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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)