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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 11 LT 10 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol 8, Geophy$icol Surveys ~. -dz:,:""" ?-.':t Drilling Permit No. :)CATION OF WELL {Pleose complolo either Io~ lb or lc.) A.O.L. NO. DISTANCE AN~ DIRECTIO~ FROM ROAD INTERSECTIONS ~. OWNER OF WELL; Feat Below 4. WELL DEPTH; (flnol) 5 BATE OF COMPLETIOn,.) . WELL LOG Surfoco / ~/~ fl. -- 9. FINISH OF WELL: ~ "// SIoI/M sh Size: Longlh; //~ Set belween fl, end ,~/' ~ Backfilling Gravel pack // ~ Above or ~o[ow land surfoco Dote I. PUMPING LEVEL below lend surface and YIELD MUNICIPALITY OF ANCHORAGE ~//['~ ft. after / hrs, pumpng ,":~ o.p.m- DEPT. OF HEALTH & ~ ft. after hrs. pumping ~g.p.m. 12.GROUTING Well Grouled; ~ Yes "~ No ~}~m ~ ,~ ~ Moterlol: ~ Ne~t Cement ~ Other: IS. PUMP: (if oveiloble} HP RECFIV Leng,h of Drop Pipe ~f" capocily ~ g.p.m. 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature o ~ F ~ C This well w~s drilled,~nder, ~y,j~risdlclio~ end lhi.~report is true 1o lhe besl of my knowledge end belief; 'V' R~gislered Business Nam.~_ ~ ~ / Conlract LIC~S~ ~smber~ .~ ..... ' ' '/ A u lhorlze~?'~epre~enlolivo er'.m:i,I;, I',.luml::~c,r ~: iiiiElC) :1. LJ p CJ r' e, cl ~:,:.) ]0 ~?:~.'Y J'::'J"l E)r'l (.:.:.? Il ..:,d., ..... ~ .I .... i::)~,,~n(cu" Nam(.:? :: I"IAI::.W I::'00'T' AI'qE:HEII::d.~t':)E ~, Al'::: ~?75 ~.~:~ Par' (:::(~:.~ 1 :1: d ',', 0:1.7...-4Zl. 1..~, 1:::.~; '~ Lc)T.. I...(.::~(;la:l.',~ SLd:u::l:i.v:i.~i:i.c)n~ IdOLINT'AZIXt F:'~I:~I< EW'r~..,:~t.~ 10 Blcicl.::~ :1.]. Plax I::;E!;I:<"I' ]: I:::'Y 'THAT ~ TiT wi. I 1 :i.n~d:..al 1 1:.he sy~it'..(,.:.)m in ac:(::(:)rdar'~c:(:>) ~,~:i.'Ll"'~ al. ]. MOA (:::c~de~, and arid J. ri (:::ciml::i].iai~c:e wi'Ll'l 'LI-IE, (:10;,~;J.J.:~r'l c:rJ.'f, er.:i,a o¢ t. lqi~rJ ~attop Technical Se-~ic$~ .... 14530 Echo Street Anchorage, Alaskc~ 9951¢ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION JUL 1 ].988 'RECEIV[D L~7- I0 ~3Lt'¢ I / _ I~ = tOO $1~ j..~'r' i~,, k'lOf4N "Fl) I IV MUNICIPALITY OF ANCHORA' ~EPARTMENT OF HF. ALTH AND HUMAN ,cERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-,1720 I~/ 7 '¢~¢ ] /¢ /_ /. /,m ~)~l~ _~_ ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na.,e '~'~~'U ?"w,~ ~_ /F,,~/~--- - DISTANCES . --J. TANKS ~ SEPTIC E~ HOLDING '--~/~/'~' ~' ~ ] No o' Co~E r~n ,s~ TYPE OF SYSTEM SEPTIC ABSODPTION TANK FIELD WELL /¢0 't- '4- AS-BUILT DIAGRAM tSnow Iocanon of well, septic system, property hnes, foundabori, ~x~TRENCH L~ BED E~ W. DRAIN ~ OTFtER /' PRIVATE OTHER fldenfifv) FT FT REMARKS: Sca;, Inspecbons Perlurh~ed Dy C i::' · 't (,~*( I __. c~,~_, ~~ cerlily Ihat Ihis inspection was pedormed according Io ail HealthDoparlmenlApprovak .~~ .. Da,e._r-XS-~ 72-013 (3,85) ROBERTA. SHAFER CIVIL ENGINFEH 694-2979 March 27, 1987 MUNIcIPA[i-~? OF A DEPT ~, NCHo~AGir: i~"~L PROTECTION 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 WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 REFERENCE: -CEIVED Lot 10; Block 11; Mountain Esttes Subdivision On-site Sewer and Well Permit ~860081 The on-site wastewater disposal system and well for the referenced property was installed in March, 1986. However, the on-site inspection report is being held in our files for non-payment of fees. A copy of this letter should be placed in your files until payment for engineering services has been made. If we may be of further service, please contact us. Sin~ ?ss cc: Dan Mar Construction SRB 196X EAGLE RIVER, ALASKA 99577 Anchorage P.C 'DX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES March 27, 1987 Dan Mar Construction % S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot 10 Block 11 Mountain Park Estates Subdivision #1 On-site Sewer and Well Pe.rmit #860081 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of March 26, 1987. Your permit expired on the date of issue basis by authority of Municipal Ordinance existing at that time. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. The new permit will come under the calendar expiration date as per the new Wastewater Ordinance (effective May 20, 1986). If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 343-4744. Sincerely, R.W. Robinson Program Manager On-site Services RWR/ljw #7 enc: copy of permit CDN'i AC;'!' F'I-'I[)NI}E~ I.,..li~ (}:hq I .. BI....[]CI<: ,~ :L :1. x-i~ 'i'ANI'::: i'"iUS~I IIAV[::: Ai' }..L.A,.. I TI,'JO [][)f"II::'AfR I'I"IEF.II'SJ I !:::' A L.. I F:"I 'I'1 'll:ii:N ( :L ) Ai".I Ef...I!}}:C'T F;: :1: C:AI.,. I:::'E]::~I"1:1: T AN:I) I BI~iiI::'I:~!:C:"I" :t: CIIq I"'11.1[~"1' I'Jlii!: Ok]]"A :1: NI!:J:D !i (.i?.) AS'"~':{IU I l...'l'~ii~ 1,4 :[ I..i... Ni]I' !:~li}i: (:~.F:'i:::'Ft'.C)',,"Ei:) 14 1 TH(iUT AIq li!i:l..EC'/'l:::'. ]: C~hl... I NSI:::'IE[:T I r:JN F;dii:F:'C)F(I" ~ AND (7.!;) THE: !:ii:l...ii}~C't'F:?. :i: CAi.. I..,.,I[j[:,,'K I"ILU:iTI' :C~i:~i: DC)NE i,.iY A I.. ]: CI!ii:N,S~[:i::]:) I}:]:l_.!~i:C"l'l::;~ I C :[ Al'q ,, .. 1 .... I. ~Z~:% ...... 1~:~ ~::>x..','r'l~: ..~ ~2.L~" ,qF:'F::'I.... :1: CAN'T, PERFORMED FOR: Mun,c,pahty of Anchorage DEPARTMENT OF HEALTH & 4UMAN SERVI~ 825 "L" Street Anchorage ALaska 99502-065~ ~OII. 8 LOG -- PERCOLATION SEAL) DATE PERFORMED:. LEGAL DESCRIPTION: ~r/~:) ,~Z~I( [/,/~ /-'~/¢~zL /~%ownship, Range, Section: SLOPE SITE PLAN 'lC ,/ / ,~ ~/' 10 11 12 13 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 14 __ -'¢~o'TT~ ~""- 15 16 17 18 19 Oeplh to Water Alter..~ ~ / ~ / Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~q~ ', t~ ~k~~ PERCOLATION RATE (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN . L~ FTAND . ~-- FT , / / :' ~', ~;~:'' ~"~ I /~~/ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ~,~ ,..-~ ' t" ':'e ~;:;'''* ~b~r"~ GUIDELINESI~ECT ON THIS DATE DATE' ~/?~ ACCORDANCE WlT~E STA~E'ANU~U~C ' ' ' ' 72-008 (Rev. 4~85) ' PERFORMED FOR: ~ O~' ,~IL'."~' ~:',,' ; ..... ~'~ ~'~NEER'S SEAL) DEPARTMENT OF HEALTH & HUMAN 825 "L" Street, Anchorage, Alaska 99502-065( ~7 ~ ,~'~ SOILS LOG -- PERCOLATION TES¢~;~;:'% '*" .z-, ...,~ LEGAL DESCRIPTION:L/o' /~11 A,fl¢', '-~,~'~¢-,'~ /~-5 .r Township, Range, Section: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? L DEPTH?IFYES'ATWHAT ~ I~_ pO E Depthlo Water Alter, - / I~onitarinD? ~J~ Date: '~/2''' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE .'.'.~'2~(mlnutesimch) PERC HOLE DIAM ET ER/'~:2 ~' TEST RUN BETWEEN I.~ * FT AND '~' FT PE~FORMED BY ~ (;';~',;.t,-."~,, ¢ ,~/~/ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) '1 su~ect: /_/(; .:// C ~lPUTATION SHEET 1~/7;,v, proc DA'rE: SHEET BY CKD OF EL.L. 0 C. ,,lPUTATION SHEET DATE_: SHEE-[ BY (';KD __ OF /'0~ 0 iD ---- P.O.E (196650 Mu~i~~¢,-~,1.~' I[y ,,~, ~ ANCHORAGE, ALASKA 99519-6650 O~ ~ ~': :;~ (907) 264-4111 ~'~ ;:: ~ . ~ TONY KNOWLES, MAYO~ DEPARTMENT OF HEALTH & HUMAN SERVICES June 23, 1986 Dan blar Construction 2830 East 88th Avenue Anchorage, Alaska 99502 Subject: Lot 10 Block 11 Mountain Park Estates Subdivision On-site Sewer & Well Permit #860081 - Issued March 26, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). Ail septic systems coustructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Aay changes in the code that could impact the constructiou requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, Susan E. 0swalt Program Manager On-site Services SEO/SSM/ljw (03 Municipality of Anchorage xy , On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-441-13 1. GENERAL INFORMATION: Expiration Date: 10-7-202,0 Complete legal description MOUNTAIN PARK ESTATES: BLOCK 11 LOT 10 Location (site address) 12549 Alpine Drive *Anchorage Current Property owner(s) Donovan Living Trust Day phone Mailing address 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: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class—Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Waiver Fee $ Date of Payment _z Date of Payment Receipt Number ('>.�r � Receipt Number COSA # t" / �J G 2.0129 7 Waiver # nkll 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 r Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend 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 _K System #1 Approved for J_ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foll 0, f: ... . y.. yeflgey Aw_cf6ess. r r t Cc 795 1• ,'��aG rof ession°:Z�� #AECC884 \`�illtttttf((���r o ter. r-- ash stip`ia. ,4T�® r w�. Original Certificate Date: 77— 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: MOUNTAIN PARK ESTATES; BLOCK 11, LOT 10 Parcel ID: 017-441-13 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA FE -1 Well log is filed with Onsite (or attached) Date drilled 7114/88 Total depth 144 ft Cased to 131.5 ft FOR Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/6/20 Static water level at beginning of test 129.6 ft. Comments B. TANK DATA Age of tank(s) 5 years Tank type/material SEPTtC,UEE Measured operating fluid level in septic tank 50" FW Standpipes/foundation cleanout per record drawing Date of pumping L4 LU D. ABSORPTION FIELD DATA DEEP TRENCH Structure served by this system 1 Well production at time of test 5.2+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes X No soliform bacteria is Negative Nitrate •fig mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L R -Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 6/5/20 C. LIFT STATION ❑ Required maintenance corn Age of lift station ,✓ Lift station mat iaf Co mme s: N/A Which system tested (date installed) 1/17115 Adequacy test date 6/6/20 Al ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade *14.1 ft (max) Fluid depth prior to test 23 in Measured depth to pipe invert from grade 5.0 ft (min) Water added 633 gal ❑ N/A — pressurized field 37 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 120 depth into effective 8.18 Elapsed time min 01 Code -required soil cover over field Final fluid depth 30 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies. SUMP FOR 1988 TRENCH APEARED TO BE FILLED WITH DIRT AND UNFUNCTIONAL - CONDITION OF 1988 TRENCH IS UNKNOWN. *AT MT COSA Checklist yellow sheet CI) E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' EYes Community Sewer Manhole/Cleanout > 100' •'ASSVIAEO ft ❑✓ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No. Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No. ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No. From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ❑ Yes if No. Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓0 Yes if No. Water Main > 10' El Yes if No ft Community Wells > 200'✓❑ Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) ft ft ft ft ft ft ft ft Building Foundation > 10' EYes if No •'ASSVIAEO ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ✓❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS MET CODE AT TIME OF INSTALL "INSPECTION REPORT FOR 1988 TRENCH INDICATES THAT THE TRENCH HAS LINE OFF OF THE SOUTH-WEST SIDE, NO PIPE IS AT THE END OF THE LINE SO WE CAN'T MEASURE TO FOUNDATION. -100'+ TO CLOSEST DRAINFIELD PIPE ON MT, PARK ESTATES; B10, L5 G. ENGINEER'S CERTIFICATION 4 � 01- f certify that l have determined through field inspections and review f of Municipal records that the above systems are in conformance with y 1 �•' �r "T MOA COSAguidelines inetfectonthis date. ,�..•,;••••,_j.•r•••••,••,...: COSA Checklist yellow sheet V.•- #AECC884 �ff rey'' 4� Gorness: k i CE—, _J \pro f ession°ate Nitrate Advisory Certificate of On -Site Systems Approval # OSC 201297 Subdivision: Mountain Park Estates, Block: 11, Lot: 10 A water sample revealed a nitrate concentration of 7.78 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. �.� � ��; 4 Ma�l�ng Address P O � Box 1.96650` Anchorage, Alaska 99519 6650 � www muni org v a r DEVELOPMENT SERVICES DEPARTMENT 04�i , 907-343-7904 On -Site water and wastewater Section a Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 201297 Subdivision: Mountain Park Estates, Block: 11, Lot: 10 A water sample revealed a nitrate concentration of 7.78 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. �.� � ��; 4 Ma�l�ng Address P O � Box 1.96650` Anchorage, Alaska 99519 6650 � www muni org v a r 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. y Mailing Address P O Box 19665Q *Anchorage,Al30- �,MlvwmmQN aska 39519 6650 * wv�iw muni org •� _� Municipality of Anchorage • On-Site Water and Wastewater Program (907) 343-7904 S A r C T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-441-13 • Expiration Date: 7-Z- l e 1. GENERAL INFORMATION Complete legal description _MOUNTAIN PARK EST BLK 11 LT 10 Location (site address) _12549 ALPINE DR Current Property owner(s) _TIM AINSLIE Day phone Mailing address SAME 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 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: 117i/(/ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 9—LI—1 t O' CD.b Date of Payment Receipt Number 2231 I c Receipt Number COSA# 05C-171 V2-0 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 MIKE N ANDERSON,P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON,PE Date 3/28/18 • F",oocoo° 6. DSD SIGNATURE System #1 Approved for bedrooms. �• c 94169 System #2 Approved for bedrooms. ,/��, Disapproved. y ,l'• Conditional approval for bedrooms, with the following stipulations: i5L-4 ON-SITE WATER AND •• wASTCWATER c.c.\4- PROGRAM �7 � By: � 'vim ,.�� � �— Original Certificate Date: "�� — 1016 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 sheet 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 EST BLK 11 LT 10 Parcel ID: 0I7-441-I3 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N)Y Date completed 7-14-88 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 144 ft. Cased to 131.5 ft. Casing height(above ground) 18"+ FROM WELL LOG AT INSPECTION Date of test 7-14.88 3-29.2018 Static water level 127 ft. 130 ft. Well production 3.0 g.p.m. 4+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 4.96 mg/L Arsenic: ND ug/L Date of sample: 3-29.2018 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL I SES C Date installed 1-17-15 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N)Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 3-29-18 Pumper AROUND THE CLOCK C. ABSORPTION FIELD DATA Date installed 1-17-15 Soil rating (GPD/SF) 0.6 System type DEEP TRENCH Length 58 ft. Width 2.0 ft. Gravel below pipe 9.0 ft. Total depth 13 ft. Eff. absorption area 1044 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3-29-2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 24 in. Water added 600+gal. new depth 30 in. Elapsed Time: 1440 min. Final fluid depth 24 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 100'+ Public sewer manhole/cleanout NA Sewer/septic service line 50'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 20'+ Absorption field 20' Water main NA Water service line 504 Surface water 1001+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 20 Water main NA Water Service line 50'+ Surface water 1001+ Driveway, parking/vehicle storage 50'+ Curtain drain NMIe k►wwr. Wells on adjacent lots 100'+ F. COMMENTS .R.,.'. .,-'11), ,� �r:: '® tt ,, • ,v G. ENGINEER'S CERTIFICATION "`�" 49TH •••....., I certify that I have determined through field inspections and :MICHAEL N. ANDLRSCN review of Municipal records that the above systems are in .......... •. •CE 69 conformance with MOA COSA guidelines in effect on this date. h",1:;* • I • �� Engineer's Printed Name MIKE N. ANDERSON, PE A igOe�E� ®w Date 313112018 COSA canary sheet_2-6-15.doc , (i • • LOT 11 •SEPTIC �%)' 7. VENTS 6, (`yp) `Si "i • 6' s sr�0- s? •• ��� �J LOT 9 �c (coo' 8• N wry. -1-'1 • • •4 N + 260 • / P rr-- N b. 4�0 X 12.0' C���� N <" mitis �rY 16.0' o It •(tw) i..) WELL r, t• O�G� 24.0' LOT 10 0/w 14P. �/ BLK 11 0��� 4Z,/ / 0.\/4 , / `, ®WELL R?0,3 y2, / o •OD / \ //7/ Roo L=43.53 � � R-30••I / / �_ �� Via. / ANCHORAGE RECORDING DISTRICT,ALASKA AS-BUILT OF: MOUNTAIN PARK ESTATES SUBDIVISION 0 =FND 5!8"REBAR LOT 10 BLOCK 11 PLAT P-501 s_'"�N� SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a �'�, O F A\\i yQ' LAND S DRvei physical survey of this property as shown on this drawing and that the // �`S. •• L9s�� �'��\° fi,�`f improvements situated hereon are within the property lines and no A.:. ..1— •.•� I# ,a4r/ t�✓� cnchroachments exist other than noted.Under no circumstance should / Gj: 4N �y ' .�o r any information on this drawing be used for construction of fences, fr ° ° �, 0. C structures,improvements,or for establishing boundary lines. 5 o . . C) EXCLUSION NOTES:It is the owners responsibility to determine il A . . i_ I. • OEN L. SCHULLER. o/= 0 ''1 the existence of any easements,covenants,or restrictions which ,g. At; do appearnot ' . LS-10408 . , .................. on the recorded subdivision plat / o •. o�/ 1831 Talkeetna Street MORK ORDER NUMBER: Mte BOLE C-M 1 ey •(.,V•x••15' a i Anchorage, Alaska 99508 JAN 15. 2015 1-=30' Imeengook.n `lQ.oteaBionol vp,' (907) 227-1455 office 15-002 au,.+et acaaa ardor®e,,mt' .LS 2838 150103 �\\\`�1'• (907) 274-4992 fax 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # Parcel I.D. # 1. GENERAL INFORMATION '¢: I Complete legal description Location (site address or directions) Property owner _ M.~¢-¥. Mailing address --J-2 q:5_~ Lending agenoy -- ~'-~-~' ~ ' " Mailing addre Agent ~A~ ~,~u-t'~T // _~MA× Address Unless otherwise requested, HAA will be held for pickup. .,, Day phone ANCt . /LK Day phone. Day phon. e NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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 NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1./91) Fronl MOA 1~21 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/or wastewater 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__]~L,qT-rOP 'T'EcH Phone Address ~/~-53o ECHo ~gT ~__~.NC/C.~k.,, ngmeers s gnature ¢~"~~ ? ~ DHHS SIGNATURE -,-/-- Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: . 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 this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state req uirements. 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. 72-025 fRev. 1/91) 8ack MOA #21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT 1o, ~Ll( II. HT' pAI~Ic E~T'¢~1 Parcel I.D. ~'l,/~2'--/-/q A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to If A, B, or C, attach ADEC letter. ADEC water system number Date completed 7/1~/~8 Driller ALPINE 131.5' ' ._Casing height I/~" -- FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) g.p.m. -- AT INSPECTION g.p.'m~ Septic/holding tank on lot ~ I~o Absorption field on lot Public sewer main ;>, Io~' Sewer service line ~ ; On adjacent lots >too ; On adjacent lots '-~ Public sewer manhole/cleanout Petroleum tank go~' e6$~eV[b WATER SAMPLE RESULTS: Coliform ~ co Date of sample: Nitrate -/¢' ~'/-~ Other bacteria ¢ ¢o/ //co/,, .~ Collected by: I~L ~1 TT°P T£ 6,/4 ~l/~S B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size Jooo ~4c .. Compartments Foundation cleanout (Y/N) 'i" ' Depression (Y/N) Alarm tested (Y/N) ~/, ~. Pumper ~"~ ~_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~- ~o¢ ___On adjacent lots To property line -~25 _Absorption field Foundation /o Water main/service line Surface water/drainage CONTINUED ON BACK PAGE 72-026 (Rev. 7/91) From C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length ~5'/ _Width :2.5' Total absorption area _ Depression over field (Y/N) Results (pass/fail) _ Peroxide treatment (past 12 months) (Y/N) hlor4~' KN¢~'~' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ l(o On adiacentlots Surface water Soil rating 2:5 ¢'//8~)~ - System type _ Gravel thickness (~ ~ - Total depth Cleanouts present (Y/N) Y Date of adequacy test _ for If yes, give date bedrooms t -Propertyline To building foundation 2o On adjacent lots ~ 3o' Surface water Curtain drain To existing or abandoned system on lot N,/~. .Cutbank_ N,A, -Water main/service line Driveway, parking/vehicle storage area ~, $ ~ 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. Signature .~-/--~ Engineer's Name_ Date /'-1'~/~, '2..,:~/ /~ HAA Fee $ _ / 7 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number : MUNICIPALITY OF ANCHORAGE ~  Department ot Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTiFiCATE OF iNSPECTiON FOR HEALTH AUTHORITY APPROVAL OF ON_S,TE SEWER AND WATER FACILITY FOR S'NGLE FAMILY DWELL'NG Parcel I.D. # ~ 1. GENERAL iNFORMATION (Must be completed prior to submittal) Description (include lot. block, subdivision, section, township, range) (a) Legal o1~ O /~/kr (( /~t°~'/~"~' ~r/m ~(/~ ¢¢f Location (address or directions) i ~Jnz Telephone: (home) ~Business ~ (b) Property owner ~~ Mailing AddreSs (c) Lending Institution Mailing Address , , . (d) Real Estate company and Agent Address Telephone Mai~ the HAA to the following address: (or check here i~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-FamilY [] Number of bedrooms ---------- 3, WATER SUPPLY Individual Well [] Community E3 Public [] . Note: If community wail system, must have written confirmation from the State Department of Environmental' Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL Holding Tank [] On-sitel~ Pu. blic ['] . cQmmunity [] written confirmation from the State Department of Environmental Note: if community well system, must have Conservation attesting to the tegaittY and status. page 1 of 2 72-025 (Rev. 7/88) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS F Ascertifiedbymysealafflxedheretoandasoft~, ........ ,. ~LESEARCH, DATAAND INFORMATION ' , ,,~ va,uauon date shown below, I verify that my/nvestigatJdn of thi~ Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of 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 Address ~ Date ~ Engineer's Seal 6. DHHS APPROVAL Approved for ~ bedrooms by ~ Approved ~ Disapproved ----------_ Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does institutions inordertosafisfycertain this as a courtesy to purchasers of homes and-their lending federal and state requirements. 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. , Employees of DHHS do not Conduct inspections 72-025 (Rev. 7/88) 8ack Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST ' FEBRUARY 1984 343-4744 Legal Description: Well Classification ~E~ If A, B, C, D.E.C. Approved Well Log Present (Y/N)~__ Date Completed ~ Yield Total DepthJz~' Cased to ~Depth of Grouting ~' Static Water Level ~' Pump Set At ~ Casing Height Above Ground-- I ~'" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: · On Adjoining Lots To Septic/Holding Tank on Lot _ ~' ¢ ' To Nearest Edge of Absorption Field on Lot ~~; On Adjoining Lots To Nearest Public Sewer Line -~~- To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ; Date I - Water Sample Collected by ~ ~ ~ ~' Sample Test Results _ . ~. Water ~ ¢ ff Comments ~ ' ~ - B, SEPTIC/HOLDING I'ANK DATA , J¢~ / ~?L~/g~_ Size ~~ No. of Compartments Date nsta ea Standpipes (Y/N) ~~Air-tight Caps (Y/N) ~Foundation Cleanout (Y/N) Date Last Pumped Depression over Tank (Y/N) ~-----J~-- ; for Pumping/Maintenance Contact on File (Y/N) ~ Holding Tank High-Water Alarm(Y/N) ~_~, Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-SuPPlY Well --~:72~- To Building Foundation I~' ' '80 ~ + To Disposal Field -- ,5~ ~ To Property Line To Water Main/Service Line ~~ d Lake or Major Drainage. Courcs. e ~ -- ~ .- .',~', ,,¢2 To Stream, Pon . . ,, ¢~ . ~,,~~- 72 026 (Rev 7/88) Fro~t Page 1 of 2 To Building Foundation Lot To Water Main/Service Line To Cutback ('if present) To Stream, Pond, Lake, or Major Drainage Course ~ ~c,w , To Driveway, Parking Area, or Vehicle Storage Area Comments C. ABSORPTION FIELD DATA So/Is Rating in Absorption Strata 'E E~- O' '?Zl'cZr,~ Type of System Design Date installed -.~/ ~.~O Width of Field ~,5" Length of Field ¢"'~~ ' Depth of Field I¢ / Gravel Bed Thickness O~ ~' Square Feet of Absortion Area ~¢ ~ Staqqdpipes Present (Y/N) Depression over Field ('Y/N) Date of Last Adequacy Test Results of Last Adequacy Test ,d~ ~...,z¢__ ~ r ~ ~¢¢,d~c,,,. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~, ~ To Property Line /o' To Existing or Abandoned System on ; On Adjoining Lots ~ D. LIFT STATION N, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at_ Tested for Meets MOA Electrical Codes ('Y/N) Comments Dimensions Manhole/Access ('Y/N) -"Pump Off" Level at Vent ('Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** .I certify that I have checked, verified, or conformed inspection, to all MOA and HA~..El~d~itlOs in effect ;~gmn::n~ ~~~~~E~ ...... ~ .... on the date of this Receipt No Date of Pa ' Ym~.. Amount: $ ~O Waiver Fee: $ 72-026 fRev. 7/88)Back Date of Payment Page 2 of 2