HomeMy WebLinkAboutDELUCIA LT 41
(Kev UwU/J16)
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP221099
PID Number: 051-141-08
Dwelling: 0 Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade
Name
DUNNACHIE SCOT
ABSORPTION FIELD
El Deep Trench El Wide Trench ❑Bed El Mound
Site Address
22914 Needels Loop
❑ Other
Phone
Number of Bedrooms
Sol Rating
Total depth from original grade
229-5398
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
DELUCIA LT 41
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
-
Distance between lines
- Ft.
SEPARATION
DISTANCES
Tol
Septic
I Absorption
I Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft=
Ft.
Well
100'+
na
na
na
TANK X Septic [1S.T.E.P. ❑ Holding El Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface Water
100'+
na
na
Material
Number of compartments
Lot Line
10'+
I
na
na
NA
PiStC
2
FoundationI
1 0'+
na
na
LIFT STATION
Manufacturer
Capacity
I
Remarks
Gal.
Narm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfiel9
Installer
Dean
Drainfield COWT D3034
Inspector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspection1-6/6/22
6/7/22
Location and description
dates:z.,
Deck
aro
4:"
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
`�P�E �F
*
* : 49 Tr+
Septic System
Approved---�-- C�J0
Date
Steve Eng
Note:
does include
111 CE -60%
this approval not well permit requirements.
(Kev UwU/J16)
A
B
ST1 34
22
ST2 38
21
DC❑ 41
22
Loot 8 Well
New 1000 allon
Septic T nk w/DC❑'s
Decomm- sioned Old
Septi Tank Flat Slope
PE UPC
Flat Slope
Loot 40 Well OQ
O
v
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a o Dco
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3 Bdrm
Flat
N OR THRI M °
ENGINEERING�P� DELUCIA LOT 41 1' = 40'
SteveEng.com •..... ... RECORD
PO Box 770724 '�... -St- :4 s .�. LAYOUT
Eagle River. Alaska 99577 a- s WASTEWATER
907.694. 7028 6/11'i22 a UPGRADE SEPTIC TANK 6/11/22 z of 3
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NOTE:
THE PORTION OF THE ASPHALT PAVEMENT
DRIVEWAY ON LOT 42 IS ALLOWED PER
AN ENCROACHMENT EASEMENT AGREEMENT
FILED UNDER RECORDER'S SERIAL
NUMBER 2019-034862-0.
MORTGAGE SURVEY X SCALE--!:-= 30' GRID NW 1259 Project No. 22-269/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, i n c . (907) 522-6476 Phone aoQ�d�Op
Professional Land Surveyors ken0i ngsurveycomax g � p
522-4625
OF AC �4
jonothan0longsurvey.com o
I hereby certify that I have surveyed the following described property:
LOT 41, DELUCIA SUBDIVISION (Plat No. P-684)
Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a
representation of the conditions that were found on the date the survey was performed.
This survey does not constitute a boundary survey and is subject to any inaccuracies
that a subsequent boundary survey may disclose. The information contained hereon shall
not be used to establish any fence, structure, or other improvements.
Dated this the ItD Day of a2 at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
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AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221099
Work Type: SepticTank Upgrade
Tax Code Number: 05114108000
Site Legal Address: DELUCIA LT 41 G:1259
Site Mailing Address: 22914 NEEDELS LOOP, Chugiak
Owner: DUNNACHIE SCOT KYLE
Design Engineer: NORTH RIM ENGINEERING
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
�1„cnC
Noy
U(:I)ill'C111('11C
5/9/2022
5/9/2023
24394
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska.
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3.. The wastewater code requires inspections during the installation: The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From Octob-er 15 to April 15, a subsurface soil absorption system::under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated .to prevent freezing
Received By:
- • : '=
Date: C5 / I
Date: �E�qz
3
MUNICIPALITY OF ANCHORAGE
1
Development Services Department J Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-141-08
Property owner(s) DUNNACHIE SCOT
Mailing address 22914 Needels Loop
Site address same
Day phone 229-5398
Legal description (Sub'd., Block & Lot) DELUCIA LT 41
Legal description (Township, Range & Section)
Lot Size 24,394 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑ Initial ❑
Single Family (SF) 0
(v✓/wo ADU)
Septic Tank
0 Upgrade El
(D) ❑
Holding Tank
❑ RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: 2_Z.
Receipt Number:
Permit No. 05P2''Z j o9 2
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 4/26/22 Number of Pages:
To: MOA On-Site Services
Subject: Delucia Lot 41
Septic Tank Failure
The subject septic tank has failed- a new tank will replace the old one. The existing seepage trench
appears to be working OK. Please issue a permit so the tank can be replaced. Please review as soon
as possible. This is a medium size lot with no nearby neighbor conflicts. Elevations in vicinity flat.
If there is need for additional information or clarification please give me a call.
Thanks-Steve
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221099, Deb Wockenfuss, 05/09/22
SteveEng.com Delucia L41
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current septic tank has failed- the seepage trench still
functions. This lot is not large and on private water well. No adverse impacts are
expected from tank replacement. No easements are present on the lot. The slope is
indicated in the area of the septic system. No conflicts to neighbor properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.
5 minimum between the tank and trench. 5 to property lines & 10 to house.
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10 from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field. Manhole Riser required in 1st tank compartment.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221099, Deb Wockenfuss, 05/09/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221099, Deb Wockenfuss, 05/09/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221099, Deb Wockenfuss, 05/09/22
GRE/-,.ER ANCHORAGE AREA BOE. JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
SEPTIC TANK:
DISTANCE
FROM WELL ~
MANUFACTURER
INSIDE LENGTH
INSIDE WIDTH
u NUMBER OF
MATERIAL _ COMPARTMENTS
LIQUID DEPTH
LIQUID CAPACITY/~:::}d GALLONS.
TILE DRAIN FIELD:'
DISTANCE FROM WELL ')(~'~
NUMBER OF LINES
ABSORPTION AREA
DEPTH:
FOUNDATION
DISTANCE BETWEEN LINES
NEAREST LOT LINE
TOTAL LENGTH
OF UNES
TRENCH WIDTH ",~C°IN. TOTAL EFFECTIVE
TOP OF TILE TO FINISH GRADE
SQ. FT.
LENGTH OF EACH LINE
DEPTH OF FILTER
MATERIAL BENEATH TILE~//¢
IN. ABOVE TILE V ~/' IN.
WELL:
TYPE ~ CONSTRUCTION
BUILDING NEAREST
FOUNDATION__ LOT LINE__
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE__
DEPTH
SEPTIC SEEPAGE
TANK. __ SYSTEM
DISTANCE FROM:
REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
piPE MATERiAL.~--¢-~'~ ~
LOT SLOPE:
REMARKS:
b
G.A.A.B.
Form EQ-032
PERMIT NO.
MUNI ts I PALIT~' OF Fi~-IISHC, RA,SE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 E. TUDOR RD. ~ ANCHORAGE, AK. 9950?
27g-222t
79284 )
8r-JE, ON--S I TE SE£4ER PEAr-11 J
APPLICANT
LOCATION
LEGAL
ARDITH SISBACH BOX ?ti - CHUGIAK
NEEPLE$ RD ACROSS FROM NEW CHUG ELEM
L41 DELUCIA SUBD LOT SIZE
688-2682
24488 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: PIT
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS- ~.
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
RED SEPT I C TANk; S I ZE= i000 ORLLOt-I':'-;
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F'ER~I I T ~'RL I D FOR O[~E YERR FROH I SSLIE
I CERTIFY THAT
i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
2: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
ISSUED
APPLICRNT ARDITH SISBACH
OEr
Ru$$e# Oyster
694-2774
Soils ~ Foundations
Performed for:
E GEO
ECHNI CAL Er DEVEL',.,PMENT
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Name: ~~-,-~
Matllng Address:
Legal Description:
CO.
Earl El~is
688-2280
Land Development
Depth (feet)
Soll Characterlst!c~
Ground Water Encountered:
ProposeU Installation:
'~:f yes, ~h~t depth___.__.
.: j
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
274-2533
May 13, 1985
Mr-. Lou Butera
Eagle Rivet. Engineering
Services
P. O. Box 773294
Eagle Rivet', Alaska 99577
SUBJECT: Waiver Horizontal Separation between Well and Septic Tank,
Lot 41, Delucia Subdivision, Eagle River', Alaska
8521-WA-153
Dear' Mr'. Butera:
The Departm~ent has reviewed the subject waiverrequest and hereby waives
the horizontal separation between the well and septic tank to 94 feet
on the subject property for' a 3 bedroom single family residence only.
Si ncerely,
Steve Eng, P.E.
District Engineer'
SE/dd
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. 051-141-08
1. GENERAL INFORMATION
Expiration Date: I
Complete legal description DELUCIA LT 41
Location (site address) 22914 Needels Loop
Current property owner(s) BERTRAND Day phone 440-1517
Mailing address
Real estate agent owner Day phone
X67 8 970
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU) h
❑ Duplex AUG 19 N19 >
❑ Multiple Dwellings (Single Family and/or Duplex)
ti
3. NUMBER OF BEDROOMS: 3 �ZZ� J
0168Lg�
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
E
Private Septic
Fx 1
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
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 Steve Eng Date 8/7/19
aaL1.� ^A J 1
6. DSD SIGNATURE 97
System #1 Approved forv
bedrooms
rr'o Steven V. Eng`
System #2 Approved for bedrooms ; PE 6.256 ,s
Disapproved
Conditional approval for bedrooms, with the following stipulations:
VIA! !lwp= ., , _
1 WASTEWATER
�
tAM
i
By: Original Certificate Date: ov— , - / —1
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 t G+�n 0Ld 2 Ll (�/tn
COSA Checklist blue sheet
COSA Checklist
Legal Description: DELUCIA LT 41 Parcel ID: 051-141-08
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1976
Total depth 190 ft
Cased to 40+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 7/23/19
Static water level at beginning of test 56 ft.
Comments
B. TANK DATA
Age of tank(s) 9176 years
Tank type/material Steel
Measured operating fluid level in septic tank 4
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 7/10/19
D. ABSORPTION FIELD DATA 9/76
Which system tested (date installed) 9/76
Al ALL standpipes present per record drawing
Total measured depth from grade 9.5 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 9'
Well production at time of test 6+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes IN No
❑ Coliform bacteria is Negative
Nitrate 6.05 mg/L E]Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Marlon Bertrand
Date of Sample 7/15/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 7/23/19
Results F71 Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 7 in
Elapsed time 60 min
01Code-requiredsoil cover over field Final fluid depth 1 in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
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)
Q
Septic Tank/Lift Station on Lot > 100'
94
ft
Community Sewer Manhole/Cleanout > 100'
0 Yes if No ft
❑ Yes
if No
ft
[z] Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' r-,71 Yes
if No ft
Absorption Field on Lot > 100' E] 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
0 Yes
if No
ft
Yes
if No
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' F1 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'
Q
Yes
if No
ft
Surface Water > 100'
0 Yes if No ft
Property Line > 5'
[Z]
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'
ft
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'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
Q
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
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
A004i I i- I SEWARD & ASSUUIATES LAND SURVEYING 694-Ud29
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCAT Z -
FOLLOWING DESCRIBED PROPERTY., OF A
DATE
AND THAT NO kbk64CHMENTS EXIST EXCEPT AS 81711?
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE M(ISTENCE OF ANY GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECMED SUBDI- # ovan. Merk 5awar
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULF& D LS - 18 Ilk
ANY DATA HEREON BE USED FOR CONSTRUCTIONCEr
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN-
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic 'Tank Advisory
Certificate of On -Site Systems Approval # OSC191385
Subdivision: Delucia Lot 41
The septic tank for this property is 43 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
�� a� Ad px o I��{# Anc _orageiME 9SON
5
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,axe
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC191385
Subdivision: Delucia lot 41
A water sample revealed a nitrate concentration of 6.05 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.
�^? a�`�".ri'�,�,`,-%�"�,, �����a,3��^�`��;�k��",.d�,`,�"�����a��„�'�"-� ��``���,.kts�.��r��"�",➢,�a�i �., ���;,���,U`'�"Lie.�'��`�`��.�?3�,tw--�.,,�'Y�*�,p�,-�``-'�"
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. 051-141-08
1. GENERAL INFORMATION
Complete legal description DELUCIA LT 41
Location (site address) 22914 Needels Loop
Current property owner(s) DUNNACHIE SCOT
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Fx-1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Expiration Date:
Day phone 229-5398
Day phone
3. NUMBER OF BEDROOMS:
3
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: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5S D Waiver Fee $
Date of Payment 6 —13 -2 2
Receipt Number
COSA# (SCaa
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
System #1 Approved for 3-- bedrooms
System #2 Approved for bedrooms
Disapproved
Date 6/11/22
ir
s C�9
:* :4.9-a* *ff
�c� Steve
Eny
CE -6256:
s
I•r/2�f
Conditional approval for bedrooms, with the following stipulations:
Jo W
OF ANCh/����i.
p,1ER PN.��o
�oc1Gh��
-9) 'v jS11.�11��\�.
By: tom. s Original Certificate Date: —7,2_
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
COSH McO..11st blue sheet
COSA Checklist
Legal Description: DELUCIA LT 41 Parcel ID: 051-141-08
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1976
Total depth 190 ft
Cased to 40+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 4/13/22
Static water level at beginning of test 55 ft.
Comments
B. TANK DATA
Age of tank(s) 0 years
Tank type/material sptcPlstc
Measured operating fluid level in septic tank new
❑ Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA 9/76
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 9.5 ft (max)
Measured depth to pipe invert from grade 5.3 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ 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
Well production at time of test 6+ qpm
Water storage tank volume0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 6.45 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by NRim Eng.
Date of Sample 5/5/22 ,
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4/13122
Results QPass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 5 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
no
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
SepdcTonNLift Station onLot >�1OO
MYas
Yon
Sewer Manhole/Cleanout �>1OO
F,JYem
ifNoft
Absorption Field > 5'
MV Yes
ifNoft
Neighboring Tank >1OO' Yeo
ifNoM
Private Wells >1OO` Yes if No.
Private Sewer/Septic Line >26'F�lYes
UNoh
Absorption Field nnLot >1OO' Yes
ifNnft
Holding Tank >1OO' Yee
ifNoM
Neighboring Absorption Fields > 100'
Yes
ifNoM
Animal Containment ��50` Yes
ifNoft
��Yes
ifNoft
Yea
ifNuft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main >75' [� ��Yem
|fNnM
E] Yes
ifNoh
FromSeptic/Holding Tank mmLot to: (Please enter distances if less than required)
Building Foundations > 10 (D Yes if No ft Surface Water> 100' Yes if No ft
Property Line >5'
MYas
Yon
ifNo#
Wells onAdjacent Lots:
Absorption Field > 5'
Yon
i[Noft
Private Wells >1OO` Yes if No.
Water Main >1U'
Yes
ifNoft
Community Wells > 200' Yes if No.
Water Service Line >10'
Yes
ifNoM
|fseptic tank isunder driveway comment below
From Absorption Field mnLot to: (Please enter distances if less than required)
Building Foundation > 10`
Yon
i/NoM
|fabsorption field hounder driveway comment below
Property Line >1D'
Yes
ifNoft
Wells onAdjacent Lots:
Water Main>10'
Yes
ifNoh
Private Wells >1UO' Yea if No
Water Service Line >1U'
Yes
ifNoM
Community Wells > 200' Yon if No
Surface Water >1DO'
Yea
ifNuft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / have determined through field inspections and neview
o/Municipal records that the above systems are inconformance mitt
MOA COQAguidelines ineffect onthis date.
COSxChecklist yellow sheet
ft
M
ft
It
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC221279
Subdivision: Delucia Lot 1
A water sample revealed a nitrate concentration of 6.45 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 x.96650 *Anchorage, Alaska 99519 6650 *www muni org t
WEDEMUME
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www murn org� v
Parcel I.D. # 051-141-08
1. GENERAL INFORMATION
Complete legal description
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DiviSiOn of EnVironmental ServiCes
~'
P.O. B°~ ':;i96650
Anchorage, Alaska 99519-6650
· ' ,; ,~ ~ 343-4744 ·
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Lot 41, Delucia S/D
Location (site address or directions)
22914 Needels Loop
o
prOperty owner
:Mailing address
Jim Sisbeach
PO Box 670711, Chuqiak, AK 99567
Day phone 272-9920
":Lending agency
Mailing address
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Re~. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my.seal affixed hereto and as of the validation date shown below, I verify that my
'i investigation of this Health At)thority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage .files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & S ENGINEERING
Name of Firm !7034 _:.-.= ~.' ....
.......
Eagle River, AJ~ska 99577
Address _~/~__~ ~/,~_._
Engineer's signature -u,. ' -
Phone
Date
DHHS SIGNATURE -
~/ Approved for T¢~,~--~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only uPOn the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of. Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~25(Rev. 1/91) Back MOA~I
RECEIVED
Municipality of Anchorage JAN 2. ] 1999
DEPARTMENT OF HEALTH & HUMAN SERVIC~I~NIClP^UTY ol= ANCH
Environmental Services Division ~,NVIRONMENTAL$~¥1C.~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
LegalDescription: ~Q t ~.~.-x,.,...,ct,,~ ParcelI.D.:
A. WELL DATA
Well type ~)~, ~[ ~.r-~.~_ If A, B, or C, attach ADEC letter. ADEC water system number
Log present ~N) ~/ Date completed
Total depth iCl 0 I Cased to
Sanitary seal ~/N) "~
Casing height (above ground)
FROM WELL LOG
Wires properly protected (~/N) ~
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: / -/o '-~i'
Nitrate
Collected by:
g.p.m.
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout6~) ~'
Date of Pumping ~ ~ i:~ ~
C, ABSORPTION FIELD DATA
Date installed ~ ~ '7 ~
Tank size
Number of Compartments ?--- Cleanouts ('~/N)_~__
High water alarm (Y/N) ~ [~'
Depression
Pumper ~T-r, Jt~
Soil rating (g.p.d./fF or fF/bdrm)
stem type
Length ~"2~ ~ Width
Effective absorption area
Date of adequacy test /- /
Fluid depth in absorption field before test (in.); Z;~ °" Immediately after;/oa gal. water added (in.):
Fluid depth (ins) Minutes later: ~>~ Absorption rate '~/.F-~' '~-
= .g.p.d.
Peroxide treatment (past 12 months) (Y/~) /,~,~/4-- ~<,/~,~ If yes, give date
Gravel thickness below pipe ~'/' Total depth ~, 5'-- '
Monitoring Tube present (-~/N)_~ Depression over field (Y/~ ~
Results~i=ail) /~-'¢~ ~ For -'~ bedrooms
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
~ed
Size in gallons
"Pump on" level at*
E. SEPARATION DISTANCES
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot cl ~ ' ~z-~ ~/~.-~ On adjacent lots
Absorption field on lot '1 -~'~ ' '* On adjacent lots
Public sewer main ~,~ Public sewer manhole/cleanout
Sewer/septic service line 2~ t* Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
~ ~ Absorption field
Foundation 1~-' Property line
Water main/service line 1~ i~ Surface water/drainage i~ ~' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation Ic~ t ~- Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots t O c>
ENGINEER'S CERTIFICATION
, certify that, have determined thru field inspections and review of Municipal~_..~'~ ~1~ .~stems are
in conformance with MOA H~ gu,del, oas in effect on this date.
Signature -~/~Z ~~ k-~' ''--"~
Date / / = I / ~ ~ ~i~ ~?.,. ....... ~'~
HAAFee $ ;:~ (~ ' ~ Waiver FeeS
Date of Payment C) / /~z---/ /~ Date of Payment
Receipt Number /-''f L//i//--] ('- ~ ~ ~) Receipt Number
72-026 (Rev. 3/96)*
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 "~-/
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(c) Applicant is (check one): Lending Institution [] ' Owner/builder~; Buyer [] ' Other [] (explain);
(d) Lending institution
Address J
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~[~' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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 (11,841
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 this inspection.
Name of Firm cA~.J c ~,,,,-.. .............. Telephone
Address EAGLE RIVER, AK .q.fl.~77
P. 0. BOX 773294
Date 694-5i95 '
ngineer's Seal
Approved for '~ bedrooms by ' / Conditi
Approved ~' Disapproved
Terms of Conditional Approval
Date
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
MUNICIPALITY OF ANC:HORAC~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOI~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~, o
MAY 2 2 1985
RECEIVED
WELL DATA
Well Classification P ~, '~'~ ~ If A, B, C, DiE.c. Approved (Y/N)
Well Log Present (Y/N) ,'Y Date Completed '/¢' 2 ~ Yield
Total Depth ) ~'~ ' Cased to
Static Water Level ~ ,) ~ i '
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) Y
/,P'7"
Depth of Grouting '~/'./"¢
Pump Set At /'.~o ~'
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Man hole ,"~
Water Sample Collected by '~-*%5
Water Sample Test Results
~J~ ,~-~ .4f¢~. ~,,,.-~; On Adjoining Lots
/'¢o ~- ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
· Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (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 ,/o~,¢~ No. of Compartments ~-~
Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)
Date Last Pumped
/¢'"/,,~ 'for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ? ~ ? ~
Width of Field '3 4,"
Square Feet of Absorption Area ~-
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /O
To Building Foundation 3¥ /
Lot
To Water Main/Service Line /o '~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~.~ ,,~Z~,,~ ~,~ ~,,~-$
t~, /~,-,,, ~ /~-,-~/.
Type of System Design
Length of Field '~'.;2. /
Depth of Field c) ,'
Gravel Bed Thickness ~" '
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ,,/¢ ¢~
To Existing or Abandoned System on
· On Adjoining Lots ,-~ ~
To Cutbank (if present) ,,,"Z.,,'~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date
MOA No.
Signed
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)