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KINCAID ACRES LT 4D
Kincaid Acres Lot 4D #011-121-19 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephoner 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S If 9 6 00.3 Y PID Number: Orr - IP -1 - r 9 Name: Allen �C/iruf,rne Lev Wastewater System: ❑ New ❑ Upgrade Address: ABSORPTION FIELD 2733 Collf e Hill wu i4'nCh /}•k 99S'Oy Phone: 3.77 - 7 z3� No. of Bedrooms: Deep Trench ❑Shallow Trench El Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Q Total Depth from original grade: 9. 16 GPD/Sq. . Ft. 19, Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ti D — I rhCGrd 4cru 2.6 Ft. G 2 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 65_ I Ft. Ft. WELL: New ❑Upgrade Gravel width: 2 i Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Pee -.f 1�/'Ivcc% Z5/6 Fl. 25'6 Ft. 01B So. Ft. D -3r/3?e Driller: Date Drilled: Static Water Level: r9_? Installer:, S£ A Enber- r,rai Date installed: 7/5/98 A 119me Dr, 11„1 S/Z/915 Ft. Yield: Pump Set at: Casing Height Above Ground: TANK -20 GPM Ft. I , $ Ft. SEPARATION DISTANCES (R Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 411c_Aora -e Tcrn�' / Z.sO Well- j (y ' 160' 2S1 Material: S I -eel Number of Compartments: 2 SurfaceLIFT > lam' (00' — STATION N. A. Water > Lot Size in gallons: Manufacturer: Line "Pump on” level at: "Pump off" level at High water alarm at: Foundation 2 9 60 _ — _ Curtain _ Pump Make & Model Electrical Inspections performed by: Drain — _ BENCH MARK Remarks: D11Cha//1/7e r,._) LL v ! p h*c �T7 SCC Trf� Location and Description: r• CO/)crek Sluff S([�vr of /cechc, e n% t(eCf in Cr e ,n Sot/ ctbsa� /,�� finch how. on Stilet 2 Assumed Elevation: �f a earl ens( /rs • s Z ENGINEER'S SEAL Inspections performed by: Flufk,ff i«ti. Sv"s, Dates: 1st -5-11 198 2nd 7/ Department of Health and Human Services approval Reviewed and approved by: e Date: g 72-013 (Rev. 9/91) MOA 25 PERMIT NO: SW980034 R 100' PAGE 2 OF 3 PID NO: 01112119 KIM "E" HOUSE CONST. TBM—' 1250 GALLON "A" SEPTIC TANK 'po, T. H. #2 O T. H #1 66' LONG SOIL ABS. TR. O W. 6.2' SEWER GRAVEL 46, ..H P.�� OF AQ q,4 40 1 w-• TH for - ••• * , 49 ...:..................... .A THEODORE F. MOORE : aj • �. �•.• •• CE - 3589 •; �c,�' �'srer •••••.••''• QiA ,\ gofesSl0f400, LOT 4D KINCAID ACRES SWING TIES: FROM: COR. "A" COR. TO: S.T. C.O. "C" 61' 36.5' S.T. C.O. "D" 59.5' 44' DBL. C.O. "E" 59' 49.5' TR. C.O. "F" 61' 88.5' TR. M.T. "G" 71.5' 104' TR. C.O. "H" ----------------------- 87' 1411 ' PERMIT NO: SW980034 PID NO: 01112119 4'+ SOIL COVER 1250 GALLON SEPTIC TANK INV. INV._ 108.11 107.9' OF A4 S4 4 , I r ml� 9 TH 0.6THEODORE F. MOORE , 0 of CE - 3589 0* 001, so.* iw A 80008* 1h1professlo fdk:110� PAGE 3 OF 3 ORIGINAL GROUND ELEV. 109.0' +12" MOUNDED BACKFILL = 110.01 3'+ SOIL COVER ....... INV. 106.4' 66' LONG SOIL ABSORPTION TRENCH 6.2' SEWER GRAVEL BELOW DIST. PIPI BOTTOM OF EXCAVATION ELEV. 1 LOT 4D KINCAID ACRES SEPTIC SYSTEM INSTALLATION AS -BUILT INSPECTION REPORT - PROFILE FLATTOP TECHNICAL SERVICES NOT TO SCALE 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 ISEPTEMBER, 1998 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOCATION OF WELL BOROUGH SUBDIVISION- = LOT. - CK SECTION QTR5 "SECTION- -TOWNSHIP RANGE. MERIDIAN- g - ❑S ❑W LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM-Ecasing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: ft BOREHOLE DATA: Depth Depth of casing: ft •. / � Material Type and Color From To DEPTH TO STATIC WATER LEVEL: fft beiow top of casing ❑ ground surface r / / Date: METHOD OF DRILLING: "fair rotary ❑ cable tool ❑ other USE OF WELL: 'S domestic ❑ irrigation ❑ monitory`] ❑ public supply ❑ other CASING STICK-UP: ft. Diam:. � ,,. to #t "7 Casing type- in. to ft A A - WELL. INTAKE OPENING TYPE:X open end Q screened ¢ 11perforated Elopen hole_ C2=L Depths of openings: to ft SCREEN TYPE:Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: 513m� RECEIVDepth: from ft to ft DEVELOPMENTMETHOD:24,1, MAY 14 Duration: Munioipahl, W AnchorRg PUMPING LEVEL AND YIELD: - WEI�aMCJAnt ft after �_ hrs pumping gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? YES ❑ NO CONTRACTOR INFORMATION: REMARKS: PLEASE MAIL WHITE COPY OF LOG T0: f DNR/DIVISION OF MINING & WATER MGMT 4uthorized Respresehtative Date 3601 C St, Suite 800 ANCHORAGE AK 99503-5935 Phone (907)269-8639, Fax (907)562-1384 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980034 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:LEVY ALLEN & CHRISTINE OWNER ADDRESS:2733 COLLIE HILL WAY ANCHORAGE, ALASKA 99504 PARCEL ID:01112119 LEGAL DESCRIPTION: KINCAID ACRES LT 4D LOT SIZE: 125373 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 3/18/98 EXPIRATION DATE: 3/18/99 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: T_x_� ISSUED BY: DATE: �3 / // cq DATE: J - �p d CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 March 4, 1998 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 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 on Lot 4D, Kincaid Acres S/D, located on Evenson Court. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed between test holes #1 and #2. As can be seen from the soil logs, the native material below 2 feet is a silty to clean fine sand with a measured perc rate of less than 2 minutes per inch. Using a somewhat conservative soil application rate of 0.8 gpd/sq. ft, this proposed 4 bedroom residence requires a total absorption area of (4 x 150)/0.8 = 750 square feet. The proposed 63 foot long trench design with 6 feet of sewer gravel has a total absorption area of 756 square feet. The topography in the area of the proposed construction slopes down towards the SSW at approximately 10%. 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. o LOT 18 LOT 3 OJG' WELL „ o--' /SE SEPTIC SYSTEM 0, - - - -------------------------------------------- --- -- -- -------- - -USE.' ------------ PROPOSED - LOT 4E WELL SITE LOT 41 R 100' LOT 4D zo� R - - - KINCAID ACRES 15% PROPOSED RopOSeo o 1250 GALLON SEPTIC TANK-� - -- �0% ; i% T. H. t\HILLS 42 LOT4F PROPOSED r \ #5% CKI 63' LONG SOIL T.H� \DEN ABS. TRENCH #2 ♦♦♦ W. USEWER GVL �% SITE FORREPL_ TRENCHr�-------------------------------- -----FY i EVENSON COURT R.O.W. _L2 --- ---- —------- --- — —._ —.—. —.-- --------------- - UNDEVELOPED PROPERTY / 00 49 TH •q.• u• Y.if ifit� �, THEODORE F. MOORE i �i fS.' CE-3589i�'f" MON, 6" orofesslO 7 4" DIA D-3034 NON -PERF. PIPE INSTALL 1250 GALLON SEPTIC TANK DOUBLE C.O. 63 CONSTRUCT 63 FOOT LONG SOIL ABSORPTION TRENCH WITH 6' SEWER GRAVEL ---- - --- ----- - - - - ------- - - - - -- - -- -- - -- - - -- - ------------------------------------ O. M.T. ��A�� 4" DIA. F-810 C.O.— PERF. PIPE 9 1 HE PLAN VIEW SCALE: 1" = 10'- 0" CLEANOUT MONITOR TUBE MOUND BACKFILL 12" ORIGINAL GROUND FILTER FABRIC 4" DIA. F-810 PERF. DIST. PIPE 1/2" - 2 1/2" SEWER GRAVEL BOTTOM OF EXCAVATION SECTION "A - A" SCALE: 1" = 5'- 0" PAr:E OFA4 44 AV:e, i A49 TH • is 1j I. THEODORE R MOORE : a,, `�,• '.� CE - 3589 1�SfPr ••''�••••�••• C+Ar 1kZpfb fe s sl0 n!� LOT 4D, KINCAID ACRES S/D SEPTIC SYSTEM DESIGN PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 MARCH, 1998 Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345.1355 Lot 4D, Kincaid Acres S/D Evenson Court (off W. 801h Avenue) Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installing a 1250 gallon septic tank followed by a 63 foot long soil absorption trench containing a total of 6.5 feet of sewer gravel. 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 with 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 site for the well should be chosen sufficiently far from the bottom of the natural depression to avoid the possibility of springtime flooding around the well casing. 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. 2.2 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 1/4"' 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 1-4 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 parallel to the existing contours of the land to a depth of 9 feet below original ground surface. 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 6.5 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 6 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 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 12 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 # 1 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 4D Kincaid Acres LOT 3 DATE PERFORMED: PERFORMED FOR: I Pt. SM Reddish sandy loam LOT 4E SM Fine, somewhat silty sand Some gravel and cobbles SP Fine, slightly silty sand No gravel or cobbles SM Fine silty sand Soft, easy digging Sidewalls smear B. H. LOT 4F SLOPE Depth to Groundwater Date No aroundwater 7/10/97 Monitor tube dry 7/18/97 273/8 19 1/8 a 1T4 -- Add water 12:27:45 OF A �IR\ ���Vo••w•, ��1 7r •� '9 TFi • j �c ......................... i THEODORE F. MOORE i �• '•� CE - 3589 ��x`�� GIVsee of I's 1 `��\� f3•o fe as%0 wO SITE PLAN IL -- -- - - - - -- LOT 4D N i i ry i i T.H. ; LOT 42 #2 T.H. 49 1 �- 0% Date Reading Clock Time Net Time Percometer (minutes) Reading Net Drop (inches) 7/10 12" Presoak 12:26:10 273/8 19 1/8 a 1T4 -- Add water 12:27:45 273/8 12:28:45 6 718 12:29:45 1 PERCOLATION RATE <<1 (minutes/inch) PERC HOLE DIAMETER 6" u TESTRUNBETWEEN 5.0 FTAND 5.5 FT COMMENTS: 2nd perc test conducted between 2.75' and 3.25' in overlying SM stratum perc'ed at 15/16"/minute. PERFORMED BY FLATTOP TECHNICAL SERVICES. I�9 o{e,�"wow CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9 /'f / 9 JJ 3PJ� Y �59 LOT 1 LO FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 [TESITHOLE7#2 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 4D Kincaid Acres LOT 3 DATE PERFORMED: July 10 1997 PERFORMED FOR: Alan Levy DEPTH SLOPE (feet) Pt. 1 SM Reddish sandy loam COMMENTS: SM Tan silty fine sand Sidewalls smear SP Gray clean fine sand SM Tan silty fine sand B. H. LOT 4E LOT 4F Depth to Groundwater Date No groundwater 7/10/97 Monitortube drV 7/18/97 273/8 w a O co v e *. 49TH 66666600900666*4 .. .V:.....•. i THEODORE F. MOORE J i CE - 3589 �,i S�'A AF �� 1 4ssloo�� QZ,XV� 0 SITE PLAN ----------------------- X- LOT 4D T.H. ; LOT 42 #2 T.H. 49 s�B � rs2 Evenson Court (R.O.W.) i 0% Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 7/10 2" Presoak 273/8 Add water & start 1:34:35 23 3/8 1:35:35 1 3/4 Add water 1:36 2j 112 #2 1:37 1 22314 3/4 Add water 231/2 #3 1:38:30 1 223/4 3/4 Add water 1:38:45 23318 #4 1:39:45 1 225/8 3/4 PERCOLATION RATE 1.4 (minutesfinch) PERC HOLE DIAMETER g' TEST RUN BETWEEN 5.0 FTAND 5.5 FT PERFORMED BY FLATTOP TECHNICAL SERVICES. I T�yt /tus CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S1 /All 3 J LOT LO MUNICIPALITY OF ANCHORAGE Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-121-19 1. GENERAL INFORMATION Expiration Date: 10 / L Complete legal description Kincaid Acres, Lot 4D Location (site address) 6517 Evenson Court Anchorage, AK Current property owners) Hodson 2016 Family Trust Day phone 230-9000 Mailing address 906 W Northern Lights Blvd, Anchorage, AK 99503 Real estate agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550- 00 Waiver Fee $ °L aD1� Date of Payment Date of Payment ✓ `t"t/ Receipt Number Receipt Number OS G l a l � � COSA # Waiver # �-P� P �0 V1 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 Michael E. Anderson, P.E. Date F 44,q ©®��•••••... 0 0 p 49th a 6. DSD SIGNATURE ©"""' c ............................................. System #1 Approved for bedrooms AL. ANDERSONo T 4;P % NO. CE -4381 System #2 Approved for bedrooms °p®'F*••.,•7/2/2019 ,.•••'�r`' Disapproved ®®° 00aFES�\ Conditional approval for bedrooms, with the following stipulations: 1)1}111111 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory „ Other�� ; Legal Description: Kincaid Acres, Lot 4D If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/2/98 Total depth 246 ft Cased to 246 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '24 in. Date of flow test for COSA 6/25/19 Static water level at beginning of test 196 ft. Comments B. TANK DATA Age of tank(s) 21 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 47 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/2/19 Isaac's Pumping D. ABSORPTION FIELD DATA Deep Trench Parcel ID: 011-121-19 Structure served by this system Well production at time of test 4.3 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 10.3 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 6/19/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 7/6/98 Adequacy test date 6/27/19 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 9.8 ft (max) Fluid depth prior to test 56 in Measured depth to pipe invert from grade 3.6 ft (min) Water added 1,022 gal ❑ N/A — pressurized field New depth 72 in ❑ Monitor tubes go to bottom of effective. If not, state 1,440 Elapsed time min depth into effective ❑ Code -required soil cover over field Final fluid depth 40 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) Gallons introduced 2,000 gallons If yes, enter date Com ments/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' F71 Yes Community Sewer Manhole/Cleanout > 100' My Yes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' Fv� Yes if No ft Holding Tank > 100' 121 Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'v� Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft [✓ Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 1771 Yes if No ft EJ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F71 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓❑ if No Yes if No ft Wells on Adjacent Lots: if No Absorption Field > 5' 0 Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10'v� Yes Yes if No ft Community Wells > 200' [✓ Yes if No ft Water Service Line > 10' 0 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' 121 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 ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Well head recently raised to >24" above grade. G. ENGINEER'S CERTIFICATION *ex� TA 114 A4 1 certify that l have determined through field inspections and review•..°'`�$ of Municipal records that the above systems are in conformance with° =",Y MOA COSA guidelines in effect on this date.; 49th ' Vi.µ MICHAEL E. ANDERSON r NO CE -4381 7/1/19 COSA Checklist yellow sheet ..". ...... Nitrate Advisory Certificate of On -Site Systems Approval # OSC191276 Subdivision: Kincaid Acres Lot: 4D A water sample revealed a nitrate concentration of 10.3 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. DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191276 Subdivision: Kincaid Acres Lot 4D 907-343-7904 Fax 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. NUNN I&A al A DOC Co dba .�BEtt �& COLE � • ULLIVAN WATER VEILS """� � P.O. Box 670269, Chugiak, AK 99567 688-2759 TO: Rob Hall rob@wolfhomes.net TERMS: 1 Y� % interest per month on unpaid balance PHONE 257-0471 DATE OF ORDER 7-5-19 ORDER TAKEN BY CUSTOMER ORDER NO. [:]DAYWORK ❑ CONTRACT ❑ EXTRA JOB NAME/NUMBER JOB LOCATION 6517 Evenson Ct. JOB PHONE STARTING DATE 7-5-19 QTY. DESCRIPTION OF WORK PRICE AMOUNT 1 Well Extension $500.00 1 Camera $400.00 Appears to be a leak at the 7' weld. 1 Wellhead Repair $1,300.00 TOTAL: $2,200.00 No discounts will apply if invoice is not paid within 30 days. If paying with credit card please add a 3.75% credit card fee. If invoice is not paid within 90 days a lien will be placed on the property. Thank you, Bill & Cole Sullivan DATE COMPLETED: 7-18-19 WORK ORDERED BY: i61Eel 0YAto] ilk] q I HEREBY ACKNOWLEDGE THE SATISFACTORY COMPLETION OF THE ABOVE DESCRIBED WORK. Municipality of Anchorage -y On -Site Water &Wastewater Program ` (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-121-19 Expiration Date: . F ,Z 7- 1. GENERAL INFORMATION Complete legal description KINCAID ACRES SID; LOT 4D Location (site address) Current Property owner(s) Mailing address Real Estate Agent 6517 EVENSON COURT, ANCHORAGE, AK, 99502 DEAN NELSON & IDONNA PIPER -NELSON Day phone 227-9105 6517 EVENSON COURT, ANCHORAGE, AK, 99502 BETH WEISER W/ JACK WHITE Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4, TYPE OF WATER SUPPLY: 762-3111 TYPE OF WASTEWATER DISPOSAL: Individual Well e Individual On-site ■ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverlVariance Received by: Date: COSA Fee $I � Waiver Fee $ Date of Payment bf C Date of Payment Receipt Number (�q 1`2 G Receipt Number COSA # �l<� Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t 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. t 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LiD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at fie time of the test, and separation distances measured to readily identifiable features. The operationallife ofall wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD, can then fore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will if confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 / Date �/13/15- bedrooms, with the following stipulations OFgNCy�frrrr/ .._ ON-SITE lfi =� WATER AND fl WASTEWATER O:Z ` PROGRAM Original Certificate Date: _ %— /.J upon the represenatations 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. ATTCHMENTS: COSA Checklist / Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10112/12) 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: A. WELL DATA KINCAID ACRES S/D; LOT 4D Parcel ID: 011-121-1 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 5/2/1998 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 246 ft. Cased to 246 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 5/2/1998 2/4/2015 Static water level 193 ft. 192 ft. Well production 20 g.p.m. 6.0+ g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate • 1 C1 mg./L. Collected by: GEG, Ltd. Arsenic: N O ug./L. Date of sample: 2/4/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/1-7/1/1998 Tank size 1250 gal. Number of Compartments 4 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping _i2 bV Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE Date installed 5/1-7/1/1998 Soil rating Elj>r ft2/bdrm) 0_8 System type DEEP TRENCH Length 66 ft. Width 2.5 ft. Gravel below pipe 6.2 ft. Total depth *9.9 ft. Eff. absorption area 818 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **2/412015 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 920 gal. New depth 35 in. Elapsed Time: 120 min. Final fluid depth 30 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **NOTE: ACCORDING TO THE REAL ESTATE AGENT, THE HOUSE WAS VACANT AT TIME OF TEST, BUT FOR LESS THAN 60 DAYS. THEREFORE, NO PRE-SOAK WAS REQUIRED. ■ ■ D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access (Y/N) "Pump off"level at wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lot: Absorption field on lot 100'+ On adjacent lots *100'+ *100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 501+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 6+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 104 Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *NOTE: THE ONLY SEPTIC PIPE THAT COULD BE LOCATED ON KINCAID ACRES LOT 3 WAS THE FCO. HOMEOWNER WAS NOTABLE TO BE CONTACTED. 100' SEPARATION ASSUMED BASED UPON FCO LOCATION AND NOTES ON INSPECTION REPORT AND DRAWING. G. ENGINEER'S CERTIFICATION 1 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. Engineer's Printed Name JEFFREY A. GARNESS Date 2 ds - (Rev. /s (Rev. 10/12/12) 1 _ . 0 Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.mani.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151059 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 4D of Kincaid Acres subdivision. This inspection revealed a nitrate concentration of 7.99 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. PLC NO. 73-111z ACR.- L'O"T 4ED EVE-I�LZOMI CGIART ry !Hot c. 3. iq zv!- a -,?o, mTim STWITMOT Or4d ! z;v. 1 a ., 7.,Z Dc cl)' T; -ME 3��Icn FARE us"INS NO "Nn, r"N-3 usiaw,- iCiTr,-,L:cr. (;m 0 FNd . A)) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _Ort - /?1- 19 COSA# gogg?) Expiration Date: '3-/7 -D9 1. GENERAL INFORMATION Complete legal description _ /-of c/ b y Location (site address) 93,17 6 -an ren 6,4-1 Current Propertyowner(s) Alfen ECAP-..rhne J- Dayphone 2'/5-0691 ® Mailing address 6'.5,17 E4-s')soA Co c,. Y Awn eA00 agA4 A -k 94S0L 39 TtF Lending agency Mailing address Real Estate Agent Mailing Address Day phone 270 -Sf77 cctr 934r'b Ktchadron, Pe4d, .T c4&jA!Ae Day phone Sd3 180/ C to it -p: p f Drive y hn�4 A -cc 9 tSO T Urdess otherwise requested, COSA will be held by DSD for pickup. p 1 t ca f t R e a„ I fa, @!� ?-70.5-4-77 2. NUMBER OF BEDROOMS: _i when COSA re av foe pick -.p 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site FXI Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the dale of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. 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. Nameof Firm FIAF a 7<chni«/ Sora.:« Phone 3H+'- 13rs Address iNs?O Eche rangy on R4o}-neA 995-1,5� Engineer's Printed Name TAeydore r• r15 -ore Date I-- 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. *a T: 60DCR' F. MOCR.� fi L• r. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By l Original Certificate Date: l oZ— 17— 0 2 M".,,105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _t gf V O , eex;d Aco-ey Parcel ID: Or I - /Zr - /9 A. WELL DATA Well type Irv/- If A, B, or C provide PWSID # Date completed S/i/9E Sanitary seal (YIN) Y Total depth ZYK ft. Cased to 2_(Lft. FROM WELL LOG Date of test _s-/ 7_/ 9fr Static water level 19-3 ft. Well production 2.4 g.p.m. WATER SAMPLE RESULTS: Coliform ,colonies/100 mL Nitrate 571111 mg/L Arsenic: -r ppb date of sample: _LY / sy/ os B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Y Wires properly protected (Y/N) `r Casing height (above ground) I A� _in. AT INSPECTION rI / -AY' /06 197 ft, 8'.0 + g.p.m. Other bacteria 0 colonies/100 mL Collected by: Fla flc+o Tic 4 Svc Tank Type/Material .S en b c 191 -ref Date installed S"/, 199 Tank size 12,5-0 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N -A, Date of pumping S / 23 /08 Pumper N10� i, /u. el C. ABSORPTION FIELD DATA Date installed 711 Soil rating (g.p.d./f 2 or ft2/bdrm) pSystem type Tir�cA �tti Length (L_ft. Width 2•S ft. Gravel below pipe G. 2 ft. Total depth &f ft. Eff. absorption area tLf!_ft2 Monitoring tube Y Depression over field V_ Date of adequacy test -0-1 ZS / adF Results (Pass/Fail) Pati For Y_ bedrooms Fluid depth in absorption field before test 261.9 in. Water added 779 gal. New depth' in. Elapsed Time: [9 min. Final fluid depth Y9.3 in. Absorption rate >= 60a g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 14 If yes, give date N. h D. LIFT STATION V. A. Date Installed Size in gallons "Pump on" level at _ in. "Pump off level at _in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ► 11, Absorption field on lot ► 60 Public sewer main too' Sewer /septic service line > S' Manhole/Access (Y/N) High water alarm level at Meets alar & circuit requirements? On adjacent lots too' On adjacent lots > ►aG' Public sewer manholelcleanout > (Uo' Holding lank P. A, Animal containment areas IVo^c 'F Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 29 Property line , 941 Absorption field N,f" Water main N•k. Water service line > to' Surface water Wells on adjacent lots > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: in. Property line 2 L' Building foundation X01 Water main ".A, Water Service line > to' Surface water -> lav • Driveway, parking/vehicle storage / o' Curtain drain None Soon Wells on adjacent lots> teJG ' F. COMMENTS . �1CPLC ►X/CLe QrLp it locc.f�c� int 'ode FG y iyn kkl� . jt• We(I .w Z:�t1�' Nio «nim oc prr;ew , K nro ya cc u a "Jelf CERTIFICATION io G. ENGINEER'S pe-(- r r • 1 certify that 1 have determined through field inspections and 1�.". ...........ueeu.l... �j'�°G.r review o/ Municipal records that the above systems are in ,f _ ��„6' conformance with MOA COSA guidelines in effect on this date. r,r:.1:)^ne F. uooRE ; L' Engineer's Printed Name f7lar�d�o2 F. rrac'o „^; •.,IZ/t�"l�3�,• ply t„l.• ,.r tt,. t,” Date 40 COSA Fee $ 130 Waiver Fee $ Date of Payment I a 1510 $ Date of Payment Receipt Number d 4 Receipt Number (Rev. 11105) Municipality of Anchorage , 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 # 080423 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 4D of Kincaid Acres subdivision. This inspection revealed a nitrate concentration of 5.46 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.