HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 2 LT 4Mountain Park Estates Block 2 Lot 4 #017-061-04 I .J;fgvltwed and approved by: Muni cipa Page of DEPARTMENT OFHEA LTH'A'0140M AN SERVICES ENVIRONMENTAL SE RVItES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 is Telephone: 343-4744 On Wastewater Disposal System and/or Well Inspection Report -Site Permit Number: P10 N Number: gy/ qqo 1&2r- , N& rinti.: Wastewater System: 0 New Ylppgrade '[Address: FIELD I 3. -ABSORPTION Phone: No. Of B ms!L) )1�peep`rrench 0ShA110W'rrench CBed Mound 0 Other Soil Rating, Total Depth from original grade LEGAL DESCRIPTION p I V Lot: SubdIvision'. Depth 10 pipe bottom from original grade: Gravel depth beneath PIP9 ILI atl%A Pa r. gr 40' A FL Township:Range: Section: I Fill added above original grade± - Gravel lenpiti: — D Ft, ; __,12 Gravel width: Number of lines: Datairce bemeen lines: I WELL: 0 New C3 Upgrade V9FA_ I F Classification (Private, A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: r- *10 Ft. Ft. 7LV �VF -X,' Driller. Date Drilled: Wale Love Static Water Level: Installer, Date In Y7,d:z/ Ft. Yield: mp Set at: Casing Height Above Ground: Height TANK Ft. Ft. S PARAION DISTANCES T 13 Septic 0 Holding 0 S.T.E.P. To Septic STean'k' AbsorDt,on Lift Holding utitio(Privint `5@w*r Manufacturer Capacity in gallons: From _,Field Station Tank Lin" material Number of Compartments! a I j. S LIFT STATION Oater Lot I _t Lint Lot 'I `1 Sin in pallone: faclurec Line ..Pum imp off- level at: High water &term at Foundation Curtain Purrip Mase 4 Model Electrical Intipipcilons performed by: "area Drain t BENCH MARK Remarks: lnPtn Local� De*it0 Met F., /2141, ov-) Assumed Elevation ENGINEER'S SEAL - V-11 inipections performed by: Dates: 1 2na..�1LI-AL ment of Health and Human Services approval lopa I .J;fgvltwed and approved by: TOBBY SPURRI AND n 1 ` 203 W 15TH. AVt"NLIF ANCH. AK. 99501 ,(907) 7?9-3916 N , ,11OVNI.dIN PdRA f;5iNY A00 2 LOT 1 5.900 OF ARYOUN' ROFiu MICHAEL DORFSH sF�nc SYSTFM AS BUILT DATF:; JUIJ 15, 1999 SH[Erl AP/3 GRIT.&P938 8fNC1/ ALAR A I 1011 l, 5. I "VIN(" Tit s CONCRfTF __• { nC 30 U IVCTAIIT�) P(!!Jrl)PUN VA�Vt OC dA S7.tNDAR1) TRCNCII 4f h IG !-fCT 0�"ft' GC 19 FT LQQRlyri NC. I F(7 r IrTrCaV( 0 <<o�t � ro��TI� I I I I TOBBY SPURRI AND n 1 ` 203 W 15TH. AVt"NLIF ANCH. AK. 99501 ,(907) 7?9-3916 N , ,11OVNI.dIN PdRA f;5iNY A00 2 LOT 1 5.900 OF ARYOUN' ROFiu MICHAEL DORFSH sF�nc SYSTFM AS BUILT DATF:; JUIJ 15, 1999 SH[Erl AP/3 GRIT.&P938 -- -4' RUORUN DIVERSION VALVE _I Suu 1 �iCC71'✓I' Rl til ll MARA "AWG( F(("Y Fig Founda tion Clean out AI tiftr ,+i OW ij 1000 gal Sepik fonk P4RCFC 1D p 017-061-04 r ��r; _ -� CSPLVOSA CONCRETE -- -4' RUORUN DIVERSION VALVE _I Suu 1 �iCC71'✓I' Rl til ll MARA "AWG( F(("Y � � zoa wl,� AI PC R NDUN 5AIfC�AfC OW ij PfRM1T 1l SW99011V P4RCFC 1D p 017-061-04 vl'( 0: (?'1 "'MUNCI A7 110 IV 825 L Straet, Pabm 302 P.O. Box 196650, Anchorage, AK 99519-8650 (907) 343-4744.; ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 09, 1999 Expiration Date: Jul 08, 2000 r Permit Number: SW990188 Parcel ID: 017-061-04 Legal Description: MOUNTAIN PARK ESTATES BLK 2 LT 4 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 005900 DE ARMOUN RD Owner Name: Michael Dobesh Lot Size: 37950 SQ. FT. Owner Address: PO BOX 112733 Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99511-2733 This permit is for the construction of: �✓] Disposal Field j Septic Tank Holding Tank [] Privy [] Private Well j 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 ( 1 BAAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 ( 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: _._ U — �_� 1A�� --— - -- ----- Date: -- lssuod By:_ 1��� Jic C -- Date: 7 / -W T�1 .1:�IL 203 W 1 Slh. AVC1iU6, b`ult6Jtf , r; ANC310RAGE, A1 04501 +r. (907) 279-3916 Fax (907)-276-6013 ! r�1 ^r, SEPTIC SYSTEM DESIGN ri) .pt LoT ,! BLOCK 2 MOUNTAIN PARK ESTATr, MICIIAEI DOAES11 5''7 a - Municipality of Anchorage June 28, 1990 Department of I Iealth and Social Services 8201 Street Anchorage, Alaska on501 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (1) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/1), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolatit)n trstS of applicAdc testholes are also enclosed. The septic system design is based on the follo"ing : No Ground Watcr of Impervious Laver to 16 n. Use Standard "I icnch Soil Relinl;- Prom Testholc 06/15/99 7 nim/in - 0 R Gal persit (1/day No. (if lledroonls l Regwwd Arco per Rcdroom I50/ O R -- 187.5 sq fit I I area required. 187 t x 1 -- 5615 sgfl I cslhulc depth 10 Ice( ISonon, Rock AI 10 feet Tap Rock At i Icer Rock I)cph 7 fcct Inch i reach !meth 56'_S ! 14 - 40 n. USE. SII 11, SYl, I I V (()NI Iiit RATION NI ANI )ARD I RI N(II I O"I AI. I.PN(i I .I I l Y)IAI. WII)I1 F1 Of ['111 10 Pf R()( K NI:I'll I I I (t)VIT 1 T (1II (K IfAI i 1,1:S IN I[X1SI IN(i CONCREITC TANK, REPAIR AS Nl,(T",SARY the inslalkllit'n of This .t puc scslem a ill nal prerenl orclls flout heirtf, installed on the adjacent iotn Isme me no ,Icvcl,operl or nnlural wrlace - sub surface rlrainap courses on thin or the adjacent Iols 1% pny osed Nelms sr w"n will not chanwe the general slope of the mwn Ninding nn&nr concentration of surfncc runoff -will not n-snll loan Ibis insinll;v,on Muni. IKattty of Anchorage �-.. DEPARTMENT OF iEALTH 2e HUMAN SERVICES i., - 82$ "L" Street, A�Ichorage, Alaska 99502-0650 , SOILS LOG - PERCOLATION TEST I PERFORMED FOR: le- 1% -GP D11L�.4''tti DATE PERFORME•Ds_° /�✓`! '1 LEGAI, DESCRIPT'ON: 1 s ;2 ep Township, Range, Section: OEPTH I`�OU Ni/'rltJ PAn-1L I=S- SLOPE SITE PLAN IFEET) i ° 2 4 5 F, u r 6 7 F r 9 � (t C 10 WAS GROUND WATER 0 1r. @NCOUNTERED> \y 11 1 v< S _ F IF YES. AT WHAT 0 F 12 r DEPTH? _ P E r e{.11 to W1ter AIIet 4 _ 13 ` Monitonnp7 Ger Oste.� / c 14 <<`" c 15 c 16 -- t3o 17 NEt_� 12 -i 19 ?-mss a I Date Gross Net 6 _fes _Qr� Time Time Depth to Water Net Drop PR,ESo i - a if) — ' 61 10 hr� 3:01 j D 5 3�y1- � ' 4 I 3 •''r/ � q _ JJ20�I ro ,, PERCOLATION RATE � (rnmutesimth) PEHC HOLE DIAMETER TLST RUN BETWEEN FT AND y ,.. FT DISCLAIh1E1 ;rDlutdwater �nditiDn�indic.ated arP fob dates shown_Qnly. Past and future presence and/or depth of grolndwater can not be predicted dram ese—observa t ions. — ii , s PERFORMED BY; = 6- .__— I I• s . — CERTIFY THAT THIS TEST WAS PERFORMED IN .f ACCORDANCE WITH ALL STATE AND MUNICIPAL Gbt, ELINES IN EFFECT ON THIS DATE DATE ' 72-008 (Rev, 4185) t r SIF,'; t�tP irk r� '� _ ,,+.a ^' t.• x;. tillI C IX - Pf �1kM01ih troP_oi lL o A �.-. 1 , �.w ,r ..•v nr; i., is w TOQBEN SPURAIANO F.F. AVENI/E 11011YTAff PAAW ES'IATY KOCK l? 1,07' •1 203 W 1.5TH. ANCH. AK. 99501 5900 0£ ARMOpUN ROA.9 }y 9O7 279-391 f MICHAEL DOBES1l PERMIT tl SEPTIC SYSTFM OFSICN DAI£: .IU"l£ 28, 1999 SHEET 1/3 ORIO: 292 r. yyr fa�J ns4;`ir r � wwwawanAYA1 `� 4sY.f 14 .... r....� y � a ...r C ,w q f �0 ��A�awwwwf r J i � 10,0,9`01 S. T E-_...{ CONCRFTF ..� +� STANDARD TRENCH may. /0 FFCl f*cp 10 lFfT (QNG RO.X lfTTCT/VI i of VOUNTUA, 11,11h'h PLOCA 1,O7' 4 .5900 DE ARMOUN ROFu MICHAFt DOWSH STPTIC SYSTEM DESIGN DATE; JUNE 18, 1999 SHEFT• 2/3 GRID: 2938 T08HEN SPUPKI NO 203 W 15TH. AvPV111 r rra. ANCH. AK. 99501 [9G71 279-391() 1i PI �MI1 VOUNTUA, 11,11h'h PLOCA 1,O7' 4 .5900 DE ARMOUN ROFu MICHAFt DOWSH STPTIC SYSTEM DESIGN DATE; JUNE 18, 1999 SHEFT• 2/3 GRID: 2938 Effoclive IUBHEN F[ JP'- ? 203 W15':h nv� /iSy� :,; AnChorogn Ah >> ats'. ��9-331G. PFRUIT /' SW9900X.t' nr; •rrr� 1, r:�r,trr 0 W z� 1000 got Septic tonk ESPINOSA CONCRCIE REPAIR RAMES ti U v ,s 7. 0 MOUNTAIN PARK EST,9Tl/' A b 1,07' 4� � .I 5900 OF. ARMOUN ]AI JUNE .29 1999 YICNAEt POOMH PARCEL ID l' 017-061-04 4r?E0:'0•:J. 1)WcG X /. ..•. . q.STq V f 1 °x p,kgF A� yr: Effoclive IUBHEN F[ JP'- ? 203 W15':h nv� /iSy� :,; AnChorogn Ah >> ats'. ��9-331G. PFRUIT /' SW9900X.t' nr; •rrr� 1, r:�r,trr 0 W z� 1000 got Septic tonk ESPINOSA CONCRCIE REPAIR RAMES ti U v ,s 7. 0 MOUNTAIN PARK EST,9Tl/' A b 1,07' 4� � .I 5900 OF. ARMOUN ]AI JUNE .29 1999 YICNAEt POOMH PARCEL ID l' 017-061-04 4r?E0:'0•:J. 1)WcG X /. ..•. . MUNICIPALITY OF ANCHORAGE DI RTMENT OF HEALTH AND HUMAN SER ES t U T Environmental Health Division b ff Q 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address TO SEPTIC ABSORPTION �fyo0�//rlovn FROM TANK FIELD WELL Phones) Permit No. No. of Bedrooms WELL 9z2z2/ �d LEGAL DESCRIPTION LOT LINE �4� Lot Bloc Subbdyuson FOUNDATION �- Township, Range, Section X/1 AS -BUILT DIAGRAM (Show location of well, septic system, property lines, loundahc driveway, water bodies, etc.) TANKS INF SEPTIC ❑ HOLDING Ma/nn J fact Lir et Capacity in gallons Tt Material) No. of Compartments TYPE OF SYSTEM XTRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from ongmal grade original grade sp, 0 LL _ _'' FT /y FT FII added above original grade Gravel depth beneath pipe o ------ FT V/ FT Gravel length Gravel wi-th—d FT Total absorption area Distance Low on lines 1 Ke 41 SQ FT /J f? FT II -- - Number of lines Soil rating Pipe material ,� G: SOFT e .b;;YV /5 �r Installer r Date Installed e -C.— WELLS c o. PRIVATE ❑ OTHER (Iden l Classihcanon lA,B, C) total Depth Cased to �� 3 FT FT Installer Date Installed: /0- W �`i� /Z— REMARKS: ZREMARKS: v 1 Scale: //i = moi �pli[�g EAL Inspections Performed by. ,.q�'\. e` Av ` I ✓G ✓J t�..O�.J.F • j At Date . wr�.•• •.�s�,♦', t 5 .,� .•.•. T ,,�,F.•....... i certify that this inspection was performed according to all Municipal and State guidelines in effect on this date: _ /�A` 7If 0••41HUGH R. BEVAN ; J J�y . �" AIS AW Health Department Approval: �' r — Date: +• , • •� P PP �lipRnrrccia�la�' 72-013 (3/85) , ISSUED BY DATE: -dPwo,l �� � DEPA�TMEN[ OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STR[E7, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 870121 UPG�ADE ��^'��+_ DATE lSSUED: 0�/08/87 APPLICANT: NELSON COHEN / BEVEN ENG, ADDRESS: 5900 DE ARMOUN Rb. �r �� ANCHOPA8E� AK 99516 - LEGAL DESCR{P: SUBDIVISION: MT. PARK ESTATES-_� LOT: 4 BLOCK: 2 SECTION: 26 TOWNSHlP: 12N RANG�: 3W L[)T SIZ[: 37950 IJ U! OR ACRES) I certi/� 1. Lhat: I am �am�liar with the requirements �or on�site sewers and we1ls as sot �o/Lh by the Municipality of Anchorage (MOA> and the State o[ Alaska. 2. I will znstall the s;sLem in accordance with all MOA codes and regulations, and in complzance to his permit. 3. I w/ll adhere to all MOA and State o/ Alaska requiremenLs for Lh� set back disLances from any exisLing well, wastewater disposal system or publ�c sewerage system on this or any adjacent or neapby lot. , ISSUED BY DATE: -dPwo,l �� � f� ,yf.ti '^I T ,dry. �'Sr• arA }�r y TrWyy y,>4y'� jt'� t. n 4i { /o'/OT G1/7e fe1K BGck �JetiryiJ ilfis�S 8 = S 6d n,J eGp . 6 • o Ft /VO &S Ae �nl�iy(�siy% UNCI/J �/oy7' ,(imN. AN ENGINEERING SOILS LOG — PERCOLATION TEST b'%.,% OF � 4 9 PO. ao. ""IS* • 91H , #r ""g., AK 9951 •••• ♦•• • •.•• •••� (907)52213 • • •••••••••••� (907) 25805 •4 �/ r•` • HUGH R. BEVAN f'•• CE 7225 .'•`$W.i PERFORMED FOR: /I/QXPiJ �O�jPi7 IPJ?` f4�� /PY Z DATE PERFORMED LEGAL DESCRIPTION:Township, Range, Section: DEPTH (FEET) oG 2 3 /Y! G 4 5 6 7 8 9 10- 11 0 S/ 12 13- 14 / SLOPE 4 V1 I a WAS GROUND WATER ENCOUNTERED? / V/ S IF YES, AT WHAT L DEPTH? O P E Depth to Water After p // / Monitoring? nb/J t- Date: 6 •% �� 1!01'1 yJ 1W 1lP/P y 16 17 18 19- 20 SITE PLAN /i>p 41Nc7 NTS Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS f�A DLGi! �� 0,-4 PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev. 4/85) FAME 0 No -so No . ON ONE No ONEME ONEME MEN /i>p 41Nc7 NTS Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS f�A DLGi! �� 0,-4 PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev. 4/85) BEVAN ENG Approved Well & Se): SOILS LOG — PERCOLATION TEST OF AL '`t y� ENGINEE S st;l �1� *:49TH *� P.O. Boz 112852 .... • • . • .... • . • i Forage. AK 99511 (907)5221383 • •••••••••••• (907) 2580584 / 9dHUGH R. BEVAN ; w �t f/'•.• CE7225 •.'�0 low PERFORMED FOR: O /e/Jon ����, "' �D" or DATE PERFORMED: LEGAL DESCRIPTION'Township, Range, Section: DEPTH (FEET) 1 oL 2 3 SW 4 5 6 7 8 9 10- 11 12 S,O 13 14 15 16 17 18- 19 QoGGiI/Lf/ %p0 � Day y/G ✓ems/// ,lc.� c>< 1"A/0- X, 6r .i A// *w o t SLOPE WAS GROUND WATER ENCOUNTERED? P S L IF YES, AT WHAT O DEPTH? P E Depth to Water After Monitoring? ;>61VS Date: G of SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE (minutes inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT �/"fLOmAaP� v f //Jc/fGfi�/ foi�J /Cr5%�i o7� /do mss/ fo fp. COMMENTS � PERFORMED BY. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 72-008 (Rev. 4,85) zz s— 2! ��✓� ., .�7� G��O `G- well C! .. I raavno9! • `" - C M -W DRQUNG, Inc. P.O. Box 4.1224 • 1310C International Airport Road (907)274-4611 ANCHORAGE. ALASKA 99509 DRILLING LOG Location (address of: Township. Range. Section, if known; or distance main Elk 2 Lot_4 Mitt Park Estates. r.dOloh:3 50SWIh of Wen Dom .M10 149 Depth Size of cad�n9 Depth of Hole 290 feet Casedte 283.2 feet Static water levet 270 w J (below) land surface. Fin' ah of well (check one) open end ( x ); Screen ( ); Perforated ( LOC ). Describe screen or.perforattm lA9AG. Perforated 6 times 0 2741-2751 Well pumping test at? g•llow ler &w=j (minute) for 1 *ours with 10011 fr of drawdown from static leveL Date of completion 22 Dec. 1975 S WELL too Depth In feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 2 TO -40- To n- To 35 35 To 55 —53 --TO 60 Silty Gravel, Med, Siltv.sand i4 Gravel • • i • =r MUM • 71S TO 116 �fi_TO tan M1 NI.M1 130. TO150 150 TO170 170 TO 180 180 TO 200 _20D.-LTn 2oa Silty gravel, med Crrh &Ah Al s VlgT-q73 Gravel, loose Clay S Gravel LAS '301-� a; M -W DRILLING, Inc. P. O. Box 4-1224 * 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG V 7 Use of Well Well Owner Location (address of: Township, Range, Section, if,known; or dktance main � - I . Zv --." -,�—x Size of casing— Depth of Holefeet Cased tofeet Static water level ft. (above) (below) land surface. Finish of well (check one) open end Screen Perforated 4' I Describe screen or perforation� Well pumping test at gallons per (hour) of drawdown from static level. Date of completion-----� Depth in feet from ground surface TO TO TO— TO— TO— (minute) forhours with ft. WELL LOG Give details of formations penetrated, size of material, color and hardness NVNJA 001, bio' C,M]Lracj,)r No's. 8 H& M 2 — STATE TO 0 —T TO TO To TC) TO— TO— TO— (minute) forhours with ft. WELL LOG Give details of formations penetrated, size of material, color and hardness NVNJA 001, bio' C,M]Lracj,)r No's. 8 H& M 2 — STATE GREG I ER ANCHORAGE AREA BMoJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 ,� -79 —04o la / INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESS 2 �c/ � —PHONE LOCATION Ciu� (/� eFXll 2P1 t d[.A�c; (lk t hod ?z &R'd / " D/l : 1 EGdL DESCRIPTION '�/ SEPTIC TANK: +z �� DISTANCE) NUMBER OF FROM WELLMANUFACTURER MATERIAL ��-tom COMPARTMENTS / r INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY x-ty--6 GALLONS. SEEPAGE PIT: } NUMBER OF PITS DIAMETER OR WIDTH LENGTH DEPTH (� i .' LINING MATERIALd_ -A J�fj B SIZE: DIAMETER�DEPTH DISTANCE FROM: WELL / C/ I TOTAL EFFECTIVE % rryyV/ BUILDING FOUNDATION . `5 , NEAREST LOT LINE -3r% ABSORPTION AREA (WALL AREA). QSQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK_ DIAGRAM QF SY :HI DISTANCE FROM: SEEPAGE SYSTEM _ INSTALLED BY: Cs PIPE MATERIAL: /Lcmc1 LOT SLOPE: p i S REMARKS: C DATE ~ APPROVED G.A.A.B. U)ota _ GRE, R ANCHORAGE AREA BOT !GH J DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE,+LJ7p�SKA 99503/. _ TELEPHON WL ale-��,. 6' �.�ffy�. SEWAGE DISPOSAL SYSTEM — 1S PLIATION�NNMM PERMIC NAME OF APPLICANT MAILING ADDRESS INSTALLATION LOCATION _ LEGAL DESCRIPTION I– INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED SEEPAGE PIT 6L���ORAI FIEL FINANCED THROUGH 4 0 TO BE INSTALLED BY "1-ems✓✓�-�' "''0 SOIL TEST RESULTS '0 Z `' 7LNOTE: THIS PERMIT IS NOT VALID COMPLETION DATE ANTICIPATED OTHER B 0 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE -Iaoo TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK-- SEEPAGE PIT TO NEAREST LOT LINE 7 DRAIN FIELD DRAIN FIELD V5140xj! j ;q/ 14, vet;00— P/ E AREA SIZE TYPE WA 8/ Screa,,teD Roc -k - DIAGRAM OF SYSTEM WELL TO SEPTIC TANK �AAw SEEPAGE PIT DRAIN FIELD —V ALSO CONSIDER AREA WELLS. a WATER MAIN TO SEPTIC TANK SEEPAGE PIT , DRAIN FIELD SEPTIC TANK, I— 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. G.A.IVB. OR ENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. l DATE f/ `' ( APPLICANT'S SIGNATURE FORM NO. EQ -016 /6� te K 8 10 12 /46 Forrester -.2.4, July 75 2 Mountain Park Estates 14aa Ci-)und Water No v AN At What - - - -- - - - - - -I-C-- -rR a —te ,e a I,- 16 f t t:. of InIct T 6 ft SP at 150 s 2 ft Gw at 85 saft/bdrm calculated average 134 sqft/bdrm Rv; Percco 24 July 75 oil The sediments were very loose! with a low water content. All contacts between soil Sp types were erratic with respect to depth. The Sp A had some silt and present but these clay bodid were of Gw minor importance. Sp Sm 14aa Ci-)und Water No v AN At What - - - -- - - - - - -I-C-- -rR a —te ,e a I,- 16 f t t:. of InIct T 6 ft SP at 150 s 2 ft Gw at 85 saft/bdrm calculated average 134 sqft/bdrm Rv; Percco 24 July 75 top Municipality of Anchorage - bb • 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.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-061.04 HAA # Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 4 Block 2 Mountain Park Estates Location (site address or directions) _5900 DeArmoun Road, Anchorage, AK 99516 Current Property owner(s) Jonathan Westbrook Day phone 345-5841 . Mailing address 5900 DeArmoun Road, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS 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. (Rev.>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 [C73 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 6. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: HAA Checklist X Maintenance Agreements Septic System Advisory Well Flow Advisory Supplemental Engineer's Report Other By: l /. Original Certificate Date: Expiration Date: Reissue Date: (Rev. 7IM) Municipality of Anchorage • "` Development Services Department Building Safety Division On -She Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.c).anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 4 Block 2 Mountain Park Estates Parcel I.D.: 017-061-04 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 12122 975 Sanitary seal y Total depth 283 ft Cased to 283 ft FROM WELL LOG Date of test 1212211975 Static water level 270 ft Well production 7.0 9 -p.m WATER SAMPLE RESULTS: Coliform -f�' colonies/100 ml Nitrate 7 mgll Well Log y Wires properly protected y Casing height (above ground) 4+ in. AT INSPECTION 811312003 249 ft 3.0 g.p.m Other bacteria -67-_ colonies/100 mi Date of sample: ,011312003 Collected by: Laura Pannone B. SEPTICMOLDING TANK DATA Tank Type/Material Concrete Date installed 3/1711976 Tank size 1000 gal Number of Compartments 1 Cleanouts y Foundation cleanout y Depression over tank N High water alarm N/A Date of pumping 811312003 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed ZIJ211999 Soil rating (g.p.d./fe or fetbdrm) Q,$ System type Deep Trench Length _0 ft Width 2 ft Gravel below pipe T ft Total depth � L$ ft Effective absorption area J&fe Monitoring tube y Depression over field 12 Date of adequacy test 811312003 Results (Pass/Fail) Pass For 2 bedrooms Fluid depth in absorption field before test 155 In Water added467 gal. New depth29 In. Elapsed Time: 1440 min Final fluid depth ,J9 in Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date (Rev.11199) D. LIFT STATION. N 1 iN Date installed _ \�� Size in i "Pump on" level at i/n"Pumi -oIF-vel at Datum r Cycles test E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access in High water alarm level at in Meets alarm & circuit requirements? _ Septic tank/lift station on lot 120 On adjacent lots 100'+ Absorption field on lot 135 On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 100' Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20' Property line 20' Absorption field 50' Water main N/A Water service line 259+ Surface water 100'+ Drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 40' Building foundation 39' Water main N/A Water Service line 25'+ Surface water 100'+ Driveway, parking/vehicle storage 20'+ Curtain drain None Observed Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION4Y 40 I certify that I have determined through field inspections and : �` °� 49 �.... i. .. ...........i..... review of Municipal records that the above systems are in r r conformance with MOA HAA guidelines in effect on this date. ..... ......... .............;...� �. ;Steven R. Pannone: = Engineer's Printed Name Steven R. Pannone. P.E.♦ No. cE 81 4 ,� AV Date ��� •.••' .. HAA Fee $ Waiver Fee $ Date of Payment 9/� Date of Payment Receipt Number t jos 3 3 Receipt Number (Rev. 11!99) Gs°may©" F i+vo 'NC* ,N d 0 EASEMENTS OF RECORD, OTHER TMOSE SHOWN ON THE RECOR PIAT, ARE NOT SHOWN HEREC NASSUILT* C W Z t' A 0 L ("=60/ THE 11 4FORMAnON HEREON tS FOR THE USE OF LENDI qG INSTITUTION$ SPECIFtC"Y TO SHOW ANY CKWFLICTS BETWEEN EVSTING STRUCTURES N ANDPLATTED LOT ONES OR EASEMENTS AND IS NOT O BE USED FOR POSITIONING ADDITIONAL. 3d U T"Ir . _4 : /•i :`• g AU TURES OR FENCEL INES. No corners sett _ Bonk p9 I hereby cerft that i have Surveyed the following described property, Lot . C.. Block MI �, Anchorage recording district Ataslul, and th8i the improhwmems situated thert'0A are within the properly lines and do not overlap or encroach on tho prop" lying soacem thereon, that no imptovethants on propertyY iyl" 04*00 t thereto encroach on the premises in question end that there are no roadways, transmission Wm or ether *sible easements on !raid property except as tndioated hereon. Anchorage. ?? /g4a An Alaska .,.�„+, Y�h :L f ; •.N� •N�i f acts MirdenM ag r % ",36 13084 O p •..sN• `�,$0 w i��4%StalihA 10e $ 'IV17I Vi.SIA 'iVI%iH3Qt1$d 881st Z99 Zoo YY3 CS:9i tiSdt 66/9 Z/LO yf (• fl �f:1,, �' � t '. ::.• •,•.:: MVI\Iv„ l91\t Lf1 71, DEPARTMENT OF HEALTH d HUMAN S� DEPARTMENT ��: i it cif vj '�i7iit n?191 :;N Vi rltwilria rOnfit@n{�8f�.i9fV�C@9','F�'k�y`�s� Dlvlslon of �nvi j �tavrc' rl. 1c,r3 2w r,Orn Site:Servic�S-Secrt�o4ltrl2t�' 1� . 1 r�l�isfit {;1t{a 1�yt1,iL Box 1966501):11nChoragei885�6G$PtC$Stselrwef^tua -htr Pla}�8iv'r �Cti''tt�tlt�lb�+Lhr, .O. >{*,IutLrt��lititJllSnibrn��s�it,uu�.Pr t)OMO '3i 3 �' ,fYIH1"A' ' � OF`NEALUTF�6A1 � ,r >tr11;moll in;=,w CERTIFICATE Ira FOR A' SINGLE PAM (LY.DVi1ELLINt,r ',.,! G t !{� ; ,, ,yt! . APPROVAL Parcel I.D. # CuIHAA#�11J — 4 1. GENERAL INFORMATION 1 ^r Complete legal description L,U 1J �, >3 ✓. n �- 0 y ✓� t-n�+ Ul •` 1 Location (site address or directions) Property owner lj n L' , �� �Day phone Mailing address C JBd� —7 l 1 r� / 3 3 Lending agency Day phone Mailing address --I Agent -T" �cl cK UI �F•1 C� r ' 5.0ir-eA Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOME: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Q. TYPE OF WASTEWATER DISPOSAL: / Individual on-site HuldIng tank Cu nmunity on-site _ Public sewer *(j! +, a, tl; NOTE; If community wastewater system, provide written confirmation from State ADEC 1 attesting to the legality and status of system. Moi rn ij,..,,inyestigation of th17s °alth A�ithbrity A�ipt�$v lI� pp ; i rxlr rand/or wastewater disposal fid"siakls l�dftl; ufiC4it3t1N1 1 and type of structure indicated herein. I furthdt�i"It}tat } r�; 'the Municipality of Anchorage files and�frQm rt yfl V" supply and/or wastewater,disposai system�ia-[,nt cam6laE• ordinances, and regulations in effect on the date df NO ,srhy", Name of Firm �F 1 Address -511 Engineerssignature Date l stir � - 6. DHHS SIGNATURE ate; Approved for Z HR E E bedrooms. Disapproved. I Conditional approval for bedrocros, with the following stipulations: I! a 01 4%Ali� number of bedrooms the information obtained from ctirspection, the on -alto water i01,Municipal and State codes, n. Phone i� 3'71 t r 7 Additional Comments M I� 111TI0 Date -7 - -2 2 - 17 The Municipality of Anchorage Department of Health and Human Sorvices (DHHS) Issues Health Authority Approval Certificates based only upon the representation* given in paragraph 6 above by an Independent professional a ng i nter registered In the State of Alaske. The DHHS does this as a oourtesy to purchasers of homes and theirlendinginstitutionsmordertosatisfycertcInfederalandatattrrequirsments.EmployeesotDHHSdonot co lu 'tii§p'ibt(onti°•ryt analyze{tl�t ,befnN'erze4tltit t0',ty/?Iistiii4r6'rUta**Itty-of ArtchorsoTWrlot responsible for errors or omissions in the professionateftght!eeft vrork. ' 7W'ISfsd)lAxi.YMlfMlllYWflti"rrW ufti r••. ... .-.. .. �.�.....ii�:l.l. rlalt LLs�'Y.3Ys'i�.�•,'S_14S9i:.atH..'�WfJnu ...i... _..a .:1i,4.: M,E �x itt•.'+lYl6i.vMliifC NO 4WV Y I Y 4 7v f 1P ,y 11"Fli,Wa7 q 1 -3 -Vl- A I VL. ?t "t, PRe W— ��r•R(��fi�t�t�i� �•�i}r tdt ���;'�'i� r �r�ptr - ``f Y y�_x „>. tura -* � r ' ,� U.:p . DStQ 1• x h, n>. r, �' d H gn. p r : ((fir i 3v'v a S _ ra 1 4 u, a� r x " '�t yyyy�� 99d' ryyI An r11VViMil •i.V ✓Sr ftSin✓q,'(!`�iwy rt�Mi Vi.A. t r lA%� , ���' S M1 t rr 7k rfY A'. v f r n xn en atirx4 rva'r+ D�$TA} ate tix.,ar`�r,A '�Yd� �raTt,,.i y<il,ryh�,'(t,i!r� t"l Ae' i ity t -0r �f,-d°.i! i�1fj � A lON DP51 ANCES FROM WELL 0 LO �'I til O` ,� " 0 iv,. it 4( t Ae e. ,v+n w , . FCifi�.+'; t ,F f r ,rK?On I!d aCnt�tota l4'r' clding tank Op tt(� age a,•;„r- lots 416n ite(d on loti a r•U'li I('u ti of r rp n [ t a �,. PUDIIo 8ewer Jnanhole/cleanout _ kewet rnatn h . i1 6-<2 uft station � /septic service line � - M' +1 r i 4 A . & IO. PTICA-f0t94Nf NtL ON LOTTO } �AT��N DISTAt�ICES FRO? $E lj Y t,ti +a,ta Property Iine Absorptlon Geld - dation.._ .. — r77rtialn/sen+lce IInA2_,Z__, Surface waterlcirnin8ger:. Wails on ad;SCent Iots r , w ifx kRATION DISTANCE FROM ABSOnPrTION FIELD ION LOT T�PIPkt - }�`s°`�`�`' Water maiNservlce iIine ingtoundallBuild)8y lneb W r hints storage aroa: ace water f Driveway, pa �►9h'o t� t�1 J a� Walte on adjacent lots, ' l�Z---- ,atn draiq-•-- « t,, e dINEEf�'3 CERTIF➢CATIONn, ,y r,1 i ;if; S nS43��4��+tt,r`" ,".�'°' W^ti'1 M a �y,e rt :^' r ^ y a i,' ." nv ._- t. � '.V •, r r x. s4,' fir.%1 / A k. i irtq� �.��.} rtKy that l have determined thru bald Inspection and rgYlany4ot MunIC1p! ado s ems are ohformance with MOA HAA guidelines in eN on"thl , r`. if,i , ew.\ f• sq • s\r. r r ti�..l' iy 5v , pf(+ linnor`s Name o k t vt " g.�h t .. n�iz• aril r i r N )r+1� .: R � t t r t':rt "•` � r M1t�'P <'ta� � Waiver Foe $'� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date g;7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, townshi11 Ip, range) Location (address or directions) (b) Property Owner E'�o� `®n Telephone: Home Business Mailing Address (c) Lending Institution Mailin Address Telephone 9 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here El, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Famil?t( Number of Bedrooms :7 3. WATER SUPPLY Individual Wel Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE ISPOSAL 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. 72-025 (Rev 8/861 Front 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 insppection. Name of Firm 2C Telephone Telephone Address .G �� riiGi p/G r io �i Date 6. DHHS APPROVAL Approved for �� bedrooms by Date Approved Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and theirlending 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. Fuge 2 of 2 72-0z5 (Rev 8/86) Back U MUNICIPALITY OF AN(MUjVIMPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICWAYINIALITHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 j u N 1 2 10 1 zsa-a�aa RECEIVED A. WELL DATA Legal Description: Well Classification If A, B, C, D.E.C. Approved (Y/N) N� Well Log Present (Y/N) -- Date Completed /2-22 - Yield Total Depth Cased to Depth of Grouting /. Static Water Level A,2� 4� y r 9• Pump Set At Casing Height Above Ground 3p `l Sanitary Seal on Casing (Y/N) X Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y/N) ; On Adjoining Lots '--6 C' :74 To Nearest Edge of Absorption Field on Lot w�; On Adjoining Lots moo To Nearest Public Sewer Line To, Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by �P��" ; Date Water Sample Test Results°O �� v r G3 /� +✓/G �i�r��� - /l1 �-� Comments B. SEPTIC/HOLDING TANK DATA Date Installed 2-1"7-'4� Size /00O No. of Compartments I/ Standpipes (Y/N) X— Air -tight Caps (Y/N) Z Foundation Cleanout (Y/N) r Depression over Tank (Y/N) Irl/ _ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) o� ; for Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026 (Rev 8/86) Front IMA N. Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field z'p Z'�' To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA _�A� 4� Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field .J u i Width of Field I �( Depth of Field /�1 q�.,N{ Gravel Bed Thickness c10 Square Feet of Absorption Area &�L. r Standpipes Present%/N) Depression over Field (Y/N) &A Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well orf To Property Line I To Building Foundation /( To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service Line ld To Cutbank (if present) A" 14 41 7L To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle StoIrage Area Comments D. LIFT STATION IV Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that pavechpffd, verified, or conformed to all MO and H A guidelines in effect on the date of this inspection. Signed Date 4 �.Z Company 4140 / MOA No. _Z2F Receipt No. �— 0(1__0C_)14 Date of Payment 46 —1 Amount: $ Page 2 of 2 72-026 (Rev 6/86) Back y1Q;•�ngin 's sfiglr� HuGm R. BEVAN �'••• CE 7226 : �' �W'NtN ag1CNC £ AA£A bg G G � GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 9, 1976 Time of Inspection 1:30 p.m. Date of Inspection 8-10-76 Tuesday REQUEST FOR APPROVAL OF Pratt INDIVIDUAL SEWER & WATER FACILITIES FOR V. A. 1. Approval requested by: Veteran's Administration Mailing Address: Phone: 274-7555 2. Property Owner: Terry J. Forster Phone: 278-9661 (Susie) Mailing Address: 4600 Pavalof Street 3. Legal Description: Lot 4 Block 2 Mountain Park Estates 4. Location: 2i mile De Armoun 5. Type of facility to be inspected Single Family No. of bedrooms 2 6. Well Data: Individual A. Type B. Depth 283' C. Construction D. Bacterial Analysis 7. Sewage Disposal System: on—site system A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 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 Page 2 of two pages - Req t for Approval of Individual S r & Water Facilities Legal Description Lot 4 Block 2 Mountain Park Estates Comments Approved . C� Disapproved Date ]q Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality 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 EQ -034 (1/74) Date MUNICIPALITY OF ANCHORAGE 04 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTE&Vd 2510 East Tudor Road, Anchorage, Alaska 99504 276.222' V Type of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA FHA }I;bNV 2. Property Owner: Ti O 2S a- Mailing Address: `���© f�AvAwF �r. Day Phone: 2`78-9(yLl 'su-tr" 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution:�aat�aat Mailing Address: �NOYf-l�,v..�, lis 9X_t�cPhone: 2l� 5. Name of Realtor or Agent: Mailing Address: Phone: 6. Legal Description: bLocK a L©T A MN VKY' �CSr(�T�cS Location: a1/a- �NNT 1) "r Nlzr.(]u,.i 7. Type of Facility to be Inspected: 8. Water Supply No. Bdrms. a Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well- 9. ell 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76)