HomeMy WebLinkAboutDELUCIA LT 46Bi~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
IPHONE 4 [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION ~ '
LOCATION 1'~ P~_../-l~- il/~ ~ , NO. OFBEDROOM/
_~ v DISTANCE TO: /00 '
~- Z Manufacturer Mater~ ~ No. of compartments
~iq. caoaciW in flallons Inside length ~idth ~iquid depth
/~ IF HOME.DE:
~ DISTANCE TO: Well Dwelling PERMIT NO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation PERMIT NO.
e = DISTANCE TO: t Z 0 ~ Nearest Io> ,~e
~ No. oflines ~ Length ofeach~ line~. Total length of lines Trench width inches Distance between lines
~ ~ ~ Top of tile to finish grade / Material beneath tile Total effective absorption area
O
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth DriJler Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
.iPE MATERIALS ~ ~_
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
App 1 ic ant:
Location:
~MUNICIPALITY OF ANCHORAGE--
Department T' Health and Environmenta~ ~rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
ON-SITE SEWER PERMIT
L IZ.F__ -}"7"'~' ~U~V_~ Mailing Address:
L,TTLE ~ir~-Rs CREEK Phone Number:
Legal Description: ~_ a~ .... ~~F~' .~' Lot Size: ~O;O~C~
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: _~ Soil Rating(sq.ft/br) ~/O
DEPTH
The Required Size of the Soil Absorption System Is:
#
LENGTH ~' GRAVEL DEPTH ~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall Pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = E~I~IN~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 br~rOoms.
Signe~: m .c-~~ Issued by:
ap~icant
Date:
SWP/024 (1/81)
- [] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720 ~t
. - SOILS LOG - PERCOLATION TEST. ~/~'~ /?-' .~ ~
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
SLOPE
8
9
10
11
12
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
"'""~/'~/'~ SITE PLAN
Per{ormed ~or
Leeal nescrintioo- Lot 4oDP. loc!'
Thi~ ~orm RecopY'ts So~ls Ion yes
TUDOR ROAD ANCHORA~[. ALASKA ~O7 · TELEPHONE ~3~-~47~
Guepe , "~'~?- Date Performed Dec. 1~ 1972
Subdivision Delucia- Chugiak
Percolation Test
~ee~ Soil ,,r'h~,-~ c ...... '~ristics
I
-. I
mate Iirr, ss Time Npt T~me De~th tn 4~0 Net
I
Percolation R a-t-e Hinute
Prnposed Installation' Seenaae Pit Se~ Drain Field
Depth of Inlet Depth To Bottom Of Pit Or Trench
CO~ENTS' 190 Square i'eeb ~ra~age area required per bedroom
No bedrock or water table ~, ft. below intended seej)age. ~i.t
Test Performed By James D. M~ck
Lab M ~.n ~ :c.( r
Data Certified By: CONSTRUCTION TEST
~ o'~? LAB
n.,~. fe ' Dee-. ~. .....
DAILY DRILLIN6 REPORT
DISTRICT
COUNTY STATE
)ATE
FROM TO
SLOPE TEST
ACCIDENT:-
GIVE NAME)
FORMATION ~-P'e E~ on Bit
FT.
DEG. Off
BIT AND COREHEAD RECORD MUD RECORD
RUN NO.
PRES.
TIME ~ ECORD
NAME
DRILL STEM RECORD
WEIGHT DRILLING SIZE D, P.
VISC. CORING SIZE COll.
MAKE WTr. LOSS-C,C. OTHER JTS. D.P. FT.
SERIAL NO. FILTER CAKE REPAIRS KELLY DOWN FT
DEPTH In PH. Trip COLLARS ft
TOTAL FT,
#l'R O m TO
FORMATION
ACCIDENT:-
SLOPE TEST
(give NAME}
@ FT.
DEG. Off
BIT AND COREHEAD RECORD MUD RECORD
RUN NO. I i
SIZE J
SERIAL__ NO. t
DEPTH IN
WEIGHT
WTr LOSS-CC.
HOURSRUN I J MTL, ADDED (REMARKS)
WEIGHT J PUMP ' NAME
ONBIT IPRES. I
!-!/-7' GMJ
TIME RECORD DRILL STEM RECORD
3RILLING SIZE D. P.
CORING SIZE COLL
OTHER JTS. D P,
~EPAIRS KELLY DOWN
TR~P COLLARS
TOTAL
HRS.
FT.
FROM
Rotary WEIGHT PUMP
TO FORMATION i ON bit
i NAME I HRS.
SLOPE TEST ACCIDENT:--
(GIVE NAMEJ
FT.
BIT AND COREHEAD RECORD
MUD RECORD iJ TIME RECORD
OAlff DRIL. LING REPORT
FROM TO FORMATION
SLOPe TEST
DEG. OFF
BIT AND COREHEAD RECORD
RUN No. /
MAKE
SERIAL NO.
DEPTH IN
HOURS RUN
STATE
MIJD REC9RD
/
~)-~lLL[nG
CORING
OTHER
REPAirS
Trip
MTI. ADDED IREMARKS)
DATE
ELLNO.
W --
D. P. STRING NO. SIZE
NAME hrS.
DRILL STEM RECORD
SIZE COLL.
REMARKS:
JTS. D P.
KELLY DOWN
COLLARS
TOTAL
ET.
FROM r TO FORMATION
HRS.
SLOPE TEST
ACCIDENT:--
(GIVE NAME)
FT.
DEG. OFF
RUN NO,
SIZE
BIT AND COREHEAD RECORD
ii MUD RECORD TIME RECORD
j Ii WEIGHT ~ DRILLING I
~ WTR LOSS-C C ] OTHER I
MAKE
SERIAL NO,
DEPTH IN
HOURS run
REMARKS:
j TO FORMATION ROTARy WEIGHT
FROM
I SPEED : ON BIT NAME HRS.
DRILL STEM RECORD
SIZE D. P.
SiZE COLL.
JtS D P. FT.
KELLY DOWN FT.
COLLARS FT.
TOTAL f I.
SLOPE TEST
ACCIDENT:--
)RL
..... Tl~ RECORD I[ DRILL. STEM Rf£Op'~
DAILY BltllLIJ/$/~FP01~T
FROM TO
FORMATION
WEIGHT
ON BIT
L NO.
STRING NO,
SIZE
NAME
NRS,
SLOPE TEST
ACCIDENT:-
(G~VE NAME)
BIT AND COREHEAD RECORD
HOURS RUN
REMARKS:
MUD RECORD
WEIGHT
wTr. LOSS.C.C.
FILTER CAKE
PH.
MTL. ADDED IREMARKS)
DRILLING
CORING
OTHER
rePAirs
TRIp
TIME RECORD
DRILL STEM RECORD
SIZE D. P.
SIZE COL1,
JTS D. p.
KELLY DOWN
COLLARS
TCTA L
FT.
FT.
FT.
FT.
FROM
TO
FORMATION
WEIGHT i PUMp
ON BIT
SLOPE TEST
FT.
ACCIDENT:
IGJVE NAME)
DEG, OFF
_, BiT AND COREHEAD RECORD
RGNNO.
SIZE
MAKE
SERIAL NO,
MUD RECORD
I TIME RECORD
I DR{LLING
TL. ADDED (REMARKS)
REMARKS:
NAME
__ DRILL STEM RECORD
KELLy DOWN
COLLARS
TOTAL
HRS.
FT.
FT.
FT.
@ FT, t
BIT AND COREHEAD RECORD
MUD RECORD
~--4 ~ WEIGHT
.SIZE I=
;ERIAL NO' I ~ II' F~; .......
EmARkS:
DRILLING
cOrING
OTHER
REPAIRS
TRIp
TIME RECORD
HRS.
DRILL STEM RECORD
SIZE o P.
SIZE COll.
JTS D
fT
KELLY DOWN
FT.
COLLARS
FT
TOTAL
ft
APPROVED
TOOL
PUSHER
U tl V � C � PA L � 7Y 0 IJ /\ IJ V C IJ LI I�A \:.J E
Department Development Services Da
P , p ... t
Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-141-52-000
Legal description DELUCIA LT 46B
Site address 19824 LACE RD Chugiak AK 99567
Expiration Date: 9/30/2023
Current property owner(s) LORRING DAVID W & TERESA L
X The On-site system(s) is/are approved for 2 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations. -
Original Certificate Date: 6/30/2023
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 Approvaijune 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department p p � 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. 051 141 52
Complete legal description DELUCIA LOT 46B
Location (site address) 19824 LACE RD
Current property owner(s) PARSONS
2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS
Day phone
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: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: t❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 18 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ �� Waiver Fee $
Date of Payment 6/z��
COSA # OSC Z 3 I r
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
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 Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
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)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
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 Phone
Engineer’s Printed Name Date
C&M ENGINEERING
CHARLES BALZARINI, PE 6/2/23
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC231183
Subdivision: Delucia, Block: , Lot: 46B
A water sample revealed a nitrate concentration of 6.79 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P O Box 196650 * Anchorage,Alaska99519 6650 *www muni org
ax.
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Ma�hng Address P O "i3ox�196650 *Anchorage, Alaska 995196650 *www muni org
EPIN
911,11c"
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. 051-141-52
1. GENERAL INFORMATION
Complete legal description
19824 Lace Rd
Location (site address)
Current property owner(s) LORRING DAVID & TERESA Day phone 907.687.4858
DE LUCIA LT 46B
Expiration Date: 1_b -) 1, Q 0 2 0
Mailing address
Real estate agent
3530 Holden Rd Fairbanks AK 99709
2. TYPE OF DWELLING:
0 Single Family (wwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request foe: Distance:
Received by: Date:
COSA to be released to the engineer; unless otherwise requested by the engineer.
COSA Fee $ IM
Date of Payment I ILz I Iq
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
COSA# D5C1415101 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1. 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 Eklutna Engineering, LLC Phone 907.355.9820
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE Date , ! 1-
'.4
6. DSD SIGNATURE .. .., _....,
...i:r ..r • s,
!r r'e f'
System #1 Approved for bedrooms �� , o r`
System #2 Approved for bedrooms Ott; °FOFROFEss�o���
Disapproved
Conditional approval for bedrooms, with the following stipulations:
NATE
VEVR z1
SMtG�c`\\\\�,
_i
By: - Original Certificate Date:
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 Checklist blue sheet
COSA Checklist
Legal Description: DELUCIA LT 46B
If more than 1 septic system on lot: COSA Check}ist #
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 1973
Total depth 150 ft
Cased to 149 ft
0 Sanitary seal is functioning correctly
Q Wires are properly protected
Casing height (above ground) > 12 in.
Date of flow test for COSA 10122119
Parcel ID: 051-141-52
of Structure served by this system
Well production at time of test 2.9 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑■ Yes ❑ No
0 Coliform bacteria is Negative
Nitrate 5.48 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by Curtis Townsend, PE
Date of Sample 10122/19
Static water level at beginning of test 89 ft.
Comments bacteria present in sample taken 10122119. Well disenfected. Bacteria negative in sample taken 11/17119
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 July 22, 2019
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2005
0 ALL standpipes present per record drawing
Total measured depth from grade 3.2 ft (max)
Measured depth to pipe invert from grade 3.7 ft (min)
❑ NIA —pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
Q 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
C. LIFT STATION
❑ Required maintenance com
Age of lift station y
Lift station material
Comm
Adequacy test date 10122'19
Results Q Pass For 2 bedrooms
Fluid depth prior to test 31 in
Water added 312 gal
New depth 33 in
Elapsed time 1440 min
Final fluid depth 31 in
Absorption rate ' 300 gpd
Any rejuvenation treatment (past 12 months) no
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
Community Sewer Manhole/Cleanout > 100'
Yes
if No
ft
❑✓ Yes
if No ft
Neighboring Tank > 100' 7 Yes
if No
ft
Private Sewer/Septic Line > 25'E] Yes
if No ft
Absorption Field on Lot? 100' ❑✓ Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' r]✓ Yes
if No ft
❑V Yes
if No
ft
Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main n 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'
❑Q Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
0
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
E]
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells? 100' ❑✓ Yes if No
Water Service Line > 10'
0
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 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
ft
ft
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 # OSC191561
Subdivision: Delucia, Lot: 46B
A water sample revealed a nitrate concentration of 5.48 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 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.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
(a) Legal Description (include lot, block, subdivision, section, towuship, range)
Location (address or directions)
(b) Applicants Name ~0~t£~ Telephone - Home Business
Applicants Address ~-~ow
(c) Applicant is (check one) Lending Institution ~-~ ; Owner/4~ ~ ;
Buyer ~-~ ; Other ~-~ (explain);
Address
(e) Real Estate Co. & Agent
Address ~)~. c~/ 0 5 .~/~/c ',r' ~.
(f) Mail the ~ to the following ~dress:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well_~.
Multi-Family~--~
Other (describe)
Community~-~ Public~-~
Note: If community well system~ must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4..~ewa~e Disposal
0nsite ~ Public ~-~ Community ~--~ Holding Tank ~-~
Note: If community well system, must have written cenfirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
e
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 regula-
tions in effect on the date of this inspection.
Name of Firm
Telephone
Address
Date
(ENGINEER SEAL)
DHEP Approval
Approved for ~ bedrooms By . /~//3
Approved r~ Disapproved
Terms of Conditional Approval
Committal
.¢ OF ,4/.
I,
Dat~
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF AI~SKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA).
CHECKLIST - FEBRUARY 1984
Legal Description:
Well Classification ~ ~-
Well Log P~esent
Total Depth [5~ ' Cased to
I
Static Water Level ~, {
Casing Height Above Ground
Electrical Wiring in Conduit ~YN)
Separation Distances from Well:
' · ~ .a' -- ..
TO Septlc/H ..... ,~ Ta,J~ C~ LOt
TO Nearest Edge of Absorption Field on Lot~eI~o'
To Nearest Public Se~ar Line
If A, B, or C, D.E.C. Approved(Y/N)
Date Completed
Pump Set At
~37~/~{~'~~ ~ Yield 7, ~7~,~1
Depth of Grouting
13o'--
Sanitary Seal on Casing (~/N)¥~
Depression ~nd ~l~ead (Y~ ~d
; On Adjoining Lots ~r/oo
; On Adjoining Lots
To Nearest Public Se~r
Cleancut/Manhole ~ ~
Water Sample 'Collected By
Water Sample Test Results
Comments 4~ F~ ~ - ~.,. I~-
To Nearest Sewer Service Line on LOt
~_ C~o~ ; Date [7 ~2~
SEPTIC/HOLDING TANK DATA
Date Installed~~-~ Size ~ / ~oo~( No. Of Cc~,partments
Standpipes ~)/N) ~f~ Air-tight Caps ~/N)¥e~ Foundation Cleanout ~/N)
Depression over Tank (Y~ k)O Date Last Pumped aU~/ lq
Pumping/Maintenance ConJact on File (Y_~ ; for I~/~j/~
Holding Tank High-Water Alarm _~/N) ~ Temporary Holding/Tank Permit (Y/N)
Separation Distances f~c~ Septic/Holding Tank:
To Water-Supply Welt ~/ /~..O '~%,~' ~_~> To Building Foundation~- lq. ~ '
To Property Line ~ ~,~ To Disposal Field ~F
To Water .Maip/Service Line M~ To Stream, Pond, Lake, or Major D~ainage
COurse ~'
' ' I i '
Date Paid: ': I - ~)_1~- ~c.d~,
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~
Date Installed ¥ g-LM-~
Width of Field 4~ ~_ ,
Square Feet of Absorption Area
ilg~J~71~,~., Type of System Design
Length of Field ~ Ec~ /
Depth of Field W. ~ '
Gravel Bed Thickness ~"
Standpipes Present ~N)
Depression over Field (Y~ A~O Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ +;~ o To P~operty Line
To Building Foundation ~ ~,~ To Existing or Abandoned System cn
!
Lot /~ ~ ; On Adjoining Lots
To Water Main/Servioe Line ~A To Cutbank(if present~O
To Stream/Pond/Lake/c~ Major Drainage Course ~ ~4~
To Driveway, Parking Area, or Vehicle Storage Area~l~O'
D. LIFT STATION
Date Installed¥ g- %9 -~;
Size.. in Gallons ~ /o5~, $ ~1
"Pump On" Level at ~L,~~
High Water Alar~ Level at
Tested for O
Electrical Codes~N)
Dimens ions ~
Mar~hole/Access ~/N) ~f~
"Pump Off" Level at O,~ !
Vent ~N)
Pumping Cycles du~ing Adequacy Test.
~ee ts FDA
Con~nents ~ F~ 4~- ~.,'1~
** Check Permitted Bedrocm Rating Against H~ Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspect, ion. [
Company ~6~c ~ MOA
KB1/d5/s ..o
2-.]1.5-8¢
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
274-2533
Alaska Environmental Control
Services
1200 FI. 33rd Avenue, Suite B
Anchorage, Alaska 99503
November 13, 1 98~UNlCm,t~TY Or ^NCHO~AOE
D~PT. Or H~ALm m
ENVIRONMENTAL PROTECTIO~
NOV
R£C£1VED.
SUBJECT:
J4aiver Horizontal Separation between Well and Septic
Tank, Stream and Septic Tank, Lot 465, Delucia Subdivision
( 8521- ~A-061 )
Dear Sir:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and septic tank to 92 feet and
to 71 feet for the septic tank to str6am on the subject property for a
1 bedroom family residence only.
rickson
Environmental Engineer
BEE/msm
ALASKA 6[1UIROFlm [1TAL CO[1TROL $ RUIC $, liE.
I~nclJnecrJncl $ I~nuironmcntal Studies
SEPT 22 1984
DAVE KIRK
P 0 BOX A-33
CHUGZAK AK 99567
SELLER - DAVE KIRK BUYER -
SUBDIVISION - DELUCCIA BLOCK -
LOT - 46B
ADEt~LtACY TEST FOR SEllER SYSTEM
THE TYPE OF ABSORPTION SYSTEM I5 A TRENCH WITH AN AREA OF 200 S~T.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 469 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
2 BEDROOM HONE.
THE SEPTIC TANK WAS PUkI~ED ON u]JLY 17 1984 .
FLOW TEST ON WELL
THE WELL FLOW RATE WAS 7.87 GPM FOR 3 HOURS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUI~ OF 1000 IS ADEqJATE FOR
THIS 2 BEDROOM HOUSE.
ADDITIONAL COIV~NTS :
ROUND CONCRETE SEPTIC INSTALLED PRIOR TO 1981.
1200 LUesl 33rd Avenue, Suite B. Anchoro% Alasko 99503.(907) 561-5040
DA {ECEIVED
I NSPECTI ON APPOI NTM ENTS
TIME? '* TIME TIME
DATE DATE DATE
,~s~c~o~ ~s~c~o~ ,~s~c~o~
MUNICIPALITY OF ANCHORAGE DEPT. OF HE~TH &
DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTION ~IRONMENT~ P~TECTI~
(~~ 825 L Street - Anchorage, Alaska 99501 ,.
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 .RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten (10) davs for processing.
1. PROPERTY OWNER ~ PHONE
MAILING ADDRESS
P~OPE~TY ~ESIDENT (If different from above) 3 PHONE
2. BUYER
MAILING ADDRESS
PHONE
3. LENDING INSTITUTION ~
4. REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
'-.~ eM..,,c c2c.,, /. O~"
STREET LOCATION
6. TYPE OF RESIDENCE
~. SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS ~
[] One [] Four [] Other~
[] Two [] Five
[] Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[~ ONE [] THREE
[] TWO [] FOUR
[] FIVE
[] SlX
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
I--ISeptic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
i--~ OTHER
Septic/Holding Tank
IAbsorption Area
Sewer Line
JNearest Lot Line
5. COMMENTS
DATE
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
^L^$K^ eFIUIROI'ImEI1TAL CONTROL SeRUICe$, II'lC.
~n§in¢~'in~j ~- ~nui~'onmcnlal ~tu~ics
SPECIFICATIONS FOR LIFT STATION, LOT 46B, DELUCCIA SBDN.
1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
2.0 THE LIFT STATION
2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,
CAPABLE OF BURIAL TO 10 FT.
2.2 THE 24" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED
WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT
2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
RICH PAINT OR COATED WITH BITUMASTIC.
2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS.
2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT
STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
2.6 THERE SHALL BE A HIGH LEVEL ALARM SET AT THE LEVEL OF
THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL
BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A
LOCATION DESIGNATED BY THE HOMEOWNER.
2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
2.8 THE SUMP PUMP SHALL BE SUSPENDED NOT LESS THAN 6 INCHES
OFF THE BOTTOM OF THE LIFT STATION WITH A CHAIN OR
NYLON LINE.
2.9 INSULATION SHOULD BE APPLIED TO A DEPTH OF 4' BELOW
GROUND.
3.0 PRESSURE SEWER
3.1 THE PRESSURE SEWER SHALL BE 2 INCH POLYETHYLENE OR PVC
PIPE BURIED TO THE DEPTH OF 5 FEET FROM THE LIFT
STATION TO THE CENTER OF THE TRENCH.
4.0 ALTERNATE LIFT STATION
4.1 A COMMERCIAL PACKAGE CONSISTING OF A 1/2 HP EXPERT
CHRONE FLUIDS PUMP AND SIMPLEX 30 GALLON TANK.
4.2 THE 36" CULVERT STOCK SHALL MEET THE REQUIREMENTS OF
PARAGRAPH 2 AS APPROPRIATE.
1220 LUest 25th Auenu¢ · Anchoracle, Alaska 99503 · (907) 276-1361
ALASKA ENVIRON~'NTAL
CONTROL SERVIC,.~, INC.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
JOB
SHEET NO. /
DATE
CHECKED BY
DATE .............
SCALE
ALASKA ENVIRONI~NTAL
CONTROL SERVICL_, INC.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
SHEET' NO.. OF
CHECKED BY DATE
SCALE...
o/y/,:,'
ALASKA ENVIRONr'-NTAL
CONTROL SERVICE, INC.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
CHECKED BY
DATE
SCALE
_1 L