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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 8 LT 11Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: _OSP231318 PID Number: 017-391-31 Dwelling: IN] Single Family (SF) n with ADU E] Duplex (D) 171 Two Single Family Project: n New 0 Upgrade Name DEBRA BRUNEAU ABSORPTION FIELD n Deep Trench 100 Wide Trench 171 Bed El Mound El Other Site Address 13000 ALPINE DRIVE -ANCHORAGE, AK Phone 907-538-8827 12 Number of Bedrooms Soil Rating 0.7 GPD/SF ITotal depth from original grade 9.81 Ft LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe' 4 Ft Subdivision MOUNTAIN PARK ESTATES; Block Lot BLOCK 8, LOT 11 Fill added above original grade SEE DWG. Ft. Gravel length 44+ Ft. Township Range N/A Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 440+ F t2 Number of trenches 1 Dist. between trenches Ft. Well 100,+ 25 TANK [9 Septic E:1 S.T.E.P. El Holding [I Other + Manufacturer Capacity INFILTRATOR 1060 Gal. Surface Water 100,+ 100,+ Material Number of compartments Lot Line 5'+ 10'+ NA PLASTIC 2 Foundation 10,+ 10,+ LIFT STATION Manufacturer Capacity Remarks PER CONTRACTOR EXISTING SEPTIC TANK WAS DECOMMISSIONED PER UPC Gal. *SEE PAGE 2/3 JAlarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 dTank to rainfield D3034 WILCO EXCAVATION Drainfield D3034 GO/MT D3034-- Inspector GEG AND M.O.A. BENCHMARK (Assumed elevation) 100.76 ft Inspection 1st 10/25/2023 10126/2023 Location and description dates: 2rd 3rd _�_0/27/2C 4 th TOP OF MANHOLE ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 0 Conditional Approval: Date Septic System Approved Date? / q/,��Zy Note: this approval does not include well permit requirements. (Rev 05/02/18) T o *..... .. . . .......... reY� �0Garness.- A.)C E #AECGB841 ofess, I PERMIT NUMBER: PARCEL ID NUMBER: OSP231318 017-391-31 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. vAPPROXIMATE LOCATION OF EXISTING DRAINFIELD I \ \ NEW IM-1060 INFILTRATOR SEPTIC TANK; 100' \\ \ ' WELL RADIUS FLAGGED DURING CONSTRUCTION' \ \\ AND TANK WAS 100'+ FROM FLAGGING \ > \\ GE T.H. / A \\ \\ y/ \ \ DBL1&2 O FD, \ \ EXISTING 1 1 BEDROOM HOME (2 11 BEDROOM DESIGN I /1 I / � 1 w I J 1 b •- I I 1 ( MOUNTAIN PARK ESTATES; BLOCK 6, LOT 12 NEW DRAINFIELD ST1 DBL384 " 22'+ — --- i DRIVEWAY a •� ;Y -- ENGINEERING - SALES = CONSULTING 3701E TUDOR ROAD, SUITE 101 `ANCHORAGE. ALASKA' PHONE (907) 337Ei79' VVEBSITE v�tiw.gamessengmeering.mm PREPARED FOR. PHONE NUMBER: PAGE NUMBER: DEBRA BRUNEAU 907-538-8827 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES; BLOCK 8, LOT 11 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM RECORD DRAWING 11/13/2023 W ry r) W z N i \J 1 n I SCALE: I A C '+ +# Aff ...........t 4 ....... ................ i rey�i••� mess : CE-7953 ' ��i W 0 LICENSE 4VAjkjkjk;L*** #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: OSP231318 RECORD DRAWING 017-391-31 PER CONTRACTOR TANK IS INSULATED TOP OF TANK AT OUTLET = 96.05 INVERT OF PIPE AT INLET = 95.42 TOP OF MANHOLE = 100.76 FINAL GRADE = 100.1 NEW IM-1060 INFILTRATOR 2-COMPARTMENT SEPTIC TANK ORIGINAL GRADE AT HIGHEST POINT = 97.08 ST1 - TOP OF TANK AT INLET = 96.03 FINAL GRADE = 95.42-97.34 2023 T.H. t 11 11 / , FILTER FABRIC s • INVERT OF PIPE AT OUTLET = 95.20 T INVERT OF PIPE = 91.27 BOTTOM OF TRENCH = 87.27 RELATIVE ELEVATION OF BOTTOM OF T.H. = 81.08 BOTTOM OF TRENCH WAS OVEREXCAVATED BY THE CONTRACTOR T.H. DRY ON 10/2412023 BY APPROXIMATELY .06'. HOWEVER, THE BOTTOM OF TRENCH STILL MET MOA CODE REQUIRED VERTICAL SEPARATION DISTANCES AND WAS APPROVED BY THE DEPARTMENT DURING CONSTRUCTION 9 LAW ENGINEERING-, SALES a CONSULTING 3701E TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 339-3246' WEBSITE: —mamessemmneenn—m PREPARED FOR: DEBRA BRUNEAU PHONE NUMBER: 907-538-8827 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES; BLOCK 8, LOT 11 TYPE OF WORK: SEPTIC TANK PROFILE PAGE NUMBER: 3OF3 DRAWN BY: D.J.G. DATE: 11 /13/2023 �• , ••• rr�,,�. �.s.........�.............. 0 /r - ;� • re harness �e Ar 1#LICENSE -79 3 #AECC884 / OF �0..49 H-I sAoo., SHANE A. HOLT LS-6914% %°Tessional ti9o—' 0 0 Z THESURVEYDA TA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WR?TEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOE' ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT . ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWIN6 ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROV£NENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOM ANDIOR ICE. L g AS -BUILT SURVEY f " = 30, NO CORNERS SET THIS DATE / HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT11 BLOCK 8MOUNTAINPARK ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTSS/TUATED THEREON AREWITHIN THEPROPERTYL/NESAND NO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED DA7EDATANCHORAGE,ALASKA THIS 3 RD DAYOF NOVEMSER , 2023 15863 232-43 235-18 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 MUNICIPALITY OF ANCHORAGE �t»cnt 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 I " Department On -Site Wastewater Disposal System Permit Permit Number: OSP231318 Effective Date: 10/11/2023 Work Type: Septic Upgrade Expiration Date: 10/10/2024 Tax Code Number: 01739131000 Site Legal Address: MOUNTAIN PARK ESTATES BLK 8 LT 11 G:2838 Site Mailing Address: 13000 ALPINE DR, Anchorage Owner: BRUNEAU DEBRA A Lot Size in Sq Ft: 26700 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 2 This permit is for the construction of: Q 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 may: �SSuP to �� Issued By: Date: Date: "Z" „..114s Municipality ®f Anchorage y-J;.� ) r 44:0 I)epa rtment P.O. Box 196650 • 4700 Elmore Road _Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Proqram * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231052 COSA#: Permit#:OSP231318 PID#: 017-391-31 Legal Description: MOUNTAIN PARK ESTATES BLK 8 LT 11 Engineer: Garness Engineering Group The proposed field is not parallel to the contours. The attached design is approved to have part of the field not following the contours. This waiver approval applies to the proposed field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: Approved by:—A, 6171 Name of Review ............................ ■ ............................. ■ ■ .............. ■ 1 **** VARIAN C E/WAIVER REVIEW **** MUNUPALITY OF ANCHORAGE 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. 017-391-31 Property owner(s) DEBRA BRUNEAU Mailing address 13000 ALPINE DRIVE *ANCHORAGE, AK Site address 13000 ALPINE DRIVE *ANCHORAGE, AK Day phone 907-538-8827 Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES; BLOCK 8, LOT 11 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 1 (2 BED SEPTIC) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field Fx� Initial -� Single Family (SF) 0 (w/wo ADU) Septic Tank EDUpgrade A (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (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: J Waiver Fees: Date of Payment: 7,07, �3 Date of Payment: Receipt Number: 0 / 0 IG Receipt Number: Permit No. <<iSF Z ( Waiver No. �S�I- J 1 C)5Z GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Application.doc n.,. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231318, Deb Wockenfuss, 10/11/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231318, Deb Wockenfuss, 10/11/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231318, Deb Wockenfuss, 10/11/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231318, Deb Wockenfuss, 10/11/23 TNESURVEYDATA AND NEASURENENTS HEREONAREPREFARED FOR THE OWNER OF RECORD AS OF THE LX 4 TE OF THIS SURVEY ANY USE OF THIS DRA NG BY THIRD PAR7 ES IS PRoHlenED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LE'NPIN6 INSTITUTIONS SPECIFICALLY TO SHOV ANY CONFLICTS BE'TUEEN EXISTING STRUCTURE'S ANP PLATTEP LOT LINES ANPIOR EASENENTS; ANP IS NOr TO BE USED FOR POSITIONING APPITIONAL STRUCTURES, INPROVENENTS, OR FENCELINES- EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE Nor SHORN HEREON ( UNLESS INDICA TE.P) NOTE= FENCEL IVES THAT NAY APPEAR ON THIS PRANING ARE Nor TO BE USE.! TO PETERNNE PROPERTY LINES OR POSITION AB.OITIONAL IMPROVENENrS• ANY PAVIN6 SHORN HEREON NAY BE APPROXIMATE PUE TO EXCESSIVE SNON ANPIOR ICE. AS�BUILTSURVEYfry mw ..30 r NO CORNERS SET THIS [SATE / HEREBY CERTIFY THA T / HA VE PERFORMED A SURVEY OF THE FOL L OWING DESCRIBED PROPERTY LOT 11 BLOCK 8 MOUNTAIN PARK" ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THA T THE VISIBL E IMPRO VEMEIV TS SI TUA TED THEREON ARE WI THIN THE PROPERTY LINES AND NO UISIBL E ENCROACHMENTS EXIST OTHER THAN NOTED DATED A T ANCHORAGEALASKA THIS 17TH DA Y OF JUL Y , 2023 15863 23243 HOLT LAND SURVEYING 9399 GROVER DRIVE ANCHORAGE, AK 99507 223-8615 i MUNICIPALITY OF ANCI-IOFIAGE / DEPARTMENT OF HEALTH & ENVIRONMENTAl- PROTECTION ,~ ENVIRONMENI'AL ENGINEERING DIVISION i~.~ .~,,t~,~ rr~ , 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT NAME ~ ~HONE MAILINGAD~ ~'~ ~) ~ ~ '~'~ ~'' ~ ~ ~UPGRADE__ LEGAL DESCRIPTION Well ~ Abs°rP~i°n araa Dwel,?~-- ~ Manufacturer Material / / No. of compartments ~ERMIT Well Dwelling NO. ~ ~ DISTANCE TO: ffoundation~ ~earest lot line P[BMIT ~0. ~.. NO. of lines . Eenflti, of each line Total length of~ Trench ~ ~ ~ Top of tile to f ~ Material beneath tile Tozal effective absorption area Length Width De~th ..... PERMIT NO. ~ DISTANCE TO: ~ Class Depth Driller Distance to lot I~ne PERMIT NO. ~ DISTANCE TO: OTHER ~ ~ __ PIPE MATERIALS '~APPROVED ..... DATE LEGAL MUNICIPALITY OF ANCHORAGE Department of Health and Environmental ~rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~\[.~ ~ WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~q/~ ~. ~~~ Mailing Address: ~f~() Location: ~-F~"'~'O~-~' Legal Description: /~/~ //~ ? Type of Soil Absorption System Is: Trench: ~ Drainfield: Maximum Number of Bedrooms: ~ Phone Number: ~ ~ 3- f~ '~/~ Lot Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH ©{ LENGTH _~ -~-'". GRAVEL DEPTH "~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~-~9--L5 GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER ~1~ 1 9 o° 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the ~n-site sewer system may require enlargement if the r~ence is ~m~eled to include more that 3 ben, rooms. Signe~: ~/.~/~/~ Issued by: Q--~/~ ~~_~3,~--~ A~plicant ..... Z./'/ Date: / SWP/024(1/81) NIUNIC!PALITYOF ANCHORAGE DEPAHTM~NI' OF I'tEAL/It AND LNVII~ONMENTAI. PROTI~CTIOI\I 8,25 L. Shoet. AIIchoiauo, Alaska 99501 264-4720 SOILS I..OG -- PERCOLATION TEST SOILS LOG f.] PEIICOI..ATION TES1- pf~R PO[~ML:D FOR: ................. ~ .......... LEGAL DESCRIPTION: ...... D/\FE I>ERFORMED: SLOPE SITE PLAN 5 6 9 10 11 13 14 15 20 DERTH? ,,z ' ,;¢ F-~ ...... R, ad:n( i Dat.. -[ G,oss ~ Net ] Pepthto [ Net [ ' ' '~ [ " I ~ ime J Time ~ Water j Drop . / :- , ,'. -- '2 / PLRCOt /,, [[O1~ RAI E .................... (minutes/inch 72-008 ((;/79) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologic(31 ~ Geophysicol Surveys Drilling Permit No. LOCATION OF WELL (Please complete either Ia, lb or lc.) A.D.L. No. I-'~' I DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL:. ,' Address: Street Address Gna Area of Well Location /r~~ WELL LOG Feet Below Surfece 4. WELL DEPTH: (finel) 5. OATE OF COMPLETION ' ,. ,' . , ' ~ Auger ~detted ~,ored ~ O~her: - ~ ~ , .., ~ Irrigotlon ~ Rechor~e ~ Commericul r ', ' '' -] ":' ''/ /i~ ; 8. CASING: ~ Threaded ,~ Welded ~ Above or ~ Below I~nd surf. ce Dote ........... LI ~F A~CF ~ 5~ ft. after ~hrs. pumping ___ g.p.m. [5. Water Temperature __o ~ F ~ C LOCATION OF WELL (ridded tomplele sorb*# is. 16 of It ) +14104 NLLL RECORD STATE OF ALASKA DE PARI MENT OF NATURAL RESOURES Division of Geological d Geophysical Survey► ortll.na Permit No A D L he f7 aoreolk sabd.eislonelse% 1/e air plate Sete� MaUlea Ne Tea Rd Rip NO P-0/—of—o1 SCWEn,al ft DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS S OWNER OF WELL:, 1 �V1 w li f r.. +I�••rr� U. Aaereer• r I Y V L' •� 1 Street Address and Area of Well Localism fol, L. E WELL LOG Feet Below Soticte a WELL DEPTH. (flnell b DATE OF COMPLETION . 11. r .t - Materiel Tillie Too Sellas f []Cable feel ❑Relery ❑Driven ❑Dae O doer njH►ed E) Sarre 6 Other 1 I r + T.0►E: © Domestic Q Public saeFlr Q Indatf/T ❑ InlEonon RetauSe CMf e'ltol Test Well O Other. f •. 1 /..i +ry I'� •' 1- 8. 1 / 'A L I i !:• •/ ( J •l , I ! 1 S CASINGS C] Threaded '0 Welded diem.y_I% to 0'1'0 ft Depth Weight ,% rbapr diem. on to to Daofh anchor / of it. Y r t ver l 'i ,• 3 It r ' T ! 7 i ? 1 •. FINISH OF WELL: ''P.'0 Tied' �.r�r..l0len*Nft1� 4 Slot/Mesh SIN; Laaath: Set bel«w It and Il. Seehlunna �� Grovel Pace 10. STATIC WATER LEVEL: !J It. S~ `Z O Above of Q Shea land Surface Delo Eeviomenf used: r < DEPT, OF ►'FAITH ft.PUMPING LEVEL below lend surface find YIELD r 11 after% Mo, fi yah (- .I_ a. P. n.. to oiler hre ovfnplae 4.0 on. N 1 v 13 R 12.41ROUTINO Well areoted: 0 YOM © No Materiel: 0 Neal Content O Other: I .� IS. PUMP: (if available) No Length of Drop ripe fl capacity o p.m p Sob. p ,lot p Canitifitel p Other Id. REMARKS: Ie. WATER WELL CONTRACTOR'S CERTIFICATION: IS Water ts•Roeretare t] F O C `' _ This Wel •ace drilled oaaor 'my )urtaditllon an! In,e #@Poll to true to 1ne bile* el/./f eneelol7• and toliff; RodUfarad SuUnNa Nefne, �., -� _ Ce+ltncl'LICe Rfo N, -tel � Aeeldsl: 1 Lem-�'Q 3 `tea. •.f :.' • � , ., �. ` Signoo:��./ �/...J _ � .�-+.-� ''. _ ._' ,. __ .___. Dore•. _.. _.�_ Adtherltoo' pea•neRlat.ve form 0=•WWR (11/811 Copy *HIT[ • 5101. OGGS, pipe -0.104•, f,ahtRr •Gue1c••v Parcel I.D. 017-391-31 Certificate of On -Site Systems Approval Expiration Date: Legal description MOUNTAIN PARK ESTATES BILK 8 LT 11 Site address 13000 ALPINE DR Anchorage AK Current property owner(s) BRUNEAU 10/26/2024 X The On -site system(s) is/are approved for 2 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 7/182024 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 X Tank Age Advisory Arsenic Advisory Other COSA Approval —June 2022 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-391-31 Complete legal description MOUNTAIN PARK ESTATES; BLOCK 8, LOT 11 Location (site address) 13000 ALPINE DRIVE *ANCHORAGE, AK Current property owner(s) DEBRA BRUNEAU 2. ON -SITE SYSTEMS SIZED FOR 2 BEDROOMS Day phone 907-538-8827 3. TYPE OF WATER SUPPLY: X Private Well F71 Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units R Community Well or Public R Water Storage 4. TYPE OF WASTEWATER DISPOSAL: RE Private Septic R Private Septic serving 2 dwelling units R Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: Fj Steel X Plastic E] Concrete R Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F-1 AWWTS E] Bed El Deep Trench X Wide Trench R Seepage Pit Waiver request for: iA4- lL� TO ( r-,P -r7 c 7,Al-'k- Distance: Expedited review requested: n 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 Waiver Fee $ / 1'Z0 Date of Payment Date of Payment ZZ/�&L( COSA # Waiver #. () 5 V 2- � / C, COSA Application —June 2022 COSA Checklist Legal Description: MOUNTAIN PARK ESTATES; BLOCK 8, LOT 11 Parcel ID: 017-391-31 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA FNI Well log is filed with Onsite (or attached) Date drilled 5/25/1982 Total depth 180 ft Cased to 180 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/27/2023 Static water level at beginning of test 161.5 ft. Comments B. TANK DATA Measured operating fluid level in septic tank N/A Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: SEE ATTACHED RECORD DRAWING D. ABSORPTION FIELD DATA Which system tested (date installed) 10/2023 0 ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4.15 ft (min) ❑ NIA — pressurized field. ❑ Per record drawings, field is insulated. FM Monitor tubes go to bottom of effective. If not, state depth into effective soaked required if (Req d if house vacant or field not used for more than 30 rior to date of test) Gallons introd Any rejuvenation tre If yes, enter date Comments/Deficiencies: 12 months) date Well production at time of test 5.2+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No X Coliform bacteria is Negative Nitrate 6.23 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L X Arsenic less than MRL (ND) Collected by Anchorage Well & Pump Services Date 6/6/2024 C. LIFT STATION ❑ Required maintenance Age of lift station years Lift statio erial Adequacy test date NEW Results Q Pass Fluid depth prior to test Water added ` gal N/A in New fluid depth in Elapsed time min Final fluid depth - in Absorption rate 300+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 0 in Effective depth remaining 48 in COSA Checklist June 2022 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' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *98'+ ft ❑a Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' 50-1 Yes if No ft Holding Tank > 100' [E Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑a Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MN Yes if No ft QYes 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' ❑N Yes if No ft Surface Water > 100' ❑� Yes if No ft Tank to Property Line > 5' ❑m Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ■❑ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ❑■ Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' [E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *SEE ATTACHED WAIVER REQUEST 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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 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 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 septic systems depend i upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate 1 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 systems; 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 can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to 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 whatsoever. COSA Checklist June 2022 0 F A T - • S�4p�( ................. .....i.. ...... .... . . V. E ` y LICENSE }��� Pro r e s s;on�Qo #AECC884 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES PARf i , it; 907-343-7904 On -Site Water and Wastewater ectio - € x: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC241220 Subdivision: MOUNTAIN PARK ESTATES, Block: 8, Lot: 11 A water sample revealed a nitrate concentration of 6.23 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. in the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. �x Marling Address P xK7 fox 1966s0�` Anchora a Alaska 99519650 * uvv�rw mun� org " * * * * VARIANCE/WAIVER REVIEW * * Waiver#: OSV241032 COSA#:OSC241220 Permit#: P I D#: 017-391-31 Legal Description: MOUNTAIN PARK ESTATES BILK 8 LT 11 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 98.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on -site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: i Date: Z Approved by: l Name of Reviewer **** VARIAN C E/WAIVE R REVIEW **** ENGINEERINGgGARNESS A rote j. ENGINEERING z� SALES, CONSULTING June 21st, 2024 Municipality of Anchorage Development Service Department ®* • 9 fi On -Site Water & Wastewater Program • • • .1; 4700 Elmore Road ®' Anchorage, AK 99507 p �F Je '79 nes5: �® Ref: n r _ `t>�'k PROFESSIONP -0' e Mountain Park Estates; Block 8, Lot 11 Well to tank waiver request \®,.�®®��► To whom it may concern: 4 �i A new septic tank was installed at the subject lot on 10/25-27/2023. During the installation the 100' well radius was flagged, however, when preparing the record drawing (based upon the post -construction as -built survey), it was determined that the well was installed slightly inside the 100' radius. Per GEG field measurements, the edge of the well to the edge of the insulated riser is 99.77 feet. Based upon this fact, we are requesting a waiver of 98 feet from the private well to the new septic tank. Justifications for allowing this waiver are as follows: • Per MOA records, the 1982 tank had a waiver from 100 feet down to 93 feet. The new tank is an improvement regarding the separation distance to the well. • The previous septic tank was steel. The new septic tank is plastic. This is an improvement regarding potential corrosion and/or leaking of the septic tank. • The house is located between the well and the tank. If effluent were to overflow, it would not travel directly toward the well head. • Water samples were pulled on 6/6/2024 and the results are as follows: o Nitrate: 6.23 ug/L o Arsenic: non -detectable o Bacteria: Negative Attached is the nitrate mapping which shows nitrate levels for the area. As can be seen on the attached mapping, nitrates are elevated in the area. In short, it is reasonable to believe that the elevated nitrates are not due to the previous tank encroachment. We feel there is minimal risk in granting this waiver. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, GaenQss,� P.E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.garnessengineering.com MUNICIPALITY OF ANCHORAGE ~:~(C_)' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) Application Date Legal Description (include lot, block, subdivision, section, township range) Location (address or directions) Applicant Name __~,: Applicant Address -- Telephone: Home Business (c) Applicant is (check one): Lending Institution []; Owner/builderwE~; Buyer []; Other [] (explain); (d) Lending Institution. Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: _ TYPE OF RESIDENCE Single-Family E~Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well ~/Community [] Public E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ~, SEWAGE DISPOSAL Onsite,[~ Public [] Community I-] Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMA'rlON As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of sfructure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Nameof :rm_..~2~-J"j.~¢,~ ~.~: .... : I~- ~Telephone ZS'/./-,~: .-~:.-? /~,' Address "~=."2 ___~'..O ,~' ~//";'~t~ ~:~-~ .~.?"1 t t~ ~ /.> ~ II,/ -- WATER [IELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of colifot3n bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or Safety of the water supply. ON-SITE SEEAGE DISPOSAL SYS'FEf~I NOTE: This Health Authority Approval inspection merely certifies that the subject on=site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods al)proved by the f.lunicfpality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system~ Construction data reported on buried system components is from NOA files and was not verified during this inspection. CE - 4369 oO~ ::'~ Approved for _-/-"~a~ bedroo ,,"~/~ '~-/, ~,. ~ Approved __ ~- Disapprove~ Conditional~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 264-4720 WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth //,~ ! Static Water Level f~'~"~'-,~ / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Cased to ~ '~4¢~) ~ Depth of Grouting Pump Set At ~',,'~//~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /f~_~_.,~¢/ Water Sample Collected by . _ Water Sample Test Results Comments ./ .,~ 4¢~. ; On Adjoining Lots /~'"'~ ,/~" On Adjoining Lots ,/~¢~/ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date ,'~ Date Installed _~¢ Standpipes (Y/N) Depression over Tank (Y/N) SEPTIC/HOLDING TANK DA'rA Size ~::~::~ - No. of Compartments ~" Air-tight Caps (Y/N) ~/~--.-~ Foundation Cleanout (Y/NJ ,,~/-~ Date Last Pumped pu mping/Maintenance Contract on File (Y/N),'~,~ ;for Holding Tank High-Water Alarm (Y/N) _ /'~//~/- ' Separation Distances from Septic/Holding Tank: To Water-Supply Well ~,~ / To Property Line /,¢)" ¢' To Water Main/Service Line ~.$_~/ ¢' Course Temporary Holding Tank Permit (Y/N) ,,,"~ To Building Fougdation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System De,s~qn Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,~/~ / To Building Foundation ~.,~,¢~" Lot ..,~,¢.,'~"~2, ~¢~___~ ~ To Water Main/Service Line ~ / ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line //.,..%"-"* To Existing or Abandoned System on ; On Adjoining Lots ~..-.~/~ To Cutbank (if present) LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t ha~/~/~, e/hc4~k?d, v~e~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed //~.~Z~./! )¢~,,~W~.~;,'~ Date Company . ~t.~i-t'J, ovv~ e~(%,,,,-, r- MOA No. Receipt No. Date of Payment Amount: $ 2...~'~-> Page 2 of 2 72-026 (11/84) //-~ - }fY l.O. '# ' ....... BACTERI ANALYSIS TO ~E C~i;LETEO BY ~TEI~ SUPPLIER .).- ' DATE COLLECTED . .TIC TYPE )IVIDUAL Residential I.D, HO. (PUBLIC '~YBTENS) CIRCLE CLASS L I t i I I I ,A B C - NAH[ OF/SYSTEM / '' TELEPHONE NUMBER SYSTEM ADDRESS CITY STATE ZIP CODE LOCATION WHERE SA~MPLE WAS COLLECTED '~OLLECT~D, B~P: { S I G)NATURE ) TYPE Of" SAMPLE (CHECK ONLY ONE I~HIS COLUMN) ~DRINKING WATER ~/CHECK l~REATMENT I-~CHLORINATED F'IFILTERED [~4JRTREATED OR OTHER ~RAW SOURCE HATER [] NEW CONSTRUCTION OR REPAIRS r~ OTHER(Specti~y).i IS THIS SAMPLE A q£HECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? [:]YES I~J~o PREVIOUS COLLECTION DATE _ ANALYSIS REQUESTE!D (IF OTHER THAN TOTAL COLIFORM) SEND REPORT T,~: (~RINT F~L NAME,ADDRESS AND ZIP CODE r-) RESUBMIT 5AI~)LE Sample rejected because: CHECK ONE OR MORE I'l Sample too long in transit. Sample should not be over 30 hours. [] Sample received too late in week []Not in proper container C] Leaked out C] Insufficient information provided. Please read instructions on form. [] Other (Specify) RECEIVED FROM RECJ~IVEO BY DATE ~-~- %" TIME ANALYTICAL HETHOO: dMEMBRANE FILTER r"~FERMENTATION TUBE Date & Time Started ~-~ Date & Time Completed LABORATORY RESULTS [] Other Bacteria ~ Test unsuitable because: [") Confluent Growth [] TNTC ~"~U ~TISFACTORY NSATISFACTO~Y [] BACllERIOLO(iE~CAL WAlleR ANALYSIS RECORD FOR LAB USE ONLY 7~/ TffTAL COLI FORMS FE~CAL COLI FORMS O~HER Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By Coliform/lOOml BGB Date _Coliform/lOOml Time A.M. P.M. READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STP, EET, SU]'TE 200 ANCHORAGE, ALASKA 99501 Telephone: (907) Address: 274-2533 July 16, 1984 Arctic Engineers Inc. 1506 ~. 36th Avenue Anchorage, Alaska 99503 Dear Sir: Subject: Horizontal Separation Waiver for Private Well to Septic Tank Lot 11, Block 8, Mountain Park Estates Subdivision, Anchroage, Alaska (8521-WA-010) Tile Department has reviewed 'the subject waiver request and hereby v~aives tl~e horizontal separation between a private well and septic tank on the subject property to43 ft. Since, rely, ~nvi ronmental ~n~ neer BEE/msm cc: Robbie Robinson (HOA) Robert B. Charles 1300 Alpine Drive Anchorage, AK 99510 MUNICIPALITY OF ANC~.~,AGE DIVISION OF ENVIRONMENTAL HEAL%H DEPAF<I'MEN~I' OF HF~tLrrH AND ENVIRONMENTAL PROTECTION APPr~ICATION FOR HFJ~LTH ~/JTHORITY APPROVAL CERTIFICATE !. Cer~ral Information Appl icat ion Da te . _04= 25 ::~ (a) Legal D~scription (include. lot:, block, subdivisions, section, township, range) Lot 11, Blk 8, Mountain Park Estates Location (add~ess or di~,ections) SW Corner of Alpine & Bristol (b) Applicants Name Arden Charles Telephone 245- 2880 ,Applicants Address 8160 0pal Anchorage, Alaska (c) ~Applicant is (check one) Lending Institution ~-[ ; O~r~er/builcbr [X~]~i ; Buyer [] ; Other ~ (explain); ' (d) r~nding Institution Alaska USA Feder~ Credi:t_.[~ Telepho~ 563-4~_~_ Address 4000 Credit Union Drive (e) Real Est:ate Co. & Agent Adcb:ess Te le phone 2. [£~v~ o~f F~sidenca Single--Family C. ~-~[ NLm~Ye~ of ~dr~ 3. Water SuDolv Mu It i-Famd, ly Other (describe) Individual Wall Ii~! Ccg~,unity L-~[ Public [~--]~i Note: If ~nity %~11 system, must ha~ w~itten ~nf~n~ticn fr~ ~e State L%pa~nt of ~]viron~ntal Con~rvation attesting to tb~ legality ~d status. Is the v.e].l adequate for the n~r of ~ks s~cified in this E~A (Y/N) Y 4. ~3~g~ p~spo~al Onsite [~7] ~b].ic ['j] ~=.nity L~ Holding Ta~k ~ Is the wastewater dis~sal system adequate f~ the n~r of ~dr~ (Y/N) Y [Page 1 of 2] 2-15-84 5. _E_qg~neering ~ .~ Providin~q ir~__sj~.ctions, %eSt:s, Data and Information I certify that i have checked, verified, or confor~red to all MOA HAA effect on the d~te of this ins~.ctiono ( ENGINEER SEAL) Name of Fi~n Address S iw~d by Date Approved for ~._-[7-~ kedr¢~,ms Date Te le.p~one Terms cf Ccnditional Apu~oval Ihe Municipality of Anchorage? Depa~lunenh of Health and Environr{en[:ai Protecticr'. not i~arantee the eonti, m.ted satisfactcry ~rfom~n~ of t~ wate~r supply and/or wastewate:~ dis~sal system. This approval indicates that, as of the validati.oa sho~n ~x}ve, ~d on tl~ ~nta and information furnished [~f an engineer registere the State of ~.aska, the water supply and wastewater disposal system is safe ~nd tional for the nun~r of ~s and t~e cf s~ucture indicated. (DHEP SEAL) Mail the HAA to the following address: KB2/dS/s [Pat;e 2 of 2] 2.~i5--84 ao WELL DATA Well Classification Individual Well Log P~esent (Y/N) Y Total Depth 180' Cased to Static Water Level 158' Casing Height Above Ground +12" Electrical Wiring in Conduit (Y/~N) Y Separation Distances from Well: To Septic/Holding Tank on Lot_~ 96' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N/A If A, B, or C, D.E.C. Approved(Y/N) N/A Date Completed 5/25/82 Yield__ unknown Depth of Grouting none Pu~mp ~t ~t unknown 5.25 Sanitary Seal on Casing (.Y/N) Y' Depression A~oundWellhead (Y/N) N Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot Water Sample Collected By Duane Maney ; Date 4/25/84 Water Sample Test Results Satisfactory for Iota] Coliform ; On Adjoining Lots 100' + 100' ; On Adjoining Lots 100' + To Nearest Public Se~%r N/A C~t~ents~Waiver for well to septic tank, distance to 80' noted on well and on-site septic permit. 4/82 B. SEPTIC/HOLDING TANK DATA Date Installed___~6~_82 Size 1000 No. of Compartments 2 Standpipes (Y/N) Y Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 4-25-84 Pumping/Maintenance Contract on FileJY/N)N/A .; for installed in 6/82 Holding Tank High-Water Alarm (Y/N) ~/A Temporal%; Holding Tank Permit~__ Separation Distances f~omSeptic/Holding Tank: To Water-Supply We-ll 96' TO P~operty Lihe 5' + To Water Main/Servi~ ]Line Course None Noted 10' + To Building Foundation __ 6' To Disposal Field 5' To Stream, Pond, l~ke, c~ Major Drainage Conwaents []Page 1 of 2] 2-15=84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 6/82 Width of Field 42' Square Feet of Absorption A~ea Depression over Field (Y/N) N Results of Last Adequacy Test 215 Type of System Design Length of Field Depth of Field 9' Gravel Bed Thickness 5 640 Standpipes P~esent (Y/N) Date of Last Adequacy Test -~- installed in 6/82 Separation Distance from Absorption Field: To Water-Supply Well 100' + To P~operty Line 15' To Building Foundation 20' To Existing or Abandoned System cn Lot None ; On Adjoining Lots None To Water Main/Service Line 10' + To Cutbank(if present) --- To Stream/Pond/Lake/c~ Major D~ainage Course None Noted To D~iveway, Parking A~ea, o~ Vehicle Storage A~ea Co~Tents D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alaz~n Level at Tested for Electrical Codes (Y/N) Dimensions Mar~hole/Access !Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Couu~ents ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date ~ this ,inspection.. 4~////~/' 'J " ~/~ Slgned'2 < ~/~ Date / Company ./~[~'?/~ /'~]. ~/-~.c_ MOA NO. KB1/d5/s [Page 2 of 2] .~g ~..,. .........