HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 8 LT 10 GRE/- iR ANCHORAGE AREA B01 !GH
' O Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS PHONE
LEGAL DESCRIPTION J'~'~'" ID l~J~' ~f ~C"~.~, ('~O~,- ~J~.~
SEPTIC TANK:
DI STANCE
FROM WELL -~--) ' . MANUFACTURER.
INSIDE LENGTH INSIDE WIDTH
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
LIQUID CAPACITY /'::,)-~GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL J/~" FOUNDATION
NUMBER OF LINES J DISTANCE BETWEEN LINES
ABSORPTION AREA SQ. FT,
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE
J~ ~ ~ TRENCH WIDTH ',~.
LENGTH OF EACH LINE--
DEPTH OF FILTER
MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
t,f~.V TOTAL EFFECTIVE
__IN. ABOVE TILE IN.
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE __,
OTHER SOURCES
DISAPPROVED
NEAREST SEPTIC
SEWER LINE__ TANK
REMARKS
DEPTH
SEEPAGE
SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
REMARKS:
DIAGRAM OF SYSTEM
Form LQ-032
GREATer ANCHORAGe
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-456!
SEWAGE DISPOSAL SYSTEM:~ APPLICATION AND PERMIT
PERMIT NO.
Name OF APPliCANT -~L C'~
INSTAllATION lOCATION ~
INSTALLATION OF: SEPTIC TANK
SEEPAGE PIT ~ ., DRAIN FIELD , OTHER
Type AND size OF FACilitY TO BE SERVED '~-~i~ ~{~{2~L~nf%
FINANCED THROUGH
COMPLETION DATE ANTICIPATED
TO be INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 2/~ HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE P~T WALL
SEPTIC TANK . SEEPAGE PiT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK / DRAIN FIELD
WATER MAIN TO SEPTIC TANK ~ DRAIN FIELD
SEPTIC TANK, ~(~ ~ r -, SEEPAGE PIT TO RIVEr, LAKE, STREAM.
DRAIN FIELD
, DRAIN FIELD
· seePAGE PIT //0~f
ALSO CONSIDER AREA WELLS.
· DRAIN FIELD
CAST IrON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
· ~'.^.^.B.
SEEPAGE AREA SIZE T PE
DIAGRAM OF ~YSTEM
[ FY THAT [AM FAMILIAR WITH THE REdYi~JIREMENTS OF GREATER ANC~G~RAGEAREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE _ . APPLICANT'S SIGNATURE ~:~-. <~
I
~,".',~.<~. : .. ~ --~,
'/~'fl~li ~ GP, EATER ANCtlORAGE AREA BOROU,..
Department of Environmental Quality
' . . 3330 "C" Street
~,, Anchorage, Alaska 99503
SOILS IX) G ,)EROI,ATION TEST
Performed for gL GJ~r__.6.) ~om~$ Date Performed
Legal Description
This form reports: Soils log. t.~l~_ ,__ Percolation [est'
Depth
Feet
1
o
10 - ~?o~,_
11 -
12-
Was ground water encountered? ,-~-~L.__ If yes, at what depth?
Reading Date Gross Time Net Time
Depth to Water Net Drop
Percolation rate minute.
· -Proposed installation: Seepage Pit brain Field
Depi;h of Inlet ,~ . Oeptli {-~Tt~Tn--~:Ci~it or trenci,
I I
Gte. ir ANChORAge Area BO Jgh
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 27~-456 I ~~-
SEWAGE DISPOSAL SYSTE APPLICATION AND PERMIT
N~mE Of aPPLiCAnt ~ ~~ MaILINg ADDRESS PHONE
SOIL TEST RESULTS ~ NOTEl THIS PERMIT IS NOT VALID WITHOUT SOil TEST
COMPLETION DATE ANTiCiPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ., SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANKi ., SEEPAGE PIT
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL,
4 inCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIt
FITTED WITH AIRTIGHT ReMovABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DIAGRAM OF SYSTEM
., DRAIN fielD
SEEPAge Pit
ALSO CONSIDER Area WELLS.
SEEPAGE PIt
, DRAIN FIELD
g
lO
~ " "One t~st it ~vorth a thousand o?inlon$"
Performed For I . ~a~e Performed
~e~a~ nescr~nt~on~ Lot
Th~s ~orm ~e~or~s So~3s Lo~ ~ Perco3a~on Tes~
9eoth
I
L ij j
Was Ground Water Encountered?
I~ Yes, At what Depth?
I Readinq Date Gross Time Net Time Depth to H20 Net Dron
ercolation Rate Hinute
Proposed Installation: Seenaae Pit Drain Field
De~th of Inlet Depth To Bottom Of Pit O~ Trench
Test Performed By_ ,.~'!~ ,~Y)..~- Data Certified B~: ~
Date:~~_
SCALE
Rudy ~ueller
LOT 10 , BLOCK 8
~!OUNTAIN PARK ESTATES NQ.
~" ' M-W DRILLING, Inc. ~
P.O. Box4-1224 * 1310C InternationalAirport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner
'Use of Well
Location (address of: TownShip, Range, Section, if known; or distan'ce main road
Size of casing (; Depth of Hole_ )'- V.{ feet Cased to -':..~:' :!l( fe~'~
Static water level 25 .ft. (A15~<~) (below) land surface. Finish of Well (check one) open end (
Screen ( ); Perforated ( ). ;
);
Describe screen or perforation - :~''''::
Well pumping test at ,:5 gallons per (hb'ur) '(minute) for
of drawdown from static level.
hours with ; )" '
ft.
Date of completion ?. ?' ".....-'-"-.. 7.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
'q': ?":': G?,': :,,' '~
0 TO
~D ¥ TO
~ TO
.TO.
_TO
.TO
TO_
TO
TO
TO
_TO
.TO.
.TO_
TO
TO
NWWA Cmt:fied Con~netor
C ..... ,-cam Nos. 81.t & ,973
2 -- STATE
r~-W DRILLING, Inc.
P.O. Box4-1224 · 1310C International Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
Well Owner
DRILLING LOG
Use of We]1
Location (address of: Township, Range, Section, if known; or distance main road
Size of easing. ~'~ .Depth of Hole .!.~.h . feet
Static water level ;C-; ft.
Screen ( ); ]Perforated (
Describe screen or perforation
Well pumping test at ~-% gallons per
of drawdown from static level.
Cased to
(below) land surface. Finish of well (check one)
).
open end ( ' );
(minute) for ~ hours with
Date of completion ~!.% ,;'~:'~; 75
WELL LOG
Depth in feet from
ground surface
TO
Give details'O~ formations penetrated, size of material, color and hardness
TO ~2
TO ~ ?
_TO¸
_TO.
TO.
TO.
.TO
.TO.
.TO
TO
TO
TO
~e~ tL,~ed Contractor
Certificate No's. 814 & 973
.TO
.TO
2 -- STATE
Parcel .D. #
MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH & HUMAN SERVICESNVN~~lTY OF ANCHORAGE
Division of Environmental Services E At. SERVICES DIVISION
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650 FI~E~ 0 $ 1997
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
RECEIVED
GENERAL INFORMATION
Complete legal descri ption
Lot 10; Block 8; Mountain Park Estates #2
Location (site address or directions)
.'Property owner ."'-. Douq C, eyer
.~:' ..-" .,. %. ;,
7200 North Park Drive
Anchorage, AK
Day phone .~' : - z_
¢:. Mailing addres~ / '50 P~rk Row West #223
" Lending agen. cy .._
:,. ',Mad!n.g address
':;... Agent
Address
Providence, Rhode Island 02903
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
xxx
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
"--'~: .' ~'.:i ~H01dingtank ..-
Publicsewe¢.- ' ·' - ..... "-"
'-.'. ' NOTE: -Ifcommcnity wastewat~system; 'l~'ovide written' Confi!~mation from Sta~e ,~DE¢;.... 'i:.::?!'.~i!.
'' ' ' . ';' attestin~j-to the legality and statUs'of system. ' '". · '.- ~".
r:' :/ ':~
72-025 (Rev. 1/91) Front MOA,~21 ~ _ .
MUNICIPALITY O? ANCHci~
bluni¢ipality of Anchorage ENVIroNMENtAL SE~V/cF.s
DEPARTMENT OF HEALTH & HUMAN SERVICES ~)
Environmental Services Division F£B 0 ~q t9.97
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist R E CE ] V E D
Legal Description:
A. WELL DATA
Well type
Log present {.~N)
Total depth
Sanitary seal (~N)
Date of test
Static water level
Well production
Parcel I.D.: fO t'7-~ z'/~,,-L ~/~,
If A, B, or C, attach ADEC letter. ADEC water system number
Date comPleted //o / t ~ / 7 J-
Cased to ~o re f~ ~ Casing height (above ground)
Wires properly protected ~(,~N) Y ~ $
FROM WELL LOG
[
AT INSPECTION
;ZS- 3 3
(~ g.p.m. O. (>
g.p.m.
WATER SAMPLE RESULTS:
Coliform O Nitrate
Date of sample: ~ / ~'/'0 7
B. SEPTIC/HOLDING TANK DATA
Date installed ~4 / I I~ ~ -/.(- Tank size I ~ $-
;~. 7 5- Other bacteria
Collected by:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Number of Compartments vi/< 'Cleanoutsi~/N). ¥~3
Foundation cleanout ~./(~ · ' ~ o Depression (Y~) ~v O
Date o~ p~mp. in~
C. ABSORPTION FIELD DAT
Dat~ installed / ~
Effecti~;abs0rption area
Date of adequs~¢test
Fluid depth in absorption field before test (in.);
Fluid depth ,v/~ (ins) Minutes later:
Pumper
High water alarm (Y/~ /v ~2
Soil rating (g.p.d./fF or~ / 0 o System type 7-~,,-,
Gravel thickness below pipe (~ Total depth -~
Monitoring Tube present (~N) ¥~-( Depression over field (Y/~I.~
Results~Fail) ?/~J For :~ ~ bedrooms
Immediately after ~ ?~ gal. water added (in.):
Absorption rate'~=; /-jtiS-O -/ g.p.d.
Peroxide treatment.(past 12 months) (Y/N) ~o~ /~,o~,,J If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in.~g~lkms
Manhole/Access (Y/N) ~J~m~vel at*
High water alarm level at* _~ *Datum
Cycles teste..~d ~~''
E. SEPARATION DISTANCES
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
~'ir6-Jholding tank on lot . ~/,./ .
Absorption field on lot } O 0 +
On adjacent lots
On adjacent lots
If)O /4--
/00 w-
Public sewer main r¢ /,q Public sewer manhole/cleanout
Sewer/septic service line ~ 0 + Lift station
SEPARATION DISTANCES FROM ~HOLDING TANK ON LOT TO:
Foundation 13 Property line 5 +' Absorption field
Water main/service line ~ 0 q- Surface water/drainage ) 0 O
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
/
0
Property line ! 0 Building foundation Water main/service line
Surface water / 0 0 "h Driveway, parking/vehicle storage area
/
Curtain drain ~ 0,,~ ¢ ¢'"' ¢ ~",'J Wells on adjacent lots / 0 0
...~-
ENGINEER'S CERTIFICATION
I certify that l have determined thru field inspections and review of Municipal
..... effect th~s date.
in conformance with MOa H~A~uldelin~s In on
S gnature
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL No.½/ 70 43
During a recent Health Authority Approval on-site inspection
and test of ti~e potable water supply well on Lot /0
Block ~ of ~0~ ?~ ~TE$ ~ Subdivision, the wel!:s
productivity was determined to be gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a bedroom residence is ~ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
Rick Mystrom,
Mayor
Municipality of Anchor e
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
March 7, 1997
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 10 Block 8 Mountain Park Estates #2
Waiver Request #WR970005. PID #017-432-16, HA970043
Dear Mr. Cowan:
Your request for waiver(s) of the required 100 foot horizontal
separation of an on-site wastewater disposal system to a private
well has been approved. The approved separation distance(s) are
the on lot septic tank to the private well of 91 feet.
This waiver approval applies to the existing on-site wastewater
disposal system to well separation only. Any future upgrade to either
will require all separation distances be met or another approval
from this department.
If there are any further questions or concerns regarding this waiver,
please Call our office at 343'4744..
.Sincerely;. ',
Daniel J; Roth
Civil Engineer
On-site Services Program
ljm:#6
Geyer
~ MUNICIPALITY OF ANCHORAGb~
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR9 ~ ~]~ PID~ 017-432-16
HA# HA970043 Permit
Date Received: March 6, 1997
Legal Description: Lot 10 Block 8 Mountain Park Estates ~/2
Engineer: Robert C. Cowan, P.E., S & S Engineering
17034 Eagle River Loop Road, Suite 204, Ea~le River,,~Alaska 99577
Applicant: Doug Geyer
Waiver Requested: Septic Tank ~o private well of 91 feet
Criteria: 1. Geology: Points:
A. water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: ~
List Conditions or Reasons~ for abov
Date: 3-- 77
Rec #: ~/02645/5728
Amount: $ $62
(907) 562-3252
~engineering group J ~ .1~[il
anchorage, alaska
Y..~,'q. P. E.C. f. 12.
4.0
4. o
2,0
HEALTH AUTHORITY
APPROVALS
SEWER &WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& F LOW T EST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
W^STEWATER
DISPOSAL SYSTEM
DESIGN
March b, 1997
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, EE.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MuniciPality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE:
RECEIVED
f¥1AR 6 1997
Municipality of Anch0rag~e
Dept. Health & Human Servi,,e~
Lot 10, Block 8, Mountain Park Estates NO.2
Request you issue a Health Authority Approval on the
referenced property and grant a waiver for the horizontal
separation distance between the well and the septic tank
serving this property at 91 feet.
The mitigating factors involved which support the issuance of
the waivers are as follows:
1. Referring to the site plan/topo, surfacing effluent
would not flow toward the well.
The house is located between the well and the septic
tank on the referenced property and provides a
barrier.
Nitrate sample taken from the well located on the
referenced property indicated 2.75 mg/1.
Atta:ched are well logs for surrounding wells which
show that leaking effluent would have to pass
through ~0 feet or more of silty so%ls before
reaching bedrock. The water bearing rock is
generally below 85 feet.
The septic tank is apparently about 3' from the
foundation and no cleanout is present. The tank
water level is below floor elevation and therefore
of no concern.
In our opinion, the separation distance requirement
prescribed by iSAAC.021 is not necessary in this case.
If we may be of further service please contact us.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
1" -- 50' SITE-PLAN WAIVER REQUEST
SCALE
BEDFO2D STBEET
~ $
,
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.# (~)\~-~ -
1. GENERAL INFORMATION
Complete legal description
Lot 101 Block 81 Mountain Park Estates #2
Location (site addreSs or directions) 7200 North Park' Drive
Property owner
Mailing address
Lending agency
Tim and Tina H~x~y
7200 North Park Driv~
Day phone
Mailing address
Day phone
Agent Phyllis Hack~tt/P~rforman~ R~al Estate.
Address P.O. Box 110508 Anchorage. AK 99511
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well XXX
NOTE:
Day phone 561-5155
244-5254 (mobi£~)
Community well
Public water
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:
XXX
Individual on-site
Holding tank
Community on-site .:.
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
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.
Phone ~F' 2_ ~ ? ?
Name of Firm5 & 5 ENGINEERING
Address 17034 Eagle River Loop Road N~3~204
Eagle River, Alaska 99577~%
Engineer's signature
bedrooms.
DHHS SIGNATURE
~ Approved for
Date ~/////~--~
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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
,~rofessional 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.
Back MOA ~21
MuniciPality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Parcel I.D.
Well type F/~'/b/,F~'-~--r'~ If A, B, or C, attach ADEC letter.
Total depth [ 2~ r
Sanitary seal ~)~
Date completed
Cased to
Wires properly protected<~)N)
ADEC water system number
(:~_..~-- ,r~,~ Driller
Casing height /~'
Date of test
Static water level
AT INSPECTION ,~R:~ c. O z
~z
g.p.nl~'l ~, P~ 9
FROM WELL LOG
)c-c 1 7
Pump level
SEPARATION DISTANCES FROM WELL TO:
/
Septic,q~nk on lot
Absorption field on lot
Public sewer main
Sewer service line
~o
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~.~,,~"7'-/,~'F~C'T'O (d 9 Nitrate
Date of sample: .~-/~.E) /~,:~
Collected by:
B. SEPTIC/EI~L=B~R~ TANK DATA
Other bacteria
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Date installed
Cieanouts(~)
High water alarm (Y/N)
Date of pumping
7/7d~~''- Tank size /~-~ '-~"-~ Compartments ~
Foundation cleanout~((Y)N) Depression (Y~'~
/~/: ~' Alarm tested (Y/N) ~/~
SEPARATION DISTANCES FROM SEPTIC/~TANK TO:
Well(s) on lot /~:? (~)
Topropertyline /"4~ ('-zL Absorption field
Surface water/drainage
Foundation
Water main/service line
72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
~i:~ti~y~l)l°n; "Pump on" level at , Manh°le/~t
High wateralarmlevel _.---"'//~ / C'~cle~ested
Meets MOA electrica~__ [~'/ / /~/
~NC E FROM LI F~:~:lc~t ~c~i l' Surface water
D. ABSORPTION FIELD DATA
Date installed
/
Length --¢"~ ( Width
Total absorption area
Depression over field (¥~/~
Soil rating //~'¢Z2 /// /)/{ System type
Gravel thickness Total depth
Cleanouts present~4)
Date of adequacy test
for ~
If yes, give date
/
Results (pass/J.~ ~"?¢;'2 ~<"% d-~ ~'/.
Peroxide treatment (past 12 months) ( .
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Welt on lot Jc/:/-¢-) ( -/- On adjacent lots j¢¢?O (
/- Propertyline
~ To existing or abandoned system on lot
I Cutbank /1../ ,/)"~ Water main/service line
To building foundation
On adjacent lots ~r'cL~-
Surface;Water
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that lhave~~o~~ all MOA and HAA guidelines in effect on the date ofi:h!si!nsp.ection.
'7JR°a~]~. '--N~ Ot~.~ rr:' .:' '.' : ..~ . .
Date
/
,:
HAAFee$ /7~
Date of Payment
Receipt Number
72-026 fRev. 3/91~ Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTHE~£ OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICAT%ON FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1., General Information Application Date
<a) ~3 ~~~ township,
Legal Description (include lot, block~ s~bdivision, section, range)
Locatlo~ (address or directions)
Telephone - Home Bus__.iness
(c) Applicant is (check one) Lending Institution
(d) Lending Institution ~ ~ ~/~ Telephone
Address
(e) Real Estate COo & Agent
Address
Telephone
(f) M~a~ the HAd to ~he following address:
T_y_pe of Residence ............. ~-' ......
Single-Family~ Multi~Family~
Number of Bedrooms ~
Other (describe)
Water
Individual Well
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation a~testing to the legality and status°
Sewage Dis osal
Onsite~ Public ~--~ 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]
5o En_~neerin~FirmProvi~ns~ Tests~ File Search~ Data and Information
o
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 shows that the on-site
water supply and/or %mstewater disposal system is safe, functional and adequate for
the number of bedrooms and ~ype of structure indicated herein.- I further verify that~
based on the information obtained from The M~anicipality of Anchorage files and from my
investigation amd inspection, ~he on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on ~he date of this inspection°
Name of Firm Telephone
Address
DHEP Approval
Approved for ~bedrooms
Approved Disapproved
Te~s of ion~ Approv~
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESENT~
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDE~ PROFESSIONAL ENGINEER REGISTEILED
IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A CO~TESY TO PURCHASERS OF HOMES AND
THEIR LENDING I~STITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT 'CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE ~S NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS ~ THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7~19-84
ae
M cmP m OF (MOA
- F RU Y 1984
~II. ~ATA
Well Class if icat~6~/~/~9/~
Well Log P~esen~/~/~/
Total Depth ~--/ ~d ~ /7~{
Static Water ~1 ~ ~ ~ ~t At
Casing ~ight ~ Gr~nd /~
Elec~ical Wiring in ~nduit/(Y~
~p~ation Dis~n~s ~ ~
To ~ptic~ Ta~ ~ ~t ~ ~
To ~a~st ~ge of ~s~tion Field on ~t/~O ~
NOi/D::]iO~d 'IV£N::]WN o~IAN::I
If A, B, c~ C, D.E.C. Approved(Y/N)
Date Completed ~' '7~ 7~5~-' iel~u. ~
~pth of ~outin~
Sanit~ ~al on ~sing~
~ession ~nd ~l~ead (~
; On Adjoining Lots //~O -/-
; On Adjoining Lots /~o /
To Nearest Public Sewer Line /1///+ To Nearest Public Sewer
Cleancut/Man/~ole //r//9~/-- To Nearest Sewe~-- --
Service Line on Lot
Water Sample Collected By /~ ~r ~ ~ ; Date
Water Sample Test Results ~_~/~ ~! p'~z~ ~ ~-~ ~'~- ~
C~,ents /C7 ~
Be
SEPTIC/H~D~%~ TANK DATA
Date-Installe~d ~/~'- Size /~--~ No. of C~,~a~tments /-,~, ,, ~ -- /,%
Standpipes/(Y/~ ~ Air-tight Caps ~Y~ Found~tion. Cleanout((Y/W)
Depression over Tank (~) Date Last~ Pumped ////'.
Pumping/Maintenance Contract on File. (~//~/~///~ ; for
Holding Tank High-Water Ala=~-~ (Y~//A- Temporary Holding Tank Permit (y~///z~
Separation Distances frcm Septic/~9~ Tank:
To Water-Supply Well /~6) ~f To Building Foundation ~ !
To Property Line /~2) ~ To Disposal Field
To Water Main~Se~vice Lir~ /~P ~ To Stream, Pond, Lake, o~ Major D=ainage
Course ' /~ ~o ~.~ ~
Receipt ~ <~
Date Paid:
un t:
[Page 1 of 2]
2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed ¢/~O'-
//O~ /h~ Type of System Design
/ (en~th of Field ~-d2 /
/
Width of Field ~ l~ Depth of Field
~ Gravel Bed Thickness
Square Feet of Absorption A~ea ~30 ~ Standpipes Present
~te of ~st A~a~ Test
Results of ~st Ade~a~st ~ ~~C
Sep~ation Distan~ f~ ~s~Dtion Field:
To ~te~-Sup~ly ~11 /~ ~ To ~o~ty Li~
To Building Foun~tion ~ ~ To Existin~ or ~ndo~d System
Lot ~ ~ ~ ~ ~joinin~ ~ts ~
To Wate~ Main/~vi~ Line h ~ To ~t~(if ~e~nt)
To St~e~ond~ke/~Major ~aina~ ~se ~
To ~i~way, Pa~king ~ea, ~ Vehicle St~a~ ~ea ~D
Ccu~ents /~ M ~-
D. LIFT STATION
Date Installed
Size in Gallons
"P~ O~" Level at
High Water Alazm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
n / /~ Off" LeveI at.
f ~ f/l/¥ Vent (Y/N)
Pumping Cycles during Adequacy Test.
Meets ~OA
Comments
**
** Check Permitted Bedroom Rating Against HAA ~quest
I certify that I have checked, verified, or confc~ed to all MOA HAA Guidelines in effect
on the date of this insPection.
Signed ~'-~ ~', EN~INH~.RIN(~ Date/--/~~'~--
Company ~ .f,I-~' ~IVE~,, A~AS~ ~[;57F MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
ADEQUACY TEST
WATER AND SEWER iNSPECTION
WELL INSPECTIONS AND
FLOW TEST
SiTE PLANS
ROAO DESIGN
SOIL TEST
ON SITE WASTE WATER
DISPOSAL SYSTEM OESIGN
EXCAVATION WORK
Mr. Rudy Muel!er
Mueller Construction
SR Box 2383-~
Anchorage, AK 99507
ROBERT A. SHAFER
November 16, 1983
CIVIL ENGINEER
694-2979
MUNIC~IPALiTy OF ANCHo .-,
RECEIVED
Dear Mr. Mue~ler:
At the' time the adequacy test was performed on Lot 10, Block 8,
Mountain Park subdivision, a~Dect/D/l_wOs al~o performed.
It was found that the well ca~ng was equipped with an adequate
sanitary seal and the wires from the pump were in conduit. The
grO-~-6-d~around th~ welf~sing was adequately slope~away from
the wel .~I~--~the same time that this-inspection was performed,
a water sample was taken from the hose bib on the side of the
house and submitted to Chemical and Geological Laboratories of
Alaska for coliforn and bacteria analysis. The results of this
test were s~ry, .
If we may be of further service, please do not hesitate to contact
· Robert A. ~na~er, ~.~. "~
~s:bg
CC:
Municipality of Anchorage
Department of Environmental and Health Protection
SRB 196X EAGLE RIVER, ALASKA 99577
ADEQUACY TEST
WATER AND SEWER iNSPECTION
WELL iNSPECTIONS AND
PLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
ON SITE WASTE WATER
DISPOSAL SYSTEM DESIGN
EXCAVATION WORK
Rudy Mueller
Mueller Constructicn
Star Route Box 2383-R
Anchorage, Alaska 99507
November 6, 1983
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
Dear Mr. Mueller,
Reference: Lot 10T Block 87 Mountain Park Subdivision 92
A sewer system adequacy.test was performed on the system located
on the referenced property as you requested. The septic tank
was pumped by Anchorage Cesspool Pumping services and was verified
to have a capacity of 1000 gallons. The absorption trench was
tested by a continuous flow of water over a period of 24 hours
without any adverse effect on the system.
It can be concluded from this test that~the .waster water disposal
system serving the three bedroom residence located on this property
is curren%ly functioning adequately. However, the system cannot
be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to contact
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA 99577
GREATER ANCHORAGE AREA BOROUGH '
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received April 20, 1976
[~. ~ ~ ~>'~ ~ REQUEST FOR APPROVAL OF / ..... ~-q ]
nq-q . ~ ,~L~[ ,~ INDIVIDUAL SEWER & WATER FACILITIES ~./<L _~ ~
~'~ ~%.q~ ~P~ ,, b,0~' FOR .'~~ ~-~"~_ '
Cony. -' .
l. Approval requested.by: Alaska Mutual Savings Bank % Sheryl Smith
4.
5.
6.
Mailing Address:
Property Owner:
· Mailing Address:
Legal Description:
Location:
Post Office Box 1120 phone:
John C. & Edna Jean Heily o Phone:
274-3561 x 216
274-9531
Lot 10 Block 8 Mountain Park Estates Subdivision #2
Corner of Foster Road and i~ ' '[ :<:-~ark Drive
Type of facility to be inspected Single Family
No. of bedrooms 2
Well Data:
Individual
A. Type
C. Construction
Sewage Disposal System:
A. Installed'
On-site system
B. Depth
D. Bacterial AnalySis
B. Installer
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
1. Size
Ii AbsorptiOn Area
Total length of lines
2. Manufacturer
2. Material
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
, Absorption area
, Other contamination
, Absorption area
Sewer Lines
Page 1 of two pages
Page 2 of~two pages-~Re,' 'st for Approval of Individual ' 'er & Water Facilities
~[egal'Descripti0n Lot 10 Block 8 Mountain Park Estates Subdivision ~2
Comments
~. APProv~',Valid for one year from date signed
Greater Anchorage ~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily,
SIGNED Date
EQ-034 (1/74)
MUNICIPALITY GF Ah!CilOI~GE
GREATER ANCHORAGE AREA BOROUGH
Dep~rtment of Environmental Quali
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
.
INDIVIDUAL SEWER & WATER FACILITIES
i. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
e
CMRO VA FHA CONV
John C. & Edna Jean Heily
Corner~sf Foster Road & Day Phone 274-9531
Moutain Park Drive
Refinance
Mailing Address: smme As Above Day Phone Smme as Above
Name of Lending Institution: Alaska Mutual Savings Bank
Mailing Address: P. 0. Box 1120
Name of Realtor or Agent: N/A
Mailing Address: ?tl/A
Phone 274-3561 (216)
Phone N/A
Legal Description: Lot lO, B~k. 8 lV[o11~-.~tl w~wl.~ w. st~_tes Subd.#2
L o c a t i o n: Corner of Foster Road & ~~ P~rk Drive
7. Type of Facility to be inspected: Single F~milyHome No. Bdrms. 2
8. Water Supply
Type of Supply: Public Utility Individual x Well
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of system: Public Utility
If Individual, date of installation
Individual (on-site)
EQ-037 (1/74)