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Home My WebLink AboutMOUNTAIN PARK ESTATES #2 BLK 3 LT 17MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 017 022 29 MOUNTAIN PARK ESTATES #2 3 17 WALTER ARRON CHRISOPHER & NICHOLE JEANETTE 13021 FOSTER ROAD ANCHORAGE, AK 99516 04 25 2023 215 A.Y. MCDONALD 24100V3LB 1.00 14 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 (Rev 05102!18) Municipality of Anchorage On -Site Water and Wastewater Section ■ (907) 343.7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201114 PID Number: 01702229 Dwelling: i•❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Bartauskey ABSORPTION FIEND [I Deep Trench El Wide Trench El Bed F1 Mound Site Address 13x21 Foster Rd ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 795-8416 4 GPDJ8F Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Mtn Pk Est #2 3 17 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines - Ft. SEPARATION DISTANCES To Septic I Absorption Holding j Seater Total absorption area Number of trenches Dist. between trenches From Tank I Field Lift Station Tank Line FtZ Ft. Well 100,+ 801+ Ila I 2�.{ TANK El Septic ElS.T.E.P. [I Holding K Other Manufacturer Advantex Capacity 1500 cal. Surface water 100'+ 100 r t Cla Material Plastic Number of compartments L Lot Line 10,+ I 101+ na NA Foundation 101+ 101+ na LIFT STATION Manufacturer Anchorage Tank. Capacity 500 Gal. Remarks Alarm location Electrical installed by Side of House MOA PIPE MATERIAL House to tank D3034Tankto drainfield Installer A+ Drainfield COIMT D3034 Inspector BENCH MARK (Assumed elevation) 100 ft Inspection 1E1 618/20 6/9/20 Location and description �no aeGk 3`d 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 0-0 OF .41 ht : y f * : 49 �i� ;: * ♦t s s f� CE shw Enp s Septic em + Approved — Date -3-2 Note: this approval does not include well permit requirements. (Rev 05102!18) AS—BUILT M A U M N A B T1 19 42 T2 30 52 T3 33 56 Neighbor -do— Septic 4% Slope New DEI th i A)(-20 Ga((o c°�Mis i A0/V Q _ ora °a ° 4% Sle X T T2 B/OoYc(e Per Sta ti° p UPC r h 1 0 co Ln o rhp bd fco o 4 Bdrm h Well 0 I� 0 Drivewa 100 Q 1LA �— :° 4% Slope � No Conflicts NOR THRIM ENGINEERING SteveEng. com PO Box 770724 Eagle River. Alaska 99577 907.694. 7028 No Conflicts s++�E °F.�`. MOUNTAIN PARK EST, 1 40 *,4 #2 BL❑CK 3 LOT 17 RECORD Ste" _ s LAYOUT ►, � WASTEWATER DESIGN UPGRADE SEPTIC Date: 7/18/20 7/18/20 r2'of 3 I 30.00' I � � I GRAVEL Lot L8' TREATMENT / SEPTIC I MANHOLES 00 SEPTIC / Z PIPES 19.8' p BALCONY < Eli N 52.3' o.s x 10.0' PORCHI �.5. O O . .'ASPHALT . .. PAVEMENT I :. I \ I 2.4' x 6.8' CANT I.I RY-1 / � I 10' UTILITY EASEMENTS—\ --I i I x -a ELEVATED %!O �PLAYHOUSE n� X 2 ,V- 77.7' Q N 8.3' x 20.0' # DECK 1 WELL CHAIN-LINK FENCE Lot 17 n 20,130 s.f. III X z 183.00' WOODEN FENCES I Lot 16 7 N 0 O w Vi Lot 8 O O 0 I � Lo 19 PLOT PLAN AS BUILT X SCALE _1L = 30' GRID SW 2839 Project No. 20-355/Rt 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000`�pOO (907) 522-4625 Fax �� p ors Professional Land Surveyors kenOlongsurvey.com F q Y jonothanOlongsurvey.com .....•• 9S�0o I hereby certify that I have surveyed the following described property: 450 LOT 17, BLOCK 3, MOUNTAIN PARK ESTATES SUBDIVISION No. 2 (Plat No. P-561) o * :` 49?H* -7 Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed • • • • • 6 P P P rtY Y 9 j Y V•A'.....Kk1gw fi ... premises and that there are no roadways, transmission lines or other visible �O ^� '.Q easements on said property except as Indicated hereon. th °��' ..LS 202.•' 3 Dated this the _L Day of i, t't'° at Anchorage, Alaska p4 a o 0 N, OFESSIONP'L It Is the responsibility of the owner to determine the existence of any easements, DOO0000a covenants, or restrictions which do not appear on the recorded subdivision plot. 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Fax 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D_,017-022-29 Property owner($) BARTAUS11W Day phone ,7-9.5", 16 Mailing address 13021 FosterRoad Site address Legal de6crlpt[06 (SuVd., Block,& Lot) UO' , UNTAXPARK ESTATES #2 BLK &.j—, 17 ............ . Legal description (Township, Range & Section) Lot'size 130 'Sq. Ft Number of Bedrooms "i - APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: puwl that apply) Absorption, Field Ej Initial 171 Single Family (SF) (wAfvo ADU) Sepik Tank' Upgrade F71 Duplex (D) El Holdlng,Tank Renewal El Multiple Dwellings El Privy Ej (SF ancVor D) 'Or,.lvate Well F1 Water Storage El THS APPLICATION INCLUDES A WAIVER REQUEST FOR: -- - ------- Distance: I certlfy'(hat:.the obove inform. atiorl"ll. - .0rrect. I further certify that this Is I accordance with 0 in applicable WniclipajOodes, Permit/Rush Fees: Date of Payment: RecelpOurnber,-, 615,341plb Permit No, OSPV-6111�1 Waiver Fees: Date of Payment Receipt Number* Weiner No. WDevelopment senkeMBUIdlngSsbtyiOn S1 - to WVer and VvntewateWorm'Cllent Forms%Pormlt Applica OoD.COVID-19 ` 9'O' DISCOUNT APPLIED SteveEng.com Steve Eng, PE, PH PO Box 770724, Eagle River AK 99577 907-694-7028 S teveEngPE@gmail.com Date: 5/12/20 Number of Pages: To: MOA On-Site Services Subject: Mountain Park Estates #2 Block 3 Lot 17 Septic System Upgrade RUSH REQUEST- Biocycle broken- Effluent can be seen running below surface The subj ect property has been served by a septic system for a number of years. The Biocycle tank is to be decommissioned and a new Advantex/Lift Station system installed. The entire subdivision is on private wells and septic systems. The terrain slopes toward west, but is flat at the site of the replacement. Please review the wastewater system design for the existing home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Steve Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201114, Rebecca Carroll, 05/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201114, Rebecca Carroll, 05/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201114, Rebecca Carroll, 05/13/20 Mountain Park Estates #2 B3 L17 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, home, in a developed subdivision. This is a rehabilitation of the existing system. An Orenco S ystem AdvanTex, with 1500 gallon processing tank and 1-AX20 filter pod with Lift Station to be used. The existing bed to be utilized. No conflicts to neighbor properties by the replacement. Decommission old Biocycle. Specification Requirements: All components and work must comply with the MOA Specifications (AMC) & State DEC , Orenco Systems Regulations Installation by an Authorized AdvanTex Installer only; approval issued by Orenco S ystems & Anchorage Tank & Welding, Inc. 1500 gallon, two compartment AdvanTex processing tank, 1-AX20 filter, VeriComm Monitoring S ystem & Mode 1a standard package per AdvanTex System Manual. Watertight couplings on inlet & outlet. 5 minimum between the tank and bed. 10 minimum to property lines. 3 of cover or insulation is required for trench; an equivalent of 1⇤ insulation for 1 soil cover. Minimum 2⇤ insulation. Tank & solid pipe must be set on well compacted, stable soil. 4 inch diameter cleanouts with airtight caps are required 1 to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, prior to the processing tank. All cleanouts must extend to at least ground level Bedding to be pea gravel or MOA-approved equal. Insulation must be placed over any pipe installed under driveways or parking areas. Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, Sewer Service Line is minimum 2% slope Maintenance agreement for the AdvanTex Treatment S ystem is required for approval. Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam HI or equal Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201114, Rebecca Carroll, 05/13/20 MunicipalitY of Anchorage Page 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: ~' W q $ o a. $,~ PI D Number: C) I 7 '-O ~- ~ Name: ~o~,~,'~ ~ ~ ~ R0~,~ ~'~,~ WastewaterSystem: ~New ~Upgrade Address: No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION o, 7 Gpg/sq. Ft. Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath p~pe Township: Range: Section: Fill added above original grade: Gravel length: ~ ~ Ft. Ft. Number of lines: Distance between lines: WELL: ¢~6 ~ New ~ Upgrade Gravel width: I ,~' Ft. ~ ~ '~' Ft. Classification (Private, A,B,C): Total Depth~ Cased To; Total absorption area: Pipe material: Driller: g j~ Date grilled: Static Water Level:Ft. Installer:~4~L~t ~X¢~V4TI~ Date installed: ~/ GPM Ft. Ft. SEPARATION DISTANCES ~ Septic B Holding ~'S.T.E,P. From To Septi~Tank AbsorptionField StationLift HoldingTank =ublic/Privatesewer Lines Manufacturer: ~/0 C- y~ ~ ~ Capacity in gallons: Well- )O ~-- ~ / jO ~'/ -- ~{ ~ Material: ~l~d;&~ ~ ~ Number°fC°mpa~ents: Surface/ , ,+ ioo '¢ LIFT STATION Water I00 ~ IOo ~ /¢d Lot / ~ / ~ / ~ / / Size in gallons: Manufacturer: ~10 ~ ~ ~ ~ ~ Line J~ ~ ~O / i ~ / "Pump on" level at: "Pump off" level at: H gh water alarm at: Cu~ain g ~ ~ ~ [~( v / ~ -- ~/~ Pump Make & Model Electrical Inspections performed by: Drain Location and Descr[ption: ~4~ ~ ~ Assumed Elevation: Department of Health a~ Huma~ervices approval ,, ~,,, --'- ......... -.....,. Reviewed and approved b~: ~ Date./ 72-013 (Rev. 9/91) MOA 25 Permit No. sw950259 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 LOT 17, BLOCK 5, MOUNTAIN PARK EST. #2 01702229 Legal Description: PID No.: MT1 A B ~ FCO 5' 52' ~ C01 21' 69' C02 24' 7~r' MT1 54' 98' MT2 62' 103' MT3 59' 64' MT4 65' 72' 95'6'~ ~9~.1' ~. 89,1' NO WATERI FOUND 6-;85-95 i C01 & C02 ARE: CORNERS OF ~HE HATCH COVER ABSORPTION iBED - - -~ 602 SEPTIC TANK L,Jim 'T' ABANDON~[~ COMPLETELY --EXISTING TRENCH SCALE 40' BIOCYCLEi UNIT LOT 1 7 WELL ..-.;...' ROI~ERT C. COWAN CE-8801 72-013A(1/93) * OCT-- 6--95 FR I I I :04 CARCEL FLECTR I C P. 02 '.=' .~'. ":..'." .k.. '. .lilI.N,~.~.i!~"~ll]~.~'¥.'iOI2 ~ .......... ~'"' ": ..... :,'" ' '' ['I'{ON~ i:l: 346-4080 '""PHON~ J21 ,.,.,,~.. m, .. ~'..L '"' ' '; ' ' ; ,?: ?; ~ ~i . . .'~ ", '4': -t · ., m ". ." ,'. , · . ,, . . . .~ .... .q,...} , ;..j:, .: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 9, 1995 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 17 Block 3 Mountain Park Estates ~2 Waiver Request #WR950051, PID #017-022-29, HA950446 Dear Mro Cowan: Your request for a waiver of the required 10 foOt separation between a septic system and a lot line has been approved. The waived distance is 1 foot to the west property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Civil Engineer On-site Servicers RWR/ljm MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ ~~ PID# 017-022-29 Hn~ HA950446 Permit ~ Date Received: October 5, 1995 Legal Description: Lot 17 Block 3 Mountain Park Estates ~2 Engineer: Robert C. Cowan, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: Robert & Rosie Tenge Waiver Requested: Lot line waiver of 1 foot Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: .~ Waiver is NOT Granted: List Conditions or Reasons for above: '/~ ~/~k ~o~ Date ~ /O 1~ ~.~- By: ,/~ ~/~_/~_. _~_._~ Name of Reviewer Rec #: 01363:3434 Amount: $ 115.00 Date Paid: 10-5-95 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:SW950259 DATE ISSUED: 8/31/95 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 8/31/96 OWNER NAME:TENGE ROBERT J & OWNER ADDRESS:13021 FOSTER RD ANCHORAGE, AK 99516 PARCEL ID:01702229 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 ELK 3 LT 17 LOT SIZE: 19800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE WASTEWATER SYSTEM INSTALLED UNDER THIS PERMIT IS AN ALTERNATIVE SYSTEM UNDERGOING EVALUATION WITHIN THE ROBERT C. COWAN, P.E. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN June 27, 1995 CIVIL ENGINEERS (9O7) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Attn: Jim Cross P.O. Box 196650 Anchorage, Alaska 99519 REFERENCE: Lot.~', Block/~, Mountain Park Estates ~2 Dear Mr. Cross, This letter is addressing the installation of'another Biocycle Wastewater Treatment System under the innovative systems program encouraged by D.H.H.S. Request you issue permit for the installation and modifications of the on-site wastewater disposal system on the referenced property. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. A test hole was excavated and percolation test performed. The approximate location of the test hole is shown on the attached site plan. At the time of excavation no water was encountered and after 7 day ground water monitoring, the monitoring tube was found to be dry. If you require additional information, please contact us. Sincerely, IRR~cb~;~ C' C°wan, P'E' Enclosures 17034 NORTH EAGLE RIVER LOOP SUITE204 ° EAGLE RIVER, ALASKA99577 '1" = 50' SCALE FOSTER ROAD UPGRADE 10' UTIL. ESMT. C) EXISTING 4 BEDROOM HOUSE z I0' UTIL N.T..S. SCA .LE ' DETAIL o 15' IPROFILE IX-SECTION 6.06' (1850rnm) DETAIL ~ (800mm) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG --TRCOLATION TEST PERFORMED FOR: . LEGAL DESCRIPTION:~_.~T/7;/~.~*~. ,/J,//7'/~, P~,4f~K. r~7:, Township, Range, Section: SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SITE PLAN WAS GROUND WATER /r~%o ENCOUNTERED? S IF YES, AT WHAT -' ~) DEPTH? - .......p~ Depth to W ie"C'~fter ~e~n Net Depth to Net g__ D---~D~'e~' ~" Time Time Water Drop / ~;',oo ~,~ I~le'' ~/g :5~ ~ ,. l~/e,, y~" I~ IS ~ ,, ~e" ~" PERCOLATION RATE /~)(~) (minutes/inch) PERC HOLE DIAMETER PERFORMED BY: 17034 Eagle River Loop Road J~q. 20zJ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: I~"1'~/-,~: LEGAL DESCRIPTION: ~ 6 ~,',,'t'ZI ,'~ DATE PERFORM ~;..~.~ ~ $ 7'. :f~ ~--Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- i7- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? IV 0 SLOPE SITE PLAN S L IF YES, AT WHAT O DEPTH? p E Deplh to Water Alter Monitoring? Date:. Gross Net Depth to Net Reading Date Time Time Water Drop .- o .... I;~ ~ ~o ~i 7 ,,,,,u '1~' " '/~" PERCOLATION RATE ~' ~'('~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ ! ~' ~- / __ FT AND -- FT 72-008 (Rev. 4/85) - GRE/V'-' ' ANCHORAGE AREA BORr' ,® ,,. ' Department of Environmental Quality 3330 C Street ' Anchorage, Alaska 99503 ....... /' INSPECTION REPORI: ~-51TE SEWAGE ~'PI~$~,L SYSTEM NAME (~ LOCATION MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL .MANUFACTURER INSIDE LENGTH INSIDE WIDTH NUMBER OF MATERIAL ~'~ gP~ ( COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY f~--'~GALLONS. DISTANCE FROM WELL '~"' FOUNDATION ~ NUMBER OF LINES ~ DISTANCE BETWEEN LINES ABSORPTION AREA ~ <~C) SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE ~.~1 TOTAL LENGTH ~ NEAREST LOT LINE ~ "~--[ OF LINES '~-~)~ ~ TRENCH WIDTH~ IN. TOTAL EFFECTIVE LENGTH OF EACH LINE '~¥- ' DEPTH OF FILTER MATERIAL BENEATH TILE__ ~ ! Iq~. ABOVE TILE ¢'~ IN, WELL: ?1~05 e ~L TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION__ LOT LINE__, SEWER LINE__ DEPTH SEPTIC SEEPAGE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: 5 ~('-. INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ-032 DIAGRAM OF SYSTEM G.A,A.B. ~' Gre, A ,NCHORAgE Area Bo, DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 995~~~~~ TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED SO,L TEBT RESULTS F' F~ ~" COMPLETION DATE ANTICIPATED SEEPAGE PIT DRAIN FIELD OTHER T. iS ...M,T ,s .OT .'A',,, WITHOUT BOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK . SEEPAGE PIT TO NEAREST LOT LINE. WELLTO SEPTIC TANK WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ~ , SEEPAGE PIT . TO RIVER, LAKE, STREAM. S D.^,N P,ELD DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT. AREA FOST£- /z.,,/ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION § FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT PITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For WALTER COLLINS Legal Description: Lot 17 Block_ 3 , This Form Reports Soils Log xxx Depth Feet Dated Performed h-Z6.75 Subdivision MT. PARK ESTATES,#2 Percolation Test Soil Test Must Be Logged To 4' Below Proposed Seepage System Soil Characteristics 0-1.5' topsoil 1.5--16' sandy silt ML:~ 275 I I Was Ground Water Encountered? NO If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 , Net Drop SIEVE A~LYSIS (R&M ~NGR.) $ PASSING' sa: 31% % PASS~G,~200 _: 5~ sl: 53% Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom oT-Pit or Trench ~OHI,~ ~IS: Date Certifiecl BY: Date: PERCOLATION TESTS (Lot 17, Block 3, Mountain Park Estates No. 2 Subdivision) Procedure: Percolation-Rate: An 8-inch diameter hole was dug (beginning 12 feet below the ground surface) to a depth of 28-inches. This hole was filled with water (7:00 p.m., April 23, 1975) and refilled again (9:30 a.m., April 24, 1975). The actual test was performed at 6:30 p.m. on April 24, 1975. The soil was saturated at the time the actual test was begun. The sides of the test hole were scratched and the bottom was filled with approximately 2-inches of sand. A measuring stick similar to the one in the attachment was used. The stick was marked at 1/2-inch distances. When placed in the hole the actual water level was marked on the measuring stick. At the end of 30 minutes the water level was again marked. The measuring stick was removed and the water-drop measurement was taken and recorded. The actual drop in 30 minutes was 1-5/8-inches. WALTER A. COLLINS, P.E. 4_q17 East 7ti' Avenue Anchorage, Alaska 99504 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section 5 Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251082 Parcel ID 017 -022-29 Expiration Date: 3/6/2026 Legal description MOUNTAIN PARK ESTATES #2 BLK 3 LT 17 Site address 13021 FOSTER RD Current property owner(s) WALTER ARRON CHRISOPHER & X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: `j� L� Original Certificate Date: 3/24/2025 This erti Cficate of On -Site Systems Approval (COSA) is intended to demonstrate the subject ;;s-'tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory Other Well Flow Advisory Nitrate Advisory X Arsenic Advisory MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section —� Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-022-29 Complete legal description MOUNTAIN PARK ESTATES #2 BLOCK 3 LOT 17 Location (site address) 13021 FOSTER ROAD ANCHORAGE, ALASKA 99516 Current property owner(s) ARRON & NICHOLE WALTER Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 5 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ® AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 50 Waiver Fee $ _ Date of Payment Date of Payment COSA # SC 2 5� 0 Z Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: MOUNTAIN PARK ESTATES #2 BLOCK 3 LOT 17 Parcel ID: 017-022-29 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 *UNK Total depth *UNK ft Cased to *UNK ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/6/2025 Static water level at beginning of test 179 ft. Well production at time of test 3+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 13.7 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 3/6/2025 Comments *UNKNOWNS – CIRCA 1977 drill date w/ various depths mentioned in MOA docs. The area, site & recent water analysis has high nitrates and this well was also previously scoped with good casing integrity verified. B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping 3/6/2025 Required maintenance completed, if AWWTS Comments: PUMPED BY ONE STOP C. LIFT STATION Required maintenance completed Age of lift station 5 years Lift station material FIBERGLASS Comments: AX MAINTENANCE BY L&S SERVICES D. ABSORPTION FIELD DATA Which system tested (date installed) 9/14/1995 ALL standpipes present per record drawing Total measured depth from existing grade 3 ft (max) Measured depth to pipe invert from grade 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 3/6/2025 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 1 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 0.5’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records appears approximate. 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 *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ 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 **1 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATII/III SEPARATION DISTANCE REQUIREMENTS. **WR950051 – PREVIOUS ISSUED WAIVER. 4BR COSAS ISSUED BY MOA PREVIOUSLY. 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 03/20/2025 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 & 03/20/25 532 008 = ■■■ ■ ■ ■ on on ONE ■ ■ ■■N■ • 8 aft ago ■ ■■ ■ ■■■ ■ ■ ■ on on on ■ ■g■ ■■ ■ ■ ■■■ ■■N ■ ■■■ ■■■ �o �"VanTeW Field Maintenance Report Unscheduled Prop" OwnorllYacking a Anon Christopher Walter sfto Addross 13021 Foster Road, Anchorage AK 99516 AX Slto ID ! County ID o Pod A 152605 1 OSP201114 1433869 Dispatcher Comments Date: 03/05/2025 Time: 12:00 AM Inspection Notification of site condition ❑ Made by VerlComm° Monitoring System ❑ Made by Homeowner IVOther i Site condition at time of call ❑ Alarm ❑ Tank Overflow ❑ Odor ❑ Sewage Backup ❑ Ottler Field Sampling/Observations ❑ Necessary KNot necessary NTU (15 ± NT 61 pH (6-9) DO (2-6) Odor of Sample, Typical ❑ Musty ❑ Earthy ❑ Moldy Non -typical ❑ Sulfide ❑ Cabbage ❑ Decay Conditions at site 0 ® 0 Alarm On ❑ Yes No 10 02 s0 (If yes, alarm type ) Tank Liquid Level ❑ Normal ❑ High (Low pump Operational? Yes ❑ No Circuit Breakers Recirc........ ❑ Tripped �?On [:]Off Discharge..... ❑ Tripped �tOn ❑ Off Controls ...... ❑ Tripped n ❑ Off VCOM° ATRTU Board: (if applicabl ) Document the panel status by shading the appropriate inputs and outputs as Indicated by the yellow and red LEDs. Inputs 0 ® 0 Outputs 10 02 s0 Power (GreQn LED) ❑ On ❑ 0 Flashing AnchorageTank 907-272-3543 Oporotor L&S Services Technician Contact Phono (907) 268-8697 RTU 9/UL A Dato of Last Inspection RTU 141239 04/04/2022 Cause of Malfunction: ❑ Mechanical ❑ Process -Related P Services Rendered: Parts Used: W = Warranty, B = Billable (✓ appropriate selection) W B 1 Item Number Description Notes/Final Recommendations: ❑ System performing; no further action needed ❑ Additional service needed SG Final/Safety inspection - Lids bolted on?VYes ❑ No (If damaged, comment ) Control Panel reactivated? _'Yes ❑ No Circuit Breakers: Recirc: On ❑ Off Discharge: On ❑ Off Controls: -J on ❑ Off Signature Date Fax completed form to 1-866-384-7404 Time NIUNICIPALFTY 011t" AN(,-.t110RA(N`E ADVANCED WASrj 1EWA1'ER 111EATME.N"r SVSFrEM AFMEN'f'MAINTCNAVCs CKF THIS MAINTENANCE AND REPAIR ACyRFFML`N'r. herein the "AGREEMENT" made and entered into as of this Dtayof of 20 2 �', by and between C S ,herein tlic "[ )WNLR," and the ML1111cipality of Anchorage, herein the "'M U N I C1 PALITY"', in accordance with Anchorage Municipal Cade (AMC) 15.G5.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced W-astewater Treatment Svstems. rFhe Municipality grants permission to the owner to utilize and operate an A(Ivaiiced WasteNvater'"l,"reatment System (AWWTS)3 described as located at (legal description) AN ADVANTEX SYSTEM MOUNTAIN PARK ESTATES #2133, L1 7 .MaintenancegRepairsanis Alterations. (Owner is required to rend, understand and initial each section) � tjThroughout the term of this Agreement, the Owner shall enter into �. ��;c��ice agreement with an AWWTS service and maintenance provider approved by the Municipality or the 1111(inuflactLircr's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing heated septic effluent in accord ancc with the equipment's approval for operation in the Municipality. s�iall be the responsiiIi bty of the 0%yner during the Perm ofthis Agreement to pay for all repairs}, maintenance, adjustments}, replacement costs, and inspection costs. This M ncludes an annual maintenance fee (typically $4D0 to X600). Owner agrees that only maintenance and repair personnel approved by the Municipality r the maTILIfiacturer"s representative will inspect ars make anynecessary maintenancel repairs or permitted alterations to the system. owner acknowledges that regular maintenance of an AWAITS reduce th � g s e potential failure of the system, which could include sewage backup and cost jy repairs or d rai nfi e I d replacement. (rev. 05/1,8/2018) Page 1 of 3 Owner acknowledges that thc M ►In I i 1% <1 i ty ii iity request records of maintenance and repairs from the mo,,mu l r r" r pr ��t t1 r maintenance provider. Q�Lj OxN-ner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.0.30. owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will bice at least 21.4-tiour notice_ V)L\) Oxvner agrees that any salt or transfer of title of tIic property tivi11 nit occur wit }gout a new Certificate of On -Site Systems Approval owner agrees that the AWWTS installation and maintenance requirements as provided btir the AWWTS vendor/installer and approved by the Municipality are the governing ouiciclincs for the construction, maintenance and repair of the owner's AWWTS,, t�j_Owner agrees to maintain remote monitoring of the AWWTS a5 required bv the 5. 6. A WWTS approval. rl'erm. The term of this Agyreement shall begin on the date of approval by the Municip,ahtv to operate the installed system, or upon transfer of title, and shall continue While the AWWTS is operational or until title is transferred. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions', nur i n any way affect the \.-af idity ot'the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. Amendment. This Agreement shat] only be amended by authorized representatives of the Owner and Municipality. Anv attempt to amend this agreement by either an.6. unauthorized representative or unauthorized means shah be void. Jurisdiction:Choice of Law. Any civil action arising from this Agreement shall be brought i n -the S u perio r Court for the Third Judicial District of the State of Alaska at Anchorage. '1'he laws of the State of Alaska shall govem the rights and obligations of the patties under this A greeme nt. 7. Severability. Any provisions of this Agreement decreed invalid by a court (-)l' Ct)lllpett;ilt jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of ONN NV.R: tip ,w 1 ( (sionattliv) Datc: (print na111c) SIATLO ALASKA 1 Ss. THIRD JUDICIAL DISTRICT ) The foregoing, instalment was acknowledged belilre me this[ day of 205 by 1_ �'� �1U11 iC,Vi,v�S STATE OF ALASKA NOTARY PU13UC uryh NOTARY PUBLIC, FOR ALASKA K�ryBewld My 6ninlission expires: �2_� �_ 70Z;(-9_ --- My Commivion Fipires: G " - signature) Date: e— )rint name) Title: _ (rev. 05.18/2018) Page 3 of3 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • On -Site Water and Wastewater Section Ar www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC251082 Subdivision: Mountain Park Estates #2, Block: 3, Lot: 17 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 13.7 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-022-29 Expiration Date: 1. GENERAL INFORMATION: Complete legal description MOUNTAIN PARK ESTATES #2• BLOCK 3 LOT 17 Location (site address) 13021 Foster Road *Anchorage 99516 Current Property owner(s) Colton & Colette Levasseur Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .`50 Date of Payment Receipt Number _ a (3 3 COSA#___ OSG22 119 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: Gamess Engineedng Group, Ltd (GEG) Phone: 907-337-6179 Address: _3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 5A I2 7 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and c�oOQ 1� industry practices. The reported results describe the condition of the system/s on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o ��..• ""•.,s�� encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and li K 99 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the y. �� ✓/ i '� system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of • . • • • • • • • • • • • . • • the well or septic system. GEG makes no representation whether an alternative well or septic system �� a .Jei r= a ;oFc,9Zsa•' 9 can be installed on the property in the event either of the current systems fail to perform adequately in (1 . '• E - 15 e` the future. The content of this report is for the sole benefit of the person/party that retained GEG to �V�F 51 S. perform the evaluation. Reliance upon the information provided in this report b any other person or c t• n� � d party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD t -SIGNATURE System #1 Approved for q bedrooms System #2 Approved for bedrooms Disapproved Conditional approval foorbedroomJJs,,- with the following stipulations: II L2I/' By: Original Certificate Date: - ^ 2 ZZ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ``l`lk«kt((((((q(, `l OF A/V 0i 7. ATTACHMENTS: XWE ��COSA Checklist Nitrate Advisory TE G� Z: Septic System Advisory Arsenic Advisory J AND TER TER Well'Flow Advisory Other Jo WASTt_v'A o pROG�`AM O l '/JJJ'J0��Nr rfju X 9 TAMAN W, Legal Description: MOUNTAIN PARK ESTATES #2; BLOCK 3, LOT 17 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1977(4) Total depth *189.8+ ft Cased to UNKNOWN ft ❑ Sanitary seal is functioning correctly On Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/16/22 Static water level at beginning of test 182.0 ft. Comments *PER GEG ADEQUACY TEST B. TANK DATA Age of tank(s) 2 years Tank type/material SEPTIC/PLASTIC Measured'operating fluid level in septic tank - ❑, Standpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTENANCE D. ABSORPTION FIELD DATA BED Parcel ID: 017-022-29 Structure served by this system Well production at time of test 2.8+ gpm Water storage tank volume N/A gallons 7fo infected for coliform test? ❑ Yes No rm bacteria is Negative Nitrate 1), 1 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L M'114 rsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 4/19/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 1- years Lift station material PLAsr'c Comments: ADVANTEX Which system tested (date installed) 9/19/95 Adequacy test date 4/16/22 0 ALL standpipes present per record drawing Results QPass For 4 bedrooms Total measured depth from grade 4.0 ft (max) Fluid depth prior to test 3 in Measured depth to pipe invert from grade ft (min) Water added 704 gal IN N/A — pressurized field 4 ❑ Monitor tubes go to bottom of effective. If not, state New depth in depth into effective Elapsed time 120 min p On Code -required soil cover over field Final fluid depth 3 in ❑ System presoaked Absorption rate 600+ gpd (Required if, vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: 'IT APPEARS THAT MT4 IS THE ONLY MT THAT EXTENDS TO THE BOTTOM OF DRAINROCK COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) R Yes Septic Tank/Lift Station on Lot > 100' ft *50'+ Community Sewer Manhole/Cleanout > 100' 171 Yes if No ft f- Yes if No ft Neighboring Tank > 100' [Q Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No Animal Containment > 50' Q✓ Yes if No ft 21 Yes if No ft 0 Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0-1 Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No **1 ft Wells on Adjacent Lots: Water Main > 10' [] Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft F. ENGINEER'S COMMENTS *AWWTS **WR#950051 DRAINFIELD SHOULD HAVE BEEN SIZED FOR APPLICATION RATE OF 0.5 GPD/SQFT. INSTEAD OF 0.7 GPD/SQFT. DRAINFIELD IS SIZED FOR 450 GALLONS PER DAY.APPROVED BY MOA IN THE PAST. 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. COSA Checklist yellow sheet #AECC884 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221191 Subdivision: Mountain Park estates #2 Block 3 Lot 17 A water sample revealed a nitrate concentration of 10.1 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this .'1 _ Day of AQoT l_ of 200A�, , by and between Aaron & Nichole Walter herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) I5.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: I . Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description) Mountain Park Est #2 L17 B3 2. Maintenance Re airs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces theP otential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I of 3 �\'`f Owner acknowledges that the Municipality may request records of maintenance and /� repairs from the manufacturer's representative or maintenance provider. Ay y Owner acknowledges that the fine for failing to maintain and repair an AWWTS WWTS may be ,- / assessed in accordance with AMC 14.60.030. �'1 "" Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. i Owner agrees that any sale or transfer of title of the property will not occur without a new W Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the constriction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring ng of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an bonze-d-represt;nt unauthorized means shall e void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OW By: n (signature) Date: Z �Mlotj Q A `fit (print name) STATE OF ALASKA ) ) 5S. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this day of 2021, byi frrQ� NOTARY PUBLIC FO My Commission expires: MUNICIPALITY: By- (signature) (print name) Commonwealth of Pennsylvania - Notary Seal DENISE N. DORAN, Notary Public Philadelphia County My Commission Expires October 21, 2029 Commission Number 5360028 Date: Title: (rev. 05/18/2018) Page 3 of 3 IM C 0411912022...14:58 Anchorage Tank gAXX7 277 3715 P.0011001 *hwrM9W FMd M*Mmam ReW Annual In. [: PAD:il00i AnchorageTank om_')70_gcnt onilmtA'b�rmdrrn>rdciCr Cur ProAoua Cumml Cotton Levasseur 2ndCo1AWtMem Larry Bette Pr" ous RtD M2*4 PMVIOW r(btRact VCOA 13021 Foster Road, Anchorage AK 98516 (.907)268-8897 Ax DAs ID M tbu* to t bow a HtU MUL tf Cito M LtA lirryaceoe AX -152803 OSP201114 433869 F�fU141239 04104!2022 Retrleve ORM Into Ratty flaw Rooiro rouo Timor w1ttnC= This Is a CO.SA Inspection. -- Please fax to Gamess-ASAP, Perform Field SomplDWObsenrstlons Writ (16 a NTVe) PH (B-5) Do (2-q Odor ta'i l3amPts 'rWCW Musty C Earthy C Moldy Nw4yptoat ride Cfabhepo D000w orytltm to OYU joN4 Foam In iank ❑Yea VINs Check Control Panel _ Roam Mips Malmo Amps ) 0 .-2j 1 I_ a Audible and visysl We" V1 or, t]tal ton try ort! � Rtio InspeaUClean pump System trispast Clean Rtear/Ud ..................... Spllae Sax .................... Floe 02rds .................. Floots....................... Rump ........................ l3lotuber Filter ................. Slowbe Pump viwt ........... Rcarrodaft 8pUA& Velm....... Commeffm Measure, gWdgefftum Sludos ar..K, tetCampartrneot Cur ProAoua Cumml pmMmm 2ndCo1AWtMem Qmern Pr" ous CMI PMVIOW InspectlClean AdvanTer Filter Inspect Clean Odor, Y, Nonnw U Ptmpem LamraW0tl ma Rlorwi ❑ pod saw eddy! Wcndln, ' NonwMlnor OExtxauva Wakevmd Inzpeet/Clean Alsdwrea Pump System Iruprat aeon MsedUd ROM SmaeS Pump Phar cordo InapecUServlce Otiror System Qomponents Inspect clean htspam Men ob3emaaro1i�riz�e1e�c�Qo 111111Gh 1 Add(fiiums eervicee Rendered 0 Moaned tmarte ewem? C Rentmad W Reno? 0 ReptacedNsed other Roma? Pette USedi W . Wertawp% 8 - Wable (rt eppropdate =leodorQ W a ttemNumber cRamttloa F(j1atJ$a{0ty (R9p8t1ttOn �: t COt(ed m ..•" �}�1lfEifiBlelL"d , ManU01d ra wMatW', hush %W m CWPO vol path reDottv4led 8vmmerylRaoommendatlorta ❑�ysldgpwict"ftnohotfootnnttonneedod C[%rkkneeQtvwfl,r4 Call for aondao [ Otttert Ra» cnmpleted form to 1-866-884- MUNICIPALITY OF ANCHORAGE Development Services Department `_ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 01702229 1. GENERAL INFORMATION Complete legal description Mtn Pk Est #2 Location (site address) 13021 Foster Rd Current property owner(s) Bartauskey Expiration Date: l2)q ZOZd B3 L17 Day phone 795-8416 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 912-.00 COL/1,0 Date of Payment 0 u i Receipt Number 0 Sb 5 Waiver Fee $ Date of Payment Receipt Number COSA# O-SG2.y)3,49 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 andior wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 894-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/24/20 6. DSD SIGNATURE x System #1 Approved for Ll bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: `N. iIt tt Y A�,�1OF t f�6,, U /JJJ�i� FNT SER��GN�,\,,. By: Original Certificate Date: /9 The Municipali y of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS_ COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other C'09A GN_'fkligl Blue �r � J t, WATER AND -- o WAST!71 v`'ATER oAU 1 Z1.1; -. C%A, a� /JJJ�i� FNT SER��GN�,\,,. By: Original Certificate Date: /9 The Municipali y of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS_ COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other C'09A GN_'fkligl Blue COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Mtn Pk Est #2 B3 L17 01702229 3+ unk 0 272+ 40+ 6.81 12+NRimEng 7/21/20 192 9/1/20 new Plastic new new plastic new New Advantex 9/14/95 same 7/21/20 4 3 0 600 2 30 0 600 no 4 E. SEPARATION DISTANCES From Private WeiI on Lot to: (Please enter 41istances if less than required or if corn munity well) Septic Tank{Lift Station on Lot a 100' Q Yes if No Community Sewer Manhole/Cleanout a 100' 0 Yes if No ft E] Yes if No It Neighboring Tank > 100' Yes if No ft Private SeweriSeptic Line > 25` [Z] Yes `rf No It Absorption Field on Lot > 100' Yes if No ! ft Holding Tank > 100' R1 Yes if No It Neighboring Absorption Fields > 100' Water Main > 10' Animal Containment > 50' 0 Yes if No It IJ Yes if No ft Water Service Line > 10' [] Yes if No ft ManureiAnimal Excreta Storage > 140' Community Sewer Main > 75' r❑ Yes if No ft ❑,. Yes if No It From Se pticfHolding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ! ft Surface Water > 104' Yes if No. Property Line > 5' if No Yes if No ft Wells on Adjacent Lots: if No Absorption Field > 5' Community Wells > 240' F1 Yes if No Yes if No ft Private Wells > 100' ❑✓ Yes if No. Water Main > 10' Yes if No ft Community Wells > 200' Yes if No _ Water Service Line > 10' [] Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter disiances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is udder driveway comment below Property Line > 10' Q Yes if No ft wells on Adjacent Lots; Water Main > 10' Q Yes if No ft Private Wells > 100' ID Yes if No Water Service Line > 10' Q Yes if No ft Community Wells > 240' F1 Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Property Line Waiver on file G. ENGINEER'S CERTIFICATION I certify that i have determined through Reid inspections and review of Municipal records that the above systems are in conformance with MOA COSA gur'Mines in effect on this date. CO SA Checklist yellow sheet ++ _� OF � 11 * :49I�l .A,,; c� Steve Ery 4i CE -6256 fJV X724%20 It It It it It MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC201368 Subdivision: Mountain Park Estates #2, Block: 3, Lot: 17 A water sample revealed a nitrate concentration of 6.8 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES 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.# 017-022-29 ' HAA# ~\ tn ci':'IL" !~i.~ ' 1. GENERAL INFORMATION Complete legal description Lot 17, Block 3, Mountain Park Estates ~ 2 Location (site address or directions) 13021 Foster Road, Anchorage, AK Property owner Mailing address Dan Repasky Day phone 345-8886 13021 Foster Road, Anchorage, AK99516 Lending agency Mailing address Day phone Agent CPr,'~c'~''' ,'~¢,,t -P~.,~..,r,,t~-/'~,~ ~,~,~ Dayphone ~'ro--},~ ~¢] Address Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank community on-site NOTE: xxx Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. xx× Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~121 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. Name of Firm S & S ENGINEERING Phone 6 9 ~J ' ~ c~ ? ~ 17034 Eagle RiYer Loop Road No, 2~ Address Ea~le River~ Alaska ~577 ~ Engineer's signature '~._ ~, ,/*¢ Date__'¢ //~;/R¢ DHHS SIGNATURE Z Approved for z~' bedrooms. Disapproved. Conditional approval for The well for this property meets bedrooms, with the following stipulations! Note: e×istin§ .State and Mun£cipal Codes. There are nitrates present, Ir ~ ~,,gg~4 ~h~ p~na~r ta~t~ng ~e performed to insure the wells continued suitability. Current aitrate concentration is 6.22 mg/l. EPA maximum ccnccntration is 10.0 mg/1. More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority ^pp.rovel'Certificates based only' upon the representations given in paragraph ~ above by ~n independent professional ~ngineer registered in the State of Alaska. The DH H8 does thi~ a~ a oou~esy 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 cedificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72~O25 (Rev. 1/91) Back MOA #21 RECEIVED, -, Municipality of Anchorage /,~.~ _ ~ DEPARTMENT OF HEALTH & HUMAN SERVICES APE{ 1 ~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · Health Authority Approval Checklist Legal Description: A. WELL DATA Parcel I.D.: 017 -0~ Well type ,[O ~ ~/8 T ~- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/~) ~ 0 Date completed ~-~ I ~ 7 ~'- Total depth ~'-~ ~' ~''~ Cased to ~0 /'J Casing height (above ground) Sanitary seal ((~N) ¥ ~ ~ Wires properly protected [~'N) y~ .r FROM WELL LOG AT INSPECTION Dateoftest 0~/ z) /13 /~ ~1 Static water level Jcl ~/ Well production ,/ g.p.m. ~ ' (~ WATER SAMPLE RESULTS: g.p.m. Coliform Date of sample: GiOc.¥c~L~ B. ~,E,~T4e~f-I~NN~TANK DATA Date installed cl/! ff/~ ~ Tank size Nitrate Collected by: Other bacteria O S & S ENGINEEI~INC. 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Foundation cleanout ~N) ¥ Date of Pumping C. ABSORPTION FIELD DATA Date instai,ed ) 5- ~ '~- Number of Compartments L./ Cleanouts (Y/N)./'/'~'c'~ c~v ¢ ~ D~pression (Y/I~ ,~' o High water alarm ~,N) ¥ '~ J" Pumper ~ -/-~. h~-/w ~ 5-&,,a¢, ~j- Length ~ 0 Width Effective absorption area ~ 0 Date of adequacy test W/' (~. '7 System type J~ ~ Gravel thickness below pipe ~' 3~ Total depth. Monitoring Tube present (~N) ¥~J Depression over fietd (Y/~ ~ ~ Results~Fail) ~4 SJ For ~ bed[corns Fluid depth in absOrption field before test (in.); ~)/~ Y -~ Immediately after ~/5"~--gal. water added (in.): ~)"~ Y Fluid depth /V/,g- (ins) Minutes later: /'//+ Absorption rate = ~ 0 0 --~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) /~J'~ ,v 4._ /c ~, ~ ~ M If yes, give date '- 72-026 (Rev. 3/96)* LIFT STATION Date installed ¢1 Manhole/Access 0/N) High water alarm level Size in gallons "Pump on" level at* 6 ',3- Cycles tested ~:~ *Datum /$- 39. "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: S.e¢~ tank on lot Absorption field on lot Public sewer main Sewer/septic service line / .J... On adjacent lots /(2 <; On adjacent lots ) 0 o Public sewer manhole/cleanout /,~ //4 / Lift station / O o '¢-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: I / Foundation ,.~' H--- Property line -~' ~ Absorption field Water main/service line /0 --~ Surface water/drainage )8 0 f'¢ Wells on adjacent lots /CO Y- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyline I ' LFwR- c~$-O~y~ ') - Building foundation ! 0 ~ Water main/service line / 0 Surface water / 0 0 ¢' Driveway, parking/vehicle storage area Curtain drain /v 0 ,v~'~. /~,~0 ~, ~ Wells on adjacent lots / ,.1 0 ¢-- ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records~Cf~.,(a~[~V~l~/~,s'~'-'''x' ,~--- "- '~3~~---z ,x~. are in conformance withMOA HAA auidelines in effect on this date, ~ c~ ~'" ~'.., ,,- ~ Signature ~~ ~ HAAFee $_ ~'~ ¢¢, ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE ,~ DEPARTMENT OF HEALTH & HUMAN SERVICES 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 ParcetI.D.# C-"17-c ;~ _~_c) 1. GENERAL INFORMATION Complete legal description Lot 17; Brock 3; Mountain Park Estates #2 LOcation (site address or directions) 13021 Foster Road Anchorage, AK Property owner Mailing address Lending agency Mailing address Robert & Rosie Tenqe Day phone 345-0161 C/0 Re~ax Properties Attn: Mary Cox 2600 Cordova St. Suite Anchorage, AK 99503 Day phone 100 Agent Mary Cox/ Re~ax Properti¢~ Day phone 257-0112 Address 2600 Cordova Suite, I00 Anchorage,, AK 99503 NOTE: Unless otherwise requested, HAA will be held for pickup. rn NUMBER OF BEDROOMS: 4 ~', ~- ~ TYPE OF WATER SUPPLY: ~ "-~ ~" ~. Individual well XXX ~ ~ ~ -~ Community well ~ ~ Public water ~ ~ ~ If community well system, provide written confirmation from State ADEC a~e~t- Z lng to the legality and status of system. 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. 72-025 (Rev. 1191) Front MOA *F21 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 inves_ti_gation 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 ,~L¢; 7 9 Name of Firm ;70~4 ~.a~J;. ;;Yur [.wp ~ga~ NO. ~.~ Phone ~ ti ¥ - Address Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Com--e-t~°te:m u The well for this property meets existing. State and Munzczpal Codes. There are nitrates present. It is suggested that a periodic testing be p~rfc%rm~ ~ ~,~re the wells continued suitability. Nitrate concentration is 6.19 mg/1. EPA maximum~onc~n~ra~ lg g mc 1 By: / , / 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 OHHS 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. 72-025 (Rev. ~/cJ1) Back MOA ~21 NIUNICIPALITY OF ANCHo~,(~i~ Municipality of Anchorage ENVIRONMENTAL,SERViCES DIVISION!~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division OCT 0 ~ 1995 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 P, ECEIVED Legal Description: Lo i- I 7 Health Authority Approval Checklist Lye 3 Parcel I.D.: A. WELL DATA Well type /0h t ¥ ~' T £ If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Log present (Y~ ~J 0 Date completed ! t Total depth ~ 7 ~. -~ Cased to H 0 -/-- Wires properly protected (I~/N) Sanitary seal (l~}tN) "/g $ FROM WELL LOG AT INSPECTION Date of test o [ 14 ii / ~ q / q ~ c~/~ lq-] Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: c] /t ~' / ~ ~" Collected by: B. ~eg~l~L-~*~ TANK DATA 96 Date installed q /t~ q / ~S_ Tank size / S- $~ Foundatior~cle~hbu~(~5~'~N) y r~ S Depression (Y/~) t,, 0 D~hfi~umping/X,/~ "~ ~:? Pumper C. ABSOR~ION ~LD D~TA Dfite:installed t ~ . _ Soil rating r Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments t.-] Cleanouts (Y/N) 14~r~6, co,~ High water alarm (~/N) y ~ 5 System type L~gth ' & ~ ' Wid/h 1 6'- / Gravel thickness below pipe 0, ~' Total depth Effectix~e/ib'~orption4t?~' q 0 0 Monitoring Tube present(~/N). Y~J Depression over field (Y/~ Date of adequacy test Results (Pass/Fail) ~ 7 b ~ For _~~-~eflrooms Fluid depth in absorption fielql b~foye te,~sj_ (in.);~ ~. water added (in.): Fluid dep~ Absorption rate = g.p.d. Pero~dE-treatment (past 12 months) (Y/N) If yes, give date D. LIFT STATION Date installed o) / / q / q ,r- Size iii gallons Manhole/Access ((~q'q) High water alarm level at* Cycles tested _-5 E. SEPARATION DISTANCES "Pump oW' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: · &~pttc-gt~Ading tank on lot / 0 ~ Absorption field on lot / a- S- Public sewer main .; On adjacent lots · On adjacent lots Public sewer manhole/cleanout Lift station dOO ?oo Sewer/septic service line t~ 6 ? O ,5- SEPARATION DISTANCES FROM S~am~4~'?~43D'~ TANK ON LOT TO: t / Building foundation I ~ Property line J 6 Absorption field Water mairdservice line Surface water/drainage /oo q-- Wells on adjacent lots IOO Building foundation SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r/ 3 Water mails'service line /o0 Surface water . ~ Driveway, parking/vehicle storage area Curtain drain r,r~--6 to,., ~, ,a Weils on adjaceot lots I 0 o Property. line F. ENG~ER~S CERTIFICATION I cert~ that l have determined thru field inspections and review of Municipal reco,~~are in conJbrmance ~Tfff~ ~ines in effect on this date· ~' ~;~ HAA Fee * Receipt Number /,~ Rev. 8/95 OSS: baa.wk.doc Waiver Fee $ Date of Payment Receipt Number /ol ¥q ':' DA~E RECEIVED ' iNSPECTiON APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPEOTOR INSPECTOR I NSPEOTO DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF H~ALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION MAR 2 6 1981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYE~ MAILING ADDRESS 3, LE~NG INSTITUTION PHONE 4. R~LTOR/AGENT~ / ~ / I PHONE MAILING ADDRESS 5. LEGA L~.D ESCR I PTION.-~ 7 /7 /5z TREET LOCATION /~ 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6~79) THIS SIDE FOR OFFICIAL USE ONLY 'l. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER ~] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY I-] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DA'rE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY ~r- Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: /'~_~ If Tank is homemade SOILS RATING give dimensions: TYPF OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Abs6rption Area Sewer Line Nearest__ Lot Line Absorption Area to nearest Lot Line "'5. COMMENTS [~APPROVED FOR Z~~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must/acce~mpany certificate) DATE BY~,~ 72-010 (Rev. 6/79) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received MaY 18, 1976 Time of Inspection Date of Inspection REQUEST. FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 5-2~76 ThUrs. Le~ B~chholz 4. 5. 6. Approval requested by: Mailing Address: Property Owner: Mailing Address: United Bank of Alaska Walter A. Collins Star Route A Box 378-H, 99507 Phone: Phone: 274-5519 x 38 Legal Description: Lot 17 Block ~3 Mountain Park Estates. ~2 Location: Foster Road off De Armoun Type of facility to be inspected Single Family No. of bedrooms 4 Well Data: Individual A. Type Sewage Disposal System: B. Depth 170' D. Bacterial Analysis On-site system A. Installed August, 1975 B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: 2. Manufacturer 2. Material A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area , Sewer Lines __ C. Absorption area to nearest lot line EQ-034 (l/74) Page 1 of two pages Page-2 of two p~ges - R~'~"st for Approval of-Individual : qer & Water Facilities '~'~'Legal · ~Desc.ri pt i on Lot 17 Block 3 Mountain Park Estates #2 Comments Approved~~% Disapproved Date J~-~6f'7~ Apprg~]~l ~Valid for one year from date signed Greater Anchorag~-~Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: I~] Mailing Address: VA FHA CONV (~o~ 37~J- tq ; ~q.~l DayPhone: 27~-5S1'~ 3. Name of Buyer: Mailing Address: Day Phone: 4.NameofLendinglnstitution:U~;~-~-J ~,~ l'~lz~¢, Mailing Address: 5. Name of Realtor or Agent: ~'~ o~- Phone: Mailing Address: Phone: Legal Description: ~J~c.~ 22 Lo~ FT? ~/J.J. P~e~. ~-~$ L Type of Facility to be Inspected: Water Supply Type of Supply: bU~,~l Public Utility If Individual, number of dwellings presently served No. Bdrms. rlndividual One. If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation 270 Public Utility Individual (on-site) 72-003(3/76)