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HomeMy WebLinkAboutMOUNTAIN AIR ESTATES #1 BLK 6 LT 10 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231412 LV_4 P 701 yg:?. PID Number: 017-171-14 Dwelling: V Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name PRUVIS ABSORPTION FIELD Site Address ❑� Deep Trench El Wide Trench El Bed ❑ Mound 15201 MESA PLACE ❑ Other Phone Number of Bedrooms Sol] Rating Total depth from ;riginal grade - 13 1.0 GPD/SF 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 4.0 Ft 5 MOUNTAIN AIR ESTATES # 1 BLK 6 LT 10 Fill Ft. added above original grade Gravel lengt Township Range Section 1.0 Ft. 47 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 2.0 Ft. Ft To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 470 Ft2 1 Ft. Well 100,+ 100,+ 50'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 1001+ 1001+ ANCH TANK 1000 Gal. Material Number of compartments Lot Line 10'+ 10'-1. NA PLASTIC 2 Foundation 10,+ 10,+ LIFT STATION Manufacturer Capacity Remarks TANK DEMO PER UPC, Gal. TANK INSTALLED 10/23/20, FIELD 1/9/24 Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 10 1 ft Ins dates 11 10/23/20 2"d 1/9/24 Location and description 3`d 41h TOP OF MANHOLE 101 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp nal Approval: Septic Sy Approved (Rev 05/02/18) Date Date is approval does not include well permit required • �_ .,• MICHAEL N. • RNDERSCN� 4@ �A j•'•• CE %- 94 9 r GR A V E L DRIV E W A Y MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231412 Work Type: Septic Upgrade Tax Code Number: 01717114000 Site Legal Address: MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 G:3139 Site Mailing Address: 15201 MESA PL, Anchorage Owner: PURVIS MARIE A Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: t�t'.11211'tIII CRt 1 /4/2024 1 /3/2025 24317 Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: A test hole is required prior to construction of the absorption field, in the location shown on the site plan, to confirm minimum separation to impermeable soil and seasonal high groundwater, as well as percolation rate. Construction may proceed at your own risk prior to 7-day groundwater monitoring. If results require a design change, construction shall stop pending approval of a change order. Please submit results with the inspection report (or change order, if required). Received By: S S ��� r—f2­3 0AJ Date: Issued By: Date: 2a Z Y OF " HCH®'v =1 GF= Development Services Department _ =$ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-171-14 Property owner(s) PURVIS Mailing address 15201 MESA PL, Anch AK Site address same Day phone Legal description (Sub'd., Block & Lot) MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 Legal description (Township, Range & Section) Lot Size 24,317 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F-xl Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ❑ Upgrade X Duplex (D) El Holding Tank El Renewal El Multiple Multiple Dwellings El Privy El and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: A_Sq 5i Date of Payment: 1 ZZ19r23 Receipt Number: 0/ 17700 Permit No. 0S 192�19 IZ Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Jan 2, 20204 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic permit Legal: MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 To Whom it may concern: This is a request for a new septic permit on the above referenced lot the home has been sold and will be seeking a COSA for the final submittal. The final COSA will include the new tank inspection report. The design requires the old trench be removed and a new trench installed in the same location. The application rate 1.2 GPD/SF was determined as follows, the existing area is 386 SF, if we divide by 3 that equals 128 SF per bedroom. Checking the new design requires 450/1.2 equals 375 SF/3 bedrooms equals 125 SF per bedroom. The system has lasted for over 50 years so it appears to be correct. The old test hole showed SW (sand) with some gravel layers, see the MOA file. That is what was observed during the tank excavation also. A new test hole will be excavated prior to installation for verification and documentation. The existing slopes are between 15 and 20 percent with no open water or cut-banks within 100 feet of the site. This permit will not impact any of the surrounding neighbors, see the site plan. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231412, Curtis Townsend, 01/04/24 SEPTIC FIELD SECTION DESIGN CRITERIA: 6.0' EFFECTIVE 3 BDRM X 150 = 450 GPD SOILS = 450/1.2 = 375 GPD 375 GA/12 = 32' 2.0' WIDE 32' LONG (1) TRENCH 10' DEEP 1. 0 ' 2.0' -10.0 -4.0 MOUND FILTER FABRIC SEWER ROCK ‘3,3( GRADE 1"=100' PROPERTY LINE EXISTING HOUSE EXISITNG/NEW DRAINAGE FIELD -M E S A P L A C E - EXISTING WELL SEPTIC SEPTIC SCALE: DJRDRAWN: DATE: MOUNTAIN AIR ESTATES #1, BLOCK 6, LOT 10 Anchorage, Alaska MARIE PURVIS 12/27/2023 16 (TH#1) 3.0 SW GM Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231412, Curtis Townsend, 01/04/24 GR A V E L D RIV E WAY 1"=50' EXISTING HOUSE EXISTING WELL DRI V E W A Y CO MT&CO REMOVE AND REPLACE EXISTING TRENCH W/ NEW NEW 1000 GALLON PLASTIC TANK INSTALLED IN 2020, FINAL INSPECTION REPORT FOR FINAL COSA 10' UTILITY EASEMENT 15 - 2 0 % S L O P E FCO SCALE: DJRDRAWN: DATE: MOUNTAIN AIR ESTATES #1, BLOCK 6, LOT 10 Anchorage, Alaska MARIE PURVIS 12/27/2023 WEL L WEL L WEL L NEW TEST HOLE REQUIRED PRIOR TO EXCAVATION OF THE SYSTEM Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231412, Curtis Townsend, 01/04/24 v Q SkQ4----FLAA-E 49 TH*O�D AS BU/L T SURVEY PI = 301 sr SHANE A. HOLT DO e LS-6914 0` O NO CORNERS SET THIS DATE fOfessiona� Lo I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY �Op0000Oa OF THE FOLLOWING DESCRIBED PROPERTY LOT IO BLOCK 6 MOUNTAIN - AIR ESTATES N0. 1 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD ,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT %EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA THIS 77 DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. DECEMBER , 2023 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON HOL TLAND SURVEYING THESURVEYDATA ON THIS DRAWING /S PREPARED FOR THE OWNER OFRECORD ONL Y. 9309 GROVER DRIVE ANYCOPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 15984 235-78 223-8615 Municipality of Anchorage Ham.• ;:,. ENCOUNTERED? t�t"a F ), Development Services Department:'' , • , • h.• • On -Site Water and Wastewater Section .ate 4700 Elmore St. 'y- *."49TH , .� ,,• t s P.O. Box 196650 Anchorage, AK 99519-6650 0 www.muni.org/onsite 00 ....... �•�• .°°°' ,_ ••••Sa ,� (907) 343-7904 / •���� MICHAEL N. ANDERSON C -949 Soils Log - Percolation Test 14 ?F,; !�i2%z.f•C\��:r Performed For: Legal Description: (fl lar V'C t? I UV�V•LS Date Performed: /uV 4,h• i,W R %h. 1,C Township, Range, Section: _ SrTTii rTTT 6P 11- 12- 13- 14- 15- 16- 17. (16�v M . COMMENTS WAS GROUND WATER ENCOUNTERED? N 6)_ S IF YES, AT WHAT DEPTH? L Depth to Water After O Monitoring? —T E D.t.:_1LL1dZ1t Site Plan 0� r PERCOLATION RATE -2 __ (r nuteatinch) PERC HOLE DIAMETER to // TEST RUN BETWEEN 7j, FT AND E* fj FT PERFORMED BY: &Ab(k • I CERTIFY THAT THIS TEST WA PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: w 7 q Permit Number:OSP201457 Tax Code Number:01717114000 Work Type:SepticTank Upgrade Effective Date: Design Engineer: Site Legal Address:MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 G:3139 Owner:PURVIS MARIE Site Mailing Address:15201 MESA PL, Anchorage Lot Size in Sq Ft:24317 Total Bedrooms:3 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 10/23/2020 10/23/2021 ANDERSON CONSTRUCTION & ENGINEERING Special Provisions: ** Locate the beginning of the field to confirm thatthe 5' separation between the tank and field will be met. Expiration Date: ¨þ ¨¨¨¨ Received By: Issued By: Date: Date: MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On-Site Wastewater Disposal System Permit 10/23/20 MUNICIPALITY OF ANCHORAGEAUSH Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section 6 Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-171-14 Property owner(s) MARIE PURVIS Mailing address 15201 MESA PL, Anch AK Site address same Day phone Legal description (Sub'd., Block & Lot) MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 Legal description (Township, Range & Section) Lot Size 24,317 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings El ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: .,Z70 CC000 Waiver Fees: Date of Payment: Receipt Number: Permit No. O S P2 C)I L4 57 Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Oct 20, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 To Whom it may concern: This is a request for a emergency septic tank permit on the above referenced lot the tank has failed and needs replacement fast. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201457, Deb Wockenfuss, 10/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201457, Deb Wockenfuss, 10/23/20 GRE; !R ANCHORAGE AREA BOR ]GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPg. S.,AL SYSTEM SEPTIC TANK: DISTANCE FROM WELL JIO~ INSIDE LENGTH MANUFACTURER._~ INSIDE WIDTH _~ NUMBER OF MATERIAL COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY /CK/'o GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /O~'" FOUNDATION iq ~ NUMBER OF LINES il DISTANCE BETWEEN LINES ABSORPTION AREA '~6 SQ. FT, DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH NEAREST LOT LINE "~'~.~<~ ___OF LINES / ~'[ ~ TRENCH WIDTH "~ '~'~" TOTAL EFFECTIVE LENGTH OF EACH LINE ~ _ DEPTH OF FILTER MATERIAL BENEATH TILE ~ ~. ABOV[II~ff ~ WELL:. : 0 TYPE ~ ~"'~"~ BUILDING FOUNDATION CESSPOOL APPROVED ...... CONSTRUCTION OK NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED SEPTIC TANK REMARKS DEPTH _DISTANCE FROM: SEEPAGE SYSTEM .... !O'1 DISTANCES: INSTALLED BY: SEWER LINE DEPTH: ~ f PIPE MATE RIAL:i~ ~ LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE ~l ~5 APPROVED G.A.A.B. Form LQ-032 GREATER ANCHORAGe AREA BOROUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PErMit NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME Of APPLICANT 'NBTALLAT,ON LOCATION COMPLETION DATE ANTICIPATED 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 ,~_~ i FOUNDATION TO BEEPAGe-P~T , DRAin FIELD ~ SEPTIC TANK TO SEEPAGE F~T-~/ALL SEPTIC TANK ~ ~ , SEEPAGE ~ . DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK SEEPAgE i=H-~, ALSO CONSIDER AREA WELLS. DRAIN FIELD / C/ . SEPTIC TANK, / ~3~) ) ~)t~ '//~) ) , SEEPAGE P~7 TO RIVER, LAKE, STREAM. · DRAIN FIELD ./' ~/~"~., CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAge PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE t,--ZO-7£ AFPL'CANT'S S'GNATURE , GREATER ANCHORAGE AREA BOROI iI Department of Environmental Qu_,ity 3330 "C" Street Anchorage, Alaska 99503 /,~'/;-')' ,//SOILS LOG - PEROLATION TEST Performed for (-~-C //d~2~.,:~.~~ Date Performed Legal Descrip~i~n~-'~' ~'<,~ p~f ~ ~~~[ This form reports: Soils log ? Percolation 'test Depth Feet 6- 7- 8- lO- 11 - 12- /~- Was ground water encountered? If yes, at wl)at depth? Reading Date Gross Time Net Time Depth to Water Net Drop I'~-~-r'-c o 1 a~3-o-n-'-r-a t~e ............ Sr~i-n-u ~-e-~ Proposed installa~-{~'n-:"~J'e~'p--a-ge Pit ................... Drain Field ',)L~pLh of Inlet Depth Lo boLtom o'f pit or Lrench COI,1HENTS: EQ 040 (($/74) MUNICIPALITY NCH 1V 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. 017-171-14-000 Expiration Date: 12/13/2024 Legal description MOUNTAIN AIR ESTATES #1 BLK 6 LT 10 Site address 15201 MESA PL Anchorage AK 99516 Current property owner(s) PURVIS MARIE A & GREGORY G X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: a Original Certificate Date: 1/17/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLiune 2022 COSA Checklist Legal Description: MOUNTAIN AIR ESTATES # 1 BLK 6 LT 10 Parcel I D: 017-171-14 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 `9/75 Total depth '150 ft Cased to 40'+ ft H Sanitary seal is functioning correctly FO -1 Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 1/8/24 Static water level at beginning of test 12 ft. Comments 'MOA FILE B. TANK DATA Measured operating fluid level in septic tank 51_' Date of pumping 1/9/24 ❑ Required maintenance completed, if AWVVrS Comments: NEW PLASTIC TANK 10/2/20 D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑0 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. fi❑ Monitor tubes go to bottom of effective. 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) If yes, enter date COSA Checklist—June 2022 Well production at time of test 4+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No H Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Date 12/13/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW Results Q Pass Fluid depth prior to test _ in Water added _ gal New fluid depth _ in Elapsed time _ min Final fluid depth _in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used 0 in Effective depth remaining 60 in 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' ❑E Yes Community Sewer Manhole/Cleanout > 100' 7i Yes if No _ ft ❑� Yes if No _ ft Neighboring Tank > 100' ❑m Yes if No _ It Private Sewer/Septic Line > 25' ❑� Yes if No _ ft Absorption Field on Lot > 100' E Yes if No _ ft Holding Tank > 100'❑Yes if No _ ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' ❑� Yes if No ft ❑i Yes if No ft Q Yes if No _ ft _ ❑� Yes _ Manure/Animal Excreta Storage > 100' If tank or field is under driveway comment below Community Sewer Main > 75' Q Yes if No _ ft Q 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' ❑E Yes if No _ ft Surface Water > 100' Yes if No _ ft Tank to Property Line > 5' 0 Yes if No _ ft Wells on Adjacent Lots: Field to Property Line > 10' Md Yes if No _ ft Private Wells > 100' Yes if No ft Water Main > 10' ❑e Yes if No _ ft Community Wells > 200' Q Yes if No _ ft Water Service Line > 10' ❑� Yes if No _ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 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 Engineer's Printed Name COSA Checklist June 2022 Phone 727-8864 Date %* •4 TH ••�tr�d .. ic�dGi *r. ...... . • MICHAEL N. ANDERSON ..� j�. CE 9 9 ��/�UHUPAU TY OF AHC ORAGE Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 3 f 1. GENERAL INFORMATION ' Parcel I. D. 017-171-14 Complete legal description MOUNTAIN AIR ESTATES # 1 BLK 6 LT 10 Location (site address) 15201 MESA PL, ANCH Current property owner(s) PURVIS 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: NU 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: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age 4 - 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: 0 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 $ y Waiver Fee $ Date of Payment COSA # Q S G Z `'% 10/ L/ Date of Payment Waiver # COSA Application—June 2022 v Q SkQ4----F4AA-E 49 TH*O�D AS BU/L T SURVEY PI =301 sr SHANE A. HOLT DO e LS -6914 0` O NO CORNERS SET THIS DATE fOfessiona� Lo I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY �Op0000Oa OF THE FOLLOWING DESCRIBED PROPERTY LOT IO BLOCK 6 MOUNTAIN - AIR ESTATES N0. 1 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD ,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT %EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA 11 TH THIS DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. JANUARY , 2024 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON HOL TLAND SURVEY/NG THESURVEYDATA ON THIS DRAW/NG /S PREPARED FOR THE OWNER OFRECORD ONL Y. 9309 GRO VER DR/VE ANYCOPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 15984 235-78, 102 223-8615 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmen/al Services ~)IRONMENTAL ~RVICES DiViSiON On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 ' RECEIVED OERTIFIOATE OF HEALTH AUTHORITY APPROVAL.FOR A SINGLE FAMILY DWELLING Parcel I.D. # O1'-/-I'7 I --I,) ~/ - ' ~,:~-HAA# 1.' GENERAL INFORMATION ~ ' Complete legal description Lot 10; Block 6; Mountain Air Estates Lo. cat on (site address or directions) ~y owr,::~.r Ir,:2 ~ Leks-: Mailing address. 152ali"Mesa Place 15201 Mesa Place Anchorage, AK Anchorage, IDay pho~i: ........ ~.~-:~10 AK 99516 Day phone. Agent Address John Blaine/ Coldwell Banker Day phone 561-8686 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well xxx Community well Public water RECEIVED MAY 1 ;5 19 ? Municipality of Anchorage Oept Health & Human Services NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Inr~ividual on-:rc;t~ XXX If community well system, provide written confirmation from State ADEC attest- ,Holding tank Commun ty on-site Public sewer ' ', NO~Ei If comm attesting to the legality and written confirmation from State ADEC' tus of system. 72-025 [Rev, 1/91) Front MOA e21 Legal Description: ko C i1~ A. WELL DATA Municipality of Anchorage MUNICIPALITY O~: ANCH(~ DEPARTMENT OF HEALTH & HUMAN SERVIC~I~IRONMENTALSERViCE$~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~4~ 3 ~997 Health Authority Approval Checklist ~ E C E I V E D Well type ~o f~ i v b T' [ If A, Bi or C, attach ADEC letter. ADEC water system number Log present (Y/~ ,%r O Date completed /3~,~ Total depth } 5'0 / {/o~o~ ~,~¢, ~ ~.,~,~S)Cased to z/0 Sanitary seal ~)N) Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG Casing height (above ground) Wires properly protected (~N) AT INSPECTION J 7 g.p.m. Coliform O Nitrate 0. I Date ofsample: ~//37]'~? ~ ,.P/3. / W7 Collected by: B. ~HOLDING TANK DATA Date installed ~/1~/'~' Tanksize }~o0 Foundation cleanout (~/N) ¥ ~ >c . Depression (Y~ tv 0 Date of Pump Dg~ ' ~/~ / ~/7 Pumper / ~' ,~ ,0 ~- J' C. ABSORP~IONFIELD DA~A' ?' Other bacteria $ & $ ENGINEERING 17054 Ea,;le R;ver Loop Road No. Eagle River, Alaska 99577. Number of Compartments u/~ Cleanouts (~N) Y~J High water alarm (Y~ ~, 0 Dateir{statled 'ct /~'/ ~.~ :;~ Soilrating (g.p.d./ff~o~ I~.? Systemtype Length ~ ~ ~ ~ ,,/ ' ~ Width"i' ' ~': Gravel thickness below pipe (; ' Total depth / o EffectiVe absorption area -~ ~0, ~r z. MonitOring Tube present ~0/N)'V $ Depression over field (Y/N). 4/ Date of adequacy test -g- )/o / q 7 Result~ail). ? ~ sj For '-~ bedrooms Fluid depth in absorption field before test (in.); ~" Immediately after¥7~, gal. water added (in.): -,z ~" Fluid depth., ;3 (ins) Minutes later: "~ 7 Absorption rate = *-/~0 -P g.p.d. Peroxide treatment (past 12 months) (Y/N) ~~'~' ~<," ~ ~' ,~' If yes, give date -- 72-026(Rev. 3/96)* o~ ~-'r4co6o b$Ou>~.r GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received January 20, 1976 Time of Inspection Date of Inspection ~.~F~,~ ~/~. \~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. l. Approval requested by: Alaska State Bank % Rosie Parks Mailing Address: 310 East Northern Lights Blvd. Phone: 279-7637 x 37 Property Owner: Mailing Address: Legal Description: Carl Manning Phone: 277-7561 (w) Anch Tele Utilities NHN Snow Flake Drive Lot 10 Block 6 Mountain Air Estates Location: Off Rabbit creek Road 5. Type of facility to be inspected 6, Well Data: Individual A. Type Single Family No. of bedrooms '~%%~ B. Depth 150' C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: Size D. Seepage Pit: E. Disposal Field: 8. Distances: A, Well to: Septic tank Nearest lot line B. Foundation to septic tank On-site system. 1. Absorption Area Total length of lines O. Bacterial Analysis B. Installer 2. Manufacturer 2. Material ~, Absorption area , Other contamination , Absorption area , Sewer Lines , C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re st for Approval of Individual ~er & Water Facilities Leqal Description T,ot 10 ]Block 6 Mounta±n A±r l~.states Comments Approved Disapproved Appro~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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) ---"~"UNIClPALITY OF ANCHORAGE 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNicfi,ALiTy OF ANcHORAC~E DEPA?MF:NT Of: HEALTH ENVIP, QNMF~N I'AL PItOTECTION RL"CI IVED 1. Type of Inspection: CMRO VA 2. Property Owner: Carl Manning FHA CONV xxx Mailing Address: NHN Snow Flake Dr L]OB6 Mt Air Estates DayPhone 277 75¢,l.worK If for either Fir.& Mrs. 3. Name of Buyer: C~rl H~nnln~n (Rol:.h employed by Anehg tele utilities) Home tf Mailing Address: ~m~ R~ ~hove ~)~l~Phone 34.9 i878 4. Name of Lending Institution: AI~I~R ~;tRf_RhRnl~ ATTN Rosie Parks Mailing Address: ~] Name of Realtor or Agent: Mailing Address: F' Nn~'t.h~vn I 10bLs Phone 279 7~37 ext 37 N/a Phone 6. Legal Description: Location: Lot 10 Blk 6 Mt. Air Estates off rabbitt creek rd. sgl fami].y residence 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: No. Bdrms. 1 Public Utility Individual xxx If Individual, number of dwellings presently served } If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation within last 6 mobths approx 15Oft Individual (on-site) /~'~' EQ-037 (1/74) ,,,, t0e LI?-f~2. , Lot t0 , B~ook ~ LOT SURVEY CERTIFICATION I hereby certify that I have surveyed the property shown and described nereo~,and that the improvements sit J~led thereon are within the prop arty lines and do not overtop or encroach on adlace.ql' property und improvements on adjacent property o?srlap or encroach on the premises in question and thotthere are no roadways, uti;it., lines o¢ other wsible easements on said propur1¥ except as ir}dicated hereon Soole /": Ret. FB. No. LEGEND (~: Br(~SS copped monument re(:~vered o Iron p~pe end/or rob<ir recovered c] ~ ? x?' hub ~ t~cl~ rec~vered ~ - [~/R"x ~",ebor .set m~s ~urvey Prepared by: (.907127~- Property of: Parcel I.D. # GENERAL INFORMATION Complete legal description MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN $ERVICES 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 MUNICIPALITY OF ANCHORAGI~ IRONMENTAL SERVICES DIVISION MAY '13 199]' RECEIVED Location (site address or directions) I:'~. ~y.owh?.r ~lailing address .'.!520i' '~esa Place ~hding agency ', Mailing address"' Agent John Bla±ne/ Coldwell Banker 15201 Mesa Place Anchorage, AK Anchorage, gay phor,:. AK 99516 Day phone Day phone 345-5910 56128686 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: RECEIVED TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: xx, x Municipality of Anchorage Oept. Health & Human Services If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. xxx TYPE OF WASTEWATER DISPOSAL: Individual op Holding tank Community on:site Public sewer ~ · NOTE: attesting to the legality }~ovide written confirmation ~rom State ADEC ' s~/stem. 72-025 (Rev, 1/91) Front MOA#21 Se STATEMENT OF INSPECTION BY ENGINEER. A~ Certifiedby my seal affixed hereto and as of the validation date shown below, I verify that my investigat~ on 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 0f. structure indicated herein. I further verify that based on the information obtained from the 'Mun'icipality 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 reg~J~,t~Lg~Cl~n the date of this inspection. 17034 Eagle R;ver Loop Road No. Name of Firm Eagle ~.iver~ Alaska Address Engineer's signature . . ~ ~ Date ~'//I ~ /~ 7 DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the follow!ng stipulations: Additional Comments Date The Municipality o~ A.~chorage Department of Health and Human Se~ices'(DHHS) i~ues Health Authori~ App[oval ce~ifi~tes:bas~ only upon the representations given in paragraph 5 above by an independent pro~iqna engt~r r~gister~ in the State of Alaska. The DHHS does this as a cou~esyto pumha~m of hom~ and their lending institutions in order to ~tis~ ce~ain f~eml and state r~uirements, Emp oyes of DHHS do not conduct insPections o~ anal~e data bef°m a ce~ific~te":i'~' i'~Oed. The UuniCipali~ 0f Anchorage is not responsible for errom or omi~ions in the profe~ional engi'~s"Wo~. 72-025(Rev. 1/91) Back MOA~Z1 Legal Description'. L o ~F ii o A. WELL DATA Well type ~ RjV4T& Log present (Y/~ /~/O Total depth} ~'0 t ( p~0~ ~.~. F,~)Cased to Sanitary seal ~(~N) Y ~ J' Municipality of Anchorage MUNICIPALITY OF DEPARTMENT OF HEALTH & HUMAN SERVICr~IRON/vtENTALSE~VICE$II~) Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~4~ ~ ~997 Health Authority Approval Checklist R E C E I V E ~57~T ~ 5 ~ I If A, B, or C, attach ADEC letter. ADEC water sYstem number Date completed /34,,~ ,~ ~r o ~1 / -/~ /~ O '-/~ Casing height (above ground) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 63 , Nitrate Date of sample: I'S-EFfi'C3HO D NG TANK DATA B. g.p.m. Date installed Foundation cleanout {~/N) Date of Pumpipg~: ~'/~./,.~ ~ C. ABSORPtION'FIELD DATA' 0.1 Wires properly protected (~N) Y~- ~ ColleCted by: AT INSPECTION 7 g.p.m. Tank size ) ¢ o 0 Depression (Y~) Pumper I ~'44 c $ Other bacteria I S & S ENGINEERING 17084 Ea.;Je R;ver Loop Read No. 21~ Eagle River~ Alaska 9957Z Number of Compartments ut~ Cleanouts ~'N) ~ 0 High water alarm (Y~ /v o Date ir~statled . cl / u / 7 ~ ' : Soil rating (g.p.d./ft~ o~ Length,- ],,~l ~ · Width 3: Gravel thickness below pipe Effective absorpti°n area 3 ~6 ~ ~r z. MonitOring Tube present ~/N)~ Date of adequacy test ('- }/o / W 7 Result~ail) ? System type T~*,' cH Total depth t o '/~. ~'Depression over field (Y/N) 4/' For "~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth L~" (ins) Minutes later:· ~ 7 Absorption rate = Peroxide treatment (past 12 months) (Y/N) ~vo ~¢' ~, ~ ~, ~ If yes, give date 72-026(Rev. 3/96)* o~ ~m~4co~O bsOu¢~r s~v~y, Immediately affer¥7~ gal. water added (in.):. W ~0 + .g.p.d. D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons ./ "Pump on" level at* ~ ~evel at* ~atum RECEIVED SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~/holding tank on lot ! o o Absorption field on lot I ~ 0 ~ Y- Public sewer main ~ ! 4 Sewer/septic service line MAY 1 ~ 1997 Municipality of Anchorage Dept. Health & Human Services On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation '1 E' /+ / ' Property line 30 -J-. Absorption field ,.C' Water main/service line ~- ~' '+ Surface water/drainage ! ~ o ~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~) '-)" Building foundation Surface water ) OO Curtain drain 'F. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots I 0 (1 ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* I certify that I have determined thru field inspections and review of Municipal records th~ systems~are in conformance w~th MOA H_~A gu~eiines in effect o. this ~a~e. Signature ~~ ~. Z~ Engineer's Name__ ~ ~ ~ C. Co ~ ~ ~ ~,.,.~~,~ HAA Fee $ ~' ~ Waiver Fee $ / / ~7/~/~ Date of Payment ~~ ~/ .) Receipt Number v Q SkQ4----FLAA-E 49 TH*O�D AS BU/L T SURVEY PI = 301 sr SHANE A. HOLT DO e LS-6914 0` O NO CORNERS SET THIS DATE fOfessiona� Lo I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY �Op0000Oa OF THE FOLLOWING DESCRIBED PROPERTY LOT IO BLOCK 6 MOUNTAIN - AIR ESTATES N0. 1 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD ,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT %EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA THIS 77 DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. DECEMBER , 2023 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON HOL TLAND SURVEYING THESURVEYDATA ON THIS DRAWING /S PREPARED FOR THE OWNER OFRECORD ONL Y. 9309 GROVER DRIVE ANYCOPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 15984 235-78 223-8615