HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 8 LT 5Moutain Park Estates Block 8 Lot 5 #017-391-37 Municipality of Anchorage •' ; . } Department of Health and Human Services Building Safety Division On -Site Water and Wastewater Program, 4700 South Bmgaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW W040118 PID Number: 17-391-37 Name: Wastewater System: ❑ New ® Upgrade Address: ABSORPTION FIELD Phone: Number of Bedrooms: ❑ Deep Trench ®Shallow Trench O Bed Q Mound Q Other. LEGAL DESCRIPTION saRatlng: Total Depth from w1l#Wgrade; Block: Lot Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: Township: Range: Section: FI, added above original prods: Gravel Length: 0-1 Ft.• Ft. Well: ❑ New C]U rade P9 Gravel width: Number oflnes: Dhm"`abetweenInes: 5 Ft. 1 ClasWcation (Private. A. B. C): Total Depth: Cased lo: Total absorption area: Pipe Material: Exist'g Ft. Ft. 364.5 Fe 3034PVCIF810 Driller. Date Drilled: Static water Level: Installer, Oats kutalled: Ft. A+ Home Services 5/16/2004 Yield: Pump sat ae: casing tlelght Above Ground: TAN K GPM FL FL_ SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ubWPrh*te Manuracwror. Capacity:From Tank Field Station Tank Sewer Line Anchorage Tank 1250ow. Wei 104.4 105.1 90 Mme. Steel NumberofComparbrmft: 2 Surfacewaler 100+ 100+ LIFT STATION Let Line 26.3 26.4 Size: Manufacturer: Gal Foundation 17.3 16.1 "Pump on' levell at T -V or `aV*` "� tipth water alarm at in. live In. curtain Drain 100+ 100+ Pump Make: Model Electrical knpections patormod by- Renu Id Td— ':x)vil —d BENCH MARK I� ConcreteC tion S b in back under deck Assunwd Elevation: f 1 100.0 FL Engineer's Stamp �,a��,aaaaa OF •qS�♦♦ Inspections performed by. Pannone Eng. Svc Dates: 1`5/16/2004 ;' 49TH l �•�� 2nd05117/2004 „..a. ..............«s..«.� Department of Health and Human Services approval ....• ... .................e,....� ve -.Steven P. Pannone; s Reviewed and approved by: Dater 4- D♦' •' No. CE 8149 �i~ ••'• (Rev.71W !♦ CG/6 •.•••' �ti .............•• * �� PERMIT NO: SW040118 RECORD D RAW 1 N G WASTEWATER DISPOSAL SYSTEM Lot 5, Block 8 Mt. Pork Estates I l 1 1 \ Q EXI 'G \ S TIC \ E EA \4 REPLACEMENT SYSTEM. 5'Wx72.9LFx3'ED, 6' TD J NOTES: 1) All work was performed in accordance with AMC15.65. 2) Materials used was in accordance with those specified in AMC15.65, Wastewater Disposal. 3) Connect post tank line to midpoint 6f drain fi6ld, typicol. 4) Maintain 10' separation to all lot lines. 5) Lots served by Private Well. No wells within 100' of proposed system. 0 5 I I I 1 5 ;`- I.- IRIZ \� i1l2.0�� \ 1 % \\ N. M1 III (IST'G \ 6.4 SETIC \ AREA \\ \ P.I.D. NO: 017-391-37 I �XIST'G L l Ali .01 JOAX�ST'G 4 BR 3 HOUSE -NE _2 K 12501 SEPTIC T 26. I DIVERTEf? L VALVE � ,,/—EXISTCG SEPTIQ AREA \ EXIST'G DRAINFIELD\IN FAILURE. REUSED \ N, \ \ N. \ DESIGN: \ CO A B PERS RATE: 1-5 MPI T1 27.2 33.8 \ PUCCXkON RATE -2 SF/BR T2 33.1 38.8 \1 D/SN > o C1 70.8 60.6 \ � BR SE M1 71.6 60 RE9.'D AR • 50 0�5 C2 66.8 .1 RF— 3' EFF'T TH, 0 L 5' T.D. M2 60.6 0.0 300 SF TOT 1250 GAL SE \ T K \ PREPARED FOR: PANNONE ENG. SVC, LLC Michael & Theresa Ford P. O. BOX 102954 5934 Bristol Drive_ ANCHORAGE: ALASKA 99510 Anchorage, AK 99516 271-5410 227-3522 P, 272-8218 Fax DATE:. - 5 -1s -o4 RECORD .....�_ .a .... PERMIT NO: sw040118 RECORD DETAILS WASTEWATER ABSORPTION SYSTEM Lot 5; Block 8 Mt: Park Estates NOTES: 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH. AND ALL MATERIALS SHALL CONFORM TO. AMC15.65. 2) ADD A MINIMUM OF 2" OF R.I. OVER ENTIRE BED. 1f10 Nv3 o c 3) MAINTAIN 30' SEPARATION FROM ALL SLOPES GREATER THAN 25%. ti rn w 4. a 0 w , n= v n. Ln Of 3018011NOW `rA 0— N 1 1 r `:?`�♦ �.. • ......».......r.... ...... .... _:.`.. �'• ' Steven R. annone• Gam• CE 8149 1►��c10rt��'� 0o I P.I.D. NO: 017-391-37 Y Q •d' 0 U z 0 _ U to I zLiJ U z d o 0 0 ( w 0aw e — CL 3 0— N 1 1 r `:?`�♦ �.. • ......».......r.... ...... .... _:.`.. �'• ' Steven R. annone• Gam• CE 8149 1►��c10rt��'� 0o I P.I.D. NO: 017-391-37 PREPARED FOR: Michael & Theresa Ford 5934 Bristol Drive Anchorage. AK 99516 271-5410 a` J O C4 n c Lu M z w Cr t. - w O N Pannone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX NTE: 5-18-04 1 RECORD OT TO SCALE •d' 0 t0 11 to 1nO NY -:n3 Ln I to I z 0 z 0 0 CL 3 w O twig z cn ^. 1 m 0 1noNv3l0 to _N LnONY3-13 i Lnowmo Y o � aj inowm Vo- 11���� N011v3 in PREPARED FOR: Michael & Theresa Ford 5934 Bristol Drive Anchorage. AK 99516 271-5410 a` J O C4 n c Lu M z w Cr t. - w O N Pannone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX NTE: 5-18-04 1 RECORD OT TO SCALE MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade � :3-D Date Issued: May 13, 2004 Expiration Date: May 13, 2005 Permit Number: SW040118 Parcel ID: 017-391-37 Legal Description: MOUNTAIN:PARK ESTATES'BLK:8 LT __51 Design Engineer: 0062 Pannone Engineering Services Site Address: 005939 BRISTOL DR Owner Name: Michael & Theresa Ford Lot Size: 20400 SQ. FT. Owner Address: PO BOX 113266 Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99511-3266 This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage W;' All construction must be in accordance with: 1. The attached approved design. t 2. All requirements specked 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: Issued By: / )���"� liC� . %��d-�� Date: 3— 0 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage; AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017.391.37 Permit Number SW 0 q D / 19 Property owners) Michael & Theresa Ford Day phone 271.5410 Mailing address (1) 5934 Bristol Drive Mailing address (2) Anchorage. AK Zip Code 99516 Legal description (Lot, Block & SuVd.) _Lot 5. Block 8 Mt Park Estates Legal description (Section, Township & Range) Lot Size 0.46 Acres/Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. 1 further certify that this .application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Date of Payment: Date of Payment: Receipt Number. , 5—Z 1U 7 Receipt Number. (Rev. 12/00) Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax May 8, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 5, Block 8 Mt Park Estates SJd Septic field Replacement Permit PLEASE RUSH Gentlemen: My firm was contacted to perform an adequacy test on the above referenced lot. When I arrived to conduct the test, I discovered the field to be completely inundated with liquid. The field is in failure. I conducted a single test hole on May 5, 2004. I have attached the soils report and percolation test for your review. I am writing to request an immediate issuance of a septic field replacement permit for this lot. No bedrock was encountered in the test hole. Ground water seepage was noted at ten feet, but there was no standing water after seven days of monitoring. There was saturated soil at the bottom of the water monitoring tube. I will use a conservative depth to ground water of ten feet for this design. The lot is approximately 0.46 acres in size and is served by a private well located on the northern portion of the lot. Lot 5 slopes to the north at approximately 1 to 3 percent in the area of the septic system. The proposed installation will be located in the south-central portion of the lot The existing 1250 -gallon septic tank will be exposed and inspected. If it is found to have corroded and is leaking, a new 1250 -gallon septic tank will be installed to serve the new drain field. The existing drain field will be abandoned in place. Both systems are located greater than 100 feet from the well serving this lot and surrounding lots. The proposed location is greater than 25 feet from the water service lines. The other surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. . If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Steven R. Pannone P.E. •""• 44 ' Al _' r. A 0 TH S. Attachments: ren R. Panne No. CE 8149 PERMIT NO: DESIGN DRAWING WASTEWATER DISPOSAL SYSTEM Lot 5, Block 8 Mt. Park Estates J i / EX / /WEt LIM I � Q I EXI 'G IC \ REA1 \\ 4 � \ PROPOSED "— � � REPLACEMENT 40.1 SYSTE -57., ` 5'Wx60LFx3' D, 10 - 'TD NOTES: 1) All work shall be performed in accordance with AMC15.65. 2) Materials used shall be in accordance with those specified in AMC15.65, Wastewater Disposal. 3) Connect post tank line to midpoint of drain field. typical 4) Maintain 10' separation to all lot lines. 5) Lots served by Private Well. No wells within 100' of proposed system. /en R. Pannone No. CE 8149 _< 1 5 1ST / O` I 1 103.�r (i 102.7 P.I.D. NO: 017-391-37 EXISrG 4 BR 15. HOUSE / 1 '0?1 Z50g EPTICANK - 6.4 VERIFY iVGEGRITY •1 �� 1 G `� %,\ 32.7 SEPTI � �—SEPTIQ \� EXIST'G �� �\ AREA \\ 6 SETIC EXIST'G DRAINFIELD IN \ AREA FAILURE. ABANDON IN \ PLACE \\ �� � ESIGN• 20 PREPARED FOR: Michael & Theresa Ford 5934 Bristol Drive Anchorage, AK 99516 271-5410 F'SRC • 1-5 MPI PP C N RATE: 125 SF/BR IN, PIP 1. !x/SF RE1 D EA! -\500 SF RF= 6 \ 3' EFF" . D H."60 LF X 6' T.B. 300 SF Ti9AL 1250 GAL PT TAC PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fox ATE• 5-6-04-_ . M DESIGN �. � mow. PERMIT NO: DESIGN DETAILS P.I.D. NO: 017-391-37 WASTEWATER ABSORPTION SYSTEM Lot 5, Block 8 Mt. Park Estates NOTES: 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH, AND ALL MATERIALS SHALL CONFORM TO. AMC15.65. 2) ADD A MINIMUM OF 2" OF R.I. OVER ENTIRE BED. 1n0 N`d310 3) MAINTAIN 30 SEPARATION FROM ALL'i~}'?: SLOPES GREATER THAN 25%. CL a v a. �'•3;'tom w ° W aenl aoJINOA Y (D z s;�s• I z x,•� i3 a LTJ EZ I N 1nO NV313 I t ry LJ 0— L) g z O z LLA � O W CL 3 W O rn Z .. N N N I O 4 0 1nONYMO Co a inowm I .inONb310 c� 1nONV310 •�•�Q��•"'•••., t•��1� NC�Ili( a� AN TH �.....' ....«...«.�.....io+ •••... • ' ......... " • Steven R. Pannone = PREPARED FOR: Pannone Eng. Svc., LLC CE 8149 • ''C�gcb�,,.•�'�'.•• P. 0. BOX Michael & Theresa Ford ANCHORAGE, 102954 ALASKA 99510 5934 Bristol Drive ........... Anchorage. Anchorage. AK 99516 272-8218 PHONE & FAX 271-5410 A 5-6-04 DESIGN NOT TO SCALE 0 a SOIL$ LOCI - PERCOLATION TEST s PANNONE ENGINEERING SERVICES P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 PERFORMED FOR: Michael & Theresa Ford DATE PERFORMED: 5/4 /04 LEGAL DESCRIPTION: Lot 5, Block 8 Mt Park Estates TEST HOLE 1 SLOPE !OREd Organics 1 Brown silt w/ 2 Sand 3 4 S 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SwISand & Gravel well graded GM/SM Gravely, Sandy SILTS with cobbles & bolds BOH TEST 49TM •_ Steven R. Pannone No. CE 8149 O WAS GROUND WATER ENCOUNTERED? Yes TEST HOLE DEPTH TO WATER AFTER MONITORING? 12'- Damp DATE: 5-11-2004 SLOPE READING DATE GROSS 77ME NET TIME DEPTH OF WATER NET DROP 5-4-04 4:50 6. ---- 5.00 10 11/4' 41/4' 5.00 ---- 6' ---- 5:10 10 1 1/4- 41/4- 1 4- 5:10 5:10 ---- 6. ---- 5.20 10 1 1/4- 4 1 4- PEROLATION RATE 2.4 (min/inch) PERC HOLE E TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by A+ Home Services. Test Hole was presoaked before pert test. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACC WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. • Luu•t A-40Jim ua111SSS C116inouiill a urvuro L.L"• S Up L•_ 1 � 1 LO' 3 I HILL [•,,�'TTJE ,� VN .. A�/' Bc-CON HP.-- M ATFS:I t LGT F b1.E.W Al j•• \, ( 'l ,��' Vii-" I" = 100,x ................................ BEACON N:LL 1 OF 1 y% ................................ =, Jeffrey �A.• Gayness. 4% CE -7953 '• r�lop •,••. ' . � ts�c • ...... • • ' �c�a� �'Z'%'T'fro/esslo�tz '� LO' 2 Lr) / !l L1' 1S; L i• USIDE Kr- CH'_. v'C_;v `G'0 t+LJi; i L`'' '4 y S Up L•_ 1 � 1 LO' 3 I HILL [•,,�'TTJE ,� VN .. A�/' Bc-CON HP.-- M ATFS:I t LGT F b1.E.W Al j•• \, ( 'l ,��' Vii-" I" = 100,x ................................ BEACON N:LL 1 OF 1 y% ................................ =, Jeffrey �A.• Gayness. 4% CE -7953 '• r�lop •,••. ' . � ts�c • ...... • • ' �c�a� �'Z'%'T'fro/esslo�tz '� / !l L1' 1S; MCCREACY IDEA-YA.S S/D; LOT S 7Y:La'YiYt1.0. C�CLL / � \ i t—'7—'— 1 i >k0%!SE i ! I k sEPTIC ARS 1 .•v 1 \ :k LMV00ir CLEW :/D. 1 \\ LOT 4 1 j 1 y �C iNt^P-GE5 1 1 —i-- -.------ __.1 GAR.NESS .ENGrINE.ERTNG GROUP, Ltd. r � c: vxmwmvov CONSULTANTS 3 GENERAL COWMCTORS ' FARCE, FOR P14O iE MUMBER: ERLING WESTLIEN 273-4590 L---C-A:- Fs:SCRIPT:CN! WILDWOOD GLENN S/D; LOT 5 SITE PLAN r'o3111e't' qw- vw j M sJa;VS LO'. 3 5/13/2004 = `G` pF A�y�'`wJ-% V b1.E.W 9+1+1 I" = 100,x ................................ 1 OF 1 y% ................................ =, Jeffrey �A.• Gayness. 4% CE -7953 '• r�lop •,••. ' . � ts�c • ...... • • ' �c�a� �'Z'%'T'fro/esslo�tz '� i- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ® ENVIRONME=NTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME�,y/��n{�( _.{) PHONE - NEW XIL.� _3 r-1 5-3,F^ ❑ 7 UPGRADE MAI LING ADDRESS �3e'p J /6 cr� ( /J /� l/�L-!/l./L //�� l LEGAL DESCRIPTION y/.,•� LOCATION {J{' �✓lit-K�J' I��..� ice`-" ✓�.C��-_l/ NO. OF B DROOM�`�� �� 1. _ DISTANCE TO: WellAbsorption area Dwel!mg - PERMIT NO. '� �3 _7 w2 Manufacturer Material` No. of compartments w Liq. capacity ingallons IF HOMEMADE: Inside length ai Width - Liquid depth 4 y' DISTANCE TO: Well - _Dwelling PERMIT NO. O z d Man UrL'r - —�� _ _ __ _ - ate Liquid capjcity -nn'gallons w w DISTANCE TO: Well �_ t /-r- Foundation d Nearest lot line �` PERMIT NO. �� U 3 / (D u- Z Q b No. of lines Length of rach Ill r. / Top of tile to finish grade Total nyth of ,I1Ines Trench width Distance betty en lines Material beneath tile ..-mems Total effective a sorp,(jg re w Length Width Depth - PERMIT NO. -- — Cry Q b w Type of crib Crib di meter epth Total efec absorpti o n area -- w DISTANCE TO: Wel Building foundati(Zn --Nearest lot line OTass, w Depth u Driller Distance to lot line �� f d PERMIT NO. � c� 7 0 w DISTANCE TO: Building foundation . _ Sewer line Septic tank A Sol ptio a -ea ) OTHER LEGAL - PIPE MATERIALS D3c)3 SOIL TEST RATING INS LLER REMARKS r y /,/�J/� ,,(J' APPR ED;DATE R mom •z IRol/ znR1 I/ r a �D v ux�q u . ..... � q. �,:_ H .-H 'L k � DEPHRTMENT Pr HEHLTH HND ENVIRONMENTHL ",OTECTION 8�5 ' STREET/ ANCHORAGE, AK 9K 1 U. . B{E/LB_ P-4C�:!n PERMlT NO. ( 810]70 ) �^�� 264�4720 /n/����" � �����-9 EE'40 K ITT HPPLICAN T MERLE BEETER SRR 1546~1,_-': HNCH LOCFIT I:ON BRISTOL ST L E Ci A I L.T 5 BLK8 MT. PK. EST LOT SIZE TYPE OF SOIL ABSORPTION TRENCH ]45�]87 25000 SI.DU MHXIMUM NUMBER OF 4 SOIL RATING (SQ FT/BR)­: 182 THE REQUIRED SI OF THE SOIL HBSORPTIC) N SYSTEM IS� �[Hr ���� u �P--B 7" 9� ~' ���? F -A "%n' E7:_ L ��11'" B-A� THE DIMENSION IS THE (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTHNCE BETNEEH THE SURFACE OF THE GROUND HND THE BOTTOM OF THE (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). _1 EK, ll'=� '11 - I C- "T FA UNIP K S', 1: 2:7 -=--- 15 IC -3 ������� PERMIT APP[ ICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT' THE WP:LL WILL SERVE. �........ ...... 1-0-11 CA ���7. �1 Cjp-jf-:­�; F:"o R! ����I IF---:� BHCKFILLTNG OF HNY SYSTEM WITHOUT FINAL. INSPECTION HND RPPROVHL BY THIS DEPHRTM�NT WILL BE ::H:;UBJECT TO PROSECUTION MINIMUM DISTANCE BETWEEN H WELL HND ANY ON~SITE SF -WAGE DISPOSAL SYSTEM Izl�; 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SENER LINE IS 75 FEET. WELL LOGS ARL"..' HND MUST BE RETURNED TO THE DEPARTMENT WITHIN OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY F[ PPL. SPECIFICATIONS HND CONSTRUCTION DIHGRHMS AF E HVHILHBLE TO INSURE PROPER INSTALLATION. �����P'll I V- E. -K 4 F: - C T'" E H: CA E-7 BE: 01 ER EE, FT __L _1.��� I CERTIFY THHT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTHND THA"I" THE ON—SITE SEWER SYST�M MR REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN 4 BEDROOMS. ~.... .... �~~~~~� APPLICANT MERLE BEETER ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE • +f.e` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 625 L. Street, Anchorage, Alaska 99501 264.4720 --� SOILS LOG — PERCOLATION TEST PERFORMED FOR: v� 12e�V �D `�.S �y DATE PERFORMED: 1 LEGAL DESCRIPTION: f\ SLOPE SITE PLAN G_6 3 G 2' — �> W onto U e + 4 6 0 0 6 16 - say 17 Depth to Water Net Drop 18 19 20 : 22 COMMENTS 1 ��� It j PERFORMED BY:(� 3G1t, ` /4" 72-008 (6/79) cm ae 43/' C,arih O. Talbot . No. 4069-E WAS GROUND WATER �� S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 2 : 22 1 1 ��� It j x;37 3G1t, ` /4" 5 4j� ff f v -Sh � L - WAS GROUND WATER �� S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 2 : 22 1 1 ��� It j x;37 3G1t, ` /4" 5 4j� ff PERCOLATION RATE O (minutes/inch) TEST RUN BETWEEN FT AND T FT CERTIFIED BY: DATE: / a;nry,A_- Zv/ CVJ LLA LU Lu Cy- E4 <4: co ri co: 0: C\J: C,.): I r-4: ,--4: -4: pop m i4 H 40 W 0 0 (d ui 00; OD: c< 0\: r-4 > q) 0: rl o L-- : C) 5- '0.: FA: C\I: 0. 4-) N:4,) rd -P: FO -W C r :P4 51 r -i '0: cd i -ri U) 3i ri) q ca; U) i rD i -q : rl : iL4 5-,( :: CH: cd :: co i .,i w o3 0:: U%: cy) Z LX 1-1: rl O 0 0 0 0 0 c): 0 0 00: 0 -1 r-1 0 : ri co: 0: C\J: C,.): ,--4: -4: --4 1 �4 i4 H 40 W 0 0 (d -0; cd M: F4:4H 4k1 a r-4 > q) 0: rl o L-- : C) 5- '0.: FA: C\I: 0. 4-) N:4,) rd -P: FO -W C r :P4 51 r -i '0: cd i -ri U) 3i ri) q ca; U) i rD i -q : rl : iL4 5-,( :: CH: cd :: co i .,i w o3 0:: U%: cy) O:: co: c): 1-1: rl O 0 0 0 0 0 c): 0 0 00: 0 -1 0 C) 0 0 C r-1 0 : ri co: 0: C\J: C,.): ,--4: -4: --4 1 4: CM: 0 0 0 A M: 2o di 0: > q) 0: rl o L-- : C) 5- '0.: FA: C\I: cl-1: M i Vi :P4 '0: FO :4-' :rOrd 4-3: z : i -q : rl : iL4 5-,( :: CH: cd :: co i .,i w o3 0:: U%: co U) :-Ci Ud V. C4 n 0 : C- 00 co: 0: C\J: C,.): ,--4: -4: --4 1 4: CM: 0 0 0 (Y -j rl o L-- co: 00i FA: C\I: cl-1: M i Vi C4 O 0 1-1 4-1 :z P- 0100 (D si P4 .rj P -(,H 0 �4 qo r-( -P 0 Cd 4- W U UI 10 CH 0 0 P4 -t- co � ul I PA pq Municipality of Anchorage Department of E ecalth and Human Services Toni Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Francis Eickbush PO Box 110496 Anchorage, Alaska 99511 Subject: Lot 5 Block 8 Mountain Park Estates Subdivision #2 Permit #880100, P.I.D. #017-391-37 A permit issued by this Department for an individual well and/or on --site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the orginal as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, A��Uv / ®P Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit MUNICIPALITY OF ANCHORAGE , Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343~4720 ON~SITE WELL PERMIT Permit Number: 880100 Upgrade Date Issued: 06/30/88 Owner Name: FRANCIS EICKBUSH Owner Address: P,O BOX 110496 ANCHORAGE, AK 99511 Day Phone: Parcel Id: 017`391'37 Lot Legal: Subdivision: MOUWTAIN PARK EST #1 Lot: � Blo�k: 8 Section: 16 Township: 12N Range: 39W Lot Gize .5A (s4.f,t. or acres> Max Bedrooms: This Permit: 4 Total Capacity: 4 WELL: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of' well completion. PERMIT EXPIRES ON DECEMBER 31, 1988" OLD WELL MUST QE PROPERLY �B�NDONED" I CERTIFY THAT: 1" I am 1 amiliar with t. he requirements I'or on-site sewers and wells as set I'orth by the 11L.1nicipality c.) f All chDPage (MOA) and the State of Alaska" 2. I will insta1l the system in accordance with all MOA codes and regulations, and in compliance with the design criteria oF this permit. 3" I will adhere to all MOA and State o1, Alaska requirements f,or the set back distancrom any existing by c-') wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid f' Or a maximum of 4 bedrooms. I also understand that the capacity c) I' the total system is 4 bedrooms and anY enl l t Signed: TE (Owner} FRANCI�~�I`CKBUSH - � DATE: �/�� 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 i Qom"n���Z PH(( 3 J 5"1�:�7 - NEW ❑UPGRADE _i,✓ MAILING AODRESS�. G C LEGAL DESCRIPTION LOCATION NO. OF B°DROOM Uv DISTANCE TO: Well / Absorption area _ Dwelling PERMIT NO. 9/b3 _70 wQ Manufacturer Material C No. of compartments Llq. capa�ty inUl Ions // IF HOMEMADE: Inside length �. Width_ Liquid depth Z DISTANCE TO: _ Well f D fling PERMIT NO. ❑ 2 Q S—< Manufa re:` �f aterial Liquid capat-gallons ❑ w x DISTANCE T0: Well Foundation tet— L Nearest lot line PERMIT NO. v O l Q 3 U J LL 2 Lu 2 ~ No. of lines � �i Length of each Ijye`, i J ' Total length of I nes J `f- Trench width ches Distance between lines ' h n Top of tile to finish grade I Material beneath tile ,_r —weHes Total effective absor re w Length Width Depth PERMIT NO. Q I— as Ile Type ofcrib Crib di eter epth Total effecti bsorption area LJ N DISTANCE TO: Wel Building fou found tC n Barest lot line J ass C/I -, ,� Depth Driller Distance to lot line PERMIT NO. 7 0 W DISTANCE TO: Building foundation. Sewer line Septic tank `f Absorptioft / area (s) // � OTHER PIPE MATERIALS (D303�{ SOIL TEST RATING INS-29(LLLEER, _ VI REMARKS V V , JL L r I , R J I APPR ED DATE LEGAL 72-013 (Rep. 3/78) L� MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION 3AB! 2 51989 RECENED LOCATION OF WELL (Please complete either In, Ib or Ic.) Subdle,siop Lot Block Bar ",a 1-. ib. I/4 qtrs.. Top Bottom DISTANCE AND DIRECTIUN FROM ROAD ii4TERSt CTIONS r � I f r ... St r of Address and Area of Well Locotlon WATER WELL RECORD STATk: OF ALASKA DEPARTMENTOF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D. L. No. Section No. Township N❑ Range ED Meridian — 3. OWNER OF WELL: / Addroas: ✓ 2. WELL LOG Feet Below S f 4. WELL DEPTH: ( final ) 5. DATE -OF COMPLETION—� . !r B. ❑ Cable tool Rotary ❑ Driven ❑ Dug ❑ Auger C]Jefted ❑ Bored ❑ Other: 7. USE: Domestic ❑ Public Supply ❑ Industry Irrigation ❑ Recliargo ❑ Commorlcal ❑ Test Well ❑ Other: ----- S. CASING: ❑ Threaded Q Welded A diem-'M_In. to _Lift Depth Weight JL Z Ibs./11. diarn, in. to ft. Depth Stickup__—, ft. 9. FINISH OF WELL: Type:! `— Slol/Meeh BISa: Length: ____ Set between ff and ft Bockfilling -- Gravel puck -- _ 10. STATIC WATER LEVLL ❑ Abovo or ]j-Bolow land surface Date Equipment used 6-'C. I I , PUMPING LEVEL. below land surface and YIELD .. J,y/4 it. after bra, pumping g.P.m. —._ft. after �hra. pumping_—_g.Pan. 12.GROUTING Well Grouted: you LJ No Material: ❑ Neat Cement ❑ Other: Tom. ---------------�-�-- --`- -_-- 13, PUMP: it available) HP --'--------"- ---`�— ---- Length of Drop Pipe ft, capacity g. P.m. "--"-"`—'----- --""—_� - - -�--- ❑ Suban. Jet ❑ Centr(fical ❑ Other 14. REMARKS: - - ---- j'i,{ 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature —° ❑ F ❑ C This well was drilled up er my jurisdlctlor and this report Is true to thq bgst of my knowledge and bellef; r i ?'yf� �`•.-� f`i r!57 Registeroo Business Nome' % j Contract License Number r '--i Data Signed ^Authorl zed Representative-� Form 02-WWR (11/81) Copy Distribution: WHITE-S1ato DOGS, PINK -Driller, CANARY -Customer _ u ace Top Bottom — f r ... j( f 4. WELL DEPTH: ( final ) 5. DATE -OF COMPLETION—� . !r B. ❑ Cable tool Rotary ❑ Driven ❑ Dug ❑ Auger C]Jefted ❑ Bored ❑ Other: 7. USE: Domestic ❑ Public Supply ❑ Industry Irrigation ❑ Recliargo ❑ Commorlcal ❑ Test Well ❑ Other: ----- S. CASING: ❑ Threaded Q Welded A diem-'M_In. to _Lift Depth Weight JL Z Ibs./11. diarn, in. to ft. Depth Stickup__—, ft. 9. FINISH OF WELL: Type:! `— Slol/Meeh BISa: Length: ____ Set between ff and ft Bockfilling -- Gravel puck -- _ 10. STATIC WATER LEVLL ❑ Abovo or ]j-Bolow land surface Date Equipment used 6-'C. I I , PUMPING LEVEL. below land surface and YIELD .. J,y/4 it. after bra, pumping g.P.m. —._ft. after �hra. pumping_—_g.Pan. 12.GROUTING Well Grouted: you LJ No Material: ❑ Neat Cement ❑ Other: Tom. ---------------�-�-- --`- -_-- 13, PUMP: it available) HP --'--------"- ---`�— ---- Length of Drop Pipe ft, capacity g. P.m. "--"-"`—'----- --""—_� - - -�--- ❑ Suban. Jet ❑ Centr(fical ❑ Other 14. REMARKS: - - ---- j'i,{ 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature —° ❑ F ❑ C This well was drilled up er my jurisdlctlor and this report Is true to thq bgst of my knowledge and bellef; r i ?'yf� �`•.-� f`i r!57 Registeroo Business Nome' % j Contract License Number r '--i Data Signed ^Authorl zed Representative-� Form 02-WWR (11/81) Copy Distribution: WHITE-S1ato DOGS, PINK -Driller, CANARY -Customer Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-391-37 COSA # Otyn 13 -- Expiration Date: — / — 0 ro 1. GENERAL INFORMATION Complete legal description Lot 5 Block 8 Mountain Park Estates Location (site address) _5934 Bristol Drive, Anchorage AK 99516 Current Property owner(s) Dave 8 Josie Hanneman Day phone 271-5225 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 112635, Anchorage AK 99511 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 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 sample results. (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 seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102954 Anchorage AK 99510 Engineer's Printed Name Steven R. Pannone P.E. Date Z 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. •�„aa lie operational life of all wells and septic systems depend on the local soil condition, ground water •••�� OF Al0#* levels that may fluctuate during the year, and the water usage of the family being served by the system .• �p �"" `� �i 7liese 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 i performance nor give any estimate of how long the system will continue to meet the operational , j requirements of the MOA DSD. lie content of this report is for the sole benefit of the owner listed P Steven R. Ponnonel�'i: above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �.� No. CE 8149 confer any legal right whatsoever. ��t •I I i 5. DSD SIGNATURE aa'aa�-•• Approved for _L�_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attacnments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (tet/ Original Certificate Date: J 0 67 4�1 (R�v 17105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type E H A. B, or C provide PWSID B Date completed 7n61'1988 Sanitary seal (YIN) Y Total depth _W ft. Cased to 1&_fL FROM WELL LOG Data of test 7n8ng88 Static water level 151 ft. Well production h " 00" Ofd, g.p.m. WATER SAMPLE RES JLTS! I Lj� Coliform oolonies/100 mL Nitrate mgr_ Arsenic: mgn Data of sample: 4M3= B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchoraas Tank Steel Tank size 1250 gal. Number of Compartments j Well Log (YM) Y Wires properly protected (YIN) — Casing height (above ground) 26 'in. AT INSPECTION 4n9rM 153 ft. 5.2 g.p.m. Other bacteria � coloniesl100 mL Collected by: Laura Pannone Cleanouts (YIN) Y Foundation cleanout (YIN)Depression over tank (YIN) N High water alarm (YM) WA Date of pumping 04I2005 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 5M7IM Soil rating (g.p.d.lftz or fe/bdrm) 1.2_ System type _Shallow Trench Length T2.9 fL Width 5 ft. Gravel below pipe 3 ft. Total depth ¢ ft. Eft. absorption area J4&ft2 Monitoring tube Y Depression over field N Date of adequacy test 065W Results (PasslFall) Pass For } bedrooms Fluid depth in absorption field before test = in. Water added= gal. New depth= in. Elapsed Time: — min. Final fluid depth — in. Absorption rate >= bCO g.p.d. Arty rejuvenation beat, ant (past 12 mo.) (YIN 8 type) JA,�Q If yes, give date D. LIFT STATION Data installed in gallorfs Manhole/Access (YM) 'Pump on' level at _ In. `Pump of / I a —in. High water alarm level at Datum Cycles tes Meets alar 8 dreuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 104.4 Absorption field on lot 105.1 Public sewer main 100+ Sewer /septic service line 40+ Animal containment areas 100+ On adjacent kits 100► On adjacent lots 100+ Public sewer manhole/deanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Ir Property line _E Absorption field r Water main 50+ Water service line 40+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20.4' Building foundation 1S Water main 100+ Water Service line 40+ Surface water 100+ Driveway, parkeigArehide storage 35+ Curtain drain None Observed Wells on adjacent lots 100+ G. ENGINEER'S I cer* that I have determined through field inspections and review of Munictpal records that the above systems are in conformance with MOA COSA guidelines in effect on this dale. Engineer's Printed Name Steven R. Pannone, P.E. ��%+leve^CE A1noo"� Date •++ice '...... �!'�'6�: COSA Fee $ D� Date of Payment 2 Receipt Number (Rev. 1145) Waiver Fee $ Date of Payment Receipt Number in. SGS Ref. M: 1061809 Client Name: Pannone Engineering Project Name: Mountain Park Est, L5, B8 Client Sample ID: Mountain Park Est, L5, B8 Matrix: Drinking Water PWSID Sample Remarks: SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 All dates/times are Alaska Standard Time Printed Date/Time: 04/17/06 16:20 Collected Date/Time: 04/12/06 16:50 Received DateMme: 04/12/06 17:08 Technical Director. /5tephe Released Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date [nit Bacteria 0.00 9222B 04/12/06 04/12/06 tN Nitrate 4.79 0.10 mg/kg EPA 300.0 10.00 04/13/06 04/05/06 alr Arsenic ND 5.00 ugtL 200.8 10.00 04112/06 04/12/06 scl .I As Built �O � 6'Q �`rT j 0< Q oG R/ I r , 1 � yo. /y/tAVEL i'q, r. . . oe•B o - mss• � o � ;qq fewer ` s sy,/e,r7 0 fo o. /,v,.., 0 1 sR • .2 ••yam\ . 1 -EASEMENTS -OF RECORD, OTH'R 7N44 THOSE S"Oyd"! ON TH. R"COROCC `j P141, ARE NOT SHOWN HULLON. No Carron Set This Date 1 hereby certify Uat 1 have surveyed the following described property, Lot_Block ,440[l.yr4", �:d'K C5'J 77irC ] Anchorage recording Precinct, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible uwments on said property except as Indicated hereon. Anchorage, Alaska 21 O c r. 1.994- �� r RfCET t/:T/CG �o ,M,) 40071 -'r. N•:/•(:, ,. _, Book No. Page No. /dints Hildonen .� Me. 1304: ee 1� �rsslo«kl lj .SroRY m •1 ry �vt o FLAME HOUSE oe•B o - mss• � o � ;qq fewer ` s sy,/e,r7 0 fo o. /,v,.., 0 1 sR • .2 ••yam\ . 1 -EASEMENTS -OF RECORD, OTH'R 7N44 THOSE S"Oyd"! ON TH. R"COROCC `j P141, ARE NOT SHOWN HULLON. No Carron Set This Date 1 hereby certify Uat 1 have surveyed the following described property, Lot_Block ,440[l.yr4", �:d'K C5'J 77irC ] Anchorage recording Precinct, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible uwments on said property except as Indicated hereon. Anchorage, Alaska 21 O c r. 1.994- �� r RfCET t/:T/CG �o ,M,) 40071 -'r. N•:/•(:, ,. _, Book No. Page No. /dints Hildonen .� Me. 1304: ee 1� �rsslo«kl Municipality of Anchorage • Development -Services Department *A9 Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ;�,.> ZUZ (907) 343-7904' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. 017-391-37 1. GENERAL INFORMATION HAA #� Expiration Date: '- O 0 1+ Complete legal description Lot 5 Block 8 Mountain Park Estates Location (site address or directions) 5934 Bristol Drive, Anchorage, AK 99516 Current Property owner(s) Michael & Theresa Ford Day phone 271-5410 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address _5934 Bristol Drive, Anchorage, AK 99516 Day phone Katherine Donohue/Prud. Vista RE Day phone 244-6939 4241 B Street, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: - 4 3. - TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ED Individual Holding tank ❑ _ Community On-site ❑ 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. 11/99) 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 Enq. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 51101C L( 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 �� -`� OF 14444 .� reported results describe the performance of the system under the conditions encountered at the time of ♦ X\P'•.•••' '••., �♦ ♦ the test, and separation distances measured to readily identifiable features. The operational life of all i �,� • /� •• ♦ o. wells and septic systems depend on the local soil condition, ground water levels that may fluctuate L ' 49TH �/�[� •: •♦♦ 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 arc no hidden defec ...... .... ... .................:, „t or encroachments. PES can therefore not provide any warranty for future performance nor give any 8' -Steven R. Pon none: s estimate of how long the system will continue to meet the operational requirements of the ADEC or ♦ 0%, M ♦ No. CE 8149 •.�•� �. MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon i ♦♦J (p �° 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: wtt((llWr��i�, Additional Comments jam:• ON-SITE ••;'�i • m: WASTEWATER : PROGRAM = Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: 411 Expiration Date: (Rev. I IM) 9))JJ11) Fwl Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: _� a- O _0q Reissue Date: .. ... F.. 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.ak.us (907) 343-7904 .HEALTH AUTHORITY APPROVAL CHECKLIST 61 B �� = n' s• cTr Legal Description: Lot 5 Block 8 Mountain Park Estates Parcel I.D.:- 017-391-37 A. WELL DATA Well type P If A, B, or C provide PWSID # Well Log .Y Date completed 7/16/1988 „Sanitary seal Y Wires properly protected Y Total depth 247 ft Cased to 158 ft Casing height (above ground) 26 in. :FROM WELL LOG AT INSPECTION Date of test 7/16/1988 4/19/2004 Static water level 151 ft . 153 ft Well production ,Ij,14 0*8 On 9 -P -m 5.2 g.p.m �e�t t o9 WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate 3.76 mg/1 Other bacteria 0 colonies/100 ml Date of sample: 4/19/2004 Collected by: Steven R. Pannone B. SEPTIC/HOLDING TANK DATA i Tank Type/Material Anchorage Tank Steel Date installed 5/17/2004 Tank size 1250 gal Number of Compartments 2 Cleanouts 2 Foundation cleanout Y Depression over tank N High water alarm NIA Date of pumping Pumper New C. ABSORPTION FIELD DATA Date installed 5117/2004 Soil rating (g.p.d./f? or fe/bdrm)11_2 System type Shallow Trench Length 72.9 ft Width 5 ft Gravel below pipe 3 :.ft Total depth 6 ft Effective absorption area 364.5 ft2 Monitoring tube Y Depression over field N Date of adequacy test .-Nfg&) Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test New in Water added --- gal. New depth in. Elapsed Time: 0 min Final fluid depth — in Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date (Rev. 11/99) D. LIFT STATION Date installed Size i IonsManhole/Access ' "Pump on" level at in"P oft' level at ! in High water alarm level at in Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 104._ 4 On adjacent lots 100+ Absorption field on lot 105.1 On adjacent lots 100+ Public sewer main 100+ Public sewer manhole/cleanout 100+ Sewer/se tic service line '40+ P Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 17 Property line 47 Absorption field 7 Water main 50+ Water service line '40+ Surface water 100+ Drainage 100+ Wells on adjacent lots 10_0+ SEPARATION DISTANCE FROM ABSORPTION FIELD ;ON LOT TO.- Property O:Property line 26.4 Building foundation 15 Watermain' 100+ Water Service line40± _ Surface water 100+ . Driveway, parking/vehicle storage 35+ Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION �P"""' �•.;Q�j, /certify that I have determined through field inspections and Cj 9TH C review of Municipal records that the above systems are in i""' �•••• •••'• • • •• •• conformance with MOA HAA guidelines in effect on this date. ♦` Y'k even R. Po�ncne** Engineer's Printed Name Steven R. Pannone. P.E. �� �, No. CE 8149 °�' Date �1�D�<<d••°: HAA Fee $ 75120511 7e. P, Date of Payment 5 -aO eOL4 Receipt Number (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number 4-2z-04; 4:04PM; ;907 S613301 0 3.- 3 w SGS/CTBE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform" Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM IDd *RIVATE WATER SYSTEM ❑ Send Res ills ❑ Send Immice u/r 6.1,sn •-w%8Ay W M•y PF.9ANwnM• 9.Nunw9r N.rriftr 7 8W. LPCu 280 W. POTTER DRIVE ANCHORAGE. ALASKA 99518 Tei: 907.562-2343 Fax 907-561-5301 1041844-* Sand Results "nd Ir.W06 er )"'n..OT.aly H wocalm" BacteriologlCai Water Analysis Record: 6. rima . N.rriftr rex . (y� V .. .0 CDZS6 a NCu- q,? r-1 b SAMPLE COL�LEClT-IONJ: n.edw. r SAMPLE TYPE: rxvw�ns vftn o�r.awa at•_�� outine �. . Treated Water sro.m Coy Yew Time: qgkda e,.1 ❑ Repeat Sarriple Untreated.Water LecoMon: &OA• -c 00-.0t Z'��fmagSt.- infer to I -b no. 1 Collector: ❑ Special Purpose muo Kwu Swain Van ported to Lab By: ame as collector Other j'•' PmoiodFayh 'O BE COMPLETED BY LABORATORY Samole Receivina: Date: 7�� �1 " Sample over 3C hours old; ❑ . RUSH SAMPLE Time: Results may be unreliable Temp: a -1A-6 ❑ 4e Hour Waiver Phone 0; Delivery Method: F ole Lmations Fax 0: Received By: Co-nments: .01.94.......19..................9..0.94u..u.nnu.0.u.u.u94.n.49........ .4..9...uu................4n...9u0n0.4...0 BacteriologlCai Water Analysis Record: Sent to ADEC: MMO-TALC (PIA) RESULTS: ANC FEK JUN lCaterrkne: Analysts Saw: 1 Total Comm Analyst: ts(i E. Coll: Sent to Client Analytical Methed: MEMBRANE FILTER RESULTS: Phoned Q Faxed Q Dlractrount Cmades1100ml. Detamme• Membrane Filter verification! Spoke with: MMO-MUG (P/A) rwe.w..� LTB. BGa: Satisfactory FC- ❑ Unsatisfactory Reported By: `p . �j r DatelTtme: y mte - Tp Nu.n.ro.. ee co..: eyreture _ Form at FW- 0053 12117!03 t1petratpublic%DOCUMENTIFORMSthlicrolCoA Form 121703.1ds 4-22-04; t:OapM; ;907 ZSIBSO1 :G5 Reftl 1041844001 :Ilent Name Pannone Eng. Srv. ?rojeetNameW Front Hose Bib -1.5/B8 Mt Park :tient Sample ID Front Hose Bib-L5/B8 Mt Park 4&trtx Drinking water IWS1D 0 All Dates/Times are Alaska Standard Time Printed DataMme 0422/2004 15:03 Collected Date/Time 04/19/2004 16:45 Received Date/Tlme 04/192004 17:03 Technical Director StgpAn C. Ede ample Remattts: arametcr Results is PQL UaIU Method Container ID LAllim t�e DDaetee ~p eater lnit raters Department NitrateN 3.76 0.100 mg/L EPA 300.0 B (<=10) 04/19/04 J1B Liorobiology Laboratory Total Coliform 0 coLfl00mL SM18 9222B A (<=1) 04/19/04 DKC 0 J... rCAKT. i ,.;_.... _ . +�ro I1 :5 roe Y }LOUSE JIV 8.49. Z! 5du.+er r ' I j Sfdnd p1pei io' a \ e ..:.. ...... _.....I . v JNED Sy s IC177 0� .5C4 [ E l ••r.�0' O c � Rp , \ . _-- EASMENTS.OF RF:CORO, OTHrk THAN F' \ 1HOSE SI1,01/t/1: ON TH'c' R`COR0E..0 j PIAT, ARE NOT SHOWN HEREON. I. \ \` As Built No Corners Set This Date Book No. Page No. I hereby certify that I have surveyed the following described property, Lot -S Block 8 ••t+� OF A1.4%1 Moc�Nry/N ,E•/< L=3 r -l# CE' S Anchorage recording Precinct, Alaska, and that i Q.` 00*00ei••ea•�s the improvements situated thereon are within the property lines and do not overlap or ~e� i encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, /e •• eN••eeN•N•NNNeN•e • transmission lines or other visible easements on said property except as indicated hereon. i ZL� IF sa Mildooen ; 2/ O C r. l 9 e 4- 1I'siti. No. 1 �oi-s l Anchorage, Alaska z G , r—*'_ c(�o, ...•... � �kC e••Nooeoo � r ,eEc E� r �F/ Er o M.� 7 �oo�{ fl 4 % offssIONM6 �J� MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M}1 Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. #/%-:� fil _� HAA # 1. GENERAL INFORMATION Complete legal description Lot 5; Block 8; Mountain Park Estates Subdivision Location (site address or directions) 5934 Bristol, Anchorage, Alaska Property owner REICCATTON RESOURCES G ' Day phone Mailing address Lending agency Mailing add Day phone Agent Shel Hensley/AREA COLDWELL BANKER Day phone Address 4105 Tudor Center Drive, Anchorage, Alaska 99508 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 561-2488 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 1121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 3 5 ENGINEERING Phone 17034 age River Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for _�p& (7./ bedrooms. Disapproved. Conditional approval for Additional Comments WTIC Date 2 -24-g(3 ROG& J.$HAFER 82 5eo 8 �4k �1?®FESW . bedrooms, with the following stipulations: Date 71b��.3 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in ordertosatisfy 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. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I.oT 5 SL 6 MoUNrAw E&ZK FS W�S A. WELL DATA Parcel I.D. l) Z% .3Z/! 2 Well type 691V1125� If A, B, or C, attach ADEC letter. ADEC water system number Log present `7/N) �€S Date completed Driller 602LE /-W14',!/JGaEA11r Total depth 042 —Cased to /S� r Casing height 2� rr Sanitary seal O/N) Wires properly protected 6N) YE Date of test Static water level Well flow Pump level FROM WELL LOG %//SIRS /SI NUl DN G.oG g.p.m. z 4v r SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Z u, o � N ur U. u ' It c� LU g.p.r�. :g i'UM i° �O% /2�l4 G /7 4RL3 r:.1 LL.1 �'. o Septic/holding tank on lot oo r ; On adjacent lots /00 t Absorption field on lot /pd f ; On adjacent lots /Gb t Public sewer main NONE /OLEE. E,uT Public sewer manhole/cleanout 4Jn1/6- F/2ESE T Sewer service line Z 5 r� Petroleum tank Kr1/ocJ1--' WATER SAMPLE RESULTS: f% Coliform lUO m'— Nitrate — Z. 3� MPJ & Other bacteria DJ Date of sample: 21alg3 Collected by: –�E--Ilq- S �iVG//JE dL/K� B. SEPTIC/HOLDING TANK DATA Date installed 21/S / F/ Tank size /ZSU Compartments Cleanouts (�VN) Foundation cleanout &) Depression (Y(�) NU High water alarm (YO Alarm tested (YA J1 Date of pumping Z/1Pumper A -t SEyU/GG�S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /�� On adjacent lots Topropertyline .—Absorption Surface water/drainage ltl n"6 LA/oG✓rV �t 16)0 Foundation /O r i Water main/service line CONTINUED ON BACK PAGE 72-026 (Rev. 7/91) Front C. LIFT STATION ,Uv NE P/ZEJ6_/,J7_ installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at — Manufacturer Manhole/Access (Y/N) "Pump off" level at _ Meets MOA electrical codes (Y/N) SEPARATION DIST-ANCE FROM LIFT STATION TO: We lot On adjacent lots D. ABSORPTION FIELD DATA Cycles tested Surface water Date installed '7//SlQ/ Soil rating IR2- System type /le&/CN r � Length IS Width 3 Gravel thickness / Total depth /d_// Total absorption area 7Zo Cleanouts presentON) YES Depression over field (Y, V(� tiU Date of adequacy test 2 Results as /fail) J° SS for bedrooms Peroxide treatment (past 12 months) (Y/N) tic'�/� i�f�A/ If yes, give date e� SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 600 '7Lg r On adjacent lots �6 ° 7– Property line To building foundation K– - To existing or abandoned system on lot .Vo,cJtr Onadjacentlots20r� Cutbank tioNE �S��Watermain/service line 2S Surface water N°iJLLP- SEI. E_ Driveway, parking/vehicle storage area 3a 114 - Curtain drain E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect oyynn((ll{ Lh date of this inspection. .nom �tlM.. 5 8, S I NGINEl RING2 � �� ese90066,o Cj�� 17034 Eagle River Loop Road No, 204®� aaa Ana =6 ,t Signature ;' �41aska 99579 e0 k tb lsta-es�aa aaeeeeecoeeo Bee scdao Engineer's Name �i oAceeaoeeee�oeo +. /L�,y mGeo as oae Date `�`T (' R0GL Ft J. ° iAFU1 t ('�a6e No. 8a 115 e°ate e { � eC aoe ��bcyEil HAA Fee $ _ Waiver Fee: $ Date of Payments Date of Payment Receipt Number Receipt Number -2-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Chemlab Ref.# :93.0665-3 REPORT of ANALYSIS Client Sample ID :L5 B8 MOUNTAIN PARK ESTATES S/D Matrix : WATER Client Name :S & S ENGINEERING Collected :02/16/93 0 16:40 his. Ordered By Received :02/19/93 6 09:45 his. Project Name WORK Order :63347 Project# Report Completed :02/22/93 PWSID :UA Technical Director :STEP EN/ C. EDE Released By Sample ROUTINE SAMPLE COLLECTED BY: S.S. 7 Remarks: Parameter ------------------- NITRATE-N QC Allowable Results Qual. Units Method Limits --------------------------------------------------------------------------- 2.37 mg/l EPA 353.2/300.0 10 Extract Analysis Date Date Init ------------------------------- 02/22/93 02/22/93 LLH ............................,........,...........................,.......................................,.,................................ ' See Special Instructions Above UA - Unavailable See Sample Remarks Above NA - Not Analyzed U - Undetected, Reported value is the practical quantification limit. LT - Less Than D . Secondary dilution. GT - Greater Than QN S13S Member of the SGS Group (Socidtd Gdndrale de Surveillance) � °e `F �, �r U 80RATORY COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEAICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER C� PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM Nano S & S ENGINEERIN Phone No. 17034 Eagle River Loop Road No. 204 neer'! Mailing Address Eagle r --' ' State ZP Code SAMPLE DATE: TT b 1 3 Mo. Day Year SAMPLE TYPE: A Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected No. LOCATION rRPZK Collected By z 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: I�Satisfactory /❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indic;ite reliable results. Please send new sample via special delivery mail. Date Rece wed Z�1 Time Race ved d o! �f 5 Analytical thod: Membrane Fitter ' No. of colonies/100 ml. 1 I Lab Rai. No. Result' Analyttt 7 O�BACTERIOLOGICAL WATER Membrane Filter: Direct Count Verification: LSB Fecal Coliform Confirmation BGj YSIS RECORD Collforni ml Final Membrane Filter Results 4 gCollform/100 ml Reported By 1-/ Date TNTC = Too Numerous To Count tl � 'r,0CY a.m. OB = Other Bacteria PART ONE OF TWO ONSiGS Member of the SGS Group (Societe REMAINDER TO FOLLOW u Ili�i1t\ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER A WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION R FLOW TEST S" F PLANS POA'D DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER M WELL FLOW TEST DATA ROBERT SHAFER, P E ROGER SHAFER, P.E CIVIL ENGINEERS (9071694-2979 FAX 694 121' CLIENT: I DATE OF TESTI: LOCATION OF WELL (Legal Description): Lor 5 m e Mowimmi Pgr2K ESTATES S/A WELL DEPTH: Zq-% CASINnG DEPTH: Ste' BY: SS DATE DRILLING COMPLETED: /l/S/�y DRILLERt TEST DATA: CLOCK TINE DEPTH TO WATER DRAWDOWN PUMPING RATE(GPM) REMARKS 1:40 A 1522'swl D (o,z FLo p vLL, Gvwa6GfEp /0:10 S7 ' S ' 6, 2. 81 Pgas'SoLot-1 to:zM lS7 �• ( Tlz Y (r `° 0 / S 7 ` �. 2 AIJA ';11461A1 A)6 . l2 0 ISS' S �.Z- 2: 4,o , AJO 7- fe6ArHCO. MISC. DATAt CASINO HEIGHT: ZC" SANITARY SEAL?: Y _ WIRES.IN CONDUIT?:�_ GRADING O.K.?t Y BACTERIA 61 NITRATE SAMPLES COLLECTED: z RESULTS: WELL CURRENTLY PRODUCES6,/ GPM WITH A S DRAWDOWN PLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR! MUNICIPALITY OF ANCHORAGE DIVISION Of` EWIRONMENTAT, HEALTH DEPAREMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION SUR HEALTH AT'.CHORITY APPROVAL CERTI 'ICATP 1, General Information Application Dates (fa) legal. Description ( include lot, block, subdivision, section, township, range) Pi" 0 Q N)- 6 A, Location (address or directions) (b) Applicants Name Tele hone Applicants Address (c) Applicant is (check oto) Lending Institution Wrer/builder Buyer. M--- ; Other (:I (explain);_. - (d) ]ending Institution tele Address (e) Real Estate Co. & Agent Address Te le phone 2. Type of ib s ide nce Single -Family Nh_i:Lti family Other (describe) Number of Bedrocxr c i 3. ClkateL' Su�Y_ Individual. vAbl.l. 4--0 Community I Public Note: If conuCe-lnity �nl.l. system, must have written confirmation fjrxi the State Departsfent of Environmental Conservation attesting to the legality and status. Is the 4 11 adequate for the number of bedrocxns specified in this [IAA (Y/N.) � a 4. Sewa 'e Disposal Onsite rzj Ribl.ic Community Holding 'T'ark 4 Is the wastewater disposal system adequate for the rumter of bDdroaiis (Y/N) (Page 1 of 21 2-15-84 S. 5nqineerinq Firm Provi.d:ina inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspec_cion. Signed Date 14 /1.6- e Name of Firm Address SM O:S U� L Signed by - -� _e_7c, zdv�t a'R✓! Date_ (ENGINEER SEAL) 6. DHEP Approval Approved for,__. /be drools Y r Approved /� Disapproved r Terms of Conditional Approval Conditional r::j r 49L y at oc cc o.acceuae au Do 2 22 5 E )Illy 25, 1971 e Date I'he Municipality of Anchorage; Department of. Health and Environvental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, used cn the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedroaTis and type of structure indicated. (DHEP SEAL) 7, Mail the HAA to the follc_hairg address: KB2/d5/s (Page 2 of 21, 2-15-54 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) 'AUG 1 1. 1984 CHECKLIST -FEBRUARY 1984 J� LC E I V ED A. WELL DATA Legal Description: --- 1 H0L). _T&1W k`ArZK ES ATM SSC 2(, ,' Well Classification If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) �% Date Completed 7/9/8 Yield13p2n� Total Depth q0.V1 Cased to I E;8 Depth of Grouting -- -- Static Water Level /70 Pump Set At %59-7 Casing Height Above Ground CV1 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N1 Separation Distances from Well: To Septic/Holding Tank on Lot I O On Adjoining Lots VACANT To Nearest Edge of Absorption Field on Lot 102.S ; On Adjoining Lots VAC4N r To Nearest Public Sewer Line W/A To Nearest Public Sewer Cleancut/Manhole N//4 To Nearest Sewer Service Line on Lot N1A Water Sample Collected By `r_s ; Date -7/9 A q Water Sample Test Results S0" Lim Comments A }ori" 3vo B. SEPTIC/HOLDING TANK DATA Date Installed to/a, Size IA6 D No. of Compartments ✓ cYi o Standpipes (Y/N) i Air -tight Caps (Y/N) Foundation Cleanout (Y/N) a/ Depression over Tank (Y/N) fJ Date Last Pumped ���✓/ $ �-% ________ ��_ Pumping/Maintenance Contract on File (Y/N) Nq for Holding Tank High -Water Alarm (Y/N) !1A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 110 To Building Foundation _1!:L__ To Property Lire -ice,, _,To Disposal Field 9_ To Water Main/Service pLine UN "6%4M To Stream, Pond, Lake, or Major Drainage Course Y�A Comments [Page 1 of 21 �VD oma'" V -)o 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 16),z Type of System Design _1AAc4c Date Installed 1 n l �0 a Length of Field 3 4� Width of Field 30 -1kC4 e s Depth of Field Gravel Bed Thickness $ Square Feet of Absorption Area Standpipes Present (YIN) Depression over Field (YIN) n1 Date of Last Adequacy Test 7/,b Results of Last Adequacy Zest S a Li, ka.c. as -r Separation Distance from Absorption Field: To Water -Supply TAb11 gs To Property Line g To Building Foundation 026 To Existing or Abandoned System cn Lot NomE On Adjoining Lots VAee4tl r To Water Main/Service Line [y,0 rA L To Cutbank(if present) X10 A LL To Stream/Pond/Lake/or Major Drainage Course WANIF- To Driveway, Parking Area, or Vehicle Storage Area 50 t Comments D. LIFT STATION N 0 til C Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Zest. Meets MOA ** Check Permitted Bedrocm 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 _ Date 71 /- Company OA No. D! KBl /d5/s (Page 2 of 21 ... SOFA cgs�9�� P���...... ' f *'.4 0�2�22E;-E4N..Y '/ *fv. . U U +� , JUNE 25, 19.71'0. ��. N - 2-15-84 CHEMMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. %:. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER �\;a_111'IIYYII=II 5633 B Street ueowwroeiee Drinking Water Analysis Report for Total Coliform Bacteria I� ETED BY LABORATORY TO BE COMPLETED BY WATER SUPPLIER �� l = (') See h on back WATER SYSTEM: I.D. NO. Lo '& V �- o00ArIN V Phone No Water System Name ; 59 3 4 Mailing Address A .t, rt &. Vi Qe?-ND State . . zip Code City (� rn SAMPLE DATE: �, r O 3 l� I� I Mo. Day Year SAMPLE TYPE: v Routine ❑ Check Sample (for routine sample1 ❑ Treated Water with lab ref. no. ❑ Untreated Water ❑ Special Purpose Time Collected SAMPLE� Col ectad By N0, LOCATION 1 I 00-Irstp 4 —ii 2 I 3 4 5 READ INSTRUCTIONS BEFORE TO BE COMPL An lysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst EEI iEEI u m J m .No of colonies/ 100 ml or No of Positive portions 061220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1993 Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Re ults Reported By COLLECTING SAMPLE TNTC = Too Numerous To Count BG Collform1100ml orm1100ml Date_ 1 —�— Time: Z�a.m. p.m. 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 2793916 TRANS AMERICA RELOCATION SERVICE INC. JULY 5, 1984 P.O.BOX 8019 WALNUT CREEK CALIFORNIA 94596 Attn. Ron Whitmill Case No. 66-432 Subject: Adequacy Test Of Well And Septic System Lot 5, Block 8 Mountain Park Estate. 5934 Bristol Drive Anchorage Alaska Gentlemen; At the request of Stephen Crissman, owner of subject property, I conducted an adequacy test of the well and septic system located at this residence on July 3, 1984. The paperwork regarding this test has been transmitted to Larry Houle of Col -dwell -Banker/ Jack White here in Anchorage. My test shows that the septic system meets the Municipal Requirements. There are no specific requirements with regards to the well. However, I pumped the well for 75 minutes at a rate of 5 gal per minute. During this time the well was being recharged at a rate of one gal. per min. The wellcasing will store in e>:cess of 300 gal. of water during periods of no water use. My assessment of the well is that the well yield rate combined with the storage ability of the well is sufficient to meet the daily requirement of the residents of this house. However, lawnwatering in excess of one and one half hour may overtax the capabilities of the well. This is not a great problem but something a prospective buyer should be made aware of. The chemical analysis of the well water showed no contamination. Yours G�.,.4a Tobben Spur) and P.E. Time APP NT FILLS OUT UPPER HAI ONLY Property Owner ��,., - , ,, ,.. '„ _ il._t..; Phone Time Date Mailing Address C `- O ', /._ G'.._i:i-' �:._` i�l ;\� (�,_ -`... Zip Code Buyer Date Address '.� •. t -.: (\ p'_ Zip Code "-�l �• Lending Institution _ _ Inspector Phone Inspector Inspector Address Zip Code Realty Co. &Agent ..- � %_ r; ..- k_ -. , . - Phone Address Zip Code Legal Description _ _ (`, �:;• i._+,.-. ;- �., i..� '(�hR, ,C. r.-�.`:,;-t_!, -i,_ Street Location Type of Residence Cir 'T C"' 'jT., : B Single Family rr ❑ Multiple Family c No. of Bedrooms ❑ Other Wate u ypply Indi 2 vidual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). El Pub' 'Utility Sew isposal ee ( ) CONDITIONAL APPROVAL' Individual Year Individual Installed: ❑ Public Utility -3 When Connected to Public Utility: ❑ Holding Tank DATE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector '1 MUNICIPALITY OF ANLNUKAOr Field Notes: Cir 'T C"' 'jT., : ENVIf< :,. :P. •.. .0 TION ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' �J "^ -3 DATE BY: Soils Rating InstalledWell To Absorption Area / / °/ / Well Log Received,. Septic Tank Size OateSew Well to Tank 7 , 72023 (3182) CHEMICAL & GL LOGICAL LABORATORIES ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER A�KGRAMRIE. 274-3364 5633 B Street , Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY WATER SYSTEM: SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. - ) ElUntreated Water ❑ Special Purposee SAMPLE Time Collected NO. LOCATION Collected By 1 I 2 I1 3 IL 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst I I F7 I I m I I m J E I m .Noof colonies/100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a. M. Date Received Time Recalvetl p.m. Lab. No. Presumetive I om, Iom, loml loml ioml _ 1.0m1 O.lml Multiple Tube Report: Membrane Filter: Direct Coun Verification: LTB Final Membrane Filter Results Reported By Broth 24 hours: Broth 4e hours: 10ml Tubes Positive/Total 10ml Portions Col (form/100m1 BG Data Time Collform/100ml p.m. I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. - ) ElUntreated Water ❑ Special Purposee SAMPLE Time Collected NO. LOCATION Collected By 1 I 2 I1 3 IL 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst I I F7 I I m I I m J E I m .Noof colonies/100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a. M. Date Received Time Recalvetl p.m. Lab. No. Presumetive I om, Iom, loml loml ioml _ 1.0m1 O.lml Multiple Tube Report: Membrane Filter: Direct Coun Verification: LTB Final Membrane Filter Results Reported By Broth 24 hours: Broth 4e hours: 10ml Tubes Positive/Total 10ml Portions Col (form/100m1 BG Data Time Collform/100ml p.m. !,n �"'---' DA.FERECEIV D INSPECTION APPOINTMENTS 6. TYPE OF RESIDENCE TIME TIME ❑ One G& Four ❑ Other TIME ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* _t) t Q , * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY DATE DATE DATE �- )5�11. INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. - INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY MUNICIPALITY OF ANCHORAGE DEPT. OF I IFALTI I & & ENVIRONMENTAL PROTECTIOBENVIRONMENTAL PROTFCTION DEPARTMENT OF HEALTH 825 L Street - Anchorage, Alaska 99501 `` P ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED ECEI\/ED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTI ONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAI LING ADDRESS SZ kA ] CA PROPERTY RESIDENT (If different from above) PHONE 2. BUYER -��--- C—) II \ ,,, ,,__ .� \` PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTO GENT 5_ c1. �A c , (._� -- w (--\� PHONE `2-`7 6-- 2 i 6 MAILINGADDRESS Gc" �„�\� :i �, C-1 SDS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS FAMILY ❑ One G& Four ❑ Other SINGLE ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* _t) t Q , * 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 )5�11. INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE Er SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO FOUR ❑ SIX 2. WATER SUPPLY (1 INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED ZAGE DISPOSAL SYSTEM IVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER l , Eteptic Tank or ❑ Holding Tank Size: I If Tank is homemade give dimensions:-' soILS RATING TYPE OF TANK �� MANUFACTURER TOTAL ABSORPTION AREA%MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS R( APPROVED FOR V BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE g L-11 72-010 (Rev. 6/79) CHEMICAL & GI LOGICAL LABORATORIES .,,'ALASKA, INC. TELEPHONE (907)•2794014 ANCHORAGE INDUSTRIAL CENTER 274.3364 5633 B Street "HORAMR1ae Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM:7-7 Analysis shows this Water SAMPLE to be: I.D. NO. Satisfactory Water System Name Mailing Address Phone No. City state �j Zip Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 1 2 1 1 3 L 4 5 06.1220 (b) Rev, 1976 Data Collected READ INSTRUCTIONS Date Recelvetl BEFORE 24 Hours 24 Hours Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result" Analyst I I m I I m I I m m � I � -No. of colonies/100 ml. or No. of Positive portions. BACTERIOLOGICAL WATER ANALYSIS RECORD _Time Received lentil I 10m1 10ml a. M. p.m. Lab. No. EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10m1 Portions Membrane Filter: Direct Count Collform/10oml Verification: LTB Bi Final Membrane Filter Results Collform/looml Reported By Date Time: A. M. p.m.