Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SKYLINE VIEW BLK 1 LT 9
5 kyli*ne View Block 1 Lot 9 #051-192-46 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191219 PID Number: 051-192-46 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New E/ Upgrade Name Jessica Moreland ABSORPTION FIELD O Deep Trench ❑ Wide Trench ❑ Bed ?,_-1 Mound Site Address 19373 Lupin St, Chugiak ❑ 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 -X- -5,3- , Ft. Subdivision Block Lot Skyline View 1 9 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 Holding Sewer Lift Station Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100' TANK 0 Septic C S.T.E.P. ❑ Holding Other Manufacturer Infiltrator Capacity 1060 Gal. _ Surface Water 100, Material Number of compartments Lot Line 10'+ NA Plastic 2 Foundationj 10'+ LIFT STATION Manufacturer Capacity Gal.� Remarks # Ing .�a ,. 1, --! � �1 ' e a.�- `i'"�iYl Alarm location Electrical installed by PIPE MATERIAL House to tank Tank to drainfieldDrainfield Installer Dean's Construction CO/MT Inspector ArcTerra Consulting BENCH MARK (Assumed elevation) 100.00 ft Inspection15 7/1 /19 7/5/19 Location and description tes. 2�d _ Porch doorway 3rd 4t ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: DateP.• .. �, � '• `ter' 9 io ���55 �•E•a#,•i Vttili#•#tf a#r#1 siSiiMA•� E!!'t Yi.Wff.t4sf.Yaaals.t . a st.f9i� �}tti� ';KEitJETH M. us!,err .—_—__....._._ ._._...__.._____...._......... ____..__._____._...—__.................... _..._ Septic System ,J ��,► Approved t.. =-a�v� i\ Date 7-- L� ;. CE z :/Ar ��`F..,'-.,7s, Note: this approval does not include well permit requirements.* lam+ •�4 (Rev 05/02/18) AS -BUILT SYSTEM DETAILS/SITE PLAN SKYLINE VIEW BLOCK 1 LOT 9 A -C=28.9 B -C=28.4 A -D=28.8 B -D=32.5 A -E=30.8 B -E=36.8 A -F=46.0 B -F=62.9 O M Z Z: EXISTING COMPUTED: BOUNDARY: N A HOUSE STAKING: N A CHECKED: KMD ASBUILT: — DATE 7/05/ Ld co GRID: NW115 00o° m i— r7 14.8' Fa O O J (n Q M o O /GRAVEL O 0 O v SCALE: NTS )01 * 4914 * � / KENNETH M, S / �sr) CE -71 140, Ar \ -%OFESSI01Ol Aw \\a_%.� & SEPTIC - WELL NEW 1060 TANK B L K 1 =100' B 0 BGG .0, 1 A ,. Permitl❑SP191219 PID# 051-192-46 1060 GAL SEPTIC TANK PREPARED FOR: JESSICA R. M❑RELAND 19373 LUPIN ST. CHUGIAK, AK (970)-209-9463 FIELD BOOKS COMPUTED: BOUNDARY: N A DRAWN: KSD STAKING: N A CHECKED: KMD ASBUILT: — DATE 7/05/ DWG. FILE GRID: NW115 ACAD FILE: FILE JOB No.: 19030 ptx SCALE: 1' = 30' SCALE: NTS MUNICIPALITY OF ANCHORAGE ,,,c n r On-Site Water&Wastewater Program ��� �' 'S;• PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 • • y httpa/www.muni.org/onsite Dcpartntcnt y( Ip On-Site Wastewater Disposal System Permit //y Permit Number: OSP191219 Effective Date: 6/17/2019 Work Type: SepticTank Upgrade Expiration Date: 6/16/2020 Tax Code Number: 05119246000 Site Legal Address: SKYLINE VIEW BLK 1 LT 9 G:1159 Site Mailing Address: 19373 LUPIN ST, Chugiak Owner: MORELAND JESSICA R & Lot Size in Sq Ft: 13942 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 October 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: (, to/ r • Date: 4 B / / ''/ loll 19 Issued By: dtk $ I� Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water&Wastewater Section - Fax: -34339 ii c‘,4)k4111e4& 4).5A ix ON-SITE SEPTIC/WELL PERMIT APPLICATION a .;. of 7 a Parcel I.D. 051-192-46 e hs, Property owner(s) Jessica Moreland & Joel Karinen Day phone Oi 6 8 L 9 Mailing address PO Box 670622 Chugiak, AK 99567 Site address 19373 Lupin St, Chugiak Legal description (Sub'd., Block & Lot) SKYLINE VIEW BLK 1 LOT 9 Legal description (Township, Range & Section) Lot Size 13,942 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 (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: 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: Q a b Waiver Fees: Date of Payment: (0/W19 Date of Payment: Receipt Number: '# a 3$533 Receipt Number: Permit No. QSPf4i 9-1q Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc ti+.RcTER,3. f �i ARCTERRA • CONSULTING, INC 'b i 1 20441 Ptarmigan Blvd,Eagle River,AK 99577 '*=;;- �,t. Office(907)696-6111,Fax(907)868-3793 ULTI NG• 0i f4' w.V95i)-43 June 7, 2019 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit- SKYLINE VIEW BLK 1, LOT 9 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will replace the existing 3-bedroom permitted septic tank for this 1-bedroom house. There is no surface water within 100' of the proposed tank. There are no Private wells within 100'. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 696-6111/FAX 868-3793. Respectfully submitted, ArcTerra Consulting,Inc. 7/./,,,,.. ?fi. Kenneth M. Duffus, P.E. Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 • I N89°40X11"W 178.89' _ _ (N89'53'00"W 180.00' R) _.,, ,, •Y-Y--Y-X-x-x X-X-x ---x • / 10' UTILITY EASEMENT CONTRACTOR TO VERIFY SEPARATION \ DISTANCES TO WELLS, PROPERTY LINES, ETC. . . cr PRIOR TO INSTALLATION ; - � � LOT 9 BLK 1 z ,--- EXISTING \ E HOUSE , . Q _ 0' ,, • lit co O�‘ 0.`-7 -o• Of No CO m LID •� • 'tj� 0I'-- La_ M 14.8' \()) FO ° ''\'76°. �y// �, /i \. rLQ: Q. 0' J cn o<Q 9/ mo x• Ix o ,-0.O �� O a tx • O GRAVEL L� , Z D/W ` el • 6titi L 5.j8, C . Ll I Reqs s 1. Decommission existing septic tank per code. / 00 ¢?%, 2. Install new 1000-gallon septic tank with two post-tank cleanouts per code. 3. Install cleanout at connection with septic line. 4. Tank to have min. 20" manway riser. H W 5. Maintain 10'+ from foundation &existing field. p, WI 6. Maintain 100' + from private water wells. 12 NOTES i— ri-IHI kJ 2 No wells on adjoining lots are within 100' of proposed tank placement. No surface water noted within 100' ANCHORAGE RECORDING DISTRICT,ALASKA of proposed tank placement. ASBUILT OF: pQ =END 5/8"REBAR SKYLINE VIEW ESTATES LOT 9 BLOCK I PLAT P-508 _ _ , . .......-.NN SURVEY SURVEY CERTIFICATE:1,John L.Schuller,Have conducted a i U[' .�44\ physical survey of this property as shown on this drawing and that the /,� ' S' 1 improvements situated hereon are within the property lines and no • /cS "_ enchroachntents exist other than noted.Under no circumstance should =! * ' any information on this drawing be used for construction of fences, ' * 9 Ti * RC T]'.)(�)<��1 structures,improvements,or for establishing boundary lines. �/'f� rI CONSULTING, INC EXCLUSION NOTES:It is the owners responsibility to determine 4 •. KE\nETH 1. / 20441 Ptarmigan, Eagle River. AK. 99577 the existence of any easements,covenants,or restrictions which 7i i s �' / Office(907)696-6111, Fax(907)868-3793 do not appear on the recorded subdivision plat. 1 k�!;r1r �.I/as+c.4'Ae WORK OROER NUMBER: : sate E-10.11, \ 174)Ti S ('' whMAY 14, 2014 1`=30' 14-018 N«BY:o$coaa ER'GtOO NUMBER: BOCK PACO 1k\\r ..LS NW1159 140131 MUNICIPALITY OF ANCHORAGE DEPT. OF ~: ":~ MUNICIPALITY OF ANCHORAGE ENVIROF:h'E ] CTION 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 INSPECTIC~J~EcP~?~/E MAILING ADDRESS LEGAL DESCRIPTION LOCATIONZ U ~/~/~' Well Absorption area Dwelling PERMIT NO. Material ~ No, of compartments ~ Z Manufacturer ~~ ~ ~- ~ · ¢ Liq, capacity in gallons Inside length Width Liquid depth / ¢¢¢2 IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation/ Nearest lot line PERMIT NO. ~ ~ ~ No. of lines/ Length of~/each~ line/ Total lengt~ of~ lines/ Trench width//~ inches Distance between/¢/~ lines ~ ~ ~ Top of tile to finish grade Material beneath tile Total effecti(e absorption area ~ ~f~ ~ inches ~ ~, ~-~ ~ Length ~idth Depth PERMIT NO. ~ Type of crib , Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: M Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~PIPE MATERIALS . .... INSTALLER / REMARKS / / APPROVEw /) ) DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. DEPFIF.'.TMENT OP' HEI~3LTH FIN[:, EN',/):RONMEN'¥SL PROTECTION 825 'L" STREET, RNC:HORRGE, BK. 9958:L 264-4728 790407 > RPPLICRNT LOCRTION LEGRL R.L. PELL. ISSIER L9 Bi SKYL. INE: VIEM PO BOX i46 CHUGIRK L.OT SI;gE TYPE OF SOIL. F~BSORBTION SYSTEM IS: TRENCH MR>~IMUM NUMBER OF BEDROOMS i9000 SQt]RF.:E SOIl. RFITING ,::SQ FT/BR)= 05 THE REQUIRED SIZE OF THE SOIL. RBSORPTION SYSTEM IS: THE L.ENGTH DIMENSION IS THE LENGTH ,.'.'IN FEET) OF THE TRENCH OR [)RRINFIEL.[:,. THE DEPTH OF FI TRENCH OR Pier Is TI4E DISTFINCE BETMEEN THE SURFRCE OF THE GROUND RNf...., "rile BO'f'TOM OF THE EXCRVRTIGN ,:;IN FEEl'). THERE IS NO SET WID'FH FOR TRENCHES. .~RMcEI_. BETHEEN THE OUTFRLL F'IPE THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF R ,-~,- RND THE BOTTOM OF THE EXCFIVRTION ,::IN FEET.'.,. PERMIT RPPLICFINT t4FIS THE RESPONSIBIL. IT'¢ TO INFORM THIS DEPFtRTMENT [:,URING 'rH[~.: I NSTRLLFITION INSPECTIONS OF RNa' WELLS R[:,JRCENT TO ]'l--I IS PROPERT'¢ FIND, THE NUMBER OF RESIDENCES THRT THE HELL HILL SERVE. E:FiCKFILLIN6 OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVBL B"r' DEPFIRTMENT NIL[.. BE SUB..TECT TO PROSECUTION. MINIMUM DIS, T~NCE BETHEEN R HELL FIND RNY ON-SITE SEHFIGE DISPOSFIL SYSTEM IS ¢.00 FEET FOR R PRIVRTE WELL.~ OR i50 TO 200 FEET FROM R PUBLIC HELL [>EPENfDDIN6 UPON THE TYPE OF;' PUE:I..IC HELl OTHER REQUIREMENTS MFI¥ RPPL.¥. SPECIFICRTIONS FIND C'ONSTIqUCTION f.':,IRGRFIMS RRE 8',,,'RILRBLE TO INSURE PROPER IN2gTRLLFITION. I CERTIFY THRT d.: IRM FRMILIRR HITH '¥HE REQUIREMENTS FOR ON-SITE SEHERS FIN[:, ~,.IEL.I_S RS SET FORTH B'¢ THE MUNICIPRLITY OF RNCHORRGE. 2.: I HILL INSTRLL THE S~'STEM IN RCCORDRNCE WITH 'rile CObES. .~ ,. , c., ~. ~, RE~ IRE bNLRR..~EMENf ~F' THE ?' I UNDERSTRND THRT THE ON-SITE RESIDEN~ REMO[>E~O INCLUDE MORE THRN 3: BEDROOMS. -RPF'L ~ L. MNT R. b O & E ENL~INEERING & DEVELO,MENT CO. Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: SOIL LOG Name: Mailing Address: Legal Description: Earl Ellis 688-2280 Tel. No ~r' ~¢¢~ Depth (feet) Soil Characteristics 0 1__ 2__ 3__ 4__ 5__ 6__ 7__ 8__ 9__ 10__ PLOT PLAN 11__ 12__ 13__ PERC. TEST 14__ 15__ 16p Ground Water Encountered: Yes No / If yes, what depth Proposed installation: Seepage Pit.__ Drain Field.__ Comments: Performed by: DEPRRTMENT OF HERLTH FtND ENYIRONMENTFtL Pt;:',O'FEC:TION 825 "1.." STREET, F4NCHOF'.RGE, RK. RF'PL~C:f~NT R, L. PELL, ISS~ER L.OCRT ~ 0~',1 LUF' ~ NE LEGffiL LD B~ 5K'¢L~NE V~EH PO E,u~s.'L4~'~, CH JGIFIK, . LOT SIZE ~0000 ~ ~ : ........ , ..... FEEl' MINIMUM DISTANCE BETHEEN A HELL AND RNY ON-SITE SEHRGE DISPOSFIL '.-:,'¢STE'."M IS ;].00 FEET FOR fl PRIVRTE HEI..L~ OR ~50 TO 200 FEET FROM ~ PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HEL.I_. HELL. LOGS RRE REG~UIRED RND MUST BE RETURNED TO THE DEPRRTMENT 14ITNIN F¢0 DRYS OF THE HELL COMPLETION. O"I't4ER REG~UIREMENTS r. IR'¢ FtPPL¥. SPECIFICBTIONS AND CONSTRUCTION DIRGRRhlS RRE Fi',/RILRBL. E TO INSURE PROPER INSTRLLR]':[ON. I t..Ef .T I I'HRT t.: I RM FRMIL. IRR HITH TNE REg~REftENTS FOR Of4--~TE _EHE~._ RND HEI..LS RS SE:T FERrH B'¢ THE I1UN~_~FI'IL~TY OF RNC. Hu~R~E. 2: Z HILL [NS~.L THE~EM ~N RCCORDRNC:E H~TH THE CODES. S ~ 6NED: .... ~.- u56� 8 Q 70�l Municipality of Anch®r�ag JUL 1 7 2019= On -Site Water and Wastewater Program �� z (907) 343-7904 A F !`�� 8 gC> CERTIFICATE OF ON-SITE SYSTEMS APP RO6 � - Parcel I.D. 051-192-46 Expiration Date: 1. GENERAL. INFORMATION Complete legal description SKYLINE VIEW BLOCK 1 LOT 9 Location (site address) 19373 Lupin St. Current Property owner(s) Jessica R. Moreland ` Day phone Mailing address 19373 Lupin St. Real Estate Agent Day phone 2. TYPE OF DWELLING ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well Holding Tank ❑ Ind.ividual'Water Storage ❑ Community Community Class = Well- ❑ Public Sewer El Public Water System El Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Waiver Fee $ Date of Payment ljig Date of Payment Receipt Number Receipt Number COSA # 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date -_7 7 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future All, occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. _Z Tii� k 6. DSD SIGNATURE System #1 Approved for bedrooms. �1 '\NE'H71"6 us �.1001 System #2 Approved for bedrooms. r\r�o 2 7 < Erli Y pp � � =" Disapproved. Conditional approval for bedrooms, with the following stipulations: VX ON-SITE zV G? r WATER r ND WASTEWATERz� _ PROGRAM `cam J'!�� FNT ���►�r�rG ��. 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: C„t COSA Checklist X_ Nitrate Advisory ' • �" Septic System Advisory Arsenic AdviseT .' c; `! Well Flow Advisory Other ti, r.,• r r COSA blue sheet 10-10-12.doc Legal Description: COSA Checklist Skyline View Block 1 Lot 9 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 11/13/79 Total depth 180 ft Cased to 180 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 36 in. Date of flow test for COSA 6/6/19 Static water level at beginning of test 162 Comments B. TANK DATA ft. Age of tank(s) New years Tank type/material Septic/Steel Measured operating fluid level in septic tank NeNv IN Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 11/11/79 ALL standpipes present per record drawing Total measured depth from grade 7'9 ft (max) Measured depth to pipe invert from grade 4.4 ft (min) ❑ N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-192-46 Structure served by this system 1 Well production at time of test 5.1 gpm Water storage tank volume gallons Well di infected for coliform test? ❑ Yes No [Coliform bacteria is Negative Nitrate � -& mg/L ❑ Nitrate less than MRL (ND) Arsenic _1W ug/L ❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 6/fs tV— 7/?//,? C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/6/19 Results Q Pass For 3 bedrooms Fluid depth prior to test '0 in Water 450 1.r agal New dept1. ` 16 i hn Elapsed time 90 min Fi Code -required soil cover over field nal fluid depth 0 in F-1Systempresoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) 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) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft 7 Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No. Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: if No ft Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft ft ft ft ft ft ft ft ft ft ft F. ENGINEER'S COMMENTS Lca-"- Id C.D. ("ftsled Q.4- 4;"e2aX I-au,k tns4ail 7-1-19. Xe -a suye,ol e Fteaitt've, ale-otk �,,5' f G. ENGINEER'S CERTIFICATION / 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 i' -49IL' ;.KEtiwETH M. ak- l"Ilitrate Advisory Certificate of On -Site Systems Approval # OSC191312 Subdivision: Skyline View, Block: 1, Lot: 9 A water sample revealed a nitrate concentration of 6.86 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. 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. AINCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: SKYLINE VIEW ESTATES LOT 9 BLOCK I PLAT P-508 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used ibr construction offences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. I JULY 18, 2019 1 1-=30' 19-063 DRAM EFY:16FEOK_E�DBY I GRID NUMM: JLS I NW1159 190127 @ = FND 5/8" REBAR S LANb upv loll t7' U"l . n 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax N89'40 11"W 178.89' (N89°53' "W 180.00' R) 10' UTILITY EASEMENT rre MHO LOT 9 SEPTIC VENT BLK 1 EXISTING (tp) F,- HOUSE 6 < .01 00 CO (_0 LL 14.8 .SF 0,' 0 0 FJ5 < CE) 0 0 y. P 0 PAVED D/W L= .38, WELL R LOT 10 AINCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: SKYLINE VIEW ESTATES LOT 9 BLOCK I PLAT P-508 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used ibr construction offences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. I JULY 18, 2019 1 1-=30' 19-063 DRAM EFY:16FEOK_E�DBY I GRID NUMM: JLS I NW1159 190127 @ = FND 5/8" REBAR S LANb upv loll t7' U"l . n 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax • • GE 9 •"t1;-- e Municipality of Anchorage ya On-Site Water and Wastewater Program � (907) 343-7904 S E T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-192-46 Expiration Date: q 1 1 1. GENERAL INFORMATION Complete legal description SKYLINE VIEW BLOCK 1, LOT 9 Location (site address) 19373 LUPIN STREET, CHUGIAK,AK 99567 Current Property owner(s) CARELY L. IDLE Day phone Mailing address PO BOX 671906, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 1 (3-BR SYSTEM) 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: J1/i/ // / „/ ,, , Date: Co lor COSA to be released to the engineer, unless o requested by the engineer. COSA Fee $ 52h Waiver Fee $ Date of Payment 4`TO Date of Payment Receipt Number GWO 9CID Receipt Number COSA# OfL/ / ( 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. Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/1/17 Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,local soil characteristics,groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen i OF A encroachments,deficiencies or discrepancies exist. v .&T4 r 4• T1i* 6. DSD SIGNATURE ,• � l _��i System#1 Approved for 3 bedrooms. 7.4111 tcE,nr1 71,'6 131., 1 � System #2 Approved for bedrooms. 'o // n6oFESSIOv Disapproved. Conditional approval for bedrooms, with the following stipulations: \� iS cep+cc �'G � l� 3 eaN'Sa-0 0(kOc o - z I: 0 pfvccf _� ON-SITE `7, • WATER AND � . n WASTEWATER PROGRAM / ,tea �\. 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 blue sheet_10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist#_of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: SKYLINE VIEW BLOCK 1, LOT 9 Parcel ID 051.192-46 A. WELL DATA Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) Y_ Date completed 11/13/1979 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y Total depth 180 ft. Cased to 180 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 1111311979 5-25.2017 Static water level 50 ft. 166 ft. Well production 5 g.p.m. 5.3+ g.p.m. WATER SAMPLE RESULTS: Coliform NE(r__. colonies/100 mL Nitrate 6.4 mg/L Arsenic: /1/44D ug/L Date of sample: 5-25-2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 11/1111979 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/8/14 Pumper JRs C. ABSORPTION FIELD DATA Date installed 11/11/1979 Soil rating (g.p.d.1ft2 or ft2/bdrm) 85 System type TRENCH Length 43 ft. Width 3.3 _ ft. Gravel below pipe 3 ft. Total depth 8.6 ft. (Measured 5125/17) Eff. absorption area 258 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5125/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 450 gal. New depth 25 in. Elapsed Time: <10 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. i O� A.4.4 ‘ ‘ Engineer's Printed Name KENNETH M.DUFFUS , Date 6/112017 I *c/)4• TF-I A 4111 11P. FiftX4r‘ COSA brown sheet_10-10-12.doc P KENNETH M. ri c 2 �I PAF, 7I 1 , ,G~$4 ,qq, Gas+ oa \moo PROP F.10 a�• _. •� Municipality of Anchorage 7 r ) Development Services Department �� Building Safety Division On-Site Water and Wastewater Program — 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # OSC 171216 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 9 of Skyline View subdivision. This inspection revealed a nitrate concentration of 6.6 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 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. 1 I N89'40 11"W 178.89' (N89'53' "W 180.00' R) — ® Y---Y--Y—Y._._Y_ -Y—Y- 1t—Y—Y-- —X - 10' UTILITY EASEMFNT CC In SEPTIC• LOT 9 VENT M (tri) BLK l 0r z — EXISTING HOUSE o w ` • �Soso, • , 00 o - m 14.8 �9 ,vs, ?O• ^•"s ai Q// 0�• Q O `� x �'Q� J t!1 'fl. C�, 'V (71 be p` m '- ; o Q •Q P �o �``� Q, o GRAVEL 0 �` z D/W I\ 61!L WELL J . 0 Reqs•OGS¢? ,;,. E-4 z ,,, I I p.,,t W LOT 10 i- N Cl) ) ANCHORAGE RECORDING DISTRICT,ALASKA ASBUILT OF: OQ END 518" REBAR SKYLINE VIEW ESTATES LOT 9 BLOCK I PLAT P-508 +���7``` r. SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a .."—.c. OF ,[� �` N.,SAD LANDRsilk physical survey of this property as shown on this drawing and that the .���••• •'•fids ��9\0 Sh'�- improvements situated hereon are within the property lines and no cnchroachrnents exist other than noted.Under no circumstance should Of t-.7.. 40'1 % �# N O�� `:'Gr any information on this drawing be used for construction of knees, t� * 1 .a 7- structures,improvements,or for establishing boundary lines. x n �'C'' EXCLUSION NOTES:It is the owners responsibility to determine i . - I' c �' -`''i` r? I N • OHN L. SCHULLER: o r� = I the existence of any easements,covenants,or restrictions which a,Q. • , �� do not appear on the recorded subdivision plat. I�s IS-10408 ,• 1'00 •..,..,.__�.. woR,t mks NUMBER: DAM SEAM rt-111M, t, ' ` ; ; '• 5;r 1831 Talkeetna Street AIRY 14, 2014 1`=30' ��op `'•l l '�"`` _IS Anchorage, Alaska 99508 114-0�$ ""�' CHECKED°'` '"""o'` 1100K/PACE `�ofessionol < r (907) 227-1455 office JLS NW1159 140131 \��`�r" (907) 274-4992 fax Ecklund, Timothy J From: Dea Duffus <dea@arcterra.net> Sent: Thursday,June 15, 2017 1:45 PM To: Ecklund,Timothy J Cc: Brent Western Subject: Re: SKYLINE VIEW BLK 1 LT 9 Per our field inspections on 6/14-6/15, we have verified that the septic tank is not leaking as the water levels in the filled tank remained consistent with no use for 24 hours. Dea Duffus ArcTera Consulting On Jun 8, 2017, at 1:33 PM, Ecklund, Timothy J <EcklundTJ@ci.anchorage.ak.us>wrote: <Onsite Review Comments.pdf5 1 • '� Municipality of Anchorage " £ On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-192-46 1. GENERAL INFORMATION Complete legal description SKYLINE VIEW BLOCK 1, LOT 9 Expiration Date: R _ �—) A -- o 4 Location (site address) 19373 LUPIN STREET, CHUGIAK, AK 99567 Current Property owner(s) DENNIS J. MITCHELL Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 6216 CEDAR LANE, ROWLETT TX, 75089 Day phone ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request for: 1 (3 -BR SYSTEM) STYPE OF_WASTEWATER DISPOSAL: ❑ Holding Tank L ❑ ❑ MAY CUr�aMty ❑ ❑ Public Sewer ❑ -z Received by: Date: N COSA to be released fhe engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ _ Date of Payment J') �'!q Date of Payment Receipt Number 00,5g0ll Receipt Number COSA# 0564flWy 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 5/16/14 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future �\ occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Ar s 10,,`11nTr-I fk 6. DSD SIGNATURE System #1 Approved for —L bedrooms. System #2 Approved for bedrooms. Disapproved. Kf:\\P'rfi N. DUF' S y f "ooh 7118 ��.// E� PACF'ES-10N � Conditional approval for bedrooms, with the following ..%n By: ZV, Original Certificate Date: The nigi ality off, chorage 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CC SA blue sheet_10-1 Mld. If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: SKYLINE VIEW BLOCK 1, LOT 9 Parcel ID: 051.192.46 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 1111311979 Sanitary seal (Y/N) Y Total depth 180 ft. Cased to 180 ft. FROM WELL LOG Date of test 1111311979 Static water level 50 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 5.75 mg/L Arsenic: ND ug/L Date of sample: 51812014 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 518114 Pumper JRs C. ABSORPTION FIELD DATA Well Log (YIN) Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 5/812014 145 ft. 6.3+ g.p.m. Collected by: ARCTERRA Date installed 1111111979 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 11111/1979 Soil rating (g.p.d./ftz or ft2/bdrm) 85 System type TRENCH Length 43 ft. Width 3.3 ft. Gravel below pipe 3 ft. Total depth 8_6 ft. (Measured 5/8114) Eff. absorption area 258 ftZ Monitoring tube Y Depression over field N Date of adequacy test 51812014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 2 in. Water added 470 gal. New depth 7 in. Elapsed Time: 20 min. Final fluid depth 2 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1004 Public sewer main 75'+ Sewer /septic service line 254 Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Animal containment areas 501+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 104 Water Service line 104 Surface water. 1004 Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name KENNETH M. DUFFUS Date 511.612014 COSA brown sheet 10-10-12.doc Aw OF 49Tx**� 1'KEtiN BU t� /6 P rEA16. ' TO Municipality of Anchorage 8 Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 141194 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 9 of Skyline View subdivision. This inspection revealed a nitrate concentration of 5.75 milligrams per liter (mg/L) was reported for the property's well water sample. 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.