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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 9 LT 14Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ~ - 4 P.O. Box 196650 · Anchorage, Alaska 99519-6650 e TeLephone: 343-474 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~NM ~21~'Ol'~i'Xl¢' ~ PID Number: O ~_~_"' ':~c:L( - 4t~ ress: No el ~drooms: LEGAL DESCRIPTION ~ubdiwsion: Block: Township:~ Range: ~ /~ D New D Upgr~ Classilicalion ~,C): Driller: ased 7o: Ft. FL ,te Drilled: aic Water Level Ft. \hove Ground: Ft. DISTANCES pump Sel at: GPM To From Well Surlace Water Lot Line Foundation Curtain Drain lastewater System: D New .~Up9rede "~Deep Trench Gravel widlh: ,.~ / absorption area: SQ. F Installer:~. ~_...~,,~ ¢_~) ~ Ft Ft __ ~'~:~ Pipe material TANK Holding nafacturor: ~ateriaL Ft Size in gallons: i on" level at: iSST.E.P. LiFT STATiOi'- Remarks: '~t..'~--c---J) lr~'c'~'~z~-~ ~ N~ ~ L~cation and Description: MARK Inspections performed by'-'"~'¢¢-- ~¢_..S¢ Dates: lst~/~/~ Department of He~alth and~fm~I'~/Services approval Reviewed and'approved ~~ 72-013 (Rev. 9/9D MOA25 '~SSU mod Elevct on: ENGINEER'S SEAL / ,A, Garness : E.7953 ~O Permit No. ~3~d ~1 t% o 14-4" Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telep.hone: 343-4744' On-Site Wastewater Disposal System and/or Well InspeCtion Report MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950144 DATE ISSUED: 7/07/95 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE: 7/07/96 OWNER NAME:SHOWALTER RICHARD W & JULIE A OWNER ADDRESS:6001 BRISTOL DR ANCHORAGE, ALASKA 99516 PARCEL ID:01739142 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK 9 LT 14 LOT SIZE: 23800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS(18AAC80) · 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION- PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING FOLLOWING SPECIAL,~ISIONS' 5 THE SPECIAL PROVISION~//~.v~ RECEIVED BY:~ I S SUED BY: DATE: 7/~/~J~ DATE: 7- 7- ~ Alaska Water & Wastewater Services "Preserving The Last Frontier" Municipality of Anchoracje I)eparl;r ent of Health and Huiflari Services O/vision oi- Environmental Serv~,ces On-Site Services Section P.O. 8ox 196650 Anclnorage, Alaska 99519-6650 Ref: Sept,to upgrade at Lot !4, Bk 9, Mountain Park Est l'o whom ii; may concern: GENERA[.: The subject property is served by a private well mhd a septic system. Currently the structure has three bedrooms. The property owner intends go build an addition which will raise the number of bedrooms Lo four. Therefore, it will. be necessary to increase lshe size of the septic system. An adequacy best was performed on tl~e well to verify that it is adequate for 4 bedrooms, and an adequacy test was performed on the existing septSc system ~o verSfy hhai; it &s adequate 1:or 3 bedrooms, g copy of the adequacy test report is at:tached with this ).egret'. TRENCH UPGRAI)E: The existino drainfie].cl was ii~sl;alied 6/92 by S & S Engineering. It is 54 fee~ deep ~ith 7 feet of drainrock below the invert, provlcling an a, bsorpbion area of 756 ft2- The pt'opos~d one ~edt'oom upgrade w~11 Do En95neorirlg.. The soils in this, area peri<ed at a rake of .6 gpd/ft>:; therefore, the upgrade will Inave to provide 250 lb2 of absorption area. The additional l;rench will be 18 'Peek. ler~9 wi-bin 7 'i':ee'l; ef drainr'ook be'iow the invert, providing an abs;,orpt~.on area of 252 ft2- In short;, it will be the same dimensions (w~d'l;h and depth) as the exist;~ng system. SEPTZC F~IqK UPGRADE: The existing !000 ga,].lon septic tarlk ~as i.r~sta].led in tl./27/82. We are proposing to upgrade with a new 1250 ~jallon tank. SURFACE ~gATERS: Thero are ~o surface waters within tO0 feet ef bh8 pi'oposed tlpgradas. TOPOGRAPHY: The end of I;he new trench segment will only abou~ 3 feot ?rom a slope which drops a~ 27~ for 12 feet (,5.25 foot a]evati, on drop), and th[m drops, 40~ bher(¢after for a. ppreximatoly 10 'Feet (4 foot elevation drop), I si]ob Telephone: (907)337-6179 · Fax: (907) 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska99504 ~hat; ~{; is on.ly abo~ 2 f~e~ I'~h~r ~han ~h~ ]~ve~ ground ~':h~.~ })o~;tom of tl'i~ m~.~t~)at~k~ 'rhe disl;ance from t:he end of the new drain pipe ~;o gh~ edg~ of bhe ~ul;bank, where ~t Gould day].~ghb, :i~; 19 feet;. The slope fror,~ the new pipe ~_rlvel-1; ~l'~e bobbom of ~he cubbank ~s approxJ, m~be]y lO~ (2 -fee~/25 WATER SOFTENER: The home is served by a water wh:ich backwashes afben every 2000 gallons of usage. The backwash cycle uses approximately 42 gallons of watser. If 600 gallons is used dail. y in bhe house ~he sysbem will baokwasl~ 2.1 bimes per week (average)_ This will result. ~.he addibion ef 88.2 gallons per week, oc t2.6 gpd in'bo the draini:ield. This addit:ional hydraulic load is ins~.gnifican~. Howevep, because of ~he advense e$fecLs of sodium chloride on sepbic systems, ~ have reoommended t. ha~ 'bhe homeowner-s look inbo using pobassiu~ chloride as an a]berna~ive regenerate. SUMMARYx I arr~ unaware of any adverse impac?,s bhis installation weuld have on any adjacenl; we].ls on septic syst. ei~s. If you have any quesbion, please call i~8 a Sho'l_2 ~ wps Alaska Water & Wastewater Services "Preserving The Last Frontier" June 17, 1995 hlul]J cir.)al _il;y o'f ~]nchorage F)epartment o'f lt(saltln and tlurnaF~ Services D.ivJsion of Env~r-or~menba]. Services On-~S~t~} Services Se(ohio] P.{]_ Sex 1.96650 Anohersge, ~].as[qa 995.1.9~66.50 Re'f: Septic; upgrade, and adequacy test at Lot 14, BI( 9~ Mountain Park Est. To whom it may concern: l'he subject property is served by a private well and a septic system. Currently 'Blue structure has Bhree bedrooms. 'the property owner in~ends to build an addition ~hioh will raise the number ef bedrooms to four. Therefore, it will be J]aCessary to increase the size of the septic system, and verify that the well is adecjuabe for four bedrooms. Prior i:o designing &he septic upgrades ~ ran an adequacy Bes~ on the septic system to see if it was adequate 'for 'l;hree bedr-ooms~ Zn addition, I ran an adequaoy test on ~he ~o ver~'Py tt]a~ it ~s adeclua~e for a four bedroom house. The results o¢ bhe tests are summarized as 'follows: SEPTZC ADEQUACY TESI' (6/10/95): 'File exisbing drainfield was :insta]le;d in 6/92 by S & S Enginemr:i. ng. Upon inspec:tJr'~g men5 Boring tube Z found i t t,o be g~_~ ]C~__ ~M.- initially introduced wa't,~r into l:.he H.]', hewever Z noted U]at the Iiquid ievel rose 20.5 inches within the first: i4 minutes of the test (6'/ gallons), clearly IlOt represenBat~ve of the }iqu~d r~se ~n the lsrench ("s~ow dna~ner"?)~ Z then began ~o ~n~roduce waBer ~n~o ~he c}ean-ou~ a~ bhe end of I:he ~ren~h. The l:Lqu~d level in ~he monibor~ng ~ube d~d riot subside [hroughoL~b Lhe remainder of 'f~ZZ&ng port,on of ~he ~esl;.. Perhaps &he mon~tor&ng ~ube ~s plugged ~:Lbh fines ~l~e lower porbJon? Regarcl~ess, Z ~n~roduced ~ater ~n~o &he trench aL an average rabe of 4.87 gpm for a ~obal of 200 m:i. nu~es (975 gallons). The ~iqu~d level Jn ~he monitoring tube rose to a depbh of 29.25 ~nches, correspond~rlg ~o 55.5 ]'he system r<:'~co\/ery was monitored for 45 mint.lbas during ~hich time the waber' lev~sZ dropped 7 inches (2.35 9aliens). The total, dept, l-~ of the trench is 7 feet, cons6, ClUent. ly, 1;l'~ere. ~as 54..7'3 inches o1: virgin dra~nr-ock above the highes~ Telephone: (907) 337-6179 · Fax: (907) 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska99504 liquid love], aciliovod dur'il~g this test. Based upon th.is data the septic system was deemed to be a. dequage fop a 3 bedroom house (450 gpd]). Zn order to upgrade ho a four bedroom syster, i8 t,~il! only be necessary to increase bhe existing trench size by 55 percent_ ]'his will require the Addition of 18 feet o'P trench the saae ~dth and depth as ex~sting 1S year old (]~/2-//82), lO00 gallon septic tank and replace tt with a new 1250 gallon tank. WEht ADEQUACY TEST (6/]0/95): 1'he static level in the well prior to beginning the test was 156 feet below the top of the well casing. The total, depth, accor-d~ng to the well leg, is 205 feet. Water was pumped al; a rate of 4.87 gpm for a total of 200 minutes (973 gallons). The ~ater revel dropped to a depth ol; 159 'feet (3 foo~ drawdown) ~ithin the 'first 10 minut;es of the test and remairled stable thereafter. Zn short, it was recovering as fast as water was bei. ng pumped out (4.87 gpm). Based upon thJs data ~he ~e].] ~as deemed to be adequate for hhe proposed 4 bedroom S~rLIOtLlre~ yOU have any question, [):Lease ceil. me a 557-6179. Sinc:are!y P.i{. ~ tq.S. NOTE: The adequacy o'? a se, p~ic s.yste.m~ J's influenced nu~erous f actors~ .fncluding, but not limited to, seasonal surface water .~nfiltrat~on, groundwater variat.~ons, septic of biolo~ica~ additives), condition of drain pipe and pipe joir~ts ~which can be damaged by seismic activity and df3teriorate with age), type of ::~ubstal]Ces deposited septic system (cigarette butts, sanitary napl<~ns, mist objects), and the amount of water beirt~ ~ntroduced on a continual tJasis. Conseque~ntly, the results of this adequacy test are oD1y va'L~d Sot the speci¢ie da~ o'f tl'~e test. S ho I 1. wps Lo'r 7 E-7953 fey A. Garm CE-7953 q~ .'5'o Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~C"'~V~/ cJ~O I J fo PID Number: 01'~ ~ame:gl~C)j~,-~'J~j~,..~ T~¢~(O~ Wastewater System: "~ ' ~ Upgrade Addr~: _, ~O, .~ IOZ~ ~ ~'~ ~/d ABSORPTION FIELD P~oje: ~ ~~ ..... ~=No. of B~ooms:~ ~DeepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION /¢_~ O,~ GPD/Sq' Ft' Lot: j ~ Block: ~ ~)O~Subdivisi°~¢~ .~ ~ Deplhto pipe bot,om fr~o~iginalgrade: Ft. Gravel depth ben% ~ipe Ft. Township: Range:_LSecti°n: Fill added above~ orig~a~_ grade: Ft. Gravel length: ~ / Ft. WELL" ~ New ~ Upgrade Gravel~ , Numberof lines: Distance between li,es: C~cation (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: F~O Drille~ StatioWaterLeveh 'nst~"~':TW¢¢O EX 6-2-?& ~~ ~kL~ ¢~ Datejj_~.~Drilled: ~¢ Ft. ~ , Date installed: Yield: Pump Set at: Casing HeJghJ Above Gro'und: TAN K SEPARATION DISTANCES ~eptic g Holding ~ S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Private ~anufaoturer: Capacity in gallons: From Tank Field Station Tank S .... Lines ~ _/0CO Well ~O~ ~0t~ --_J~/~ ~/~ ~ Material: %~L .__Number°f C°mpartments: s.rfac. ' ¢/A LIFT STATION Water ~ ~ .]¢0' P Lot ~ ~ Size i~ gallons:~ Line ~0'~ ~ ~ "Pump on" level at: "Pump off'~h ~ater~ alarm at: Foundation ~,~ Curtain ~/~ ~/~ Pump Make & Model ] Electrical lnspections performed by: ~ Drain ....... Remarks: ~StS~I~ ~tc I~ ~ BENCH MARK Location and Description: / Assumed Elevation: I ¢0~ ~,~ lnspections performed by: ~* % ~e,~,~ Dates:lst ~-¢-~& Department of Heal~ a~d Human Services approval Reviewed and approved by: Date: Z- 2~- ~2 -~- ,r,~. / 72-013 (1/91) MOA 25 Permit No. ~,~/9~Ott& Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: LOT I~r, ~l...~.c~ /~l~o~NT~'l~ ~ ~s % / / '-- / ~ .... 72-013 A (2/91) MOA 25 Permit No. ~/~/~O)1~ Page Municipality of Anchorage DEPARTMENT OF HEALTH ANB 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 72-013A(2/91) MOA25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 I.~- ANCHORAGE, ALASKA 99519-6650 ~'> ~o .~ ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920116 DATE ISSUED: 5/29/92 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 5/29/93 OWNER NAME:NORTHERN TELEVISION INC OWNER ADDRESS:P.O.BOX 102200 ANCHORAGE, ALASKA 99510 PARCEL ID:01739142 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK LT 14 LOT SIZE: 23800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE DISPOSAL FIELD MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S RESIGN DATED 052192. RECEIVED BY: ~ ~' DATE: ISSUED BY: . , . DATE: May 15, 1992 ROBERT SHAFER, P E. ROGER SHAFER. PE. CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SiTE WASTEWATER DISPOSALSYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Mountain Park Estates, Block 9, Lot 14 Request you issue a permit to upgrade the septic system serving the referenced property. The existing system is in a state of failure. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, ~.~ ~ ....... ROGER J. SH~%FER, P.E. RJS/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I"= 50' SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN IF YES, AT WHAT DEPTH? p E Oeplh to Waler AFter Monilorinl]? Reading Date Gross Net Depth to Net Time Time Water Drop / 2. ~. ~ ~ ~,. ~'/~ " ye" PERFORMED BY; o ~t o gn,~,~-~;~r,-.],~.~G I ACCORDANCE WITHIA'TL~_2S'~r~I~¢~r01~f~P/~I~,ii~I~)~iN EFFECT ON TH~S DATE. DATE: Eagle River, Al~ska 99577 72-008 (Rev. 4/85) PERCOLATION RATE ¢2~O (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 1,0/7,/¢ CERTIFY THAT THIS TEST WAS PERFORMED IN % MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PH ONe' '" MAILING ADORESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well [ Absorption area Dwelling PERMIT NO. DISTANCE TO: -~ [ ~CJ' ~ ~ M~nufacturer Material No. of compartments ~ H Liq. capacity in gallons Inside length Width Liquid depth /d)~(3 IF HOMEMADE: ..... Well Dwelling' PERMIT NO. ~ ~ DISTANCE TO: O ~ < Manufacturer Material Liquid capacity in gallons  DISTANCE TO: Well ~'-/20F Foundatio~ / Nearest lot li~e PERMIT NO. ~ ~ ~ No. of lines Length of each li)~e Total length of lines Trench width Distance between lines ~ ~ / ~/ ~/ / ~ ¢ inches ~ ~ Top of tile to ~nis~de~ - Material beneath tile ¢¢ [. i.6~ Totaleff~ct,veabsorptionarea¢;~ Length Width Depth PERMIT ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: ~ Cl~s , ~ Depth b~iller Distance to lot line PERMIT NO. ~ Buildin9 foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO; ~ ~- /~/ ~-/.20 .... ( PIPE MATERIALS (~ -- SOIL TEST RATING INSTAL G ( 'L APPROVED DATE LEGAL 72-013 (Rev. 3/78) ~ ('~ ~[~I)X ~-~ ,~TAR I{OUTE A ANTCHORAGE~ ALASKA SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF PROPERTY OWNER LOCATION OF WELL SITE WELL LOG: COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF DATE THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRI!~LING WORKS ~ERVlCE ChARgEOF 1V~% Per MONTH WILL BE A~SE~SED ON PAST DUEACOOUNT~. F'ERh'I I T NO. iPF'LICFINT E:ECHFIROF C:ONE;T E:O',:.:', 6;403 FiNNE',:.:', 95.,502. .OC:RTION BRISTOL .EGFIL. LJ. 4B9 FIT F'K ESTFITES LOT SIZE "'SF:'E OF SOIL. RBSORF'TION S'SSTEM IS: TRENCH 'IR',:.,',IHIJM NLIP1BER OF BFDROOMS = g SOIl_ RFITING ,::SQ tHE REQLIIRED SIZE OF' THE SOIL FIBSOF.:PTION SVSTEM IE;: [> E F" -F B--~ ==: d_ :~_ L_ F_E" i"..,~ L-~ T' I---t == -5 ~.E-~ NZ:,~ g--: F~ %." ~£ L_ 'I"HE LENGTH [>IHENSION IS THE LENGTH <IN FEET:.', OF THE TRENCH OR [:,RFIINFIELD. THE DEPTH OF Ft TRENCH OR PIT I'.{; THE DISTFINC:E BETI4EEN THE SURFRCE L-IF THE: GF:'.OUND RN[':, THE E:OTTOH OF:' THE EX(.7. R',,,'IaTION ,::IN FEET;,. THEF.:E IS NO SET 1.4IDTH FOR TRENCHES. THE GRRVEL DEPTH I':..l THE: HINIMLIH DEF'TH OF' GRFI',/EL BE]"I.qEEN THE 01~ITFlaLL PIPE FIND THE BOTTOH (:iF THE E',,.:',C:R',,~RTI'ON 4]:1'4 FEET.':,. :'ERI"II'F I-aPPLICHNT HFIS ']"HE RESPONSIBILIT"? TO INFORM THIS DEPFIRTP1ENT DUF.'.I'NG THE IN:.-T, TRLI_FFI'ION INSPECTIONS OF FIN¥ HELLS RDJFIC'.ENT TO 'f'FlZS PROPERT'9 RND THE '.4UI"IBEF.': OF' RESIDENCES THFIT THE HELl._ HILL. SEF.:',,,'E. T' [4 E? ( L-~ ::,, .l: i"-4 "-E-.'; F" i EZ: -F Z i.~J f-,t S la F=: EE F: E (;:~ El 3: F: [E [.~ E:RC[.'.:FILLING OF' FIN'¢ S'SS'T'EH H:['FHOUT F~NFIL INSF'ECTION RNB, RF'F'RCI'¢FtL E:'9 "FH.T.S ::,EPRF.'.TMENT HILL E:E 9LIL::JEC:T TO PF.'.'C~SECUTZON. MINIMUM [:,][STRNCE BETbE-:EN R HELL laN[::, RN'90N-S.'[TE SEI.,.IRGE D.!:SPOSRL SYSTEM IS :L00 FEET FOR F~ PRI',,,'RTE HELL CIR :1.50 TO 200 FEET FRi3r,1 R F'UE:LIC HELL DE:PENDING UPCIN THE T'T'F'E OF F'UBLIC NELL.. hllNIhlLIH [:,ISTFINCE FROM la F'RI'¢FITE HELL TO R PRIVRTE SEb. IEF.: LINE IS 25 FEEl" laN[::, TO FI COHMUNITY SENER I_ZNE IS 75 FEET. 14EL. L I..OGS RRE F.:EQUIRED RND MUST BE F,::ETIJF.:NED TO THE DEPFiF.'.TP1ENT b4ITHIf.,I _-...':0 DFI'SS OF THE bJEI_L COHF'LETION. OTHEF:'. REf2UIF.'.'EMEN'FS P1R'9 FtF'PL'9. SF'ECIFICFtTIONS FINE:, CONSTRUCTION DIRGF.'.RMS RRE R',,¢R]:LFtBLE 'T'O INSURE PF.'.OPER INSTRLLFIT:[ON. F:"E£ F;-:l"-I Z T' EE::-::F' :[ I1::~.". E'. "-% [~:,EECZ:E I'.IEE:EF-: -~::~..-, I CEF.:TIF'.¢ THFIT 1: I RI"'I FRI"IlLIRI~: HITH THE REQUIREMENTS FOR ON-..SI]"E SEHERS RND b. IELLS RS SE'[' FORTH B'9 THE MUNICIPRLIT"r' OF FINCHORFIGE. 2: I HILL INSTFtLL 'THE S'SSTEM IN FICCOF-.'DFINC:E I.,.IITH THE CODES. 3: I UNDERSTFIN[:' 'fliRT THE ON-SITE SENEF..: S'SSTEM r,IR'¢ REQUIRE ENLRRGEf'IENT Il:' THE RESIDENCE IS REMODELED TO INCL.UDE MORE THRN 3: E:EDF.:OOMS. S I GNED: .............................................................................. FIF'F'L I IZ:RNT E:EC:I-IFIF.:IZ~F' _.. ~N_-:,T ................ F'iPPL lc.~Nl' 6~6H~ .... ¥:7 . ~ , -.>~ ~ .' ~ . .~ ~ ~ 74/:', / - i TH~.~ tlRQU[REI) -~[ar~ OF,"' rite SOIL ~:::::..: ::: :FHE;~ Et~ ~) ~1' [,][DTH FOR :: THE ~V~ O~TH IS THf~ N[N[~flJN O~fH ,,~ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SLOPE DATE PERFORMED: /0--' SITE PLAN 3 5 10 11 12 13 14 15 16 17 18 19 2O PERFORMED BY: I'? '7 72-008 (6/79) ENCOUNTERED? O P E IF YES, AT WHAT DEPTR? Gross Net Depth to Net Reading Date Time Time Water Drop 0 r Parcel I.D. 017-391-42 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 A F r T Y Certificate of On -Site Systems Approval I. GENERAL INFORMATION: Expiration Date: JW og Complete legal description MOUNTAIN PARK ESTATES; BLOCK 9 LOT 14 Location (site address) 6001 Bristol Drive *Anchorage Current Property owner(s) Mike & Callie Hauser Day phone 201-602-3724 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® 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 ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Jr' 5 Q Waiver Fee $ Date of Payment /�/rg/ Date of Payment Receipt Number Qq? 7(G Receipt Number COSA # 05 C 2 11 6:2 (o 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 Engineerinq 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: 10 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 upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and 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 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. 6. DSD SIGNATURE 'z vl' System #1 Approved for .1 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following #AECC884 10/1 r/ ON-SITE iG, WATER AND m �JvlatiOMT',_--VATER z DPROGRAM ,c. ,1 J),),, r,SERv��\\��� By: IiJJ Original Certificate Date: 10bQ/2,0 a / 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 Tar ������� Checklist � ����.�m� ��mm����u���� ( Legal Description: MOUNTAIN PARK ESTATES; BLOCK Q.LOT 14 Ifmore than 1septic system onlot: COGAChecklist #oi A. WELL DATA blVVe||log iefiled with Onsite (or attached) 1112/82 Total Tota|depVh 205 ft UNKNOWN ft Sanitary sea! iufunctioning correctly Wires are properly protected Cayingheight (above ground) 12+ in. Date ofU10/8/21mw�eatfnrCO3A Static water level a' beginning of test 159.9 ft, C-omrnente B. TANK DATA AQeoftank(a) 26 years Tanktypa/maUaha! ====" Measured operating fluid level in septic tank 40" W1Stand pipeo/foundadoncleanout per record drawing Date ofpumping D. ABSORPTION FIELD DATA DEEP TRENCH Which eyo�emtested (date installed) 729" JE:1ALL standpipes present per record drawing Total measured depth hnmgrade 14.8+ft(mmx) Measured depth to pipe invert from grade 8.0 ft (mm) [I NA\—p/eseurizedfieid Monitor tubes go to bottom of effective. If not, state depth into effective ____ 1:N]Code-required soil cover over field ��Systemp/emoaked 'Required ifvacant for greater than 3Odays prior to date oftest) Gallons introduced N/A gallons Commenta/Deficienciea:*TESTED 1oozTRENCH ONLY COSA Checklist yellow sheet [)f�\/k�(�� Parcel ID: 017-391~42 Structure served by this system Well production zttime oftest 6.7+ ~pm Water storage tank volume N/A gallons coliform test? M' Yes l� No �V �o|Vn bacteria is Negative Nitra1el`mQ/L i] Nitrate less than MRL (ND) Araen|cug/L [k'A/oeniuless than MRL (ND) Collected by GEG.LTD Date ofSample 1014/21 C.LIFT STATION LJ Required maintenance completed Age oflift station years Lift station material Comments: N/A �omm� A�q������ Results E]Pasa For 3 bedrooms Fluid depth prior to tent _vin Water added °005 gal New depth 39 in Elapsed time 205 min Final fluid depth 7 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12months) If yes, enter date N/A From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station onLot 1771 Yes if No ^ Community Sewer Manhole/Cleanout 100' F2[Yea ifNoft FR^yeo ifNoft Property Line >5' n/ Yes Neighboring Tank >1OO' ZYes ifNoft Wells onAdjacent Lots: Private Sewer/Septic Line >25'[E]Yes ifNoft Absorption Field onLot >10O' [�n/es ifNo� ifNoft � HoNingTank >10O' ��r,eo ifNoft Neighboring Absorption Fields > 100' Water Main >1O' ifNoft Animal Containment >GO' Yes ifNoft Yes if Yes ifNoft Water Service Line >1U' ��Yeo -- ifNoft Manure/Animal Excreta Storage 08'FiA ` ifNoft Community Sewer Main >7G' [9Y*o ifNoft LIJYeu From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations >1O' 1771 Yes if No ^ ft Surface VVater>1O0' Yen ifNoft Property Line >5' n/ Yes ifNoft Wells onAdjacent Lots: Water Main >10' Absorption Field >5' Yea ifNoft Private Wells >1OO' Yeo ifNoft Private Wells >1O8' Yea ifNnft Water Main >1O' ifNoft Yes ifNoft Surface Water > 100' Community Wells >2OO' Yes ifNoft Water Service Line >1U' ��Yeo ifNoft |fseptic tank iaunder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation >1O' Yea ifNoft |fabsorption field iaunder driveway comment below Property Line >1O' Yeo ifNo____ft Wells onAdjacent Lots: Water Main >10' RqYea ifNoft Private Wells >1OO' Yeo ifNoft Water Service Line >!O' MV Yes ifNoft Community Wells >2OU' Yeo ifNo____� Surface Water > 100' MV Yes if No ft F. ENGINEER'S COMMENTS 18'PORTION OF DRAINFIELD & SEPTIC TANK WERE INSTALLED 7/28/95 FOR THE PURPOSE OF ALLOWING THE SYSTEM TO SUPPORT 4 BEDROOMS. THE l,q'TRFN(',H IS COMPLETLEY FULL. *2'FROM ST1 TO DECK POST (S�EE PHOTO) � G. ENGINEER'S CERTIFICATION certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with A. Fries rotess MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Nitrate Advisory   Certificate of On‐Site Systems Approval # OSC211626  Subdivision: Mountain Park Estates, Block: 9, Lot: 14  A water sample revealed a nitrate concentration of 7.08 milligrams per liter (mg/L).   The  Environmental  Protection  Agency  (EPA)  has  established  a  maximum  contaminant level (MCL) of 10.0 mg/L for public drinking water systems.  While  private wells are not subject to this regulation, EPA standards are based on existing  health information and can therefore be used to gauge the relative quality of water  from private wells.  Since nitrates are known to slowly increase, we recommend  you monitor the water quality.  Please see the attached “Nitrate Fact Sheet” for  important information regarding nitrate.  This advisory must be attached to all copies of the subject Certificate of On‐Site  Systems Approval.                                 Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org  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 medi a with a strong affinity for negatively charged  ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.  TESTING:  Nitrate analysis is usually done by one of the several  “wet  chemical”  methods  using  a  spectrophotometer to read the final color endpoint.  Specific ion electrodes also can be used to detect  the activity of nitrate in water.  This laboratory uses several different wet chemical methods approved  under the public water supply laboratory certification program.  They also have test kits available, which  the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can  monitor the change in nitrate levels from their well.  They recommend comparing the test kit results  against a certified analysis from the lab occasionally to verify the accuracy of the kit.  We recommend  using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.          MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Septic Tank Advisory   Certificate of On‐Site Systems Approval # OSC211626  Subdivision:  Mountain Park Estates  Block:9, Lot: 14  The septic tank for this property is 26 years old.  The average life for a steel septic  tank is 20 years. Typical replacement costs range from $7,000 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 30 year old steel tank MAY look like.      ��WzTm; • • { g G eislc Municipality of Anchorage On-Site Water and Wastewater Program a 1 " (907) 343-7904 SA CTY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-391-42 Expiration Date: 1-13-0 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES BLOCK 9, LOT 14 Location (site address) 6001 BRISTOL DRIVE,ANCHORAGE,AK 99516 Current Property owner(s) ALAN &JUNE WILSON Day phone Mailing address 6001 BRISTOL DRIVE,ANCHORAGE,AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be release. e e neer, unless otherwise requested by the engineer. COSA Fee $ 5 2 to Waiver Fee $ Date of Payment 5.--""K -17 Date of Payment Receipt Number cog 1-0 Receipt Number COSA# SSC- 1/ 1 IWaiver# 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/1212017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen �-411"- • encroachments,deficiencies or discrepancies exist. OF4 tS- 6. DSD IGNATURE ,',4, TI1' /\ -`�1, i - System #1 Approved for bedrooms. � hENNE,� /,r ` System #2 Approved for bedrooms. 4 �'r 116 ;�, 1 p 1 Air Disapproved. \�''OF�ss.10,s ' Aar ' \\_�� Conditional approval for bedrooms, with the following stipulations: �Qp'�"1TY 0A- `,'fr.( Vn /51O(i o WA EFQ �c�-. _ NI WATER z= =`, o PROGRAM o:. QJ�_ 4 ',,P,SERVICEs., t..."..--.._\' i Original Certificate Date: /(C) —( 3 --(7 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheel_70.10.12.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES BLOCK 9, LOT 14 Parcel ID: 017-391-42 A. WELL DATA Well type PRVT If A. B. or C provide PWSID # Well Log (Y/N) Y _ Date completed 111211982 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 205 ft. Cased to 205 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 1112/1982 5.11.2017 Static water level -- ft. 161 ft. Well production 5.6 g.p.m. 5.8 g.p.m WATER SAMPLE RESULTS: Coliform NEG &NEG colonies/100 mL Nitrate 7.65&7.79 mg/L Arsenic: ND ug/L Date of sample: 4/19/2017& 10/9/17 Collected by: PANNONE ENG.SERV.&ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC /STEEL Date installed 7/2911995 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 5/10/2017 Pumper ALASKA SEWER&DRAIN C. ABSORPTION FIELD DATA Date installed 6/2/92&7129195 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type DEEP TRENCH Length (54'&18') _ 72 ft. Width 2.5.3 ft. Gravel below pipe 7 ft. Total depth 14.8 ft. (measured 5/11/17) Eff. absorption area 1008_ft2 Monitoring tube Y Depression over field N Date of adequacy test 5-11.17 Results (Pass/Fail) PASS '(Tested 1992, 54'L Trench) For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 820 gal. New depth 28 in. Elapsed Time: 1350 min. Final fluid depth 0 _ in. Absorption rate >= 600+g_p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ - Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN_ Wells on adjacent lots 100'+ F. COMMENTS 1995 trench is saturated. 1995 trench is slightly lower than 1992 trench based on elevations taken. 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. OF AZ'al A. Engineer's Printed Name KENNETH M.DUFFUS •j Date 1011212017 4 9 TH* Alav aziOranir COSA canary sheet_2-6-15.doc + KLNr rIH'. 4� + � 7i re el k , I ' !2— • Municipality of Anchorage _,�;= 8` } 'iii o.r Development Services Department n;,:; `- p: Building Safety Division F. 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 # OSC 171179 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 9, Lot 14 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 7.79 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. • • Municipality of Anchorage On-Site Water and Wastewater Program <'� (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-391-42 Expiration Date: g 17 -1 1 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES BLOCK 9, LOT 14 Location (site address) 6001 BRISTOL DRIVE,ANCHORAGE,AK 99516 Current Property owner(s) ALAN &JUNE WILSON Day phone Mailing address 6001 BRISTOL DRIVE,ANCHORAGE, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: C17 —/ 7 COSA to be released t ngineer, unless otherwise requested by the engineer. COSA Fee $ 52-4 - Waiver Fee $ Date of Payment 7/15111 Date of Payment Receipt Number OOH I Q Receipt Number COSA# Qejc 11 ti-loi 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. 1 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 5/12/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments,deficiencies or discrepancies exist. Apr �, OF ,4. � 1- , 6. DSD SIGNATURE — ��-- /)C System #1 Approved for �l bedrooms. + F KENNETH M ,� r A 7116 System #2 Approved for bedrooms. 4 % Disapproved. t P'»10`'•\' Conditional approval for bedrooms, with the following stipulations: WATERON-SITE �,. AND • TFR oz `• WASTEVVA \ PROGRAM , By: ;� �1—•1. ot/ Original Certificate Date: 6---/ 7 -( 7 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheel_10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES BLOCK 9, LOT 14 Parcel ID: 017-391-42 _ A. WELL DATA Well type PRVT If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 111211982 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y Total depth 205 ft. Cased to 205 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 111211982 5-11-2017 Static water level -- ft. 161 ft. Well production 5-6 g.p.m. 5.8 g.p.m. WATER SAMPLE RESULTS: Coliform _ NEG colonies/100 mL Nitrate 7.65 mg/L Arsenic: ND ug/L Date of sample: 4/19/2017 Collected by: PANNONE ENG.SERV. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC!STEEL Date installed 7/29/1995 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout(Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 5110/2017 Pumper ALASKA SEWER & DRAIN C. ABSORPTION FIELD DATA Date installed 6!2192&7129195 Soil rating g.p.d./ft2 sr ft2/bdrm) 0.6 System type DEEP TRENCH Length (54'&18') 72 ft. Width 2.5- 3 ft. Gravel below pipe 7 ft. Total depth 14.8 ft. (measured 5/11/17) Eff. absorption area 1008 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5-11-17 Results (Pass/Fail) PASS *(Tested 1992, 54"L Trench) For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 820 gal. New depth 28 in. Elapsed Time: 1350 min. Final fluid depth 0 in. Absorption rate >= 600+g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ _ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS 1995 trench is saturated. 1995 trench is slightly lower than 1992 trench based on elevations taken. G. ENGINEER'S CERTIFICATION l 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. o r i OF Al-4t11 Engineer's Printed Name KENNETH M.DUFFUS s AQ� I 1 Date 5/12/2017 /2119' 4 • TEl * # COSA canary sheet 2-6-15.doc ` 9 KENNETH.?�' ���� IB L p'�FESSI�~a4 � • Municipality of Anchorage �' y , � "� Development Services Department ;-, g41111:°:104; Building Safety Division s,,,,, 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 # OSC 171179 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 9, Lot 14 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 7.65 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAt.TH & HLJMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) ~)(~ / [~, ~l..qTO L_ Property owner Mailing address ~0/ Lending agency 9f~~ ¢~'~,~ ~o~ ~ Day phone Mailing address_~Oo ° Agent ~(~:v- ~&~ ~ / ~'~: ' ' . Address IG~,O0 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verily that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ; Name of Firm Al~.k~ Water & Wa~ewate~ Phone ~20 Eas~ Chester J-~t s.~ Circle Address ~,,"'h. o h ,dV~ o'o//~l'~¢rl~ ~ qg.~fl4 Engineer's signature / 7t..0, Vl . ~ DHHS SIGNATURE X Approved for 4 bedrooms. Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health Authority ApprovaJ Gertificates based only upon the representations given in paragraph $ above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a ecu rtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ 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 professionaJ engineers work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description:/...oT'/L'[! ~L~f y~tuT~rllL~ .'~__----'~b~C ~(( ParcelI.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~© ~' A. WELL DATA Well type ~-~\Uh-~-- Log present (Y/N) Total depth Sanitary seal (Y/N) Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Static water level (~,~J~ ~ //o / Well production ~- ~ g.p.m. //"7~ (~ g.p.m. WATER SAMPLE RESULTS: Coliform '-~-- Nitrate ~. /~ Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed :~/;~cllc~ Tank size .J,~%© ~;~ Number of Compartments ~ Cleanouts(~N). ,~ Foundation cleanout (Y/N) /L/~£ Depression (Y/l~) ~,.)o High water alarm (Y/l~ /'')//'/)- Date of Pumping ~/P.'/?~' Pumper /'~¢//~'."',~'~ ~u.~.?/~JC System type Total depth C. ABSORPTION FIELD DATA Date installed ~ :)_ L~'r~or~ Soil rating or fF/bdrm) ~ Length ~C~+l(& ~. '~ Width ,~,%' - [,0 ' Gravel thickness below pipe __ Depression over field (Y/~__ For Effective absorption area /~ ~ ~ Monitoring Tube present (~/N). ~ Date of adequacy test ~/~l/~ Results (P~/Fail)~£J- bedrooms Fluid depth in absorption field before test (in.); "~/-L~' Immediately after'~5~- gal. water added (in.): ~ I/~ Fluid depth ~l"Z-t/' (ins) Minutes later: ~%~-,~,,.~ Absorption rate = (~00 ¢ .g.p.d. Peroxide treatment (past 12 months) (Y/I~ /'~o If yes, give date 72-026 (Rev. 3/96)* Manhole/Access (Y/N) High water alarm level at* Size in gallons ~~"~~'~ "Pump off" level at* *Datum ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line /Oo ¢- /oo '4 On adjacent lots On adjacent lots / Oo ',¢ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ ~ ~ ' Property line / o ~f Water main/service line /O ~¢ Surface water/drainage /Oo'¥- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: /O -f Property line Surface water Curtain drain Absorption field .S Wells on adjacent lots /OO Building foundation /C~ ~.L Water main/service line '-/- Driveway. parking/vehicle storage area .~ Wells on adjacent lots /4~0 ',/- ENGINEER'S CERTIFICATI~,~ Signature Engineer,s Nam/~ HAA Fee $ .-~(~(~ pO ¢ Date of Payment Receipt Number ~)~'~7 o¢~/'~ 3J~'/ ! 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Lot 14; Block 9; Mountain Park Estates Location (site address or directions 6001 Bristol Drive Property owner ~~oan Northern Television, Inc. Mailing address 1~'~'~,,,, , W~t ,,=,~,~= °'~'~ A~,e~tu~.,z'*,,,c, Lending agency Day phone Day phone 562-3456 Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 % TYPE OF WATER SUPPLY: individual well ×X Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. t/9~) Front MOA~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and typeofstructureindicatedherein. I furtherverifythat based on the information obtained from the Municipality of Anchorage files and from my' investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for 5 & 5 ENGiN~F.~iNG 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 9957Z Phone bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72q)25 (Rev. 1/91) Back MOA It21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /_-(D'T Il'-// ~(.,~ o{ /V)OOZAiT/~dlU Parcel I.D. A. WELL DATA Well type ~'(\uPr~F-_ If A, B, or C. attach ADEC letter. Log present ,~N) Y/~-'~% Date completed ( Total depth C-~('~ ,~ Cased to Sanitary seal (~N) F-~ ADEC water system numb r //%-~- ~,',~ Driller Casing height Wires properly protected Y~N) FROM WELL LOG AT INSPECTION Date of test / [- o~.- ~ ~ / /- 5- ~ [ Static water level (/t. ~ I ~8 Well flow < - ~ ~.p.m ~ Pump level (~ /~ + SEPARATION DISTANCES FROM WELL TO: Septic/~ tank on lot Absorption field on lot Public sewer main Sewer service line I~O '~- ; On adjacent lots /OQ '/' J I 0 '~- ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: ~:~- ~-~ ~' Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed I Cleanouts (~) ,,3_. High water alarm (Y/I~ Date of pumping Tank size /00 0 (--,¢¢-- Compartments Foundation cleanout ~_,¢~J) Y~--~ Depression (Y/~) ./'L)o Alarm tested (Y/~_~ ~- ~ ~ Pumper /-}' ¢' ~0~:~ SEPARATION DISTANCES FROM SEPTIC/H~iC~I~I~qG TANK TO: Well(s) on lot I ~O ' ~' TO property line L.(0 ¢,F Surface water/drainage On adjacent lots Absorption field /0o '+ -FFoundation . Water main/service line 2,5 72-026 (Rev 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION High water alarm level ~ Cycles tested ~ Meets MOA ele~~_ ~TANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length. 5~' Width Total absorption area Depression over field (Y/~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/~_~) Soil rating $' ~'~' {~ ¢*¢'~'/= System type 7 Gravelthickness ~ ~ Totaldepth. /[ ~ /~; / Cleanouts present (~_2N) ~'~5 Date of adequacy test A~/.,cr for bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots /0o ¢- Property line_ /O '-/' To existing or abandoned system on lot Cutbank f'¢/¢~- Water main/service line. Driveway, parking/vehicle storage area Well on lot //0 '/' To building foundation On adjacent lots ~0 ' Surface water I/Od Curtain drain ,~ 0/'J~-- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, $ & $ ENGINEERING Signature ~7034 Eagle River Loop Road No. ~:~ie ~iver, Alaska 99577 Engineer's Name Date ~¢'- / '~ - ~t ~ HAA Fee $ ~ Date of Payment Receipt Number 72-02~ (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number APPLIC FILLS OUT UPPER HAl. .ONLY PropertyOwn~r -',~..~(/ /1/~f~2~/' (~>.,,~:'./~ ~/ ~ Phone Mailing Xddre~ ~3~ X /F Address Zip Code Lending Institution _ -- ~/~ ~ ~__ Phone , - Realty Co. & A~nt Phone Address Zip Code Type of Residence ~'¢Single Family ~ Multiple Family No. of Bedrooms ~ Other W%e~pply ~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June 1975· ~ Community For wells drilled prior to that date, give well depth (Attach log if available). ~ Public Utility Sew~ Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~7~ ,.). C') /~/._., ~?:.:,./ MUNICIPALITY OF ANCI4ORAG~ · //.:/.. DEPT Cc i,:'Li RF_.C, EIV ~ APP~OVED BEDROOMS 'CONDITIONS OF APPROVAL ( ( ) DISAPPROVED ( ) CONDITIONAL AP~BOyAL' Soils Rating Date ~wer Installed Well To Absorption Area /(~ t', } Well Log Received / .d'"'~ ~) - /i1. '~-'2, "'J;'~. 'i. Well to Tank /? ~'--~ t Septic T~R Size 72.023 (3182)