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WALLNER LT 4
Wallner Lot 4 #017-421-03 STATE OF ALASKA 71161 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER 1 Alaska Hydrologic Survey ps o� oq WATER WELL LOG f- rev sed 0& !81,22,016 U11111119 Jtaf teu: r / L4 / LULU Uorrtpletea: r / ou / LULU rump fnsian: City/Borough Anchorage Subdivision WALLNER Block Lot 4 Property Owner Name & Address Poehling Hildegard Revocable Trust , AK Well location: Latitude 61.107 Longitude -149.74353 Meridian S Township 012N Range 003W Section 25 , SW 1/4 of NW 1/4 of NW 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna's hydrogeologic classification system* httos://mv.nawa.oro/NC Product?id=a185000000BYub3AAD Depth From To Brown silty gravel 0.0 17.0 Silt: Brown 17.0 19.0 Bi,do._ = a.g,fil� -dW, k1,y -,I] vrei,,s pSlnspo d F—i- 19.0 502.0 M buildings, etc.): n (induce roaa names, AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: httos://dnr.alaska.aov/welts/ OR email electronic well logs to dnr.water.reports(a alaska.gov uide for Using the Hydrogeologic Classification Water Well Boreholes by Thomas M. Hanna NGWA Press Drillinq method: it rotary, able tool,QOther Well use:FlPublic supply, Domestic, E]Reinjection,nHydrofracking 0 Commercial, QObservation/Monitoring, OTest/Exploratory, 0 Cooling, ElIrrigation/Agriculture, Grounding,©Recharge/Aquifer Storage, El Heating, OGeothermal Exploration,E]Other Fluids used: Depth of hole: 502 ft Casing stickup: 3 ft Casing type: A53B Steel Casing thickness: 0.25 inches Casing diameter: 6 inches Casing depth: 42.2 ft Liner type: Depth: ft Diameter: inches Note: Well intake opening type: EJ Open end, Open hole, ° Other Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, Perforated 17 -Yes E No Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packedOYes QNo Gravel start: ft , Gravel stop: ft Note: Static water (from top of casing): 40 ft on-/- / Artesian well D Pumping level & yield: feet after 6 hours at 8.5 gpm Method of testing: Submersible pump Development method: Air surge and expioswelracking Duration: Recovery rate: gpm Grout type: Bentonite - dry grout method Volume 200 lbs Depth: From ft, To ft Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion? Yes 7 -. ' No Method of disinfection: Chlorine bleach Was water quality tested?ryes ElNo Water quality parameters tested: Well driller name: ....................... ' ...... * .......... * ...... ame:................................................... Company name: .M. W. PRI.LLING .INC ........................................................ Mailingaddress: .................................................................................... City: State: AK Zip: Phone number: ( ) - Driller's signature: Date: / / Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: Date of Issue: Parcel Identification Number: Job No. 20-126 Permit No: OSP201223 Drilling, Inc. ®P.O. Box 110389aAnchorage, AK 99511 # 907-345-4000 0 GROUNDWATER WELL LOG Well Owner: Poehling Hildegard Revocable Trust Use of Well Domestic Site Description: 12555 Hillside Drive, Anchorage, Alaska Legal Description: Wallner Subdivision, Lot 4, Plat 72-246 Well Coordinates: 61406424N -149.44.33W CONSTRUCTION Drill Method: CasingMaterial: Air rotary Hole Size: 6" Well Depth: 505' A53B steel CasingSize: 6" Wall: 0.250 Cased to: 45.2' Well Com letion: 0 en end X Screen Perforated Method: Screen Perforation Description: Grout Notes: 4 Sacks (50#ea) of Bentonite — dry grout method Well Development: i Air surge & explosive fracking Well Disinfected: Yes Method: Chlorine bleach Yield Test at 8.5 Gal Hour 6 hours with 100% of drawdown DD from static level SWL . Method: Submersible pump IStatic Water Level SWL): 40' Start Date: Test Pump Date: 7/24/2020 8/10/2020 Completion Date: 7/30/2020 Final Pump Install Date: 8/10/2020 WELL LOG MUNICIPALITY OF ANCHORAGE Asa ., , /f. Development Services Department.41 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installati®n Log Well Drilling Permit Number: OSP201223 Date of Issue: 7 -10 - 20 Parcel Identification Number: 017 - 421 _ 03 Legal Description Block Lot Property Owner Name & Address: Wallner Subdivision 4 Poehling Hildegard Revocable Trust (Plat 72-246) 12555 Hillside Drive, Anchorage, AK 99516 Pump Installation Date: 8 - 10 - 2020 Pump Intake Depth Below Top of Well Casing. 493' feet Pump Manufacturer's Name: Red Jacket Pump Model: 25AEI Pump Size: 1 hp Pitless Adapter Burial Depth: 12 feet Pitless Adapter Manufacturer's Name: Maas - 1" Weld -on Pitless Adapter Installer: M -W Drilling, Inc. Well Disinfected Upon Completion? X Yes ❑ No Method of Disinfection: Chlorine bleach Comments: Low yield well. In house system incorporates 150 gallon holding tank. Pump Installer Name: Ian DeMello Company: M -W Drilling, Inc. Mailing Address: P.O. Box 110389 City: Anchorage State: AK Zip: 99511 gz Pl-'sidefl r is 1, ��-1 �,ii: li[t , If1G. YM Cl',rEs(i lli(wiUt.:1 rrltirGtGr hdlg en Volitr Lic l4`0 i 000 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. _ FC 00°02',00 E 1L2.7 4'V _ FND S 00° 10 54 E 152.74 C J O Z rn N ! 00 LO rn of 6� 00 M� I O FOO-1 Na W� k - o N 6Fen G en d+ 00 0 C 00 0 �•` i = U) x--- W x Fenced � I Gorden x e} I Q N I � 5' Underground AV Easement per plot 72-246 I _ 1 N 00°02'00" E 152.74' h Edge of Roa Hillside Drive 't _ FC 00°02',00 E 1L2.7 4'V _ FND S 00° 10 54 E 152.74 C J O Z rn N ! 00 LO rn of 6� 00 M� I O FOO-1 Na W� k - o N 6Fen G en d+ 00 0 C 00 0 �•` i = U) x--- W x Fenced � I Gorden x e} I Q N I � 5' Underground AV Easement per plot 72-246 I _ 1 N 00°02'00" E 152.74' h Edge of Roa Hillside Drive v U O c c � c o o 3 v u U N O N -O i UE Tru v `n �oo _l v y z O OE T a /^ -O 03 i� O N �n U O N O c Z N @ Q n3 c N v Z L E a1 (O a1 E 0 0 W Z dU;zy 'v�ov� (c � L v o (L c a Q O (4 Q C) N E n O "a z L 0- y T Q O v S— D SO N@a m o C ^\ U• O s v a w 00 W < C V1 c �-' L < Lu O o z w o v O( w° z c Q c a) I tD L 4—� lii of j U OC O OO In t/�1 Y W-0 -6 U O v J O o;.. )� > + � U • 7 'Yw 3 t E z C) n _Z O z m i o O �+ W i 0 i W_o j O o� i O Cz — c II z >cn (•� U J L N l7 i aUl 00 L- • j `� o a1 N y W ' (o (1) 92 7 W •0 CtCIO U) = cl� zcoc Q) cc S o Q) -Q on p O d i A 'c OC� r c 0 = 'v l N 00 L. �. O _ !22N CO O•• = JO,W " v X _0 QJ C >L �� � �0 o .Q Xv Q)v��o� Of N CJ w X O Q �a I W 00 v U O c c � c o o 3 v u U N O N -O i UE Tru v `n �oo _l v y z O OE T a /^ -O 03 i� O N �n U O N O c Z N @ Q n3 c N v Z L E a1 (O a1 E 0 0 W Z dU;zy 'v�ov� (c � L v o (L c a Q O (4 Q C) N E n O "a z L 0- y T Q O v S— D SO N@a m o C ^\ U• O s v a w 00 W < C V1 c �-' L < Lu O o z w o v O( w° z c Q c a) I tD L 4—� lii of j U OC O OO In t/�1 Y W-0 -6 U O v J O o;.. )� > + � U • 7 'Yw 3 t E z C) n _Z O z m i o O �+ W i 0 i W_o j O o� i O Cz — c II z >cn (•� U J L N l7 i aUl 00 L- • j `� o a1 N y W ' (o (1) 92 7 W •0 CtCIO U) = cl� zcoc Q) cc S o Q) -Q on p O d i A 'c OC� r c 0 = 'v l N 00 L. �. O _ !22N CO O•• = JO,W " MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program j - PO Box 196650 4700 Elmore Road r Anchorage, Alaska 99519-6650 Phone: {907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite 4"CHO RN�'� On -Site Water System Permit Permit Number: OSP201223 Effective Date Work Type: Well Initial Tax Code Number: 01742103000 Site Legal Address: WALLNER LT 4 G:2840 Site Mailing Address: 12555 HILLSIDE DR, Anchorage Owner: POEHLING HILDEGARD REV TRUST Design Engineer: This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Expiration Date 7/2t(/ z.0 ,rneInt o Department Lot Size in Sq Ft: Total Bedrooms: 7/10/2020 7/10/2021 42000 Q Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From 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 jSpecial Provisions: To close out this permit, please submit the following: r 1. Well log i j 2. Pump install log I 3. Water sample results Received By: Issued By: l' Date: Date: 7 n MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section ANCHORAGE ON-SITE SEPTICIWELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Ifj i 253V I 07 /A 20 1.13 rPM Parcel I.D. 414 Q3 n_! .. 1. S ar: _. i c ,� st a,�_ -._, Property owner(s) 0-ri-g ���L%l��,�'�L ���'��G��l%i Day phone Mailing address AMe Y d Site address l W6' I lI-WO)I✓, Legal description (Sub'd., Block & Lot) Legal description//(Township, Range & Section) Lot Size (p �� Sq. Ft. Number of Bedrooms / 04 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family Absorption Field ❑ Initial (SF) (w/wo AD U) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Q 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 applicabl,p Municipal Cedes. Ila / '-I Ill, (Signat re of property O'Aef or authorized agent) Permit/Rush F 6 //On ?��/l 6S, 75 Waiver Fees: Date of Pay ent: Receipt .Number: 038 7 2 Permit 4 OSPZC 1223 Date of Payment: Receipt Number: Waiver No. GADevelopment Services) ilding Safety\On Site Water and Wastewater\Forms\Client Forms\Permit pplication.doc Z'0 TIxi fooaflon Of the'structure(s) a,'.q Ohown on this record alraliving milt:) conri.-)liez wit") Title 21, AMC. 611 Date: 0 I 2790 54 Q SEPTICS_ P S PMP EX/ST/NGw STRUCTURE I.Q) @ oo 50 Q N® �o g zo 0, IN 0 aN g 01 4-2,6375.F. .,j fro?050 2 7,9._"z4' lz o N OF AAI ORWAY /-ACCESS LOT / V- 0, "o 'F0 ipERK 035907goo ,or 1 e V 46.00-W. a as a a" 0.00 l 0OX- *a a j! C 0 0 .000 )00000. l o 0 o R. L. Butfon 0 Lot 4 Block P,. 'o. LS -1192 �U4; '� 0 0 0. WQ11nCr 3UbdIVISIon '09 0.00000 % OFESSIONpL\Y Anchorage Recording District, Alaska Easements of record other than those shown on the plot of record are not shown hereon unless otherwise noted. LOT SURVEY CERTIFICATION LEGEND I hereby certify that I have surveyed the property shown and described 0 Brass or Aluminum capped monument recovered hereon, and that the improvements situated thereon are within the prop- 0 Iron pipe and/or rebar recovered. erty lines and do not overlap orencroochon adjacent property and that 0 2 x 2 hub 5 tack recovered no improvements on adjacent property overlap or encroach on the premises 0 5/8" x 30" rebor set this survey in question and that there are no roadways, utility lines, or other visible easements on said property except as Indicated hereon. Scale iia Date Prepared by: R. L. BUTTON OU Registered Land Surveyor (907)27-9-6200 519 W Eighth Ave. Anchorage Alaska 99501 Ref.FB. No �_1147 Property of: 2640 1 r_/ -40 )Qn,:4--)Iron Municipality of Anchorage Page of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW OOOO Z7 PID Number: 0/7 - YZ/ - 63 Name: 01`110 Paehl;A Wastewater System: ElNew ❑ Upgrade Address: 3507 N. Pa',nl- Dr. AAeA 994 -IS ABSORPTION FIELD Phone: 2 V8-7 Zl o Pto. of Bedrooms: Y 13 Deep Trench D Shallow Trench D Bed O Mound D Other LEGAL DESCRIPTIONSoil Rating: Total Depth from original grade: 11.2 GPD/Sq. Ft. S• D r Lot:LI Block Sutdrvision: 17 Depth to pipe bottom from original grade: Gravel depth beneath pipe ha//ner 1.0, Ft. Y' O / FI. Township: Range: Se�iion: Fill added above original grade: Gravel length: -2. Or Ft. 65 Fl. WELL: 69IST E) New ❑Upgrade Gravel width: 2.5 ' Number of lines: Distance between lines: Ft. t — Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F -61G Pei Ft. Ft. SZO SO. FL n-34939/ Non-Perf Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. Cetr-,:r 14- /6>0 Yield: runty set nl: Ona 1911.19m Above Dmund, TANK GPM FI, pt. SEPARATION DISTANCES t%Seplic DHolding Ds.T.E.P. To Septic Absorption Lift 'Holding Public/Private Manufacturer: Capacity in gallons: From Tank Fteld Slalion _lark SewcrLines !lAG�r%rQ @ 7dnk l 2S(> Well - 13.i r t 3 r — Zur r Material: sr e e / Number of Co2partments: w ai re >too' >toof - - - LIFT STATION N.A. Lot 30' ll' - Size in gallons: Manufacturer: Line Foundation 9 r t 0 t — — — "Pump on" level at: "Pump off' level at: High water alarm at: Curtain Pump Make &Model Electrical Inspections performed by: Drain — — — Remarks: S �.„, ll,� BENCH MARK 1 ,r, Location and Description: Con c rr le slab @ corner "A" Assumed Elevation: fall. 6 Pt - ENGINEER'S SEAL 2 u Inspections performed by: Fte-tkeT!chnicalSvc.Dates: 1stNls/4949 ItaA' L'e 2nd w/S/ors ooe oom aoeoee eoaoeeaee'-«eo J Department of Health and Human Services approval r�ee9�eee. Oe Oe0e6f k A %TIeODof<F F. !AOOR6 o Reviewed and approved by:' &-S-os CE -3539 e ,, ® ti,.-, Date: 72-013 (Rev. 9/91) MCA 25 PERMIT NO: SW000027 PAGE 2OF2 PID NO: 017-421-03 "G" 65' LONG SOIL ABS. TRENCH W. 4.0' GRAVEL BELOW PIPE T. H. 1250 GALLON #5 SEPTIC TANK SITE FOR "F" REPL.TR.� IF "C" "E" I D" M.T. ;; DBL. FIAT. H.. C.O. - BM I' 0 �>I -BDRM HSE " #4 ` UNDER CONST. SWING TIES: I "13 o0 FROM: COR. "A" COR. "B" TO: PRIVATE WELL USED FDN. C.O. "C" 7' 40.5' TO SUPPLY WATER TO S.T. C.O. "D" 12' 44' LOT 4 LOT 4, WALLNER S/D ONLY S.T. C.O. "E" 18' 44' WALLNER S/D DBL. C.O. "F" 21' 45' TR. C.O. "G" 41' 69.5' ; TR. M.T. "H" 24' 34.5' TR. C.O. "1" 37' 17' PLAN VIEW rt� SCALE: 1" = 30' 0000nuo 0 oa orr Cc -3589 z INV. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW000027 Legal Description: WALLNER LT 4 Date Issued: Mar 07. 2000 Expiration Date: Mar 07, 2001 Parcel ID: 017-421-03 Design Engineer: 0019 Flattop Technical Services Site Address: 012555 RABBIT CREEK RD Owner Name: Otto Poehling Lot Size: 42000 SQ. FT. Owner Address: 3507 N. Point Dr. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99515-1220 This permit is for the construction of: M Disposal Field [,/ Septic Tank Holding Tank ❑ Privy ❑ Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Gil Date: a� Date: 3 — ( — d© CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 February 25, 2000 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities to serve a proposed 4 -bedroom residence on Lot 4, of Wallner S/D, located at 12555 Hillside Drive. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test holes # 4 and 5. As can be seen from the soil logs, the native material between 2' and 8' below ground level is silty sandy gravel with a measured percolation rate of less than 5 minutes per inch. A separate perc test conducted in the overlying sandy loam stratum confirmed that this material also peres at a rate of less than 5 minutes per inch. Bedrock was encountered at 11.0 feet in test hole # 5 and at 11.5 feet in test hole # 4, necessitating that the bottom of the proposed trench be no deeper than 5' below ground level. Using the soil application rate of 1.2 gpd/sq. ft. specified in the wastewater ordinance for soils that perc at 1 — 5 minutes per inch, this 4 bedroom residence requires a total absorption area of (4 x 150)/1.2 = 500 square feet. The proposed 63' long trench design with 4.0' of effective sewer gravel has a total absorption area of 504 square feet. A site for a similarly configured replacement trench is shown on the site plan. The topography of the lot in the area of proposed construction slopes downwards towards the west at approximately 20%. Water supply for the proposed residence will be from a presently unused private well located just east of the property line on the W '/2, S E '/4, NW '/4, NW '/4, Section 25, T 12N, R3 W, S.M. A copy of the recorded agreement allowing exclusive use of this well is enclosed. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. I I I F LOT 3, WALLNER SID 1LT1TIAIIIIIIII HOUSE SEPTIC SYSTEM FE LOT 4 T.H.r WALLNER S/D coNST 5 T.H. UCT 63' LONG SOIL #1 ABS. TRENCH W.4'GRAVEL #4 I ME INSTALL v 2 1250 GALLON z rn STEP TANK z z L N N F w N �j Z O c/)co r „V < (e p p OOb0000 0000000p 01p pep4�--._ e seooecnnVoaooepp opv TIIEODOtE F. ?A0QiU .° a-3�3, p" �!� R 10rn WELL I LOT 4, WALLNER SID PROPOSED WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 11 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 ,JANUARY, 2000 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. WASTE LINE FROM 1250 GALLON SEPTIC TANK 4" DIA, ASTM F-810 PERFORATED PIPE 63' -LONG SOIL ABS. TRENCH WITH 4.0' GVL. BELOW PIPE BETWEEN 1.0'& 5.0' B.G.L. A DBL. C.O. C.. 0.. I C. 0. 63 M.T. "A" PLAN VIEW SCALE: 1" = 10' CLEANOUT MONITOR TUBE MOUND BACKFILL 2' OVER INSULATION 2" RIGID INSULATION 3 1 F ORIGINAL GROUND FILTER FABRIC 4" DIA F-810 PERF. PIPE iE 1/2" - 2 1/2" SEWER GRAVEL BOTTOM OF EXCAVATION SECTION "A - A" SCALE: 1" = 5' a o o e e o o o o o ea000aoaoeea Jd aeei" oo:6n'o5tlooa oee c-o',� THECDO',t F. MOO a Y5 R8 cc. a -' 0 o Cd J•�;:. a� y 4r Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345.1355 Lot 4, Wallner S/D 12555 Hillside Drive Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installing a 1250 gallon septic tank which discharges effluent into a 63 -foot long soil absorption trench containing a total of 4.5 feet of sewer gravel between 0.5 and 5 feet below ground level. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 1.6 The property owner shall be responsible for accurately locating the north property line prior to start of construction so as to allow determination of the required 10' offset from the property line. 1.7 Particular care shall be used to avoid excess slope in the waste line so as to allow for gravity flow without having to unnecessarily elevate the basement floor level in the proposed residence. 1.8 The driveway shall be configured such that it does not cross either the soil absorption trench or the replacement site. 2.0 Septic Tank: 2.1 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 114"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within"" feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 63 -foot long trench in the location shown to a maximum depth of 5.0 feet below original ground level. Particular care shall be taken to ensure that the long axis of the trench parallels an existing contour of the ground and that the maximum excavation does not exceed 5.0 feet. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 4.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 4.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the 9200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 4 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 4, Wallner S/D DATE PERFORMED: July 29 1999 PERFORMED FOR: Otto Poehlina DEPTH Pt (feet) 1 SM Reddish silty, sandy loam 2 —:1 GP/GM Silty sandy gravel Densely Rounded pebbles PR Yt:' E ¢ �i S:••��d:ELighter T - 10 GP Somewhat silty gravel 11 Coarse, angular pebbles B.H.(Bedrock) 14 15 16 17 20— Iu PERCOLATION RATE 3 (minutes/inch) PERC HOLE DIAMETER g TEST RUN BETWEEN 4.0 FTAND 4.5 FT COMMENTS: Another percolation test was conducted in the SM stratum between 1.0 and 1.5 feet below ground level. The data for this 2nd pert test is shown on the soils log sheet for test hole #1. 07, PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,_/moi -L. 9PL,-en <_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: SLOPE 0#/0.... Depth to Groundwater Date No groundwater 7/29/99 Monitor tube dry 8/6/99 1L 27 1/2 T.H. 3:11 23 3/8 f ;1 F. ^.aooaE CE -3589 {ert, SITE PLAN Date Reading T.H. Net Time (minutes) Percometer Reading Net Drop (inches) #t 1L 27 1/2 T.H. 3:11 23 3/8 8Q � #1 3:21 N �6 Add water 3:22 23318 #2 64 X95 T.H. T.H. 77> 23 3/8 #3 #3 3:42:30 10 19 15/16 37/16 Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 8/3 12" Presoak 27 1/2 Add water & start 3:11 23 3/8 #1 3:21 10 19 7/8 Add water 3:22 23318 #2 3:32 TO 1_9 15/16 Add water 3:32:30 23 3/8 #3 3:42:30 10 19 15/16 37/16 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 5 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 4 Wallner S/D DATE PERFORMED: January 7 2000 PERFORMED FOR: Otto Poehlinq DEPTH Pt SLOPE (feet) 1 '.. SM Reddish silty, sandy loam See log of T.H. #1 for pert. 8 9 10 11 12 13 14' GP/GM Silty sandy gravel Densely packed Rounded pebbles Lenses of GP. ML GP Somewhat silty gravel Coarse, angular pebbles B.H. (Bedrock) Depth to Groundwater Date No roundwater 1(7/00 Monitor tube dry 2/28/00 271/2 T.H. Add water & start T.H. 6� ooc c00000ee0000`o °°norm�o `'. ;.- o_TWeODO::E F.::M1OORE C,. - 353'? eeee�o�, rt �- SITE PLAN ... - _..:.20% ..:... 15%q - U 15% J i.. J 0 Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 1!1/00 12" Presoak 271/2 T.H. Add water & start T.H. 6� tl5 12:19:40 1L5 at 59/16 80 12:20:25 as 23318 N 16 10 181/2 47/8 Add water 12:31:05 64 233/8 �A9 T.H. 10 T.H. 49/16 Ad -water 117 1 231/2 as #4 12:51:50 ... - _..:.20% ..:... 15%q - U 15% J i.. J 0 Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 1!1/00 12" Presoak 271/2 Add water & start 233/8 #1 12:19:40 10 1713/16 59/16 Add water 12:20:25 23318 #2 12:30:25 10 181/2 47/8 Add water 12:31:05 233/8 #3 10 131 18 13116 49/16 Ad -water 12:41:50 1 231/2 #4 12:51:50 19 41/2 zV LAPERCOLATION RATE 2 (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 3.75 FT AND 4.25 FT COMMENTS: Another percolation test was conducted in the SM stratum between 1.0 and 1.5 feet below ground level. The data for this 2nd pert test is shown on the soils log sheet for test hole #1. PERFORMED BY FLATTOP TECHNICAL SERVICES. I CERTIFY THAT THIS TEST WAS PERFORM ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2./ 26 / dr) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 1 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 4 Wallner S/D DATE PERFORMED: July29 1999 PERFORMED FOR: Otto Poehling 4 A_'! fi M. 10 11 12 13 14 15 16 17 18 19 B.H. (Solid bedrock) Perc test conducted adjacent to T.H. #4 SLOPE 661. Depth to Groundwater Date No groundwater 7/29199 Monitor tube dry 8/6/99 c! loe 00000000coa°ca a ee `, j' t) 0 71dEODOc F.:000RB ; , CF, - 3539 w SITE PLAN ....:... 206A 15% - 15% t Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 8/3 12" Presoak Add water & start 4:33:30 23318 #1 4:43:30 10 197/8 31/2 Add water 4:44 26616 #2 4:54 10 1915/16 37/16 Add water 4:54:30 231/2 #3 5:04:30 10 1915/16 39/16 Ly PERCOLATION RATE 3 (minutes/inch) PERC HOLE DIAMETER 511 u TEST RUN BETWEEN 1.0 FTAND 1.5 FT COMMENTS: Note: The perc test shown on this sheet was actually conducted adjacent to T.H. #4, not T.H. #1 PERFORMED BY FLATTOP TECHNICAL SERVICES. 1 7� /n-e,� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 2- / 2j'/ cG rr537PG'1'2I AGREEMENT FOR WELL EASEMENT Agreement made this /� �day of August, 1999, between JAMES R. and ALIDA P. HENDERSHOT, of P.O. Box 190929, Anchorage, Alaska 99519-0929, and OTTO POEHLING, of 3507 North Point Drive, Anchorage, Alaska 99515. RECITALS: WHEREAS, the parties own real property situated in the Municipality of Anchorage, State of Alaska, and described respectively as follows: Hendershot Parcel: W1/i, SE'/4, NW'/4, NWI/4, NW'/4, T12N, R3W, Section 35, Anchorage Recording District, Third Judicial District, State of Alaska; a parcel containing approximately 54,450 square feet, generally located north of Hillside Drive and south of Upper Huffman Road, and adjacent to and east of the Poehling parcel described below. Poehling Parcel: Lot 4, Wallner Subdivision, Plat 72-246, Anchorage Recording District, Third Judicial District, State of Alaska; a parcel of approximately 42,697 square feet, fronting Hillside Drive, and located adjacent to and west of the Hendershot parcel described hereinabove. WHEREAS, the parties hereto now desire to enter into an agreement allowing Poehling to use a water well located on the Hendershot parcels. Page No. 1 +3537PG122 NOW, THEREFORE, in consideration of the mutual promises and conditions herein contained, and for other good and valuable consideration, the receipt and sufficiency whereof are hereby acknowledged, the parties hereto agree as follows: 1. Hendershot grants to Poehling the right to use the existing water well on the Hendershot parcel. See Exhibit "A" attached hereto, for illustration purposes only. 2. Poehling is free to abandon the use of the well at any time. If and when the Municipality of Anchorage makes water available to the Poehling parcel, then Poehling's right to use the well located on the Hendershot parcel shall cease five (5) years after water is available to the Poehling parcel from the Municipality of Anchorage. 3. Hendershot acknowledges that Poehling has paid the sum of Two Thousand Dollars ($2,000.00) as total consideration for the right to use the well on the Hendershot parcel, and for the right to enjoy an easement across the Hendershot parcel, running between the Poehling parcel and the well location. 4. Hendershot grants to Poehling, his agents, representatives and contractors, the right to enter onto the Hendershot parcel for the purpose of testing and maintaining the well. Poehling agrees to indemnify Hendershot against any loss or damage which shall be caused by the exercise of the rights of ingress, egress, maintenance and testing granted by Hendershot to Poehling. 5. Hendershot grants to Poehling an easement consisting of an eight foot (8') radius from the well, and a water pipeline easement fifteen foot (15') in width running from the well across the Hendershot parcel to the Poehling parcel. Page No. 2 r3537Pc 123 6. The water line use, access, and maintenance easement described herein shall run with the land, and shall be for the benefit and use of Lot 4, Wallner Subdivision, its owners, Poehling's heirs and assigns, their grantees, executors, administrators, successors in interest. 7. Hendershot agrees for themselves and their successors in interest, that they shall not interfere with Poehling's use of the well and the easement for the purpose of using, maintaining and testing the well. 7. This agreement and the covenants and conditions contained herein shall inure to the benefit of and be binding and obligatory upon the heirs, executors, administrators, successors and assigns of the parties hereto. OTTIJ POEHLING Page No. 3 ?�33537Pc 124 STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on the 17 ��day of 1999, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared James R. Hendershot and Alida P. Hendershot, known to me and to me known to be the individual described in and who executed the within instrument and acknowledged to me that they executed the within instrument and acknowledged to me that they signed the same as their free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN UNDER MY HAND and official seal the day and year last above written. Notary Public in and for Alaskay ! �S My Commission Expires: STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on the �Z day of1999, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared Otto Poehling, known to me and to me known to be the individual described in and who executed the within instrument and acknowledged to me that he executed the within instrument and acknowledged to me that he signed the same as his free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN UNDER MY HAND and official seal the day and year last above written. -�e YU r1vlq- X0 / / Notary Public in and for Alask Z7 My Commission Expires: 7 22 Page No. 4 p%S/s yIJ3537Pc`1'25 Well location(approx NOT TO SCALE FOR ILLUSTRATION PURPOSES ONLY 0 5931 Di A C E g3DiACE RECORN,,- DISTRICT EXHIBIT "A" 1999 cp 20 �i� 9� t, t BY on �7 N z c; s cz " 3 � > cn 3 POEHLING cC s c 1 Lot 4 k7z �Cf) A C11 ai Wallner SID N d 3 E m NORTH •Q�x —329,54 — Well location(approx NOT TO SCALE FOR ILLUSTRATION PURPOSES ONLY 0 5931 Di A C E g3DiACE RECORN,,- DISTRICT EXHIBIT "A" 1999 cp 20 �i� 9� t, t BY on Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road u P.O. Box 196650 a Mark Begich Anchorage, AK 99507 Mayor www.muni.ora/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel IdentificationNumber:017421',03 Date of Issue: II Legal Description Proper Ow � a &Address: OUGX h6� 0 DR C/1 41VL Pump Installation Date: }p` /L/—f& Pump Intake Depth Below Top of Well Casing: yofeet Pump Manufacturer's Name: --> Pump Model: Pump Size q5� hp Pitless Adapter Burial Depth: ) Q feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: %/ba w �? .+S a P -r - Well Disinfected Upon Completion Y es ❑ No Method of Disinfection: (az— ?2e_ a,� Comments Pump Installer Name: ANCHORAGE WELL & PU 330 EAST 70 AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. UNIMPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-421-03 1. GENERAL INFORMATION Complete legal description Wallner Sub, Lot 4 Expiration Date:/ D — 7-9'-7-1_ Location (site address) 12555 Hillside Dr, Anchorage, AK 99516 Current property owner(s) Poehling Hildegard Rev Trust Day phone Mailing address Real estate agent 12555 Hillside Dr, Anchorage, AK 99516 Joy Merriner 2. TYPE OF DWELLING: W Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone (907)350-6307 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well lk Private Septic ❑® Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .550 Date of Payment Receipt Number 266 8y Waiver Fee $ Date of Payment Receipt Number COSA # 0_e_ -,C. 21 1 y 09 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 7/19/21 6. DSD SIGNATURE System #1 Approved for 4 System #2 Approved for Disapproved bedrooms bedrooms _ Conditional approval for T bedrooms, _�- AW, of %* TH *1 Benjakn<Bchiller C 97/19/22 PROFESS104.` with -the following stipulations; OFA* PJ 40— -T=v,' WAS o NM 9�, /VT SEg;� �))))))))))0)SW� 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 Advisor Well Flow Advisory Other l O." fid oc s uoy; A-t+ate COSA Checklist blue sheet COSA Checklist Legal Description: Wallner Sub, Lot 4 Parcel ID: 017-421-03 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA R Well log is filed with Onsite (or attached) Date drilled 7/30/2020 Total depth 502 ft Cased to 42.2 ft ❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 34 in. Date of flow test for COSA 7/7/21 Static water level at beginning of test 63 ft. Comments B. TANK DATA Age of tank(s) 21 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 43 W Standpipes/foundation cleanout per record drawing Date of pumping 6/28/21 Isaacs Septic D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 4/5/2000 ® ALL standpipes present per record drawing Total measured depth from grade 6.6 ft (max) Measured depth to pipe invert from grade 2.7 ft (min) ❑ N/A — pressurized field ❑® Monitor tubes go to bottom of effective. If not, state depth into effective © Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 5.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No On Coliform bacteria is Negative Nitrate 6.79 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 07/02/21 FT STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/14/2021 Results Z✓ Pass For 4 bedrooms Fluid depth prior to test 37 in Water added 937 gal New depth 42.5 in Elapsed time 1440 min Final fluid depth 37 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0✓ Yes Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' [D Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No Water Main > 10' Animal Containment > 50' F Yes if No ft P/ Yes if No ft F✓ Yes if No _ Water Service Line > 10' F✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Q✓ Yes if No ft FV� Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0✓ Yes if No ft Surface Water > 100' ®✓ Yes if No _ Property Line > 5' F✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ED Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Main > 10' ✓Q Yes if No ft Community Wells > 200' F✓ Yes if No _ Water Service Line > 10' F✓ 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' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓® Yes if No ft Private Wells > 100' Yes if No 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 G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet .� F AJ, r..e;.. .. .. ..... � Benjarrrq chiller 1 CE 125927/19/2021 pROFESSIQNP�-®� AMP- - ft ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT z 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 vvvxvv.nouni.o,r/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC211409 Subdivision: VVa|lnerSub Lot 4 Starting at ZO years of age the K4DA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. ,MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Wafer and wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211409 Subdivision: Wallner Sub Lot 4 A water sample revealed a nitrate concentration of 6.79 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. 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. „� � � ,� � MaiUngAddress �P O Box 196650 �=Ahc�iorage,�Alaska 99519 6650 * wuriw mum 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. " " �Mailtng Address P O�, Box 196650 *Anchorage, blaska�99519 6650 *www mum org `'