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Home My WebLink AboutMOUNTAIN PARK ESTATES #2 BLK 6 LT 3Mountain Park Estates #2 Lot 3 Block 6 #017-432-03 Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650•http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181278 PID Number: 017-432-03 ❑ New Q Upgrade Name: JOE& KRISTA PIHLAJA ABSORPTION FIELD Address ❑ Deep Trench 0 Shallow Trench 0 Bed 0 Mound 12640 LUPINE ROAD 0 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. MOUNTAIN PARK EST#2 6 3 Fill added above original grade Gravel length Township Range Section Ft. Ft Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic AbsorptionHolding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line Ftp Ft. I Well 106.8 N/A N/A I N/A 94.5 TANK p Septic ❑S.T.E.P. ❑Holding ❑Other Manufacturer Capacity Surface Water 100+ N/A N/A N/A Anchorage Tank 1250Gat. Material Number of compartments Lot Line 17.2 N/A N/A N/A STEEL 2 NA Foundation 14.3 N/A 1 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ i N/A 1 N/A N/A Gal. Remarks Pump on level at Pump off level al High water alarm at TANK REPLACE ONLY in. in. in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield A+ HOME SERVICES Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 901 ft Inspection s, Location and description dates: 1 8/22/18 2nd 8/28/18 p 3'd 4m NW BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date r,�OF A4.4jk eco s77 iteven f5annorae j ��1�� . CE 8149 Approved �^� ■.� �..�iL�� Date 7^-2 0— +1� A• .f 4 1\\\7t�•- Inspection Report_1-1-12.doc I I I I / 1 / I / I\' ' I I , \ A B I I f .' I 11 Ti• 15.9 10.3 I I I I ! \1 I ' I T2 22.8 16.0 7i DCO 25.0 18.0 W -_ DV 26.6 19.5 \\ H CO 31.6 24.1 ! \ / 3 \ I \ '°IA \ + 1 0 / / I \\ CI\ / 1 I g < ! i/ I ! \ 2 1 \ i �SEPTIC� \\ \s 1 \\ I \ \ I I I AREA \ IN TA 12500 PTI TANK 1982 DRAIN FIELD (E) TO BE REUSED W/DCO & DIVERTER VALVE AFTER II 1 CONNECT TO DV. INSTALLED CO AT • \ TANK y \� START OF FIELD DV / R MOVED 1 OG SEPTIC TANK 17___ 1 r CO' PER MOA CODE � -7 \ V — W 1 r , ) _VCE uce s.*� 1 1 I I `N I \ SCO SCE a.^ t \ I I N 4BR I p / LOTS SERVED BY I \ T2 Ti ! PUBLIC WATER SYSTEM , SFD \ WELL (E) Q / S II \\\ \ \ ( �/ / \ \ ! \ / - I << II \ J �� i J \ DRIVEI'iAV \\ Z S\ //// a, I \ \ !y /� ! /I 1 D / I \ , 1\1\ -T--.---i-I -J SEPTIC \ •1.97 PR,IN FIELD E /I'1 /// ��AREA I / II -IN FAILURE -\ -� i I i- / I I / 1 I 1 I �� / — .1 I SEP/TIC� / ��Nw \ / / i• f I ,.AR/EA ED 19041 I 908 I / / I I a96 i 9, / / \ I I / / I I II \ t/ \\\ I II /// V }' I I il I // L,, J O 0 j Q O tS W0 1;-_ O o OG.FG. i $d - 898 - -- - - 4.0 --J— -1 _ � 1250 g SEPTIC elli TANK �-`— -- 893.2 PROFILE SCALE: NTS NOTES: - PANNONE ENG SVC, LLC I Date RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 P'� : ,� 08/30/2018 PHONE (907) 745-8200 FAX (907) 745-8201 �4,...%� Scole *�•� A`� .* r' = 50' MOUNTAIN PARK ESTATES #2 B6 L3 •.°410 .,i* �' P.I.O. NO REV 1: 9/7/2018 2-03 DRAWN ACP PIHLAJA FAMILY TRUST even •I .�I5 hWo• PERMIT NO. - 12640 LUPINE ROAD �� 8140SP181278 SITE PLAN ANCHORAGE, AK 99516 ;. �••fe .11 Sheet 2 OF 2 o� 8/Z Z//g Tank_ • ,,N,"°""r'o MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program N0 '30, of r ` PO Box 196650 4700 Elmore Road ,. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,� r, - , http://www.muni.org/onsite 4.,.,-. Department rCHOP"G On-Site Wastewater Disposal System Permit Permit Number: OSP181278 Effective Date: 8/20/2018 Work Type: SepticTank Upgrade Expiration Date: 8/20/2019 Tax Code Number: 01743203000 Site Legal Address: MOUNTAIN PARK ESTATES#2 BLK 6 LT 3 G:2839 Site Mailing Address: 12640 LUPINE RD, Anchorage Owner: PIHLAJA FAMILY TRUST Lot Size in Sq Ft: 19032 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: 1. ' f ALI. I • + Date: 21 / </ Issued By: faiitUlA Qac, , /.1 Date: E old I? EFLAWS MUNICIPALITY OF ANCHORAGE Community Development Department „ r Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-432-03 Property owner(s) PIHLAJA FAMILY TRUST Day phone Mailing address 12640 LUPINE ROAD, ANCHORAGE, AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES #2 B6 L3 Legal description (Township, Range & Section) Lot Size 19,032 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: vA. 5 Waiver Fees: Date of Payment: $ l «"I Cg Date of Payment: Receipt Number: OZ"ZC) Receipt Number: Permit No. C,S'PI?) pZ7-g' Waiver No. Permit App_:.:•::...c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE Pannone Engineering Services ac OSP181278,Rebecca Carroll,08120A Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com August 1, 2018 Municipality of Anchorage Development Services Department On-Site Water&Wastewater Program 4700 S. Bragaw Street Anchorage,Alaska 99519 S 1� 1,n < # ljU 1. J Subject: -'t•"• - eCY\�`-PC-1(2CC-1 l / • ► : T Ladies and Gentlemen: I am writing to request that a permit to install a new 1250 gallon septic tank be issued for this lot.The proposed systems will serve an existing four-bedroom house.Currently the lot is developed.The existing 1250 gallon septic tank is in failure.The existing tank will be removed per MOA code.The existing tank is located outside the 100' well radius,the proposed tank will be placed outside the 100'well radius.The surrounding lots to the north,south and east are served by private wells,and there are no wells within 100 feet of the proposed septic tank.The lots to the west are on a public water system. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water:There is no surface water within 100'of the proposed installation. 3. Topography: Lot 3 slopes from east to west at approximately 5%-10%in the area of the tank replacement. The proposed installation will be located in the northern portion of the lot in the same area as the existing septic tank and absorption system. The proposed installation will not affect the future development of the surrounding or existing lots.There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 615 East 82""Ave, Cuite B6, Anchorage,AK 99503 Telephone: (907) 272-8218 FAX: (907) 272-8211 Municipality of Anchorage ! l 1 / I / vn-site vvaieraria +t vas ewater ! / I REVIEW�D FOR CODE\C • • • • I \ I ! ! i I OSP1 1278,Rebecc4 Oa I.1. I:! \ \\ I i I I, 3 — — ! ! \ lj I \ H \ Ii i \ /, / \ �o\ /M --\ - // 1\ / I V — t t 1 I ! t / I � � I YIt \I i \ / \ \ 1 \ t i \ � 1 AREA \ 1 \ I I I I ! I IN TA . 1250G SEPTI TANK P \ W/DCO & DIVERTER VALVE AFTER 11 1982 DRAIN FIELD (E) TO BE REUSED \ TANK t CONNECT TO DV. INSTALL DCO AT START OF FIELD REMOVE 1250G SEPTIC TANK( I1 i I \ i 3 - t \-� w—/ —� ;t t '�•-tic f 1 �--- W _ucf ucf �.�i,r/ 107.5 I \ \ 1 i_ I \ ucf ` 1 I \ LOTS SERVED BY I \ ! 4BR \ 1 a / PUBLIC WATER SYSTEM I I SFO \WELL (E) a0 \ wl I \ \ \ I_. /� 1' 0 l 1 I \ \ \ L� 1 \ t \ DRIVEWAY \ Z t I • // , � I I ^ 1 1 \ \ `4 /\ ( r /1 I D / / SEPTIC \ '�� 1997 DRAIN FIELD (L) M IJ �/ ��AREA !// i IN FAILURE I'V \1 ! r l I �� // / — /! I SEP/TIC / / I • / / r I AREA 900 19041 I 19081 DE / / / l ( I 896 / . 1 1 I i \ ! / \ I // / \ 1 / t \ I I // \ ! / ! I t / I / I \ 1 J I I t / I I I / t I 1\ - f I I 1 I tt // z /1 //1 \ / I — — — I // �1 // 1 I'WELL (E) I t I / ) I ABBREVIATIONS 1 / \ /I I —w W — WATER LINE / TH TEST HOLE / \i I I I \ WELL RADIUS (P) PROPOSED / I I I 1 (E) EXISTING / II —ss —SS/— NfW SEPTIC CO CLEAN OUT NO. / / R %� I MT MONITOR TUBE NO. / I / \NK. TYP TYPICAL NOTES: PANNONE ENG SVC, LLCDote FOR teltIFREVILSolcIric P.O. BOX 102954 ANCHORAGE, AK 99510 4°F" •. 08/17/2018 C 0745�Rvc:-10/✓;_ PHONE (907) 745-8200 FAX (907) 745-8201 eQ'.�• Scale .. .( •*I . TH I't '..* 1" = 50' •`` •�� P.I.D. NO MOUNTAIN PARK ESTATES #2 B6 L3 I17-432-03 PIHLAJA FAMILY TRUST •41'even )12.15annope PERMIT NO. DRAWN JRLCE 8149 12640 LUPINE ROAD ��'• .. .,.' s osPxxxxxx SITE PLAN ANCHORAGE, AK 99516 °-�� , Sheet 1 OF 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181278, Rebecca Carroll, 08/20/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181278, Rebecca Carroll, 08/20/18 Jun 14 07 02:01p J.R. Eker 348-6123 p.1 Dwalaparet Gawks papartaaart t aft iah" DNWM Ox4U9v Water i Wastowtaw• hapraat •• 4700 w straaa z 'w P.O.,aa t0i6Q0 . • ylvk And"s, All 99919.6650 s • • * r Pump 1 niata3eflon Log wen DrnlEts Fw a!t Nears Date of lams; Parcel Identttteatlaa N*MbM va a — �� Lepl w 'tach I lat OwateNatas AdRrsuc MPUntCtC 'l r f >Gki-k 'X u}h E l�icr Mate 2 LcxD'Ac,-J Iw,p DHaMa Dap vdaw Tap of wan Cntap cis , FW Pww tila0afit tnest s Tfam v,n�,� PM stmt t/9 6n PtAgsAdapWNwWDapW ,2- fast YftlenAdaptarMewhetarvesNam: nod,nnanll-,f 4,ar� Pitlaaa Adapter butd3srr won Ubwaeted ilea CoYptstin2 W Yat a No Matttod of Dt>ffiaatlaat_ct4.1= Coatmsab: ftwp [r tsAncrNama' c n r ' j1/� rn Campa*gtS�r!M Mantra: Adirna ;n . d Nx 1 f )Oe n Amwdeat 'Tim pm® 6ubriar ahaU p ow& a pump aO la0 to= mitlda 30 dns ofvmwv iaaallattaa. Municipality of Anchorage Page l of fir_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspecti n R port Permit Number: SW Cr7-0 1 C7 PID Number: C2A3L' " Name: Wastewater System: ❑ New (:Upgrade µ AJ rubra �-t �F sc d Address: i 2 (4 ABSORPTION FIELD Phone: SIS-- x-`7' 4 rf No. of drooms: `7 ❑ Deep Trench Shallow Trench El Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: . Z GPD/Sq. . Ft. �' �r Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 6 'M-C`po'ax J& -Z i'6- Ft. 0-,G- Ft. Township: Range: Section: Fill added above original grade: Gravel length: _ z r Ft. $O.2 �$•'b• Ft. WELL: ❑ New ❑ Upgrad Gravel width: Number of lines: Z Distance between lines: IO'JK' Ft. Ft. Classification (Private, A,B,C): Tot Cased To: Total absorption area: Pipe material: *F9W Ft. Ft. S O SO. Ft. 1303'1 Driller: ( Date Drilled: Static Water Level: Installer: Date inst lied: Ft. Ac)402A CdNS-r. S Z Yield: Pump Setat: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P To Septic Absorption Lift Holding Public/Private Manufacturer: �S� i y in gallons: From Tank Field Station Tank Sewer Lines ys' li Well- f 06.6 � u �r `�D I Material: Number of Compartments: SurfaceLIFT Water tc - It 001 STATION Lot Line O / Size in gallons: Manufacturer: Foundation -ftq 6_/ "Pump on" level at: " Pu� at: High water alarm at: Curtain _k Pump Make Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: Co2N.e2 Assumed Elevation: .2�Ft ENGINE SEAL OE A4 ZJqw3 9�Qy�> �fr�3t1► J Inspections performed by: S -FQk^JAX,VdFiR'a Dates: 1st 51��Q� GbrllMNM4ii))pf 2nd p. e"R. Panlrone ret _FwAc s1311 49— Department of Health and Human Services approval CE • 8149 JJ�, g,,�,�r44��' Date: fad.:; Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Exist, drain field abandoned in PlaCB�. Flow splitter Installed to evenly distribute effluent between trenches. New 5 -Wide Trenchs 50' Long, 0.5' Effective SWING TIES L) U 0 C1 U U 99.2' AS -BUILT WASTEWATER ABSORPTI❑N SYSTEM LOT 3, BLOCK 6 Mt, RK #2 Exist. Drain Field Exist. Drain Field E SEE SECTIDN = S FDR E 4' Din Perp Pipe 5' Wide Trench 1 e 502' Long, 1 2 50.7' Lang TRENCH PROFILE W. TRENCH E TRENCH MT2 C0311,4 MTI CM&2 94.7' - 95.0' I I 1 1 I I n 95 TO 98' LE2XIST.PTICaTANK r\"95.0' Tank Integrity Verified TANK ELEVATION Ci\Work\3-6MTPK.DWG PREPARED FOR; John & Marybeth Schoen 12640 Lupine rive Anchorage, AK 99516 (907) 345-7994 T1 94.0' Original Grade ML Filter Fabric 4' dIa Drain Pipe GM Drain Rock TRENCH SECTION 80.5' Bottom of Test Pit WATER at 86.2' PANNONE ENG. SVC P. D. B❑X 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax ATE, 5-31-97 AS -BUILT SCALE, 1'=60' 118, ' Exist, 1250 septic tank ve led & Found Complten , CAUTIONII m �s I nderground r - I Electricait'-S/ i Fc B kxist. 4 BR n MTI House 6' b Driveway Exist. Drain Field E SEE SECTIDN = S FDR E 4' Din Perp Pipe 5' Wide Trench 1 e 502' Long, 1 2 50.7' Lang TRENCH PROFILE W. TRENCH E TRENCH MT2 C0311,4 MTI CM&2 94.7' - 95.0' I I 1 1 I I n 95 TO 98' LE2XIST.PTICaTANK r\"95.0' Tank Integrity Verified TANK ELEVATION Ci\Work\3-6MTPK.DWG PREPARED FOR; John & Marybeth Schoen 12640 Lupine rive Anchorage, AK 99516 (907) 345-7994 T1 94.0' Original Grade ML Filter Fabric 4' dIa Drain Pipe GM Drain Rock TRENCH SECTION 80.5' Bottom of Test Pit WATER at 86.2' PANNONE ENG. SVC P. D. B❑X 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax ATE, 5-31-97 AS -BUILT SCALE, 1'=60' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 / r /,' 4 o ,O A*. S�.ODP �* PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970100 DATE ISSUED: 5/20/97 DESIGN ENGINEER:STEVEN R. PANNONE EXPIRATION DATE: 5/20/98 OWNER NAME: _ e_�1N c1 Ltd �1_FIUE Yl OWNER ADDRESS:12640 LUPINE DRIVE ANCHORAGE, ALASKA 99516 PARCEL ID: 94 -4 -34+ -G - LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK 6 LT 3 LOT SIZE: 30384 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: I . THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: --�- DATE ISSUED BY: ayi a DATE 37- 20- /7 Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax May 13, 1997 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 3, Block 6 Mt. Park Estates #2 Septic Upgrade Permit Gentlemen: My firm was contacted to conduct a Health Authority Investigate of the well and septic system serving this lot for a pending sale. The existing system was completely inundated with liquid. The fluid levels were at the elevation of the lateral pipe. I informed the owners that the system was in failure. The owners requested my firm investigate the possibility of installing a replacement system. A single test hole was excavated on April 11, 1997. The soils report and percolation test result is attached. Ground water was monitored for 30 days. Ground water was encountered at eleven feet (11') while excavating and monitored at a depth of ten feet (10') on April 19, 1997 and 7.8' on May 10, 1997. No bedrock was encountered in the test hole. The lot is approximately 0.43 acres in size. Lot 3 slopes to the west at a rate of approximately 2 to 3 percent. The proposed installation will be located on the southwestern portion of the lot. The existing field will be abandoned in place. The septic tank will be verified during the installation. It will be reused if found competent, and replaced if found to be deteriorated. Double clean -outs will be installed down stream from the tank. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation shall not impact the future development of the surrounding or existing lots. See the attached design. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, Steven R. Pannone, P.E. Attachments: �a C:\WORK\3-6MTPK.001 R. Pennons Un. SE -8149 pAOff 1ST O�p�'. Exist, drain field to be abandoned. Install flow splitter to evenly distribute effluent between trenches. Proposed 5 -Wide Trenc'. 50' Long, OS' Effective DESIGN` WASTEWATER ABSORPTION SYSTEM LOT 3, BLOCK/6 Mt. PARK ESTATES Exist, Drain Field 1250 & ElectrlcdIts%I c Exist, 4 BR House 1 '`15 tee` ➢rlveway �� ,�`{ M 1 , Exist, Drain Field 1 I Exist, Drain Field I VC, 14 ,o c 49—TH kSteven..R... Pannon N( �C�E, X8149 ®®g®®r E55®* 4 0 C,\Work\3-6MTPK.dwg PREPARED FOR, John & Marybeth Schoen 12640 Lupine rive Anchorage, AK 99516 007> 345-7994 DESIGN 4 Bedroom House Perc. Rate = 3__M/Inch Solt -Sating -425 sf/br 500 sf required. 5-w1de trench, 0,5' Effective 3.0' Total Depth Reduction Factor = 1.0 Required Length 100 LF Use 2 trenches each 50' long Area= 500 sf equly. area PANNONE ENG. SVC P. 0. BOX 142025 ANCHORAGE, ALASKA '99514 272-8218 Phone & Fax DATEI 4-18-97 DESIGN ' ALEI =60' DESIGN DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 3, BLOCK 6 Mt, PARK ESTATES 1nONV3l3 d GQC3 O. of 9b4 � 4� d A ,6 1.0' s m c _rl y di L u o tz ff u F- C y<s N L s L u ; d at `` A of Am aollNON e a w { d c . a J a a d 3 t e Lninr� v a z .e �b IBJ 6 6 J 0 0 H o� U LL O Q W ln()Ntl310 1. d°o IL O.. 1.0' rn c� p 4 - Ln -C4- LD lnI)NV313 4 v 1nONV310 d 4ja d of ln�dV31041 0 J d C e i' t� F d 1nONV310 X w S d �(G ® L Q10. AV C.l)�e'• . .mu..�• • + Ld � i LEO •, 1nONtl310 ® • O, 4 NOI VEINn0.1 o^ 3 u 49TM ...46 z' a �.....a...... ...... ......... A ..... � ....... ... ..................... '� 'PREPARED FOR: STEVEN R. PANN❑NE, P.E. O� :Steven R. Pannone• AV ®®0 m John & Marybeth Schoen P. ❑. BOX 142025 o. CE 6149 P ANCHORAGE, ALASKA 99514 � ..•��r .�ma 12640 Lu Ine rive . ®®o Anchorage, AK 99516 274-0308 272-8218 FAX �4 t•"E �}C ®� (907) 345-7994 DATES 4-19-97 $®�s®®�m�� AS—BUILT f m h E J {f7 E Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Zal{'N�' aA.lf��.•C`gC3z('�' SC�}O�L�4 DATE PERFORMED``+'tif'[r$�'i� LEGAL DESCRIPTION:�(o M �AnK LST Township, Range, SEC ion: SLOPE SITE PLAN DEPTH 1f ILII I' 'I 1 (00— � �ILOC.JrtI 2 SILTS W( SILTY S�AN1i 1vt L, 3 4 StL e Git2Ja�l�C t'�SA�� 5 6 - ML ML 7 N N 10 11 C LIZ A nJ Gy t✓ 12 �'("rRACa. SILT .0m 13- '2014 3'!3oPt 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? 4 14%4 tiZ Date: 10e S L 0 P E 7 Y Reading Date Gross Time Net Time Depth w of Water Net Drop -- 1 lZ '/ 31 L G 3/Y 3/ ( t G Sl$ C� L 6 g •�� ( G 3 20 r. lug PERCOLATION RATE 3 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 41 FT AND FT I� COMMENTS TgaT Eiot2 w�F C2aSOAKP� TL3Sr`�c-r � CAVATEII V3 `1 /N* O�tQ StlG. PERFORMED BY: S •RSA r)nlbn� �.P•a • i 'R"`^`� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: tc6 ((` 4 72-008 (Rev. 4/85) 72-013 (R¢y/3/78) LI/ (/ MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION J. ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE ieq'e_" e n <Y _ p EW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOM�S(�// TO: Well Absorption area DwellinPERMIT /vY ,afo�dDISTANCE wQ F, Manufacturer G�� _ Material , �[ _ i No. r E L.-. of compartments N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ._- ❑ DISTANCE TO: Well Dwelling PERMIT NO. J0z ❑ z Q X F- Manufacturer Material Liquid capacity in gallons ❑ � DISTANCE TO: Well Foundation Nearest lot line ( PERMIT ? NOLu . w x OS�d LL Z No. of lines Length of each line . Total length of-. fyaggs ( Trench width Distance between lines ? w 5� Ca 3 6, inches F. Top of tile to finish grade / Material beneath tile Total effective absorption rea ❑ � irreltes Length Width Depth PERMIT NO. w C7 Q V— Type of crib Crib diameter Crib depth Total effective absorption area as w wWell Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER VW PIPE MATERIALS 303 N SOI L TEST RATING 41— CD, INSTALLER ��2 �(_ f. C�� 'r✓ �/f�' Fly- REMARKS 2U vS�c� Lf'4VT F_ 0 3 �f i APPROVED DATE LEGAL �;/-) j1zPyee%1 61�4z>� 72-013 (R¢y/3/78) LI/ (/ DEPHRTMENT OF HEHLTH HND ENVIRONMENTHL PROTECTION ~ �� . _ PE�MIT'NOF ISSU 40 ***NHRNING � DUE TO CHHNGING REQUI�E��TS THI5 PRINTOUT MHY MOT BE | � *** COPY OF THE ORIGIONHL PERMIT | HPPLICHNT BEETER CONST ��S 1546 E � nI LGCHTION LUPINE DR ) LEGHL L] B6 MT PFYRK EST LOT SIZE 20080 SQUF��f��T ' TYPE OF SQIL HBSOR8TION S9STEM IS� DRHINFIELD MHXIMUM NUMBER OF BEDRQOMS � 4 5OIL RHTING (SQ FT/BR)= 85 � THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� � L'E_�27 THE LENGTH DIMENSION IS THE LENGTH`(IN FEET) OF THE TRENCH OR DRHINFIELD � THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BET�EE� THE SURFHCE OF T�E GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) VD E'D F��= THE GR8VEL DEPTH IS THE MIMIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE B�TT�M OF THE EX�HV�T�O� (�N FEET) ' �� 1 _�� SC :-2. � � �� .... .... � BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTI�N HND HPPROVHL GY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWE�N H WELL HND HNY ON�SITE SEWAGE DISPOSHL SYSTEM IS 10@ FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET FOR H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIYHTE WELL TO H PRIYHTE SEWER LINE IS 25 FEET HND TO Al COMMUNITY SE11ER LINE IS 75 FEET. WELL LOGS FIR." REQUIRED HND MUST BE RETURNED TO THE DEPHRTME��T WITHIN ]0 DHfS OF THE WELL COMPLETION OTHER REQUIREMENTS MRY HPPLY � SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION F EE �/ I CERTIFY THHT HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF H�CH8RHGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES SYST�M MHY REQUIRE ENLHRGEMENT IF THE RE I THAM 4 BEDROOMS HPP ISSUED'BY__- INSPECTION^�ISTORYSEWER 2 0 WELL INSP 0 WELL LOG DHTE 0 DRILLER rlAj � °_- ~� I -u' ~�^ � � ^ Z_= �� 7, � Cn'�� ^= ' � �� - w t SOILS LOG Q TV i1CIPALITY OF ANCHORAGE S.� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST - �Y. Pouch 6550, Andiorcge, Alaska 99502 276-2221 Y SOILS LOG — PERCOLATION TEST PERFORMED FOR: Nit C' -i- J G �C-G+�f ^� DATE PERFORMED: 4/, 7rV z LEGAL DESCRIPTION: Es�n.4-�S J4 - SLOPE SITE PLAN DEPTH ' (FEET) 1 2- 3- 6- ,7- 8- 9- 10- 11 36 ,789 1011 - 12— :13 14- 15- 16- 41516 150 it 17- 18- 19- 20 7 181920 COMMENTS h r`s. i-sA 1C-Is� S G/ays• �et,AAA6 5 OZ IX. �... S o.ac�.� S �,t• WAS GROUND WATER S G ENCOUNTERED? D L G,t—a.t�lS• 11 O P IF YES, AT WHAT E DEPTH? -Sc J&%/ ,S IAs •.y�rye,✓a..va s THONAS..{{ft.*M1-:1 qr aso.: 224 8-C s t , •; Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN 13ETWEEPJ FT AND (minutes/Inch) — FT PERFORMED BY: I CA t-� e*>e CER"'FIED BY: DATE: WATER WELL RECORD p STATE OF ALASKA A DEPARTMENT OF NATURAL RESOURES MUNICIPALITY OF ANCHORAGE bFPT. OF HEALTH p. Dlvision;pf Geological & Geophysical Surveys ENVIR: )i JhSftv � A- P RO i E!'TI _ iJ .i UL 1.2 192illing Permit No. LOCATION OF WELL (Please complete either lo. Ib or Ic.) A.D.L. No. la. Borough Subdivision Lot Block Ib. 1/4gtrs. S on o h N� Range E❑ Meridian .of. of_of— '. �,t li S❑ W❑ •3'i r'_f_t t�9 Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: r Address: Street Address and Area of Well Location 2. WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLE Surface t1 _ '(LI. Material Type Top Bottom ft. -- 'e ``}- 6. Cable tool Rotary ❑Driven Dug i`•i!i ;-r:t _; ,-^t _ Auger ❑ Jetted ❑ Bored ❑ Other: -..I =1 S ` ':". -_,Sr' co l.. '. C::� i. �- as %''.1 `.(� A }t A'i'- '1'l' rl(i 7. USE: Q' Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑Recharge ❑commerical r1..11.:1 `.5 co E] Test Well ❑ Other: i/ '-d 7i -"=)'T ��' � S. CASINGX, Q Threaded ,❑, Welded diam r' in to U'7ro-r'ft. Depth Weight / lbs,/ft. diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: rl ft. } '' L. Above or Q.'.Below land surface Dote - Equipment used: ti; ,!.,).Ai. is I I . PUMPING LEVEL below )and surface and YIELD„ ft. after hrs. pumping ° �" 9 -P.M. ft, after hrs. pumping g.p.m. 12.GROUTING Well Grouted: 10 Yes ❑ No Material: E] Neat Cement 0 Other:--�-- 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. ® Subm. Ej U Jet E) Centrifical C] Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° 0 F C — This well was drilled under my jurisdiction and this report is true to the best of m7y knowledge and belief; Registered Business Name Contract License Number -:)� - ':a t'•'t,it if �,_ l tr �, ,.,.� :r. .f. .r.._ Address: -- - - Signed :•irt^'-y?A,' 1.-� ,>�,..<-%... �:,/;_�""' Date: ...} - Authorized- Representative Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY-CustOmer •-(�'� Municipality of Anchorage On-Site Water and Wastewater Program (907)343-7904 ti . = S l t .: i Y Certificate of On-Site Systems Approval Parcel I.D. 017-432-03 Expiration Date: 12—g.`1-1 1. GENERAL INFORMATION Complete legal description Mountain Park Estates #2 Block 6 Lot 3 Location (site address) 12640 Lupine Rd. Current Property owner(s) Pihlaja Family Trust Day phone Mailing address 12640 Lupine Rd. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community El Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received ., : % I a A Date: cii.V6 COSA to be released t. t e engineer,un• t - ' s te• y the- •inee. COSA Fee $ Waiver Fee $ Date of Payment q/alt Date of Payment Receipt Number 0051023C? Receipt Number COSA# SC 1811153 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are)safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes,ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Date 8/31/2018 P, OF 6. DSD SIGNATURE it; �TM �� •..* System#1 Approved for ti bedrooms "t}even -.—annoae System#2 Approved for bedrooms CE8149 .; , ;*,' r � Disapproved Conditional approval for bedrooms,with the following stipulations: ..CP -4. /�r'uCf/0 _ SND WAEWAGE R o c) WS GRAM PRO = ' `�A. SS \I\C" ' • By: - C Original Certificate Date: a-vZ ( --1 2 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 Stale of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory _ _ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheat '- .. c If more than 1 septic system is on the lot: COSA Checklist# 1 of I Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Mountain Park Estates #2 Block 6 Lot 3 Parcel ID:017-432-03 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 5/15/1982 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 100 ft. Cased to 66.5 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/15/1982 8/6/2018 Static water level 45 ft. 56 ft. Well production 7 5 g.p.m. 2.3 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 6'73 mg/L Arsenic NO ug/L Date of sample: 8/6/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Anchorage Tank Date installed 8/28/2018 Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A Date of pumping NEW Pumper N/A C. ABSORPTION FIELD DATA 5/28/19971.2 GPD/SF Shallow Trench Date installed Soil resting (g.p.d./ft2 or ft2/bdrm) System type Length 50.2/50.7' � �' ►o►W dth 5 ft. Gravel below pipeKL'S ft. Total depth 3-7 ft. Eff. absorption area 504.5 ft Monitoring tube Y _ Depression over field N Date of adequacy test 8/6/2018 Results(Pass/Fail) Pass** For 4 bedrooms Fluid depth in absorption field before test 1.511.5 in. Water added 600 gal. New depth 1.9/1.9 in. Elapsed Time: 30 min. Final fluid depth 1.9/1.9 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.)(Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on"level at in. "Pump off'level at• in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ 100+ On adjacent lots Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ + Public sewer manhole/cleanout 100 Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ 100+ Water Service line 1 Surface water Driveway,parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS **Installed divert valve, and new tank. G. ENGINEER'S CERTIFICATION ._ '•mss`', I certify that I have determined through field inspections and Q' 1�.• •• review of Municipal records that the above systems are in air�-?. TN %1 '. conformance with MOA COSA guidelines in effect on this date. ,: •(N : Engineer's Printed Name Steven Pannone '2, '• �=—•:-- levan f�. annope . Date 8/31/2018 :• • CE 8149 • •�:, ; r •• •C .. COSA canary sheet_2-6-15.doc If more than 1 septic system is on the lot: COSA Checklist# 2 of 2 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Mountain Park Est. #2 B6 L3 Parcel ID: A. WELL DATA Well type If A, B, or C provide PWSID# Well Log(Y/N) Date completed Sanitary seal (YIN)_ Wires properly protected(Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: . _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material See Sht #1 Date installed Tank size gal. Number of Compartments 2 Cleanouts(YIN) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm(Y/N) N/A Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed 4/27/82 Soil ratingc_, ((g.p.d.//ft22or ft2/bdrm) 85 9•p•d/sf System type Wide Trench Length 46 ft. Width!" J ft. Gravel below pipe 4 ft. Total depth 6 ft. Eff. absorption area/ea�g 'ft-2 Monitoring tube Y Depression over field N Date of adequacy test 9/4/18 Results(Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 1 in. Elapsed Time: 240 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.)(Y/N&type) None Known If yes. give date D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on"level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100 + On adjacent lots 100 + Absorption field on lot 1001+ On adjacent lots 100 + Public sewer main 75 + Public sewer manhole/cleanout 100 + Sewer/septic service line 25'+ Holding tank 1004 Animal containment areas 50 + Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 101+ Property line 10'+ Absorption field 10'+ Water main 25'+ 25'+ 100'+ Water service line Surface water Wells on adjacent lots 100 + ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 101+ Water Service line 25'+ Surface water 1001+ Driveway,parking/vehicle storage 104 Curtain drain 50 + Wells on adjacent lots 100 + F. COMMENTS See checklist #1 - system presoaked. G. ENGINEER'S CERTIFICATION �oF AC�� I certify that 1 have determined through field inspections and A.e�%Q� qs'�r • review of Municipal records that the above systems are in *x:'49 Tt-i \ .*� conformance with MOA COSA guidelines in effect on this date. 6Ai,a�•• Steven PannonerA Engineer's Printed Name •Steven R. Pannone Date 9/19/2018 rcia.v;-fti ... cE-81 G • �� 7. Itkv�\�ao COSA canary sheel_2-6.15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT !/• r '`� 907-343-7904 On-Site Water and Wastewater Section 1\ F i ' Fax: 343-7997 www.muni.org/onsite \-� Nitrate Advisory Certificate of On-Site Systems Approval # OSC181453 Subdivision: Mountain Park Est., Block: 6 , Lot: 3 A water sample revealed a nitrate concentration of 6.73 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. 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 distillatidn 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 I ---I i ` / I i // I / i I S' � I Lore / R=100' '• N89°56'06"W 1.93.00' 1 i 4 el a I 0---_____SEPTIC I Q I' /PIPES M\ 26.6' 'HELL. p tZ ® i b ® cdaIQ I DECK I 4 z I QTYrAC. 40.2' I g p If I ® ra¢E 1 SINGLE � N ,%3 �W FORT Y • FAMILY ' ° 1 ' © w`' .HOUSE 16.0' % 1 o i OORCPJ It \c'Wi v ell L O V N I IIISTPIFS $1.9' s� / x'iE?t r RETAINING WALL �/ I' s iz LOT 3 �, o 1 © BLOCK 6 N ,PAVED • DRIVEWAY L �� I © 19.032 SQ FT 24,.2 y:1-vi- I i i- 0.44 ACRES 6,rE \ IRETAININGEL I l o az � \. i • D •o ,s I 1 �ah a © pi SHED27.3'c _ piAIN LINK PENCEI 14 �, d \ 589°56'06"E 153.00 1 I \ 1 1 1 _ _ _ _ - --r 1 e'0O\t®� ` a a L0T4 •o, I, 8 Al*:49 T� %\ ..* 0$ 1 /,•y 6 Iz 9:• MATT T.CROW :x a 4 iI l� S'.. LS-11597 ,••a`a'� l a �OQ��9F0 ...•. SJR 11 Sep 2018 I I ASBUILT CERTIFICATION I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING PROPERTY,LOT 3 BLOCK G.MOUNTAIN PARK ESTATES SUBDIVISION NO.2,AND THAT NO ENCROACHMENTS EXIST,EXCEPT AS NOTED. EXCLUSIONS ITIS THE RESPONSIBILITY OF THE O1+7IER OR BUILDER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS,COVENENTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR ESTABLISHING BOgUNDARyYOR FENCE LINES. MATT T. CROW,LS 11597745:117 I . � Alaska Construction Survey's iA I SA Office:(907)344-5505 907 E Dowling Rd,Suite 10 "Alli1,1 ALASKA Fax:(907)344-4775 Anchorage,Alaska 99518 • CONS�'RUCTIOI\A Email:mcrow@akconstsurveys.com SURVEYS Site:Residential 1 Drawn by:.4.V. AField Surety 0 Lupine RQ Anchorage09/111AK \ Scale:l"=30' Survey Date:08/26/2010.09/1 1 201 3 Crew:D.G.&R.C.,A.V. ASnlll.TSD.'Er PREPARED FOR LOT 3,BLOCK PIHL 1JA,JOE MOUNTAIN PARK ESTATES SUBDIVISION#2 13640 LUPINE RD. NEI/4.SEC 26,MN:R.:IrTED IA' rnln;a.e.,t,S:", ANCHOR4GE.ALASKA 99516 Municipality of Anchorage z On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-432-03 Expiration Date: 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES S/D #2; BLOCK 6, LOT 3 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 12640 LUPINE DRIVE, ANCHORAGE, AK, 99516 JENNIFER GARDNER Day phone 12640 LUPINE DRIVE, ANCHORAGE, AK, 99516 FSBO 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Day phone 223-1552 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 . Individual On-site Individual Water Storage ❑ Individual Holding tank _❑ Community Class Well ❑ Community On-site U Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: OOSA to be released to the engineer, unless othemise requested by the engineer. Date: I3. lr COSA Fee $ / Waiver Fee $ Date of Payment Date of Payment Receipt Number hI It `J y Receipt Number COSA# 05G15/05 Waiver# O istance: - 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(am) 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. Address 3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life ofall wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lest results do not guarantee future performance of the system, not do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSO. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 4__ System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. Phone 337-6179 Date bedrooms, with the following stipulations: OF of rey A. G ness .\_= I WC� 7 53 %%FVA ESSION�.�� .itttlllstl tiff. ` ON-SITE =� WATER AND r_ sa WASTEWATER o Original Certificate Date: ,� - The��K4 plcip�(ty XA chorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upoir-tre represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10112112) Ll Nitrate Advisory Arsenic Advisory Other M If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA MOUNTAIN PARK ESTATES S/D #2; BLOCK 6, LOT 3 Parcel ID: 017-432-03 Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 5/14/1982 Sanitary seal (Y/N) YES Total depth 100 ft. Cased to 66.5 ft. Date of test Static water level FROM WELL LOG 5/14/1982 45 ft. Well production 7.5 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate b-03 mg./L. Arsenic: )'JD ug./L. Date of sample: 2/2/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping % - � ` ) -5— Pumper Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/2/2015 2.19+ g,p.m. Collected by: GEG, Ltd. Date installed 412711982 Cleanouts (Y/N) YES High water alarm (Y/N) N/A ,+ HOME SERVICES C. ABSORPTION FIELD DATA FBELO EExisrmG GRADE Date installed 5/28-31/1997 Soil rating (CE?>r ft2/bdrm) 12 System type DUAL TRENCH so.zTOT 515 ft. Gravel below e 0.5/0.5 ft. Length 100.9 TOTAL ft, Width pipe Total depth `5.1/3.75 ft. Eff. absorption area 504.5 ft2 Monitoring tube YES Depression over field NO Date of adequacy test "2/2/2015 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 600 gal. New depth 5 in. Elapsed Time: 150 min. Final fluid depth 2 in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - '"ACCORDING TO HOMEOWNERR, HOUSE WAS VACANT FOR 3 WEEK PRIOR TO TEST. TESTED EAST TRENCH OF 1997 SYSTEM ONLY. WEST TRENCH WAS DRY UPON INSPECTION. _. 1 _: 1 D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access (Y/N) "Pump off' level at we er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line 25'+ Holding tank NIA Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main NIA Water service line 104 Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main NIA Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS VAA.4`i be '1�A` SEs -n .c P1oe parr FL-Lt.su (Nrm Gaa G. ENGINEER'S CERTIFICATION I certify that 1 have determined througf review of Municipal records that the at conformance with MOA COSA guidelin date. Engineer's Printed Name JEFFR Date 9•%/l� (Rev. 10112112) Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151057 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 3 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 6.03 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anch On -Site Water & Wastewater Pr (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-432-03 Expiration Date: f -2, — '?, (" — 1 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: MOUNTAIN PARK ESTATES #2; BLOCK 6, LOT 3 12640 LUPINE ROAD *ANCHORAGE, AK JUSTIN ROSTANT Day phone 469-766-2628 12640 LUPINE ROAD *ANCHORAGE, AK JULIE ERICKSON W/ DYNAMIC Day phone N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 242-9282 TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ WiO _ Date of Payment '5l 120 h;' c ! Receipt Number br,; cl G COSA# 05C Ia H31 Date Waiver Fee $ _ Date of Payment Receipt Number. Waiver # S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfac0ry test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not pro, ide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 4 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date / /] j t7 It?- oo�`,OpO o �F A opo oP�........ ..... ... I ..... . 49 T. ............t 7 l G O.. ..f y . :....r ess. Qm '. CE 795 up bedrooms, with the following stipulations: ON-SITE WATER AND WASTEWATER PROGRAM The Municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory fOther BY 1__� r/ (Rev. '11/05) L! Original Certificate Date: 9 " 2— 6 `% 2 If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES #2; BLOCK 6, LOT 3 Parcel ID: 017-432-03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 5/14/82 Sanitary seal (Y/N) YES Total depth 100 ft. Cased to 66.5 ft. FROM WELL LOG Date of test 5/14/82 Static water level 45 ft. Well production 7.5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: NO ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 5.01 mg./L. Date of sample: 7/31 /12 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/31/12 g.p.m. Collected by: GEG. Ltd. Tank Type/Material SEPTIC/STEEL Date installed 4/27/82 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/NY YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/22/12 Pumper DENALI SEWER & DRAIN C. ABSORPTION FIELD DATA Date installed 5/28-31/97 Soil rating (g.p.d./ft'or /bdrm 1.2 System type DUAL TRENCHES Length 50.2/50.7 ft. Width 5/5 ft. Gravel below pipe 0.5/0.5 ft. Total depth *5.04/5.50 ft. Eff. absorption area 504.5 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **9/14/12 Results (Pass/Fail) ***PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 640 gal. New depth 8 in. Elapsed Time: 1 113 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) TERRALIFfED If yes, give date 8/8/12 **ON 9/11/12 EAST TRENCH WAS PRE—SOAKED WITH 500 GALLONS OF WATER AND WEST TRENCH WAS FILLED WITH 640 GALLONS OF WATER. ON 9/12/12 EAST TRENCH WAS PRE—SOAKED WITH 370 GALLONS OF WATER AND WEST TRENCH WAS FILLED WITH 360 GALLONS OF WATER. ***EAST TRENCH TESTED ONLY. EAST TRENCH MT EXTENDS 5" BELOW THE LATERAL. D. LIFT STATION Date installed Size in gallons Manhole/Access(YM) "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 1 Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 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. Engineer's PrintedName JEFFREY A. GARNESS Date cd 17 1( 12 (Rev. 11/05) o OF q�1sf V -.V 44a�?rofess;a�°o Municipality of Anchorage 'EXE Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 121434 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 3 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 5.01 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. J.K. tier J4Z7t1Cd p.Y 81 �� DD AECEdVED 101 3 1991 DATE of L07 4? OI _ I S S9' Seo' Q'o E "0: /z3� 4 Com' .,• a a cyst WICUL • q � sfs�' ■ ■ f la UNF+A vm O. �1 O � t_oT 4 Lot ,3 1 Blocs Mf PQrk ESf(77eS No. 2 Anchorege Recording District, Ateske F.444n1Pefl 4r reesrd 41w r IN rr S ZSURVEY CERTIFICATION y tsrtl I not IdwS ear44yed INS pr4Aer17 Snow dad d4uN64d amen. and IMI ttr brr"memm a 811vet4d WW4M we v1 wn M pnp. IN nlre end d4 e4i 4rir140 K4w.re4M M 44,etm, p.4pM1y Nod 1,441 ee %wwvw&%Wa M ur pnep ed7oeirg p.464p ar Mrs041d"1M "014444 411MI1dt1 end IMI Nos are r t4Sdsere. 4aUNnno, tleldir Yh1bl4 441g1111t1 M saki property pogt me lddloetw Swrs4n, so 0444 4e INS ►lit SS r4eerd we not 41pee !141444 i dtn4rV144 doled.. LEGEND Q gross or AEiNnuln capped monurant O 4an pipe and/er riber r4eo.erdd. 0 2 312 Rub 6 took r4ew4rcc ■ 3/8"s3erebor srt Is# elwgo� Scale. /r/c®, D^te Prepared by: R. L, BUTTON 0 oT 29 -92 r9 /�S_�� PirDirrrreeLond Swvdror 3l9W. £pAmAvp. FncRtvvps dlosae99:Cy Ref 0539 Fe.Na ! Fraperryot: V �� /G�4 I r',�n�il/�nrii r��i•efv�,� Municipality of Anchorage • -� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 / www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-432-03 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address COSA# CSC, I G f 0 3 3 Expiration Date: 9-%9 /0 MOUNTAIN PARK ESTATES #2: BLOCK 6. LOT 3 12640 LUPINE ROAD • ANCHORAGE. AK ' 99516 ADAM do JENIFER VANHOLLAND Day phone 240-8697 12640 LUPINE ROAD • ANCHORAGE. AK • 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory Lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _y__ bedrooms. Disapproved. Phone 337-6179 Date f0 b @'O`(OF,q�y `. 2P.. ,. O a�ON-SITE WATER AND ; m= t.WASTEWATER : Conditional approval for bedrooms, with the fllowing stipulations: '0 PROGRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Nitrate Advisory Other By: IU, ':� 0 (Rw. 11A5) Original Certificate Date: " 1 O Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAIN PARK ESTATES #2; BLOCK 6, LOT 3 Parcel ID:_0 1- 03 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N Well Log (Y/N) YES Date completed 5/14/1982 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 100 ft. Cased to 66.5 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/14/1982 1/29/2009 Static water level 45 it. 46 —ft. Well production 7.5 —9 -p -m- 2.1+ —9 -P.M. WATER SAMPLE RESULTS: Coliform (D colonies/100 mi. Nitrate 7- mg./L. Other bacteria colonies/100 ml. Ars e n I c--.< —5- C1 g./L. Date of sample: 4/28/10 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA I Tank Type/Material SEPTIC/STEEL Date Installed 4/27/1982 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5 1 Pumper A+ Hl) tyle,� J I V; <t S C. ABSORPTION FIELD DATA I -BELOW EXISTING GRADE Date installed 28/1997 Soil rating r ft2/bdrm) 1 .2 System type DUAL TRENCH 50.2/50.7OE> Length 100*9 TOTAL ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth *5.5/4-4 ft. Eff. absorption area 504.5 fl:2 Monitoring tube YES :Depression over field NO Date of adequacy test **1 /30/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY In. Water added 640 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN _ If yes, give date **PRE-SOAKED ON 1/29/2009 WITH 1030 GALLONS. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. 'Pump off" leve ' . E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on tot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service tine 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field S'+ Water main N/A Water service line 10'+Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 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. Engineer's Printed Name JEFFREY A. GARNESS Date S-/10 ho COSA Fee S % Date of Payment 6 ill 11 C Receipt Number_ O 13 ZZ y (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department :� @'�: Building Safety Division -tel ��' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Old- 43p — y3 COSA# H,4 D q00,;?3� 1. GENERAL INFORMATION Expiration Date: '5__-/ — Complete legal description MOUNTAIN PARK ESTATES #2• BLOCK 6 LOT 3 Location (site address) 12640 LUPINE ROAD ' ANCHORAGE. AK • 99516 Current Property owner(s) JONATHAN & RUTH ECKER Day phone 348-6123 Mailing address 12640 LUPINE ROAD * ANCHORAGE. AK * 99516 Lending agency Day phone Mailing address Real Estate Agent KEVIN BARRET W/ KELLER WILLIAMS Day phone 865-6500 Mailing address 101 W. BENSON BLVD. #503 • ANCHORAGE AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Z 5 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily idontitiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for — 14L bedrooms. Disapproved. ...:r . . ................. y . Car ss! CE- Conditional approval for bedrooms, with the Blowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory O er By: l� o (Rm. 71A5) Y OF ON-SITE WATER AND WASTEWATER : PROGRAM Original Certificate Date: 2 — 1 0 5 77 Municipality of Anchorage Development Services Department Building Safety Division ; -- �—" On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munl.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAIN PARK ESTATES #2; BLOCK 6, LOT 3 Parcel lD: 0/7-0'�"03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 5/14/1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 100 ft. Cased to 66.5 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/14/1982 1/29/2009 Static water level 45 ft. 46 ft. Well production 7.5 g.p,m, 2.1+ g.p_m, WATER SAMPLE RESULTS:iLJ Coliform O colonies/100 ml. Nitrate -10 mg./L. M Other bacteria —colonies/1 00 ml. Arsenic: -LJ C)ug./L. Date of sample: 1/22/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 4/27/1982 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/16/2008 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA "FLOW EXISTING canoe Date installed 5/28/1997 Soil rating.p.d./ rft'/bdrm) 1_2 System type DUAL TRENCH 50.2/50.7 Length 100.9 TOTAL ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth '5.5/4.4 ft. Eff. absorption area 504.5 ft' Monitoring tube YES Depression over field NO Date of adequacy test **1/30/2009 Results (Pass/Fail) ' PASS For 4 bedrooms Fluid depth in absorption field before test DRY In. Water added 640 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - '*PRE-SOAKED ON 1/29/2009 WITH 1030 GALLONS. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent tots 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATIONo OF A A ......... •: 1 certify that I have determined through field inspections and e 9 y review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this ........ date. O J A. or ess: Engineer's Printed Name JEFFREY A. GARNESSO�Q a E -79/j FFG .,Z Date .L COSA Fee $ LJ et 0 Waiver Fee $ Date of Payment 2 5� 0 Date of Payment Receipt Number Receipt Number (Rev. 11105) J.K. tKer J4t5-101 CJ p.'t —I NECEIVED WAD 3 1997 DATE e I CDT 0 OI s s9• 5a' c<o� E 3O= .,, a � �c � wEt� • �J G.¢ wiay 607'4 ; I Lot J 1 Block .6 .Mf )%/* Esfotes Anchorage Recording District. Alaska (qun••II of newd she, oh LOT SURVEY CERTIFICATION I ►r.hy CB"I?y Pa laws wnp•d the ererlrt., ehaan cad d.wfNd hween. and that Rw Inwov.0 $;Mated *We" We .IMI" he w•p- vly e.ua red da a•t "alae w.aw•a•h •a salae•na r.eete to ase Ih6 1 M h'hhrewerla en edlea•at weevy ~'P w "Meech as It.. ye•wlaa. 4 P.rtldn and P41 then ws ha raadaq., dtldty(Inca, welh.r Ylsl a 04I4a11101 M Sale properly QDe7t dr Ihdladted h•naa. e• 1 66 eh• yyr yJ I'MOla el r.asrd rs nsl hereon hsea oth e J' • •. �../ Q •, elh #!elle haled.. .•ff//� LV_k '• LEGEND . +� ! .•non ��`$; 151192 l on oe and/c ANNnum eapFdd mond.roent rof�'`v.a'ld, , ..!': �..• O kon pipe lu,d/or rdbcr recovered. Q . �•' O 2 2 hub 6 tock reawence Z;,hr;.J LNa•. t 4 • 5/8 z3Aar.bar ddt We ewaey +'n`.,•to4i Scale ft- 30, Date 07-29-92 Prepored by: R.L. avrroN 0 rs�iZ7S_S2W ReDlrrerveLana,Swreror 5/9 W 60M Ave. A17cAa rhe Alasto R-41-411 Ret~ zt�39 F e. No. Property of. Day phone X62-S�2Q ;Y- A r- 14!3-0a 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 date of this inspection. Name of Firm S T'a VA A) 2 (0 Phone zC� Address Q -o, © t c(2oa w Atm �J9�(K Engineer's signature Date so A C2` 'A -- stwen R. Pannone 6. ®HHS SIGNATURE �Q.Q149 Approved for bedrooms.pROFE59t��p4� e- Disapproved. - e_ Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificatesbased only upon the representations given in paragraph 5 above by an independent professional en9 neer registered in the State of Alaska. The DHHS does this as a courtesy to 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 k21 - - - Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICER E C E I �_ Environmental Services Division 1 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3427442 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: L -3I R6 Wl ,, PAPER Qa Z Parcel I.D.: ©FF- 34I -c58 A. WELL DATA Well type`►� t0A'C12�, If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 5-/°`t I gsZ_ Total depth too Cased to 6 ( -.S Casing height (above ground) Sanitary seal (YIN) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 5/' K i T- /31 / 4 Static water level c/gt Well production g.p.m. 2 g.p.m. WATER SAMPLE RESULTS: Coliform Q Nitrate /. 2 7 ^^ y �t . Other bacteria Date of sample: `$ Zq / 4 Collected by: L -R• �L[.< <SF).w nL B. SEPTIC/HOLDING TANK DATA Date installed q-2:7-"37- Tank size t "Z -so Number of Compartments Z- Cleanouts (Y/N) Foundation cleanout (Y/N) u Depression (Y/N) ✓`) High water alarm (Y/N) N Dateof Pumping Pumper A'�Ao.Mask(C- C. ABSORPTION FIELD DATA Date installed -e-17f5 4 Soil rating (g.p.d./ftz or ft2/bdrm) ( 'Z System type S -L&) DLI Length bb:9 Width �k Gravel thickness below pipe Total depth Effective absorption area So# sy- Monitoring Tube present (Y/N) c Depression over field (Y/N) ,j Date of adequacy test NLcA 2 Results (Pass/Fail)PAS-1 For It bedrooms Q rtc Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth — (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) tn/ If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES "Pump `Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" level at" Septic/holding tank on lot /06!4' 06r6' On adjacent lots f Cab t- Absorption field on lot i # 2.0, On adjacent lots /bO `r Public sewer main ✓y CA Public sewer manhole/cleanout A/ JA t Sewer /septic service line 8a Lift station G d r- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line 2-SAbsorption field Water main/service line 50` Surface water/drainage /dot Wells on adjacent lots t cot SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation SI -r Water main/service line Surface water too Driveway, parking/vehicle storage area Curtain drain t ey0't, Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that t have determined thru field inspections and review of in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name ec c Q.L;AL Date '513 11 R HAA Fee Date of Payment (0 Receipt Number 72-026 (Rev. 3/96)" Waiver Fee $ I 6 0 `f' �aY4co $t t air v to in- $toren R. Pennono � sCE s. Date of Payment Receipt Number are 4 11 A.AT, BUI 1- 1<53. SEPrIC STANQ prFWS 0 0 407 4? , (4Th k 2 JAN PENNINGTON ra,E ,� .Q 'D�. j WR44 4 N 630 56' 06" W 4.or 4 Lot ,3 ,Block Fj 1147'a- /Dirk Anchorage Recording District, Alaska tm.eaestr of m wd 0hu than twee am" so OF th ow M teewe Mt 0"m 1Mraoa aela ► ►at• •.•.� st 91" awed. • L e LOT SURVEY CERTIFICATION GEAIC 1 WOW swtlry that Inns ewaeyae ted wooly utoea of eaaarlbee Oram or Aluminum Cq*ed tnanumrnt r • •,.�*•-••'�S� baram, wA ►hot tee bwmv aara .irmtae "Moan vs witma tha per. 0 on and/or, r*bar movered arty lkw aM do not warl" or allor000e as W laowt pnpwty wd tM# Q 2 X bub soak r000wn0 � 1 �'4 no bapa=MR!a an edf~t eraxa►ty aoww w of --" N th OMMM 0 5/6 x 30 rsbar set this survey � to *0010 aM th0 tiara va ao roaaaeyo, arlury IM", or Dow Wtlhte IMMUNIMa en 800 poNrty *M"t as xytaatee bola" Scale„_ .30' fat. 07-2.9�92 Prpared by. R L. aurrory Ref. � �� F S. No. Prowty of: 9Z- /44 Dr1 �'/0/0 wq MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 'O77_�3� D HAA# 1. GENERAL INFORMATION Complete legal description Lot 3: Btock 6; Mountain Pa)Lk E6,tate.a � Location (site address or directions) 12640 Lupine, Road Property owner Danny C. and Ban.batm Jat'owau Day phone -345-7682 Wk: 564-5031 Mailing address 12641) lupine Road Anohanage. APaAbt7 99516 Lending agency Day phone Mailing address Agent Mike, Lew.i3 PIHIHOMEQUITY Day phone 214-506-8808 400 E"t Lai Coti.na.6 Bowee.vand Address 0,300 Inv.ing, Texan 75039 Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 4 v 3. TYPE OF WATER SUPPLY: Individual wellXX 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 XX 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 date of this inspection. Name of Firm Phone S & S ENGINEERING Address 17034 Eagle River Loop Road No. ;04 Eagle River, Alaska 99577 Engineer's signature Date 6. DHHS SIGNATURE Approved for - Disapproved. Conditional approval for Additional Comments L0 bedrooms. 111Th OF _A( No. pR0 F EC SrJ`Qt.,m�a bedrooms, with the following stipulations: Date IleZ 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. Employeesof DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A nn � Legal Description: � �7 �u� 1 j /Ay( 711JAWC P/ Parcel I.D. A. WELL DATA / Well type ?_XZhJ'-_?F ye A, B, or C, attach ADEC letter. ADEC water system number /"/A / Log present ON) eC, Date completed s"j'i-82 Driller EpSS biziuING I Total depth Cased to 66, (!-> Casing height 1/« Sanitary seal (�jr N) 7�S Wires properly protected O/N) IES WATER SAMPLE RESULTS: Coliform q Nitrate a r" t- Other bacteria 0 Date of sample: �— I11 ` L, Collected by: C 4 �> F_N&tNGE2IN(r B. SEPTIC/HOLDING TANK DATA Date installed ��°2 Tank size I PSU GAL Compartments Cleanouts (DN) 2- Foundation cleanout ( JN) yas Depression (Y/V iso High water alarm (Y/@) Alarm tested (Y/6W 11 JJ )IA Date of pumping �' �� r Pumper A+ PoAA-_ SaaIJICES SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots too Foundation Y To property line ac) r Absorption field W -Water main/service line r Surface water/drainage (UO + CJ O r+ CONTINUED BACK PAGE 72-026 (Rev. 7/97) Front - - -` INSPECTION Date of test FROM WELL LOG AT m o z �. z� Static water level L15 S3 ISI m - - D `D �.5 3 Well flow g.p.m. g.p.rr�ii ca, m O Pump level �S r g5 n z rw N O SEPARATION DISTANCES FROM WELL TO: Gni Septic/holding tank on lot 100 r4 ; On adjacent lots M Absorption field on lot /UU r+ ; On adjacent lots � w�A Public sewer main Public sewer manhole/cleanout r� Sewer service line 0 Petroleum tank WATER SAMPLE RESULTS: Coliform q Nitrate a r" t- Other bacteria 0 Date of sample: �— I11 ` L, Collected by: C 4 �> F_N&tNGE2IN(r B. SEPTIC/HOLDING TANK DATA Date installed ��°2 Tank size I PSU GAL Compartments Cleanouts (DN) 2- Foundation cleanout ( JN) yas Depression (Y/V iso High water alarm (Y/@) Alarm tested (Y/6W 11 JJ )IA Date of pumping �' �� r Pumper A+ PoAA-_ SaaIJICES SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots too Foundation Y To property line ac) r Absorption field W -Water main/service line r Surface water/drainage (UO + CJ O r+ CONTINUED BACK PAGE 72-026 (Rev. 7/97) Front - - -` C. LIFT STATION Date Iled IN) /Y'tg� Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump evel at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface water Date installed 9-d-3-'-` .2. Soil rating 85 SF�t3& System type f RENC-"f Length _16 Width _�> Gravel thickness K Total depth 6 Total absorption area 3, CE SF ` _ Cleanouts present (ON) UNF_ Depression over field (Y/O iib Date of adequacy test Results (pass/fail) for bedrooms Peroxide treatment (past 12 months) (YA4 c> 7 Kfvocwrr, If yes, give date 1Ni 114 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot loo On adjacent lots /UO r+ Property line i,�? To building foundation �� _ To existing or abandoned system on lot N/f? On adjacent lots 1} Cutbank —Water main/service line Surface water X06 r S t j� I Driveway, parking/vehicle storage area Curtain drain ' ` oNc- KNOW N E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signature 17034 Eagle Rimer Loop Rand No 204 ,� � v kia.1le (Fiver, f laska 99577 M � a'j1 � ai.�;W21 Engineer's Name Date HAA Fee $ � Zy , Oro Date of Payment 5 -- Receipt -Receipt Number 2%3( 2 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number J r,; I A 1 4'. h. Pla. �21;i MUNICIPALITY OF ANCHORAGE • T DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 017 -LI -2;;,;L— (9 _3 HAA # .&,4 f�&6 1. GENERAL INFORMATION PLr'AL Complete legal description Location (site address or directions) LIP L to I ) Property owner ,J rt-�i i�rtAl ( Lt CL!=,A C=,Day phone Mailing address Iiz 0 LukV I, Q rI � E i Lending agency Ll-�n� r2 f� •S A jay hone Mailing add Agent Address Day phone Unless otherwise requested, HAA will be be hheld for pickup. 2. NUMBER OF BEDROOMS: � 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 7P6 -27i °/ 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 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. 1791) Front MOA #21 -W,a 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 date of this inspection. Name of Firm 7C C-, Phone 7 - 3 f ! E� Address ' of , t 5 Engineer's signature 6. DHHS SIGNATURE X_ Approved for bedrooms. By: Disapproved. Date (i,91I � Conditional approval for bedrooms, with the following stipulations: Ah Ar �- Additional Comments =❑TIG 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 doesthis as a courtesyto purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 1121 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:�� `�✓t�� Parcel I.D. /_1 ,11:14437_1%fa1 Well type If A, B, or C, attach ADEC letter. ADEC/water system number Log present (Y/N) 1 Date completed _y/ 9Z-- Driller 1 ©� Total depth 10-0 Cased to 66 , Casing height Sanitary seal (Y/N) / Wires properly protected (Y/N) T FROM WELL LOG AT INSPECTION z �`yl % 7 1 !L / 7 0 Z Z z Date of test / z zn ,-- Static water level r -n r' t K v y o Well flowg.p.m. g.p.m. ` n z Pump level I� 0 2 N �0 SEPARATION DISTANCES FROM WELL TO: y m O Septic/holding tank on lot 107 ; On adjacent lots 0_0 Z Absorption field on lot X07 ; On adjacent lots > /0-6, i,_1 f�. IA Public sewer main Public sewer manhole/cleanout Sewer service line > 0 Petroleum tank W// -N WATER SAMPLE RESULTS: Coliform �. Nitrate Other (bacteria Date of sample: a 1 L Z- Collected by: -0, B. SEPTIC/HOLDING f TANK DATA Date installed //L7/9 -L Tank size I X 5 0 Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) N% High water alarm (Y/N)/fes Alarm tested (Y/N) i N/A Date of pumping 3f�}� l �i Pumper -Re, `t'o T?c)e,74er SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 101 7 On adjacent lots -,), /6q o Foundation— To property line s12 --p Absorption field �v Water main/service Ii Surface water/drainage t!�t fr3 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION 114/A Date installed Size in gallons Vent (Y/N) High water alarm level _ "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed Soil rating 0�� System type Length Width _15 -Gravel thickness % / Total depth Total absorption areaG9r�� — Cleanouts present (Y/N) Lt- 1/ Depression over field (Y/N) N Date of adequacy Results (pass/fail) 2�� for bedrooms Peroxide treatment (past 12 months) (Y/N)I� i� If yes, give date _ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots —Property line f To building foundation To existing or abandoned system on lot �/A On adjacent lots > _-4 o Cutbank—h_ Water main/service line- Surface water �f Curtain drain �_qla E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 27 I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name e_ Date HAA Fee $ ��~� Waiver Fee: $ Date of Payment i� X12, Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/91) Back MOA 21 LEGAL: 11, 0 pl-*;4" V!". L~��J 11-p F!!:.~ E-.� 20WBT 15TH. AVENUE SUITE 206 ANCHURAG[,ALASKA 9Y50~3Y04 (907) 279-3916 RESIDENTIAL WELL INSPECTION Nn/mtain Park Estate #2 � — �� r LOCATION: Inigiolml� 12640 Lupine Dan Jaloway TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: y INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 5 Gi n i.. PUMP YIELD FROM TEST: 3 Gallons per Minute DATE OF INSPECTION: February 17, 1992 TEST PROCEDURE: Well was pumped at a constant rate while the this drawdown was monitored with an acoustic assessment of the condition of the probe. At the beginning of the test water level was found at 53 feet below top of casing" At a pumping rate of 6 gallons per minute the water level dropped to 85 feet at which level the pump sucked air" The flow were reduced to 3 gallons per minute and the water level rose 79 feet and stabilized there. A total of 660 gallons were pumped. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on February 18, 1992 E.Coli 0" Total Nitrogen 3"2 mg/l. Max. allowable Total Nitrogen 10 mg/l. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER LMINUTE ' FOR� MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of wa�er per bedroom per day" This well exceed this requirement" The assessment of the condition of the well applies only to the conditions as of the day tested" The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. �� Fz R 203WEST 1TH.AVENUE SUITE 206 ANCHORAGE, ALASKA Y950~3Y04 (907)279-3Y16 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 3 Block 6` Mountain Park Estate 4.12 LOCATION: 12640 Lupine |^ OWNER. Dan Jaloway RESIDENCE: Single Family, 4 � WELL: Private On Site , SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 4 Bedroom TANK: Greer Steel 1250 Gal, Two Comparts, ABSORPTION SYSTEM: Trench ABSORPTION AREA: 368 Sq. Ft^ SOIL RATING: 85 [NSTALLATION DATE: 4/27/82 DATE OF LAST PUMPING: R"oto Rootc-�r- -311*.-5/91 DATE OF TEST: February 17, 1992 TEST PROCEDURE: Systefrt was inspected and measured. Tank was found with 3 feet of cover and with a liquid level of 49 inches. Trench sump was 6 feet deep with 36 inches of water" 660 gallons of clean water was added to the trench while the water levels in the tank and the monitor tube were monitored. The water level in the tank did not change, while the level in the sump rose 10 inches. During a time period of 60 minutes the level in the sump dropped 2.5 inches indicating that the trench was absorbing the water" TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate 6uring the year, and the water usage of the family being served by thesystem. These conditions are outside the control of the evaluator of this septic system" We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. APPLK ,AT FILLS OUT UPPER HAI ONLY -- Property -Owner ,--rf -� y� �"�s) �7"Ga��J`�� I ]Phone Date Mailing Address Zip Code 'V Date Buyer t( NJ%jEl� r j/cif 6f� /` Address ycc� Zip Code Lending Institution Inspector Phone Address Zip Code 3 !15-`Av3 J Realty Co. R Agent /,� P/�yy �j�(/t�� V - - Phone Address ;270 2 "k ' ,f L G4 / 671 Zip Code Legal DescriptionAe /( t i= Street Location A 1982 Type of Residence RECEIVED `4 Single Family ❑ Multiple Family No. of Bedrooms 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ❑ Other ( ) CONDITIONAL APPROVAL' Water Supply R Individual - - ATTACH WELL LOG. A -well log is required for all wells drilled since June 1975. ❑ Community Forwellsdrilled prior to that date, give well depth (attach log if. available). ❑ Public Utility Well To Absorption AreaWell Log Received -Q— Sewer Disposal .--_ Well to Tank J. Individual - Year Individual Installed: % gk-) ❑ 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 Date Date Date Date Inspector Inspector Inspector Inspector I/�, Y 1 �YCt. A Field Notes: i MUNICIPALITY OF ANCHORAGE CJ DEPT. OF I '' 13� ! R. ENVIRONMr_I:;A.. _0,1KTION A 1982 RECEIVED { X APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: r Soils Rating Date Sewer Installed Well To Absorption AreaWell Log Received -Q— .--_ Well to Tank Septic Tank Size 72023 (3182)