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HomeMy WebLinkAboutASPEN HIGHLANDS #1 BLK 1 LT 8Aspen Highlands #1 Block 1 Lot 8 #017-013-19 Municipality of Anchorage Page I of 4 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW000452 PID Number:. 017--013--19 CENDANT MOBILITY SERVICES Wastewater System: r-I New · Upgrade ,~d~.,.: ABSORPTION FIELD CONTACT AWWC. INC. (537-6179) "~ep Trench r'tShellow Trench 1:3Bed OUound 13Other LEGAL DESCRIPTION ~ "~: 0.5 ~o~ .. 11.9 UAX. 8 1 ASPEN HIGHLANDS ~/1 SEE DWG. ,~ 8.0 MIN - - - SEE DWG. ~L 75' (3 O 25') WELL: D New I-1.~Upgr°de / ~ "~ ~ ¢ ~ =T~9' ~ 2.5 rL 5 +/- r~ ~ 1200 s~ ~ D 3034/ F--810 rt DENAU 12/5/00 - 12/6/00 ~ ~ TANK SEPARATION DISTANCES =s,.uc =.o,o~n~ · s.T.~... From Tonk Station Tank ~ u,., ANCHORAGE TANK 1500 Well 100'+ '89' 100'+ -- 25'+ STEEL 2 Surface Wotar 100'+ ~oo'+ ~oo'+ - - LIFT STATION Lot mu, I Une 5'+ '1'+ 5'+ - - 1500I ANCHORAGE TANK/ORENCO SYSTEMS Foundation 5'+ 10'+ 5'+ -- ~ ""' ~ "~ I~""~ ~' ~ "~ I~' "~' ~ ~ - TIMER TIMER 46" Curtain ~-.e Ua~ & u~see Drain '- NON[i KNOW q ~20 OSI 05 HHF M.O.A. Remarks: *WRO00087. e9 rS~T tO WELL ON LOT BENCH MARK VERBALLY AMENDED BY DAN ROTH WINDOW SILL ON NORTHWESTERN SIDE OF HOUSE. DURING CONSTRUCT]ON. ORIGINAL WNVER WAS FOR 90 FEET. ~ ~ 94.00 Inspections performed by: AWWC,INC.Dates: 1st 12/5/2000 6th 1=,~/~ooo 7th 1~/1~/=ooo Sth 1=/~5/=ooo 9th 1=/1,/~ooo .,~.,,.;.,:.j..;.,,~=..:.......~' Depertment of Health and Human Servicee approval (] ~ ..... ... Rbvlewedend~pprovedb¥: 0~.~..-,- b~/./~,,~/~ Dote: '~'~-~1 ~°"~,f~,_,._.,,,o~' ....... PER~iT NUMBS: 017-015-1g A B A B C01 46.2 ~g.9 005 61.0 70.0 ~1 48.~ 42.1 SP 51.9 67.9 I C02 37.1 36.9 ~1 59.6 74.8 C03 60.7 60.4 C07 46.8 68.9 / [ ~ S~C ~DPIPE C04 36.~ 50.7 ~3 61.0 78.6 / m~ 50.7 so.8 cos~os.s ss.~ / / / W~ O~ I .' ~ 10' ~ _ _ ~_ ..... // I~. ----~ / . ~ ~ ~7~ nL~ ~/~ / / I ~ 1 ~ go ~ ~2 ~_ ~ ~ / ~. u.~ f / F--~/~;~~~ ......... ~ ~: ~ ....... ,~. ~}~,~.... ~-~s~ .... ,~X A B C01 46.2 39.9 ST1 48.3 42.1 MH 55.6 49.8 C02 37.1 36.9 biT1 49.5 50.2 C05 60.7 60.4 C04 36.3 50.7 MT2 50.7 60.8 A B C05 61.0 70.0 SP 51.9 67.9 C06 49.2 65.5 FS1 59.6 74.8 FS2 61.6 77.6 C07 46.8 68.9 MT3 61.0 78.6 C08 68.6 85.1 ALASKA WATER & WASTEWATER C.J.G./K.D.W. CONSULTANTS, INC. ,, ~ CENDANT MOBILITY SERVICES CONTACT AWWC 2 OF' 4 ASPEN HIGHLANDS S/D; LOT 8, BLOCK 1 AS-BUILT OF SEPTIC SYSTEM UPGRADE pERMIT NUMBER: swooo4s2 AS-BUILT DRAWING 017-013-19 / - ew~,~ lil~ ~J ~.~?. f~ _~I ~. ~ 94.46 ~/s/2oo~ K.D.W. ~.~,, ~/~ ..~ ~S~ ~TER ~ WASTE%~TER ~ CENDANT UOBILI~ CONTACT AK~C ~ OF 4 ~ o~.,~: ~o~1~.... ~ ~ ..., .,~ ASPEN HIGH.ND5 S/D; LOT 8, BLOCK 1 ~[ OF ~R~ ~r - · AS-BUILT PROFILE OF SEPTIC SYSTEM UPGRADE (R/ACTEX) "~""""""~ AS BUILT DRAWING "~'° "~ SW000452 -- 017-01 /-- 88 INCHES / ~ (~.2)~ ~~ ~ . ~--~' - - ' ,~ ~ - 95.69 ,~'~:~-~. ~s~.~¥,:;..-,~;~ .... OUTLET INLET ~'"~ l_~.. ~: ...... ~/s/2oo, ~S~ ~TER & ~S~TER ~ , , f .. CENDANT MOBILI~ CONTACT AK~C 40~ 4 ASPEN HIGH~NDS; LOT 8, BLOCK I .'"' PROFILE OF UPFLOW FILTER Municipali ,of Anchorage Building S,'ffe~' Dxx~slon P.O. l~x 19C~c~,0 * 4700 S. Bmgaw Street Anchorage, Alaska 99519-6C~0 * (907) 821-3-8301 http:l/~',vw.cl.m~chon~g¢.ak.us 03/14/01 Jeffrey A. Gamess, PE Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Aspen Highlands # 1 Block 1 Lot 8 Waiver Request #WR000087 Parcel ID #017-013-19 Permit Number SW000452 .Public Work~ Dear Mr. Gm-ness: 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 84.0 feet. This approval is amended from the previous approval on October 25, 2000 for a 90 feet separation. 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC, March 6, 2001 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Waiver Amendment Request and Health Authority Approval Aspen Highlands #1, Lot 8 Block 1 ATTENTION:Mr. Dan Roth DearMr. Roth, During the installation of the upgraded septic system on Aspen Highlands #1, Lot 8, Block 1, a septic pipe was noted on Aspen Highlands #1, Lot 6 Block 1, (property to the north) which is 84.6 fi from the well of the subject property. A waiver was approved on October 25, 2000 for a separation distance of 90 fi from the well on the subject property to the new septic system. We request that this waiver be amended to 84 fi, to include the drainfield on Lot 6. Following is justification for the amendment: · Subsurface Migration: This potential path of contamination ofthe well is mitigated by the depth of the aquifer and the protective soil profiles overlying it. The well log (attached) for Lot 8 shows a clay strata from 41 fi to 72 fi below surface. This impermeable layer has served to protect the aquifer from subsurface contamination. · Water Analysis: Results of a water sample taken February 15, 2001 from the well on Lot 8 reported nitrates at 2.47 mg/l with no bacteria present. Other properties in the area have similar nitrate concentrations. Attached is recent water sample analysis for the wells on Lots 4 & 10, Block 1, Aspen Higlands #1. Both have nitrate levels greater than 2.5 mg/L. In short, nitrate levels are slightly elevated throughout the area. · Topography: Although the well is located slightly downhill from the septic pipe, the expected flow of potentially surfaced wastewater would be to the west of the well, by following the natural topography. If the septic system were to overflow, it appears that the effluent would not travel toward the well head. · Vegetation: The area between the septic pipe and the well is heavily vegetated, which would inhibit flow ofwastewater to the wellhead. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 33%6179 * Fax: (907) 338-3246 * Website: akw~vc.com Fcbrua~ ~l, ~O01, pa~ 2 · Visibility: The well is located in the back yard of Lot 8, with a deck and a kitchen window nearby. Any potential surfacing of effluent would be quickly noticed and corrected. Based upon this justification, we request that the existing waiver be amended to 84 feet separation distance from the well to the drainfield on Lot 6, Block 1, Aspen Highlands #I. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 6901 Debarr Road, Suite 2B · Anchorage, AK 99504 Ph: (907) 337-6179 · Fax: (907) 338-3246 · Website: akxvwe.com BL~CK 1~ BK)C) 5. BLOCK 1 6. BLOCKI s~ BLOCK 1 8LOCIC I 16 IdANOR LOT 14 k4ANOR LOT 13 KiMB[RLY i4ANOR PREPARED FOR MIKE CRO~: WORK: SITE PLA~ 'ILANDS SEPTIC PHONI (907) 227-1 BLOCK 1 RAD£ $C~LF..: 1 OF3 MUNICIPALITY OF ANCHORAGE Deparlment of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343.4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000452 Legal Description: ASPEN HIGHLANDS #1 BLK I LT 8 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Mike Croft Owner Address: 7435 Upper DeArmoun Rd. Anchorage, AK 99516- Date Issued: Oct 25, 2000 Expiration. Date:. Oct 25, 2001 Per,lID: 017~13-1~ /I ~/~ ~ ~ Site Address: 007435 DE ARMOUN RD Lot Size: 27091 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Municipality of Anchorage Department of Health and Human Services 825 'L" Street George P. Wuerch, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor h~t p~/www.ci.anchorage.ak.us October 25, 2000 Jeffrey Garness Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B Anchorage, AK 99504 Subject: Waiver Request for Aspen Highlands #1, Lot 8, Block 1 Waiver Request #WR000087 Parcel ID #017-013-19 SW000452 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation fi.om the absorption field to private well has been approved. The approved separation distance is 90.0 feet. A one foot lot-line waiver between the east property line and the proposed septic system has also been approved. This waiver approval applies to the existing on-sitewastewaterdisposal system to property line and between the east property line and proposed septic system separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval fi.om this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000087 PID~: .017-01~-19 HA~: Date Received: October 10t 2000 Legal Descrip§on: Aspen Highlands #1~ Lot 8~ Block I Pe. i : swooo 5 Engineer:. Alaska Water & Wastewater Consultants~ Inc. 6901 Debarr Road~ Suite 2-B~ Anchorage~ AK 99504 Applicant: .Mike Croft ......... Waiver Requested: 90 foot waiver from private well located on propert~ to the proposed dralnflelds. 1 foot lot-line waiver from east propert~ line to proposed aeptlc Criteria: 1. Geology Points: A. Water Table B. Soil Sorp§on C. Permeability D. Water Table Gradient E. Horizontal Separation Totsl: 2. Special Conditions: 3. O~her:. Waiver is Granted: )~ Waiver is not Granted: List Conditions or Reasons for above: ~ ~' E /~-/'T'A ~/-/E D Date: /0- Rec~: 06382 Amount: $920.00 Name of Reviewer Date Paid: 10110100 IlU' Ft I 19.1 ALASKA WATER & WASTEWATER CONSULTANTS, INC. October 9, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic System Upgrade for Aspen Highlands Subdivision #1; Lot 8, Block 1 RECIRCULATING UPFLOW FILTER 01eactex) SYSTEM To whom it may concem: 1. GENERAL: The existing 4 bedroom home is served by a private septic system and a private well. The existing septic system is surcharged and must be upgraded prior to the sale of the house. There are numerous site constraints which are as follows: ,, The location ofthe house and driveway ,, The small lot size · The location ofthe existing well · The location of the existing septic system · The presence ofsurface water Given these site constraints, we are proposing to install the Recirculating Upflow Filter 0>~EACTEX) system. 2. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.5 gallons/day/ft2 should be used. 3. DRAINFIELD: The intent is to install a Recimulating Upflow Filter (Reactex) System that will allow the use ora small drainfield in the area within a 30 foot radius of the test hole. The size of the drainfield will be based upon the previously established criteria for the Reactex systems, which dictates that soils percolating between 60 & 120 minutes/inch have an allowable application rate of 0.5 gpd/ft2. Given a percolation rate orS0 minute/inch, we .propose that a 0.5 gpd/ft2 application rate would apply. We are proposing to install a 2.5 foot wide drainfield that is 12 feet deep by 75 feet long (3 drainfields ~ 25' each). We propose that 8 feet of clean, 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: ak~wvc.com washed sewer drainrock be added below the distribution line. This corresponds to an absorption area of 1,200 ft2, or an application rate of 0.5 gpd/fl2 (assuming 600 gpd total flow). 4. ORENCO PACKAGE SYSTEM: The STEP tank with the trickling and upflow filter will be manufactured by Anchorage Tank & Welding to meet the latest design criteria established by Orenco Systems, Inc. The point of contact at Anchorage Tank is Lowell McNutt. As with their standard STEP tank, it is equipped with a high water alarm per M.O.A requirements. 5. SURFACE WATER: Surface water is present in a ditch running along Upper DeArmoun. The proposed septic system will be located I00'+ from this surface water. There is no other surface water within 100 feet of the proposed septic system upgrade. 6. WELL WAIVER: We request that your department issue a 90 foot waiver from the private well located on the subject property to the proposed drainfields. The topography is such that surfacing effluent cannot migrate from the drainflelds to the well, leaving subsurface migration as the only potential path for contamination. Attached is a copy of the most recent water sampling results (9126100), which indicated that no bacteria were present and nitrates were 2.7 mgq. In short, the nitrate levels are only slightly elevated. The proposed Reactex system has proven to significantly reduce effluent nitrate and TKN levels (to a combined residual of 13 based upon 41 separate samples taken in the MOA). This reduction in nitrates will more than compensate for the 10 foot waiver requested. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. 7. LOT LINE WAIVER: We request that your department issue a I foot lot line waiver from the east property line to the proposed septic system. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. 8. TOPOGRAPIIY: As can be seen on the attached topography site plan, the average topography of this property is a 5 to 15 percent running from approximately north to south; in short, there are no slope concerns. The trenches are to be installed parallel to slope contours. 9. CLOSING: I am open to any suggestions from your department that would be an improvement to the proposed system. I am unaware ofany negative impacts that this installation would im ~ose on ~djacent wells, or septic systems. If you have any questions, please call us at 337-6179. ~4 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 33%6179 * Fax: (907) 338-3246 * Website: akw~vc.com I ~, LOT 3. BLOCK 1 · I ~ I ~ FOR D~. ~ ~ / I I , ~ ~: I , I , ~ ~ ~ ~ KIMB~LY ~OR L~ 13 I LOT 12 CONSULTANTS, INC.' MIKE CRO~ (907) 227-1195 1 ASPEN HIgH~NDS S/D; LOT 8. BLOCK 1 SITE P~N FOR SEPTIC SYSTEM UPGRADE / I I. 1~' S~K ~u SURF~E WA~ mN ~E D~H ~ONO ~E SO~ PROP~ UNE OF ~E SU~E~ PROPE~, / J ~ 2. 3. ~E NO~ PROP~ UNE OF ~E SU~E~ PROP~. ..... ~ L~ ..... ~ ...... J ~L~ ~[ ~ ~___ ~ .... UPPER De~MOUN ROAD 10/5/2000 ~SI~ W~FER & 5~STE~FER CONSULTANTS, INC. · ....... 14 MIKE CRO~ (907) 277-1195 2 OF 3 ASPEN HIGH.NBS S/D; LOT 8, BLOCK 1 DESIGN OF SEPTIC SYSTEM UPGRADE (REACTEX) CONSULTANTS, INC. MIKE CR0~ (907) 227-1195 ~ Or ~ ~'A. s~/ '*~: ~sP[N H~.~.~S S/~ LOT ~, BLOCK * PROFILE OF REACTEX AND UPFLOW FILTER ASPEN HIG"H~DS 11, BLOCK BLOCK 1 $/o C~""EP11C LOT 6. 1 ASPEN BLOCK I B~K1 UPPER ROAD 16 MANOR LOT 14 LOT 13 KIUBERLY I,L~N OR LOT MIKE CROFT __ IC;HLANDS TOPOGRAP DRAWIN{ PHONE (907) 8, BLOCK 1 SCALE: 1"- pa, GE NUMBER: 1 ALASKA WATER & WASTEWATER CONSUI~TANTS, INC. ISOlLLOG - PERCOLATION TESTJ LEOA,. DESCR'PT, ON.' , PE, H,OH OS 'OT 8..LOCK, ....... ........ PERFORMED FOR: MIKE CRAFT DATE PERFORMED: 9/11/2000 ~. ;.... IT[ST .o~[ ~ I %" ............ "~¢~ 2 ML I ' IN ~ P~ ~w ~ OR~'o"=~r= ~oo'~ ~M cc /-~ -~ ............ ~--V' GC OL SC / ' DEPTH TO -- ' GROUNDWATER DATE , ~ ' ' _ D~ 9/14/00 ) UPPER DeARMOUN RO~ D~ 9/26/00 11 DATE RE.lNG CLOCK NET TIME WATER LEVEL NET DROP TIME (MIN~ES) RE. lNG (INCHES) 12 9/14/00 PERC, HOLE W~ PRESO~ED 4+ HOURS PRIOR TO TE~NG 13 1 12:30 -- 2 1:00 30 5 5/8" 3/8' 14 3 1:00 ~ 6' 15 4 1:30 30 5 5/8' 3/8' 5 1:30 ~ 6' 16 6 2:00 30 5 5/8' 3/8' 17 18 19 PERCO~TION ~TE 80 (HIN./INCH) PERC. HO~ DIA. 6 (INCHES) 20 TEST R~ BETWEEN 7.5 FT. ~D 8.0 .FT. COHHE~S: PERFORMED BY~ WATER & W~ATER. I, JEFFR~ A. ~RNESS, CERTI~ ~T ~IS W~ PERFO~[~ IN ACCORDANCE W~H ~ ~ATE ~D MUNIClP~ GUIDEUNES IN EF~ ON DATE: /o DEPTH TO GROUNDWATER DATE DRY 9/11/00 DRY 9/14/oo DRY 9/26/00 ~ IOfi/oo PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated OCT I0 ,200~_ is made between the Municipality of Anc. horj~ge Department of Health and. Human Services (DHHS) and the property owner(s) of This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the DHHS. Property Owner Nan{e ' (Notarize Here) State or bs, a Judicial District On this/~4.( day of ff~O/}tgF' in the year ZOC~, before me. the undersigned notary public, personally appeared: /4~?'/'t96'[~q (~/~e~?' ~F~r~ known to me to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged that he/she/they executed the same for the purposes therein contained. In witness whereof, I bereugto set my hand and I seal. IVfil~ary Publ{c (.~nat~e) . - __ .i m la /4. (Notary's printed name) My commission expires: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVl RONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS 17..4 o I LEGAL DESCRIPTION ' LOCATION DISTANCE TO: ret DISTANCE TO: Manufacturer PHONE 3EDROOMS [--INEW [] UPGRADE IF HOMEMADE: Absorption area Inside length Width Dwelling Material ;ompartments quid depth PERMIT N...Q~ .,~ Liquid cap~"~ty'in gallons DISTANCE TO: No. of lines Top of tile to finish gr~.e line Foundation Total length, Length Width Depth Type of crib Crib diameter Well DISTANCE TO: Depth. j ~ / Building ~oundation DISTANCE TO: lines tile Nearest lot line inches inches ,PERM,T Distance between lines Total effective absorption area I?; PERMIT NO. Crib depth Building foundation Sewer line Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS ' SOIL TEST RATING INSTALLER REMARKS ,/ ~ ff_"~. --/!~-~ .~.,,~.,..~. ' ~ eeeeet o~ oo'// ~e~ e ~eeeeeeeeeee eee o u',~ APPROVED '~i' ~'J~[':~'5;t~'~ 4~' DATE LEGAL 72-013 (Rev. 3/78) MUN I C I F'AL I TY OF ANC~ORAGE DEPARTMENT OF HEAL'TH AND ENVIRONMENTAL PROTECTION 825 L. STREET, ANCHORAGE, AK 99501 ON--S I'T'E SEWER- & WELL PEFtM I T' PERMIT NO: DATE ISSUED: 840662 r~8/05/84 APPLICANT: ADDRESS: CONTACT PHONE: TOM MCGEE 12801 FLORAL LANE ANCHORAGE, AK 99516 .545-0052 LEGAL DESCRIP: SUBDIVISION: ASPEN HIGHLANDS. LOT: 8 BLOCK: 1 SECTION: 25 TOWNSHIP: 12N RANGE: 5W LOT SIZE: 270~0 (SQ. FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options' available to 'you in designing your septic system. Choose the option that best ~its your site. TRENCH BED ~U. DRAIN DEPTH TO PIPE BOTTOM (FT. ) GRAVEL DEPTH (FT. ) TOTAL DEPTH (FT. ) GRAVEL WIDTH (FT. GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS. ) TANK SIZE (GALS) SOIL RATING (SQ. FT. /BR) 4.0 4.0 4.0 2.0 0.5 2.0 6.0' 4.5 6.0 2.5 52.0 5.0 445,0 ** 62.0 250.0 ** 10~.0 75.4 115.7 1,2~0.0 ** 1,250.0 ** 1,250.0 ** 445 550 445 ** GRAVEL LENGTH '> ,75"!FT~::REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT,LEAST TWO COMPARTMENTS I certify that: 1. I am ('amiliar with the're,qui~e, ments For' on-site sewer,~ and wells as set Forth by the MUnicipality oF Anchorage (MOA) and the State oF Alaska. 2. I will install the system in accordance with all MOA co~ and regulations~ and in compliance with the design criteria o~ this pe.omi~. 5. I will adhere to all MOA and ~State of Alaska requi~emen~s~ ~or the set back distances From any existing well, wastewater disposal.system or public sewerage system on this or 'any adjacent or nearby lo~ 4. I understand that this permit is Val'id £.or a maximum~o~. 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN A'N AREA COVERED BY MOA BUILDING CODES, .]'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A 'LICENSED ELECTRICIAN. APPLICANT: TOM MCGEE ISSUED BY ~-- DATE: DEPARTMEN'T OF HE:AL. TH AND ENVIRONMENTAL_ F:'ROTECTI(::)Iq 825 L STI=(EET:, ANCI4ORAGE, AK 9950 ]. 264-472() F'E R PI I T NO: DATE I ..... ~UED. APPL. I CAN]": A D D R E S S: C..)N fAC 1 F'HONE: 8 4.66 ~ 08/()3/8.4 'TOM MCGEE .1.28A1 FLORAl... LANE ANCHORAGE,, Al<: 99516 345-0032 W EL--_' b. L_ IF:-'" E F.~ Ih'~ :E T' I...E'GAI .... DESCRIP: LOT SIZE: MAX BEDROOMS: SLJBDIVISION: ASI='EN 1'41'GHLANDS SECTION: 25 'TOWNSHIP: 12N 27090 (SQ. FT. OR ACRES) 4. L.O'F: 8 E L.O(.,' .... RANGE;: 3W I...isted below are the optic~ns availabl'e to; yc~u in clesigning your sept:Lc system. Choose 'Lhe option that best fits youn site,, D E P"I" H T 0 F:' I F' E B O'T"I" O I'd ( F T. ) GRAVE:'L. DEF']"H (F'T.) ]'OTAL DEP]"F'I (F'T.) GRAVEl_. WIDTH (FT.) GRAVEL. I_I::'I~IG'fH (Fl".) GRAVE]_ VOLUME (CU. YDS. ) TANI< SIZE (GALS) SOIL RATING (SQ. FT./Bt~) *'~' DEPTH TO PIPE BOTTOM < 5.5 Fl-. REQUIRES INSULATION .~'~ DEPTH TO PIPE BOTTOM < 4.() FT. MAY REQLJIRE A LIFT' STATION '~'~ GRAVEL I...EN["3TI~ > 75 F:T. REQLIIRES MUI_'I"IF"LE RLJNS (NO'I" E.']XCEEEDING 75 I::"l". F.'!:ACH) '.~'~ 'T'ANK MUS'I" HAVE AT I_EAST TWO COMPARTMENTS I certify that: ' 1,, I am Familiar with the r'equiremeimts {'mr on-sit, e sewel*s arid Wel].s as set for'tl"~ by the Idunicipality of Anchorage (MOA) arid the State of Alaska,, 2, I will. ins'~a].l the system il; accmrdance with ail MOA c(](:Je~ ~t"~(:l r'egulatimns~ and in complzance with the design cnitenia of this permit. :3, I wil]. adhere t:.c~ all IdOA and State (mr Alasl.::a reqLtir'emGJnts fc}r' the set back distances From any exist:i, ng well, wastewater disposal system Ol" publ:i.c sewerage system c]n this (:m any adjacent mr near'by ].~t.,, 4. I undenstand that this per'mit is valid Fop a maxi~Lt~ of 4 bedrooms and any enlargement will require an adclit, i~nal permit. IF: A I....IF'~T STATION IS INSTALLJED IN AN AREA COVERED BY MOA BUlL. DING CODES:, THEN (1) AN ELECTRICAl_ PERMIT AND INSFEC] ION tdUST BE OBTAII4ED; (2) AS-BLIII_TS WIU_..NOT BE APPROVL:[D WITHOUT P~N ELECTRICAL INSF'ECTION REPORT; APl[) (3) "['HIE E;LECTRICAt. WORK MUST BE DONE BY A L. ICENSE]D IEL. ECTRICIAN. S ]: GNED DATE AF:'F'%ICANT: TOM, MCGEE ISSUED BY DATE PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE SOILS LOG PERCOLATION TEST SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? O P IF YES, AT WHAT ~ E DEPTH? CE - 3816 · .,,,.~ COMMENTS ~E~ Gross Net Depth to Net Reading Date Time Time Water Drop 4 " I~ ,, 57~. , " " PERCOLATION RATE ~)0 ' '(minutes/inch) TESTRUN 5ETWEEN ~ FTAND --/ ' . FT ~ .~(_~ CERTI FI ED BY: DATE: 72-008 (6/79) SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE PERCOLATION TEST SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ENCOUNTERED? O P E IF YES, AT WHAT ~- DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I I~A~/~ g', z~ -. 5" _--. 77_ " 4 :.o ~,o.~r= ! 1 '~"~',~m 40.;. 5~" 7~" / PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: ~T~o ~. .'.'~ ~C.-H-I~. CERTIFIED BY: DATE: 72-008 (6/79) PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4- 7 8 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 SLOPE SITE PLAN ":15 ' 18 19 20 COMMENTS~ EDWARD WAS GROUND WATER ENCOUNTERED? NC) ~ O P E IF YES, AT WHAT ~ DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop 7..... " /z;-~5 Z,'O,,,',, 4-" I" ~ ,, ~ .~ ,, ~,. ....~/,,. LATION RATE ,,'.~ (minutes/inch) TEST RUN BETWEEN FT AND '~ FT CERTIFIED BY: DATE: 72-oo8 (6/79) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a GeophysicolSurveys Orllline Parmll No. LOCATION OF WI[LL (PIcnic camplele either la, lb Or lc.) A.D.L. No. r..,,.~ c..~y ~il~ ~/~2~kI'~ ~W Ilq_ OT.,,W.,, ~,--,~11 I.,t-. ~.~"-~ ~r,F i~fl ,,,.. Ir ,.. ,0~,,.,.,,, ,,,,,, ]~/ ,-./,,. :~J~ ; ~:1~-~- t~../ I~1 Iqg "'"'. '". '0 '-~"'~ ~""" ". Slet/Mll~ 8111: kl.gfh: I0'. STATIC WATER LEVEL~ ~ Above or .. ~'g~J.~o~ '" "'"' ~'" '"'""'--'""' DEPT. OF ENVIIiONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 November 15, 1984 McGee Industries 12801 Floral Lane Anchorage, Alaska 99516 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 MUNICIPALITY OF ANCHORAGF.. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIONJ NOV 2 t¥,x RECEIVED SU BJ E CT: Waiver Horizontal Separation between Absorption Field and Stream Lot 8', Block 1, Aspen Highlands ( 8521-WA-062 ) Dear Mr. McGee: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the absorption field and stream~ to 17 feet on the subject property for a 4 bedroom single family resi- dence only. Si ncerely, Bruce E. Erickson District Engineer BEE/dd cc: Susan Oswald, DEHEP MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 017-013-19 Certificate of On -Site Systems Approval Expiration Date: S 3 z 2. Z Legal description ASPEN HIGHLANDS #1 BLK 1 LT 8 Site address 7435 UPPER DE ARMOUN RD Current property owner(s) McGINNIS JASON & MICHELLE ANN X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory x Tank Age Advisory x Arsenic Advisory Other COSA Approval_June 2022 Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-013-19 Complete legal description ASPEN HIGHLANDS #1; BLOCK 1, LOT 8 Location (site address) 7435 UPPER DE ARMOUN ROAD *ANCHORAGE, AK Current property owner(s) 17f+S 01,j /14 C, C-, I /V IV I o 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 210-902-7368 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 22 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment �i�3�2� Date of Payment COSA # _05C 2� 0 7G� Waiver # COSA Application—June 2022 M COSA Checklist Legal Description: ASPEN HIGHLANDS #1; BLOCK 1, LOT 8 Parcel ID: 017-013-19 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 10/22/84 Total depth 150 ft Cased to 150 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/4/2022 Static water level at beginning of test 116.4 ft Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping * ❑ Required maintenance completed, if AWWTS Comments: *SEE ATTACHED MAINTENANCE D. ABSORPTION FIELD DATA Which system tested (date installed) 12/5-612000 X ALL standpipes present per record drawing Total measured depth from grade 13.8 ft (max) Measured depth to pipe invert from grade 3.75 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Q Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 5+ gpm Water storage tank volume N/A gallons Welsinfected for coliform test? ❑ Yes IN No [� Coliform bacteria is Negative Nitrate I—L.0 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 3/22/23 GEG C. LIFT STATION ❑ Required maintenance completed Age of lift station 22 years Lift station material STEEL Comments: Adequacy test date 4/4/2022 Results Q Pass Fluid depth prior to test Water added *770 gal 38 in New fluid depth 71 in Elapsed time 120 min Final fluid depth 58 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used *58 in Effective depth remaining **38 in Comments/Deficiencies: 'TESTED SOUTH TRENCH ONLY; LIQUID DEPTH ON 4119/22: SOUTH TRENCH = 41"- MIDDLE TRENCH = 1" NORTH TRENCH = 13" **RECOVERY DATA IS FOR SOUTH TRENCH ONLY. LIQUID LEVELS FOR OTHER TRENCHES LISTED ABOVE COSA Checklist—June 2022 0 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' **50'+ Community Sewer Manhole/Cleanout > 100' Di Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' g Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No **50'+ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft R Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑ Yes if No **50'+ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' no Yes if No ft ❑ Yes if No * 1 �'1 ft Yes if No ft Yes if No ft F. ENGINEER'S COMMENTS *WR#000087 **AWWTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No **50'+ ft ❑Q Yes if No ft If tank or field is under driveway comment below NORTH TRENCH RUNS UNDERNEATH SHED ON CINDER BLOCKS. CONDITION OF STEEL STEP TANK AND UPFLOW FILTER IS UNKNOWN. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gayness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gayness Date 31.71 2? 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 systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; 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. COSA Checklist June 2022 ;;W& a .A hTitrate Advisory Certificate of On -Site Systems Approval # OSC231078 Subdivision: Aspen Highlands #1, Block: 1, Lot: 8 A water sample revealed a nitrate concentration of 9.6 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P =O Box 196650 *Anchorage, A4ska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Ma�hng Address P O Box 196650 0,""A16 W 99519 6650 *www muni org Septic 'Wank Advisory Certificate of On -Site Systems Approval # OSC231078 Subdivision: ASPEN HIGHLANDS #1 Block:1, Lot: 8 The septic tank for this property is 2 2 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 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 OV Day of Ploj, of 20,P3 , by and between '5� Z , 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: I. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 735 Upas- J)P located at (legal description) if J 2. Maintenance Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term 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. XK It 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). Owner 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. K6 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 of3 04—Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. _et Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe 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 AWWTS vendor/installer and approved by the Municipality are the governing guidelines 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 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 OWNER: By: ,� (signature) Date: I K15i-o (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 2%"day of larc, , 2023, by V!fiSb. L - Ko+ -z ------------ J. C. WILLME NO- T Notary Public State of Alaska — mission expires: My Commission Expires Mart, 2026 MUNICIPALITY: By: 01/1, �7 —_ (signature) GU 4'1-� S T'O 1^ brint name) Date: 1 / 2 Title: C t V L (rev. 05/18/2018) Page 3 of 3 Gf r!L • Municipality of Anchorage On -Site Water and Wastewater Program =' (907) 343-7904 s A I E T Y Certificate of On -Site Systems Approval Parcel I. D. 017-013-19 1. GENERAL INFORMATION: Expiration Date: Y` 13 ^Z 0'2! -?— Complete ZZ Complete legal description ASPEN HIGHLANDS #1; BLOCK 1, LOT 8 Location (site address) 7435 Upper De Armoun Road *Anchorage Current Property owner(s) Seth Green Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 210-902-7368 Day phone 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. Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -550 Waiver Fee $ _ Date of Payment —(p- 2622- Date of Payment Receipt Number Receipt Number COSA# QY)CZ211 12 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: _ 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: <j In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water, usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DIGNATURE System #1 Approved for q bedrooms System #2 Approved for Disapproved Conditional approval for 4 - bedrooms bedrooms, with the followin of A, � N Via`✓ f� . �= .5��� A. Garne4 �. CE -795? �1.._.o+essic_� #AECC884 QP�\�Y "' J� ON-SITE `9 g WATER AND �§Vu1 3T`=v`rATER z J� PRn .r AM `o t0vt G( ( t -t (ttn �i U -I i/v'P '� 1`�► P 'e (Q$+tG .. �r, A �J//�cNT 4 FR\I\G� ���� �^ I Original Certificate Date: � _2 0 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 Septic System Advisory Arsenic Advisory _ Well Flow Advisory Other i/�- �� (--,wVL �-44��-4_�4 Legal Description: ASPEN HIGHLANDS #1; BLOCK 1, LOT 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10"22'84 Total depth 150 ft Cased to 150 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/4/22 Static water level at beginning of test 116.4 ft Comments C. TANK DATA 2t,t.tZ�27 Age of tank�"s) years Tank type ma erial S.I.,F_p1 � - ` 1 Measured operating fluid level in septic tank '��(zl Z2 ❑ Standpipes/foundation cleanout per record drawing . Date of pumping SEE ATTACHED MAINTENANCE D. ABSORPTION FIELD DATA 3 x DEEP TRENCH v ../3 5-[Q-177 Parcel ID: 017-013-19 Structure served by this system M92 Well production at time of test 5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No ❑ Coliform bacteria is Negative Nitrate 9.32 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 3/23/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 22 years Lift station material STEEL Comments: Which system tested (date installed) 1y ' Adequacy test date 4/4/22 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 13.8 ft (max) Fluid depth prior to test 38 in Measured depth to pipe invert from grade 3.75 ft(min) Water added *770 gal ❑ N/A — pressurized field 71 ❑ Monitor tubes go to bottom of effective. If not, state New depth in depth into effective sed time 120 min Ela p ❑ Code -required soil cover over field Final fluid depth 58 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: 'TESTED SOUTH TRENCH ONLY LIQUID DEPTHS ON 4/19/22: SOUTH TRENCH -41"- MIDDLE TRENCH -l'- NORTH TRENCH -13" 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' El Yes if No Community Sewer Manhole/Cleanout > 100' [Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *84+ ft Holding Tank > 100'[]✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft (I Yes if No ft 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' Manure/Animal Excreta Storage > 100' if No Community Sewer Main > 75' [] Yes if No ft P1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field >.5 - ' 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10'❑ Yes if No *1 ft Wells on. Adjacent Lots: Water Main > 10' Yes if No ft Private Wells>'100' Yes if No ft Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' Z✓ Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *WR#000087 NORTH TRENCH RUNS UNDERNEATH SHED ON CINDER BLOCKS. CONDITION OF STEEL STEP TANK AND UPFLOW FILTER IS UNKNOWN. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review �`> O F of Municipal records that the above systems are in conformance with pO P MOA COSA guidelines in effect on this date.l : • • • i • .Il • / • .... do COSA Checkilst yellow sheet f orness_: C CE -7 3 4�leaPro fesslc> o' #AECC884 &I Ecklund, Timothy J From: Jeff Garness <Jeff@garnessengineering.com> Sent: Thursday, May 12, 2022 10:26 AM To: Ecklund, Timothy J Subject: Aspen Highlands #3, B3, L1 [EXTERNAL EMAIL] Mr. Ecklund, The advanced wastewater treatment system (AWWTS) on the subject lot was installed in December of 2000 and utilized a trickling filter referred to as a "Reactex" filter. During a recent inspection by A+ Home Services it was discovered that the Reactex vessel media was badly fouled. Per Mike Blakeslee, the "Reactex" media is no longer available, and he recommended replacing the "Reactex" trickling filter with an Orenco AX -20 trickling filter (modern Advantex technology). The filter was replaced by Mike Anderson, PE in April 2022. This is believed to be an improvement to the trickling filter system. It is important to note that the existing STEP tank and Upflow filter are steel vessels and have a limited useful life before they succumb to corrosion and leakage. The subject steel vessels are over.21 years -old, so it is reasonable to believe they are approaching the end of their useful life. When the STEP tank needs replacement, it is reasonable to assume that the system will be upgraded to a modern Advantex system and the Upflow filter will be abandoned in place. Please contact me if you have additional questions. Jeffrey A. Garness, P.E., M.S. President Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 Mobile: (907) 244- 9612 Website: https:Hurldefense.com/v3/_http://www.garnessengineering.com_;!!N9vJ2dmNYjWGSw!QmrPdmri42dreDcOTOtH9y GTYXdurvgndcs_dU05EDexa4nkSi0oZbCKg3kOUxYdCl7ryXglxLfBmKvHwujwl2Rv7lHNEuPmGw$ www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSCOSC221192 Subdivision: Aspen Highlands #1 Block 1 Lot 8 Starting at 20 years of age the MOA issues Advisory's for steel septic/STEP tanks The septic tank for this COSA / property is 22 years old A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $12,000 to $17,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221192 Subdivision: Aspen Highlands #1 Block 1 lot 6 _ __ A wader --sample revealed a nitrate concentration of 9.32 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. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can :include. avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. 1vILJN1c7FALITY OF AINCEORAGE - CUMInuniry Development Department: , On-51te Water & Wastewater Program P: 907-3434904 - F: 907-343-7997 - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org Intermittent Dosing Sand Filter -MaintenanGe LogL Owner r, - Street Address 7133 Uoper . ba q orx Phone_ IJNE— _ Legal Desc. Tank: Z10 gog . PID Septic -Sludge level inches -Pumping: required es no -Pumping completed yes n Absorption Field: I *Liquid level -Flushing valves per approved designyes n .All flushing valves opened, distribution lines flushed, and flushing valves closed.. ygs no Lift station: -Pump basket.cleaned a no -Biotube effluent filter cleaned es no -Timer float setting 1 YI inches -High level float setting j inches -Reference pointTop A ""S e t- -Pump on__6A_seconds -Pump off­�—S—minutes -Cumulative lifetime cycles2D X26 -Cumulative run time _ 3 ,�. 7t hours -Operation satisfactory e no Air System: pa-tl -Air pump filter cleaned yes no -Air pressure _psi -Date of latest install or rebuild -Air system operation satisfactory not satisfactory Alarm Smem: *De . dicated electrical circuit (es no •-Audible and visual alarm inside dwelling rve�s) no -Floatsetting I inches -Alarm system operation Oatlsfactory not satisfactory Comments: ....................... I .................. I ................... ..................................................................................................... 11 ......... ......................................... ...................................... I ............................................................ ........................................... ........................................................................ ...... ................... .............................. ............................... I ............ I ............................ ...' .............................. I ..... I ...... I ................... I ..... I ....... I., ..... ... ......... I ..................... I ...... I .............................. I .................. ................................... I ........................... Maintenance Provide Technician Date of maintenance_l Company 00'e�'t4arvl& 5 -1r - Signature Datel(�- 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 _ Day of 1ya,'e A of 20 Z Z , by and between 72san ? ffic he / /,--, A6; na. S7 , 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 (AWW'IS) - described as Q.SkP,tA1Ak located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term 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. It 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). Owner 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. t Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfreld replacement. (rev. 05/18/2018) Page I of 3 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 AWWTS 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 AWWTS vendor/installer and approved by the Municipality are the governing guidelines 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 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 O WNE, R: B � 1(signature) J� tI 'Ag _ (print name) C�)Anis STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT Date: �i �2oZ2 The foregoing instrument was acknowledged before me this; • f. ` day of 17 -7 y —NOTARYPUBLIC FOR ALASKA NOTARY PUBLIC.. My Commission expires: ;t%?.� i,.:% %=; NICOLE MANDEL STATE OF ALASI(A MY COMMISSION EXPIRES NOV. 26, 2024 MUNICIPALITY: j�— y: (signature) print name) (rev. 05/18/2018) Date: Title: Page 3 of 3 ? 89 • u�6 G� 4847 Municipality of Anchorage ti , • ;,R On-Site Water and Wastewater Program (907) 343-7904 a NOV s3,a` ii Certificate of On-Site Systems Approval yol 9 h� 6 8 Parcel I.D. 017-013-19 Expiration Date: Eb a i O 1 9 1. GENERAL INFORMATION: Complete legal description ASPEN HIGHLANDS#1; BLOCK 1, LOT 8 Location (site address) 7435 Upper DeArmoun Rd. *Anchorage,AK 99516 Current Property owner(s) Eric&Amy Schwalber Day phone 223-6451 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Aft Date: 14V_Zg_ COSA to be released to thei ,,-er, unless otherwise requested by the engineer. COSA Fee $ 52( Waiver Fee $ Date of Payment 1013/1i3 Date of Payment Receipt Number 06157 Receipt Number COSA# 65C('81561y Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: I I J q J i ca 000ro�pO In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o`Q Q r , 4.'04 in accordance with the guidelines and regulations established by the Municipality of Anchorage and g�C�.••.•.. ••.."4:16.N- c j industry practices. The reported results describe the condition of the system/s on the date/s of the O P.•' 4 •... -DA evaluation. Separation distances were measured to readily identifiable features. Hidden defects or , v encroachments may exist that were not identified during the evaluation. The operational life of all wells / ;. 419 Ti /. �7 VQ and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 Q groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and /.... • • ••• are outside the control of GEG. Satisfactory test results do not guarantee future performance of the f • J- .•e '. Gor ess.• q system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of QQlg CE . . ,; the well or septic system. GEG makes no representation whether an alternative well or septic system Q •s,, f .•. (PG' can be installed on the property in the event either of the current systems fail to perform adequately in 44 e, , !.t• Ct °Ap the future. The content of this report is for the sole benefit of the person/party that retained GEG to �04 pro f ess o�°oma perform the evaluation. Reliance upon the information provided in this report by any other person or ,OODppoo party (including subsequent property purchasers) is not authorized, nor will it confer any legal rig:: t l.ir=,., whatsoever. J=G\ Vr'}�; #AECC884 s ON-SITE �y 6. DSD SIGNATURE WATERAND m System #1 Approved for 7 bedrooms T ASTEWATER C System #2 Approved for bedrooms p PROGRAM c� Disapproved ,t/TSER\ItC.C Conditional approval for bedrooms, with the following stipulations: a , /�OV �?7 nu tc By: Original Certificate Date: , The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist x Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.eoc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: ASPEN HIGHLANDS#1; BLOCK 1, LOT 8 Parcel ID: 017-013-19 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/22/84 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 150 ft. Cased to 150 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/22/84 10/1/18 Static water level 128 ft. 124 ft. Well production 6 g.p.m. 4.8+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate 9.37 mg./L. Collected by: GEG, Ltd. Arsenic: <5.0 ug./L. Date of sample: 10/1/18 B. SEPTIC/HOLDING TANK DATA * fldvc, Te. u.P-c\ow c;1-‘e.4-..... per GAG Tank Type/Material S.T.E.P./STEEL Date installed 12/19/00 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping - Pumper MAINTENANCE WITH A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE AT MONITORING TUBE Date installed 12/5-6/00 Soil rating (kp.d./ r ft2/bdrm) 0.5 System type DEEP TRENCH Length 3 x 25= 75 ft. Width 2.5 ft. Gravel below pipe 8.0 ft. Total depth *12+ ft. Eft absorption area 1200 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 10/1/18 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 900 gal. New depth 42 in. Elapsed Time: 120 min. Final fluid depth 25 in. Absorption rate>= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NO If yes, give date - -TESTED MIDDLE TRENCH ONLY -HOUSE WAS VACATED ON 9/1/18 -ALL MONITORING TUBES DRY ON 11/8/18 *SEE ATTACHED 2018 MAINTENANCE LOG PERFORMED BY A+ HOME SERVICES **2ND COMPARTMENT OF 1500 GALLON S.T.E.P.TANK D. LIFT STATION Date installed 12/19/00 Size in gallons **500 Manhole/Access (Y/N) YES "Pump on" level at * in. "Pump off' level at * in. High water alarm level at * in. Datum * Cycles tested * Meets alarm & circuit requirements? * E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 50'+ On adjacent lots 100'+ Absorption field on lot 50+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 50'+ Wells on adjacent lots 50'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *1' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 50'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 50'+ F. COMMENTS *WR#000087 G0,,40Ln0,1 oK S te- � TA- k uPPL.0 ) F►1.-74€2- 1 c - €2-1c Ue.11G�bwNI . lokilxitit OF i 144 1 G. ENGINEER'S CERTIFICATION 4,41"<c>.2.\> /' •:95,•1k : •. 1►-,; 4'.. I certify that/have determined through field inspections and ... ., ,.,.9;'' review of Municipal records that the above systems are in i ... conformance with MOA COSA guidelines in effect on this • . • •• •., ••;=• '. date. o crl . J- f.e, A. Games = JEFFREY A.GARNESS I•-d, ' E-79 . . =: Engineer's Printed Name •♦<<�•.•..• 11 I ct ..P.'<'': Date 11 1 Ji .�4.%)FESSOA.:'• LICENSE ,I , ,ik' #AECC884 (Rev.10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT f r 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181594 Subdivision: Aspen Highlands #1, Block: 1, Lot: 8 A water sample revealed a nitrate concentration of 9.37 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org W,L.N.•EI:I S 89051'50"E 164.23' 4 10'UTILITY FA$FI/FII' II • H2O :• SA • U , .i • if • • • OwEll J OFGK A r • • • -.1• :4 I O o j•• WF, v,Au is SIFI SLE FAMILY RI J O I rHAME HOUSE R1u� O CO ' L () r LIFT STATIY. • JO,D• - 6- 1 - CZ{ _ _ 50.2 UJ O •:1 I 0 O i.• D£c" • N w O 0 n: O °O n.... O Z f-Sr-Z4 11 (A :1 I 1, ii. g j� �' pgwwAy F • I IN P' , I I r 4 • N 89°51'50"W 164.13' 0000000 4,,,....\;-.•<<G.OF q•xioN ,�►, UPPER DEARMOUN ROAD off: 49 T" °° °o v S .�, /� o O• %/i/ SHANE A.HOLT .• :XI I Op4P • LS-6914 . •.. J,� 140' D/essional apo AS-BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 8, BLOCK 1, ASPEN HIGHLANDS NO. 1 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN EXIST OTHER THAN NOTED. HEREON C UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS S TH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE SEPTEMBER , 2018 PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYIN MUNICIPALITYF ANCHORAGE :velopment Services Department Phone: 907-3,,.3 7 904 i-Site Water &Wastewater Section Fax: 907-347. 7997 .-Perq ...1 Vied S ' ' ft Station/rump Vault Maintenance Log tvner3,4n .4,__ I-1 r Street Address_.. 14W- tipp-e- -.C. o,, i _.. Ione_.. Legal Desc.. PID dudge level _,_e<rches 'Pumping: required yes -Pumping completed "... _f:.4 yes(:)25 ft station: 2- 'Limp basket cleaned a. I I . •Effluent filter cleaned es no. ;;onto! floats cleaned e etc -Proper float settings confirmed , )peration satisfactory 02 n ,arm System: 7edicated electrical alarm circuit ( ,Jag -Audible and visual alarm inside dwellin YE: ? —_ -71 J.iarm system operation t� er around water intrusion at riser to tank connection y !o rot.nd water intrusion around pipe penetrations yesre -Weep hole functional 0 nn Manhole lid: Functihna( Insulated Cres—\n0_ Properly Secured ka )tizet All manufacturer required inspections and maintenance completed y S DQ ;omments: Vi watia. a •.y. jt ytenance Provjdera �' - , . -- Technician s r` _ S Date of m« • .: ance .Sep )g Company _. \t3zp_Inyne cre Signature l Date 6,S - J . . . . . • - . :. . 1 .. .• 0, nchora a la,Alaska 99519-6650 ` www.muni.orq 1 Municipality Anchorage Development Sergices Department Building Safety DNIston On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343.7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017'013-19 1. GENERAL INFORMATION Expiration Date: CompletalegaldescriptJon ASPEN HIGHLANDS SUBDN1SION #1; LOT 8, BLOCK 1, Location (site addrass or directions) 7435 UPPER DEARMOUN ROAD ANCHORAGE, AK 99516 Cu~Tent Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address . MR. &: MRS. SCHWALBER Dayphone 552-1479 7435 UPPER DEARMOUN ROAD ANCHORAGE~ AK 99516 Dayphone CLAIR RAMSEY w/ DYNAMIC PROPERTIES Day phone 3111 "C" S~RE~ ANCHORAGE~ AK 99503 261-7552 Unless olherwfse requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: !ndivldual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Indivldual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professtonal civil engineer registered In the State of AJas~a. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for proper'des served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (CertJf~catos may be reissued for a per~od of up to one year with valid water samples.) Certificates are valid for one year for prope~es served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vadfy that my Investigation, based on procedures outlined In the Health Authorf~y Api:rovel Guidelines for this application, shows that the on-site water suppO/ and/or wastewater disposal ~Tstem is(am) safe, functional and adequate for the number'of bedrooms and ~:e of structure indicated herein. I further varify that based on the information obtained from the Munidpali~y of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewatar disposal system Is(are) in compliance wfth all applicable Municipal and State codes, ordinances, and r~julations in effect at the time of lnstallation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD. SUiTE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. OARNESS. P.E. Date 337-6179 Engineer's Comments: In conducting this eva/ua~fun, AIMWC, Inc. attempted to provfde a th~reugh, consclenff~ds engineering analysis of the system In accordance with ADEC and MOA DSD Guldelines & R~julations. Tho reported results descnT~ed the ped~rnance of the system under the condi~iuns encountered at the t~'mo of the teat, and separe~fon distances measured to readily Identifiable features. The operational life of all wa/is and septic systems depend on ~he Iocal soils condition, groundwater levels that may fluctuate during the year, and the water usage of the famity being sen/ed by the system. These conditiuns are outside the control of the evaluator of the system. Sa~factory test results do not guarantee future pedormance of the system, nor do they guarentee t~at there are no hidden def~cfs or encreachmenis. AWWC. Inc. can therefore not provide any warranty or future esttmate of how long the system ~II eantinue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of tho owner listed aJxwe. Any re/lance upon or use of this report by any other peraon or party is not authorlzed, nor vdll lt confor any legal dght wha~:;;~wer. 5. DSD SIGNATURE Approved for /-/L. bedrooms. Disapproved. Conditional approval for .dtl{( ¢l(((fF. fr~' .' . ~.', %x., '."0 ~ .. ON-S TE WATER AND = ; WASTEWATER . · bedrooms, with the fllowIng aUpulaU ~<'i~, ,.. .,, ~.~.~ Attachments: HAA Checidist Septic System Advisory Well Flow Advisory ManItenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Sou~h 8ragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 A. WELL DATA Well type ~,mv^'rz If A. B, or C provide PW~ID~ N/A Date completed 10/22/84 ~an]tep/~ (Y/N) YES Tot~depth 150 lt. Castro 15o ~ FROM WELL LOG Date of test 10/22/54 Static water level 128 .ft. Wel~ production 6 g.p.m. WATER SAMPLE RESULTS: Colifon~ 0 colonles/100mi. Nitrate 2.47 mgJL. Olherbecterla__ Date of ~ample: 2/15/O1 Collected b~. AWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tenkelze 1500 gal. Number of Compartments 2 Foundation deanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper D, ABSORPTION FIELD DATA Length75' (5 e 25'~ ~ 2.5 Toteldeplh o!3-1¢.?ft. Eff. e___t~, onareal200 fl= Monltedngtube YES Date of adequacy test NEW Results (Pas~/FalI) - Fluid deplh In eb~ field before test - In. Water added - gal. Elapsed Time: - min. Final auld deplh - In. Abeorpl~on rate Any rejuvenation trealment (past 12 mo.) (Y/N & l~fpe) NONE KNOWN HEALTH AUTHORITY APPROVAL CHECKLIST ASPEN HIGHLANDS S/D ~1; LOT 8, BLOCK 1~ ParcellD: 017-015-19 wee Log (Y/N) W~res propee/protected Casing height (above ground) AT INSPECTION m/29/2ooo 5.5 g.pJn. O .colonies/100 mi. System type TRENCH Gravel below pipe 8.0 ft. Depression over aeld NO For 4 bedrooms ,g.p.d. New give date 18+ In, Date Installed 12/11/2000 C~eanoute (Y/N) YES Hlgh water alarm (Y/N) N/A D. UFT STATION Date installed 12/7/2ooo 'Pump on' level atTIMER In. Datum BOTTOM OF TANK E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size In gallons 1500 'Pump off' level a~Mlmln. Cycles tested N~ Sel~C lankllllt 6;aGon on lot 100'+ A__l'~O_.~ptin tild on lot *89' Publlo sewer maln N/A Sewer/septic eewlce line 25'+ High water alarm level et 46' In. Meete alarm & circuR mqutremonte? YES *WANERS GRANTED On ad, cent Ints lOO'+ On adjacent lots *84' Public sewer manhole/cteanont Holding lank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Abeorptin lield 8uliding foundation 5'+ Propen'y line 5% Water main N/A Water .endce line 10'+ Wells on adjacent Iote 100'+ SEPARATION OISTANCE FROM ABSORPTION FIELD ON LOT TO: Buliding foondatin 10'+ Surface water 1 oo'+ Wells on adjacent lots. 100°+ Water se~dce Ine 1 o'+ CurtaIn drain NONE KNOWN F. COMMENT8 100'+ Water main N/A Odveway, paddng/Vehlcle~orage 50'+ G. ENGINEER'S CERTIFICATION I cerffry that I have determined through field ~ end review of Municipal records that {fie above sj~ems are In '"*' conformance with MOA HAA guldeflnes In effect on this date, .././.., Date Date of Payment Receipt Number (Rev. Waiver Fee $ Date of Payment Receipt Number .~I0-02-00 18:11 FROI/,-CTE EXVII~flI[NTAL 5515301 T-887 P.0Z/02 F-576 CT&E Environmental Services Inc. Laboratory Division w~m'~w~m'~m.~mM~w~l~m'm'm.m~w~.m,m~wm.m.~~m~ 200 W. Potter Drive rinking Water Analysis Report for Total Colifot'm Bacteria Tel: (9071 682-2343 ~ INSTRf./CTION$ ON ~F. YER.$E SIDE BEFORE COllECtING SAMPLE Fax: ~9071661.630~ MUST BE COMPLETED BY WATER SUflSLIER. 13 PUBLIC WATER SYSTEM I.D. # IIIIIII ~ PRIVATE WATER SYSTEM · $~n~ In~ SAMPLE DATE: TO BE COMPLETED BY LABORATORY, '~is shows this Wat~t SAMPLE to be:. aris factor/ 13 Unsatisfactory Sample ave 30 hour~ old, results may be unreliable O Sample mo Io~$ in transit; sample should not be'ove~D~oun old at examination to indicate reliable results. Pleue new sample v~a special de~/~ L . T,.. '?-O ^na~,l. ,~.. ~'.~ / Analytical Methed: I~/Membmne Fil~er O MMO-MUO · Number of colonies/lO0 mi. ~ Re, nit· Analyst SAMPLE TYPE: ~1~ Routine O Repeat -Rample {for ruuflne sample Untreated Water with lab ref. ne. · } 0 Special Purpose Time Collected SAMPLE LOCATION Collecml l~y Anck Irok~ Jun [] Due: Time: Client notified of unsntbfaetory rtnults: Phoaed Spnke y~th Fazed Da~ Time: -- BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Resell: Total Co~etm jr Membrane rfitm DIn~t Couat Colonies/lO0 nd Verification: LTB BOB i ' COLIFIRM Feell Coliform Conflrmsfiea CollrorJn/IO0 ~ d~~ Idembir of mi SOlS ~rouo tSocllti Ginlma de Sun~l~inco) ENVIRONMENTAL FACIL~IES IN ALASICA, CALIFORNIA. FLORIDA. ILUNOIS..MARYLAND. MICHIGAN. MISSOURL NEW JERSEY. OHIO. INE$? · 5615301 T-887 P.01/02 F-575 18:11 F~U-CTE ENVII~ONI, ENTIL ~I~K c'r&E Environmental Services Inc. CT&E Re£# 1005S21001 Client PO# Client Name AK Water & Wasiewater Consultants Inc. Printed DatetTime 10/02/2000 17:03 Project Name,W Aspen Highlands #1 L$ BI Collected Date~rl~lme 09]26/2000 16:00 CllentSamplelD Asp~nltighl~n~#1LgBl RecelvedDate/Tfme 09]26]2000 16:30 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By Sample Remarks: Parameter Rcsul~ l~[trate-N 2.70 Allowabl~ Prep Analysis PQL Units Method Limits Dam Date Init 0.500 mg/L EPA 300.0 ] 0 max 09t27/00 '~CL TomlColi~rm col/I OOmL SMI8 9222B 09~00 JDT MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) L~-~ ~, 1~ ~-- ~ A ~. ~ .H Z~ 'L~ Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution t~,~m~d.~/~/~ ~'~-~, Mailing Address (d) Real Estate Company and Agent // r~, L-~, F~ F_.. ~. ' Telephone '(home) Business Telephone Address (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: / 2. TYPE OF RESIDENCE .~ Single-Family~ Number of bedrooms_.~.__~ 3. WATER SUPPLY Individual Well~/ C~mmunity ~ Public [] I. Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ Public [] . Community [] Holding Tank [] . Note: If/r 'community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. ~ 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as Of the validation date shown below, I verify that my investigatio,~ of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Engineer's Seal 6. DHHS APPROVAL Approved for --~ bedrooms by Approved /~,,. Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 (Rev. 7/88) Back Page 2 of 2 .~,,Lg"~['~'~_:.:?'MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (NAA) CHECKLIST - FEBRUARY 1984 343-4744 A. WELL DATA Well Classification Well Log Present (Y/N) Y Total Depth /.5-0 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 J J L3 -- To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Date Completed "/5--/--~' /'~ Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At /~ c~ 7- Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ I g) '?~- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole r'//A ;Date /X~o/ Comments B. SEPTIC/HOLDING ]'ANK DATA Date Installed ~r~F Size /~)-,,J-~,) Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) 1'"--~ Pumping/Maintenance Contact on File (Y/N) 'r'-/'//~_.~ Holding Tank High-Water Alarm (Y/N) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well I ! ~ '~ To Building Foundation To Property Line L//~ ~ To Disposal Field To Water Main/Service Line T"/'//~.~ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption yStrata Date Installed Width of Field Type of System Design Length of Field '-~O -f- ,~ Depth of Field /c~ Gravel Bed Thickness Square Feet of Absortion Area / ~¢~-'-t'~ Statndpipes Present (Y/N) . ~',,/ d ,Date °f..~Last Adequacy Test ~ ~! Depression over Field (Y/N) O Results of Last Adequacy Test ~ ~ ¢. 7zL,, ¢' SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / / 0 ..G-- To Property Line To Building Foundation ~rO '-- To Existing or Abandoned System on Lot /'"/~/h/~ ;On Adjoining Lots To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 Company Date MOA No. Receipt No. c~(~ (~-~¢--? (.. /--~/¢ ,] Date of Payment / '~//"--b~,7 Amount: $ /,~)~ ~2 (-,) Waiver Fee: $ Engineer's Seal Date of Payment 72-026 (Rev, 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal D. escription (include lot, block, subdivision, section, to_wnship, range) Location (address o~ directions) - BusinesF (b) Applicants Name 'To~. ~C~-~ Telephone Home~-~-~-~ Applicants Address (c) Applicant is (check one) Lending Institution ~--~ ; Owner/builder~ ; Buyer ~--~ ; Other F-q (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address ~ / Telephone  .M~ the HAA to the following. ~)d~ess/~._r O '" 2. Type of Residence Single-Family ~ Multi-Family ~-~ Other (describe) Number of Bedrooms 3. 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. &. Sewa;e Dis, p.osal ,~ Onsite~ Public ~ Community ~--~ Holding Tank ~--~ Note: If community well system, must have written confirmation from the Department of Environmental Conservation attesting to the legality and [I~,$e 1 of 2] Sta=e status. 5. En~ineerin~ 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 regula- tions in effect on the date of this inspection. Name of Firm ~--~-~ b-4 t ~ Telephone P 'i:,t.,', CE-o816 o .~;z.. DHEP Approval (~,,:~, ,,., o..O ..,~,~, ~ ~o~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON ~HE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 Well Classification ~-4%/~ .,, w~n Log P=e~nt Total Depth Static Water ~1 Casing ~ight ~ Gr~nd Elec~ical Wiring in ~n~it ~p~ation Distan~s To ~9tic~oldi~ Ta~ ~ ~t MUNICIPALITY OF ANCHORACE DEPT. OF HEALTH & 5NVIRONMENTAL PECTECT[OFI ~u~czP~I~ OF ~C~O~ H~T~ ~O~ ~V~ (~) NOV 5 ~84 - R EC E IV E D Legal Description: ~~ ~ % Zf A, S, ~ C, D.E.C. ~o~(Y~) ~-- Sanit~y ~al on ~sing (Y~)'~ (y~) ~ ,, ~essi~ ~nd ~l~ead (Y~) ~,Q I ~ O' ; On Adjoining I~ts I,C~,,~D4-- To Nearest Edge of Absorption Field on Lot I ~ ~' ; On Adjoining Lots To Nearest PUblic Sewer Line %d/]~ To Nearest PUblic Sewe,~ Cleancut/Manhole., .k~.--/4~'-. To Nearest Se~s~ Service Line on Lot Water Sample Collected By ~ ~v% ~ S~.; Date ~-,/~' ~ ~ Water Sample Test B~sults S6Tk~K-~-Y ....... Cc~m~nts ...... B. S,EPTIC/HOLDING TANK II~TA Date Installed ~,/~/,~_ Size .,,IZZ~-~D No. cf Compartments ~ Standpipes (Y/N)' .~ Air-tight Caps (Y/N,,),,~'~ Foundation C~anout (Y/N)?~ ,,, Depression over Tank (Y/N) ~O Date Last Pumpeb ~.~/~. ~.1~--v~) , Pumping~intenance Contract on File (Y/N) ~.3 _. for '-- -- , ......... Holding Tank High-Water Alaz~n (Y_/N)----"-- Temporaz~y Holding Tank Permit (Y/N)--'-- ..... Separation Distances f=cm Septic/Holding Tank: To Water-Supply Wsll. % [O' To Building Foundation 4~/ To Property Line _'~ ! '~~ To .Disposal Field I~ z 2-15-84 C. ABSORPTION FIELD E~TA Soils Rating in Absorption Type of System Design Date Installed Length of Field Width 'of Field ~t, Squa=e Feet of Absc~ption A=ea Depth of Field (O Gravel Bed Thickness /~ ~5/Standpipes P=esent Depression ove~ Field (Y/N) ~O .. Date of Last Adequacy Test Results of Last Adequacy Test ~/~ Separation Distanus f~cm Absc=ption Field: To Building Foundation '%~ To Existing To St=e~ond~ke/= ~jo= ~aina~ ~ To ~i~way, P~ki~ ~ea, ~ Vehicle St=a~ ~a D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at / Dimensions ;"Pump Off" Level ,.at Ven~" (Y/N) /' High Water' Alarm Level at Tested fo~ - Electrical Codes (Y/N) Ccall~nts M~ets MOA ** Check Pemnitted Bed=oGre Rating Against HAA Request ** I ce=tify that I have~, verified, c~ confcz~med to all MOA .HAA Guidelines in effect - signed Date {/ '- ~% .~' ...... .' '.~_ m %%. ~~~ MOA No. . C~any KB1/d5/s 2-15-84