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WILDWOOD GLEN LT 4
Onsite File Wildwood Glen Lot 4 #015-092-66 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201430 PID Number: 015-092-66 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Name Upgrade LYNDA FAST ABSORPTION FIELD Site Address 7610 WILDWOOD CIRCLE *ANCHORAGE, AK ❑ Deep Trench ❑Wide Trench ❑ Bed ound Phone ❑ Other Number of Bedrooms Soil Rating Total depth original grade 907-529-9899 g GPD/SF Ft LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot WILDWOOD GLEN; LOT 4 Ft. Ft. Townshi Fill added above original gr Gravel length p Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Ft Ft, Septic Absorption I Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft= Ft., Well 1 004 TANK E Septic ❑ S.T.E.P. ❑ Holding ❑ Oiller Manufacturer Capacity Surface Water 100' 1 I I GREER TANK 1000 Gal. Material Number of compartments Lot Line I 51+ I NA HDPE 2 Foundation 1 U'+I LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR *5'+ TO DECK POSTS Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield NORTHERN EXCAVATION Drainfield o3o30ExIsTING co/MTD3034 inspector GEG AND MOA (TIM ECKLUND) BENCH MARK (Assumed elevation) 99.35 ft Inspection 751 11/18/20 - Location and descri tion dates: 2nd p 3'd _ 411, _ TOP OF MH f ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's St'mp Conditional Approval:�F Date Septic Syst ApprovedDate j Z t{ en 4C% Note: this approval does not include we I permit requirements. w 05/02/18) PERMIT NUMBER:pp / R PARCEL ID NUMBER: OSP201340 RECORD DRAWING 015-092-66 X00' DRIVEWAY .? / APPROXIMATE / WELL LOCATION gapRokiy� MH 25.4 64.7 ST1 30,7 68.8 DBI -1 31.9 69.6 32.8 COt 41.9 Col 70.1 78.1 MT1 40.3 74.9 \ ` i I � I RADI S 100' WELL \ 'fit• � ' 100' WELL IUs Aq 1 WILDWOOD GLEN: LOTS NEW 1090 GALLON HDPE EERTANKA +.•, r! "!'�. ' . ;�:.; ''f�i•.' ' ; • Fes: r . a �• t X00' DRIVEWAY .? / APPROXIMATE / WELL LOCATION gapRokiy� /\-"-EXACT CURVATURE OF EXISTING TRENCH IS UNKNOWN PER CONVERSATIONS WITH NORTHERN EXCAVATION ON 11/20/2020 THE MT IS ON THE INSIDE OF THE TRENCH. THEREFORE, IT IS BELIEVED THE TRENCH CURVES (BASED UPON CLEANOUT, SUMP AND MT LOCATION). IT SHOULD ALSO BE NOTED THAT 5 FROM THE EDGE OF THE TANK WAS EXPOSED DURING GEG INSPECTION TO CONFIRM T SEPARATION TO TANK N SCALE: 1°=40' 1 Oki ri Ed ENGINEERING: SALES � CONSULTING s, .� _. ,�.�.3 .,_ ,--- >� .• a,. 3791 E. TUDOR ROAD, SLATE 101 -ANCHORAGE, AK 99507-PHONE(907)337.6179- FAX (907(37BJi48-WESSRE: wwN m—njjm-ngwm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LYNDA FAST 907-529-9899 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: WILDWOOD GLENN; LOT 4 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 12/4/2020 ®,:W .w s®nit oil t. ,4 ;. .. .. ............. ... .............. li ffrey A. Garness �c Q m EXISTING HOUSE /\-"-EXACT CURVATURE OF EXISTING TRENCH IS UNKNOWN PER CONVERSATIONS WITH NORTHERN EXCAVATION ON 11/20/2020 THE MT IS ON THE INSIDE OF THE TRENCH. THEREFORE, IT IS BELIEVED THE TRENCH CURVES (BASED UPON CLEANOUT, SUMP AND MT LOCATION). IT SHOULD ALSO BE NOTED THAT 5 FROM THE EDGE OF THE TANK WAS EXPOSED DURING GEG INSPECTION TO CONFIRM T SEPARATION TO TANK N SCALE: 1°=40' 1 Oki ri Ed ENGINEERING: SALES � CONSULTING s, .� _. ,�.�.3 .,_ ,--- >� .• a,. 3791 E. TUDOR ROAD, SLATE 101 -ANCHORAGE, AK 99507-PHONE(907)337.6179- FAX (907(37BJi48-WESSRE: wwN m—njjm-ngwm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LYNDA FAST 907-529-9899 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: WILDWOOD GLENN; LOT 4 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 12/4/2020 ®,:W .w s®nit oil t. ,4 ;. .. .. ............. ... .............. li ffrey A. Garness �c Q m MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO BOX 196660 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone. (907) 343-7904 Fax (907) 343-7997 http:flwww.munt.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201430 Work Type: SepticTank Upgrade Tax Code Number 01509266000 Site Legal Address. WILDWOOD GLEN LT 4 G:2440 Site Mailing Address: 7610WLDWOOD CIR, Anchorage Owner. BOYLE STEVEN P & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of-. 11 Disposal Field Ef Septic Tank 01-Iolding Tank 13 Privy Effective Date: Lot Size in Sq Ft; Total Bedrooms: Department 10/19/2020 10/19/2021 55845 171 Private Well 13 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.65 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (I 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either a. Opened and Closed on the same day, or b. Covered, seated, and heated to prevent freezing Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201430, Rebecca Carroll, 10/19/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201430, Rebecca Carroll, 10/19/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201430, Rebecca Carroll, 10/19/20 MUNICIPALITY OF ANCHORAGES--•-" ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION a 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /� `�(� `bE1_6zA-r �UPP�/� PHONE 3yy �EW 1• ❑UPGRADE MAILING A�D ESS- �p ao71 LEGAL DESCJT�f✓71 LL Loo I I LOCATION NO. OF BEDROOMS U Y DISTANCE TO: Well 3 Absorption area Dwelling PERMIT NO. �I/a-'26 a F Z `w F. Manufacturer yyjj /j O Q Mated No. of compartments ti Liq. ca a®n Ballo IF HOMEMADE: Inside length Width Liquid depth DISTANC TO: Well Dwelling PERMIT NO. J t7Z O z F Manufacturer Material quid capacity in gallons DISTANCE TO: Well Found ion /14j� Nearest lot line PERMIT NO. No.oflines Length f each e i lent of lines Trench wid Distance between lines Iffl- •—��iYTChes Top of tile to finish rade , Material bene the Total effecti rption ar a s Length idth Depth PERMIT O. w D y i F- wd Type of cri Crib diameter Crib depth Total effective a s-tion area y ISTANCE TO: Well Building foundation a N st lot line .% J Class Depth Driller Distance to lot line PERMIT NO. J U L o oG lJ DISTANCE TO: Building foundation Sewer line Septi I n IZ ..S Absorption area(s) OTHER 4 o PIPE. MATERIALS S C. iN SOIL TEST RATING INSTALLER `b+- S xc. REMARKS / /a/ YC • us T a� p GS ±LLv APPROVED DATE �) LEGAL t��y 72-013 (Rev. 3/78) v O M M M M M M M M M M M M O O O O O O O O O O O O O i H N :O ,.., rn W r CD CD y d m a O 0 PV d O ,rrn 0 z 'rn > z x H r M y E h :p tf p � d ifs lR : N• P,Fl iN by ih o i E< Q? W r CD CD y d m a O 0 PV d O ,rrn 0 z 'rn > z x H r M y E tf p 09/12/2007 03:29 9072430742 AWPS, INC. i Deveicpvnent Services Department Building Safety Division '1 n -Site Water & Wastewater Program 4700 Brognw Street F.O. Box 146650 Mark Segich Anchorage, AK 99519-6650 Mayor www munioTo/ontim (907)3A3-7904 Pump Installation Log Well Drilling Permit Number: SW— Date of Issue: : Parcel Identification Number:_6j6-0%;,-t0(/ PAGE 03/07 Legal Description �U� PropFrty Owner Name &Address: '7446 c. 'LP4000V C-R asaLa Pump Installation Date: _ i-00) : Pump Intake Depth Below Top of ell Casing: feet 33 Pump Mannfacturer'a Name: i �TiiClC ��.i Pump Nlodel: CAX.;L I V rt Pump Size hp Pitless Adapter Burial Depth: /Q! feet Pltless'Adapter Manufacturer's N im11e: 4A Pitless Adapter Installer: /, n Well Disinfected Upon Completiog7 f & es ❑ No !S pi JET'+ 44S Method of Disinfection: Comments: Pump Installer Name., ANC 330 EA ORAGE WELL & PUMP SERVICE, INC T 76TH AVE. ANCHORAGE, ALASKA 99518 - FAX:(907)243-0742 ((907)243-0740 E-MAIL: pumpmanjim©alt.net Attention: The pump installer shal)!provide a pump installation log to the DSD within 30 days of pump installation. i I.°P.A. Ar E J. 1_7 I F= "F I I "-s- 01 f- V1rAA_:ulQ AF="FAA?E_ DEPARTMENT f HEALTH AND ENVIRONMENTAL OTECTION Bc L.J STREET: ANCHORAGE, A4::. ?: uOi 264-4720 • 6 F_ 9.. L. FA VA E_ a CD 54 =" 1rEE : 825 'L` STREET, 511 { _ 1=F�TITo►K:. i R�R�: j I 47 DE L MMT ) K$'FEF:T UTIM-4 #II LD140- a £=I R eIL' LOT 4 WILIMM, GLEN S -L161 E Or SOIL FIE:{.r -$WTI' Ott4 6�iY IEM IS: I OF p t r LOT 'SIZE 55-A&O -SC&ME FEET Still- RAIM! kSQ FIS=- MiDUIR€D SIZE OF:T#IE:--,nIL Rte£ f'TICNI SYSTEM JS- Tt S-- -� i_ E i ii {E= , #�LEI.�T## 6IPEfI�•T# 35 '##� LE#i[I#T f3f# t`E€i� T#� Tti�� �F€�IEL#'r_ VE ):prp7I# t Es Il t C i till IS I# €>I Tf�tff€ gEl t# 7fIE € `E i t##F £#_*4i Rt-jD THE WITlg4 &F 714E ESC£•-FfftTJOU 4IN FEET). 1#EF I mc; sEi w3vtH For< imus -w-5_ ;'11W iC�: VEL TjFF'IH IS THE MINIM114 DEPTH CW GRFIV€L 13ETt�EFi THE., C4tTff� L #'3 6M 1#IE MT40t4 CIF THE EX[!RVRTjOR CIN FEET). :I�?t�€ 3 �i�C=� ���`'T' 3 �_: Tit-1€�� � 3 �I� � S+�q� moi'=F3.aF��:.at-•#�° P1IT RFF'LI£->hY-tT #ter-=. THE RE £ IVILIT4' i 3fiFC4siS it#3E• F T#4ftiT G*L 7ItCs THE T LRT3C OF MIN RELLS R%JAC:E"1 TO THIS MT-*ERTY F T#IE QEF ' OF R[E�S DENCES THRTq IKE #�tfELL�� WILL SEfFa-S E- F (.Yc.C3 _-f _G s_=*T ["��- Aii'M>E 3"° 3`.•aLs2 i'�i Rei` �' _ f. 1 -TILLING OF FhIY SYSTEM M1IhV-1T FMIL Iir-+F•EC-TION f"—, 'f'PVVRL €? THIS Lill L E£ SL11c�€ECT TO PRO, CLITION, 1F€1 PI-Tf#•K-E WI:1REN,A UELL j, Ys` Chi -SITE `E3� f3# t i5£1L 4'STEri IS FEET FOR R F-RlVfigE CELL OR 3 TG FEET FkOK R F E -11C NELL MPENDING At 114E TYPE CIF FC IC WELL- If4L44 D]Slf*ICE FT4Cd4 R Ffc3YRT€ #TELL JO t'€ MIYATE =EWER LINE IS 2t• FEEI M> fl," It:R#ITY SUtEF LINE IS 7=. FEET. '1>. L -S REOURED f � MST feE MICS Eb TO I}tE iEs�i�:iSiESiT #2ITF;}!d f,F1sb- }FIE WELL C-EgIF-LETIM 4R REQUIREMENTS RRY FIRP YY. S L'IF}Cf1T7£ MID [TA T #Intl GIRBRRt45 PRE . ALF0LE TO It- JWZE Fi<UPER INSTRURTIM [R,I3F't I"RT v:f9i FIVULI€R #III#; THE kEQUIREMENTS FOR ON -5 -ITE 5ENER • Wt#> WELLS Fid. SET v: LSV THE HLYaI C I Pf4L l I Y OF WCHCRF°SC I; WILL INSTALL THE SYSTEM IN >iC3:;O E WITH THE MDES, rt*4*;�STMD 1HRT THE M --SITE s€kER--ASTEM MY RECKUK FNLFMjE EN`T IF THE 7:'.i itCE IS RENCOELEI, TO IMC.LUDE t'iC*ZF. THfR t = MMOCIfAS, PPPLIC"47 6EL� I RC t T SOILS LOG MUNICIPALITY OF ANCHORAGE �`.✓ DEPT. OF HEALTH & oN,kAENTAL PROTECTION MUNICIPALITY OF ANCHORAGE PERCOLATION f, DpEgPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Ai R J 1981 825 L. Street, Anchorage, Alaska 99501 264-4720 (\ cn11 c I nr; _ PFRCnI_ATION TEST RECEIV/E® -- ----- PERFORMED FOR: Ll -I POp---r DATE PERFORMED: LEGAL DESCRIPTION: �O / /4 /Q W -aa c{ Cil `" � �n DEPTH {. SLOPE SITE PLAN d ZM t �C F—T--F—T--] 7 6 1N 2 3 !' 4 5 Sz G z7.rs. 11 6 7 8 9 (6 }7) 10 Q5 �J 11 �- 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 1( 'Y 15-3/i.Jz !0 />I.>^ aof S' 5,-y -L la /.7Y d.vs- 20 LJ /� PERCOLATION RATE 16 / (minutes/inch) / qq TEST RUN BETWEEN __,L_. FT AND ` FT COMMENTS Pzrk � ry-00L3A&.,e PERFORMED BY: f?C A /LLaO- S` CERTIFIED BY: DATE: l b 72.008 (6/79) . A , A. —A, 1 '1-- 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEECYM OF HEALTH & 825 L Street - Anchorage, Alaska 99501 tNYIRONMENTAL KOTECTION • ENVIRONMENTAL SANITATION DIVISION AUG 2 6 1981 Telephone 264.4720 R �' (' 1 / .R REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND`�VY�3�Gl E IES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER \ - PHONE (_.) — �f+ )'K !_\�P_ r—\ 1� . lam._ A INDIVIDUAL/ON-SITE** MAILING ADDRESS S (� �� 0 1- (Z Y i .. 15 0 PROPERTY RESIDENT (lf d1iffere'nt rom above) PHONE V� i lNe \ c� •r'�-- PHONE 2. BUYER MAILING ADDRESS , 3. LENDING INSTITUTION PHONE MILINGADDRESS �. PHONE 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LO,AT{�ON� J (� 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other rA SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY rA Three ❑ Six 7. WATER SUPPLY (L INDIVIDUAL- *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM - - ���i � SYSTEM WAS INSTALLED. A INDIVIDUAL/ON-SITE** YEAR ON-SITE ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 14_;� THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED v �( INSTALLER / ❑Septic,a kor ❑Holding Tank Sizer If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL orrpp`tiioo 4. DISTANCES WELL TO: Septic/Holding Tank Abe Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS V❑f— APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72-010 (Rev. 6/79) APPLIC;-_JT FILLS OUT. -UPPER HAL,__ONLY Time Property Owner Delbert Ruppert =Z4-1965 Mailing Address 7610 Wildwood Circle SRA Box 20718 Zip Code Date - Date _ O c Buyer Charles A. Blomfield Inspector Address 44-17 E 671-b Anchn'rage, 99507 Zip Code Lending Institution Alaska Mutual Field Notes: Phone Minnesota -Benson Branch MVN1Cp0 EPT. OF V* &e/ AddressZip 99503 Code338-72-0 pp (� � it*� L U � FLP" r Ato td - Realty Co. & Agent Coldwell Banker/Jack White Co. Clair Ramsey _ Phone Address i2ol e St Anch Zip Code ('}) APPROVED B EDROOMS *C,O�Nf DITIONS O APPRO�VQAL1 ( ) DISAPPROVED LegalDescriptionLot 4, Wildwood Glen ( ) TE COf1D �10/NAIN P OVAL'to DAle, ` BY: ^ t box 1!^ l Soils Rating Street Location Well To Absorption Area Well Log Received Type of Residence ❑yASingle Family - ❑ Multiple Family No. of Bedrooms 3 ❑ Other Water Supply ❑glndividual - �.-u C JC, ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal L7Xlndividual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFOREPROCESSINGCAN BE INITIATED. Time Time Time Time Date Date - Date _ O c Dat Inspector Inspector Inspe,Ctor J I Y C2`t Inspector �I !Q N! Field Notes: Op ANCHORAO9 MVN1Cp0 EPT. OF V* &e/ AL PROTECTION _ ENVIRON'NiNT n )� C b,Yr than np Oao /low el - pp (� � it*� L U � FLP" r Ato td Pin 4Gu.i u � nie2 oo u'jO o1 ('}) APPROVED B EDROOMS *C,O�Nf DITIONS O APPRO�VQAL1 ( ) DISAPPROVED 7 2 ( ) TE COf1D �10/NAIN P OVAL'to DAle, ` BY: ^ t box 1!^ l Soils Rating Date Sever Installed Well To Absorption Area Well Log Received Septic Tank Size - dLl2J W Yj 1 Well to Tank (1113 MUNICIPALITY OF ANCHORAGE 0 <4( a -..e Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-092-66 1. GENERAL INFORMATION Complete legal description WILDWOOD GLEN LOT 4 Expiration Date: / ` P Y" Z0z Location (site address) 7610 WILDWOOD CIRCLE, ANCHORAGE, AK 99507 Current property owner(s) YVONNE TIJERINA-BURLESON Day phone Mailing address Real estate agent 7610 WILDWOOD CIRCLE, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1 H 5 Date of Payment y /12 0,2 9 - Receipt Receipt Number r�0 a 1 O 2- COSA # COSA# 0SC'�aA�-�(2 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST. WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/8/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to `+��1�� these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory Q: • . • :1 for current or future occupants or guarantee that no unseen encroachments, deficiencies or j g•' '9 �rJ discrepancies exist can be given by First Water Consulting & FWCS ' *� � TH ••* r 6. DSD SIGNATURE �� • Curt• •is • • • • •Huffman , j • • System #1 Approved for bedrooms CE 128991���� �l TF�F�pR /8/25 . System #2 Approved for bedrooms 11�\\ ESS0 Disapproved Conditional approval for bedrooms, with the following stipulations: G) z p - o Z^ KI'SQ ER_o PSC;v M J J � 1 J ` 1 \ )AIFNT�� S�¢,,� . / 1 IT,Y: VL-, Original Certificate Date: L ^ /4/ " Z0 ZZ 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 Legal Description: WILDWOOD GLEN LOT 4 Parcel ID: 015-092-66 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 4/26/1981 Total depth 340 ft Structure served by this system Well production at time of test *1+ gpm Water storage tank volume * gallons Well disinfected for coliform test? ❑ Yes ® No Cased to UNKNOWN ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate *9.45 mg/LE]Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) * in. FWN Date of flow test for COSA 3/26/2022 Collected by•° Static water level at beginning of test * ft. Date of Sample 3/25/2022 Comments *WELL IN VAULT PER 2020 GEG COSA & 2003 MOA DOCS. SWL 2401+ & PRODUCTION BASED ON 1981 WELL LOG & PREVIOUS COSAS AT 6GPM. 500 GAL GALVANIZED STORAGE TANK W/ NO ACCESS NITRATES PER MOA DOCS. B. TANK DATA Age of tank(s) 2 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 3/25/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/6/1981 ® ALL standpipes present per record drawing Total measured depth from grade 14.2 ft (max) Measured depth to pipe invert from grade 6.7 ft (min) ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of effective. If not state C. LIFT STATION ❑ Required maintenance completed Age of lift station — years Lift station material Comments: Adequacy test date 3/26/2022 Results 2 Pass For 3 bedrooms Fluid depth prior to test 41 in Water added 600 gal New depth 70 in depth into effective 7_5 Elapsed time 1330 min ®Code -required soil cover over field Final fluid depth 40 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: F<�5. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' M Yes if No ft M Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' M Yes if No ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100' M Yes if No ft _ Water Main > 10' Yes if No ft -- "-Community Wells> 200' M Yes if No ft Water Service Line > 10' M 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' M Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' M Yes if No ft Private Wells > 100' M Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' M Yes if No Surface Water > 100' M Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF .44 Tib . .......`... Curtis Huffman r� CE 128991 �Eks�FFo .4111/2?. P������ kkPROFE$S1�N„�, Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221136 Subdivision: Wildwood Glen Lot 4 A watersampie revealed a -nitrate concentration of 9:46 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. N: Mailing Address P O Box 196650 * Ancho`rage, Alaska 99519 6650 *www muni org • '� Municipality of Anchorage On -Site Water and Wastewater Program ` (907) 343-7904s ; ::1V Y :. Certificate of On -Site Systems Approval Parcel I.D.015-092-66 Expiration Date: 1. GENERAL INFORMATION: Complete legal description Wildwood Glens Lot Location (site address) 7610 Wildwood Circle *Anchorage AK Current Property owner(s) Mailing address Day phone Real Estate Agent Dar Walden Day phone 2. TYPE OF DWELLING: X Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: g 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. COSA Fee $ gl2,50 Cy jjI n Date of Payment .2 - I - Z.d 0 Receipt Number 0-7 :� tq 8 COSA#_05G 166C_j Date: Waiver Fee $ Date of Payment Receipt Number Waiver# 0A 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as,of the validation date shown below, I verify that my investigation, 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: 907-337-6,179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99501 /I'D Engineer's Printed Name: Jeffrey A. Garness Date: tl 1� 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 dates 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 grr�(gr(�(( are outside the control of GEG. Satisfactory test results do not guarantee future perf`rrr��taa��� system/s; therefore, GEG makes no warranty (express or implied) regarding the future the well or septic system. GEG makes no representation whether an alternative wel��r sp`Cfc system can be installed on the property in the event either of the current systems fail to pe dequatel%� the future. The content of this report is for the sole benefit of the person/party tt ained Gf.to perform the evaluation. Reliance upon the information provided in this report by�nther to rQ` C p cT I �7 _ �.I u \ Xti m party (including subsequent property purchasers) is not authorized, nor will it carjZany a� i htP� =A "�? y whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved C/) "#AECC884 �P �Q c�` i��J�LFJ OP)),)MEt�,ls Conditional approval for bedrooms, with the following stipulations: By: `�- Original Certificate Date: 12 ^L1 ZD 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 ChecklistNitrate Advisory Septic System Advisory Arsenic Advisory �— Well Flow Advisory Other Legal Description: WILDWOOD GLEN; LOT 4 If more than 1 septic system on lot: COSA Checklist# of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/28181 Total depth 340 ft Cased to UNK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA 11/25/20 lu�V t STS 12 / /2-0 Parcel ID: 015-092-66 Structure served by this system Well production at time of test 6.0+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 9.92 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 7/17/20 Static water level at beginning of test UNKNOWN ft Comments WELL LOCATED IN VAULT IN DRIVEWAY UNDER'MANHOLE' (SEE ATTACHED PHOTO AND EMAIL FROM KYPE BROWN. ^GEG DID NOT EVALUATE THE STORAGE TANK SYSTEM B. TANK DATA Age of tank(S) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 7/6/81 X ALL standpipes present per record drawing Total measured depth from grade 14.25 ft (max) Measured depth to pipe invert from grade 6.75 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 7.5 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/'4 gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7123/20 Results ✓Pass For 3 bedrooms Fluid depth prior to test 42 in Water added 639 gal New depth 68 in Elapsed time 120 min Final fluid depth 52 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' M Yes Community Sewer Manhole/Cleanout > 100' Fv Yes if No ft 7✓ Yes if No Neighboring Tank > 100' FV -1 Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 0✓ Yes if No Neighboring Absorption Fields > 100' 0 Yes if No. Water Main > 10' Animal Containment > 50' F✓ Yes if No ❑✓ Yes if No ft Yes if No. Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' [V Yes if No ft M✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' F Yes if No Property Line > 5' Fv� Yes if No ft Wells on Adjacent Lots: M Absorption Field > 5' if No Yes if No ft Private Wells > 100' 0 Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' El Yes if No ft. If absorption field is under driveway comment below Property Line > 10' P/1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Water Service Line > 10' M Yes if No ft Community Wells > 200' Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *5'+ TO DECK SUPPORTS G. ENGINEER'S CERTIFICATION i certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft ft ft ft ft ft ft Q Yes if No ft Yes if No ft 49ijH P _Jfrp A.'6orD.ess;- t�+ E-7953 04 9S 1 • �r f , •' `cyG pre ••.t'2t �-� �'•' �°jo �W-,,°rofessio0000 #AECC884 Jeff Garness From: Kyle Brown <kyle@discoverydrilling.com> Sent: Wednesday, July 22, 2020 5:33 PM To: Jeff Garness Subject: 7610 Wildwood Circle Jeff, As we discussed by phone, I made up a plumbing assembly to connect a garden hose to the drain on the well vault in my neighbors (Linda Fast & Steve Boyle at 7610 Wildwood Circle, Anchorage AK 99507) driveway, and with the exception of minor dribbles leaking from my pressed fit PVC hose connection, the water appeared right away flowing out of the gravel at the NW property corner some 40 feet away, downslope, by the mail box, exactly as described by Ted Moore in the 2003 drawing and report you forwarded to me. The drain has never been utilized since the sealed vault is at the highest point in the driveway such that snowmelt or rain runoff ever approach the vault. Let me know if something more formal is required to document the functionality of the vault drain. Best Kyle Brown Discovery Drilling Inc. 344-6431 Nitrate Advisory Certificate of On -Site Systems Approval # OSC201664 Subdivision: Wildwood Glen, Lot: 4 A water sample revealed a nitrate concentration of 9.92 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. s s� Mailing Address P O Box 196650 *Anchorage, I' 99 A a 519 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 * Anchorage, Alaska 995196650 *www muni org I AvzA zp <opmcnyozm z �ATomoC�, czi�zi�"'i�. cm =mc��m^'� pv,zzx,o�o 2A�m"mcm'�O rtmi= ooiz�"-p'gi aaam�2�'� m;az�a�z ApAp_.O C�rtI 0x-0`3Zym f~ilO� <�:16 0 mzczi a��czi roC� "� tomo p z H ozm m �m2i ti, Oy p-iinmp�pn �m p m n�oa=rnc� o�zzo oz< N. �Ro,oa-z,� m ma � A A � Cn �mm� rnw Z ti 0080 i2 It, m o �z �o Roan a o c��o < i < �wo CA Z i m �bN m� o A m N 00 00' 40" W 166.09 y Municipality of Anchorage Development Services Department rpF 4'�p Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. 5 . E T 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 LD. ©rS - d 17 Z - 6 r HAA # Expiration Date: 1. GENERAL INFORMATION Complete legal description I -o f % u11 I cvo0,=X 6r1." Location (site address or directions) '76140 k/t l ce w ocyc.Q C r -c t< Current Property owner(s) "7Zny 136--" 4�"'el Day phone 5'6 2 - *z 7 tre Mailing address Lending agency Mailing address Real Estate Agent Mailing Address to zoo pro-rpsef %ir �K , f}r+cticrage A-4 995G7 Day phone Vec,k; GarntgL!�d Proof, (I#JAR Day phone 36 Z-6Yd y qzv "Q" SA-, 4-k 99S707 Unless otherwise requested, HAA will be held by DSD for pickup. Plebe to l/ o cap"#, 2. NUMBER OF BEDROOMS: 3 ctrhAeco/-e i1 rerery �' M�k��n• 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 19 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. 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 properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 Flee hooe TacAn �c ct r .5 ee&ic er Phone 3 y'S- 13 S'r Address 1q6' 30 Ec4oS1�• A0�c2w . i}k 995"/e Engineers Printed Name � .� T. •1 Date s 2 03 �'h2�Glc,,re F• I`fciorr 5 ®°` id ®,49— 5. DSD SIGNATURE./. X Approved for 3 bedrooms. " r:*oDo�E r.i'!ryoos ; y ® 0 ([•y 4 Disapproved. Conditional approval for bedrooms, with the following stipulatioya u' = NOTE: The well for this property meets existing State & Municipal_ codes, There are nitrates grecent. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.47 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates Additional Comments is availphIp from the nn -Site SPryi c c Program, at 143-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Gt/ Original Certificate Date: 9-27-03 (Rev. OM2) Tank Typalt taterial"=$2 Yx G. f S P Tank size 100O ga.. Number of oundation cleanout (Y/N) Depression D2 a o`. purnping 81S7 /03 Pump+ ABSORPTION FIELD DATA Da e insteed 7/10/8t Soil rating (g.p. Leet, yd ft. Width _ I o:al aept'1 % .S �t. Eff. absorption. area ^401 815,103 Date o` acecue.c test rf 1S / a =ina:l fluid rm) EOO� Systemtype 77`e*wch l3/�Rrs ft. Gravel below pipe Monitoring tube Y Depression "over field LhL Municipality of Anchorage �) Dev,elopmelnt 5ervlces Qepalrtment Bwldin SafetyDivision I` e�s ;`. ^�-� z4 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 Tank Typalt taterial"=$2 Yx G. f S P Tank size 100O ga.. Number of oundation cleanout (Y/N) Depression D2 a o`. purnping 81S7 /03 Pump+ ABSORPTION FIELD DATA Da e insteed 7/10/8t Soil rating (g.p. Leet, yd ft. Width _ I o:al aept'1 % .S �t. Eff. absorption. area ^401 815,103 Date o` acecue.c test rf 1S / a =ina:l fluid rm) EOO� Systemtype 77`e*wch l3/�Rrs ft. Gravel below pipe Monitoring tube Y Depression "over field LhL t D. LIFT STATION f11. !!j• Date installed _ Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at—in.' High water alarm level at in. Datum Cycles'tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank"llift station on lot 103 On'adj'acent lofs � '� 10'.04 Absorption field on lot 192 6 { On adjacent lots > !GD Public sewer main At. A. Public sewer manhole/cleanout N7•'f{:'. Sewer /septic service line 7 2S'' Holding tank N•. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundafion Sof " Property line 167" Absorption field I k Water main > 1 G Natter service line ` 10 rSurface water• tCxj Wells on adjacent lots ? 100" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:— Propertyline Building foundation 75Water main Water Service line t0' Surface,water'10o Driveway, parking/vehicle storage Curtain iirair /V"3 S PN+ Wells on adjacent lots , tts::�, ` F. COMMENTS Durr�ry am ta✓ lj� 5: �♦ o�"/ ao�iQ«acy �srl� uwa 1-e huGl ;i a ro aaAa . fie: r4ilr of oeo o l* io r+tA+j fa+ `1sgS! ic.dl tso6.6: 7%+Cn 63 rroi9ai�e1' lwf+t� '2'� Or, Al' �C t4i GtC/ ,„ !fA r^CCteI>p� Il °°o►►oo►®• w> G. ENGINEER'S CERTIFICATION '�.y� 8�2 /G m ► '-+°►°a- �°� 6 3 ► I certifylhat l'have determined through field inspections and : Tk ` �q+sees+des ►®+++►++r++s ► o++ review of Municipal records that the above syste ins are i, conformance with MOA HAA guidelines ,n effect on this data ►sees++++r+►+ es+oe+®+• `► tm000lm F. k4ni1RE ; Ar Engineer's Printed Name - Accr t./Ot'� F°° /`►c+or� � � ` ► 0 358D �sJa Date A+!.4 HAA Fee $ S' 7S oo Waivef Fee $ _ Date of"Payment ?►a f 03 _ Date of Payment ° t' Receipt NumberReceipt Number (Rev. 12101) LA/ 61-c,(AFA DRAIN oar z • srprc 0 LOT 5 �O Lot 4 , Block WildW0001 (5/en SU1)V Anchorage Recording Precinct, Alaska LOT SURVEIL CERTIFICATION LEGEND' I hereby certify that t have surveyed the property shown and described 0 = Brass capped rnorumentrecovered iiuueon and that the improvements situated thereon we within the prop- o = Iron pipe and/or rebor recovered arty lines arxl da rqt oaeriop or emxoadn: adjacent property and thm no c = 2x2 hub 5 tack recovered unprcner rft on odjaard property overlap or encroach on the premises 0 = ""x Wrebor set this survey in queat{on and that theca ore no roo0woys, unilty lines or other visible easements on said property except as indicated hereon. LJn-r.S1 • O °O�4e.°ew��s°aOc�J aI Stole /iii 1 Date _ i5 _may^ L.�C..� Prepared by: R.L. Land S4N RagisJered Land Swveyar (907)279-6200 "W- Eighth Ave. And&wge, A/osAav 99501 Ref. z44C� F.B..= � No.." CIVIL. & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 August 20, 2003 ANCHORAGE, ALASKA 99516 MOA DSD On-site Services P.O. Box 196650 Anchorage, AK 99519 Dear Sirs: By means of this letter I am requesting approval of the wellhead enclosure that has been installed to protect from contamination the well serving the residence on Lot 4 of Wildwood Glen S/D, located at 7610 Wildwood Circle. Your approval is necessary because the wellhead does not extend 12 inches above ground level as is normally required for issuance of a HAA certificate. I am enclosing a cross- section drawing illustrating relevant components of the enclosure and have indicated the location of the daylight drain outfall on the as -built survey. I discussed this configuration in some detail with Dan Roth on August 6. As you can see from the as -built survey, this 340 -foot deep well was poorly sited directly in the middle of the asphalt driveway that leads up to the garage. In an effort to eliminate the resulting health and driving hazard, the owner arranged several years ago to have the wellhead enclosed inside an 18 - inch diameter protective steel housing. The top of this housing is sealed with a gasketed steel cover that is bolted into place, and it is surrounded with a 4 -inch high asphalt "bump" that deflects water away from the vault while allowing cars to drive over it. The wellhead inside the vault is now fitted with an approved sanitary seal and the wires leasing up to it are enclosed in conduit. There is a 1 -inch diameter PVC drain inside the vault that would allow water that somehow made its way inside the vault to flow away to a daylight outfall covered with washed gravel. I verified the functionality of this drain with a garden hose on August 6, 2003. I recommend that you approve this installation because in my opinion it does adequately protect the wellhead from contamination, whereas the alternative of extending the wellhead above ground would create a worse health and safety hazard. Please feel free to give me a call if you have any questions on this request, and thank you for your assistance. Sincerely, Ted Moore, P.E. 4" ASPHALT GASKETED STEEL COVER BOLTED INTO PLACE WELL SEAL 4" ASPHALT DRIVEWAY PAVEMENTS 111 I I h 15" 3" CONDUIT FOR ELECTRIC WIRES-—- -'18„ l \ '-1" PVC DRAIN TO DAYLIGHT - 40' NORTH Ni 8" STEEL "MONITOR WELL" HOUSING 6" STEEL WELL CASING .i i i r'=.�ramasanaoa0a�aa sa LOT 4, WILDWOOD GLEN S/D WELLHEAD PROTECTION DETAIL CROSS-SECTION FLATTOP TECHNICAL SERVICES SCALE: V= F- 0" 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 AUGUST, 2003