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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 4 LT 18Mountain Park Estates #2 Block 4 Lot 18 #017-023-18 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page I of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211062 PID Number: 017-023-18 Dwelling: A Single Family (SF) El with ADU El Duplex (D) F-1 Two Single Family Project: F-1 New W Upgrade Name KAREN SIEGEL ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench F] Bedound Site Address 13001 LUPINE ROAD *ANCHORAGE, AK El Other Z"PZ Phone Number of Bedrooms Soil Rating Total dept original grade 207-450-5349 2 GPD/SF I !��, Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 Fill added above original gr Ft. length Ft. Township Range section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption on Lift Station Holding Sewer Total rption area Number of trenches Dist. between trenches From Tank Field T� Line Ft2 Ft. Well 1001+ TANK El Septic [9 S.T.E.P. El Holding El Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 51+ NA HDPE 2 Foundation 101+ LIFT STATION Manufacturer ' capadit-1 Remarks OLD TANK DECOMMISSIONED PER UPC GREER TANK/' *416 Gal. PER CONTRACTOR *SECOND COMPARTMENT OF 1250 GALLON TANK Ala mVro-c-at-iorr`E- TV, k.Af-7d 5encal installed by�_ U 0 Y_V­11 �Yl Pq`PE--MATERIA_L,,-Hol!'seto tank D3034 ink -E)17 Jr draC— Installer A+ HOME SERVICES nfield Drainfield EXISTING CO/MTD3034 Inspector MOA AND GEG BENCH MARK (Assumed elevation) 100.00 ft Inspection st 4/20/21 Location and description dates: 2" aro 4 th TOP OF MANHOLE #2 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date .:.'4°.i ... fi/e A. r ess.-' '0CE-7953 �q 4 Septic System Approved �Wx Date 112,11) 1A Note: this approval does not include well permit requirements. #AECC����4opoa�1�� �IICv U,;IV41 1 01 PERMIT OSP211062 RECORD DRAWING PARCEL 017-023-18 NUMBER: 23-18 100' WELL RADIUS MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 19 / NEW 1250 GALLON \ �, HDPE GREER TANK / J \ A i 100' WELL RADIUS 1 EXISTING 2 \ BEDROOM HOUSE I Ll i. �00, W MOUNTAIN PARK ESTATES #2; CK 4, LOT 17 PAD U'q / 1 l -CONTRACTOR CONNECTED TO EXISTING PRESSURE LINE I GARNESS ENGINEERING GROUP, Ltd ENGINEERING -SALES CONSULTING 3701E TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179 -FAX (907) 3383246' WEBSITE: — g.m.s.ng...r g c.m PREPARED FOR: PHONE NUMBER: PAGE NUMBER. KAREN SIEGEL 207-450-5349 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 5/5/2021 I Ll I GARNESS ENGINEERING GROUP, Ltd ENGINEERING -SALES CONSULTING 3701E TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179 -FAX (907) 3383246' WEBSITE: — g.m.s.ng...r g c.m PREPARED FOR: PHONE NUMBER: PAGE NUMBER. KAREN SIEGEL 207-450-5349 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 5/5/2021 PERMIT NUMBER: OSP211062 RECORD D RAW I N G TOP OF TANK AT INTLET = 95.79 INVERT OF BUNG AT INLET = 95.14 TOP OF MANHOLE #1 = 99.92 TOP OF MANHOLE #2 =100.00 FINAL GRADE = 99.5-99 . 7 MH1 MH2 NEW 1250 GREER TANK WITH ANCHORAGE TANK COMPONENTS USED AS LIFT STATION NO WATER WAS NOTED IN THE TANK HOLE BY THE ENGINEER DURING CONSTRUCTION; HOWEVER, THE TANK HOLE WAS PARTIALLY BACKFILLED. THE CONTRACTOR NOTED THAT THERE WAS WATER APPROXIMATELY 1 FOOT BELOW THE INLET BUNG. BASED UPON THIS FACT, A TANK MT WAS INSTALL THAT EXTENDS APPROXIMATELY TO THE MID -DEPTH OF THE TANK M PARCEL ID NUMBER: 017-023-18 2" INSULATION PER CONTRACTOR OF TANK AT OUTLET = 95.80 01 T EVGtNEERtNIG SALES -CONSULTING v,... w 3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE. AK 99507' PHONE (9071337-6179' FAX (907) 338-3246 - WEBSITE: vrxw.nam.sse"aine rm wm PREPARED FOR: KAREN SIEGEL PHONE NUMBER: 207-450-5349 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 TYPE OF WORK: �, SEPTIC TANK PROFILE PAGE NUMBER: 3OF3 DRAWN BY: D.J.G. DATE: 5/3/2021 Carroll, Rebecca M. SIMMEMMIM From: David Garness <David@garnessengineering.com> Sent: Thursday, July 22, 2021 2:09 PM To: Carroll, Rebecca M. Subject: Mountain Park Esattes #2; Block 4, Lot 18 Follow Up Flag: Follow up Flag Status: Flagged Rebecca, Soil cover was added over the field and the damaged caps were fixed. Sincerely, David Garness, P.E., M.S. Civil Engineer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Mobile: (907) 632-4528 Website: www.garnessengineering.com 4� GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTINGquanics I�ar�a�:5.c��? 7�1� 9h ... XE AeroCell' CA)Ett*pRAUON A ar ..d a •,r A11t1'V.XQ 1 Ai;I$kl D4itlil#utot THE INFORMA TION HEREON IS FOR THE USE OF LENDING INSTITUTIONS 5PECIFICAL L Y TO SHOW ANY CONFLICTS BETWEEN EXISTING 5TRUCTURE5 AND PLA TTED L O T LINES AND/DR EASEMENTS; AND I5 NOT TO BE USED FOR POSITIONINGADDITIONAL STRUCTURES, IMPROV`EMENT5, OR FENCELINES. EASEMENTS OF RECORD, OR ANY OTHER LEGAL ENTITY, OTHER THAN THOSEAPPEARING ON THE RECORD PLA T; ARE NOT SHOWN HEREON, (UNLESS INDICATED) NOTE.- FENCELINES THAT MAYAPP£AR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPER TY L INES OR POSITION ADDI TIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MA Y BE A PPROXIMA TE DUE TO EXCESSI VE SNO W A ND/OR ICE. THIS DOCUMENT IS PREPARED FOR THE OWNER OF RECORD; ONL Y NO O THER USE BY O THERS 15 ALL OWED , INCL UDING ANY SURVEY DA TA OR MEASUREMENTS HEREON WI THOUT WRI TTEN PERMISSION. ASBUILTSURVEY Irl -201 NO CORNERS SET THIS DATE 1 HEREBY CERTIFY THA T 1 HA VE PERFORMED A SURVEY OF THE FOL L0WING DESCRIBED PROPERTY L 0 T 18, BLOCK 4, NIDUNTAIN PARK ES TA TES NO 2 ANCHORq GE RECORDING D15TRIC T, ALASKA AND THA T THE '151ELE IMPRO 51 TUA TED THEREON ARE W1 THIN THE PROPER TYLINESANO NO V151BLE ENCRO4CHMEN75 EX15T 0THER THAN NOTED. DATED ATANCHOR,46E,ALASKA TH15 26 Tx DA Y OF APRIL , 2021 1294, F8211-43,212-63 HOLT LAND SURVEYING 9309 GR€1VER DRIVE ANCFIGRAGE,AK 99507 907-345-5513 3/8/2021 AnchorageLive - Parcel Print 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 - httpWwww.muni.orgbnsito On -Site Wastewater Disposal System Permit Permit Number: OSP211062 Effective Date: 3/11/2021 Work Type: SepticTank Upgrade Expiration Date: 3/11/2022 Tax Code Number: 01702318000 Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 4 LT 18 G:2839 Site Mailing Address: 13001 LUPINE RD, Anchorage Owner: SIEGEL KAREN E Lot Size in Sci Ft: 20130 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 2 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 (24/7). 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 Received By: Date: i Issued By: �1 Date 4 1 2021 70/188 MUNICIPALITY OF ANCHORAGE 6*1R, Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Ethan Berkowitz On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 017-023-18 Property owner(s) KAREN SIEGEL Mailing address 13001 LUPINE ROAD *ANCHORAGE, AK Day phone 207-450-5349 Site address 13001 LUPINE ROAD *ANCHORAGE, AK Legal description (Sub'd, Block & Lot) MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Sq.Ft. Number of Bedrooms 2 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: $225. Date of Payment: 3 O a 0 2 Receipt Number: 002 5 y G Permit No. OSP211062 Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211062, Rebecca Carroll, 03/11/21 NG I�GJJ L� „IN r_ " r t>.... ENGINEERING` SALES, CONSULTING March 1, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed STEP Tank Upgrade for Mountain Park Estates #2; Block 4, Lot 18 To whom it may concern: The subject lot is served by a private well and septic system. Per MOR records, the existing septic tank and lift station is approximately 33 years old (installed in 1988). Per MOA memorandum, a septic tank of this age must be physically inspected and/or replaced prior to COSA approval. Based upon this fact, we are proposing to replace the septic tank and lift station. We are proposing to decommission the existing septic tank and lift station per UPC and install a new 1250 -gallon HDPE Greer tank with Anchorage Tank lift station package. See attached design drawings for tank location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. _., M. S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.garnessengineering.com ALL WELL LOCATION SHOWN ARE APPROXIMATE AND TAKEN FROM MOA RECORDS / I \ CSE-PTIC MOUNTAIN AREEAD// �O i ; #2; BLC s / MOUNTAI pARKESTAT #2; BL CK 5, LOT S MOUNT `IV PARK ESTATESAM \ #2; �L \ 5, LOT (:'SEPTIC ARE y\ i \ \ F<<4 ARK ESTATES II ;K 5, LOT 8 11 N�"41 0 #2; Municipality of Anchorage On-site Water and Wastewater 00 GARNESS ENGINEERING GROUP, Ltd -2 ENGINEERING, SALES o CONSULTING ANCHORAGE, ALASKA' PHONE (907) 337-6179 • WEBSITE: w .gamessengineeringxom PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KAREN SIEGEL 207-450-5349 1 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM DESIGN UPGRADE 3/1/2021 �. . ey Gaff i 1I� C 7 53 LICENSE.`�0�� #AECC884 1/21 MOUNTAINPA11k ESTATES #2; BkOCK 4, LOT 6 \ PARK ESTATES �K 4, LOT 19 CSSE_PTIC I SEPTIARESAREnD / AWWTS ' I �'Ietogzljs_ jai \ / O ( \ ARE�Dl 100 (,y FCL AWrS 1 WRAO/US LL W \ ir MOUNT IN PARK ES E.i _ _ #2; ALOCK 4, LOT 7 O LL ARK RTES MOUNTAIN PARK ESTATES .gVOT 17 #2; BLOCK 4, LOT 8 00' wECC \ CS_EPTIC AWWiS /U3 1 ARE I —1— 00 GARNESS ENGINEERING GROUP, Ltd -2 ENGINEERING, SALES o CONSULTING ANCHORAGE, ALASKA' PHONE (907) 337-6179 • WEBSITE: w .gamessengineeringxom PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KAREN SIEGEL 207-450-5349 1 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM DESIGN UPGRADE 3/1/2021 �. . ey Gaff i 1I� C 7 53 LICENSE.`�0�� #AECC884 1/21 Municipality of Anchorage On-site Water and Wastewater GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. BY PROCEEDING \ I U6P21 1 Ub2, Rebecca Carroll, 11/21 0 SURVEY NOTE: CONTRACTOR TO FORWARD WITH THIS INSTALLATION, THE WEST TRENCH IS SHY ON COVER BY APPROXIMATELY 4 INCHES. SOIL HAVE NORTH LOT LINE AND 100' ENGINEER, WELL DRILLER, CONTRACTOR AND COVER MUST BE ADDED OVER WEST TRENCH. THE CAPS FOR THE WELL RADIUS FLAGGED BY A SEPTIC TANK PER AS -BUILT SURVEY AND INSPECTION REPORT PROPERTY OWNER AGREE THAT THEY HAVE CLEANOUT AND/OR MONITORING TUBES IN THE TRENCHES ARE REGISTERED LAND SURVEYOR PROPOSED 1250 GALLON HDPE GREER TANK WITH READ THESE SPECIFICATIONS AND AGREE TO . . DAMAGED/BROKENCAPS TO BE REPLACED AS NEEDED PRIOR TO CONSTRUCTION TO EXISTING PRESSURE LINE TO DRAINFIELD — ACCEPT THE TERMS AND CONDITIONS OUTLINED. \ MOUNTAIN PARK FGTATFc Hr RI (1cK A I nT 1a i APPROXIMATE LOCATION OF EXISTING "SPILLOVER" TREANCHES TO REMAIN IN PLACE FOR FUTURE USE. TRENCHES PASS A SEPTIC ADEQUACY TEST PERFORMED BY GEG ON 2/18/2021 -7 10' BUILDING OFFSET I SHED SHED FROM HOUSE AND SHE r ; \ � r EXISTING 2 I BEDROOM HOUSE I Q A. , • - 4 _ .. •� DRIVEWAY o- - J \ MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 17 / J� O� Q� l I I I i I q ( I I / I I / / ENGINEERING SALES CONSULTING `ANCHORAGE, AK 99507 - PHONE (907) 337-6179 • WEBSITE: www.garnessengineenng=m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KAREN SIEGEL 207-450-5349 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 D.J.G. TYPE OF WORK: DATE: DESIGN OF SEPTIC TANK UPGRADE 3/2/2021 O i o I I I I N Q SCALE: 1"=40' ��•'" 11141, ,1 reY�A..Ga . ess •,c i # C 9 ROF LICENSE � #AECC884 �,,"` i \ I I 0 APPROXIMATE LOCATION OF EXISTING SEWER LINE PER INSPECTION REPORT IN MOA RECORDS — O I APPROXIMATE LOCATION OF EXISTING PUMP VAULT AND n/ SEPTIC TANK PER AS -BUILT SURVEY AND INSPECTION REPORT UJ \ L•� IN MOA RECORDS i0 BE DECOMMISSIONED PER UPC Z PROPOSED 1250 GALLON HDPE GREER TANK WITH \ ANCHORAGE TANK LIFT STATION PACKAGE; CONNECT \ TO EXISTING PRESSURE LINE TO DRAINFIELD — i APPROXIMATE LOCATION OF EXISTING "SPILLOVER" TREANCHES TO REMAIN IN PLACE FOR FUTURE USE. TRENCHES PASS A SEPTIC ADEQUACY TEST PERFORMED BY GEG ON 2/18/2021 -7 10' BUILDING OFFSET I SHED SHED FROM HOUSE AND SHE r ; \ � r EXISTING 2 I BEDROOM HOUSE I Q A. , • - 4 _ .. •� DRIVEWAY o- - J \ MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 17 / J� O� Q� l I I I i I q ( I I / I I / / ENGINEERING SALES CONSULTING `ANCHORAGE, AK 99507 - PHONE (907) 337-6179 • WEBSITE: www.garnessengineenng=m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KAREN SIEGEL 207-450-5349 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 D.J.G. TYPE OF WORK: DATE: DESIGN OF SEPTIC TANK UPGRADE 3/2/2021 O i o I I I I N Q SCALE: 1"=40' ��•'" 11141, ,1 reY�A..Ga . ess •,c i # C 9 ROF LICENSE � #AECC884 �,,"` i THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTI TUTIONS SPEC7FICAL L Y TO SHOW ANY CCNNFLICTSBETWEEN EX15TINGSTRUCTURESAND PLATTED LCATLINE.SANDIOR EASE ENT5, AND 15 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OFRECORD ORANYOTHER LEGAL ENTITY, OTHER THAN THOSE'APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON, (UNLESS INDICATED) NOTEFE CELT ES THAT AYAPPEAR ON THIS DRAWiNGARE NOT TO BE U 'ED TO DETERMNE PROPERTYLINES OR POSITIONADDITIONAL IMPROVEMENTS, ANYPA VING SHOWN HEREON MAYBEAPPROXIMATE DUE TO EXCESSIVESNOWANDIOR ICE THIS DOCUMENT IS PREPARED FOR THE OWNER OFRECORD, ONLY. NO OTHER USE BYOTHERS IS ALLOWED, INC'LUDINCANY.S RVEYDATA OR ME45UREMENT5 HEREON WITHOUT !WRITTEN PERMI5510N. W CMERS SET THIS DATE I HEREBY CERTIFY THA T I HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY L 0 T 18, BLOCK 4, A40UNTAIN PARK E5 TA TES No ANCHORAGE RECORDING DISTRICT, ALA5KA AND THA T THE VISIBLE IMPRO VE ENTS SI TUA TED THEREON ARE W1Tl 111 THE PROPERTYLINESAND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED A T ANCHORAGEALASIKA THIS 26 TH LSA Y OF FEBRUARY, 2021 1294, FB 211-.3 HOLT LAND SURVEYING 9309 GROVER DRIVE AWCHORAGE,AK 99507 907-345-5513 72-013 (3/85) MUNICIPALITY OF ANCHORAGE tf Z�j D. ARTMENT OF HEALTH AND HUMAN SERVICES 1 / D Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES A•JIg• n TO SEPTIC ABSORPTION WELL Address FAOM TANK FIELD Phone(s) Permit No. No. of Bedrooms WELL [/ ` 24'0 a -I 1-1 LOT LINE I LEGAL DESCRIPTION -1 I Lol Block Subdivision - I �b -i- 10 ' G Z_ '` FOUNDATION Township, Range, Section �• �2 •y � AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS I� SEPTIC ❑ HOLDINGL-1A _f� h!T :Lel: A— Manufacturer Capacity in gallons 2 ( Material No. of Com part 1 D (I i 7i ;v G'1, Ir TYPE OF SYSTEM 1 ❑ TRENCH ❑ BED W. DRAIN ❑ OTHER I I 1 Depth to pipe bottom from Total depth from original grade original grade 'L d9 FT ";5 r 0 FT Fill added above original grade Gravel depth beneath pipe hFT 1 0,15 FT tO FT Gravel length 1 Gravel width to 1 Lpp FT St"O FT Total absorption area I Distance between lines `'ice SQ FT�'0,OFT Number of lines Soil rating Pipe material 2 Z�►�I SQ FT V4,(f, - Instal er Yr Date installed /t .�Q --)-2' 1 `� `� �\ WELLS j, PRIVATE -1 OTHER (Identify) L'GG icauon (A,B,C) Total DepthCasetl to —• 1 11�Ya ��0 1 FT '2x: -->'i FT _ g Installei Date Installed: y'� - lcl- 8Z - = Z s_ G o• y REMARKS: _v — fli-v o U I � ami 't Scale: 1 -12L :JENGINEER'S SEAL Inspections Performed by: Date: 3_2J� `rte � ` 0 9 S ENOINEERING certify that this inspection was peliorined according to all t b4ala River LSP R®aed N®.204 Sty a de tie I ell c h e �a1e: �'— s Municipal a �for r1 t r Health Department Approval: 72-013 (3/85) , ~ '. ~ MUNICIP�LITY U|ANCHORAGE �ep�rtment �f Health & Human 825 L Stree|, Anchorage, Alaska 8 N S I T E S E W E Se/`vices 99501 343-4720 Pprmit N:m�er: 880009 Upgrade Date lssoed: c3/02/88 Engi|eer Designe� Owner Name: H`U"D. / S&S ENGINEERING Uwne�Address: 17�1 C STREET Day Phone: 694-2979 AN[HOR�GE, AK 99517 Parcel Id: O17-�23-i8 LoL Legal: Subdivision: , PARK^EST, # Lot:'18` Block: 4 Section: 26 flips'ski i p-: i0-Ra����`3W''`' Lot Size 20131) (sq.ft. or acres) Max Nod rmom : lhis Permit: 3 Total Capacity: 3 S�PlIC T'NK: Minimum total septic tank capacity: 1,0O0 gallons. Each septic tank mu�t have W. least 2 comparimentin , Depth to top of vii 1: iiic tank(s> feet requires insu]atioil over tank(s). [WSl. LL PER lot SINEERS DESISN 401 DRAINFIELD: 160' X 5 X 1. [UTAL 0EP|fi 3.()'. 1. FIT STATION TO BE INSTALLED AFTER EXlS[ING 1000 No. iANK WI[11 41I8HWA1ER ALARM. ELECTRICAL lNSPECTION RE&1IRED AS WELL AS PAN 1T FROM 811ILDLAIR SN" 50 l CERTIFY |HAT: �amiliar with the revuirements ior onsite sewers and wells as seL �orth by Lhe Municipality and Was State of Alaska, 2. I will ins! all the system in accordance with all MOA cocles and r�gulaiions� and ix compliance with criteria of this permit. 3. [ w111 adhere to all MOA and State ov A1as4:a requirements |or the set back Jistances (rom any existin-A well, wastewater disposal system or pub]ic se�e�age system on this or any adjacent or nearby Ant... 4. I understand Vital, this permit is valid for a maximum of 3 bedrooms. I also understand Wat the ca[:iacity o[ the total is 3 bedrooms and any enlargemeni will req:ire an additional permit. Signed: tOwner> H,U,it. /nS&SQENGINEERI�� lssued By: DATE: LEGAL DRAWN CKD. lW SHT. 159 IMY ��y � ltd ) L 9 �X�yrle-�Cy t�t� I 0 / 83, oo' V)6LA,-'!) c F3 ar � e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 4:r'•- �`` r� 6 - PERFORMED PERFORMED FOR: �/'� l �: 1T73T t—c�T t3—I 1`C�i71 DATE PERFORMED: - � I � LEGAL DESCRIPTION: LI �J �4 tY. B�i='L-Township, Range, Section:-�-1Zt--� 9-57t. e�2—b JRtEPT,I{.,Sl� y. SLOPE SITE'PLPi r/ N µ i 2 3 4- 5 r M L— test r \ � J 6 r6 ��1i /i✓, • J / (( 7f/ 8- 9 9 -C� t 10 r WAS GROUND WATER ENCOUNTERED? 11 � D IF YES, AT WHAT O k 12 DEPTH? p 13Depth to Water Aher Monitoring? �Y=*— Date: 24:q= --e>0 14- 15 16- 17 81920 18- 19- 20 COMMENTS - Reading Date Gross Time Net Time Depth to Water Net Drop Z• •Z �jo til t rl, tp `~ I 2 14 �7`. oGj t0 �t�`. (p l` 1b" S PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT S & S ENGINEERING ! ' PERFORMED BY'7034 1�kihiiveri Loop Road No. -204— Ll , v� / CERTIFY THAT THIS TEST WAS PERFORMED IN etqgg� J ACCORDANCE g4R! ✓rANFAUFIIC 9A*Q IPAL GUIDELINF1I19.E FECT ON THIS DATE. DATE: C— ` 2,Y U 72-008 (Rev. 4/85) a (ENG NE@RO?;EAE9, 7s ;a'4 Municipality of Anchorage r, F i ,_ DEPARTMENT OF HEALTH & HUMAN SERVICES ' 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST'"''",:.,, PERFORMED FOR: 1A, `"�• l=�IS`�=liber-� (t`�-Y L�'��� DATE PERFORMED:_ LEGAL DESCRIPTION: ` ���r(LTownship, Range, Section:T1 Z ;r ` �� `G �T— SLOPE � 1 ` v •< 2 3 `U o4-- 4-/- 6 4 /- 6 � e 9 or` 10 'tel 11 12I b rel pF 13- 14- 15- 16- 17 314151617 18 19 20 COMMENTS WAS GROUND WATER ---I� ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water After 88 Monitoring? � Date: ?r1y1 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER (O~ TEST RUN BETWEEN ?! FT AND —�-- FT S & S ENGINEExrnv PERFORMED BY: 034 Ea.. t.. 1��offSver I OOP Road ACCORDANCE WIT F9W1eSR�AADa0ffVIC"IiPAILGUI 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: 2 Z e✓ �� L _4 - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME `-� PHONE 110qN EW J ?�. h V\ r PoLD�i 7�� .�(� ❑UPGRADE MAI LING ADDRESS AK. `✓%so LEGAL DESCRIPTION 4T LOCATION NO. OF BEDROOMS Well / Absorption area / Dwelling / PERMIT NO, v DISTANCE TO: /6 Y a Q w� Manufacturer Material v No. of compartments y Liq. cgpacity in gallons p IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Jaz 0.z z a Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well ly Foundation P / Nearest lot lin / PERMIT�O.O w= LU LL Z No. of lines Length of each line Total length of Ines I Trench width Distance between lines f Z w ' 4t inches FTop finish Material beneath the11Total effective absorption area of tile to grade ! p inches Length r Width t Depth PERMIT NO. w U Q I- Type of crib Crib diameter Crib depth Total effective absorption area CLC W ur Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J Lu R: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS CA -5T I &c)N PL A��t� SOIL TEST RATING /6-0 A r Yv1 INSTALLER Gr P &X CATIA -7 1N6 , REMARKS TAmK To 5 E "O, ov- 6, rr v'o FOA r" I M A ®W A�llc © 6 �E7t/lL7lJ 5 �u 5 O 5 = - APPRO D /may DATE LEGA `® I�` ll 72-013 (Rev. 3/78) -,MUNICIPALITY OF ANCHORAGE—, Department 'f Health and Environments Protection VU 825 Street, Anchorage, AK. .9501 264-4720 # # # HANDWRITTEN PERMIT # # # Permit WELL AND/OR ON-SITE SEWER PERMIT9�Z Applicant: J, 201-) ivy 61ds Mailing Address:17 Location: -------- Phone Number: 3 V -q- 50 VA - tl-<9c Legal Description: (j' bgfi Lot Size: ,Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: k�- Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) /150 The Required Size of the Soil Absorptign System Is: DEPTH LENGTH .26 x 2 _ GRAVEL DEPTH TH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # # REQUIRED SEPTIC(HOLDING) TANK SIZE _ % QQ 0 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection.and approval by this department. will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if. ?R, resideLis remodeled to include more that 3.bedrooms. Signed : �7 �„IiIt1 /V Issued by: Applicant _ Date: f+ ,�� SWP/024 / \1/81) (� %� �z�e r �� (7 eLtd l SOILS LOG -- ' MUNICIPALITY OF ANCHORAGE o, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED LEGAL DESC 0-" ✓1 DEPTH (FE CO 15 aly lG 1 g 2 q •r05 3 �,') j(C7D) 4 5 6 P DATE PERFORMED: T/�?• l3/a,/ a, Lv-/ /? E SITE PLAN 7 / / / / 8 f�i Tln ry C -L 12.0 • 9 7�n �y spm kp�v-e 10 0'(Y WAS GROUND WATERS 11 9 ENCOUNTERED? e-5- LO 1211 ��•/< CG.1 . MSI n P E IF YES, AT WHAT DEPTH? t� 13 �. . /t Reading Date Gross Time Net Time 14- Net Drop 15 16 17 is- 819 19- 20 COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT J PERFORMED BY:-','/, At � CERTIFIED BY: 72-008 (6/79) DATE:7=1,;z SOILS LOG MUNICIPALITY OF ANCHORAGE \ , R +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION J< PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 _ 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �(' l �C /(�/III (J� DATE PERFORMED: LEGAL DESCRIPTION: a(•III ! 17 �TAI.P�6i1 ��� /C�C� `7 i h-O� SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS -ON6aie1' 5A (~1L)--si1+ ls�P_eP 1-e jro \1L) 3i�� I Paelc��s� sdhc� (:5P)a-Prior14 g'Iraaed WAS GROUND WATER S '5anUS ENCOUNTERED? L 0 P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop r ZD (v: f541 : 00 Z O. J-3 C2 PERCOLATION RATE `�'t.� (,minutes/inch) TEST RUN BETWEEN .�' - FT AND "' FTS. PERFORMED BY: J_ —CERTIFIED BY: 72-008 (6/79) DATE: 7-,;2 FQ 9 2701 Eagle Street DAILY DRILLING LOG SYREN BROS. DRILLING, INC Anchorage, Alaska 99503 274-6437 OWNER OF LAND .... Jeff ...B.o.n.i.n.Z.S.e.n.t. ry ......B.u...i..l...d...e...r...s ......... 8329 Stormy Place ADDRESS.............. .................................................................................... Lot 18 Block 4 Mt. Park Estates WELL- SITE ............................................................................................... DATE -STARTED ..... L1.51.8.2 .............................................................. DATE -ENDED ......... 7/19/82 . . . .......... ................................................... 201 Feet DEPTH OF WELL ....................................................................................... STATIC LEVEL OF WATER FT ..... ...... f...g.,.J.� .................... DRAW DOWN FT ........... ....o.f f ...b.o.t..tom ........... GALS. PER HR/MN ................ 5 gal. ........ Z��in, .............................................. 3" A53 GRD "B" Steel KIND OF CASING ...................................................................................... KIND OF FORMATION: .............. FT. TO ... 2 . 4 . .......... FROM......... . . .. ............... FT ... clay. (damp) FROM ........................ FT. TO ....................... FT ..................... 24 45 11 FROM........................FT. TO ....................... FT ................................... (dry) FROM ........................ FT. TO ....................... FT ................................... FROM.... ...............FT. TO..5.8. ............... FT ........... I......................... (wet) FROM ........................ FT. TO ....................... FT ................................... FROM.... 5 . 8 ...............FT. T02.6 ................ FT... .............................. (dry) FROM ........................ FT. TO ....................... FT ................................... FROM... 96 ...............FT. TO135 ................ FT ..... (damp) FROM ........................ FT. TO ....................... FT ................................... 135 1 (wet) FROM.................._....FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... FROM. 15 5 .............. ......... ..... FT. UP5 ................ .......... FT..�ight ... clay/ ........... .. gravel (dpfEam ........................ FT. TO ....................... FT ................................... 195wet clay/gravel FROM ........................FT. TJ.9.8 ve ................ FT ................................... FROM ........................ FT. TO ....................... FT ................................... 198 201gravel/sand/water FROM........................FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ..................... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... MISCL. INFORMATION: FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... FROM........................FT. TO ....................... FT ................................... Stephen D, Syron, DRILLER'S NAME ....... ............................................................................... 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 OSC251113 Parcel ID 017 -023-18 Expiration Date: 3/20/2026 Legal description MOUNTAIN PARK ESTATES #2 BLK 4 LT 18 Site address 13001 LUPINE RD Current property owner(s) ANGER EDWARD F & MARY E X The On-site system(s) is/are approved for 2 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date: 4/8/2025 This C ificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject Sys m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, D velopment 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 Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE /4� 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. 017-023-18 Complete legal description MOUNTAIN PARK ESTATES #2 BLOCK 4 LOT 18 Location (site address) 13001 LUPINE ROAD ANCHORAGE, ALASKA 99516 Current property owner(s) MARY & EDWARD ANGER Day phone 2. ON-SITE SYSTEMS SIZED FOR 2 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 4 - See advisory if steel 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 $ D c� Date of Payment COSA # OcpC 2_5111'; Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: MOUNTAIN PARK ESTATES #2 BLOCK 4 LOT 18 Parcel ID: 017-023-18 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/19/82 Total depth 201 ft Cased to UNK ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 3/20/25 Static water level at beginning of test 165 ft. Well production at time of test 5 gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate *11.7 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 3/20/25 Comments *Area has higher nitrates / similar to last 2021 results & well was scoped by AAROW - per MOA docs. B. TANK DATA Measured operating fluid level in septic tank *NA Date of pumping 3/20/25 Required maintenance completed, if AWWTS Comments: *Floats / Lift Station C. LIFT STATION Required maintenance completed Age of lift station 4 years Lift station material PLASTIC Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/7/1988 ALL standpipes present per record drawing Total measured depth from existing grade 3.6 ft (max) Measured depth to pipe invert from grade 2.4 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) 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 gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 3/20/25 Results Pass (Tested West Trench) Fluid depth prior to test 0 in Water added 450 gal New fluid depth 3 in Elapsed time 45 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 12 in (MOA 1’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 12 in Comments/Deficiencies: Tested the West Trench only. The East Trench fluid level had 9” of fluid. Similar per previous COSA testing in 2021. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No *4 ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *PREVIOUSLY ISSUED WAIVER – WR#970007. MOA ROW ISSUED NON-OBJECTION LETTER DATED 10/18/2025. 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 of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 04/03/2025 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 04/03/25 MUNICIPALITY OF ANCHORAGE 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 13001 U)l V1 Septic Tank: -Sludge level inches -Pumping: required es no -Pumping completed (gL no Lift station: -Pump basket cleanedes no -Effluent filter cleaned es no -Control floats cleaned tes no -Proper float settings confirmed es no -Operation satisfactory es no Alarm System: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling es no -Alarm system operation s tis ac o not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection -Ground water intrusion around pipe penetrations -Manhole lid: Functional es no Insulate es o es no -Weep hole functional no Insulated a es no Properly Secured es no Other -All manufacturer required inspections and maintenance completed e no Comments: r Qualified Maintenance Provider: Technician Company So- U f Signature Date of mainter' a' nce r S Date pl f DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite --� Nitrate Advisory Certificate of On -Site Systems Approval # OSC251113 Subdivision: Mountain Park Estates #2, Block: 4, Lot: 18 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 11.7 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a 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. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Parcel I.D 017-023-18 � QO Municipality of Anchorage -. On -Site Water and Wastewater Program ` (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date: 0a d 2M Complete legal description MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 Location (site address) 13001 Lupine Road *Anchorage Current Property owner(s) Karen Siegel Day phone 450-5349 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ❑X Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual z Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -6-50 Waiver Fee $ Date of Payment 7Z2�� ( Date of Payment Receipt NumberReceipt Number COSA # 05C 2, 1 13 90 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 it Ivestigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 3 itl'Z( In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE �1 I/ System #1 Approved for d bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, :...9 .................... �.. ......... ...... l fe vi Garne s f/• CE ?953 wpr0 f essi0 #AECC884 OF ON-SITE with the followirjs ipuWNfFsR AND Q WAST`r \+ATER O By:QW—ox Comm Original Certificate Date: 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 Septic System Advisory Well Flow Advisory Nitrate Advisory _ Arsenic Advisory Other V COSA Checklist Legal Description: MOUNTAIN PARK ESTATES #2; BLOCK 4, LOT 18 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA n Well log is filed with Onsite (or attached) Date drilled 7/19/82 Total depth 201 ft Cased to UNK ft X Sanitary seal is functioning correctly no Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/18/21 Parcel ID: 017-023-18 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Q No AN Coliform bacteria is Negative Nitrate 10.9 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L F61 Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 2/18/21 Static water level at beginning of test 174.4 ft Comments SEE ATTACHED EMAIL FROM AAROW PUMP AND WELL REGARDING CAMERA INSPECTION B. TANK DATA Age of tank(s) NEW years Tank type/material STEP/HOPE Measured operating fluid level in septic tank X Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA DUAL SPILL-OVER TRENCH Which system tested (date installed) 3/7/88 OR ALL standpipes present per record drawing Total measured depth from grade 4.08 ft (max) Measured depth to pipe invert from grade *2.08 ft (min) ❑ NIA — pressurized field F01 Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION 0 Required maintenance completed Age of lift station NEW years Lift station material HDPE Comments: SECOND COMPARTMENT OF 1250 TANK Adequacy test date 2/18/21 Results [D Pass For 2 bedrooms Fluid depth prior to test 0 in Water added **466 gal New depth 4 in Elapsed time 100 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 300+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: 'DRAINFIELD IS INSULATED **TESTED WEST TRENCH ONLY- EAST TRENCH HAD 11 INCHES OF LIQUID IN IT COSA Checklist yellow sheet q1J 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' F✓ Yes Community Sewer Manhole/Cleanout > 100' [✓ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' r7l Yes if No ft Absorption Field on Lot > 100' F71 Yes if No ft Holding Tank > 100' Z✓ Yes if No ft Neighboring Absorption Fields > 100' Q✓ Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft M✓ Yes if No ft 0✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' [✓ Yes if No ft F/I Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F✓ Yes if No ft Surface Water > 100' M Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' Surface Water > 100'✓Q Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Main > 10' 0✓ Yes if No ft Community Wells > 200' 0✓ Yes if No ft 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 ft If absorption field is under driveway comment below Property Line > 10' Yes **4' if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS "PER AS -BUILT G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet Yes if No ft Yes if No ft J y A. a ness., C — 3 4 fP�e 1 � 0fesslonoo #AECC884 D MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • '� On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC211062 Subdivision: Mountain Park Estates #2, Block: 4, Lot: 18 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 10.9 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 4:51 oil 5GEA ) 2 Messajes < 0 13001 Lupine Rd. Jeff Garness 3/ 2 1 EN i 41 To: Sonja Cc: Erik! David > From: David Harper <dIharp2er2@ gmCkiI.com> Sent: Wednesday, March 3, 2021 10:49 PM To: Jeff Garness <Jeff ggarnessengineering.com> Subject: 13001 Lupine Rd. Jeff, we ran the downhole camera on the well at the above properties to 50 feet.. We did not find any breaks, holes and no entrancing water. Casing and appurtenances appeared to be in good order. David Harper Aarow Pump & WeIll Service, LLC See More Sonja Blewett To: David Garness > N Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program s 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-023-18 1. GENERAL INFORMATION HAA #0a-p5z'o Expiration Date: .1 — 2 O 6 Complete legal description Mountain Park Estates #2 Blk 4 Lot 18 Location (site address or directions) 13001 Lupine Rd Current Property owner(s) Erie V & Joanne E Johnson Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 13001 Lupine Rd, Anchorage, AK 99516 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 21 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 10/25105 S. DSD SIGNATURE ✓ Approved for-3—bedrooms. Disapproved. Conditional approval for bedrooms, with the foltowin Additional Comments Note: The well for this property meets existing State and Ilfunicipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration Is 7.48 mg/l. EPA maximum concentration Is 10.0 mg/l. Alore Information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: D 5- (11cv. 01107) Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Sotto Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onstte (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descxipfiwr Mountain Park Estates #2 Blk 4 Lot 18 Parcel ID: 017-02318 A. WELL DATA wen type Pri Date completed mama Total depth 201 ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Sanitary seal (Y/N Y Cased to 201 ft. FROM WELL LOG 7/19/82 170 ft. WATER SAMPLE RESULTS: Colftm 0 colonies/100 ml. Arsenic: NA mg.A. B. SEPT11WHOLDING TANK DATA Nitrate 7.48 mg.A. Date of sample: 10""06 Tank Type/Material Steel Tank size 1000 gal. Number of Compartments 2 Well Log (Y/N)) es Wires Party Protected (Y/N) Y Casing height (above ground) 13 in. AT INSPECTION Sep 28, 2005 173 5.0 ft. g.p.m. Other bacteria 0 colonies/100 ml. Collected by: Rocky Trainor, Watkins Entn Date installed 10119/82 Cteanouts (YM) Yea Foundation cleanout (Y/N) Yea Depression over tank (YM) No High water alarm (Y/N) Yes Data of pumping 8/18/05 Pumper Isaac's Pumping C. ABSORPTION FIELD DATA Date installed 3/7/88 Son rating (g.p.dJfe or fe/bdrm) 299 System typa Wide Trench Length 160 1 ft. Width 5 ft. Gravel below pipe 1 ft. Total depth 3.8/4A ft. Eft. absorption area 920 ft? Monitoring tube Yes Depression over field No Date of adequacy test $ep 28, 2005 Results (Pass/Fall) Pass For 3 bedrooms Fluid depth In absorption field before testo_ In. Water added 457 gal. New depth 1.75 kr. Elapsed Tune: 62 min. Final fluid depth 0.75 in. Absorption rate >z 450 g.p.d. 1 Any rejuvenation treatment (past 12 mo.) (Y/N & type) no If yes, give date I I' D. LIFT STATION Data installed 3/7/1988 'Pump on" level at 33 in. Datum Bottom Of Tank E. SEPARATION DISTANCES Size in gallons 500 Manhole/Access (Y/N) Yes 'Pump ofr level at 28 in. High water alarm level at 36 in. Cycles tested 10+ Meets alarm & circult requirements? Yes SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 129 Absorption field on lot 157' Public sewer main 100+ Sewer /septic service one 12D+ On adjacent lots 1 W+ On adjacent lots 1W+ Public sewer manhols/deanout 100+ Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property line V Absorption field 49' Water main 100+ Wells on adjacent lots 100'+ Water service line 130 Surface water 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property one 4" Water Service one 25+ Curtain drain none known F. COMMENTS Building foundation -' Water main 100+ Surface water 10D+ Drlvmay, padtlnglvehide storage E Wells on adjacent lots 107+ 'Measuremerrb for west trench. East trench stayed full. "Epatlng waiver. MOA Nonobjectlon to drain8etd in easement. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and 41.V A N', review of Municipal records that the above systems are in 49THW conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis Date /0 -25 -05 Cl dy W. Ellis ., CE.10 HAA Fee E 73o '1z Date of Payment /D"5- S Receipt Number 15y,:2q_7�'- (Rev. 12J01) Waiver Fee $ Date of Payment Receipt Number Oct 24 05 10r37a JORnne Johnson 907-348-8870 p.l Municipality of� Anchorage Jl.1 Rich—_.-17aI,Mllbi.sv.II: ):CC�Ays,1:7r'�d1 l!lt•uea.\p.\.u1Y.lIwIcw-n:I'il.a.Itit1n!cOlt.�:Y.I ti!a[ctII::C{.I}lErIYd.1+l).c1I1U)•IILt;tr/tl/lwll wnl:wftt.clO!yunanNdl V..wn•j:r irk , October 19. 2005 L• ie V. Johnson 13001 Lupinc Raid Anchorage, AK /9516 M-.ir Mr. Johnson: RE: Encroachment: Leach Field and Fence Block 4, Lot 18. Mountain Park F_.ntcs #2 Subdivision. Grid 2939 11.•1.:11'1111.'lll '111c Right of Way I)ivision has reviewed a request for a letter of nonobjection to an existing field and fence, which encroaches 9 -fact into the 10-fiwt Utility Easemen, on the eastcm property boundard. On the as -built survey dalcd June 27. 1995. submitted with the retlucst, the petitioner has shown the existing Leach Field and fence. This letter of nonobjection is imed with stipulations. and by usin}; it the Ix-titioncr is agreeing to the following: I. Municipality of Anchorage (MOA) will be held harmless, now and ftwever, for any damages or injury to any person as a result of the encroachment,. 2. All applicable codes and regulations will be observed and maintained within the casement. 3. This letter of nonobjection will in no way prLclude MOA from full use and enjoyment of its rights, within any portion of the cacenlcut. 4. Additional and extraordinary cants incurred during :my future required construction. tepair or reconstruction of MOA improvemcnta to accommodate any or all of the encroachments shall be paid by the property owner. 5. Obtain later.: of Ism-obi—lion from the following utilities: ® Anchorage Water& WastewaterUtilily © AI:Ls,kaCOnlmunivat10n5Systems ®❑ Chugach Electric Awuciation. Inc. ❑ anuska Telephone Association Mta Matanuska Electric Association. Inc. © Enswr Natural G:Is Company ❑ Municipal Light & Power (;(.[Cable of Ala%ka ❑ Eyocom (Girdwolxl Cable TV) All Inters of nonobjection should be retained in your permanent files. If you have any questions. please call meat 3434033. Sincerely. Concur 1� .. Frost, Jr. `J Right of way Supervisor )`roperty Owner(s) Canlmu.nity, .Security. P)-rn�erity (i;VIVMM•(1NM'I//5�++..'�1✓PI/II'W1W+,M1JtY/F.'/i.YIrN�A1nWIIYi.1I Y/I iJ/•//f.S I.OI )�YI41, .I.AnGM .a SCS ReUI 1056867001 All DateaMmes are Alaska Standard Time Clknt Name Watkins Engineering Printed DatdPime 10212005 8:15 Project Name/# Mt Prk Est No 2 Bk 4 Lot 18 Collected DatelTlme 10/142005 14:02 Client Sample M Mt Prk Est No 2 Bk 4 Lot 18 Received Datelfime 10/142005 15:02 Matrb Drinking Water Technical Director Stephen Q Ede Sample Remarks: Allowable Prep Analysis Parameter Results PQL Unita Metbw Container ID Limits Date Date Init Nitrate -N 7.48 0.100 mg/L EPA 3531 B (�-10) 10/14/05 ATS Microbiology Laboratory. Total Coliform 0 coVlOOmL SM209222D A (o-1) 10/14105 TLF MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES hft 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 LD.# Dt1-0za—IS` HAA# �1ilgln f�f��l� 1. GENERAL INFORMATION Z Complete legal description �a -r Location (site address or directions) I3 °Q i L-UPIn1E 20afl P-1Gt1 • ale- �i95►iC Property owner To to% M `'`F H"CMS4 Day phone 345 —1653 Mailing address 6'c1A-`E P'& Ag°vim Lending agency Q Day phone N (� Mailing address— Agent ddress Agent P1 1,4- — Day phone ►� (�° Address tJ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Z 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC_attest- ing to the legality and status of system. - 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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 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 da of this inspection. Alaska erSer & 337—W-7? Name of Firm WasteN�aterSavices f+:ti't3i1t1rit r�lae (1 Phone Address Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Date 48��asa�P�� Conditional approval for bedrooms, with the following stipulations: Additional CommentSUTILITY EASEMENT ADVISORY: The wastewater disposal system serving this property is'partially located within a utility easement. At time is 1 -ho fut-iira it may harnma necessary to partially or completely abandon nd.x',elocathe exis i g on–site wastewater disposal system if the uti3.- By;Date CAUTION 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 courtesyto purchasers of homes and their lending institutions in orderto 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. 1/81) Back MOA #21 RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES FEES 2 1 1997 i Environmental Services Division Municipality of Anchor I'15 825 L Street, Room 502 • Anchorage, Alaska 99501 • )Nw,44414man Services Health Authority Approval Checklist Legal Description: LO -T- 16, 1R1G4� hvuaiNe-1a ParzK _ Parcel l.D.: 01-7 CZ3-1 t� F_r=rr -ttz A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number rl'il Log present (Y/N) Yips Date completed -7%9./8Z_ Total depth Zo I Cased to 4,04- Casing height (above ground) > 1 Z �� Sanitary seal (Y/N) _ Date of test Static water level Well production �t✓S FROM WELL LOG 7/101 / Z 1-70 5 Wires properly protected (Y/N) AT INSPECTION z l P4h 179 �t 4a 4-s- y� S g.p.m. d - WATER SAMPLE RESULTS: Coliform Nitrate act Other bacteria co f Date of sample: Iti/5-7 Collected by:�SS m B. SEPTIC/HOLDING TANK DATA Date installed iv t 9 B2 Tank size Number of Compartments 2 Cleanouts (Y/N) y� S '1 Foundation cleanout (Y/N) V Depression (Y/N) tjO Date of Pumping V lit q7 Pumper dL'P h c b0^1A"'-0S C. ABSORPTION FIELD DATA High water alarm (Y/N) NF.S t4 �..o.rL" � Pc,aElr � S Mo��Ell purS�oE '�-4E 1-wuSE. �6cC Date installed 3 e Soil rating ,(gda d /W or ft%drm)2'�19 System type `Tt25`X'� Length 160 Width 5 Gravel thickness below pipe 1 Total depth 3 Effective absorption area 9 Z O Monitoring Tube present (Y/N) Depression over field (Y/N) /J Date of adequacy test 2114' Rb Results (Pass/Fail) PAss For 2 bedrooms ,r Fluid depth in absorption field before test (in.); : Immediately after_�gal. water added (in.): ta: Fluid depthW ° " (ins) Minutes later:_ Absorption rate = > 300 g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)" NO JF— If yes, give date 01A D. LIFT STATION Date installed 3 �� A 8 Size in gallons 5_00 Manhole/Access (Y/N) 5 "Pump on" level at* 33 a�� "Pump off' level at* 7,13 High water alarm level at* 36 *Datum -e07-r4>,+ Cycles tested Z+ 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 &_ p&2- A-S--9uIV-1 On adjacent lots On adjacent lots N (f4 Public sewer manhole/cleanout rJ If4- 100 Lift station } (ID D/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ��+ Property line (� 1 Absorption field ID q - Water main/service line �- to Surface water/drainage `io0 Wells on adjacent lots ICAO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 4 Building foundation 10 4 - Water main/service line Surface water ' too Driveway, parking/vehicle storage area Curtain drain NONE L'NOW"J Wells on adjacent lots 10 COQ > 10/ F. ENGINEER'S CERTIFICATION <,P I certify that l have de rmi d r field inspections and review of Municipal record�t01 die" d,' are in conformanc wi gui elines in effect on this date. Eo �. a °` ° ° f'9 oD e9 uo + e •° co°vane pre.+ Ai Signature ,a Engineer's Name c��7 fTl L�"/ 'F , " o fey A, C+arness ° (v 6 CE -7953 ay Date� HAA Fee $ Z P --D , A_e) Date of Payment 12-,l Receipt Number = 6 S�2 !2 Z 72-026 (Rev. 3/96)* Waiver Fee $ 1 \,�,cn Date of Payment .')- \ \ `l I Receipt Number Cj,-)[A, C, `C [L"O ® IVIUnieipanty ®f Anehorage 61 Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor March 18, 1997 Jeff Garness, P.E. Alaska Water and Wastewater 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 18 Block 4 MountainParkEstates #2 Waiver Request #WR970007, PID 1017-023-18, RA960056 Dear Mr. Garness, Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 4 foot from the trench to the east property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. S'ncerely,� � ��. 1y JJames P.. Williams V/Civil Engineer On-site Services JPW/ljm: Homza MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR970007 PID # 017-023-18 HA# RA960056 Permit # Date Received: March 17, 1997 Legal Description: Lot 18 Block 4 Mountain Park Estates #2 Engineer: Jeff Garness, P.E., Alaska Water & Wastewater 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: Tom & Julie Homza Waiver Requested: Lot line from east nroyertv'iine to trench 4.feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons// for above: L/�7EIIA 02tElju ci 11\j'S7igtt,EV ,4,-< C.cA-S Ftcuot /E -o7 to l FFtz ,4/✓cC_ rfa�.a l��-:C?uc2�,i��iv�7 !-c3Jt lQ ` S�PFI�IA-7tcr}�I; bvSirVir�n- -X27/f=ig, _rgA`t Zl- ILt Vl/«(- Date: cz /S By: of Reviewer Rec #: 02681/5968 Amount: $ 115.00 Date Paid: March 17. 1997 Alaska Wateir & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 M URAGE Phone (907) 337-6179 — Fax (907) 338-3246 EWIRpMMENTAL SERVICES DIVIBIDIV Consulting Engineers MAR 17 1997 March 12, 1997 n n - D-2) _ l � 2_'�-) Coo -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 Attn: Jim Williams CEIV. ED Subject: Septic System Lot Line Waiver for Lot 18, Bk 4, Mountain Park Est. #2 Dear Mr. Williams: Per your direction we are requesting a waiver of the separation distance from the septic system on the subject lot, to the east property line. Per the as -built survey (submitted with the original HAA package), the monitoring tube for the east trench is only 6.5 feet from the property line. Since the trench is 5 feet wide, I am assuming the monitoring tube is in the middle of the trench, and that the east end of sidewall is only 4 feet from the property line. This is a conservative assumption, based upon the sketch shown on the 3M88 inspection report. This encroachment has existed since 1988 with no adverse effects that I am aware of. Furthermore, the encroachment does not appear to restrict the potential for future septic upgrades on the adjoining properties. In short, I am unaware of any adverse impacts associated with this waiver. As addressed in the original HAA submittal, the trench is inside the 10 foot utility easement which parallels the east property line. The homeowners are in the process of obtaining letters of non -objection from the utility companies, and will provide them to the lending institution.. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely, JeflreyA#garne3gR'E., M.S. 115 � 21-r/ (5_N- 8) 91171 ?7 RECEIVED MAR 17 1997 lViunicipality of Arlchora0e .Dept. Health & Human Services !1\l aSjka WateIr & Wca Steal tell MUNICIPALITY OFANCHUiwvt Et,IV'QnNMENTAL SERVICES DIVISION: 8471 Brookridge Drive — Anchorage — Alaska 99504 r,,. Phone (907) 337-6179 -� Fax (907) 338-3246 FEB 2 191) Consulting Engineers E CE IV ED Febniary 20, 1997 Municipality of Anchorage Department of Health &_ Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well & Septic System. Lot 18, Bk 4, Mountain Park Est. #2 To whom it may concern: The subject lot has a 2 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL,, On the day of my inspection (2/14/97) the static level was 179 feet below the top of the casing. Water was pumped from the well at a rate of 4.45 gpm for 165 minutes (734 gallons). Within the first 10 minutes of pumping the water level_ dropped to 188 feet (end of pumping cycle) and stabilized between 183 feet, and 188 feet throughout the rest of the test. At the end of the pumping period the recovery was monitored for 15 minutes, during which time it recovered completely. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 2 bedroom house (300 gallons per day). In addition, the production exceeds 720 gallons in 4 hours, as required for FILA financing. B_ SEPTIC TANK! The existing septic tank was installed in October of 1982 ( almost 14.5 years old). According to the M.O.A records, it is 1000 gallons, has two compartments and is made of steel (Greer). No warrantee is made regarding the future life of the septic tank, or the lift station (installed 3/88). C; SEPTIC SYSTEM ADEQUACY TESTS The drain -field consists of two trenches that are five foot wide each. The east trench is 75 feet long and the west trench is 85 feet long. Both have an effective depth of 1 foot. The system was designed so that the west trench only receives spill over from the east trench. Prior to beginning the test there was 11.5 inches in the east trench and no water in the west trench. Water was added into the east trench at a rate of 4.45 gpm for a total of 165 minutes (734 gallons). At the end of the filling period, there was 11.65 inches in the east sump (rise of only .15 inches!), and the west sump was dry. Clearly, the water was being absorbed as fast as it was introduced. Based upon this data, it was determined that the absorption rate of the trench exceeds 300 gallons per day; as required for a 2 bedroom house. Do NORTH END OF EAST TRENCH SURCHARGED: Prior to beginning the adequacy test, and at the end of the filling period, it was noted that there was approximately 8 inches of standing water in the subject clean-out. The south clean-out of the same trench had no standing water in it. I shot the elevations at each of the pipes associated with the east trench and they are summarized as follows: a. North C/O (rod sitting on bend in elbow): b. South C/O (rod sitting on bend in elbow): c. Monitoring Tube: 8.56 feet below H.I. 8.18 feet below Height of Instrument (H.I.) 7.44 feet below H.I. Based upon this data, it is clear that the north end of the trench is not at the proper elevation. The elevation of the north c/o is approximately 89 inches below the south c/o. The south c/o is at the correct elevation. Although this is not ideal (the drainpipe not level), given the fact that it has operated adequately for 9 years, it is reasonable to assume that the future performance of the system will not be impaired. E. DRAINFIELD IS IN THE UTILITY EASEM : The east trench is inside the 10 foot utility easement along the east property line. Attach is letters of non -objection from the affected utility companies. ;" p� 1 vF� t2n (�rz w��-A -,ti t u u A� If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your business. Julie Homza HAA Report. wps NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations; septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, mise. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid_ for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected No warrantee is made regarding the future performance of this well or septic system MUNICIPALITY OF ANCHOI • DEPARTMENf OF HEALTH & HUN ;Division of EnvironmenEal On -Site Services Sect P.O. Box 196650 rAnchorage, Alas 343-4744 ,,4 13 ! CERTIFICATE OF HEALTH A APPROVAL FOR A SINGLE FAMI Parcel I D# C1 - CZa 3- 1 R 1.GENERAL INFORMATION{�c; Complete legal description Lis B4 t8u4�ain `a�t',Estates #2 } Location (site address or directions) 13001 Ltpinn t�rAge Au 99516 Property owner Jeff Glaser Day phone 242-6262 Mailing address 130001 runinP Anchor agQ Au AAKiti Lending agency Day phone Mailing address Agent Day,phone "N' 1IS lir ,rii 7 t 5.' STATEMENT OF INSPECTION BY, ENGINEER;' As certified.by my seal affixed hereto and as of the validatlon'dMe 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 invest!gation,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 date of this 'inspection. Name of Firm Phone °� y a 7 ENGINEERING Address 17034 Ea a Ri a Eagl RIa a 99 6 />- Ars Engineer's signature - Date ••e` OF rj _t'I P'�•pn :,.. �� �, ..t};ze age' ii i� e I ,�1,1'ljniial , el nl 1 all uwlNll..i1, ..I r Ili r r1 .M.•.•.. r�.{•'IA�j.� t„ �, ROBERT C. COWAN f /� ��°C;CE 8801 r'•��;.✓+`✓� 6. DHHS SIGNATURE „ ;.. Approved for 7i bedrooms .. ' j: Disapproved) ; Conditional approval for `i'bedrooms, with; the •following stipulations; t • I � a 1 I, Additional Comments Irr3 1, I, .`4,r' I_. tii'1lii%'1'df:, i'°���'�•L�r�l���l�,��ilr§ fy� J 'i 6y Date E �l s 1. F v��3tiI1F'�j•r5aryr!'�I �� � .Y Iii,/f CAUTION The Iviunicipality of;Anchorage Department of Health and Human.Services''(DHHS) issues Health Authority "Approval Dertificafes based only upon the representations given_in paragrap,h,6-,above by an independent professional engineer registered in the State of Alaska, The,DHHS doesthls as a courtesy to purchasers of homes andtheir lending Institutions inordertosatisfy certain federal and state requirements: Employees ofDHHSdonot : .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' �'Ei "i r 72-025 (Rev. 1/97) Sack MOA 021 is ,' Municipality of Anchorage Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST to718 Legal Description: /Vl/Ju�/% tr>•Aiu pme- Z T � Parcel I.D. A. Well Data Well type T QP -TF- If A, B, or C, attach ADEC letter. ADEC water system number \)//4 Log present (Y/N) YDS Date completed !g/82 Driller �i�rN 1�7US. Total depth aU I Cased to 0`10 l Casing height I/ � Sanitary seal ON) ye�S Wires properly protected CEN) Z FROM WELL LOG AT INSPECTION; r �_ Date of test 1191 / s2 �a5�95 o, - Static water level S w Well flow g.p.m. : K r g.p.m. �i 9 Pump levell Uruic SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot On adjacent lots leo Absorption field on lot On adjacent lots /<Xi Public sewer main LA Public sewer manhole/cleanout Sa. �,/// f � PWPr CPrvinp Tin Co r + Petroleum tank Y ofurz J�f�oW^�• WATER SAMPLE RESULTS: Coliform Nitrate y mq�L Other ?t� ia,, �— at 5 r', Date of sample: S �� �9� Collected by: 17634, tt®ad No. 204 B. SEPTIC/HOLDING TANK DATA Date installed 16119 k Z Tank size IO66 6AL Compartments i:;2 CleanoutsON) / S Foundation cleanout (ON) 1EJDepression (Y/N) � High water alarm �(jY'N) PSC Alarm tested (Y/M J1)1A Date of pumping -r. /'ac(Pumper -LS Acs SEPARATION DISTANCES FROM SEPTIC/F TANK TO: Well(s) on lot ( 3*�4 On adjacent lots 106 + Foundation S'4 To property line !C (4 Absorption field to Water main/service line /� f Surface water/drainage 10()'4- 72-026 (3=)' Front 00`'I' 72-026(3t)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 3AB -l0,00 Manufacturer Size in gallons Manhole/Access ON ��s 1/ r+ Vent ( N) Y&S "Pump on" level at 33 "Pump off" Level at o�(4 High water alarm level 3S I/ Cycles tested ._ Meets MOA electrical codesYli 1) 7 S SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ( + (O On adjacent lots c> ` k Surface water I oo L D. ABSORPTION FIELD DATA Date installed 3 I -� I m Soil rating (GPDtff) 212 SF(22 System type 5 1 Length 16U Tcg(j L _Width I Gravel thickness I Total depth Total absorption area i20 SF Cleanout present (DN) , Depression over field (Y/W Na Date of adequacy test s JoXG 1 15 Results Os/f•1) t'fiSS for 2- Bedrooms Water level in absorption field before test Wp,T MT, E+7 /SIT- d,8 After test WA z mr- D1, m a8 / Peroxide treatment (past 12 months) (Y/& terAmwo If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 153 On adjacent lots 1W Property line To building foundation 10'4 To existing or abandoned system on lot On adjacent lots 4 Cutbank OJIA Water main/service line_ Surface water l �20 ' t Driveway, parking/vehicle storage area /� a Curtain drain �\)A E. ENGINEER'S CERTIFICATION in I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in eN�g(this inspection. Signature Engineer's Name 1/i J /t ��a C C o c✓ 9� i' '�'a£Y`� 01' �� Date cr S� �����TF �,�•,.,, ..,.; .. •;`t?. ,, MAA Fee $ ` �� Waiver Fee $ Date of Payment 5 J� Date of Payment Receipt Number Receipt Number, 72.026 (3/93)' Back MUNICIPALITY OF ANCHORAGE Y3I DEPARTMENT OF HEALTH & HUMAN SERVICES 1 7 U DIVISION OF ENVIRONMENTAL SERVICES���_ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ((� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Manch. 7, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18; Bloch. 4; Mountain Pa,%k E,6tates #2 2. Location (address or directions) 13001 Lupine (b) Property Owner H•u.D• Telephone: Home Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent MARSTON PROPERTIES/ John HubeA Address 4105 Tunnagain Boutevand, Anchon.age, A2asha 99517 Telephone '`*o—" I' (e) Mail the HAA to the followina address: or: Check here IN, if hold for pick up. List contact person and day phone number below. S k S Enol nee-Unq/h94-2979 17034 nyPo R.ivon Lno.p Road, Suite 904 TYPE OF RESIDENCE Single -Family N Number of Bedrooms _ Thaee 3. WATER SUPPLY Individual Wellb Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite M 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. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A 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 —�& S ENGINRFRING Telephone (9 Address 17034 Eagle River Loop Road No. 204 Eagle River, as Date � — %— " � J% l • ;���.,°s- :tea 9�k3d3, V jOpt A-0 ifl DHHS APPROVAL Approved for ateI� bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval dhhs CAUTION A7 -Zi -4 && 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. Page 2 of 2 72-025 Rev 8186) Back MUNICIPALITY OF ANCMo RMPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVIC�Mlfj31pttAUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 "AAR 1988 264-4744 escrRECEIVED Legal Q C>-)ipti _ - 4 Z A. WELL DATA Well Classification ���VPTC" If A, B, C, D.E.C. Approved (Y/N) �`�` Well Log Present dqN) — Date Completed �`� _ 'E�Z Yield x.L�4 K 0,5 (20- I Total Depth 20 t ( Cased to Za t Depth of Grouting t'/A Static Water Level 1- S r Pump Set At J1e, u Casing Height Above Ground )S Sanitary Seal on Casing VON) Electrical Wiring in Conduit(IDN) Depression Around Wellhead (Y/&p IA Separation Distances from Well: _ 1 To Septic/Hotd Qq Tank on Lot �� ; On Adjoining Lots 1 � To Nearest Edge of Absorption Field n Lot «� ; On Adjoining Lots OC k To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole rff P' To Nearest Sewer Service Line on Lot Water Sample Collected by l7 �'L I��- 62'I' 9� ; Date Water Sample Test Results Comments2-,22- B. SEPTIC/HOLDING TANK DATA Date Installed )o'- k5:A `-g�-Size � No. of Compartments 2 Standpipes(5?N) T—Air-tight Caps 4'51N) Foundation Cleanout4JWN) —y Depression over Tank (YiDY a Date Last Pumped* 2-`- -�t3 Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) �` Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Hofd4i%Tank: i To Water -Supply Well -To Building Foundation Ih To Property Line �� To Disposal Field — I To Water Main/Service Line ic::, To Stream, Pond, Lake, or Major Drainage Course ` `- ' Comments Qs-+ Page 1 of 2 72-026 (Rev. 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed —Pa8 Width of Field Type of System Design ( Length of Field�- _ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 4--1 20 Standpipes PresentCVN) Depression over Field (Y/W f� Date of Last Adequacy Test P .Results of Last Adequacy Test ►�; l� e:2 4 `r Separation Distance from Absorption Field: To Water -Supply Well k L� -;�7 To Property Line 1�_-)1 To Building Foundation To Existing or Abandoned System on k Lot �S ; On Adjoining Lots -A- To }To Water Main/Service Line \ D To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course I To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed q1_t7 I_�_ Dimensions �� C-546�1t /-"�. T (�— Size in Gallons �o0 1 Manhole/AccessCY7N) u "Pump On" Level at "Pump Off' Level at 2g u High Water Alarm Lel at Vent (9N) Y Tested for IJ�Ir Pumping Cycles during Adequacy Test. Meets MOA Electrical Code4RN) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed & S ENGINEERING 17034 Eagle River oop Hoad No. 2U4 Com eR4verTAlaska 99577 MOA No. Receipt No. �/O F Date of Payment Amount: $ �� U beer al Page 2 of 2 72-026 (Rev 8/861 Back �1 �a�3ig MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES l/ DIVISION OF ENVIRONMENTAL SERVICES I /� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL / ��RI — Cctloli OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date February 1, 1988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)_ (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18; Block 4; Mountain Park Estates 02 Location (address or directions) 13001 Lupine Road (b) Property Owner HUD Mailing Address (c) Lending Institution Telephone: Home Telephone Mailing Address (d) Real Estate Company and Agent MARSTON PROPERTIES/John Huber Address 4105 Turnagain Boulevard, Anchorage, Alaska 99517 Telephone 248-1717 (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. S & S ENGINEERING/694-2979 170'14 Fagl P River T mop Read, Suit -e 204 F;;ql p Rliro=r, Alaska 99577 ordered by John Huber 2. TYPE OF RESIDENCE Single -Family LJ Number of Bedrooms 2 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Business Note: If community well system, must have written confirmation from the State Department of Environmental 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. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 S & S ENGINEERING Address 17034 Magic itiver Loop Road N% -XV-4 Date Eagle River Alaska 99577 Z — S— 66 •`��' ni oor c g6nl c' - 6. DHHS APPROVAL Approved for 7"- 12 bedrooms by 4e5 Date�elr� Conditional Terms of Conditional Approval a e 7'�Zff 6ldSev�DTiah t21'CQ , 7"o Q. c/t�7Li H�f°ooY9rt�cytr TLiQrt T�,c ,doTTe.� �� TLi� q�avt/6�d. Z1 //Wa r�.- rNo�r.'�r�'h9 T 6G CDLN�nl�y�d 6eTivecyr .iutie /S�yE'3o�/q�', .3J ,&e4d w fuvedJ 7'O e4vej- T1s -e 41C141, S4,cale/ svlOy�'revitla S401u �,�► ,� mosr /a r�p��zte,,hj 4 neer! � G!D Zj . �1 1� CAUTION 7-4e- /lAferro r/;1.,1 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. Page 2 of 2 72-025 (Rev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MU[ "CIPA1.17Y OF At\,CHOR GE HEALTHCHECKL SOT - FEBRUARY 1 APPROVAL (HAA) CNVIRONMENiAI SE yICEs DI'✓Is1ON 264-4744 _`s � Legal escription: A. WELL DATA PQ Well Classification ����� If A, B, C, D.E.C. Approved (Y/N) Well Log Present 6Y N) Date Completed % — ) 9 — BZ Yield �X�` OSlaPr1 Total Depth Zd I 1 Cased to Zot Depth of Grouting Static Water Level /-7-57/ Pump Set At Casing Height Above Ground Sanitary Seal on Casing ON) Electrical Wiring in Conduit O�N) Y Depression Around Wellhead (YAW AJ Separation Distances from Well: To Septic/HeWiag Tank on Lot �'� I / ; On Adjoining Lots 4007 To Nearest Edge of Absorption Field on Lot /0(9 ; On Adjoining Lots / oo t To Nearest Public Sewer Line I fi To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by S S I r,�il r ; Date 2' 3 S B Water Sample Test Results Comments A 4 f`SEL+- `air✓`L/� TAT St�r�f� �/FE W�z� To �,�oDur-� i.•l �X��SS c� a S�PrI B. SEPTIC/K0t0tNG TANK DATA Date Installed %©-M-92- Size 10,90 No. of Compartments -2-- Stand pipes Standpipes ON) Air -tight Caps (VN) Foundation Cleanout (23N) y Depression over Tank (Y 1v P4 Date Last Pumped 2 Pumping/Maintenance Contract on File (Y/N) /A ; for Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) N A Separation Distances from Septic/Hefdiag.Tank: To Water -Supply Well To Building Foundation To Property Line ! To Disposal Field i To Water Main/Service Line O To Streah"i, Porid; Lake, or Maj or`Drainage Course spa Comments /k-(' 1-646 S ✓!4�5 Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / Sb nrL Type of System Design 13 6;7b i Date Installed / D - 1 9 'SZ• Length of Field Width of Field :44 Depth of Field . Square Feet of Absorption Area . Gravel Bed Thickness Standpipes PresentV/N) 2. Depression over Field (Y/151} /''1 Date of Last Adequacy Test 2 " 3� g8 Results of Last Adequacy Test GJD�f1S I� ��r� — 3 f'�2 Separation Distance from Absorption Field: 7 I To Water -Supply Well 3 / To Property Line 1 Z To Building Foundation Lot I To Water Main/Service Line 10 To Stream/Pond/Lake/or Major Drainage Course To Existing or Abandoned System on i On Adjoining Lots f ;'7/A To Cutbank (if present) I 0c, ).t_ To Driveway, Parking Area, or Vehicle Storage Area �t'p Comments ' SEPT 1G 5 y S rn- i ,�LL7U/� 7 6 1�r%2- 3 f3lL 1466_ 2v c)N L-`! /N- ZF32 A -P Po�v'� 1.5 10 c L) es.T t:p D. LIFT STATION `)1A Date IntalJe Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pum Iles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments *' Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Compa4& S ENGINEERING MOA No. 17034 Eagle RI -ver Loop Road No. 204 Receipt Ugle River Alaska 99577 d 2 -- -Date Date of Payment ° Amount: $ 1'O En ineeYs ea g Page 2 of 2 72-026 fRev 81861 Back 1 3 �� 1•L"e'�t;,,,i V. - .,els,?�.�'G.'ia`3•',v,'I'v�^..' MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL. CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, tamship, range) Tot 7.8Block 4 Mt P rlcEstates �2 Location (address or directions) 13001 Lupine Road (DeArmoun to Lupine, turn North, house is 4th on right side (b) Applicants Name Alan & Susan Lubold Telephone 3452300 Appplicants Address 13001 Lupine Road, Anchorage, 99516 PLEASE CALZ AGENT, c pp scant i scheck of l—Tending Institution Owner/ Buyer P Other (explain);- - - r e a r Mort i ineMortgage 561 1744 (d) Tending Institution RaTelephone Address Anchorage Business Park, Bldg G (e) Teal Estate Co. & Agent Konni Snyder, Totem Realty Address 724 Ea 15th Avenue, Anchroage, AK 99501 Telephone 272-0571 Please call Agent to pick up & take to MOA ��. ,r 1-!'fv / ` 6�/%li < 2. Type of R-asiden Single- Farnily LEJ Multi -Family Other (describe) Number of Bedrooms two (2) 3, water Supply Individual WellCcrffnunity � Public Notes If camunity wall system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bad -rooms specified in this HAA (YM) t i 4o Sewage Disposal Onsite Publicl Community Holding Taf;k i Is the wastewater disposal system adequate for the number of bedrooms (Y/N) _—__--- [Page 1 of 21 ' .i 2-15-84 rF 5. Engineering Firm Providinq Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in it effect on the date of this inspection. Signed �+�, ® Date -_- Name of Firm' Telephone i Address i Signed by Date ` %' / I _� � r� OP A44� -� m.•�—tea-® 4714% �ooepO PC V o 0 g'Ooesato jo. mo°°o° 006°.&L.01F �.. (ENGINEER SEAL) �04 def C. Raid, Jf., ec • EP Appr`!AT�lo. 2257.E 6.DHoval A®od®n ,, Approved for - e �edroomA;L Dy � __ + �._ Date Approved D-Isapproved C< d'tiona% Term of Conditional Approval The Municipality of Anchorage Department of Health and Environmental Protection dors not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shim above, based on the data and information furnished by an engineer registered in the State of Alaska, the grater supply and wastewater disposal system is safe and func- tional for the number of bedroom and type of structure indicated. �1 (D'riEP SEAL) is Mail the HAA to the following address: ! 1, MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG 12 95, RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /,mt `i (`' 60Ck ki=J+-� PaAZ �24 /a ZZ n-2 7-�,z,y <Zec� Well Classification get vak If A. B, C, D.E.C./Approved (Y/N) 1F Well Log Present (Y/ ) Date Completed � �1 �Z— Yield dM ("'r J1V(d Total Depth � / / Cased to Depth of Grouting 'f Static Water Level �`ZG/ s Pump Set At Z" Casing Height Above Ground_ ��y� Sanitary Seal on Casing N) Electrical Wiring in Condui&) Depression Around Wellhead (Y� Separation Distances from Well: / c. To Septic/Holding Tank on Lot 49 On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Date Water Sample Test Results CommentseqA'ea BS�66 B. SEPTIC/HOLDING TANK DATA Date Installed /1' 1c g2� Size 1000 No. of Compartments -X� Standpipe (Y ) A Depression over Tank (Y6)) Air -tight Cap (Y N) Foundation Cleanou (Y N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N)for �— Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well Lam/ tr I To Building Foundation To Property Line /?' oir To Disposal Field S To Water Main/Service Line -/40 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(1 vs4) A C.' ABSORPTION FIELD DATA Soils Rating in AbsorptionStrata���� Type of System Design Date Installed O%5/? Length of Field 3`f Width of Field Depth of Field to / Gravel Bed Thickness / ,5(�- Square Feet of Absorption Area TP Standpipes Present (�/N) Depression over Field (Y� Date of Last Adequacy Test & 7�. f Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well©� / To Property Line To Building Foundation/ To Existing or Abandoned System on Lot �/ 1" ; On Adjoining Lots 7L To Water Main/Service Line -f-M ` To Cutbank (if present) A/ i— To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Stora e Area '© , Comments {�fP/yt � � Gro 9-12-Ckk �-=FSk D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water AlarmLevelat Tested for Electrical Codes (Y/N) Comments Di nsio Ma a Access (Y/N) ump Off" at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify thave c ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �Date Company�MOA No. Receipt No. � � _ OF Ak %I ODQ�ae�ae�sevo��b $ Date of Payment �� ea.� 8� F. ° 6Y �gineer's Seal Amount: $ ��Z s,;. s._ @'tp Pei3C AO"t��O000f�ODremD Page 2 of 2 72-026 (11/84) Lg�TC'. Reid, Jr. No. 2251-F 50495 ALASKA NONMETAL C0nTROL SRUS, IX Cngineering & 6nuironmental Studies 8/12/85 KONNIE SNYDER SELLER—ALAN LUBOLD KONNIE SNYDER P.O. BOX 112075 P.O. BOX 112075 ANCHORAGE AK 99511 ANCHORAGE AK 99511 LEGAL:MT PARK ESTATE#2 BLOCK 4 LOT 18 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -8/7/85 THE TYPE OF ABSORPTION SYSTEM IS A BED WITH AN AREA OF 864 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 470 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 7/15/85 . FLOW TEST ON WELL WELL FLOW DATE -8/7/85 A FLOW TEST WAS PERFORMED ON THE WELL. 470 GALLONS OF WATER WAS PUMPED AT A RATE OF5.1 GP OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 10 WITH/A RECOVERY TIME OF 20 MINUTES AND THE STATIC WATER LEVEL WAS 176 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. bF A C v4 a�maeoeoo,,oei N apppp Fr,.�,ryh �f \\11"CELL r y C. Reid, �No.2251-E ext •.,�d oen^ `��}�. �<kv 1200 fest 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 561-5040 Time APPLI' � AT FILLS OUT UPPER HAI " ONLY Time Property Owner %- - - - - Phone Mailing Address 2 , )(- s;• Zip Code ��(5 Buyer Date 1e�j / r Inspector Address Zip Code Inspec r IS, Lending Institution Phone �% 01- �. Address C (. 0- - P(: -,CA �A �J �S Zip Code Realty Co. & Agenf APPROVED BEDROOMS ( ) DISAPPROVED Phonet y�� ( CON/DIITIONA.LfAPPROVAJ,' DATE Y' `7" ' -t�. Y.�'U •.c�.c.. .,�G'o4tv�r/!OX .�c� Address - Zip Code Well To Absorption Area_'„'” Legal Description L 4:-�- z 5 L/ IAT 1 Street Location L C) % y tv '... Type of Residence - Ingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Water ly Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). Cl Public Utility Sewer Disposal ndividual - Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank - - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time -`i Date Date Date 1e�j / r Inspector Inspector Inspec r IS, Inspector Field Notes: lays 01- �. �z APPROVED BEDROOMS ( ) DISAPPROVED /J 'CONDITIONS OF APPROVAL C✓°`v'.> �'�� tit/ y�� ( CON/DIITIONA.LfAPPROVAJ,' DATE Y' `7" ' -t�. Y.�'U •.c�.c.. .,�G'o4tv�r/!OX .�c� BY:� Soils Rating Date Sewer Installed Well To Absorption Area_'„'” Well Log Received m� Well to Tank Septic Tank Size 72023 (3182) / s _ rg.f