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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 1 LT 5AMountain Park Estates Block 1 Lot 5A #017-061-35 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 33•— n7 IC71 n EW l❑'1 UPGRADE MAILING ADDRESS / o x'aL LEG L ESCRI TION d' �9 T L LOCATION d NO. OF BEDROOMS UY DISTANCE TO: W f r �� Absorpti n ar a � 7 Dwe ling ��"' i� T O. PERY,968,9 w2 Manufacture Matawal/ d No. of compartments Liq. c�pa�ty in gallons IF HOMEMADE: Inside length Width Liquid depth J (DZ DISTANCE TO: Well Dwelling PERMIT NO. = Z Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: We Foundation / �( Nearessk $ lin ` C_ P T NCO � _ j LL z F Z No. of es Le th Bach line Total len hof lines Trench wid inches Distant between lines `— l F D Top of the to finish grade ( Material beneath tile inches Total,affectiVo absorption area Lu C7 Length Width Depth PERMIT NO. a. F- wa Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. w w � DISTANCE TO: Building foundation Seer line w Septic tank Absorption area(s) OTHER PIPE MAT RIALS � SOILTERATIIAG 6 t_ R INSTALLEnA qq r tN REMARKS olta dA VV,PROVfDATE LEGAL 79\41R IRev 3/VAI ' / f 1 -1 1 V" DEF'AF:"F MEhIT _2 'L. 0.4 E"._ 9._. C_. d � � �1 U ■ HE:AL.TH AND ENVIRONMENTAL. MEN NAL. , .:OTECTION E_I"F:EET: ANCHORAGE., AK. 99508- 264-4720 AF'F'L.I CAN -JT JF C.K GRIFFIN 4220 BAXTER #17 99504 t..O ATI ON RENEWAL #E-21 048 B {( L.E:i 1AL 1- �A "111T PK ESTATES I LOT -,1: "�E Y� 'TYPE OF SOIL. AE�SORPTIONd S'r'STE11 IS: :F:AINdFIEL...1) 1974 4 999999 SQUARE i' IA,<, I MU11 NUMBER OF BEG�Fa_u��NME.' = � SOIL RAT I N•dG (SQ FT,'BR) = --:E-,2 �¢bj fiL rz r4 THE REQUIRED SIZE OF THE SOIL- ABSORPTION SYSTEM I S : pW.n ':. " `"6"" II••--t'�.:M awn 9._._ F=" P-.1121 _,N"" F-1=- jjEMG� 0 IFS-° 9-•-G "•"°" Imo: IL_. -■ �... �n "f." 9,-•-9 ==' `.` -_ .:... THE L-EI'•d(TF••1 D I MEN S I CINd IS THE LENGTH ..IN FEET) OF THE TRENCH OR DRAI N•dF I EL_D. 'THE DEPTH OF A TRENCH OF, PIT IS THE DISTANCE BETWEEN THE SURFACE OF 'THE GROUN I.) AND THE BOTTOM OF THE EXCAVATION (IN FEET:. T" " E' -' F .C. Fes.. t°-4 A_„_ -A t•°A .iC. �. " �' n _ t _- 01,=•7 F-- E I�._ _T'... THE GRA%JEI._. DEPTH IS THE N'1I Nd I i, -1U1-1 DEPTH OF GRAVEL BETWEEN THE OUTFAL-L. F'IF'E AND THE BOTTOM OF THE EXCAVATIOt1 1::INd FEET). FR t— tl "w 0.3 T:: Fa_ EE 6. _-n :•.�" E:F=" -F T ! : -F F::o R °9 F _ -5> 1 "0 E ._ � � _ C--1 M� A Awn A_.� e -9 � _ l PERMIT AF'F'L..I iW ANdT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING 'THE I N•d=•TALL_AT I C INd INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NdUMEDEF: OF RESIDENCES THAT THE WELL WILL SERVE. ..._ _......_._ "T'- II"tib Ch n + ..•-:,� _=" .. �"•� .`y a F'�° . A. _- ""� T AD t -a ." �� F::9 "» A --:-X I1 1 F^-''.: F: I..=° __-_ ._.... ..._. BA ie"F I L_L. I N•dG CIF ANY SYSTEM WITHOUT FINdAL_ INSPECTION AND AF-'F'F:OVAL. BY 'THIS I -EF'ART MENdT W I L.L_ BE SUBJECT TO PROSECUTION. MINIMUM DISTANdCE BETWEEN A WELL AND ANY ON-:= ITE r EIJAGE DISPOSAL SYSTE M IS 9..0.10 FEET FOR A PRIVATE WELL OR 150 TO :=:ti:; 0 FEET FROM A PUBLIC: WELL. DEPENDING UPON THE TYPE OF' F'UE,L_IC WELL. M ]: Nd I N1UM DISTANCE FF'OM A PRIVATE WELL TO A PRIVATE SEWER L. I NdE 15 25 FEET AND TO F1 COMMUNITY SEWER LINE I' . 75 FEET. WEl_.L.. L_OG_; ARE RE(?I_IIREC•1 AND I'11_iST BE RETURNED TO THE. DEPARTMENT WITHIN :•tit DAYS OF THE: WELL. C011PL.ETI ONd. OTHER F:Ei !U I RENIF_NT' MAY AF'F'L4'. SPEC: IFI CAT I O -JS AhID CONSTRUCTION GIAGRAf' S ARE FI'v'FI.IL..ABLE 'TO INdSURE, PROPER IN STALL_ATIONd. 1..T" ;= t=° C 6w=° =° " A t• E F' L. _° . _ r _= I CEF:'TIFY THAT 1: I A11 FAMILIAR WITH THE: REQUIREMENT:. FOR ON-SITE SEWERS AND WEI._L.S AS 'SET f OF»:"fF f E,',` THE i'IL.IN•d I t I PAL I T'r OF' ANCHORAGE. 2: I 1.411.1- INSTALL STALL THE SYSTEM IN ACCORDANCE WITH THE CODE,--';. _.: I UNDERSTAND THAT THE. ON --SITE SEWER SYSTEM MA'•r' REQUIRE ENdLAF:GEMEN+1I IF THE RESIDENCE IS RE[-IODE:LED TO I NdC L.UDE MORE THAN :.<.: BEDF'OOF& Yz ,"el Heal As -b t a n station ti Instal ' .. ___-_._--______._. In the event that and inspection mu; � ti eleGtrlcal perm APPL.I GANdT TACK GRIFFIN t. uilts cannot be approve til #pp electrical inspection is received it / oft)pe, The electrical work must be formed by a licensed eleo,tr; pi •of ISSUED UEC E,, ��E � J _._.___..._.__ _.___ _ ...___.._..._._._. _._DATE____ I. <Permit #: 821040 January 31, 1.983 TO: Permit Applicant I Subject: Lot 5A Block,,�Mountain Park Estates Subdivi-s;ion A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-buil.t.s for our files and documentation. If there are any further questions, please call this office at 264-•4720. Sincerely • '•�,� Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 9 KAC 1 Ii AI III <Permit #: 821040 January 31, 1.983 TO: Permit Applicant I Subject: Lot 5A Block,,�Mountain Park Estates Subdivi-s;ion A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-buil.t.s for our files and documentation. If there are any further questions, please call this office at 264-•4720. Sincerely • '•�,� Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 9 ral 01 r-4 I I--- I =1 I I -r I -e C -I F=' F-1 r-4 NZ. F' F."F-1 F3 F= DEPARTMENT HEALTH AND ENVIRONMENTAL ...,OTECTION 825 'L' STREET.- ANCHORAGE, AK. 99501 264-4720 44 EF I I n r4 C -N r-4 I -IF F= •F= L4 FE F;?_ F=" F= F:R M l -r PERMIT NO. < 82:1046 ) APPLICANT JACK GRIFFIN 4220 BAXTER #17 99504 333-1974 LOCATION LEGAL L5AEkMT PK ESTATES LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ED- FE F=' -r " *_S_ -::L S-:'* 1.3 F;;? " V FE L. L --m FE 1=> -T- " :i_ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). T'H FEE -r F;,> E= r-4 0" L4 10—F" I E �. ID C-1 0 F= FEET_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FREE C-1 U I FZ FE EN !F, [-= F=1 -r I NE- -F n N K :F. 10E= A C-1 C-21 0 0 Fi L_ I ---A N PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. RCeOUI F.;^EC-. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F= F= F;Zm M I -r FE X F::" I f;? r= -!F. C, e 0 F= M 0 E: F;;." =<::L , A- 0-=4 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO,144CLUDE/IMORE THAN 3 BEDROOMS. SIGNED ISSUED BY- ' _;� �a_ d' V4. 0 CT SOI LS LOG MUNICIPALITY OF ANCHORAGE s \\ \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION PERCOLATION TEST' \r 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST r ,- PERFORMED FOR: �'��� Y '�l + _I - _ DATE PERFORMED: i r LEGAL DESCRIPTION: SLOPE SITE PLAN 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 n !r WAS GROUND WATER' S (��✓� ENCOUNTERED? �-. J� %,�_ L 0 P IF YES, AT WHAT E i DEPTH? — Reading DEPTH (FEET). 1i Net 'Time i Net 2 1 /v(� c; Water Drop 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 n !r WAS GROUND WATER' S (��✓� ENCOUNTERED? �-. J� %,�_ L 0 P IF YES, AT WHAT E i DEPTH? — Reading Date Gross Net 'Time Depth to Net Time Water Drop 10 r PERCOLATION RATE—`__ (minutes/inch) C� TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: ril " CERTIFIED BY: `' �cr DATE'` -- 72-008 (6/79) ' . 6000 A STR~:~'T ANCHORAGE, ALASKA ~LL LOG DEPT. SIZE OF CASING 6" DRILLER' Kirk Whitehurst GAL. PER. MIN. CLIENT Jack' Griffin DATE 10/28/83 PROJECT Kalcin &. Cres.tview ' ~ ~ M~ ~,~ ~/~ /I .......... / LEGAL DISCRIPTION' A,~' ? '~'~,', DRILLING EQUIPMENT T-4 ic~p,~/-~/(~ AN mVI~O~E~TAt ~OT~CT~O~ 0-100 .i00-200 ~R~. ~s,~IC,T~O,. R E C E IV E D Dry Sand with Silt gravels - 200-217 . ~217-224' ~ Dry cobbles with silt and sand. Clean water gravel at 95~ ':'", '-;;-; r. Moist silty cravei with sand . _W_et sloppy silt 'wi{h few cobbles ~46 = D_amD sands with gravel -' -- 250-260 260-271 -Damp silt with sands Damp sandy silt with cobbles , %iet thick silty sand with small qlravel. ~A~"b'~¢~'' ' ' "'" ,,.....:.. S~t~ic Head 30. ·feet . . · ' .. i '.'..'~'.'"'~"..'.'~'...i.i:.":` !j/)(":':?. ~'!i~ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program <^ 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017.061-35 HAA# 05D 19q Expiration Date: _8 1. GENERAL INFORMATION Complete legal description Lot 5A Sk 1 Mountain Park Estates Location (site address or directions) _5800 Kalgin Drive Anchorage AK Current Property owner(s) Paul Forman Day phone 224-9179 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 1665 Seward AK 99664 Day phone Rona Florio/Homes Unlimited Day phone 279-8877 517 W.12'" Ave.. Anchorage AK 99501 Unless otherwise requested, HAA will be held by OHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. 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 ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority 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 sample results less than 30 days old. 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. (Pe . f IM) 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on- site water supply and/or wastewater disposal system is In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date �i ifZjC Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious �����--"n o t engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The P . .............,< reported results describe the performance of the system under the conditions encountered at the time of AP the lest, and separation distances measured to readily identifiable features. The operational life of all a CJ,••'.. wells and septic systems depend on the local soil condition, ground water levels that may fluctuate ; {s 49 TH during the year, and the water usage of the family being served by the system. These conditions are �••• i .. �l�\ outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results 0 are do not guarantee future performance of the system, nor do they guarantee that there ano hidden defects .... ..• • .. ..... or encroachments. PES can therefore not provide any warranty for future performance nor give any '.Steven R. Ponni estimate of how long the system will continue to meet the operational requirements of the ADEC or �� �i s, No. CE 8149 MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon ♦� ry , or use of this report by any other person or party is not authorized nor will it confer any legal right �� ,5,+,•' whatsoever. ��4�,; 6. DSD SIGNATURE _( Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 0 Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other - By:! /c�%/ —_ (� • Original Certificate Date: Expiration Date: Reissue Date: (R« 1,199) Municipality of. Anchorage s[ s ' Development Services Department Building Safety Division On-Ske Water and Wastewater Program s . 9 T I 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 5A Bk 1 Mountain Park Estates Parcel I.D.: 017-061-35 A WELL DATA Well type i? If A, B, or C provide PWSID #_ Well Log Y Date completed 10128M933 Sanitary seal Y Wires property protected Y Total depth _M_ft Cased to -AQ_+ft Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10128/1983 419/2005 Static water level 30 It 192 ft Well production 3-5 9 -p.m _ 3.2 9 -p.m WATER SAMPLE RESULTS: Coliform -Q_colonies/100 ml Nitrate 0.310 mg/1 Other bacteria 0 colonies/100 ml Date of sample: 4/29/2005 Collected by Steve Pannone Arsenic NIA mgA B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel Date Installed _9/20/1983 Tank size 1000 gal Number of Compartments $ Cleanouts X Foundation cleanout X Depression over tank )V High water alarm NIA Date of pumping 10/812004 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 912011983 Soil rating (g.p.d./ft2 or ft%drm) 462, System type Wide Trench Length 44X3 ft Width ji ft Gravel below pipe :L_ ft Total depth ¢ ft Effective absorptionI (3 areajL"t= Monitoring tube Y Depression over field N Date of adequacy test 419/2005 Results (Pass/Fall) _Z_ For 3 bedrooms Fluid depth in absorption field before test p�(r in Water added469 gal. New depth4 in. Elapsed Time: Al min Final fluid depth try in Absorption rate » 450+g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) (Rev. 11/99) If yes, give date D. LIFT STATION Date Installed 'Pump on" level at _ in"Pump off Datum E. SEPARATION DISTANCES Manhole/Access In High water alarm level at _ in tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELLLOT TO: Septic lankAift station on lot!&U i$ On adjacent lots 100+ it Absorption field on lot 100+ Public sewer main 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15 Property line 110+ Absorption field 10' Water main 100+ Water service line 35+ Surface water 100+ Drainage 100+ Wells on adjacent lots01 0+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10+ Building foundation 35' Water main 100+ Water Service line 60' Surface water 100+ Driveway, parking/vehicle storage 10' Curtain drain None Observed Wells on adjacent lots01 0+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. i j 0,� Ste en F Pannone?L Engineer's Printed Name Steven R. Pannone, P.E. 0,0%,+. N, (e 8149 v Date �� I zl c� ••i•�; q HAA Fee $ Date of Payment Receipt Number KII (Rev. 11199) Waiver Fee $ Date of Payment Receipt Number .W SURVEY TYPE ❑ AS -BUILT ' a ' aL lvo : 0 N.85059' E. 90.00 ^7 e a aeo. o wfLL � • 00 r - v1 o v. K ON'9OOlt , 1 Y s 1 Y4ao6III tb' t .Z t STORY GRAVEL r NovSF� 'z6Y .1 ?r V`p O arcie 49 CqN/ILCViR ' IV•1• -5 �:l �-O7I d' v NrY eV 0. CAI !� ?9S. L1 PLOT PLAN ❑ LOT SURVEY Q;J RECERTIFICATION AS -BUILT SYMBOLS O ELEVATION ..DRAINAGE e—e�- WOOD,FENCE CHAIN LINK FENCE NOTE: FENCES ARE SHOWN IN THEIR APPROXIMATE LOCATIONS ONLY. 11 n the respons,billly of the builder or owner, prior 10 LEGEND hub a lock -found O set C construction, to venty proposed bl lldinq grade relative- ' - : ''iron rebor -found 0 set • to finished grade and uway connecuons and to determine'. Iron pipe -found E) 521 0 the esistence of any easements, covenants or restrictions bross'cpp -found set !7� which do not appear on the recorded subdivision plo6 alurn. cap -f Ound 8 set Lod ,urveyCcrtifiCal. PSENCH re ;Wed by tler<by etrn+rn,athaR.ln" P�j ;MARK INC. eyldme VCV1+yshon M Oro �'� •.....,.1,1 Professlanol Land Surveyor ygttxd h+n's; on7lrOl aD •• + goo,�j a] II.(+n+envnis sh ualydlMwl <�+I SCaIe.• I Drown by: * � ll c a.. �n"ntle p.ywty Mec and � / ' h+rolo.R.Upo• Drm encroochm �•» 49: . ,...»,, q•?.;;�' D1rie Surveyed: Chec Ad by odr,.<.nl plglerty and nwlyd � ./�12-5-85 by: onadrx.'olprm. �' It •• •• �'("(�'%yJ': •••� - Grld: W.O. 85-330 1111"k,101 •IYIOJchonde i 7 as G. Minton- y „ / Data Drown: 12. 5-85_ _ I�1 aO1Ql 83-216 o.ry.ad 1101 4 TP % No. 57815 J Q) .% 2839 u.aar n;,n�?dwr+. vt't"Y N•••s. 'OQ,� Legol DOscriptlon' .9p_4" LOT 5-Ae BLOCK 1, MOUNTAIN PARK ESTATES In SAC I.IV'.rlY llpY Ol 3- 2-059 3113PM9 9007 36,330, 0 :i e ;CS M.N 1052174001 All DateLTimes are Alaska Standard Thee cleat Name Pannone En;. Srv. Printed Date Time DS/02!2005 9:02 'SName/p Itat HentSampkID Ka12rn gyve Front Have Bib Ka19=DriveFrontHoseBib Collected DateITlme 04/25/200S 19:15 datia Drinkin Water U 5A ^ I,(� �1� T-- ,S' f'� ReceivedDats/Ttme Technical Director 04/162005 8:26 Stephen CEde iamDle Remuks: Albwable Pap AOelysis anmuer Rmu:e pQi Units Mr.E9d Cmuimer ID Ul Itg Rte Date snit raters Department Ninue-N 0310 0.100 LiezobloloOV Laboratory Taw Coliform 0 r: _ -- __= __----- =&/L EPA 300.0 B (a10) 04/2&05 WAW coV100mL SM209222B A (o-1) 04IMS TLF MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information � � \ Application Date 3181495 _ (a) Legal Description (in Jude lU , block, subdivision, section, township, range) L,oT 3AA BK H0061 -4//V thAPK IR&KI1E SEG24J/JA/JR2!g Location (address or directions) rll Saco - '.LT,1- & 79/ (b) Applicants Name -1 /KL -s `j ri 4rtq Telephone - Home Business Applicants Address -6-5-3 H – S e tZ7 44 4o (c) Applicant is (check one) Tending Institution ; Owner/builderh— Buyer E�] ; Other [� (explain); (d) Lending Institution '�i �s/�S1 Lz;IN A,MV _1 E L Telephone Address (e) Real Estate Co. & Agent A?P-\L K LSE. F a I V N t,. P aOFtERT'I kES Address Telephone � 6 a-`7 6 5:N (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply. t-oL� Multi -Family 0 Other (describe) Individual Well IK Community E=1 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 Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1. of 2] ki 5. Engineering 771rm Providing Inspections, Tests, File Search, Data and Informatio, As certified by my seal affixed hereto and as of the validation date shown below, I verify that any 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 at- 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 i= compliance with all Municipal and State codes, ordinances, and regula- tions in effre ct on the date of this inspection. Name of Fir -z tOROIEN SPP e1eAt4A1Q PhE� Telephone A"/7-391.6 Address &© Date IL -Y" 19 "ch /�.�� 6. DHEP A rov, Approved for---�✓<- Approved \ Terms of Conditional (ENGINEER SEAL) i bedrooms By ' Disapproved Approval CAUTION A f,��.• ,fir.. +7 :..•_, a 0�... . ti .. ... `'s+ N 2225-E: ^' i �R,<) 1 NE 25, i311 �r•�. 1s. i ea.�a.te �-. ; 77,77 Conditional THE MUNICIPA.,ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEIN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER 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 REQUIRE- MENTS. 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. (DHEP SEAL) 'RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MAR 181986 CHECKLIST - FEBRUARY 1984 RECEIVED A. WELL DATA Legal Description: Lo j SA, Bks M 001ATA I N i?A VC Ca_; 'r6TE * I SEL 24 T12 N Well Classification RES If A, B, or, C. D.E.C. Approved(Y/N) y Well Log Present (Y/N) y Date Completed I()%Z91/g3 Yield TJgpwl Total Depth 271 Cased to ;L Depth of Grouting No N E. Static Water Level A14c) Pump Set At 13, 0 T'To M Casing Height Above Ground 18 Sanitary Seal on Casing (YM) Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y ) Separation Distances from Well: To Septic/Holding Tank on Lot Q 0 Y, On Adjoining Lots Int' f To Nearest Edge of Absorption Field on Lot IO A ; On Adjoining Lots Imn To Nearest Public Sewer Line NID N f To Nearest Public Sewer Cleanout/Manhole No NS To Nearest Sewer Service Line on Lot Water Sample Collected By T7 _S ;// Date '-''/7/8-5 Water Sample Test Results sa-4.s c Ian= Coml a nts '- VO L_Z"'4 - o I:e tae, v d oz B. SEPTIC/HOLDING TANK DATA Date Installed 12,0.0Size I &Zpo No. of Ccanpartments -r L4P O Standpipes (Y/N) Y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) M Date Last Pumped ISI EW Pumping/Maintenance Contract on File (Y/N) W/A I for h//^ Holding Tank High -Water Alarm (Y/N) V6 Temporary Holding Tank Permit _(Y/N) WA Separation Distances from Septic/Holding Tank: To Water -Supply %bll Q D To Building Foundation y To Property Line 10+ To Disposal Field 10 To Water Main/Service Line ;Z6; To Stream, Pond, Lake, or Major Drainage Receipt # Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 362 a�i_ Type of System Design �/i✓t'7�uo.c� Date Installed 4/2-0/" Length of Field /32. Width of Field _ two A/ Depth of Field 6 Gravel Bed Thickness 3 ' Square Feet of Absorption Area Standpipes Present (Y/N) y Depression over Field (Y/N) N Date of Last Adequacy Test !�/ C— �✓ Results of Last Adequacy Test s Tit u c.7-1 o n/ Separation Distance from Absorption Field: To Water -Supply till IDS To Property Line / f To Building Foundation 3 ,Z To Existing or Abandoned System on Lot N 0 N C On Adjoining Lots 3 O -t To Water Main/Service Line 50 f To Cutbank(if present) No N L To Stream/Pond/Lake/or Major Drainage Course b L To Driveway, Parking Area, or Vehicle Storage Area �{ d Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed — C Date Company MOA No. 95-51'-0 / KB1 /d5/s [Page 2 of 21 P •.4 a' • + C ... ...• •......`' EP �:• o. 2225-E: JUNE 25, 1971 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 March 15, 1985 Mr. Tobben Spurkland, P.E. 203 W. 15th Avenue, "C" Suite 203 Anchorage, Alaska 99501 BILL SHEFFIELD, GOVERNOR SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 5A, Block 7, Mountain Park Estates Anchorage, Alaska (8521 -WA -118) Dear Mr. Spurkland: 274-2533 The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 90 feet on the subject property for a 3 bedroom single family residence only. Sincerely, eve W. Eng, District Engineer SWE/msm