HomeMy WebLinkAboutDRAKE BLK 4 LT 3Drake
Block 4
Lot 3
#017-462-17
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of3
www ci.anchorage.ak.us (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT
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Permit Number. PID Number:
Name
Golan I I
Wastewater System: El New ❑ Upgrade
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CY .' ABSORPTION FIELD
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LEGAL DESCRIPTION
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Remarks
BENCH MARK
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S i S ENGINEERINC9
Inspections performed by:17034 Eagle River Loop Road, NO- es: 1" —� (/b
Engineer's Stamp
.pe-'ry`whr'ti ,
y e River, Alaska 2nd
Development Services Department Approval
$ ~ti4 G1�
Conditional Approval Date:
a'• »••• .seeeea,ee(,,.1
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Reviewed and approved by: _ Date: J ILQ
0
PERMIT NO. SW060049 PACE 2 OF 3
Municipalityof Anchorage
DEPARTMENT OF HEATH 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
LEGAL LOT 3, BLOCK 4, DRAKE S/D P.I.D. NO.
017-462-17
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PERMIT N0. SW060049
PAGE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEATH AND HURAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 *Anchorage, Ataska 99519-6650 • Te'lephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 3, BLOCK 4, DRAKE S/D P.I.D. No. 017-462-17
FINAL GRADE
MH
89.7'X NEW 1500
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SYSTEM
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WATER AND B.O.H.=91.2'—
89.5'
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DT ELECTRIC
October 31, 2006
S do S Engineering
17034 Eagle River Loop
Eagle River, Alaska
Subject. Electrical Wiring
In October 2006, DT Electric performed the electrical wiring of the sewer lift station at 2800 Merganser
Avenue, Anchorage, Alaska..
Sincerely,
Don Tummonds
Owner, DT Electric ' 0A
6716 PAULA PLACE • ANC11CRAGE, AK • 99307
PHONE: 366-3676 • CELL: 916-7970
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 05, 2006
Expiration Date: Apr 05, 2007
Permit Number: SW060049 Parcel ID: 017462-17
Legal Description: DRAKE BLK 4 LT 3
Design Engineer: 0003 S & S Engineering Site Address: 002800 MERGANSER AVE
Owner Name: GLENN BALL Lot Size: 99000 SO. FT.
Owner Address: 1621 BELLEVUE CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99515-0000
This permit is for the construction of:
❑✓ Disposal Field ❑/ Septic Tank ❑ 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 Stale of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (1 BAAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (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.
5. The following special provisions.
-THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST
BE VEGETATED SUFFICIENTLY TO PREVENT EROSION.
-ENGINEER NEEDS TO DO AN ADDITIONAL GROUNDWATER MONITOR CHECK ON TESTHOLE #1A & 2B
DURING CONSTRUCTION. PLEASE WRITE THE RESULTS ON NEW SOIL LOG WITH STAMP AND
SIGNATURE OR THE ORIGINAL TEST HOLES AND INITIAL AND DATE.
Received By.
` q 5 6
Date:
Issued BAA/ Date: ri /J
Municipality of Anchorage
Development Services Department =�` •'.
.t Building Safety Division �.
\
On -Site Water and Wastewater Program _ s. <,.
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEPTICMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C) )1 H 6 q_-113
l 1.t;Nlo I }LL Day phone ;2'L "-5`a�(P
Property owner(s) /1
Mailing address 16),1 Z>r-L(_C-vuyC- C4 ICC4_, Zip Code rot
Siteaddress 2 )CO �1>✓P_[ r�N� L_ �r� Zip Code C19G)S
1 _ i _
Legal description (Sub'd, Block & Lot) '
Legal description (Township, Section &Range)
LOT 3' 1�JL�c K f'i ') 1�,2+� IG E S%1b
Lot Size99 1(�MSq. Ft.
THIS APPLICATION IS FOR (®ail that apply):
Absorption Field
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial ❑
Upgrade
Renewal
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
5 ENGINEERING
1 770034 Eaglo River Loop Road No. 204
(Signature of property owner or authorized agent)
Permit/Rush Fees:�i�DO 'Gv Waiver Fees:
Date of Payment: •3 3i w
Receipt Number: d 09 0
(Rev. 11105)
Date of Payment:
Receipt Number:
S&
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER PE.
CML ENGINEERS
(907)694.2979
March 28, 2006 FAX(907)694-1211
MUNICIPALITY OF ANCHORAGE
IEALTHAUTHORITY
APPROVALS
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
SEWEMAIN EXTENSIORNS
REFERENCE: Lot 3, Block 4, Drake Subdivision
It is requested that you issue a permit to install a new septic system with a pressurized
SEWER&WATER
04PECTION
bed and S.T.E.P. tank to serve the proposed four bedroom dwelling on the referenced
property.
Two test holes were excavated and percolation tests performed. The approximate locations
ENGNEERRIGSTUOIES
"REPORTS
of the test holes are located on the attached site plan. At the time of excavation (6-22-99)
water was not found. After seven days of monitoring, ground water was not found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
WELLM6PECTION
&FLOWTEST
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
SITE PLANS
If you require additional information, please contact us.'
Sincerely,
ROADDESIGN
?X//Z `
Robert C. Cowan, P.E.
SOIL TEST
RCC/bjj
Enclosure
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
CISPOSALSKTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577
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• t_ Municipality of Anchorage ,
q( DEPARTMENT OF HEALTH & HUMAN SERVICES
825'L' Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
-*IA
PERFORMED FOR: GLV-tv" ' 13 ALL DATE
n .... 0—.1—
LEGAL
2
3
4
5
6
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8
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10
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12
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16
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Q2GArV.IGS
Sri
(5m.4 -u- k�,-(OUNT"C n4flEL)
WAS GROUND WATER
ENCOUNTERED?
Reading Dow Grose
Time
S
IF YES, AT WHAT
L
Pay F
DEPTH?
E
y as1o6
Otplh Y taller Atte TiV
ehllalm? 631c6/
Naay
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�mm REM
Reading Dow Grose
Time
�mm REM
21 IL._ JI PERCOLATION RATE/h _ (minulevinthl PERC HOLE DIAMETER
TN
I n TEST RUN BETWEEN Z FT AND FT
�T.
COMMENTS J N AL I'i
PERFORMED BY: =Tim�e�-+Jo--904 F CERTIFY THAT THIS TEST WAS PERFORMED lH
ACCORDANCE W14l'iiR.JYAlfIN7D9alPt kT7AL GUIDELINES /INr,EFFECT ON THIS DATE. DATE: G ZZ -Z7/
72-000 Ines. 41851 _
.
i
r Municipality of Anchorage
O DEPARTMENT OF HEALTH & HUMAN SERVICES ff
825 `L` Street, Anchorage, Alaska 99502.0850 �.._
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: GL✓<Ar A) 13A LL DATE PEn FOnMEI11
LEGAL DESCRIPTION: Lor 3 / / /3LOC_K-j Township, Range, Section: 1,) j,4. KE_
SLOPE SITE PL/
(FEET)
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COMMENT!
617181920
COMMENT;
Jqn//GS
(SMFl/L f}r?OUAIr C/Q�l ✓C( )
ROBERT C. COWAN
WAS GROUND WATER /n
ENCOUNTERN
ED? .
S
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IF YES, AT WHAT — L
O
DEPTH? P
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/
qzslob DepA to water ABR
v I MoNlor(n0? __LAI_ able:
-rt+#x13
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• r'was
4- A I
PERCOLATION RATE 5P / (minutvvimh) FERC HOLE DIAMETER
TESTRUNBETWEEN ( FTAND 3 FT
S & S ENGINEERING � l—, J .. -CERTIFY THAT THIS TEST WAS PERrORMED IN
PERFORMED BY. .a0 a ver oop Road No. 204 /
ACCORDANCE vAT1EAg1e7diAiE,AM9iNYSP!'x GUIDELINES IN EFFECT ON THIS DATE. DATE: �� h
72-oos In". 4/as) ,
n
Municipality cipality ®f Anchorage
Department of Health and Human Services
825 °L" Street
Rick Mlystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
http://www.ci.anchorage.ak. us
June 7, 2000
Lawrence & Margaret Sajdak
1300 E. St.
Anchorage, AK 99501
Subject: Drake, Block 4, Lot 3
Permit # SW990212 PID # 017-462-17
The subject permit #SW990212 issued by this office for a single family well and/or on-
site wastewater system, is due to expire 365 days after it's issuance on July 21, 1999.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater system and a licensed Professional Engineer has inspected
the installation, the original as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports must be submitted within 30
days of construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-4744.
Sin ly,
James Cross, PE
Program Manager
On-site Services
enc: Copy of Permit
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 21, 1999
Expiration Date: Jul 20, 2000
Permit Number: SW990212 Parcel ID: 017-462-17
Legal Description: DRAKE BLK 4 LT 3
Design Engineer: 0003 S & S Engineering Site Address: 002800 MERGANSER AVE
Owner Name: Glenn Bell Lot Size: 99000 SQ. FT.
Owner Address: 1621 Bellevue Circle Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99515-0000
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑Holding Tank ❑Privy ❑Private Well E] 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:
Date:
?-12—q %
Issued By: 1 (2� /"""' Date: 7.-9
30' DESIGN DETAIL
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e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825"U' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 1� plL-✓' DATE
LEGAL DESCRIPTION: 22 t>4- 2Z.,,A Yi S Township, Range, Section:
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81920 18-
19-
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COMMENTS
-5" /5W
V�-
WAS GROUND WATER
ENCOUNTERED? '_Yy
S
IF YES, AT WHAT L
DEPTH? lJ O
P
E
Depth to Water Aller lys �tQ-g2
Monitoring? V Dale: 1
SITE PLAN
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
8-io'i1 1=42
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PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER Ce
TEST RUN EETWE�N Z FT AND 1p FT
rev 16 .
�J
PERFORMED BY: S & S ENGINEERING ( CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loo Road No Q
ACCORDANCE WITH A'�aT�'Itr/��DEIYYlYiI$�� fi�I.,IDELIN�$TN EFFECT ON l IS DATE. DATE:
R It I• 1 t U t ,l ,) • :tl t t ) t AREA ��� / R• E t " H
t
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPO T -SITE SEWAGE DISPOSAL SYSTEM
NAME MAILING ADDRESS/�; 7 ��., PHONE
, s�,�
LOCATION%PFeJ' ���f��✓ LEGAL DESCRIPTION •X9
SEPTIC TANK:
DISTANCE' // NUMBER OF
FROM WELL MANUFACTURER_65Z ' m MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY xz/0 GALLONS.
c '
NUMBER OF PITS DIAMETER A✓ OR WIDTH , LENGTH—, DEPTH
LINING MATERIAI_Qg14 2_le CRIB SIZE: DIAMETER DEPTH _�LL DISTANCE FROM: WELL_?
BUILDING `FOU DATIN �, NEAREST LOT LINE X
ADDITIONAL ABSORPTION
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) WSQ. FT.
WELL:
TYPE CONSTRUCTION f% ��/�ii/ /�i DEPTH
BUILDING NEAREST Ri¢ NEAREST i SEPTIC 1
FOUNDATION �� LOT LINE--, USEWER LINE l d—, TANK
CESSPOOL OTHER SOURCES
DISTANCE FROM:
SEEPAGE
SYSTEM
APPROVED — DISAPPROVED REMARKS �% `'1r'.G e—N,21i.'0
DISTANCES: �'�✓��
INSTALLED BY:
PIPE MATERIAL: ✓ P%S? ill/✓
LOT SLOPE: Z LuE /
REMARKS:i� � cue/F
Form No. EQ -031
DIAGRAM OF SYSTEM
4 ell
Cts,'
DATE _ZzZ/426APPROVED
G.A.A.B.
NAME OF APPLICANT MAILING ADDRESS PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED 43,
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS NOTE: THIS PERMIT M NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPECP-7-Lk!�-e �47'&--SEFPAGE AREA SIZE 'TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC 'TANK -- 5- —
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK I'D SEEPAGE PIT WALL
SEPTIC TANK --.s-
--, SEEPAGE PIT
t
DRAIN FIELD ---.`._1
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD – ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK .:PAGE PIT– -–
DRAIN FIELD
SEPTIC TANK. -.Aj7:L SEEPAGE PIT -/ �./–, DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
7150 �4=,L
CONFORM70 BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE to /VAPPLICANT'S SIGNATURE
FORM No. EQ -016
G.A.A.S.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE to /VAPPLICANT'S SIGNATURE
FORM No. EQ -016
onitotuation gait a
"One test is worth a thousand opinions"
3620 TUDOR ROAD. ANCHORAGE, ALASKA 99507 ® TELEPHONE 333.8472
Performed For Mr. Ben Wards Date Performed 7-169 1973
Lecaal Descrintion: Lot 3 Block Subdivision Drake Subdivision
This Form Renorts Soils Loq yes Percolation Test
Readinq
Date Gross Time
Net Time
Depth to H2O
Net Drop'
verso l ati on hta e r11 nute
Proposed Installation: See,Da(ae Pit yes Drain Field
Depth of Inlet Depth To Bottom Of Pit Or Trench
CnMMENTS: 250 sq, -f—t dFa ni ago area required per bedroom
No bedrock or wa er a e e ow seep age pi
Test Performed By Jim Mack _ Data Certified By: Construction Testlab
Lab Manager Date: 7-1 -73
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 017 -462-17
Certificate of On -Site Systems Approval
OSC251120
Expiration Date: 3/31/2025
Legal description DRAKE BLK 4 LT 3
Site address 2800 MERGANSER AVE
Current property owner(s) BALL THERESA MARIE
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
By:
Original Certificate Date: 4/16/2025
This ,Eertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sys'tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
/Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X
Absorption Field Advisory
Tank Age Advisory
Other
Well Flow Advisory
Nitrate Advisory X
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
Development Services Department
Phone:907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-462-17
Complete legal description DRAKE BLOCK 4 LOT 3
Location (site address) 2800 MERGANSER AVENUE ANCHORAGE, ALASKA 99516
Current property owner(s) THERESA MARIE BALL — Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well F-1 Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units F-1 Community Well or Public
n Water Storage
4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic Fj Private Septic serving 2 dwelling units
n Holding Tank n Community Septic or Public Sewer
5. SEPTIC TANK: Z Steel R Plastic R Concrete R Fiberglass
Age 19 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS Z Bed F-1 Deep Trench R Wide Trench R Seepage Pit
Waiver request for: Distance:
Expedited review requested: F-1
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 Date of Payment
COSA #-'Z`5 t I Z"o Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: DRAKE BLOCK 4 LOT 3 Parcel ID: 017-462-17
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 1973 Total depth UNK ft
Cased to UNK ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 3/31/25
Static water level at beginning of test * ft.
Well production at time of test 3+ gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 9.31 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 3/31/25
Comments *Artesian plug
B. TANK DATA
Measured operating fluid level in septic tank NA*
Date of pumping 3/31/25
Required maintenance completed, if AWWTS
Comments: *Pressure system / Floats
C. LIFT STATION
Required maintenance completed
Age of lift station 19 years
Lift station material Steel
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/5/06
ALL standpipes present per record drawing
Total measured depth from existing grade 4.8 ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 3/31/25
Results Pass
Fluid depth prior to test 0 in
Water added 600 gal
New fluid depth 1 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 6 in (MOA 0.5’ ED)
Effective depth used 0 in (Final Fluid Depth)
Effective depth (ED) remaining 6 in
Comments/Deficiencies:
COSA Checklist.docx
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’
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
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’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to 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
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 04/16/2025
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO 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 &
04/16/25
MUNICIPALITY OF ANCHORAGE
. Aw
Development Services Department -343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
Owner Street Address 2,aQo ne(ncoos 2x --
Septic Tank:
-Sludge levelno inches -Pumping: required Les•Pumes ping completed no
Lift station: � ( ��
-Pump basket cleaned Qno -Effluent filter cleaned es no
-Control floats cleanedrsn
-Proper float settings confirmed e' no
-Operation satisfactory
Alarm System:
-Dedicated electrical alara�siatisAfactorv,
no -Audible and visual alarm inside dwelling es no
-Alarm system operationnot satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connectiones2nd
-Ground water intrusion around pipe penetrations es
-Manhole lid: Functional 6Q no Insulated es no
Other
-Weep hole functional e no
Properly Secured e no
-All manufacturer required inspections and maintenance completed
Comments:
Qualified Maintenance Provider:
Technician
Company S eC- V 1 C(.S
Signature
gQno
Date of maintenance
Date 7
MUNICIPALITY
DEVELOPMENT SERVICES DEPARTMENT t \� 907-343-7904
On -Site wafter and wastewater Section Fax: 343-7997
www.muni.org/onsite �
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC251120
Subdivision: Drake, Block: 4, Lot: 3
A water sample revealed a nitrate concentration of 9.31 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P O.Box 196650 *Anchorage; Alaska 99519-6650 *www muni org