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Home My WebLink AboutMOUNTAIN PARK ESTATES BLK 10 LT 6Mountain Park Estates Block 10 Lot 6 #017-441-23 Inspection Report_ -1-12: oc, Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:l/www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSPI21207 PID Number: 017-441-23 ❑ New ❑✓ Upgrade Name: Benjamin & Rod Hron ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 12600 Alpine Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.6GPDISF 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 Ft. Gravel depth beneath pipe 5.OFt. Subdivision Block Lot Mountain Park Estates 10 6 Fill added above original grade 0 Ft Gravel length 75.0 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines NIA Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 750 Fez 1 N/AFt. Well 112.6 105.6 N/A NIA 85.6 TANK ❑+ Septic ❑ S.T.E.P, ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1000Gal. Surface Water 100+ 100+ N/A N/A Material Steel Number of compartments 2 Lot Line 27.5 10.0 N/A NIA NA Foundation 24.6 15.7 N/A NIA LIFT STATION Manufacturer N/A Capacity Gal. Curtain Drain N/A N/A NIA N/A Pump on level at Pump off level at High water alarm at Remarks in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank PVC Tankto drainfeld PVC Installer A+ Home Services Drainiield PVC CO/MT PVC Inspector Steven R. Pannone BENCHMARK (Assumed elevation) 100.Oft Inspection 1s' $19/2012 dates: m 2 8/9/2012 Location and description 3'tl 8/10/2012 4`h 8/10/2012 Corner of Deck COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date Ak'Q��1, rr@,�' "4g TH f} Steven onnome j CE 81 ZOO4-9 ;1I�7pj Approved f2 l�/ bate 8 -1 z `/ i 1o+ Inspection Report_ -1-12: oc, WELL (E) / W-� InI::�:W M N M\ �W_w—� RESERVE DRAIN FIELD (P) 751-F, 2.5'W, 5.0'ED, 10.O'TD (REMOVE AND REPLACE) 5 \ TH_1 777 \ NEW PRIMARY DRAIN FIELD �7 �M-75LF, 2.5'W, 5,0'ED, 10.0'TD T2 M1 Cl Jp 3 °<WELL O 3 B y� 105.6 M 70, L (E) 'o \SFyF M2 2 DCO 3BR H!(E) USE 6 _ 6 \DRAIN FIELD (E) r ABANDONED PER CODE "F O�GF NEW 1000g SEPTIC TANK —INSTALLED DCO 10009 SEPTIC TANK (E) ABANDONED PER CODE F I F w -w I� FcrR� �< WELL (E) WELD). w \ . WELL (E) �2\\ Wim- W�'N / \ ��w�w 21 -77 3 3 3 NOTES: A B FC 25.8 11.2 T1 27.0 25.9 T2 29.6 32.0 DCO 31.2 35.1 Cl 47.3 18.1 M1 46.8 17.6 C2 72.9 81.1 M2 74.0 81.5 F w -w I� FcrR� �< WELL (E) WELD). w \ . WELL (E) �2\\ Wim- W�'N / \ ��w�w 21 -77 3 3 3 NOTES: PANNONE ENG SVC LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 -` pF ACXk �4ti �-• ""' .'c - //GDP �y+� �.... .. . .. .. .... Steven R. 'Pannone %PERMIT PF.•, CE 8149 .•,�?/� c '��lll"R?OESSONP�'r Date 2012 RECORD DRAWING Scale MOUNTAIN PARK ESTATES, BLOCK 10, LOT 6 BENJAMIN & RORI HRON 12600 ALPINE DRIVE ANCHORAGE, AK 99516 P.I.D. NO 441-23 Na. OSP121207 PLAN Sheet 2 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK WAS IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALLED NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.0 FEET BELOW EXISTING GRADE. '0 0 NEW 1000g SEPTIC TANK DESIGN PARAMETERS TER FABRIC 0 PERF PIPE 41N ROCK 6" ABOVE PIPE INV TH-2 - 4.5 COPPER DIP L 1 TEST HOLE 94.8 IT 5.0 O S T# GM DRAIN ROCK CLEAN OUT NO. M# MONITOR TUBE N0, R. 1. 89.8 DCO DOUBLE CLEAN OUT s 6.0 SECTION w FLOW SPLITTER BEG BELOW FINISH GRADE OG ORIGINAL GRADE FG 16.0 BOH —83.8-1r o FILTER FABRIC o 0 =o o m DRAIN ROCK 6' ABOVE PIPE INV o o 4" 0 PERF PIPE 1 In nn PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g (E) PERC RATE = 19.2 MPI SOIL RATING: 0.6 GPD/SF AREA RQD: 750 SF SYS. TYPE: DEEP TRENCH 5.0' E.D. MIN LENGTH: 75.0 LF USE: 75 LF X 2.5' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 750 SF NOTES: RECORD DRAWING PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC TRENCH SEE DESIGN on-41-iklyff.Avire►4 CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE N0, R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BEG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE PANNONE ENG SVC, LLC : 0��••l�l Date P.O. BOX 100217 ANCHORAGE, AK 99510 ,.- (��F A�q��l� 8/13/20,2 PHONE (907) 272-8218 FAX (907) 272-8211 ow co, y+�� Scale *. 49 M MOUNTAIN PARK ESTATES, BLOCK 10, LOT 6 .,,,,,., „•,•••••„ BENJAMIN & RORI HRON ` Steven R. Pannone 12600 ALPINE DRIVE /f+ c•• CE 8149 DESIGN DETAILS ANCHORAGE, AK 99516 +`h.�R R inNP Ems' NTS NO N0. 3 OF On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121207 Tax Code Number: 01744123000 Work Type: Septic Upgrade Permit Effective Dates: July 26, 2012 to July 26, 2013 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: MOUNTAIN PARK ESTATES Site Legal Address: MOUNTAIN PARK ESTATES BILK 10 LT 6 G:2838 Owner/Address: HRON BENJAMIN J 12600 ALPINE DRIVE ANCHORAGE AK 995160000 Site Mailing Address: 12600 ALPINE DR, Anchorage Lot Size in Sq Ft: 21200 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. , / 1-T -f /h 7`" I -","- `tel OY Com/ fdham.. -A Yt Vi-e, jf 4-e- c- dvc o�c Received Issued By Community Development Department Development Services Division On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Phone: 907-343-7904 Fax: 907-343-7997 Parcel l.D.0t_(qQj-23 Property owner(s) t6uaA..W d Rt Neo/t) Day phone Mailing address_J260b &F1.4,6 0(Ztur;� P4K �I4S1 Site address I?_60o 4L -f i.vE 02tvC Legal description (Sub'd., Block & Lot)AjwAs 1rA 1,4) P^Ak ESTrtEr��k lO, Lar � Legal description (Township, Range & Section) Lot Size 21, Z06 Sq. Ft. Number of Bedrooms 13 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (0 all that apply) Absorption Field [� Initial El Upgrade K Septic Tank F] Renewal ElHolding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I 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) Permit/Rush Fees: $ Waiver Fees: Date of Payment: Date of Payment: Receipt Number: NS -310 Receipt Number: Permit No. 0500/A6__� Waiver No. GABu11ding\0n SiteTorms\Client FormsTermitApp_010411.doc (Rev. 1/11) Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@yanengak.com July 25, 2012 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Mountain Park Estates, Block 10, Lot 6 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to construct an upgrade septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The existing drain field is in failure and will be abandoned per code. The new drain field will be built along the west property line. The lot is served by a private well that is located over 100' from the proposed system. The surrounding lots are also served by private wells that are over 100' from the proposed system. 1. Soils. One test hole was excavated by Pannone Engineering Services in July, 2012, and the ground water was monitored for seven days. No water was monitored in TH-1. Bedrock was not encountered either. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.6 gallons/day/square feet should be used for a conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The topography slopes at approximately 1%to 3%to the east in the area of the proposed drain field. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments -Soils Log -Septic System Design Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 0 �wl (E) V 10.7 A( — TH-1 9y 5vlp&Rm*r * PR MAR i DRAIN FIELD (P) 751-F, 2.5'W, 5.0'ED, 10.O'TD ss 0 WELL O 15.0 3BR lotis (E) .8 70 - ILL (E) '0, DRAIN FIELD (E) ABANDON PER CODE tiF ilk "I x 10009 SEPTIC TANK (Q VERIFY INTEGRITY AND INSTALL DCO w— \N WELL (E) W EL LrWELL(E) VV—_ W_— w ti ---w —w -1 NOTES: PAMONE ENG SVC, LW DER P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 0/2012 .... ... P. I1 NO MOUNTAIN PARK ESTATES, BLOCK 10, LOT 6, ..... lo� 017-441-23 StWv n R- an one ; T NO BENJAMIN & RORI HRON Ar - IW PERMIT 12600 ALPINE DRIVE% - CE 8149 19 OSP121207 oi '01 PLAN ANCHORAGE, AK 99516 Sheet 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. FABRIC ROCK 6' MOW PIPE INV TH-2 1000g SEPTIC TANK (E) DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g (E) PERC RATE = 19.2 MPI SOIL RATING: 0.6 GPD/SF AREA RQD: 750 SF SYS. TYPE: DEEP TRENCH 5.0' E.D. MIN LENGTH: 75.0 LF USE: 75 LF X 2.5' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 750 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC ROCK s R FABRIC � p IN ROCK 6' ABOVE PIPE INV i =may 0 PERF PIPE s ci TRENCH SEE DESIGN NOTES: PANNONE ENG SVC, LLC 'DER P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 WAWA G t ► 0% CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# ' C# GM 5.0 MONITOR TUBE NO. v0.5O sDM DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER 6.0 BELOW FINISH GRADE SECTION ORIGINAL GRADE FG FINISH GRADE $qqi qqz 0 !9 � -16.0 p o flu im OF r�4 �H oU U o o 3 �� 1000g SEPTIC TANK (E) DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g (E) PERC RATE = 19.2 MPI SOIL RATING: 0.6 GPD/SF AREA RQD: 750 SF SYS. TYPE: DEEP TRENCH 5.0' E.D. MIN LENGTH: 75.0 LF USE: 75 LF X 2.5' WIDE, 5.0' E.D., 10.0' TO TOTAL AREA: 750 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC ROCK s R FABRIC � p IN ROCK 6' ABOVE PIPE INV i =may 0 PERF PIPE s ci TRENCH SEE DESIGN NOTES: PANNONE ENG SVC, LLC 'DER P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 WAWA G t ► 0% CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE MOUNTAIN PARK ESTATES, BLOCK 10, LOT 6 BENJAMIN & RORI HRON 12600 ANCHORAGE, AK KDRIVE 99516 Irtf� DESIGN DETAILS ,+A Scale TH NTS P.I.D. NO 017-441-23 W_ .hW6 / PERMIT NO. CE 8149 �� OSP121207 ssoNPV*. Sheet 2 OF 3 TEST HOLE OR ORGANICS 1 ML ORGANIC SILTS z 3 4- 7— SILTY 7SILTY GRAVEL 8 GM & SAND. SANDIER W/ 9 DEPTH. 10 tt 12 13 14 15 18 BOH 17 18 DATE PERFORMED: 6129112 SOILS LOG - PERCOLATION TEST SLOPE X TH W_� W— ?7\TH-1� N; M 3BR � M H6lfS (E) WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY-' DEPTH TO WATER AFTER MONITORING? -DRY- DATE: 7/17/12 tiF O�iGF v SLOPE TH X READING DATE CLOCK TIME NETTIME WATER LEVEL READING NETDROP 1 7/10/12 1:54 -- 3.79 -- 2 2:24 30 MIN 5.59 1.80 3 2:24 -- 3.79 4 2:54 30 MIN 5.39 1.60 5 2:54 --- 3.79 -- s 3:24 1 30 MIN 1 5.35 1.56 PEROLATION RATE 19.2 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 6 FTAND 7 FT COMMENTS: Test hole excavated by FLINTSTONE ENTERPRISES. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: ��Date PANNONE ENG SVC, LLC pF At<q�llt 7/25/2012 FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 .� PHONE (907) 272-8218 FAX (907) 272-8211j g�p y�+, Scale NTS *' •• •• •• * P.I.D. NO MOUNTAIN PARK ESTATES, BLOCK 10, LOT 6= ............. ....„ 7-441-23 BENJAMIN & RORI HRON Steven R. Pann me PERMIT N0. ' 12600 ALPINE DRIVE tr+ ,/ CE 8149 OSPI21207 � SOILS LOG ANCHORAGE, AK 99516 ,�>r%fig`=�' Sheet3 0F 3 �' MUNICIPALITY OF ANCHORAGE %® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE f WNEW .. i4...� '1 Lam- _ _.> ' I ---- --- �J`•i'ch lJ�Ulo ❑ UPGRADE MAILING ANDD` CESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 6DISTANCE We+lLl Absorption area Dwelling`1� PERMIT NO. TO: ;,- ..j--- cy ..�T�t •�.. h z — Manufacturer Material No. of compartments W a m� Liq. capacity in gallons IF HOMEMADE: Inside length --�---- Width --_---�-�---- Liquid depth �..s._.__ _j DISTANCE TO: Well ,, \ Dwelling PERMIT NO. 0 2 f- 0 h ! Manufacturer Material Liquid capacity in gallons Well I Foundation 1 Nearest lot linef PERMIT N0. DISTANCE TO: iJ :Y�<slyw C)•� Z 1��' No. of linesLength of each lin` ` Total len thoQs Innes ` Trench width - ` Distance betweeI�t e �w L r 1 l� inchesN Top of tile to finish grade Material beneath tile Total effective absoini narea J - - 1 Z_. inches 4;;4r_' - 1 ..._ - Length Width Depth — PERMIT NO. w C9 Q I- Type of crib Crib diameter }.- nb depth Total effective absorption area F, /j wWell Building foundation Nearest lot line DISTANCE TO: Cys ,_ Depth J, � Driller Distance to lot line PERMIT NO. -J w � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE T0: OTHER / PIPE MATERIALS SOIL TEST RATTING INSTA�-LyLER /I REMARKS --—�v +vJ ' f`/Y ii✓. �. .ne O.yD aN - c 'W� a e !.r ' dr ^ '• . oo ,aoD a .� fr nborl A. Shafer ,,, No. 1, •D. M.J APPROVED 0 .3 17 ;:10INEERIM DATE LEGAL 1i-1CZ €9S)i ') i;.,:, 1VM37, ALASKA ,"D �ZSJ� Ju4`2a(} L ISSUED BY DATE: y/r/ / � 7-11.1HA 1 TA X 17� Z A y X "V - ![ M A SIM! DIRM MY: DEPARtit! EW OF HEALT|! AND ENVI NTAL PR�TECTIO� 825 L STREET� ANCHORADE, AK 99501 ' KA 1720 1: 1 TO A 1 147 S, I T W RE: Q V A. THA -1 TM 1�0K 1" V PERMIT NO: S50258 DATE ISSUED: 06/05/85 APPLICANT % S&S ENGINEERING DANMAR CONSTRUCTIOM ADDRESS: SRB 196X CONTACT 17HONE: EAGLE RIVER`, 69!^2979 AK 99577 LEGAL DESCRIP: SUBDlVlSION: M, PARK 94[0TES iOT6 9LJCK� !8 SECTION: 26 1O00131 1 V RANDE: 30! LOT SIIE: 220�0 (SO.FT� �� ACRES) MAX BEDROO�S: 3 Listed below are ihe options availablp to you i� des�gning your septic system. Choose the option that best 1 U your site. DEPTH TO PIPE 807111M (FT,) GRAVEL DEPTH (FT.) 0.5 TOTAL DEPTH <FT.> 3.0 GRAVEL WIDTH (FT.> 19.0 GRAVEL LENGTH (FT.) 38.0 GRAVEL VOLUME (CU .YDS.) TANK SIZE (GAiS) 1�000.0 ** SO[L RATING (SQ.FT.AM) 159 ** D2PTH TO PIPE BOTTOM < 3,5 FT INSPLATION ** DEPTH C PIPE BOTTOM < 4.0 FT. MAY REQUIRE A 1 11T STT:ON ** TANK MUST HAVE An LEAST TWO CO�PAKT�ENT3 L ISSUED BY DATE: y/r/ / � ❑ SOILS LOG - _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: `; � �I`-j I11-1 K -j �> I DATE PERFORMED: lL° 11' tT' LEGAL DESCRIPTION: i.�--` I��' �Y� ��'�. 1' t2--1�� --FA -- . p�OT� SLOPE SITE PLAN E ) 2 3 4 t. / , 5 6 t, v r 8 -1l 9 u 10 / 'u 11 i - 12 /c-) 13 rJ 6 14 r 15 16- 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? CSr .4 ��® .`�''`� o<.< :4 �` t YES, AT WHAT c�� < E�berf A. Shnbar N6. 1047.E i 1 S L P E n < .Reding Date Gross Time Net Time Depth to Water Net Drop Iµ WAS GROUND WATER ENCOUNTERED? CSr .4 ��® .`�''`� o<.< :4 �` t YES, AT WHAT c�� < E�berf A. Shnbar N6. 1047.E i 1 S L P E n < .Reding Date Gross Time Net Time Depth to Water Net Drop o ly PERCOLATION RATE: 'Z'r� \� (minutes/inch) TEST RUN BETWEENFT KY n a e4 't -JV ITV�iw�i�1� PERFORMED BY:CERTIFIE rx ,.., .: NIVI211, ALASKA V1,157! TIK 604-ZM9 72-008 (6/79) DATE; PERFORMED FOR LEGAL DESCRIPTION a_ -d i 2 ^ I S d. osrowN) (� i�` -f— P E —3 EPTH? 4 2� I t -- GrAV.2c- 6 0'0 9 10 11 12 13 14 15 16 17 18 19 20 SOIL LOG PERCOLATION TEST ,C //Y //e/`/�.S(fi'/ �>FRcol AntiN 13. ItEDROOtdB ,DI, i,utnt3ui DAIF PERFORMED /y71,la ler71&SLOPEs ^ I S osrowN) (� i�` -f— P E 49 EPTH? ---��----- 2� I t -- GrAV.2c- -- -------- — 12 �'v �/o cuh L)ry o��e5'�' C.Ar A, kl4r �o / 0 1 r� 6rn ve l � -w 1 �-- `/ 000°.0"" o00 11 JAME&; U ilankil.) 00 " o 000e00000" C �1�7>'S"si�~Uh M A$ GROUND WATER ^ I S ERC -D? Q __— __ OL 7 P E 49 EPTH? ---��----- 2� 000°.0"" o00 11 JAME&; U ilankil.) 00 " o 000e00000" C �1�7>'S"si�~Uh M A$ GROUND WATER ^ I S ERC -D? Q __— __ OL 7 P E ]YES. AT WHAT EPTH? ---��----- .Sm � " 2 6 /vein SITE PLAN r.al Reading ea Date Gross Time Net Time Depth to Net Water Drop 2� zoo„ t -- -- -------- — 12 IDEPTH PERCOLATION RATE - _ _. -_. _ _.. (minutes,inch) ls�2!J i ,y/'� G J� /`/j TEST RUN BETWEEN -?,. S F1' AND 3 _ FT COMMENTS 6"-essoal e<-'". I" e/GJ-�P 1��7/</'Ovt /11661e� C'_ C oiv(i','l:'.!'f %� cl--�F��{-/,CJ//G �_5 , zze,- P o6eS 71 - ;/r!` �C_-�.7�Se��' r`� �c .J �iC+' � 4,' :._l 'L�. ON/ ZO 71 1p/ f, PE.flf URMED Ry If it 1) H ,/'%i`� DATE Date Drilleds 9-16-85 Static Water Level 115 feet Draw Down N/A feet Type Material Drilled: 0 feet to 20 Brw. Silt 20 feet to 45 Brw. Silt w/Gravel 45 feet to 84 Sand, Dry Gravel 84 feet to 94 Clay, Gravel 94 feet to 120 Dry Loose Gravel 120 feet to 134 Bedrock w/Water Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 Lot 6 Blk. 10 Mt. Park Estates Gallons Per Minute 3 Total Feet of Casing 120 JMUNICIPALI Y OF DEPT. Or l7PdVIROi�1;AErdT� L f;.� I;w �i Municipality of Anchorage 'Ill/UI • Development Services Department ��#> Building Safety Division a On -Site Water and Wastewater Program C , 4700 Bragaw Street r P.O. Box 196650 / ' J c i Anchorage, AK 99519-6650 Pi l a f7. www.muni.org/onsite C . ) (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-441-23 1. GENERAL INFORMATION COSA # o Ck )\35-_) P Expiration Date: f 1 - i / j Complete legal description Mountain Park Estates Block 10 Lot 6 Location (site address) 12600 Alpine Drive Current Property owner(s) Benjamin & Rori Hron Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12600 Alpine Drive, Anchorage AK 99.516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: I 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 isnot responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 272-823.8 Address P.O. Box 3.00217 Anchorage AK ggSio Engineer's Printed Name Steven R. Pannone, P.E. Date! 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 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. 5. DSD SIGNATURE te` Approved for _:� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: ` 1 (Rev. 1ll03 a Municipality of Anchorage Development Services Department°��, Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Mountain Park Estates Block io, Lot Parcel ID: 017-441-23 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed q/26120 Sanitary seal (YIN) Y Total depth 134 ft. Cased to 12o ft. FROM WELL LOG Date of testg/16/1985 Static water level 115 ft. Well production 3.0 g.p.m. WATER SAMPLE RESULTS: Coliform Neg_colonies/100 mL Nitrate 1.20 mg/L Arsenic: ND ug/I Date of sample: 6/29/203.2 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size z000 gal. Foundation cleanout (Y/N) Y Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 612q/2012 115 ft. Collected by: PES Date installed 8/gho12 Number of Compartments 2 Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping New Pumper C. ABSORPTION FIELD DATA Date installed 8/10/2012 Soil rating (g.p.d./ft2 or ft2/bdrm) o.6 gpd/sf System type Deep Trench Length 75.o ft. Width 2.5 ft. Gravel below pipe 5.o ft. Total depth lo.o ft. Eff. absorption area 75o ft2 Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) 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 >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Size in gallons "Pump on" level at in. "Pump off' level aft Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 3.22.6 Absorption field on lot 3.o5.6 Public sewer main ioo+ Sewer /septic service line 85.6 Animal containment areas So+ Manhole/Access (Y/N) alarm level at Meets alarm & circuit requirements? On adjacent lots ioo+ On adjacent lots ioo+ Public sewer manhole/cleanout ioo+ Holding tank ioo+ Manure/animal excrete storage areas 200+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 24.6 Property line 27.5 Absorption field1-4.2 Water main io+ Water service line vo+ Surface water ioo+ Wells on adjacent lots ioo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo.o Building foundation 26.4 Water main so+ Water Service line 3.o+ Surface water ioo+ Driveway, parking/vehicle storage 3.o+ Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots ioo+ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. / Date l f3 l lt-- COSA Fee $ (05'�� X5('1 Waiver Fee $ _ Date of Payment ?s'11 I'D coo Date of Payment Receipt NumberCgob'3 lr) Receipt Number (Rev. 11105) . �D 49TH ien R. Panni No. CE 8149 in. L=16.30' R=1970.00' i Septic Pipes o o asphalt driveway C 0 W1B ,tiry 17z, 29.3 c 1—story frame Z/ house PBZ, ti LOT 6 eF o oy wood deck m \ QFk 44 AF �Q:•••. ''••:p'� • 649 TH :9 * � %.. .o ..�.. ..... A ♦♦ s •• Na. L&5318 � ��" / n'••...... 40,. ••P00 \ v RrFEss IoNP�� \ \ lk'sMV"W'W NOTE: 1) Bearings and distances areas per Plat No. P-501. 5ENTEC Surveying • Engineering 2525 Gambell Street, Suite 200, Anchorage, Alaska 99503 Tele: (907) 563-3835 Fax: (907) 563-3817 AS BUILT OF: LEGAL DESCRIPTION Lot 6, Block 10, Mountain Park Estates, Plat No. P-501. U cal survey of this property as shown on this g and that the improvements situated thereon are the property lines and no encroachments exist EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenant or restrictions which do not appear on the recorded subdivision plat. NOTE: Under no circumstances should any data hereon be used for the construction or for the establishing of property lines. LEGEND • FOUND PROP. COR. O SEPTIC VENT ® WELL 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 Parcell.D. 017-441-23 COSA# 05L1D/t788 Expiration Date: 9 - 2 %- / O 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES BLOCK 10, LOT 6 Location (site address) 12600 ALPINE DRIVE ANCHORAGE, AK 99516 Current Property owner(s) TAMES k MARY HAY Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12600 ALPINE DRIVE ANCHORAGE, AK 99516 Day phone KAREN DANNENBRING-NTRE Day phone 360-8438 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 Onsite 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 Onsite 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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date _ 06/11/10 Engineer's Comments: This Investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics; groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a _ system will function satisfactory for current or future OF occupants or can ArcTerra guarantee that no unseen i► . encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE f ,�rII'"�"� y' keg _1G Approved for bedrooms. • \ \ ,,,r/ Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: 1 Original Certificate Date:_ rlw 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAIN PARK ESTATES BLOCK 10, LOT 6 Parcel ID: 017-441-23 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed 9A6/1985 Sanitary seal (YM) Y Wires properly protected (YM) Y Total depth 134 ft. Cased to 120 ft. Casing height (above ground) 36 in. FROM WELL LOG AT INSPECTION . Date of test 9/16/1985 6=010 Static water level 115 ft. 116 ft. Well production 3 g.p.m. 3.52 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100ml- Nitrate 1.61 mg/L Arsenic: ND mgA Date of sample: 06/02/2010 Collected by. ArcTerra B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/ Steel Date Installed 7112/1 98s Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping figP010 Pumper A++ C. ABSORPTION FIELD DATA Date Installed 07/11V1985 Soil rating (g.p.d./fh or ft2lbdrm) 268 System type Dcep Trench Length 67 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 13.2 ft. (measured 6/2110) Eff. absorption area 804 ftp Monitoring tube Y Depression over field N Date of adequacy test 6/2/10 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth In absorption field before test 38.4 in. Water added 470 gal. New depth 62.4 in. Elapsed Time: 1335 min. Final fluid depth 38.4 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date _ D. LIFT STATION Date installed 'Pump on' level at _in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump ofr level at _in. High water alarm level at _in. Cycles tested_ Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer main 751+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 100'+ Animal containment areas _50'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation _51+ Property line 5'+'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surfacewater 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 7+ Water main 10'+ Water Service tine 101+ Surface water 100'+ arkin Driveway. y p g/vehiGe storage 101+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATIONOF -►'�'`\ I certify that I have determined through field inspections and /�4Yf-,' review of, Municipal records that the above systems are in / 9 conformance with MOA COSA guidelines in effect on this date. � 4 / Engineer's Printed Name KENNFFH M. DUFFUS V ` F cu+e+rra n y % Date 04/21/2010Awl COSA Fee $490.00 Date of Payment 6�y/%t' Receipt Number -15 7 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Aare F (R� LCrACO NGLf ylnl �II) wF.�fltl��a.[ctYAA • rw Ir01 M/Ibr food !9s/rw1/ o s'/'. Ao'rrw.r rr HmL renwAeo PVR. A;-'Aflf 0 a' ra •a I m kn rnLfo As-euar ; GOTI� G'GL�.L' /o w„swr�✓v�surFsrA7Fs sr,.., L Aw.pr pwfr owes •row» rr/.sNW LrNrrr/ /rwr*p/ pmpw&- iH rNr �! I// f4IIIp A191rpMHr M»NM f1NM m •NM Mr Properly fr.! M Io tel ~topw, rmork "so Nopwry 6+4 N/a9.N flrnp Mal N rP'yr• m Mw•b&Me .tNwA e.w» "aWg l er LAI /pwsH M gwow M M LNI AMM W as !•rAgp &010" 860 11»! Or ~ .alar 9HH.r/r « !rM /nf9lC 0010 W J~W tweet. Oaw/ N MNom^ /Ard4!"- hVlM 9f I r s d e•LpN• LZ r. lc7s /YO!PMr.7 it CORWIN Q ASSOCIATES 1000 C. olmomo ILM lWrt tot AMOMOIAtt. ALASKA $9311 (1071 ttt-13n e a � I ra •a I m kn rnLfo As-euar ; GOTI� G'GL�.L' /o w„swr�✓v�surFsrA7Fs sr,.., L Aw.pr pwfr owes •row» rr/.sNW LrNrrr/ /rwr*p/ pmpw&- iH rNr �! I// f4IIIp A191rpMHr M»NM f1NM m •NM Mr Properly fr.! M Io tel ~topw, rmork "so Nopwry 6+4 N/a9.N flrnp Mal N rP'yr• m Mw•b&Me .tNwA e.w» "aWg l er LAI /pwsH M gwow M M LNI AMM W as !•rAgp &010" 860 11»! Or ~ .alar 9HH.r/r « !rM /nf9lC 0010 W J~W tweet. Oaw/ N MNom^ /Ard4!"- hVlM 9f I r s d e•LpN• LZ r. lc7s /YO!PMr.7 it CORWIN Q ASSOCIATES 1000 C. olmomo ILM lWrt tot AMOMOIAtt. ALASKA $9311 (1071 ttt-13n 11 -S-G-S SCS ReLH 1102462001 Client Name ArcTerra Engineering and Surveying Project Name/a Mountain Park Est DIO,L6 Client Sample ID Mountain Park Est DIO,L6 Matrix Drinking Water Printed DatelPime 06/10/2010 14:03 Collected Date/Time 06/02/2010 11:10 Received Date/time 06/02/2010 12:20 Technical Director Stephen C. He Sample Remarks: Allowable Prcp Analysis Parameter Rcsults LOQ Units Method Container ID Limits Date Date Init Metals by ICP/M3 Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/03/10 06/08/10 KDC Waters Department Total Nitrate/Nitrite-N 1.61 0.100 mg/L SM204500NO3-P D (<10) 06/02/10 AYC Microbiology Laboratory E. Coli Negative I 100mL SM209223B A 06/02/10 DLC Total Colirorm Negative I 100mL SM20922311 A 06/02/10 DLC Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ig On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING !i 1 7 - Ui I - 3 HAA # �1 ��i �`V ��D 1. GENERAL INFORMATION Complete legal description Lot 6; Block 10; Mountain Park Estate -o Location (site address or directions) 12600 Alpine Drive Anchorage, AK Property owner Lisa Scott Day phone 345-811.0 M Mailing address 12600 Alpine Drive Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 tN RONMENTA( f�AJ�`nu^l1`'t 3. TYPE OF WATER SUPPLY: h Rr'�cFSo�v�SToN Individual well 1996 Community well �?`C �% V Public water "r 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 (Rov. 1/911 Front MOA H21 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 Firm5 & 5 ENGINEERING 17034 a -U a rver oo , 04------- Phone y `f -7 Address : a Ia River, Alaska 99577 Z Engineer's signature 6. DHHS SIGNATURE k Approved for Disapproved. Conditional approval for Additional Comments bedrooms. Date y 4 `l O .. �) > A , RC3FCT C. cov"AN t,2 bedrooms, with the following stipulations: 4 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Aev. 1/91) Back MOA k21 MUNICIPALI i c r �i�ir u Municipality of Anchorage ENv1RONMENrpLSFRyICES DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 1.99825"L" Street, Room 502 0 Anchorage, Alaska 99501 • (907) 343-4744 C.. E Health Authority Approval Checklist Legal Description: t -o r` 6 Ci Lo c cr i u i/�+' Nw (is s:. Parcel I.D.: u /7 - N -Y A. WELL DATA Well type to"?IV iT£ Log present (&N) Y 'i i Total depth 13 4 Sanitary seal &N) Date of test Static water level Well production YC S If A, B, or C, attach ADEC letter. ADEC water system number Date completed q // G /£SS Cased to 15 ' FROM WELL LOG C11iG�rSS' h 5- 3 3 g. p. m. WATER SAMPLE RESULTS: Casing height (above ground) Wires properly protected &N) _ AT INSPECTION �lr �c16 1 1 3 .. �4-- 1 Y c S" g.p.nl. Coliform b Nitrate 1, 0 O Other bacteria Date of sample: it N ( Coltected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC OLDINIG TANK DATA Date installed -7 1 ' z / V,5- Tank size /0 y Number of Compartments Cleanouts (9/N) VS -S Foundation cleanout &N) Yl S Depression (YM ^ y High water alarm (Y& Date of Primping q/ `; l c1 � Pumper 19 '}" 1/ a ' i C. ABSORPTION FIELD DATA Date installed 7 /1 ays-� �� Soil rating (g.p.d./ftZ or ft/bdrm System type % R .Length Width 3o Gravel thickness below pipe 6 Total depth Effective absorption area �' U H Monitoring Tube presento/N) `/,'- S Depression over field (Y& N 0 Date of adequacy test G t/ c/ (. ResultsPaa YFail) �'� S S For 3 bedrooms Fluid depth in absorption field before test (in.); ))/'Y Immediately after ,SSagal. water added (in.): I o Fluid depth 3 I o it (ins.) Minutes later: �k 3 Absorption rate = Lf CJ 0 +- g.p.d. Peroxide treatment (past 12 months) (Y/N) JA)ti g K P6 L- Ai If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles teste E. SEPARATION DISTANCES Size in gallons "Pump on" lev "Pump off' level at* *Datunn SEPARATION DISTANCES FROM WELL ON LOT TO: Seti holding tank on lot 100 t On adjacent lots Absorption field on lot / 00 / ; Oil adjacent lots Public server main N 44 Public sewer manhole/cleanout too P 00 4- >v /,q Sewer /septic service line a S -f- Lift station W l A SEPARATION DISTANCES FROM SEPTI HOLDING TANK ON LOT TO: Building foundation l 0 f Property line a v Absorption field t Water main/servicc line S` Surface water/drainage / 0 o i- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 'a o 4— Water main/servicc line t Surface water % 00 f Curtaindrain /va.v✓. K.yoy,v F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area S` 4 - Wells on adjacent lots i 00 t t Property line /n 1 certrfv that I have determines/ thru field inspections and review of Municipal records that are are in conformance with A40A H 1 guide 'nes in effect on this date. j� Signature N f a Ell Engineer's Name �dl36A.7- Cs uti� Ett S �/ . Date l l D -(v 0, T��1 k013ERT C. COWAN f � HAA Fee $ Cy/ Waiver Fee $ _ Date of Payment / I� Date of Payment Receipt Number _ ��l�`3 Receipt Number Rev. 8/95 OSS: lnaa.wk.doe 04/09/96 15:56 (.list tb I HIIUMURr u - ME z IL Environmental Environmental Services Inc.utlIrM I co Laboratory Division Laboratory Analysis Report CT&E ReP.k 961187.9479 Client Sample ID L6 B10 MOUNT PRK EST 1187.01 Matrix prinking `Nater P'WSID 0 Parameter mItrate•" Collected Date 04/04/96 Technical Director Released By_ -!5- vOL Units Method Allowable Prep Analysis Init Results OG Limits Date Date _ _ pual - - — 04/04/96 MCE� 1,06 0.100 mg/L EPA 300.0 200 W. Potter Drive, Anchorage, AK 99515-1605 -- Tel- (907) 562-2343 Fex: (90 661-5301 3180 Peger Road, Fairbanks, AK 99709.5471 — Tel: (907) 474-8656 Fax: (907) 474 EW JSRSEY. 01110. WEST VIRGINIA ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, N CT&E Environmental Services Inc. 'ztlL Laboratory Division ra®dio/d//////ods'd/.e'vid/dd/®�'oirddii/dddiimeo�. Drinkincr Report Water Analysis Rort for Total Coliform Bacteria 200 W. Potter Drive Y Y Anchorage, AK 99518.1605 READ INSTR UCTIOtVS ON REVERSE SIDE BEFORE COLLECTING SAiVfPLE Tel: (907) 562.2343 Fax: (907) 561.5301 MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. 9 PRIVATE WATER SYSTEM Send Results 15 Send Invoice \Yaer )yztem �'ana omp+aY �°^1e onucl nvn< Phone Number er as I um Fer Mvlmq Addmr Ory Mm. Ip od. ❑ Send Results ❑ Send Invoice ompzny fume unutl none sluhn6 Aodrm cay sole ZIp ode SAMPLE DATE: 211 ' 00 l- EJ Month Day Year SAMPLE TYPE: Routine ❑ Treated Water ❑ Repeat Sample (for routine sample )zr Untreated Water with lab ref. no. ) ❑ Special Purpose Time Collected SAMPLE LOCATION Collected By 1-0 O L K 10 I"QV,%Q'H L? EST. /0 "/, New Print TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,0--� Satisfactory ❑ Unsatisfactory O Sample over 30 hours old, results may be unreliable 0 Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received T I( ) / a, Time Received / O s's— Analysis Began / G tv Analytical Method: Membrane Filter ❑ MMO-tvfUG ' Number of colonies/100 ml. Lab Ref. No. Result* Analyst 96.1187 Sent to A.D.E.C. 4nc Fbks Jun ❑ C� Faxed Date: CJ Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Faxcd Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD PYHY10-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Coliform Confirmation BGB E. Coli O Colonies/100 ml C 0 L I FI R NI r\'TC - n..I ,V -mesas n, Caanr on - thher Haereriu Final Membrane Filter ResultA (bColiform/100 mi Reported By Date ' Time v hrs Comments: r{ 1®1 scis Member of the SGS Group (Soci60 GAndrale de Surveillance) FN\rIAnA4+c•I.+� r.. �� ..rr IN] AlAcwA rel IenamiA ZI na In III uInIC &AAov1 AAIn +.I�wr. n+I +I ICCnI IOI Aln+r Ieeewv nuln IAICCT VIn/:I NIS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTI-IORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ( ()--z- " 0 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Telephone: Home ��r`� � '� t® Business C:�'�� _ Applicant Address _%c=.>-,_��z `fes -- (c) (c) Applicant is (check one). Lending Institution E7 ; Owner/builder E5; Buyer 0 ; Other E] (explain); _ (d) Lending Institution .___ __ _ Telephone— Address —-- - ---- - ----- ---- (e) Real Estate Company and Agent Address Telephone _-- -- -- — --- __ -- t'rvu-.r� (f) .Maft the HAA to the following address: 2. TYPE OF RESIDENCE Single-FamilyO Multi -Family E7 Other Number of Bedrooms 3. WATER SUPPLY Individual Well;] Community® Public E7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite' --/Public C] Community 1 --]Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11,8'1) 2 5. ENGINEERING FIRM PROVIDI. _, INSPECTIONS, TESTS, FIDE SEARCIi, D,-, i'A AND INFORMATION m As certified by my seal affixed hereto and as of the validation dates h own below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 0 t' c Date --- i.. �71U Telephone DFIEP APPROVAL \ � Approved for d_ bedrooms by _ (�� ` ,1 4yp- v X to Approved Disapproved -__.__ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (1 1,84) N1UNICIPALFY OP ANCNORAG MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HE,',iTlI �crlGil HEALTH AUTHORITY APPROVAL (HAA) CPtvIRON AENrP.L P. �f CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: I A. WELL DATA �5 Well Classification S� �. If A, B, C, D.E.C. Approved (Y/N) )'% Well Log Present 6%) Date Completed 19-1(10-85 Yield 61r-" Total Depth ( -224+ Cased to Depth of Grouting Static Water Level I I 15 / Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit PN) Separation Distances from Well: Sanitary Seal on Casing4DN) — Depression Around Wellhead (Y9P To Septic/HokWg Tank on Lot I � ' 1 ; On Adjoining Lots I �� To Nearest Edge of Absorption Field on Lot I ; On Adjoining Lots (� To Nearest Public Sewer Line d To Nearest Public Sewer I Cleanout/Manhole 4 To Nearest Sewer Service Line on Lot L� Water Sample Collected by '%f!-�e//�Z $ Date i`,�/ ' �9J Water Sample Test Results Comments B. SEPTIC/H0VM4ffG TANK DATA Date Installed r1- 12.- f�5 Size L C% -::'c2 No. of Compartments -2- Standpipes 6>N) Air -tight Caps9?N) Foundation Cleanout ()N) Depression over Tank (Y/9P Pumping/Maintenance Contract on File (Y/N).4 Holding Tank High -Water Alarm (Y/N) ki 13 /1, Date Last Pumped NJY_-Ae� ;for tZ Temporary Holding Tank Permit (Y/N) �n Separation Distances from Septic/Hef&Rg Tank: 1 To Water -Supply Well — I L�o (__�' To Building Foundation 24' To Property Line To Water Main/Service r -N Course Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2��O' �54--� Type of System Design 17�SIA Date Installed — 17_ — z�� Length of Field L -)- Width of Field ��>Depth of Field I I Gravel Bed Thickness . J /� Square Feet of Absorption Area t'E Standpipes Present4MN) Depression over Field (Y/4V N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well I�+ To Building Foundation ,J Lot IN To Water Main/Service Line I �` A - To Stream/Pond/Lake/or Major Drainage Course Date of Last Adequacy Test�� To Property Line � ��,�- To Existing or Abandoned System on t� On Adjoining Lots �o To Cu)bank (if present) � To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons _ Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed A err P >wSNI NE -t; 10 Date o 1-L S SAB 196X Company,,_o)l r- 11AIV__ i ]. ALASKA ZVI MOA No. era, VIH. 69WU_(Q_ f 7 i ` ` r `' Receipt No. ; * 4n Date of Payment q—`-5 . °n 3.y ! b Amount: $ y ear,"-, ;A ko6ori A. 5hs8�r Page 2 of 2 72-026 (11/84)