HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE #1 BLK 4 LT 10Mountainside Vill
#1
Lot 10
Block 4
#020-172-47
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion?;;<HV No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
020 172 47
MOUNTAINSIDE VILLAGE #1 4 10
JACKSON WAYNE P JR & PATRICIA M
17524 WOLF CREEK DR
ANCHORAGE, AK 99516-5747
03 01 2023
135
RED JACKET
50C311-8S12
.50
14
MARTINSON
PELLETS
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE AK 99518
I (T�
Municipality of Anchorage Page _Lot
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: -5t J 920337 PID Number: OZD /7Za171
Name:
/Cc~? Mt bp qALh
Wastewater System: dNew I ❑ Upgrade
Address:
/75z WoLr CAM -u_ Deev
ABSORPTION FIELD
Phone:
No. of B rooms:
❑ Deep Trench O Shallow Trench o sed k Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
Lot: ID Block: / Su i 's,on: ,l
•�'
• GPD/Sq fl.
Depth to pipe eonom uom orp�w grew;
+3a -m-jam- a
Gravel depth beneath Pipe
I I
+ "S' TD t5- 5— FI
• S
Township: Range: Section: I i
Fill addedabove;ig-M Brads:
fl
Gravel length:
-r ! FI
r
I 50 ft
WELL: New ❑Upgrade
Gravel dap, Wlb7e;
Number Oflmes:ID4w"bnsenlmes
Classification (Private, A,B.C): Total Depth: Cased To:
30 FI
Total absorption area:
FI
Pippo mate W: I
Ft. fl.
Ortllert Dat Dulled' Static Water Level:
tall 1,'
1` Iv 7. • L• : 31
I SOO SO. FI.
Installer.
!ZE.JEGaDC
t3.I 3 1 . U
Date inel Iib:
FL
Yield: Pump Seat: Casing /Might Above Ground:
// S 9L
GPM r . Ft.
TANK
SEPARATION
DISTANCES
IVSeptic
E3 Holding ❑S.T.E.P.
TOSeptic
From
Tale
ADWrption
Field
Lin
Holdingpresale
M nufacturer
Capa Air In gallons:
Suhon
Tars
Sewer Liles
pa' E2
W011
IiI,L� .t.
IOCFI'
J t
Material:
Number 0f Compartments:
SurfacWater
Water
�+�,
IUUi 1'
LIFT STATION
Lot
Line
r
{
�r
Sizein allons:
Manufacturer.
Foundation
7f,r
/
y /a
Y77
"Pump on'levelat
'lev
Nigh water alarm at:
curtain
Drain
Pump MasaBM
Eledncal Inspections performed
fle Y
Remarks:
BENCH MARK
Location and Descn bon:
Lei: OF tilge, OK). I I
Assumed Elevation:
I UO.00Ft
'edF.. VIA ' EAL
OF Al -411
av�c,�,••
I,a ,a
a•-V�ir�
.�.
s:
Inspections performed by: A q.4P-4 LA Dates:1st 10 Sn
rlr.�iTL{=c� �t ui
p
2nd /V S 1w.
N.ichool E. Andorran
s approval l
Department of HAVEMIDate:3
4381 . E 'a
spa••.,, .••'°�
e�GLooF�
Reviewed and approved by: -3/-73
v�
1241] ItAL Yr]a %
I
PermltNo. 5W 97,0337
age of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit No. SLA) 9 LO 337 Paye
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: L,�
9 � H061%lk�PID No.:
i
72-017A(2As)MOA20 -
+te\Na5r'
FiIMm
��......a . �-
Mishoel E. Anderson
A381•E
Permit No. _5 W 9LD 3?7
Page y of�
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LIO (�y'I as i (� PID No
7J
72-0/0 A (2M1) GOA ]S
e-v✓]Ij'Ij
�
�� l
-SAPIb -= �1 y � ��• ��(I✓
TANK
_
go
"1�71Y1
e 1—LF-NGINEER'6 EAL
L•
0 !,A^Ttl
Michael E. ndeno f40
W
0 oe`�0w'I
72-0/0 A (2M1) GOA ]S
'-,STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF WATER
WATER WELL RECORD
LOCATION OF WELL
BOROUGH
, SUBnnBNI� 19N LO/T�
-144M
!Q
UOCK
SECTION OTRB
SECTION
TONMSNIP
[IN
❑S
RANGE
CIE
❑w
yEepyym
LOCATION/SKETCH:
WELL OWNER:
DEPTHS MEASURED FROM:❑casing top ❑ground surface
WELL DEPTH: DATE OF COMPLETION
Depth of hole: ft
Depth of casing: A it t
�
BOREHOLE DATA: Depth
!.Material Type and Color From To
O
DEPTH TO STATIC WATER LEVEL:
-% tt below ❑ top of easing ❑ around surface
/ D
a
Date: 171
METHOD OF DRILLING: aair rotary ❑ cable toot
❑ other I
USE OF WELL: ddomestic ❑ Irrigation ❑ monitor
❑ public supply ❑ other I
�%S
CASING STICK-UP: ft. Diam- li IL to�ft
Casing type: .l In.,to -2—v ft
0
WELL INTAKE OPENING TYPE: ❑ open end ❑ screened
❑ perforated A open tole
J•>v
Depths of openings: _� to ft
SCREEN TYPE Diam• I In.
Slot/Mesh Size: —^e enoth: ft
GRAVEL PACK TYPE
Volume used: Depth to top:
R E C E I
_
GROUT TYPE: _ Volume:
Depth: from ft to ft
JUL 2 19
g
DEVELOPMENT METHOD: I
Duration:_ i/.. �..
Municipality of An
Dept. Health & Hume
norage
Service
PUMPING LEVEL AND YIELD: I
1 /4/ ft after /y hrs pumping do gam
PUMP INTAKE-DEPTH.---}t-Horsepowers
WELL DISINFECTED UPON COMPLETION? ❑,Y&S ONO
CONTRACTOR INFORMATION:
REMARKS:
iRFP( v&@ ' 1
PLEASE MAIL WHITE COPY OF LOG TO:
DNRIDIVISION OF WATER
PO BOX 772116
EAGLE RIVER AK 99577.2116
1993
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
July 28, 2000
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, AK 99502-0260
Attention: Dan Roth/Jeff Poet
Subject: Lot 10, Block 4, Mountainside Village Subdivision
Septic System Inspection and Certification
Certificate of Health Authority Approval
Dear Dan or Jeff:
The septic system on Lot 10, Block 4, Mountainside Village Subdivision was
constructed in 1992 to the requirements of the Municipality of Anchorage. Due to the
slope of the ground surface on the lot and the presence of groundwater at shallow
depths a massive sand bed was required to level the area and provide a minimum of 4'
separation from the bottom of the bed to the groundwater surface. The depthlof the
sand bed varied from 3.5' on the high side to 7' on the low side. The absorption bed
was then constructed atop the sand mass.
A monitor tube was placed in the bed to the full depth of the sand mass rather than to
the bottom of the actual bed itself. The additional depth of the monitoring tube was
intended to provide information concerning the actual effluent activity in the sand mass
as well as the absorption bed. The monitor tube is shown to this depth on the certified
as -built of the system which was approved by the Municipality in 1992. Unfortunately,
the installer of the septic system extended the perforations on the monitor tube above
ground contrary to the requirements of the Municipality. This has since been repaired
and the monitor tube now conforms to Municipal requirements. The depth of the tube,
however, remains to the bottom of the sand to allow monitoring of the sand mass. The
tube is currently dry to the full depth indicating the absorption bed continues to function
as designed.
On Tuesday, August 8, 2000, an adequacy test was performed on the absorption bed to
determine whether it was capable of absorbing the Municipal requirement of 600 gallons
of water per day for a four-bedroom home. The water was injected into the bed lat the
post septic tank cleanout and measurements taken periodically in the monitor tube to
note any increase in the water level in the bed. Measurements were also taken lin the
septic tank to verify that no backflow of water would occur. The entire 600 gallons of
water was absorbed into the bed and the underlying soil during the test period. No
water appeared to accumulate in the monitor tube and no backflow was noted into the
septic tank. All 600 gallons was absorbed into the bed. The bed is capable therefore of
Lot 10, Block 4, Mountainside Village Subdivision
August 12, 2000
Page 2
absorbing a minimum of 600 gallons of water in a 24 hour period meeting the Municipal
requirement for a four bedroom home.
The cleanouts in the bed are no longer at the same elevation as when o ginally
constructed. This is no indication, however, that all the piping in the bed is out of level.
Substantial landscaping and grading has taken place over the bed since original
construction probably causing settlement in the cleanouts. Additional movement can
also be attributed to seismic activity causing the sand mass to shift and the pipe to
settle or distort from original condition. Our measurements indicate the cleanouts on
the east side of the bed are within 2" of the same elevation, which seems acceptable
after 8 years. The cleanout to the west is nearly 8" lower than the southeast cleanout
and was probably subjected to a heavy load at some point in the past causing the
settlement. The water from the septic tank however, is unimpeded in its flow to tlic bed.
The piping in the bed is perforated on the bottom and the water falls out from the pipe
almost immediately as it encounters the bed. Irregularities in the piping are not
impacting the performance of the absorption bed at this time.
The original owner of the property constructed a retaining wall near the east property
line. He backfilled behind the wall with coarse gravel and placed a perforated pipe at
the wall base. The perforated pipe is then attached to a flexible drain pipe, which lies
parallel to the absorption bed and 40' to 50' to the south. The elevation of the pipe is
above or level with the bed. We could find no outlet to the pipe and assume it is
covered completely with original ground material. The owner/installer stated the pipe
was placed approximately 3' deep and backfilled with original ground. Overflow from
behind the retaining wall is apparently absorbed into the underlying soils.
The Municipal Ordinance requires a subsurface disposal field to be "100 feet from the
mean annual flood level of any surface water, major drainage course or any
source of domestic water supply." The area immediately south of the bed at th'e pipe
overflow location is in the natural drainage for the lot. During periods of heavy, runoff
such as the recent heavy rainfall some water may accumulate as overflow from the
drain behind the retaining wall is slowly absorbed into the ground. This area dries out
once the runoff is finally absorbed into the ground. This area does not appear to meet
the definition of surface water, major drainage course or source of domestic water
supply as outlined in the Municipal Ordinance.
In summary, the septic system on this lot is now 8 years old. It is exhibiting signs of use
and wear that any system would after this much time. The average life of any Iseptic
system varies greatly, but is usually 10 to 12 years. This system does not exhibit any
signs of failure and is currently capable of absorbing the minimum amount ofIseptic
effluent required by the Municipality for a four-bedroom home and is eligible for a
Certificate of Health Authority Approval. I
Sincerely,
w"� Ejtt,�
Michael E. Anderson, P.E.
VI
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOR 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSA
PERMIT NUMBER:SW920337
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:MCDONALD KEVIN W & ECHO L a77 -A40
OWNER ADDRESS:17524 WOLF CREEK DR
ANCHORAGE, AK 99503
PARCEL ID:02017247
LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE #1 BLK
4 LT 10
LOT SIZE: 77904 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
i
i
PAGE 1 QF
L
SYSTEM PERMIT
DATE ISSUED:10/06/92
EXPIRATION DATE:10/06/93
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS SYSTEM MUST BE INSTALLED AS SHOWN ON THE APPROVED
ENGINEER'S DESIGN DATED 9/27/92 HOWEVER THERE MUST BE AT
LEAST TWO FEET OF SAND FILTER LAYER THROUGHOUT THE BASAL BED
AREA.
RECEIVED
ISSUED BY:
DATE • /0 g /9L
DATE: 6�
September 27, 1992
Municipality of Anchorage
Dept. of health R Human Services
Environmental Services Division
825 "L" Street, Room 502
Anchorage, Alaska 99501
Subject: Lot 10, Block 4, Mountainside Village
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The water table on the subject lot ranges from 3-1/2' to 4' belowl the
surface. It appears the only suitable system for this lot is a mound
constructed parallel to the slope. In addition to the shallow water table the
topography of the lot is very steep varying from 10% to 15% froml the
roadway to the back of the lot. We have searched extensively for better
soil conditions, but have been unable to locate an area where a different
type of system is possible. The lots south, east and west of this property
are vacant. The systems on the lot to the north will present no conflict to
the well and septic system on this lot.
The system, if constructed as designed, will have no adverse
impacts on the wells currently in use or to be placed in the future
on lots located in the area.
2. The system, if constructed as designed, will have no adverse
impact on existing septic systems in the area or those to be
constructed in the future.
3. The system, if constructed as designed, will have no adverse
impact on reserved space either surface or subsurface on any
located in the area.
4. The system, if constructed as designed, will have no adverse
impact on drainage patterns in the area.
Sincerely,
74Gt/.ttk
Michael E. Anderson. P.E.
lots
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FERFORMEO BY: ry/• 4^jb Lcoj I �,� ���
°6iAifF'Y'iMAT TMIS EST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE .3�LLJ9l I
Municipality of Anchorage
So)
DEPARTMENT OF HEALTH & HUMAN SERVICES
Is
825 "L' Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
ERFORMED FOR: ��� I•rC bo jA b
DATE PER
EGAL DESCRIPTION: for/Dt $Ge Ol- 4 n40u�l M Ij Sr 0 e7ownship, Range. Section:
1
2
3
4
5
6
7
e
9.
10•
11 -
12-
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14-
15-
16-
17-
201
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16-
17-
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MMENTS
PT/046AA+ICs V LLAGC
Gn.A�Elu/ Sa..a0y S►rr
ML
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WAS GROUNDWATER
ENCOUNTERED} 7
PERCOLATION RATE 306 q
(r^i^uteYnth) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND 2- �2- FT
J rE 1 /1
�-kjT}iC C:FORMEDBY. •AN8E'RS0AlRTIFY HAT THIS /EEST WAS PERFORMED IN
:CROANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 9/Z%�j
,CZ JR". 4rE3) �—
S
IF YES, AT WHAT ,, II
DEPTH?
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Depth b Wtttr Atter I
MaNbrinp? Date, 9 u 2
ReadingDau Gross
Time
P/Ll Q.t- M rL "
Net
Time Wto Not
ate
Water Drop
cS7' I
9 bc5
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is— ny L"
/ S L r. u
PERCOLATION RATE 306 q
(r^i^uteYnth) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND 2- �2- FT
J rE 1 /1
�-kjT}iC C:FORMEDBY. •AN8E'RS0AlRTIFY HAT THIS /EEST WAS PERFORMED IN
:CROANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 9/Z%�j
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TEST RUN BETWEEN ' /Z- FTAND Z),Z-
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•FN.ED BY: - M• QN AE -fl SOA! I m ?1 Z
;DANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS CATS DATE:
IR t+. 4, 6:)
TEST WAS FERFORI.IED IN
Ll-- I'
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street `
P.O. Box 196650
Anchorage, AK 99519-6650 -
www.muni.org/onsit/onsite
(907)343-7904
CERTIFICATE OF ON-SITE S
- 15Svj'V4.9
Ff o6 037 6
AL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. �� 1'�ot- (47 COSA# tyo t)5)%_
1. GENERAL INFORMATION Expiration Date: !3— I R - 0
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
MOUNTAINSIDE VILLAGE 41, LOT 10. BLOCK 4
17524 WOLF CREEK DRIVE • ANCHORAGE. AK
JAMES W & TAMMY L PILGRIM Day phone
176 GROGHAN SPUR STE 200 • CHARLESTON. SC 29407-7558
Day phone
DAN LEE w/REMAX PROPERTIES Day phone 257-0115
110 W. 38TH SUITE 100 * ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
E
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
E
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (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, 1 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage riles 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. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the solo benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
S. DSD SIGNATURE
✓ Approved for 4 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
[/ Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
NHUtiHAM
By: /1� / W i — Original Certificate Date: 6-15-0-7
(R". tIVS)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragew Street
P.O. Box 198650
Anchorage, AK 995198650
www.muni.orglonette
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: MOUNTAINSIDE VILLAGE N1, LOT 10, BLOCK 4 Parcel ID: D Z 09 - /%2 - * 7
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 12/23/1992 Sanitary seal (Y/N) YES
Total depth 143 ft. Cased to 33 ft.
FROM WELL LOG
Date of test 12/23/1992
Static water level 37 ft.
Well production 6 g.p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 24 in.
AT INSPECTION
3/27/2007
23 ft.
5.68 g.p.m.
Coiiform 0_ colonies/100 ml. Nitrate 1.27 mg./L. Other bacteria _0 colonies/100 mi.
Arsenic: ND ugJL. Date of sample: 3/27/2007 Collected by: GEG Ltd.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material
STEEL
Date installed
11/5/1992
Tank size 1250 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) N/A
Date of pumping 7/19/2006 Pumper NORTHLAND PUMPING SERVICES
C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE. R IS BELIEVED THA
PORTIONS OF THE BED ARE INSULATED
Date installed 11/5/1992 Soil rating Oiid.Oorftz/bdrm) 0_4 System type MOUND/BED
Length 50 ft. Width 30 ft. Gravel below pipe 0.5 ft.
Total depth •3.25-5.9 ft. Eft. absorption area 1500 fe Monitoring tube YES Depression over field NO
Date of adequacy test 5/21/2007 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption Geld before test !tu in. Water added•'623 gal. New depth"6.5 in.
Elapsed Time: "0 min. Final fluid depth **6.5 In. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
**SEE ATTACHED REPORT
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at —in. "Pump ofP le High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAlft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface Water '80'+ Driveway, parking/vehicle storage 10'+
Curtain drain ""401+ Wells on adjacent lots 100'+
F. COMMENTS
*WAIVER REQUEST **BED DOWNHILL FROM CURTAIN DRAIN
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1. /r s/,p9-
COSA Fee $ J 150. 0 0
Date of Payment 1.s�
Receipt Number n C) C7
(Rev. 11/05)
Wainer Fee $
Date of Payment
Receipt Number
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS,
June 13, 2007
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
Ref: Mountainside Village # 1 Subdivision; Lot 10, Block 4
On May 21, 2007 a septic system evaluation was done on the subject property for the purpose of
obtaining a COSA. Prior to testing, four monitoring tubes (MT) were installed, one in each
corner of the bed, to replace the old, non-functioning monitoring tubes. The MT's to the north
and west were completely dry, while the MT's to the south and east contained approximately 6"
of water each. This supports previous investigations that the bed is out of level. All of the
cleanouts on the system were dry.
For the duration of the test, water was added to the eastern most MT and the CO adjacent to it.
The liquid level in eastern most MT rose 0.5" for a total of 7" of water in the MT. This rise
lasted for a duration of 31 minutes between 9:40am and 10:11am. After 10:11am the water
dropped back down to 6.5". It remained at the initial 6.5" for the duration of the test. The CO's
as well as the north and west MT's stayed dry for the duration of the test as well. The liquid
level in the MT to the south remained at approximately 6 inches for the duration of the test.
The post tank cleanout was monitored for water backflowing into the tank for the entire test.
There was no backflow from the bed into the septic tank. A total of 623 gallons of water was
absorbed by the system indicating that it is capable of absorbing 600 gallons a day.
If you have anyAluestions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259
Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamcsscnginecring.com
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS r -
June 13, 2007
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water R Wastewater Program
4700 Bragaw Street
Anchorage, Alaska 99519-6650
REFERENCE: Mountainside Village Subdivision #1, Block 4, Lot 10. Request Waiver of
Required Separation Distance Between the Drainfield and Surface Water.
To Whom It May Concern:
A COSA was issued for the subject property on 8/8/2006. Another firm performed the
engineering work. We were recently retained to perform an inspection of the subject well and
septic system and obtain a current COSA. Upon inspection we noted that much of the drainfield
was short on soil cover.....one area had less than six (6) inches of soil cover. We also noted that
surface water from a curtain drain was discharging water within 14 feet from the edge of the
drainfield.
To resolve the issues we imported fill, placed it over the drainfield, and hydroseeded the impacted
area. Given the natural topography, it was noi possible to grade the slopes on the mound to 3:1 or
less. In addition, we extended the curtain drain so that it discharges about 80 feet from the
drainfield. The location of the discharge is such that overflowing effluent from the drainfield
(should it ever daylight) would not run towards the surface water.
Attached is a site plan showing the curtain drain and the topography. We are requesting that your
department waive the required separation distance between the surface water and the drainfield to
80 feet. As stated previously, the topography is such that surfacing septic effluent would not flow
towards the curtain drain outfall.
If you have any questions, please contact me at 337-6179.
3701 E. Tudor Road, Suite 101 • Anchorage, Alaska 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246' www.gamessengincering.com
Municipality of Anchorage
Development Services Department
• rr Building Safoy Division
On -Site Water and Wastewater Program
4700 Bragaw Strcct
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:070031 PID#:020-172-47 HA1Permit# IIA060376
Date Received: June 19, 2007
Legal Description: Mountainside Village #1 Block 4 Lot 10
Engineer.
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Applicant: James Pilgram
Waiver Requested: 80 foot horizontal separation from absorption field to surface water
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: X Waiver is not Granted:
List Conditions or Reasons for above:
Date: 6/19107 By: Joe Goodall
Name of Reviewer
..........................................................................
Rec#: 09096 Amount: $1150 Date Paid:181 912007
m ,ibi0+.e
Mayor Nark Begich
Municipality of Anchorage
P0. Mx 1!X;(';7)0 • Anchonige, Alaska (Y47110.6rM • Telephone (!X)7) 339-(•" I • 1'ax (fX)7) SaA"fM)
4700 nmgaw Sima • Anchanige, Alaska EYM07
June 19, 2007
Jeffrey Garness, P.E.
nimmunl.ngt
Iluilding Snfcty Division
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Subject: Waiver Request for Mountainside Village #1 Block 4 Lot 10
Waiver Request WR#: 070031
Parcel ID # 020-17247
IIA060376
Dear Jeffrey Garness, P.E.:
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field to the surface water has been approved. The approved separation
distance is 80.0 feet.
This waiver approval applies to the existing absorption field to surface water 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,
tJocGoodajll
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
EXISTING 4
BEDROOM
HOUSE /
ArmJ
S(
e
DRAINAGE TO
FLOW SOUTHWEST
5
GARNESS ENGINEERING GROUP, Ltd.
• - - - -• CONSULTANTS 5 GENERAL CONTRACTORS�.�
JMI L TAM Ip10. 41AC 101-MCM]C4L MI /Y!0) • 111C,[ (907)W- 1" • fm (001)3) " A91L w..ysn,rpYrYiyw.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
WAYNE JACKSON 229-403-4972 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
MOUNTAINSIDE VILLAGE SUBDIVISION #I; LOT 10, BLOCK 4 J.N.T.
TYPE OF WORK: DATE:
40 SCALE OF CURTAIN DRAIN 1 6/12/07
a trey or
ss.
Ate. CE -7953 �`�
A
B
1 C
D
E
F
1
77.45
93.32
105.48
94.53
97.23
2
82.04
97.09
109.31
96.86
98.25
3
83.00
97.08
109.32
96.88
98.22
4
105.25
114.51
126.91 106.04
99.55
3
100.06 108.72
121.29
100.28
93.93
8
106.42
112.39
124.90
101.17
92.11
93.16
7
101.23
107.3
119.55
96.07
87.47
88.72
MTI
68.47
84.48
96.58
MT2
88.46
101.66113.92
EXISTING 4
BEDROOM
HOUSE /
ArmJ
S(
e
DRAINAGE TO
FLOW SOUTHWEST
5
GARNESS ENGINEERING GROUP, Ltd.
• - - - -• CONSULTANTS 5 GENERAL CONTRACTORS�.�
JMI L TAM Ip10. 41AC 101-MCM]C4L MI /Y!0) • 111C,[ (907)W- 1" • fm (001)3) " A91L w..ysn,rpYrYiyw.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
WAYNE JACKSON 229-403-4972 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
MOUNTAINSIDE VILLAGE SUBDIVISION #I; LOT 10, BLOCK 4 J.N.T.
TYPE OF WORK: DATE:
40 SCALE OF CURTAIN DRAIN 1 6/12/07
a trey or
ss.
Ate. CE -7953 �`�
A -A TYPICAL
4" DRAINPIPE BEDDED
IN DRAINROCK —
F-4'-5'-1
. 0
GARNESS ENGINEERING GROUP, I.td. p 9�
--.------.-- CONSULTANTS& GENERAL CONTRACTORS O""'•'• •• '• • ""' •"••'••!
)Nt L TAOI1 .OM, M.11E 101 • ANOODPACL M N 7 • n1o1L (90))1]]- M . Ntt (e01)S.M " • .umG ...q.n....iOiwYq.me
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • ••• .•••••• •••••; •••
WAYNE JACSON 229-403-4972 3 OF 3 Q P ';j ar ess:
LEGAL DESCRIPTION:DRAWN BY: QO CE -7953
MOUNTAINSIDE VILLAGE SUBDIVISION #1: LOT 10, BLOCK 4v J.N.T. DOS
TYPE OF WORK: DATE. �OQOProf oaa
PROFILE OF CURTAIN DRAIN 6/12/2007
(R.. 01M)
Municipality of Anchorage :P�
• -�1 Development Services Department i
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street 9/1 5/0i P.O. Box 196650 0(
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 6 2 O—/ 7a — 1/ 7 COSA # Q 3
Expiration Date: / I — I S O cc
1. GENERAL INFORMATION
Complete legal description Lot 10 Block 4 Mountainside Village #1 I
Location (site address) _17524 Wolf Creek Drive Anchorage, AK 99516
Current Property owner(s) _James Pilgrim Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Lisa Herrington/ Dynamic Properties Day phone 229.8822,
3111 C St. Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
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 On Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
— engineer -registered in -the Stateof Alaska.—Certificates of Onsite Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 engineers 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 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 Pannone Engineering Services LLC Phone 272-8218
Address
Engineer's Printed Name
Date S 6 O(,o
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis orthe system in
accordance with MOA DSD Guidelines R Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, X{td;tbe water usage of the family
being served by the system. These conditions arc outside the control of the evaluator of this system. Alltams eventu i
..
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that themt;�tk'no h' c�jCo� .
encroachments. PES can therefore not provide any warranty for future performance nor give any cestimatc, fho mgah . RrnI•x7f
continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole$cn 6j owner list atfg9
Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any I t whatsocv
5. DSD SIGNATURE
Approved for bedrooms.
leo 0. SCOTT caOWIMER
Disapproved. c, CE. yl 1
Conditional approval for bedrooms, with the followinip `fly
RofESS10N�
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory
Other
By;%4/,44 , /../ L' _ Original Certificate Date: S —19—OL
tn.,.. I vast
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 eragaw Street
P.O. Box 196850
Anchorage, AK 99519-6650
www.muni.org/onske
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
I
Legal Description: Lot 10 Block 4 Mountainside Village /1 Panel ID: O as 10 - 17A.
A. WELL DATA
wen type r
Total depth 14Lft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (YIN) Y
FROM WELL LOG
WATER SAMPLE RESULTS:
ft.
6.0 9 -p.m.
Well Log (Y/N) Y
Wires propedy protected (YIN)I
Casing height (above ground) 124 in.
AT INSPECTION
7202006
22 ft
4.9 g.p.m.
Coliform _Q_colonies/100 mL Nitrate 2.69 mg/L Other bacteria __L colonies/100 mL
Arsenic: 'Q' mgll Date of sample: 07.2046 Collected by: Laura Pannone
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel Date installed 1011=992
Tank size 1250 gal. Number of Compartments j Cleanouts (Y/N) Y
Foundation cleanout (YM) X Depression over tank (YM) If High water alarm (YM) NIA
Date of pumping 719106 Pumper A,+ Home Services
I
C. ABSORPTION FIELD DATA
Data installed 11PA992 Soil rating (g.p.dAe or ft=Ibdrm) 0A System type Mound
Length 50 ft. Width 30 ft. Gravel below pipe .5 I ft
Total depth I¢ ft. Eft. absorption area MW Monitoring tube Y Depression over field y
Date of adequacy test 720@006 Results (Pass/Fall) Pass For 4 bedrooms
Fluid depth in absorption field before test = in. Water addedtj gal. New depths in.
Elapsed Time: j!Q min. Final fluid depth 1.1 in. Absorption rate >= 600+ I g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date
I
-47
Date installed
'Pump on' level
'Pumit duel at _ in.
Cycle
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/Oft station on lot 100+
Absorption field on lot 100+
Public sewer main WA
Sewer /septic service line 25+
Manhole/Access (Y/N)
at
Meets alarm b circuit mWiremerrts?
On adjacent kits 100*
On adjacent lots 10M
Public sewer manholeldeanout WA
Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 7+ Property line 65+ Absorption field 10
Water main 1W A) JA Water service One 25+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One 20 Building foundation 25 Water main WA
Water Service line 25+ Surface water 100+ Driveway. perkinglvehide storage 30+
Curtain drain Wells on adjacent lots J—
F. COMMENTS
P�-
G. ENGINEER'S CERTIFICATION
I certify Mat I have determined through field inspections and A 49!!r 9
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines
in effect on, lthis dale.
Engineer's Printed Name Cs SICl 1 C�I�Ass»A k
a sm t oaowrrmr
Date�1LY oC
COSA Fee S *30 / Waiver Fee $ _
Date of Payment 9—/ O — 0(, Date of Payment
Receipt Number .Z Receipt Number
(Rev. llroe)
in.
MunicipalitN'of Anchor.
!� -- Department of Health and Human
Division of Environmental Services
On -Site Services Section 825 "L' Street R
P.O. Box 196650 Anchorage, AK 99519
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORIT
Parcel I.D. 020-172-47
FORA SINGLE FAMILY DWE'.
HAA#
Expiration Date: I
GENERAL INFORMATION
Complete legal description Lot 10, Block 4, Mountainside Village
Location (site address or directions) 17524 Wolf Creek Drive
Current Property owner(s) Dave & Kerryann Scott Day phone 229-11637
Mailing address 177
Lending agency
Mailing address
Real Estate Agent
Mailing Address
eek Drive
9951
Day phone
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Four (4)
TYPE OF WASTEWATER DISPOSAL:
I'm Individual On-site
Individual Water Storage p
Community Class Well
Public Water System
Individual Holding Tan
Community On-site
Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by ari 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) on properties served by a single �amily cn-site
wastewater disposal and!or water supply system. DHHS also issues HAAs upon request to home owners.
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 less than 30 days ofd. Certificates
are valid for one year for properties served by Class A or 6 wells or a public water system. The Municipality
of Anchorage is net responsible for errors or omissions in the professional engineer's work.
72 C:5 igov 01 00�
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 Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson En ineerinq Phone
522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 8/12/00
6. DHHS SIGNATURE
_L,-' Approved for L_ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
ENGINEER's
STAMP
bedrooms, with the following stipulations.
Attachments:
HAA Checklist Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: /)." /t . , !/" / C-C/t Original Certificate Date: 9- 2 9 -O O
Expiration Date: / / - a C/- 0 o Reissue Date:
75C:5,Rev O'.COP
Legal Description:
A. WELL DATA
'Municipallty of Anchorage
Department of Health and Human Service
Division of Environmental Services W1
On -Site Services Section 825 V Street Room 502
R ECE IV ED ,��
P.O. Box 198850 Anchorage, AK 99519-6650 G 1420
VYWW.CI.anChorege.ak.Us MJNK.IVALIrr Of ANCHC Ls
(907) 343-4744 V"'Uk MEMAL gERyM DIV13r:
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 10, Block 4, Mountainside Vi
Well type Private If A, B, or C provide PWSID #
Date completed 12 23/92Sanitary seal Yes
Total depth 14 4 It Cased to 3 3:. it
Date of test
Static water level
FROM WELL LOG
12/23/92
37 It
Well production 6 9 -p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml Nitrate 1 . 87 mgll
Date of sample: 8/4/00 Collected by: MEA
S. SEPTIWHOLDING TANK DATA
TankType/Material steel
Well Log Yes l
Wires properl
Casing height (above
AT INSPECTION
6/00
22 It
4.5
9•i
I.D.:
72-4T—
Yes
Other bacteria 0 coloniei/100 ml
Date installed 1 1 /92 Tank size 1 , 250 gal Number of Compartments 2
Cleanouts Y Foundation deanout Y Depression over tank N High water alarm N
Dateofpumping 8/11/00 Pumper Old MacDonald's
C. ABSORPTION FIELD DATA
Date installed 11192 Soil rating (g.p.d./ft2 or ft2/bdrm) .4 System type Shaljow Bed
Length 50 It Width 30 It Gravel below pipe .5 It
in.
Total depth -!--7—ft Effective absorption areal. 5042 Monitoring tube Y Depression over field N
Date of adequacy test 8/8/00 Results (Pass/Fail) PassFor 4 bedrooms
Fluid depth in absorption field before test 0 in Water added 600 gal. New depth 0 in.
I
Elapsed Time: 0 min Final fluid depth 0 in Absorption rate >= 600 g.p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
72 026 (aw. 01=)'
D. LIFTSTATION - N/A
Date installed
Size in gallons Manhole/Access
"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 tankAift station on lot
> 100' On adjacent lots >100'
Absorption field on lot
>100, On adjacent lots >100,
Public sewer main
N/A Public sewer manhole/cleanout N/A
Sewer /septic service line
>25' Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation > 5 '
Property line >5' Absorption field >5'
Water main N/A
Water service line > 10 Surface water > 100'
Drainage 50 13
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Building foundation >10' Water main II/A
Water Service line > 10
Surface water >100, Driveway, parking/vehicle storage >250
Curtain drain None Noted
Wells on adjacent lots >100'
F. COMMENTS
J See Attached Letter �
G. ENGINEERS CERTIFICATION •.�}���• ((� �J
I certify that I have determined through field inspections and ERV,'
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. f, ,
Engineer's Printed Name Michael E. Anderson, P.E.it
� 2000
Au st 12
Date 9 � •'
�- Vis:•-r,r�iwrlrr�-�
HAA Fee $ C CV
Date of Payment X I I'f fl -v
Receipt Number 40 z V q C (7 Zfl7
72.026 (Rev. 01/00(•
Waiver Fee $
Date of Payment
Receipt Number
FARRIS DYNAMIC DIRECT FAX V 907-261-76M 148/10/00
Sent By: Alaska Water & Wastewater Consu; 907 338 3246 012.S6PM 02/2
Aug -10-00 11:26; I Page 2/2
ALASKA WATER Sr WASTEWATER'
CONSULTANTS, INC.
WELL FLOW TES T DATA
I
(Lt�"E
NUMBER OF BEDROOM. ` GALLONS PER DAY NEEDED: 6Do—
'WELL, "SEE H.A.A. SITE VISIT CHECKLIST* DATF OF TEST:
1. Casing Height Ab ve Ground): —2—
2. Sanitary Seal: E�O (if "NO' , describe in Comments)
3. Wires in Conduit: / NO (if "NO", describe in Comments)
4. Water Samples Needed: YES / (Zif "YES date taken: )
5. Depression around Well: YES if "YES", descn' e m Comments)
6. Does Well need Four Hour Flow Test (FHA): YES / N(
TIME
METER
READING
NUMBER OF
GALLONS
FLOWRATE STATIC
G.P.I. WATER LEVEL
I
DRAWDOWN
L(� I
6214
c o
z
f l 1
32
1 iitl 63 z
y: 1
o
1
47-
675I'i
co
61.
1 1
I
I
1
WELL PRODUCTION: GPM ( GALLONS IN MINUTES)
Comments:
Signature:
Date:
69cR e c e i v e d Ti m e2•A u s .10 . aol 1: 5 6Ail>504 • Ph: (907) 337-6179 • Faa: (907) 338.3246 • aww, malaskamet
4
ALASKA WATER �& WASTEWATER
CONSULTANTS, INC.
July 14. 2000
Dave Scott c%
Dynamic Properties
3111 C Strect
Anchorage, AK 99516
Atte Pete Farris
Subject: Well and Septic System Evaluation at Lot 10, Block 4, Mountainside Village
Dear Mr. Scott, I
Per the request of your agent, we performed an evaluation on the septic system which I ryes the
subject property. The results of our investigation are summarized as follows:
WELL TEST: Prior to the start of the well test (on 7/12/00), the static water level was 30 feet
below the top of the casing. Over a period of 135 minutes, 601 gallons was pumped from the
well (4.45 gpm) with only 51 fret of drawdown. Based upon this data it was concluded that the
well meets the MOA flow requirements for a four (4) bedroom house (600 gallons per day).
SEPTIC: According to MOA records the septic system consists of a 1250 gallon steel I septic
tank and a bed type drainfield (both installed in November of 1992). It was incorrectly noted on
the 7/2/98 Health Certificate that there is a monitoring tube in the drainficld. The monitoring tube
utilized for the 7/2/98 adequacy test is a perforated pipe that extends to the bottom of the sand
mound that the drainfield was built on. During our site visit we used a surveyors level to shoot
the elevations in all of the drainfield pipes. The so called 'Ynonitoring tube" extends
approximately 5.74 feet below the highest drainfield clean-out elevation, rather than 6 inches (as
would a properly installed bed monitoring tube). The invert elevations of each clean-out were
measured (89.36, 90.06, and 89.86), and it was determined that the drainfield is out of level as
much as 8.4 inches. The drainpipes should be level (within about 0.25" to 0.5'). We discussed
this concern with the MOA (Jim Cross, PA @3434360) and he indicated that he would be
receptive to issuing a health certificate as long as it passes an adequacy test.
In order to perform the adequacy test it will be necessary to install functional monitoring tubes at
each comer of the bed (4 are necessary because of the fact that the bed is not level). • Q,Ur
..ter• r
6901 Debarr Road, Suite 2-B • Anchorage, Alaska 99504
Ph: (907) 337-6179 • Fax: (907) 338-3246 * website: akwwc.com
t
86ed :aL:EL 00.8Z•Tnt•
!9bZE BEE LOR `nsuo, �eleaalser,� q .Ja1e!� eNseTy :.5a :ues
SEPTIC SYSTEM IS TOO CLOSE TO SURFACE WATER: The drain5eld is only about 27
feet from surface water that is running from the northeast to the southwest across the lot. It is
unlikely that the MOA will issue a waiver to this surface water. Consequently, it will be necessary
to install buried culvert/pipe that will charnel this water subsurface until it at least 100 feet from
the drain5eld. AWWC, Inc. can perform the design, solicit bids, and inspect/document the
installation.
The following is a summarization of the engineering costs associated with the proposed work:
• Charges to date for records research, well test, septic evaluation, and preparation of report:
$600.00•
• Engineering services to coordinate & inspect the installation of the monitoring tubes: $125.00
• Installation of the monitoring tubes: please call us for recommended contractors.
• Engineering services to design and inspect the installation of a drainage system to eliminate
the surface water: $85.00/hr, estimated total cost of $850.00 (the actual cost will depend
upon the method of construction and the number of inspections required).
• Adequacy test on the drainfield after the monitoring tubes are installed: $400.00, plus septic
tank pumping (if necessary).
The items marked with an asterisk must be paid prior to submitting the design package to
the Municipality of Anchorage: I
After the repairs and the adequacy test are perfomud (and the system passes), we will need to do
the following prior to sale of the house:
• Take water samples to test the water for coliform bacteria and nitrates: $100.00 1
• Apply for a Municipal Health Authority Approval (HAA). The Municipality charges $300.00
to process the HAA.
If you have any questions, please contact us at 337-6179 or visit our website at akwwc.com We
look forward to assisting you with your engineering needs and will do our best to provide a cost
effective solution.
JAG/gd
6901 Debarr Road, Suite 2-B • Anchorage, Alaska 99504
Ph: (907) 337-6179 • Fax: (907) 339-3246 • website: akwwc com
_.._ __ -' "' ...�-... ...._ ...,- ....,.... ��,r•..atse�+ � 9eiea� ersety :•t6
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 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 acid/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 less than 30 days old. (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 welts or a public
water system. The Municipality of, Anchorage is not responsible for errors or omissions in the professional
engineer's work.
I.
ANDERSON. ENGINEERING
P.O: BOX 240773
ANCHORAGE_, AK 99524
522-7773' 522-6779 FAX
MEMORANDUM
DATE: April 25, 2001
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 10, Block 4, Mountainside Village Subdivision No. 1
Certificate of Health Authority Approval
The water samples for the previous certificate issued on this property have expired. We
are therefore submitting new water sample test results and are requesting the certificate
be reissued. A new certificate is attached for your review along with the test results.
Please review this information and reissue the certificate. Call if you have any
questions. Thank you for your time regarding this project.
U-24-01 18:11 FR011-OTE ENVIROMENTAL
CT&E Environmental Services Inc.
CP&E ReLN
Client Name
Project Namely
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
1011938001
Anderson Engineering
Mountainside Village
Lot 10 Block 4
Drinking Water
0
i
5615301 T-655 P.01/03 F-831
Client POp
Printed Date/time 0424/2001 11:13
Collected Date/rime 04/182001 16:30
ReceivedDate/flme 04/192001 14:45
Technical Director Stephen C. Ede e
Released By I A
Allowable Prep Analysis
Panmew Results PQL Units Mahal Limits Dam Dau Init
Waters Department
Nitrate -N 1.66
Microbiology Laboratory
Total Coliform 0
Received Time Apr -24- 5:13PM
0.500 mg/L EPA 300.0 10 rnaz
0 cot/100ml. SM189222B
04/19101 sCL
04/19101 SKW
04-24-01 16:12
AL
FROW-CTE ENVIRONIENTAL
5615301
ME Environmental Services Inc.
Laboratory Division
i
T-655 P.03/03 F-831
200 W
Drinking Water Analysis Report for Total Coliform Bacteria T cho
READ INSTRUCTIONS ON REVERSE SID£ BEFORE COLLECTING SAMPLE Faz: i9i
MUST BE COMPLETED BY WATER Surruttc
13 PUBLIC WATER SYSTEM LD. R
D PRIVATE WATER SYSTEM,
O Send Rasmus C1 Send to"Ice
.. .
M Y
Y. w
Yy
S dnhs O Seedlneolee
"QOE
pjbJ6�
�0 Ro 1c ZJo-IV^
MYIW
1,J 01,48 rt.lkb t�5
SAMPLE DATE: go -q ® M
Month Day Year
SAMPLE TYPE:
Routine O Treated Water
t7 Repeat Sample (for routine samFle X�, Untreated Water
with lab ref. no. )
Cl Special Purpose
SAMPLE LOCATION
Id r-10 9 (.0 L jL- `% .11
Comments:
Time
Collected
Collected
r" •
,By
4
rw
Patter Drive
mile. AK 99618-1606
Analysis shows this Water SAMPLE to be:
'< Satisfactory
p Unsatisfactory
D Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be over3lohours old at examination
to indicate reliable results. Please send
new sample via specie delivery snail.
Date Received 'L
Time Received 'T
Analysis Bean
Analytical Method: `b MMeMG-MUOFilter
• Number of colonies/100 ml.
• �It* Analyst
101 1938 of 4LJ
I
kr Jun
Date: Time:
Client notified of unsatisfactory results:
❑ i
Phoned
Date: _
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform
Membrane Filter.. Direct Count O
Verification: LTB BGB
E. Cori
COLIFIRM
Spokt with
Time:
C0lmdes/100 ml
Fecal Collform Confirmation
Final Membrane Filter Results /I) Collfrrmino0 ml
Reported By Date T 20 r Time «� bra
Faaed
F1 d
TNTC -TN N.n sTi CJ.•w
os-ate.aavnJ
V�_ ; iMembor of tho 606 Group lSoei/te GMMaIe de Surveillance) _
ENVIRONMENTALR e C 6 i V e d T i.m e— r • 24 •3I 5 •.I .;IDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA
12-29-00 ?11:51 FROU-CTE ENVIRONIENTAL 5615301 T -762 P.03/03 F-570
//1�� CME Environmental Services Inc.
W Laboratory Division
200 W. Poner Drive
Drinking Water Analysis Report for Total Coliform Bacteria Anchorage. AK 99616.1606
Tei: (907) 562.2343
READ INSTRUCTIONS OA' REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561.5301
11y
O PUBLIC WATER SYSTEMLD-ff
C3 PRIVATE WATER SYSTEM
WA
O Send Resefts 0 Send/areice
.. .
S.
H
0 Sind Results 0 Sendlmeice
AA .t4C%Oe.I �iJL y�l E't7t(iJL
r«...�e,. Z-YO713
PO go+c
„ ; c,�3 fLe Gc ASL Rq:5 Z-4
SAMPLE DATE:
Month
SAMPLE TYPE:
-1k Routine
O Repeat Sample (for routine simple
with tab ref. no. )
D Special Purpose
SAMPLE LOCATION
Or -!De BGp Glc.
A0;j4-,* "( j §I� 1�/WICK
Comments:
1
Lz- oo
Day Year
O Treated Water
O Untreated Water
Time Collected
Collected By
/ a: 3o AM MCA
rkue rmr
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
.bt Satisfactory
O Unsatisfactory
Cl Sample over 30 hours old, results may
be unreliable
0 Sample too long in transit; sample should
not be over3 lPhouts old at examination
to indicate reliable results.' Please send
new sample via special delivery mail.
Date Received Ia'aa-d-o
Time Received 13 ,?b 1,
Analysis Began I®�
Analytical Method: 0 MM brans Filter -MUG
0078?7 esult• Analvst
W O CeCJ �/
Seat [o A.D.E.C. Arch Fbks Jun
Fated
Dam: Time: -
Client notified of unsatisfactory results:
❑ 1 ❑
Phoned Spoke with Fated
Dam: _ Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO.MVC Result! Total Collferm Ji, Coli
Membrane Filter: Direct Count O K/O (JiL(� Colonies/100 ml
COLI FIRM LVTC-Tr Iv a ..T.4.r
Verification: LTB BCB i
Oe-Oweeenem
Fecal Coliform Confirmation
Final Membrane Filter Results ColiforMlOo ml
Reported Bv7' Datc /�' �3 Time 1G c�1 bra
Z�3i7 M -tuber of the SOS Group iSociati Ganarale du Surveillance)
Received Time ec,29•-11:53AM
ENVIRONMENTAL FACILITILS IN ALASKA, uALtrOMNM. rkurt10A, ILUNOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO, WEST VIRGINIA
12-29-00 11:50 FROWCTE ENVIRONIENTAL
L1G • CUE Environmental Services Inc.
■r[a• �rrrrrri�.rrrirrrrr�
CT&E ReLn
1007877001
Client Name
Anderson Engineering
Project Name/#
Mountainside Village
Client Sample ID
Lot 10 Block 4
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Remarks:
5615301 T-762 P.02/03 F-570
Client PO#
Printed Datefrime 1229/2000 9:06
Collected Datelrime 12222000 10:30
Received Date rime 1222/2000 13:20
Technical Director Stephed C. Ede
Released By
i w&
Allowable P
Parameter Rcsalu P L Units Mahod rete, Analysis
Q IJmlts Date Date Init
Waters Department
Nitratc-N 1.73 0.500 mg/L EPA 300.0 10 max 12/22/00 SCL
Microbiology Laboratory
Total Coliform
0
Received Time Dec•29. 11:53AM
col/IOOmL SM189222D
12/22/00 SKW
MUNICIPALITY OF ANCHORAGE
• �'- DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska., 99519-6650
343-4744.
CERTIFICATE OF HEALTH AUTHORITY.
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 02017247
2.
3.
4.
HAA #� 96017 `
GENERAL INFORMATION
Complete legal description Lot 10. Block 4, Mountainside Vi lage
AAdit-ion No 1
Location (site address or directions) 17524 Walf Creek Drive
Property owner xevi n and Frho Mt Donald Day phone 345-00 I 07
Mailing address 17524 Wolf r k Drive Anchorage AK 99516
Lending agency Day phone
Mailing address
Agent
Address
Unless otherwise requested, NAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Four (4)
xxx
Day phone
NOTE: If community well system, provide written confirmation from State
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
NOTE:
Holding tank
Community on-site
Public sewer
attest -
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-M(Rw.1/91) Frof MOA.21
Y
$. STATEMENT OF INSPECTION SY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm __Andersnn Engineering • Phone 522-7773
Address P.O. Box 240773 Anchorage AK 99524
Engineer's signature -n^Ld (f Date 7/2/98
6. DHHS SIGNATURE
Approved for1=06JI2 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
•
bedrooms, with the following stipulations:
Date 7- 2-7g
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof 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-M (RM. 1/91) Ba MOA M
i,
e Municipality of Anchorage D
DEPARTMENT OF HEALTH & HUMAN SERAW E I V E D
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (90w"M8
Municipality of Anchorage
Health Authority Approval Check %* Health & Human Samc9s
Legal Description: Tat 1n, Block 4, Mountainside Parcel l.D.: 02017247
4
A. WELL DATA Village
Well type Private If A, 8, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) V Date completed 12/23/92
Total depth 143' Cased to 33' (Bedroc)Sising height (above ground) 12'
I
Sanitary seal (VIN) Y Wires property protected (YM) Y
FROM WELL LOO AT INSPECTION
Date of test 12/23/92 6/27/98
e
Static water level '17' 13'
Cteanouts (Y/N) Y
nate mstacea i t / o!ya 5011 rating (g.p.dAP or tt'/bdrm) •'a System type _ Had
Length 50' Width 30' Gravel ft duress below pipe .5' Total depth 3' —7'
Effective absorption area —JAHk%lonttoring lube present (Y/N) Y war er field (YMI ) N
Date of adequacy test 6/27/98 Results(PassifFaiQ Pass For Four I bedrooms
Fluid depth In absorption field before test (in.); 0 Immediately afteb48 gal. water added (In.): 0
Fluid depth 0 (ins) Minutes later: 0 Absorption rate = > 6 0 0a.1
Penmdds treatment (past 12 months) (Y/N) N If yes, give date
72-026 (Rev. 3/96)-
D. UFT STATION -
None on Lot
Date installed
Manhole/Access (Y/N) _
High water alarm level at' _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at'
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at'
Septic/holding tank on lot >100' On adjacent lots >100,
Absorption field on lot >100, On adjacent kits >100,
Public sewer main miles Public sewer manhole/cleanout Miles
Sewer /septic service line >10, Lift station Nnno nn T.nt
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation > 5' Property line > S' Absorption field > S'
Water main/service line > 10 Surface water/drainage >100' Wells on adjacent lots >1001
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation
Water maintservice line > 1 0'
Surface water >100' Driveway, parking/vehicle storage area >20'
Curtain drain None on Lot Wells on adjacent lots >100,
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field hupecfions and review of Municipal e systems are
in conformance with MOA HAA guidellnes in effect on this date.
Signature ru4Aall
Engineer's Name Michael E_ Anderson, P -E. .
Date 7/2/98.4DER5vrJq
E.4,
r 4361-E
HAA Fee 3 300-400
Date of Payment7�2hq,
Receipt Numbero 3 766,23 766 6SS2
72-026 (Rev. 3/96)'
Waiver Fee $
Date of Payment
Receipt Number
N'.J . ;iPALITY OF ANCHORAGE
DEPARTMEN , OF HEALTH & HI,MAN SERVICES a� ^
Divisior of Environmerta: Services
O:. -Site Services Section
P.O. Box 19E�5:; Anchorage, Alaska 99519-6C"3
343-4744
CERTIFi%, TE OF HEALTH AUTHORITY
APPROVAL FGR A SINGLE FAMILY DWELLING\^
Parcel I.D. N (1Lp17 Z' -y7 HAA # 'A c):
1. GENERAL INFORMATION
Complete legal description LO7' lo �`Ctic- `/ AAov�r'—'1f DG
V/1 i L A 6 C- A t) o,.j . nio. l
Location (site address or directions)
Property owner j9c %It ^J AHC by JAW Day phone
Mailing address I7S7-A10(.j Ctenc f>�z -Vc I
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA wil'; /b., bald for pic.'rup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, pr_',Jde written confirmation from State ADEC attest-
ing to the legality and status system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater sys em, provide written confirmation from State ADE C
attesting to the legality and s.etus of system.
1b025JAw.1/91) Frml MOA921
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 4^10 crt SorJ t "jG rJc Lai rJ (, Phone S4q – ` G S l
Address rU I L��<)K `�V I y-'� /77V U, r _ rrr`
Engineer's signature 74CZ-41.L Date
6. DHHS SIGNATURE
X Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
M
ael E. �.ndurson
4201 •E
PROPEL'
bedrooms, with the following stipulations:
Date .3 –_3/—/Z?
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
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Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: lor/B Le elf 4/ N%"wwA',tc'deParcell.D. DLat7Z'i7
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A. WELL DATA
Well type RV47=' If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Y
Datecompleted/ZlZ319Z
Driller Atnr,��
z%K/t UrJL
Total depth
Cased to 33 Casin9 het ht Z i
9
Sanitary seat (Y/N) Y Wires properly protected (Y/N) Y
Date of test
Static water level
Well flow
FROM WELL LOG
/Z�23�q Z
37/
g.p.m.
Pump level I%.r X -,Q () W of
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /0Z r 't-
,
Absorption field on lot /as 4 -/Ob
On adjacent lots
Public sewer main ii/%r "CSPublic sewer manhole/cleanout / I SIS
Sewer service line > SD / Petroleum tanka4/� I
WATER SAMPLE RESULTS:
Coliform AL --4--C PTARLC Nitrate -�� /L Other bacteria
Date of sample: - 3I/7I93 Collected by: A4 C_ i
B. SEPTIC/HOLDING TANK DATA
Date installed //5 9Z- Tank size �ZSO Compartments TI 0
J/r
Cieanouts (Y/N) _L_ Foundation cleanout (Y/N) Y Depression (Y/N)�
High water alarm (Y/N) A] Alarm tested (Y/N)
Date of pumping ICUJ C4 /J ST T/0 n►_ -Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot /OZ f Onadjacentlots >/007 Foundation— 7 ,
I� I
Topropertyline- (019 Absorptionfield /Z Water main/service line Sb/
Surface water/drainage- �O-- /YOn1C MrA
72-026 (Rev. 791) Fm l t
CONTINUED ON BACK PAGE
AT INSPECTION
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On adjacent lots i/DO
,
Absorption field on lot /as 4 -/Ob
On adjacent lots
Public sewer main ii/%r "CSPublic sewer manhole/cleanout / I SIS
Sewer service line > SD / Petroleum tanka4/� I
WATER SAMPLE RESULTS:
Coliform AL --4--C PTARLC Nitrate -�� /L Other bacteria
Date of sample: - 3I/7I93 Collected by: A4 C_ i
B. SEPTIC/HOLDING TANK DATA
Date installed //5 9Z- Tank size �ZSO Compartments TI 0
J/r
Cieanouts (Y/N) _L_ Foundation cleanout (Y/N) Y Depression (Y/N)�
High water alarm (Y/N) A] Alarm tested (Y/N)
Date of pumping ICUJ C4 /J ST T/0 n►_ -Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot /OZ f Onadjacentlots >/007 Foundation— 7 ,
I� I
Topropertyline- (019 Absorptionfield /Z Water main/service line Sb/
Surface water/drainage- �O-- /YOn1C MrA
72-026 (Rev. 791) Fm l t
CONTINUED ON BACK PAGE
C. LIFT STATION ,
Date installed
Size in gallons
NIA
Manufacturer _
Manhole/Access(Y/N)
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots",
"Pump off" level at
Cycles tested
Surface water
Z O t1 01.1C)
Date installed 1115 I6 Z— Soil rating ' q GP' A� System type
� 1
-Length Width 3pi Gravel thickness Sf Total depth +3 7y +7
'Total absorption area �SoO a Cieanouts present (Y/N) �
Depression over field (Y/N) N Date of adequacy test /` //t �/J ST-/wun00
Results (pass/fait) JDA55 for `f bedrooms
Peroxide treatment (past 12 months) (Y/N) AJ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 105 Onadjacentlots Propertyline
�ITo building foundation 25 To existing or abandoned system on lot !�
r f
Onadjacentlots M0 AJC Cutbank AIDNC Water main/service line S�
Surface water 14D"JL Driveway, parking/vehicle storage area
Curtain drain /Vtwc
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature A�J ^ Jo :• e^`?' r C,
/+ 11 C4l.r4CL H
E N01.'RSOnJ F'ic : CcC1TH :ss is
Engineer's Name �•••• ....................
....... �•°• •°•Y+• "l7 : ' �°.
Date -?/L2193 �.................
0 1;% Michael E. Anderson
4381 • E ,• \.d
• � .. yr
HAA Fee $ / 70 ` 'Waiver Fee: $ -
Date of Payment 3" u � 2 Date of Payment
Receipt Number S LL3%� Receipt Number
72-M (A". W)9•ck MOA 21 '