Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 13 LT 2Mountain Park
Estates
Block 13
Lot 2
#017-391-50
\ Municipality of Anchorage
• -- Development Services Department • 0,
__
Building Safety Division —
�=
On -Site Water 8 Wastewater Program, 4700 South Bragaw St. ' '
• •
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW050286 PID Number. 017-391-50
Name:
GARY k TAMMY CROWLEY
Wastewater System: ❑ New ■ Upgrade
Address:
12915 ALPINE DRIVE a ANCHORAGE, AK 99516
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 345-8332 4
■ Deep Trench O Shallow Trench O Bed 0Mound aethera
LEGAL DESCRIPTION
Se •.Dep a5
Total Depth sem WVkw* troch
cPD/aa.
rt 11 MAX n.
Block: . LDC Subdivision:
13 2 MOUNTAIN PARK EST.
Depth to yips bettem sem ergs,ol rade:
SEE DWG.
or" depth sewoth pips
6
R in,
Township: — Range: — Sectlon:
n doses a0oe enti n Veda:
cn vw wnpin;
—
SEE DWG.
n. 113 rL
WELL: ❑New ❑Upgrade
ue « . O h
2.5
•arra a rua
1
ole Dred. set... r�
—
n
Ft.Cbwiriaalian
PrNate, A&C : Total
Ceeed Ta�q
Total ebomptim area
Pipe "Wt~.
R
I n
1356 so. re
D 3034/ F-810
a=- Dae orwm
stand wow twat
sumer.
A+ HOME SERVICES
Dae hwtokd:
1 9/2/2005
FL
vela
►wap $et At
ow'" "9" Above aauta
r�
n
R
TANK
SEPARATION
DISTANCES
■Septic 0Holding 13S.T.E.P. 13 Other*
w0iM1t0Ct'^" Ceoordb le gene a
To
Septic
Absorption
Uft
Holding Pubtk/Prhab
Fm
ro
Tank
Field
Station
Tank Saar lJrw
Notriok NumMr mimwda
sr sanp
Well
a 70'
100'+
—
— 25'+
Surface water
100'+
100'+
—
— —
LIFT STATION
Lot Une
5'+
10'+
—
— —
sr. In °p1o"
Me.hddasaar:
Foundation
5'+
10'+
—
—
W level at
OW at
"gk aaer dw.m a:
Curtain Drain
NONE KNOW
Pw°p Yoe'
a"nioot Nopcti'w W. er:
Remarks: 'WAIVER j 050063
BENCH MARK
Looetwn anal Dwe nplwn:
EXISTING SEPTIC TANK VERIFIED TO BE OF GOOD
TOP OF GARAGE SLAB AT SOUTH END.
INTEGRITY. I x • ( A
100.00 n
ENGINEE" SEAL
ObpO� OD
vo �.• .F.....-9s4p0
Inspections performed by: GEG. Ltd.Dates: 1st 8/31/2005 p.......................:.°.D
0 *C')4 �
2nd 9/1/2005
3rd 9/2/2005
D�
QO t,
f r y A amess-
E-7953
Development Services Department Approval
`e
�p
Reviewed
��oo
and approved by: Date:
(d«, tx/01)
p°o Prof O
0� eeeloo�
4440
PERMIT NUMBER: AS -BUILT DRAG PARCEL017NUMBER:
SW050286 017-33 91-50
STI
ST2
DBLI
\ I osu
\ I FCO
\ FS
COI
I\ MTl
I CO2
36.36 13.85
32.02 6.73
36.87
37.89
38.04 16.76
75.04
94.27 -
94.35 -
43.23 1 -
7% M I —
I
9t=_
1, I
\ NEW DRAINFIELD
SINGLE iAMILY �� q'•�\'� �1 I
FRAME HOUSE , .�,�;�' •': FS 1
DBLI
C
;.\!
OB it li
A OEGK'� HI 1�i� jl I
1
�'..i•. `�•" colIWTI
WR�
[SEPTIC
ARE
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS& GENERAL CONTRACTORS
]AI C now foq fort 101 • Mfiof.CG A< fbef . Mf.� Tfenill-e1R1 • M Lfe,llo.a.f • . '
PREPARED FOR: IPHONE NUMBER: PACE NUMBER:
GARY do TAMMY CROWLEY 1 345-8332 2 OF 3
LECAL DESCRIPnON: DRAWN BY:
MOUNTAIN PARK EST.; LOT 2, BLOCK 13, B.F.M.
TYPE OF WORK: DATE:
AS—BUILT FOR SEPTIC SYSTEM UPGRADE 10/13/4
.. ... .......
A. ness.
I
I
� -
8
Iz
\
I
•I
\
\
r
I< \
\
I\
1
1
`
I I
I
9t=_
1, I
\ NEW DRAINFIELD
SINGLE iAMILY �� q'•�\'� �1 I
FRAME HOUSE , .�,�;�' •': FS 1
DBLI
C
;.\!
OB it li
A OEGK'� HI 1�i� jl I
1
�'..i•. `�•" colIWTI
WR�
[SEPTIC
ARE
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS& GENERAL CONTRACTORS
]AI C now foq fort 101 • Mfiof.CG A< fbef . Mf.� Tfenill-e1R1 • M Lfe,llo.a.f • . '
PREPARED FOR: IPHONE NUMBER: PACE NUMBER:
GARY do TAMMY CROWLEY 1 345-8332 2 OF 3
LECAL DESCRIPnON: DRAWN BY:
MOUNTAIN PARK EST.; LOT 2, BLOCK 13, B.F.M.
TYPE OF WORK: DATE:
AS—BUILT FOR SEPTIC SYSTEM UPGRADE 10/13/4
.. ... .......
A. ness.
PERMIT NUMB' AS—BUILT DRAWING PARCEL ID NUMBER:
-
SW050286 017-391-50
RELATIVE ELEVATION OF
BOTTOM OF TEST HOLE
- 62.74
(TEST HOLE DRY)
BRIO
GARNESS ENGINEERING GROUP, Ltd. 4
CONSULTANTS d GENERAL CONTRACTORS
100011 RWA 11R 101• •••••••••• •• •• ••••••••••
=I L
YbOMC[ MI MO) • I.,fl,[ (M/}t,Tfy111 • IK (•0'1}W�1QN � �Ofti waMrO'^—Mr+ O
PREPARED FOR: IPHONE NUMBER: PAGE NUMBER: •• ••• .. ...... ..........
GARY & TAMMY CROWLEY 907-345-8332 3 OF 3 Q p r Y mess.-.
LEGAL DESCRIPTION: DRAWN 8Y: Qa i E-79 3 .`A
MOUNTAIN PARK EST.; LOT 2. BLOCK 13, B.F.M. V� sus •{I'3• p*4ov
�Rr
TYPE OF WORK: DATE: 004pOp'sQ o e,
PROFILE AS—BUILT OF SEPTIC SYSTEM UPGRADE 10/14/2005
Permit Number: SWO50286
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 15, 2005
Expiration Date: Aug 15, 2006
Parcel ID: 017-391-50
Legal Description: MOUNTAIN PARK ESTATES BLK 13 LT 2
Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 012915 ALPINE DR
Owner Name: GARY & TAMY CROWLEY Lot Size: 22532 SO. FT.
Owner Address: 12915 ALPINE DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99516-3126
This permit Is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3_ The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date: F/5 -0S`
Issued By:Date: S t T o
Municipality of Anchorage
.r
Development Services Department ,' `Crt�a.•;
Building Safety Division
On -She Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D._ 017-391-50 Permit Number
*roperly owner(s) GARY AND TAMMY QRMI EY — Day phone 240-843n —
Mailing address (2)
..:
Legal description (Lot, Block & Sub'd.) LOT 2 Al OCK 13• MOUNTAIN PARK ESTAT S St BDM1^BION
Legal description (Section, Township & Range) N/A
Lot Size A2 Acre q.Ft. Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade 0
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above Information is correct. I further certify that this application is being made fora
Single Family Dwelling and is In accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP Ltd.
Permit Fees: _
Date of Payment: I J15 -os'
Receipt Number. o-7 ��)
Waiver Fees: y'ZO
Date of Payment: �f7- /0S—
Receipt
oS—
Receipt Number o l Z -4 O,-( ,( y
DARN ESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
July 21, 2005
Municipality of Anchorage
Development Service Department
On -Site Water R Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic System Upgrade for Mountain Park Estates Subdivision; Lot 2, Block 13,
To whom it may concern:
The existing 4 bedroom house is served by a private well and septic system. The drainfield is currently
in the state of failure and needs to be upgraded. We are proposing that a new deep trench type drainfield
be installed. Three test holes were excavated by Bruce Corwin in 1989, and one confirmation test hole
was excavated by G.E.G. on 6/23/2005. The drainfield will be designed around the 30 foot radii of these
test holes. Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the area
of the proposed drainfield is relatively flat. In short there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have aW questions, please contact us at 337-6179. Thank you for your assistance.
M.S.
NOTE: Attached it a site plan drawing, a design drawing, a detail drawing, and three soil logs, which are all part
of the design package for this septic system. (Contact G. E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: garnessengineering.com
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
July 18, 2005
Municipality of Anchorage
On -Site Services
Dept. of Dev. Services
4700 S. Bragaw St.
Anchorage, Alaska 99507
Attn: Dan Roth
Subject: Mountain Park Estates, Bik 13, Lot 2
Mr. Roth,
During our preparation for the upgrade to the subject property, it came to our attention that the
well on Lot 3A (to the south) is only 76 feet from the subject septic tank. When this "new" tank
was installed in 1991, the engineer on the project requested and obtained a waiver (#910005) for
"70 feet from the well to private septic tank...." The waiver further approves a distance of 88
feet between the subject well and the system to the north on Lot 1.
At the time all of these systems were originally installed, a distance of 50 feet (well to septic
tank) was adequate. Since the new tank was installed in the same location as the original,
perhaps the assumption was made that a waiver to the south wasn't necessary, for whatever
reason it appears that the issue was not addressed accurately.
We are planning to allow the continued use of the 1991 septic tank provided upon inspection it is
still watertight/ undamaged. The well on Lot 3A occupies relatively the same position on the hill
as the subject well.
Therefore we are requesting that you amend the 1991 waiver to encompass the additional well -
tank distance of 76 feet. Should we find the tank damaged, a new 1250 septic tank will be placed
outside of the setback to both wells and beyond the edge of the existing driveway.
If you have anAuestions, please contact me at 337-6179
P. E., M. S.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: garnessengineering.com
MOUNTAIN PARK ESTATES S/D I
\ \ I (NO CONCERN)LOT 4. BLOCK
I I
ROBIN HILL S/DI21
\ \ (NO CONCERN)
\ \ LOT 9, BLOCK 12
\ MOUNTAIN PARK ESTATES S/D
LOT 12, BLOCK 9 \ 1 (NO CONCERN) I I
MOUNTAIN S/
NO CONCERN
I 1
-f-- --- LOT MOUNTAIN PL. -�
---
MOUNTAIN ISAW ESTATES I MOUNTAIN SCK BLOCK 9 If 13 \ ESTATE$ I I i J
\ :.••+�:�•:,
SITING
IX LOT 1. BLOCK 3
• ROSIN HILL
WELL EAST HOUSE.o
FIELD VERIFY WELL
SHEDCORWN TH/3 LOCATION PRIORTO
J
JO
11 PROPOSED CONSTRUCTION��—.—` LL I
\
SE
PnC SYSTEM
A I / .•,•` : a:Ti r:i � 1
I RYAN THI1 I
0 1 I
tsEpnlnc
EXISTTIIINNSGfEy� I \ 1
/LOT 10. BLOCK 6 I \ 1 \ �` ILS I 1 �TER� TEMOUNTAIN PARK ESGTES S/D\ V \i / J n I N TH/2WELLI 100, >mI •"'IK OT 3A, BLOCK 13 11 I I APPROXIMATE
NTAIN PARK ESTATES LorwTKx+.U,1 ro i — —
r---------------
I
I
I
I
LOT 2, BLOCK
ROBIN HILL S/I
I
(VACANT)
I
I
I
I
I
I
ARNESS ENGINEERING GROUP, L
�otd. p �:
�....:. .
+ c noa Taw SW • wcicroc we wear . nac �rn • a+ w . �onp ...
UMa
PREPARED FOR: PHONE NUMBER: PACE NBER:
GARY AND TAMMY CROWLEY (907)-261-9724 1 OF 3
LEGAL DESCRIPTION: DRAWN BY: VO°o•
MOUNTAIN PARK ESTATES S/D; BLOCK 13, LOT 2, R.A.L. Or+
OF WORK:
E PLAN FOR PROPOSED SEPTIC SYSTEM
7/21
LOT U. BLOCK 13
LOT 11. BLOCK 6
MOUNTAIN PARK ESTATES S/0 1
MOUNTAIN PARK ESTATES S/D
(NO CONCERN)
(NO CONCERN)
Lii
Z
1
Q
I
LOT 3. BLOCK 13 I
MOUNTAIN PARK ESTATES S/D
LOT 12. BLOCK 6
(NO CONCERN)
MOUNTAIN PARK ESTATE$ S/D
1
(NO CONCERN)
I
r---------------
I
I
I
I
LOT 2, BLOCK
ROBIN HILL S/I
I
(VACANT)
I
I
I
I
I
I
ARNESS ENGINEERING GROUP, L
�otd. p �:
�....:. .
+ c noa Taw SW • wcicroc we wear . nac �rn • a+ w . �onp ...
UMa
PREPARED FOR: PHONE NUMBER: PACE NBER:
GARY AND TAMMY CROWLEY (907)-261-9724 1 OF 3
LEGAL DESCRIPTION: DRAWN BY: VO°o•
MOUNTAIN PARK ESTATES S/D; BLOCK 13, LOT 2, R.A.L. Or+
OF WORK:
E PLAN FOR PROPOSED SEPTIC SYSTEM
7/21
NUMBER OF BEDROOMS.- 4
GALLONS PER DAY (GPD): 600
PERCOLATION RATE/S: 60 MIN./INCH
PROPOSED APPLICATION RATE: 0.45
MINIMUM DRVNFIELD SO.FT.: 1333
DEPTH:if FEET
APPROVED SAND FILTER: N/A
IVE:6 FEET
LION FAC10R: N/A
. SO.FT.: 1344
�- *IF GRAVITY FLOW CANNOT BE
/ ACHIEVED FROM THE PROPOSED
/ SEPTIC TANK TO THE PROPOSED
/ DRAINFIELD, A 1500 GALLON S.T.E.P.
TANK WILL NEED TO BE INSTALLED.
I LOT 1, BLOCK 13
MOUNTAIN PARK ESTATES
S/D
I
d ; � ' •lam
TO OBTAIN A COPY DF THE LETTER
CONTACT CEC. BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND : •.'
PROPERTY OWNER AGREE THAT THEY ,
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPF THE TERMS AND
DUSTING 1250 SEI
TANK VERIFIED TO
y OF GOOD 6ftECRR1
7 7/21/2005.-
�� b ��
Y`
NOTE: THE CONTRACTOR SHALL HAVE TF
SOUTH, AND EAST LOT LINES, AND At
RADII SHOWN FLAGGED BY A REGISTER
A
N
1�I
CORWIN
TH{3 1
PROPOSED
\\ ORAINFIELD1\
EXILING DRAINFIELD \
TO BE ABANDONED
DXISRING
4 BEDROOM
HOUSE \ ��
.L . J
WELL
LAND
SHED f
` C.E.C.
THf1+ I
eru l n
I I
TTH122"II
"INSTALL+ II
DOUBLE
CLEANOUT
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS i GENERAL CONTRACTORS
L TNNI AID. TUR Wl . NooWL M x•.01 . N.11[ pw�w.•IT . RY (.0))A ". w 1 �
PREPARED FOR: PHONE NUMBER I PAGE NUMBER:
GARY AND TAMMY CROWLEY 1 (907)-261-9724 2 OF 3
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES
TYPE OF WORK:
DESIGN FOR PROPOSED S
BLOCK 13, LOT
SYSTEM UPGRADE177
R.A.L.
SITE WILL REWIRE
THE USE OF A
M.O.A. APPROVED
RECIRCULATING
7UNG FILTER
(SRED FOR 4
BEDROOMS)
..` 4 .. ......::y
. ••••• OFR633,' ••
a�G
CE -795
�.
I
I
el
/I
SITE WILL REWIRE
THE USE OF A
M.O.A. APPROVED
RECIRCULATING
7UNG FILTER
(SRED FOR 4
BEDROOMS)
..` 4 .. ......::y
. ••••• OFR633,' ••
a�G
CE -795
�.
I
78'
OUT ----- -----J1
INSTALL
I FLOW SPUTER
34'
IN FROM TANK
I°
L 0�
GRADE
GARNESS ENGINEERING GROUP, Ltd. per,
CONSULTANTS 6 GENERAL CONTRACTORS
1101 L TDM FAAM � 101 • MaO01GL M( MOOT AOL (Wr}W jft • W (aW)]M.CMI • ► wa ,tel
PREPARED FOR PHONE NUMBER: PAGE NUMBER: 0
GARY AND TAMMY CROWLEY (907)-261-9724 3 OF 3 p J
LEGAL DESCRIPTION: DRAWN BY: 004°0 .I
MOUNTAIN PARK ESTATES S/D; BLOCK 13, LOT 2, R.A.L.
TYPE OF WORK: DATE: 04
DETAIL FOR PROPOSED DRAINFILED UPGRADE 7/21/2005
A. Camess:'
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 6 GENERAL CONTRACTORS
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES S/D: LOT 2. BLOCK
PERFORMED FOR: GARY AND TAMMY CROWLEY
DEPTH
EST HOLE4
DEPTH TO DATE
GROUNDWATER
DRY 6/23/2005
DRY 6/30/2005
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
$�
II1111111
6/27/20051 1
111111
%//%
6'
/.%
NHH
•
d�4±
Illllllli
1/2'
3
4:32
—
Mill!
4'.6.0,
•
5:02
30 1
DEPTH TO DATE
GROUNDWATER
DRY 6/23/2005
DRY 6/30/2005
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
6/27/20051 1
4:02
—
6'
2
4:32
30
5 1/2-
1/2'
3
4:32
—
6'
4
5:02
30 1
5 1/2"
1/2.
5
5:02
— 1
6'
—
6
5:32
30 1
5 1/2'
1/2'
PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 6.0 FT. AND 6.5 FT.
A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: JOE MARCHETTIE
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS P RFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: -719105
y� bhuiicipality of Anchorage
1'.(). M% ItXXN1 - Anchorage, Alaska 9!1.519fiGiO - Telephone (!M)7) 343-KU)1 - PLL[ (!N)7) 343-tOx)
47110 Iim),mw Sl reel - Anchorage, Alaslar 9!M907
aim muni a g
Mayor Mark 13cgich
Building Safcl3• DiA islon
August 15, 2005
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Subject: Waivcr Request for Mountain Park Estates Block 13 Lot 3
Waiver Request WR#: 050063
Parcel ID # 017-391-58
PERMIT #: SW050286
Dear Jeffrey Garness, P.E.:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to the private well has been approved. The approved separation distance is a
76 foot horizontal separation from well on Lot 3 to septic tank on Lot 2.
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
roodall
Civil Engineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Strcct
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 050063 PID#: 017-391-58 HA/Permit# PERMIT #: SW050286
Date Received: August 15, 2005
Legal Description: Mountain Park Estates Block 13 Lot 3
Engineer:
Jeffrey Garness, P.E.
Garness Engineering Group
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Applicant: Gary and Tammy Crowley
Waiver Requested: 76 foot horizontal separation from well on Lot 3 to septic tank on Lot 2.
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
7.27
3.25
2.21
2.90
2.04
Total:. ___ 17.6761
..........................................................................
Waiver is Granted: X Waiver is not Granted:
List Conditions or Reasons for above:
Date: 8115105 By: Joe Goodall
Name of Reviewer
..........................................................................
Rec#: 72404 Amount: $M Date Paid: 811512005
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
August 2, 2005
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request for Mountain Park Estates Subdivision; Lot 2, Block 13,
The existing 4 bedroom house is served by a private well and septic system. We request you
grant a 76 feet separation distance waiver from the well on Lot 3, Block 13, Mountain Park S/D,
to the septic tank on the referenced property. The following items are justification for the
waivers:
• The lots is sloping from the septic tank to the road. There is a slight mound and heavy
vegetation between the well on the subject property and the neighboring septic system. If the
septic system was to overflow, it appears that the effluent would not travel toward the well
head.
• The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
• The integrity of the existing septic tank was verified on 7/21/2005 and appears to be of good
integrity with no leaks.
The other path of contamination is subsurface migration wastewater should the tank begin to
leak. As can be seen on the attached well logs, the aquifer is relatively deep, with approximately
149-305 feet of silt, sand, and clay soils that have served to inhibit the migration of untreated
wastewater into the aquifer. Recent water sample results from Lot 3, Block 13, indicated nitrate
levels to be 1.17 mg/L and coliform bacteria results to be 0. Based upon the aforementioned
facts, it appears that there is minimal risk associated with the 76 feet separation distance waiver.
estions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
-Ph: (907) 337-6179 • Fax: (907) 338-3246' website: gamessengincering.com
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 0/7—
/7_ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
ON-SITE
Name _
IZALt�K QRZ
DISTANCES
TO
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
A0°fBSS
h D. 3 o O 22 L
WELL
-70
q D
r
Pnone(s)
A-)7 a
-3K3
Permit No.
9"C) 6�
No. of Bedrooms
�3
LOT LINE
IeGAL DESCRIPTION
Lot
Block
t3
Subdivision
("toll &' CSI"
FOUNDATION
Township, Range, Section
t t a C_b
AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
tlrive-way. water bodies, etc.)
TANKS
e
SEPTIC ❑ HOLDING
Q
C
e!
Manufacturer
AcNIC-14A-N IL
Capacity in gallons
I :L.. D
%
2..
Material
No. of Compartments
TYPE OF SYSTEM
❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
original grade FT
Total depth from original grade
FT
f7
R
D
I
N 1
\
\
\tJ
Fnl added above original grade
FT
Gravel depth beneath pipe
FT
Gravel length
FT
Gravel width
FT
Total absorption area
SO FT
Distance between lines
FT
Number of Imes
sou rating
SOFT
Pipe material
Installer
Date Installed
WELLS
❑ PRIVATE ❑ OTHER (Identifv)
Classification IA,B.CI
Total Depen
FT
Cased to
FT
Lil ,D
b
Installer
Date installed:
REMARKS:
L
SW�AW
I P
Municipal and Stale guidelines In effect on We
date::
Health Department Approval: .on
,G2:n:t
72-013 (3/85)
I 1-1
♦Sciale': •ENGINE[R'S 6EAL
Inspections Performed by: - ,3 " Ur All. ,: r
Date: I `c•s .: '' .;_ v� V: ,-,1
• (J.•a� :••,»cs..'a^noon. • 1
cerfily that this Inspection was performed aceording N all
L pROFESs1�„�:�
Date:
M U N I C 1 P A L l I Y U t' ANCHUNAUL
Department of Health & Human 'cervices
8'-'b L Street, Anchorage, Hlask:a 99b01 a4:_�-4720
O N- S I T E S E W E R F E R M I T
Permit Number: 900085 Upgrade
D,:(te Iasur!d: 04/30/90 Engineer Designed
L� Uf vnL
Owner Name: RALPH OR 1 Y` ERTZ Day Phone:
Owner Address: P.O. BOX 230224 277-3003
ANCHORAGE. AK 99 23
Parcel Id: 017-391-50
Lot L_F�gal: Subdivision: MT.PARIk:: ESTATES Lot: 2 Block:: 13
Section- 26 Township: 12N Range: 3W
Lot Size '2225-52 (sq. (t. or acreo)
Max Bedrooms: 'This Permit: 4 Total Capacity: 4
SEPTIC TANI::: Minimum total septic tank: capacity: 1,250 gallon_. Each septic
t<-anl:: must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
feet requires insulation over tank(s).
INFORM D.H.H.S. PRIOR TO INSPECTIONS BY ENGINEER, OF AFTER
OFFICE HOURS, CALL 34.3-4681 AND LEAVE A MESSAGE.
THIS PERMIT EXPIRES 12/31/90 AND VALID FOR A SINGLE FAMILY HOME"-'.
CONSTRUCT PER ENGINEERS ATTACHED DESIGN.
ABANDON CRIB PROPERLY AND NOTE ON AS -BUILT FORM AS A CONDITION
TO CLOSE OUT PERMIT.
I CERTIFY THAT:
1. 1 am familiar with the requirements for on-site sewers and wells as; ret
Forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. 1 will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. 1 will adhere to all MOA and State of Alaska requirements for the set back:
distances from any e;cisting well, wastewater disposal system or public
sFaw0rage system on t.h .s or
any adjacent. or nearby lot..
Z. I Undorstarc that this pk�rmit is valid for a maximum of 4 bedrooms. 1
al. so under s: and that capacity of the total system is 4 bedrooms and
any canl�-r. y r. -nt. wi rF luire an additional permit.
':3i.gned: DATE: �� �Q
.___.._______,____.--.----_____ _—_/-;�._.---
(Owner) f of 'H 07 L 3VONNE ERTZ
l:ssucad EJy:----- DATE: qO
• } ['� Municipality of Anchorage
i f DEPARTMENT OF HEALTH & HUMAN SERV
825 "L" Street, Anchorage, Alaska 99502-065 0
SOILS LOG — PERCOLATION TES .
I
PERFORMED FOR: / ,C-2RL.4sL 77-a4C r ��(t
LEGAL DESCRIPTION: Z47-.9. BGC, /3�JJwpTownship. Range, Sect
DEPTH
1
2
3 CA/v!
4
6
7-
8-
9 8 9
SLOPE
10 WAS GROUND WATER
ENCOUNTERED? A/O
11 S
IF YES, AT WHAT L
12 DEPTH? `— P
2
Depth to WateO /OZ F - mQ
13-AMonitoring? Date:f
E
14-
15
16-
17-
18-
20
6171820
COMMENTS
PERFORMED BY.
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72.008 (Rev. 4/85)
(ENQINEER'S SEAL)
/L 3W
SITE PLA
26t
PERCOLATION RATE 55.54D(minutes/inch) PERC HOLE DIAMETER 6 '/
TEST RUN BETWEEN FT AND 5 FT
3 2 3 SA, Ae .,/6 �i1iaovH— r .tom �► ��'L
I CERTIFY THAT THIS TEST)VASE PERFORMED IN
!UIOELINE EFFECT O THIS GATE. DATE: 01 LZJp —{
.".' Municipality of Anchoral
DEPARTMENT OF HEALTH & HUM.
825 "L" Street. Anchorage. Alaska
SOILS LOG -- PE/RCOLATI
PERFORMED FOR:`%J/�_
LEGAL DESCRIPTION: LO 7< 26 /&. /.3 Township. Range. Section: T/?N 2 3d✓, SFI � 6 S.�?.
v
DEPTH lb� TH m J A- Zp4,1, # SLOPE SITE PLAN
1
2
3
4
5
6
s
9
10
11
12
13
14
15
16
17
16
1f
2C
5114
C
WAS GROUND WATER No
ENCOUNTERED?
' S
IF YES. AT WHAT L
O
DEPTH? P
E
cepm to W=f Ater %frl 1 r rr/CGi
COMMENTS d yr r 7 rn
7/ 710 4
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72.008 (Rev. 4851
PERCOLATION RATE 'j 5!0 (minuteVii+ ; PERC HOLE DIAMETER
TEST RUN BETWEEN 3 FT AND 4— FT
A 2 3 S cr. </. .
1 V RTIFY THAT THIS
/7rp��- wA5 PERFORMED IN
EFFECT THIS DATE. DATE: /Tr
tl��L.7t7d�' � ai
COMMENTS d yr r 7 rn
7/ 710 4
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72.008 (Rev. 4851
PERCOLATION RATE 'j 5!0 (minuteVii+ ; PERC HOLE DIAMETER
TEST RUN BETWEEN 3 FT AND 4— FT
A 2 3 S cr. </. .
1 V RTIFY THAT THIS
/7rp��- wA5 PERFORMED IN
EFFECT THIS DATE. DATE: /Tr
• cwo {r+w, vw)
D
Ne�•1�+n4 .r Pe�cd3
C.o. • TN'''/
� 0 _
pnve i� • i'<ct'Y8
Proposed'
vGWUr F pC'Oband" is k Rav
a
• sclff efo
J.
�/ 30' �/o�Bec�OPJ'igrJ
2'•/n SY /rt /.n, ( ' �' ' /n ie -
47 IJe40 S,T• E. P Ta, e,
� � �' - 30 �An<G�myP'lanlr a►"��ud/� %'1`
Zc C.C.
26/o A
Bed Svc{it�� e� g C o ia�nf<f /oum/o W-4' '7'- 7/0 ¢'r
NOTE: r —�
All Dimension/And Locations Must Be Field Verified Prior To Construction
SYSTEM -LOCATION PLAN
LOT BLOCK PR /C.• SUBDIVISION
Or
\ /Yn/ p
SECTIO
eC�C 2lO P/R%— -,OU /� 3W SM. AIl uz4�
rr;� At; w„L•jY a SCALE' / NOTE.
5i• R
•r Zir ,• •• rMu /QQ The Accuracy Location Of snAnd
°e, rw� Y Proposed Pco{aererty Cotners, Wells.
and
Septle
(
DRAWN B70 Systems Indicated Is Not Exact. Oimcnsions
x ;
• •+�-=• NORTH 16.1C.Indicated Have Open Determined O use OC Cloth
• �• y •.� � _ Tape •,d/oc Municipal Records, And Net By
Sur oyLn9 Techniques
i• ..w•,.t. «•re,. .m�
�yy r j PREPARED FOR- .
V by w. ar. '' •i �y �d DSa �Q/ /
°-ryF;�T,(r•\A�•:wr SU t(r Tt1e CS:
SNEET OF !
Municipality of Anchorage
Department of Health and Human Services !
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
January 31, 1991
Tobben Spurkland, P.E. - -
6751 West Dimond Boulevard
Anchorage, Alaska 99502
Subject: Waiver Request for Lot 2 Block 13 Mountain.Park Estates
Waiver Request #WR910005, Pib #017-391-50, f#A910023
Dear Mr. Spurkland
Your request for waiver of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The approved separation distance is 70 feet from the well to
private septic tank and 88 feet from private well to leachfield.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sin�ely, pConur:Robert W. Robinson on S, P.E.
Civil Engineer VPrograMAa4nager
On-site Services Ong -site Services
ljm:#6
CAA9-HO•I •. GRATER ANCHORAGE AREA BOROL' 'i
OkrARTMENT OF ENVIRONMENTAL QUALII.
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
'j� �ywC
MAILING
�l�%{ / 1 y 71"_�/'%liJ�
NAME ZT h>7 ' ADDRESS PHONE
NUMBER OF
DISTANCE FROM WELL
�liMATERIAI 7-P •I -COMPARTMENTS
-
LIQUID t �%%fit' 7 Z LIQUID
LIQUID CAPACITY 2�c GALLONS. INSIDE LE GTH I�SIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH 2 % LENGTH 3 3 DEPTH h
LINING MATERIAL ��17 5 DISTANCE FROM WELL iL11fPC , BUILDING FOUNDATION ,
NEAREST LOT LINE �Q TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 7 -ZO SO. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE F LINES ,
LlU►n R OF LINES DISTANCE LINES T �IDTH IN. TOTAL EFFE I
ABSORPTION AREA SO. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: ✓' �"�//rl Yf DISTANCE FROM WATER
TYPE
DEPTH —.BUILDING FOUNDATION_ _SAMPLE NEAREST
NEAREST SEPTI SEEPAGE/ /1� OTHER
LOT LINE SEWER LINE ,TANK 214� << , SYST a`7_SPOOL , SOURCES_
.5 DIAGRAM OF SYSTEM
DISTANCES:
�z
I
., . , ... ! / ✓ LTi \ , w `, ` _.._ :. �.
elloi
tk
]4
tom;,
l 1 y ,
<1 i%
... I % ...
DATE APPROVED
G.A.A.B.
i Grm4TER ANCHORAGE AREA BORO''M
HEALTH DEPARTMENT 899
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/ MAILING �h:
NAME t O 1 Y1 i C7 G� 1/ %% ADDRESS s f G'�C 7S� 1 �1 PHONE
LOCATION �t . � Ae � ML^,'"id recV Allff'ck LEGAL DESCRIPTION/ Z Bll�i3 gnu»/gi11 ir�l: ES%ifes
SEPTIC TANK:
DISTANCE FROM WE ►"C?ti�T^F MATERIAL S'L Pl
LIQUID CAPACITY -Z2 5-0 GALLONS. INSIDE LENGTH_
SEEPAGE SYSTEM: SEEPAGE PIT:
2
CR J/ P/ le�7Z LIQUID
_INSIDE WIDTH DEPTH
1&tV/�✓XZ7XIZS
NUMBER OF PITS / I OUTSIDE DIAMETER g OR WIDTH , LENGTH , DEPTH
LINING MATERIAL DISTANCE FROM WEL ���/�P BUIL !N OUND/A�10 g'
S 3 ��IcZlz S/icr��)
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM-WETFOU AJION NEAREST LOT LINE OF LINES_
NUMBER OF LINES DISTANCE BETWEEN LIN
AREA
SQ. FT. LENGTH OF EACH LINE
TRENCH WIDTH
IN. TOTAL
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:
LOT LINE
DISTANCES
A=very
�c= �za
Dcz 35,
A c = 9'
TYPE//4 T d DEPTH
EAREST S
SEWER LINE-. T
DISTANCE FROM WATER
BUILDING_ FOUNDATION.
�SAMPLE, NEAREST
EEPAGE �OTHER /,T��r✓SEOOL OURCES_
DIAGRAM OF SYSTEM
DATE F` 'zit q -7;7-,� a�PPRoueo`d
HEATH AUTHORITY
yj GREA , ER ANCHORAGE AREA BOR�IUGH (�
/ DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3500 TUDOR ROAD POUCH 6.650
1 �� ♦' r �ANCHORAGE, ALASKA 99502
7/ �� r, / v��7
6 Y TELEPHONE 279.8685
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT "�f MAILING ADDRESS �nn �+ PHONE
INSTALLATION LOCATION /
LEGAL DESCRIPTION r Y-� ,�/
INSTALLATION OF! SEPTIC TANK ' V SEEPAGE PIT L' DRAIN FIELD—. OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS r�"- NOTEI 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
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE 10,_ TYPE SEEPAGE AREA SIZES or'TYPE
MINIMUM DISTANCES, REQUIREMENT DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT �n /. / DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
J
SEPTIC TANK S SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK /C/ .SEEPAGE PIT /
DRAIN FIELD _—
SEPTIC TANK, �SEEPAGE PIT `�� DRAIN FIELD ,
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 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.
IIEALiH THORITY
OR
LICENSED DESIGNER
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHO ifzAGE AREA BOROUGH ORDIUANGE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE /4 �j/�j APPLICANT'S SIGNATURE
GRhhER ANCHORAGE AREA BOROUGHr,y
DEPAR..IENT OF ENVIRONMENTAL QUAL, CASE #
3500 TUDOR -ROAD
i ANCHORAGE; ALASKA 99502
Performed ForMr, Lr u Date Performed IeD-14-71
Legal Description: Lot z Block 13 Subd vision [ic,pk:- li1R1C iGs
This Form Reports SoilsTg >c Percolation Test
Depth
Feet Soil Characteristics
1
T�P�o�l Ijt•tvr��y St� v'�
2
`
3'.
5'
8414
S;Vy
9
10
11
Was
Ground
Water Encountered? /Vo
If
Yes, At
What Depth?
-------,
>> mmmm �
�mm ==
Reading Date Gross Time I Net Time Depth to H2O 1.Net Drop!
erco at on Rate Mi nute
1 1 V'/V a GV • 114 U I I a %. 1 V11 • JCr_Fava f 1 b V1 a 111 f I C 1 Y
Depth Of Inlet Dept To -Bottom o Bottom Of Pit Or Trench
COMMENTS: 9 13 - C-""}1/ �,P, , "-
lest Performed By- _ f►f Data Certified BY:
Date:
3 fr
Parcel I.D. 017-991-50
N
Municipality of Anchora;
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems
1. GENERAL INFORMATION
Expiration Date: 1J- I -
Complete legal description MOUNTAIN PARK ESTATES; BLOCK 13, LOT 2
Location (site address) 12915 ALPINE DRIVE ANCHORAGE, AK
Current Property owner(s) JENNIFER KELLY
Mailing address
Day phone 312-3436
Real Estate Agent NATE BAER Day phone 350-7984
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF
4. TYPE OF WATER SUPPLY:
Individual Well
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: 7/2 Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number
COSA# ©5? /4P133
Waiver Fee $
Date of Payment
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. 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 Gayness 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. Garness Date At
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic
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
date/s 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 system/s.
These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the systems; therefore, GEG makes no warranty (express or
implied) regarding the future performance of the well or septic 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 benefd of the
person/party who retained GEG. Reliance upon the information provided in this report by any other
person orparty, 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
System #2 Approved for
Disapproved
Conditional approval for
bedrooms OFq�CyO
bedrooms, with the following stipulns: ON-SITE
WATER AND
ATER a
PROGRAM ��-
Original Certificate Date: �� 1
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 State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist M Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSH 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; BLOCK 13, LOT 2 Parcel ID: 017-391-50
A. WELL DATA *PER GEG INSPECTION **ASSUMED BASED UPON NEIGHBORING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 1975(?) Sanitary seal (Y/N) YES
Total depth *217* ft. Cased to *"40+ ft.
FROM WELL LOG
Date of test
G
Static water level
N
Well production g.p.m.
WATER SAMPLE RESULTS:
Well Log (YIN) NO
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/22/16
211.6 ft,
6.3+ —
9 -p.m -
Coliform 0 colonies/100 ml. Nitrate 326 mg./L. Collected by: GEG, Ltd.
Arsenic_: ND ug./L. Date of sample: 7121/16
26 YEAR OLD STEEL SEPTIC TANK IS *FCO IS JUST BEFORE
B. SEPTIC/HOLDING TANK DATA I APPROACHING THE END OF ITS USEFUL LIFE SEPTIC TANK
Tank Type/Material SEPTIC/STEEL Date installed 1990
Tank size 1250 gal. Number.of Compartments 2 Cleanouts (Y/N). YES
Foundation cleanout (Y/N) 'YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping a- l Pumper �'4u'flG tc o c IC
C. ABSORPTION FIELD DATA BELOW E��XI��STING GRADE
Date installed 9!2/2005 Soil ratingor(t7t>Lffn11' 0.45 System type DEEP TRENCH
Length `'t'13 ft. Width 2.5 ft. Gravel below pipe 6 ft.
r e3SL.
Total depth *10+ ft. Eff, absorption area fIMonitoring tube*"'YES Depression over field NO
Date of adegdacy test 7/22/16 Results (Pass/Fall) PASS For 4 bedrooms
Fluid deplfl in absorption field before test 52 in. Water added 772 gal..,,. _ New depth -**Y64 in.
Elapsed Time: 120 min. Final fluid depth 61 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date -
**MT ONLY EXTENDS ABOUT 68" BELOW INVERT
`APPROXIMATELY 41NCHES BELOW THE INVERT
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump of
level at in.
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot 100'+
Public sewer main
On adjacent lots 100'+
On adjacent lots
Public sewer manhole/cleanout 100'+
Sewer /septic service line 254 Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 1004
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation "" Properly line 5'+ Absorption field 51+
Water main 101+ Water service line 1a+ Surface water 100'+
Wells on adjacent lots «78.+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10' Building foundation 101+ Water main 101+
Water service line 1(Y+ Surface water 100'+ Driveway, parking/vehicle storage 104
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
"BOTH WAIVERS GRANTED UNDER #WR910005 ""#WR050063 —6.6 FEET FROM CLOSEST EDGE OF SEPTIC PIPE
TO FOUNDATION. SMALL CORNER OF TANK MAY ENCROACH UPON FOUNDATION.
G. ENGINEER'S CERTIFICATION -W
l certify that I have determined through field Inspections and *'
review of Municipal records that the above systems are in .....1..
conformance with MOA COSH guidelines in effect on this 0 .••
date. I F
♦ C)
Engineer's Printed! Name JEFFREY A. GARNESS +j��` I
Date
LICENSE
#AECC884
(Rev. 102112)
E2
Ari A«aDOS
-------------------------------------
3AI
o
§;|
§} Q
■
k
BO
00
j)2§
g9§�
k
//t;�
�
a§|■ § §
-
r§:■ pro
�
)\
\
�§k§
§;;( §;|
)!§■ £/
§(N( `§§
�l;, |§_
oz, z
�§/\\
;!!`z§N}
|§|((!!§
§t;;§|7|
! ;
)Nr\§)@
|
(l�2�•
» .
n §
X222■
o
(§§|
§} Q
■
k
BO
00
j)2§
g9§�
k
//t;�
�
a§|■ § §
-
r§:■ pro
�
)\
\
�§k§
§;;( §;|
)!§■ £/
§(N( `§§
�l;, |§_
oz, z
§HH/\
;!!`z§N}
|§|((!!§
§t;;§|7|
o
§} Q
|!l
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street)
P.O. Box 196650 �
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING r F_ le 5L/
Parcel I.D. b / 7 — 3 I - 50 COSH# O So G
1. GENERAL INFORMATION Expiration Date: %Z O —0 &
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
MOUNTAIN PARK EST.: LOT 2 BLOCK13
12915 ALPINE DRNE ' ANCHORAGE AK 99516
GARY & TAMMY CROWLEY Day phone 345-8332
12915 ALPINE DRNE • ANCHORAGE AK 99516
Unless otherwise requested, COSA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
N
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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 riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 16 06
Engineer's Comments:
In conducting this evaluation, GEG, Lt D. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results doscrtbed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readilyldontifiable features. The operational fife of all wells and
septic systems depend on the local soils condition, groundwater to vets 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 soie 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.
5. DSD SIGNATURE
Approved for 4 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the illowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
L/
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
ON-SITE •:�G�s
WATER AND fn=
WASTEWATER
PROGRAM
By: &I Original Certificate Date: it OG
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -She Water 6 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196850
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: MOUNTAIN PARK EST: LAT 2. BLOCK 13, Parcel ID: 017-391-50
A. WELL DATA 'PER 1991 HAA
Well typeRP NAE If A. B. or C provide PWSID# N/A
Data completed $1975 Sanitary seal (YIN) YES
Total depth '246 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test
Static water level ft.
Web productIon g.p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N) NO
Wires property protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/14/2005
212 ft.
77 —
9 -p.m -
Coliform _Q_ colonies/100 ml. Nitrate 1.39_mgJL. Other bacteria Q_colonies/100 ml.
Arsenic: ACL- ugA. Date of sample: 6/5/2006 Collected by: GEG. LtD.
B. SEPTIC(HOLDING TANK DATA
Tank Type/Materlal SEPTIC/STEEL Date installed 5/29/1991
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) YES
Foundation deanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Date of pumping 9/2/2005 Pumper NORTHLAND PUMPING
C. ABSORPTION FIELD DATA
Date installed 9/2/2005 Soil rating jk.p.d ft%bdrn) 0.45 System type DEEP TRENCH
Length 113 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth '10.75-1 !ft. Eff. absorption area 1344 ft' Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fall) PASS For 4 bedrooms
Fluid depth In absorption field before test = in. Water added =gal. New depth =in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= - g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NEW If yes, give date
D. UFT STATION
Date installed Size in gallons Manhole/ ,ess{Wtd�
"Pump on" level at _in. "Pump High water alarm level at
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAtft station on lot `70On adjacent lots "76'
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manholeldeanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manureianimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkingIvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS ' BOTH WAIVERS GRANTED
WAIVER # 050063
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
cordbfmance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A GARNESS
Date ala 6
COSA Fee
Data of Payment
Receipt Number
(n«. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
01
_
? to
U,m�
_ a
•
' A =
D
••y
%G�
JO
tz
m
Io
N
I0
0
0
El
--------------V 3NId-Ib' ---
N 0000'571W 1 15.00 —
S O°00'33"W 1 15.00
FA
m
m
N
0
0
m
ID
N
6
0
��
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services w
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # CA -1 - elq (- SO HAA # WZ9 \ ()a \\
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2; Block 13; Mountain Park Estates Subdivision
Location (address or directions)
12915 Alpine.Drive, Anchorage, Alaska
(b) Property owner
Mailing Address
HUD #111-031611-703
(c) Lending Institution
Mailing Address
Telephone: (home) Business
Telephone
(d) Real Estate Company and Agent ASSOCIATED BROKERS/ATTENTION: Sandy
Address 640 West 36th Avenue, Anchorage, Alaska 99503
Telephone 563-3333
(e) Mail the HAA to the following address: (or check here 6, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family Cf Number of bedrooms
3. WATER SUPPLY
Individual Well:? Community ❑ Public D
Note: if community -well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-siteX3 Public ❑ Community ❑ Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
pass (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION,
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 wastewater disposal system is safe,
functional.and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations In effect on the date of this inspection.
Name of Firm Telephone
4 J �•
17C34 Emla River Loop Road No. 204
Addressitiy
'rt��ieersk
� Alaa 99577
Date
6. DHHS APPROVAL
Approved for :&*' )edrooms by �`�`'`� Date
Approved Y, Disapproved Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev, 7/88) Back Page 2 of 2
Municipality of Anchorage ARL
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
kot2,Lln_K?,•MtParcelI.D. 0171 391-5-0
A. WELL DATA
Well type ,',1hxiFA If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) N Date completed q �{'� Driller 0 K,
Total depth a! �J Cased to Z �{ Casing height /
Z
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
o
Date of test .' \ E -Y -29_ 9
N
Static water level QF3
i
LLJ
Well flow tj g.p.m. Z. g.p.mg_
a
W
2
Pump level
a
W
0
0 13
Z
SEPARATION DISTANCES FROM WELL TO: �C,�p�"�q 1 �1 I
V '
Septic/holding tank on lot �n �' ; On adjacent lots off'
rf
Absorption field on lot — I C) ; On adjacent lots
Public sewer main /J /A Public sewer manhole/cleanout C,�1A
Public sewer service line N Petroleum tank _ n)0NE
/ tJoto/J
WATER SAMPLE RESULTS:
\
Coliform g''Aor(I Nitrate r r�.�11t Other bacteria'
1 /
'-"> e'- Ua
Date of sample: Collected by: d- S L5/VG
r/Jcert0a
B. SEPTIC/HOLDING TANK AT P -9r
Date installed /—v Tank size > S 0 4tA Compartments
z
Cleanouts (Y/N) Foundation cleanout (Y/N) �J Depression (Y/N)
ti
High water alarm (Y/N) Alarm tested (Y/N) /J I I A
Date of pumping�—
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wells) on lot 0 On adjacent lots 00 t Foundation `f
Topropertyline l O f Absorption field 2,1Water main/service line l D
Surface water/drainage J(M rt I
72-M(Rev.3re1)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level —
Meets MOA electrical codes (Y/N)
on" level at
SEPARATION DISTANCE FROM LII
Well on lot
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
ATION TO:
lots
On as
_ Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed (a — z Soil rating System type <'_,P 01
Length 3 Width Gravel thickness (2—Total depth 9
Total absorption area Cleanouts present (Y/N)
Depression over field (Y/N) A) Date of adequacy test 2 4 C1
Results (pass/fail)n a 'S—for bedrooms
Peroxide treatment (past 12 months) (Y/N) f (A If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ,
Well on lot (too rf On adjacent lots nn Propertyline
To building foundation Z� �= To existing or abandoned system on tot
On adjacent lots 30 r f Cutbank Watermain/service line / n
i
Surface water =0 O Driveway, parking/vehicle storage area >Drtveta o0ci/ CRI
Curtain drain FJ �5��/tn'�/ FOf fi0 ��S�iNc,
E. ENGINEER'S CERTIFICATION .�Gft ELD o^/Ly LL,� �J
F7G2
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eftect.e4�9w4ate, of this inspection.
s & S ENGINEERING n CJ ' ::: ?" •ti9 b�
Signature },xrY:'� ^(v- L000 Road NQ 704 s A
t"
r ... ...........«,•.«.•
Eagle River, Alaska 99577 � ".r;-
' �
Engineer's Name •••
obart
Date
r(o. 1457-E
HAA Fee $ I—) Waiver Fee: $
Date of Payment t a -s'� i Date of Payment
Receipt Number a1 �� �F �tP1 Receipt Number
72-026 (Rev. 3/91) Back MOA 21
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # 7— 3 q d ) HAA # /4-0— % y c �•3
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range
Location (address or directions)
12q is Ar L_ K.e D'. v -e—
(b) Property owner �R[i C r� Telephone : (home) Business
Mailing Address 'FO- Tom* 0-322,2L1 �. Ami &CL q`14+ Z3
(c) Lending Institution N t3 v A Telephone
Mailing Address
(d) Real Estate Company and Agent Ni D N 1:—:,
Address
Telephone
(e) Mail the HAA to the following address: (or check here if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 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.
724it (Re .7/88) Page 1 of 2
S. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm 10616e!" �� rlclwKc� {7 E Telephone AL/A — S� n'?
Address /A 7Y) Le--. b wr OOVLX
Date
6. DHHS APPROVAL
Approved forte? .bedrooms
\!
X
.,r
��7f,�.\'ate...: sic.•. �.�:.. is
••1
Engineer's Seal
by J-�v+.� . c •1- r. Lt Date
Approved Disapproved Conditional
�erms�f-Go "•' ' " �)_�•�,-�.•�-(-r.�� ,�.c`-��� ��-C �c.i.�Gl. I���..
.ct- a,+,�-cam i
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
,9 343-4744
Legal Description: Loi A,91< 11
A. WELL DAT
Sc� .Z.(o'� Z'�2Ni1'31t/J
Well Classification If A. B. C, D.E.C. Approved (Y/N)_
Well Log Present (Y/N)_ Date Completed Yield ►�
Total DepthCased to gfPIL Depth of Grouting rgyo 'e_
Static Water,Level Pump Set At 3b
Casing Height Above Ground la- Sanitary Seal on Casing (Y/N)
� O $ -
Electrical Wiring in Conduit (Y/N) 1 Nr; ed Depression Around Wellhead (Y/N) �
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot -70 On Adjoining Lots fOo
To Nearest Edge of Absorption Field on Lot IW X+ ;;On Adjoining Lots gg
To Nearest Public Sewer Line kZA To Nearest Public Sewer Cleanout/Manhole N�rO
To Nearest Sewer Service Line on Lot i 3
Water Sample Collected by TS ; Date o 'Jo`(//`t
Water Sample Test Results
Comments N ���e (o c(i�r,��o0
71 SYs1-c-..... c.n. Loi IF lR&s- No uVaL. v,4- '
B. SEPTIC/HOLDING TANK DATA / S+
Z3 X91
Date Installed fI qqO ( Size Ia D No. of Compartments 7 -Le, J
Standpipes (Y/N) Ott Air -tight Caps (Y/N) Foundation Cleanout (Y/N) >—/
Depression over Tank (Y/N) r Date Last Pumped N -A
Pumping/Maintenance Contact on File (Y/N) ��� ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) NSA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well To Building Foundation >
To Property Line > 10 To Disposal Field
To Water Main/Service Line > 10
To Stream, Pond, Lake or Major Drainage Course
Comments
72-028 (Rev. 7/88) Front Page ,1 of 2,
,r
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata -233 Type of System Design t m.e, 66L
Date Installed i Q -7 Z Length of Field .3 3
Width of Field al Depth of Field c?
Gravel Bed Thickness
Square Feet of Absortion Area 7 Z a Statndpipes Present (Y/N)
Depression over Field (Y/N) N Date of Last Adequacy Test 117 – t& 1 49 I
Results of Last Adequacy Test ." t'o V v� 'I'Se(i roo W a J •yL
SEPARATION DISTANCE FROM ABSORPTION FIELD:�,Pis–`�
To Water -Supply Well 120 To Property Line O
To Building Foundation 40 To Existing or Abandoned System on
Lot No 4e - : On Adjoining Lots
To Water Main/Service Line > 3 Q To Cutback (if present) N/A
To Stream, Pond, Lake, or Major Drainage Course _ Nei_
To Driveway, Parking Area, or Vehicle Storage Area
I
D. LIFT STATION
Date Installed Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at —
Tested for
Meets MOA Electrical Codes (Y/N)
Comments —
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
Pumping Cycles during Adequacy Test.
1 certify that I have checked, verified, or conformed to all MOA and HAA.guid-e(inbs.in effect on the date of this
inspection.
–�::. •;s..j'u,
�C``�T:''
Signed
f
Company
�mbb�., �O�r�CIDI�
/i '- ie�"t; ;➢, r ': �;
� l4`i l
a Engineers Seal
Date
r�,c•�''
MOA No.
r
d�, 0.. .t
� • LI >22i5 �•..!
•. r
�3� C"/ dU
Receipt No.
oZ o
Receipt
Date of Payment
–r�_c:;L
Waiver Fee: $
Amount: $
% 20_
Date of Payment
72-028 (Rev. 7/88) Back Page 2 of 2
Municipality of Anchorage
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
January 31, 1991
Tobben Spurkland, P.E.
6751 West Dimond Boulevard
Anchorage, Alaska 99502
Subject: Waiver Request for Lot.2 Block 13 Mountain
Waiver Request #WR910005, PID #017-391-50,
Dear Mr. Spurkland.
Park Estates
HA910023
Your request for waiver of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The approved separation distance is 70 feet from the well to
private septic tank and 88 feet from private well to leachfield.
This waiver approval applies to .the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincely, pConur:Robert W. Robinson , P.ECivil Engineer Manager
On-site Services Ong -site Services
ljm:#6
f�
i
III
�I
Ze77-,�, �•� �.3�1�!/�1T_ /�/ / Z/� 57"
C'
I
�a
Loo
4/ 2��0 /
i
1�
Lo7 -1_74,2 4-7 '
S 2 nAJ 0/JS
q�i
I/G/ - /73 Cly
-�
���1�y �I
_
;G%-11) tel: iJ
I
�G�
n^.
L
E
i
9-q— G a
c&l_r—�
/ul _! 161.
- ---'�
1�
i/�,�-moo a�>�� �►��-r�
i l70 r—or
i � r
-moo _
g
1 a
- $O ` � ---��" moo, —_—.— 7st=
�dOf j
---
------------
.s
II dO�n Poin!J
T _ E;F---> UF"7Zl <LLAN0 E_' .. C
6751 M. DIHOND BLVD.
'r ANCHORAGE, ALASKA 99502-3904
sem;.
(901) 248-5095
96
M i_ipa of Anchorage
I, � s 3- Environmental Health
De �� _nt of Health and Social Services
8 1 Street
An hcrage, Alaska 99501
Subject: REQUEST FOR
PRIVATE WELL
PRIVATE WELL
LOT 2, BLOCK
Gentlemen;
January 28, 1991
WAIVER OF SEPARATION DISTANCES FOR
TO SEPTIC TANK
TO DRAINFIELD
13$ MOUNTAIN PARK ESTATE
We are submitting a request for waivers from the separation
distances stated in Title 189 Alaska Administrative Code, Chapter
80.020.
During an Health Authority Inspection for this property it was
discovered that an HAA had been issued in 1986 where the separa-
tion between the well on subject property and the drainfield on
Lot 1 was reported to be 88 feet. No waiver was applied for at
that time, but the HAA was granted. To correct this oversight, a
waiver is applied for at this time. In addition the original
septic tank, which was located 70 feet away from the well, was
replaced in 1990. The required separation distance between well
and tank. was 50 feet in 1972 when the septic system was in-
stalled, but according to Municipal Guidelines, any upgrade or
repair must comply with the code at the time of replacement,
which in this case would require a 100 foot separation between
the well and the septic tank. Installing the tank 1O0 feet from
the well would place the tank in the middle of the parking area
for the residence and in front of the garage doors. It is also
possible that the tank would be encroaching on the absorption
area. The measured distance between the tank and the standpipe
for the absorption pit is 42 feet.
Mitigating circumstances includes the fact that the well casing
is located on a side hill. The elevation difference between the
well and the leachfield is 8 feet. The tank location is 2 feet
lower than the well. In addition, the residence is located
between the well and the septic system on Lot 2. It is impossible
for overflowing waste water from either septic system to reach
the well casing
No well log exist for this well, therefore I have used well logs
from surrounding properties to evaluate the contamination poten-
tial.
The well logs used are for Lot 4A, Bi-, 13 MPE, Lot 79 Bk.. 13 MPE,
Lot 4, Bk. 5, Robin Hill, and Lot 19 81:. 5 Robin Hill. The
WAIVER REQUEST
LOT 2, BY,. 13 MOUNTAIN PARI: ESTATE
pg. 2
Jan. 28, 1991
location of these lots are shown on one of the attachments. Note
that the sketch is not to scale, nor is the exact well locations
shown.
The information from the well logs is summarized in the following table.
By going through the DEC's procedure of analyzing the potential
for contamination I arrive at the following points:
Ground 'Water
Soil Sorbtion
Permeability
Gradient
Separation
Total
(at 100 ft.+ ) 7.0
( Silt,Sand, Clay) 5.0
( Silt ) 3.0
Away from well 4.0
( 88 ) 2.0
21.0
Cori cIusion: Almost sure to be free from any form of contamina-
tion.
As an added safe guard. Tank is a steel tank. Cast Iron pipe was
used as well as water tight couplings.
Please issue an waiver for this well.
Yours
T�
Tobben Spur.land P.E.
,.I.� '♦CO'I Y.i1. 11111•` �1 i,
C'a.�• ...l��e . 1a. to :a • 1
1.1.. ►,�. ............ • ✓.
• T?.. :: "C:,L CACI 6�
�C�,':' �• 0.22'15 .' �'��
L.Ci4.11� Iry t w.
1•tii . ..
LOT 21
LOT 4A,
LOT 7
LOT 41
LOT 11
WELL DEPTH
246
170
167
280
265
STATIC
204
147
150
219
225
DRAWDOWN
3
2
SOILTYPE
SILT
CLAY
CLAY
CLAY
By going through the DEC's procedure of analyzing the potential
for contamination I arrive at the following points:
Ground 'Water
Soil Sorbtion
Permeability
Gradient
Separation
Total
(at 100 ft.+ ) 7.0
( Silt,Sand, Clay) 5.0
( Silt ) 3.0
Away from well 4.0
( 88 ) 2.0
21.0
Cori cIusion: Almost sure to be free from any form of contamina-
tion.
As an added safe guard. Tank is a steel tank. Cast Iron pipe was
used as well as water tight couplings.
Please issue an waiver for this well.
Yours
T�
Tobben Spur.land P.E.
,.I.� '♦CO'I Y.i1. 11111•` �1 i,
C'a.�• ...l��e . 1a. to :a • 1
1.1.. ►,�. ............ • ✓.
• T?.. :: "C:,L CACI 6�
�C�,':' �• 0.22'15 .' �'��
L.Ci4.11� Iry t w.
1•tii . ..
it I /i m�_7lrfb�or i •
ALASKA ENVIRONMENTAL
CONTROL SERVIC'• INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907)561.8040
DRiUEwAy
1
4oe- L.2.9.� MTN. PK- ESZA i
fHEETNO or
CAICVLAffD s• o TK DATE
CHECKED •r DATE
SCALE —1 v 30
+oGBfS��Pe
' 9.2 NE16 H6OC; _... _
/ F)Eta (L1)
,
LQtil +!L3' L
House
Apr
1 ; i
.971
i
Location (address or directions)
_ A114
(b) Applicani Name I RRLP%f _6 9 T9 Telephone: Home 7-3 Business
Applicant Address. 12
(c) Applicant is (check one): Lending Institution El Owner/builderlQ*; Buyer 0 Other 0 (explain);
(d) Lending Institution Telephone A//A
Address IV
(e) Real Estate Company and Agent
Address
Telephone NIA
(f) Mail the HAA to the following address:
WIA
2. TYPE OF RESIDENCE .,+
.;N 4-
Single. _Fam,ilyp Multi -Family 11 Other
Number of Bedrooms
31' WATER SUPPLY
Individual WellX Community 13 Public 13,
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 [3 * Community 13 Holding Tank 13
Note: If community well system, must have written confirmation from the State Department of. Environmental Conservation
attesting to the legality and status.
72-025(11/84)
Pagel of2
e
�MUNICIPALITY OF. ANCHORAGEr'!"--
DEPARTMENT OF, HEALTH AND ENVIRONMENTAL: PROTECTI0 W:,
DIVISION OF. ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
'Application Date
31A kI PI/I
1. GENERAL INFORMATION
,(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
_ A114
(b) Applicani Name I RRLP%f _6 9 T9 Telephone: Home 7-3 Business
Applicant Address. 12
(c) Applicant is (check one): Lending Institution El Owner/builderlQ*; Buyer 0 Other 0 (explain);
(d) Lending Institution Telephone A//A
Address IV
(e) Real Estate Company and Agent
Address
Telephone NIA
(f) Mail the HAA to the following address:
WIA
2. TYPE OF RESIDENCE .,+
.;N 4-
Single. _Fam,ilyp Multi -Family 11 Other
Number of Bedrooms
31' WATER SUPPLY
Individual WellX Community 13 Public 13,
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 [3 * Community 13 Holding Tank 13
Note: If community well system, must have written confirmation from the State Department of. Environmental Conservation
attesting to the legality and status.
72-025(11/84)
Pagel of2
13 13 L Z N1 %', AW, K Wil,
5. ENGINEERING FIRM PROVIDII .INSPECTIONS, TESTS, FILE SEARCH, D. 4 AND INFORMATION t
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 watersupplyand/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. n
Name of Firm r! E--S, G l Telephone / S/1
Address /Z0n 0) �`�� � � AMC11, AKp
, 7 9503
Da
'te .4 Ju�.y 1 1981fl -
OF AL
grs deal /
♦ � 0600..0 0 0 60000 ..• .�
LE C. ItEID, JL p
II rA �6 CE - 2251
I
6. DHEP APPROVAL {
Approved for �uK bedrooms by
Approved x Disapproved Conditional
Terms of Conditional Approval .
M�
�- eg'
I
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an Independent professional
englneer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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:
Page 2 of 2
72.025 (11/84)
Mond OF A"040KAW
/� OW. OF HEALTH &
I [IVINOMAENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOry
HEALTH AUTHORITY APPROVAL (HAA) J U L O 7 061
CHECKLIST - FEBRUARY 1884 (�
264-472°
Legal Description: M �,C 1 V j+
T L
r tV 3W Z6 SEG,
A. WELL DATA
Well Classification I fQ) U1DUAL- If A, B. C, D.E.C. Approved (Y/N) ! //4
Well Log Present (YO Date Completed 1126: Yield
Total Beth i Cased to 2Y6 , Depth of Grouting AIA
Static Water Level 2 10,S Pump Set At
i
Casing Height Above Ground Sanitary Seal on Casing aN)
Electrical Wiring in Conduit (ON)
Depression Around Wellhead (Y)©
Separation Distances from Well:
To Septic/Holding Tank on Lot 7ol On Adjoining Lots
To Nearest Edge of Absorption Field on Lot too /t ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole I To Nearest Sewer Service Line o Lot
Water Sample Collected by �� K� Tl.LK ; Date
Water Sample Test Results -3&rl S FAC7-oR
Comments-SES)7-6 L2_ 4- T N RrpoRz: 4508
Lor 1 (D fcg Ftay TAT 6/ZZ/86 SEE WOO MUMS R6#wr
B. SEPTIC/HOLDING TANK DATA
Date Installed o 2 Size JZs_ 0 No. of Compartments
Standpipes @N) Air -tight Caps ©N) Foundation Cleanout Y*J,
Depression over Tank (Y> IQ Date Last Pumped _ql6
Pumping/Maintenance Contract on File (Y/N) t A ;for lei
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)�
Separation Distances from Septic/Holding Tank: r q
To Water -Supply Well 7p To Building Foundation
To Property Line � © To Disposal Field 2 9
To Water Main/Service Line n(fA' To Stream, Pond, Lake, or Major Drainage
Course -100
Comments
L
Page 1 of 2
72-026(11/84)
ar3 z MTV, PAle. �T�s
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Striata 2 Type of System Design CRI15
Date Installed 6 7K Z Length of Field
Width of Field 27 Depth of Field ><
A
Square Feet of Absorption Area
Depression over Field (Y© _
Results of Last Adequacy Test
Gravel lied Thickness a
Standpipes Present 69N)
Date of Last Adequacy Test 6
,5A Trs Fdc r�& FOK f5pws,
Separation Distance from Absorption Field:
To Water -Supply Well too 114— To Property Line y0 /
i
To Building Foundation 20 '� To Existing or Abandoned System on
Lot A ; On Adjoining Lots Sa i4 -
To Water Main/Service Line N To Cutbank (if present
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Aree�-D
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at —
High Water Alarm Level at
Tested for
Electrical Codes (Y/N) _
Comments
. Dimensions
E
le/AcceF(Y/N)
mp O "
Ven
Check Permitted Bedroom Rating Against HAA Request ••
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I havJt
k d v rifled or conformed to all MO and HAA guidelines in effect on the date of this inspection.
Signed Date �f
Company - G• MOA No. �✓ 0Z 1
Receipt No. �� QF Al. 1%
Ak
Date of Payment J �.•' '•.;r�r `
Amount: $ r 4j� 4 Se
al% �`
RTVAOWNT 0/ DkUrc -& Rehr �.*:... ..
0 2 Wt"MR S#M&F C. RECD, X•• t
Page 2 of 2'•�• CE - 2231AV
4#3 517(,a ,PtAA'
72-026(1ve4) , rNsPECrroN REi0vRrFW w
a
13 L) Mrly. PK. EsPIMS
M -W DRILLING INC.
P.O. BOX 110378
ANCHORAGE. ALASKA 99511
)TY
PHONE 349-8535
NAME
2
ADDRESS
C
LEGAL DESCRIPTION
LEGAL OWNERS
BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST
HOMEPHONE WORKPHONE
3 SYS - //j?3
n INVOICE No 3431
/
DATE_ 7—a _e6
UNIT
MATERIALS PRICE AMOUNT
Alf charges shall be paid in lull within ten
ORKMAN
c
DATE
%—a a
IN
c% Cd
OUT
3;406oln
TOTAL MATERIALS
HOURS
RATE
WELLNUMBER
i Ark
DIAMETER
6411
DEPTH
R q6
STATIC LEVEL
A09,f
GPM
DRAWDOWN
PUMPMAKE
HP
SETTING
VOLTS PHASE AMPRATE
SERIALNUMBER
MODEL
SCREENLENGTH
SLOT SIZE
LINER/SCREEN
DESCRIPTION
OF WORK
DATESvj"jW
7-a- F
`w�eP .� a'r6 `
.� 1
le-
�•�z� �.� �1
a -L .
a
-Aoo
MQ-ccl—
Alf charges shall be paid in lull within ten
ORKMAN
c
DATE
%—a a
IN
c% Cd
OUT
3;406oln
LABOR
HOURS
RATE
OO
MATERIALS IFROM ABOVEI
CRJ
days unless other arrangements are made
prior to drilling. The customer Shall pay in-
terest at the rate o/ 1!12 % per month on any
amount not paid within ten days. Failure to
1�
12S
OTHER CHARGES
pay may result in a lien against the property.
CUS MER SIGNATURE
/p -i ,., n
PAY THIS AMOUNT �►
I
11 l /t rl�.jl f n� v i
ALASKA ENVIRONMENTAL JOB L2 913- M rN. PK. Es rAr6S
CONTROL SERVIC"', INC. (O�
SHEET NO. OF
1200 West 33rd Avenue, Suite 8
ANCHORAGE, ALASKA 99503 CALCULATED BY �� DATE 1 121
(907) 561.5040
CHECKED BY DATE
MUNICIPALITY OF ANCHORAGE
ell
Ito: 461
__
UMBE F BEDROOMS
ENVIRONMENTAL ENGINEERING DIVISION
❑ One lb Four ❑ Other
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ay _
825 L Street . Anchorage. Alaska 99501
UMBE F BEDROOMS
ENVIRONMENTAL ENGINEERING DIVISION
❑ One lb Four ❑ Other
Telephone 2644720
❑ Two ❑ Five
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
❑ Three ❑ Six
DIRECTIONS: Complete all parts on paps 1. Incomplete squab will not be processed. Please allow tan (101 days for processing.
1. PROPERTY OWNER
I PHONE
❑ COMMUNITY
Aa It d' rz
Igo/400-9kyo&
depth (attach log if available.)
h
iyrl INDIVIDUAL/ON-SITE"
MAILING -ADDRESS
a&* 481&!� pip mr4o
❑ PUBLIC UTILITY
PROPERTY RESIDENT Of different from above)
PHONE
2. BUYER
PHONE
e
MAILING ADDRESS
& LENDING INSTIjkgION
T
PHONE
..7'
MAILING ADDRESS
4. REALTOR/AGENTONE
r�
MAILING ADDRESS
B. LE AL DESCRIPTION
STREET OCA ION
,
Zoo
6. TYPE OF RESIDENCE
UMBE F BEDROOMS
❑ One lb Four ❑ Other
0 SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
TI INDIVIDUAL'
' ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
iyrl INDIVIDUAL/ON-SITE"
'*If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATEDL
--�
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
❑ APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter mu ccompany certificate)
fCYDISAPPROVED
. I& :1A -M # /0�_�
DATE am/ BY (Titl 1
-010 (Rev. 3178)
r' 'L7
'THREE
r-NVE 4' VAPOT L
❑ SINGLE FAMILY
❑ ONE
❑
❑ MULTIPLE FAMILY
❑ TWO ❑
FOUR
❑ SIX
sT
2. WATER SUPPLY
PERMIT NUMBER
••.
K I
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED t
❑ PUBLIC UTILITY
Connection Verified
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
-"
❑INDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY
-
�Z
Connection Verified
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: I aWO If Tank is hgnemade
jtljLSFATING , Z .
give dimensions: ' i►
3'3
TYPE OF TANK
MANUFACTURER
STF—c\
TOTAL ABSORPTION AREA
MATERIAL ,
4. DISTANCES
Septic/Holding Tank
Absorpt
n Area
Sewer Line
Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS 't" e- A
^ _
A
❑ APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter mu ccompany certificate)
fCYDISAPPROVED
. I& :1A -M # /0�_�
DATE am/ BY (Titl 1
-010 (Rev. 3178)
� F-
�� Oe L'
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-456111
Date Received b — 3 — -I
Time of Inspection `7%
\ S Date of Inspection -)-7--79'
V REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Addratc-
3. Legal Descr
4. Location:
`1 GV � _ Phon'�: a-1I-'A.S'X!5
Phone:
5. Type of facility to be inspected \ U No. of bedrooms
6. Well Data:
A. Type
C. Construction
7. Sewage Disposal System:
B. Depth
D. Bacterial Analysis
A. Installed 1%1 1'1. B. Installer
C. Septic Tank: 1. Size IZkS0 2. Manufacturer
D. Seepage Pit: 1. .Absorption Area :2j -.o_ 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area , Sewer Lines ,
.Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest ,lot line
EQ -034 (1/74)
Page 1 of two pages
. ... .. Y. v .... ..........r....i..�..a.n.ww'�....w.—nw�a�n...ur.n...�.�.... .. ..�... .... .... ......r •....� ....� I... n. r ..r. n.a.. rarYr n1.1.'w r...w+.r m.�...��a '.1 .
x
Page 2 of two pages -'Re'" )t for Approval of Individual F �r & Water Facilities
Comments
Approved
Disapproved Date
Approval;Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
W Jk
DIAGRAM OF SYSTEM
I 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)