HomeMy WebLinkAboutHAWKINSON LT 1Onsite File
Hawkinson
Lot 1
#015-235-04
foi /7n/Cn nasal
- a
-sluawaa!nba.i 1!wjad Ilam apnlou! jou slop lenoidde s!ql :GION
Akl-���f%`
panoaddy
�- :.... •. >�.
walsAS olldaS
'N 13`yE4J[LV • C3� f?�
.
,..a.00aooa°°.oc •o..o..F�
<<•e000000000�a•oe�
617. e r
°,� ,���
a;ea :lenoiddV leuoll!puoO
`0`e• ••
° o 0 0 0 • °� � � ,av
-lVAO?lddVN01103S 2131VM31SVM aNid U3iVM 311S -NO
S � S 3 S)
yjb wE
V V�JV EJ
uo!;duosep pue uo!;e0o-I
8 b/ZZ/9 PUZ 81,4Z/9 ,:6 uo;oadsul
ad t76 (uo!;enala pawnssy) NUVW HON38
'3Fd `NOS2j3aNV N �INIA jo;oadsul
bE0£lwro0 tcoc PlaauleJo
'3'd `N0S�IDONV N 3INIW
veoc PI !Julep t COC glue; o; esnoH -lVIU31VW 3dld
Jallelsul
11W2:13d `dOW
�DNVd �:101d31Nl
S-1I0S 2]31139
Cq palle;su! Ieou;0913
uo!;eool W181V
leo 005 �
NNV I H`JNV
Ana 03N3d330 SVM HON3?:Jl sveway
!l!oede0
jam;oe;nuew
+,O
+,Q
uo!;epunod
NOIlV1S 1=111+,Q
Z
�D31S
VN
+i0
+,0t
+,0
aul,lo,
s;uaw��agwnN
leua;e
Wedwo0;o
-F-,QQ (,
+�Oo �,
+,QQ (
Ja;eM aOepnS
leo
005 ( >Mi HONtJ
!a!0ede0 jain;oe;nuelN
Jagl0 [:]6u!PIoH E]'d'3'1'S Mo!;daS E] �INVl
+���
+i00
+�QQ
+.00
IPM
Id
zld 09L
au! -1
3iUej
uo!;e;S linuo!;djosgy
Pie!3
duel
wojd
sag0ueil uaaAgaq •;s!a
sopuai;;o jagwnN
eaje uo!;diosge Ie;ol
James
6u!ploH
0!1daS
0,
0'Z
S30NV1SIa NOIlVNVd3S
sau!1 ueaNaq aoue;s!Q
saws;o jagwnN :spa8
q;p!M IaneJO
uo!;oas a6uea d!gsumol
g16ua1 IaneJO
apeJ6 leu161Jo anoge poppe 111d
L 11 NOSNIJiM`dH
lo -i x{0018 uo!s!nlpgnS
ld Cs L
;d 07
N011dlUOS30 -IVOTI
adld q;eauaq q;dap IaneJO
apek 18UI61JO woJ; }Janu! ad!d o; q;dad
S'6
dSAadJ 2'0
-b
apei6 Ieu!6uo woj; q;dap Ie;ol
6uge�:1 I!oS
swompa8;o jagwnN
auogd
JENIO ❑
�R4 VNiVW OOCL
punon ❑ peg ❑ gouajl ap!M ❑ gouaJl deal 0
ssajPPd alis
f 0W
4-131=1 NOIldNOSSV
aweN
apea6dN ❑ MGN 0 :Ioafod Al!wed 916u!S onnl ❑ (() xaldna ❑ nciv qi!m ❑ Lis) AI!we-j al6u!S 0 :6u!l!anna
-b0-S£Z-5 t-0 :,agwnN Old ZLO t- dSO :,agwnN I!wJad
lNOd321 NOUO3dSNI U31VM31SVM 31lS-NO
Z jo ( abed b06L-Et C U06) • uo!}oaS JalennalseM pue J@IeM el!S-u0
06ejogouV;o Aj!led!o!unN
Permit No. OSP181072 Page 2 of 2
Municipality of Anchorage
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
Legal Description: HAWKINSON LOT 1 PID No.: 015-235-04
M
RK
A
B
C
01
47
25
0232
56
C01
32
58
/
CO2,
i
30
63
T1
90
95
T2
i
110
107
I
I
I BENCH, G RAGES B ELL
I
I
1
\ CO1
\ B
/
i
1CO 1
CO- •,
TCO2
I
#1
DRIVEWAY DRIVEWAY I /�/ • // MT�
/UT -r
NEW 1500 GALLON STEEL STEP TANK
ASBUILT
SCALE: 1"=50'
N.T.S.
OG DF
R
ff
49 TH
DRY, MAY 2018
;MICHAEL N. ANDERSON; tZA
No. CE 9469
•.•4-6-20 •
AV
...............
ESS ��.�
/
i
I
I
I BENCH, G RAGES B ELL
I
I
1
\ CO1
\ B
/
i
1CO 1
CO- •,
TCO2
I
#1
DRIVEWAY DRIVEWAY I /�/ • // MT�
/UT -r
NEW 1500 GALLON STEEL STEP TANK
ASBUILT
SCALE: 1"=50'
N.T.S.
OG DF
R
ff
49 TH
DRY, MAY 2018
;MICHAEL N. ANDERSON; tZA
No. CE 9469
•.•4-6-20 •
AV
...............
ESS ��.�
•UOIIenaasuo0 le}uawuoa!nu3 jo }uaw:pedao :gSnoaog nSjeA
uo!leAaasuo0 leluawuoalnu3 10 }uaw:wedao ao/pue saa!naaS uewnH '8 glleaH 10 juawliedaa :@SeaogauV jo A}!led!a!unA
Ajpogjne aado,id ay} o} Bol Ilam aqj jo Ado e }!wgns of aaunno A:Wado.id aqj jo Al!l!q!suodsaa ay} s! 11 :NOI1N311V
uenllin5 aloe :aweN saall!a0
N0o.lpa8
laneag 'Q pueS A4I!S
Aelg /nn laneag 7g PUeS Ajl!S
uapanq.lan0
dn�aljS.Ou!seg
XIMME
85 9T
9T ti
ti Z
Z 0
01 woaj
y�da(]
e;eo aloH agog
sjuawwo0
Add OS au!aolg0 :u01jaalu!s!Q 10 pogjaA
0 F-1 saA® :uoljaldwo0 uodN pa}aaju!s!Q IIaM
jaaj Zti 01 '1@@j Z woaj:41daa
sql OS :awnlOA ajluojuaq :adAl jnoag
paddojS ;aaj jaejS suoljeaoJaad ❑
paddojS }aaj Jaejs pauaaaaS FI
aloy uado® pua uado ❑ :adAl Su!uad0 aNejul IIaM
a!V ;lu!}sal 10 poglaA
yd8 ❑ wdS ® ST a}ed Aaanoaa8
�aad 6T :lanal aajeM a!}ejS
adAj aau!1
laaj V9 gjdap 'sagow 9 :aa}awet4
sapul OSZ' ssauN:)!q} IleM IaaIS :adAi gu!se0
,EOT :IIaM jo gjdaa
loos algeaR Aae}oa .ile® :Bu!II!aa jo Poq;aA
ON 11 saA® :uoljeaol jlwaad panoidde }e paleaol Mann sl
000170SUSTO H3SAnN NOI1VJ1311N301 XVI
8T -8-S :3nSSl 30 31V4 ZLOT8TdSO :2J39ygm 11Ai13d
8T -S-6 :31VG
T fol uosu!NnneH N011dlUDS34 IV931
:SS3WICIV
za.ua!ing sasloA — FDA :GNVI 30 d3NMO
BSLZ-889 L9566 )1V `Me16ng0 `69ZOL9 xo8 'Od
S113M U31VM NVA1110TO),
eqp 00 000
ol uiliiaa pal jilaa:)
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW OSP181072 Date of Issue 5-8-18
Parcel Identification Number: 01523504000
Legal Description Property Owner Name & Address
Hawkinson Lot 1 MGJ
Pump Installation Date:
9-25-18
Pump Intake Depth Below Top of Well Casing:
90 feet
Pump manufacturer’s Name:
F&W
Pump Model:
4F11P05301S
Pump Size:
1/2 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
Mike Anderson- Anderson Engineering
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Martinson
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Coy
cr
m
�
cnDi
i)m
�
:-
I
Cop
=
T
O
CD b
CD
D
Fn
0
x
r� O'4
CD IV
prop
CD '1 0 �
CD
bx
aq
w e*
w y
`3 o
t7'
0
d
40 m
Q
p,00�o�'
Cb m
� OD 0
cl
RR
V
V
4.
H
N
Q
z
19'02 L M <00<ZO.00 N
In Ha
W
02
v
m
CD b
CD
r� O'4
CD IV
prop
CD '1 0 �
w e*
w y
K p �
40 m
o
p,00�o�'
Cb m
� OD 0
O]
RR
19'02 L M <00<ZO.00 N
In Ha
W
02
v
4,00
-°—""Ty0 MUNICIPALITY OF ANCHORAGE `„C„r
• On-Site Water&Wastewater Program :\° 5.;.
f • r 71.::—) PO Box 196650 4700 Elmore Road y �f
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997�� /// http://www.muni.org/onsite
liblitir
C„oaPG� Dt i
m tmcnt
9 h
On-Site Water & Wastewater System Permit
Permit Number: OSP181072 Effective Date: 5/8/2018
Work Type: WellSeptic Initial Expiration Date: 5/8/2019
Tax Code Number: 01523504000
Site Legal Address: HAWKINSON LT 1 G:2739
Site Mailing Address: 7300 ALATNA AVE, Anchorage
Owner: GUTIERREZ MOISES Lot Size in Sq Ft: 42700
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
C✓I Disposal Field Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: N. Date: //
Issued By: fJiA2. eDate: 5 g 16'
ltd,50
MUNICIPALITY OF ANCHORAG
a
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-235-04
Property owner(s) MJG Building Group Day phone
Mailing address
Site address
Legal description (Sub'd., Block & Lot) Hawkinson s/d Lot 1
Legal description (Township, Range & Section)
Lot Size 42700 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑x Initial Single Family (SF)
(w/wo ADU)
Septic Tank C8I Upgrade ❑ 6c ;, : (D) ❑
Holding Tank 11] Renewal 111 �)t ti ,�p ellings 111Privy ❑ I°i�� /a , o r D)
Private Well MAY 0.2 2018
Water Storage ❑ a
THIS APPLICATION INCLUDES A VARIANCE/WAIVER '/:,_t_17. -
L9 %''ti
A
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 12,9f,40 Waiver Fees:
Date of Payment: 5 f r3 Date of Payment:
Receipt Number: C'.k4$ 1523 Receipt Number:
Permit No. OSPL9I oia Waiver No.
Permit App__-: : .,c
•
May 2, 2018
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage,Alaska 99519-6650
Fax 249-7847
Re: New Septic& Well Permit
Legal: Hawkinson Lot 2 /
To Whom it may concern:
This is a request for a septic and well permit on the above referenced lot. A test hole was
excavated and found silty gravels GM,for the entire depth with no bedrock or water observed.The
perc rate was 12 minutes per inch. From the site plan the slopes are fairly flat (less than 5-10
percent) at the test hole locations. The lot is large (one acre plus) and the soils are good with no
ground water or bedrock.
This permit will not impact any of the neighboring properties due to the lot layout.
Please call me if you have any questions.
Sincerely ��
it,
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
`tf
DESIGN CRITERIA: 4' I MOUND OVER
(TH#1) -- GRADE
4 BDRM X 150 = 600 GPD10
SOILS .ORGW
= 600/0.8 = 750 GPDI SM FILTER FABRIC
750 12 = 62' 1 0 m,.>+ 1.25"0
SEWERR ROC ROCK
(1)TRENCH
7.0' DEEP
-7.0
6.0' EFFECTIVE GM
2.0' WIDE 12.0' I
62' LONG 18.0
SEPTIC FIELD SECTION
J_---- - - - - --t I I I
I / IS\
' I .
PROPOSED t I
WELL 100' WELL N, /-
RADIUS I\ I /
—1
I rSEF�'TIC
\\ i ._/ I — J L — ,— —4
,.. l --� . ''-ALATNA-AVENUE-
�� - T - t -\ _ - -�- - - , — -
� t is 1
11 PROPOSED • t 11 A I 1 tI
I i / n 1 I ' WELL I
1 II WELL HOUSE \ / `II' / I \
\ \ /
/JIi . \ '
\ II --'•' ��PROPERTY LINE ---''
II SEPTIC'
IIPROPOSED
II SEkTIc DRAINAGE FIELD
�`� VACANT LO4 >
T _ — — —
W
0
J
J
\
L .. _.
I
I
I
Septic Design Prepared for
MGJ BUIDLING GROUP X44% OF q4'*•• •
HAWKINSON LOT g! °• '— ♦♦♦
Anchorage, Alaska ; �`:�• 449T—"4......I\ ♦,
• •
Michael N. Anderson, P.E. DATE: 4/26/2018 .0A3\,..1::MICHAEL N. ANDERSON/
4601 NATRONA AVE ♦ No. E 46 :
DRAWN: DJR 1♦♦s� •.•••
ANCHORAGE,ALASKA 99516 �t� •7 .•••'•...._v:
�4
(907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=200' ♦lit, "ss\ ibi
41 _
/ BREITZMAN
I / LOT 4
L — '
\
ice'------- \\
/ \
/ -ALATNA AVENUE- \
r \
, .,--PROPERTY LINE I
cr I
WELL �� ., i r, r,MT I
C? .�T—_1``
I i
i ► 1 01
• 1 o
/`, /
\ / \ / J
\\\ PROPOSED 4 /' �•\ `yi =I
\\\ BEDROOM .1'4.- NJ MT
\\ HOUSE /'
PROPOSED ,/ PROPOSED WELL
RESERVE FIELD—1%— FC CO 't „ 100'RADIUS
CO �A.
TCO
HAWKINSON _ I
LOT 1
2'CONTOURS HAWKINSON I
TYP LOT 2
PROPOSED 1,500
\\\ GALLON STEP TANK I
z I
w
2
w
Q
w
_
F
n
O
10'UTILITY EASEMENT
TENGBERG
TRACT B2A
Septic Design Prepared for
MGJ BUIDLING GROUP .•.% OF 44 11
HAWKINSON LOT$ / :c-)..•• I, ..7.•
Anchorage, Alaska
�`:� 49TH /\ Y .
P.E. i.
•
i alit/4 .
il%� �� •
Michael N. Anderson, PDATE: 4/26/2018 ?\1-.MICHAEL N. ANDERSON/,i
it
4601 NATRONA AVE �4G:),.%•. No. 7,E 4 '
ANCHORAGE ALASKA99516 DRAWN: DJR 1 '
SCALE: 1"-50' •11 i', / .' .��
(907) 727-8864/FAX: (907) 345-1391 4i, SS,**���
Municipality of Anchorage F, GRNIt=k'S°SE41,,c,"h
p Y 9 p L •• •• /-- :a
Development Services Department• o,, '. " ;
On-Site Water and Wastewater Section d 'fit' '4 9TH ' �. . '/
4700 Elmore St. �� J �.
f P.O. Box 196650 Anchorage.AK 99519-6650 r/ G ! ".
•�... ''
�� .1k4 / ww (907)3.orq/onsite ' ••• •••.... ,
(907)343-7904 le^• MICHAc1. N. ,
.,,•. A`N/D£R�CN
•
Soils Log - Percolation Test @� .gip•' • `'
Performed For: Z.) VA. bigt,tl�tY 4(iv\ Date Performed: 57 ;,t/IAIS\
'-
Legal
-
Legal Description: i4o j k t N 4-U 0 L c)+' ( Township,Range.Section:
Slope Site Plan
Depth
(Feet) •
1------------
2-
------2- "( ;oe\ k t 67'r'e__—'
3 �6t - c- /2(d1,74- j�
5
6- 4)/ // 1-7
7 (Zrvv.t(r
8-
WAS GROUND WATER
9- ENCOUNTERED? Ni c)
10- IF YES,AT WHAT DEPTH?
U .
Depth to Water After P
1 1- Monitoring? Pi.-1 F
12- Date (y/ , /7-
13-
0
-
13 0/Y Ortl
14- Reading Date Gross Tim Net Time Depth to Water Net Drop
15- S/1 /7 Zi Or i r, co,
ii
Z. S"
16- (D /1 ?/ K'/
17- Co /r 7, C
,r
18- /r ?t 5 ('/
19-tea(5 0 V v✓t
20-
PERCOLATION RATE '�_(rninutes.ircrn PERC HOLE DIAMETER Le"
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS
PERFORMED BY: Nf N1✓ . I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5(i/ e
(...
bi
LOT SQUARE FOOTAGE 42,700 S.F.
LOT COVERAGE 08.46% A E A T\ A AVE \ U E
— ® BFB:
O 4�
. r ec,
N 89°54'49" W 265.22
1 �s I
\D „t9 50 I-
0 o
U)
z -
o U
O 60.0 27.0 ml-- -I Z
Pl
O 28.0 O
N `
O "0 O
CA b fT) O
D N U
N 9 17 .0 a (1)
r. F.G.F. ELEV 934.5 Q 111 0 AJ
m o 6 m .: I-
z
O
43.0 75.0
P1
2
O CA
0
C O)
50
N 89°54'41 " W 285.00 ��-��
GRAPHIC SCALE OF AL\
LEGEND 1 Inch = 40 Feet I / �� 4
SPOT ELEVATION /<<�' i' ,
y DRAINAGE DIRECTION 20 0 20 40 60 of*49 TH 6? '
*
BOBBY I. BURNETT
2941 Carriage Drive
Anchorage. Alaska 99507 Legal Description
(907) 350-5541 gI hereby certify that the property described hereon has been / r /
surveyed byme, or at mydirection, and that the improvements BOBBY F. BURNETT
Date Scale Lot 1 y p ` N
4 20 2018 1' 40' are within the property lines, and do not overlap or encroach on 1 a�, LS-5484 ,
Grid - the property lying adjacent thereto unless otherwise shown. That
2739 PLOT PLAN HAWKINSON SUBDIVISION no improvements on the property lying adjacent thereto encroach 1 p� �P� Air
on the premises in question and that there are no roadways, \ ssioru , Aor
Drawn by Field Book PLAT # 2003-4 transmission lines or other easements on said property except aslib'
BFB shown. ``
Certificate of On -Site Systems Approval
Parcel I.D. 015-235-04
Legal description HAWKINSON LT 1
Site address 7300 Alatna Ave Anchorage
Current property owner(s) Carol and Landon Grills
Expiration Date: '7 -40 2 3
- i
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 4/7/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovW_June 2022
UH C I LQ 1 Y OF' H0R% „ G
4
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-235-04
Complete legal description Hawkinson Lot 1
Location (site address) 7300 Alatna Ave, Anchorage, AK 99516
Current property owner(s) Carol & Landon Grills Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: 9 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 5 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $, 5L Waiver Fee $
Date of Payment qA7 Date of Payment
COSA # 'OSC 2 -1078 Waiver #
COSA Application_June 2022
Hawkinson Lot 1 015-235-04
4.7
103
64
6.30
18
3/22/23 Forge Engineering
15.3 3/20/23
48"
3/2/23 A+
6/22/23
11.4
N/A
N/A N/A
N/A
5
Steel
3/22/23
40
838
64
1440
41
>600
90
41
49
Benjamin Schiller, P.E.3/24/23
(907) 522-7773
-®Titrate Advisory
Certificate of On -Site Systems Approval # OSC231079
Subdivision: Hawkinson, Block: , Lot: 1
A water sample revealed a nitrate concentration of 6.3 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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
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.
# aanleMge) I o 4 � �✓" Pl # b'S00
aagwnN ldlaoo�j I jegwnN ldlaoa�I
— luawAed 10 alea oVqe 1+ 1 h luaulAed Jo a1ea
$ aa.� JanleAAD�vl $ aaA `dS00
auogd Aea
auogd Aea
3WVS
rSA
lua6e alelse lead{
sseippe 6uIIleW
(s)jaumo A:pado.id luaiin0
NV HONV `3AV VN1d1V 00£L (sse.ippe ales) uolleool
11 NOSNINAAVH uolldljosep lebal alaldwo0
NOI1bWUO:INIIVNBN3J I
,c P
:alep uollealdxS
IanoaddV s;wajsAS 91!S -up jo ajeopiaO
t,0 -5£Z-510 'a'I I90Jed
L66L-EK-L06 :xeJ u011096 aalemOlseM -�R aaleM aIIS-up
tI06L-CVC-L06 :auogd luawlledaQ saolruaS luawdolanaQ
30V OHONV =10 All-lVdIOINnw
•jaaui6ua aga Aq palsenbai asuuuagao ssalun 'jeaui6ue aga oa pasealai aq oa VSOo
:aleQ
:Aq panlaoad
:aoue;sia
:jol Isanbei JanieM
❑
aama oI n
S Iqd
❑
wa sA ja a of n
� S lM Iqd
❑
Ap.unwwo0
❑
IIaM Allunwwo0
❑
Xuel 6ulploH
❑
06elols JoleM
0
olldaS alenljd
F
IIaM aleAIJd
:TdSOdSla 2I31t/M31SVM =10 3d U
:Alddns UBIVM JO 3dA1 'ti
:SW0021aas ziO m3awnN '£
(xaldna ao/pue Allwed 9I6uIS) s5ullla^^d oldlllnW ❑
xaldna ❑
(nciv oM/M) AllweA aI6uIS ❑x
:JNIII3M4 :10 3dA1 'Z
auogd Aea
auogd Aea
3WVS
rSA
lua6e alelse lead{
sseippe 6uIIleW
(s)jaumo A:pado.id luaiin0
NV HONV `3AV VN1d1V 00£L (sse.ippe ales) uolleool
11 NOSNINAAVH uolldljosep lebal alaldwo0
NOI1bWUO:INIIVNBN3J I
,c P
:alep uollealdxS
IanoaddV s;wajsAS 91!S -up jo ajeopiaO
t,0 -5£Z-510 'a'I I90Jed
L66L-EK-L06 :xeJ u011096 aalemOlseM -�R aaleM aIIS-up
tI06L-CVC-L06 :auogd luawlledaQ saolruaS luawdolanaQ
30V OHONV =10 All-lVdIOINnw
jaags aniq IsiN3840 VS00
aaglo �uoslnpy MOIA IleM
tioslnpy oluasad luoslnpy welslS oljdeS
;(aoslnpy aje.tjlNX }slNoaNO `dS00
:S1N3WHO)d1LV 'L
')ijonn s�aaulsue jeuoissajad eqj ui suoissiwo jo sjo.ua joj egsuodsaj jou
si abejogouy jo Ajpdiolunn aql 'ejsejy jo ajejS ayj w p8JajS]O8I.I88ui6ua Jinia jeuoissajad juapuadepw ue /q g gdei6eied ui u9ni6 suoijejueseidej
eqj uodn Aluo paseq (VSOC)) lenaddy swajsAg alis -up jo sajeoggiao sanssi (dSd) uoisinid sooimoS juawdoIanap a6eJo14ouy jo Apledioiunw ayj_
:a)ea 91e0111la0 leul6up , :A8
���de00uoljelndljs 6ulnnollol ay) q}Inn 'swoojpeq
aSS33p
°^ d9ti6 3:) swoojpeq
.•NOSMIOve 'N� :--VHpjw / swoapeq
•. • *.ease'*.. ....`...... c(/.
it A•
° �r9
�z V
SOI Ienoidde leuoljlpuoo
panaddesla
— SOI panojddy Z# wajsAS
17 X03 panoiddy 6# walsAS
3anIVNJIS USO
OZ -SZ-£ ale(] 3'd `NMO(IMd N 3NIW aweN pajuud s,Jaaw6u3
NV HONV 3AV VNOI:]iVN Mt, ssaippy
t,988-LZL auogd '3'd `NMOCINV N 3NIN jwl=l 30 aweN
-pajjlwgns uogejwoIul aqj /(Tuan o) ajls agj jlsln !ew .4ejs ajlS-up 1241 96p91nnou�0e I -uogepejsul )o awg aqj je joa}}a
ui suoijeln6aj pue 'saoueupo 'sopoo ajejS pue ledlolunlN algeolldde lle gjlnn eouelldwoo ul (ale) sl wajshs lesodsip
jajemajsem jo/pue Alddns jejuni ajls-uo eqj 'uoljoadsul pue uolje6ljsanw Aw wojj pue sail) 96ejogouy )o fgiledlolunVy
aqj woj) paulejgo uoi)ewjo)ul eqj uo paseq )eq) /(}I an legpn} l •wajaq pajeolpul ainjonijs jo ad�4 pue swooapeq
)o jagwnu aqj jo) ajenbape pue leuoljounj 'ejes (a.ie) sl wajsAs lesodslp jajemajsem jo/pue Alddns jajem alis-uo
eqj jegj smogs 'uoljeogdde slgj jo) soullapm0 Ienojddy swajsAS ajjS-up )o ajeoilpoo aqj ui paulljno sampeowd uo
paseq 'uolje6ljs8nul AW jegj A)lJan l 'moleq unnogs ajep uoljepllen 941 10 se pue ojejaq paxl}}e leas Aw Aq pagpeo sy
M33NION3 AS N01103dSNI :10 1N3W31`d1S
COSA Checklist
Legal Description: HAWKINSON LT 1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 9/5/18
Total depth 103 ft
Cased to 64'+ ft
0 Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) 24"+ in.
Date of flow test for COSA NEW
Static water level at beginning of test 19 ft.
Comments
B. TANK DATA
Age of tank(s) NEW years
Tank type/material STEPISTEEL
Measured operating fluid level in septic tank NEW
0 Standpipes/foundation cleanout per record drawing
Date of pumping NEW
D. ABSORPTION FIELD DATA NEW SYSTEM
Which system tested (date installed) NEW
0 ALL standpipes present per record drawing
Total measured depth from grade 10.5 ft (max)
Measured depth to pipe invert from grade 3.0 ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 0 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-235-04
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate 9.66 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 0 Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 4/1/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station NEW years
Lift station material STEEL
Comments:
Adequacy test date NEW
Results p✓ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added NEW gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate 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'
✓❑
Yes
Community Sewer Manhole/Cleanout > 100'
F/ Yes
if No
ft
M Yes
if No
Neighboring Tank > 100' ❑✓ Yes
if No
ft
Private Sewer/Septic Line > 25' 0✓ Yes
if No
Absorption Field on Lot > 100' ❑✓ Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' ✓0 Yes
if No
❑✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
—❑✓
Community Sewer Main > 75' ❑✓ Yes
if No
ft
Yes
if No
ft
ft
ft
ft
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft
Property Line > 5'
✓❑
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100'✓❑ Yes if No ft
Water Main > 10'
❑✓
Yes
if No
ft
Community Wells > 200'✓❑ Yes if No ft
Water Service Line > 10'
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' E✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l 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
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Nitrate Advisory
Certificate of On‐Site Systems Approval # OSC201138
Subdivision: Hawkinson, Lot: 1
A water sample revealed a nitrate concentration of 9.66 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a medi a 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.