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MOUNTAIN PARK ESTATES #2 BLK 3 LT 3
,, '" Municipality of Anchorage Page I of '~' 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: ~'vJ ~1~) oo ~.~:> PID Number: E:)I"J -O'ZZ. - Name: /~. G;,e~.~,~.'; ~,. t?=,~u~ o~t A. ~e~ Wastewater System: C New ~ Upgrade Address: ~J~ ABSORPTION FIELD No. of Bedrooms: Phone: ~ _ff~fl ~ ~ Deep Trench ~ShallowTrench OBed ~Mound ~Oth~ (~1.~ Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: ~ GPD/Sq. Ft. ~,~ Subdiv~ion: ~ 3epth to pipe bo~om from original grade: Gravel depth beneath pipe Lot: ~ Block: ~ ~e~<~t~ ~ I ' ~ ,~ Ft. l, ~ Ft. Township: ~ Range: Section: Fill added above original grade: Gravel length: I Number of lines: Distance ~een lines: WELL: ~t~,~ew D Upgrade ~erave, width: 5 Ft. I -- Ft. Classification (Private. A,B,C): Total Depth: ~ Total absorption area:~ Pipe material: Date instal{e~: Driller: ~riiled: Static Water Level: Installer: ~ ~ ~o~ ~/{t laid: ~~ Ft. y J Casing Height Above Ground: TAN K / GPM I Ft. Ft. SEPARATION DISTANCES D Septic ~ Holding To Septic Abso~tion Lift Hotding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~C~O ~ ~ Number of Compa~ments: Sudace -- -- LIFT STATION Water lO01+ Joel+ Lot t Size in gallons: Manufacturer: Line ~O~ ~Ot~ ~ ~ ~oO~ ~o~A~E ~ ~a~ "Pump on" level at: ~ "Pump off" level at: High water ararm at: Pump Make & Model Electrical Inspections pedormed by: Drain ~ . Remarks: ~ I~ ~ )~od~,q~ BENCH'MARK Location and Description: Assumed Elevation: /Oq.~ Ft.: Inspections performed by'. .......... ~ ~-.,---.~ates: 1st s ~ ~..,~ ~: ~F 7320 East Chester HtS. ~,e 2nd ~" ~ Depadment of Health and Human Se~ices approval Reviewed and approved by: ~ Date: ~'Z~ .?~ 72-013 (Rev. 9/91) MOA 25 PEE~ .U~aR: AS BUILT DRAWING ' $W980026 ' 017-022-15 ~. ,..INSTALLED ~PLE POET (SP) ~ ~LD mENCH, NOT CONNECTS. ~ ~ ./ / __~ ~ ~ ~ ~ / v~ ; ~H2 37,75' . ' - ~ ~ ~ ~ ~ / ~RA~u~ :o3 - 27.~5' 39,5' I I ~ ~ I ~0 ~ = ~ ~.::,::'::c~'~.",'-~95.36 C03 87 7.78 WAS~WA~R A~S~ WA~R ~ ....,~ AS-BUI: OF SEPTIC SYSTEM 3REP~ED FOE: PHONE NUMBS: GREGORY R. BALOUGH/LORI A, STEPHENSON 545-9899 vO~,~......~ J.L.M. 1 = 30' 2 OF 2 INSP/C'I'iON I~EPORT /~I(JN!CIPALtTY OF ANCHOFL~.GE, BUILDING SAFETY DI'v'iSION 3500 EAST TUDOR ROAD NAME. ADDRES~ LOT CO~V, ME,NT8 c.r DiREC. TiGN$. ~.NO NONCOMPLIANCE OE~ERVED [ ] WILL ~[.E~JINE AT N~T iNSPeCtION [ ) 00 NO'r CONC~L U N'IIL ~INSP/CTED DO iqOT AE,¥OfiE TP, J$ ,NOTtC~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980026 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:ROSENBLUM FRED & ANDREA OWNER ADDRESS:12840 SAUNDERS RD DATE ISSUED: 2/06/98 EXPIRATION DATE: 2/06/99 PARCEL ID:01702215 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 3 LT 3 LOT SIZE: 20130 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION 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 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS IS A PERMIT FOR AN INNOVATIVE WASTEWATER DISPOSSL SYSTEM (RECIRCULATING TANK WITH UPFLOW FILTER). INSTALLATION SHALL BE ACCORDING TO THE SPECIFICATIONS OF ANCHORAGE TANK AND WELDING. RECEIVED BY: ISSUED BY: DATE: -' A\][aska Wa cer & W,a :ewa : r 7320 East Chester Heights Circle ~ Anchorage - Alaska 99504 February 24, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers Ref: Septic System Upgrade for Lot 3, Bk 3, Mountain Park Estates #2 RECIRCULATING UPFLOW FILTER (RUF) SYSTEM To whom it may concern: 1. GENERAL: The existing 3 bedroom home is served by a private septic system and well. The existing trench is surcharged and must be upgraded prior to the sale of the house. Due to the protective radius' of the well on the lot and the wells on the adjacent properties, there is only one suitable site on the lot to put the septic system upgrade. One test hole was dug to the north of the existing trench. The soils are summarized as follows: 2. SOIL CONDITIONS: The test hole was dug to a depth of 17.5 feet. No groundwater was encountered during the excavation, or after monitoring 7 days later. A percolation test was done at a depth of 7.25 feet to 7.75 feet and the absorption rate was 120 minutes/inch, unsuitable for an onsite septic system, but not impermeable. A percolation test was run at a depth of 3.75 feet to 4.25 feet, and the absorption rate was 10 minutes/inch. The intent is to place the bottom of the trench at a maximum depth of 3.25 feet (high side of the hill). 3. DRAINFIELD: The intent is to install a Recirculating Upflow Filter (RUF) system that will allow the use of a small drainfield in the area of the TH. The size of the drainfield will be based upon the previously established criteria for the RUF systems, which dictates that soils percolating between 1 & 30 minutes/inch have an allowable application rate of 4 gpd/ft2, and soils percolating between 30 & 60 minutes/inch have an allowable application rate of 2 gpd/ft2. Given the perk rate of 10 minutes/inch the 4 gpd/ft2 application rate would apply. We are proposing to install a 5 foot wide trench that is 30 feet long and has an effective depth of 12 inches. This corresponds to an absorption area of 171 ft2, or an application rate of 2.63 gpd/ft2 (assuming 450 gpd total flow). 4. ORENCO PACKAGE SYSTEM: The STEP tank with the trickling and upflow filters will be manufactured by Anchorage Tank & Welding to meet the latest design criteria established by Orenco Systems, Inc. The point of contact at Anchorage Tank is Lowell McNutt. Since you are familiar with the operation of the system I won't elaborate. As with their standard STEP tank, it is equipped with a high water alarm per M.O.A requirements. 5. SURFACE WATER: There are no surface waters within 100 feet of the proposed upgrade. 6. TOPOGRAPHY: The entire lot slopes moderately downhill (approximately 15%), from east to west. There are no slopes greater than 25% within 50 feet of the proposed trench. 7. LOT LINE WAIVER: In order to fit the new trench into the limited space available (and maximize the separation distance to the old trench) it will be necessary to place the new trench as close as possible to the north lot line. The only impact which may result would be that it may limit the neighbor to the north (Lot 2, Bk 3, Mountain Park Estates//2) from obtaining a similar type waiver in the future and placing a trench within several feet of their south lot line (in the vicinity of the proposed trench on Lot 3, Bk 3). Given the space available on Lot 2, Bk 3, it is unlikely that this scenario will ever be necessary. We are requesting that your department waiver the required separation distance to 1 foot. The $115.00 waiver fee was submitted with this package. 8. SANITARY SEAL ON WELL: The existing sanitary seal on the well is no longer functional. As part of this project the contractor will be required to install a new sanitary seal. 9. CLOSING: Clearly, this property has numerous site restrictions which limit the potential for septic system upgrades. The suitability of this design will be limited by the soil conditions at the proposed trench site. I am open to any suggestions from your department that would be an improvement to the proposed system. I am unaware of any negative impacts that this installation would impose on adjacent wells, or septic systems. If you have any questions, please call me a 337-6179, or 244-9612. Sincerely'I~.,//~~ J?r~ffi~ce' G~mess,"P~., M.S. LOT 2, BK 3, MOUNTAIN PARK EST. #8, PVT, WELL & SEPTIC PER M.D.S. RECORDS. NO GROUNDWATER TO 12 FEET TOTAL TRENCH =7 ERAL LOCATION OF WELL LOT 83, BK 3, MOUNTAIN /I / PARK ESTATES #8, LOT INSPECTION AND M,O,A. COMPUTER SEARCH, ~ ~ARK E~T #~ /AND SEP.T~t'F-..'-PER M,B,A _ [ RECOR~ OR~NDWA~E. ~H OF TRENC~ : G FT PAR~ES ~2, PVT, WELL ~DT 81~ BK 3, MDUN A m ~DRDS~TAL DEPTH D~ -- T~NCH =~N- WELL / L--ND GROUNDWATER TO 16 FEET ON 6/14/77. TOTAL DEPTH OF TRENCH = 12 FEET. NDTEj THIS IS NOT A SURVEY, THE LOCATION DF ALL WELLS, SEPTIC SYSTEMS, AND STRUCTURES IS APPROXIMATE, THE CONTRACTOR SHALL VERIFY THE SEPARATION DISTANCE FROM THE SEPTIC SYSTEM UPGRADE TO ALL WELLS DN ADJACENT LOTS, SEPTIC UPGRADE: PREPARED FOR: {PARED BY: DATE: LOT 3, BK 3, MOUNTAIN PARK EST, ~2 FRED & ANDREA ROSENBLUM ALASKA WATER & WASTEWATER 2/23/98 DRAWN: GARNESS SCALE: 1" = 100' GENERAL LOCATION OF NEIGHBORS SEPTIC, ]BURIED '- N TE', NOTE. THE CONTRACTOR SHALL BE RESPONSIDLE FOR I UTILITY LOCATES, AND LOCATING THE PROPERTY LINES. I THE WELL RADIUS ~WHICH ARE NEXT TO THE NE~/ TANK I ~ AND DRAINFIEL]D SHALL BE FLAGGED ]BY A REGISTERED ' LAND SURVEYOR. IN ADDITION, THE NORTH LOT LINE SHALL BE FLAGGED, THE INSPECTING ENGINEER WILL ~ ~ NOT ATTEMPT TO LOCATE THE WELL RA~IU~~ DR LOT LINE. REPLACEMENT OF THE FENCE, REGRADING IN THE ~PRING OF 1998, TOP~DIL, AND RESEEDING SHALL ~ BE NEGOTIATED ~ETWEEN THE ~UYER AND THE j , ~ELLER PRIOR TO ISSUING THE CONTRACT. THE , CONTRACTOR SHALL INCLUDE THESE ITEMS Ag A ~ j SEPARATE LINE ITEM ON THE BID. i ~DOG RUN AREA~ I , J ~PPER PER~ 4' PVC ~SAMPLE PORT ~ ' ~ ANCHORAGE TANK ~ESIGN '. - / x .l A I /'1 ~ ~ LID~ AND FILL ~ITH ~OIL, NEITE: NOTE~ THE CONTRACTOR SHALL DE RESPONSIDLE FOR UTILITY LOCATES, AND LOCATING THE PROPERTY LINES. THE WELL RADIUS ~WHICH ARE NEXT TO THE NE~/ TANK AND DRAINFIEL]D SHALL ]~E FLAGGED ]BY A REGISTERED LAND SURVEYOR. IN ADDITION, THE NORTH LOT LINE SHALL BE FLAGGED, THE INSPECTING ENGINEER WILL NOT ATTEMPT TO LOCATE THE WELL RADIUS' OR LOT LINE. REPLACEMENT OF THE FENCE, REGRADING IN THE SPRING OF 1998, TOPSOIL, AND RESEEDING SHALL DE NEGOTIATED ]BETWEEN THE I]UYER AND THE SELLER PRIOR TO ISSUING THE CONTRACT. THE CONTRACTOR SHALL INCLUDE THESE ITEMS AS A SEPARATE LINE ITEM ON THE BID. ~RECIRGUI' LATING.~ILTER, THE SANITARY SEAL ON THE WELL AS PART SEPTIC UPGRADE, LOT 3, BK 3, MOUNTAIN PARK EST, ~2 ,~..:-...~.~..~.. PREPARE]] FDR~ FRED AND ANDREA ROSENBLUM ~.;~.. PREPARED BY: ALASKA ~ATER & ~ASTE~ATER ~ATE~ 8/83/98 9RA~N~ GARNESS SCALE: 1' = 30' -~~ · - [MIN COVER = 2 FEET, ySLDTTED PV[; PIPE, /~4 INCHES DF BLUEI]DARD / /\OVER TOP OF FILTER. / DRAINRDCK FROM TOP OF BLOCK PEA, TO ~/-2 INCHES OVER TOP DF SLOTTED PVC PIPE. ~ l':." '. ;'.' ' :" : i / SAND AND GRAVELS 'BLOCK PEA'". / 5~T~H~-~[i~gC~?iN~G"-T'Ri[~'~'~hG FRO" HOUSE. D~YnD ~ FILTER. PER ANCHORAGE TANK DESIGN. INFILTRATOR ~u~D;CHAH~ER (1~ INCHES TALL) / SET TANK LEVEL DN ~DTTDM DF TANK IS COVERED ~ITH MIN. DF ~ INCHES DF DRAINRDCK, BOTTOM DF ~OX TD ~DTTDM DF B~ P~ ~ APPRDX. ~5 INCHES. / 1.85 INCH PVC PRESSURE LINE FROM STEP TANK. CHECK VALVE NOTE. THE UPFLD~ CHAMBER SHALL BE INSULATED ~ITH ~" IN STEP TANK PREVENTS ~ACK- DF SPRAYED URETHANE, 9Y ANCHORAGE TANK. FLD~ TO TANK. MIN BURIAL DEPTH OF 4 FEET, AND 4 INCHES OF INSULA- TION BOARD (~ FEET ~IDE) OVER THE TOP DF THE PIPE, FOR EFFECTIVE BURIAL DEPTH OF 8 FEET, 4 INCH PVC, 6 INCHES DF DRAINRDCK BELOW PIPE, "'. :. · . ~, TOTAL ABSORPTION AREA : ~+ gQ. FI, , 5.0 ~ "'~ TH~" [~{ ALASKA ~ATE~ ~ ~ASTEVATER CENSULTANTS ............. ]]ATE: ~/E1/98 D~N~ GARNESR SCALE: NTS '~~ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: ~-/~_~ WAS GROUND WATER ENCOUNTERED? ['~(~ S DEPTH?IF YES, AT WHAT j~ pO E Monitorinli? ~/f~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop . ~: . , ¢oo ~ o ..~ /~. I /~. " IQ PERCOLATION RATE ~- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~' FT COMMENTS '"~'~-"'~:: ~'¢~"2"~-'-RS '~' , ,,,~ ~'~l-~,Jl~,~ CERTIFY THAT TI-/IS TE/ST WAS PERFORMED IN PERFORMED BY: ~1~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: 72-008 (Rev. 4/85) 7320 East Chester Heights Circle ~ Anchorage N Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers February 26, 1998 Municipahty of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED FEB 27 1998 Municipality ot AnChorage Oept. Health & Human services Ref: Conditional Health Certificate for Lot 3, Bk 3, Mountain Park Estates #2. To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The trench is currently surcharged (just at the drainpipe invert). Alaska Water & Wastewater was retained to design the upgrade. The design was submitted to DHHS on or about 2/24/98. At this time we are requesting issuance of a conditional HAA so that the sale of the house can proceed. The existing system is functioning adequately, and does not appear to be in danger of surfacing or dayllghting in the near future (water level is still about 5 feet below the ground surface). Based upon my observations, there are no environmental or health concerns associated with granting the conditional HAA. The intent is to install the new septic system prior to June 1st, 1998. In addition to the septic system, the well needs a new sanitary seal. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, ~/~// , J M.S. Principal~/ ~X] FRO~, : ALASKA [dATER & ~ASTE~ATER PHONE NO. : c/~373383~46 Har. 03 1998 03:30PM P2 PROPERTY OWNER AGREEMENT FOR ~ ,MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated ~1~¢ ~ ~ 199J~_, is made between the M~eip~i~ of Anchorag~ Dep~~ of He~ ~d Hm S~vices ~HHS) ~d ~e pmpe~ This agreement is made for the purpose of maintaining aa on-site wa~tewater d/~osal system on the subject property.. The proper~ o,rraer~ agTee to tl%,efotlowiag: Submit to ~he Mu~cipalit7 of Anchorage, on an ammal basis, an inspection aud operation statement from a re¢$tered professional engineer. Tlns inspection and .. operation statement shall verify that Se engineer has haspected all effluent and ak pumps, deers, and alarms, and tlmt any deficiencies have been repaired and tlmt the system is ftmctioniag as designed. ( Name) ~/ ' (Printed N~am¢) ~ ge~,~¢ ~, ~/~ ~ ~--~Sj' ~ ~)~¢~fJ~t~pe~onally appeared bm~ore ~, who i6 personally kno~ go me whose' identity [ proved on the_ _ __. ~. ~.basis of of whose ide~¢ity I p~ov~d on , a credible [o be the ~igner of the above document, ann he/she acknowle~a~e/she FROM : AL~SKA WATER ~ O~ST~WRT~R PHON~ MO. ; ~073~0~4G Ma~. 0~ 1990 OS:30PM Pi Rick Mystrom, Mayor Mu ficipality of Anchorage Department of Health and Human Services 825 "L" Street Box !96650 Anchorage, Alaska 99519-8650 Dear Homeowner/Prospective Buyer: The on-site wastewater disposal system you are parchasinfl/installing is an "alternative" wastewater disposal system. This system, lmown as a "Recirculating/Upflow Filter Septic System", is undergoing testing within the Municipality of Anchorage under the ARemaMve System sect. ion of the Wastewatar Disposal Regulations (AMC 16,65), There are certain risks involved with the owrlershlp of one of these systems: 17 The technology used in this system has been shown to be effective in other areas, The system is eurreaatty undergoing a two y¢ar tes0ng period in Anchorage m~der the guidance of the Department of Health and Hmuan S~wices (DI-IHS) and the State of Alaska Deparl'mertt of Environm*ntal Conservation (ADEC) to determine its effectiveness in a subarctic envir~m~ent, 2. The system for this property_ received a vertical reparation d/stan~¢ waiver from both State of Alaska and Anchorage Municipal Code~ to ground water. This waive~ was granted due to the system's expected performance within the site conditions on this property. I (we) ¢ertlfy that I (we) have read the above statements and mm (are) aware of the risks outlined, I (we) also certify tl~t I (we) am (are) i~ the process of purchasing (property legal description): .............. Notar/z¢ Here ........... = ................................................. On ~his y '?~c~. day. ,f P~'z'~ ~.. , / whose iden~i~y I proved on the basis of "' x~ t~[;' ~"~ whose identity I proved on th~ oath/affirmation of .."77~.'~,~ ;... to be the ~igner of the above document, and he/she ae~owled~that he/she..~i~ned:ig;' ' / Np~ar~ Publi '~, ,:::, ," My commission expires My Commission Expires January 31, 2001 as required. IC is unders=uod =hat ~ resulted Ces~in~ p~r~od ~ w~11 ~ at c~ ra~e of S45/h~u=. Additi~al s~lc The ~ropexc~ o~sr a~rses ~o keep ssr~lir~ area~ an~ to provide r=a~onable acc=ns co :o any control panel wlch~n :he dwelling. The con~: t,~ake evar~ efZorc ~o give add.acs noc~ce prior cc Th~ agre~menV ~y'~e ce~aced o~ ten (10) days' notice. curren=ly ~he co~C ~£ ~ bo~ne by .n provided :~udin~ access actor wll~ ~¢~y owner a rain £mum Assocla2ss R/ck Mystrom, Mayor Mtm3cip B of Ar Chor e Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us 907-343-4744 March 6, 1998 Jef~ey Gamess, PE Alaska Water and Wastewater Services 7320 East Chester Heights Circle Anchorage, AK 99504 Subject: Waiver Request for Mountain Park Estates #2, Lot 3, Block 3 Waiver Request #WR980006, PID #017 022 15 HAA #HA980034 Permit #SW980026 Dear Mr. Garness: Your request for a waiver of the required 10 foot hor/zontal separation from the on-sitewastewaterdisposal system to a propertyline has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding th/s waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGm Department of Health and Human Services On-site Services Section Waiver Review Worksheet Date Received: Feb 24, 1998 Legal Description: Lot 3 Block 3 Mountain Park Estates #2 Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Services 7320 East Chester Heights Circle, Anchorage, Alaska 99504 Applicant: Fred/Andrea Rosenblum Waiver Requested: Lot line waiver of 1 foot to the north property line. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability Do Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: ~x~,~,'~ ,~D~q Date: Nan~e of Reviewer Rec ~: #03617/7269 Amount: $ 115.00 Date Paid: 2-24-98 OGRE ' :.R INSPECTION ANCHORAGE AREA BOR' ]GH Department of Environmental Quality 3330 C Street n~% Anchorage, Alaska 99503 )~/~5 REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS ~)~' '-~') 7 ~ ~--_ 5~)~ PHONE LEGAL DESCRIPTION !J/!~L, ~')~d'J~. ,~d,)'~')'~T%S' .~ ~ SEPTIC TANK: DISTANCE FROM WELL ,J MANUFACTURER ~-¢'~ Ac~:Z;O'' MATERIAL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS ,J LIQUID CAPACITYI'Z)'-'~.~ GALLONS. DISTANCE FROM WELL TOTAL LENGTH FOUNDATION -~ NEAREST LOT LINE [~' OF LINES NUMBER OF LINES ) DISTANCE BETWEEN LINES "~ TRENCH WIDTH ~ IN. TOTAL EFFECTIVE ABSORPTION AREA d(~,~. SQ, FT. LENGTH OF EACH LINE ~'~/~ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE ~-~ / MATERIAL BENEATH TILE iQ'r I~. ABOVE TILE '~ IN. WELL: TYPE ~ ~ CONSTRUCTION __ 'i)p~OS~ C! DEPTH _ I i BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE__, SEWER LINE TANK__, SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: DIAGRAM OF SYSTEM GrEATEr ANCHORAGE AREA BorOUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-/I56 ! PERM[T NO. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK ~E A ~ , DRAIN COMPLETION DATE ANTICIPATED . FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SI~~ ~G E ~/ MINIMUM DISTANCES, REQUIREMENTS R FOUNDATION TO SEPTIC TANK CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO ~"F~A~ WALL ~ v SEPTIC TANK . SEEPAGE PIT , DRAIN TO NEAREST LOT LINE. WELL TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD , ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK SEEPAGE Pit ., DRAin TO RIVER. LAKE. STREA~. EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit PITTED WITH AIRTIGHT REMOVABLE CAPS. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATE~-y~NCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE RiM Civil Engineers ENO ',lEERING & GEOLOGIt :iL CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907-279--0483 TELEX 090-35419 Geologists Land Surve. JAMES W ,ROONEY, P. E. MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. IV[ay 3, 1973 R &MNo. 36604 RALPH R. MIGLIA( Engineering Geolo, /V[r. Paul Vazar Willy Sherman Realty 3110 W. Northern Lights Blvd. Anchorage, Alaska 99503 Re: Test Hole and Soil Log Report for Sanitary System Lots 2 & 3 Mountain Park Esta~;es No. 2 Dear 1V[r. Vazar: We are submitting herewith the test boring results and our comments regard- ing soil conditions encountered at the subject site. This investigation was per- formed in accordance with your request of April 30, 1973, and those procedures outlined {na letter dated September 13, t971 by IV[r. Roll Strlckland o~ the Greater Anchorage Area Borough, Department of Environmental Quality, A single test hole was put down within the Lots 2 & 3 area for the purpose of ~]ef~n/ng general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended ~o a total depth .of 20 feet below ground surface. One sample was recovered from the bottom of the test hole and retained for grain size analysis. The sample will be held in storage, up to approximately one month, for possible testing before it is discarded. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered {n the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions wi~h regard to the above, please do not hesitate to contact Very truly yours, R & ]VI ENGINEERING & GEOLOGICAL CONSULTANTS oeney ~ Partner .~WR:wb Enclosure T.H.-I 5-5-'75 ORGANICS W/SOME SiLT 0.0' SANDY SILT SOME GRAVEL (GM -SM) SAND TRACE TO SOME SILT , FINE GRAIN Tan (SP - SM) SANDY SILT SOME GRAVEL (GM-SM) 10.5' No Water Table 20.O' T.D. Note: Hole was extended with an auger :type drilling rig. 'F~ Engineering ~ Geological Consultants . ~..~,.B~,.KS ALASKA 0UN[AU Willy Sherman Reality LOG OF TEST HOLE Anchorage Alaska NAME OF APPLICANT Gte, ZR ANCHORAGE AREA BOI' 'Ugh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C"STREET ANCHORAGE, ALASKA 99503 TEL~. HONE 274-456 I M -- APPLICATION AND PERMIT PERMIT NO, . INSTALLATION LOCATION EGAL DESOR,PT,ON INSTALLATION OF: SEPTIC TANK SEEPAGE PIT OTHER DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THRouGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY ~"~~'~ ~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL OUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. · ~*:' · ..... TYPE SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTB FOU SEPTIC TANK TQ_S~P,~GE, P~~wAL~L WELL TO SEPTIC tank f~ DRAIN FIELD /~/~ WATER MAIN TO SEPTIC TANK DRAIN FIELD //) SEPTIC Tank, ~ /_. SEEPAGE Pit TO RIVER, LAKE, STREAM. DRAIN FIELD DRAIN FIELD SEEPAGE PIT f~L~) ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD ~/~ ~ / . CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO.--~J~R AND THAT THE ABOVE FORM NO. E~-016 ,--~lO~>DV 3~qCi ISYd NO 0~$S3SS¥ ':18 '1-11~ HINOI~I ~':ld %~A t ~IO'~O~VHO 301^~3S --E 'oN ~Nzvto MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251461 Parcel ID 017 -022-15 Expiration Date: 9/30/2026 Legal description MOUNTAIN PARK ESTATES #2 BLK 3 LT 3 site address 12840 SAUNDERS RD Current property owner(s) FORGE ENGINEERING X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: 0 Original Certificate Date: 10/22/2025 This Ce Cate of On -Site Systems Approval (COSA) is intended to demonstrate the subject syste (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, De lopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory X Arsenic Advisory Other Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel l . D. 017-022-15 Complete legal description Mountain Park Estates #2, Block 3 Lot 3 Location (site address) 12840 Saunders Rd Current property owner(s) Weston Tardy & Emily Davis Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well serving # dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: FE -1 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 6. SEPTIC TANK: R Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 27 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ t6D l� Date of Payment COSA# 65C_25' Waiver Fee $ Date of Payment Waiver # COSA Application_Apr2025.doc COSA Checklist Legal Description: Mountain Park Estates #2, Block 3 Lot 3 Parcel ID: 017-022-15 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 8/4/75 Total depth 225 ft Cased to 225 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12* in. Date of flow test for COSA 9/30/25 Static water level at beginning of test 50 ft. Comments *Met code at time of install B. TANK DATA Measured operating fluid level in septic tank N/A Date of pumping 9/30/24 ❑ Required maintenance completed, if AWWTS Comments: STEP tank, level varies D. DISPOSAL FIELD DATA Which system tested (date installed) 1998 FE -1 ALL standpipes present per record drawing Total measured depth from grade 3.7* ft (max) Measured depth to pipe invert from grade 3.0* ft (min) ❑ N/A — pressurized field. ❑■ Per record drawings, field is insulated. ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced NSA gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 6.0 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 7.15 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by Forge Engineering Date 9/30/25 C. LIFT STATION ❑■ Required maintenance completed Age of lift station 27 years Lift station material Steel Comments: Adequacy test date 9/30/25 Results II Pass Fluid depth prior to test 0 in Water added 604 gal New fluid depth 5 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used 0 in Effective depth remaining 18.5 in Comments/Deficiencies: *Approximate grade difference of 1' between CO and MT COSA Checklist_May2025.docx 18.5 in E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' ❑E Yes if No ft Neighboring Tank > 100' ❑� Yes if No ft Disposal Field on Lot > 100' ❑■ Yes if No ft Neighboring Disposal Fields > 100' R Yes if No ft Sewer Line/Main > 100' R Yes if No ft Sewer Manhole/Cleanout > 100' ❑� Yes if No Sewer Service/Septic Line > 25'[E Yes if No Holding Tank > 100' Yes if No Animal Containment > 50' Yes if No Manure/Animal Excreta Storage > 100' ❑■ Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' 0 Yes if No ft Surface Water > 100' 9 Yes if No Field to Foundation > 10' ❑■ Yes if No ft Tank to Property Line > 5' Yes if No ft > Field to Property Line > 10' ❑ Yes if No ft Water Main/Service Line > 10' ❑E Yes if No ft F. ENGINEER'S COMMENTS *Waiver request #WR980006 Wells on Adjacent Lots: Wells > 100' ❑� Yes if No _ Community Wells > 200' ❑� Yes if No _ If tank or field is under driveway comment below ft ft ft ft ft ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name ofFirm Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. COSA Checklist_May2025.docx Phone (907) 522-7773 Date 10/13/25 .' SOF A�q�ll �* •'qg TH .. .. .. ... ........ J� '. • Benja. ' . chiller ����F�;l , CE 12592 • .������ 1 tl`F�pROFESSI4N�t.� � ATTENTION: Buyers and owners of a property served by an Advanced Wastewater Treatment System (Ai11WWTS) ** TO AVOID SEWAGE BACKUPS** Prior to using the wastewater system, contact the service provider to ensure that regular maintenance is completed. Many of the systems require remote monitoring, the provider will tell you how to provide this capability. Who to contact: • AdvanTex: Anchorage Tank at 907-343-3704 ■ Quanics Aerocell: Garness Engineering at 907-337-5179 ■ Biocycle: Biocycle Alaska at 907-274-0314 +� BioBarrier: Tim Ecklund at 907--250-0100 * Intermittent Dosing Sand Filter (IDSF): contact MOA onsite 907.343.7904 Please complete the attached document, Advanced Wastewater Treatment System Maintenance and Repair Agreement. When signing this document, you acknowledge that you are required to provide regular maintenance for your AWWTS. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND .AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this A� - ]day of L of 202 5-, by and between 00�yun - .r+ _syr �,� � � herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.355. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Inovative recirculating tank with upflow filter located at (legal description) Mountain Park Estates #2, Block 3 Lot 3 2. Maintenance Repairs and Alterations. (Owner is required to read, understand and initial each section) 6�hroughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the cquipment's approval for operation in the Municipality. 6�-It shall be the responsibility of the Owner during the terra of this Agreement to pay for all repair(s), maintenance, adjustmcnf(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $440 to $600). 04�Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and snake any necessary maintenance, r repairs or permitted alterations to the system. V t� Owncr acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system. which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. "Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Al1�'Owner agrees that any sale or transfer of title off the property will not occur without anew Certificate of On -Site Systems Approval. 0__� Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing pp..-- guidelines Por the construction, maintenance and repair of the Owner's AWWTS. A-IAO—Owncr agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The terxn of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives. of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a count of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. {rev. 05/18/2018) Page 2 of 3 OWNER: By: A 6 {signature) name) STATE OF ALASKA } )ss. THIRD JUDICIAL DISTRICT } Date: J b 2 i Dko Z4'` The foregoing instrument was acknowledged before me this V 20LS_, by Ar.N.C7 j _P,6!6 V NOTARY PUBLI FOR. ALASKA My Commission expires: AU irk! Coeq signature} D-, day of aiv�r , arint name} Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( �l 907-343-7904 On -Site water and wastewater Section Fax: 343-7997 www.muni.org/onsite � -1 Septic Tank Advisory Certificate of On -Site Systems Approval # OSC251461 Subdivision: Mountain Park Estates #2 Block:3, Lot: 3 The septic tank for this property is 27 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. Steel septic tanks utilizing "Coal Tar Pitch" coatings are subject to corrosion as the steel reacts to water and rusts. These tanks have a finite lifespan buried in the ground. These tanks can become structurally compromised and pose a health risk. They could collapse and/or leak untreated wastewater directly into groundwater. In the interest of protecting public health and the environment, the Municipality of Anchorage Development Services Department has issued Policy W.05 Standard of Care Regarding the Inspection of Steel Septic Tanks when Performing COSA Inspection. Please request a copy of this policy from the Department if interested. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT '"�� 907-343-7904 On -Site water and wastewater Section f Fax: 343-7997 www.muni.org/onsite �--� Nitrate Advisory Certificate of On -Site Systems Approval # OSC251461 Subdivision: Mountain Park Estates #2, Block: 3, Lot: 3 A water sample revealed a nitrate concentration of 7.15 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MUNICIPALITY OF ANCHORAGE -"via �4 Development Services Department t�-_ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 017-022-15-000 Expiration Date: 8/31/2023 Legal description MOUNTAIN PARK ESTATES #2 BLK 3 LT 3 Site address 12840 SAUNDERS RD Anchorage AK 99516 Current property owner(s) BALOGH GREGORY R & BARBARA J X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 5/31/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval_June 2022 Mountain Park Estates #2 Block 3 Lot 3 017-022-15 5.1 8/4/75 225 225 7.85 18 4/25/23 Forge Engineering 54 4/26/23 N/A N/A 5/29/98 N/A N/A N/A Steel 4/25/23 0 734 13 1440 0 >450 0 Benjamin Schiller, P.E.5/9/23 3* Waiver #WR980006* (907) 522-7773 MUNICIPALITY OF ANCHORAGE Development Services Department' % Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-022-15 Complete legal description Mountain Park Estates #2 Block 3 Lot 3 Location (site address) 12840 Saunders Road, Anchorage, AK 99516 Current property owner(s) Gregory & Barbara Balogh Day phone (907) 441-4198 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK:❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 24yrs _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ '5_5_0 Waiver Fee $ Date of Payment 5-zI ILO -L> Date of Payment COSA # 0 Sc- 2 3 1( 2, 6 Waiver # COSA Application—June 2022 Lot 3, Block 3 Mountain Park Estates Subdivision No.2 20,130 Sq. Ft. +/- 12840 Saunders Road 2 Story Wood Frame House With Attached 2 Car Garage ℄ SAUNDERS ROAD ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;;;;;; ; ; ; ; ; ; ; ; ;;;;;; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;;;;;;; ; ; ; ; ; ; ; ; ;;;;;; ; ;;;;;; OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHUOHPOHPOHPOHPOHPOHP 4.1 7. 9 12 . 2 8.1 24 . 3 19.9 23 . 9 32.3 12 . 1 12.2 12 . 0 15.5 24 . 1 15.3 S8 9 ° 5 6 ' 0 6 " E 1 8 3 . 0 0 S00° 03' 45"E 110.00 S00° 03' 45"E 110.00 N8 9 ° 5 6 ' 0 6 " W 1 8 3 . 0 0 S S SS S S S SSS GE T E SC SC SHED 30.5 31.8 46 . 7 53 . 1 17.5 47.9 47 . 1 10' UTILITY EASEMENT 10' UTILITY EASEMENT EDGE OF DIRT ROAD PA V E D D R I V E W A Y LOT 4 LOT 2 ;;;;;;;;;;;;;;;;;;;;;;;; SH E D W 30 . 0 ' 30 . 0 ' 1 0 0 ' WE L L RAD I US PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. May 3rd, 2023. Legend: Scale 1" = 30' Gas Meter Electric Meter/Outside Power Deck Septic Telephone Pole Fence Overhead Utility Lot 3, Block 3 Mountain Park Estates Subdivision No.2 General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Nora Delolli 23-151 05/03/2023 P-561 2839 E Elec. Pedestal Water Well Tel. Pedestal G E S [T W May 04, 2023 R E GISTEREDPROFESSIO N A L L A N D S URVEYORPierre M. Stragier No. L.S. - 9812 SS Septic Cover JIM UN, �C PAL�TV©FAFHC HO° L E DEVELOPMENT SERVICES DEPARTMENT 0,.;111 b-.� 907-343-7904 On -Site Water and Wastewater Section i Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231136 Subdivision: Mountain Park Estates #2 Block:3, Lot: 3 The septic tank for this property is 24 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. 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. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Day of A� of 20 ,93 , by and between G{,iun AAfd awi', herein the "OWNER," and the Municipality of Anchorage, erein the " ICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWtiVTS), described as Innovative recirculating tank with upflow filter located at (legal description) Mountain Park Estates #2 Block 3 Lot 3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) b^�T oughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. ZC 150 It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). K' 1�0 Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. rrP., n.,,.o 1 ^C'! W towner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. UT -0 Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. 7 Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. lam' eb Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. A Mwner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. J J (rPv 0 V 2P)01 Rl Dn- 7 -P2 OWNER: By: A , 1 iJa�►wS /1\ c STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing i strume�t was ac 20.2�3, by c NOTARY PUBLIC FOR My Commission expires: fie) Date: 15 L; Si, ss. ed before me this2ml-day of i--• 1 �,a""'=yq CHERIE ANN SEOPA E Notary Public ID State of Minnesota �, My Commission Expires January 31, 2027 MUNICIPALITY: By: (signature) Date: (print name) Title: frr+v 0 /1 R/7f11 R) Phot -'2 nf'2 MUNICIPALITY OF ANCHORAGE V Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner �� Street Address Septic Tank: -Sludge level inches -Pumping: required yes no -Pumping completed yes no Lift station: -Pump basket cleanedjestno -Effluent filter cleaned es : no -Control floats cleaned •Proper float settings confirmed es no •Operation satisfactory Alarm Svstem: -Dedicated electrical alar7satirsfacto cis no -Audible and visual alarm inside dwelling es no -Alarm system operation not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection Asn•Ground water intrusion around pipe penetrations e•Weep hole functional•Manhole lid: Functional Cyes no Insulated o Properly Secured es no Other -All manufacturer required inspections and maintenance completed / yes no Comments: kc V ,1 Qualified Maintenance Provider: Technician G"SOS y�°� ('S Date of maintenance0 1,10, Company _ ►tee Se_CVIC e j Signatura�'i L, Dateo---1Ioql;�� I 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Day phone Mailing address Agent *%,l~/t~-~ b.3~m-~ ,/(-("1~E--- /¢/~.z~ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUI~IBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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 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 ver. ifythat my investigation of this Health Authority Approval application shows that the on-site water supply a0d/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 Alaska Water & ~&fa~t~ Address, 7 3~0n cE~,~ Engineer s signature ~/~/~ rater Phone :ircie Date D~S SIGNATURE Approved for --~,~ bedrooms. Disapproved. Conditional approval for 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 this 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. 72-025 (Re~. 1/91) Back MOA~21 Legal Description: A. WELL DATA Well type ¢~.~,JA.'r~' Log present Total depth '~'z.~- Sanitary seal (~'N) Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SER~{[ ElY E D Environmental Services Divisio~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (9~,7/~94~ Health Authority Approval ChecI~li~unicipality of Anchorage 'D~t. Health & Human Se~ices ~ ~o~ ~ ~od~A~ ParcelI.D.: ~ If A, B, or C, attach ADEC letter. ADEC water system number ~/ES. Date completed t Cased to '~_~-~ Casing height (above ground) E~ ~'---+ Wires properly protected (~YN) Date of test Static water level FROM WELL LOG AT INSPECTION ' I Well production WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of Sample: ~/?_.~./9~, Date installed ,~/ll/qf~: Tank size ~ g.p.m. Collected by: Number of Compartments __ '7. ~' g.p.m. K~ Oo~ ~o I o~ ~ . Other bacteria - ~ Alaska Water & Wastewate~ 7320 East ~hester ~ts. C~]e Anchorage, Alas~ ~5~ ~ Cleanouts ~) V~ Foundation cleanout (~1) 'hJ~.~ Depression (Y/~)~ /~Jo Date of Pumping ~ ~>J Pumper " C. ABSORPTION FIELD DATA Date installed _~1,/~' Soil rating ~or fF/bdrm) % Length ~l~ Width --~ Gravel thickness below pipe Effective absorption area ~01 :~ ~Monitoring Tube present ~N) Date of adequacy test ~//~1,/9 ~° ~'~ ~'¢"~R es u Its (Pass/Fail) High water alarm (~) ~/~ System type "~ ~,Jc'R Depression over field (Y~ ~,,)o For -~ bedrooms Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Immediately after '-' gal. water added (in.): Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* LIFT STATION C1¢-,¢' Date installed Manhole/Access (~/N) High water alarm level Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* Gl ~ "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots Ioo ~ ¢' On adjacent lots I0o I.f- Public sewer manhole/cleanout Sewer/septic service line ._/~; I~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation .~.~ ~ 4- ~ Property line ~¢o ~ 4- Absorption field Water main/service line IO~+ Surface water/drainage Icc, 14- Wells on adjacent lots I I O©I SEPARATION DIS~;I'ANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation /~' Water.main/service line Jo I_/.. Surface water /oo~'/- Driveway, parking/vehicle storage area Curtain drain /,J o,d ~ J~J o~ Wells on adjacent lots icc ENGINEER'S CERTIFICATION ;.,': ,,,, I certify that I.~e dlC~rmjr~c// 'u field inspections and review of Municipal recq'r. Es"'l.~Et'¢i¢ in conforms/nee ~/it~/~O~ ~/¢~z( ! ydelines in effect on this date. /,:. ~, .~; Signature/ ~~ ~ ~ ,~~"~, Engineer's Nae ~ '~' ~~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* "K, ~f&E Ellvlmnmenta[ ServlG~ Ina. CT&E Ruf,# CHent Name Proj~ Name/# Ciieut Sample ID Ma~LY Ordcr~l By PWS~ 0823~000I AK Water & Wastewater ~ervlces 12840 Sa-n~icrd Rd. 12840 S~tudcrs R!.. Drinldng Wa~r 0 Saraplc Rcraarkm; 1oral Rele.~edBy~ ~__ Re~utC{ POL Un{C~ M~had Lin{~$ oa~a, Date In~t RECEIVED MAY ~ 6 1998 ~UNICIPALII'Y O~ ANCHOtb~O~ iINVIRQNMIiNTAk $IR¥1C§$ DIVISION 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 Parcel I.D.# (~) I~7--~)vZ""Z---/~'' NAA# ~ ~('~¢"'~,OhC/ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~-~_.~ ~ Mailing address ~z>vq-'~___~ Lending agency ~ Day phone Mailing address ~" , A;::J~nt ~-~[~ b~--- / ~ ~ (D,~'/~ Day phone Address ~ ::2-0I ~C_, ¢~ c~q-. ~ ~L~tT-~ bO/ · ,Z~J~___~, 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- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: Holding tank Community on-site 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 ) 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/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure i.~dicated 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 dat, of this inspection. Alaska Ware & Waste. Name of Firm Address Engineer's signature 6. DHHS SIGNATURE Phone Date_ Approved for bedrooms' Disapproved. Conditional approval for "~~' bedrooms, with the following stipulations: Money shall be put in escrow to construct a new wastewater disposal system in accord~ed ermit SW980026 and to re seal. .. lace the well The a '" - escrow shall not be released until this office has given final approval. ' 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 and their lending institutions in order to satisfy certain federal and state requirements, of homes 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-O25(Rev. 1/91) I~ck MOA~21 Legal Description: A. WELL DATA Well type PV ~-~ Log present (Y/N) TOtal depth "~ ~--~ ~" Sanitary seal (WN) Municipality of Anchorage ...^..C E IV E D DEPARTMENT OF HEALTH & HUMAN SERVIC Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)l'~4;7f4z~~° Municipality of Anchorage Health Authority Approval Checklis~ept- Health & Human Service~ ~'~'" ~i ~'~ 5 J~ou~ ParcelI.D.: Ot"7'-(~Z'Z.-I---%"' If A, B, or C, attach ADEC letter. ADEC water system number '/*J ~ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ ~,~/~_- ,~ Date completed Cased to FR~)M WELL LOG Casing height (above ground). Wires properly, protected (Y/N) AT INSPECTIOn/ ~-O/ Nitrate g.p.m. Other bacteria {~ B. SEPTIC/HOLDING TANK DATA ~ ~ "':" Date installed '?/"/~' Tank size ! ;~-'-O Number of Compartments / Cleanouts (Y/N) ¥ Foundation cleanout (Y/N) /%/0 Depression (Y/N) ,A/O High water alarm (Y/N) /~//fi' Date of Pumping ~/~- Pumper /q'/,~' '7"0 Date installed "/ Soil rating (g.p.d./fF or fF/bdrm) ~"~ System type Length Width ~ · Gravel thickness below pipe J 0 Total depth /'~' Effective absorption area C~ 0 Monitoring Tube present (Y/N) y Depression over field (Y/N) Date of adequacy test Z./I~/'~ Results (Pass/Fail) ~-~ L~.~ For ~ bedrooms F~ -~b-~nrption field bnfore test (in.); Immediately after gal. water added (in.): Fluid depth (ins) M~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ f.,4 date 72-026 (Rev. 3/96)* Date installed ~~__ ~ in gallons ~ "Pump off" level at* Manhole/Access (Y/N) ~ High w~ *Datum ~ Cyele~tested 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 -- On adjacent lots /OO /+" On adjacent lots Public sewer manhole/cleanout ~7'~'/'+ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / ~-'{L~-~ Property line ~f-~'/4' Absorption field ~ Water main/service line /O (4- Surface water/drainage ! (~2 ("f- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I O I,+. ._ Building foundation ~'O / 4- Water main/service line Surface water / CO / ~ Driveway, parking/vehicle storage area '~'-¢ Curtain drain /k/OrdI¢~ ~--'dOL~fJ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that lhave detcC~/nedJhl'/ in conforr, Signature //¢ Engineer's Name Date inspections and review of Municipal res in effect on this date. s are HAA Fee $ Date of Payment Receipt Number ((~) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number APPLIr" NT FILLS OUT UPPER HA" ,:ONLY --~roperty"(~wne'~' ~-~O '~-k ~ '~-~ ~ ~ ~ ~ ~ : Phone M~in~ Addre~ ~ ~ '~ '~ '~ ~ ~ ~o~ ) ~ Zip Code Buyer ~L~ Address Zip Code Lending Institution ~[ ~_~ ~O~ ~-- ~ ~T- '~{~ ~O1~ ~ ~ ~L ~[ ~ Phone Address ~ 0~CL~ ~00~ ~ ~C [~0~ ~, ~ Zip Code Realty Co. & A~nt Phone Address ~ g ~ Zip Oode Legal Description Type of Resi~nce Single Family Multiple Family No. of Bedrooms ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l 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 Sewer Disposal ~ Individual ~-~ Q Year Individual Installed: ~ Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ~DISAPPROVED ( } CONDITIONAL APPROVAL' O,T~ i~-%'%" ~%. Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received "~ -- ~ ~' Well to Tank Septic T~k Size 72-023 (3182) September 15, 1982 John F. Dye Jr. SF~ 377E Anchorage, AK 99507 Subject: Lot 3 Block 3 Mountain Parks Estates II Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The top of the well. casing sealed with a sanitary seal so that it is water tight. The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. The septic tank pumped with a receipt submitted to this department. ~i~/~-- An adequacy test needs to be performed on the existing \ leaching area. ~is test will determine if the system is \ adequate according to National Standards. A listing of ~pri~ate firms performing the test i~ enclosed. This report ~needs to be submitted to ~is office for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, RP184/p/EH Enclosure Robert C. Pratt Associate Environmental Specialist ALASKA [1UIROrlm rlTAL CO[1TROL S RUIC $, I[1C. ~n~ineerinq ~ ~nuironmentd Studies 9/16/82 I¢~UNICIPALITY OF ANCHORAGE [,c~T C~ ~.. ..... ¢ ~. ENVIk ~ I .A..O ~ ,' I RECEIVLD JOHN DYE SRA BOX 796 ANCHORAGE AK 99507 SELLER - JOHN DYE BUYER-ANDREA ROSENBLOOM SUBDIVISION-MOUNTAIN PARK ESTATES #2 BLOCK-3 LOT-2 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 960 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 700 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 9/16/82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1250 IS ADEQUATE FOR 1220 LUcst 251h Auenu¢ · Anchora% Alaska 99503 * (907) 276-1361 #1: Time Date Insp ,'-",,MUNICIPALITY OF ANCHORAGF ",~ ~j~'~&/~C DEPARTME, , OF HEALTH AND ENVIRONMEN~, _ PROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: September 12, 1977 ~!~f~O~x_. ~2: Time #3: Time 9-iq - ~% L3L~ A. Date Date JKennedy Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 2 o Lending Institution Request: Alaska National Bank of the North Mailing Address: Phone: Property Owner: Walter L. Riley Mailing Address: Star Route A Box 377E 99507 Phone: 344-1244 3. Legal Description: Lot 3 Block 3 Mountain Park Estates #2 4: Single Family Residence: (x~ Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System: Permit # Construction Individual well (x) Community/Public System ) Depth of Well Well Log on File Bacterial Analysis Sewage Disposal System: On-site System~lx~ Public Utility ( ) Permit ~ Installed -1-gq~3-r' Installer Septic Tank Size /~O Manufacturer~,~/~~ Absorption Area ~ O Soils Rate ~3~-~ Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE ' .... Department of Health and Environmental Protect 825 L Street, Anchorage, Alaska 99501 264-4720 uest for Approval of Individual Sewer and Water Fa..cili~i Property Owner: C<./-~ / /'-dh' ~' Mailing Address: ~/~ ~ 377/~ Phone: 2 o Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Phone: Phone: Realtor/Agent: Mailing Address: Legal Description: Street Location: Single Family Residence: Multiple Family Residence: Number of Bedrooms: Number of Bedrooms: Water Supply: *Individual Well If Individual Well, well depth If Community System, name of system Sewage Disposal System: On-site System If On-site System, date of installation: *NOTE: Public/Community System ) Public System ( A well log is required on ALL wells drilled since 6/75. 3/77 Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 3 Block 3 Mountain Park Estates ~2 Affadavit Attached: (i) Letter Attached: ( ) Disapproved: Date: Da%e: Department Worksheet: k ./ / .5 /UU O0 PROPOSED DWFZ2[J2q~ LOCATION It ts ~dhe omatractot'~ re~rpons~bill~ to eheel~ Top of Foundation in relationship to F/mish Grado. Top of Foundation a~ indicated is one ~mrse of block ~'C~Ve Fir6sh C:':wto I hereby certify that I have surveyed the following described property: z~d~7'" ,~; ~--//~', ~, Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premis, es. in .question and that there are no roadways, transm~ssmn hnes or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska Nv 75, thisI lday of , l0 FRED WALATKA & ASSOGIATlgS Fmgineers and Surveyors