Loading...
HomeMy WebLinkAboutGOLDEN VIEW HEIGHTS LT 8AtKev uo/uuits) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201028 PID Number: 020-042-92 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name MICHAEL & KIMBERLY HOWELL ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 15901 WINDSONG DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot GOLDEN VIEW HEIGHTS LT 8A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'-+- 50'+ TANK 0 Septic ❑ S.T.E.P. E Holding ❑ Other ManufacturerCapacity 4 C)fG_ 1000 Surface Water 100'+ Gal. Material Number of compartments Lot Line 10,+ NA PLASTIC 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield 3034 co/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection Is' 2-26-20 2-26-20 Location and description GARAGE SLAB 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 49€g1 ° Septic System -® E= hUC AEL Il!. ANDLRSGIN Approved (� Date g CE 9 69 Note: this approval does not include well permit requirements. tQ�I 5t tKev uo/uuits) Permit No. OSP201028 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: GOLDEN VIEW HEIGHTS LT 8A MARK A B col 85; 95 101 T 2 90 96 103 108 CO2 98 110 CO3 11,00 1 112 PID No.: 020-042-92 (— — — — — — ` ASBUILT SCALE:_ 1 "_50' .2 �02 a®® DF 44, .•y o 0 a` 49 TH ®` e tg&j T0 GALLOON000AC TANKK 7A7 , 7 10t' -.MICHAEL N. ANDERSON: ® 1®% No. CE 9469AV .E 3-1-20 ® SEPTIC SECTIO ®® +® MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201028 Work Type: SepticTank Upgrade Tax Code Number: 02004292000 Site Legal Address: GC)LDE.l� Site Mailing Address: 1 5901 Owner: HOWELL MICHAEL S VIEW H E (G H -T S LT � J\ WIND SONG ��� N-k)clA Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: »cnt c of .S' Q n v. Department Lot Size in Sq Ft: Total Bedrooms: 2/25/2020 2/24/2021 ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing AReceived By: Date: 2_,/Zt�? n Issued By: Date: 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-042-92 Property owner(s) MICHAEL & KIMBERLY HOWELL Mailing address 15901 WIND SONG DR, Anch. AK Site address same Day phone (A 04 Legal description (Sub'd., Block & Lot) GOLDEN VIEW HEIGHTS LT 8A Legal description (Township, Range & Section) Lot Size 49,500 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo AD U) Septic Tank ElUpgrade F1Duplex (D) ElHolding Tank ElRenewal F-1 Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 9 10 it 7,1 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: h ,off M � Disn I certify that the above information is correct. I further certify that this I� abbor }it applicable Municipal Codes. g Zl `&t 'O'A' (Signature of property own -r or authorized agent) Permit/Rush Fees: `� 3&U Waiver Fees: Date of Payment: ala Date of Payment: Receipt Number: Ir" /ll Receipt Number: Permit No. 01510ac) Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Feb. 18, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: GOLDEN VIEW HEIGHTS LT 8A To Whom it may concern: This is a request for a septic tank pen -nit on the above referenced lot. The new system is a simple gravity flow 3 bedroom system which needs replacing. This new tank installation will not impact any of the neighboring properties. The slope is very gentle slope to the west, see the site plan. Sincerely MA Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 I ( — n WE L �EPTIq >C I h tSEPTI` I / I I -WEIR-�_— SEFTIC j SEPTIC ( j \ — I ELL I \1 )1 ` WELL i � WELL tl PROPERTY LINE w \ / 1 I (SEPTI� / EXISTING HOUSE WELL WELL ti 1, �I �EPTIdj WE I (ELL I Septic Design Prepared for MICHAEL & KIMBERLY HOWELL GOLDEN VIEW HEIGHTS, LOT 8A Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: a IF '•••'y ®:. 49TH ®............... ....................... o...................................... 2/18/2020 ®1.MICHAEL N. ANDERSON;® 1®Ar ®� N o. E 9469 Ar DJR 1 „=200' ®s® I — — — — — — — — — — — — --- — —/-— — — — — — — — — — a 5-10 PERCENT DC SLOPE PROPERTY LINE STING 100' 10 T&E 5-10 PERCENT SLOPE EASEMENT NEW 1000 GALLON PLASTIC SEPTIC TANK, WITH 20" RISER, DECOMMISSION OLD TANK PER UPC PROPERTY LINE Septic Design Prepared for MICHAEL & KIMBERLY HOWELL GOLDEN VIEW HEIGHTS, LOT 8A Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: DF AV Aff Aw 49 TH a 0 .................. A ........................ . . .............................. ... • 0 MICHAEL N. ANDERSON;-/ . 2/18/2020 No. 7C 7 9 69 DJR 1 "=50' MUNICIPALITY OF ANCHORAGE Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2~4-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~me DISTANCES Address ~ {i~ TANK FIELD WELL Permit No. NO o' Beams WELL p~,'~ [~ ~:/- Township, Range, Section _ TF/~ ~ a ~ ~mO~ ~-- drlveway.A':"UlLTwaterDlAG"A"bodles. ,,c,(Sh°w ,DCa, .... ,well. septic system, property I ..... foundation. 'TANKS U TYPE OF SYSTEM .¢ p -- Depth to pipe bottom from To[al depth from ongmal grade Distance between Ilne~ I Totalebsorptionerea ~ ~+8OFT, FT Number ol Ones Soil raCng Pipe matedal __ : PRIVATE ~ OTHER (Identify) Classification (A,B,C, Total ~ep'h FT C.,~d,o ~"d = :2~~ Health Depadment Approval: ' ": ': / 94,04 1000 OF~L, SEPTIC TANK 6751 ~/, DII4OND ~LVD, ANCH, AK, 9.~50~-~904 LOT 8A 6ULDENVIEW HEIGHTS REItGE,~, t~[ZCKWELL O~T~, I?EC. Z iY?~ ~W-FECT, GRID, RESEEVE A~,E~ ~O00st¥+ 7 6 _sq ft REQUIRED. o~,~ GED FAB~Id. (~ ft ~.ONG) (Sft SEWER ROCK) = 608 sq ft. = 7~o~[~, ~ ~'~<~'({'d 6ERfE~ INSTALL /2DO GALLON, STEEL, 2-COMPARTMENT " SEPTIC TANK. 8'DEEP INSTALL CLEAN-OUTS AT FOUNDATION~ BETWEEN ( TANK & TRENCH, AND AT EACH END OF TRENCH. iNSTALL MONITOR PIPE NEAR MIDDLE OF TRENCH. ALL CONSTRUCTION ~0 MEET M.O.A. SPECIFICATIONS. ~0~ .SEWE SYSTEM'LOGATIO PLA (ENGINEER'S SEt,L) · : i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER~ 825 "L" Street, Anchorage, Alaska SOILS LOG -- PERCOLATION SLOPE Township, Range, Sec~.ion: OEPTH (FEET} © 1 5 6 7 8 9 10 11 12- 13- 14- 15- 16 17 ~9 WAS GROUND WATER IF YES, AT WHAT SITE PLAN N / DEPTH? -- p I Reading Date Gro~ inet De~th to Net 'llme Time Water Drop ('2, s'o Io~.!.~m 1~'~/~,¢-~ /~p, ~, ¢~ ~, / / PERCOLATION RATE ~'~. (min¢c~inchl PERC HOLE DfAMETER ~ //' TEST RUN BETWEEN ~ FT AND ~ .F"T ' '¢ IA '1 .' / '- . ,' ~':, / PERFORMEOBY:' ~ ~¢¢ ~ ' ~~; ¢ ~RTIFYT~TTHISTESTW~P.FORMEDIN 72-~ (R~. 4/~7 ' ( / WASTEWATER NARRATIVE FOR LOT 8A, GOLDENVIEW HTS. The location of the wastewater disposal system on the subject property should have no negative affects to the adjacent properties or the environment for the following reasons: WELLS The adjoining well on Lot 8C is properly separated from the planned wastewater extension by at least 100 ft. and the proposed well is located such that there will be no negative impacts. WASTEWATER SYSTEM The wastewater system proposed for this property has been located so that there will be no effects to any surrounding properties. All setback distances have been satisfied as required. Further the soils are of such a nature that treatment will be assured over a long term period. RESERVED SPACE The wastewater system on this property have no effect in taking away reserve area set aside on other adjacent lots and there is adequate reserve space on this lot lot for future replacements. SURFACE AND SUBSURFACE DRAINAGE The wastewater system will have no impact to surface water drainage due to the location and the fact that the contours will remain unchanged. Subsurface drainage will be unaffected since treatment of wastewater is assured before it reaches groundwater tables. / DEPT. OF ENVIRONMENTAL CONSERVATION 360! C Street, Suite %nchord~c, AN 99577 lit, Rogar Rockwell P.o. }ox 111512 ~nchorage, AR 99511 ['{ C .. WA~.TER J. HICKEL, GOVERNOR .%DNC .Project ~'u:?.ber 93.°~... ...-~".x-,..~r-.~.,, installation, of a Class ~.. Pub].ic .... '~ ..... :'~!1 Rev ' ~ ..... ' a,.,. ..,vbte ~ Source , This is in r .... }on~ to your bub,.~.Lta~, £ ' ' ,_ ~'~.. ~'~ ...... '' ': eceJ. ved ir, ti!.tS office on rl~l W~J.= Oil .. ~,.ua~.:~, _1 991, in which ~vou recu~zc~..~ _ to ~ ~, ~' TM - ' :'?'; ~ "' ' ~ ~ " Dub'I ic ~T ..... t'e~er~nceJ ~ot, which, in ti;;te, ..... ~I bocome a ,...uc~.,::~ t ..... System serving a 3ed ~ TM ...... ~':'~' - i!~ '-- "'-' ....... - . ' · , . ,~_ :,_=~ ~ j.~ ' iot ha/3 completed my r~view of the .~. i.,.L~.~;.~ ~ormation, this o~tzcs's ..... z.~c~'-- on th'is project,' and iiscussel the r)soject with T'~v~n ....... t..n~ ~on,.er Jll0 ~lJ.S ,.~a~:,:~ ,. 11 can be ap)reval at this tiros by the De-}:~st;aent, The location o~ AS ~ ).u. OVe~ for Co~lceli~s o~ (2}]is ~ ............ ' ]?zovisions o~_.~S ~-~a~,,,~ ........ ~-~_na..n~t~atlve" '~ ~' ~ ....Code ~0, 3rin,:ing' ?ater. only for :-?,~ location and insta} :ation of ..... refe~ enced waker sys c 2::t an! is :::ub-' ~ - to ~he ;following _,.~ ...... ~n~ ~pzLaiLel Lhe ;;ashe ;,;acer Satisfactory ,}ma]_yt{"a]..u ~ x.ozuits ~o=': ' bac"-~ariolog~a~'-'" an2 to ...= ):ovi2e'? to tnz;, ~...~_,.~ b,.~fora '~.=:-~.;ing .... ~" to 'oho public,,:ea,..:." 'i2s .~..:~ot'~,.~ _. ~ ~.~'~ :3ub:nittei Iii'Ir]er tl:e ~ ..... 'bi ic 'fNi.~ approval does not i~.-~piy the Uranting of any aiditiona! authot'i~ations nor ebl. i~ate any stat~:, fe~-"arai, or local rc~gulatory boc]y Lo gra~t roiuired autho~:izat;'.ons. Than!< you for your- cooperation v;ith this Del2art:ne.'.~t. if you have any questions, }0!ease :]o net hesitat2 to contact me. Since['sly, ~. ia rnows..', i Environmental Engineer onclost~ros MUNICIPALITY OF ANCHORAGE .R Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-042-92 Expiration Date: 1. GENERAL INFORMATION Complete legal description GOLDEN VIEW HEIGHTS LT 8A Location (site address) 15901 WINDSONG DR ANCH, AK Current property owner(s) MICHAEL & KIMBERLY HOWELL Day phone Mailing address Real estate agent SAME 2. TYPE OF DWELLING: F-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATE l a L: Private Well El Private Septic s 6 1> Water Storage ❑ Holding Tank - d> -Sy �o Community Well ❑ Community .= ❑ Public Water System ❑ Public Sewer �, ❑ pro "� CPAr 9 S d W Waiver request for: Dista i Z Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ O 600 Date of Payment Receipt Number 2, q q .�.97 COSA # C_ 2-0 (� 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Date 3-1-20 xe— i € x �Gaa ed9l� G&Ca¢ wN ba0a C�; g . Cs Qdfj? it � . -0 with the following stipulations: Original Certificate Date: — L4— Z d Z0 The Municipality of Anchorage Development Service3-Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet R�* Legal Description: GOLDEN VIEW HEIGHTS LT 8A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA D Well log is filed with Onsite (or attached) Date drilled Total depth 167 ft Cased to 67 ft A 0 Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12"+ in. Date of flow test for COSA 2/5/20 Static water level at beginning of test 35 ft. Comments * yV1 n R� (` 0 -25 B. TANK DATA Age of tank(s) NEW years Z-* ZC' 20 Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA HOUSE VACANT Which system tested (date installed) If -2--1—J 0 0 ALL standpipes present per record drawing Total measured depth from grade 13.4 ft (max) Measured depth to pipe invert from grade 5.3 ft (min) ❑ N/A — pressurized field ❑- Monitor tubes go to bottom of effective. If not, state depth into effective Q Code -required soil cover over field X System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000+ gallons Comments/Deficiencies: NEW PLASTIC TANK INSTALLED COSA Checklist yellow sheet Parcel ID: 020-042-92 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ N n Coliform bacteria is Negative Nitrate 13.7 mg/L Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 2/5/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/5/20 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 8 in Water added 500+ gal New depth 46 in Elapsed time 1440 min Final fluid depth 7 in Absorption rate 500+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' L�J Yes Community Sewer Manhole/Cleanout > 100' ® Yes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft Q Yes if No ft if No ft , F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' El Yes if No ft Property Line > 5' L�J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 't p Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' 't p Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓Q Yes if No ft Private Wells > 100' U Yes if No Water Service Line > 10' [Z] Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft , F. ENGINEER'S COMMENTS D � rd � 5 ( [� � �t v► � � �s u h C� e>r' G� �� v �Ly®cc.� ft ft G. ENGINEER'S CERTIFICATION I certify that ! have determined through field inspections and review 't p of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date.fl %_ av ..C9C 6.Q nQ BDB •QQRW�fl ,.d >_ AAiCF-Pe4Ei. t;�. Ai D�Ge �✓+ CP— i r COSA Checklist yellow sheet ., 5,, r:,Iv 10 t , ft ft EcIdund, Timothy J From: Mike Anderson <mnanderson58@gmail.com> Sent: Wednesday, March 4, 2020 12:53 PM To: Ecklund, Timothy J Subject: FW: Well report see below for the well inspection... M From: johnny [mailto:heftydrilling@aol.com] Sent: Wednesday, March 4, 2020 12:45 PM To: mnanderson58@gmail.com Subject: Well report Mike After a video check of the well at 15901 Windsong Dr. we found no breaks or leaks in the pitless adaptor or well casing down to 63' the static water level was 42'. Thanks Johnny Kay Sent from Mail for Windows 10 M„90,20.00N OD �� N - - --��I�fa NOS ONIM - `� ��' �cD t,.l imp o N c N mom rC p 0 Q� N QS ),, nun 0E _______._______— f P, Cn II CD "ep�•N __._.....__.__....____..__.__ I � c N C p� 0 0 O � � 3 i ! n 1 . A i s O m 3 F UQ 1 1 -� m o C N r I I r?l tJv = CO Ul n O I I D v K I jCD b I C Fey O �{�� IZ I 00 cu 0i II i 5 I co a:�+aft I Co I o Rc j 0-) 113 W w 00 ! f cam, 3►ra��oM N A21ois 33ar11 0' .. r i N CD .0 .. '*� i N i m 8'9i ,a RIO mp 1 Cp ..__._ �; i p 00 CO ti CD 0 V i % 3 '. O — I 1 •� i CY) 00 mmow0 -1 ' a I Z y !- .:' . .J� 0 mCDco CD f i pp.���� U)Lo5 °CD CD CD M per ( I I pxKKM m 0 o a t� • p a. e+ 1 I oCD 0e•`Q 0 ED i � P CD w 4 I I a cc 'b m Q `t W" row1010 °yCDo1 �Lo pG O I/ Imo; o m N 1 ��� i l6'-�91 M„LZ,OO.00N �CO�'T•'O �”' ��T m'• � K �O o p.p 2 S . ;A. /� f m to CD i p p, ��: • 7F f ; i I i t -Titrate Advisory Certificate of On -Site Systems Approval # OSC201073 Subdivision: Golden View Heights, Lot: 8A A water sample revealed a nitrate concentration of 13.7 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. �� '"� Mailing Address �P`�O Box 196650��`�gnchorage, 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. Mad�ng Address P O Box 196650 * Anchorage, Alaska 99519` 6650 *www muni org Parcel I.D. # MUNICIPALITY OF ANCHORAGE ,,~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) /~-¢,,~ / /-~/,~/2/~¢/p~ D~'¢~ Property owner Mailing address _ Lending agency Mailing address Day phone Da~/phone Agent Address Day phone Un/ess otherwise requested, HAA will be held for pickup. HUmBeR OF BEDROOMS: TYPE OF ~!ATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to fhe legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1191) 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. Name of Firm. KNDEngineering 20441 Ptarmigan BWd, Add ress Eagle River, ^1~ 99577.87~ Engineer's signature Phone Date DHHS SIGNATURE Appro,,ed for T-'H .CE bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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 MOA Municipality of Anchorage U DEPARTMENT OF HEALTh{ & HUMAN SERVICEASI Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 o~¢~r3~-L~C4/~S DIW$1~ Legal Description: /--~/~ A. WELL DATA Well type 4/~/~-/~.~ Log present (Y/N) y Total depth /~.¢ / Sanitary seal (Y/N) ~/ Date of test Static water level Well production Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~, 7 / - ? / Casing height (above ground) ~,~ / Wires properly protected (Y/N) ~ FROM WELL LOG g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform / Nitrate Date of sample: El. SEPTIC/HOLDING TANK DATA Date installed ///,~) Tank size /~0 Collected by: Other bacteria --. . Number of Compartments ~ Cleanouts (Y/N) ¢ Foundation cleanout (Y/N) Date of Pumping C, ABSORPTION FIELD DATA Length ~4" Width Depression (Y/N) /V/ Pumper /g,/¢~ ~'~/,¢-~¢ 4/ Soil rating (~l~d~--o,~dr~ Z,5'/ Gravel thickness below pipe High water alarm (Y/N) /'V/,4 Effective absorption area 5¢¢~ Monitoring Tube present (Y/N) / Date of adequacy test, ~/,~ ~/~'¢¢ Results (.ass,~Fefl) Fluid depth in absorptien field before test (in.); [~, ~5 "Immediately after~'d2) gal. water added (in.): Fluid depth /~G,~'" (ins) Minutes later: /G//z9 Absorption rate = G'"~'C) G 0.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date System type ~ ~¢' / Total depth //. . Depression over field (Y/N) /t/ For _ .~ bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested //' Size in gallons / ,/~"Pump on" level at* ',~'Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots ?¢4::3 Public sewer manhole/cleanout Lift station /t,//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /~) /¢' Propertyline /'~ t'k Absorption field //-.) ~'P Water main/service line 2,.5 z-f- Surface water/drainage /BO/-/' Wells on adjacent lots /¢~ /¢~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /(~ /"P Building foundation ?~ ~ Water main/service line ~_~,~ ! ._,o Surface water //~ ~ /'~ Driveway, parking/vehicle storage area Curtain drain ,/~ 0 /~' Wells on adjacent lots /~/-) ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and rewew of Municipal reco~gC~_"~e.~O~i ~stems are in conformance with MOA HAA guidelines in effect on this date. _~"~,..,-..O.o-- "~"- -'4.~ ', ' ,/ % .- %/ '.2 Sgnature ~~~ ~ ~'~' 9~ ~ ~ ~ .... Engneer's Name ~¢~ ~ ~*~ 4 ~~ ~ - ~ ~~,~"~ '~ Date ~/¢/~ ~., CE 71~6 ¢ ~ HAA Fee $. ,~(~(:~ - ® 0 Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number