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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 7 LT 3Mountain Park Estates Block 7 Lot 3 #017-391-16 M Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of �— www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5 w c2So (,2- o PID Number: 0(-7-3 q f —fCo Name: Wastewater System: ❑ New [R Upgrade o v 6L 2 Address: Z C, - I -Vi -,,ui ABSORPTION FIELD Phone: Number of Bedrooms: Deep Trench El Shallow Trench ❑Bed ❑Mound El Other: LEGAL DESCRIPTION Soil Rating: 0,10 GPD/Ft' To�ta,l1Depth from or; ' ---'— O l f Ft. Block: Lot: Subdivision: Depth to pipe bottom fro p orininal grade: Gravel depth beneath pipe.? M tlV✓I �«i P f k- I_ -,4 4 -r,7 , It / Ft. Ft. Gravel Length: I Township: Range: Section: Fill added above original grade: I, S Ft. % Ft. Well: El New Upgrade ❑ Gravel width: Number of lines: Distance between lines: 7 Ft. (, _f� Ft. Classification (Private, A, B, C): Total Depth: to: Total absorption area: Pipe Material: Ft. Ft. V (P 3 `1-Z'`1�7 6 Zi Ft' -5o Driller.e Drilled: Static Water Level: Installer: l �lI �^ Date Installed: Ft. C✓t p 14 p S` Z O Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Ir 6 � /000 Gal. Well I /L90 OQ 7 ,5� Material: ( Number of Compartments: .-e r L.. Surface Water icya / lot_/ LIFT STATION Lot Line �.4l /V / Size: Manufacturer: Gal. Foundation l t 'z v "Pump on" level at: in. "Pump off' level at: in. High water alarm at: in. Curtain Drain i`r N/� Pump Make & Model ctrical Inspections performed by: Remarks: ` , BENCH MARK 1 , 5 1� -e&7M^ -ec 4 -Ar w- u, rz all If Location and Description: 1 �1 Y/ Y 7' — �c`i � S� C (. h(I, / r _ r I 1 � 7 'i Wt '''11.1 PTVIC Assumed Elevation: A2 i iWf JA dr j Ft. /00. A Inspections performed by: M(.(n.r �/���ln�rrtvl/ Dates: 1st Enginee,� tamp .�� �''� �,� _ OF 2 nd Development Services Department Approval y ° dq 1 Conditional Approval Date: R> ° ° • • • : " ° f' 'i'. ° w° •�a� ° e a r e ° J '`� /_) CZE -9469 Reviewed and approved by: (�j/ Date:51-Z0111 (Rev. 04/06) Permit No. SW050120 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: LOT 3, BLK 7 MOUNTAIN PARK ESTATES S/D PID No.: 017-391-16 MARK q B GRND. PI E ELEV. EV. C01 30 10Y8. 5.7 CO2 38 125 CO3 39 135 \ TC01 45 18 I / \ TCO2 49 22 C04 52 244.8 NQ05 53 254.8 C66 48 354.7MT \�60 43C07 \ 87 634.7 � \ I SINGLE FAMILY I FRAME H $E DECK �o,/ I ? \ SEPTIC C01 02 TC00 \\ \ / TC \\ \\ CO CO \ \ / 000 / oo� 1,4 i BENCH, WOO DECK NE OLD FIELD ABANDO ���DUE TO WATER BCE \ TEST HOLE RADIUS \ \ SEPTIC \ SEPTIC TOTAL TRENCH LENGTH 61' ASBUILT \ I 1 S E: 1"=30' TA Yj _1 �C01 �CO2 D3 TC01 Tco2 C04 cos cos rcol .�•�� OF q/ 111#1 I X7'7 96.4 • .v\♦,� `♦ Ar FILL AV ♦ ♦ 0 OR 49 $Y ♦♦. INSUL4ilON -1. FILTER FABRIC W/ INSULATION 0 94.8 .. .. .... . •• / 95.7 1,000 GALLON 7 7 srxea xocn 94.7 � � / 95.0 STEEL TANK ,.♦ ^ '.IyI CI IAEL•N• ANDERSON �� H2O AT -13.5 5/12/05 ELEV, 82.9 SEPTIC SECTION N.T.S. -18.0 ELEV 78.4 r 1#1# SSl �• 0 MUNICIPALITY OFANCHOR4GE Development Services Department On -Site Water d Wastewater Program 4710 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SWO50120 Legal Description: MOUNTAIN PARK ESTATES BLK,: 7, LT -13 Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: SARAH STEPHENSON Owner Address: 12944 RIDGEVIEW DR ANCHORAGE. AK 99516-3106 Date Issued: May 13, 2005 Expiration Date: May 13, 2006 Parcel ID: 017-391-16 Site Address: 012944 RIDGEVIEW DR Lot Size: 19600 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 0 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 specked 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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, seated, and heated to prevent freezing. 5. The following special provisions. 1. Additional perk test during construction to cover that part of absorption field outside 30 foot radius of existing test hole. 2. Engineer to verify all wells within 200 feet of subject property. Received By: Date: Issued By. 4�22� ' z lN. / J Date: 16--13-05 \ Municipality of Anchorage Development Services Departme14tOADEVELOPME4 §E CES.DEPL Building Safety Division RECE_ On -Site Water and Wastewater Program , A T , 4700 south Bragaw St. MAY 0 3 P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 ON•SITEWATER &WASTEWATER PR06R M ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ni q - ? I - I (c Permit Number SW OSo /2.O Property owner(s) Ses t a O 54 -c -4A M 5v 11 Day phone Mailing addressI % qN'f Qi i e _ V "'o Zip Code '795% Site address Code Legal description (Lot, Block & Sub'd.) C. ✓ f-3 614K, ;Z Ajovt iw,„ 12,r k ,st 4�nj� Legal description (Section, Township & Range) Lot Size R (COV Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only §c . Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 14 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: '� Li b.00 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Wn CQL f Receipt Number: (Rev. 09/04) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4640 Shoshone Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 May 1, 2005 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Mountain Park Estates S/D Lot 3 Block 7 To Whom it may concern: This is a request for a septic upgrade permit. A test hole was excavated at the southeast corner of the lot and found silty sand for the complete depth. My per was 8.5 minutes per inch after a 4 hour per - soaking. however, the pervious perc from the old system by Lee Reid was 50 minutes per inch. The soil log consisted of silty sands with some silty gravels mixed throughout the entire depth. An application rate of 0.6 gallons per day per square foot will be used for the design. No water was observed during or after the 7 -day monitoring period. The offset distance between the two systems of 16 feet has been shown on the plan which is twice the depth of the gravel of the old system. The old system will be tied into the new system with a valve for future use. The lot to the south has an old test hole with a depth of 15 feet, no water was measured in the monitoring tube at the time of excavation. The slope is very flat starting at the house and sloping down toward the southwest comer of the lot at about 1 or 2 percent. No pounding of water has been observed near the site or in the surrounding area. None of the surrounding lots will be impacted by this new system upgrade. If you have any question please call me at 345-3377 Sincerely - / Michael N. Anderson, P.E. DESIGN CRITERIA: 3 BDRM X 150 = 450 GPD APPLICATION RATE: 6.0 GPD/SQ. FT. 2.9' WIDE TRENCH 450/0.6 = 750 SO. FT. REQURIED 750/14 = 54' REQUIRED TRENCH TREN Q DEEP 7.0' EFFECTIVE 2.0' WIDE (1) 54' LONG OLD TEST -5' —6SM —8' 13.5'-3Z Q 5-12-05 —18' TH# l e Tlou RIDO� �C�f ' 100' m P OPOSED 5 ALLON ST P I@ HOLDEN DRNE Septic Design Prepared For SARAH STEPHENSON LOT 3, BLOCK 7 MOUNTAIN PARK ESTATES SUBDIVISION Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=200' MAY 12, 2005 OVER k INSULATI01 1 1/4'0 PIPE SEWER ROCK 2.0' pR� 4L 4 MICHAEL N. No. CSE _7 LOT Z WELL P LOT 3 '\ Sl2c �`� EXISTIIIC'TANK-I(LBE S INSPECTED FOR HOLES AND RELACED IF c/ REQUIRED / TANK CO_ � i \ ` II NNIN EXISTING DRAINFIELD JO 402i' n \� QISTINC SEPTIC j LOT 7 6 / / / / / / I 1 1 I `o. i ;,\------------ ----------- I �0 RNE' i i I ' 1 /—PROPERTY LINE / / / o O WELL LOT 4 1 rw,wc�yv;c v Ey, -rEXISTWG!FC / :D 500 STEP T NNI .M PROPOSED SEPTIC TRENCH ------------- EXISTING ----.EXISTING SEPTIC ------------- Septic Design Prepared For SARAH STEPHENSON LOT 3, BLOCK 7 MOUNTAIN PARK ESTATES SUBDIVISION Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' MAY 12, 2005 As . W49n, gyj °. MICHAEL N. No. CE O 0 Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 5ltrq ti -1C 6<"4.Pe1 DATE 2 LEGAL DESCRIPTION: L 3 1n'fvM •II♦ A Prvic Township. Range, Section: D�TH1 SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19. 20 - COMMENTS 4 Sra cL r r 4; ISL, rTfry�l CAyT�1r JABY WAS GROUND WATER ENCOUNTERED? Ce Cali S IF YES, AT WHAT w 0. rT�s� O DEPTH? 177 P S�3P5 E Deotn tow . An 1-yi; 0 FAonimrinp? tici D71C 00 MICHAEL N. ANDERSON : Qr / +L rG_OAAO PERCOLATION RATE a • (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN �0 FTAND SOFT Liv♦1 Gr+�♦ cunsI&, Fdi jok uS4Cf Pce Car.vtl w'4li er rn Per C- a<na.�. PERFORMED BY: m, h e-�4r7 1 V ..rrt 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATER' 0 72-008 (Rev. 4/95) -�=Amg M1. 094 �. � PERCOLATION RATE a • (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN �0 FTAND SOFT Liv♦1 Gr+�♦ cunsI&, Fdi jok uS4Cf Pce Car.vtl w'4li er rn Per C- a<na.�. PERFORMED BY: m, h e-�4r7 1 V ..rrt 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATER' 0 72-008 (Rev. 4/95) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE IWNEW , Y"VV M C�, 34 OUPGRADE MAILING ADDRESS T14 p LEGAL DESCRIPTION MT P^K K s LOCATION NO. OF BEDROOMS UP r� c meq -V r, Well Absorpbo era Dwelling PERMI y O Y DISTANCE TO: I©Z Manufacturer Material G SfiL- No. of compartments H Lip. apac,ty in Ile ons IF HOMEMADE: Inside length Width �— Liquid depth dwe DISTANCE TO: Well Dwelling PERMIT NO. �v2Al _? FQ- Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well / Foundation I Nearest 1 tie PER IT NO. Z No. of lines Length of each bn' Total len th I lues Trench w.d to Distance between lines W Inches H Top of the to finish grade Material beneath tile 'ej Total effective absorp ion area Ci inches 17 12,2 Length Width Depth PERMIT NO. W U H d Type of crib Crib diameter Crib depth Total affective absorption area W O. a DISTANCE TO: Well Building foundation Nearest lot line j jClass Depth Dr�t r Distance to lot line PERMIT NO. W DISTANCE TO: Building fou ation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS a1- SOIL TEST RATING _/ A! - 1 INSTALLERIF atj :Z % 1►.1G, REMARKS f //lrS A. F ' s. . eir �'* r f�• it � p LI .......Yr»j N Abbott JIL thoPot0! No. 1457•E+—rd+ La 2L APPROVED SRU 10cx DATE LEGAL c.,CLE RIVER. ALASK-% =77 PH, e04-2379 —Z/ —8 8 72413 (Rev. 3178) WELL LOG Date'Drilled: 1-8-85 Static Water Level 165 feet Drax Down Ll/A feet Lot 3 .. L -7�'J Blk,.Y Mt. Parks Estates Gallons Per Minute 8 Total Feet of Casing in h 0,g0 Type Material Drilled: 1/ 0 feet to 20 Brom clav, w/^ ravel mi ;ed ?n feet to 57 Silt 57 feet to 40 Sand. �r^vel 80 feet to 165 Silty sand, nr?Vel_, boulders 155 feet to 1.75 Bock, boulders 1.75 feet to 174 gravel, Si.lt•., water at -n^, 178 feet ---_ro 7.07 Cravot.v w/bouIdPr�--------------__--- --- 07 feet to 329 Bedrock w/water Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: mu I C I 1---�1L I TY OF= ANCF--fiznc-,-I , DEPARTMENT L HEALTH AND ENVIRONMENTAL JTECTION 825 L STREET, ANCHORAGE, AK. 99501 ` ^ 264-4720 ON—S I -T"F= WE=LL CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: 840981 12/31/84 DAMMAR CONST. INC. 2830 EAST 88TH AVE ANCHORAGE, Ah 99507 349-2386 SUBDIVISION: MT. PARE; EST. LOT: 3 BLOCK: 7 SECTION: 26 TOWNSHIP: 12N RANGE: 3W 15600 (SQ.FT. OR ACRES) •J Listed below are the options available to system. Choose the option that best fits you in designing your septic your site. T3 EI) TF<ENCH DEPTH TO PIPE BOTTOM (FT.) 4.0. GRAVEL DEPTH (FT.) 8.0 TOTAL DEPTH (FT.) 12.0 �_1 GRAVEL WIDTH (FT.) 1 GRAVEL LENGTH (FT.) 132.0 ** GRAVEL VOLUME (CU.YDS.) _77.0^* 60.7 TANK SIZE (GALS) 1,000.0 *� SOIL RATING (S0..FT./1?R) 407 you in designing your septic your site. T3 EI) t1i . nF:A I N 4.0 4.0 0.5 3.5 4.5 7.5 27.0 5.0 52.0 132.0 ** 52.0 97.8 1,000.0 ** 1,000.0 312 407 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) *+� TANK MUST HAVE AT LEAST TWO COMPARTMENTS , - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes ..and regulations, and in compliance with the design criteria of this permit. I will adhere to all MOA and State of Alaska requirements for the set back: distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-E:UILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK. MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED --- /�-- � DATE: APPLICANT: DAN1- CONST. INC f ISSUED BY PERFORMED ❑ SOILS LOG •• AUNICIPALITY OF ANCHORAGE n DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST DATE PERFORMED: C�e4 It ' 4 LEGAL DESCRIPTION: F1 nor• -I. n �y: cr—Sa'4e j' f l' L:1 s,A1,4 "1 G 7 ] =! I -P7 SLOPE SITE PLAN (F� ETI r I. fT 3 nti•..,J e,,r s,i 4 z• R 5 6 7 8 9 10 I 12 I I Fn .<!s F.tt e•.. •� tr_t {,cam 13 t 14 15 17 19 1 w '491 .1 N.N eH».•�„ 19' :• a Y C. Reid, Jr.q 4' 0' 20 s N -. 2251-E �F •••'�V/ PERCOLATION RATE 5 (minutestinchl `S51. _ OTEST RUN BETWEEN 3 FT AND 3 FT COMMENTS S C V""+'vu�_ I 7. I L' r • a /� 0C' 4,. � WAS GaOUND WATER N^ L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop fNzo o,< ,, y — 1 21 4 I O v H , C'1 4N1D Loo - 9y -f 25c' r0 r/Y 3 ;,yo ,o .-Jo p LY I — ,. so — y X, ti -r' q 'if 30c 1C, V3 .03 C 3,c I ,0 / If PERFORMED BY: .'• 1 CERTIFIED BY: DATE: 72.008 (6,/79) v- tl- O VJ CY) � CY) C7 ccyi M LO N O N d' r N C O cu 0- x X W (J 0 CD 1 co 0-) C'7 1 ti O Q Q) U C'7 J � M Y /JQ I( is C/) / W O co Q LU Y � Q 0- \W Z W z C) D V c N O �- Q U) U Cn ^O W '0 co CD J Cn U CO U) W CU) W 06U W z O U)��Q/� L(u 0 a� sz O L Q. 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U) co E %- LU 0 UL 0 0 4- z C: C-4❑ El c 4- 0 u) w N uj u) a) a. D U) 0 a) (D -0W W -0 LU LU -a LL cn ca LL zU) m cn m z a) a) Z (3) (1) 0 0 LL LL LL U)•Ri a) 5; 44? uj 0 0 iL W Z a) E m a) L co LU LU 0 LU - CL a) to 0 F- F- U) < .> a) M cu> CV vi d ui co x w0 -W LL it" W COSA Checklist.docx COSA Checklist Legal Description: MOUNTAIN PARK ESTATES BLOCK 7, LOT 3 Parcel ID: 017-391-16 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1/8/1985 Total depth 329 ft Cased to 208 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 2/14/2024 Static water level at beginning of test 168 ft. Well production at time of test 4.2 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.14 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 2/15/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 2/14/2024 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/20/2005 ALL standpipes present per record drawing Total measured depth from grade 10.4 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 2/14/2024 Results Pass Fluid depth prior to test 33 in Water added 650 gal New fluid depth 49 in Elapsed time 1170 min Final fluid depth 34 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in (MOA 7’ ED) Effective depth used 34 in (Final Fluid Depth) Effective depth (ED) remaining 50 in Comments/Deficiencies: Approximate total measured depths from existing grade at time of test. ED per elevation measured shots & appears approximate with 7.6’ ED. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MOA ISSUED WAIVER OSP131423 G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 2/28/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 02/28/24 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-391-16 Expiration Date: a ry I�f 1. GENERAL INFORMATION Complete legal description Mountain Park Estates, Block 7, Lot 3 Location (site address) 12944 Ridgeview Drive Anchorage, AK 99516 Current Property owner(s) Lloyd StlaSSny Mailing address Real Estate Agent Day phone 230-6436 12944 Ridgeview Drive Anchorage, AK 99516 2. TYPE OF DWELLING: Fx7l Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: }` Received by: - �-_ � Date: COSA to be released to the''engineer, unless otherwise requested by the engineer. COSA Fee $ "- 0 Waiver Fee $ ile Date of Payment t a r Date of Payment Receipt Number d 15 39A Receipt Number i�}c2 �SiT COSA# 0tp, I315-9 Waiver# CL ' nn1.3jLla-� 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 app' shows that the on-site water and type of structure indicated d/or wastewater 1pherein. I furthersystem is (verify that based on rictionaIand adequate the information for the number of bedrooms and typ 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE t/ System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the follow Date 10/19/2013 FOL^ Original Certificate .. y •---"--�— Th Municipality of Anchorage Development Services Division (DSD) issues Certificates of On 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: Nitrate Advisory COSA Checklist X Arsenic Advisory Septic System Advisory Other Well Flow Advisory COSA bWe sheel_f :., c If more than 1 septic system is on the lot: COSA Checklist # _of T Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Park Estates, Block 7, Lot 3 A. WELL DATA Well type Private Date completed 1 /8/85 Total depth 329 ft. If A, B, or C provide PWSID # _ Sanitary seal (YIN) Y Cased to 208 ft. Parcel ID: 017-391-16 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) >12 in. FROM WELL LOG AT INSPECTION Date of test 1/8/85 9/21113 . Static water level 165 ft 112.6 ft Well production 8 g•P•m- 5.6 9-13 m WATER SAMPLE RESULTS Coliform 0 colonies/100 mL Nitrate 1.07 mg/L Arsenic N/D ug/L Date of sample: 9/19/13 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Date of pumping 10/16/13 Depression over tank (YIN) N Pumper Isaac's Pumpi Date installed 5/20/05 Cleanouts(Y/N) Y High water alarm (YIN) N Iq Service C. ABSORPTION FIELD DATA Date installed 5/20/05 Soil rating (g.p.d./ft2 or ftz/bdrm) .6 GPD/SF System type Deep Trench Length 61 ft. Width 2 ft. Gravel below pipe 7 ft. Total depth 10.5 ft. Eff. absorption area 854 fe Monitoring tube Y Depression over field N Date of adequacy test 9121/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 19 in. Water added 505 gal. New depth 36 in. Elapsed Time: 11440 min. Final fluid depth 19 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: adjacent lots >100' Septic tank/lift station on lot >100' On ad 1 >1 00' On adjacent lots >1 00' Absorption field on lot 1 Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25 Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >51Absorption fiel Water main >10, Water service line >10' Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: d >5' >100' Propertyline >10' Building foundation >10 Water main N/A Water Service line >10' >100' Surface water Driveway, parking/vehicle storage > 10 None Noted >100' Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E.Anderson, P.E. Date 10/19/2013 COSA brown sheet_10-1a12.doc t Muni of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:/lwww.mu ni.oro/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131423 COSA#:OSC131647 Permit#: PID#: 017-391-16 Legal Description: Mountain Park Estates, Block 7, Lot 3 Engineer: Anderson Engineering Applicant: Llovd Stiassnv Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5 feet. Your request for a waiver of the required 14 feet horizontal separation from the onlot absorption field to the adjacent absorption field has been approved. The approved separation distance is 9 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Waiver is not Grant d: Date: t i (� 12i Approved by. Name of Reviewer .............................................V ................................ Rec#: 07265G Amount: $200.00 Date Paid: 11/5/2013 **** VARIANCE/WAIVER REVIEW **** November 5, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 3, Block 7, Mountain Park Estates Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The as built documentation of the septic system completed on Lot 3, Block 7, Mountain Park Estates and certified by the engineer of record and the City states the absorption trench was constructed 10' from the east property line. The plan design for the same system permitted for construction shows the trench 5' from the property line. Similarly, the as built documentation indicates the trench is constructed 5' from the property line. A recent survey of the property completed by a professional surveyor verified the absorption trench is 5' from the west property line. Unfortunately the new owner of the property is now required to obtain a lot line waiver in order to get a COSA and sell his property. We are hereby requesting a waiver of 5' to the east property line be granted. The absorption trench on Lot 3 is only 9' from the absorption trench on the property to the east or Lot 4, Block 7, Mountain Park Estates. A Lot Line Waiver was issued allowing the trench on Lot 4 to be constructed within 4' of the common lot line even though the trench to the west was already in place and supposedly 10' from the property line. The 7' effective depth of the trenches requires a minimum 14' separation distance to meet Municipal Code. A waiver is therefore required to allow the trenches to be 9' apart. Percolation tests completed on both properties in the area of the absorption trenches indicated an absorption rate of 8.5 and 8.7 minutes per inch. We assume in soils this porous that most of the septic effluent will be absorbed downward with little migration toward to the common property line. The opposite sidewalls of each trench have unobstructed outward flow for at least 14'. The trenches have been acting in this Lot 3, Block 7, Mountain Park Estates November 14, 2013 Page Two manner since June of 2009 when the trench on Lot 4 was constructed. The recent inspection of the trench on Lot 3 indicated 19" of water in the trench after 8 years of use. This further indicates little migration of effluent into the 9' separation area between the sidewalls has occurred. We therefore recommend the waiver be issued allowing the absorption trench on Lot 3 to be 5 from the property line and 9' from the absorption trench on Lot 4. Sincerely, Michael E. Anderson, P.E. 49th MICHAEL E. Na C OF I NO. -r. QF 'e"O '4 AS -BUILT � 4,. 4 � < nr—Y cernrY Enal 1 nave surveyed the tollowing described -Operty:t� 401 C, 4' improvements on proffer the == mnestrn Mme,ithe .ept as indicated hereon. ted at Eagle River, Alaska I s P gay of, C7 C ROB ALE: Regis x -30 Phor November 5, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 3, Block 7, Mountain Park Estates Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The as built dcoumentation of the septic system certified by the engineer of record and the City states the absorption trench was constructed 10' from the east property line. The drawing shows the trench to bey' from the property line. Unfortunately the new owner of the property is now required to obtain a lot line waiver in order to get a COSA and sell his property. We are hereby requesting a waiver of 5' to the east property line be granted. The system is more than 10' from the septic system on the property to the east and does not have an adverse impact on that property. Sincerely, /n� `nt_�/ C!7j .�--1 Michael E. Anderson, P.E. `9 49th °. MICHAEL E. ANDERSON No. CE -4381 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 2644720 Application DateY 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) "7- 3 84,0a 7 H7. /"XZA� EST. 'ejh% 5,64t y (e Location (address or directions) (b) , Applicant Name P/Cylfk£t 51WI Telephone: Home 34'w 7x96 Business 5'41(_ 37f1r Applicant Address hr -74q elh6� ✓14V (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution�f A Telephone Address A (e) Real Estate Company And Agene !/ A Address �I/9 Telephone W/A (f) Mail the H,/) to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual WelIX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite'g Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 J1 V84) 5. ENGINEERING FIRM PROVIDIN, INSPECTIONS, TESTS, FILE SEARCH, DArA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Hekth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this in d�C s S ' Name of Firm /T e Telephone G /-So Address �Z� j3 �¢r/C• S/rlTB 15 L /M. 9 lS03 Date . ,�'i�Lf' 6. DHEP APPRO `�) "o4, Approved for '� bedrooms by .;,iLl LC z6 Approved Disapprove Conditional _ Terms of Conditional Approval CAUTION Date OF 060 4 h thAeuW The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-025 p+/54l n n MUNICIPALITY OF ANCHORAGE (MO,y HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 M"NICIPALITY OF ANCHO.'.AGc DEPT. OF HEALTH & ENVInONMENTAL PR0TECtION 11 L 1 ;1986 Legal Description: "7-3 AoCe 7 R Cy Cb~ Tiaw 'Z3'0J r A. WELL DATA Well Classification ��✓ilT6 If A, B, C, D.E.C. Approved (Y/N) Well Log Present) Date Completed I -Y4 ' Yield Total DepthjZ9� Cased to �8 Depth of Grouting W14 Static Water Level td ' 163.3 Pump Set At Casing Height Above Ground _ Electrical Wiring in Conduit &N) — Sanitary Seal on Casing) _ Depression Around Wellhead (Y&J Separation Distances from Well: To Septic/Holding Tank on Lot /40x 11 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot Z/40 ; On Adjoining Lots To Nearest Public Sewer Line A114 To Nearest Public Sewer 9 /i Cleanout/Manhole �ewer Service Line on Lot Water Sample Collected by �/' W��J ; Date Water Sample Test Results sSfih`To�7 Comments Mal fi-,vJ 7e5T3'X°- B. SEPTIC/HOLDING TANK DATA Date Installed �"Z�"%S Size AV &4L No. of Compartments L Standpipeso) Air -tight Caps6N) Foundation Cleanout&) Depression over Tank (Yo Date Last Pumped 7 746 Pumping/Maintenance Contract on Fite (Y/N) Al —;for — A1/4 Holding Tank High -Water Alarm (Y/N) t Temporary Holding Tank Permit (Y/N)41— Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation 9 To Property Line Z� To Disposal Field G To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84( ALL__ L3 d7 ffT. /,/ rST- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata J07 Type of System Design Date Installed / `L/'^, � Length of Field 77 Width of Field S -•S Depth of Field /1 - Gravel Bed Thickness 8 i Square feet of Absorption Area /y3yd Standpipes Present&) Depression over Field (Y© Date of Last Adequacy Test 7-7 6o Results of Last Adequacy TestA0p/�� ' SZF- /19r/M/AJ LtSNc7-f Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation Lot On Adjoining Lots i To Water Main/Service Line /O -t- To To Stream/Pond/Lake/or Major Drainage Course To Existing or Abandoned System on To Cutbank (if present) i To Driveway, Parking Area, or Vehicle Storage Area SO i Comments D. LIFT STATION Date Installe Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — 'Pump Off' Level at " Check Permitted Bedroom Rating Against HAA Request .e Vent(Y/N) during Adequacy Test. Meets MOA Icertify thatlh i he d,veri e_d,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. Signed Date CompanyGS MOA No. OF A \� hi Receipt No. `qs�� Date of Payment 7' a �'�� *y' TH� ••'.�9♦�' Amount: $ �� few. •• ..L...� -- (a/ / •�••• goes*..* ****so.% /!7//kf�2�i— W�tc cob C.REID xry. Page 2of2 c✓rffak Sri/� Ys7.c� ,� '•9��i.•' AFI sfrE Puy✓ di+w�,�ti ��••p�i.�: 72.026 n 1, fa) ALASKA ENVIRONMENTAL ,oB 467 3 Bz4e, 7 i1T jF /�i1Rt CONTROL SERVICr')INC. 3 ENEET NO. t4w",� OF 1200 West 33rd Avenut Suite 8 ANCHORAGE. ALASKA 99503 CALCULATED BY DATE Phone 561.5040 CHECKED BY DATE /� 30 ALASKA u dlRO1 nTAL COnTROL S ulCCS, InC. Enyincering 5 Enuironmental Studies JULY 18 1986 HOME EQUITY/ANN LANDON SELLER—MICHAEL & CAROL BARRY CASE i 4230-976 1300 POST OAK BLVD SUITE 950 HOUSTON TEXAS 77056 ht;;N CIPALITI OF ANCHORAO,' DEPT. OF HEALTH & 60344 FNVI.^,C,,vAENTAL PROTECTION !!! 1 1986 LEGAL:MOUNTAIN PARK ESTATE BLOCK 7 LOT 3 D E C E I V E D ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE—JULY 7 1986 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1232 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 2000 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JULY 7 1876 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE—JULY 7 1986 A FLOW TEST WAS PERFORMED ON THE WELL. 688 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.7 GPM OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 65.7 ' WITH A RECOVERY TIME OF 180 MINUTES AND THE STATIC WATER LEVEL WAS 163.3 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. ••••' 2 REIo. JR. 12251 27-1 1200 Wesl 33rd Aucnue. Suite B • Anchorage. Alaska 99503o(907) 5615040 _ r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION (a) Legal Description (include Location (address or directions) Application Date y •: S— subdivision, section, township, range) (b) Applicant NarRe t... •� .1�. Applicant Address 6.31) Business (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ;Buyer ❑ ;Other W(explain);Zo!� (d) Lending lnstit�u�tioo__4�t—/* :lc���«�° ';>;' 11 - Telephone Address /1s'.�`/ !/tc.•-% - J�G� 'C. ��s'-L7��-sc�or�.. i, ,�.I -.ZCe�.G� C/5'i5r' (e) Real Estate Company and Agent Address TN�l- ee�lephone // (f) J�lecl the HAA to the following address: (,l) �( C u -P 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well P/ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsiteia:l Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 r2-02501,e<r A A FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date DHEP APPROVAL Approved for bedrooms by _ Approved Disapproved Terms of Conditional Approval Telephone CAUTION Of A` hfi Robert A. Shefa, �l.• /fisc The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 d'2 A. WNCPALIIY OF ANCHORAGE DEPT. OF HEALTHB `MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HFJa= AUTHORITY APPRovAL (HAA) I.AY p 3 W5 CHECKLIST - FEBRUARY 1984 Legal Description: ZV ,$C I V E D FELL DATP► a1JAJ-r. .1AJ 7Al,'Jl A_�_5T. ' Well Classification If A, B, cr C, D.E.C. Approved(YM) Well Log Present &N) Date Completed Yield _Cv Total Depth 329 Cased to 2of; Depth of Grouting_ Static Water Level I L.<' Pump Set At (J, /% Casing Height Above Ground 30 " Sanitary Seal on Casing V") Electrical Wiring in Cmduit MYN)- Depression Around Wellhead (Y�o Separation Distances frau Fell: To Septic/BeldiM Tank cn Lot I OZ On Adjoining Lots 1 DO '4 - To Nearest Edge of Absorption Field On Lot I)(eL f On Adjoining Lots _L=2!+ + To Nearest Public Sewer Line ")IA To Nearest Public Sewer Cleancut/Manhole 'U14 To Nearest Sewer Service Line an Lot r15 �t Water Sample Collected By S¢ S 63QZ,. ; Date 5-2--8S Water Sample Test Results Caments B. SEPfIC/F XMNG TANK DATA Date Installed 1-2/ -Q� Size /CE' o No. Of Caq=tments Z Standpipes OM) Air -tight Caps �_ Foundation Cleanout Q/N) Depressicn over Tank (YAO Date Last Pumped Nc)J Pumping/Maintenance Contract on File (Y )'''eft ; for Holding Tank High -Water Alarm (Y/N) '"'l Temporary Holding Tank Permit (YM) Separaticn Distances from Septic ,g Tanks To Water -Supply Wall /n 2 ' To Building Foundation To Property Line Sa i4 To Disposal Field To Water Main/Service Line by "t To Stream, Pond, Lake, or Major Drainage Course Ccaments Receipt # �i�etito� Date Paid: Amount: [Page 1 of 21 2-15-84 C ly ilijI •may , •: Soils Rating in Absorption Strata 40 `7 4�61oR.— Type of System Design 7rc'�c,v Date .Installed /--z/ - 6!5, Length of Field 77 � Width of Field '5� `" Depth of Field /2 Gravel Bed Thickness 9 " Square Fleet of Absorption Area /7-3z4 Standpipes Present QM) Depression over Field (YAD Date of Last Adequacy Test A,49Lo Results of Last Adequacy Test 7�/Q Separation Distance from Absorption Field: To water -Supply Wall //(o a To Property Line /o � To Building Foundation Sc '1 To Existing or Abandoned System on Lot �,4J On Adjoining Lots 3c �� To Water Main/Service Line 7o �t To Stream/Pond/take/cr Major Drainage To Driveway, Parking Area, or Vehicle Storage Area 70",-4 Comments D. LIFT STATICN Date Installed Dimensiors Sias in Gallons /Access (Y/N) 'Pump On" Level at Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumpi les during Adequacy Test. Meets MOP, Electrical Codes(Y/N) Comments #* Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checked, verified, as conformed to all MOA HAA Guns in effect on the date of this inspection. 1 Signed_ $ & a8RBime�f Riti� ,�• 1 .COSI II Congany FH. la MOA No.ff ,i"OO 3 0 • • N J... 7 ,• e KB1/d5/s R mih•,1•A•SMI•r [Page 2 of 21 f U Es -"'T 4 2-15-84