HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 8 LT 3Mountain Park Estates Block 8 Lot 3 #017-391-39 (Rev 05/02/18) Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241102 PID Number: 017-391-39 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Fol Upgrade Name Thomas Myatt ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5846 Bristol Drive ❑ Other Phone Number of Bedroomsating Total depth from original grade 3 GPD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe in from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Mountain Park Estates 8 Lot 3 Fill added above original grade Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Line Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches risetwe enches From Tank Field Tank Line Ftz Well >100' >100' N/A N/A >25' TANK ❑ Septic F!] S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer* Capacity 1250 Gal. Surface Water >100, >100 N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation> 1 Q' > 10' N/A N/A LIFT STATION Manufacturer Anchorage g Capacity 1250 Gal. Remarks *Deep burial tank. Alarm location Electrical installed by In Laundry Room I Rising Son Electric PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer Hiland Excavation Drainfield D3034 CO/MT D3034 Inspector J. Opheim BENCH MARK (Assumed elevation) 100 ft Inspection 15t 7/18/2024Location dates: 2°° and description Bottom of Siding @ Point A aro 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp FA Date 145r, Conditional Approval: THi . '. Benjarrrchiller Septic Syste Approved Date S 25` CE 12592w� �e, 3/3125,,�� –�=—'— PROFESSiO Note: this approval es not include well permit requirements. (Rev 05/02/18) Benjamin Schiller CE 12592 R E G ISTEREDPROFE S S I O N A L E N GINEER 1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP241102 PID # 017-391-39 MOUNTAIN PARK ESTATES, BLOCK 8 LOT 3 A B MH1 19.5 MH2 21.9 A B 14.6 18.5 FEET 0 30 60 BRI S T O L D R I V E 3-BDRM HOME PLAN AS-BUILT 1/17/25 SHED 10' UTILITY EASEMENT MT MT MT MT FCO 1250 GAL STEP TANK EXISTING 72' LONG TRENCHES MH2 MH1 12.0 PROFILE AS-BUILT (NO SCALE) PERMIT # OSP241102 PID # 017-391-39 MOUNTAIN PARK ESTATES, BLOCK 8 LOT 3 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A L E N GINEER 8/12/24 94.3 89.2 94.8 98.8 FC O MH 1 MH 2 1250 GAL S.T.E.P. TANK �jSTo� \ F r 9Z \I n n AFP 0 5� N 261 d' d' • PH O•MH. 'V CIO D SNE oti of 0000000 0 N o 49 TH* C Q SHANE A. HOLT i • �O LS -6914 ` G 4�a a p � �oO°iessiona� �Qo O \ I y S 88 4 F9s��'FN\ --- � AS -BUIL T SURVEY � 8 4 „ NO CORNERS SET THIS DATE SCALE: 1" = 30' 1 HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. 3, BLOCK 8, MOUNTAIN PARK ESTATES SUB. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE STRUCTURES OR FENCELINES. PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. DATED AT ANCHORAGE, ALASKA THIS _14 TH_ DAY OF AUGUST 2024 . NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES FB 76-31,136-63,7095,236-48 238-39 HOLT LAND SURVEY OR LOCATE STRUCTURES. 375C7GCl.NET 907.223.8615 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: OSP241102 Work Type: SepticTank Upgrade Tax Code Number: 01739139000 Site Legal Address: MOUNTAIN PARK ESTATES BLK 8 LT 3 G:2838 Site Mailing Address: 5846 BRISTOL DR, Anchorage Owner: MYATT THOMAS & KIMBERLY Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Deharhnent 5/31 /2024 5/31 /2025 20400 ❑ Disposal Field Q 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 Received By: S O Issued By: Date: Date: S a l 2 Y t_1 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-391-39 Property owner(s) Thomas Myatt Day phone Mailing address 5846 Bristol Drive, Anchorage AK 99516 Site address 5846 Bristol Drive, Anchorage AK 99516 Legal description (Sub'd., Block & Lot) Mountain Park Estates, Block 8 Lot 3 Legal description (Township, Range & Section) Lot Size 20,400 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) 0 (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex ElHolding (D) Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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 Z� 5 Date of Payment: 22 2p 2 Receipt Number: Permit No. '05 P 2 y 1 1 c)2. Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_:;- : . _.,:c May 21, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Mountain Park Estates, Block 8 Lot 3 – 5846 Bristol Dr Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the STEP tank with the same size designed for 3 bedrooms. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241102, Curtis Townsend, 05/31/24 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MOUNTAIN PARK ESTATES, BLOCK 8 LOT 3 FEET 0 30 60 BRIS T O L D R I V E 3-BDRM HOME SEPTIC PLAN 5/20/24 SHED 10' UTILITY EASEMENT MT MT MT MT FCO DECOMMISSION EXISTING 1250 GAL STEP TANK WITH DUAL OUTLETS PER UPC NEW 1250 GAL STEP TANK, CONNECT TO EXISTING PIPING TO BOTH TRENCHES EXISTING 72' OF TRENCHES TO REMAIN IN SERVICE MH Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241102, Curtis Townsend, 05/31/24 a �jSTo� \ F o \ I y \ S 6,8 o FgSF�FN� \ 48 4 \ o'F \ ti SN do � • LIFTSTATION "2 O o N 49 TH �7 ................................. . . S^ .fir li�a� SHANE A. HOLT i �O LS-6914 G 0, �pfOiessiona� �Qo ��D0000�o AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALE: 1" = 30' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. 3, BLOCK 8, MOUNTAIN PARK ESTATES SUB. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE STRUCTURES OR FENCELINES. PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. DATED AT ANCHORAGE, ALASKA THIS _1 ST_ DAY OF MAY 2024 NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES FB 76-31,136-63,7095,236-48 HOLT LAND SURVEY OR LOCATE STRUCTURES. 375C7GCl.NET 907.223.8615 Page 1 of 1 Poet, Jeff W. From: David Garness [David@garnessengineering.comj Sent: Monday, September 21, 2015 10:00 AM To: Poet, Jeff W. Subject: Mountain Park Estates; Block 8, Lot 3 Jeff, We were contacted by a buyer about a COSA at Mountain Park Estates; Block 8, Lot 3. It was noted that during our well flow test that we drew the well down to 161', however, the well log states that the total depth of the well is 152'. According to the drilling log, bedrock was encountered at 148 feet. It is our belief that at some point the well was deepened. David J. Garness, EIT Consultant Garness Engineering Group, Ltd. 3701 E Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: 907-337-6179 Cell: 907-632-4528 Fax: 907-338-3246 Website: www.garnessengineering.com 9/22/2015 Municipality of Anchorage Page 1 of 3 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: SW990048 PID Number: 017-391-39 Name: PAT AND BROOKE CORKERY Wastewater System: El New ■ Upgrade Y Address: ABSORPTION FIELD 5846 BRISTOL Phone: No. of Bedrooms: 3 ■Deep Trench El Shallow Trench 11 Bed ❑Mound 13 Other LEGAL DESCRIPTION Soll Rating: 0.6 Total Depth from original grade: 10.03 MAX Ft. GPD/Sq. FL Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 8 MTN. PARK EST. APPROX. 2.7 FL 7.07 Ft. Township: — Range: — Section: — Fill added above original grade: Gravel length: 72" TOTAL APPROX. 1' F L Ft. Gravel width: Number of lines: Distance between linea: WELL: ❑ New ❑ Upgrade 2 FL 2 19' Ft. Classification (Private, AB,C): Total De Caned To: Total absorption area: Pipe material: Ft FL 1008-1. so, Ft, ASTM D-3034/SCH 40 (1.25') Driller. �IP, Date Drilled: Static water Level: InetaA+ HOME SERVICES e Installed: Dat 5/5/99 — 5/13/99 Ft. Yeld: Pump Set At: Casing Haight Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 0 Septic 0 Holding ■ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer. ANCHORAGE TANK Capacity In gallons: 1250 From Tank Field Station Tank Sewer Lines Well 100'+ 100'+ 100'+ — 25'+ Material: STEEL Number of compartments: 2 Surface 100'+ 100'+ 100'+ - - LIFT STATION Water LotSize 5'+ 10'+ 5'+ — — In gallons: 1250 Manufacturer. ANCHORAGE TANK Line 'Pump on' level OL Pump offlevel at: High water alarm at: Foundation 5'+ 10'+ 5'+ — — 41" 41 ,, 45" CUrta In NONE KNOWN — Pump Make h Model: 20051 05 HHF Electrical Inepactlone performed by: M.O.A. Drain BENCH MARK Remarks: Location and Description: TOP OF LOWER WINDOW SILL LOCATED NEAR EXISTING FOUNDATION CLEANOUT. Assumed Elevation: 100 Ft. ENGINEER'S SEAL 0oo604pO " F 4 p :9 Inspections performed by: AWWC, INC. Dates: 1st 5/4/99 ........ ... ... .........:....OD 2nd 5/5/99 _ D 3rd 5/13/99 OQO�'. e r A...G.. ...s::.. Department of Health and Human Services approval -7 Op�4�0�., -7953 cA`QOQ Reviewed and approved by: �' � wl Date: R� 4peafrofessiona' 40O���p00 72-013 Rev. 9/91) MOA 25 PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW990048 017-391-39 I oR�VE I a AV DfCk Z! B / =00 OJT / m Z \ NEW 1250 GALLON S.T.E.P. TANK W/ T1 A.W.W.C., INC. POINT "C" DUAL OUTLETSST2 i =TREE WITH PINK - ° MHC SURVEYOR'S FLAGGING. MT1���� MT2 T3 GENERAL LOCATION OF TEST HOLE MT. GROUNDWATER MONITORING TUBE \\ (INSTALLED 6/9/99) \\\ --� ( NEW TRENCHES MT4 NOTE: OLD TRENCH WAS \/ "A" TO "C"= 35.0' "B" TO "C"= 58.0' ALASKA WATER AND WASTEWATER CONSULTANTS, INC. o�OF Ho/op, 6901 DEBARR ROAD, SUITE 28. ANCHORAGE, AK. 99504 y} PHONE: (907) 337-6179/FAX: (907) 338-3246 0� • • '/ MOUNTAIN PARK EST; LOT 3, BLOCK 8 TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: PAT AND BROOKE CORKERY 564-6754 (AGENT) DATE: DRAWN BY: SCALE: PAGE: 7/13/99 K.D.W. 1 = 30' 2 OF 3 •, of ey CarnW.- CE ;CE 7953 m4 �paa,or o f e s s10�o�� p00o��0�0 PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW990048 017-391-39 PIN& GRADE - 96.50 511 5f2 w fOP 9 fANK _fOP a TANK Af INLEf - 92,k9 \ Af OLtfLEf - 92,45 INVERT OP DING Af IWf - 91,99 ORI6IN& GRADE - 102,76 (HI(di 5POf) NSW 1250 GAU.ON 5f, P. fANK GRADE - 103,2+_ GROLN7 WAV MONIfaIN6 fLff N%91,E176/9/99 GRACIE - 101.19+_ ORI61% GRADE - 97,16 (HIGH 5FOO Mf PIN& GRADE - 983+_ INVERT OF PIPE I'l#j3IILi;�3##;; -99,80 INVERT OP PIPE -94.45 lz DOffOM 9 f(eNLH - 92.73 2,68' DOffOM OF f9NCH - 89.37 DOffOM OP Mf - 84,69 ALASKA WATER AND WASTEWATER CONSULTANTS INC, oo�oo 6901 DEBARR ROAD, SUITE 28. ANCHORAGE, AK. 99504 0 PHONE: (907) 337-6179/FAX: (907) 338-3246 s OO ��• O' •' ••.9Si4p ;AL DESCRIPTION: pl MOUNTAIN PARK ESTATES; LOT 3, BLOCK 8 �ll7J .H .... O AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: Odo f A. ess, PAT AND BROOKE CORKERY 564-6754 (AGENT) V E-7953 v� pp s c°O DATE: DRAWN BY: SCALE: PAGE: 3 OF 44a�Pr 7/13/99 K.D.W. N.T.S. 3 0fesslo6a� 4000�0 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 July 12, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Attn: Donna Mears Subject: Mountain Park Estates, Lot 3, Bk 8, As -built Documentation Dear Ms. Mears: Attached is the as -built package for the subject septic system installation. The trenches were installed on 5/4/99 and 5/5/99. The STEP tank was installed on 5/13/99. Prior to the installation of the trenches the test hole monitoring tube was dry to 16 feet below grade. No water was encountered during the excavation of the south (upper) trench or the STEP tank. A moderate weep was encountered several feet below grade at the west end of the north (lower) trench, but otherwise the trench excavation was dry. On 5/17/99 I stopped by the site to inspect the final work and noted that surface water was present all over the lot to the east (Lot 4, Bk 8), water was running back into the STEP tank from the old drainfield, and there was approximately 40 inches of water in the new lower trench. It appeared that trapped surface water was migrating laterally from the adjacent property, into the old trench, and backing -up into the STEP tank. Since that time the following observations and/or actions have been made/taken: • By 5/27/99 the neighboring lot had dried up and there was no standing water on it. • The old septic system was disconnected fi•om the STEP tank and abandoned in place. • The liquid level in the lower trench gradually declined from 40 inches to 23 inches between 5/17/99 and 6/28/99. A monitoring tube was installed between the new trenches on 6/9/99 and was dry to the bottom of the hole, however several light weeps were encountered. Jeff Poet, DHHS field engineer was onsite to inspect the test hole. The bottom of the monitoring tube was 16.5 feet below grade. After several days the MT had about 6 inches of water in it (probably due to weeps) and was dry a week later. The bottom of the MT is 2.78 feet lower in elevation then the bottom of the lower trench. When the MT was dry, the bottom trench still had approximately 27 inches of water in it (5.03 (+/-) feet above the elevation of the groundwater monitoring tube). This is confirmation that the water in the lower trench is not from rising groundwater but, rather, weeps that are introducing more water into the lower trench than it is capable of dissipating without building a standing head of liquid. ABSORPTION CAPACITY SEPTIC SYSTEM PRESOAK (2600+ GALLONS): An adequacy test was performed on both of the trenches to confirm whether they are capable of handling the 450 gallon per day absorption requirement for a 3 bedroom house. On 6/28/99 and 6/29/99 the lower trench was presoaked with over 1300 gallons and the upper trench was presoaked with over 1300 gallons of water. The presoak caused the liquid depth in the lower trench to rise from 23.5 inches to 61.5 inches. The liquid depth in the upper trench went from dry to 37 inches. ADEQUACY TEST ON UPPER TRENCH: On 6/30/99 (3:07 PM) the liquid depth in the upper trench was 18.5 inches. Over a period of 4 hours, 510 gallons were introduced, causing the liquid level to rise 18.5 inches, to a total depth of 37 inches (27.6 gallons per inch). Twenty hours later the liquid level was 20.5 inches, indicating that approximately 455 gallons had been absorbed (225 required for each trench). The trench was only filled to 44% of capacity in order to achieve this absorption rate. ADEQUACY TEST ON LOWER TRENCH: On 6/30/99 (10:35 AM) the liquid depth in the lower trench was 54 inches (64% full). Over a period of 4.36 hours, 622 gallons were introduced, causing the liquid level to rise 18.5 inches, to a total depth of 72.5 inches (86% full), which corresponds to 33.6 gallons per inch. Four (4) hours later the liquid level had dropped 4.5 inches indicating that approximately 151 gallons had been absorbed, which corresponds to an absorption rate of over 37 gallons per hour (when filled to that level). After 24 hours of recovery the level had dropped a total of 10 inches, indicating that roughly 336 gallons had been absorbed (225 gallons required for each trench). Based upon the above test data it was determined that the absorption capacity of the septic system is greater 790 gallons per day, which exceeds the MOA requirements for a 3 bedroom house (450 gallons per day). Several days after the adequacy test it was noted that the upper trench was dry and that the groundwater monitoring tube had approximately 4 feet of water in it. This was obviously the result of water migrating from the upper trench into the disturbed soil surrounding the recently installed groundwater monitoring tube, Undoubtedly, the lower trench will be impacted by effluent migrating downward, and laterally, from the lower trench. On 7/8/99 the liquid level in the lower trench was 42.5 inches deep (20 inch drop in 7 days). CLOSING It appears that the lower trench was/is being adversely impacted by infiltration due to either subsurface seeps, or surface infiltration from sprung run off through the disturbed (excavated) soils. It is likely that the impact of this infiltration will be reduced after the construction area is re -vegetated, but subsurface seeps may still be a problem, diminishing the performance of the lower trench only. We have confirmed that the septic system is greater than 100 feet from surface water, is at least 4 feet above groundwater (groundwater is at least 16 feet below grade), and exceeds the absorption requirements for a 3 bedroom house; therefore, it is our recommendation that the installation be approved by your department. The only other viable option would be to install an innovative system (BioCycle or Reactex) and discharge the effluent only to the upper drainfield. Such a conversion would probably cost over $10,000 and seems difficult to justify based upon the aforementioned facts. If you have any questions, or if we can be of further assistance, please contact us at 337-6179. Thank you for your afsistance and consideration in this matter. Je4k�V J�/barne�s, YE., M.S. Pat & Brooke Corkery ARCTIC LIGHTS EL CTRW INC,, rmousTsrat P.O. Box'110135 Attcbragt,;AR. i'4 i7i„RiI35 Phone: (407) 345-7896 i ax nine; (9G7i 4i -'/ht,:; FAX COVER S H E E N ®ATF: May 28th, 1999 TO; Mike & Bev Blakeslee COMPANY, A -Plus Horne St.r�i g:S PHONF: 345-189) PAX: 345-139. s FROM: Brian D. Miller PHONE; 345 - 7€% President PAX_ 345 - 7€74 RF: Final Electrical Inspection Report for 5846 Bristol Drive, Number of pages including cover sheet: 2. Please call back immediately ,f yc)Ij clir'i r!_: receive all sheets as indicated , or if the transmission quality was poor artcl rtna�le t ; Message %iey guys! Following is the inpsection report for your rec:onis. T will also send a copy to Jerr Garness of Alaska Water & l`da5r cls ager „irk:_:, review/ records. Thanks much!! See you oil the next one. 3%0 LEAST '!"UDk Mc, N'A'OE, SO SLOCK ....P TFRAC z -riesti ..... . .... .... CC)MMENT8, WHEN CC ARF r MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade LL�L�j 5 S i 1 Date Issued: Apr 02, 1999 Expiration Date: Apr 01, 2000 Permit Number: SW990048 Parcel ID: 017-391-39 Legal Description: MOUNTAIN PARK ESTATES BLK 8 LT 3 Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 005846 BRISTOL DR Owner Name: Pat & Brooke Corkery Lot Size: 20400 SQ. FT. Owner Address: 5846 BRISTOL DR Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE , AK 99516-3104 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 (907) 343-4744 ( 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 By: Issued By: Date: Date: � —2-77 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 213 — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers March 18, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED MAR 2 5 1999 Municipality of Anchorage Dept. Health & Human Services Ref: Septic Upgrade Design for Lot 3, Block 8, Mountain Park Estates Subdivision To whom it may concern: The existing 3 bedroom house is served by a private septic system and private well. The existing septic system consists of a 1000 gallon septic tank and a 60' long trench. The septic system will not pass an adequacy test and must be upgraded prior to the sale of the house. We are requesting a permit to install two pressurized conventional draintields and a 1250 gallon S.T.E.P. tank. Comments regarding the design are summarized as follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation tests results. The soil below the organics is ML material with some SM/SW lenses to a depth of 16 feet (bottom of test hole). No groundwater was encountered during the excavation. Two percolation tests were performed, one at a depth of 4.0 to 5.0 feet and the other at a depth of 7.0 to 8.0 feet. The upper bench perked at a rate of 10 minuteshnch and the lower bench perked at a rate of 30 minutes/inch. The soils visually looked poor, so a 0.45 application rate will be used. 2. TRENCH DESIGN: a. Percolation Rate: 10 & 30 minutes/inch b. Allowable Application Rate: 0.45 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 1000 ft2 f Total Depth: 10 feet maximum (at any point) g. Effective Depth: 7 feet h. Width: 2 feet i. Minimum Length: 72 feet total len,h (2 @ 36 feet long each) j. Effective absorption area= 1008ft (>1000 ft2 OK) k. Reduction Factor = N/A The distribution line shall be 1.25 inch schedule 40 PVC. The two pressurized lateral shall be 34 feet long each with 1/4 inch holes spaced 24 inches on center with the holes facing down. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the proposed septic upgrade area is at the base of a bowled slope that is 25+ percent. The area where the trenches will be installed is generally flat and the trenches will be installed parallel to uphill slope contours. CLOSING: I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, Jeffrl v h. Udrness. P14-M.S. Note: Attached is a site plan, design, detail & profile design, topography site plan, soil log (2 pages), and a 4 page specification letter which are all part of this design package. o, cs'EPnc ARS i0� o� ' }yam / y '•. - cid U`v NZr(]Q \ Oy to s 4 /cnVint 4 v EXISTING 3 BEDROOM (j 'gip HOUSE w.J�' ac; \N.a F �. �� - o / / EXISTING SEPTIC d ,�/1 S,�`y\�b"`♦ / SYSTEM - I IC UPGD `-y - 'R0P0SE7 SEPRA t1SEE DESIGN. PAGE 2 OF 3F}y 4 V 0 [SEPTIC ARS Cil ,� �" � -- �, •` \ i'� � ,,,• /4 nN¢ �-- o N�. w U AL V ALASKA WATER AND WASTEWATER CONSULTANTS, INC.o��� kk 0 6901 DEBARR ROAD SUITE 28, ANCHORAGE, AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 QAC •S 40 •• •• LEGAL DESCRIPTION: S, ' 0 * o00 MOUNTAIN PARK ESTATES 5/D; LOT 3, BLOCK rYPE OF WORK: SITE PLAN FOR SEPTIC UPGRADE Q PHONE NUMBER: e r y A. Garness; 0 PREPARED FOR: PAT AND BROOKE CORKERY 564--6754 7953 u pD Q ,gyp 4Vrp5 U 4�Bd Pio f essio��Q� DATE: DRAWN BY; SCALE: PAGE: 1 OF 3 3/18/99 J.L.M. 1 = 100 t�;o 1 :XISTING DRAINFIELD TO BE USED AS A RESERVE SITE. � I DeC/r 04 to r0 � � a CO PROPOSED 1250 GALLON .1T S.T.E.P. SYSTEM� (WITH DUAL OUTLETS) 19 Co —EXISTING SEPTIC TANK TO BE ABANDONED COMPLETELY. Ml THii M - - APPROXIMATE LOCATION OF POSSIBLE CLASS "C" WELL 150 FEET RADIUS. TO OE FLAGGED PRIOR TO ANY CONSTRUCTION. _v ' PROPOSED PRESSURIZED DRAINFIELD.`- /o i EXCAVATE 10 FEET DEEP MAXIMUM (AT ANY POINT) BY 2 FEET WIDE NOTES: 1. THE CONTRACTOR SHALL HAVE THE 100' WELL RADII / SSE/AFS - BY 72 FEET TOTAL LENGTH (2 AT AND THE EAST PROPER'IY UNE FLAGGED BY A REGISTERED - _ 36 FEET LONG EACH). ADD 7 FEET LAND SURVEYOR PRIOR TO CONSTRUCTION. _- - OF CLEAN, WASHED DRAINRCCK. SEE 2. THE CONTRACTOR SHALL FIELD VERIFY THAT ALL SEPAR- DETAIL (PAGE 3 OF 3) FOR PROPOSED ATION DISTANCES WILL BE MEI' PRIOR 10 CONSTRUCTION. PRESSURIZED DISTRIBUTION LINE DATA. 3. THE CONTRACTOR IS RESPONSIBLE FOR HAVING UTILITY LOCATES PERFORMED PRIOR TO CONSLRUCTION. ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEDARR ROAD SUITE 28. ANCHORAGE, AK 99504 0 PHONE: (907) 337-6179/FAX: (907) 33B-3246 11. DESCRIPTION: QU' • /• "( MOUNTAIN PARK ESTATES S/D; LOT 3, BLOCK 8, fr -.761 .. .. .. ......... ..... . OF WORK DESIGN FOR SEPTIC UPGRADE .. .. . ............... e fr ar ss:' PARED FOR: PHONE NUMBER: O- PAT AND BROOKE CORKERY 564-6754 4 ' . C 795 \� DRAWN BY: SCALE: PAGE: �4e�e�,p.•.....••.p�F.�d� 3/18/99 J.L.M. 1 = 30' 2 OF 3 �0°4pp�oo��• POSSIBLE 2ND WELL LOCATION t�;o 1 :XISTING DRAINFIELD TO BE USED AS A RESERVE SITE. � I DeC/r 04 to r0 � � a CO PROPOSED 1250 GALLON .1T S.T.E.P. SYSTEM� (WITH DUAL OUTLETS) 19 Co —EXISTING SEPTIC TANK TO BE ABANDONED COMPLETELY. Ml THii M - - APPROXIMATE LOCATION OF POSSIBLE CLASS "C" WELL 150 FEET RADIUS. TO OE FLAGGED PRIOR TO ANY CONSTRUCTION. _v ' PROPOSED PRESSURIZED DRAINFIELD.`- /o i EXCAVATE 10 FEET DEEP MAXIMUM (AT ANY POINT) BY 2 FEET WIDE NOTES: 1. THE CONTRACTOR SHALL HAVE THE 100' WELL RADII / SSE/AFS - BY 72 FEET TOTAL LENGTH (2 AT AND THE EAST PROPER'IY UNE FLAGGED BY A REGISTERED - _ 36 FEET LONG EACH). ADD 7 FEET LAND SURVEYOR PRIOR TO CONSTRUCTION. _- - OF CLEAN, WASHED DRAINRCCK. SEE 2. THE CONTRACTOR SHALL FIELD VERIFY THAT ALL SEPAR- DETAIL (PAGE 3 OF 3) FOR PROPOSED ATION DISTANCES WILL BE MEI' PRIOR 10 CONSTRUCTION. PRESSURIZED DISTRIBUTION LINE DATA. 3. THE CONTRACTOR IS RESPONSIBLE FOR HAVING UTILITY LOCATES PERFORMED PRIOR TO CONSLRUCTION. ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEDARR ROAD SUITE 28. ANCHORAGE, AK 99504 0 PHONE: (907) 337-6179/FAX: (907) 33B-3246 11. DESCRIPTION: QU' • /• "( MOUNTAIN PARK ESTATES S/D; LOT 3, BLOCK 8, fr -.761 .. .. .. ......... ..... . OF WORK DESIGN FOR SEPTIC UPGRADE .. .. . ............... e fr ar ss:' PARED FOR: PHONE NUMBER: O- PAT AND BROOKE CORKERY 564-6754 4 ' . C 795 \� DRAWN BY: SCALE: PAGE: �4e�e�,p.•.....••.p�F.�d� 3/18/99 J.L.M. 1 = 30' 2 OF 3 �0°4pp�oo��• -- — — — — — — — — — — — — --- yf —F 0 Mr—m ----------------_J ----------- 1.25i INCH PIA, 5CH.,110 PVC FW55121 ZW LIW 1-1=5 PER LAtM (578 HOLES f0%) 1/ 41' PLA. HW5 (24 10AC-5 O.C.) A- — — — — — — — — — — — — — — — — — — — — vo, Tr RIOIM& DETAIL DRAWING 6 il)'3E oj?ffr V rpmc 006IN& 46 fLff 0ffr ItIZ rANIG KJ I nEP 10 ftf MAXIMUM 'M� j I 71 Vl`�CTIW MAXIMUM �"cllvE LFtu PROFILE DRAWING ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD SUITE 2B, ANCHORAGE. AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 I i MOUNTAIN PARK ESTATES S/D; LOT 3, BLOCK 13, TYPE OF WORK: DETAIL AND PROFILE OF PRESSURIZED SEPTIC SYSTEM UPGRADE r"LI-AICLU VUIC PHONE NUMBER: PAT AND BROOKE CORKERY 564-6754 3/18/99 1 J.L.M. I N.T.S. 1 3 OF 3 ' CSEPnC AR u J CL m 6 ui d �Jq� 11 E f ILVW i A RAN W TEWJ�XOMGE, . CONSULT. 6901 DE ROAD SUITE 29, AK 99504 PHONE: (91 3�7-07) 338-3246 'A K EST 'E 5/D; OT 3, BL GK 8. - R PTIC UPGRADE PHONE M9ER: OOKE�RY4-6- DRAWN BY: SCALE: PAGI J.L.M. = 100' lb -4* odd` I r, ALASKA, WATER & WASTEWATER CONSUL'T'ANTS, 7320 E. CHESTER HTS. CIRCLE + ANCHORAGE, AK. 99504 PHONE (907) 337-6179 r FAX (907) 338-3246 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES S/D; LOT 3, BLOCK 8, PERFORMED FOR: PAT AND BROOKE CORKERY DATE PERFORMED: 3/2/99 DEPT" feet "; - TEST HOLE 1 ( ORGANICS 1 PAGE I OF 2 2 3 4 5 6 7 11 12 13 14 15 16 17 18 19 ML WITH 3M/SW LENSES DENSE SILT WITH VERY LITTLE GRAVEL E� SOIL CLASSIFICATIONS DEPTH TO GW GP GROUNDWATER ORG ML DRY 3/2/99 GM -7-7; CL 3:45 GC SWI \ OL MH CH 2 - -- 3 4 5 6 4;15 SP // - - - Sm V I OH I Sc it 53Y°o%^ DEPTH TO DATE GROUNDWATER 1° = 100' _ a��rS]' / DRY 3/2/99 DRY 3/11/99 INC. - SITE PLAN \\ \\ CLOCK TIME 1° = 100' _ a��rS]' / WATER LEVEL READING 3 EXISTING / -0 Uf�IV HOUSE 3:45 \ \ - 6" - 3 3/8" -,3"- - 3" 2 - -- 3 4 5 6 4;15 -- - 4:15 4:25 4:25 4:35 4:356" ----- - 4:45 4:45 4:55 4:55 5:05 5:05 5;15 - - - 7 - ---- 8 8 9 10 11 12 13 14 V I 10 MIN. I n I n QSEPTIC it qp ` `--"-•cN -'�" J SYSTEM ;�q� PSROPOSED SEPTIC UPGRADQ EE DESIGN, PAGE 2 OF 3 $ �i DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/12/99 UPPER - BENCH 1 3:45 30 MIN. - - -- 10 MIN. 6° 0" 6" 6" 2 5/8" 3" 6" 3 6- 3" 6- 3" - 6" - 3 3/8" -,3"- - 3" 2 - -- 3 4 5 6 4;15 -- - 4:15 4:25 4:25 4:35 4:356" ----- - 4:45 4:45 4:55 4:55 5:05 5:05 5;15 - - - 7 - ---- 8 8 9 10 11 12 13 14 ----- 10 MIN. 10 MIN. 1D MIN. 10 MIN. 3" 3" 20 I PERCOLATION RATE 10 (MIN./INCH) TEST RUN BETWEEN . ANPI COMMENTS: PRESOAKED PERC CAVITY FOR 4+ HOURS PRIG T ES . PERFOMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFORM D ly ACCORDANCE WITH ALL STAT A M CIP DATE. DATE: 3 HOLE DIA. 6" (INCHES) CERTIFY THAT I DELINES IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS, INC. 7320 E. CHESTER HTS. CIRCLE • ANCHORAGE, AK. 99504 PHONE (907) 337-6179 " FAX (9 7) 338-3246 SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES S/D• LOT 3, BLOCK B, PERFORMED FOR: PAT AND BROOKE CORKERY DATE PERFORMED: 3/2/99 DEPTH TEST HOLE #1 (feet) 1 PAGE 2OF2 2 g GROUNDWATER SOIL CLASSIFICATIONS 3/2/99 B 3/11/99 3:46 cn GW J ORG 9 3 4 5 gw„_.%a z O Q O BENCH - GP GM GC SW SP SM SC �'' i��� ML CL OL MH CH - -- 6 ,� - ✓i. rig .eu -,. .Uu �`' T7Lj- 4:46 30 MIN. W (n - CD 4:46 15 7 g GROUNDWATER NET TIME (MINUTES) O 3/2/99 B 3/11/99 3:46 cn 2 12- J 4:16 9 O -- BENCH - 0 4:16 - in - -- 6 ,� - - -- -- DEPTH TO DATE GROUNDWATER NET TIME (MINUTES) DRY 3/2/99 DRY 3/11/99 —CLOCK ry CLOCK TIME NET TIME (MINUTES) O NET DROP (INCHES) 11 W 3:46 6” 2 12- 2 4:16 30 MIN. 5 -- -- BENCH - 0 4:16 - 13 13— - -- 6 ,� - - -- -- 14 4 4:46 30 MIN. W 1 - CD 4:46 15 Q W 5:16 16- 6 5 W W 17 17- 18— 18 e r Garness: C 7953 ,•' .�c°� pore, ••.......•• �ro,G,o 4��npr o f e s sio �'Oa� DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 3/12/99 1 3:46 6” LOWER 2 4:16 30 MIN. 5 -- -- BENCH - -- - 3 4:16 - - - - -- 6 ,� - - -- -- 4 4:46 30 MIN. 5„ 1 - 5 4:46 — 6 6 5:16 30 MIN. 5 19 PERCOLATION RATE 30 (MIN./INCH) 20 TEST RUN BETWEEN 7.0 FT. AND _ COMMENTS: PRESOAKED PERC CAVITY FOR 4+ HOURS P OR TO/lT4 PERFOMED BY ALASKA WATER & WASTEWATER I, V THIS WAS PERFOR ED /IN ACCORDANCE WITH ALL STATE NICI DATE. DATE: HOLE DIA. 6" (INCHES) I FT. , CERTIFY THAT I IN EFFECT ON TH15 i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMEN"iA) PROTECTION it ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 'Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEIVI AND/OR WELL INSPECTION REPORT NAME PHONF D & B GENERAL, INC. C C BUCK CONSTRUCTION 349-6965 EW El UPGRADE MAILING ADDRESS P. 0. BOX 10-1349, ANCHORAGE, ALASKA 99511AA �� n LEGAL DESCRIPTIONL ��C rI LOT 3 BLOCK 8 MOUNTAIN PARK ESTATES #2 ''�1 �� � ' Ly � t LOCATION NO.O L3,�99MS ' BRISTOL DRIVE) ' } Well -- Absorption area Dwelling PF MIT NO. O DISTANCE TO: not in yet _� _ % t �,0 r X10598 E- Q Manufacturer Material No. of compartments w Greer STL 2 N ILiq. capacit in allons Inside length Width - Liquid depth HOMEMADE: DISTANCE TO: Well Dwelling PERMIT NO. z Q Manufacturer I Material Liquid capacity in -_Tllons © Well Foundatior Nearest lot line PERMIT NO. Z DISTANCE TO: Y10�_].Yl yet _ 17 t _ _ 15' __ _j a Z No. of lines Length of e ch line Total length of lines Trench width -61stance between lines �2W 1 0' 60t 24i_nche_s _ H Top of tile to Finish grade Material beneath tile Total effective absorption area o �b48 inches 480 -- -- - Length ���- Wid th�� � Depth �����----� _�_.—.�—.`—�— PERMIT NO. to 0 --— Q 1_ Type of crib Crib diameter Crib depth Total effective absorption area w N. Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. �� r__ __ _ ___ W Building foundation Sewer line Septic tank Absorption areas) DISTANCE TO: O -CHER PIPE MATERIALS PVC SOIL TEST RATING 150 INSTALLER ij dc J5_GENERAL_; -NG REMARKS � Min 2150 n - F . �' -- ---- — °b` r OCT. 24, 1970- i < +s. td WEED DATE i LEGAL 9& ;?//L/B/ /`'TLS. t2-013 (Rev. 3178) B IIT I�-roL_ I _Dj 2 t 65 I i r 7 ©�1 I 1 i I SIi B IIT I�-roL_ I _Dj 2 t 65 S SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION. t TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 - -� SOILS LOG - PERCOLATION TEST — I PERFORMED FOR: .� f`).J'C—h1r;7941— DATE PERFORMED: t 7 � LEGAL DESCRIPTION: Aci T , 7 �_ v7' f��N;nr. ,, - �IK) rc _ -'rpT--� E�PJf�; SLOPE SITE PLAN . 2 3 4 i3 5 6 i 8 i 9 i 10 11 I 12 13 14 15 g„ 16• 17 18 19- 20 COMMENTS PERF.O'RMED BY: 72.008 (6/79) ., r1N1 t- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH) Reading -Date.. Gross_ Time - .Net .. ' Time., 'Depth to Water _ Net - - Drop WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH) Reading -Date.. Gross_ Time - .Net .. ' Time., 'Depth to Water _ Net - - Drop PERCOLATION RATE.- - TEST RUN ^BETWEEN CERTIFIED BY: _1mirt%tesLinch)'� �'`y� - �"'•' P, r FT AND P „'• �T T I{ . t f .", • N o: 21 G 0 - E"._. / Y �� r8 ^ • PATE'. .!n Iro'o IL I -T� DEPHRTMENT HERLTH HND ENYIRONMENTHL ]TECTION ` 825 'L' STREET/ HNCHORHGE/ HK99501 264~4720 �-T1E:-: T -o-, 1 '. q KE�.`.­ ?Fi� ��E-E. Pol 11: T" PERMIT NO. ( D10598 ) HPPLICHNT CC BUCK 44]1 E 2ND ]45~5764 LOCHTION BRILSTOL LEGRL LTEST ���~ // LOT SIZE 19800 SQUHRE FEET . �. ' ��� --~~~ ~-~�^`� '��' TYPE SYSTEM IS: TRENCH MAXIMUM NUMBER 0F BEDROOMS � ] SOIL RHTING (SQ FT/BR)� 150 THE REQUIRED SIZE OF THE SOIL HBSORPTlON SYSTEM IS: QE1:1 1- 1-U.--; ��-f Q VIE Fos 00 VIE.' L.-.. go:-, 0 ... P. Q THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE D�PTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) Fit �CIA U :11.. 1: E> F::`," , V-, -.C: Y0���� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THF -IT THE NELL WILL SERVE. 10, ::-u �1"" n c: w :1 C-0 1%1 m Fos FEE H FY GA 1.11 1 PF�P. FE'�".. Lj� BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON`SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PU8LIC NELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMM�NlTY SEWER LINE IS 75 FEET. NELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENIT WITHIN ]0 DHYS OF THE WELL COMPLETION OTHER REQUIREMENTS MHY HPPLYSPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILRGLE TO INSURE PROPER INSTHLLHTlON. KE�Rol �-1 - �X 1=1 X it! IEE SE'. �������P" J ...., �%--3" :1 EUGENE F. FISHER .rte -7. CIVIL �"NGINEERS LASKA BOX W8!__...__ WASILLA, ALASKA H 99687 E�f PHONE 376- 2313 Nar_ch 17, 1983 HLin ic.ipality of Anchorage Department of Health & Environmental Protection 825 L.Street Anchorage, Alaska 99501 Re: Lot 3 Block 8 ,Mountain Park Estates #1. Sewer Permit x/810598 pAUNICIPAi.IfY OF ANCHORAGE CEPT. OF NgfLTH OTeCT10N ENVIRONI�`NTAL PK Of kv, To whom it may concern; Please note that the subdivision is Mountain Park Estates #1 not #2 as shown on the report by typographical error. Please change your records accordingly. Thank you for your help. Sincerely, Eugene F. Fisher, P.E. WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol 8~ Geophysicol Surveys ~ ~,:='~-~- ~ ~ ~,_,,_.,_.,- -o Ic'--~ DISTANCE AND DIRECTION FROM ~OAO INTER~ECTION~ 3, OWNER OF WELL: ~./~ ~/~ ~ ~~ ~ '"' o ,-,,.,,~. ' o ...-,. ' "o c....,,., &~F ~~ x~-~ ,~-c ,,... ~ .. ,.~,. ~.,,~ ~.,;,,/~",".2,. ( ' II. PUM~NO LEVE~ bile. ~A- ~/o~ N C r- 0 C �/ ... For ............. I .......... . ... 0 .... .... Location ....... ............... ....1 ... ... ... Datecompleted ........ ........ ........... ........ .................. ...................... I r, -) Depth of well........... ...I .................................. ......... ......... ............................ Size of casing.........._`. . .......... ........ ...... ........ ... . ..... .. ..... Distance to water .............. ................... .... ....... ...... I ................. Distance to water while pumping.. .......... .. . . ........................ at rate of ................................... ........... gallons per hour. ............. I ................ ..... .... . . ............ Driller DELTA D'YQ]1.Lh`JG, MJPANIY SRA E30X 394 E3 ANCHORAGE. ALASKA 99507 —ro in---- —1--t--o--- I ............. I ................ ..... .... . . ............ Driller DELTA D'YQ]1.Lh`JG, MJPANIY SRA E30X 394 E3 ANCHORAGE. ALASKA 99507 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-391-39 Expiration Date 1. GENERAL INFORMATION: Complete Complete legal description MOUNTAIN PARK ESTATES; BLOCK 8, LOT 3 Location (site address) 5846 Bristol Drive *Anchorage 99516 Z —Z o -e- Current Property owner(s) Olga Fedorova Day phone 907-223-4579 Mailing address Real Estate Agent 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. (7 COSA Fee $ / Waiver Fee $ Date of Payment / 7 / 20'?o Date of Payment Receipt Number. zC! Receipt Number COSA# OsC.4 / V Waiver# 01 7 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: Garness Engineering 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: C-dahz, 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 industry practices. The reported results describe the condition of the system/s on the date/s of the o� OF evaluation.Separation distances were measured to readily identifiable features. Hidden defects or o ��•. �' 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, OO ` L • T groundwater levels (that may fluctuate during the year), quality of construction (materials and " " :. 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 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. Gorn,ess. can be installed on the property in the event either of the current systems fail to perform adequately in �) .� I CE-- t�'� , G the future. The content of this report is for the sole benefit of the person/party that retained GEG to 9�( perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right ��V pyo°essl000� o G whatsoever. Opp�po� #AECC884 6. DSD SIGNATURE System 41 Approved for bedrooms System #2 Approved for bedrooms \ll����((((({{{{��r Disapproved 'S Conditional OF Conditional approval for bedrooms, with the foil g s lajmll}s: �G� Original Certificate Date: 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. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other _���1,,,,,(,cL Legal Description: MOUNTAIN PARK ESTATES; BLOCK 8, LOT 3 c— Parcel ID: 017-391-39 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 8117/81 Total depth *156.4+ ft Cased to 10Z ft © Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/1/20 Well production at time of test 3+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes FE -1 No ® Coliform bacteria is Negative y Nitrate +' �' 5 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L FE� Arsenic less than MRL (ND) Collected by GEG, LTD. 11� Date of Sample 5"''0's y%1 ZD Static water level at beginning of test 147 ft. Comments "PER GEG INSPECTION - SEE DOCUMENT IN MOA RECORDS STATING THE WELL MAY HAVE BEEN DEEPEND B. TANK DATA Age of tank(s) 21 years Tank type/material STE'STEE` Measured operating fluid level in septic tank 50" - F Standpipes/foundation cleanout per record drawing Date of pumping 5/11/20 D. ABSORPTION FIELD DATA DUAL TRENCH - NORTH/SOUTH Which system tested (date installed) 5/13/99 ® ALL standpipes present per record drawing Total measured depth from grade 10.8 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field FW Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION 0 Required maintenance completed Age of lift station 21 years Lift station material STEEL Comments: Adequacy test date 2/4/20 Results Pass For 3 bedrooms Fluid depth prior to test 18 in Water added 471 gal New depth 28 in Elapsed time 120 min ® Code -required soil cover over field Final fluid depth 22 in ❑ System presoaked Absorption rate 450+ god (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: TESTED SOUTH TRENCH ONLY -NORTH TRENCH HAD 80-82" OF LIQUID UPON ARRIVAL AND THROUGHOUT TEST COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 1771 Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'✓0 Yes if No ft Absorption Field on Lot > 100' F/� Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' QQ Yes if No ft Water Main > 10' Animal Containment > 50' F/� Yes if No ft 17,71 Yes if No ft ✓Z Yes if No ft Water Service Line > 10' M✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0 Yes if No ft FV7I Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 1771 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F Yes if No ft Private Wells > 100' QQ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ✓Z Yes if No ft Water Service Line > 10' M✓ 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' ❑7 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' F/ Yes if No ft Community Wells > 200' ✓� Yes if No ft Surface Water> 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS 21 YEAR-OLD STEEL S.T.E.P. TANK MAY BE APPROACHING THE END OF IT'S USEFUL LIFE. NORTH TRENCH WAS ESSENTIALLY 100% FULL PRIOR TO TEST. SOUTH TRENCH .WAS ONLY 25% FULL PRIOR TO STARTING TEST. HOUSE OCCUPIED BY 1 PERSON. ,.0600 � 4 G. ENGINEER'S CERTIFICATION F o O F �4 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. �*.:.....j ..f.. ......����.. t`f'CE— COSA arne s;1.z Checklist yellow sheet t%ro f e $ 510oQ�' #AECC884 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201189 Subdivision: Mountain Park Estates Block 8 Lot 3 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Ma�hng Address P :O. Box 196650:: *Anchorage, Alaska 99519 6650 *www muni org } 1Nlitrate Advisory Certificate of On -Site Systems Approval # OSC 201189 Subdivision: Mountain Park Estates Block 8 lot 3 A water sample revealed a nitrate concentration of 7.35 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. Ma�lmg Address P O Box 196650" Anchorage Alaska 99519 6650 *www muni or 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. Mailing Address P O Box 196650 *Anchorage, klaska 99519 6650 *www muni org � x ? 5,., ,�;. s �.:�,✓ x.,,c:.-.mss w„�s.3..y<,..,...,r.-�..ni. ,� ^, ..,.K=,'._. �.,., ,., iw�.a-.W -, x . ..fi • .r_r 05/12/2020 05:02 8686770 APLUS PAGE 02 AN ft1_.%&%RAGE Ml,,, qlCIPALITY OF -bad Phone: 9c,7_343.7904 Fax: 907-343-7997 Development Services [:I! )atment V On -Site Water & Vlastev, ter Section I mp Vault LiftStatl.onjpu V�' Maintenance L09 rk Street Address Owner sPSD._.._— Phone: Legal Oese. BAD&IIankapignping completed rviSj.ja ell Pumping'. required .Sludge level inc, 1.►� station.•Effluent filter. craned -pump basket cleaned Conflrmed -proper float satting&* -control 1103ts cleaned .Operation satisfactory! <9 11a -Audibi6 and visual alarm inside dwelling' (��_O_Q L .Dedicated electrical arra circuit .Alarm system ope„a,'. n maahwo-RIS9E at riser to tank•Wr,"O'tIOT' -Weep h 0% -OV -Ground water intrusi, I stiomhale functional susii n around pipe penetr vg_S6 Wed Ground water int Insulated properly Secured Fum,. ono! rY%4_W -Manhole lid: Qtbsrred inspections and maintenance completed. - es -All manufacturer re(I Ji CPnMM= ........ -1”, .......... ­­* ................................... ...... .............................. ............................. ........ I ........................ I ........................ .... .. ...... ............ . ........ ............... .......... ......... ......... ............... ........ . ...... ........... ........... ... ...... ...­ .................... I I ........................... ................ . ...... ............................. ... ............................................. ......................... "..' ................. ................. .. .... .................................. ........... ........................... ...... ......... it { Date of maintenance� Technician Company Signature ' KM, x .":P Parcel I.D. 017-391-39 Municipality of Anchorage On -Site Water and Wastewater Program s 6 (907)343-7904 x Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: % O2L ' l 7_/ Complete legal description MOUNTAIN PARK ESTATES: BLOCK 8, LOT 3 Location (site address) 5846 BRISTOL DRIVE *ANCHORAGE, AK 99516 Current Property owner(s) SEAN THOMAS & TRACY TRASKY Mailing address Real Estate Agent Day phone 360-2555 5846 BRISTOL DRIVE *ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: ❑ Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: Received Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ rJ7i(o " Date of Payment Receipt Number 0111 (o COSA# 01�('_►5/50!1 Date: 9 /r 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 Garness Engineering Group Ltd (GEG) Phone (907) 337-6179 Address 3701E Tudor Road Suite 101 Anchorage AK 99507-1259 ��`/ (t Engineer's Printed Name Jeffrey A. Garness Date � / In conducting this evaluation, GEG provided an engineering evaluation of the well and/or seotic system in accordance with the guidelines and regulations established by the Municinality of Anchorage and industry orectices. The reported results describe the condition of the systems on the data/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and seotic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanshio), and the waterusage 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 oerformance of the systems; therefore, GEG makes no warranty (exoress or implied) regarding the future oerformance of the well or seethe system.. GEG makes no representation whether an alternative well or septic system can be installed on the prooerty in the event either of the current systems fail. The content of this report is for the sole benefit of the oerson/oarty who retained GEG. Reliance upon the information erovided in this recon by any other Berson orearty, including but not limited to subsequent property purchasers, is not authorized. In short GEG disavows any legal duty to anyone other than the eerson/oarty who paid for this mean. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms - System #2 Approved for Disapproved Conditional approval for By: bedrooms bedrooms, with the followi Original Certificate Date: The t4ni ' alit chorage 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 Slate of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. ATTACHMENTS: / COSA Checklist (/ Septic System Advisory Well Flow Advisory COSA blue $beat_91-12.doc Nitrate Advisory Arsenic Advisory Other 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; BLOCK 8, LOT 3 Parcel ID: 017-391-39 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 8/17/81 Sanitary seal (Y/N) YES Total depth 152 ft. Cased to 152 ft, FROM WELL LOG Date of test 8/17/81 Static water level 123 ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/25/15 47 Well production 3.5 g.p.m. 2.7 g.p.m. WATER SAMPLE RESULTS: Coliform —B�colonies/100 ml. Nitrate -7' Samg./L. Collected by: GEG. Ltd. Arsenic: r4c> ug./L. Date or sample: 8/27/15 B. SEPTICIHOLDING TANK DATA Tank Type/Material STEP/STEEL Date installed 5/4-13/99 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) YES Date of pumping 5/11/15 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 5/4-13/99 Soil rating .p.d. r felbdrm) o-6 Length 36/36 ft. Width 2 ft. System type SHALLOW TRENCH Gravel below pipe 7.07/7.08 ft, Total depth *9.8+/*10.5+ ft. Eff. absorption ared.008+ fe Monitoring tube YES Depression over field NO Date of adequaby test **8/25/15 Results (Pass/Fail) PASS For 3 bedrooms *** Fluid depth in absorption field before test21- in. Water added 950 gal. New depth 51 in. Elapsed Time: 1063 min. Final fluid depth 35 in. Absorption rate >= 450+ g,p,d, Any rejuvenationtreatthent (past 12 mo.) (Y/N & type) NONE If yes, give date - **SOUTH TRENCH TESTED ONLY NORTH TRENCH HAD 76 INCHES OF LIQUID IN MONITORING TUBE DURING INSPECTION ***INTRODUCED WATER DIRECTLY INTO SOUTH TRENCH MT. r I **APPROX PER TETHER LENGTH ***MANUALLY HOOKED FLOAT AND CYCLED D. LIFTSTATION *PER 1999 MOA ELECTRICAL INSPECTION REPORT Date installed 5/13/99 Size in gallons 1250 Manhole/Access (Y/N) YES "Pump on" level at **39 in: "Pump ofr level at **35 in. High water alarm level at 43 in. Datum BOTTOM OF TANK Cycles tested *** Meets alarm & circuit requirements? *YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots Public sewer manholeldeanout N/A Holding tank Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE'KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's PdntgV N me JEFFREY A. GARNESS Date �S' (Rev. 11/05) Municipality of Anchorage ® Community Development Department Development Services 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 # 151508 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 8, Lot 3 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 7.52 milligrains per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Prograi 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING r� Parcel I.D. 017 " 2 ✓� L 3� COSA# 09 0 "1/, "1 1. GENERAL INFORMATION Expiration Date: 09 Complete legal description MOUNTAIN PARK ESTATES: BLOCK 8, LOT 3 Location (site address) 5846 BRISTOL DRIVE ► ANCHORAGE. AK * 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KIM WILLIAMS Day phone 336-2522 5846 BRISTOL DRIVE • ANCHORAGE. AK • 99516 Day phone RYAN TOLLEFSEN W/ PRUDENTIAL Day phone 276-7282 3801 CENTERPOINT DRIVE, #200 * ANCHORAGE, AK " 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site e Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues t',OSAS upon request to homeowners. Certificates of On-Sitd Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the syste These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Phone 337-6179 Date 6118 oy RI'1NAM Conditional approval for bedrooms, with the filowing stipulations: pp���lrirrrrrr. OF glyr r ��QP oyo, ON-SITE WATERAND ; R'= WASTEWATER PROGRAM c' "U1111111111' Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: 3 0 — 0 9 )Rsv 11N5) Municipality of Anchorage Development Services Department ! Building Safety Division On -Site Water & Wastewater Program ` 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAIN PARK ESTATES; BLOCK 8, LOT 3 Parcel ID: 0/7 - 31q 1- 341 A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N/A Well Log (Y/N) YES Date completed 8/17/1981 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 152 ft. Cased to 752 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/17/1981 6/5/2009 Static water level 123 ft. 123 ft. Well production 3.5 9 -P.M. 3.17 9 -p -m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 6.93 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: 0 ug./L. Date of sample: 6/5/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Date installed 5/4-13/1999 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alar (YIN) YES Date of pumping 6/5/2009 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 5/4-13/1999 Soil rating .p.d./ or ft'/bdr) 0_6 System type DUAL TRENCH ((2 0 36) 7.07 Length 72 TOTAL ft. Width 2 ft. Gravel below pipe ft. •10.0-11.3 Total depth •1os- 11.oa ft. Eff. absorption areal Monitoring Monitoring tube YES Depression over field NO Date of adequacy test "6/5/2009 Results (Pass/Fail) PASS Forbedrooms Fluid depth in absorption field before test 50 in. Water added 535 gal. New depth 60 in. Elapsed Time: 1080 min. Final fluid depth 50 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - "TESTED SOUTH TRENCH ONLY. NORTH TRENCH WAS 99% FULL. NOTE: 1981 TRENCH COMPLETELY ABANDONED. D. LIFT STATION Date installed 5/13/1999 Size in gallons 1250 Manhole/Access (YIN) YES 'Pump on" Ievei at 41 In. "Pump off" level at 41 in. High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION o "' ' F,......... 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 0 date. O J e Come ss: Engineer's Printed Name JEFFREY A. GARNESS Qa r E— 53 `�`i Date 6/1 6�u q 0�0 ,� tx1°oo t\ P _ n..n0 0 Q 9 COSA Fee S 0 Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number 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 # 090199 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 8, Lot 3 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 6.93 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. xr1 1 aa rON ° a ° ° �Llrt STATION G S 4T1[ITy se. �VfN Qel CNT tea. )Z� O n N m O^ 00�0000�0 4 N � �� OF..A.�,9 4�0 p ,� 49 TH* p....:................`......L... SHANE A. HOLT on LS -6914 0 , s o a U�c °Fonwnd o SCKE 1•.3P �DOpppoo� AS -BUILT SURVEY NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEES INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 3. BLOCK B. MOUNTAIN PARK ESTATES SUB_ ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE&FORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPE CIRCALLY TO SHOW MY CONFLICTS BETWEEN THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE EXISTING STRUCTURE S AND PLATTED LOT LINES OR EASEMENTS MD IS NOT TO BE USED FOR POSITIONING ADOITIONAL PROPERTY LINE S AND NO VISIB4 E ENCROACHMENTS EXIST STRUCTURES OR FENCELINES. OTHER THAN NOTED. EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ME NOT SHOWN HEREON, DATED AT ANCHORAGE. ALASKA THIS 25TH_ DAY OF_JUNE 2008_ NOTE. MY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ME NOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LAND SURVEYING OR LOCATE STRUCTURES TEL.3/}5513 FBM31,136-63.?M MUNICIPALITY OF ANCHO?�,%GE DIVISION OF ENVIRONMEN"AL HEAL'(H DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _� �✓ -/ (a) Legal Dascri.ption (include, lot, block, subdivision, section, tcxrship, range), Locaticn (address or directions) (b) A lir_ants Nacre pp- \= r �c:. Te, lephone Applicants Address c Y� c' - (c) Applicant: is (check one) Lending Institution. Owner/builder. Buyer ��� ; Other F t (explain) ; (d) Lending institution Te 1e P hone Address (e) Peal Estate Co. & Agent Address Te lephorz 2. jyp2 of Pi sidence Single -Family Number of Eedreoms 3, water SU � 1V Multi -Family Other (describe Individual wall Cormmuni.ty Public F::j Note; If crxmnunit_v 'Hell system, must have ,written confirmation from the State Da partm-int of Environrp-nta.I Conservation attesting to t:he legality and status. Is the well adequate for the number of bedrooms specified in this HAA LI) =1. Sewage L)is-rosal Onsite '' 1� Public I � Community ��� Holdin(7 Tank Is the wastewater disposal system adequate for the number of bedrocros Y N) [Page I of 2) 2-15-84 5. En ineerir. Firm Providinc T.ns ctions, Tests, Data and ]Information __..�..e._._._�..a ��..�-�.��__�...�..__-._lam �..m..._....�� _._... I certify that I have checked, verified, or cor;fr_,rffed to all MOA [SNA Guidel.in3s in effect on thy, date of this inspection, Signed Dated Nang of Firm _ _C�r=, �.Celephone Address r '` Signed by Dates j� � c (ENGINEER SEAL) 6. DHEP ADproval OF 4� a efnna. oar3. . o r d 6" oy L. Reiu, O. �2251-E `d g9FDoaQe• so eao b PROI�ESS10h �:n Approved for `� be dr D �� _-u�. (`I,/ o pi y t, <,G-- cc7Dat.. 2? � L[ `.1 ._ Appr_o,a)d Disapproved Conditional F-1 Terms of Conditional Approval The Municipality of Anchorage Cepartment of Health and Crvi.ronmental Protection. does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. `T'hi's approval indicates that, as of tli-- validation date shrxan above, based on the data and information furnished by an engineer registered in the State of Alaska, the c -nater supply and wastewater disposal. system is safe and funs-- ti.onal for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Pact'= 2 of 21 2-15-8n ALASKA h iOIROW11TAL CONROL SekuIUS, Inc. Engineerinq b 6nuironmenial Studies MARCH 8 1984 LES MCRAE 7938 WISTERIA ANCHORAGE AK 99502 SELLER — LES MCRAE BUYER — CORKY SUBDIVISION — MT PARK ESTATES 01 BLOCK — 8 LOT — 3 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 480 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 572 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 3/12/84 . FLOW TEST ON WELL THE WELL FLOW RATE WAS 3 GPM FOR 3 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM ROUSE. do �Otr • •ate ',rd e`o�er:ae a°(r� 0 OF 1200 best 33rd Auenue, Suite B 9 Anchorage. Alaska 99503 • (907) 561-5040 MUNICIPALITY OF ANCHORAGE (M@WICIPAUIY OF ANCHORAGE DEPT, OF HEALTH & HEALTH AUTHORITY APPROVAL (H&WIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 19 4 (31ocLc fig0 .�iK A. WELL DATA `;9IE3q RECEIVED. Well Classification -FLvJ4_ If A, B, ar C, D.E.C. Approved(Y /U/4-) �4- 4e',d Well Log PresentY/N) Date Completed 9/7431 Yield , Total Depth /6' 7 — Cased to / g c, Depth of Grouting 6e4t Keow !�j Static Water Level ��' Pump Set At Casing Height Above Ground �,�r Sanitary Seal on Casing Y ) Electrical Wiring in Conduit Y Depression Around Wellhead (Y Separation Distances from Wb11: To Septic/Holding Tank on Lot �l v o � On Adjoining Lots 7/y u I To Nearest Edge of Absorption Field on Lot 7/�C�� ; On Adjoining Lots >/tlo� To Nearest Public Sewer Line 11)14 To Nearest Public Sewer / Cleancut/Manhole �•� 'To Nearest Sewer ServiFe Line on Lot wrest _ • 3�/rS 7 Water Sample Collected By < � � ��� � �� Water Sample Test Results— Calment5 r t i 1 r n 5 rJi%!u c iu �✓JZ�2 LrJG Ci �i B. SEPTIC/HOLDING TANK DATA of Compartments0 No / Size 60. 2 Date Installed -7/'e / � - Standpipes &N) Air -tight Caps N) Foundation Cleanout Depression over Tank (Y Date Last Pumped 31121 Pumping/Maintenance Contract on File WIN) N4 ; for O�� Holding Tank High -later Alarm (YM)'ulA- Temporary Holding Tank Permit (YM)'1A Separation Distances frau Septic/Holding Tank: To Water -Supply Wall ;�> 10 of To Building Foundation 11 -_ To Disposal Field "1 ' To Property Line ;>30� To Water main/service Line INA To Stream, Pond, Lake, cr Major Drainage Course N �•ti Comments -- [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata rf y, 10 k„ Date Installed 7/b/ Length Width of Field 2t Type of System Design T2F4C(,� of Field &C) Depth of Field e � Gravel Bed Thickness q/ Square Feet of Absorption Area /(�L)/Zj Standpipes Present fQIN) Depression over Field (Y- Date of Last Adequacy Test -Yejla L( Results of Last Adequacy Test -/S-C) �,,J Separation Distance from Absorption Field: To Water -Supply Wall 7/00 To Building Foundation ?3' To Property Line �- To Existing or Abandoned System on "Lot �ti!.} ; On Adjoining Lots To Water Main/Service Line N �� To Cutbank(if present) A_1 To Stream/Pond/Lake/or MajorDrainage Course ��/A To Driveway, Parking (Area, or (V'ehiclefO OI / Storage Area ' Cwents {1�OSt�2 crw 4'.l�_ tn,L-(2ue S(n� O£iL CSS Jc p'� i D. LIFT STATION uv � A Date Installed A) A- Dirensions �d1A Size in Gallons /OG+ Manhole/Access (Y/N) `Vial "Pump On" Level at IIIA- "Pump Off" Level at J1A High Water Alarm Level at it)(+ Vent (Y/N) fJIA Tested for iUIA Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) A)( r Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Gu on the date of this inspection. Signed Date 9//0 Company /�1 Cv MOA No. RB1/d5/s [Page 2 of 21 in effTct 041. p ipw .. ,. �.7110� 8J44U ;'0 #�iA No. 2251-E V� AO �ip� ROFE5510��P�� 2-15-84 N - DATE RECEIVED `J INSPECTION APPOINTMENTS TIME TIME TIME 6� 1? 1 s7-Ve-e 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE DATE ICS J6 -'1 1i ,Lx�s. ❑ MULTIPLE FAMILY Three ❑ Six INSPECTOR INSPECTOR INSPECTO * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY %bey�S 1,171. 1 MUNICIPALITY OF ANCHORAGE DEPT. o ;.: 1,: 15�k[1U` MEN1�LCTI0N OF HEALTH &ENVIRONMENTAL PROTECf�C7N DEPARTMENT 825 L Street - Anchorage, Alaska 99501 • ., ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 Y, E C E I V l9 D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER jeyAl 13/9Sh/l91r/ /'j t+c' K PHONE aT MAILING ADDRESS jb-77 e 15'7,- �lc e. rf olvAl / �o7iV�Y�n%6 /t� /4L i's7NT f+ilrTfiH PROPERTY RESIDENT (If different from above) ONE IV LAI ddl-5704 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE / MAILING ADDRESS 4. REALTOR/AGENT �C1/7�li/ /919S%f/fff�i PHONE MAILING ADDRESS /9�Y7 el, 59;_Aeye /94� r`�579 5. LEGAL DESCRIPTION STREET LOCATION N/1111 6� 1? 1 s7-Ve-e 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other �- SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY C�5- 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 leg if available.) 8. SEWAGE DISPOSAL SYSTEM (ice INDIVIDUAL/ON-SITE** C5 % 7g� YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. f 72J010 (Rev. 6_/79) Q � r 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 ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 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 ❑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 Nl/APPROVED FOR �j BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE / �) �' BY / ' ✓ !./ a 72-010 (Rev. 6/79) u s i O -� � °sn 1m o (� < m v r N A Z o �oCrn 0', p z z o V rn w m Y � 0 O 2 W tri 'i G fTi � � �in � iv70 -1 o oN 'n F Cl) 7) � i O -� � °sn 1m o (� < m v r A Z o �oCrn z z V •17 t7 O 2 'i N Ln C, ,zi-0oi 3aot+,ais �0 9 s