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MOUNTAIN PARK ESTATES #2 BLK 4 LT 4
Mountain Park Estates #2 Block 4 Lot 4 #017-023-4 Municipality of Anchorage Department of Health and Human Services Building Safely Division Onsite Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 2 www.d.anchorage.ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW W0102 8 PID Number. 017-023-04 yWastewater System: ❑ New ® Upgrade Ad°"` nqtpr ABSORPTION FIELD Phar.: Number of 9.aoonw: 22 -snag 4 D Asap Tn ncl O ShabrTlrrch p aed D Merrd O 00w LEGAL DESCRIPTION So d Tarl Depthalanalgi el We" Black: La: SWdMuon: Depth b ppe batlom hem or4lnel mode: dml depth beneah o": fl. fl. To"nadp: Ran W: Secton: Fa added above -' pude: Grawl Lwglh: Ft. R. Well: ❑ New E]Upgrade c..nl.Add,: Mum" *I area: I CrWrte be"e"n Ines: fl FL Clarfka6m (Prl•er. A B. c): Tari Depth: Cued r: Tort ab•erpaen lau: P" Met~ 3o3K'WC— fl fl Fr wala: Dae DrNNd: seat Warr LwM: serrpar: SJL Dar anraed: 7113101 R TrM:""npa".r. caWrpHrpMA Ground: TANK GPM R R SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From Septic Tank Holding Tank vudi sewarum mwwo lar Anch Tank cap—Orr 1250". wr 120 110 Materia: Steel N~ a Canprb.es 2 s..rar.wrr 100+ F LIFT STATION La liu 26 Gn: Gal Mr"Irver: 5 A••p on, tell.: Pup ar "no'a: Hrpn erer•Tenn a: Fourdatbn In r r. 100+ 1 pun;, Make a Model floor" kapec "pe.M ned W. ..1100+ R rice Se tic Tank Replacement only. BENCH MARK Leraoon lard Creole m: Back Window Sill Asr"nal Eruoan: 100.0 R Engineer's Stamp Rs OF Inspections performed by: Pannone Eng. Svc Dates: 17/13/2001 ; tj agTH *i 2nd0711312001 roval Department of Health a uman S es• P _ " e one ���Slven R. PonnoneJ0 Reviewed and approved by: Date: 07— i No C 8141- cdrOi PERMIT NO, SVOI0238 AS -BUILT P.I.D. NO, 017-023-04 WASTEWATER ABSORPTION SYSTEM LOT 4 BLOCK 4 MT. PARK EST S/D 1 I AXIS 'G 1 ELLS & SEP`1u i ❑SATE; GREATER THAN 400 '-EE F,��!V. TH. PREP?SED XIS1 SEP EIC TANK ELL I EXIST'G DRAIN FIELD TO REMAIN DC i CO A B TI 15.3 38.4 T2 19.6 40.5 DCI 23.7 39.1 DC2 33.7 40.2 NEW 250 EXIST'G HOUSE_- B IST'G 12509 -S PTIC TANK A ANDONED EXIS 'G �fl -OCCATED G RK Iii 17E`._; F R SEP T;.0 TALK r '.DWG DESIGN 4 BEDROOM HOUSE 12508 SEPTIC TANK REQUIRED TANK REPLACEMENT ONLY •- LS & SEPTIC �ATER Tl --IAN �M 1 INSTALL 2' R.I. J n OVER TANK nn qac II 1196.6 94.8 NEW 12508 SEPTIC TANK 'G • PREPARED FURi PANNONE ENG. SVC,LLC R. Pannone i P. O. BOX 102954 � Mr. Dan Grnhnn " 8149 �� 12900 Foster 99 ANCHORAGE, ALASKA 99510 Anchorage, AK 99516 (907) 223-8088 272-8218 Phone & Fax 1 ATE, 7-31-01 AS -BUILT crei c, 1•=en• Permit Number: SWO10238 MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 i'X- r,.,armc,7- 7-/Y-O/ tr 7-/3-O/ /: 3040. ••I ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 13, 2001 Expiration Date: Jul 13, 2002 Parcel ID: 017-023-04 Legal Description: MOUNTAIN PARK ESTATES #2 BLK 4 LT 4 Design Engineer: 0062 Pannone Engineering Services Site Address: 012900 FOSTER RD Owner Name: Dan Graham Lot Size: 39204 SO. FT. Owner Address: 12900 FOSTER RD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE , AK 99516-3231 This permit is for the construction of: ❑ Disposal Field Q✓ Septic Tank Holding Tank ❑ Privy Private Well E] Water Storage 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: C�10 7-'-t3 Date: 7-13-01 Municipality of Anchorage Development Services Department l Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-023-04 Permit Number SW Property owner(s) Mr. Dan Graham Day phone 223.8088 Mailing address (1)12900 Foster Road Mailing address (2) Anchorage AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Lot 4 Block 4 Mt. Park Estates:W2 Legal description (Section, Township & Range) Lot Size 0.46 Acres q.F Number of Bedrooms 4 3eia.og4 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ® o,uL-e THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Date of Payment: Receipt Number. (Rev. 12100) Waiver Fees: ZiA Date of Payment: ZReceipt Number. Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax July 11, 2001 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 4, Block 4 Mt Park Estates#T- Septic Tank Replacement Permit Gentlemen: My firm was contacted to conduct a Health Authority Investigation of the well and septic system serving this lot for a pending sale. The system was completely dry before and after the test. I was asked to inspect the condition of the existing septic tank. The tank was uncovered and inspected on June 27, 2001. Pin-hole leaks were discovered in steel sidewalls of the second compartment of the tank. The tank was recovered. I informed the owner that the tank needed replacement. This permit is requesting a permit to replace the existing septic tank only. The lot is approximately 0.46 acres in size. Lot 4 slopes to the west at approximately 2 to 4 percent. The proposed installation will be located in the western portion of the lot. The existing tank will be abandoned. The proposed septic tank will be installed outside the well radius. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Steven R. Pannone, P.E. Attachments: {I J 4QTH j� %.* un..».dni � tSteven R. Ponnone Nn Cr {fir 49•• .•.-Z, ♦♦h��'ESS�a � • r. Cl\ PERMIT NO, SVO10 DESIGN WASTEWATER ABSORPTION SYSTEV. LOT 4 BLOCK 4 MT. PARK EST' S -/D P.I.D. NO, 017-023-04 EXIST'b DRAIN FIELDIII — TO REMAIN III r III III PROPOSED/f2509 . . . . ............ pi. X EXIST'G <7HOUSE— M,ml- .1k E��I S TG 12 5 0 g SEPTIC TANK T[� BE ABANDONED [\,�\A. T E R -11-1 ... 1AN 0 4 T E 11.) CC, SF.- C T Al N K TIESTGN 4 BEDROOM HOUSE 1250g SEPTIC TANK REQUIRED TANK REPLACEMENT ONLY Mr. Dan Graham 12900 Foster Road Anchorage, AK 99516 (907) 223-8088 INSTALL 2' R.I. OVER TANK n NEW 12508 SEPTIC TANK E T'G PANNONE ENG. SVC,LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax DESIGN E.1 r:.% A'T'El) O?� G E��-)'FR Hl A N . ..... 7-XIST VELL FA N K EXIST'b DRAIN FIELDIII — TO REMAIN III r III III PROPOSED/f2509 . . . . ............ pi. X EXIST'G <7HOUSE— M,ml- .1k E��I S TG 12 5 0 g SEPTIC TANK T[� BE ABANDONED [\,�\A. T E R -11-1 ... 1AN 0 4 T E 11.) CC, SF.- C T Al N K TIESTGN 4 BEDROOM HOUSE 1250g SEPTIC TANK REQUIRED TANK REPLACEMENT ONLY Mr. Dan Graham 12900 Foster Road Anchorage, AK 99516 (907) 223-8088 INSTALL 2' R.I. OVER TANK n NEW 12508 SEPTIC TANK E T'G PANNONE ENG. SVC,LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax DESIGN Municipality of Anchorage I,IEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6.650 ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL NAME�1t�:- � ADDRESS SVS\ LOCATION f:��s Rct y Q�L4 Kt!-� � 7 c((9 PERMIT NUMBER r #OF BEDROOMS PHONES) -$gtA^ q�1� LEGAL DESCRIPTION l.. SEPTIC TANK V-QLQv TILE DRAINFIELD Iag-o MANUFACTURER i pp C�J��I CAPACITY IN GALS. NUMBER OF LINES LENGTH -EACH � /0 ` MATERIAL � #OF COMPARTMENTS INSIDE DIMENSION TRENCH WIDTH DEPTHS: LENGTH WIDTH DEPTH SEEPAGE SYSTEM TILE DRAINFIELD i pp C�J��I NUMBER OF LINES LENGTH -EACH TOTAL LENGTH /0 ` 1(00 DISTANCE BETWEEN LINES TRENCH WIDTH DEPTHS: TILE TO GRADE FILL BELOW TILEFILL ABOVE TILE SEEPAGE TRENCH OR ❑ PIT WIDTH LENGTH DEPTH ❑ LOG CRIB FOUNDA ❑ RINGS- DIA. FILL MATERIAL DEPTH j TOTAL EFFECTIVE ABSORPTION AREA: SO'i SO. FT. �e P WELL CLASSIFICATION DEPTH PIPE MATERIAL INSTALLER REMARKS d5o"l's k)s Q�otuY.c) ,-00.�r c� $ �k Qt, i Q"tc . DATE l 7 1 APPROVED BY - �✓�-+ 72-012 (9/77)' SYSTEM DIAGRAM SEP IC TA FOUNDA TION INNS SYSTEM DIAGRAM ��. �"� P -A (-T FA W Ill 1=1 pit 1`1 ��PHRTME�T O, fEHLT� AND �����ONME�THL F^ �TECTIO@ ' \ "TREET/ HNCHORHGE, HK. 99`� LL� �F-E., �01 JE P � � HPPLICHNT D RIGHT SR8 BOX 1585H 344~4210 LOCHTION FOSTER ROHD LEGHL L 4 B 4 MT PHRK EST LOT SIZE 20100 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: T8ENCH MAXIMUM NUMBER OF BEDROOMS := 4 SOIL RATING (SQ FT/BR)= 125 T UIRED SIZE OFTHE SOIL FiBSORPTIOhlS I � 12, FIT go, -V 1-0 1-4- �LE. Iil�_fi KA -1- 11-11112 F=H 10 M It-- � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GRQUND HND THE BOTTOM OF THE EXCHYHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ^1~ THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE 8ND THE 8OT1'OM OF THE EXCHYHTION (IN FEET) ��D.-,- 45 127 V W 3: c! -V M VA 11-f.: :S=-, -1 ,-E! IE -L ��..... ���� �--��. ���3 E -FE MIL.. 91:1 PUT- W IF" W :1 1:1 P"A H P8CKHGE PL -HNT MAY BE INSTHLLED AT THE PERMITTEE/S; OPTION SUBJECT TO THE FOLLOWING CONDITIONS� i. EITHER H CLHSS I OR II NSF HPPROVED PLHNT MHY BE INSTHLLED 2. R CONTINUOUS MHINTENRNCE AGREEMENT IS REQUIRED. IF H MHINTENHNCE HGREEMENT IS NOT KEPT CURRENT YOU MHY BE REQUIRED TO ENLHRGE THE SOIL / RBSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION �.......... ������������������....... .... �����.... .... ������...... .... .... ..... ��~ _V W 11) ��:,-A 1 4-41 :-=E-- np.-.� trE., , V 1 9D P -A '_1E-- got IT! FEE IT! I=-. kJ I 1E. -H ��~ BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPRQVHL B9 THIS DEPHRTMENT WILL BE SUBJECT TO PRQSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON-SITE SEWHGE DISPOSAL .9STEM IS 100 FEET FOR H PRIVHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LQGS ARE REQUIRED HND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION OTHER REQUIREMENTS MY HPPLM cot, ECIFICHTI0NS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION ���M X "T 1 0-;;2: Q W KEE M 13 M It, ��' ��.'�" I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2: I WILL INSTILL THE SYSTEM IN HCCORDHNCE THE CODES. ]: I UNDERSTAND THHT THE ON-SITE SEWER SYSTEM MHY REQUIREENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. SIGNED� ~� a N ---'SO I LS LOG MUNICIPALITY OF ANCHORAGE 0 PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6-650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: f N' T DATE PERFORMED: r C% t S 77 LEGAL DESCRIPTION: 1-3 4-- MT, (� �• SLOPE SITE PLAN DEPTH e v 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 P -- I I ' —I i I N I)J 5 l L7 WAS GROUND WATERYC—S S ENCOUNTERED? L O P E IF YES, AT WHAT r DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop JPERCOLATION RATE (minutes/inch) tt TEST RUN BETWEEN FT AND .l FT L COMMENTS 7Z P o f S I L riJ M %T i L V -.� 677— �/ L PERFORMED BY: Gt /c �'s C/G'�7/� CERTIFIED BY: 72-008 (7n6) 7 % 4/7,77 DATE: 1)14AI 1::i$k - .,-pL.t ••l lbf ,i.0 �j,� 3330 "C" Street i�': ��'� Anchorage, Alaska 99503 �'1RC 1)OY.YY ` SOILS LOG - PEROLATION TEST _ �� Date Performed_ 6�2L Performed for P064 7� Legal Description: It.P This form reports: Soils logs Percolation test Jr Depth Feet 2- 3- CO A r s e 6!`A ve tS 4- 5 - ME 7 6W-610 6 5 8- 9 - (3 a p) 10 - 11 - 12 - S/opo 13 - .s i 74 h �$/I/ Q S A'1 14 - t� 13 Was ground water encountered? �Q, If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minure. — ---- Proposed installation: Seepage Pit Drain Field _ _ _ �- _ ----------------------- ;iepth of Inlet Depth to bottom of pit or trench Performed 6 Certified By:�_�J�_�---__.___. Date: _6� EQ -040 (6/74) 'I Lag Location:Blk.: 4 hot 4 �ountain Park description: 6" well cased to 57 Kt„ IMaterials:. 20 topsoil gravel, . 22 4I sand, surface water '42 53 weathered rock(water 54 62 Static water level:45cftstorage) Yield: 2_-5 gpm 15) 1 approx. 65 ft.. east of house bearing) Drilled b ga lon cavitated storage y:Thomas Drill urs P.0,. box 10-516 Anchorage,Alaska:_ 99511 344-3133 License_#WD 78020 Completed may 12, 1978 � Reteiuecl tiyi :COSA to he•re10sed to t esnglneer,:unless,'oftierwfse:requested,liy.the,engirieer, uVaiver•.Fee i:'r :5:.; 2' ' Dafe.of' Payment , ... L � 1 , ..� {�.��'' .. <•Date of:Raymenf '' �' Receipt.:Number Rec@ipt Number: C05P # PJcv.C.t 1 b .. Wai.y.er # If more than 1 septic system Is on the lot: COSA Checklist # _of Structurerserved by this system r Certificate of On -Site Systems Approval Checklist Legal Description: U90—TAM PARK ESTATES 92 SID BLOCK 4 LOT 4 Parcel ID: 917••023-04 A. WELL DATA Well type Pf a If A, B, or C provide PWSID #_ Well Log (YIN).Y. Date completed 51121 978 Sanitary sea[ (YIN)y Wires properlyprotected (YIN) Y Total depth 193 ft.* Cased to119ft. Casing height (above ground) 20 FROM WELL LOG AT INSPECTION Date of test 511211978 1218/2015 Static water level V* ft 112" ft Well production 1.2 g.p,m. 0.77 g.p,ni. WATER SAMPLE RESULTS: Coliform NEG coloniesK00 mL Nitrate L.9 7 mg/L 7118x111. Arsenic: ND _ ug/L Date of sample: 1217!2015 - Collected by: MNA B. SEPTICIHOLDING TANK DATA Tank Type/Material 8EFncIsTEEL Date Installed 7113101 Tank size 1250 gal Number of Compartments g Cieanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 11-30.15 Pumper Around the Clock C. ABSORPTION KfELD" DATA- i988 SYST15M TESTED: house vacant, presoaked w/ 2300 gallons Date Installed 10/27177 Soil rating (g,p.d./ff or f12/bdrm) 125 System type DEEP TRENCH Length 126 • ft. Width 3 ft. Gravel below pipe 2.0 -ft. Total deptfi4_3 R, P. absorption area 504 ft Monitoring tube Y Depression over field Date of adequacytest 1113012015 - Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 9 in. Water added 600+ -gal. New depth 10 in. Elapsed Time 24 rs min..-: 'Final fluid depth 9 In. Absorption rate r_ 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) UNKNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (`f/N) "Pump an" level at In. "Pump offlevel at In.Hlgh water alarm level at —in. Datum Cycles tested Meats alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/liit station on lot 1001+ Absorption field on tot 11004 Public sewer main 751+ Sewer /septic service line 50'+' Animal containment areas 100'+ SEPTICIHOLDING TANK ON LOT TO: Building foundation T+ Properly line rte'+ On adjacent lots 1004 On adjacent lots 100'+ Public. sewer manhole/cleanout 100'+ Holding tank 1004 Manure/animal excrete storage areas. 1001+ Absorption field 5'+ Water.main 1001+ Water service line 101+ Surface water - low+ . Wells on adjacent lots 100'+ ABSORPTION -FIELD ON LOT TO: Property tine 404 Building foundation D,+ Water main 104 Water Service line 104 Surfacewater 100'+ priveway, parkinglvehicles!orage 101+ Curtaindrain 504ftneknawni.- Wells on adjacent lots 100,+ F. COMMENTS - A•d+* R•dd.E.Leowt l opokt wo, 5 ,*J C. '110 it G. ENGINEER'S CERTIFICATION .y �t O A(4litfl I certify that / have determined through Netd inspections and y �P••�••••..•'. S'I` �P review of Municipal records that the above systems are In ".•ir 1 conformance with MOA COSA•guidellnes in effect on this date. Engineer's Printed Name 0N. PF, ! • • ....... ............. :�r•• MICHAEL N. ANDERSON 'ft Date 121412015 f CE -9469 . ,... OOSA canary sheet,2.5-15.dw Municipality of Anchorage a i3;A , ..� Development Services Department y= Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC151667 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 4 of Mountain Park Estates subdivision, the well's productivity was determined to be 0.77 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. 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 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 # OSC151667 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 4 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 6.97 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. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a 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'` *FE On-Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL -i, Parcel I.D. 017-023-04 Expiration Dater O 1 GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES #2 S/D BLOCK 4, LOT 4 Location (site address) 12900 FOSTER DR ANCHORAGE. AK 99516 Current Property owner(s), ROBERT SPAMAK Day phone Mailing address 12900 FOSTER DR ANCHORAGE, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank Community Class Well ❑ Community Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: ! rA Distance: Received by: Date: COSA to be released to the engineer, unless othervise requested by the.engineer. COSA Fee $ 5-01-G / Waiver Fee $ Date:of Payment la `l �►5 CA< A312 Date of Payment- Receipt Number Receipt Number COSA# 0SCA6 t 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 MIKE N ANDERSON P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MM N ANDERSON, PE Date 12/4/15 6. DSD SIGNATURE°"�49r f�S y ,n;; •°°° °..°.°°r. System #1 Approved for L� bedrooms. .A,,,t„,,,, rte^ MICHAEL N. ANDERSotJ ' w System #2 Approved for bedrooms. Q 69 r' Disapproved.121°C 4: �$ P�OTESStr11 L . Conditional approval for bedrooms, with the following stipula\(�Ac��®��” 41 ;o WPST RPM j_ -WRIT SER By: Original Certificate Date:__�Z'2 z^15 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 StateofAlaska. The Municipality of Anchorage. is not responsible for errors or omissions in the professional engineers work:" - - 7. ATTACHMENTS: COSA Checklist k Nitrate Advisory _ J Septic System Advisory Arsenic. Advisory Well Flow Advisory Y4 Other COSA blue sheei_10-10-12.doc - If more than 1 septic system Is on the tot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES #2 S/D BLOCK 4, LOT 4 A. WELL DATA Well type Private Date completed 511211978 Total depth 193 ft.** Date of test Static water level Well production Parcel ID: 017-023-04 If A, B, or C provide PWSID # _ Well Log (YIN) Y Sanitary seal (YIN) Y Wires properly protected (1'/N) Y Cased to 119 ft. FROM WELL LOG 511211978 49** ft. 1.2 g.p.m. WATER SAMPLE RESULTS: Casing height (above ground) 20 AT INSPECTION 1218/2015 102*" ft. 0.77 g.p.m. Coliform NEG colonies/100 mL Nitrate 6.6 mg/L Arsenic: ND ug/L Date of sample: 121212015 Collected by: MNA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC ISTEEL Date installed 7113101 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN)'N Date of pumping 11-30.15 Pumper Around the Clock C. ABSORPTION FIELD DATA -1985 SYSTEM TESTED: house vacant, presoaked w/ 2300 gallons Date installed 10127177 Soil rating (g.p.d./ft orfelbdrm) 125 System type DEEP TRENCH Length 126 ft. Width 3 ft. Gravel below pipe 2.0 ft. Total depth 4.3 ft, Eff. absorption area 504 ft? Monitoring tube Y Depression over field N Date of adequacy test 1113012015 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600+ .gal. New depth 10 in. Elapsed Time: 24 hrs min.. Ftnai fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at in.High water alarm level at _ in. Datum Cycles tested Meets alarm & circuit requirements? _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 751+ Sewer /septic service line 50'+' Animal containment areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas. 1001+ Building foundation 5'+ Property line 54 Absorption field 5'+ Water main 1001+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 104 Water main 104 Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+(None Known) Wells on adjacent lots 1001+ F. COMMENTS a Ub,iI.L so.(,, 5 _add. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name MIKE N. ANDERSON, PE Date 121412015 COSA canary sheet -2-6-1 5.doc tuvTV', rvrr4.�k- OF A14X�� ,Y �•.�! • sr �..... . ......... MICHAEL N. ANDERSON . @ 11+aif�Fo;.CE: 9469 tn Municipality of Anchorage .� Development Services Department ° Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC151667 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 4 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 6.6 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 P=6E Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # osc151667 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 4 of Mountain Park Est subdivision, the well's productivity was determined to be .77 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 907 Water Well Services 6630 E STH AVE ANCHORAGE, AK 99504 (907)230-1868 johnnie.nethertonl702@gmail.com INVOICE BILL TO Mike Anderson (Anderson Engineering) 4661 Natrona Dr Anchorage, AK 99516 INVOICE # 1156 DATE 12/08/2015 DUE DATE 12/08/2015 TERMS Due on receipt 7 '- a T111tTX i, AATE AMOUNT '. In regards to work at 12900 Foster Rd Services 1 Well(amera inspection Results, Total Depth 193 feet, S.W.L.102 feet, Cased to 119 feet bedrock exposure from there on, pitless burial depth 13 feet (top of casing), casing stick up 18"+ Thank you!! BALANCE DUE t MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES b� DIVISION OF ENVIRONMENTAL SERVICES il9 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date '7 -�-S'r 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) .407- el S"cx el /Y7- 19Nx 95y 'Z- -Ste- z'6 Location (address or directions) (b) +Property Owner �id x)65= N#C• Telephone: Home Business Mailing Address— (c) Lending Institution 'Mailing Address_ 226-6 3o6 (d) Real Estate Company and Agent ;99AAy ~S�i tfP/Ow Address � d Telephone 76 - X70 / (e) Mail the HAA to the followina address: or: Check here Lam; if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/661 Front gel h— ;�,�e r e5 7 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. (/ Name of FirmGS Telephone Address /7,O0 IJ 33. /N� StiiT 23 /TLa %/X 99Svj Date yy*'►w*,t 0 A4 ••.• ..t '•.••• ••e•,. ..P IEROY�, J • •••••1 4 ine 0 Note: The well for this property meets exi a lapt'-.r Municipal Codes. There are nitrates IA;,••40 " r it is suggested that periodic testing b . .0 insure the wells continued suitability.at'e concentration is 5.7 mg/1. EPA maximum concentration is 10.0 mg/l. DHHS APPROVAL Approved for 44�_ bedrooms by ' t Date Approved �� Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-028 )Rev 8186) Back IPALITY OF ANCHORAGE (MOA) POERNGWHECKL SQ%AUTHORIFE RUARY TY A 84HAA) ��A `G�pENT 264-4744 g 198a Legal Description:�7` A. WELL DATA Well Classification f��'+�/ � If A, B, C, D.E.C. Approved (Y/N) N�A Well Log Present(Y ) Date Completed /�- %� Yield �• ��� I Total Depth �� Cased to �% Depth of Grouting /4 re 1 1q Static Water Level �, Pump Set At Casing Height Above Ground r Sanitary Seal on Casing (Y N) Electrical Wiring in Conduitts) Separation Distances from Well: Depression Around Wellhead (Y(9 To Septic/Holding Tank on Lot 1/!r ; On Adjoining Lots r To Nearest Edge of Absorption Field on Lot 1.30 ; On Adjoining Lots To Nearest Public Sewer Line 4 To Nearest Public Sewer / Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected byGS /� ; Date Z �� Water Sample Test /FResults 7e- 7 Comments a �( )kA !✓z q -J 7Z,57- B. Z'Si B. SEPTIC/HOLDING TANK DATA Date Installed Size /,?- 5�O No. of Compartments I:lr- Standpipes) Air -tight Caps) Foundation Cleanout Y N) Depression over Tank (Y© Date Last Pumped Z "7, %�MA5 Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: r To Water -Supply Well To Building Foundation r r To Property Line To Disposal Field To Water.Main/Service Line: %d f' To Stream, Pond, Lake, or Major Drainage r Course Comments Page 1 of 2 72-026 (Rev. 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata IA--5r,Type of System Design Date Installed Width of Field 3 Square Feet of Absorption Area Depression over Field (Y/01 — Results of Last Adequacy Test i 71 Length of Field %Z& Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments — D. LIFT STATION Date ihst led Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Depth of Field Gravel Bed Thickness Standpipes Presen Y/ ) Date of Last Adequacy Test _7- "a 40' To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) -.I- Dimensions r_ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) mping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hahec d, vera ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /�%E /�- Date TC/ "0 0 14 ate. a Company _ �j MOA No. '� �� � OF A4 �0@ Receipt No. /D 0/ U00 Date of Payment Amount: $ Page 2 of 2 72-026 IRev 8/86) Back b ,f} i moo °° oo•oa " � fr .o rs • 0000sa.on•" io osoeF A® 'ROY C. R@Ip, JR w CE.2.251 . N CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE Client PO# : NONE RECD Req #: Client Smpl ID: L4, B4 MT. PARK ESTATES Sample Recd FEB 2 88 Ordered By Send Reports To: AECS ACCOUNTS PAYABLE 1200 W 33RD AVE, STE B ANCHORAGE, AK. 99503 Special Instruct. Chemiab Ref #: 9001 Lab Smpl ID: 3 Matrix: Water Parameter Tested Result/Units ---------------------------------------------------------------- NITRATE-N 5.7 mo/I Sample SAMPLE COLLECTED 2/2/88, 1525 NRS. ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 2-4-88� LABORATORY SUPERVISOR: STEPHEN C. EDE 1 Tests Performed See Special Instructions Above ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than Work Order No. : 5012 Client Account : AKECSRP Date Report Printed: FEB 4 88 d 12:29 Released By : 21dGf/ Reports Address #2 Method EPA 353.2 Allowable Limits 10 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Nhone Applicants Address IQQ�1►-A®!�1n l�),V `��11'C���� _-:�p3^� (c) Applicant is (check ore) Lending Institution ; Owner/builder Buyer � ; Other (explain); (d) Lending Institution F-1Sz5-,-e Telephone Address _ �� , ��C� =0--0 �.K 9 S l Ci (e) Real Estate Co. & Agert'c���� J Address Y 1lM y- , bli�! T Telephone -S� 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well Community Public Note: If ccmmnity well system, must have written confirmation from the State Departrent of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this FAA a) 4. Sewage Disposal Onsite 5�f Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedrooms GM) (Page 1 of 21 2-15-84 5. FEngineerinq Firm Providing Inspections, rihsts, Data and Information I certify that I have checked, verified, or conforried to all MOA EVO, Guidelines in effect on the date of this inspection. � �b . Sigrid - iz� / t Date_ Name of Firm /yam Telephone "sal LQ; �J Address l-Z-K)�) \, \- M K-\�G SU=s� r r Signed by Date��J (ENGINEER SEAL) c;.DHEP Approval Approved for bedrooms Approved Disapproved Terms of Conditional Approval uN Conditional ���i'o ac^ ea •��•� r; f�Y J' • No. 2257E Date (�l,� 6 The Municipality of Anchorage Department of Health and Environmental Protection dc, -.s not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates thatr as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional ungitional for the number of bedrooms and type of structure indicated. (DHEP SEAL) i. Mail the HAA to the following address: LKB2/d5/s (Page 2 of 21 r 2-15-84 �x MUNICIPALITY of ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) do CHECKLIST - FEBRUARY 1984 1./ 310U ie1NgwNOaIAN3 A. WELL DATA 18 H11V3H dO 'ld3a aowoHQNV 3o 4L11Vd1a1NCIIN Well Classification If A, B, or C, D.E.C. Approved(Y/N) Well Log Present &/N) Date Completed_ Yield,?S .ter Total Depth Cased to C_7/ Depth of Grouting %L:Zr7d/i Static Water Leveler °` Pump Set At jJ�tit�//tUz �v r`dt�x; �'�� w Ce.;� i Casing Height Above Ground /,. Sanitary Seal on Casing /N) Electrical Wiring in Conduit �/N) Depression Around Wellhead (Y Separation Distances fran Well: To Septic/Holding Tank on Lot �iC�Ur ; on Adjoining Lots �ic70/ To Nearest Edge of Absorption Field on Lot on Adjoining Lots To Nearest Public Sewer Line �( To Nearest Public Sewer 4) 'To Nearest Sewer Service Line on Lot t Water Sample Collected By 1W9 Date � Water Sample Test "Results - an! � Cc merits B. SEPTIC/HOLDING TANK DATA Date Installed 1"1,-17`7 Size gS (D No. of Ccopartments PC Standpipes {j IN) Air -tight Caps :Foundation Cleanout /N) Depression over Tank (Y Date 'Last Pumped Pumping/Maintenance Contract on File ('1/N) 1J/+; for "1A Ho Tank High -Water Alarm (Y/N) AVIA Temporary Holding Tank Permit Separation Distances fran'Septic/Holding Tank: To Water -Supply Well �/DOTo Building Foundation 7:6- ' To Property Line( To Disposal Field i5� To Water Main/Service Line To Stream, Pond, Lake, cr Major Drainage Course Ott convents Jf1 r_e7t r77.7la e /f0 it iCrS` rJ �(C+3y b'?�ciS ri�i / ��i Ids [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design /l ,1qc.4 Date Installed 101X711Q `9 Length of Field width of Field �' '� Depth of Field' Gravel Bed Thickness J Square Feet of Absorption Area Standpipes Present ,EIN) Depression over Field Date of Last Adequacy Test Results of Last: Adequacy Test Separation Distance from Absorption Field: To Vk.,ter-Supply Y 11 IjQC�I To Propertv Line To Building Foundation To Existing or Abandoned System on 'dot 101A On Adjoining Lots > 3a To Water Main/Service Line ti(A To Cutbank(if present) w//t To Stream/Pond/Lake/cr Major Drainage Course MIA r, ( To Driveway, Parking Area, or Vehicle Storage Area Pcte.,.,q iiIII-V' )" Comments I(fcs`U�S.I�X� 'iii%ii!-CiA2/�✓/rr1 fC /%frr` i A .J eia" D. LIFT STATION fU�� Date Installed 0(A Dimensions Size in Gallons — Manhole/Access (YIN) "Pump On" Level at -- "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for — Pumping Cycles dining Adequacy 'list. Meets MDA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, -verified, ;or• conforrred to all MOA HAA Guidelines in effect on the date of this inspection. ©V A �@ Signed / Date/7 ., .Ci 4� �ifY90f`f3 g 3 f UP C�,� Q �� Company _��;1 -_��� MOA No. KBl /d5/s 72.1 C,y� ' [Page 2 of 2.] idS}t �, AFL 2-15-84 ALASKA �i 01ROMI]TAL C011TROL Engineerinq & 6nuironmental Studies ROHODI KARELLA 1000 E DIMOND BLVD SUITE 103 ANCHORAGE AK 99502 SCIloICCs, Inc. MARCH 8 1984 SELLER — REMAX REALTY BUYER — SUBDIVISION — MOUNTAIN PARK ESTATES 2 BLOCK — 4 LOT — 4 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 504 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1200 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON MARCH 2 1984 . FLOW TEST ON WELL THE WELL FLOW RATE WAS 1.2 GPM FOR 4 HOURS. THE DRAWDOWN OF THE WELL WAS 10.94 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. �fl Or ... c..- 11 yA lri ^OF 1� J k. 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503. 907) 561-5040 f d_ o 5. LEGAL DESCRIPTION DATt 'RECEl V ED INSPECTION APPOINTMENTS Q0 07 TIME TIME TIME i p 6. TYPE OF RESIDENCE i DATE DATE DATE /A-' , ❑ MULTIPLE FAMILY ❑ Three ❑ Six INSPECTOR INSPECTOR INSPECTOR p COMMUNITY since June 1975. For wells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE PROTECTIONPT. OF 11=ACTH & - DEPARTMENT OF HEALTH & ENVIRONMENTAL 825 LStreet -Anchorage, Alaska 99507 ENVIRONMENTAL PROTECTION • 0 -to 1 81979 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 FF [[�� FF vv FF DD REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SERfzR`F7a'�IEITIES 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 - - _ 4g4i qveIz4�! PROPERTY RESIDENT (If different from above) -46sle-il PHONEOW 54 -&/6) �'`'� . 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE ��g0 �Z CN - iY MAILINGADDRESS ( - f-�-!{_i�tI.0 �1;_ � r/l ](/ I f 0 iCY 1� ✓�it!t �� /'i I� %%tJ 5. LEGAL DESCRIPTION - Lid Q0 07 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDRO MS ❑ One Four ❑ Other ` SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER UPPLY 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 INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST A MPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) -1 a 72-010 (Rev. 6/79) 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 DATE INSTALLED INSTALLER 1_.y ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ' 1 O Vt' APPROVED FOR 4— BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac omp y certificate) (JY DISAPPROVED DATE / ^ -� BY ` 72-010 (Rev. 6/79) 1�%0711�7d�e �Gi7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 - - - - ENVIRONMENTAL ENGINEERING DIVISION ❑ One Fk7f' Four ❑ Other Telephone 264-4720 ❑ Two ❑ Five 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. P64QPERTYOWNER PHONE I/iJ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled MAILING ADDRESS - - since June 1975. For wells drilled prior to that date, give well 1��% depth (attach log if available.) PROPERTY RESIDENT (If different from above) -- PHONE INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date -727, 2. BUYER PHONE ❑ PUBLIC UTILITY by this Department. MAILING ADDRESS 3. LENDING INSTITUTION aPHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NU ER OF BEDROOMS SINGLE FAMILY ❑ One Fk7f' Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER LY I/iJ 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 D POSAL SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date -727, If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) RGA -s i n l at THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME - TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 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 INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE Y (Title) z LEGAL DESCRIPTION 72-010 (Rev. 3/78)