Loading...
HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 8 LT 4Onsite File f s x moss's^" k '��` Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191282 PID Number: 017-432-22 Dwelling: ■❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑Q Upgrade Name: James & Kaija Anderson ABSORPTION FIELD ❑ Deep Trench e❑ Shallow Trench ❑Bed El Mound Address 12700 Saunders Rd Anchorage AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 830-8997 1 4 6.0 GPD/SF 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot Mountain Park Estates #2 Block 8, Lot 4 Fill added above original grade 0.6 Ft. Gravel length 25 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 250 Ft2 1 Ft. Well >50' >50' N/A N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding Other Manufacturer Advantex FAP Capacity 11500 Gal. Surface Water >50' >50' N/A N/A Material Fiberglass Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain None Noted Remarks Trench &tank installed under the Pump on level at in. Pump off level at in. High water alarm at in. supervision & licensing of A+ Home Services. Trench Is Insulated. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Owner Install Drainfield D3034 CO/MT Inspector J. Wlllams BENCH MARK (Assumed elevation) 100 ft Inspection151 7/18/19 7/22/19 Location and description dates: 2n,, aro 41h Threshold of lower level back door. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ®*����� OF qC�� °'°'°••.9����� Conditional Approval: Date �e�p',.••'''°°° � �"•• 9th ` 'tt.u..0 ...a.. a... .. ...... .... _ �a �^`--00 '0.. ® ... .......nuu.................. a..... e..n10 ��n ;MICHAEL E. ANDERSON MV 1 }.� No. CE -4381 ,'�_� �� �t� ''•. 10/2/19 ,.0' � �� �Fo •'°•°....,...._•• Approved i T Date 15 pp �iC �� ®�� tit PROFFSS��N �® inspection Keport-9-1-12.doc MOUNTAIN PARK ESTATES #2, BLOCK 8, LOT 4 PERMIT # OSP191282 PID # 017-432-22 ® I I r n II v EXISTING WELL LOT I�� // I LOT L — — \4 EXISTING WELL \SERVES LOT 3 & I �\ --- \ 100'WELLRAD I c I 1 \ I�LTERNATE SI z I \ w XIS ING HOLDING ANK / > EXISTING WELL I u` KT EC MMISSIONED IN CE < m \ \ \ PER OA CODE ' �� LaT 7 1 B MT1 02 A BDRM HOME \ \ \ o 50' RADIUzco S MT2 • l FCO _ I n MH2 H1 � \ \ \ \ \ NEW 5' WIDE x 25\\LONG x4' 500 -GAL EFFECTIV DEPTH % ADVANTEX TANK I \ I ABSORPTION T�NCH. I w/ AAX20 POD. \ I 1 \ \ LOT 6 ` I� 1i / LOT 5 E�ISTING WELL 7 I\ V I GE ENGINEERING PLAN AS -BUILT 0 50 100 FEET 1 II=50' A B FCO 2.5 21.5 C01 32.8 46.9 MH1 36.0 49.7 MH2 46.0 57.8 2CO 43.1 52.6 MT1 56.8 59.9 CO2 55.2 58.0 MT2 59.1 69.9 CO3 57.8 69.0 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH -TEST HOLE MOUNTAIN PARK ESTATES #2, BLOCK 8, LOT 4 PERMIT # OSP191282 92.4 Q H P I D # 017-432-22 Vv.,J 2" INSULATION 96.0 FINISH GRADE /- 95.4 ORIGINAL GRADE 2i0 DRAINFIELD ROCK 88.4 88.4 25' 82.4 NO GROUNDWATER 6/14/19 PROFILE AS -BUILT (NO SCALE) 92.4 _00oo0��O OFA_O FCO 49 TH . 0 CD 0 �Oai4,N SHANE A. HOLT � Da LS -6914 A �a o �°fessiona� �D�OOoo�� N 89 56'06" W 183.00 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" =20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4, BLOCK 8, MOUNTAIN PARK ESTATES NO. 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _19 TH DAY OF AUGUST , 2019. 13024, FB 172-36, 198-78 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223.8615 MUNICIPALITY OF ANCHORAGE 1~ �` On -Site Water & Wastewater Program �l , PO Box 196650 4700 Elmore Road E` ' •' ;: / j Anchorage, Alaska 99519-6650 Phone: (907) 3437904 Fax: (907) 343-7997 i http://www.mud.orglonsite A'YCNOAAa� On -Site Wastewater Disposal System Permit Permit Number: OSP191282 Effective Date: Work Type. Septic Upgrade 7/12/2019 Expiration Gate: 7/11/2020 Tax Code Number: 01743222000 Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 8 LT 4 G:2839 Site Mailing Address: 12700 SAUNDERS RD, Anchorage Owner: ANDERSON JAMES CLAYTON & Design Engineer: FORGE ENGINEERING This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Lot Size in Sq Ft: 19032 Total Bedrooms: ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7), 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, seated, and heated to prevent freezing issuedReceived By: Date: `� Date:©�' r MUMCPALITYOFANCHORAGE o tip Community Development Department 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. 017-432-22 Property owner(s) James & Kaija Anderson Mailing address 12700 Saunders Rd Anchorage AK 99516 Site address Same Day phone 830-8997 Legal description (Sub'd., Block & Lot) Mountain Park Estates #2, Block 8, Lot 4 Legal description (Township, Range & Section) Lot Size 19,032 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑x Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 1ZUpgrade ❑x Duplex (D) ElHolding Tank ElRenewal ❑ 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: 5 �� Waiver Fees: Date of Payment: Receipt Number: Permit No. 01 Permit App__- : Date of Payment: _ Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 4, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Mountain Park Estates #2, Block 8, Lot 4 – 12700 Saunders Road Septic System Design Dear On-Site Services Engineer: The owner of the above lot intends to replace the existing holding tank on the property with an advanced treatment septic system. We are submitting this design and permit application for the construction of a new septic system. The attached site plan identifies the location of existing wells in the area, the existing holding tank and the proposed septic location and alternate site. No conflicts exist between the proposed system and any other well or septic system on this or adjacent lots. The ground surface on the lot slopes at a slight grade toward the west. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 50’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 8’ from the primary site. Please refer to the attached test hole log and plan and profile sheet for the septic design. If this design is followed no adverse impacts will occur to adjacent properties. Sincerely, Michael E. Anderson, PE 7/4/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191282, Rebecca Carroll, 07/12/19 955 950 96 0ALTERNATE SITE 10050 0 FEET 1"=50' INSTALL 1500-GAL ADVANTEX TANK w/ AX20 POD. NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO THA MOUNTAIN PARK ESTATES #2, BLOCK 8, LOT 4 7/3/19 3-BDRM HOME SAUNDERS ROAD10' UTILITY EASEMENTGARAGEEXISTING WELL SERVES LOT 3 & 4 100' WELL RADII EXISTING WELL 50' RADIUS CO 2CO CO MT INSTALL NEW 5' WIDE x 25' LONG x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. EXISTING WELL DECOMMISSION EXISTING HOLDING TANK PER MOA CODE. MHMH EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191282, Rebecca Carroll, 07/12/19 MOUNTAIN PARK ESTATES #2, BLOCK 8, LOT 4 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 1-5 MIN/IN APPLICATION RATE: 6.0 GPD/SF 5' WIDE TRENCH SYSTEM 1,500-GAL ADVANTEX F.A.P. TANK w/AX-20 POD TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 2' 6" 4' NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 7' BELOW GRADE FLOW LINE ELEVATION: 3' BELOW GRADE TOP OF TRENCH: 6'' ABOVE GRADE 600 GPD / 6.0 GPD/SF /5' WIDE * 0.5 RED = 11.7 LF TRENCH REQUIRED (25 LF SPECIFIED) 7/3/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191282, Rebecca Carroll, 07/12/19 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE A SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) Mountain Park Estates #2, B8, L4 6/7/19 J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? NO - NONE 2.9 6 2 3 017-432-22 James Anderson 3:29 / 3:39 6/13 1 2 3 4 5 6 10 6 / 9 14 16 " 3 14 16 "3:41 / 3:51 3:53 / 4:03 4:04 / 4:14 4:21 / 4:31 4:33 / 4:43 1' OB GM (SILTY GRAVEL) 6/14/19 Professional Engineers Stamp: 7/3/19 10 6 / 9 14 16 " 3 14 16 " 10 6 / 9 13 16 " 3 13 16 " 10 6 / 9 10 16 " 3 10 16 " 10 6 / 9 8 16 " 3 8 16 " 10 6 / 9 7 16 " 3 7 16 " Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191282, Rebecca Carroll, 07/12/19 THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 17�Day of —TLJX,'1f of 20A, by and between herein the "OWER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (A.MC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1.` Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex Waste Water Treatment System located at (legal description) Mountain Park Estates #2 Block 8 Lot 4 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) -; _ ' hrouehout the tern of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval:for operation in the Municipality. t shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). wner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 i Scanned with CarnScanner MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 17�Day of —TLJX,'1f of 20A, by and between herein the "OWER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (A.MC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1.` Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex Waste Water Treatment System located at (legal description) Mountain Park Estates #2 Block 8 Lot 4 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) -; _ ' hrouehout the tern of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval:for operation in the Municipality. t shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). wner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 i Scanned with CarnScanner f,4g�er acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. �er acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. / 7 --Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. / Owner agrees that any sale or transfer of title of the property will not occur without a new I/ Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendorlinstaller and approved by the Municipality are the governing guidelines for the constriction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. N onwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute. a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 Scanned with CamScanner OWNER: / By• - — (signature) Date: e5`l'.>-1,� �? 1�print name) STATE OF ALASKA ) ) SS. THIRD JUDICIAL DISTRICT ) The foregoing instrument was c1 owledged before me this J2 day of J4M4 , 20 , by--S&MV. A/1G,KIW6 Notary Public i OTARY PtJBLIC FOR ALASKA RJ REPUYA My Commission e..Pires: g QQ� � State of Alaska My Commtsslon Explr®s May 20, 2020 ��ooDOO�O OF "49 TH 7oo o O O ` N SHANE A. HOLT O� LS -6914 b��� �ofessiona\ N8956'06"W 183.00 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" =20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4, BLOCK 8, MOUNTAIN PARK ESTATES NO. 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _31ST DAY OF JULY , 2015. 13024, FB 172-36 HOLT LAND SURVEYING 600 HIGHVIEW DRIVE ANCHORAGE,AK 99515 345-5513 . I Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW' c~.~:~Ol?~ PID Number: O/~'q~,l.~. Name: ~ ,~ ~, ~ ~, Wastewater System: ~ New ~Upgrade Address: J ~ ~o w _,~ -'Au~,~'~I ;,~.,~ ~3 ~/~ ABSORPTION FIELD Phone: ~ _~ No. of B~rooms: ~nch ~ Shallow Trench ~Bed ~~Other Lot: ~ Block: ~ ~., Subdivision:~ ~ ~ Depth to pipe bottom from origina~ ~el depth beneath pipe Ft. Township: Range: Section: Fill added above original gr~ G~: / Ft. Ft. Gravel depth: / Number of lin~tance between lines: WELL: ~Zi&Ti~New ~ Upgrade ~ Ft. I ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total~rption area: Pipe material: Drifter: Date Drilled: Static Water Leveh I n~ ~ Dato installod: Ft. Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. From Tank Field Station Tank Sewer Lines~ ~ ~ ~ Well ~ ~ ~ ~ ~ ~. ~ Material: ~ Number °f C°mpa~ments: Surface -- -- LIFT STATION Water ~ 10~ ~ ~ ~ ~ ~ ~ ~ ~ "Pump on" level at: ~igh water alarm at: Foundation Cu~ainDrain ~0,~ ~ . , ~~_ ~ Electricallnspectionspedormedby: ~ Remarks: ~ ~H ~ ~ BENCH MARK Location and Description: I Assumed Elevation: ENG~NEER'~ SEAL Inspections performed by: S&S ~N6~N~m~ Dates: 1st ~-~-~~ ~ 170~4 Eagle Riv~ Loop R~ Ne. 2~ 2nd ~-[o-~ 7//~ Eagle River, Alaska ~577 /~~~ Department of Health a~d~Human Services approval . ,~,~..-%% ~ Reviewed and approved by: Date: ¢ -~'~ '~ ~''-''~,~°~"~'t;~~ 72-013 (1/91) MOA25 Permit No. ~..~'¢/,~00/.~ Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~'~¢~/.//F7'~/d ~/¢/~r. ~?;4-¢~F_~ ¢~:/-4~? '¢ NEW: 72-013 A (Rev. 9/91 ) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930013 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SECRETARY OF HUD OWNER ADDRESS:222 W. 8TH AVENUE ANCHORAGE, ALASKA 99513 DATE ISSUED: 2/10/93 EXPIRATION DATE: 2/10/94 PARCEL ID:01743222 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 8 LT 4 LOT SIZE: 18720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. RECEIVED BY: ROBERT SHAFER, P E ROGER SHAFER, P.E. February 9, 1993 CIVIL ENGINEERS (907~ 694-2979 FAX 694-!211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. Box 196650 825 L. Street Anchorage, Alaska 99501 REFERENCE: Lot 4, Block 8, Mountain Park Estates 12700 Saunders Road Request you issue a permit to install wastewater holding tank to serve the 3 located on the referenced property. a 2000 gallon bedroom house Due to the proximity of several wells in the area, there is insufficient room on the property to install a conventional septic system (see our letter to ASSOCIATED BROKERS dated December 14, 1992). Also, due to the slopes of the property to the west and the groundwater levels in the area, we do not feel separation distance waivers can be justified. The well serving this property is located on the adjacent Lot 3. Lot 3 has also installed a wastewater holding tank for similar reasons. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE UPGRADE ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PR&CTICES and M~TERIAL SPECIFICATIONS REFERENCE: GENERAL: 1. Lot 4, Block 8, Mountain Park Estates ~2 12700 Saunders Rd. The scope of this project includes the installation of a 2000 gallon wastewater holding tank to serve the 3 bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be resposible for ensuring a satisfactory vegetation growth over the mounded area. HOLDING TANK INSTALLATION: A holding tank is to be constructed by a certified wastewater holding tank manufacturer. Construction shall include a 6" cleanout for pumping access and watertight manholes. The holding tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the holding tank shall extend a minimum of 12 inches above final grade. 4e Holding tanks installed with less than 4 ft. of cover shall be insulated. Se The holding tank shall be equipped with a high water alarm which registers both visually and audibly inside the dwelling. The alarm shall be positioned to allow at least 450 gallons of storage after the alarm has been activated. page 2 Lot 4, Block 8 Mountain Park Estates 2 0 Final grading over the holding tank shall be such that a positive slope exists away from the holding tank. MINIMUM MATERIAL SPECIFICATIONS: me The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of PiDe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Holding tank inlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Tom Fink, Mayor nicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 April 27, 1994 Michael W. & Kristina L. Renfro 12700 Saunders Road Anchorage, Alaska 99516 Subject: Lot 4 Block 8 Mountain Park Estates Subdivision Permit 9SW930071, ~PID~9017-432-22 The subject permit, issued April 23, 1993 by this office for a single family well and/or on-site wastewater system, has expired as of April 23, 1994. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by'the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Fyhn Smith, P. E.- ~rogram Manager On-site Services enc: Copy of Permit cc: S' & S Engineering Secretary of HUD PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930071 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SECRETARY OF HUD OWNER ADDRESS:640 W. THIRTYSIXTH AVE. ANCHORAGE, AK 99503 DATE ISSUED: 4/23/93 EXPIRATION DATE: 4/23/94 PARCEL ID:01743222 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 8 LT 4 LOT SIZE: 18720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: DATE: DATE: unicip Hty of nchor e Department of Health and Human Services Torn Fink, 825 "L" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 343-4744 May 15, 1992 Ingrid Pedersen 12700 Saunders Road Anchorage, Alaska 99516 Subject: Lot 4 Block 8 Mountain Park Subdivision #2 Permit ~SW910097, PID ~017-432-22 The subject permit, issued May 15, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of May 15, 1992. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, /? ~rogram~Manager On-site Services enc: Copy of Permit MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW910097 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:PEDERSEN INGRID OWNER ADDRESS:12700 SAUNDERS RD ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/14/91 EXPIRATION DATE: 5/14/92 PARCEL ID:01743222 LEGAL DESCRIPTION: MT PARK ESTATES #2 BLK 4 8 LT LOT SIZE: 18720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY I I I I I I I I I I I I I I I p/~oPos£ D ~ So.uTH p~.~K DRwE L3, BI L~BI sEpTIC. NOT[; T~t[ ?Rof'osEb ~v'[l-L iS To B~ LOCATED No ~oR[ THfiN 72' EAST OF ~BE HOUSE. ON LoT N ~ BLOCK ~7 ~Nb ~RoX. IOE' F~O~ ~E CLoSesT SEPTIC STANDPIPE THE LOT. WATE~ L~E FRoI,~ CO~UN~T~ WELL LOT 3 15 TO CUT C6 fPE~ OFF. L~, B[~ MT. PARK ESTATES PRoPosED WELL SITE PLAN DATE NOTE: THIS IS NOT A SuRVE"IEb PLAT ALL LOCATIonS ARE' APPRO×IMATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAl ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [ E~UPGRADE LEGAL DESCRIPTION NAME MAILING ADDRESS LOCATION DISTANCE TO: I /,S--~ Manufacturer ~' I Liq' cal~acit/y~ i n ~all°ns I IF HOMEMADE lOC ~ : Manufacturer Well · DISTANCE TO: I / 5'- ~ NO. of lines / I Length of eas~ine Top of tile to finish grade ~ I Length Class DISTANCE TO: Width Absorptio~ ~aMaterial Dwelling W dth NO. OFBEDROOMS PERMIT NO, ~ Inside length Liquid depth Dwe ling PERMIT NO. Liquid capacity in gallons Foundation Material Nearest lot line ~/~;) Trench w d~o ']~inches Total length of lines Material beneath tile Depth No. of compartments PERMIT NO. (d~ ~- 0 2~ ~,~ Distance between lines Total effective absorption area s-ye PERMIT NO. Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER APPROVED DATE LEGAL F'ERM I 'T' biO: I)ATE 1SSUED: DEF'ARTMIENT ;, r"Ui:'AL'TH AND ENVIRGNMIENTAL ]TECTION 825 L STRE/ET, ANCHORAGE, AK 99501 ,o, x..A ..- .~ ":,' ".', ( ) · C)["4 ..... S'][ Till S]EEb~ER F" EF'.H I 'T' 06 / 1.3/85 AIZ'PL I CANT: ADDRESS: CONTACT PHOblE: LEGAL DESCRIP: LOT S I ZE: NAX BEDROOHS: TOM LGNGINO 12700 SAUNDERS ROAD ANCHORAGE, AK 99516 545-0625 SUBDIVISION: MT. PARK ESTATES SECTION: 26 TOWNSHIP: 12N 19052 (SQ.FT. OR ACRES) 3 LOT: 4 BLOCK: 8 RANGE: 5W Listed below are the optio[~,s availabIe rte you in designing your septic system. Choose the opti6n that best fits your site. DEPI"H '1"0 F'IPE BO'TTOM (F"T'.) GRAVEl_. DIEPTH (F'I".) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL I_ENGTI"] (FT.) GRAVEL VGLUME (CU,,YDS.) TANK SIZE (GALS) SOIL RATING (SQ.FT./BR) T F~ E[ N E; ~-~ 4.0 6.0 ~ 0 2.5 ~-45. O' ' .27.' 1 1,000. O 177 ~'~ TANK MUST HAVE Al' LEAST TWO COMF'ARTMENTS 5.0 0.5 5.5 20.0 40.0 29.7 000.0 .~ 1 '77 4.0 3.5 7.5 5.0 58.0 45.0 1,000.0 ~'~ 17'7 ce~*'L i fy that: 1. I am f'amilian with the pequirement, s eof on-site sewers and wellm as set For-th by the Municipality oF Anchor'age (MOA) and the State of Alaska,, 2,, I will install the.system in accordance with all MOA codes and negulations, and in compliance with the design cpitenia of this penmit. 3. I will adhepe to all MOA and State of Alaska pequi~ements fen the set. back distances ¢~om any existing well, wastewaten disposal system of public sewenage system on this en any adjacent o¢ near'by let. 4. I understand that this penmit is valid £er a maximum oF 5 bedn~ems and any enlapgement will nequine an additional penmit,, IF: A I,_IF:'T STATION IS INSTAL.LED IN AN AREA COVERED BY MOA BUILDING [,*ODES, THEbl (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILl,_ NOT' BE APPROVED WITHOUT AN ELECTRICAL. INSPECTION REF'ORT; AND (3) THE ELECTRICAL. WGRK MUST BE DONE BY A I,_ICENGED ELECT~'(ICIAN. .SIGN[ED ~__~ ............................ :__~___ DATE: _.~.~_~',~_~... 'AF:'PL. ICANT: TOld LOI~INO~ [~- SOILS LOG '~ mUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCR,.'r,ON~ EI~ ~ L~+LI 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DEPTH , D*TE PERFORME=: SITE PLAN SLOPE WAS GROUND WATER '~ (",~ O ENCO"NTERE£'? SL IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop IT'7 I. oq ~Hp_o i~._)~_p,:5- /s,'7 lo i,0,,, /q7 4r'z?" ~ 15-7 /O t,o~ ' - e¢.~o ~I zi? io i,oO PERCOLATION RATE TEST RUN BETWEEN '~///P-" , FT AND (minutes/inch) , FT COMMENTs'TI-Iree fL-T~so:% ~.-~-. ~' /7:~~-' '/r.:,'/e 72-008 (6/79) ~ I./// //1' DATE: Certificate of On -Site Systems Approval Parcel I.D. 017-432-22 1. GENERAL INFORMATION Expiration Date: ju tA )a_ 0 Complete legal description Mountain Park Estates Sub #2, Block 8, Lot 4 Location (site address) 12700 Saunders Road Current property owner(s) James & Kalea Anderson Day phone (907) 830-8997 Mailing address 12700 Saunders Road, Anchorage, AK 99516 Real estate agent 2. TYPE OF DWELLING: ❑Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the. engineer. COSA Fee $ 280 Date of Payment 5 0 Receipt Number. COSA # OSC211149 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 3/25/21 49 TH 6. DSD SIGNATURE / / .... . ......... f System #1 Approved for `T bedrooms/ Benja 'Schiller System #2 Approved for bedrooms �+�c�sTF�, CE 12592 Disapproved kkF, PROFESS10Nt`L-� Conditional approval for bedrooms, with the following stipulations: `�1OF (l((((((am Z ON Jc� WAST V,?Aj to� ) 0,By: / Original Certificate Date: 2/ % d o ,� t The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Mountain Park Estates Sub #2, Block 8, Lot 4 Parcel ID: 017-432-22 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date filled Total dept ft Cased to ft ❑ Sanitary seal is functl ing correctly ❑ Wires are properly protecte Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Community Well PWSID 217720 Well production at time of test N/A gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 0.326 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 3/18/21 Well is on neighboring lot and serves two homes. B. TANK DATA Age of tank(s) <2 years Tank type/material Advantex/Fiberg lass Measured operating fluid level in septic tank New Al Standpipes/foundation cleanout per record drawing Date of pumping Installed 7/22/19 D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 7/22/19 ❑■ ALL standpipes present per record drawing Total measured depth from grade 7.6 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION uired maintenance completed Age of lift stat) years Lift station material Comments: Adequacy test date New Installation Results ❑ Pass For 4 bedrooms ��depth prior to test in Water a gal New depth Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Septic Tank/Lift Station on Lot > 100' N/A Community Sewer Manhole/Cleanout > 100' N/A ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ❑ Yes if No N/A ft Neighboring Absorption Fields > 100' N/A Animal Containment > 50' ❑ Yes if No N/A ft ❑ Yes if No ft Surface Water > 100' 0 Community Sewer Main > 75' ❑ Yes N/A if No ft Manure/Animal Excreta Storage > 100' 0 Yes N/A if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' P1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Z Yes if No ft Private Wells > 100' ❑ Yes if No >50 ft Water Main > 10' r❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' F1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' r❑ Yes if No ft Private Wells > 100' ❑ Yes if No 50 ft Water Service Line > 10' ❑r Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet i :* 49TH *, Benja. .chiller CE 1259203/25/21 • `i i PROFESSIO V' �4 372579 mmoncommon OMNI MINE 111110111111111111 0 1 on on MEME I i AdvanTexO Field Maintenance Repod Annual Inspection AnchorageTank 907-272-3543 Property OwnerfTracking # pH (6-9) Operator � 13 19 Jim Anderson _71 Larry Betts Clean Site Address El Pungent Contact Phone 12700 Saunders Road, Anchorage AK 99516 Biom ormal (907) 555-5555 AX Site ID # County ID # Pod # RTU #/UL # Date of Last Inspection AX -147716 I OSP191282 431430 RTU139854 07/29/2019 Retrieve O&M Info Daily flow Recirc ratio Timer settings: Perform Field Sampling/Observations NTU (15 t NTUs) pH (6-9) DO (2-6) � 13 19 —5 _71 Odor of Sample Typicalusty [I Earthy ❑ Moldy Non -typical Vulfide [:1 Cabbage El Decay Oily film in PVU El Yes0 Foam in tank El Yes 490 Check Control Panel Recirc Amps Discharge Amps 12,3 N 18 Audible and visual alarms �O K Dial tone (telemetry only) Yes El No Inspect/Clean Pump System Inspect Clean Riser/Lid .................. Splice Box ................. Float Cords ................... Floats ........................ Pump..................... Biotube® Filter ................. Biotube Pump Vault ............ Recirculating Splitter Valve....... Comments Measure Sludge/Scum Sludge Scum 1 st Compartment Currerlt, 3 Previous Current Previous 2nd Compartment Current Previous Current Previous Inspect Inspect/Clean AdvanTex Filter Inspect Clean Riser/Lid 0 Floats 0 El Inspect Clean OdorNormal El Pungent Laterals/Orifices El El Biom ormal ❑ Excessive Pod Bottom Inspect .t� Bridging/Ponding. one/Minor ❑ Excessive Intake Vent osi Inspect/Clean Discharge Pump System Inspect Inspect Clean Riser/Lid 0 Floats 0 El Splice Box El Pump 11 ❑ Float cords R Inspect/Service Other System Components Inspect Cie Inspect felean Disinfection Equipment * Dispersal Laterals/Orifices(�!r osi Observations Additional Services Rendered EI Cleaned textile sheets? El Replaced UV items? El Replaced/Used other items? Parts Used: W = Warranty, B = Billable (V appropriate selection) W B Item Number Description Final_ Safety Inspection RSV reinstalled anifold reconnected; flush valves closed Sumrpary/Recommendations �System performing; no further action needed ' El Call for service Lids Control on 0.rol panel reactivated El Tank needs pumping R Other? Fax completed form to 1-866-384-7404 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE} ANDIREPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ' L 1 Day of of 20 by and between V&kln—L-ky herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex Waste Water Treatment_ System located at (legal description) Mountain Park Estates #2 Block 8 Lot 4 2. Maintenance. Repairs and AIterations. (Owner is required to read, understand and initial each section) VR.,-Zhroughout the term of this Agreement, the Owner shall enter into a service agreement with an ANVWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. WIt shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). caner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. FIOwner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainheld replacement. (rev. 05118/2018) Page I of 3 Ac— Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AW V4 IS may be assessed in accordance with AMC 14.60.030 - Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval - Owner agrees that the AWWTS installation and maintenance requirements as provided by the AW\VfS vcndorlinstaller and approved by the Municipality are the governing f uidelines for the construction, maintenance and repair of the Owner's AWWTS.Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of AIaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7_ Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. {rev. 05118)2018) Page 2 of 3 OWNER. � By: (signature) 1VVM (print name) Date: --,? IL-1 STATE OF ALASKA } ) ss. THIRD JUDICIAL DISTRICTro } The fore oin 'nstrument was acknovvled ed before me this, Tda of CJt � 24 by-' " Y NOTARi' Pt., 'LIC FOR ALASKA �CIALSEAL My Commission expires:i 4 '� "ZC} � NoaryPub�c.S�eOA�a� MY Conan Ems 11 V022 MUNICIPALITY: By:B (signature) Date: / /,?- 0� (�elce Ca,— eo-c ro l ( (print name) Title: (rev. 05/18/2418) Page 3 of 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description Lot 4; Block 8; Mountain''Park Estates #2 12700 Saunders Rd. Location (site address or directions) ."~ .: Anchorage, AK ~- :" 'owner' '~ "",.Wade Renfro -Day phone property , Mailing address ':12700~ Saunders Rd. Anchorage, AK 99516 Lending agency Day phone 348-0624 Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER. OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: 3 XXX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: xxx Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & $ ENGINEERING Name of Firm iiU;~4 Eagie River Loop Road No. 2~ Address Eagle River, Alaska ~./577 . EngmeeCs s gnature Phone Date. DHHS SIGNATURE ' '/ Approved for '~'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Re¥,1/91) Back MOA#21 MUNICIPALITY O~ ANCHoP, A,O~ EI'~/I~ONMENTAL SEPwIcE$ MunicipaliW of Anchorage 997/ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~I~iVE~ 825 L Street, Room 502 * Anchorage, Alaska 99501 * (907) 34~ Health Authority Approval Checklist Legal Description: L ,) 1-' ~ E, ~-o¢~c ~f -Parcel I.D.: poo ~ ,v'l ~ ~,.~ ?,~ /~c ~ 5 7,'¢ T.~ .J ~--?--- A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) C Date of test WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to _~ight (above ground) ~ Wires properly protected (Y/N) AT INSPECTION g.p.m, g.p.m. Coliform O Nitrate LO · ! Date of sample: ~ / B. SEPTIC/HOLDING TANK DATA Date installed '3] lo / c~ 7) Tanksize Collected by: ~oo0 Foundation clea. n0ut {~;~N) ~/~- $ Depression (Y/I~ /''' 0 Date of:ip~mpi'ng ' ' <~'/'~'1,? Pumper ABSORPTION FIELD DATA' Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments High water alarm~,~/N) Y,¢-- $ D~.te installed Soil rating (g.p.d./ft2 or fF/bdrm) System type Length Z ~ .Wi~lth/ Gravel thickness below pipe Effective absorption area Monitoring Tube present (~..~.~pression over field (Y/N) Date of adequacy test ~ail) __ For bedrooms Fluid depth in absorption ~(in.); _ Imm.e. diatel~ after gal. water added (in.):_ Fluid depth /~tes later: Absorption rate =_ g,p,d. ~past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles_~.te~sm~ E. SEPARATION DISTANCES ------/ *Datum Size in gallons "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots Public sewer main ,..-.-~ Public sewer manhole/cleanout S ewe__..~epti~ Lift station SEPARAFION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ /-~' ~ / Property line Absorption field Water main/service line iO Surface water/drainage /o0 ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation ~ Surface water ~- ..~------Drlv-6'~ay~/vehicle storage area Cu~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records ~1f~~ are in conformance with MOA HAA gui~jelines in effect on this date. Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-432-22 HAA# HA930140 1. GENERAL INFORMATION Complete legal description Lot 4 Block 8 Mountain Park Estates S/D ~2 Location (site address or directions) 12700 Saunders Road Anchorage, Alaska Property owner HUD #111-03680 Mailing address Day phone Lending agency Mailing address Day phone Agent Fran Shell % Associated Brokers Address 640 West 36th Avenue, Anchoraqe, Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Three (3) TYPE OF WATER SUPPLY: NOTE: Day phone 563-3333, 99503 Individual well Community well xxxxxxx Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank ~:: Community on-site NOTE: XXXXXX Public sewer If community wasfewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As certified by'my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm S & S Enqineering Phone 694-2979 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Address Engineer's signature Date DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health ,~uthority Approval Certificates based only upon the representations given in paragraph' 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72q)25 (Rev. 1/91) Back MOA#21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 4; Block 8; Mountain Park Estates Subdivision~ Location (site address or directions) 12700 Saunders Road, Anchorage, Alaska Property owner Mailing address RTID ~1 1 1 Day phone Lending agency Mailing address Day phone Agent Fran Shell/ASSOCIATED BROKERS Day phone Address 6&0 .west 36th Avenue, Suite O[ke, Anchorage, Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water xxx N NOTE: 563-3333 99503 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA #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-ske 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 & S ENGINEERING 17034 Eagle River.L;do~'~ad No. 204 Address Eagle River~ Ala~'ka Engineer's signature DHHS SIGNATURE __,~ Approved for Phone bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72¢025 (Rev. 1/91) Back MOA ~2~  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: //07' 4/ ~L~--~/ /~t/~7',~/H /~,t~¢ ~F:~,Parcel I.D. A. WELL DATA Well type ~0/~v/gf¢(7'¢/ Log present (Y/N) Total depth, Sanitary seal (Y/N) If A, B. or(~ attach ADEC letter. ADEC water system number ~k,///~ Date completed /~/~ Driller A-J///~ Cased to /¢t//~ Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION / -S~/holding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL TO: Sewer service line /~,~¢ ; On adjacent lots /qJ',/~ ; On adjacent lots Public sewer manhole/cleanout /t/'----~ Petroleum tank /~//~ WATER SAMPLE RESULTS: ¢ S~C= Coliform (~ Nitrate Date of sample: %~ l c~ ~ c~ ~ ra~-/fl~ Other bacteria 0 Collected by: B. ~/HOLDING TANK DATA Date installed Cleanouts ~'N) High water alarm (~)'N) / Date of pumping Tank size ,~OOO ~/- Compartments Foundation cleanout (~N) LC/' d., 7, Depression (Y/~ ~.~ "~ Alarm tested . .(~N~" : F/~-~ " /'l¢/'~/,¢ ~/g-/'3~' Pumper:'!' /LJ)/,~'' ,-~ SEPARATION DISTANCES FROM ,~/HOLDING TANK TO: Well(s) on lot /LJ/~ To property line ~ + Surface water/drainage On adjacent lots -~ 4'- Foundation Absorption field (A.)/~ Water main/service line c~ ~"~ ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE A TION , ~  Manufacturer Size in gallons ,,_ , Manhole/Access~ ~:: (wY:~e)r a--~-arm level P~ ~e;'tPe7p °ff'' level a~t Meets MOA electrical ~ ~ S A ,O. TO, W.~.mto't On adjacent lots Surface water Date Soil rating System type Leng Width Gravel thickness Total Total absorption area Cleanouts present (Y/N) __ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Date of adequa¢ __ If yes, give date bedrooms SEPARATION DISTANCE FROM TO: Well on lot acent lots Pro ine To building foundation Onadj Surface drain To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature $ & S _~NG!U~mNG Engineer's Na~lo ~:vor, Alaska 22577 $ waiver Fee: Date of Payment D ~g~ ~-- ~ '~ Date of Payment DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 March 24, 1993 (907) 349-7755 Mr. Jim Williams S & S Engineering 17034 Eagle River Loop Rd., Ste. 204 Eagle River, AK 99577 Subject: Lot 4, Block 8, Mountain Park Estates Class C Public Water System ID no. 217720 Dear Mr Williams: The Department has reviewed it's files concerning the public water system serving the above property and an approval from this Department was found. Results from the recent water samples submitted were satisfactory for both total coliform bacteria and inorganics for nitrate. Therefore, for the concerns of this Department, this system is in compliance with State of Alaska Drinking Water Regulations (18 AAC 80). Attached is an "Approval of On-Site Residential Water and Sewer Systems" certificate verifying this Department's approval. Thank you for your cooperation with the Department. If there are any further questions concerning this matter please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineering Assistant II ML/pf Attachments STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Lot, Block & Subdivision or U.S. Survey Certificate Issued tot Application NO.: This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. WASTEWATER DISPOSAL The domestic wastewater system was: [] inspected by the Department of Environmental Conservation and found to be in compliance with applicable requirements of 18 AAC 72; [] inspected by a Professional Engineer who certifies that the system complies with applicable re- quirements of 18 AAC 72; [] installed by a Certified Installer who certifies that the system complies with applicable requirements of 18 AAC 72; or [] tested by a Professional Engineer who certifies that the performance of the system is satisfactory and that the system complies with the minimum separation distances specified in 18 AAC 72. This approval is valid for a [] single family [] multi-family unit with a total of bedrooms. Name Title Date MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ,qu dc,'y Applicant Name-~l? ~onq/MO Tel'ephone: Hc~me ._~4,~'- (b) Business A/oo ~L Applicant Address /0?00 .~ x~nd6r~ ¢d. /4.c bor~?% /4~: ~.¢/.6 (c) Applicant is (check one): Lending Institution []; Owner/IC~l~er J~; Buyer []; Other [] (explain); (d) Lending Institution A 4. ~ 5~/J ..~?-/gT'~E',, ',~-~M,, ... ~',.. ' Telephone (e) Real Estate Company and Agent (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/[~}' Multi-Family [] Other Number of Bedrooms-7%'¢¢ WATER SUPPLY · ,/- Individual Well~ Community.-~' Public [~\ Note: I! community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite]~] Public [] Community [] Holding Tank [] Note: If/'community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGII'~EERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~. ~1~, /-t ~- ~ 6 t~J~-~ l~== Telephone Address ~/~ ~c~(~ ~' ~ A~./ Date ~/~ / Cg Engineer's Seal DHEP APPROV_.~. ~ Approved for ~(~A-. bedrooms by./~-~I/~') ' .~-'~::d::na~..~_Date '¢ Approved ~ Disapprovdd. Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above'by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purci~lasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's wor,k. : Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MO,-,) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ./--,~7' VIRON/vI=~ .... ~ & ,...,'~u~ PROTECTioN 30 1986 RECEIVED Well Classification ~ If A, B,OD.E.C. Approved (Y/N) Well Log Present (Y/N) (~/ Date Completed -~ / ~7[ ? Total Depth / ~-q~' Cased to ~_.E~epth of Grouting /~/o Static Water Level /~/o-C {dr, o~/-) ~'""~~ Pump Set At /o,~T Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: ~/~__ To Septic/Holding Tank on Lot * To Nearest Edge of Absorption Field on Lot f.o ~ / Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~) / ; Of~ Adjoining Lots ~ ! ; On Adjoining Lots /_B'~- To Nearest Public Sewer Line /,//~r TO Nearest Public Sewer Cleanout/Manhole )V///¢ To Nearest Sewer Service Line on Lot /V'//~ Water Sample Collected by '-'D~/_~T /--//?/,-- ; Date 4/~4/~(,,~ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /¢~'% Size it2OO ~,/-f~ No. of Compartments ~ Standpipes (Y/N) y Air-tight Caps (Y/N) )¢" Foundation Cleanout (Y/N) ~ ,. Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~/'A Separation Distances from Septic/Holding Tank: / To Water-Supply Well / To Property Line ~.-4 / To Water Main/Service Line Course 4//4- ~"" Date Last Pumped ~gOD ; for / Temporary Holding Tank Permit (Y/N) To Building Foundation ~/O / To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /¢¢¢-~' Width of Field -~0/~ (-~¢ Type of System Design~'~-..~/~"'.'¢ Length of Field ~ .~//¢:]---~.~-- ~. Depth of Field /O / (/~¢0) Gravel Bed Thickness Square Feet of Absorption Area ~¢¢,¢P $'. ~ ("/~'¢C) Standpipes Present (Y/N) Depression over Field (Y/N) /V' Date of Last Adequacy Test Results of Last Adequacy Test --~.oO Separation Distance from Absorption Field: ,~ .......... To Water-Supply Well /(~O / Z.o.r ,¢- '7 ......... ~-T'o:Prdp~rty Line To ~:3uilding Foundation ~ r~/ ~ Lot ~O / To Water Main/Service Line ,M'/ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots ¢¢' /~Z To Cutbank (if present) Comments D. LIFT STATION Date Installed ~ Size in Gallons ~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at  Vent (Y/N) ,~,,,~umping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that Ifh"~"b,hecked, verified~, or cj;~formed to all MOA And HAA guidelines in effect on the date of this inspection. Signed '~ /-~.~ ~-----~/ Date Company 0~/(,,/4 / .. ~='A/~.,,~ MOA No. Receipt No. '~c~ Date of Payment ~/ Amount: $ t.e .~'~¢;~-% Engineer's Seal Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the Z~ < ~~ ~b~ Water System is in compliance with the State Drinking Water Regulations Sincerely, District Engineer -0 LoC I¢'r'':''' I "-,. o .2' LoT' ,Io' Lrriu[-r-~ ,} GRID, !D\'!G: IoFI -0 LoT' .5 L~T s Lof 4 Lo-'r I CHKD: DATE, AI,~SI~,~ J]ItI~I_OP,'/,E'~I' Co;sUlTan'Is, l,~c. Eng;nt~r$ U Surveyor~ Planners 5313 A,ct.c Bird , Suite 201 J P O. Box 4.3187 ~,ncho'aoe. AK ggso2,7?~A"~chol"age. AK ggsOg-3'187 GRID' zD%q PR. NO: OWG: J o~:l