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MOUNTAIN PARK ESTATES #2 BLK 8 LT 7
Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211172 PID Number: 017-432-19 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New R Upgrade Name JACK MCCANN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bedound Site Address 12701 FOSTER ROAD *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-229-0661 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe . Ft. Subdivision Block Lot MOUNTAIN PARK ESTATES #2; BLOCK 8, LOT 7 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ TANK X Septic ElS.T.E.P. ❑ Holding El Other Manufacturer - -------- GRE"ER-TANK- Capacity 1"000---- "-- -"- -- -- Gal. -------"-----"---------- Surface Water 100'+ -----"------ ---------- Material Number of compartments Lot Line 51+ 1010 NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034Tank to D3034 drainfield A+ HOME SERVICES Drainfield D3034/EXISTING CO/MTD3034 Inspector TIM ECKLUND AND GEG BENCH MARK (Assumed elevation) 100.00 ft Inspect1s' 8/36/21 - Location and description 2nd 3'd _ 41h _ TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp oo�QO . 0 Conditional Approval: Date o ��• "'�s,4� `' 4 9/ 0 .._ �....... .. ........ . Q�• s • p ef�r/ey A. Garr�ess; � Septic System / Approv Date d q CE 79,53 p Note: this approval does include 4 �e �� o gyp° not well permit requirements. ess°�°oma OO�QQOO� #AECC884 �AJ PERMIT NUMBER: p c �-+ �- /� , /�, �+ PARCEL ID NUMBER: OSP211172 RECORD DRAWING 017-432-19 /- \\ MOUNTAlh PARK STATES �\ #2; BLIOCK 8, LOT 8 / �\ A 6 MH1 48.0 23.5 \\ AACENTIUAWWTS ST1 49.1 27.6 / \ / DBL1 49.0 29.4 \ DBL2 50.0 30.0 SWING TIES TAKEN / FROM AS -BUILT SURVEY \ \ Fp'OoS 00 1 / SMP 7 0�_--- 90' WAIVER AMENDMENT SEE ATTACHED COSA r w _ 1n w ' Q DRIVEWAY '. 'e I Lu O c EXISTING 3 BEDROOM HOUSE W U) / / 0 O LL. MO \ 1 1 NEW 1000 GALLON HDPE GREE TANK v / \MOUNTAIN PARK ESTATES #2; BLOCK 8, LOT 6 GN .y T �• T 100 WE�� SOUTH PARK DRIVE SCALE: TA VA �•®®�� VI 40 A DESS ENGINES /r # 00 ENGINEERING, SALES CONSUTA ING 37DiE TUDOR ROAD, SUITE t01•ANCHORAGE.AK99507-PHONE (907(337.6179'FAX (9071338-3246-WE8SRE:wr gam en0inn..(lyra ,,,.. .,.,.. PREPARED FOR. PHONE NUMBER: PAGE NUMBER: �0 �1 ;�ffrey Gar ess ,'• ® JACK MCCANN 907-229-0661 2 OF 3 00. �„ CE 79 LEGAL DESCRIPTION: DRAWN BY: ®p��%�� •, (, � 7- D.J.G. ••: � �s MOUNTAIN PARK ESTATES #2; BLOCK 8, LOT 7 D.J.G. ®® F� ''••. `,,.�••`•'� ®a TYPE OF WORK: DATEEI13I2O21 #AECC88444%OFESS `®® SEPTIC TANK RECORD DRAWINGS torr PERF:IIT NUMBER: RECORD DRAWING PARCEL ID NUMBER: OSP017-432-19 211172 TOP OF MANHOLE = 100.00 FINAL GRADE = 99.83-99.88 MH1 ST1 TOP OF TANK AT INTLET = 95.52 TOP OF TANK AT OUTLET = 95.53 INVERT OF BUNG AT INLET = 94.77 INVERT OF BUNG AT OUTLET = 94.63 NEW 1000 GALLON H. D. P. E. SEPTIC TANK OF w._: �_ Ar 1 .GROUP Ltd �'`-�k91t� ENGINEERING -, SALES =, CONSULTING .. •••••..•••• ••l•.,i�.t ....`..... ...® 1% 3701 E TUDOR ROAD, SUITE 101 -ANCHORAGE. PIC 99507 • PHONE (907) 337-6179 -FAX (907) 338-3246 - `A£©SITE—ga—sengn—ng.mm -- - - - .--_ , -rr�/ ` 9 - ............. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ®�;.f f ei'freyA. Garness c0 JACK MCCANN 907-229-0661 3 OF 3®� CE 7953 LEGAL DESCRIPTION: DRAWN BY: #� ��� ® J '•, MOUNTAIN PARK ESTATES #2; BLOCK 8, LOT 7 D.J.G. •' TYPE OF WORK: DATE: LICENSE �pROFESS���O®� SEPTIC TANK PROFILE 9/10/2021 #AECC884 ���lkoa � co 0 J C) C) C6 co WO C ,It O J 00't O I M „gtb,£O.O N ;uawaseD fi!mn ,0 -6 — O N U C a Y C N C U •- C JU o ! O �;aap �1aaP . "" L�1, "' Ew"ITJL`MI •l l: FYI II GVMJ �131SO-J v C J N O _ -6 CL Q W C m C (nd T � 0 N ry Q 9 7 .O U Q -N mi Q.j o d O U U N 9 .LO.. 'O o rn p 0 N Q pZ s o-�� 0'U) c 0 c n m LO d 10 :) m 0 c s m N � a� cc m m o o o m q E u 3 c w o o > Y c '`o d WII '00` y w a w nci N n lu Q c ro w N UJ omo �°ocE°E� z -�° �a�o EIIp C,4 3mo>0wo a a �_� o m m 0m o c- o > ro E c N N > Z nim Z 'Z o o O 0 ai n Y a W, -m o o� UVT oL U•EL Ta N �c U o c T. 'R p > J F- Z• d �. C O m •(9 m LL. W -00 11 O , =uaj-i O �O O C °� N Q N'm o" 3 N p_ a w C O c4 U Ou OC L cc,: uj Z S II a o Q1 . u C L O L N OL m m c in O O C C O CNC p �}, w a (h .�.' N p > `1 E U T- CSD t t0 'C a CO S� c a I m c o a) a) m y ¢N co E o U o NQ � v�U (n O)E �"' L1 lII �' N p � C m m >, o w c` m c c o m o_ n. o C? LL1 p !- O ` '00 U O '� CO 'II N N .m N '00 u GU') H � Q -o m m n 22 r -- (D 3L c'o m �- M N U) C C "d l0 . n m m O F-- . LL a yWca w a co m co => c� ol m o a Uo C N w N O O C 16 O 'O 0 O O o Ema m N e • • , �,,,, • s01 0 N O C� 00 Q;; a •.2g E m m 00 00 .. \ II • � U 'O 07 J 0 "` • YIYI//��0 O E cu O m En N 00 0 Cg 0 f' �• N ¢� f a u' 6 E CO ��Cb( ~� • •����� m n ID E c= LO`S i�` N '9 > c 0 t9 CL CD a d E j 00 V O 0 0 0 3 C U N N ca O o m N T 0 N C c m v °: a o Ne` m-° o m Q U Q7 � N N m O N m 7 C` C co Mn N r NX CL N O O N N C ca3 E TN o� N ca N o ro 0 m m ai W .c � y LL z a i 05 O Q 2 0 O W = F ww, O E N E o \ o =� �oz� co N p r LL = W o co a�_Z CV r N N G'9Z 0-Z2 oN 0'84 a o 0 U Y � -Q Q C Q m 0 O L�1, "' Ew"ITJL`MI •l l: FYI II GVMJ �131SO-J v C J N O _ -6 CL Q W C m C (nd T � 0 N ry Q 9 7 .O U Q -N mi Q.j o d O U U N 9 .LO.. 'O o rn p 0 N Q pZ s o-�� 0'U) c 0 c n m LO d 10 :) m 0 c s m N � a� cc m m o o o m q E u 3 c w o o > Y c '`o d WII '00` y w a w nci N n lu Q c ro w N UJ omo �°ocE°E� z -�° �a�o EIIp C,4 3mo>0wo a a �_� o m m 0m o c- o > ro E c N N > Z nim Z 'Z o o O 0 ai n Y a W, -m o o� UVT oL U•EL Ta N �c U o c T. 'R p > J F- Z• d �. C O m •(9 m LL. W -00 11 O , =uaj-i O �O O C °� N Q N'm o" 3 N p_ a w C O c4 U Ou OC L cc,: uj Z S II a o Q1 . u C L O L N OL m m c in O O C C O CNC p �}, w a (h .�.' N p > `1 E U T- CSD t t0 'C a CO S� c a I m c o a) a) m y ¢N co E o U o NQ � v�U (n O)E �"' L1 lII �' N p � C m m >, o w c` m c c o m o_ n. o C? LL1 p !- O ` '00 U O '� CO 'II N N .m N '00 u GU') H � Q -o m m n 22 r -- (D 3L c'o m �- M N U) C C "d l0 . n m m O F-- . LL a yWca w a co m co => c� ol m o a Uo C N w N O O C 16 O 'O 0 O O o Ema m N e • • , �,,,, • s01 0 N O C� 00 Q;; a •.2g E m m 00 00 .. \ II • � U 'O 07 J 0 "` • YIYI//��0 O E cu O m En N 00 0 Cg 0 f' �• N ¢� f a u' 6 E CO ��Cb( ~� • •����� m n ID E c= LO`S i�` N '9 > c 0 t9 CL CD a d E j 00 V O 0 0 0 3 C U N N ca O o m N T 0 N C c m v °: a o Ne` m-° o m Q U Q7 � N N m O N m 7 C` C co Mn N r NX CL N O O N N C ca3 E TN o� N ca N o ro 0 m m ai W .c � y LL z a w O Q 2 0 O W = F ww, w~OL W 0 X: \ Oo0W =� �oz� W W o zwau co a�_Z wI-ILD MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni,org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211172 Work Type: SepticTank Upgrade Effective Date Expiration Date: Tax Code Number: 01743219000 Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 8 LT 7 G:2839 Site Mailing Address: 12701 FOSTER RD, Anchorage Owner: MCCANN JACK W JR Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Go 5� Delp artnient 6/2/2021 6/2/2022 Lot Size in Sq Ft: 19032 Total Bedrooms: *- 1 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 0 r �# 1 U_f +D , 2 5 U �c °� s Vdi V) 2-1 Received By: Date: Issued By: Date: X -z 0- I MUNICIPALITY F ANCHORAGE Development Services Department one: 907-343-7904 On -Site Water & Wastewater Section -- � --- __ -.a 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 017-432-19 Property owner(s) JACK MCCANN Day phone 907-229-0661 Mailing address 12701 FOSTER ROAD *ANCHORAGE, AK Site address 12701 FOST ROAD *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES #2; BLOCK 8, LOT 7 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) I—XI (w/wo ADU) Septic Tank Z Upgrade ❑ X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: N/A 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: a 5 Waiver Fees: Date of Payment: J(vC) 1 Date of Payment: Receipt Number: © '231 Receipt Number: Permit No. 0SP :) 11 J-72- Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Clie nt FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211172, Rebecca Carroll, 06/02/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211172, Rebecca Carroll, 06/02/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211172, Rebecca Carroll, 06/02/21 — U 0 t� ?� C f/I C C N oU a =� a H a �' (a cz m��o�=� °� ¢ m m ° w M I o I� �Q=M=Z m�==a) a a: -� �ca 8 _ F 0 a=0 3:a mem fl ¢m C=cm �4 Q m0 ID m= �' m°m c�gYm,Eczx > i0 c vm OO'trO � M 5t,CO O N mpg 2 Y° Qpm z¢ ca N"� u o m c E E ao'v o � �a0 Qcoomm�m ¢� allo 'C t�C4 co N U p V O "' p ° m N }uauaase� f4min ,Q ( z CL z 'U a -mi o f ° ori a x a w m c mu, �= U—= >,-a c U o >-it- z 0- o�mm m u.w °5 <-U sa.0 0 'z Iwo a N@03 c.�0 -¢ W c omvmc cc�t4 cl 000 co`mmmE o�- co iomo� w J m e 0. N m m .._+ +_+ tm/7 N Ct1 o E Q U O m t 2- H m ap .Q w 2> O C roCry m mm C W cV CL d 0 .0 m fi C!J LN V 'C QE 0 LO T7 U U .' o a tV N m v CO w¢ m�stin v~i CEC:dami0),Z6 ~o S��tma O c'o w¢ E m m mw>=ow rn o m c Q N U :0:.2 c o m °'O N p m C U o C,59 4*4� • '� \ m m T m O 00" AW 7 mZo a ( ti• S m m 75 M ow 15 o ..y� t E0 co 00o • V, / N o% -' •o/ Eat°°' m o map �IaaP ° /" Q ; � o , / T'' m m 0 w 6) • O° o �/ dot r 15 E LO 0'05 - I• dJN:,2� mNN°o O CV tO- N Q1 N rC �' s•r�1�. — 5� �O I C J C ,m QQ .•so.=N m Cm mmU)EW _ AW oy g�► cv c0 O O 0 � RG omo N _tt aD 1 Q a N 0) r n m E00 - 9Z 0 Z£ N 0'81 Z 8� m t 1'LZ oc=io§N U z' ° �_°c� q> mmoa C �=�,m a mm0 OL o 2- m _N ca-Z o rn m @ o ° c fV Q tmy C o m C UJ � •� C m � ¢ > N Lo m _ o 0 N m mLL F=- w aa) z 00't,O 6 M „gtr,£OoO N ° = ,,a 0 ocM � o dwww M DWM II o=zz �- wZ0001 croa4 abol �OiSOJ --m J o z �- �ozf.- W�wo w Cn :E < w ~ J < z 1 X808 w i 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 I ~'~ EW ~ O~ .- L~O~ [] UPGRADE NAME DISTANCE TO: / Manufacturer Liq. Well D STANCE TO' Manufacturer ] Well DISTANCE TO: I No of I nes J Length o.Lgach/line Top of tile to finish grade ,~- / Length Width ~ Crib diamete~ ISTANCE TO: Well icl s Depth DISTANCE TO: Building foundation Absorption aie~/ [Dwelling Mater ¢ inside length I Width Dwelling Material Nearest lot lin~/¢ / Foundation ,~ ~:~. / Trench T°ta' 'en4t~ °~ lines w~.~tc~L./f i n ch es Material beneath die z~7 / inches Depth Crib depth Building foundation Driller Sewer line NO. OF BEDROOMS PERMIT NO, No. of~ompar tments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank IPERMI~ NO. '70oo HI Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) ~-~ E IL_ L IR IP41 F'ERMIT NG. ,' '78C~EI4± ) I::IF'F'L. I CFINT LOF:FIT ]: ON LEGFIL [:,EPRRTMENT CIF HEFtLTN FIN[:' EN',,,'IRONMENTFtL F'ROTECTION 825 "L" STREET., FtNCHOF.'.RGE., L:'.'64-472~ C~ ~..~ .--- ~ F E 1'4[..,E[-.. M ]SE ......... '-"--' F~21T E F.: RD L7 B8 MT PFIRK ESl" 3:49 42Eft ::.:'SE~E~E~ SC!I_IFIRE F'EET TYPE OP SOIL FtBL:.;FtRBTIOI'.,I S"r'STEM IS: TRENCFI MFt::'::IMUM NLIMBER I]F EEDR3FMS = 4 'E, OIL RFI'FtNG "SQ FT,."'E:R)= '~£~:"~ THE REI_::¢JIF.:ED SIZE OF' '['HE ':;I-ITL HDz,_RPTION =.~.: FElt IS: E:. F_C F" 'T Fl == 1 2 b. E: ~'-,~ L--:~ 'T l'-t = :~,: ~_:; C_i ~:;-." F~ %." E~ L [:. E£ F" -F Fl == ",---' THE LENGTH DIMEN2;ION IS THE LENGTH ,'.:IN FEET) OF THE TRENCH OR DRFIINFIELD. THE DEPTH OF Ft TRENCH OR PIT IS THE DISTFiNCE BE]"I.,JEEN THE SURFRCE i]iF ]'HE GROUND RND ]'HE E:OTTOM OF THE E:qCI=IVRTION (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. TFtE GRR',,,'EL DEPTH IS THE MINIMIJM DEPTH OF GRR',,,'EL 8ETHEEN TFIE OUTFRLL PIPE FIND THE BEiTTOM OF THE E::.:',CFt',/FITION (:IN FEET). .:IL ~ -_, ~.~ ~7:~ Ftb. L C~ ~-~ '_--C; ~;: E.: ~3:.~ lj :E F~: E.C [:, ~; E F" T ][ C: 'T Fi ~-~ I~::: ~:5 :[ ":ZC liE: == - .... ' ':= "=~ ........................... F' F:~ C: 1-;-,',] Fl ~G E:- F' L R ~'-.t ]'" El F' T' I O I',.,! Fi F't~CKRI]iE PLRNT MFt'¢ BE INSTF~L. LE[:' FiT THE PEF.:MtTTE:E'"S OPI"ION SUE:JECT TO THE F'OLLOHING CONDITIONS: :t. EITHER R CLRSS I OR. ti NSF RPPRO',,,'ED PLRNT MR"r' BE INSTRLL. E[:'. 2. Fi CONTINUOUS MFIINTENFINCE RGREEMENT IS F.:ELT~UIRED. IF' R MRINTENRNCE RGREEMENT IS; NOT I<EPT CURRENT YOU MR'T' BE I;.:Eg!UIRED TO ENLRRGE THE FIE:SORPTION S'¢S'FEM FIND/OR '¢OU MR"/ BE SLIE:JECT TO PROSECUTION. '"F [t.,_~ C~ ,:"..=_--:-" .":. ~ ~'-.~ _-.:. F- E _.- T % ~_~! ["-,~ ".C-~ F~ F..: E-2 F.: E~. ~]:.". bi ][ ..F-: E:-' BFICKFILI_ING OF RN'T' ':-;'¢STEM !-,.IITHOIJ-[' FINFIL INSF'EC:TIOI'.,i RND FiPPRO',,,'FIL B"r' THIS DEF'F¢;.:TMENT HILL. BE SUBJEC:T TO F'RCISEC:LITION. MINIMLtM DISTFtNCE BETHEEN R HELL RND RNY ON-SITE SEHRGE DISF'OSRL S'¢STEM IS ±SE~ FEET FOR R PRIVRTE HELL OR 2E~E~ FEET FuR FI PUBLIC HELL. HELL LOGS RRE REI..-.!LIIRED RN[:, MUST BE RETURNED TO THE DEPFIF,.':-['MENT HITHIN ]:El [:'R'T'S OF' THE HELL E:I]MPLETION. CITHER REQUIREMENTS I"IR"r' RF'F'L'¢. SPECIFICRTIONS FIND CONSTRUCTION DIFIGI'7'.RMS F~RE R","RILFIBLE TO INSURE PROPER INSTRLLRTION. I CERI"IF'¢ THRT 1: I BM FRMILIFIF:.: WITH THE REC!UIREMEN'FS FOR ON-SITE SENERS ting' HELLS I"]S SET FORTH B'T' THE MUNIE:IPFILIT'¢ OF FtNCHORFtGE. 2: I HILL. INSTFtL. L ]"HE S'¢STEM IN RCCORDRNCE HtTH THE CODES. 3:: I UNDERSTFtN[:' THFIT THE ON-SITE SEWER '_=;"/STEM MR"r' REQUIRE ENLRRGEf'IENT IF TFIE F,'.ESIg',ENCE IS REMODELED "FO INCLU[:,E MORE ]'HFtN. 4 BEE:,F'.OOMS. , ?' ' . " ' Anchorage, Alaska 99507 - This form reports:'- ~bil~ 1 ............ Depth : " 9- /':~"'10 - 11 - 12- 13- lo Was ground ~atcr e!~c,ountered? '?~adi n~. ~ D.a't e Gross Time if ye~, at-what Net Time Uepth to Water ........................ -. '-.: :_.-.. :.Z ! .........: : 7- -~ - :7_.]::-_.]:"_ ...................... Percolation ra~"/-;;.~ ¢.~ i~[i~n-u-t~ ......... :- ' 'Proposed, ins '"-'- ~al]at]on: e Pit :- [)rain Field UepLh ofqnlet Oept~ ~B bb~(o~'-bY'pit or trench COHH[~T5 i ...... ' .' .... EQ 0:10 (6/74) ' ...................... • Municipality of Anchorage V On -Site Water and Wastewater Program (907) 343-7904 a < Certificate of On -Site Systems Approval Parcel I. D.017-432-19 1. GENERAL INFORMATION: Expiration Date: ) 2-/ -2I Complete legal description Mountain Park Estates#2; Block 8, Lot 7 Location (site address) 12701 Foster Road *Anchorage, AK Current Property owner(s) Mailing address Real Estate Agent Day phone Day phone 2: TY-P-E--OF-DWELLING:DWELLING- 0 Single Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Ssi] Waiver Fee $ _ Date of Payment q 15 �z 021 Date of Payment Receipt Number 0 a S) 3G Receipt Number COSA # 05_-C2_1 15 4 CA 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 systern 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 Engineednq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 j Engineer's Printed Name: Jeffrey A. Garness Date: `_1 �1 Z/ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and, workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, an(I are outside the control of GEG. Satisfactory test results do not guarantee future performance of th , system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The _-content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _ X System #1 Approved for _'3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foll • 3 . . ................ t'N •,• l CE -7953 � tit S`.���'. .•� '`�G - .9 #AECC884 ON-SITE g WATER AND �'' �el�stiATER z 1 �T PRnrr.AINA CP J � JJ Original Certificate Date: �1 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 Nitrate Advisory C Septic System Advisory Arsenic Advisory Well Flow Advisory Other CA*SkChecklist Legal Description: MOUNTAIN PARK #2; BLOCK 8, LOT 7 Parcel ID: 017-432-19 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 drilled 6/29/78 Total depth 215 ft Cased to UNK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/9/21 Static water level at beginning of test 45.7 ft. Comments B. TANK DATA Age of tank(S) NEW years Tank type/material SEPT"'"°P' Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA 6/1978 Well production at time of test 1.35 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 5.29 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG . Date of Sample 5/13/21 / C_LIFT_.STAT_lON _ ❑ Required maintenance comp Age of lift station rs Lift station materi Commen Which system tested (date installed) Adequacy test date 5/9/21 ❑ ALL standpipes present per record drawing Results QPass For 3 bedrooms Total measured depth from grade *12.08 ft (max) Fluid depth prior to test 56 in Measured depth to pipe invert from grade *6.5 ft (min) Water added 632 gal ❑ N/A — pressurized field **58 New depth in ❑ Monitor tubes go to bottom of effective. if not, state 60 depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 56 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) Gallons introduced N/A gallons If yes, enter dale N/A Comments/Deficiencies: 'AT SUMP ON NORTH END OF TRENCH - DRAINFIELD LOCATED UNDER DRIVEWAY -9 INCHES BELOW INVERT COSA Checklist yellow sheet 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' Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0 Yes 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' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F/ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' F/ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑ Yes if No *190&95 ft Water Service Line > 10'✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *50'+ TO AWWTS ON ADJACENT LOTS **THERE IS A 95' WAIVER TO THE WELL ON BLOCK 8, LOT 6 THERE IS ALSO A 95' WAIVER TO THE WELL ON BLOCK 7, LOT 4. WE ARE REQUESTING THIS WAIVER BE AMENDED TO 90'. WELL ON BLOCK 7, LOT 4 HAD NITRATE OF ND ON 4/23/15. SEE ATTACHED NITRATE MAP G. ENGINEER'S CERTIFICATION OF I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with p� MOA COSA guidelines in effect on this date. G....:. • . . . ........... e,frey A. G`orness•, CE -7953 � COSA Checklist yellow sheet �Q r n o a opofessio 0 #AECC884 INTitrate Advisory Certificate of On -Site Systems Approval # OSC 211549 Subdivision: Mountain Park Estates #2 B8 lot 7 A water sample revealed a nitrate concentration of 5.29 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Ma�lmg Addre s P Q Box 796650 anchorage Alaska 99519 6.650 w iv muni ot_g ;�'`gl a.xa+at*r.��'�' -..�s.,� From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratoryuses 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. 'r'�,'2n�� MM£' Mailing address P O Box 196650 Anciorage, Alaska 99519 6650 fi wwrnr mtinh org George P. Ill uerch. Mayor 4/24/2003 Municipality of Anchorage Buildfiig Safcty Division Jeffrey A. Gamess, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Mountain Park Estates #2 Block 7 Lot 4 Waiver Request #VvR030029 Parcel ID #017-432-12 Health Authority Approval Certificate Number HA030156 Dear Mr. Gamess: Anchorage All -America City r a 2002 Your request for a waiver of the required 100 feet horizontal separation from the absorption field to private well has been approved. The approved separation distance is X5 -feet. The absorption field is located on Mountain Park Estates #2 Block 8 Lot 7. Amet" fo QO . See Garners reZ,uesf (ZZ1) i'✓l 611< 0- L 7 �- i i e. q/&/zI This waiver approval applies to the existing absorption field to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Teleplionc: (007) 343-8301 • Fax: (907) 343-8200 4700 South Bragaw Strect • Anchorage, Alaska 99507 littp://����1� .ci.nnch or:e�c.alc.us M'UNICIPALITY 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 Parcell. D.# O1'7- ~;~,2-I~ '" HAA# ~-~-~c~"~"~L~C~ GENERAL INFORMATION Complete legal description Location (site.address or directions) %Z 70 ~ Property owner Mailing address Lending agency Mailing address Agent "'~ ~ Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: Holding tank Community on-site Public sewer If Community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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, Phone ordinances, and regulations in effect on the date of this inspectionl Name of Firm "7~'~e~ ~;~,~k~[&.,,,t~ -~-' Address ~.0 Engineer's si~r~ature bedrooms. DHHS SIGNATURE V*/ Approved for '~/'/~-- Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~,,, ~ {'i. / 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 net responsible for errors or omissions in the professional engineeCs work. 72-025 (Rev. 1/91) Back MOA ~Y21 Municipality of Anchorage OCT ~ 7 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division '' V E D 825 L Street, Room 502 * Anchorage, Alaska 99501 * (907) Legal Description: ~,1~ ~: Health Authority Approval Checklist t~., ~-~ptZ,. ~t L-o~ ~ Parcel I.D.: A. WELL DATA Well type "~ Log present (Y/N) . ~'/ Total depth ~./~ I \ Sanitary seal (WN) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~,.~v-o ~.,~- Casing height (above ground) Y Wires properly protected (Y/N) Date of test Staticwater level Well production FROM WELL LOG g.p.m. AT INSPECTION WATER SAMPLE RESULTS: Coliform .~.~ Date of sample: I O/i....// Nitrate ,~/¢~. /~ ~ ¢ Y/'4~X Other bacteria Nb Collected by: ~ ~ , g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed ~ / ~7~, Tank size J~,:,b-O Number of Compartments ~ Cleanouts (Y/N)___.~ Depression (Y/N) ~-] t~ High water alarm (Y/N) ~,.I o Foundation cleanout (Y/N) ~,/ ~///'Z./ Pumper Date of Pumping ~'7 '~,[,~ C. ABSORPTION FIELD DATA Date installed /"/~-~/7~ Length ~ ~,,~ Width ~-.~ Effective absorption area /~O ~//~ Monitoring Tube present (Y/N) . Date of adequacy test 1. O/) '7 /~'7 Results (Pass/Fail) Soil rating (g.p.d./fF or fF/bdrm) System type 1'""~ ~-~ c~ Gravel thickness below pipe -7 ~ Total depth ~' Depression over field (Y/N) For /7// bedrooms Fluid depth in absorption field before test (in.); Fluid depth ¢~,~-"- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after~Z¢~ gal. water added (in.): Absorption rate = ~ ~ ~ g.p.d. If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum "Pump off" level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ,~ ,2,:5' On adjacent lots On adjacent lots Public sewer manhole/cleanout ~//'~- Lift station SEPARATION DISTANCES FROM SEPTIC/~K ON LOTTO: Foundation / ~ t Property line c~ O ~ Absorption field Water main/service line "~ 2.~' ~ Surface water/drainage ~"~ I E) Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ D Building foundation ~o t-- Surface water h'-\ I 0 Curtain drain ~"'~' / 0 Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ?8 ENGINEER'S CERTIFICATION " I certify that I have determined thru field inspections and review of Municipal r,e'~r.d~.that th'e' abOve~ ys.~.~sYSt .,ms are Ain conformance HAA guidelines in effect on this date. (,'. c,~ ,~,,.,. ,,; :'. , *.' N me · V ~ -,?~}~::,,?~% .}.,..,/.. Date ~ ~1 ~ ?~ ~17~'~;'~ ~ ......... :...;.:..'.:~' HAAFee $ ',~ Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number dCT-24~1997 &&:42 CTS, E ESI RNCHORRGE 90756&5301 P.02703 Zt~mmm, CT&E Environmental Services Inc. CT&E ReL# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 976459001 Tobben Spurldand P.E, 7/8 MPE No, 2 7/8 MPE #2 Drinking Water Client PO# Printed Date/Time 10/23/97 15:15 Collected Date/Time 10/17/97 00:00 gzeceived Date/Time 10/17/97 15:30 Technical Director: Stephen C. Ede Released By~ ~/~~ Parameter N]tre~e-N Tote[ PQL Unite Method Atlowable Prep Ana[ys~s L~mit~ Date Date Init 1.&4 O,lO0 mg/L EPA 300.0 10 max 10/17/97 IlCP O.O0 eo[/1OOmL SF.'m8 92228 10/18/97 RAM Tom Fink, Mayor un pahty of Anc ora e Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 December 14, 1988 Ms. Jeanette Griggs ERA Realty Center 8400 Hartzell Rd. Anchorage, AK. 99507 Subject: Lot 7 Blk.8, Mountain Park Est. #2 Dear Ms. Griggs, On August 15, 1988, this office granted approval of the well and septic system on the subject lot. At that time various separation waivers were granted from the well to a neighboring septic system and from the septic system to neighboring wells. Since that time, however, other adjacent properties have shown elevated nitrate levels close to the EPA maximum. These same wells have also tested positive for bacteria. As such we must request that new water samples be obtained from the subject lot prior to habitation. Through discussions with you and Mr. Ted Moore, P.E., Flattop Technical, it has been learned that the buyers plan to move in about a month from now. Since the house will have to be dewinterized prior to their moving in, it would be permissible to allow the sampling to take place at that time. This is provided the test results are made available to this office prior to the buyers moving in. It must be stressed that the current test results from neighboring wells indicate possible contamination from septic sources. As such if further water samples are not obtained and results delivered to this office, we will have no option but to rescind our previous approval. Please contact this office as soon as possible. You may call our office at 343-4744 or come by 825 L St. Room 502. We look forward to a timely solution to this problem. Daniel N. Bolles On-site Services db/35 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES s .v,c- CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~T~!y 88'; /~' GENERAL INFORMATION (MUST BE 'COMPLETED PRIOR T~) SUBMITTAL) . (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner /~l~:~r~:~. 5"~"//4~ Telephone: Home ? 9'5-- 42 7 ~O Mailing Address ,/¢-~0'1 ~--o$/-ffr- PI~. J /~rnC~O~'~'¢/ ~ ~q¢),¢'l~' (c) Lending Institution ~,A, Telephone Mailing Address (d) (e) Business Real Estate Company and Agent Address r~' ~(242 [~l~r-~¢ [/ ~..j Telephone Mail the HAA to the followin~ address: or: Check here I~, if hold for pick up. List contact person and day phone number below. Mailed: Milford Sutton 5200 Villa View Dr~ve: 87401 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 CRev 8/861 Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site Water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~..~/~,/~'/'~ "~¢_~,,,t~¢~cf ~U~ Telephone Address I~¢ ¢~ ~. g Date ~{~ ~ Note: insure the wells concentration is 10.0 mg/1. The well for this property meets existing State and Municipal Codes. There are nit~ates present, however, it is suggested that periodic testing be performed to continued ~uitabilit~ngin~e 6.2' mg/1. EPA-makimum concentration is DHHS APPROVAL /(~~ Approved for ~'- bedrooms by Approved ~X Disapproved Conditional Terms of Conditional Approval . ~. TH , ..: ~ ~ THEODORE F, t~OOR~ ~ ~ ~ CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Hea;th Authority Approval certificates based only upon the representations given in paragraph 5 above by an }ndependent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/861 Back MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVtSI(~NIOIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) AUG' I 1988 CHECKLIST- FEBRUARY. 1984 264-4744 RECEIVED Legal Description: WELL DATA Well Classification' ,F'-~,~ u,'¢~ f, ~, Well Log Present (Y/N) Y Total Depth ~ ,'5' ' Cased to Static Water Level ~?' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot I05 To Nearest Edge 'of Absorption Field If A, B, C, D.E.C. Approved (Y/N) Date Completed ~¢'/gY/ 78 Yield Depth of Grouting N, 4I, Pump Set At I,S-O Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~/' ; On Adjoining Lots I01' to -To Nearest Public SeWer Lihe /~, R-.' To Nearest Public Sewer Cleanout/Manhole N,/~,, To Nearest Sewer Service Line on Lot WaterSampleCollectedby "/-~'/'f- F(c~ ~-~c~ .~¢,z* ;Date Water Sample Test Results ---~/(~.~Aeo~w ' O, co(~;f-~.~,/'tOO ,~.~./ ~ ~ ~(~ ~,~ Comments ~ ~e~¢~ ~ ~C ~n~ o~ ~ W, ~ B. SEPTIC/HOLDING TANK DATA Size Date Installed Standpipes (Y/N) ~" Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well 105'~ ..~Q,, ~ To Property Line '~ 7~ ~ To Water Main/Service Line /~' No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped 'Y[~'~/'~' ; for Temporary Holding Tank Permit (Y/N) Ah To Building Foundation 1¥ To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72 026 fRev 8/861 Front ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed O"' / ~ / Width of Field ~ E¢ $oO Square Feet of Absorption Area / Depression over Field (Y/N) Resblts of East Adequacy Test Separation Distance from Absorption Eield: To Water-Supply Well I ~ To Building Foundation ~o" Lot To Water Main/Service Line /~h To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking. Area, or Vehicle Storage Area Comments 6o/~r ~u¢," /~,*,~ Type of System Design Length of Field Depth of Field I 8,5-' Gravel Bed Thickness 7 Standpipes Present (Y/N) Date of Last Adequacy Test -r"renc~ ToPropertyLine IQ' ¢,'~ ,nort~ ?,,'~ /,'ne To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) /,,I,/¢. ~ IoO' D. LIFT STATION N¢~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ..~ Receipt No. Date of Payment ~,,~,rnount: $ S' 026 fRev 81861 Back ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ?~ ~ ~ Date ~""~ ~ /,¢.¢~ Company ~'/'¢4/-'~ ~ ~u~ MOA No. ¢~ ~ ~,~..~ ~- %~,.¢ ~ ~ .... Seal ENVIRONMENTAL SERVlCPS DIVISION -~ . THEODORE F ¢~OORE * ~ ¢,'~ '% CE- 3589 .. ¢',¢ CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THI~ODORE F. MOORE, P.E. PH: (907) 345-1355 July 28, 1988 14530 ECHO ST. ANCHORAGE, ALASKA 99516 M.O.A. Dep't. of Health and Human Services P.O. Box 19-6650 Anchorage, AK 99519 RE: Lot 7, Block 8, Mountain Park Estates #2 - Waivers Dear Sirs: MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION AUG ! 1988 RECEIVED By means of this letter I am requesting waivers of the required 100 foot separation distance down to 88 feet between the well on the subject lot and the septic tank on Lot 8, and down to 95 feet between the end of the absorption trench on the subject lot and the well on Lot 6. The well on Lot 4, Block 7, across Foster Road, is also approximately 95 feet from the closest portion of the absorption trench, however since it was drilled subsequent to the installation of the trench, the responsibility for obtaining a waiver should fall on the owner of that lot. To assist you in your review of this request, I have prepared the enclosed site plan and am submitting copies of pertinent backup documents. According to the driller's log, the well on the subject lot was drilled in 1978 and has a total depth of 215 feet. The log reports a stratum of clay and sand between 1 and 10 feet, and a stratum of gray clay and gravel between 25 and 41 feet. Bedrock was encountered at 41 feet, and the well yield estimated by the driller to be 4 gpm. On Julyl 2 the static water level stood at 39 feet below the top of the casing. To determine the well yield, I caused the pump to run until the water level was drawn down to the pump intake at 150 feet, and measured the recovery rate. Based on two such cycles, I determined the well yield to be 2.5 gpm. Water samples taken from the well on July 8 showed 0 coliform bacteria per 100 mi, and 6.2 mg/l nitrate-N. While less than the maximum allowable level of 10 mg/1, the nitrate level is sufficiently high to be of some concern. To assess whether the relatively high nitrate level is an areawide phenomenon, I took comparison samples on July 22 from two nearby wells. The sample from the well on Lot 8 (located 100 feet north of the subject well, and at approximately the same elevation) showed less than 0.1 mg/l nitrate- N, which is surprising until one examines the log for that well. Bedrock was encountered at a depth of 44 feet, but no significant amount of water. The casing was driven an additional 9 feet into the bedrock, apparently sealing off any source of infiltration. The well was then drilled on down through another aquifer at 364 feet, which provides the production of this well. Apparently, this deeper aquifer is free of any measurable nitrate level. I could not obtain a sample from the well on Lot 6, due to the fact that the house is vacant and the utilities are shut off, but I did obtain a sample from the well serving the residence on Lot 5 (located 250 feet to the southeast of the subject well and at a 10 foot higher elevation). This sample showed an identical nitrate-N level of 6.2 mg/l as had been measured in the subject well. Unfortunately there is no driller's log for this well, however the septic system as-built reports a total depth of 150 feet. Thus, it obviously does not draw from the same aquifer as the aforementioned well on Lot 8, and probably gets it's production from water at the bedrock interface, as is apparently the case with the subject well. Based on this comparison sample, it is my opinion that the observed high nitrate levels are an areawide phenomenon, and not related to a single local source of contamination. The standpipe of the septic tank on Lot 8 is 91 feet away from the well on Lot 7. Allowing for underground projection of the tank, the requested waiver distance is 88 feet. The ground surface in the vicinity of the tank is approximately 5 feet lower than at the subject well, and slopes down to the west. Thus, there is no potential of surface effluent from the tank reaching the well in the event of tank failure. The soil rating of 150 square feet per bedroom should effectively prevent subsurface tank effluent from reaching the well before it is thoroughly treated. There is no shallow groundwater table reported in the area. It is my opinion that this waiver can be safely granted without concern of adverse public health effects. Since the only possible impact of the waiver is on the subject lot, there is no need to obtain concurrence from the owner of Lot 8. The wastewater disposal system serving Lot 7 consists of a 1250 gallon, two compartment septic tank, followed by 86 feet of soil absorption trench containing 7 feet of sewer rock. To test it's adequacy, I metered 630 gallons of water into the trench through the cleanout at it's south end, while monitoring the fluid level both at the north end and in the septic tank. Based on resulting measurements I concluded that the trench continues to accept effluent at a rate of over 600 gallons per day. The well on Lot 6 is located 104.5 feet from the standpipe near the south end of the soil absorption trench on the subject lot. However, the septic system as- built drawing indicates an additional portion of the trench of unspecified length extending further south from the standpipe. The as-built indicates a total trench length of 86 feet, whereas I measured a distance of 79 feet between the standpipes. Thus, I concluded that the trench must extend an additional 7 feet to the south, bringing it within 100 feet of the well. The requested waiver distance of 95 feet will encompass this underground extension. The topography in the vicinity of the trench slopes down to the west at 5%, which means that any surfacing effluent would tend to flow in a direction perpindicular to the direction of the well, and thus should not pose a threat. The soil rating upon which the trench was sized is 300 square feet per bedroom, which implies it is rather tight, and should provide good subsurface treatment. No groundwater is reported in any of the soil logs in the vicinity. The log for the well on Lot 6 indicates that it was drilled in 1976, has a total depth of 273 feet, with the casing driven 4 feet into bedrock at a total depth of 44 feet. The water production is reported as occuring in small fractures throughout the bedrock, rather than at the bedrock-soil interface. In a December 1984 Health Authority Approval report, the static water level stood at 30 feet below the top of the casing, the yield was 6.5 gpm, and a water sample was satisfactory. As mentioned above, due to the fact that the house is presently unoccupied, and the utilities disconnected, it was not possible to obtain a new water sample from the well, or to request the owner's concurrence in this waiver. Based on the other information presented, however, it is my opinion that this small waiver can be safely granted without concern of contamination reaching the well from the subject soil absorption trench. A similar rationale could be applied to the waiver between the trench and the well serving Lot 4, Block 7; however, since the well is newer than the trench, the responsibility for a waiver lies with the owner of the well. That well is located directly downhill from the trench, but roadside ditches alongside Foster Road should divert any possible surfacing effluent away from the well. Please give me a call if you have any questions on these waiver requests. Sincerely, Ted Moore, P.E. Flattop Technical Services 14530 Echo Street ~nchorage, Alaska 99518 :1 P 017 4.-~ 20 7201 ~aT~ £/tm pi?. F~TT-~ P I,.,A N N07-~ : 'rHt~ tx N~, p,l..l.. Loc/4 r' loN..q Afl APPLIC-'NT FILLS OUT UPPER HAl' "ONLY -.- _: Phone Pro~brty Owner ..:: . .. ,,.,. ,~._ ,,~ " Zip Code '/;" /,'/ .'~/': ' /' /'-// Mailing Address - ~ ,,.; ~ ., , ,:: / . ,,'/ · Buyer Addr~,ss Zip Code Phone Lending Institution Address Zip Code . Phone Realty Co. &.,Agent /~?'/ r . .., ,,.'~" .: Address Zip Code Street Locatio~ ~ ' -- .'" -' · i~ "-" ,(. / Type of Residence ~' Single Family [~Multiple Family No. of Bedrooms [] Other Water Supply ~Jndividual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach Icg if available). [] Public Utility Sewer Disposal · {~._,tndividual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] H61ding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Inspector Inspector Inspector Inspector (~)) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE /',~ ~ ~ ~'~ ~,~ ~ ' ~CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received '/~'?z'~. Septic Tank Size 72-023 (3182~ ~ ~'~ ALASKA E~IidlROIqm~DTAL COFITROL ~n§in~e~ir~(I ~ ~n~i~onrnental SKlcJics $~RuICeS, 113C. JOHN SEVIGNY 12701 FOSTER ROAD ANCHORAGE AK 99507 SELLER - JOHN SEVIGNY BUYER - SUBDIVISION - MT PARK ESTATES #2 OCTOBER 6 1983 BLOCK - 8 LOT - 7 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 650 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 LUcst 33rcl Aucnu¢, Suil~: J~ · J~nchora§¢,/~laskc~ 99503 · (907) 276-1361 January 5~ 1978 Mose Pendergrass Star Route A Box 1585B Anchorage, Alaska 99507 subject: Lot 3 Block 7 Mountain Park Estates Subdivision Permit #77560 Lot 2 Block 7 Mountain Park Estates Subdivision ~untain Park Estaess Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis~ as stated on the pe~it, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section NIUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~/iRONMEN1.AL ;_.; ~'~[ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION U~ Telephone 264-4720 DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER J PHONE Roland ?tess±onI 345-1662 St~. 2385 P ~¢borage, Alaska 99507 PROPERTY RESIDENT (if different from above) PHONE 2. BUYER PHONE 3Chh T. and Joan M'. Sevigny MAI LING ADDRESS S. LENDING INSTITUTION J PHONE Mtg. co. °A 4, REALTOR/AGENT PHONE' ¢oZette T.aRose/Marston 1248-~804 MAILING ADDRESS 2804 No~ther~ L±~jhts 5. LEGAL DESCRIPTION Lot 7, Blk 8, Mountain Park Estates ~2 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) ~%~d'~ c **If !ndividual/on-~te, give installation date If ~ystem is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3178) jl~ THIS SIDE FOR OFFICIAL"USE ONLY CATE RECEIVED -' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE F-] OTHER [] MULTIPLE FAMILY [] TWO; [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER []Septic; .Tank or [] Holding Tank Size: (o~-S~' IfTank ishomemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER //(L~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS -. [] CONDITIONAL APPROVAL (letter must accon~am~ certifLcate) 72-010 (Rev. 3/78} .~ /' t~l%t,,1 t/ ~UNICIPALITY OF ,~NC~ORAGE MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONME.TAL E.GI.EEmNG D~VlSION OCT 1 6 1978 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ~c~LCi~SVED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROP~RTYOWNE~ ,"~ PHONE MACLOG ADDRESS z ..... ~ ~ .... P~O~E~TY ~SiDE~T (If different from a[ov*) .... PHONE 2. BUYER PHONE MAILING A[DRESS 3, LEN[IN~ I[STIT[TION ~ PHONE I ~AiLI~G ~DDRESS 4. REALTOR/AGEN}, , ~,, IPHONE MAILING ADDRESS :./ 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE I~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM [~[ INDIVIDUAL/ON-SITE~ [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.} **If individual/on-site, give installation date t~?~' If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED iNSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR I NSPECTO R INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] IVIU LTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~, ~ ~ F Connection Verified INSTALLER []Septic Tank or ED Holding Tank Size: /',:,~__("7~ If Tank is homemade SOILS RATING give dimensibns: ~ deO TYPE OF TANK MANUFACTURERx~. ,,,~L' TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I W, ELL TO: Absorption Area to nearest Lot Line 5. COMIV1ENTS (~'~/APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED LEGAL DESCRIPTION 72-010 (Rev. 3~78)