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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 13 LT 5 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 'I of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221441 PID Number: 017-391-53 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New W Upgrade Name pg MUNK ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 13015 APLINE DR, ANCH ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot MOUNTAIN PARK EST BLK 13, LOT 5 Ft Ft. Fill added above original grade Gravel length Township Range Section Fl. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft Ft To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well 100'-1- 50'+, TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ GREER TANK 1250 Gal. Material Number of compartments Lot Line *5'+ NA PLASTIC 2 Foundation 101..E LIFT STATION Manufacturer Capacity Remarks * LOT LINE WAIVER Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield MIKE N ANDERSON, P.E. Drainfield CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection ates: 1,1 10/26/22 2-d10/26/22 Location and description 3rd 4th TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date p- '`�� .•' A •: s= ' ; ,�.• - •'� 00, 49TH ?t • MICHAEL N. ANDERSCN ;?' 11.0 Septic System - �' �r •. c - 9469 ,•.. - - Approved�� " •. Date Note: this approval oes not include well permit requirements. B) (Rev 05/02/1 Permit No. OSP221441 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MOUNTAIN PARK EST BLK 13 LT 5 MARK A B c01 13 8 CO2 10 17 TC01 22 33 TCO2 27 39 CO3 28 40 C04 28 41 8.5' SEPARATION LOG CRIB AND N TANK PID No.: 017-391-53 OLD TANK PUMPED AND FILLED W/ PEA GRAVEL\\ NEW 1250 GALLON PLASTIC TANK \` I MOA WAIVER OF 0' FROM PROPEF TY UNE I I _ I ® WELL I _ I 01 I / I L a 04 \ CO2 / CO3?1 \ \ \ BENCH, TOP OF MH i EXISTING 8X8 CRIB \ \ ASBUILT \� WELL SCALE: 1"=50' I ( I TCOi C C04 TW2OF ® ; 49 TH G, ., TIlllC =ME0� ;MICHAEL N. ANDERSON:. J No. CE 9469 '' ® N.T.S.SEM SMON 0 ESS i i / / PID No.: 017-391-53 OLD TANK PUMPED AND FILLED W/ PEA GRAVEL\\ NEW 1250 GALLON PLASTIC TANK \` I MOA WAIVER OF 0' FROM PROPEF TY UNE I I _ I ® WELL I _ I 01 I / I L a 04 \ CO2 / CO3?1 \ \ \ BENCH, TOP OF MH i EXISTING 8X8 CRIB \ \ ASBUILT \� WELL SCALE: 1"=50' I ( I TCOi C C04 TW2OF ® ; 49 TH G, ., TIlllC =ME0� ;MICHAEL N. ANDERSON:. J No. CE 9469 '' ® N.T.S.SEM SMON 0 ESS Sqz J, , 3 e --__�- �/� — � \ \ } 0 LL } MUNICIPALITY OF ANCHORAGE ,C„t On -Site Water & Wastewater Program °� Is, PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 ^ .• �' http://www.muni.org/onsite V Department On -Site Wastewater Disposal System Permit Permit Number: OSP221441 Effective Date: 10/25/2022 Work Type: SepticTank Initial Expiration Date: 10/25/2023 Tax Code Number: 01739153000 Site Legal Address: MOUNTAIN PARK ESTATES BLK 13 LT 5 G:2838 Site Mailing Address: 13015 ALPINE DR, Anchorage Owner: MUNK WERNER R LIVING TRUST Lot Size in Sq Ft: 22236 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The'wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Locate the edge of the field prior to installation to confirm that the 5' separation between the tank and field will be met. I I Received By: Date: Issued By Date: jo Z s Z Municipality of Anchorage .. P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221073 COSA#: Permit#:OSP221441 PID#: 017-391-53 Legal Description: MOUNTAIN PARK ESTATES BILK 13 LT 5 Engineer: Garness Engineering Group Your request for a waiver of the required 10 feet horizontal separation from the septic tank to the property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: Zs ZZ Approved by:k� Name of Reviewer **** VARIANCE/WAIVER REVIEW **** RAUMUPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-391-53 Property owner(s) ERIC MUNK Day phone 907-486-5293 Mailing address 13015 ALPINE DRIVE *ANCHORAGE, AK Site address 13015 ALPINE DRIVE *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES; BLOCK 13, LOT 5 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial 0 Upgrade ❑ Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: SEPTIC TANK TO LOT LINE TYPE OF DWELLING: Single Family (SF) El (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 0 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: f , ")_ �5 Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: l ()hZL%1,7,2, Receipt Number: 0 Z232�� Waiver No. 63V -2a/615 GADevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221441, Deb Wockenfuss, 10/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221441, Deb Wockenfuss, 10/25/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221441, Deb Wockenfuss, 10/25/22 S 00000'33" W 109.00' EO EO EO EO EO EO EO EO EO EO EO OVERHEAD UTILITY LINE _10' UTILITY EASEMENT SHED LOT 5 22,244 sq. ft. UTILITY POLE EO EO EO EO (V Lo A 109.79'REBAR M R1130.00' 0 M —ALPINE DRIVE – – �i ,*:'49 LH ............ . , .. . 0 15' 30' i �G� Buku Sal z �o �i �s ••. LS -14837 •� �`"_= ��rr�4� 8 22 2022. • 43_ EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (P-501) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. JOB #JOB # 221911NO CORNERS SET THIS DATEISCALE 1" = 3000RNERS SET THIS DATEISCALE 1" = 30' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 5, BLOCK 13, MOUNTAIN PARK ESTATES SUBDIVISION ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 22nd DAY OF AUGUST, 2022, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services 907.290.8949 225 W 23rd Ave., Anchorage, AK 99503 WWW. FIXED HEIGHT. COM ORX X -X' FENCE X� X WELL \f x I � / I /} \ f J \1_Xx� I 00 0')�0 I � LOT 4 w ICV CO <u� LOT 6 O Lr) CO 2 -STORY 31.9' I o FRAME C, I00 23.3' HOUSE i Z 00 I DECK \x DIRT - DRIVEWAY :: - SEPTIC STANDPIPES (V Lo A 109.79'REBAR M R1130.00' 0 M —ALPINE DRIVE – – �i ,*:'49 LH ............ . , .. . 0 15' 30' i �G� Buku Sal z �o �i �s ••. LS -14837 •� �`"_= ��rr�4� 8 22 2022. • 43_ EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (P-501) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. JOB #JOB # 221911NO CORNERS SET THIS DATEISCALE 1" = 3000RNERS SET THIS DATEISCALE 1" = 30' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 5, BLOCK 13, MOUNTAIN PARK ESTATES SUBDIVISION ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 22nd DAY OF AUGUST, 2022, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services 907.290.8949 225 W 23rd Ave., Anchorage, AK 99503 WWW. FIXED HEIGHT. COM Feb 1.3 19 10:56a Anchorag= VVe11 & PunTp Ser 9079_430742. p. 7 Development Services 0apartment Bui9d% safety Division Cin -Site. Water A Wastewater Program 4700 Emare Rood P.C, Box 195650 s ,trark6agleh Anchorace AK ;995 ' ° F T Y �''� �layor •.vow-w.�ru�;.ero/o�sir� (907)@3'E3 -7>04 Pump Installation Log Well Drilling Pi;rmit Number: SW Date Of Issue: Parcel ideatification Number: Legal Description — Pr-oper-ty Owner Name & Address: %101 ficin �� ��aS 613 Pustzit Installaticru Bate:: PulTip Intake Depth Below'rep of Well Casing: Z7,(" eet Primp NIan ufa cuirer It :Vance: Pump Model: Pump Size � lip Pitless Adaptcr Burial Depth: ('-" reet Pitless Adapter Nlanufacturer's ante: V'i Lei s/, y, Pitless Adapter Installer. WeR .Disinfected Upon Com letion?="-Yes No Method of Disinfection: Comments: Pump installer Name: Attentions: The ru.np installer shall pravrCe a Pal -up 'installation log to the DSD within 30 days o, pump instal:atio-r. GPr, A, TER ANCHORAGE AREA BORO~;.~H f ~ HEALTH DEPARTMENT '~ 327 EAGLE ST. ANCHORAGE. ALASKA 9950! 279-251! INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MAILING ~'~° --- ~------~, PHONE ADDRESS~,,'-~- DISTANCE FROM WELL ~'4P LIQUID CAPACITY /~'~%~'~ GALLONS. ~~__~ ~ NUMBER OF MATERIAL_ COMPARTMEN~.S LIQUID ~___ INSIDE LENGTH ' INSIDE WIDTH. ~ _DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIA, ~/~'-.~~-~ NEAREST LOT LINE ,,~ OUTSIDE DIAMETER OR WIDTH/,'~'.~ ~-,~' ", LENGTH_ ,~ /, DEPTH DISTANCE FROM WELL /'O~ ~'~'~,.~.~'_~,., BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA ~ALL AREA) ~/~ ~ SQ. F~. TILE DRAIN FIELD: AB~..T4ON AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~- · ~DEPTH OF FILTER MATERIAL BENEATH TILE "- ~ -" ' ~ -~ ! DISTANCE WELL: TY DEPTH ... ~ . BUILDING FOUNDATION. SAMPLE ~ NEAREST SEPTIC _ SEEPAGE __ ." LOT LINE , SEWER LINE ~ TANK. , SYSTEM , CESSPOOl TOTAL LENGTH OF LINES. ., IN. TOTAL EFFECTIVE IN. ABOVE TILF NEAREST OTHER ~ SOURCES DISTANCES: DIAGRAM OF SYSTEM .~,~;.,~,~ , ............... ~ ;, -. ' ~ ' I' - - ' : · ~ : : .............. :" ; .... 7 ............ ~ '. ' '- : ~ ' ~:: ........ ~.- .' ......... ....... :..::.:-:..:::...:~:..~:~-7..:.~..:~.: .... ~.~.::..._~::.:Z.(~.7~??-..->~, .... , .... ~ ~":->~':': ; /~/~ : ~/~ ~' '~ ": ~ ~ - -~-;..~~. =- '" ~: OA~B'-ll D-2 GREATEI ANCHORAGE AREA ?'gROUGH IIEALTI! DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case N o. Z'~-~ _ ,..~,/~. (~ ,}~ ' NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH I~'/'~C~ TO BE INSTALLED BY ~/~,~'~/~' PERCOLATION TEST RESULTS ~ 7~-Z~//~Z),,¢_/~I ANTICIPATED DATE OF COMPLETION PHONE NO SEEPAGE PiT /,DRAIN FIELD. , OTHER BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS lS TO SERVE AS ~/1~-, PYICI)-L~- ,PERMITT01NSTALLA AS DESCRIBED BELOW. SIZE OF UNIT TO .BE SERVED ..SEPTIC TANK SlZE~"/~5'**Z) TYPE '~"(L'~'~SEEPAOE AREA :-DISTANCES: , [,~CLL ~ '-' TYPE DIAGRAM OF SYSTEM I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinafce No. 28-68 and that thst- above described system is in accordance with said code.' DATE ~/~-' ~/7' APP U CANTS BIG N ATU R ~"~~ii~ ~REATER ANCHORAGE AgEA BOROUGH~ ~ "... HEALTH D~PARTHENT ,. CASE 3~7 EAGLE STREET ANCHORAGE, ALASKA 99501 .Depth Feet Soll Characteristics Location Sketch Was Ground Waten Encountered?_~ If Yes, At.What Depth, · ! I I Reading Date Gross Time Net Time Depth To H20 Net Drop ~rcOlation' '~t e'"'i.. / MinU't'e ...... Froposed Installation:L Seepage PiZ ~/ Drain Field De,th'Of Inle~ - ~epth To B'o'ttom,Of Pit Or T~ench COMMENTo: ~ ,, Da~a Certified By:~ ©,fTE Development Services Department - T Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 01739153000 Certificate of On -Site Systems Approval Expiration Date: 2/18/23 Legal description MOUNTAIN PARK ESTATES BLK 13 LT 5 Site address 13015 ALPINE DRIVE Current property owner(s) MUNK WERNER R LIVING TRUST MUNK W/TRUSTEE X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 11/18/22 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 Arsenic Advisory Other COSA Approval June 2022 MUHUPAUTY of AmHORAGE a Afte Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-391-53 Complete legal description MOUNTAIN PARK ESTATES; BLOCK 13, LOT 5 Location (site address) 13015 ALPINE DRIVE *ANCHORAGE, AK Current property owner(s) MUNK WERNER LIVING TRUST Day phone 907-486-5293 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 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: Q Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench FO -1 Seepage Pit Waiver request for: N/A 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. S COSA Fee $ 5 -D fi 33iJ Waiver Fee $ Date of Payment 111151-2-2-()31)4'q Date of Payment COSA # CSSCD,Z Waiver # COSA ApplicaUon June 2022 E COSA Checklist Legal Description: MOUNTAIN PARK ESTATES; BLOCK 13, LOT 5 Parcel ID: 017-391-53 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 5.1 gpm Date drilled 1970(?) Total depth *220+ ft Water storage tank volume N/A gallons Cased to LINK ft Well disinfected for coliform test? ❑ Yes X No Q Sanitary seal is functioning correctly R Coliform bacteria is Negative 0 Wires are properly protected Nitrate 5.85 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 12+ in. Arsenic ug/L M Arsenic less than MRL (ND) Date of flow test for COSA 9/29/22 Collected by GEG Static water level at beginning of test 216.6 ft. Date 9/30/2022 Comments *PER PUMP INSTALLATION LOG - MAX DRAWDOWN DURING FLOW TEST WAS 218.4' BTC B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank NEW ❑ Required maintenance co Date of pumping NEW Age of lift station years ❑ Required maintenance completed, if AWWTS Lift statio erial Comments: NEW SEPTIC TANKments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1970 R ALL standpipes present per record drawing Total measured depth from grade 9.1 ft (max) Measured depth to pipe invert from grade * ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective'J® 7 Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced **849 gallons 9/29/22 date Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A Adequacy test date 9/30/22 Results Q Pass Fluid depth prior to test 41 in Water added 620 gal New fluid depV 56 in Elapsed time 120 min Final fluid depth 50 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used ***78 in Effective depth remaining ***6 in Comments/Deficiencies: SEEPAGE PIT "FILLED TO 100%- BACKING UP INTO POST TANK DOUBLE CLEANOUTS "DURING THE PRESOAK AND ADEQUACY TEST, LIQUID LEVEL WOULD APPEAR# IN THE POST TANK DOUBLE CLEANOUTS WHEN THERE WAS ABOUT 56 INCHES IN THE SEEPAGE PIT (INDICATING IT IS 100% FULL). ***ASSUMED BASED UPON WHEN THE SYSTEM WOULD "BACK UP" INTO THE POST TANK DOUBLE CLEAN s COSA Checklist June 2022 G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, 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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 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 E. SEPARATION DISTANCES �F_ �Q were measured to readily identifiable features. Hidden defects or encroachments may�f exist that were not identified during the The From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) evaluation. operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, levels Septic Tank/Lift Station on Lot > 100' * Community Sewer Manhole/Cleanout > 100' year), quality of construction (materials and workmanship), and the water usage of the family utilizing FE Yes if No ft Q Yes if No ft d Neighboring Tank > 100' o Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft performance of well or septic system. GEG makes no representation whether an alternative well Absorption Field on Lot > 100' 51 Yes if No ft Holding Tank > 100' 0 Yes if No ft ff e A. Garness,: s E Neighboring Absorption Fields > 100' Animal Containment > 50' QYes if No ft property purchasers) is not authorized, nor will it confer any legal right whatsoever. Qi Yes if No ft COSA Checklist June 2022 - ENSE r6fs$Sso4`� aaEccsaa ��da�� Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft Q Yes if No ft ILI ❑ N/A - Served by Community Well (not on lot) or Public Water 4 p2 From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' FNI Yes if No ft Surface Water > 100' ❑■ Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No uNV- ft Private Wells > 100' FE -1 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line-? 10' ■ Yes if No -- ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS vt-►0 *ALL TANK SEPERATION DISTANCES ARE BASED UPON INSPECTION REPORTS BY MIKE ANDERSON, PE SEEPAGE PIT IS UNDERSIZED FOR 4 BEDROOMS BUT WAS PREVIOUSLY APPROVED BY THE MOA IN 1974 **WR#OSV221073 G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, 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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 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 �F_ �Q were measured to readily identifiable features. Hidden defects or encroachments may�f exist that were not identified during the The ' . '' evaluation. operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, levels groundwater (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing * .' T 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 the performance of 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 ff e A. Garness,: s E to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent 73 �A- `7 't I•��`.`�� property purchasers) is not authorized, nor will it confer any legal right whatsoever. ire COSA Checklist June 2022 - ENSE r6fs$Sso4`� aaEccsaa ��da�� ANCHORAGE WELL & PUMP SERVICE, INC. 7640 KING STREET ANCHORAGE, AK 99518 PH. 907-243-0740 Bill To: Eric Munk 13015 Alpine Dr Anchorage, AK 99516 Invoice Invoice #: 20223062 Ship To: Eric Munk 13015 Alpine Dr Anchorage, AK 99516 SALESPERSON YOUR NO,. SHIP VIA COL PPD SHIP DATE TERMS DATE PG. TYLER S RIDGWAY 35469 Net 30 11/17/2022 1 :)TY. ITEM NO. DESCRIPTION PRICE DISC % EXTENDED TX. PRICE 1 Service Call CAMERA WELL FOR INTRUSIONS, DEPTH, STATIC, CASING 1 Field Service 11/17/22 - Check system. Locate well and $400.00 $400.00 remove sanitary seal. Set up camera on well head and camera well, Pitless adapter set at 11' from top of casing. Static water level at 216' from top of casing. Pump set at 233' from top of casing. No perforations or intrusions in casing, cased down to or past the level of the pump. 0.5 ST5-Tyler Service Tech 0.5 ST2-Mark Service Tech SALE AMT. $400.00 We appreciate your business. Thank you! FREIGHT $0.00 SALES TAX $0.00 TOTAL AMT. $400.00 PAID TODAY $400.00 BALANCE DUE $0.00 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC221547 Subdivision: Mountain Park Estates, Block: 13, Lot: 5 A water sample revealed a nitrate concentration of 5.85 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 Q Box 196650 *Anchorage, Alaska 99519 6650 *www muni org 1. Approval requested by: GREATER ANCHOP~AGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: ~ ~?~._~.Y--// Phone: Mailing Address: 3. Legal Description: 4. Location: ~,~//;/~-'~ 5. Type of facility to be inspected 6. Well Data: No. of bedrooms e A. Type /~.~J~ C. Construction Sewage Disposal System: A. Instal 1 ed C. Septic Tank: D. Seepage Pit: E. Disposal Field: B. Depth B. Installer ~,~/<<. 1. Size /~,.~' 2. Manufacturer~~~~ 1. Absorption Area ~/~ ~ 2. Material Total length of lines Be Distances: A. Well to: Septic tank ,.~) ×/' , Absorption area ~ ~-, Sewer Lines Nearest lot line /~ ~ , Other contamination B. Foundation to septic tank .. ~ /. , Absorption area C. Absorption area to nearest lot line ~.,~ EQ-034 (1/74) Page 1 of two pages - ] ~age 2 of two pages - Req~.~t for Approval of Individual S...-'r & Water Facilities Legal'Description Comments Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED /(//~ /~/~//~._~ ~/~t-- Date EQ-034 (1/74)