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MOUNTAIN PARK ESTATES BLK 10 LT 5
Mountain Park Estates Lot 5 Block 10 #017-441-24 Municipality of Anchorage Page or 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number:_�`� �g O 3 $4' PID Number: 441- 7Z4 _ Name: Wastewater System: ❑ New Upgrade Address: l25:B ��-pl�►� pR �'99S1� ABSORPTION FIELD Phone: Iqe I No. of Bedrooms: p Deep Trench O Shallow Trench )t4sed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: D ".'B Total Depth from original grade: 3.8 -7 `� 6.9 -1 YA(ZiWW GPD/Sq. . Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe to Movf�l1%4tr.J V --M-2.19-7— %-U7 Ft. � FI. Township:- 1J 14 Range: a Section: A Fill added above original grade: 0—.5 Gweve+-length: :L' - 19 6e65 z3 141'5' rJ Ft. 54 Ft. ❑ New ❑Upgrade Gfaye1-Wtfl+ h. IaG ���• Div Ft. Number of lines: Distance between lines: '4'•-I "' �� O FI. Classification (Prlva ,C): Total Dep Cased To: Total absorption area: () 1(05 Pipe material: D3034 - FBID - Ft. FI. SQ, Ft, Driller:le Drilled: Static Water Levet: Installer: tae��So I- Darya sstry95 f FI. Yield: Pump Set at: Casing Het ve Ground: TANK GPM Ft. SEPARATION DISTANCES Kseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: C," Capacity in gallons: tonc) From Tank Field Station Tank Sewer Lines try-"^ Well- 110 �_!' 13214' t. -S N�4 i >ZS Material: s t L Number of Compartments: Surface Nia LIFT STATION _ obi " 1 �� N,p. N/A E5Lj ` * Size in gallons: cturer: Line Line _ Foundation IJr. r 5 .{- N h ,,�r ^ �{ "Pump on" level at "Pum e High water alarm at: Curtain N JA Electrical Inspections performed by: Drain _lw Remarks: al:' �x� G `� s��� w BENCH MARK Paa,r1s"% (= )oN DP_ r�.1l��d f•rS4P. –r4 -w l, A11D ALl )o l& Location and Description: ^f }A 2 SI l D lD o -F `; `fro rJy rJo(?�r"'}a jzpap of-- 'BED 7}12ou61-t, C-,t-5Ew - Assumed Elevation: 100.06 7010 _;044• –M Fot lDu1 Savoy. SC4,& wL1-44 N+ A)A-L-. SuLt 55, ENGINE R'S SE 4 ` �� OF 01t �� So',t,s \j,WA" APPG-&2Fri2-m P00pr. �F�`f 1bµ�r- sDu�r�+ r.7D v �p •.. ...�,�, ®r � '�o•� '•*Ai CSVF-E'a1(. SOILS v1$v?�- .PPP »D Tb t-,Ga7,M7i6,j 1553ydviwa-,+ Inspections performed by: J�-� �''Dates: 1st 7 13 9s -4 00:00., . .0616.....:.,. 2nd 7 17 '9S i 2`L/4S 7/2J GS"' �..f.. .. ......;.� de R`�: ray A, Garnets e: Department of He' Ith and H n ervices approval ��/% �o��0; CE -7953 : �.� f, _ �^ 6 AW Q�9eo •6...666.•6 AW �b\v�ua�+•r�� Reviewed and approved b Date: > 72-013 (Rev. 9/91) MOA 25 Perm!tNo, sSwq46364- Page Of Municipality of Anchorage DEPARTMENT OF HEALTH AND HU;4N SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 * Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L-07' 5%, $Y- l0 MOukrrADQ P&'-4/- PID No.: -qQ 'A,) "Zo ....... ...................... .. ............ . .... ...... 44 3' ................ Rp= 5cl.q' 9 �3&� L ................ ... ...................... .................. ................ .............. ... . ... ....... .2 AT= 60.1 lal 5"= Z C' -Fm"j V, Co b ..... . ..... ----------------- 0/0 C/O N_Z) LA S� 41c) Mr N 3 ............. . ... ...... ......... ....... ....... - .... ...... 0 lot JAW % 0 Hrey A, rne$p 53 '00 SLE' ( " = 'Zo I Permit No. ' Sw R4 o 3 64• Page 3 _of-� _ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 IN Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L -o -r 5 le- t0 M0urj-rAo1 prae.K. �-:-s i PID No,: _017 -44-/-Z4_ i-2"10SWLA-nal i DOneD 5�� PLAN V iF-..ti1 REQ 2ouTia� o ion � P1PMC-rU 6� Dir-1��5(oJS� �ocA-y rJ I — q7 97 - of et '. ,oU i covFz-: Z.8'To a.3 19D , _ ......... ; ...... -�- 1G:...� �i S U L';X-r+W ... ', ........ .... ......... *.... _. �¢ ._..... .. ......... _ °l0 c% clo clo qL•r. 96 • U; -T b 9E5 F1 n r1 rl vows -177 3' h�iNIMVM c.ov q5. Da 94 11 NISV4 11000 6A _.�.. s♦q2� Y+PT40. TAAJ{C — '1--t-Tz--9--'--"--Y+--- g0.OU bH-r�ET iNv 93 --Q�_ SQTTD&I TH # Z (2 G-7.411 N restf:V -= 136.65 OneaLmWir; $r --G PL6,j v1f�_w PO4- 43 04- 4 No GeouNowaq[Ee_ (o�zS�94 y/94 7 31 qs L � c� w ->•'�a U .• .......... ................. 5�.;, ..... L,,, ep �eor�o 1-i1 # 3 Ga 3I No . 6kA-cJNDw SOI� i ��• Unl���l.l/I n1�7--�.�011_S, ZO GJ 83.9 3 onl '/3/gar Ta c1l . �. 1 ENEAL - 9 FF- 1 d;- 7( Alak'�Gt' �FrIIJW P P� u:,rf0 4 �� loss .IN 4 0� .0 *4040040:1 � tfra amass� f . • \`�w� I` CE -7 3 ' too 72.013 A (1/03) 1'�Iru�icipali y of Anchorage Department of Health and Hurnan Services 825 "L" Street Rick Myslrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor September 22, 1994 Jeffrey A. Garness, P.E., M.S. Alaska Water & Wastewater Services 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 5, Block 10, Mountain Park Estates. Waiver Request #WR940050 Dear Mr. Garness: Your Request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is nine (9) feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Robert W. Robinson Civil Engineer On-site Services MUNICIPALITY OF ANCHORAGE Departmentof Health and Human Services On-site Services Section Waiver Review Worksheet WR#k3"-0050 _ PID# HA# Permit # ri - P 4 Date Received: Legal Description: Lo Engineer: �`z Y� {� Cq ✓�'tSS Applicant: Waiver Requested: S ur �tU Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or easons for. above: vb�b 3 C>0-2 Rec # Amount: $ �Date Paid: �� ty of .l nchoraae Department of Health and Human Services w wV •�' 825 "L" Street byj Rick Mystiom, p.p, Box 196650 Anchorage, Alaska 99519-6650 1 1 r 1. September•22, 1994 , is T I; Jeffrey A. Garness, P.E., M.S. Alaska Water & Wastewater Services " vF (F(T, X r , ,: ,;,18471 Brookridge Drive G, Anchorage, Alaska 99504 " Sdbject: Waiver Request for Lot 5, Block 10, Mountain Park Estates. '=1 Waiver Request #WR940050 l ,. r 1 n . Deaf Mr. Garness:� + tween �a /septic system Your Request for waiver of the required 10 foot separation be d a 1 lot line has been approved. 'The waived distance is nine (9) feet, Fy` This approval applies to the existing septic system lot line separation only. Any future r` upgrade to the septic system will require all separadons be met or another approval from`lJ' Us department. e :Sincerely , Itr.R Fi 1 i 6 Robert W. Robinson Civil Engineer On-site Services l i ` � 1 tT •i\YL �`lj� 1.7 n r rt 1!y'r4k➢ sju, �t. 5 -ill 1 4 . 1 ! 'r 1 jYlf d SSf`f`fS}�y. 1 Alaska Water & Wastewater SerSvicles "Preserving The Last Frontier" REC;�IM rif r-�� ,JIJI. � G 199 PHONES 337-6179 Munic pality 01 Anchorage FAX -8 - 3 2 6 Dept. Health & Human Services DATE: -7 �� _ NUMBER OF PAG4 S: _----_---- (Including Cove)-) TO: FROM: - FROM:_-��12' fps COMPANY: �� SUBJECT: L-6 1 ' MESSAGE- : ----- -- — - --- ----. -- Up®nJ \J1�U,6et, F,=%,,j4weUA--`-70�J �r�� LS �- � � toy �.V� Q � I � ��ay�,. S l�-�"-�• s S U �.1 tom- b � 1? - . ate j�•�1 �--��(�- V �--v� (.vO1S (ej --Tz) LZ L w S N O-,{ \-1 �'- 4'9sC)42- 7o� ge:- P( lcS PL�_� Sincerely, Jeffrey A. G rness, P.E., M.S. Owner/Consultant v Telephone: (907) 337-6179 • Fax: (907) 338-3246 • 8471 Brookridge Drive > Anchorage, Alaska 99504 r74 - - I � - z�- _ f did 4 I -IN ggi 4: ._ f ,JAN T ylla S^'� _ I -r s Ak - 'FdyaWE- � 1 la `.�1 _ _ S E z 3 • - - f 1. e I p y I 71 2 I � 71 2 I � r # r I _ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 (�'cj ANCHORAGE, ALASKA 99519-6650 � A_2) i5 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW940384 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:SINGYKE ROBERT OWNER ADDRESS:12536 ALPINE DR ANCHORAGE, AK 99516 PARCEL ID:01744124 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK 10 LT 5 LOT SIZE: 24800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. 2. 3. 4. 0 (UPGRADE) PERMIT ���� d'-\ �od'a_k�� DATE ISSUED:10/06/94 EXPIRATION DATE:IQ-06/95 cul 1 ��V THE ATTACHED APPROVED DESIGN. 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). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 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 THE FOLLOWING SPECIAL PROVISIONS - SPECIAL PR RECEIVED B ISSUED BY: DATE: DATE: r/ `' Alaska Water & Wastewater Services "Preserving The Last Frontier" September 22, 1994 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section P:O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well adequacy test at Lot 5, Bk 10, Mountain Park Estates S/D. To whom it may concern: Recently, a permit was applied for from DHHS to upgrade the septic system on the subject property. When performing records research for the upgrade, it was noted on the well log, and the approved HAA paperwork (1985), that the well capacity was 15 gph (360 gpd). In short, an HAA had been issued even though the well appeared to be inadp-e,ny- Prior to designing the septic upgrade �r3 � 00 A?/ Ap5 C recommended to the homeowners that we test to verify whether the well is capa �% gpd. The test was performed on 7/14/94 summarized as follows: WELL DRAWDOWN: Time (min) H20 Level Meter Total Flc 0 167' 22,830 0 11 171' 22.,840 10 reduced flow rate 35 181' 22,855 25 reduced flow rate 60 188.5' 22,870 40 flow rate 360 238.5' 23,030 200 increased flow rate 380 260' 23,061 231 390 288.5' 23,120 290 stopped flow The pump continued to the flow was stopped, t at period, the water started to monitor the run for 24 minutes, 10 filling the pressure leval in the well rose recovery after the pump seconds, after tank. During to 284.5'. I shut off. Telephone: (90 ) 337-6179 • Fax: 907) 338-3246 . 8471 Brookridge Drive RECEIVED SEP 2 6 1994 Municipality of Anchorage Dept. Health & Human services WELL RECOVERY: Time, H20 Level Recovered Volume_ in Casing Recovery Rate Based ut>on 1.47 gal. ft. ;x 0 284.5' 0.0 gallons 5 282' 2.2 .44 gpm 10 281' 5.1 .29 15 279.5` 7.4 .44 20 278.3' 9.2 .37 25 276.9' 11.1 .39 30 275.7' 13.0 .37 45 271.6' 19.0 .40 60 268' 24.3 .35 90 261.5' 33.8 .32 120 254.8' 43.6 .33 The recovered volume in the well casing was 43.6 gallons over 120 minutes, corresponding to a recovery rate of 26.8 gph, when the well was near maximum drawdown (between 255- 285 feet). The ability of the well to sustain this recovery rate over an extended period of time is uncertain; however, based upon this data, it appears that the well is adequate for a 3 bedroom house (450 gpd) at this time. NOTE: The results of the :est are only valid for this given day, as the adequacy may fluctuate due to seasonal conditions, seismic activity, annual precipitation, ect. If you have any que tions please call me a 337-6179. 4incerel Garne -.E-, M..S.u.l tart w • *.•� ';� to C.0 Bob & Jan Singyke ��'•_• •• of see Ago •♦ •• •UNC •N Singyke2.WPS ��^ yA.Garn �O✓ �e •• CE-7953 �•; ���� r 1 (�Q •h "see so �iaAi �� °ROFESSI4HP•p�r Alaska 'Water & Wastewater Services "Preserving The Last Frontier" Sep )-,ember 17, 1994 Municipality or Anchorage Department of health and Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99S19-6650 Ret. Septic system upgrade at Lot 5, Bk 10, Mountain Park Estates S/D. To whom it may concern: �1- GENERAL. 'The existing bed, installed in October, 1.9€34, is currently ir-r a failed condition (surcharged with B inches ov`c-� of water on 9/6/94) , and must: be replaced. Attached is they 1+'A application, site plan, and design drawings -for the Subject `koolvp- • upgrade. Comriienr...> regarding the proposed sy.,r,rm are ac> fol lows: 2. SO.fLS DATA: Anter evaluating three Lest no Los, Performing 'i percolation tests, and reviewing the soil test: data from 8/15/83, it; is my belief that the existing bed rn� be installed in soils which are not representative of the application rate used for th3 design. 1�urtiiermore, 7 Am concerned that there is not enough suitable toils on the property to inS>:a11 a "tt=xt book" upgrade_ An evaluation of the soils data is surnrnar:ized as follows: a_ __Soils _'esi s.- p rforfged'��t3 .1.3� Attached are copies of the soiJ.s `logs arrd g,c:icolation tests. At a depth of 6- 6.5 Pcet the percolation rate was 40 rninutc:s/inch, and at; 2.5-3.0 feet the rate: was 7 minutes/inch. The location of the test mole was near what is now tilt-' front entry of the house, about 30 feet from the nearest edge of the bed_ According to the inspection report, dated 10/€34, the bottom of the bed is 3-5 'rept below original grade;. Based upon the depth of the best, the location of tho 8/15/83 test, hole relative to the bed and recent, test hold data, it is reasonable to ��,ssc1111e that the application rate used for the existing bed (19/ ft2/bedroom) was tori high_ Telephone: (907) 337-6179 . Fax: (907) 338-3246 . 8471 Brookridge Drive . Anchorage, Alaska 99504 k>'--- osI- hale arrdper,�coIa.tionreslrIts ..- We;/94)_;_ When performing these percolation tests, only strata which would allow for gravity flow From the existing septic, tank were evaluated, primarily for the following reasons: --the soils above this, elevation were visually very tight in test hole #2 (perked > 120 min./inch at depth of 6 feet). --The soils above this elevation ware tighter in Tti Bl. --The ML layer .in test, hole 46 was only 2._5 feet thick (cepll-h of 1-5-4.0 feet.), and lying directly over impermeable soils (based upon perk test >120 min_/inch at depth OF ii ier�t,and visual analysis of soil sample pulled at depth of 5 Ieet). Attached are copies of the logs for T11 41, 41:2, & 413. Based upon these test: holes it: appears that the soil conditions change, rapidly, from suitable soils in TFI 1t.1, to unsuitable soils- in TH #z & 43. What lies ander the existing bed is unknown, but is probably a combination of the soils. 3. LOCATION O1= EXISTING WELLS: Attached is a plan view which shows the location of nearby wells. There are two Wells can the subject lot, one at the southeast corner, and one at the; southwest corner. The one at the southeast corner was never used (inadequate), consequently, it will nerd to be properly abandoned. The 100 Pool: radios for the well. located on Lor. 1.0, Elk 1.1, Mountain Park Estates passes through the north portion of the subject property, leaving minimal space for any septic upgrade (perhaps this is a moot p( -Ant, since the soils are so poor in this area (fil #2)). Regardless, it can be seen by reviewing the site plan that there is minimal area for the proposed upgrade,, only about 1000 ftz on the: northeast corner. 4. PROPOSED DESIGN: Based upon the percolation rate of the silty sandy soil layer in 1"El #1 (3 min./inch), a bed applic:.ation rate of .8 <lp(_I/ft2 could be used; however„ givon the fact that soil duality varied so dramatically just. a short distance away, [ am reluctant to do that.. Instead, I am proposing to i-nstal.lanother bed, essentially the carne size Ps the existing one (,approx. 1.000 ft2). This design would l)e conservative, if r.'re find soils similar to those- encountered hose:encountered in 1""11 #2. , bu'i; would be inadequate if soils wP:re similar to those encountered in Ti -1 *12, & tt3. i anticipate that we will find a mix of both. T also intend to install an alternator v,alvc -o that Flow can be switched Between etre two be d�- , aT i:er giving the existing bed a period of Little to rest/r-cr:over_ This should add a. factor of safety to the dr=:sign. In addition, I ,.ti il- require the contractor to hay. the-xi<SAirrg bed Pumped cry, so as tcn hasten its recovery. Z�F. 1?or�r.._soi l S (.less t,hart_--._S. kation rate ) areeilcountered over Hie._ entire area for _ the new__ j?W _ theil Lneagjj:�de _Would be undersized, however- dome the best we can dcj no room left:! )_._ If this turns out to be the case, it would then be necessary to do a follow --up adequacy test to verify the maximum number of bedrooms the system could he rated for.. I ' f required, we could "peroxide" the ol.d bed and operate both systems simultaneously, in an attempt to meet: the absorption rate requir-ed for a 3 bedroom house. 5. LIED DESIGN CRS IERIA: T �:,rn suggesting that we pit in a .`�{ 18 foot wide bed, which is 56 feet lona, providing a total ond"' absorption area of 1«08 ft2. The 18 foot; width exceeds the maximum specified by M.O.A. regulations, however, in this a ` particular case I think a variance is justified. The objective- of increasing the width is to shorten the length, keepin+; the systr.rn as close as possible to test hole fit, where we found good soils- With a 15 foot width the beet would have to be 67 feet long, placing the, south end of it closer to test hole #t3, where poor soils were, encountered, 7= TOPOGRAPHY: The lot is generally flat, consequently, there are no slope concerns, t;_ SURFACE WATERS: No surface waters were observed within 100 feet of the proposed septic upgrade. T. am unaware of any negative imparts tha% this ins(-,al.lat .on would impose on adjacent wells, or septic system,. I am open to any sugge sti.ons, or recommendations from your department, If you haves any questions, or would like to make a site visit, p:i ease; call roe a 3137--6179. Si.naerel. /, Ow e /Consultant S=ingykel , t'JPS t'_F., M,S_ iz vGarnetsA. •7953 •••: ; �4 NFESS��Nk." LINE WAIVr=:R,: in order to maintain some separation 11-0 r from t.heI old bed to the new one, it will be necessary to crovrd the east property line as much aC possible. ot% 'fLlerefore, T am requesting a waiver of the 'Lot p - t0 cepa rat ion distance to 1 foot. T unaware .line of any adverse �. irflPact`i aSSOCiated with this waiver. 7= TOPOGRAPHY: The lot is generally flat, consequently, there are no slope concerns, t;_ SURFACE WATERS: No surface waters were observed within 100 feet of the proposed septic upgrade. T. am unaware of any negative imparts tha% this ins(-,al.lat .on would impose on adjacent wells, or septic system,. I am open to any sugge sti.ons, or recommendations from your department, If you haves any questions, or would like to make a site visit, p:i ease; call roe a 3137--6179. Si.naerel. /, Ow e /Consultant S=ingykel , t'JPS t'_F., M,S_ iz vGarnetsA. •7953 •••: ; �4 NFESS��Nk." LO'F ^7 1_0 r 0 gl gloGK II (3LOLK 11 Lo,r ,n1ELL. a ?dT. 10 SV- -r 0 \\ \\ &K, (HJT• •wf LL � � w6LU. Pvr. IF gK 10 J LA r to �,Lc:ck II L o -r & _g K- to LoT 10 wELL ' -tea WF -LL-- I.0 . j LOT Io 9v- to pvr wE�L orr Fj ,/�° \ BK ip l PwELL \ 9? wEw i NO�Fir7 : t o i -7 eK 10 . r nY S lS NO i %\ CURVE / T"Hb ICP la/� STe u c-ru 2s=S 1 APf o A -rrr 2. (a -Ll. 1�o�-S A•R-� IN Movr.l'I`a��.l P�.K �:iv�1�.S SEP�G IJPGP�AD� : Lo -r 5� �k IUB TSTA5 s/D. PP,E=-PAaF-D FUR : P--,08 P2F—PACM : ALASk-A Wh`rIEZ Wks cEWP.TFR SEP—VIC,S P��pAT�, 1 Lo -1" I A Gv- 12 l,or 2A BK. IZ cvaca.Jr) sy- 12 LflT 4 J Zoo � Av/�l `E OF A4 1 �•..ee.eee.'Y.�i fA�. n 'a� 9Fop �..........•••;��o 2 �xFy,-ia Cr D � waLk-; L c�1 h� r r E� .4 d o' ,4; • PIPE • Sb LID pi Pc ° C/n so�-10 4 DRA10 wiTH PE9-FD9-;-1lord p [bw N L6n N o , o,c �U- 6 J • p v ae44 NnT : DPJ�IrJ ROCK S4AU- P>E ' -ro 2 A a ..o •4 k7VP-lfUEr ' UBI=• PEQf=oP1rTE0 KJ GRPJF— 9'b Bp�Kt'ILL- wiTaa tL4M\Js= r- ROCK , e. -o I�!rI �ILTF� FaSiZ�('r SILT 5o I L. FOS p2�PAR� By ALASKA V847ER \NASI�wA�{�vlcES� 17 /qui' I >2Avti l: C � SCIal E NTS,. 66:46 m mtt most t .. mt. Q. ,, I� loba 40 fr Gaines$ �ruS' • -7953 t PRO ESSkko•��s .M._ ti 4 Pno2"T��.r.IavLfl = 100,QO ., Kltinlclpallty of Anchorage " DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SAILS LOG — PERCOLATION TEST h. e:�n6 PERFORMED FOR; 16 Time Water L.oi S LEGAL DESCRIPTION: MDUwTYAW tls�6P+atcS DEPTH 96.43'7 Ila 1 -— h. ,� U Vatl y O I.I 16 Time Water 1t1� 2 it t6�q4• A0 - g2.1► 18 D S4.ap USAS� rim 19 Hv t s2 t•5 4- ' n �. - ' 3N ML,� 2 7 5w-lYl some PDCV£'r.5 op p� 6 CS > nl 3 , 9 g, l0 n� 8 T DATE PER nship, Range, SeCM SLOPE ML PFaL WAS GROUND WATER 10 , �xGA��rrti2 ENCOUNTERED? No CE -7953 0, so or —t—A — SITE PLAN WA ,� U Vatl y O I.I 16 Time Water Drop 17 it t6�q4• A0 - g2.1► 18 D S4.ap USAS� rim 19 Hv t s2 t•5 CE -7953 0, so or —t—A — SITE PLAN WA ,� ..�/ Reading Date Time Time Water Drop it t6�q4• A0 - _ 3/ D rim S L IF YES, AT WHAT0 DEPTH? N P E Depth to Water Alter J ^ 7 Z 9$ M-11.'1.0 I? Date: N Gross Not Depth to Net Reading Date Time Time Water Drop it t6�q4• A0 - _ 3/ D 2 ' n z . 3N m 20 20 PERCOLATION RATE ` (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND !! -- FT z,. COMMENTS S�PiIG �A,1�� CJ0 e F'CE—y. 012.92 PERFORMED BY: * Ex�sna6 SrD Ea�v 95'} I-C����S CERTIFY THAT THI TEST WAS PERFORMED IN — ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: . 7x94 72.006 (Rev. 4/65) H `T— D P/7 O r1 9/(7/54 - DATE /(7/cl4- -4 1OD.Gb Munlcipallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES .r 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: v LO -r" q LEGAL DESCRIPTION: MDUN"IYa IL-1 P� k t171 DEPTH 7�1,ANIG S d - 198.oh 3 2 kL 3 0 i� 4 0 5 6 7 0 ' 9 X10 W 11 12 13 14 15 16 17 18 4 Folvo-I'S of p(LlrAra.fLll}-t SIISi—'�GIA•r DATE Township, Range, SLOPE WAS GROUND WATE 1 ILLED &a�� ENCOUNTERED? 11 S Du [r o•� IF YES, AT WHAT gj , (0 0 DEPTH? P ,�"1 E 00poHe-WateT"lcd¢r VAP /94- � ,...�..��.4-y nalP� 7L (68 •(n5 - 89 . fc-)_- 92.0) )y A. Gamms CE -7953 SITE PLAN 2 '14- a 19 20 minutes/Inch) PERC HOLE DIAMETER PERCOLATION RATE TEST RUN BETWEEN FTAND -FT rjT'IL an�r� clo @ �2.9Z'= �xtS,t�� SEP @ ELE-v.= 'OMMENTS SatL,S L.J�n� NoT" pC2�Soa-4'-�D QR -+o2 "Its "[�ST1•�b HooT''r'� SoIL.S_fNAO64uA'76' PERFORMED BY: ``�r���� I CERTIFY THAT TH S TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. D. � 2 q4 72-008 (Rev. 4/85) M , T DC -1 0,J -7 �94- _ I Municipality of Anchorage � " DEPAR7MENT,0F HEALTH & HUMAN SERVICES � 825"'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST J i DATE PER tj PERFORMED FOR: — b re •eery •• ••• ••• •• �4 • �• • • e ••• eU M• r A. Gams%e�W ®i`%.•, a -7M �= t o^r K t U v lilLEGAL DESCRIPTION: fou TAl Ga��'-®�rOwnShlp, Range, Sec N SI SLOPE SITE P P � (F LOU Mt- 3 - 4 L3 4 5 O 6 \ �--- -- =r - 7 S I LT` -1 G (1a `f Fi 8 SOIL. IP,arspa;.O 10 11 12 13 14 f� cd1 33 _ 49� 15 16 17 'OMMENTS WAS GROUND WATER I r spy FNCOUNTERED7 �-�- ,. s > L IF YES, AT WHAT nT*17�M 0 DEPTH? --- P E z r -s Depth to Water Alter �Iy 9 7 4 LJ Monitoring? _ Date: cht Gross Reading Date Time Ca/ �ar,�pROFr vh JQ s cAA-r-- . 1't= 4or Net Depth to Net Time I We _ _ Drop >-.4 ACOLAT10NSAIE. 7 0 (rninules/inch) PERO HOLE DIAMETER TEST RUN BETWEEN 8� Z F7 AND g�' 7 FT b QED _ n V c 5 CERTIFY THAT 1S Tr WAS PERFORMED IN PERFORMED BY: g /� j /^ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ �� 72.008 (Rev, 4185) 44 V z I. Au m Z W W C I y � rrrr {{3� Y Y� I i •> tl 1 � 13 ^7� • ay Q� Y it MO D b T31 'L: �a e c2 < 1 I C) \ \OU \ v � • Gt�CG. L. � F .v• ar 4001 •o.e Gerald V. Rondol Jr• 1 1p i � `%,.e NO. 40595 e �� AROFESSIONAL�•SY•,a"n / --�—"'—"' SURVEY CERTIFICATION: I hereby cortlfy that I hgv surveyed the property shown and do, haroon end thnt Ilio Improvaman is sltuntnd tha qon are within the property Ilnes and no scribed :encronchmonts exist other than noted. - •" PLLASEi NOTE: It Is the contract LEGEND: ,' SET FOUND,La EENGINEERS ' PLANNERS • SURVEYORS -or's ro.ponslbinty to chock top S/o" REotafi A O 181 --/�$ onN.ey: !� —yv R 440 WEST BENSON BLVD, of foundation In m1mlon to HUD R. TACK ❑ 272.9231 finish grade and bulldlnp set- MONUMENT 0 8 backs In relatlon to lot Ilnas_-AL.CAP Q •Q citxo �f, ANCHORAGE, ALASKA 99503 562.5291 and easements. PK NAIL X @ onio: IRON PIPE LdOAL DfiBCRiPTION: AS BUILT ELEV$. - DATUM ASSUMED % /� ""p^� /N� % / �} 40/......... 6 --0c/< /v 60AL€I / lI tom' L�D �jd �1/ /( MUNICIPAU CY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \\ 825 L Street - Anchorage, Alaska 99501 Telephone 264-472.0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE NEW F-Ia�-W 3�/.S'�S'Z'� ❑UPGRADE MAI LING ADDRESS - _ )i4_oto Als3rU l w,4t, -Nchar>A-(,v- +r- (7c7) i r _ LEGAL DESCRIPTION L T6' 6)c 10 i p ruk_5t4-f-IF5 LOCATION ALpwNr f i scue-tav NO. OF EDROOMS _ _ F _ Well f Absorption area Dwelling PERMIT NO. DISTANCE TO:- /(� 7 - I t I rU o�cb O i� -� y y a Q Manufacturer Mater ' �l-a L No. of comp;im ents iLiq. capacity in gallons pQ s F HOMEMADE: Inside length Width ®_ r• i Liquid depth j D ell DIS I -A N C E T "---------�.. I welling PERMIT NO. - __ `' d Ulmtufacturer-7dfat`P.i'l al'----�-------�._ L!guirl capacity in gallons (5 z O Well , DISTANCE TO: % O _ I �ength FOUnda ion Nearest lot line I _-- —3' _ �u osc P_ PERMIT NO. C�[�� __— w {� No, of line- of each line �._--l=/Z"it 1-otal leng>�of lines T"Uar-11 width ktc�.,O 10 IACtl@5- Distance between lines ilk 1 -t Y - op of isle to finish yr3de '�Ue n{l Z' Su�l•F�t - Piaterial beneaeh the % inches total effective absor ion area r f5 ength bUidtii PERMIT NO. Depth W coo d I- Type of crib Ffrd+au ur Crib depth Total effective absrirftion area Ld-- p1 - --s t ilc i g foundation Nearest lot line --__ —_ DISTANCE TO: Well Class Depth Driller L1 Building founclation Sewer line DistaYice Septic to tank at-ltiae.� PERMIT Absorption NO. area DISTANCE 70: , OTHER PPE NIATERIALS Ij� — — 'P3c - _ SOIL TEST RATING IY rl �� •fit IG2-- 30 - - -- ' - -I-- 'Y - - INSTAL LER _ AA II.. ,, II --�-�i ---- -- -- - REMARKS t1 Nsu�kAi �ory 0 vEryIrl I xrLt- B6'0 -- 5_ .' - - I---Fst-L. cov-PI -bsor6P' Ocn-4t-6A- un/n - ., v�.r7 iso �� -fin � -L =-�7 /- --- I � �'I -- I - I:� 04(1 � - )_}I�� ,)0 _ ' — =5 'I — 11� I I --- --- ---� 9 LEGAL LT y Bic i o wt N PMLIC -S7 APPROVED DATE I v z�1 70 M -W DRILLING, Inc. P.O. Box 10.378 • 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Location (address of: Township, Range, Section, if known; or distance main Lot J bl_oCi. 10 Motintain 3 -ark 1.-,Uites - Anciiora�,e Size of casing G Depth of Hole 30' _-feet Cased to ljU —feet 64-304 of Well �` 1d!St' C_ Static water level LO ft. Z(we� (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation hone Well pumping test at 15 gallons per (hour) ( RRih iR) for hours of drawdown from static level. Date of completion 2=t ber 17_L 1984 WELL LOG _ Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness U TO 2 Cas:in� stickup — 2 Tn 6 Cravel fill G TO 9 9 TO 89 89 TO 1.01 101 TO 140 140 TO 146 146 TO 300 TO O — -- TO- TO—TO -TO TO TO TO TO Salty gravel JILlty :iS� i & fTs ave]- uN�efF A FMko Bi — �IIerS. �NENSAI.�� EN��Ror� Silty gravel Ana:, Silty har•doan _ Wdrock Nr,rTgA Catt,fied tractor Ceruncate Nes. 814 & 913 3 — CONTRACTOR /ERMIT NO: /ATE IS�UED: \PPLICANT: >DDRESS: MNTACT PHONE: EGAL DESCRIP: OT SIZE: 1AX BEDROOMS: 11411.111411 JE AL 1 '11 IF':" 11 IE::::,, 11 .. I C::J1 IP':! 1EE: DEPARTMENT OF HEAL11 AND ENVIRONMENTAL PROTECTION 825 L STREET� ANCHORAGE, AK 99501 264~4720 :31: "T"EH: �11,."11 JUE, If`;�,! 11,01,11 FEE: IL_ L._ ���EA-:� P, 11 JE - I- 840812 09/25/84 GERALD N HANSON 13400 BRANTWAY ANCHORAGE, AK 99515 345-5277 SUBDIVISION: MT SECTION: 26 26100 (SQ"FT. 3 PARK ESTATES LOT: 5 ' BLOCK: 10 TOWNSHIP: 1214 RANGE: 3W OR ACRES) .isted below are the options available to you in designing your septic ;ystem^ Choose the option that best W.s your site" ~ ~ � ' . � ~ ~ � _ � � _ �RAVEL `OTAL DEPTH (FT.> 0.5 �RAVEL DEPTH (FT.) WIDTH (FT.> 2.0 22.0 �RAVEL LENGTH (FT.> 41,0 �RAVEL VOLUME (CU.YDS.1> 'ANK SIZE (GALS) j(")): I.. RATING (SQ.FT./BR> 33.5 11,000.0 197 X. DEPTH TO PIPE BOTTOM < 2"0 FT, REQUIRES ADDITIONAL GROUND ** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATIDN ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS len 11 COVE � certiIy that: 1" l am �amiliar with the requirements Ifor on~site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. it I will install the system in accordance with all HOA Cluj os and regulations� and in compliance with the designC:ritewia of, this permit. 3. I will adhere to all. MOA and State o� `Alaska requirements �or the set b�ck distances from any existing`well, disposal system or public sewerage system on this or apy adjacent or nearby lot. 4" I understand that this permit is valid for a maximum o1" 3 bedrooms and any enlargement wiAl require an additional permit" [P A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODE31, [HEN (1> AN EMCTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS JILL. NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE �LECTRICAL WO I SED ELECTRICIAN" �IGNED DATE: �PPLICANT: �GERALQ' N/ HANSON ^ [SSUED BY DATE: ~~�� _^'/ / _-__-_'-_�_- __�'�_������_�`-��� �� ��---------r-� - - n � \\�^ ~ d / 3 \ \ ± & R G �Rm w # ^ t \ q K \ \ \ © ° > ] / /§\ >o2 7z\ U. . � \\ � /\\ \/j 3®§ . ,o�' SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 625 L. Street, Anchorage, Alaska 99501 264-4720 .� 1�• SOILS LOG - PERCOLATION TEST T 'D„j g/I x /p PERFORMED FOR :I C C ItI / fi Sr.'V} DATE PERFORMED:-T�c'. LEGAL DESCRIPTION: LoJ yL_01 (d ( oo6fe � �Q-Irl ES 10.125 N A_� ' '� Su,�l le,X DEPTH SLOPE SITE 1_AN -- 1 M r-• Orin J.^1 �� S X 2 Ml Girey �r Sr /s C'r 110,5� c,H 3 y S'roe 4 c 6 /✓11 �� Cir �I �/ Cvbtiles Mo`lSt N 7 S tr� x 9 r r� 10 X 11 12 SIC-id AA ' 5-( S'V'Vl }r!, me,'ttl'tn1 WAS GROUND WATERS S ENCOUNTERED? ,"J L 13 N_f S;Cr50- 14 15 l� Apra va A OF AZ� '•a•. e•os �� 17 tr,sa �A- T III 18 id.ae oe • •es .o••e® 19 4 ° e NEIL HAW'iHd RNit • ,(� 0 Cr - 4369 O A150 /Jooe P E IFYES,ATWHAT 3,17nyi (ra �P.r DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop - Sir I sf I � 30 til tj �aP I _ I. J I jrL IISI Reading Date Gross Time Net Time Depth to Water Net Drop - 612 30 ` 546 a2 ftp 30 20 ®®r`I zee°°81i�1B3e•°esS'& /' ( Z 1 , pa'professionae�±w PERCOLATION RATE_ v _ Iminutes/inchl•,V3S,4 L`'s �rw ,1 �} TEST RUN BETWEEN FT AND COMIM E/NTS— Ca.tZYac� YVtJS�Q�_z;,�Py$teW. res'L-ld_C�s+� r� vJ�ivPv.>>S LJ�'�ISIN//az��rr.�t, PERFORMED BY: �� - ____-_ - __._ _CERTIFIED BY: _ _ -.__ DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE o DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TERCOLATIor �tr TEST B25 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST p"3 PERFORMED FOR:__b)jj) � Y>•. -Ie, 9 CYt _ DATE PERFORMED: LEGAL DESCRIPTION: DEPTH (FEET) 1 2 3, 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE • '�99 •• t •e• s•o••ee �� '•••• •• can ea ee•ta•°e e•s� I °e NEIL. HAWTHORNE � CE 43 %Ojjw �PJ7 WAS GROUND WATERS ENCOUNTERED? A/O L 0 P E IF YES, AT WHAT DEPTH? PNIz 6" Reading Date Gross Time Net Time Depth to Water Net Drop I__� z;v� —� 3 1-s -- �' 2 - - —-1 I 7_ --- — IF F Reading Date Gross Time Net Time Depth to Water Net Drop z;v� —� 3 1-s -- �' 2 - - —-1 I 7_ --- PERCOLATION RATE _ (minutes/inch) Se< e /TEST RUN BETWEENp _?, S F�Tj AND �� FT COt+�r✓.ENTS _ e1- A--.—�.+<'� �I-G� r �� f' ✓ O r e� S '- CU v I e� _fU SSI -�Y (o �Gi��[:._._�Y� 1 / Sajo��� �� �. l=--,2-QO f'� 6 P c�i �u,•� i,_ %ice_ 5.2� r,.� tri i , .._ u s �' c PERFORMED BY: jv-� _CERTIFIED BY: /" 1 _ DATE:_/ Jr C'v,71 rO 61- PAU5t stay a'A a.re.0 f fir L2xCczva 4 '6' ki i 'ee 51/ s tE?1N tS, vse-w. /A73/9e?e --roll S'✓ijleS ted. r U lm''11h, H Municipality of A'ch'6h g%2016 K i'gl€{t^ai On -Site Water and Wastewaten(PrgM0iiEn �• .�' _. ff (907)343-7904 x Certificate of On -Site Systems Approval Parcel I.D. 017-441-24 Expiration Date: fi ` 1. GENERAL INFORMATION Complete legal description MOUNTIAN PARK ESTATES; LOT 5, BLOCK 10 Location (site address) 12536 Alpine Drive `Anchorage 99516 Current Property owner(s) Tom & Beth Chesterman Day phone 782-5871 Mailing address Real Estate Agent Rachel Wit Day phone 250-5036 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well R Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: N/A TYPE OF WASTEWATER DISPOSAL: Individual Q Holding Tank ❑ Community ❑ Public Sewer ❑ Received by..— y ��. I�'Z� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 21 l1(�2 Receipt Number C) j 6gc COSA# 0loIa001 Waiver Fee $ Date of Payment Receipt Number Waiver # S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Gayness Date 7/7-a i` In conducting this evaluation, GEG provided an engineering evaluation of the well and/orseptic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well orseptic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms l System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the 49lipfl'a�troRxz--)N r, Original Certificate Date: 7 -I -1 L The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the Stale of Alaska. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 7. ATTACHMENTS: COSA Checklist IN6 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc If more than 7 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTIAN PARK ESTATES; LOT 5, BLOCK 10 A. WELL DATA Parcel ID: 017-441-24 Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed 9/17/84 Sanitary seal (Y/N) YES Wires property protected (Y/N) YES Total depth 300 ft, Cased to 150 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/17/84 7/8/16 Static water level 150 ft. 141.2 Well production 0.25 g,p,m, 4.2+ g,p,m, WATER SAMPLE RESULTS: Coliform 0 oolonies/100ml. Nitrate 3.25 mg./L. Arsenic: NO ug./L. - Date of sample: -7/1/2016- B. SEPTIC/HOLDING TANK DATA TankType/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Collected by: GEG, Ltd. Date installed 7/13-20/1995 Cleanouts (Y/N) YES s;'Foundatlon cleanout (Y/N) YES " Deprea ion over tank (Y/N) NO High water alarm (YM) N/A Date of pumping : ! �' Pumper A,'r Nlon� S�vl c a C. ABSORPTION FIELD DATA ;_3EL0w EXISTING GRAD Date installed 7/13-20/1995 Soil rating .p.d./ or ft'/bdrm) 0-8 System type BED Length. *VARIES ft, Width *VARIES ft. Gravel below pipe 0.9 ft. .Total depth *'5.4 ft. Eff. absorption area 1165 ft' Monitoring tube YES Depression over field NO Date ofadequacy 7/8/2016 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test 1 in. Water added 639 gal. New depth 3 in. Elapsed Time: 120 min. Final fluid depth 2 in. Absorption rate >= 450+ g,p,d_ Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Ifyes, give date - : TESTED 1995 -BED ONLY; 1984 BED WAS DRY UPON ARRIVAL AND STAYED DRY THROUGHOUT THE TEST. CONDITION OF Tf E. 1984 BED IS UNKNOWN. IT SHOULD BE NOTED THAT TWO OF THE THREE MONITORING TUBES IN THE 1995 BED WERE DRY UPON ARRIVAL AND REMAINED DRY THROUGHOUT THE TEST. READINGS WERE TAKEN FROM THE DEEPEST MONITORING TUBE WHICH IS APPROXIMATELY 12" BELOW THE INVERT OF THE LATERAL LINE. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump oft" level ami High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line L5 + Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *1.5 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WR#940050 Na w4V*-2 S7v2o<-A j-4AA4C ,,,J H+o�C,-- f'�✓1. —rDr ICiao ,� `�fi��+J Pwe Cot dPo , -am 7%-z l/6 G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 7/Z0116 (Rev. 11105) -It 4£CC88'P Municipality of Anchorage On -Site Water & Wastewater Program = `_ (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-441-24 Expiration Date: I uP J 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES; BLOCK 10 LOT 5 Location (site address) 12536 ALPINE DRIVE *ANCHORAGE AK 4. TYPE OF WATER SUPPLY: Current Property owner(s) MOLLY TATARKA ALESSANDRO RIGUTTO Day phone 830-5067 Mailing address Real Estate Agent 2. TYPE OF DWELLING: 12536 ALPINE -DRIVE *ANCHORAGE, AK DAR WALDEN Day phone N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 865-6406 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: 1 Date:��✓ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `t qA • V Date of Payment lo�+I,3 fl3O Receipt Number /)oo- DG COSA # dSC13 /Act Waiver Fee $ Date of Paymen Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE V System #1 Approved for __3__ bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 ) Date ✓ ' 1 h� bedrooms, with the following stipulations: OF A rt e�t A rrtess.•' CE -795 P'. fess ON-SITE WATER AND WASTEWATER PROGRAM Original Certificate Date: The Mwficipakry 0 nchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES: BLOCK 10 LOT 5 Parcel ID: 017-441-24 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/17/84 Sanitary seal (Y/N) YES Total depth 300 ft. Date of test Static water level Well production Cased to 150 ft FROM WELL LOG 10/17/84 150 ft. 0.25 — 9 -p.m - WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic:, vi ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate-�5 mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/24/13 140 ft. 3.93 —9-10 m. HYDROFRACTURED APRIL 1998 Date of sample: 5/17/13 Collected by: GEG. Ltd. Tank Type/Material SEPTIC/STEEL Date installed 7/20/95 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N11) NO High water alarm (Y/N) N/A Date of pumping j� 3 Pumper Qev1 a `1 OL� i C. ABSORPTION FIELD DATA BELOW EXISTING GRADE 10/22/84 197 Date installed 7/20/95 Soil rating ( r /bdrm 0_8 .p.d./ft 38 2 Length 23 VARIES ft. Width 46 VARIES ft. *5.16 943 System type An 1-12101 0.5 Gravel below pipe 0.9 ft. Total depth *4.75 ft. Eff. absorption area 1165 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/24/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 760 gal. New depth 6 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — TESTED 1995 BED D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' Cycles E. SEPARATION DISTANCES Manhole/Access water alarm level Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Properly line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line *1.5' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 5 � 2'9113 (Rev. 11/05) S\n�h LOT 9 �0 491h* `?; .................... dlaFael L Jokela.+ r_i WEST LOT 5 / A LOT 6 The locatmn at the structuroMas Ihown on this record drawing ;ss�amtt) uwrn Iles With its 1,A Date: LOT 6 WM1 M DRAM 6 M M x—I LOT 5, BLOCK 10, MOUNTAIN PARK ESTATES SUBDIV19ON T Alaska Water & Wastewater 7320 East Chester Heights Circle — Aneborage — Alaska 99504 Phone (907) 337.6179 _ Fax (907) 338-32U Consulting Engineers March 23, 1998 Robert Singyke 12536 Alpine Dr. Anchorage, Alaska 99516 Reference: Well Flow Test. Lot 5, Blk10, Mountain Park Estates. Dear Mr. Singyke Per your request we have performed a well flow test on the well serving the referenced property. On March 18, 1998 the static water level (SWL) was measured at 195 ft. below top of casing (BTC). A flow meter was cormected to the water system and the flow turned on W. After pumping for twenty four minutes a total volume of 147 gallons were pumped from the well and the SWL had dropped to 293 ft. BTC (within a few feet from the well pump). The pump was then shut off and the well was allowed to recover for a period of 75 minutes. The pumped was then turned on and 16.5 gallons was pumped until the SWL had dropped to 293 ft. BTC (again close to the pump). This process was repeated again over a recovery period of 62 minutes, and a total volume of 14 gallons was pumped. Based upon our test results, it was determined that the well produces approximately 0.23 gallons per minute, which does not meet the Municipal requirements for a three bedroom dwelling (0.31 gallons per minute). It is our recommendation that the you contact Dave Harper with Alpine Drilling @ 345-0202 regarding corrective measures. If you have any questions, please contact me at 337-6179. cerely, James P.Williams, P.E. Civil Engineer lnlFit+.- Wo.3 trsEl F+� `7 �i5 F12,�r� ro FLOW -rE ST, Z P9-oPLE. 1� F+vu LE M5 MUMCIPAUTY OF ANCHORAGE • '� DEPARTMENT OF HEALTH $ HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 995196650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMIL�L�Y DWELLING Parcel I.D. # 017-441-24 HAA # 1,11 (666 J 70 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES SUBDIVISION, LOT 5 BLOCK 10 Location (site address or directions) 12536 A PIN DR ANCHORAGE AK 99516 Property owner ROBERT SINGYKE Day phone (907)345-1 141 Mailing address 12536 ALPINE DR. ANCHORAGE AK 99516 Lending agency Day phone Mailing address Agent MARGARET GOCHE Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water 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: Individual on-site xx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-M (Rev. 1191) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1100.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affnced 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 i spection, the on-site water supply and/or wastewater disposal system is in compliance with all Muni I and State codes, ordinances, and regulations in effect on the data of this inspection. Name of Firm Address Engineer's Signature Phone (907) 337-6179 In conducting this evaluation, AWWC, /f1cJ�atfe}npted to provide a thorough, conscientious engineedng analysis of the system in accordance with ADEC and ����gA�}{�HS Guidelines &Regulations. The reported results described the performance of the system under the conditl s encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water Q0000pp�/ usage of the family being seared by the system. These condtttons are outside the control of o 0 r /{ the evaluator of the system. Satisfactory test results do not guarantee future performance ......SCJO of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. .... .. ............. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, Q ..... nor will it confer any legal right whatsoever. Qp � ff A. rness,% ` 6. DHHS SIGNATURE QO°s E-7953 ••^\eG L,"_ Approved for 3 bedrooms Disapproved Conditional approval for Additional 0 bedrooms, with the following stipulations: Date 'R - / r-_ d 0 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not Conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's woric. 72-025 (Rev. 1191) Beck MOA #21 Computer Vemlon RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICERIG 14 2000 Environmental Services Division AEM 825 RV Street, Rm 502 Anchorage, Alaska 99501 (907) 34W~mITY OF ANCH " mRONMENTALSERVICES - Health Authority Approval Checklist ►@ P�-6 Legal Description: MOUNTAIN PARK ESTATES; LOT � BLOCK it Parcel I.D.: 017-441-24 A. WELL DATA Well Type PRIVATE If A, B, or C. attach ADEC letter. ADEC water system number N/A Log present (Y/N) Y Date completed 10-17-84 Total depth 300' Cased to 150' Casing height (above ground) 2'+ Sanitary seal (YM) YES Wires properly protected (YM) YES FROM WELL LOG Date of test 10/17/84 Static water level Well production 15 G.P.H. H WATER SAMPLE RESULTS: Coliform Nitrate 1'6764 AT INSPECTION 7/12/2000 140 3.5+ g.p.m. 4iM x 0aAW0 oWAt OF- 3,* Date of sample: 7/12/2000 Collected by: A.W.W.C., INC. B. SEPTICIHOLDING TANK DATA Date installed 7/20/95 Tank size 1000 Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression (Y/N) NO High water alarm (YM) N/A Date of Pumping 7/12/2000 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 7/20/95 Soil rating (g.p.dJft2 or ft2lbdrm) 0 – 0.8 System type BED Length 23' VARIES Width 46' VARIES Gravel thickness below pipe 0.9' Total depth 4' – 6.5' Effective absorption area 1165 SQ Fr Monitoring Tube present (Y/N) YES Depression over field (YM) NO Date of adequacy test 7/12/2000 Results (PasafFall) PASS For 3 Bedrooms Fluid depth in absorption field before test (In.); o" Immediately after 485 gal. water added (in.): 0" Fluid depth- 0" (ins) Minutes later. 0 Absorption rate = 450+ GPD Peroxide treatment (past 12 months) (YIN) NONE KNOWN If yes, give date – 72-M (Rev. 3/Wr Computer VereWn D. LIFT STATION Date installed Size Manhole/Access (Y/N) on" level at, "Pump off"level at*__ High water alarm level * *Datum JGyakwrested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main NSA Public sewer manhole/cleanout NSA Sewer/septic service line 25'+ Lift station SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line *1 5. Building foundation 10'+ Water maln/service Ilne_ 10'+ Surface water 100'+ - Driveway, parking/vehide storage area— 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ *WR940050 QoO�p�O F. ENGINEER'S CERTIFIC ON I certHy that 1 ha d e e fl Id inspections and review of Municipal ids t aa stems are In conformance r' with MOA H gulden i. pQ ct on this date. �* .... „ „ .�D Signature J Q EFFREY A. GARNESS D Engineers Name m t –953 S' *00 40°- '•. ..• ,apo Date it��4ee • .........• 4 " ofesaio� ��0000�co HAA Fee `y ` Date of Payment Receipt Number 72-m (Rev. 3Mr computer Version Waiver Fee $ Data of Payment Receipt Number Date: August 11, 2000 TO: Municipality of Anchorage Dept. of Health and Human Services FROM: AAROW Pump and Well Service Brian Wille REFERENCED PROPERTY: Mountain Park Estates Lot 5 Block 10 12536 Alpine Drive The old well has been abandoned in accordance with the current MOA well ordinance. If you have any questions, please contact me at 727-3541. 7 , Brian Wille 4 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT Or HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General. Information (a) Legal Description (include lot Location (address or ' "/" RP/w /' /eft Application Date block, subdivision, sec�ion, f K 77 hip, range) (b) Applicants Name_l3 67JbA /iii i� L/ Telephone - Home Business Applicants Address__Zj2'a_�!�r�- (c) Applicant is (check one) Lending Institution ; Owner/builder ; ; Other (explain); Buyer r__— (d) Lending Institution Address (e) Real Estate Co. & Agent Address A Telephone `J L f 020 — (f) Mail the HAA to the follo ing address: 2. Type of Residence Single -Family Number of Bedrooms 3. Water SuPP1Y Multi -Family hone Other (de- scribe) _ - --�-- Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public E:7 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. V� [Page 1 of 21 5. ineer V4'.,., D" Ins Tests. File -Search to and Information As certified by my seal affixed hereto and as of theyAppvaliddationroval sdatehows shown ,site verify that my investigation of this Health Authority 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 n investigation and inspection, the 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 the date of this inspection. `' Telephone Name Of Firm /�G+'I �� '' �--��-�--�""'"®"�" Address. Date (ENGINEER SEAL) 6. DHEP Approval Approved for tiu-.2, bedrooms By Approved 7� Disapproved — G Terms of Conditional Approval CAUTION a y C'�oms od,6aS�OO'000�ocao� as`�fl-•>�r.ln'L(/. ,i k- I Lor E. k 1cl, Jr. (1 ; o. 2257'U j} Conditio THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION REPRESENT - (TIONS GIVENS INALTH PARAGRAPH 5ITY ABOVEPBYVAL AN INDEPENDENTS BASED SOLELY UPON PROFESSIONAL ENGINEER REGISTERED ATI _ IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES R THEIR LENDING INSTITUTIONS IO ONDOIR TCO�RCTISINSPECT ONS ORFY CERTAIN ANALYZRAL E DATA E BEFORERIA MENTS. EMPLOYEES OF DHEP D CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERROR OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE MOA DEPT. OF HEALTH I & (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 JI', L l 195 264-4720 Legal Description: LOT 8wkE U I V E A/ % We G-" 7//MY A. WELL DATA '7"Jz-,J 93t,) SEc zZ Well Classification lam/'/ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y N) Date Completed /� `� �" �' Yield i Total Depth _31x0 Cased to /5'0 Depth of Grouting Static Water Level / O� Pump Set At .✓ /9 / Casing Height Above Ground A& Sanitary Seal on Casing (Y ) Electrical Wiring in Conduit ON) Depression Around Wellhead (Y(9 Separation Distances from Well: To Septic/Holding Tank on Lot // % /' 7 On Adjoining Lots To Nearest Edge of Absorption Field an Lot /U On Adjoining Lots 16Z } To Nearest Public Sewer Line A To Nearest Public Sewer Cleanout/Manhole To N arest Sewer Service Line on Lot Water Sample Collected by ��C5 A /�A ; Date 6 - a_ -9'�r Water SampleTestResults S�/3-/ 7&, Z Comments 7t ACA;1"^'e;11ez/1, Irku/GT,c'irr Td ST/1x/�i'ii' 5 -A Mi/./ .rte � % / - ,/. i , B. SEPTIC/HOLDING TANK DATA Date Installed Size 16'0' 6A No. of Compartments F__ Standpipes (Y ) Air -tight CapsON) Foundation Cleanou (Y ) Depression over Tank (Y(9 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) �//�_ Temporary Holding Tank Permit (Y/N) .J X Separation Distances from Septic/Holding Tank: 7 To Water -Supply Well _ 117 To Building Foundation VV To Property Line 0 /' To Disposal Field �t / To Water Main/Service Line To Stream Pond L k Course Comments 14 '_ ;6!t l PJ Page 1 of 2 72-026(11/84) a e, or Major Drainage C. ABSORPTION FIELD DATA 197 Type of System Design Soils Rating in Absorption Strata j/ �Q _ Length of Field — Date Installed SM .771 Q _Depth of Field/� �'��� —�� /o„ , Width of Field -- Gravel Bed Thickness Square Feet of AbsorptionArea Standpipes Present&) Depression over Field (Y N) — Date of Last Adequacy Test _—�---- Results of Last Adequacy Test --- f—? -- Separation Distance from Absorption Field: To Water -Supply Well '7;�7 Q 7 To Property Line To Building Foundation To Existing or Abandoned System on Lot -,x 1A On Adjoining Lots /t) �- To Water Main/Service Line — To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Olr At Comments (� e1/s.rn4o( 2',ru.c, itvu (' i£Icl uctz; cd ve A4 C d , D. LIFT STATION Date InsfWf6,--- Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at Vent(Y/N) g Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request " I certify that I hav ec d&ver,.fied, or conformed to all MOA nd HAA guidelines in effect on the date of this inspection. �' �_7 Signed Date Company MOA No.�� ,`SL[ Y7 Receipt No. Date of Payment Amount: $ —�� Page 2 of 2 72-026 (11;84) ��. eseeoe oa@Oo tJ :y �Y w• ��' � BCa63i fj ter G. Raid, eo o. 2251.1: PROFE `` •}f ALASKA ENVIRONM`-'NTAL CONTROL SERVICL INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 i0.o1 1 vcn_ in; Grum Mass C!". SHEET NO. OF CALCULATED BY DATE CHECKED BY z DATE acAiF /G