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