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Home My WebLink AboutMOUNTAIN PARK ESTATES BLK 10 LT 1Mountain Park Estates Block 10 Lot 1 #017-44-128 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 95005$ PID Number: 017 "iWaS Name:Wastewater 6412L Tc7aRScA/ System: ❑ New 0,u Y pgrade Address: R4105 dillicolm e7 u1vEAL�'q gol ABSORPTION FIELD Phone: - 2"]9` No. of Bedrooms: ❑Deep Trench SShallow Trench D Bed ❑Mound ❑Other9o�1-790 LEGAL DESCRIPTION Soil Rating: J Total Depth from original grade: O• T 5" GPD/ Ft. Lot: Block: Subdivision:T Gyf; i Depth to pipe bottom from ori ,nal grade: v Gravel depth beneath pipe 10 Ma-jMTA1 QP. H. Ft 3•SFt. Township: Range: Section: Fill added aboveoriginal grade: Gravel length: f14E6'1' 1 r Ft. IQgI• IQE4' 109 TOTAL Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between lines: L�XIST,n,t- Ft. ice- Ft. Classification (Private. A.S.C): Total Depth: Cased To: Total absorption areae, Pipe materiel: AST sN �RIVATIC /S l Ft. 161 Ft. �� I SO Ft I 'D303,1f 9/O Driller.�n� M -EA% yr�11.L1a�(. Date Dolled: 7l-su-sl static Water L": ISS s Ft. Installer. T iio Mt: SBIZVI Date Installed: b -q -q,5 Yield: 0/K Pump Set at: /K Casing Height Above Ground: TANK GPM Ft. 10+ Ft. SEPARATION DISTANCES sKseptic ❑Holding ❑S.T.E.P. To Septic Abwrption un Homing PubliuPrivate Manufacturer.city Capa In gallons: From Tank Field Station Tank Seer wLinn N Ho QA&e xs4y /000 Well I t6, 115' 2S'+ Material :'5=L Number of Compartments: Cl - Surface W, ater Wter IOO r IoeT- I "'- '— LIFT STATION Lott 4 1 III Size in gallons: Manufacturer. Line — Foundation to I ' 3 1 "Pump on' level at: "Pu level at: High water alarm at: Curtain Pump Maka 8 M Electrical Inspections performed by: Drain Remarks: s STt ►A 't� �u wAs BENCH MARK AL7F-RED {z- O LtVC OACHN Location and description: _10OR ee,,jCRATt SLA13 OF tf-Kt 11`4 &- SY ST6►^ 0 CA 7 AT 13,0"onn o"F 5TA12S Assumed Elevation: >shz D C s STFhn 4S7JC 100.6 F, ENGI SEAL .eLOFA f5�,,......,v,��s S 8 S ENGINEERING Inspections performed bff034Eagle Riw.� Rd No. teS:1St L -S -4S tS ERg • Rivlr, Alaak� 9957ee7 2nd L-4-26' ..._. _._ ................ 1 ,^� ROBERT C. COWAN "l�Q (I+r�'•'., Department of Health Hu ervices approval CE -8801 tt�, ... �j:i; Reviewed and approved by �� Date: ;:.;t��i:'1� 72-013 (eev. 991) MOA 25 Permit No. SW950058 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 1, BLOCK 10, MOUNTAIN PARK ESTATEJ3ID No.: 01744128 72-019 A IM . PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950058 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:PETERSON CARL A & LAURIE L OWNER ADDRESS:12440 ALPINE DR PARCEL ID:01744128 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK 10 IT 1 LOT SIZE: 24800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: IOU rrn Son-\ Snt-n to-lk-W DATE ISSUED: 4/26/95 EXPIRATION DATE: 4/26/96 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 S. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL RECEIVED ISSUED B PROVISION . BY: DATE: Y: -� DATE: �- Ap4it 14, 1995 ROBERiC. COWAN, P.E. ROBERTA. SHAFER P.E. CML ENGINEERS (907) 694-2979 FAX(907)694-1211 H-ALTHMOMMTY APPRMA S MUNICIPALITY OF ANCHORAGE Depak.tnent 06 Heatth and Human Sertvicea P.O. Box 196650 SEWER&WATER MAINO(TENSIONS Anchorage, AK 99519 REFERENCE: Lot 1; Stock 10; Mountain Partk E6tateA SEWER & WATER INSPECTION Requat you .L66ue a permit to upgrade. the 6eptic 6yatem dehvcng .the, three bedroom houae on .the xe6eaeneed pwpuay. ENGINEERINGSTUDIES Two teat ho.tea wehe excavated and a pen.co.tation tebt6 peA6o,med. The ANDREPORTS appaoximate .tocation o6 the teat ho.tea 4.a .toeated on the attached d.ite plan. The p4opo6ed 1000 ga.tton 6epti.c tank .c6 to 6e ptace out6ide the wett ;P OWTTESTRON protective 2adiu6. Attached i.6 a site plan which depiet6 the .tocation o6 the pnopo6ed tank. 16 you %equine addi iona.t in6o)tmation ptea6e contact. SITE PLANS Si.ncenle{t/may, ROAD DESIGN / RobW C. Cowan, P.E. RCC/gk SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 'I' = 50' SITE PLAN Dmf D ti *C A -01 r 0a Fk-mc-zM Dar;O-ri-,�' ztn v>N=� or z Cin z• -<' o�N �0o *ZC) Cs .Z7zy z Z.-o-+ITI A yoommmK' mCzi D mmoo� NO SDA Nn S = 0 p y z m 00 z z Z m O N z �rM O \ ' oro x x O r p O�l �,�^ II C) r W 7C�DN Ln Vl II o NO4nw03C7 I ;nz 11 II eco ®0056=�Np[ij �cn rri X O i1 X A / / AOrpt / o m�M Or -ni 1533 H th Enz z 0En GO ulm z A ' v Dmf D ti *C A -01 r 0a Fk-mc-zM Dar;O-ri-,�' ztn v>N=� or z Cin z• -<' o�N �0o *ZC) Cs .Z7zy z Z.-o-+ITI A yoommmK' mCzi D mmoo� NO SDA Nn S = 0 p y z m 00 z z Z m O N z �rM O \ ' oro x x 100• WELLL RADIUS o 0OmZ C) r W 7C�DN r1 O I ;nz 11 DSO m I X O i1 X A / / m <>0 Drip / o Z LAO ON 1533 O Sow r1 x- n xo . Dmf D ti *C A -01 r 0a Fk-mc-zM Dar;O-ri-,�' ztn v>N=� or z Cin z• -<' o�N �0o *ZC) Cs .Z7zy z Z.-o-+ITI A yoommmK' mCzi D mmoo� NO SDA Nn S = 0 p y z m 00 z z Z m O N z �rM O 0 %ZtiN \ ' oro x x 0OmZ C) r W 7C�DN r1 O I ;nz 11 DSO m I X O i1 X A ' I m <>0 Drip o y I p Z LAO ' N ADO W I 1533 O AD SLS x- n xo . 0 %ZtiN S & S ENGINEERING PERFORMED BY: I CERTIFY THAT HIS TEST WAS PERFORMED IN 034 Eagle River Lo" Road No.2O4 �� ACCORDANCE GUIDELINES IN EFFECT ON THIS DATE. 0-1- 7 72-008 (Rev. 4/85) PERFORMED LEGAL DESCRIPTION bEPTH 'CA" C-5 1 L32 I /Ml - 3 / 4 CsM 6 7- 8- 9- 10- 11 a91011 12- 13- 14- 15- 16- 17-11 2 13 14 M�Idrn 15 16 17 B.(&44. 18- 19 20 COMMENTS WAS GROUND WATER tO ENCOUNTERED? 10 IF YES, AT WHAT DEPTH? Depth to Water AtterI, I IAONtortag? �ADatt — M171 Reading Date Gross Time Net Time Depth to Water Net Drop ._ ' D Oatrn, i 4;'; 10 •' 231vair Y too 110 Iva �1 Oiwsu YL" .23 iot• 2 y�. v^ I PERCOLATION RATE C (minutevmcn) PERC HOLE DIAMETER 6 F€ST RUN BETWEEN J FT AND 4- FT PERFORMED BY: S a S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WIT 17034 Eagle (� Ro�� IN EFFECT ON THIS DATE. DATE: �/./ r / q r h�C�b�FPYe�, A1iika'Wi� 72-008 (Rev. 4185) HEALTH AVT HOF NTY APPROVALS SEWER A WATER MAIN EXTENSIONS SEWER&WATER MPECTION ENGINEERINGSTUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS CN SITE WASTEWATER DISPOSALSYSTEM DESIGN W GENERAL: ROBERT C. COWAN. P.E. ROBERTA. SHAFER P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CMLENGINEERS CONSTRUCTION PRACTICES FAX(994-2907)6944-- 1211 and FAX (907) MATERIAL SPECIFICATIONS : Lot 1; Block 10; Mountain Park Estates 1. The scope of this project includes the installation of a 1000 gallon septic tank and two five foot wide drainfields to serve the three bedroom residence located on the referenced property. The existing leachfield is to be abandoned in place. The existing 1000 gallon septic tank is to be excavated, pumped, crushed, and abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 Page Two Lot 1; Block 10; Mountain Park Estates April 14, 1995 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 1; Block 10; Mountain Park Estates April 14, 1995 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tyne of Pine Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the $200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 1; Block 10; Mountain Park Estates April 14, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR OWNER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 2644720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE L P+tEW ]UPGRADE MAILING ADDbEESSS �� LEGAL DESCRIPTION L LOCATION r NO. OF BEDYOMS � D Y I Well DISTANCE TO: �M, Absorption ares pwelling PERMIT lip jj r0 (p ;L5 EZa f- Manufacturer Mater No. oLcompartments ...LL w Liq, cpp6tyinellons ` CJ IF HOMEMADE: Inside length Witlth Liquid de th q E_ _,0Z _?� DISTANCE TO: Well. Dwelling PERMIT NO. Liqui gallons Manulat xrial W DISTANCETD: ffLength Foundation _ _ __ ♦�L '0Dines, Nearest lot hneOJ= ♦ PERMIT NO.ptvWZ Z W F- am cc f- No. of lineeach lix, Total length � Trench width .S inches Distance between 'nes Total el festive absorption area to 3 z. Ton of tile to finish grade Material beneath tiles A- d inches W C7 Length Width Depth PERMIT NO. n f- W� Type of crib Crib diameter Crib depth Total effective absorption area Lu W DISTANCE TO: Well Building foundation Nearest lot line J W Cl Depth Unller Distance to lot line PERMIT NO. !Q/v 2 r J 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 'D2,,o,6ci I r6 r% SOIL TEST RATING INSTALL REM KS I PeI F1 d5 bo'ec.Ttcrf DT05 l ✓ JE-fall P APPROVED DATE LEGAL ^ t c9 1 13o a' r ` M -W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Carleson Cnsnt-rundon Cornnnnv Use of Well !!nr.r.;ri Location (address of: Township, Range, Section, if known; or distance main road Tnr 1 P,lnrl- 10 Ttn^n Ynin purl- Size of casing "' TTepth of Hole 1 r;1 feet Cased to 1 "T - feet Static water level I i,'i ft. (above) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ), Describe screen or perforation ABX Well pumping test of "I gallons per (hdut); (minute) for--Z---hours with_ n -t) ft, of drawdown from static level. Date of completion ''^ . 10 10n1 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of mateljA,FppfrincfdR.4� GE TO TO- O _TO -To TO Ll 21 m„ 159 159 TO 1.11. —TO- -TO- -TO- -TO- '—TO- -To OTOTOTO' TOTO TO TO TO DEPT. CF HE-,LHI & Cr-inr •t ri r!.-,�, ENVIRONMENTAL P:.CTCTION Fro -.:or. :silty gravel na, D 1481 Silty gravel Sandy gravel, dari Silty Travel Sandy )•,ravel ,nid watccr 3 —CONTRACTOR M lJ t4 I C I F0-9 L- I T •T C F F1 hF Cv H F=l C3 E ICS DEPARTMENT G. HEALTH AND ENVIRONMENTAL i JTECTION ` , Ukls_i-ELL 625 'L' STREET, ANCHORAGE, AY,. 99501 fob. Al kAA 264-4720 WELL F r4E> Ctrl—SITE SEIJEFZ PEFZtl I T PERMIT NO. C £10625 > In APPLICANT CARLESON CONST. CO PO BOX 10-905 J�� 349-2057. L LOCATION ALPINE DR. -] -��` Id,'_;A LEGAL LOT 1 BLE: 10 MT. PARK ESTATES LOT SIZE 24800o 2/4£00 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH " ul�tt�i� nM/ MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSQ FT/BR)= 2£6 C7_�fy THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: '1(jJ/ FJEPTH= C LEt4C3TH= 1.253 C3FZF N?E"L_ E>EPTH= 4 THE LENGTH DIMENSION IS THE LENGTH CIFJ FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIFJ FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MIFJIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE _. AND THE BOTTOM OF THE EXCAVATION CIFJ FEET). Ft EG!L� I RE[? SEPT I C -rnNt< SIZE= 1-10,113 GFiLLOitJS PERMIT APPLICAFJT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TW CD C 2 ] I tJSPECT I CDt415 FiFtE FZEG!lJ I FZE"E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MIFJIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LIFJE IS 25 FEET AND TO A COMMUNITY SEWER. LIFJE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS FRE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZt7 I T EXP I FZES FCaECTE=rl 3EFZ'r:2:1.. __lL I CERTIFY THAT r 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR&N-SITE SEWERS AND'WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGEr_.` Q 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE.6JITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: ---------------------------------------- APPLICAFJT CARLESON CONST. CO ISSUED B'i V4. 0 ,.,�_- r�I1JTJ LLQ IwJFst-lL I TY 4f= i=ir•tCi-i+a F2t�+3� N t mv. TNr_Tt r d+' HATH lido a IY I r?Org" rfo- PRO TEC T I ON i S25 -L' S TREE r, f"310RA0E. rlr_ 264-47V i•1�t .L 1=1r -4c> C3r4 -1-:=; I 'r4E •_ E 3.JE-Z R f}1=ftM I T 1 PEP.n I T N0. < e tOt;2S > i HF7'uavir +.R3 -SON owsr. co PO SOX i0-943 349-2t?Sl ! LOCA T I Ott Alii' [ t r- OR L£CTL Lor i Bilk i9 Mr. PFRK ESTATE LOT SIZE 24-39 '54J iR£ FGEil rrf'E it SOIL mr-NxRPr[OII Sr'3TSti IS: rRE:trH PtrT?Cf?XJt4 fAMI EP r -F SorL RAT[N4 CSQ Fr/SR)= 2:35 1 71V- REOUIR50 5tcW- 4f' THE SOIL 06-30WTI9N gr`Srem t5: G•f+I�TH� e3 i_t=riGTH� :t._?•a +3RI�4fEl_ OGf'TH� 4 TiC Ls=MOTH OINLI-61ON I5 THE L04TH CIN FEET) O!" THE TRQM:H OR DRAUFIELO. T1-!=' IjeP rH ex A TRE1>t,H 0,4 PIT vi THE D t S rm)x FE T14E£N THE SURFIiix OF ne 1 +3FROUID AND TW BOTT0M OF TNG exrnyArtON <IN FEET). rHCRC IS NO '-fir WIDTH FOR TRUX>IC . THE +;RAVEL DEPTH t5 THE t4tN[r>'JN ccprH OF t-zzhYEL t3EncEN THE rJUTFALL PLP£ 1 0#10 THE BOTTOM OFF THE F30CAVATI0N GIN Mr). •E=+AttLf��I? •��I�TI+� Tr=fr.4K •= Izf +3RL_L+71T-451 PERr7I T FSPI'I.ICANr HA5 Tilt. Rf:`XON5 t a to rY TO INFORM THIS DEPART ei r Oman THE ' ! INGTI-0-1-11TION IIt--:PC-CTl0l6 OF my ILLI -S Ho,4tp w ro THIS PROPERTY ANo THS i tAJN^eR Or Restoanei THAT Tic wELL HILL 5FJ w.- ! TLl+� Com? ir•7�+1�'i_+�TI+�rJ'= I�Ri~ �:�+�LllftEtJ -i eal� I LL I na OF ANY S'r5 T£t4 W I THOU r F I tM I rt•:PEC r I ON rvio APPR6vFL 8Y THIS I-AAf? mum r H r LL E;E 5va lel r TO PROSEa T I Ott - t4INIPAR4 DISTIWDE Ej£T1'1£EN A I-KLL ITND ANY ON-SITE SB -"3E DISPQ'--,Fil. Sr5TEt1 IS U12 FEET FOR. A PRIYArE b1ELL OR 139 TO 29A FEET FROfi A PUBLIC 14ELI. DFPE4DIN0 IJ.00N THE rW. OF P1JEaLIC 1 -ELL MINIPW DISTANrF_ FROM A PRIYATF y,ELL TO A PRIVATE SEl•iEP. LINE IS 23 FEET fM TO A rlix-trJNlrY I-rE1dER LINE IS 73 FEET. WELL LULT3 RRE REQUIRED Arlo rrJS r cc RE TURNS% To rHE Dmw TP ew w I TH IN 30 OW's OF TW- WELL M41LE r I Ott Or" REoU I RFJ'1Eti r5 my APPLY. SPEC IF I CA T I OttS IiNo WU'3 TP.UC r t ON O I Ar3Rrlrt; ARE RW"BLE TO I I RM PRr3PER I NS To.t A r t ox f-`f=rZ r•1 L T i7Z.%�r-:1 ifs �; OLf�F=ttL�i=f2 3 L.. 2 J:31 I evr[PV rHOr L- I AN FNtt IL IAR WITH TI -C FOR ON -1V TC St)C�s Am WO -1.5 fry Ser FOR Tt l SV rl, PA.Ra C t PAt. [ rY a: RN�� MJRrP3F 2: I NIU. IIdTfll-l- THE S'r�STEN IN fWX`0ROi kt E WITH THE COOLS. 3; I UNDER 3 TANG THA r THE ON -SITE SEWER S'T3 TEN 148-1 REQUIRE ell -M30 -)ENT IF TRE f.`£StCrEliX IS R£rWELED TO WXUOE tms nm 3 aeol;0O ! 5[Or1s0:�lILCGC _ - -- -- ��Pl. rr�xtT +�iRlE5ON COtrsr. co >� ISJcO IIY__�'!F_C..a.:.F•_,_,� --____OATS Z' _ r__'r• QL__ Y4. D' (",N, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST SOILS LOG ^ i/%Ir/ PERCOLATION TEST PERFORMED FOR: P/a y!/ es0l• ' ♦,t t / / DATE PERFORMED:__ LEGAL DESCRIPTION: .44//lC /� /�� p�/F E`il7K' DEPTH SLOPE �IT/E{�li r, a,r F ET Trsor� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 417 If c/ S/# A.T,1 74 OGG2s"d• -e/ f/d ee/ ALleoi . WAS GROUND WATERS ,r I ENCOUNTERED? c L 1Js,t / IF YES, AT WHAT E DEPTH] FA Reading Date Gross Time Net Time Depth to Water Net Drop 20 Z, 1 z 0,;2y 2,/0 0• /a y /sso P- 46 -S-4 0./0 PE OLATION RATE - ` 7 T '/ (1minutes/inch),- TEST RUN BETWEEN 6.f FT -AND' .-G,) _. FTJ 3 PERFORMED BY: ! Ru, S. CERTIFIED BY: �r DATE: 72.008 (6/79) - s z •�f g4 • '� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 s. Certificate of On -Site Systems Approval Parcell.D.01—�f�O—A—a61 Expiration Date: / y - 5-- / y GENERAL INFORMATIONS% Complete legal description t, Outs ax kC /o L v� Location (site address) t 2 N J-11211-=— V Current Property owner(s) Mailing address Real Estate Agent Day phone Day phone 2. TYPE OF. DWELLING:. Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) sualAITTAL JUL 3 0 Z01% 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE O WAF!E,Wt' TlE i]i tN"; . . Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Pt'.ter `t@m n oubr;s evver.b" aS ❑ WaiverNariance request Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-2( Date of Payment '7 L06 Receipt Number 0� Ito COSA# b5C (� 1310 Date: Waiver Fee $ Date of Payment Receipt Number. Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below; I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address " U b ! l��c (rvr e (u ��t ff5-/G Engineer's Printed Name l �itrVdC! /t( 2 �ywrry 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone Date Z 3d /y, Cir jai �d 0/•4....... ......... /I ....a ... d MICHAt N. ANDEP.SCN CE -9469 Conditional approval for bedrooms, with the following stipu BY -- Original Certificate Date: 6 `S — l d Theunici y -.rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r - c 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/'(bu Ljjj PaVG(, Le,%, B/O /—A ( Parcel ID: 0(�-Nk�-2� A. WELL DATA Well type &oueAfi If A, B, or C provide PWSID # Well Log (Y/N) _Y_ Date completed ! ( Sanitary seal (Y/N) Wires property protected (YIN) Total depth ad—ft, Cased to —LV—ft. Casing height (above ground) /Y in. FROM WELL LOG AT INSPECTION Date of test Q �/6-( 7 /c( N Static water level I N i; ft. 114 fL Well production —0 g,p,m. S f g.p.m. WATER SAMPLE RESULTS: Coliformcolonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: V 7 —j Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Matedal 5L er ( Date installed frz 9/f 5— Tank size (Duo , gal. Number of Compartments Zi Cleanouts (Y/N) Y Foundation cleanout (Y/N) ) Depression over tank (YIN) /�� High v, ter alarm (YIN) Date of pumping _7/7 (�f Pumper 4 r aN 4 f` tic z (o r C. ABSORPTION FIELD DATA Date installed L 4 Soil rating (g.p.d./ft2 or ft2/bdrm) (%, System type 5 6 (IV U.2 Length Width S_ ft. Gravel below pipe 3. �9— fl - Total Total depth ft. Eff. absorption area lC fh . Monitoring tube Depression over field /, ( Date of adequacy test—4�=FZV1 Results (Pass/Fail) 4Q_/_71 For bedrooms Fluid depth in absorption field before test _t in. Water added y S f gal. New depth in. Elapsed Time: min. Final fluid depth _ in. Absorption rate >_ q'SO f g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level in. "Pump off" leve4t in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: i Septic tanktlift station on lot 160 Absorption field on lot 1 t9d t Public sewer main Sewer /septic service line Z r 'F Animal containment areas 5J -IL- SEPTICiW01* DlG TANK ON LOT TO: rol s (YIN) _ water alarm vel at alarm & circuit re On adjacent lots r Uo r 4 - On adjacent lots (0 c � Public sewer manholetclea/,pout Holding tank r� Manure/animal excrete storage areas /!9� � I � Building foundation tQ Property line 5 Absorption field 5 r i Water main 0 Water service line Z 5 Surface water /0 D -7L Wells on adjacent lots / r9 d t ABSORPTION FIELD ON LOT TO: � t Property line f "- Building foundation -ZWater main L/ i Water Service line S t7 Surface water 100(4-- C) Driveway, parking/vehicle storage S Curtain drain /�n K f U u i� �e—NV�Jvt F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adiacent lots I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MDA COSA //�l�N guidelines fin effect on this date. r Engineer's Printed Name M �on 1 k eYsLn of E—� i Date Svl`1 COSA brown sheet_10-10-12.doc OF, Algs,�'jpf 11 *:491••' 1p.. MICHAEL N. .� ANDERSON100 • CE - 9469 in. Municipality of Anchorage p su Community Development Department Development Services Division s E, 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 # 141370 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 10, Lot 1 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 5.17 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. Municipality of Anchorage Davelopment Services Department Building Safety Division On -Site Water & 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 /R A SINGLE FAMILY DWELLING Parcel I.D.—�7i175 COSA# yAeq��rl,+� 1 1 g ZJ 1. GENERAL INFORMATION Expiration Date: _ _— 0 19 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOUNTAIN PARK ESTATES: BLOCK 10, LOT 1 12440 ALPINE DRIVE • ANCHORAGE. AK * 99516 ANDREW & TERESA BENSON Day phone 12440 ALPINE DRIVE • ANCHORAGE. AK • 99516 Day phone 783-1235 DEBBIE w/ BUYERS REAL ESTATE Day phone 561-2227 401 E. FIREWEED LANE. #201A • ANCHORAGE, AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 On -Site 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 date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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) sale, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 . ANCHORAGE, AK 99507 Engineers Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all 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 therefore 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 ofthe owner listed above. Any reliance upon or use of this report by any otherperson or party Is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: COSA Checklisty Septic System Advisory Well Flow Advisory Nitrate Advisory Phone 337-6179 Date 4. t7�j Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other `�ltttt�(Y OFrr,r r 0111 ON-SITE •••'�r;>'s WATERAND WASTEWATER PROGRAM ' By:. Original Certificate Date: 15 —0cl tR" nmst Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: _ MOUNTAIN PARK 'ESTATES: BLOCK 10, LOT 1 Parcel ID: 0/7 H q/- 28 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 11 /10/1981 Sanitary seal (Y/N) YES Total depth 181 ft. Cased to 181 ft. FROM WELL LOG Date of test 11/10/1981 Static water level 145 ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 4/23/2009 152 ft, Well production 209.p.m. 5 g.p,m, WATER SAMPLE RESULTS: Coliform t / colonies/100 ml. Nitrate Ogmg./L. Other bacteria 1colonies/100 ml. Arsenic: A r1 ug./L. Date of sample: 4/23/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/9/1995 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/23/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA w XISTINC GRAD Date Installed 6/9/1995 Soil rating .p.d. rft'/bdrm)0.45 System type SHALLOW TRENCHES Length 109 TOTAL ft. Width ! 5 ft. Gravel below pipe 3.5 ft. Total depth :8,t /8.6/8.6 ft. Eff. absorption area 1009 ft' 'Monitoring tube YES Depression over field NO Date of adequacy test "4/23/2009 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test ? in. Water added 700 gal. New depth 8 in. Elapsed Time: 950 min. Final fluid depth 1 in. Absorption rate >= 450+ g_p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — ••TESTED SOUTHWEST TRENCH ONLY. OTHER ,TWO TRENCHES WERE COMPLETELY FULL. D. LIFT STATION Date installed 'Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access 'Pump off' level a�' �High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5*+ 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'+ Buildingfoundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printe, Name JEFFREY A. GARNESS Date S/ 41097 COSA Fee A Ll Cl o Date of Payment < n U Receipt Number 3 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage ...�Y • Development Services Department II�1IY , e Building Safety Division ' s• sr♦ 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 # 90118 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 10, Lot 1 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 5.04 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. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Y,cuj, YX 0 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �1 Parcel I.D. X 119 -14 t. 1 I- ul X COSA# r) U ri 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOUNTAIN PARK EST: LOT 1, BLOCK 10, 12440 ALPINE DRIVE " ANCHORAGE. AK 99516 ELIZABETH FOWLER OUT OF STATE Day phone CALL AGENT Day phone JANIS MITCHELL w/ PRUDENTIAL J/W Day phone 273-7726 3801 CENTERPOINT DRIVE #200 • ANCHORGAE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 On -Site 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 date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (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 engineer's 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 riles 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. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: 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 8 Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life of all 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 therefore 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 otherperson or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE %✓ Approved for-3—bedrooms. Disapproved. Conditional approval for 337-6179 bedrooms, with the fllowing stipulations: - ' WATER AND WPSTE\NAi tK • pROGRAM / JJJ OPAfc7JJSEN �\ Attachments: (/ COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other By, (.C�. r Original Certificate Date: (w– 11m, Municipality of Anchorage ' Development Services Department Building Safety Division OnSbte Water 6 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www munL*Wonsite (9D7)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAIN PARK EST: LOT 1, BLOCK 10, Parcel ID: ra / l I' A. WELL DATA Well type PWATE_ If A, B, or C provide PWSID# N/A Well Log (YM) YES Date completed 11 /10/1981 Sanitary seal (YM) YES Wires properly protected (YM) YES Total depth 181 ft. Cased to 181 ft. Casing height (above ground) 12+ in. i' FROM WELL LOG AT INSPECTION Data of test 11/10/1981 2/1/2006 Static water level 145 ft, 154 ft. Well production aO tl14111NO IT' g.p.m. 5.2 g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate -.BL mg./L. Other bacteria _0 colonies/100 ml. Arsenic:4_rP_ugJL. Date of sample: 2/1/2006 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA i. Tank Type/Material SEPTIC / STEEL Date installed 6/9/1995 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YIN) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 2/1/2006 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA FSELOW EXISTING GUM Date installed 6/9/1995 Soil rating .p.d ftibdrm) 0.45 System type SHALLOW TRENCH Length 109 TOTAL ft. Width 5 ft. Gravel below pipe 3.5 ft. Total depth 9 ft. Eff. absorption area 11009 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/1 /2006 Results (Pass/Fal) PASS For 3 bedrooms Flub depth in absorption field before test *DRY in. Water added733 gal. New depth 7 in. Elapsed Time: 1165 min. Final fluid depth DRY in. Absorption rate >- 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date - THE SOUTHWEST TRENCH WAS TESTED, WHICH THE LIQUID LEVELS WERE DRY. THE LIQUID LEVELS IN THE SOUTHEAST TRENCH WERE 7 INCHES, AND 8 INCHES IN THE NORTHWEST TRENCH. D. LIFT STATION Date installed "Pump on" level at _in. Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ � � � • � • Absorption field on lot 100,+ On adjacent lots 100'+ Printed Name JEFFREY A. GARNESS Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manureianimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLOING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ 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 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinghrehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION `!� /•C: 1 ceAfy that I have dete►mined through field inspections and review of Municipal records that the above systems are inconformance with MOA COSA guideffnes in effect on thisdate. � � � • � • vo_ massaEngineer's Printed Name JEFFREY A. GARNESS —753! 0 3 .Date .146* COSA Fee Waiver Fee $ Date of Payment M n ' Date of Payment p Receipt Number. a /•5_ Receipt Number (WV. 11/05) i ' oI k.z F U N `1 e NE.�f T FEB-( 2-2006 E:= PRUDENTIAL VISTA REAL EST 937 s 5485 mE '¥ $( * !E! 2� QE62Zl ! li g . � • , , . � . _22� a!� 2239.gR � �RealNd : E O.0 1 /� 61| k j k I 2§� I Us\ a a § @� It , • . # / \ & $ / � � • j/ � � 0 2 § LO bd °°0 K - \ �- .LA ` /§ . & § a § ± �2 � -, � • � k � �k.3.00.0 L®~ 3�$ �� § �■� � ¥ j2{ f . §-@ . g .TOTAL R. �Q Municipality of Anchorage �. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. F.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us , (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-44-128 1. GENERAL INFORMATION HAA # H A 0 10 10 R Expiration Date: 6 -.719-01 Complete legal description Lot 1 Block 10, Mountain Park Estates _ Location (site address ordirections) 12440 Alnine Drive Current Propertyowner(s) Steve tdilliams Mailing address Lending agency Mailing address Real Estate Agent Day phone 428-6310 12440 Alpine Drive, Anchorage, AK 99516 Day phone Gallery Ifomes/Scott Stroud Dayphone 441-8829 Mailing Address 3120 Denali Street, Ste. R.Anchorage, AK 99503 _ Unless otherwise requested, NAA will be held by DSD for pickup. ?4V4.4L2 4 _ i/3q 10 1 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site [y] Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Deve!opment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval ere 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined In the Health Authority 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. 5 3 5 ENGINEERING Name of Firm +7.ne+ G � a Loop head Pde 3G4 Address Eagle River, Alaska 99577 Phone CgX/—a979 Engineer's Printed Name Robert C. Cowan. P.E. Date r r p k RCZ!RT C. COWAN i 5. DSD SIGNATURE �ft`o,a� CE -80.01 ;\`, Approved for 3 bedrooms. +ttl`,'f� `t>, z Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory U� •v •, 1 WATER AND 141e PTMA F-Trn e PROGRAM :• <c FTT'SEr V J�JJJJJJII)1)1))l�l Maintenance Agreements Supplemental Engineer's Report Other By: 1'!y/� Original Certificate Date: 3 — -2,9—fl i (Rev. t2'CO) Municipality of Anchorage •�, Development Services Department°; Building Safety Division ` On -Site Water & Wastewater Program 41, � ` , 4700 South Bmgaw St. P.O. Box 196650 Anchorage. AK 99519-6650 wwwxLenchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ! Of / f;10 Grc /9 047N. PatK li r1TG1 Parcel ID: 01 l- "1# -15, S A. WELL DATA Well type flevoirt If A, B, or C provide PWSID # Date completed 4 rp/ 7/ Sanitary seal &N)_Ye-,r Total depth t Y l ft. Cased to t T/ ft. FROM WELL LOG Date of test '11 / /v / r / Static water level 1'f S- ft. Well productiony/K g.p.m. WATER SAMPLE RESULTS: Well Log(9fN) Yl- S Wires properly protected (9AV) Y c s Casing height (above ground) ► d —4in. AT INSPECTION ?/a t/'►9 I r4— ft. y. 3 Coliform O colonies/100 ml. Nitrate a_°) MO. Other bacteria colonies/100 ml. Date of sample: 3 / s % o t Collected i S ENGINEERINGed by: p er Read ph. 204 B. SEPTICIHOLDING TANK DATA EftN it w►, Alaska 9997 Tank Type/Material S LAT, C-/ S r t E t Date installed Tank size /000 gal. Number of Compartments Cleanouts CON) `/ 1 J Foundation cleanout ft YL S Depression over tank (Ye NO High water alarm (YJQ O Date of pumping -3/141/01 Purr A+ H O m t 9 e A 0 cif J C. ABSORPTION FIELD DATA Date Installed 6/ 11 /) 5 - Length Length ) 0 0 t.:, L. ft. Soil rating (g.p.dJW or ft'Ibdrm) Width S ft. S*t d.. O V System type 7Rt,v�N Gravel below pipe 3 1/i ft. Total depth L_ ft. Eff. absorption area %009 ft2 Monitoring tube YES Depression over field N O Date of adequacy test 74-8 / 99 Results 85 Fail) PASJ For 3 bedrooms 'A Fluid depth in absorption field before test O in. Water added�Et gal. New depth $ In. /, Elapsed Time: 17 min. Final fluid depth as 0 in. Absorption rate >= Al s- J g.p.d. Any rejuvenation treatment (past 12 mo.) (YM 3 type) /" C t K N6 d "-� If yes, give date * MT '& C/ftc,c40 3/ "Lin t — ; " ex 4.-#7q 'q D. LIFT STATION Date installed Size in gallons `Pump on" level at _ in. "Pump ofr level at Datum l Cvdes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot Absorption field on lot 0 'f Public sewer main N 1.4 Bawer /septic service line ar ', water alarm level at in. Meets alarm 8 circuit requirements? i On adjacent lots On adjacent lots 100 �4- Public sewer manhole/cleanout ey 14 Holding tank IV 19 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /0 + Property line10 f Absorption field Water main p1 A Water service line /0 4- Surface water / 0 0 Wells on adjacent lots 10 0 '10- SEPARATION i SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I/ Building foundation -13 ' Water main !✓ /R Water Service line 10 Surface water / 00 Driveway, parkinglvehide storage .r 0 Curtain drain H C r4 - rf,ypwa/ Wentron adjacentlots 00 �f F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guideNnes in effect on this date. Engineer's Printed Name rC b B E 2 i C. Cd w,4 Date 3 /3 > / C I HAA Fee $ 3 0 0 - o Date of Payment '31a 3 /o / Receipt Number O 0 A I Lf a (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 10 p ' IAMP COWAN f�A- 449 CE -8801 �s MUNICIPALITY OF ANCHORAGE O DEPARTMENT OF HEALTH & HUMAN SERVICES AiEM Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O 17 — If If — I ;O HAA # _4.1 X'1 r 1. GENERAL INFORMATION Complete legal description Lor 1; BCock 10; Mountain Pank Estates Location (site address or directions) 12440 Atp.ine D2ive NONE "'M . Property owner Carte Pe.tertaon Day phone 790-2794 Mailing address 2403 Aunona Count Juneau, AK 99501 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. nmstRw.1/91) Front M0AQ1 S. 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 of this Health Authority Approval application 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. S & S ENGINEERING Name of Firm EagleV M4 a o Phone �� — �i ��f Address Eagl• Rlver, Alaska 99577 Engineer's signature i''`ce �"� Date �� A s 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments M bedrooms. • •r, n 9 RCBERT C CCWAN I2 �V�A CE -8801 bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHHS 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 engineer's work. 72425Ip«. /911 5' MDA nt ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriptan:ll,r 1, R! / �; lVorm +" P� & Parcel I.D. A. Well Data Well type r RIl1A7i= 1 /If A, B, or C. attach ADEC letter. ADEC water system number Log present &N) 7 q j5�; Date completed /1618/ Driller /N- W uiNG Total depth 18 I ` Cased to /8/ ` Casing height Sanitary seal (f'N) ya Wires properly protected (Y/N) Yes FROM WELL LOG AT INSP CTION o � ro Date of test nT(8 / l 9S n g Static water level I y� I o N o Well flow Ute. g.p.m.cn Pump levee UNK. 159 ` f 0 SEPARATION DISTANCES FROM WELL TO: z. SeptWholding tank on lot /:)(,' ;On adjacent lots Absorption field on lot / r S ; On adjacent lots Public sewer main Public sewer manhole/cleanout NIA Sewer service line Petroleum tank AwE rs,� WATER SAMPLE RESULTS: Coliform Nitrate a.93 , fl Otherbacteria I S & S ENGINEERING Date of sample: �i bLi LS Collected by: I cap RAW Ns, 20—f -- Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date Installed 1 1115 Tank size 1000, &AL Compartments CZ Cleanouts &N) ytt' Foundation cleanout 04) ycf Depression (Y/@ /\�o High water alar (Y/l NIA Alarm tested (y* --LLA Date of pumping �fl ' Ncu/ 7twl� Pumper /JCA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / 92 6 On adjacent lots /Do Foundation IS ' To property line /y, Absorption field a3 Water main/service line /0 !- Surfacewateddrainage ICO%4 7zazer-x -r-fflM CONTINUED ON BACK PAGE fJ/)4 C. TAT10N Date Installed Size in gallons Vent (Y/N) 'Pump High water alarm level Meets MOA electrical codes (Y/N) FROM LIFT STATION TO: tested ott' Level at on lot On adjacent lots Surface D. ABSORPTION FIELD DATA Date installed —Soil rating(GPD/Ftz) D,ys Systemtype W'De �^N Length /09 ' Ta74L Width S Gravel thickness &S Total depth Total absorption area MCI I Cleanout present (DN) YES Depression over field (Y/& �6 Date of adequacy test A - -w Results (passtfaii) NJA for 3 Bedrooms YS Water level in absorption field before test /JCA After test A)l1 / Peroxide treatment (past 12 months) (Y/&V /JA If yes, give date 4/i SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / S r On adjacent lots 1(36,4 Property line To building foundation v3r r To existing or abandoned system on lot to 't On adjacent lots 2 S 4- Cutbank /'J IA- Water main/service line Surface water I oo '+- Driveway, parkingiveh;de storage area Curtain drain NIA E. ENGINEERS CERTIFICATION I certify that I have checked, verified orconfamed to all MOA and HAA guldelines in effect (fit Signature�- Engineer's Name IPM E Q 7- C. ' Cp w,; ,1 Date C I rt / h r _ HAA Fee $ r30!) • 0 Date of Payment 6 -a0 --y9S^" Receipt Number 1003 t � l� 72-026 rM- Back Waiver Fee $. Date of Payment Receipt Number. ROBERT C. COWAN CE -8801 ,4 this inspection. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 1 DIVISION OF ENVIRONMENTAL SERVICES 3434744. 'CERTIFII�� E OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF Oa-Si._WER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.#f'CAD —4QI—A51 HAA# �AgtMtA 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) /Kounk4n Park dgcAk/ Location (address or directions) 12 yyo f}dprn[ Dr•r&'e (b) Property owner F -( Telephone: (home) Business 3l wm 725 Mailing Address 27 SS Rd MS yB33y (c) Lending Institution SwYte /`run a Telephone 562-562 Mailing Address 560 E 3 Y M &ciC f}nch Alr 99503 (d) Real Estate Company and Agent C¢n r.Y 2/ - "" /%mon - Darrel/ �%/InSti7 Address 2 Z/ 3 T don Rd f)ncAcn2 e f7c 99SO7 Telephone set -233 (e) Mail the HAA to the following address: (or check here U. if hold for pick up.) List contact person and day phone number below: =,k -•r rtoohc 3525-13s� - Q�cty /3ow�uct 2. TYPE OF RESIDENCE Single -Family R Number of bedrooms 3 3. WATER SUPPLY Individual Well B Community 0 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site a Public O Community O Holding Tank O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 7:-MS(R".WN) Page 1 of 2 Z 10 Z e6ed I„8 (ML *"U) Smet ,Njom s jaau!6ua leuo!ssalad eyl ul suo!sspojo sjajajolalq!suodsaj lou sl a6ejo14auV;oAllled!o!unW etll •panssi sl eleolpliaoeejolagelepazAleuejo suo!loadsu! lonpuoo lou op SHHO to saaAoldw3 •sluawai!nbai eleis pue lejapal u!euaoAls!les of iapio ul suollnpisul 6ulpual i!ayl pue sawo14 to siaseyand of Asalinoo a se s!yl saop SHHO eyl eNsely to ale1S ayl ul paials!6ai iaau!6ua leuolssaloid luapuadopu! ue Aq anoge S 4dei6eied u! uaA16 suo!leluosajdaj ayl uodn Aluo paseq paleo!luao IenwddYAl!jo41nV ylleaH sanss! (SHHO) soolAjaS uewnH pu8gIleaH loluawuedaa 86eioy3uV;oAl!led13lunvq0141 NOLLf1YO lenoiddV Ieuo!l!puoO to swial Ieuo!3!puoO panaddes!O panaddV olua . ' Aq swoojpaq ( sol panaddV 9VAOHddY SHHO '9 d�t4 . e >> 6 SE 3J •' �� C 3Y0ol- •i 3Y000,pi .�• 04 leas s,jaaw6d .... ... .. •.u.• A •.. .........•............ •`O lY .. •..••�•��O a 4n �v_`t�_ �o 7 S66 1661 t voc ale0 ssajppv suoydalal .taj nIuo /n�� v 1 �� w�!j to eweN •uo!loodsul s!yl to alep eqj uo loalla u! suo!leln6ai pue 'saoueu!pio 'sapoo elelS pile lediolunVI Ile 43!m eouel!dwoo ul sl wapAs lesodslp Jalemalsem Jo/pue Alddns Jalem ells-uo ayl'uo!loadsu! pue uolle6!lsanu! Aw wojj pue sol!3 s6ejo4auV to Al! cIpunyl eqj wool pau!elgo uo!lewjolui ey1 uo paseq leyl AluaA iaylJnl I •umaq paleo!pu! elnlonils to edAl pue swoojpaq to jagwnu eqj jol elenbope pue leumpunl 'ales sl walsAs lesods!p jalemalsem jo/pue Alddns jalem ails-uo 041 1941 sm014s lenaddv Al!joylnV ylleaH 0!14110 uolle61.lsanu! Aw Iey1 AluaA I'molaq umogs olep uo!1ep!leA 014110 se pue 0IM4 paxyl9leas Aw Aq pa!lll[ao sV NOI1VWUOdNI ONV viva 'Homs 3lld'sisn ,sNOLLOUSNl ONIOIAOUd WHId ONI1:133NION3 'S pd MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) `SEQv CHECKLIST - FEBRUARY 1984 Jy��tP 9 343-4744 1;i;ll ,PN Ci 4o Legal Description: hof 1, fS/!c lU� GGC�-w Maun turn Pah cr/a/e- #1 A. WELL DATA�y Well Classification Pe act ke If A, B, C, D.E.C. Approved (Y/N) N,h• Well Log Present (Y/N) Date Completed 1114'161" 1/r'/61 Yield 2 s 6vn 1"'lxlr r"1<190 Total Depth161 Cased to 1490 Depth of Grouting N. of. Static Water Level 1520' ( 1'-/6190) Pump Set At ' r s> Casing Height Above Ground 32" _ Sanitary Seal on Casing (Y/N) r Electrical Wiring In Conduit (Y/N) Y ✓ Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 12 Z' 40 15 a ; On Adjoining Lots rt I YO I To Nearest Edge of Absorption Field on Lot 110 ; On Adjoining Lots 133, To Nearest Public Sewer Line :�:t 100' To Nearest Public Sewer Cleanout/Manhole > r6e To Nearest Sewer Service Line on Lot 115" Water Sample Collected by FIE4i Tech S; V" - Date 12/ N / 90 Water Sample Test Results Sc+h1X40".4 O eo1r1'o�� /(00^4.!!* -2 "I" Ae —N Comments � !11 -?-(CIL& _r .[T .0q z 17 rrw• a m o- -.�., of 'fa! 1naXll"mm eq MJ! 0uFPuf oJ^ S. � 4/JM ec, uiea AAA wu hr /eur/1At1d! •H,� to 6e drawn G/dUlI1 /o IS --7'i Su/ Ao ArMf B. SEPTIC/HOLDING TANK DATA Date Installed '7/30/61 Size 1000qul No. of Compartments Z' Standpipes (Y/N) Y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) (N Depression over Tank (Y/N) N Date Last Pumped 119/91 bx Ssaarl Pumping/Maintenance Contact on File (Y/N) N A. ;for N' A. Holding Tank High -Water Alarm (Y/N) N- A Temporary Holding Tank Permit (Y/N) N' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 122' To Building Foundation' 7 ^' G a, To Property Line '22 To Disposal Field .82-0 To Water Main/Service Line HSS To Stream, Pond, Lake or Major Drainage Course > loo' Comments 72-M (Aw. vee) FMI Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating In Absorption Strata _ B6 �/6cCr� Type of System Design 7r[ncb Date Installed Length of Field 129 • Width of Field 3a' Depth of Field -%:- 7 c Gravel Bed Thickness Square Feet of Absortion Area 1o,7 3 2 Statndpipes Present (Y/N) Depression over Field (Y/N) k Date of Last Adequacy Test 1/7/91 Results of Last Adequacy Test��guuE[ ctbto��/ra� rw�[ jo/ 3 beeem rY1%od[t7« SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 110, To Property Line 10 To Building Foundation ' ' 2S s Tc Existing or Abandoned System on Lot N A. ; On Adjoining Lots = &/O To Water Main/Service Line ^ 3S' To Cutback (if present) N.A. To Stream, Pond, Lake, or Major Drainage Course > 100 ' To Driveway, Parking Area, or Vehicle Storage Area 3S' Comments D.LIFTSTATION Date Installed Size in Gallons "Pump On" Level at'_ High Water Alarm Level at Dimensions Manhole/Access (Y/N) _ - "Pump Off" Level at Vent(Y/N)'_ Tested for 11. - Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. n�ac Signed 17_14 � J� S1 tcwG A OF At c, �.......,.,��? 0 Company—F/ufs6r Tchir'.ca/ S�rya�y dc�'A�'•.;:� Oc .DateJan 9. /99 0�----/J Engineer's Seal ...................... �J MOA No. 9 v X019 0..J!`.. <..' cc. 35-7 Receipt No. ��y��— `�`f°O6 Receipt No. Date of Payment /- 9- 9/ Waiver Fee: $ _ Amount: $ 176 Date of Payment nax (Ft". 71W) Back Page 2 of 2 ti -r' 5. LEGA DESCRIPTION DAic RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME Anp 6. TYPE OF RESIDENCE NUMBER OF,SEDROOMS DATE DATE DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY 4 INSPECTOR INSPECTOR. INSPECTOR _ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8 \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIMIRONMENTAL NOTECTION \1 825 L Street • Anchorage, Alaska 9H501 • NOV ENVIRONMENTAL SANITATION DIVISION Telephone Telephone 2644720 R E C L �� L iJ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on Page 1. Incomplete requests will not be Processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHON c ds e MAILING ADDRESS PR OPERTY RESIDENT lit ditterent rem�a/boveI /l HONE 3 V, v 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION p, PHON MAILING A DRESS 1 I%t✓-n /�' PHONE 4. REALTOR/AGENT MAILING ADDRESS 5. LEGA DESCRIPTION i STREET LOCATIOy t 6. TYPE OF RESIDENCE NUMBER OF,SEDROOMS ❑ One ❑ Four ED Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY �: Three ❑ Six 7. WATER SUPPLY INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM j� `4 INDIVIDUAL/ON-SITE" / �JLYEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72010 (Rev. 6/79) ' 6f x. 0'.2 a THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED ❑Sep�ti�c Tank or C3 Holding Tank Size: _200 If Tank is homemade L.(` give dimensions: INSTALLER SOILSRATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ` 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS F7 APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 0 BY 72010 (Rev. 6/79)