HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 7 LT 8
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP251014
Work Type: SepticTank Upgrade
Tax Code Number: 01743208000
Effective Date
Expiration Date:
Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 7 LT 8 G:2839
Site Mailing Address: 12641 LUPINE RD, Anchorage
Owner: MCMICHAEL CHARLES R
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
1 /23/2025
1 /23/2026
Lot Size in Sq Ft: 19032
Total Bedrooms: 4
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: 70 P G1 Date:
Issued By: ' Date:
V\
'W
MUNICIPALITY OF ANCHORAGF,
Development Services Department
Phone: 907-343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I. D. 0 17-432-08
Property owner(s) CHARLES R MCMICHAEL Day phone
Mailing address 3005 DAUFASKIE ROAD SUMTER SOUTH CAROLINA 29150
Site address 12641 LUPINE ROAD ANCHORAGE, ALASKA 99516
Legal description MOUNTAIN PARK ESTATES #2 BLOCK 7 LOT 8
Number of Bedrooms 4
Engineering Firm FIRST WATER CONSULTING
Building Permit Number
Not Applicable FN
APPLICATION IS FOR: APPLICATION IS AN:
(Z all that apply)
Absorption Field
❑ Initial ❑
Septic Tank
Upgrade
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees:
Date of Payment: _
Permit No. CS P -z- -/ 0 14-1
Waiver Fees:
Date of Payment:
Waiver No.
Distance:
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
!
!!
January 23, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC S.T.E.P. TANK UPGRADE PERMIT
LEGAL: MOUNTAIN PARK ESTATES #2 BLOCK 7, LOT 8
The owner has requested that we obtain a septic permit to upgrade the existing aged steel STEP
septic tank on the above referenced lot which has become nonfunctioning and is in urgent need
of replacement. We propose to install a 1500-gallon HDPE STEP tank per the attached design
to serve the existing 4-bedroom residence.
Groundwater was noted in the MOA on-site file and is not anticipated to affect the septic tank
installation. However, if groundwater levels are encountered & determined to affect the
installation of the tank, buoyancy measures may have to be taken, and the tank anchored and/or
an epoxy coated steel septic tank or other action may be required.
The lot and area are served by private water and any encroaching wells, easements, … must be
staked prior to construction. The design will not impact any of the neighboring properties.
Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251014, Curtis Townsend, 01/23/25
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
STEP SEPTIC TANK
DESIGN DETAILS:
MOUNTAIN PARK ESTATES #2 BLOCK 7 LOT 8
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251014, Curtis Townsend, 01/23/25
:. Municipality of Anchorage Page ! of ~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal Syst. em and/or Well Inspection Report
Permit Number: .~t_~ ~._q'c~ PID Number: ~[~- ~3~-~
N~m~: Wastewater System: D New ~ Upgrade
~r~: . ABSORPTION FIELD
Phone: No. of Be~ooms:
~_//~ D Deep Trench ~ShallowTrench D Bed D Mound D Other
LEGAL DESCRIPTION so, Rating:/~ GPD/Sq. Ft. ~~T°tal Depth from~,~origin~ grade:
Lot: ~ BIock:~ ~A~ ~~Subdiv~iOn: Dep~boUo~rom originalgrade:~ ~.~ Ft. Gravel depth beneath pipe/~lt ~1 Ft~
Township: [ Range: ~ Section: Fill added above original grade: Gravel length:
~ ~ ~ Ft. ~ ~ / Ft.
I
I
WELL: D New D U pg rade Gravel width: ~ Number[ of lines: DJstance_obe~een_ lines:Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: /
Ft. Ft. ~ SQ. Ft. ~ 3 q~ST~
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Ft. ~,~ ~~ II--l
Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TANK
SEPARATION DISTANCES ~ Septic a Holding ~S.T.E,P.
TO Septic Absorption Lift Holding >ublic/Private Manufacturer: Capacityin gallons:
From Tank Field Station Tank Sewer Lines ~ ~C~ ~ [~ ~ ~
Material: Number of C~paHments:
S~ac~ LIFT STATION
Water ~ l o~ ~ / ~ ~ ~ 1~ ~
Lot Sizein gallons: Manufacturer:
Foundation ~ NZ~ 1~~ -- ~ "Pump on"N~level at:I~ "Pump off"N/level at:I~ High water ~ alarm
Electrical Inspections pe~ormed by: ~-~ &~
CuAain Drain ~ ~[A ~[~ ~ ~ Pump Make & Model ~ ~
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
2nd lt-t~ '
Department of H ea~ Human Services approval '&~:~.~'~-~///~,~,.~....~._%,~, ~. ~...~?:~'~..~ ~, .,, ~'
72-013 (Rev. 9/91) MOA 25
I I I
·, AS-BUILT
' A-1=42,3' ]]-1=71,6'
WASTE~/ATER ABSORPTION SYSTEM A-2=44,4' 3-2:47,0'
/~-3:87,8' l]-3=30,2'
Lo~ 8, 9iota 7, Moun~tn P~rk Es~, ~2 ~-4=26,4' ~-4=39,8'
A-5=21,1' B-5=34,5'
Neighboring well, A-7=20,8' ~-7=28,4'
50 ~eet to system '
100+ ?ee~ ~o ~ ~ ~~1~ ' ' '
Neighboring
50 ¢ee~ ~o
Existing system
Ne~ 1500 G ~TEP T~nk ~b~m~one~ Im prince,
~ Neighboring well,
' 50 Cee~ ~o system
Existing ~
4 bedroom ho
* Existing Wett
Lupine 9PIve
Use ~ 5 ~i~e
~ .............. ~ For ~ 4 9edroom House - 500 SF Is Requlre~
~ ~.." · "*..~'~. Nee~ 84 L,F, o¢ 5-~lde Trench ~/6' oF Gr~vet
l~' 49~ ~ Need New 1500 Gallon S,T,E,P, Tank
.-~ .................... ~ To~[ 3epth Is 4 ¢ee~, EFCec~lve 9ep~h 0,5
I
~:?~~-.~ .......... ;.~.~.~m 'PREPARE9 FUR, STEVEN R, PANNDNE, P,E,
~ ~Steven R. Ponnone,~
~.'o~ .~ ~avl~ 3ennlg P, D, BOX 142025
e~y~...~llt~.....~-~~~_ 12641 Lupin Drive ANCHORAGE, ALASKA 99514
'~,~2 ............. ~',.~.~ Anchorage, AK 99516 272-8218
~~~ ~ATE, 11-18-95 ] AS-BUILT
A -BUILT ]}ETAIL
VASTE~/ATER ABSORPTION ~YSTEM
Lo~c 8, Block 7, Mountain P~rk Est, ~8
.LflDN¥,3-13
:~[n.L
Z
I'-I
F-
W
NDZ£V~NnDJ
PREPARED FOR,
David Benni9
18641 Lupin Drive
Anchorage, AK 99516
STEVEN R, PANNDNE, P,E,
P, D, BOX 142025
ANCHORAGE, ALASKA 99514
274-030B, 272-8218 FAX
DATE, ~1-18-95 I
NOT TO SCALEI AS-BUILT
RECEIVED
NOV 2 9 1995
Municipality of Anchorage
Dept, Health & HUman Services
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950384
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NAME:BINNING DAVID R & CAROLE S
OWNER ADDRESS:12641 LUPINE RD
ANCHORAGE, ALASKA 99516
PARCEL ID:01743208
PAGE 1 OF 1
DATE ISSUED:il/13/95
EXPIRATION DATE:il/13/96
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES #2 BLK
7 LT 8
LOT SIZE: 18720 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY~~
ISSUED BY: ~?
DATE: lt-!
DATE:
Steven R. Pannone, P.E.
Consulting Engineer
P.O. Box 142025
Anohorage, Alaska, 99514
(907) 274-0308
(907)272-8218 Fax
November 6, 1995
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Lot 8, Block 7 Mt. Park Estates #2
Upgrade permit
Gentlemen:
My firm recently conducted a Health Authority Approval investigation at the above referenced property. I
found the existing trench type system in failure. There was approximately eight to ten inches of fluid above
the laterals of the bed. I was requested to investigate the possibility of installing a new system adjacent to the
existing system. Two test holes were excavated on October 27. The soils reports and percolation test results
are attached. Ground water was encountered eight and a half feet below the surface.
The lot is approximately an half acre in size. It slopes to the west at a rate of approximately two to three
percent. The proposed installation will be located greater than 100 feet away from the welland 25 feet from
the water service lines. Lot 9's system is located along its southern property line and is approximately 50 feet
from the proposed system. Lot 7's system is located along its northern property line and is approximately 50
feet from the proposed system. Both neighboring wells are located greater than 100 feet from the proposed
system. Soil absorption systems east of the proposed installation are located greater than 50 feet away. The
existing septic tank will be removed. A new 1500 gallon S.T.E.P. tank will be installed to lift the effluent
from the house to the field. The existing soil absorption field will be abandoned in place.
If you have any questions about the proposed installation, please contact me at 272-8218
Sincerely,
~teven R. Pannone, P.E.
I I I
· - DESIGN
WASTEWATER ABSDRPTIFIN SYSTEN
Lot 8, Brock 7, Nount~ln P~pk Es~, ~E
~ 100+ ?eet to l
NeighborinQ
Ppopose~ Flve-wMe
SysteM
Neighboring
50 Ceet to system
A~ndon Existing system
New 1500 G STEP T~.k ~~ ~ In price,
Neighboring
50 Cee~ ~o sySteM
Existing
I 4 bedroom house
o Existing Wort
Lupine Drive
~~. PetE, R~e = 3 Min/Inch
~ ~ ~?~m Use ~ 5 WMe Trench
_~;~r~ ..... ~.. For ~ 4 Bedroom House - 500 SF Is Requlre~
~. ~ -~;~ ~ Need 84 L,F, o¢ 5-Wide Trench W/6' o¢ Gr~ve[
~ .~ .., ~ Need New 1500 G~Lton S,T,E.P, T6nk
~.,.,,& .................................. ~,.,,~ Tot6I :Depth is 4 Ceet, E¢¢ective Depth 0,5 ~
~?j?;~,_ ....................... ~. ..~
~Steven R Pannone-~ PREPARE3 FOR: STEVEN R. PANNDNE, P.E.
'-. ' ..' ~ ANCHDRAGE, ALASKA 99514
DATE, 11-1-95 ~ DEDIGN
~CALE~ 1'=30~
I
DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEN
Lot B, Block 7, Nountaln Park Est,
ir~NV393
i~BN¥393
PREPARED FOR~
David Dennis
12641 Lupin Dmive
Anchom~§e, AK 99516
STEVEN R, PANNDNE, P,E,
P, D, BOX 142025
ANCHORAGE, ALASKA 99514
274-0308, 272-8218 FAX
~ATD 11-1-95
NOT TD SCALE DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED POR:~ ,~%,/1'~ "'-~(~..l'-.[-[~,.,.~ I~ ~
DATE PERFORME
LEGAL DESCRIPTION: iL~; ~'-'~'~'
Township, Range, Section:
5
6
7
8
9
10--
11
12
13-
14-
15-
16-
17-
18-
19-
20-
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After _
Monitoring? /l-6-q''r Date:
SITE PLAN
I /// I I.tt~ [" ~ll I I%_I I I
Gross Net Depth to Net
Reading Date Time Time Water Drop
l c~- 2~- I ? c~o ~ ~ /Iz~
~ ~ ~ ~ ,/~ ~/~
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND '~- FT
PERFORMED BY: ~' r~(~¢~AJP~- ~, (~.- ~ CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; v/~) - "~"~_~ c~ ~
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORME
Township,
Range,
Section:
LEGAL DESCRiPTiON: ~. P~ :-~,~ /'~C-r'--PA~I4 ~-~,'~.
SLOPE
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SITE PLAN
WAS GROUND WATER
ENCOUNTERED7
S
L
IF YES, AT WHAT t O
DEPTH? c~ P
E
Depth to Water After
Monitoring? Date:.
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN __ FT AND FT
PERFORMED BY: ~, ~ ~ (~/'J~'d o~J ~ ~:~' ~- I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~::)~ ~ ~'"'-(~'~--~
72-008 (Rev. 4/85)
'~i' ~ ' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME JPHONE ~NEW
DISTANCE TO: Dwelling
Man ufacturer
Well
DISTANCE TO:
No. of lines ~. Length of each line
Top of tile to finish grade
Length Width
Type of crib er
F°undati°n~(43
'Total length of lines
Material beneath tile
Depth
Crib depth
Building foundation
Dwelling
Material
Width
Material
Nearest lot line tO
Trench ~vi~ht', inches
inches
NO. OF BEDROOMS
PERMIT NO,
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Total effective absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
R EMAR KS !::
72-013 (Rev. 3/78)
DATE
LEGAL
L E EIIt::!L
I
I.)E:I.::?h':;i:TPiE:N"f' [?.~ :!E:I::II_'I"FI FIND EN',,,'! F?.ONHEI'.,!'T'F&.." "I"ECT I ON
',L:", L-':: '.5 '" L. STI.REE"I", F:INC:HOF;i:F:!GE., I::t!.:::.
E:5"F. E.; L. CFI" SIZE ;;i:2tZlEliiEl ~i;([!IJFtI::::E FEET
TYPE OF' :"II;OIL. F[I:::'::"'F;':TT-N .... '"-""rTM .
I"II::I;:'::iMLIPi NUi"!EE!:[;~: OF DE:Dr.;;:Eu:3HS!; .... :!.
THE: F~'n':~ ....." I:;'[::' ":, :5 1 Z.E 'OF "FIDE SO I L. F:IE:SOF.:F"r'
...... :...,_. ,, .....
............ " .... . , . ......
'T'HE t. I:::'N"3TH [::, Z HEI'.,!S ;i. ON :I: :ii; THEE L.I,'ZNEiTH ,::
THE I,.':,I,EI.:'TH 1,31.:' R TFdENE:H OF: I.:'IT I% THE E:,ISTRNCE BE'I."HIEEN THE S:;LII.:~:F:'FIE:I,E O1.::' THE
EiF:::OUI',!D t:::Ir.,ID THE BCITTOH CiF THE EXC:FI',/FFTiON ,:.'Zt'.ii I:::'EE:T').
'T'HE:.I.~:I,~: ]:S NO S:..E:T HII.::,TH FOR
'T'HI,E GIRFI',/EL. [.':,E::P'TH Z:i!i; THE P1tr.,I:[P'IUH DI,EF'TH OF EiRFt',/EI... BETHEEN THE: OU'T'I.::'FIL.i_ I,::'!I.::'I,E
FIND THE E~I.:FI"TOH O1,:' THE EXCFCv'FIT!'ON ,:.'iN I,:'EET).
l,:'!ii!:l:;i:[',l :i, T FIF'I,::'L. l CF!NT [dl::l':~; TI.-!E-: I:~:EE;I,::'Cq'.~.S.'; :1: E: Ii: L ]: 'T'Y TO ]' NF:': I,;.:H TH ! '_:.:; DEF'I:::II::::THEI'-,IT [)1...11,;i: ]: t'-41}~ "HE::
]: N:E:Ti:::!I....L..FIT Ii: E:d'.,[ Z ['-,IS, F'ECT :[ ONL:i; C F:' FINY t.,.IEI...L.S F:IE:,,:rF:iCE:NT TO TH I :E; F'ROt::'ER'I,'Y I:::[NE:, TFIIE
N. I','IE E:' O1.:' I:;~:E:i; ~: t)E'N z E':~ THI.:IT THE: HELL. H Ii: t....L. E;[EI'~'.',,'['L
!"IlN]:HUI,1 I.)ISTI.:d'.IE:E: E:ETI.,.IEEN FI HELL. FSI(? PINY C N -... ':2; ]' T F: SEHF:IGE L':,IS.;I:::uDE!;FIL. :5'.??1"I,E1',! !:::5
::i. :;P F'E:ET Fii)l:;i: FI F'!:~:I',,,'F:ITE HELL...: "LIE'
:]..!~:[::ji TO ;::':j:ll:j I::EET F'F?.I.31'q I:::1 F'UE',I.]:: HI'ELL. E:'E~F:'ENE:,tNG LIF'CI!".! 'THI'E 'I"YI:::'E ElF: F'U[Ii',L]'"': ,HEiL! .....
HI'ELL.. L.C~LEiS I.::!I';~:E F'?.EX;!I...I:[I.;;:E:D l::iiN[::, H_':J"." I'3E REZr'IjRNEE:, "l,"J~ THE
r'jF' THE HI,':']L.L.
OTHEF: I:;~:E{I.i:!IJ I F:EH[i!:N'T'S HI::IY F F I ..... ':'51:::'EE: I I,:' I C:FFF: LqNS:; F:iNI..) C:(TIN'.:JTI:;?.... L.... I,:: L.I.::. TCI I N:i.:.:UF;;:I,E I.:'t:;b3F:'ER i N:E';TFtLLFIT Ii: ON.
t CE:R'T'II.::'Y THFt'T'
:1..: :i. RH. F:'F:!HIt.~].'FII.;.: H:[TH THE: I.;".E6Z!LtlF;'.EMENT'.:~; F'OFi: Cq",I~"E;ITE SENE:RE; I::d"iiD HELLL:"!; F!:5 SET
I'::CII:;i:TH EFt' T!'"IE r,'!IJNIC]:I.::'F:iL.:[TY Cfi,::'
;2: :t: H ].' L.L.. I NSTI.::IL!._ 'THE '.':'SY::.:;TE:H 1' N FICCOF:'.E:,II::iI'.,IC!.Z H :[ TH THE CEd:::,ES:;.
_T.i:: Z UNDEI:;:::BTFff.dD THF:IT 'T'HI,II: ON.....E;ITE SE'!.,.II:{IR :.'.E;Y:ETI"E!,I I"tF1Y I-REX;!L.IIF.:E I,"..:I'.,IIJ:::fl:~:Cq!!!ZHE:NT ZI.:' T!-.I.E:
F:E:S :[ [::,ENCI,!: ]::.5 I,;.:EMCE::,!ELE:[::, TO ]: NCLUDE I"!ORE THF!N 4 E~E:DROOHS:,.
' 'FIN'T .:r...-E:, I.Er..4. TE:F;~:PI.,:! Z'SE':5 '
' "::' E)
e--'I
2204 Cleveland Anchorage, Alaska 99503
Performed For J-D Enterprises Date Performed_ 4-11-78
teaal qescrtntion: Lot 8 Block7_J__Subdtvtsten Mountain ~ark
This ~orm Reports Soils Lop Yes Percolation Test Yes
~eeth
Feet
Soil Characteristics
Silty Sand
14--
16--
18--
20--
Sandy Silty Gravel ~
Brown Sandy Silt
Bottom of Test Hole
Was Ground Water Encountered?. No
If Yes, At what Depth?
Roadtnq
Oate
4-12
4-13
4-13
Gross Time
Net Time
24 Hr. Sat
Depth to H20
22"
_bio Wa_t~ r
Percolation Rate ~Utnute ~-,
Prnposed Inst~on: Seeoaee Pit Drain Field
Deot-]~-T-~-b~f~-~'om Of Pit O~
......
Oate:~o
Net Drop
Parcel I.D. #
MUNICIPALITY OFANCHORAGE
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
el~'-z.- (~ HAA#
GENERAL INFORMATION
Complete legal description
Location (site address or directions) /'z
Property owner"'~'v~-'~ -'~¢ ~,"~ ~,
Mailing address I~,ql /-'O'~,,w~. -'~z,u~- ,
Lending agencY
Mailing address
Day phone ~/~'-//~'~
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3.._. TypE OF WATER SUPpLY:.~
· ' Individual well·
Community well
Public water
Individual on-site .
Holding tank
Community on-site
NOTE: If community well system, provide written confirmation from State ADEC attest- .
ing to the legality and status of system.
4. TYPE OF wAsTEWATER DISPOSAL:
.
NOTE:
Public sewer "
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 rlisposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm%A,'~',~,~'~
Address '~,o. ~:~ ~
Engineer's signature-_ ~~;~
Approved for d
Disapproved.
Conditional approval for
DHHS SIGNATURE
bedrooms.
Additional Comments
bedroomsl with the following stipulations:
t.,. ~..:¥ .;. ; £.'~ a
: T,.lie Mur[icipa]i,ty of A.n,c~.o,rb. ge Department of Health and Human Services (DHHS) issues Health Authority
*APl~rova[ Ce~'i}icates"b'ased only upon the representations given in paragraph 5 above by an independent
professio, nal engin, eer registered ~n the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and theii'tending institutions in order to sat sfy certain federa and state requirements. Emp oyees of DHHS do not
conduct'inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91 ) Back MOA/~21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825".L" Street, Room 502 · Anchorage, Alaska 99501. (90R ~4~4~$v E D
NOV 2 8 1955
Health AuthoritY Approval Checklist, Municipality of Anchorag. e
Legal Description: L
A. WELL DATA
Well type
Log present (Y/N)'
Total depth ~ I '~-
Sanital~ seal (Y/N)
Dept, Health & Human Serwces
ParcclI.D.; ¢I:Y"' q;~--- O~B
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL LOG
q~ t~--'~
g.p.m.
Nitrate
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~)
Date of sample~ I I- t q
B. SEPTIC/HOLDING TANK DATA
bacteria
g.p.m.
Collected by: ~ · ~ ,~2>th.,o,x~ o ro ~. ~ ~"~. ,~.
Number of Compa~m_~__eaxts~ Clcanouts (y/N).__
High water alarm (Y,qff)
Date installed Tank size
ound~epression (Y/N)
C. ABSORPTION FIELD DATA
Date installed t(- I ~ ~ c?f-
Length. ~ ed Width
Effective absorption area g-'~l~
Date of adequacy test 'lq t~,c~)
Fluid depth in absorption field before test (in.);
Fluid depth - · .(ins.) Minutes later: ~
Peroxide treatment (past 12 months) (Y/N) ~
Soilrating (g.p.d./ft20rft2/bdrm) /'Z~'- Systemtype t.o,
Gravel thickness below pipe / ~ Total depth 6-~- g, 4~
Monitoring Tube present(YfN) "~ Depression over field (Y/N)
Results (Pass/Fail)
For q bedrooms
Inm~ediately after ~ gal. water added (in.): ~
Absorption rate = ~, .g.p.d.
If yes, give date
D. LIFT STATION
Date installed l~--/~-
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested b4
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum ~l~c~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot t'/
Absorption field on lot
Public sewer main
"Pump ofF' level at* q / e,
: Ou adjacent lots
On adjacent lots / ~ '~'
Public sewer manhole/clcanout ""c't"
Sewer/septic sen, ice line / ~ ~ t Lift station / / C> {
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation / O { Property line ~ ~ ~ Abso~tion field / q
Water mai~se~ice line ~o + Surface water/drainage /~o ~ Wells on adjacent lots
SEP~A~ON DISTANCE FROM ABSOR~ION FIELD ON LOT TO:
Building foundation ~'J Water mai~ffsemce line
Surface water /~o ~ Driveway, parkinffvehicle storage area
Cu~ain drain ~/A Wells on adjacent lots / ~ Property line
F. ENG~ER~S CERTIFICATION
I certiJ~ that I have determined thrufield inspections and review of Municipal recor& th,ak~n~E[,&vstems
in conformance with ~[OA H~ gutdehnes m effect on th s date ..~y,~C~%~
S~gnature ~. - ~ ,4z
Engineer s Name ~ ~ ~ ~~.~ ~e~at~Here
................................................................................... ~z~;~ .....
HAA Fee $ ~ ,~ Waiver Fee $ :. '~*x~'
Date of Payment '~ ~ - ~' ~ Date of Payment
Receipt Number ~ k ~ (:/~ P ~ Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1o General Information
Application Date
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(c) Applicant is (check one) Le~ing Institution ~; ~er/b~lder ~;
(d) Lending Institu~ion_~ Telephone
Ad~. ss
(e) Real Estate Co. & Agent
Address
Single-Family.~
Number of Bedrooms
Water
Telephone
(f) Mail the HAA to the following address:
2. T~e of Residenc~
Multi-Family,~,
Other (describe)
Individual Well .~. Community ~ Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation a~testing to the legality and status°
0nsite~ Publico Community~ Holding Tank~-~
Note: If community well system~ must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
E.g_ngineerin~. Firm Providin~ Ins actions Tests File Search Data and Information
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of. this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein°. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection~ the on-site water supply and/or wastewater disposal
system is im compliance with all Mumicipal and State codes~ ordinances~ and regula-
tions in effect on the da~e of ~his inspection°
Approved
CAUTION
TH~ MUNICIPALITY OF ANCHORAGE DEPAR~/~ENT OF REALTH AND ENVIRONMENTAL PROI~CTION
(DHEP) ISSUES HEALTH AUTHORIT~ APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAP~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF AI~ASIQ%o THE DHEP DOES THIS AS A C0~TESY TO PURCHASERS OF HOMES ~/~D
THEIR LENDING I/~STITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE~
MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED° THE MUNICIPALI~f OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIOnaL ENGINEER'S WORK°
SEAL)
~4/aJ/D~8
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
~UNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Legal Description: .
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ~ i ~, Cased to {~'~' '
Static Water Level 80f'
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
IfA, B, C, D.E.C. Approved (Y/N)
Date Completed ~/I ~ / 78 Yield
Depth of Grouting
Pump Set At f.,Z~ I~' ~"
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
Il ¢ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot /~/~.
; Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Del~ression over Tank (Y/N) ~/
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well j OO '
To Property Line ,5'"0 ~
To Water Main/Service Line
Course ~
~/,,,~1/7~;'" Size i~"~al "'No. of Compartments ~ ~
Foundation Cleanout (Y/N)
Date Last Pumped
; for N~.
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~' ¢
i
To Disposal Field '7
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ / ~,1 / 7' ~
Width of Field ~-I
I '?b"
Square Feet of Absorption Area '?~ 8 '¢ '
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
Type of System Design
Length of Field ~'.~' '-
Depth of Field '~. ~ -
Gravel Bed Thickness ;~ i -O
Standpipes Present (Y/N) Y
./ v/"
Date of Last Adequacy Test
To Property Line /¢ ~
To Existing or Abandoned System on
; On Adjoining Lots ~ ~¢ ~
To Cutbank (if present) N,,¢,
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) %.
Comments
Signed ~-'~ ¢ ~ Date
Company ~(¢x~¢'~ 7-~a~¢~( ~.~'.~ ,MOA No.
Receipt No. ~ ~ ~
Date of Payment ~'~-~
Amount: $ ~ ~'~
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection.
Page 2 of 2
72-026 (11/84)
~ 0
0 7
0
.q
m
r'- ITl
0
Z
FLATTOP TECHt'.IICAL SERVICES ,.vo.¢~-o.
Anchorege, Alo$k~ 99516
APPLir'' 'flT FILLS OUT UPPER HA .... 'ONLY
Prop~rty o~n~r John Custer Phone
SRA 2385Z 243-7378
Mailing Address Anrhnff~ge~ Al4 qqgN7 Zip Code
Buyer Peter M. Elson
SRA Box 2366)6 99507
Address /[nrhnr,~ge ~ AJ~ Zip Code
Lending Institution Alasaa USA FCU Phone
2600 Debarr Road 276-5100
Address Zip Code
Realty Co. & Agent Phone
Address Zip Code
Legal Description Lot 8 Bi~ock 7 Mountain Fark Estates Bubdivision //2
Street Locatio~ Lupine Road (12641)
Ty~ of Residence
Single Family 4
[] Multiple Family No. of Bedrooms
[] Other
Water Supply
~ Individual ATFACH WELL LOG, A well log is required for all wells drilled since June 1975.
[] Community Paid Fee #0305 For wells drilled prior to that date, give well depth (attach log if available):
[] Public Utility
Sewer Disposal 1 978
~ Individual Year Individual Installed:
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
~)'-APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
(
( ) DISAPPROVED
( ) CONDITI/ON~A_ APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3/82)
' APPLI(--' NT FILLS OUT UPPER HA: ONLY
Prop. erty Owner, Phone
J,~('~ C~:.~t~,(L ~;-:¢A ~ ~ ~-
Mailing Addre~ Zip Code
Buyer
Address Zip Code
Lending Institution Phone
Address Zip Code
Realty Co. & Agent ",, Phone
Address Zip Code
Legal Description
Street Location ~_ ,.'¢,f3i ?'Ab (I ~- ( ~'! ~
Type of Residence
[] Single Family
[] Multiple Family No. of Bedrooms
[] Other
Water Supply
~. Individual ATTACH WELL LOG. A we~l Icg is required for all wells drilled since June 1975.
[] Community ,.~ , . ...... ~o_?. ~wel!.s._db_e.d Er. pz _to_that__.d..,a.t_e~.~g. ive well depth (attach Icg if available}.
Sewer Disposal ~
~ Individual i Year Individual Installed: /(/
[] Public Utility I When Connected to Public Utility:
[] Holding Tank [
NOTE: THE INSPECTION FEE MUST AC . MPANY EACH REQUEST BEFORE PRO~ES~ING CAN BE INITIATED.
Time Time Time ~L~NI Time
L Date
Inspeclor Inspector Inspg6d~r ~ Inspector /~
Field Notes: ~ ~¢,t MUNICIPALITY OF ANCHORAGE
~ z~ ~ DEPT. OF HEALTH
ENVI~ONMENTAL
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL~
( )DISAPPROVED ~ ~~ ~ ~~ '~
(~CONDITIONAL APPROVAL*
Soils Rating Date ~wer Installed Well To Ab¢orption A~ea ~ ~ 'We I Log Received
72-023 (3182)
ALASKA B IUIROIqm I1TAL COF1TROL SeHUICe$,
IF1C.
JUNE 10 1983
JOHN CUSTER
SRA BOX 2385-Z
ANCHORAGE AK 99507
SELLER - JOHN CUSTER BUYER-ELSON
SUBDIVISION-MT PARK ESTATE #2 BLOCK-7 LOT-8
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 850 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 950 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 900 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 6/10/83 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 4 BEDROOM HOUSE.
1200 LUcst 33rcl Aucnu¢, Suite I~ · Anchoraq¢, Abka 99503 · [907) 276-1361
Dq'PARTMENT OF liEAL'FI~ ~z ENV~RDNMENTAL PROTECTION
82,5 I- Street - Auchorage, Alaska 99501
OEO & 1978
ENVIRONMENTAl. ENGINr~ERING DIVISION
Telephone 264-4720
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAl. WATER AND SEWER FACILITIES
· DhC;~'~CTION~: Complete aH parts on pag'~ !. ]ncon;p!ete ~oquests ,.,.-'iii ~*.ot he processed. Please allow ten (10) days for processing.
MAI LING ADDr, ES.,
j~?(~q~r~ y RES~E)EN-t hf d~f,e~,mt from ~d}ove)
PHONE
'.,
PHONE
LEGAL DESCRIPTION
~ Sq'i-1F_- E T LOCATION
TYPE OF RESIDENCE
SINGLE FAMILY
MULTIPLE FAMILY
WATER SUPPLY
NUMBER OF BEDROOMS
[_~] One ~ Four ETl Other_ .........
~ Two F~} Five
.~ Three L~ Six
INDIVIDUAL~'
COMMUN!TY
PUBLIC UTILITY
~.= SiEWAGE DISPOSAL SYS'i'EM
iNDiVI DUAi_/ON_SiTE~*
PUBLIC UTILITY
ATTACH ¥~ ELL LOG. A well log is required fo'r all wells driiled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) ~.__~
'~,f individual/on-site, give installation date.~ i~,
/f system is over two (2) years oici an adequacy test is required
by ti~s Del)at truant.
NOTE: TFIE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFOP, E PROCESSING CAN BE INITIATEtL
72-O!
'I-IHS .t':ll} E "~ "' '
.......................................................................... r~,&i!:"~U:&:Wu~._._, _ ,~ ...................
APP()IN'FNEF! ]~",
TIME
DATE
INSPEC FOR
SINGLE FAMILY [~] ON~
' t. 'i'HF]EL~ t~ .~ Fly ......:
~,':JI_'-IPLE FAMILY [~] 'IWO ',~ FQ[.JI~ [ i SIX
PERMIT
COidMtJN ITY
DATE DRII LED
I*UBLIC UI'I[.ITY
Connection Verified ............. t..OG RECEIVFD
3. ;i:WAGI~ DISPOSAl.. SYS'I'E['~ PE~MI'I
u !'m~kor []llohti~qTank
~._1~ Tank ishon-mmadu 'S7~I~.SlIATIN,i
' ,: ,,~;S()lqWI ION AI1EA MA'f'EIII/~. ,
:>, ,. ,h ~lo
I (X)NDI-I'IONAL APPFIOVAL (h:tter must acuoml);my cur tificate)
: J DISAI~IU7OVED
/ /
John
3221 West 69th ~%venu~
.Apt. 3
~ohorage~ Alaska 99502
completed~
( ) .9~ne depre~sion or pit around the well casing should
If there are a~y further qu~sti~s~ please ~n~act this
office at 264-4720.
Alas~ U.S.A. F~era! =r~l Union
777 J~nea~ 99501