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FOREST CREEK LT 3
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org 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. Forest Creek Lot 3 #015-292-51 Municipality of Anchorage Development Services DepartmentBuild_ \ Safety Division On-Ske Water and Was ewater Program. 4700 Braga, St. P.O. Box 196650 Anchorage, AK 99SIMSO Page of www.d.anchorage akus (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number SWO60070 PID Number. OIs-292-51 The Dittrich Company Wastewater System: 0 New ❑ Upgrade Ada P.O. Box 90411 Anchorage, AK 99509 ABSORPTION FIELD Peu. 632-8730 N' a1 Be w Five p o.ao Tmei O Snaor intim p aad C Yaun D Oeur LEGAL DESCRIPTION a°eR"° tz �r 10 10 Fl. aodc lot �� S'�Oi••'0m Forest Creek GaPm bPVa Eaean Aom eePw�Vtla Grwwi aagn Drnwn P"3.5 TEwelap Re go Fl. 6.5 Sateoe Fe added •EON MV'w flaaa GrM l/qE: 1-3 Fl 50 Fl. Well: New El Upgrade c.. a.n":34 rAnwa aaEw owa.Eaa�aoa. Cbwnorion IPm+A A & Cl 7aW G•Pe+ Private Coadft Ft. Tota aaawraion arw 1 FL Pva Mawr 80 Fl. 79.32 F, 650 Fla ASTM D3034 PVC G'a•r M-W Drilling, Ina Car Drwd 7!/106 sEwc war lnv 40.5 Fa ewraar Glacier Masonry Gar Ymaaad 616-61122006 Yid Pn Saiat Cawap rryaA Cwa 20 GPu Fl. >2 FL TANK SEPARATION DISTANCES O Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Uft Holding uErr/PrNotsro •du`r n 'soot, Fm Tank Field Station Tank sewer une Anchorage Tank 1Gr. W44>100' >100' WA WA >251 Mawr Steel moor 0Caapwmraa Two (2) sew.. >100' >100' N/A N/A LIFT STATION La u!" >51 >10' N/A N/A GM acW.. Foxd m'Pnpvn >5 >1a WA WA MwI aL 'ganp aR r•el ✓, Iq,walar alrm al in w h cora• Gran None Noted Pw v Yana a aau Frau Mwxmw Prluewd M Rwrraa BENCH MARK LOuOon.,d o..o,Pr� Garage Slab wwwn 100.00 Ft ,. a•.w w� performed by: A. Harala Dates: 1' 6/7/06 ...A ..?�.py; �eInspections 2"d 6/9/06 6/9/06 F•.. .....n :.yam •,•.+Q p C7: Development Services Department Approval rI TF Conditional Approval Date: a!r .• .....••.•••••.. f t` CE-4381 �`Qiz,sa�``4 Reviewed and approved by: z kl -/3-07 '•• 0y�� Na• ower ate. i:ti:s. OUR ROAD CA 0 ------------ 10' P -11 O m U) I� O N D z � D � y o o N I O I b o C z H r 0 N n o w � I ------------------------ N 10' P -11 O m U) A O� y o Cl) Cf) m o dvv N -� m 0] d 0 cn*uK vm m� h O Z n Z Dv' H ym mm2 c�� No<.. mm 0 �� O i>00C N 10CD 0) C N 6 CD m CD C N -I O M N O V w I O N Oa + r I Q N y 1.j W I ,0 y o o N I O alQ wm I z I 1 0 I o I � I ------------------------ N 10'T.Q E ESYT. N CA J N 00'05'.32 W 150.00 A O� y o Cl) Cf) m o dvv N -� m 0] d 0 cn*uK vm m� h O Z n Z Dv' H ym mm2 c�� No<.. mm 0 �� O i>00C N 10CD 0) C N 6 CD m CD C N -I O M N O V w Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 Onsite Wastewater Disposal System or Well Inspection Report Permit Number. SW060070 U 99.2 n U iE -4—__-4— On9inalGround Z; Galton Septic Tank 90'6 � I Grainfield Rods L �I 84.1 75.0 101.5 U UL )Nn 96.8 E G PROFILE AS -BUILT - No Scale Page 3 of 3 PID No. 015-292-51 a U 95.0 90.6 •E ANDERSON' C CE-43el M -W Drilling, Inc. • P.O. Box 110378 • Anchorage, AK 99511 • •907-345-4000 • 907-345-3287 Fax• Job No.: 06-142 Parcel No.: 015-292-51 Permit No. SW060070 Pcrmit Datcd: 26 April 2006 Groundwater Well As -Built & Jr oJ:, ♦ Well Owner The Dittrich Company ♦Legal Description: Forest Creek Subdivision. Lot Construction ♦ Role Depth: 80' ♦ Casing Size. 6" ♦ Cased To: *Drill Alethod: Air Rotary ♦ lull: ♦ Use of Well: Domestic 79.32 ♦Alaterial: A 53 Steel Prrj. • Well Completion- Open end X Screen Perforated Perf.Alethod: ♦Sereetr/Perjoration description: None — ♦ Grout Notes: (2) Sacks- No. 8 bentonite granules • Notes: ♦ Disiajecled Yes No Metirod: Chlorine Pills ♦ I$ ell Development. Alethod: Air surge Notes: ♦Static water level (S111) 40.5' (above) (below) top of casing (TOC). ♦ 1 {'ell yield test at 20+ gallons per minute (Gptt)/geNousperheur{GPR) jor I hour with 100% of drawdown (DD) from static level (SIU). ♦Alethod: Airlift ♦ Date ojstarted: 06 July 200G ♦ Date ojcompleNar: 07 July 2006 ♦ pump Install• Depth in feet from top of casing. Details of formations penetrated, size ormaterial, color and hardness. _0 __TO 2.5 Casing stickup 2.5 TO 11 _Silt: hard packed - 11 TO 17 Sand and gravel 'Silty 17 TO 27 clay: ravel) -- i 27 TO 36 Sand and gravel: loose 36 TO 73 Siltyclay -- ---_—._.._.__.._.------_--_-- 73 TO 80 Water gravel: coarse ----------- TO --- - TO -- TO TO TO - To WAYNE E. WESTBERC TO P!eeldent; M -W Drilling, -Inc . - Nowa Certltled Master Gruwdrra2er.Cot&&.W TO Contractors Lloense No.10oo TO FED -10-2007 02:21 AM Development Services Department Building Safety Dlvision . ' On -Site Water A Wastewater Program ��"`���_' 4700 Brogaw Street '�� P.O. Box 196650 Mark9991ch Anchorage, AK 99519.6650 Mayor www.muni.ora/or&T (907)343.7904 Pump Installation Log Well Drilling Permit Number: SWJMW�o Date of Issue- Qi-2%-2bco Parcel Identification Number:D1.5- 292.61 Legal Description Foyesf Crux, Lots Installation Date: p5 �janirAyU Pump Intake Depth Setow Top of Well Casing: q. feet Pump Manufacturcr's Name: Grwid fDS Pump Model: /690E 01- I eD Pump Size 314 hp, Pltless Adapter Burial Depth: 1.2 feet Pltless Adapter Manufacturer's Name: 17Gkzr� Pltless Adapter lastaller: M- W P ri! 1 195 , 1 nt_- Well Disinfected Upon Completion? eyes ❑ No Method of Disinfection: ( lDr1V1L 7ai,;,t s Comments: Pump Installer Name: M --W DRILLING INC. P.O. BOX 110374 ANCHOP_AGE, ALASKA 99:5111 y Owner Name & Address: DitFrl'th Com�pru� P.02 Attention: The pump installer stall provide a pump Installation log to the DSD within 30 days of pump installation. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 MEMORANDUM DATE: February 10, 2007 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 3, Forest Creek Subdivision COSA Attached is a copy of the Pump Installation Log completed by M -W Drilling. I have also included a copy of the inspector's log indicating when the inspections were called in. More than 6 inspections were completed on the project as indicated in the report. Test Hole No. 7 was placed to a depth in excess of 20' below the original ground surface. The depth of the trench below original ground was a total of 10'. The test hole was therefore 10' below the bottom of the trench. Nearly 4' of fill was placed atop the completed trench near C4. No bedrock or groundwater was found in the test hole. The inspection report has been modified to reflect the correct elevations for the test hole. Please let me know if you have further questions. Project: C -.c $ L'°�►-/ ` C hryt T. _ _ DAILY ACTIVITY REPORT at rime to Events i S utGG IF Jrn,L f n i 31 ,'LyG. /o t I n lt, — is if �c,,,1-r� It a s� 1. .. . (t yv t 1 s to : N � r . C De .�. •�Po y •{'� IG E ✓ TIS rf1�5 a s N Go 5 K i Alan marala Municipality of Anchorage Development Services Department • "-� Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Mike Anderson Legal description: Forest Creek Lot 3 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. _ ® Discrepancy in information submitted. Total depth of system. ❑ Topographic information missing or Inadequate. ® Incomplete; missing Pump Installer Loo ® Incomplete; missing No Inspections called in. ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measurediproposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer. Teff Date: 2-8-07 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW060070 Legal Description: FOREST CREEK LOT 3 Date Issued: Apr 26, 2006 Expiration Date: Apr 26, 2007 Parcel ID: 015-292-51 Design Engineer: 0014 ANDERSON ENGINEERING Site Address: NHN OUR ROAD Owner Name: THE DITTRICH COMPANY Lot Size: 44913 SO. FT. Owner Address: PO BOX 90411 Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99509 - 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 State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 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. Received By: Date: ql*O Issued BDate: < 7 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-292-51 Property owner(s) The Dittrich Company Day phone 632-9730 Mailing address P.O. Box 90411 Anchorage, AK 99509 Zip Code Site address Our Road Zip Code Legal description (Sub'd., Block & Lot) Lot 3, Forest Creek Subdivision Legal description (Township, Range & Section) Lot Size 44.913 SF Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field 0 Septic Tank (] Holding Tank ❑ Privy ❑ Private Well 0 Water Storage ❑ Number of Bedrooms Four (4) THIS APPLICATION IS AN: Initial ❑ Upgrade ❑ Renewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: $460.00 septic & $175.00 Well Date of Payment: 4/10/2006 Waiver Fees: Date of Payment: Receipt Number. q&55-3 Receipt Number. (Rev. 11105) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX April 7, 2006 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3, Forest Creek Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of the subject property intends to construct a new four-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the home. No conflicts exist with adjacent septic systems or wells and the proposed septic system and well on this lot. The attached Site Plan and backup documentation identify the location and configuration of the proposed well, septic system and alternate site. The current drainage pattern is identified on the Site Plan. The drainage pattern will be maintained after development of this lot is complete. Test holes were placed on the lot during the subdivision phase of the project. These holes indicated poorly graded sand with some gravel and silt lenses (SP) in the area of the absorption trench and alternate site. The accepting soils were tested and found to have a percolation rate of between 1 and 5 minutes per inch. Groundwater was not encountered during the original test hole placement, and none was noted on May 15, 2004. Our design includes the placement of a new 1,250 -gallon septic tank along with a 50' long by 5' wide by 4' effective depth absorption trench to collect and treat the sewage generated in the house. The bottom of the trench will be 8' below the surface. The distribution pipe will be 4' below the surface. A minimum of 3' of cover will be placed atop the trench and a minimum of 4' of cover will be placed atop the new septic tank. The ground surface on the lot slopes at varying grades toward the northwest. The ground slope in the area of the absorption trench is 10%. The absorption trench will be constructed parallel with the slope of the ground surface as much as possible in conformance with Municipal requirements. The new septic system will be constructed a Lot 3, Forest Creek Subdivision April 7, 2006 Page Two minimum of 100' from the well on this and on the adjacent lots. It will also be constructed a minimum of 100' from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, ma'a-1 E-� Michael E. Anderson, P.E. Attachments o!—. -?r\* 4.CHAII E. ANDERSON ,,. No._CE_4.181 % ,00'O9l /I.Lf,90.00 N m rR InS3 3 V '1 ,01 n r ------------------------------ I I I 1 I I I I I 1 I I I I I I O I U) I. I 1 A', vb Ile c +. 'Q co En P BWOm a N W J Y c , +i o U 1 M LiW I Ew I Ivo (n I O u= LLI OM O0 I 1 I � I I 1 __ -------------------------- ,•.., 'lA ,0t m ���• A (ig0. . �IIyy t ovoa ano s sra. u c AREA MAP scue 1-.100' tV0LANM s eTes'32'E %BY.73' ..te�aa 0 t L OE E sw .72' ti— VACWr r LOT 2 $ — 40.012 $1. i S e75e'32 E 2".71' W4cwr A LOT 1 40.011 SF. i s sra. u c AREA MAP scue 1-.100' LOT 3, FOREST CREEK SUBDIVISION DESIGN FACTORS: Four Bedroom House Perc. Rate: 1 to 5 Min./Inch Application Rate: .1.2 GPD/SF SYSTEM REQUIREMENTS: 5' Wide Trench System 1,250 Gallon Septic Tank 4' Drainfield Rock 3 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area 500SF/5 SF/LF'..5 (Red. Factor) = 50 LF Trench Length THEREFORE: Construct an Absorption Trench 50' Long x V Wide x 4' Effective Depth. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be 8' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Natural Backfill Fabric Fabric 6„ I I I " Perforated t PVC (Holes Down) 4'0" I I Z>—t— Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION .,�.-•..��� (NO SCALE) ... NOTE: Grade Area Over Trench to Drain Away. v Minimum 6' Separation From Bedrock. ,• �•»a9u,...... » ........ .4 Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. ��; «CINELENOER801 Minimum 100' Separation From Surface Water or Streams: �i� `. No Minimum 10' Separation From Water Services in the Ansa.��, •,:r -e •: '4�: 1 2 3 4 5 6 7 8 9 R I I MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Jamie Dittrich DATE PERFORMED: 2/9/2004 LEGAL DESCRIPTION: Proposed Lot 3 Dittrich Subdivision Wmjjj TEST HOLE # 7 �SLOOPPE� SITE PLAN 111111111 OG/OL I I 0 SP/SM Poorly Graded to Silty Sand Olive ° .a ° ° SM/SP Dry ,Q. X49th � I I WAS GROUNDWATER NO S ENCOUNTERED? NET DROP Start 2/21 4:05 L IF YES, WHAT DEPTH? 1 0 10 Dry P DEPTH OF WATER None AFTER MONITORING: E DATE: 2/24/2004 Dry 7.5" S is zooms 4:27 Q �= MIC,NELEANOFASO,! 16-00" � 4 No. CEa l 17 ° Sloughing @ 16' BOH @ 20' SEE SITE PLAN FOR TEST HOLE LOCATION Varies READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 2/21 4:05 7.5" 1 4:15 10 Dry 7.5" Recharge 4:16 7.5" 2 4:26 10 Dry 7.5" Recharge 4:27 7.5" 3 4:37 10 Dry 7.5" PERC RATE: 1_1 MIN./INCH PERC. HOLE DIAMETER:8" TEST RUN BETWEEN 5 FT. AND 6 T. COMMENTS: Test Hole Pre Soaked Prior to Test. TEST PERFORMED BY: ALAN HARALA I, MICHAEL F. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/24/2004 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Jamie Dittrich DATE PERFORMED: 2/9/2004 LEGAL DESCRIPTION: Proposed Lot 3 Dittrich Subdivision TEST HOLE # 8 SLOPE SITE PLAN OG/OL 1 2 3 4 5 6 7 8 9 K 11 N I: I1 17 0 SP/SM Poorly Graded to m Silty Sand N Olive a .v A 49th YICHAEL E ANDER . No. CES l BOH @ 20' SEE SITE PLAN FOR TEST HOLE LOCATION Varies READING DATE WAS GROUNDWATER NO S NET DROP ENCOUNTERED? 4:10 A 1 L • IF YES, WHAT DEPTH? 7.5' 0 4:21 Sloughing @11' P 2 DEPTH OF WATER None 7.5' AFTER MONITORING: 4:32 E DATE:2/24/2004 3 4:42 10 Dry Sf5 zoey 49th YICHAEL E ANDER . No. CES l BOH @ 20' SEE SITE PLAN FOR TEST HOLE LOCATION Varies READING DATE GROSS TIME NET TIME NET DROP Start 2121 4:10 1 4:20 10 h5" 7.5' Recharge 4:21 2 4:31 10 7.5' Recharge 4:32 3 4:42 10 Dry 7.5' I PERC RATE: 1-2 MIN./INCH PERC. HOLE DIAMETER: B— TEST RUN BETWEEN 5 FT. AND 6 T. COMMENTS: Test Hole Pre Soaked Prior to Test TEST PERFORMED BY: ALAN HARALA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2 /2 412 0 0 4 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 3, FOREST CREEK SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,250 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 4' below the existing ground surface. Total depth of the trench will be 8' below the existing ground surface. A separation distance of 100' from the well on this lot and on adjacent lots and 100' between the septic tank and absorption trench and any surface water must also be maintained. In addition, a separation distance of 10' between components of the septic system and any water service line is required. A minimum of 3' of fill is required over the absorption trench and 4' over the septic tank. In lieu of the required fill 2" of insulation and 2' of fill may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 3, Forest Creek Subdivision April 7, 2006 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Lot 3, Forest Creek Subdivision April 7, 2006 Page 3 of 3 MATERIAL SPECIFICATIONS: Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Municipality of Anchorage Development Services Department �i Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: ANDERSON ENGINEERING Legal description: FOREST CREEK LOT 3 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing _ ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. NEED TO GET CORP OF ENGINEERS APPROVAL FOR CLASS "B" WETLANDS PRIOR TO ISSUANCE OF ONSITE PERMIT. Name of reviewer: JOE GOODALL Date: 4/17/2006 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK fif�st{ISI I ? _�• �<I ; _ ; RR «i'� i '��tll'fil�'I� i;! 14 t . ;t 1111o �� I . t t i Ie s J miry i F Pill ' \I I ;I 11 !t t ! os� i I it tli P tt I°ti 6 I 'r I IIS 1 , L_,�s 9 j j° I � I!I - I• rtlr'1 I� ji3! Y J--- ----L------ L---- .-J ter-=- ---- - ——-------L..- --- •--- --- --—- II•i ! p.iRTiRi1'6;.itR5 ' I;� iii '. �' � � I rrornc••tiT.itTFit $ ^ �( l� , 1 ? ` .."• -------- ------ - ���...... i . ]TJffTfa I tt• f "`�-.a ��,f• �;�' i, •'� I rrr t o' � 1 It eeei !I I��f;t:I f1 I �-- = 1r f I�f111111i1 !iff'• ` �• ------- .---- ' [1 •• MIS 11• ti111!11 �. i� P �y o �1�1a1 — 11 i ,11 I ` � III .` • Z�\` 1 j I I all - �----I O el gig 1 •may 1\ 1 V.a .YM f � eQ Hill b I 19 r flit pt e 6 g am R���Ye �i%i{ !�e� 9- 1 �j = R a Y . F �•Y! « • Z � �� F it i i �•�@Q(t�� tt�����t Gds rYi _ i��9 ;> At ch eta: �po�ya `, _ o NGas 1I ,@11�9 z�'Q t tet Q <�A02 Irill _ ill 114 g`si t peT: e 9211 Ilat bit s I I all t q °° lal °a, I I fa. I r' I tt� OM E A., :• lA tit Q. �s Ajit `p699 . • • . L f R . 7•s1Pi a « M M • r 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 Parcel I.D. 015-292-51-000 Legal description FOREST CREEK LT 3 Site address 10075 OUR RD Anchorage AK 99507 Current property owner(s) MARLATT KYLE A & JILL Expiration Date: 8/12/2023 X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: a Original Certificate Date: 5/23/2023 %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 Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUMUPAUTY OF LAI HCC HOG3AGE `.,, tea 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. 015-292-51 Complete legal description FOREST CREEK LOT 3 Location (site address) 10075 OUR ROAD, ANCHORAGE, AK 99516 Current property owner(s) KYLE & JILL MARLATT Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ® 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 17 - 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 $ / D Waiver Fee $ Date of Payment I I ! �NZ Date of Payment i COSA # O S G 2 2,--) Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: FOREST CREEK LOT 3 Parcel ID: 015-292-51 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 7/7/2006 Total depth 80 ft Cased to 79.3 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/25/2023 Static water level at beginning of test 43 ft. Well production at time of test 5.7 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 11.2 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/25/23 Comments PER RECENT COSA, WELL SCOPING, WATER SAMPLING THE NITRATE LEVELS ARE SIMILAR. B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 4/25/2023 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/2006 ALL standpipes present per record drawing Total measured depth from grade 11.9 ft (max) Measured depth to pipe invert from grade 4.9 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 4/25/2023 Results Pass Fluid depth prior to test 41 in Water added 1080 gal New fluid depth 63 in Elapsed time 1370 min Final fluid depth 41 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 78 in (MOA 6.5’ ED) Effective depth used 41 in (Final Fluid Depth) Effective depth (ED) remaining 37 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately to be 6.77’ ED of MOA 6.5’ ED. 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 5/11/2023 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 & 5/11/2023 Received Date/Time 04/25/2023 16:00 04/25/2023 15:00Collected Date/Time 1231646001 Matrix SGS Ref.# Client Sample ID Spigot Client Name Project Name/# Printed Date/Time 05/11/2023 9:32First Water Consulting Services (FWCS) Technical Director Stephen C. Ede Forest Creek Lot 3 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS HGS05/09/23EP200.8ug/LArsenic 05/03/23ND5.00 (<10)B Waters Department EBH04/27/23SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 11.2 0.400 (<10)*C Microbiology Laboratory M.A04/25/23SM21 9223B100mLE. Coli Negative 1 A M.A04/25/23SM21 9223B100mLTotal Coliform Negative 1 A 2 of 5 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC231120 Subdivision: Forest Creek, Block: , Lot: 3 A water sample revealed a nitrate concentration of 11.2 milligrams per liter (mg/L). 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. Thank you for your business!Invoice 25041194 Invoice Date 4/25/2023 Completed Date 4/25/2023 Payment Term Due Upon Receipt Due Date 4/25/2023 Billing Address First Water 13021 Montego Circle Anchorage, AK 99516 USA Job Address 10075 Our Rd 10075 Our Road Anchorage, AK 99507 USA Task #Description Quantity Your Price Total SEPTIC Pumped out the septic tank 1.00 $225.00 $225.00 Sub-Total $225.00 Tax $0.00 Total $225.00 Payment $0.00 Balance Due $225.00 Please call us with any questions or concerns at 907-561-7669. If you enjoyed our service, please leave us a review on Google. • Municipality of Anchorage =hTGt On -Site Water and Wastewater Program " (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-292-51 1. GENERAL INFORMATION Complete legal description Forest Creek Lot 3 Location (site address) 10075 Our Rd. Expiration Date: 3 ��V Current Property owner(s) Aspengren Family Trust Day phone Mailing address Real Estate Agent 10075 Our Rd. Anchorage, AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received by: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5_50 lza Waiver Fee $ Date of Payment 3 A $L2oz- O Date of Payment Receipt Number 7,4'18'0- -7 Receipt Number COSA # dS GZ o I I C) 0 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 incl ��(llddjVt *1 characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being see Ct�e©�sfE�y perational life of all well and septic systems are subject to these various and dynamic characteristics and are e control o �j� evaluator of the well and septic system. Therefore, `�` Q�i� ArcTerra can not give any estimate of how long a ` �V S�TE system will function satisfactory for current or future O�' +��\ occupants or can ArcTerra guarantee that no unseen WATER A�� z ^ 01' A.j� encroachments, deficiencies or discrepancies exist. J S . 01VER O� /���� PROGE\PMTH 6. DSD SIGNATURE J�O'c/yj M��G��`,,� / JF T SfGR� )�\� _... KENn �5 J System #1 Approved for -1 bedro8M1JJ)))))`l ` 1 �� , Is �� System #2 Approved for bedrooms. �c��'YFo /7 E?°~•� ''Es;1o��' i Disapproved. Conditional approval for bedrooms, with the following stipulations: a' n'I�ro.�e reSulis (�.9ere 1b.2 L, Qbit 1,WsWm -I��/ re-SCLMP\,�V\,_a !A -he rest_�-k 0 -me- lb0.cic W Al.z moo, / L. A - S'4( -fie re C1D Mf" ek1\A S ' GO_MD `1 ria 4' e G,0e LAOAe" ay\ U. reined iia oo r �_ 6r\ -ire wt \ 64 _ re=,ut reA iA -�n e "of . By: (��� �0 ' of �`m cock IUA Original Certificate Date: `� % 3 40 o The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: COSA Checklist Forest Creek Lot 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/7/06 Total depth S0 ft Cased to 79.32 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 3/3/20 Static water level at beginning of test 48 ft. Comments B. TANK DATA Age of tank(s) 14 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 2/20/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 12/2006 ® ALL standpipes present per record drawing Total measured depth from grade 12.5 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-292-51 Structure served by this system 1 Qe,v Dim Well production at time of test 14.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 16.2 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 3/3/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/3/20 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 29 in Water added 600 gal New depth 50 in Elapsed time 70 min Final fluid depth 29 in Absorption rate 600+ 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft ® Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'k] Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 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' ® Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ® 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC201100 Subdivision: Forest Creek, Lot: 3 A water sample revealed a nitrate concentration of 16.2 milligrams per liter (mg/L). A re‐sample revealed a nitrate concentration of 11.2 milligrams per liter (mg/L). 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. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org 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 medi a 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. _SGS SGS Ref.# 1200872001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 03/16/2020 8:48 Project Name/# Forest Creek Lot 3 Collected Date/Time 03/03/2020 12:50 Client Sample ID Forest Creek Lot 3 Received Datelrime 03/04/2020 11:30 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/l. EP200.8 B (<10) 03/06/20 03/09/20 BMZ Waters Department Total Nitrate/Nitrite-N 16.2 * 0.800 mg/l, SM21 4500NO3-F C (<10) 03/06/20 EWW Microbiology Laboratory E. Coli Negative 1 lOOmL SM21 9223B A 03/04/20 A.A Total Coliform Negative 1 IOOmL SM21 9223B A 03/04/20 A.A. Page 2 of 5 Carroll, Rebecca M. From: Wockenfuss, Deborah M. Sent: Monday, April 13, 2020 1:11 PM To: Carroll, Rebecca M. Subject: FW: Aspengren Well - Nitrate Issue Follow Up Flag: Follow up Flag Status: Flagged Here is what Wayne sent regarding Forest Creek Lt 3. From: mw@mwdrillinginc.com <mw@mwdrillinginc.com> Sent: Monday, April 13, 2020 12:43 PM To: Wockenfuss, Deborah M. <deborah.wocl<enfuss@anchorageal<.gov> Cc: aspengren.al<@gmail.com Subject: Aspengren Well - Nitrate Issue Ms. Wockenfuss: Per our phone discussion this AM, following are our findings as a result of the video inspection of and water sample from the subject well. On 4/01/20, MW sampled the well water per the following procedure details: the owner had run the well for 3 hours prior to our arrival the sample was taken from the outside faucet/hose bib the hose bib was flared with a propane torch for 30 seconds the water was turned on and run for 2 minutes the water sample was then taken and delivered to SGS On4/08/20, MW returned to the well site and ran a downhole video of the well which revealed the following: . the Baler pitless adapter is installed at 12' from the top of casing and is in good shape .the well casing and welds thereon are all in good shape down to the total depth of 80' from 50' down the casing has heavy encrustation/scale there is some small scale float in the water a close office review of the video shows no leakage around the pitless adapter or from any of the casing welds there is about 3 feet of small water gravel fill up in the casing from the 80 foot depth but this has no affect on well yield adequacy Wayne E. Westberg, MGWC President M -W Drilling, Inc POB 110389 Anchorage, Alaska 99511 Main: 907-345-4000 /Cell: 440-2536 1 Carroll, Rebecca M. From: Wockenfuss, Deborah M. Sent: Monday, April 13, 2020 1:12 PM To: Carroll, Rebecca M. Subject: FW: Nitrate Follow Up Flag: Follow up Flag Status: Flagged This too From: mw@mwdrillinginc.com <mw@mwdrillinginc.com> Sent: Monday, April 13, 2020 12:48 PM To: Wockenfuss, Deborah M. <deborah.wockenfuss@anchorageak.gov> Cc: aspengren.ak@gmail.com Subject: Nitrate I forgot to state that the Ni level SGS determined was 11.9 mg/liter Wayne E. Westberg, MGWC President M -W Drilling, Inc POB 110389 Anchorage, Alaska 99511 Main: 907-345-4000/ Cell: 440-2536 1 A+ CUSTONAER s ERVICES, INC, 7501 E. 140Lh Avenue Anc-bora-z-.e, Alaska 99516 Block Lot DATE DESGRIPTION W11 ¢Mted ICY beh nd house, - Atcess*'nm R side Se as INVOICE # AMOUNT S 21.00 it - doh X99w, TOTAL �7 Gallons —,f�f Saptic Leach Area Holding Tank Standpipes PROBLEM AREA — CALL FOR MORE INFORMATION NEEDS TO BE DONE AGAIN IN 6 MONTHS, IShape I L �o �§iudge buildup on bottom Floater on top od Cut standpipe to V above grou nd Needs Septic Jim cap missing or trine, needs replacing Municipality of Anchorage •; Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onske (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0(,41292-51 COSA# blmla Expiration Date: _ -r- 13— 0 7 1. GENERAL INFORMATION Complete legal description Lot 3. Forest Creek sutdvldon Location (site address) 10075 Our Road Current Property owner(s) The Dmrtcn cornyany Day phone 632.8970 Mailing address P.O. cion 90+11 Arhorage, A<99509 Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA wX be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Five (5) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of OnSke Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 4. 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 Onsite 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 stricture 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-sfte 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. Date 2/1!2007 6. DSD SIGNATURE Approved for .; bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory Other ey Original Certificate Date:o2 r,« „=1 Municipality of Anchorage ., Development Services Department Su" Safety DNlsbn OnSite Water b Wastewater Program 4700 Bragew Streat P.O. Box 198650 An horage, AK 99519 -WW www.nnmi.oryonske (90'1) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: W A F~ crook M vwak Parcel ID 015.212-51 A. WELL DATA Wes type !—ft NA, B, or C provide PWSID e Dace completed 7,7109 Spry seal (Y" Y Total depth fL Cased to 78.32 IL FROM WELL LOG Date of test 717M Static water level 483 R Well production 2D 9.p -m. WATER SAMPLE RESULTS: Coliform o colonies/1WmL Nitrate •727 mg/L Arseri c: NO mgfi Date of sample: 11_11_w B. SEPTIC/HOLDING TANK DATA Tank TypdMaterlel SePerIsreer Tank size 1Aoo gal. Number of Cortrparbnents Yeo Formdetioo deanout (Y" Y Data of pumping New CorWhI M C. ABSORPTION FIELD DATA Well Lou (Y" Y Wires property proteomd (YIN) Y Casing height (above ground) >24 in. AT INSPECTION f. g.p.m. Other leader® 8 colonies/IW ml- collected L Collected by: F. leD= Date kksfalled elrrmoe Cieanouts (YIN) Y Depression over tarok (YIN) N High water alarm (Y" N Date kutaped de -12M6 SW rating . (g.p.dJttr or fModml)1.2 aPDW System type ONIP Teich Length 50 R Width 34 ft. Gravel below pipe 6.5 ft Total depth 1n 1t Eftabsorption area a fe Mon for ft tube Y Depression over field N Date of adequacy teat NOW Gens Results (PassiVam For _ bedrooms Fluid depth in absorption field before test in. Water added gaL New depth in. Elapsed Tkne: min. Final fluid depth in. Arry, rejuvenation treabnent (past 12 mo.) (YIN & type) N Absorption rate >- g.p.d. H yes. give date D. LIFT STATION Date irstalkd Size in gallons ManhoWAaeeaa (YIN) 'pump on' keel at _ m. 'Pump Or travel at _ in. High water alarm level at in. Datum Cycles tested Meeh alarm 3 areWt requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankRR station on lot >tea Absorption field on lot >toa Public sewer mein WA Sewer /septic service Ina >25' Anhnal cmWnrnerht areas None On acgacerd im _ >+oa On ad(acm t lots >IW Public sewer manhok/deanout WA Holding tank WA Manuro/ankrtal excrete storage aress Nae SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >s promrty, we yv Water main >ta Wella on adjacent kits "ov Water service Ina »a Surface a water »ar SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine »e' Building foundation »o' Water main »a Water Service tine »a Surface water »ar Day. ftjde sfarrge >y. Curtain drain N" Nomd Wetia on adjacentbb >tar F. COMMENTS: G. ENGINEER % CERTIFICATION I cetly flrat / have determbW Nuowh field Inspections and review of Munk*W rewds that tie above systems are in con*vmance with MOA COSA oddelloes in effect on ids data Engineer's Printed Name Michael E. Andeaon, RE Date Mr=7 COSH Fee i Y � • 5� Waiver Fee $ _ Dai of Payment Date of Payment Receipt Number Reeelpt Number. (nay. IImm VV 0 SCS ReEN 1070183001 Client Name Anderson Engineering Project Name/N Lot 3 Forest Creek Client Sample ID Lot 3 Forest Crock Matrix Drinking Water Sample Remarks: All Dales/fimn arc Alaska Standard Time Printed Date/time 01/23/2007 11:10 ColleetedDate/rime 01/11/2007 11:10 Received Date/time 01/112007 11:36 Techoksl Director Stephen C. Ede Allowable Prep Analysis Pmameter Results POL Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 01/11/07 01/15107 TK Waters Department Total NitrateMitrik•N 0.727 0.100 Microbiology Laboratory Total Colirorm 0 mg/L EPA 3532 R (<10) 01/12/07 JDS coUl00mL SM2092221) A (<I) 01/11/07 DPT m p n V � O) D O N 2O Ol.il min�m rnrn( N W N !•10 Z \ ? a< �� o �to40 mAr� r w Ov (31 = N A N m . o�0 0;lux o z Zii���� a gN0 50M o 0 =gzo �=QNg Z�go o :lD 0 4-- 0 cu .G3: � w mc Z zoz 53��o : a m 7 rr N I Cl4.YR•rl�.lil•PA•1. 10' T. do E. ESMT. 1 N OO'Lld'.52-W I,O.OU X -r— m N COOmo WwCAw O Z .,p. % ••F ■w.r�p :T / o�t•�• n 1/♦10 /� Air : ;ate 7 rr N I Cl4.YR•rl�.lil•PA•1. 10' T. do E. ESMT. 1 N OO'Lld'.52-W I,O.OU X -r— m N COOmo WwCAw O Z