-
quate to meet the need for land in this zoning category?
Are public services (i.e., water, sewer, streets,
electric, gas, etc.) available to the petition site? If
not, when do you expect that they will be made available
and how would this affect your development plans under
this rezoning?
If the proposed rezoning alters the use of the property
from that which is indicated in the relevant
Comprehensive Plan, explain how the loss of land from
this use category (i.e., residential, commercial,
industrial) might be regained elsewhere in the com-
munity?
Explain how the proposed rezoning meets the goals of the
Comprehensive Plan?
?
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D.
015-13T-07
Certificate of On -Site Systems Approval
Expiration Date: (- 2 0 - Z a ZZ
1. GENERAL INFORMATION
Complete legal description Prospect Heights #5, Block 1 Lot 7
Location (site address) 10300 Schuss Dr
Current property owner(s) Cartwright Revocable Trust Day phone (907) 230-2392
Mailing address 10300 Schuss Dr, Anchorage, AK 99507
Real estate agent Jon Wagner
2. TYPE OF DWELLING:
W Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone (907) 360-4884
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
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 $ 56_6
Date of Payment /_0Z6
Receipt Number 077 x-10 0
COSA #_ I I S Ct 3
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date
OF A/`��ll
i �?•' TH 9 �l
6. DSD SIGNATURE All
--�, ,-
System #1 Approved for 5 bedrooms � •�•�
Benjar*vSchiller
System #2 Approved for bedrooms ��s'• sE3 2592 A-
Disapproved ,kkF, PROI�ZNFESSt��P���
Conditional approval for bedrooms, with the following stipulations:
\\6pPLITY pF
O s
rF F
oVVI �^
� A RA
Or,
TF,hi
Y �^- Original Certificate Date: f! —2 O - 2r/
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 C
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other M0 -4r
('
COSA Checklist blue sheet
Legal Description
rA
c
Prospect Heights #5 Block 1 Lot 7
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 6/01/99
Total depth 245 ft
Cased to 158 ft
0 Sanitary seal is functioning correctly
R Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 9/28/21
Static water level at beginning of test 134 ft
Comments
B. TANK DATA
Age of tank(s) 22 years
Tank type/material STEP/ Steel
Measured operating fluid level in septic tank 53
®❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 5/26/1999
fiff-I ALL standpipes present per record drawing
Total measured depth from grade 7.4517.3 ft (max)
Measured depth to pipe invert from grade ft (min)
91 N/A — pressurized field
Q Monitor tubes go to bottom of effective. If not, state
depth into effective
W Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID:
Structure served by this system 1
015-137-07
Well production at time of test 4.8 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
9 Coliform bacteria is Negative
Nitrate 7.55 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L C Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 9/09/2021
C. LIFT STATION
®❑ Required maintenance completed
Age of lift station 22 years
Lift station material Steel
Comments: Isaacs Pumping Service 10/15/21
Adequacy test date 9/28/2021
Results 0 Pass For 6 bedrooms
Fluid depth prior to test 0 in
Water added 1050 gal
New depth 0 in
Elapsed time 0 min
Final fluid depth 0 in
Absorption rate >900 gpd
Any rejuvenation treatment (past 12 months) No
If yes, enter date N/A
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
Community Sewer Manhole/Cleanout > 100'
ft
El Yes
if No
ft
M,/ Yes
if No ft
Neighboring Tank > 100'
M Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100'
✓❑ Yes
if No
ft
Holding Tank > 100' R1 Yes
if No ft
Neighboring Absorption Fields
> 100'
Surface Water > 100'
0
Animal Containment > 50' r7l Yes
if No ft
ft
M Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
�✓ Yes
if No
ft
M Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No 8.5
ft
Surface Water > 100' Q Yes
if No ft
Property Line > 5'✓❑
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q Yes
if No
ft
Private Wells > 100' Q Yes
if No ft
Water Main > 10'
Q Yes
if No
ft
Community Wells > 200' ✓Q Yes
if No ft
Water Service Line > 10'
M 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'
P/1
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
,� IF��q�-kl
49
T-"
Benjarr Lry8chiller
�� •.. CE 12592¢� •4`� r�' is�F�. 9/30/21 .�,0
-:0- -®
Lift Station/Pump Vault
Maintenance r
Owner . c �/W/v a%./- Street Address/22' 7c; AC / ijrli� gort 7
Septic Tank:
®Sludge level 2.inches -Pumping: required es ®Pumping completed
Lift station: 1P I .191 , eat f 19
*Pump basket cleaned na
-Control floats cleaned , no
-Operation satisfactory yed no
Alarm System:
Effluent filter cleaned YZS no
Proper float settings confirmed
1 '�ZC'1-
*Dedicated electrical alarm circuit yts no -Audible and visual alarm inside dwelling y� no
-Alarm system operation satssfactory not satisfactory
Manhole Miser
*Ground water intrusion at riser to tank connectioney s `no's
*Ground water intrusion around pipe penetrationsey s ®Weep hole functional 1�0
-Manhole lid: Functional Ao"' no Insulated 'K no Properly Secured no
Other
-All manufacturer required inspections and maintenance completed Vls no
Comments:
Qualified Maintenance Provider:
Technician Ah Date of maintenance
Company- � V
Signature 1 ��� 1 '�' Date d i r'
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 211593
Subdivision: Prospect Heights #5 Block 1 lot 7
A water sample revealed a nitrate concentration of 7.55 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.
Mallmg AddressP 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. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
MailmgNddress P O Box 196650 *Anchorage, Alaska 99519 6650 * www muni org
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 211593
Subdivision: Prospect Heights #5 Block 1 lot 7
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 22 years old. Typical replacement costs range from $9,000 to $12,000
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 Address P O Box 196650 *-Anchorage, Alaska 99519 6650 *www muni org
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The location of the structure(s)
as shown On this record drawing
(as -built) cQnplies with Title 21, AMC.
13y: L
Date:
-- GRID 1S+D
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHO' / sNY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
STRUCTURES OR FENCEUNES.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON.
NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
CR LOCATE STRUCTURES.
FINAL STRUCTURE AS -BUILT
AS -BUILT SURVEY
SCALE: 1-=4(r
I HEREBY CERTIFY THAT I HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBED PROPERTY.
LOT 7, BLOCK 1. PROSPECT HEIGHTS SUB.,
ADDITION NO. 5 -
ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT
THE IMPROVEMENTS SITUATED THEREON ARE WITHIN TF_
PROPERTY LINES AND NO VISIBLE ENCROACHMENT S ='•:: -
OTHER THAN NOTED.
DATED AT ANCHORAGE. ALASKA THIS 14TH
DAY OF JUNE 1999 . -
HOLT LAND SURvEYICJG 7483. F8 80.51.92.23
TEL. 345.5513