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HomeMy WebLinkAboutGREAT LAND ESTATES #2 BLK 1 LT 9 . .TER ANCHORA,GE AREA £ UG ~ Departmen3t5;~ ~nu~i~n~-noean;al Quality Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSA. L SYSTEM LOCATION LEGAL SEPTIC TANK: DISTANCE - . ~ ~,,z( _ NUMBER OF ~ /' ~,~'~'~') C O M PA RTM E NTS INSIDE LENGTH. ~ INSIDE WIDTH , LIQUID DEPTH -~- LIQUID CAPACITY ./~, ~-2~2 GALLONS. SEEPAGE Pit: NUMBER OF PitS ./ . DIAMETER '-' OR WIDTH/~( LENGTH/~,'/ DEPTH -- LINING MATERIAL ~'~¢)~z: CRIB SIZE: DIAMETEI~'~DEPTH ~/~/ DISTANCE FROM: WELL //)~2 // TOTAL EFFECTIVE :'-~ , NEAREST LOT LINE /~'.3,~- . ABSORPTION AREA (WALL AREA) /-~/~-//~ SQ. FT. BUILDING FOUNDATION ~- ~ / - ADDITIONAL ABSORPTION TYPe ~ ~/~' ~ '// CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION '~' LOT LINE ~' ' SEWER LINE TANK CESSPOOL '---~- __, OTHER SOURCES APPROVED_ DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE /~2~/ // SYSTEM PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATe / <~L ~//~ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF I='NVIRO.MENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PER~!T~,,-~;~v :~,~v'~chorag~ lO BE INSTALLED BY % _~ ~'__ ' SOIL TEST REiULT5 /~// i NOTE~ THI~ PERMIT 19 NOT VALID WITHOUT BIL PF~MIT VAI lB ARE YFAR SEPTIC TANK SIZE / , ~'*~"-'~t~ TYPE~t(~-~-] r)~ ~-Dn~-~$EEPAGE AREA SIZE TYPE - MINIMUM DISTANCES. REQUIREMENTS 5 f~. FOUNDA'nON TO SEPTIC 'rANK SEPTIC TANK TO SEEPAGE PIT WALL [5 [[, SEPTIC TANK 5 f~, . SZ~PAOE P,T 20 ft. . DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK , · SEEPAGE PI I' DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK. ~.0 :ft, . SEEPAGE PIT lO f~; · DRAINF,ELD. 10 ft. SEPTIC TANK. -- 25 ft.. SEEPAGE .,T.100 ft. , DaA,N F,ELD 50 ft* CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSS~N~ ~AP OF '[~3~'~]~'~--- 4 INCH DIAMETER CABT IRON SIPHON PIPES ON SEPT, lC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVA~ / 'GRAVEL BACKFILL CONFORM TO ~IORODGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF BY,STEM '. f;O SD:I;~ tlil£- lO · ./ .............. J I;[~R[~T t0f Lift[ I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTB OF GREATER ANCHORAGE /~REA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DERCRIBED I~YSTEM IG IN ACCORDANCE WITH SAID CODE, ~'~ DRILLING, /nc. P. O. Box 4-1728 · 2811 Dawson A C 907-279-1741 ANCHORAGE, ALASKA 99~09 DRILLING LOG RECEIVED OCT 1 1 '1991 ~ ~Use of We]~, es Location (address of: Township, Range, Section, if ~own; or distance main roa~ L9, Blk 1, Great Land Estates ~ubdivision Peters Creek_~Ak. Size of casing~o" & 4' Depth of Hole 22~ feet Cased to__2~3 ~feet 6": 0-195' 4": 13-22~' Static water level 2~ ~ft. (~e) (below) land surface. Finish of well (check one) open end ( Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at_10___gallons.per (h~) -- of drawdown £rom static level. Date of completion_, j~,__Ap~7~' ~ Depth in feet from None (minute) for 5 -hours with~lO0_~ Nolte: 6~'casing hung up $ 195 feet; well completed with 4" liner to 225 feat. Liner cut off ~ 15 feet for pitless WELL LOG adapter installation in 6" casing. x ); ft. ground surface -_9__° To lo 10 TO__ 12 ~ 15~TO 222~ 222 TO~. ~TO~ ~TO~ .... TO~ TO~ Give details of formations penetrated, size of material, color and hardness Silty Gravel Sandy Medium Gravel Silty Gravel with occ~isional b~oulders Boulder Boulder Gravel -' -- Cemented GravM1Lsm~l1 Bo____ulder Cemented Gravel Till~ hard --6~ c-~-~nsing point 4oose Medium Gravel L~waterbearin~' Parcel I.D. 051-131-20 Certificate of On -Site Systems Approval Expiration Date: / 9 Zo 2 3 Legal description GREAT LAND ESTATES #2 BLK 1 LT 9 Site address 20211 Upper Greatland Dr Current property owner(s) Amanda Frolander X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 4/19/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory Other Well Flow Advisory Nitrate Advisory X Arsenic Advisory COSA Approval_June 2022 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. 05113120000 Complete legal description GREAT LANDESTATES #2BLK 1 LT 9 Location (site address) 20211 UPPER GREATLAND DR Current property owner(s) FROLANDER AMANDA 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 441-0731 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer .5...SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass . Age 19+ - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment V�V'-O-L5 Date of Payment COSA # IC)5G 23 ID q a Waiver # COSA Application—June 2022 COSA Checklist Legal Description: GREAT LANDESTATES #2131-K 1 LT 9 Parcel ID: 05113120000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 4/11/73 Total depth 223 ft Cased to 195 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 3/28/23 Static water level at beginning of test 33 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 8/9/22 ❑ Required maintenance completed, if AWWTS Comments: Steel, 19+ yrs D. ABSORPTION FIELD DATA Which system tested (date installed) 6/25/03 Q ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. 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) If yes, enter date Comments/Deficienci COSA Checklist June 2022 Well production at time of test 6 gpm Water storage tank volume0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No 0 Coliform bacteria is Negative Nitrate 7.01 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by NRimEng Date 3/28/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/28/23 Results Q Pass Fluid depth prior to test 18 Water added 600 gal New fluid depth 25 in Elapsed time 60 min Final fluid depth 21 in in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 Effective depth used 21 in Effective depth remaining 27 in in 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' Community Sewer Manhole/Cleanout > 100' ■0 Yes if No ft ❑■ Yes if No Neighboring Tank > 100' R■ Yes if No ft Private Sewer/Septic Line > 25' *Yes if No Absorption Field on Lot > 100' ❑■ Yes if No ft Holding Tank > 100' ❑■ Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ■❑ Yes if No ft ft ft ft ■0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' W Yes if No ft M 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 Surface Water > 100'■❑ Yes if No _ Tank to Property Line > 5'■❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ■❑ Yes if No ft Private Wells > 100' ❑■ Yes if No _ Water Main > 10' ❑■ Yes if No ft Community Wells > 200' Fm -]Yes if No_ Water Service Line > 10' ❑■ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS li ft ft G. CERTIFICATION & STATENJENT 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 NorthRim Engineering Engineer's Printcd Name Steve Eng COSA Checklist June 2022 Phone 694-7028 Date 3/3/23 +P�� of Al No Ar �I s *: 49 r o �... .. c Steve Eng 0 1 CE -6256 N4 3/3%2 Nitrate Advisory Certificate of On -Site Systems Approval # OSC231090 Subdivision: Great Land Estates #2, Block: 1, Lot: 9 A water sample revealed a nitrate concentration of 7.01 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Ma�hng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www rr�uni or MUNICIPALITY OF 6) Ed's . Development Services Department r On -Site Water & Wastewater Section \� Parcel I.D. 051-131-20 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: b 2- Complete legal description GREAT LAND ESTATES #2 BLK 1 LT 9 Location (site address) 20211 Upper Greatland Dr Current property owner(s) ELROD KENNETH & JENNIFER Day phone 717-5081 Mailing address Real estate agent Cindy Wilson Day phone 244-1930 Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J�J�/ / Waiver Fee $ Date of Payment Date of Payment Receipt Number Q(a Receipt Number COSA # 06U l 1110 1 Waiver # Distance: 568970 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex a fdil i 0 011y D ❑ Multiple Dwellings (Single Family and/or Duplex) �6 'v 3. NUMBER OF BEDROOMS: 4 << C � V OC 6 8 Lg 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J�J�/ / Waiver Fee $ Date of Payment Date of Payment Receipt Number Q(a Receipt Number COSA # 06U l 1110 1 Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name y: DSD SIGNATURE Steve Eng Date 5/15/19 ..A^ 4— System #1 Approved for bedrooms N1 Seven yr cry 1 a• System #2 Approved for bedrooms '? n��: hE oz5 Disapproved`9F`��is':`��I'���•u-� �• UPpOF�SS1'v ' ;:;, - Conditional approval for bedrooms, with the following stipulations'`'�a` Original Certificate Date: J� 2-1 —17 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory, Other Legal Description: GREAT LAND ESTATES #2 BLK 1 LT 9 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/1173 Total depth 223 ft Cased to 195 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 5/14/19 Static water level at beginning of test 34 ft. Comments B. TANK DATA Age of tanks) 6125103 years Tank type/material Steel Measured operating fluid level in septic.tank 46 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 7-1 q D. ABSORPTION FIELD DATA Which system tested (date installed) 6/25/03 ❑ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-131-20 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 ❑ No ❑ Coliform bacteria is Negative Nitrate 6.9 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRim Eng Date of Sample 5/6/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/14/19 Results r7l Pass For 4 bedrooms Fluid depth prior to test 30 in Water added 600 gal New depth 36 in Elapsed time 60 min ❑ Code -required soil cover over field Final fluid depth 30 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' Building Foundation > 10'✓Q Yes Community Sewer Manhole/Cleanout > 100' []Yes if No ft Yes if No ft Neighboring Tank > 100' ❑✓ 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' ❑✓ Yes if No ft ❑✓ Yes if No ft Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓❑ Building Foundation > 10'✓Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ✓U Yes if No ft Private Wells > 100'✓❑ Yes if No. Water Main > 10'✓❑ Water Main > 10' Yes if No ft Community Wells > 200'✓l Yes if No _ 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'✓Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓V Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with r. MOA COSA guidelines in effect on this date. NIkiE R ; .,.A>� 6 e w p r r COSA Checklist yellow sheet r� 'R J FE ft ft ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section r� www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC191169 Subdivision: Great Land Estates #2, Block: 1, Lot: 9 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.9 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. 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. IV�ailmg Ads�ress P C1 Box 196650 *Anchorage, Alaska 99519 6650 *wwSIN w 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. Parcel I.D. # (-'~\ - \~ ~ -,-~-~,(~') 1, GENERAL INFORMATION Complete legal description M[,.INICIP~LITY 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 HAA # ~,\ Lot 9; Block 1; Greatland ~states" Location (site address or directions) 20211 Greazland Drive Eagle River, AlasKa 99577 Property owner' Mailing address Dale and Gloria Kachllne Day phone 688-2044 Lending agency NORTHLAND MORTGAGE Mailing address Eagle River, Alaska Agent Don McKenzie/DON MCKENZIE REAL ESTATE Address P.o. Box 772922¢ Eaqle Riverf Alaska Day phone Day phone 694-9035 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: IndividUal well ××× Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 ~ ;i: ; STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that 'm'y 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 6n the date of this inspection. Name of Firm Address S & S ENGINEERING 17034 Eagle River Loop Road Phone Ecgle River, Alaska 99577 Engineer's signature DHHS SIGNATURE ~/X~_ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date /~,,/~'~/.~.'/' 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 DHHS does this as a courtesy to purchasers of homes and their fending 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 61 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, WELL DATA Parcel I.D. Well type Log present ~/N) Total depth Sanitary seal ~N) If A, B, or C, attach ADEC letter. Date completed Cased to \c~.~ ~ ADEC water system number 'Ct ~ [I -'75 ,Driller Casing height Wires properly protected ,~!~N) Date of test Static water level Well flow Pump level FROM WELL LOG O¢--- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \.c)(..~ ~'- Absorption field on lot Public sewer main Sewer service line ~' g.p.m. N~UNICIPALITY OF ANCHORAGE AT INSPECTIO~I, NII~ONMENTA~ SERVICES DIVISION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (;:P ~'"'"'?~,~c~ Date of sample: Cl B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts~/N) High water alarm (Y,~ Date of pumping Nitrate Collected by: Other bacteria S &S ENGINEERING Eagle River, Alaska Tank size ~, oc:::~ c:~ Compartments '7- 'Foundation cleanout (Y~) /'-J Depression (Y,~ >-~ Ai~Jrm' 'tested (Y/N) "J//4, Pumper .-'~-- ~-.~c.S~O~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~, r~C:>~ To property line I'c:::' ~ Surface water/drainage On adjacent lots Absorption field Foundation_ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electric~~ SEPA~ANCE FROM LIFT STATION TO: Vy. efl'on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump on" level at ./Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed tO -"J~ Length 1~~ Widt'h ~ '~ Total absorption area '¢¢¢¢~' ~ Depression over field (Y/~ ~ Resutts ~ail) ¢'A-SS Peroxide treatment (past 12 months) (Y~ /~-J~ Soil rating [~c~d~ ~o~¢.,1~, System type Gravel thickness Total depth Cleanouts presen'(~N) Date of adequacy test °t for ~("'¢~ ~ 14 ,~ ,.,J~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots "~ Surface water Curtain drain On adjacent lots ~o~ ~*'' Property line To existing or abandoned system on lot Cutbank ~l~ Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S' CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecl S & S ENGINEERING Signature 17~_~,~ I~n~l¢, 17;~,~. I Ea~le River, Alaska Engineer's Name HAA Fee $ /'/~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE ALASKA99518 TELEPHONE (907] 562-2343 FAX:(907) 561-5301 ANALYSIS RE?05~ BY SM~LZ fez WOSKorder~ 38759 Date Repor~ Printed: SEP 30 91 ~ !6:63 CliEnt Sample ID:L9 Bi GREATLAND EST. Collected SEP 2T 91 ~ 13:30 hrs. Received SEP 27 91 0 16:35 b:es. Preserved with :AS REQUIRED Client Name :S S S ENGINEERING C].lant Aeet :SNSENGP BPO 9 PO ~ NONE RECEIVED Req ~ Chen~ab gaf $: 915125 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result g~its Me~hod Limits NI~RATE-N 3.3 ~,~/1 EPA 353.2 10 $amplo ROUTI}IE SAI, IPLE COLLECTED BY: gAY. Tests Performed See Speolal Instzuetion~ Above UA-Unavaiioble }:[one Deteetad *~ See Semple P~omazks Abow Not AnalyzEd LT~Lass Than, GT-Gzeatez Than ~,~'~-~L~~-~ Member of the SGS Group (Soci~t~ GCnOrale de Surveillance;,