HomeMy WebLinkAboutPROSPECT HEIGHTS #4 BLK 2 LT 5Prospect Heights Block Lot 5 #015-132-39 Municipality of Anchorage Page I of Department of Health and Human Services Division of Environmental Sen/ices On-Site Services Section 825 'L' Street Room 502 Re. Box 196650 Anchorage, AK 99519-6650 ww~?ci,anchorage.ak,us (907) 3~-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~[J'~:~y~5(:~) PIONumber (:~/.~*_/,,,,,~ .. Name: ~..~.~_~ 5- ~-..~)I~"~M/'~ WastewaterSystem: f-tHew ~Upgrade ~ ^d~.~: ~O~O I. hL~- 14/~F.4J ~ ~51 ~, ~E,~,5~u6 ABSORPTION FIELD Number of Bedrooms: I-I Deep Trench 1-1 Shallow Trench ~nd [] Mound [] Other 5oi Ralmg: iotal [3eptt~ ~ original grace; LEGAL DESCRIPTION GPo~e FI, Ft. ?ownship: Range: Section: -"ia added above original g~ade: Gravel Length: Ft. Ft. Well: 1,4/~, [] New [] Upgrade **~lw~h: Ft.Number of Llnes: DJstanc~be~vee~l#nes:Fi. Classification1 (Pn ate, A, B, C): Total Depth: Cased lo: Total absorption area: ptpe Material: Fl. Fl. Ft. ~ · r~ rt. ~ TANK SEPARATION DISTANCES ~se~c •No~ng •S.T.E.P. Delhi: Septic Abso~h3n Lift Holding Publlc/Pdvate Ta.k Field Staflo~l Tank Sewer Ll~e A~.- O ~,, r~,o,S~= w~,.'~'~+ IOO'o ~ LIFT STATION ~, I 'PUmp O~' level at:'Pump off' level at: I High water e~arm el: ~I..6.~_..~D 't",~kJ~ Ot,~. OL.O BENCH MARK ~U~l~¢ ONSlq'E_, SEE~ Ft. Inspections performed by: ,~.~,OL.I-~..E,~ Dates: 1st Dates: 1st Department of Health. and Humar~.Servlces approval [,~..CURTIS E. HOLLER Rev,ewed and approved 72-013 (Rev. Ol/O0)' Existing 1,2,50 ga,on septic tank pumped, crushed, buried...,..._._~ 2" Insulfoam over new tank & lines 2.5' section new CI[ with Rornac coupler Relative Elevations BM: Bottom of siding @ NW side = 100.00' Top of inlet pipe = 92.46' Top of tank#1 = 92.56' Top of tank #2 = 92.59' Top of outlet pipe = 92.21' SwinR '13e Distances A- ST1 = 18'8" B - ST1 = 39'1" A- ST2 = 25'6" B - ST2 = 46'6" Lot 5 Block 2 Prospect Heights ~ Septic Tank Replacement Record Existing approved bed in retained CO Ties in @ header tee New PVC 3034 w/2 cleanouts Job#O0050 J 9-12-00 I noscale New 1,250 gallon steel Anch. Tank F.~sfing 4 BR Horn / drive Notes 1. This septic system does not lie within the protective radius of any known well. 2. No surveyor's asbuilt was provided. The new tank was placed in the same area, which is near the center of this +2 acre lot. Existing private t CE 96O7 September 12, 2000 Dan Roth MOA DHHS-Onsite 825 L Street, # 502 Anchorage, Alaska 99519 Re' Record of Septic Tank Replacement Lot 5 Block 2 Prospect Heights ~4 Dear Mr. Roth: On behaifofCraig Kauffman, we are submitting record information for the recent septic tank replacement at the referenced site. Abandonment of the old tank consisted of pumping, crashing and burial on the lot. A new Anchorage Tank brand, 1,250-gallon steel septic tank was installed in approximately the same location as the old tank. A short section of new 4" CIP was installed at the inlet side, fitted fully into the tank nipple and secured with a strong "Romac" coupler at the joint. All CIP after the tank was replaced with 4" 3034 PVC, and two cleanouts were added within the first 10'. The new outlet line runs to an existing PVC tee fitting in the bed manifold. Septic rock visible was dry and light colored, and there were no indications of a liquid level within the bed. All excavated portions of the system received 2" of Insulfoam and more than 2' of soil cover. Please see the attached record drawing. Thank you for your timely assistance issuing the permit for repairs. Please feel free to call with your questions or if you need additional information Curtis E. Holler, P.E. c: Craig S. Kauffman w/enclosure 09/12/00 Kauffman p.l/1 MUNICIPAUTY 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 Upgrade Date Issued: Sep 01, 2000 Expiration Date: Sep 01, 2001 Permit Number: SW000350 Legal Description: PROSPECT HEIGHTS #4 BLK 2 LT Design Engineer:. 0828 Holler Engineering Owner Name: Craig S. Kauffman Owner Address: 10000 Hill Haven Cir. Anchorage, AK 99516- Parcel ID: 015-132-39 Total Bedrooms: 4 Site Address: 010000 HILLHAVEN CIR Lot Size: 101759 SQ. FT. Permit Bedrooms: 4 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. Ail 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. Date: Date: August 30, 2000 Dan Roth MOA DHHS-Onsite 825 L Street, # 502 Anchorage, Alaska 99519 RECEIVED SEP 07 2000 blunicipality of Anchorage Dept. Health & Human Services Re: Urgent Review Request - Proposed Septic Tank Replacement Lot 5 Block 2 Prospect Heights g4 Dear Mr. Roth: At the request of Craig Kauffman, we investigated the condition of the septic system at the referenced property. During a routine servicing, the septage pumper noted elevated liquid levels in the septic tank. Our investigation included exposing the tank outlet and portions ofthe sewer line running to the drainfield. The existing cast iron line is apparently plugged between the fu'st and second eleanout fittings. During excavation, we noted stained soils near the outer and a steady stream of effluent coming from holes in the tank near the outlet. At that point, a tank replacement was indicated and the excavation was fdled back to level. No liquid level was present in either monitor pipe within the drainfield, and the second cleanout was also dry. This replacement will include an MOA-approved, HDPE 1,300 gallon septic tank Manufactured by Premier Plastics. All cast iron pipe from the tank to the drain field will be replaced with 4" ABS. Sloped surface grade over the tank and line will require stepping the outlet line down steeply out of the tank, to a depth which will support a I to 4% grade aiong the remainder of the run. Mr. Kauffman will stop by your office to fill out a permit application and pay the $320 fee. An original copy ofthis letter will also be mailed. Due to the leaking at the existing tank, we hope to proceed as soon as poss~le. Please feel free to call with your questions or if you need additional information. Thank you for your assistance. Curtis E. Holler, P.E. c: Craig S. Kauffman w/enclosure 08/30/00 Kauffman p.l/1 Existing approved / Pump & remove existing septic tank and cast iron sewer line to field. Replace with MOA approved HBPE 1,300 gallon septic tank, Verify 4' cover over tank or 2' cover with 2' insulation minimum. New tank shall be placed in same location as existing tank. Provide 4" ABS pipe from tank to field, with (2) cleanouts within 10' of tank outlet. CO Lot 5 Block 2 Prospect Heights ~4 Septic Tank Replacement Plan Existing 1,250 gallon septic tank is leaking 10(7 CO Existing 4 BR Home Notes 1. This septic system does not lie within the protective radius of any known well. 2. See surveyors asbuilt drawing. Job # 00050 I 8-30-00 I no scale pm~ec~ ~. ~ Peg,. ett~:h~ I I LEGEND O LOT CORNERS FOUNDATION ORAINAGE ARROWS NOTES ~ I. IT SHALL BE THE RESPONSIBILITY OF THE RUILOER OR OWNER TO VZRIFY THAT SU~L~IHG LOCATION SHOWN MEETS ALL SUBDIVISION DOVEHAHTS &ND ZONING ORDINANCES, Z, IT IG THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONG WITH RESPECT .TO ALL UTILITIES. 3. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING A D D R E"%S LEGAL DESCRIPT ON LOCATT~I O~ [ DISTANCE TO: ~ Z I Manufacturer JLiq' capamtY '" gallons I ,F H ...... ~,.~ I g~ST*~C~TO: Iw~ ~-- ~ J Manufacturer ~ ~ ~ No. of lines Leng¢ of each line ~ Top of tile to finish grade  Length Width  I Type of crib Crib diameter ~ DISTANCE TO: Well  Class Depth ~ J DISTANCETO Bu dngfoundation PHONE ~-[ ~ ~{¢' ~'O ~ [] UPGRADE NO. OF BEDROOMS Dwelling Mater~.~_~ IWidth Absorption area PERMIT NO. G~ 3~- No. of compartments Liquid depth Inside length OTHER PIPE MATERIALS (_( SOIL TEST RATING 8>5'-~,1b.,- INSTALLER Dwelling PERMIT NO. Liquid capacity in gallons Material Foundation ~" "~ Nearest lot line V/ Total length of lines Trench wicLth~ Mat aria beneath tile inches PERMIT NO. r.~ %--O i/OZ' Depth REMARKS g~;~s ,h e~,~,~e ~ ~.d o,~s,"ue .... lis' ¢Distance between lines Total effective abso.rptio~ area .~-'~l'"l o' PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorpt on area(s) ? AP ROVE..~"/ i/)// I I DATE LEGAL Well bwner. rV~-W DRILLING, Inc. P.O. Box 10-37~ · 10300 Old Seward HighwAy · , (907) 349-8535 ANCHOP~GE, ALASKA 99511 DRILLING LOG C. ra~ ~n!lFft..n ,. , '" Use of Wel~ Location (ad~ess of: ownship, ~ange, Section, if ~own; or distance main road Size of casing 6" Depth of Hole ~n~ feet Cased to aa feet,~: Static water level li "'ltl '; (below) land surface. F~ish of well (c'~:ck one) open end ); Screen ( ); Perforated ( ). Describe screen or perforation, None Well pumping test at 5 gallons Per {~ (minute) for I hours with 1001 ~t. of drawdown from s~tic level. Date of completion J~Y 27, 1985 ~ ~/~ ~ WELL LOG m/5- /4~303, 7 Depth in feet from ground surface -Give details of formations penetrated, size of material, color and hardness TO TO TO TO TO. .TO, TO TO .TO. TO TO. MUN/CIPALITY OF ANCHORAGE DEPT. O," HrALTI; & ENVIRONMENTAL PROTECTiO~ RECE IVED .... MAR 1986" ' "J'-' L.E!X:3¢q L.. ZO Ei% E;;F;; ;I; F:' :i i...EYT' 9; ;[ ZE; ',; N,'f.::~X BIE.'.,'3F;:OE)NE~ ,',, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage~ Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERPORMED POR: LEGAL DESCRIPTION: 2 3 4 5 Gm 7 SLOPE SOILS LOG [] PERCOLATION TEST P/Zo,~pEc7 SITE PLAN 10 11 12 13 14 15 16 17 18- 19- 20~ o p E IF YES, AT WHAT DEPTH? / Gross Net 'Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE. .(minutes/inch) COMMENTS TEST RUN BETWEEN FT AND -- FT R/~T/~ /'-~a/.~ ;Z.5~. TO ~ / /Z~' .ER.ORMEDS¥: ~ , CERTIFIED BY: 72~008 (6./79) set at 6 feet deep would ha've at least 2 feet of 85 soil beneath it, and would be at least 6 feet above any water table. I noted that at the shallow end they were also on the 85 soil. Therefore, I approved the system. If you have any questions, please feel free to call me. Sincerely, Approved B,y: / ~ero.y ~eld Jr.~ PhD, P.E. Presidtnt z/marcy B~ens ' Engineering Geologist a/\. MUNICIPA LI "~=~ F ANCHORAGE MEMORANDUM Date // ~,, .~.~ From: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION .,..(a)~Leg~cription (include Iot,~lock, subdivisig~.section, township, range) Location (address or directions) ~~ ephone' Home~ (b) Applicant . Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder/~; Buyer []; Other E] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the fol, L~wing address: TYPE OF RESIDENCE Single-Family/,~ Multi-Family [] Other Number of Bedrooms ~ ~ f WATER SUPPLY Individual Wel Community [] Public [] Note: If community well system, must have written co'nfirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,~ Public [] Community [] Holding Tank [] ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation ~ attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGI'NEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA ,~ND INFORMATION 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 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 t~ection. , ~ /"~ Name of Firm -/----~'~'~--~'-¢~- ~'~'-,/?,'?-.% ' ~ ~ ' ' ._~¢/~ - ~ I etepnone Address .~/~-~-~ ~ ~ Approved for ,h~/~-- bedrooms by :/ .~ ~(~Date Approved ,~'/ Disapproved Conditional Terms of Conditional Approval CAUTION ~' The Muncipality of Anchorage Department of Health'and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ~nuHIcJIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Legal Description: ,/ Well Classification / ?f%.'.4 Well Log Presen~N) ? Total Depth Y~ 2' Casedt. o Static Water Level Casing Height Above Ground Electrical Wiring in ConduO) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed -~//~J-.~' ~ /-~'~'-:;'"'"~ Yed ~/ ~'-:;~'/~.~ Depth of Grouting '¢~ .... Pump Set At Sanitary Seal on Casing(~) Around Wellhead (y~b Depression To Septic/Holding Tank on Lot /~_~ / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ./~ ~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole /~' / ' / To Nearest Sewer Service Line on Water Sample Test Results ~2/~//~'~ ~/ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) Tp iBuilding Foundation To Disposal Field TO Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Corn ments B. SEPTIC/HOLDING TANK DATA Date Installed~'% '~,¢' ¢k~- Size Stand pipe~'4) Air-tight C a pt~'f~) Depression over Tank (~ Pumping/Maintenance Contract on File (Y/N) - Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /'~'2 To Property Line ,-~'~ To Water Main/Servic~e' ~ _~/¢-~ ''~/ Course ~.../ /*.--z.-~~- -~--~¢/~.¢~-~ -- Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date No. of Compa~ments~ Foundation Clea~') Date kast PumpeO Tomporaw Hol~in~ Tank ~ermit (Y/~) To BuiMinO Foundation To Disposa~ Field ~d To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~'~'~--~ /~-~f~'~pe of System Design Date Installed ~ '- ~¢/' '- ~'~'~"~ / Length of Field ~ '/ Width of Field ~ Depth of Field Gravel Bed Thickness ~2 /~/¢ Square Feet of Absorption Area -~*~ -~ ~ Standpipes Present) Depression over Field (Y~_ Date of Last Adequacy Test Results of Last Adequacy Test ~/<~/~-~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ',--~/~' '/ Lot /l~.~j~- ~ To Water Main/Se~ice Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ ~.~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at To Property Line High Water Alarm Level at Tested for To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,~'~.;-¢~,-~- ~"~'~-~'----¢// -- Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Company~- -~-¢'~ ,~/~ ,-<'./'~-~'~---4VlOA No. /' Receipt No. ~'~'-~ ~'~'R '~ ] Date of Payment ~ ~ I O '~ ~ . ' .' Amount: $ ~o r~,) ** Check Permitted Bedroom Rating Against HAA Request ** certify that I~ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed//-E~ ~¢~'~""7' f Date _~ _ ~ Z~__¢~_.¢~ Page 2 of 2 72-026 (11/84) Loc~ rio.: Client'-- Nan.: Address: 8ESSE, EPPS & DOTTS 2220 EAST 88 AV~3E ANf~{OfCA~, AK 99507 (907) 349-645Z WATER ~-L TF~S~ Tes tar: Initial Readin~ on Meter: • '-� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-132-39 Expiration Date: ro — D z-© 2 2 1. GENERAL INFORMATION: Complete legal description Prospect Heights #4; Block 2, Lot 5 Location (site address) 10000 Hillhaven Circle *Anchorage AK Current Property owner(s) Craig Kauffman Day phone _C/O agent Mailing address Real Estate Agent 10000 Hillhaven Circle *Anchorage AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $. JJ D Waiver Fee $ Date of Payment %�6�7 Z Date of Payment Receipt Number (D 9 R 2 5 G Receipt Number COSA # 1 3 SS Waiver # CID 6. 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the datels of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for q bedrooms System #2 Approved for Disapproved Conditional approval for 0 bedrooms bedrooms, with the fo ,~`� l ,1 l 3 j y 0 essl0 #AECC884 J)V)11>Lt5 Original Certificate Date: 7''� r?d ?—Z The Municipality of Anchorage Development Services Divtsion (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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other S4 -c; COSA blue sheet_10-10-12.doe A ` Legal Description: Prospect Heights #4; Block 2, Lot 5 If more than 1 septic system on lot: COSA Checklist # of Parcel ID: 015-132-39 Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 4.1+ - gpm Date drilled 7127/85 Water storage tank volume' gallons Total depth 204 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 33 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 5• _'*mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ZArsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG, Ltd. Date of flow test for COSA 6/9/22 Date of Sample 6/9/22 Static water level at beginning of test 10.8 ft. Comments N B. TANK DATA *On 7/1/22 Age of tank(s) 22 years t_- --- Tank type/material Measured operating fluid level in septic tank `51 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/12/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments D. ABSORPTION FIELD DATA Which system tested (date installed) 1985 Adequacy test date 6/9/22 ❑ ALL standpipes present per record drawing Results ZPass For 4 bedrooms Total measured depth from grade 4.8 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 633 gal ❑ N/A — pressurized field New depth 0 in OR Monitor tubes go to bottom of effective. 1f not, state Elapsed time 0 min depth into effective " ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If y n/a Gallons introduced n/a gallons es, enter date Comments/Deficiencies: r o cros in bed_ •AssuMGd - _Z J' ._S L;aV 71 E>..1 �: _-R�.. �l� �� -t .��. 1 _ � i`7 - P�7",5• COSA Checklist yellow sheet �Al E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes if No *5+ Septic Tank/Lift Station on Lot > 100' Surface Water > 100' Q Yes if No ft Community Sewer Manhole/Cleanout > 100' Q Yes ❑v Yes if No ft Q Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100'✓Q Yes if, No ft Holding Tank > 100' [✓ Yes if No _ ft Neighboring Absorption Fields > 100' ft If septic tank is under driveway comment below Animal Containment > 50' Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft E✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: R11 Yes Absorption Field > 5' Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10'✓Q Yes if No ft Community Wells > 200' 0 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' ED Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' R11 Yes if No ft Private Wells > 100' [) Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' [j Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review Do�Q� ' Q of Municipal records that the above systems are in conformance with flf ; ' T QQ MOA COSA guidelines in effect on this date. 4 d _ COSA Checklist yellow sheet TX Je rey A. rness., QQ � CE 7 53 f ,��2?. �Ao ��Qea pr 0 f e s sio�o #AECC884 4��OODOOo www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221333 Subdivision: Prospect Heights #4 Block 2 lot 5 A water sample revealed a nitrate concentration of 5.77 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 *Anchorage, Alaska 99519 &650 *www muni org ' z 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 B&496'650 *Anchorage, Alaska 99519 6650 *www muri� org Septic Tank Advisory Certificate of On -Site Systems Approval #OSC221333 Subdivision: Prospect Heights #4 Block 2 lot 5 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 22 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. 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