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MOUNTAIN PARK ESTATES #2 BLK 3 LT 16
Mountain Pa k states lock Lot 16 ! 7-022 -28 IVIU UyanLy vi M IUI wi dye On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211317 PID Number: 017-022-28 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Robert E Usgaard A ORPTION FIELD ❑ D Trench El Wide Trench El Bed ❑ Mound Site Address 13041 Foster Rd Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Subdivision Block Lot Mountain Park Estates #2 3 16 Ft, Fill added above original grade Gr I length Township Range Section Ft. Ft. Gravel width Ft. Beds: Number of Lines Dist between lines Ft. SEPARATION DISTANCES TO Septic Absorption ? � Holding Lift Station Sewer Total absorption area p Number of trenches Dist. between t hes From Tank Field Tank Line Ftz Well 100+ TANK ® Septic [:1S.T.E.P. F-1HoldingElOther Manufacturer Capacity i surface water 100+ Greer 1000 Gal. Material Number of compartments Lot Line ! IIII 5+ NA Plastic 2 Foundation 110+ j ATION ivlanufacturer Capacity Remarks Field verified tank to arctic entry 5'+ Gal. Alarm location Elects ' �by_ Installer PIPE MATERIAL House to tank D3034 Tankto ld D3034 ...Highland excavating; Drainfield CO/MT D3034 Inspector Areterra BENCH MARK (Assumed elevation) 100 ft Inspection�� dates: 9/10/21 2°d 9/10121 Location and description 31d 9/13/21 4th Arctic Entry corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval` Date AW 49TH 4` _ „Ia Yny KENNETH M. U S ;m ''o�- CE 711 A Septic System �% %%�% Approved Date l u 1 Note: this approval does not include well permit requirements. 4 SS����� �4�'4ss�,a►�'° AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP211317 MOUNTAIN PARK ESTATES #2 BLOCK 3 LOT 16 PID# 017-022-28 � o \ � o d 0 1 ° a a. HOUSE .:.4' H❑USE a 1000 GAL TANK FY❑ C6F E ri n �� 06 , _ � Q' O / I E 0 SCALE+ 1' = 20' A—C=18.3' B—C=23.9' 100.89 100,7 A—D=16.8' y B—D=26.5' W ssW J ��� W A—E=15.5' = Z W WW> Fid. p B—E=28.2' f OR null a A—F=16.2' B—F=28.0' A o A-6=17.5' �' 1000 GAL B—G=30.3' SEPTIC SCALE, NTS PREPARED F❑R1 BOB USGAARD 13041 FOSTER RD, ANCH❑RAE, AK 99516 RELD BOOKS BOUNDARY: N/A STAIUNQ NLA ASBUILT: _ DWG. FILE: ACAD FILE` FILE COMPUTED: DRAWN. KSd CHECKO: KMD DATE 9 /1DATE�16 /2 GMD: SW2839 'ADB N°' 21056 SCALE; NTS Ito" 30$ z 0 0 0 0 E4 0 0 0 LOT 17 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: MOUNTAIN PARK ESTATES Not LOT 16 BLOCK 3 PLAT P-561 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAJU NOV 16, 2021 1 "=30' schuiier®ok.net 21-1 6 3 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAR JLS SW2839 210370 LOT 15 .�. I - a"! I , NINN O F �l QTH? 'A '•`' , ?A PA .,..... . .......................�► �•,JO ' N L. SOHULLER.-4 0? �` '• LS -10408 vis ' 1 air o Lam � f essiono��.®'®' ,�0 NIJ W': v a r 1881 Talkeetna Street Anchorage, Alaska 99508 (907) 227--1455 office (907) 274--4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:l/www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211317 Work Type: SepticTank Upgrade Effective Date: Expiration Date: Tax Code Number: 01702228000 Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 3 LT 16 G:2839 Site Mailing Address: 13041 FOSTER RD, Anchorage Owner: USGAARD ROBERT E & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Lot Size in Sq Ft: Total Bedrooms: ,.,rnt ry DQparunenr 8/11/2021 8/11/2022 20130 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing -JNj ` i Special Provisions: Contractor shall stake the 100 ft well radius for the well on Mountain Park Estates #2 Block 3 Lot 15 (lot to the south) prior to tank installation. Received By: Date: U/// 4-: Issued By: Date: Development Services Department On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-022-28 Property owner(s) Bob Usgaard Day phone Mailing address 13041 Foster Rd. Anchorage, AK 99516 Site address 13041 Foster Rd. Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Mountain Park Estates #2 Block 3 Lot 16 Legal description (Township, Range & Section) Lot Size 20,130 Sq. Ft. Number of Bedrooms 3 one: yUi-J4J-iyU4 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank Upgrade 0 Duplex ElHolding (D) Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: Z Date of Payment: 1/30 2_021 Receipt Number: 022 iol G Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211317, Rebecca Carroll, 08/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211317, Rebecca Carroll, 08/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211317, Rebecca Carroll, 08/11/21 ' Municipality of Anchorage Page / 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: ,-~'~ ~/1/ O i~,~)-.- RID Number: ~ ~m~: ~L~O~O~ ~L~ Wastewater System: D New ~Upgrade Address:'~,O~ ~/ /~ __~ ~ ~ ABSORPTION FIELD No. of Bedrooms: ~eep Trench ~ Shallow Trench D Bed D Mound D Other Total Depth from origin~l.~rade: LEGAL DESCRIPTION Sol, Rating: O, ~ GPD/Sq. Ft. Lot: ) ~ Block:~ ~¢w~t~~~Subdivisi°n: Depth to pipe bo om rom original~ grade: Ft. Gravel depth beneath//~ip~ .~ Fh Township: ~ Range: Section: Fill added above original.grade: Ft. Gravel length: (,~_/ /~/ 'Ft. I Number of lines: Distance between lines: Grave] width: ~ Ft. ~ ~ ' Ft. WELL: ~ New~ ¢~ 9~a ~grad~ : : Total absorption area: Classification (Private, A,B,C): I sed To Pipe material; Driller: Date pti[led: Static Water Level: Installer: Date inst~lled: Yield: Pump Set at~ Casing Height Above Ground: TAN K SEPARATION DISTANCES u s~¢io u Ho~i~ u S.~.E.~. TO Septic Absorption Lilt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Slalion Tank Sewer Lines Material: Number of Compartments: we. I~ iO ~ Sur~o~ .~ ~ LIFT STATION Water LineL°t '~ O ~ Size in gallons:I~ Manufacturer: Foundation ~ ~ "Pump on" level at: "Pump off" level at: High water alarm at: Curtain ,.~ .~ Pump Make & Model ~ Electrical Inspections performed by: Drain I Remarks: BENCH MARK , ~ Location and Description: , I ~, Assumed Elevation: /~NGINEER'S CE~L th~ ~rvices approval ' ~':' Department of Heal Hum Reviewed and approved by Date: ~--~9~ 72-013 (Rev. 9/91) MOA 25 93 4' ++ ++ + + + +++++4-+ + + + + + ~ *s FF 100.00 96 BULL JET AE,~A TIDN TANK~ ~gIVE£SIITN VALVE --~ __X_ 15 0 15 30 ' 45 60 75 SCALE; 1~ 30 FT TOBBEN SPURKLAND P.E. 205 W 15TN. AVENUE AK. 99501 LOT 16 BLOCK 3 MOUNTAIN PARK ESTATE 15041 FOSTER ROAD WARREN LOWRY SEPtiC SYSTEM ASBUILT DATE: WAY 25, 1994 SHEET: 2/5 GRID: 2859 Under Pipe 28 FT 0 CD Fr, FND, 0 IBULL f~UN zgIVE£SIDN VALVE LOT LiNE Cl eonouf ~ ' ' ' ND SCALE // /--ycov~r ~ ~!~ ~ JJ~ / ~ _ Je~ Aero ~ion SCALE 83 fig ~o fer d/H/gd ~ BENCH WARK: GARAGE SLAB. ASSUIdED ELEK I00.0-0 205 W15th Ave Anchoroqe Ak 99501 · 279-,3916 BLOCK3MOUNTAIN PARK 15041 FOSTER ROAD /I WARREN LOWRY SHEET: 5/'5 GRID: 2839 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940122 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:MILLHOLLAND MADELYN A OWNER ADDRESS:PO BOX 10-631 ANCHORAGE, AK 99511 DATE ISSUED: 5/12/94 EXPIRATION DATE: 5/12/95 PARCEL ID:01702228 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 3 LT 16 LOT SIZE: 19800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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: AND THE THIRD COMPARTMENT OF THE SEPTIC TANK PUMPED. 2. LOT LINE WAI~P~_O~.~FEET GRANTED. ~WR940016. THE EXISTING JET AERATION EQUIPMENT MUST BE REMOVED AND DATE: DATE: Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 12, 1994 Tobben Spurkland, PoE. 203 west 15th Avenue #206 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 16 BLock 3 Mountain Park Estaets #2 Waiver Request #WR940016, PID ~017-022-28, SW940122 Dear Mr. Spurkland: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. waived distance is 2 feet. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Civil Engineer On-site Services ljw#7 "~'~ MUNICIPALITY OF ANCHORA~~1 Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~i t%~q~(%('~%{~ PID# .3~-022-28 HA# Date Received: April 13, 1994 Legal Description: Lot 16 Block 3 Mountain Park Estates ~2 Engineer: Tobben Spurkland, P.E. 203 West 15th Avenue Suite 205, Anchoraqe, Alaska Applicant: Warren Lowry~ Madelyn Millholland Waiver Requested: Lot line waiver of'~ ~- f~-~. Permit 99501 Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. 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: N 0 /~ .~--~- Date: Na~e of Reviewer Rec #: 25809/3703 Amount: $ 115.00 Date Paid: 4-13-94 T.SPURKLAND P.E. 203 WEST 15TH. AVEN~E SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 April 13, 1994 Subject: HAA for Lot 16, Block 3 Mountain Park Estate Gentlemen; I am requesting a conditional HAA for this property. An adequacy test performed on February 7, 1994 indicated that the septic system was capable of absorbing approximately 300 gallons per day. The water level in the trench was found more than 14 inches below pipe invert, showing that the system was not operating in a surcharged condition. This system was installed in 1976 and has been operating satis- factory for 18 years. The system was designed with a soil rating of 275. A testhole excavated on March 10, 1994 showed no groundwater or bedrock to 18 feet. Percolation test at 7 and 8 feet depth indicated minimal absorption, more than 2 hours per inch. A second testhole excavated March 28, perc'ed at 30 min per 1/4 inch at 7 feet. According to Municipal regulations a holding tank should be installed on this lot. However the fact that the existing system is still operating satisfactory for the residents of the house should indicate that a soil absorption system can be installed in spite of the poor absorption rate measured. We request permission to install approximately 120 linear feet of trench, with 6 feet of effective rock depth This will give us 1400 sq. ft. of absorption area, which is twice the present amount. We intend to leave the present trench intact utilizing a "BULL RUN" diversion valve to switch between the new and old system. Due to the load restrictions the new trench can not be installed at the present time. Because of the silty material, it will be best if the work was performed during dry weather. The owner are finalizing the sale of this property and a conditional approval with the proper escrow provisions would expedite the approval process of the property transfer. A lot line waiver is also requested, partly to maximize the length of the trench, and also to protect a mature tree. The two testholes have been monitored periodically. No ground- water has been observed. T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 LOT 16 SEPTIC SYSTEM DESIGN BLOCK 3 MOUNTAIN PARK ESTATE WARREN LOWRY No Ground Water or Impervious Layer to 15 ft. Use Standard Trench Soil Rating. From test 3/28/94 120 min/in Three percolation tests were attempted. At testhole #1 a test was run at 6.5 to 7 feet. No water absorption was observed in two hours. A second test at 8 feet showed an absorption of 3.5 inches in 18 hours. At testhole #2 a percolation rate of 1/4 inch per 30 minutes was observed after 5 hours of soaking. The existing drainfield was installed in 1976. Total depth of trench is 16 feet. Rockdepth is 12 feet. The sump at the end of the trench is not perforated and does not represent the liquid depth in the trench. The system was tested in 1985 and in 1994. A steel monitor was driven into the into the trench in order to observe the water level. 730 gallons of water were added to the trench without any water entering the tank. A 14 inch rise in the monitor was observed. After 24 hours the water level in the monitor had dropped 7 inches, indicating that approximately 300 gallons had been absorbed. The tank was not full at the time, and any water discharged from the house was contained by the tank. The fact that the existing system is still functioning satisfac- tory at the actual loading rate, indicates that the soil is capable of accepting effluent. By leaving the existing trench intact, and installing a replacement trench to the maximum possi- ble length, I feel confident that a alternative to a holding tank is possible. We do request a lot line waiver in order to obtain the maximum separation from the existing trench, to save a mature spruce, and to maximize the trench length. The new owners of the residence have been made aware of the soil conditions. Septic System Design Lot 16 Block 3 Mountain Park Estate 12 Finish Floor Garage Ground Surface at Tank Approximate Tank Outlet Surface at Absorption Field 100.00 ft. 100.00 95.00 96 100 Testhole Total Depth 18 Elev 80 Less 6 feet 12 Elev 86 Less 3 Cover at lowest point. Elev 96 - 3 = 93 Rock Depth ~~~r--~Elev 86 to 92 Total Length ~--~---~i~0 Ft.~ Total Absorption area ~12 = 1440 sq. ft. Existing Absorption Area 32 x 24 = 786 sq. ft. Number of Bedrooms 3 .CONFIGURATION STANDARD TRENCH TOTAL LENGTH 120 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 10 14 FT. ROCK DEPTH 6 FT. COVER 3 8 FT. SEPTIC TANK 1000 GAL. Existing INSTALL BULL RUN VALVE TO EXISTING TRENCH. The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 16 Block 3 Mountain Park Estate 22 L~T ? LDT 18 LOT 8 Well Well LL1T LB? LDT 11 LOT 14 I 17 I TOBBEN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH. AK, 99501 IlI ~ , ,50 100 1.50 £00 c%50 300 SCAL& I* = 100 FT, LDT 16 BLD£K S MDUNTAIN 13041 FOSTER ~RREN LD~RY iLOT I ILDT I0 I I I i ILD1- 11 Ill I I I I SEPTIC SYSTEM ~ESIGN DATE, NA££H 4 1994 SHEE% 1/$ GRID, 2839 Tes 97 I0 N X #£ FF 100. O0 FR£M LDTLINE b/ell 15 0 15 30 45 SCALE: I' = 30 FT 60 75 TOBBEN SPURKLAND p._F. 203 ~/ 15TH, AVENUE ANCH, AK, 99501 LOT 16 gLOCK $ MOUNTAIN 15041 FDSTE£ ~/mR£EN LDWRY SEPTIC SYSTEM DESIGN DATE~ M~RCH~ 1994 SHEET, 2/3 GRID: 2839 40 +- FT ~~L L 46+- FT 10 L LOT LINE FND, CO 0 DIVERSAIDN VALVE NO SCALE 3.5 Pt o£ Septlc Rock C(eonout~ ~ Moni~.om % ////-- 3' Cover Ex,'xtJn9 1000 got, septic tonk Jet Aero t/on ND SCALE 83 No lVo ter 4/I]/94 TDBBEN SPURKLAND P,E. 203 ~/15th Ave AnchorcQe Ak 99501 ? 16 BLOCK 3 NOUNTA[N PARK ES1 I304J FOSTER ROAD WARREN LOWRY SEPTIC SYSTEM ASBUILT ~ATE: APRIL 16 1994 SHEET, 3/3 6RID, 2839 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST 1 2 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 2O (ENGINEER'S SEAL) Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ DEPTH? P E Depth to Water After, Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'"~ tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~-~ FT AND ? Y'L.. FT COMMENTS PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GRE/,,,~R ANCHORAGE AREA BOR, Department of EnvironmentsI Qusli~y 3330 C Street Anchorsge, AIsska gg503 .iGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL /~ NUMBER OF COMPA RTM ENTS"~L'~__ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. T~-~ L.D: ,~, ~, -~I-OTAL LENGTH,-., DISTANCE FROM WELL~ F _NEAREST LOT __ - FOUNDATION /7 ~/m~-' LINE~:~~:)~ OF IINES ~ NUMBER OF LINES- / DISTANCE BETWEEN LINES TRENCH WIDTH~ IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER ,,~'/ CONSTRUCTION IN. DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE-- SEWER LINE__. TANK . SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED DISTANCES: __ INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: Form LQ-032 'o' DIAGRAM OF SYSTEM '/" M-W DRILLING, INC.. DRILLING LOG Well Owner . om :'..k'.Gee []se of We]] Location (address of: Township, Range, Section, if known; or distance main road Size of casing .5" 2S9' Depth of Hole 24,.)' feet Cased to feet Static water level 2.()O ft. ('a. bgye) (b.elow) land surface. Finish of well (check one) Screen ( ); Perforated ( ). Describe screen or perforation open end ( ~1~.~ ) ; Well pumping test at ~ gallons per 0~0~-r) of drawdown from static level. Date of completion ~.'- /i/7~ (minute) for ! hours with WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness C~sing t4~ic kus- ft. TO TO_ J~" TO TO 42 TO .... TO ..... TO. TO. TO TO TO 'TO Sit 't ~ (ir av;~ ). Si t/cv Gravel NW1VA Certi[!cd Contractor Gerti["icMe No'c. 814 & 973 2 -- STAT E i¥%- ¥¥ I.; i~l L Lt i~1%.;r I I~1 ~.. C DRILLING LOG Use of Well Location (adctress of: Township, Range, Section, if known; or d/stance ma/n road ;ize of casing 1~". Depth of Cased. to :: - ~ feet: I,~O9 --/,q- 9 '-/- 9" ~3'. O ;t:ati¢ wat:er level ;;IO0 ft.. (above) (below) land surface. Finish of well (check one) open end ( .~,,.f ); Screen ( ); Perforated ( ). Describe screen or perforatio,~ ~'eI1 pumping test at .3 gallons per of drawdown from static level. Date of completion ll.O/t/75 ('I~o6J:) (m/nute) for · I hours with l O0'To , ft. WELL LOG )epth in feet from Found surface Give details of formations penetrated, size of material, color and hardness O _TO ~ Casin~ Sticku~ ~ TO. 5~ Ora~_ni 9~9 TO ~0 ~,~ndy ~4 TO 1~~ Silty Gra. vsl l~r~ TO 200 gi7.~ ..TO - ' .TO · N~.~VA Ccr~!cd Con~ctor 2 -- STAT~ PERH~ 1' NC. FIF'F'L]:C:RiqT 1~(3H HC: GEE LL3E:FIT ]: ON F LL:, I ET.. DF.: LEC~iFIL. L.:1_6 B3: HT. F'K ES:.' E:,EF'AF~:THEN].' ': HEALTH AND EN',,,'IF,.':EdqHENTRL." '~".""].E'"]TIFN / /i~)-i-/~'~/z,.~ ,.--~,~ ~ .//£'¢ Z.':Et:L 14. 64. TH ~2:::1.,::I. 2:',.":",:$--.E~::3E;:t. L. OT 25 Z ZE ;:2 ~':1."~ O 25C,,]LIRF..:E FE:ET TYF'E OF' :L";OIL I=IE:SIL'IRE:TIIEIN ::,T.:,TEI1 I25: TF. EN_.H _ _ . F1 ,. BT:'.. = ~:. .... ,='~._, i'"IFaXIHLIH i'.,II_Ii',IE~EF.': OF EEDF.'-qI'"IS = Z-': SOIL F.:AT]:NG ,: 2.'; L.':! .... ''" THE REC!LIIF.:ED S]:ZE OF 'THE :,i_iTL HE,:,UF, FTION :T_-TEi'I :[25: ...... :F.t--t .- E-ElL [.::.EF"TH:;'= . IE:, E: F" "'IF IF-~ ."== :_1_ ~ g. E: li"4 ,"3 T ~-I1 == -:=" "=-~ " ...... ""'" ~"" '- T'HE LENGTH [:,lf'IENSION IS THE LEi'.4G].'H ,'IN FEE'Ti:, f')F ]"HE TRENC:H OF.: [:,F,.':AII'.iFZEL. E:,. ]'HE DEF'TH OF FI TF.:ENCH OR F':[T lb"; :.'HE [:,ISTFINCE E:E].'HEEI'.,t ]''HE 25UF.'.FRC:E OF THE GROUN[:, FII'.~[:, THE BOTTOH OF THE EX:':FI',,,'RTION ,.'ill'.,! FEET::,. t'F..E1.1 ~.HE:, THEF.'.E IS NO SET WIDTH FOF.: - -' ..... THE ~F d,EL [:,EP].'H I25 THE HINIHLIH DEF'TH OF GRFI',,,'EL. BETWEEN THE OUTFAI...L PIPE FIND THE BGTTOH OF THE EXCAVATION (IN FEET::,. EZ['THEF.: R C:LFI'.E;S I 0~: II tq25F AF'PF.'_-'v'ED F'LFtNT HFIY E:E INSTALLED. A CONTINUOU25 I"]RIN'T'ENRNCE RGREEHENT IS F.:Eg!UIF.:ED. IF R HRIN].'EI'.4FINF:E RGREEI"IENT IS NO:.' I.:::EF'"I' CLIF.':REI'-,II" Y":J HRY BE F.:EC.".!U ]: RED TO Ei'.4L. RF?.EiE THE EOIL FIE:SFIF:'.F"FI O1'.4 25Y25TEH RND,.-'L-IR YOIJ HRY BE SUE:._TEC:T TO F'F.'.O25EE:UT I Eilq. IF Ft CLASS I SYSTEH 125 USED THE L. ENGTH 125 25. Et FEET. If:" FI CLASS II: SYSTEH IS U25E[:' THE LENG"FH IS _-':::2:. (t FEET. '-IF IL-.It ,2, ,,'~::., :[ t'-4t _?_-: F" E C: T' LE. C, ~'-.~ S~; R F.: E'E F:-" E: ,.L::L" LI1 :E F~-': EE BFICi<:FILLING OF ANY 25Y25TEH HTTHOUT FIIqFIL .1:i",I25F'ECTION FIN[::' FIPPt:;.'.OVRL BY :.'HIS E:,EPFIRTHENT W]:LL. E:E $UBZECT TO F'ROSEE:IJ'I'tON. MIt'4IHUH D:[25"['FINCE BETWEEN FI HELL. AN[." ANY ON-SITE .25EHFIGE DISPOS:;FIL "_"-';Y25"FEI"l .'l. Eua F'EE].' FOR FI PF.:I',,,'FITE WELL OR 200 FEET FOR R PUBLIC WELL HELL. LOGS ARE REQUIREL':, FIND HUST BE RETLIRNED TO THE DEPFIR"FHENT WITHIN S:O DFI"?S OF' THE WELL COHPLETION. SF'EE:ZFTCFrT']:ONS FIND CON25TRUE:TION [.',tFIGRFII','IS ARE A',,,'FIZLABLE TO ]:N251JRE F'ROF'ER :1: NS TFILLF:I].' .I ON. :t: CERT I FY THFt]" i: I Ftl',l FAHILIFIF.: HITH 'THE REQUIREMENTS FOR ON--25I'T'E :SEWERS AND WELLS FI:S SET FORTH B"r' THE HUNICIPFILITY OF FINCHORRGE. 2: ]: HILL. INSTFILL ].'HE SYSTEH tN FICCORDFtNCE WITH ':''PIE CODES. ~:: I UNDER25TFIND THAT THE ON-25ITE 25EWER 25YSTEH HFIY REC!UIRE ENL. FIF.:GEHENT IF' THE F.'.ES:[[:'ENCE IS REHODELED 'TO IIqE:LUL::'E MORE THFIN _.3-': BE[:,ROOH25. FtF'F'LIE:FINT TOH HC GEE 0 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. Expiration Date: �Vb 1. GENERAL INFORMATION Complete legal description Mountain Park Estates #2 -Block 3 Lot 16 Location (site address) 13041 Foster Rd. Anchoracle, AK 99516 Current Property owner(s) Day phone Mailing address 13041 Foster Rd. Anchorage=AK 99516 Real Estate Agent Dayphone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual z Individual Well z Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ 5 rD 0 Date of Payment :i Receipt Number 01 b 8 3 COSA# 05C2 115 Waiver Fee $ Date of Payment Receipt Number 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 _ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS _ _ Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist.}� \ ,} � *` �-Li TH 6. DSD SIGNATURE System #1 Approved for ,3 System #2 Approved for Disapproved. Conditional approval for bedrooms. ` KENNETH M. ,5 ; pf bedrooms. ;.r, . L`�;•�� i bedrooms, _ 1 By: with the following stipulations: OF���((/� IS �Q3 J,= 0 N SITE—N WATER AND o WAST[:v\`ATER oz J� PROGF�AM- J /JJ��i�FNT SERv�G�`���\ Original Certificate Dater J_I_ p; 2 f 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 -10-1 0-12.dDc COSA Checklist Legal Description: Mountain Park Estates #2 Block 3 Lot 16 Parcel ID: 017-022-28 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA [■I Well log is filed with Onsite (or attached) Date drilled 1976 Total depth 240 ft Cased to 239 ft ❑■ Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 17 in. Date of flow test for COSA 7/7/21 Static water level at beginning of test 186 ft. Comments B. TANK DATA Age of tank(s) New years Tank type/material Septic/Plastic Measured operating fluid level in septic tank New ® Standpipes/foundation cleanout per record drawing Date of pumping New tank installed 9/10/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/20/1994 10. ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Structure served by this system Well production at time of test 3.3 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes R Nc U Coliform bacteria is Negative Nitrate 7.08 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 7/8/21 . IFT STATION ❑ Requi iaintenance completed Age of lift station years Lift station material Comments Adequacy test date 7/7/211 Results p✓ Pass For 3 bedrooms Fluid depth prior to test 37 in Water added 450 gal New depth 44 in Elapsed time 1440 min Final fluid depth 37 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date Field operating within the top 50% of its capacity. 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft fO Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' 0 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) Building Foundation > 10' 0 Yes if No 8* ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 2** ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Approved Per 1994 Inspection Report **Waiver #WR940016 approved 5/12/94 G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet * 4 KENNETH M Du CE 1� ft ft ft ft Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211562 Subdivision: Mountain Park Estates #2 Block 3 Lot 16 A water sample revealed a nitrate concentration of 7.08 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. Mailing Address P O Box 196650 Anchorage, Alaska 99519 6650 * www ,muni- 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 Development Services Department Building Safety Division On-Site Water & Wastewater Program 4Z00 B~a.g.a~S.t. Ee~et P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-022-28 1. GENERAL INFORMATION COSA# (~' ~--~/ Expiration Date: Complete legal description MOUNTAIN PARK ESTATES S/D; BLOCK 3, LOT 16 Location (site address) 13041 FOSTER ROAD * ANCHORAGE, AK * 99516 Current Property owner(s) KURT & JOAN ADLER Day phone 602-1560 Mailing address 13041 FOSTER ROAD * ANCHORAGE, AK * 99516 Lending agency Day phone Mailing address Real Estate Agent TAMMY GILLS W/ DYNAMIC PROPERTIES Day phone Mailin~,g address 5111 C STREEI * ANCHORAGE, AK * 99503 Unl°§s othO~:]So requested, COSA will bo held by DSD for pickop. NuMBI=R OF BEDROOMS: 3 727-8115 3. 'TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat aEixed hereto and as uf ,.e.v,~.do,tun date shown ~' .... ~ .... :'~" "~'~ '~"' 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 infor,,mation obtained from the Municipality of An.chomge 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. Phone 337-6179 Address .3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG,'LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at'the time of the test, and separation distances measured to readily identifiable features. The operational life of afl wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can' therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE [,,,'"/ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory N,u,~,o r, uv,~u~ (Rev, 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (907) 343~7964 · CER~.IF!t',CA~E, O:F ON~SJT~E SYSTEMS AP'R:R,OYAL CHECKLIST Lc:,~aJ-D~sc~i~ti~::t~el;lil~tTA~, ~K-'E~AT~.'S/D ~2; '.BLOCK 3, LOT 16 P~' ID: ~ /7- ~'~ ~- ~ .Of test FReM',WEEb,LOG .1:0/.'f/;1;9.76 , Static, water?,level 20;0 fi, ,3 g..p.m. WeJl .Log Wires pmPedy protected (Y/N) Casing height'(above ground) AT INSPECTION . !2/2/2010 191 .ft. 4~'1 .g;p.m. YES YES 1,2+ in. !,l~F-~ate 7.09 mg./L. Other bacteria 0 . colonieS/lO0 mi. ~.Date of sample: 1'~/2/20t0. Collected by: GEG Ltd.. *JET :,AERATrON TANK .W/ AERATION UNIT REMOVEO. Date installed 1'0/7/1976 . ,~umberef Cempartments -2 CJeanouts (Y/N) YES, 275' :NO,. ANCFteRA(~.E CE~-SPOQL !.'P~U~:(~ :[1~ .dL~, th:~: abs~n;~b~ere'tes~ t' ,.· ~,4; ,in, ~ater :ad~ 470 :Elapsed Time: 150~- rein: - ~.al:~.dePth 18. in. Absorption" rate >= T~NCH. System 'type- 2. ft. GraVel below Pipe. MOnitoring.tube YEs' ReSults (Pass/Fa[l~,. .Depress[on over field N9 For' 3. bedrOOms New depth' 21. in. 450+ g..p.d. NONE ,,KNO,W,,N If'yes,.give date - CONNECTED AS. I~.E,s~RvE.:r.S~E. PIER ~HE HO~IEOWNER,..S~M:P FOR BE' 'L, OCATED DURING INSPECTION; TESTED 1994 TRENCH ONLY. D. ~EIFT STAT]~ Septic tank/ti,ff,statidn en 4et Absorption field on, lOt PUblic sewer main Sewer/septic service line Animal contei~mentareas Cycles tested> SEPARAT ,SEPARATION DIST~'S FROM ;WELL ON LoT TO: 100'+ 100'+ N/A 25'+ 50,'+ SEPARATI~i DISTaNCeS CROMSEPTIc/HOLDING TANK ON :LOT TO: Bui,lding foundation 5'+ Property.line 5'+ Water main .N/A Water service Hne 10!+ Wells on a~cent Iotsr *98' SEPARATION DISTANCE FROM ~.PTION FI,ELD .ON LOTTO: Property line *'2'+ Water.;service./ine 10'+ Curtain dmi, n NONE,. KNOWN C~NTS *#,WR99OO27. **~WR9~0Ot,6 B~i,C~g' feurtdation. ***8' Surface. water 10;0"+ / .We~,' s onadjacentiots 100'+ On adjacent lots 100'+ On adjacent 'lots, ?00'+ PuMic seWer maahole/cleanout N/A Holding tank.. N~A Manure/an~] excmte'.st, orag~ areas Absorption field 5'+ surface water 100'+ 100'+ ' 'W~er main N/A DriveWay, parking/vehi¢lestorage. 3'+ **~AP'PROVED ,PER ~,994 I~PECTION;. 'REP(~T. ! cer~,,that, l':'1~ve d~r~',,~ug~ fieldins~tionsand review of'~a r je~,or,~,,~., t:t~, ~e systems are'i~. co~orma~ w.~ ~, COSA g~tit~es~.f,~ effeeC on this date. Engrneer'sPdnted."~a~me JEFF, REY A. GAR-NESS Da~e ' ,~/i~,./':0 w, aiYer Fee,.$ Date. of ~Payment Receipt Namber (REV. 11/05) Municipality of Anchorage Community Development Department Development Services Division On-Site Water and Wastcwater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # osc 101341 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 16 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 7.09 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS ReL# 1106331001 Client Name Garness Engineering Group, Ltd Printed Date/Time 12/07/2010 10:31 Project Name/# MPE #1 B3,L16 Collected Date/Time 11/29/2010 11:55 Client Sample ID MPE #1 B3,LI 6 Received Date/Time 11/29/2010 12:45 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 152 5.00 mg/L SM20 2340B C 12/01/10 12/03/10 NRB Waters Department Total Nitrate/Nitrite-N 7.09 0.100 mg/L SM20 4500NO3-F B 12/02/10 AYC Microbiology Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 11/29/10 SDP Negative 1 100mL SM20 9223B A 11/29/10 SDP Private Individual Analysis Alkalinity 101 10.0 mg/L SM20 2320B D 11/30/10 LP Aluminum ND 20.0 ug/L EP200.8 C 12/01/10 12/03/10 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 12/01/10 12/03/10 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/01/10 12/03/10 NRB Barium 10.8 3.00 ug/L EP200.8 C (<2000) 12/01/10 12/03/10 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 12/01/10 12/03/10 NRB Calcium 47500 500 ug/L EP200.8 C 12/01/10 12/03/10 NRB Chloride 25.2 0.100 mg/L EPA 300.0 D (<250) 11/30/10 12/01/10 SDP Chromium 2.07 2.00 ug/L EP200o8 C (<100) 12/01/10 12/03/10 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 11/30/10 LP Conductivity 364 1.00 umhos/cm SM20 251 OB D 11/30/10 LP Copper 66.9 1.00 ug/L EP200.8 C (<1300) 12/01/10 12/03/10 NRB Fluoride ND 0.100 mg/L EPA300~0 D (<2) 11/30/10 12/01/10 SDP HCO3 Alkalinity 101 10.0 mg/L SM20 2320B D 11/30/10 LP Iron ND 250 ug/L EP200.8 C (<300) 12/01/10 12/03/10 NRB GARN-ESS ENGINEERING G ROUP, Lt,d. CONSULTANTS & GENERAL CONTRACTORS December 21, 2010 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road, P.O. Box 196650, Anchorage, Ak 9951%6650 (907) 343-7904 REFERENCE: Mountain Park Estates Subdivision #2; Block 3, Lot 16; To whom it may concern, The original 1994 inspection report lists the distance between the drainfield and the foundation as 8'. During our inspections, this distance was measured and confirmed to be 8'. We believe this reduced distance will not cause a problem for future homeowners. Since this distance was approved by your department before, we request you approve the existing separation distance. If you have any questions, please contact us at 337-6179. -~e~trte]y/~ma~~es: P.E., M.S. Presf/de~/t ~.2 3701 £. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com L~T t7 31:)' 30' $89°56'06"E 183.00' N89"56'06"W 183.00' LOT t6 -~J ,~'r m,,~Y SURVEY TYPE PLOT PLANS & LOT ~STRUC~ON, TO ~Rl~ PR~O~ 8UI~ING GRADE TO RNI~ ~AD~ AND U~U~ ~NEC~S AND TO DE.MINE SYMBOLS ASPNALT o F~NO ~ ~ ~ ~ ~ NOTE: ONLY ~0~ I~PRO~UEN~ ~O~ ~ND AND ~ ~LL ~[ ETC, ARE ~O~ IN ~R ~PRO~MA~ LOGA~, ~LY. SNOW Prepared by Robert Professional Land Surve~rs ' ' ~2 ~ 12 A~ MOUNTAIN PARK ESTATES BLOCK 3 LOT 16 , 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) 1'50 ( Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent Day phone Address = Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 'i'~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: 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 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 ~--~ k~/~4-'~-4-~. Phone Address 303 ~ / :.-~ /¢ ~ --% Engineer's signature ~~ Date / 6. DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. CL 222::; ,'. bedrooms, with the, following stipulations: By: Additional Comments Date 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 DH HS 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 (Rev. 1/91 ) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Parcel I.D. Well type ~-- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~/ Date completed 1~/~/7/.~ Driller Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Cased to .~ -~ '~1 Casing height Wires properly protected (Y/N) ! FROM WELL LOG AT INSPECTION o ~ g.p.m. ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: f~/"?//~/---- ~ ~ Nitrate '~,- 7 ~ Other bacteria .~" ~/~ Collected by: ~ -~ B. SEPTIC/HOLDING TANK DATA Date installed /0/?/?u~ Tank size ] ~z_~.p Compartments Cleanouts (Y/N) ~"/ Foundation cleanout (Y/N) ~// Depression (Y/N) / High water alarm (Y/N) {'-//~¥ Alarm tested (Y/N) ~///~ Dateof pumping ~"/] ~/~ ~/ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ / 0 On adjacent lots ~ / ~ Foundation ~ To property line ':> .l © Absorption field / .~-- Water main/service line ~,~ '~-- Sudace water/drainage ~ / C) 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed ~:~/~¢ ~/ Length / (',L/~ Width Total absorption area Date of adequacy test ~"//,/% Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) ,~, Gravel thickness Cleanout present (Y/N) y Results (pass/fail)["~ h~ System type Total depth Depression over field (Y/N) for After test ~.///",- If yes, give date ~/',/~. Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / / To building foundation On adjacent lots Surface water Curtain drain On adjacent lots / ¢ ¢ Property line ~ To existing or abandoned system on lot ~' Cutbank 1',( o ~ '4-- Water main/service line ';~ ,~ .b-- Driveway, parking/vehicle storage area ,~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect°n,'the'.date otthiS inspection. Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date J~ ~ ~/ GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~, '~4t~¢CC/-~f'elephone: Home ~.~'~.,¢..d/ (~ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-FamilyX Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Envrron mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank [] Note:/" 'If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING iNSPECTIONS, TESTS, FILE SEARCH, DA3 .~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of 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 ~ Telephone Date N"' "" Engineer's Seal Approved for ~-~3~¢~ bedroomsb~ , ,~'~~~ Date ¢/V Disapprov Conditional Approved v Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 {11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L ~T WELL DATA Well Classification Well Log Present (Y/N) Total Depth .0., Nt~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Y Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed ! O l ! J "/~:~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Water Sample Collected by Water Sample Test Results Comments To Septic/Holding Tank on Lot J 10 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots To Nearest Public Sewer Line ~ ~t~ To Nearest Public Sewer Cleanout/Manhole &j'~ I~- To Nearest Sewer Service Line on Lot ~ ~:~, ;Date SEPTIC/HOLDING TANK DATA Date Installed t ~/.~ l./~ Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Si?e ¢~)~ O No. of Compartments 'T'~/ Air-tight Caps (Y/N) ~'J Foundation Cleanout (Y/N) ~%/ Date Last Pumped Y ; for ~/~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond; Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,27.5 Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~"'~.~....~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots '~' To Cutbank (if present) D. LIFT STATION ~l O ~ ~' Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) ,Pump Off" Level at -.' .Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th~av~ch, ,, .ec, k. ,~d~'zi:i:d/c°nf°rmed t° all1~ / /") ,,'0 / ~"~. ~"'- MOA and HAA guidelines in effect on the date of this inspection. Signed I,~ , -- Date Company '~"~' ~~MOANo. Receipt No. ,~-- ~ Date of Payment Amount:$r~%;~ ¢*"4~U ?";~ ~:: Engineer's Seal ~,.~ Page 2 of 2 %.':. 72-026 (11/84) , ~, , .. :. 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 16, BLOCK 3, MOUNTAIN PARK ESTATE LOCATION: 13041 FOSTER DRIVE OWNER: MADELYNE MILLHOLLAND RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WATER SYSTEM: ON SITE WELL SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: JET AERATION ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 768 SQ.FT. SOIL RATING: 275 INSTALLATION DATE: OCTOBER 1976 DATE OF PUMPING: 7/16/85 NORTHLAND PUMPING DATE OF TEST: TEST PROCEDURE: ~5. 1971 ' ~(- NOVEMBER 21, 1985 SYSTEM WAS INSPECTED ON NOVEMBER 19, 1985. THE WATER LEVEL IN THE 8-INCH SUMP WAS FOUND TO BE 6 FEET BELOW GROUND SURFACE. WHEN WATER WAS ADDED TO THE SUMP THE WATER LEVEL ROSE IMMEDIATELY THEN SUBSIDED SLOWLY, INDICATING THAT THE SUMP WAS NOT CONNECTED TO THE PERCOLATION PIPE. THEW TANK WAS FOUND TO HAVE FIVE FEET OF COVER AND A LIQUID DEPTH OF 53 INCHES. ON NOVEMBER 21 670 GALLONS OF WATER WAS ADDED TO THE TRENCH WHILE THE WATER LEVELS IN TANK AND SUMP WERE MONITORED. THE ADDITION OF THIS AMOUNT OF WATER DID NOT CAUSE ANY INCREASE IN WATER LEVELS. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 16, BLOCK 3, MOUNTAIN PARK ESTATE LOCAT ION: 13041 FOSTER ROAD OWNER: MADELYNE MILLHOLLAND TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 3 GALLONS PER MINUTE WELL YIELD FROM TEST: PUMP YIELD: 4 GALLONS PER MINUTE WITH 12 EET OF DRAW DOWN 5 GALLONS PER MINUTE DATE OF INSPECTION: NOVEMBER 21, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 195 FEET BELOW TOP OF CASING. AFTER 17 MINUTES OF PUMPING AT 5 GPM. THE WATER LEVEL STABILIZED AT 207 FEET BELOW CASING. PUMPING CONTINUED FOR TWO MORE HOURS WITH OUT ANY FURTHER DROP IN WATER LEVEL. AT THE END OF PUMPING WATER LEVEL RECOVERED TO 199 FEET WITH IN 6 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON NOVEMBER 20, 1985. TEST WAS NEGATIVE. TEST RESULT: ~ ~' ., .-.~ F'/.: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. /"/~ ? ~MUNICIPALITY OFj~NCHORAGr~''~ /~/e~~' .. ° DEPARTME~ ~OF HEALTH AN~RC~NMEN', ~ PROTECTION [[~'~/I 825 L Street, A~e~ Alaska -99501 ~1: Time ~~ ~i~e _~;~ / ~ ~ F3: Time ~e ~ ~S ~ ~~ ~ ~ v~ate REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Statebank Mailing Address: Post Office Box 240 99510 Phone: 279-7637 2. Property Owner: Thomas/Naida Mc Gee Phone: 274-0861 Mailing Address: 301~West 64th Avenue 9214 3. Legal Description: Lot 16 Block 3 Mountain Park Estates #2 Subdivision 4: Single Family Residence: (~ Number of Bedrooms: 3 Multiple Family Residence: ( ) Number of Bedrooms: e e Well System: Individual well ~) Community/Public System ( ) Permit # _~m_~__ Depth of Well z~~ Well Log on File (~) Construction Bacterial Analysis Sewage Disposal System: Permit # ~ Septic Tank Size Absorption Area On-site System (~ Public Utility ( Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ~Pa~e T~o Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 16 Block 3 Mountain Park Estates ~2 Subdivision Comments: Affadavit Attached: ( )// Letter Attached: ' ~ ~ Date Approved: ~ ~ : Disapproved: {/~ ~ ~~' Date: ( ) Department-Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. IqUNICIPALITY OF ANCH, o DEPT. OF ~ IEAi Tiff ENVIkoF""' 7";"'4 ?JAY' :i ~,,) VA Property Owner: Mailing Address: 301 Wes~ 6/+th ,~2-1J4 3. Name of Buyer: R. Greg,__', and Linda Dixon Mailing Address:Box ~-q76 4. Name of Lending Institution: Alaska Statebank Mailing Address:~Anch,-.. Ak 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Lot 16 Block Location: Mt. Park Estates #2 FHA. RECEIVED .CONV 'X' Day Phone 27/*-0861 __ Day Phone:__2?b,-4679 Phone: 279-76_37 Phone:___ 7. Type of Facility to be Inspected:single family_ residence 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well_ 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms.__~- Individual Well _Individual (on-site). Septic 72-003(3/76)