HomeMy WebLinkAboutSUMMIT ESTATES BLK 1 LT 7Onsite File
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1:Stat s
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP2211199 PID Number: 015-072-25
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
KATHY MORRISON & RONALD FEIGIN
ABSORPTION FIELD - EXISTING
❑ Deep Trench El Wide Trench El Bed EJ Mound
Site Address TH
5521 E 97 AVE, ANCHORAGE, AK 99503
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
SUMMIT ESTATES 1 7
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
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Fl?
Ft.
Well
100'+
--
25'+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1500 Gal.
Surface Water
100'+
--
Material
HDPE
Number of compartments
2
Lot Line
5'+
-_
NA
Foundation
*71+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks *MOA WAIVERS WITH THIS SUBMITTAL
*2' TO PL & 85' TO WELL FROM EXISTING FIELD. 7'+ TO
Alarm location
Electrical installed by
ST & FOUNDATION.
-installer_MIKE-N-ANDERSON-(MNA)— -
PIPE MATERIAL House to tank 3034Tank to 3034
- - ___ drainfield
Drainfield CO/MT 3034
Inspector MNA / FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection �5` 6/3/2022 2 ,6/17/22
Location and description
aro 4'h
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
_
r, ...:1,��1
Conditional Approval: Date
*: 49 TM ��
....•:*
', •••• -
Curtis Huffman
Septic System
Approved - —
�••• •:
('F 1989ql
Date
l • • • 6//27/22 •' �G�
�'0pR
Note: this approval does not include well permit requirements.
It\OFESS10Np�'��.�
\.�`11•►`�
tRCV VJ/VL! 10)
PID: 015-072-25 PERMIT: OSP211199
Parcel 5C
N 89'59'00"E 125.00'
B—C=3,9'
-
UTILITY EASEMENT
B—D=10,0'
PER MOA IR
Z
EXISTING TRENCH
A—F=35,3'
47'L X VW X 4'ED100' PROTECTIVE
/WELL
U)
0
RADIUS Lo} 7
SUMP
Q
w
MT 13,125 S.F.
�0,,
Lot 8
24.3'
0
DC
F
�
0 FDCO
E C B
Cn
0
2 STORY
0
O
BM TOP OF RESIDENCE w/
c
MH /RISER WALKOUT BSMT.
A—C=26,1'
B—C=3,9'
-
A—D=28,6'
B—D=10,0'
A—E=30,3'
B—E=14,3'
A—F=35,3'
B—F=17,7'
I DECK
N BRIDGE WELL
24.5'
S 89'59'00"W\125.00'
ASPHALT-
SEPTIC SECTION
SUMMIT ESTATES BLK 1, LT 7
PREPARED FOR:
RONALD FEIGIN & KATHY MORRISON
ANCHORAGE, AK 99503
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 firstwaterAK@gmail.com
Lot 6
SCALEi NTS
SUPPORT$ SERVICES: ®®®®
AZ4' VA
FWC!
9TH *O
DATE: 6/30/2022rtis Huffman. -
SURVEY: LANG r
CE 128991
DRAWN: FWCS $�
SCALE: 1 " = 30' 6./3.... �
%FESSIOts , ,_
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
mcnt S
1J �'
Ucpartmcnt
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV221049 COSA#:OSC221321 Permit#:OSP211199
PID#: 015-072-25
Legal Description: Summit Estates Block 1 Lot 7
Engineer: First Water Consulting
Applicant: Ronald Feigin & Kathy Morrison
Your request for the following waivers has been approved:
85.0 feet horizontal separation from the absorption field to the private well.
2.0 feet horizontal separation from the absorption field to the west property line.
7.0 feet horizontal separation from the septic tank to the foundation.
See engineer's waiver request for justifications.
This waiver approval applies to the existing absorption field and septic tank only. Any future
upgrade to the on-site wastewater disposal system will require all separation distances be met or
— --another--approval-from-this-department. - -- -- - --- -
Waiver is Granted: X Waiver is not Granted:
Date: ( 1 ° Z) 2L Z Approved by: �� amz
Name of Reviewer
rk Aki r4iI Iola IN AN I WOM
0
First Water
a
�CONS a E s' T'N
AST T-
F T F1
SUPPORT E PLANNING
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
June 30, 2022
Municipalities of Anchorage
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SUMMIT ESTATES BLOCK 1, LOT 7 - VARIOUS WAIVERS
Due to very limited site constraints (field, foundation, elevations,...), the existing tank was
removed, properly decommissioned and the new tank installed in the same location. Given
the justification below, we respectfully request a 7' tank to foundation, 2' from existing
trench and property line and 85' from existing field to existing water well waivers be
granted at this time. Granting of these waivers will not impact any of the neighboring
properties.
The existing tank was within 10' of the foundation for the past 40 years without any known
issues or adverse impacts, the improved new tank is made of higher quality HDPE material
with proper bedding, the perpendicular orientation of the tank to the foundation lessens the
encroachment, the most likely manner of a typical tank failure is the top collapsing and this
would appear to have minimum if any impact on the foundation and the compacted / insitu
soils.
Granting of property line waiver and all of these waivers is justified since the existing field has
been in operation since 1982 with no known issues or ill effects to the adjacent property and
it is anticipated that the field will not impact the neighboring property. The existing field is
also down hill and on the opposite side of the residence from the existing well. There have
been no known issues of this existing septic field and the nitrate levels are moderate. Granting
of these waivers will not impact any of the neighboring properties.
Sincerely,
i
Curtis Huffman, P.E.
ii-fc5lut1w aiING SLRVICES
lSNPPONI Y. Vd7FN luigA 51 -A
-N
AI EA
` � � PIANNIHC
10' UTILITY EASEMENT
Lot 8
ii
O
SEPTIC
O f f PIPES
W
34.7'/ /
SEPTIC y
MANHOLE J
1
I
Parcel 5C
N 89'59'00"E 125.00'
100' PROTECTIVE
WELL RADIUS
2.0'x5.5' CANT
/COVERED - 24.3
BALCONY N
2 STORY
RESIDENCE w/
WALKOUT BSMT.
�1� BRIDGE I DECK
S 89'59'00"W 125.00'
ASPHALT'
E. 97th AVENUE
PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2437 Project No. 21-296/A2
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax o6op�OpOO 4
Professional Land Surveyors ken6langsurvey.com OF A � �p
jonathan®langsurvey.com
i
s
00
is
Lot 7
13,125 S.F.
41.6'
WELL
s
0
O
O
L
C Lot 6
m
I hereby certify that I have surveyed the following described property:
LOT 7, BLOCK 1, SUMMIT ESTATES (PLAT No. P-628)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on sold property except as indicated hereon.
Dated this the 22 N= Day of "<- L- , 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 plot.
-*� 49THW :y*�
.................. .............
KENNETH lJG o
0 LS -5202.
44�� F"F S10to't- "' o
AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wwastawater Program
PO Box 195&50 6700 Elmre Road
AncharagL-, Ararke 5 519-U&b phone_ (1*7) 34:�-7904 Fpw- jqW) 343-7-Pg7
htV+lmw.MuMi.-0r&nase
Ort -Site Wastewater Disposal System Permit
Permit Number_ 0P2111
Work Type_ SepticTsnk Upgrade
Tax Gads Numdm1r, 01507225000
Site Legal Address- SUMMIT E-57ATE BLK 1 LT F 0:2437
Site Mailing Ad -d res a, 5521 E 97TH AVE, Anchorage
Owner. 1`00-;�RISCN KATHY L &
Design Engineer, FIRST WATER CONSULTING
This perm it ie for the cc nstru pct io n ❑ f -
Effective Date,
Expiration Date:
Lot Size in $q Ft.-
Total
t;
Total BE-deaarns:
&1112421
6111 X2022
13125
❑ Disposal Field 10 Septic -ank ❑ Holding Tank ❑ Privy ❑ Private Weil ❑ Water storove
All ocrrstruction shall be in accardanc-o with,
1. The attached i9vpFuver; design.
2. All requirements spedfled In Anchorage Munidpal code Chapters 15.55 and 15,66 and the State of Naska
ti V8&lewater Di,5po!sa I Regulations (1 MAC72) ;a rld Drinking VNater e Iatio n s (18AAB84)
-3. The wastewater coda req ulres ImpEmlom OijiMg M6 i68nll�ti5T5. I ha engineer ehall na* the Uoveloprr,enl
Sarvicos Departrr eM per AMC 15.55_ Previde notification �y o$llin4 (90 7) 343-704 (2-45).
4. From October 1:5 to April 1$, a su t)surf:aoe wil absorption systarn u nder QOrlS N01140n dU ring f r'aezi ng weather
$hall be aither_
e. Opened and Closed on the sarne day, or
b. Covered, sealed, and hoatad to prauent Freezing
Special Proairia ns: The Feld :Rpp4�,,ars to aricroach in the 100 it well radius and is leis than 14 ft tram the west
property line. Tease items will need to be addressed prior to future COSA appal.
Received By:
Issued By: �+
611412021
Date=
Dale:
1
3
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 015-072-25
Property owner(s) KATHY MORRISON & RONALD FEIGIN LIVING TRUST.. Day phone
Mailing address 200 W 34TH AVE., ANCHORAGE, AK 99503
Site address 5521 E 97TH AVENUE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) SUMMIT ESTATES 131, L7
Legal description (Township, Range & Section)
Lot Size 13,125 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
(N all that apply)
Absorption Field
❑
Initial ❑
Septic Tank
Q
Upgrade 0
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
TYPE OF DWELLING:
Single Family (SF) Fx_1
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance:
I 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: 1� v2 2 -`� Waiver Fees:
Date of Payment: �! `7 Date of Payment:
Receipt Number: —01701( Receipt Number:
Permit No. 0519,211 /% � Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
June 1, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: SUMMIT ESTATES BLOCK 1, LOT 7
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank with double
manholes per the attached design to serve the existing 3-bedroom residence. The lot and area are
served by private wells. The design will not impact any of the neighboring properties. Please
contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211199, Rebecca Carroll, 06/11/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211199, Rebecca Carroll, 06/11/21
Parcel 5C
N 89'59'00"E 125.00'
10' UTILITY EASEMENT
m
ro
Z N
100' PROTECTIVE
Q / WELL RADIUS Lot
7 8
2.0'x5.5' CANT 13,125 S.F. O
Lot 8 VSEPTIC /COVERED 24.3' o Lot 6
PIPES / BALCONY M
34.7' / `""
2 STORY
N RESIDENCE w/ 16.0' 41.6'
> WALKOUT BSMT.
I w
0
32.3"
J m BRIDGE DECK WELL
io N
-- S 89'59'00'v 125.00'
I -ASPHALT -
W
O
\ O
E. 97th AVENUE
PLOT PLAN ___ AS BUILT _x_ SCALE _1_\30_— GRID _ SW 2437Project No. ____21=291A1____
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone op0O�040
(907) 522-4625 Fax oo OFA / ppp
Professional Land Surveyors kenOlangsurvey.com c .`9
jonathanOlangsurvey.com �d�..•' A •.s.0�
I hereby certify that I have surveyed the following described property:
LOT 7, BLOCK 1, SUMMIT ESTATES (PLAT No. P-628)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the _R _ Day of J��", _L:-_'� _, 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.
49TH
..............I
Or
�o
'G
O
J
,'�FfSSIONAE
AECC963
, ~ 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
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: / ¢ ~
~ ~ Liq. capacity in gallons
~ Manufacturer ~
(~ I F HOME,DE: Liquid depth
PERMIT NO.
DISTANCE TO;
Manufacturer
DISTANCE TO:
Length
grade
[AbsorCtion are?~ /
Inside length
Dwelling
[] UPGRADE
Foundation
Total length~f~nes
Material beneath tile
Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
Class Depth Driller
Building foundation Sewer line
DISTANCE TO:
OTHER
Width
Material
Nearest lot line
Trench'~'~h inches
inches
NO. OF BEDROOMS
PERMIT NO.
/
No. of compartments
Liquid capacity in gallons
PERMIT NO,
Distance between lines
Total effective absorption area
3?6
PERMIT NO.
Tote] effective absorption area
Nearest lot line
Septic tank
Distance to lot line
PIPE MATERIALS
Pb
SOl L TEST Ri&TING
INSTALLER
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78}
F'ERMZ T NO.
F!PPL. I E:RNT
LOC:FIT ~ ON
LEGRL
[)EPFIRTM~'~T NEBLTH FIND EN'v'ZRONMENTRL, 'tOTECT!ON Oum&
, 8~:5 "'I~~ STREET. F, NPk ']R'FIGF- Flk' '~':,~'~~ ~' ~ ~'/
' ;....?: ......................
/
DFIS,'ZE:, Fl. LRGFIE:,Z ]:2:]:0 RR'f'iC BL',,,'D.., ,~--1 :[~2: :,.=,g
Sr7T'H FI',/E.
L7 B:t. St..If,lf,l~"l" ESTATES S,'E' LOT '.SIZE: J..Tt:L25 SQUARE FEET
..... :,T~H TR:ENCH
TYF'E OF SOIL RB':_']ORPTtZN ':'-"" '"' iS;:
b'IRXZMUM NUME, E.R OF BE[:,ROOMS: = ~:
SOIL RRT'[NG ,'S'J) F:'T?E~R)= -1:::_:5
]"HE RE~::!IjtRED b,t:'E OF ]'HE _,JIL HE,.':,.UR., TIuN SYSTEM IS:
TFtE L.ENGTH [:,IMENSION IS THE LENGT'H -'-'.Ih! FEET) OF' THE TRENCH OR DRRINFIELD.
"['HE DEF'TH OF R T'RENCN OF'. PIT ]:S; THE DISTRNCE BETHEEN THE SURFOC:E OF THE
GROUND FIND THE BOTT'ON OF' THE EXC. FIVFITiON -'.'.'IN FEET).
"rHERE IS NO SET WIDTH FOR TRENCHES.
THE GRR',,,'EL DEPTH tS; THE I'dlNIMUM DEPTH OF EiRR',,,'EL. BETHEEN 'THE OUTFRLL PiPE
RND THE BO"f'TOH OF THE EXC:FIVRTION (IN FEET).
F'ERMIT BF'Pl IF:RNT HI..=, THE R. Ez, F]IbLr:,IE,.[LiT? 'ri..] INFORM 'fHI_, DEF'RRTHENT F:,IIRING ]'PIE
.................. Fi-! ....
iNSTFILLRTION TkJqF'F'-TI-N':4 I]F FlNY HELl c; FI[:,JRBENT TO" f,:: PROPERTY FINE:, THE
N...MBER ]P' RESIDENCES T'HRT ]'HE fiE-- !,I'[LL. SERVE.
,-'"-" E" ....... · ........ · THIS
E:RCKFILLING OF FIN'-? .=,~.= F_I1 HITNOUT FINRL ZNSF'ECTZON FIND
E:,EPRRTMENT HILL BE SUEL_TE']T TO PF.:OSECUTION.
HZNZMUH DISTANCE BETHEEN R 14ELL RND ANY ON-SITE SENFiGE DISPOSAL SYSTEM IS
:t.00 FEET FOR Ft PRIVFiTE !4ELL. OR i.50 TO 200 FEET FROM 8 PUBLIC HELL [:,EF'ENDiNG
UF'ON THE TYPE OF PUBLZB HELL
HINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRI',,,'WTE SEWER LINE IS 25 FEET FIND
'TO Fl COHHUNIT'Y SEWER'. L. tNE IS 75 FEET'.
HELL LOGS FiF.'.'E FREQUIRED FIND MI..IS]' BE RETtJRNED TO THE DEPARTMENT FI~TRIZN :Z;O DFl. YS
OF THE HELL COMPLETIOf,L
OTHER REQUIREMENTS MAY FlPPLY. SPEC:ZFICRTIONS FIND CONSTRLtCTtC~N DZFIGF..'Flr'!S RRE
W,/RZLFIBLE TO INSURE PR:OPER .INSTRLL. FITZON.
I CERTIFY THRT
±: IRM FRMILIFIR HZ[TH THE REQUIREMENTS FOR: ON-SITE SEHERS RND P.iELLS FlS SET'
FORTH BY THE MIJNICIPFiLIT'¥ OF RNCHORRGE.
2: I WILL IN~"f'RLL THE SYSTEM IN RCCORDRNCE HITH THE CODES;.
]:: I UNDERSTRND THRT THE ON-SITE SEHER SYSTEM MRY REQUIRE ENL. RRGEMENT IF THE
RESIDENC:E !S REMODELED ~I',,CLLIDE MC, RE 'rHRN ]: BEDROOf'IS.
lES E[' E:'~ ..................... DM] ...... V4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82§ L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~SOILS LOG
[] PERCOLATION
TEST
PEREORMEO EOR: ~AO
LEGAL DESCRIPTION: ./~, ¢"}'7-
3
4
7
13-
14-
15-
16-
17-
18-
20-
SLOPE SITE PLAN
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading ,Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
· CERT,E,ED;¥: /)
72-0O8 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
AppLication Date.
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
P[ope~y O~ner' ' ~ Telephone: Home Business
Mailing, Address
(b)
(c)
(d)
Lending] In~{!tutio,h '~.
Mailihg Add r?.s '
Telephone
Real Estate Compar~' an~l Agent
Address
(e)
Telephone ~'¢~- ~(
Mail the HAA to the followina address: or; Check here I~, if hold for pick up.
List contact person arid day phone number below.
TYPE OF RESIDENCE
Single-Family'J~
Number of Bedrooms"
WATER SUPPLY
Individual Well ,~/, Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environ mental 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 legalit, y and status.
Page 1 of 2
72~025 IRev 8/861 Front
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 ~his Heaqth
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 ,/~-"'/---~ff Telephone
DHHS APPROVALs__ ~
Approved for ...~._ bedrooms by Date
Approved ~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
oertificates 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.
Page 2 of 2
72-025 fRev 8/86) 8ack
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
072
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
t
Property Owner/~/~¢'~- :/~/~"~.¥ Telephone: Home
Mailing Address ' '
Business
Telephone
(b)
(c) Lending Institution
M~iling Address
(d) · Real Estate Company~and Agent
Telephone
(e)
Mail the HAA to the followina address: or: Check here ~1, if hold for pick up.
List coqtact person and day phone number below·
TYPE OF RESIDENCE
Single-Family J~'
Number of Bedrooms
· 3.
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 Environ mental Conservation
attesting to the legality and status.
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 Municipafity 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 ,~ ~-,c $ ~-.4"-. Telephone ~'/""-- J~ ¢-' 4;~
Address /°~-O~) /~) '~.~ '~-d/ '~ t S~' ,~
DHHS APPROVAL
Approved for ~ bedrooms by
Terms of Conditional Approval
CAUTION
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 D H HS 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.
Page 2 of 2 72-o25 trey 8861 Sack
MUNICIPALITY OF ANCHORAGE (MOA)
..... ~.u~RAG~EALTH AUTHORITY APPROVAL (HAA)
~uN~CIPALITY Or' A~~'~'-''~ ' CHECKLIST - FEBRUARY 1984
~.NVi~oNMENTAL SERVICES DIViSIO? 264-4744
r E B 1 ! 1BBB
WELL DATA RECEIVED
Well Classification ~r-[ u ~- ~
Well Log Present
Total Depth /O -~7 Cased to
If A, B, C, D.E.C. Approved (Y/N)
Static Water Level ['~, ?--
Casing Height Above Ground
Electrical Wiring in Conduit~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Date Completed ,/o,/'~/~'~ Yield
/~ 2 Depth of Grouting /d//~
Pump Set At 4z ~,~,-~
?, .~-/ Sanitary Seal on Casing(~N)
Depression Around Wellhead (Y~
To Nearest Edge of Absorption Field on Lot
To Nearest PubLic Sewer Line
Cleanout/Manhole /J
Water Sample Collected by
Water Sample Test Results ~'~ ~:,,',,~
; On Adjoining Lots
/O ~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
; Date
~,~F~-. ~.~ ,~/~.
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ..:Z,//
Standpipes~N) Air-tight Caps ~"~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size / ~P L~ ~rO NO. of Compartments ~-
Foundation Cleanout (Y/~
Date Last Pumped :~'~
; for ,"J.'"/""/-
Temporary Holding Tank Permit (Y/N)/c//'/~
,/
To Water-Supply Well ,/'D~ To Building Foundation ~'
To Prope~y~ I~ii~c~'" ,~:r~.,.~ ~ ~-~ To Disposal Field /~ _
To Wa~er~Ma~n/Se~ ~:' ' '~: ' '~ce.~ ~ '"~'~e ~. ~ ~ '~o To Stream, Pond, Lake, or Major Drainage
Pagel0f~-'' ' '~: :' '"
72 026 IRev 81861 Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ,-2~//~/
Width of Field c~ /
Square Feet of Absorption Area ~ ~
Depression over Field (Y~4~
Results of Last Adequacy Test ~c¢/~¢u-'-
Separation Distance from Absorption Field:
To Water-Supply Well /"D [') ~'
To Building Foundation -~ /
Lot /L) ~,-'~
To Water Main/Service Line ~ 2¢ /
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field '-r/ P /
Depth of Field ~'!~: :i!
Gravel Bed Thickness ¢ /* , ·
Standpipes Present ~:)/N)
Date of Last Adequacy Test
To Property Line /'~'
To Existing or Abandoned System on
; On Adjoining Lots ~ ¢¢'~"
To Cutbank (if present) /,.,r / /¢
Comments
D. LIFT STATION
Date installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments ~"
Dimensions ~-
Manhole/Access (Y/N) ~
"Pump O~f~U~
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I~h~d _verified, 9r gonformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'~'/ Date ¢¢7,/~//~¢ ~ ___
Company ,~¢:"~'-~'./) MOA No.
Receipt No. ./~:~ ~,.'~../
Date of Payment
Amount: $ /
Page 2 of 2
1. General Information
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATIO. A=HO ITY P OVAL
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name =go~ ~~ Telephone - Home Business
Applicants ~dress ~ ~1 ~ 97 ~
(c) Applicant is (chec~ one) Lending Institution ~; ~er/~ ~ ;
Buyer ~; Other ~ (explain); ~
Address ~ / ~ ~O D~ '~ I T~ I O 7
(e) Real Estate Co. &Agent C~ ~ S~ ~ ~~
Address ~0~0 ' 0[~ C~
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single-Family..~_.
Number of Bedrooms
3. Water Supply
Individual Well~-~
Multi-Family~
Other (describe)
Community~ Publie F-~.
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewase 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 i of 2]
Engineering Firm Providin$ 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 investigatiou 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 aud 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 7A&~'; ~79~'~--~-~ "~ Telephone
Address ~.~ o~' ! 5 ~
(ENGINEER SEAL) -.., ........ '~
DHEP Approval /] ¢ 1(~.. JUNE 25, 1971 ·
Approved for ~ bedrooms By ~ ~~'~.,D~,.~,%...~./~/~/c~
Approved .~ Disapproved Co~ltton~
Terms of Conditional Approval
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 ALASKA. 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)
RR¢/ej/gt8
[Page 2 of 2]
7-19-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
~LL DATA
Well Classification
Well Log P~esent (Y/N)
Total Depth 1 o 7 Cased to
Static Water Level ~ ~
Date Ccmpleted
Legal Description:
If A, B, ~ C, D.E.C. ~p=o~d(Y~)
~pth of ~outing
Sanit~y ~al on ~sing (Y~)
~essi~ ~ound ~l~ead (Y~)
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f~c~a Well:
To Septic/Holding Tank on Lot ~ O ~ ; On Adjoining Lots '//
To Nearest Edge of Absorption Field on Lot ~gO.~.~-; On Adjoining Lots /~
To Nearest Public Se~= Line ~ To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected By
Water Sample Test ~sults
Cc~rre nts %% ~ ~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~_.]~ [q~,, Size !~O
Standpipes (Y/N) ~7~/O Al-w-tight Caps (Y/N) ~
Depression over Tank (Y/N) ~ Date Last Pumped
No. of Cc~pa~tmsnts
Foundation Cleanout (Y/N)
Pumping/Maintenance Contract on File (Y/N) ~//~( ; for ~/ /A
Holding Tank High-Wate~ Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) ~%//~
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well [ 0 ~
To lhroperty Line ~0
TO Water Main/Service Line ~//%
course lxl o '
To Building Foundation ~
To Disposal Field ~G
To St~e~, Pond, Lake, c~ Major D~ainage
Conlnents
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ ~-. ~ ~, ~ O_
Width of Field ~ ~
Squa=e Feet of Absorpt'ion A~ea ~ 7 ~
Depression over Field (Y/N) ,~q
Results of Last Adequacy Test
Type of System Design
Length of Field CF
Depth of Field
Gravel Bed 'I~ickness
Standpipes Present (Y/N)
Date .of 'Last Adequacy Test
Separation Distance frc~ Absorption Field:
To Wate=-Supply Well
To Building Foundation
Lot ~,! O IV ~
To Water Main/Service Line
To Stream/Pond/Lake/c~ Majo= D~ainage Course
To D~iveway, Pa~king A~ea, c~ Vehicle Sto~age A~ea
Co, ants
~ ~ To Property Line
20 To Existing or Abandoned System cn
; On Adjoining Lots
~OtV~ To Cutbank(if present)
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Lavel at
Tested fo~
Electrical Codes(Y/N)
Co~ents
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Pe=mitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, c~ confo~rN~d to all MOA HAA Guidelines in effect
on th~ date of this inspection.
si ed
Company
MOA No. ~'~ ST-O t (
KB1/d5/s
[Page 2 of 2]
2-15-84
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
NANCY SWANSEN
CENTURY 21, SLEEPER
8050 OLD SEWARD HIGHWAY
ANCHORAGE, ALSKA 99503
OCTOBER 17,1984
RESIDENTIAL
WELL
INSPECTION
LEGAL
Lot 7, Block 1, Summit Estate
LOCATION
5521 E97Th.
OWNER
Robert and Debra Bingham
TYPE OF WELL
Residential
ELL LOG AVAILABLE
Yes
INSTALLATION REQUIREMENTS MET
Yes.
WELL YIELD FROM WELL LOG 5 gpm.
PUMP YIELD
8.5 Gallons per minute.
DATE OF TEST
October 16, 1984
TEST PROCEDURE
On October 16 the well was pumped at a
rate of 8.5 gpm. for a total time of 65
minutes. A total of 500 gallons was
pumped.
TEST FOR COLIFORMS
The well water was tested for Coli-
forms. Test was negative.
TEST RESULT
The Municipal requirement for wellflow
is 150 gal. per bedroom per day. This
well surpasses this requirement.
The assessment of the condition of this
well applies only to the conditions as
of this date. The flow rate of the well
may change due to subsurface conditions
that may not be observed from the sur-
face, changes in land use and other
factors that may impact the conditions
of the aquifer feeding the well.
CONSULTING ENGINEER
203 W. 15th AVE 'C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
NANCY SWANSEN
CENTURY 21, SLEEPERG
8050 OLD SEWARD HIGHWAY
ANCHORAGE, ALASKA 99503
OCTOBER 1~,1984
SEPTIC
LEGAL
SYSTEM ADEQUACY
LOT 7,BLOCK 1, SUMMIT ESTATE
TEST
LOCATION
5521 E 97TH.
OWNER
ROBERT AND DEBRA BINGHAM
RESIDENCE
SINGLE FAMILY, THREE BEDROOMS
WATER SYSTEM
ONSITE RESIDENTIAL
SEPTIC SYSTEM
DATE OF TEST
FROM MUNICIPAL RECORDS:
TANK: 1000 gal. Greer, Two Compt.
ABSORPTION SYSTEM: Trench,9 ft. deep
47 ft. long, 4 ft.of rock.
ABSORPTION AREA: 376 sq.ft.
SOIL RATING: 125
INSTALLATION DATE: Aug. 1975
10/16/84
TEST PROCEDURE
TEST RESULT
~-.~L~
'.?
System was inspected on August 29, 1984. Tank
had 17 inches of clean fluid in it with no
sludge buil up. The sump to the trench had 10
inches of ~ater. The resident was vacant. An
attempt was made to pump the tank,however the
tank was so far down hill from the nearest
accesspoint for the pumptruck that suction
could not be maintained. A portable sumppump
will be required to pump the tank.
On October 16 the field was charged with 500
gallons of water. The field was dry at the
start of the test. With the addition of 500
gallons of water to the trench the water
depth in the trench rose to 28 inches. With
in 6 hours all the water had been absorbed.
This system meets the absorption requirements
of the Municipality. A portable pump must be
used to pump the septic tank.
The operational life of all septic system
depends on the local soil conditions, ground-
water levels that may fluctuate during the
year, and the water usage of the family being
served by the system.
i APPLI~_~NT FILLS OUT UPPER HA~· ONLY
Prdpeay~Jw~Jr~F~V t I) ~ ~ ~ ~ ~ ~ ~ ( Phone
Buyer
Lending Inslilulion Phone
Address :~ 0/0 ~X~¢' ~ Zip Code
~8ingle Family
Water Supply
~lndividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~lndividual Year Individual Installed: ~/~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time G
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
~)~ ,,~ ENVIRONM~NiA,. b;~O,ECTION'
RECEiVEI)
( _d'APPBOVED BEB~OO~S 'CONOmO~S OF APPROWL
( ) ~SAPPROWO
( ) CONDmONALA~P~OVAL'
72.023
Time Time
Date Date Date
Inspector Inspector Inspector
Comments Condit ionaQ~_p proval~)/~
Date Sewer Installed ~ ~ Permit No. Septic Tank. Size
Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
We~l to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~ ~/~t' Phone
Mailing Address ~ A ~ ~
Buyer
Address ~ ~ ~
Lending Institution /~,~ ~ ~ ~P~ j~ ~/~ ~hono
Realty Co. & Agent ~ Phone
/
ke~al Dos~ript[on
Type ~ Residence
~SJngle Family
~ Multiple Family No, of Bedrooms
Q Other
Watff~Supply
~ Individual A~ACH WELL LOG, A well Icg is required for all wells drilled since June
~ Community 1975. For wells drilled prior to that date, give well depth (attach Icg if
~ Public Utilit~ available.)
Sew~ Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Ho~ding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
January 27, 1982
David Lagadi
3330 Arctic Blvd.
Anchorage, AK
Subject: Lot 7, Block 1, Sun, nit Estates
Dear Mr. Lagadil
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° A well log submitted to this office for our files and
review.
The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our revie%~.
The permit for the installation of the on-site sewer system
expired December 31, 1981. We have not received the as-
builts of the installation in this office. If a private
~ngineer inspected the system, please send us the report
for our files and review.
Please notify this department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Robert C. Pratt
Associate Environmental Specialist
MUNICIPALITY OF ANCHORAGE
c�E`'A�
Development Services Department r Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-072-25
1. GENERAL INFORMATION
Expiration Date: i ® ` l q
Complete legal description SUMMIT ESTATES BLOCK 1 LOT 7
Location (site address) 5521 E 97TH AVE, ANCHORAGE, AK, 99507
Current property owner(s) KATHY MORRISON & FEIGIN LIVING TRUST .... Day phone
Mailing address
Real estate agent
5521 E 97TH AVE, ANCHORAGE, AK, 99507
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
—Private -Well
Private -Septic
N
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment
Receipt Number
COSA# 0 S c.22 13 1
Date:
Waiver Fee $
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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/28/2022
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 of a�sll�
these various and dynamic characteristics and are outside the control of the evaluator of the l
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or j g•• •9 ��
discrepancies exist can be given by First Water Consulting &FWC5 ' *• 9TH •'*
.. .......
6. DSD SIGNATURE �••• •••' ••''�/
• • Curtis Huffman
System #1 Approved for bedrooms ��,�F��� CE 128991
..aw,��
System #2 Approved for bedrooms �ikkF, PROF SSt0x�+~
Disapproved
Conditional approval for bedrooms, with the following stipulations:
OF
By:
e
Original Certificate Date:
viv-Jf I C
n �
M
WATER AND
t'�—o
PROGRAM
-
6
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
Legal Description: SUMMIT ESTATES BLK 1 LT 7 Parcel ID: 015-072-25
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 10/1/81
Total depth 107 ft
Cased to 107 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 5/10/21
Static water level at beginning of test 39 ft.
Comments
B. TANK DATA
Age of tank(s) NA — NEW TANK years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank NA
® Standpipes/foundation cleanout per record drawing
Date of pumping NA
D. ABSORPTIONFIELDDATA -- --
Which system tested (date installed) 2/1/82
® ALL standpipes present per record drawing
Total measured depth from grade 6.8 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field
Well production at time of test 4+ gpm
Water storage tank volume _NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 5.27 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
WEE
Collected by=
Date of Sample 5/16/2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments: 1500 HDPE GREER FOR FLEXIBILITY
Adequacy test date 5/10/2021
Results ED Pass For 3 bedrooms
Fluid depth prior to test 21 in
Water added 450 gal
New depth 37 in
❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1 n min
depth into effective 3.3'ED OF 4'ED MOA
® Code -required soil cover over field Final fluid depth 20 in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: MT/CO AT GRADE / PERF - FIELD OPERATING IN THE TOP / MIDDLE OF THE ED.
NES
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
❑ Yes
if No *7+
Septic Tank/Lift Station on Lot > 100'
Surface Water > 100'
® Yes if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes
® Yes
if No
ft
® Yes
if No
ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No *85+
ft
Holding Tank > 100' ® Yes
if No
ft
Neighboring Absorption Fields >-100'
ft
If septic tank is under driveway comment below
--Animal Containment > 50'- -- ® Yes
if No
ft
® Yes
if No
ft
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No *2+
ft
Manure/Animal Excreta Storage > 100'
Water Main > 10'
Community Sewer Main > 75' ®Yes
if No
ft
® Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No *7+
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Main > 10'
® 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'
® Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No *2+
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells >' 100
_
®Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*MOA WAIVERS WITH THIS SUBMITTAL.
G. ENGINEER'S CERTIFICATION
l certify that l 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.
AQW or -
TM .
.. .. .... .........•
Gurtis Huffman
I G'�,p •. CE 128991 �c�®rp►�
ko�Essia P`� AW
1�°pR'""
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221321
Subdivision: Summit Estates Blk 1 lot 7
A water sample revealed a nitrate concentration of 5.27 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P O Box 196650'*'-horage, Alaska 99519 6650 *www mum org e;