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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 10 LT 10 Municipality of Anchorage Page . I of ~-' DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report %~: ~}~ ~o¢~ Wastewater System: ~ New ~Opgrade Addre's:5~( ~t~ ~r , ~5 ~& ABSORPTION F~ELD _,. Phone: ~No. of B~rooms: ~DeepTrench D Shallow Trench ~ Bed ~ .... Mound ~ Other '~ Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION o. 45 ~/s~. ~. ~4~ Block: __ , Su'~div~iom 3epth to pipe bottom from original grade: Gravel depth beneath pipe Township:[%~ Range: 5¢ [ ~¢1/~ ~ ~ Ft. ~-~0 ~' Fi:  Gravel depth: ~ Number of lings: Distance between I~nes: WELL: g New ~ ~Pg 18. Ft. % J i~' Ft. Classification (PdCate, A,B,C): ~Ft. Cased To: Ft. Total 8bsorption/~o~ area: SQ. Ft, Pipe~jO C~material: ~)rJJler:~~ Data Drilled: Static Water Level:Ft. Installer:/~G~O~ ~ ~ ~,', Date installed:~. Yield: / Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~ Septic ~ Holdi .E,P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: ~ Capacity in gallons: From ~ ~an~. ,Fi~i~. 1 ~tation Tank Sewer Lines Well &J~ ¢~%'~. 5 *~ J[¢' ~ ~ Number°fC°mpartmenls: Surface ~' ~' . ~00' LIFT STATION Water ~ .r. ~T ~ Size in gallons: Manufacturer: · ~ ~ High water alarm at: Foundation ~ t ~, ~ "Pump on" level at: ' level at: Curtain ~ ~ ~ . ~ _ ~ Electrical Inspections performed by: Drain '91) MOA 25 PermitNo. %'uJ ,::j~Ot~,G Page of Municipality of Anchorage DEPARTMENT OF HEAL'rH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and~or Well ~nspection Report Legal Description: £,o ~jl~ Meu~l-~.'~ ~¢~ -~--~.'J¢.~ '~ PID No.: q13A (2/91) MOA25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910166 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. OWNER NAME:MCCRORY WILLIAM J & OWNER ADDRESS:5~31 BEVERLY DR ANCHORAGE, AK. 99516 DATE ISSUED: 6/24/91 EXPIRATION DATE: 6/24/92 PARCEL ID:01744131 LEGAL DESCRIPTION: MT PARK ESTATES BLK 10 LT 10 LOT SIZE: 21200 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT,: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: DATE: ABSORPTION SYSTEM DESIGN Lo_' ABSORPTION AREA CALCULATIONS: 3 Bedroom X 150gpd/bedroom = 450 gpd Soils rating: 0..45 gpd/sf 450 sf / 0.45gpd/sf = 1000 sf required surface area 1000sf/(10'/'x 2) = 50' trench length IMPACT ON ADJACENT LOTS: There are no lots replacement of the absorption system, as all developed and all protective well radii are met. impacted by this proposed adjacent lots are fully SITE PLAN DETAILS--PROPOSED ABSORPTION SYSTEM LOT 10 BLOCK 10 MOUNTAIN PARK ESTATES PREPARED FOR: LYNN & WILLIAM McCRORY 5931 BEVERLY RD ANCHORAGE~ AK, 99516 NOT TO SCALE DRA~/N BY CAL CONSTRUCTING ENGINEERS3A6-2000 9601 BUDDY WERNER DR 69A-9098 ANCHORAGE, AK, 99516 DRA~JING // 91-S2-06-1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~/~'lJ I ~ ]~)\ C"'~'~Y"'L~ DATE PERFOFIME~;~ LEGAL DESCRIPTION: LIC::,~:> ID ~o~'~'~a('~,"~''='~'~ ~-~"~'~'~ Tow~nship, Range, Section: N/~*-,~'/~- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS ('~"~ "~ ~,",. 1 '~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ O DEPTH? p E Oepth to Water AfterM ~ ~ Monitoring? Date: G-I'~-.~ I Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~o~,~, ¢o~,~. "/~" "/~" ~ ~ ~. -~o ~, Z~/~'' PERCOLATION RATE--~ ''~ (mmutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN '~ FT AND ~ FT PERFORMED BY: ~-~,".'~,."O ~..dr',;"~ ~-c~.~'~.~ ,~,/'.': I ~.J~,~/xoLo,..~l- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE: 72-008 (Rev 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~loBIO 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 5 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, ATWHAT ~ O DEPTH? p E Oeplh to Water Alte[ ,~;~E.~ Monitoring? gate: . "~¢u c,,, 1,.1 Gross Net Oepth to Net Reading Date Time Time Water Drop G :, ~k~ ~ .... ~ ~/8' '/~,, / ~. /,, PERCOLATION RATE "::dtO (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN__~ FTAND __~' FT PERFORMED BY; ~:~"'¢ ~'~ ~¢~ ~,,, )%~ "~" '~-~ ~'/'/ I ~-¢~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GRANT OF EASEl~ENT We, Geoffrey B. Knight and Yolanda H. Knight Grantors), of /0 Mountain Park Estates, Municipality of Anchorage<~ State of Alaska, in coesideratios of TEN DOLLARS ( $-!-~ )', receipt of which is acknowledged, and other valuable consideration, do hereby convey and release to William McCrory and Patricia L. McCrory (Grantees), an easement and right of way, more particu- larly described herein, for a certain existing water well and water line, on and across lands owned by us and siteated in the Anchorage reco'rding district, and more particularly described as follows: Lot 9, Block 10, Mountain Park Estates, Anchorage Recording District, Third Judicial District, State of Alaska. The right of way granted shall include the area described as a circle 20 feet in diameter centered on the well casing, and in addition the area included between the above-described circle and the common property line but limited by two parallel lines perpendicular to the common property line, each line extending from the common property line to points directly opposite each other on the above-described circle. Grantors agree that no structure or cosstruction which could in any way impede access through the right of way will be placed on the above-described right of way. The easement and right of way hereby conveyed and released is for the sole purpose of locating, establishing, constructing, and maintaining on and across the above-described land a water well and water line for the purpose of supplying water to the beneficial estate described in the following paragraph. This easement is ~or the benefit of and appurtenant to that land, or any portion thereof, in the Municipality of Anchorage, State of Alaska, described as Lot 10, Block 10, Mountain Park Estates, Anchorage Recordin~ District, Third Judicial District, State Of Alaska. , ~,,--'~-- GRANT OF EASEMENT Grantors convey and release to¢3ether with said easement and right-of-way, such rights of entry upon, passage over, and stor- age of material and equipment on such area as may be necessary or useful for tbe construction, maintenasce, cleaning out, repair, and deepening of such well and water line or an additional well or wells and water line within the above-described easement that may be necessary to secure as adequate water supply to the domi- nant estate if applicable laws and regulations would not allow a new well to be placed within the boundaries of the dominant estate. Grantees, for themselves, their heirs, and assigns, covenant with Grantors, their heirs, and assigns, that Grantee, from time to time, and at all times hereafter, at their own cost and expense, will repair and maintain, in a proper, substantial, and workmanlike manser, the above-described water well and water line, up to such time as tbe well may be abandoned. If the well is abandoned, Grantees will close and seal the well in accordance with any state or municipal codes applicable at the time of aban- donment and will be relieved of any furtber responsibility to maintain the well so long as if remains abandoned. The parties agree further, as part of the consideration of this conveyance, that Grantees shall maintain and operate the right of way herein granted in such a manner that the operation thereof will in no way hinder or prevent the proper and reason- able use and enjoyment of the property tbrough which the easement and right of way is hereby granted. This grant of easement shall run with the land and shall be binding on and shall inure to the benefit of the parties hereto, their heirs, successors, or assigns. IN WITNESS WHEREOF, we have hereunto set our hands this ~7 GEOffReY B. KNIGHT GRANT OF EASEMENT 2 -- STATE OF ALASKA ) ) Ss. THIRD JUDICIAL DISTRIC'r ) THIS IS TO CERTIFY that on this~7 day of ~7~z~/ , 1984, personally appeared before me Geoffrey B. Knig'ht and Yolanda M. Knight~ to me known to be the individuals described in and who executed the within Grant of Easement and acknowledged that they signed the same as their free and voluntary act and deed, ~or the uses and purposes thereis mentioned. .. lIVeN ~.pNDER MY ~AND and of[icial seal the day and year last /~1 ~3f My Commission Expires: ,,?,,? WI LLIA~CRORY ~ STATE gE ALASKA ) THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this p da~ of~ 1984, personall!/ appeared before me W~iam McCrory ~nd~aErfcia L, gcCror~ to me known to be the individuals described in and who executed the within Grant of Easement and acknow]edD~fl;; ghat, they signed the same as their [ree and voluntary acb'.',a~-<~ ....... .d~d,~'~_,,),,~:,,.., ~or the uses slid purposes therein mentioned. GIVEN UNDER MY [lAND and official seal the:~a above written. ~~~~/S Lt C.. ~fa~ [~)lic ~n and f6b~Al~ka dLR/kdm/6 1749 GRANT OF EASEMENT - 3 - ~ lO.]OVa MLJNICIPALITY OF ANCHORAGE ' ~~ ENVIRONMENTAL ENGINEERING DIVISION . 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME~ -- 1PHONE ~NEW ADDRESS LEGAL DESCRIPTION ~6. OF ~OROOMS ~ATI O N ~) -- ] Well ' ~Absorpt,on area- ' Dwelling ~ , PER~IT NO. ~ Z Manu~cture; Uateri~L/.¢~_ No. of compartments Liq. c~pacity in gallon¢ IF HOMEMADE: Inside length Width Liquid depth Well Dweili~9 PERMIT NO. ~ ~ DISTANCE TO: O Z ~ Manufacturer Material Liquid capacity in gallons ~ Well' / ' Foundation Nearest otline_ / PERMIT,NO. ~ d ~ DISTANCEline~ TO: Length /)(~of eaeh line Total leogtb ~f lines Trench widtlb Distance between lines ~ ~ No. of ~ ~ ~ Top of tile to ~nish 9rade . - Mateliat beneath tile Total effective absorDtion area ~- ~ength ' ' Width Depth PERMIT NO. ~ Type of crib Crib diamete~ Crib depth Total effective absorption aree ~ Well Building foundation Nearest lot line ~ DISTANCE TO: -- j Class D~pth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Sepdo tank Absorption are~(s) ~ ~ISTANOE TO: PiPE MATERIALS I SOIL TEST RATING APPROVED -:-- / / ~, DATE LEGAL June 29, 1983 Christopher Fejes 6917 Old Seward Highway Anchorage, Alaska 99502 Subject: Lot 10 Block 10 Mountain Park Estates Subdivision ttl A well and on-site sewer permit were issued to you on April 27, 1982. The sewer system was installed on June 1~, 1983 and 'the well was completed on June 14, 19~2. ~' A complaint has been registered with this office in regards to the well location from the property directly behind Lot 10 Block 10 Mountain Park Estates Subdivision (Lot 4 Block 10 Mountain Park Estates Subdivision). After investigation, it was noted the well was placed approximately 77 feet from the sewer system on Lot 4. This is in violation of State and Municipal codes and will need to be corrected prior to September 1, 1983. If there are any further questions, please call this office at 264-4720. Sincere:2 Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Robert W. Robinson Environmental. Engineering Manager MUIklICIPALITY OF ANCHORAGE DEPARTMENT OE ltEAL]'H AND ENVIRONMENTAL PROTECTION 825 I.. Street, Anchorage, Alaska 9950'1 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 3 4 6 ? 10 11 ~3 ~4 16 SITE PI_AN SLOPE IF YES, AT WHAT DEPTII? Depth to Net Water Drop Gross Net Heading Date 1-ime 'l'ima 'T.F;,:? .... >'; ....... I-,??-z7 ...... / ~ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permll No. LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L, No. ~.lBerou§b, Subdivision Lot Block~_~lb.II I/4qtrs. Section No. Township NF-~ Range E[~] Meridian __of__of__of .-- sE3 Ic.IIDISTANCE AND DIRECTION PROM ROAD INTERSEC'rlONS 3. OWNER OF WELL: Streel Address and Areo of Well Location 2. WELL LOG Feet Below 4. WELL DEPTH: (final} 5. DATE OF COMPLETION Material Type Top Bottom ' rr ' : 7. USE; ~ Oomeilic ~ Public Supply ~ Industry '. : ..: ~ Irrigation ~ Recharge ~ 6ommericel 8. CASING: ~ Throodod diam. ' in. to : J ;~-}: ft. Depth Weight lbs./ft. Slot/MeSh Size: Lenglh; Set between ft. and fl. [0, STATIC WATER LEVEL: Date II. PUMPING LEVEL below land surfo~o and YIELD ft. offer hrs. pumping g.p.m. ft after hrs. pumping g.p.m. I~.GROUTING Well Grouted: Materiel: ~ Neqt Cement ~ Other: 13. PUMP; (if oveiloble) HP 14.REMARKS: 15. W~t~r Temperature C December 31, 1979 Wayne Cooper 9310 Carlson Ancl',oracle, Alaska Permit {! 790028 99 507 Subject: ~,o~ 10 Bloc}: !0 '.~ou.:nta~.,'~ 2ark ........ t~ Sklbdivision ,. ~ ~p~r=,nenu for well and/or sewer A eermit issued by this d ....... system has expired. Permits are iss'~ed on a ca].endar year basis, as stated on i~2 you have drilled the well, a ,.,~e.~.z log should be sen~ to this department to document 2he n.n~ta~ation date. If an engineer has insoected_, the installation of the on-.site sewer system, elease have ii, em send us the as-~'bui!ts ~'or our files. tf there are any further quesuio~-~s, el. case contact ~n.~.~ office at: 264-.-4720. LNB/ljw eric: Copy of Permt,z I::'IERH): 'rF NC L ['~ G t:;:1L. I.,.11::1 '*r' I",1E COOI:':'E:R E:, E: I::1 t;? 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E:,E:F'Et.,II:::,):I',IG IJPON THE T"r'F'E OF PUEII .. ]: Ii: I.,.IIEI_.I .... OTHEi:]:;?. I:;~tE:(;!U I I;;'.E!:I'4[EHI":!!:i i"ll::l"r' FIPPL"r'. SF:'E:C: ]: F I::l',,,'FI :[ I..t::l[:."',l...li~:: TIiJ ]11",I?..';Ui:?.E: PROPE:R ]: Nt!.'Tf'FII..L.I:;IT .1: 01"4. J: CE:r~:"fll::tr' 'r'HFl"r '_'L: ): RI',1 F'F:tFIIL. I I:II"< I.,.l:['f'H TI-lEi RE(;:!LI]:I;;:E:f,IE:NT:5 F'OI;: Ot.&.-.SITE 'SEI41!:I:;;:S I:~I',IE:, FI:tRI"H E¢.r' TFIE f,llJl',l :!: C )1F'I:IL I T"r' OF' 2: i1:14 1 LI.... ~: I",ISTF:IL.L.. THE 91'.¢STE:H :1:I",1 FICCOF::E:'I=It'4CE H I 'f'H THE: 3: ]: I...II'.4ii:,ERSI'FIHI3, 'TFIRT THE OH"<:ii;):TE %E[*.1[!:~,i: :!i;"r'S"FEi'd i"ll::l'T' 1:;~:Ii:6!LIII:;.:IE [EN[.I::IRGEr,IE:HT IF THE f;i'.E:'i!; ]: OIEi'4E:E I :.{.; RE:I',IOI:)E:I..E[:, "1"0 I NE:LU[::,h: f,IORE: THRhl 3 Mr. Larry Thomas 3402 Arctic Blvd. Anchorage, Alaska 99503 February 15, 1979 Subject: Soils investigation for sanitary sewer system on Lot 10, Block 10, Mountain Park Estates Subdivision, Anchorage, Alaska. Dear Mr. Thomas: At your request of February 7, 1979, I conducted a soils investigation at the proposed location of a sanitary sewer system on the subject lot. This investigation which was accomplished on February 12, 1979, consisted of the inspection of soils removed during drilling of 6 inch diameter, 17.0 feet deep test hole, using solid flight augers powered by a track mounted Mobile B-50 drill rig. After completion of drilling, the test hole was filled with water and a percolation test performed. The results of this test are tabulated on an accompanying sheet. The soils encountered are graphically shown on the accompanying test hole boring log. The soils consisted of a layer of Organics and Peat 2.5 feet thick, overlying a Silt with a trace to some Sand and Gravel to a total depth of 17.0 feet. No water table was encountered. The topography of the subject lot consists of a low hill in the Northwest, North and North east portions of the lot, dropping approximately 15 to 20 feet to a low swale in the South and Southeast. Vegetation present on the subject lot consists of scattered to dense spruce and birch to 30 feet tall, groups of dense alders to 10 feet tall and a low ground cover of mosses and grasses. A snow cover of approximately 3 to 4 feet deep was present on the lot. An accompanying sketch shows the subject lot with the approximate location of the test hole in relation to the property lines. I appreciate the opportunity to be of service to you. Please contact me if you have any questions regarding this soils investigation. Very truly yours, Attachments: Drawing of test hole boring log with location sketch, and tabulation of percolation test results. xc: Department of Health and Environmental Protection February 15, 1979 Lot ]0, Block 10, Mountain Park Estates Subdivision Anchorage, Alaska Percolation test performed on February 12, 1979, using Test Hole No. 1, by filling the 6 inch diameter, 17.0 feet deep test hole with water, and measuring the water level drop periodically for one hour. TABULATION OF PERCOLATION TEST RESULTS TIME LEVEL(inches) DROP(inches) ET(min) RATE(min per inch) 1121 21.0" start start start 1131 26.5" 5.5" 10 1.8 1141 27.75" 1.25" l0 8.0 115]. 28.25" 0.5" 10 20.0 1201 28.5" 0.25" 10 40.0 1211 28.75" 0.25" 10 40.0 1221 29.0" 0.25" 10 40.0~ ~ ~ > Average percolation rate for entire hour = 7.5 minutes per inch Average percolation rate for last one half hour = 40.0 minutes per inch Michael B. Bergmann Consulting Geologist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 00,' S N 63°35'00'' W 109.60' 10' Utility Easlement ! Lot 10, Block 10, Mountair Park Estates, Anchorage, Alaska. R=1590.00' 1!7.81' Beverly Drive NOT TO SCALE Distances are approximate and ]]ave not been measured by surveying methods as to location of test hole. Michael B. Bergmann Consulting Geologist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 T.H. No. 1 2-12-79 -0.0' anics & Peat: soft, moist, brown. Silt: with a trc to some Sand and Gravel, vy moist to si moist (decreasing moisture with depth), loose to med dense, brown. (ML) ".~TJ NO WATER TABLE ENCOUNTERED 'iT.0'TD Test Hole Boring Log represents soils encountered on Lot 10, Block 10, Mountain Park Estates, Anchorage, Alaska. WATER WELL RECORD STATE OF ALASKA DEPARTMEi~T OF NATURAL RESOURES Division of GeoIogicel 8~ Geophysical Surveys LOCATION OF WELL (Please complete either la, lb or lc,) ~]DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Section Nc Slreel Address eno Arec of Well LocGfion E. WELL LOG Materiel Type Feet Below Surfece Top Bottom Drilling PermH No. A.O.l. No, Township N[~]IS[~ Ronge OWNER OF WELL: Addrees: E[~ Meridian we3 4 WELL DEPTH: (final) I 5. 3ATE OF CO~IPLETION 6 L~ Ceble 1001 [] Rolory [] Driven [] DUG E] Auger [] Je,ted E; Bored E3 ot,,er: 7. USE ~ Domestic [] Public Supply [] InDustry [] Irrigation [] Recharge [] Commericol [] Te=t WeII [] Other: CASING: [] Threaded [] Welded diem, in. 1o fl Depth Weight IDS./ ft. di(~m, in. fo ft. Depth Stickup ft. 9. FINISH OF WELL: Type: ' _ ' Slot/Mesh Size Set between Backfilling Length :. fl end ft. IO. STATIC WATER LEVEL: fl. / // []Above or [] Belay, land surface Oote Equipment used: II. PUMPING LEVEL below land surface and YIELD fl. after hrs. pumping__g.p.m. ft after hrs. pumping g.p.m. 12.GROUTING Well Srouled: [] Yes [] No Material: [] Neat Cemenl [] Other: 15. PUMP: (if available) HP Length of Drop Pipe ft. capacity ~.~ Subrn. [~ Jcl [] Centrifical [] Other 14. REMARKS: Form 02-WWR {Il/SI) Dopy Distribution: WHI'I'E-SfoIe DGGS~ PINK-Driller~ CANARY-Cuslorner MUNICIPALITY OF ANCHORAGE i~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section 665¢4UN ,-.,-,~, P.O. Box 196650 Anchorage, Alaska 99519- E .... IN¥1R~,NMENTAL SERVICES DIVISION 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY J U L - :L 1991 APPROVAL FOR A SINGLE FAMILY DWELLING ]~ / NAA# .'/¢//'¢'/tO) ~--~'~ 1. GENERAL INFORMATION Complete legal description LtO ~lO /Wov~JF'4, h 'p.~A¢ ~-5o~'~46/~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address O~.).[t~t~,c,)CC(.~a~,l/P'/:Jl'~i~.hq L. ~c~'~:).('/Day phone 111415 Day ph'one Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Y Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA ~21 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 vedfy 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, andr?gulations in effect on the date of this inspection. Name~fFirm :' ~---,~W,~4~,-'C~, ~.m~.,~l'h~-¢,'~ Phone Engineer's signature '¢~/~¢-~ ,¢---',~_~ Date DHHS SIGNATURE /'~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L~/o ~/O ypt~'. I"~,. ~__~. ParcelI.D. O/"7 Legal Description: A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. Log present (Y/N) '~' DJ+~' ~JL~';. Date completed Total depth Cased to Sanitary seal (Y/N) ~/ ADEC water system number Driller Casing height Wires properly protected (Y/N) '¥ /5'/, FROM WELL LOG g.p.m. Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / Z ~ Absorption field on lot AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer main Public sewer service line -k (00 / WATER SAMPLE RESULTS: Coliform [)ate of sample: & ' ~' ¢' col"V oF Nitrate Public sewer manhole/cleanout Petroleum tank Other bacteria Collected by: ~,/, ~ B. SEPTIC/HOLDING 'rANK DA'rA [:)ate installed Cleanouts (Y/N) High water alarm (Y/N) [::)ate of pumping Tank size /000~ Foundation cleanout (Y/N) Compartments F Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ On adjacent lots To property line /~' f Absorption field Surface water/drainage + [0-0 ! 72-026 (Rev. 3/91) Front MOA 21 ¢ Foundation ~ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION /L) ~ F /'/' ~' C~' r'~, Date i ~ s~'~ Manufacturer ~ Size in gallons~'~_,, Manhole/Acc~ Vent (Y/N) ~~ ~- ',:;;'~off,, level at High water alarm level ~ ~ ~'"~ Cycles tested Meets MOA electS/N) __ ~ S,E ,P,A~STANCE FROM LIFT STATION TO'.~ W_..CJ~dn lot On adjacent lots Surface water '"'----.. D. ABSORPTION FIELD DATA Date installed Soil rating ' ¢/'{~?¢~//~ ~. System type Width Total absorption area ¢/~¢r-U~ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Gravel thickness /O ¢ Cleanouts present (Y/N) Date of adequacy test Total depth for yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots '/' ~'~' Surface water ./_ / ~ ~ Curtain drain /f)~t) ~" On adjacent lots / ~' / Property line /~ To existing or abandoned system on lot ~ ¢ ~ Cutbank ,A,/¢/J~ ~J~ Water main/service line '/"~"~" ~ Driveway, parking/vehicle storage area ENVINGNMENTAL SER/IC~.~; DIVISION Date of Payment ~'/?/~ / Receipt Number ~'~4~. ~ L~ Z-~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number HAA Fee $ / ~/~, '¢'¢'~ E. ENGINEER'S CERTIFICATION ,certifythat, havechecked, verified, Signature Engineer's Name Date ~' ~ ~¢ 'HOME SERVICES, INC 15900 Francesca Drive Anchorage, Alaska 99516 ~ · ,,-- ......... ~ ..... :-~..~-~ .... -345-1890..~..or ~- 3-'45-2444 ..... g ....... ;-. ~ ..... CUSTOMER ' ." , William & Patricia r~cCrory INVOICE P.O. Box 111415 Anchorage, Alaska 995~-1415 Block ~t '-- DATE DESCRIPTION AMOUNT ~ump Set'tic at 5931 ]3everly 'Dr3. ve $ $0 O~ REMARKS ~. : · ~ PRO.L~. AREA--C*LL FOR .OR~ ~NFOR.AT~0. ~ NEEDS TO BE DONE AGAIN IN 8 MONTHS' ... ~ Good Shape ~ Sludge buildup 0n bottom ~ Floater on top ~ Jim cap missing or ~ Cut standpipe to 1' above ground ~ Needs Septictrine needs replacing : CUSTOMER COPY ~ KEEP FOR YOUR RECORDS --PLEASE PAY FROM THIS INVOICE F . SF'LIF'-~i'::1 L--~.-~ lxlI.,'.'~ · ~NCHO~E, AL~SK~ (907) RESIDENTIAL WELL INSPEOTIO.N. LEGAL: I_ot 1('), Block' 10~ Mountain Park' Estate. LOCATION: 5939 Beverly OWNER: William McCrory TYPE OF WELL: Private~ Sin~qle Family~ Located on Lot 9 WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET: Yes WELL YIELD FROM WELL LOG: 3.5 Gallons per Minute PUMP YIELD FROM TEST: 3.35 Gallons per Minute DATE OF INSPECTION: March 19, 1991 TEST PROCEDURE: drawdown was probe. At the beginning o~ the test water lew-~l was ~ound at ~eet below top o~ casing. At a pumping rate o~ 3.3 gallons minute the water level dropped to 143 ~eet a.~ter 20 minutes pumping. Pumping continued ~or a total o~ ~our hours. A t~tal 805 gal lc~ns were pumped. Well was pumped at a constant, rate while the monitored with an acoustic 129 per o~ o~ Recovery was monitored ~or 60 minutes. During this period well recovered to 131 ~eet, a 87% recovery. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested ~er E.Coli and total nitrogen on March 7, 1991 E.Coli O..Total Nitrogen 1.Smg/1. Ma>:. allowable Total Nitrogen 10 mg/1. TEST RESULTS: This well meets 'the requirements o* the Municipality o¥ Anchc~rage. THIS WELL WILL PRODUCE MORE THAN 5 GALLONS ~ER MI___NUTE ~O~R ~ORE THAN ~OUR HOURS The Municipal requirement ~or well ~low is 150 gallons o~ water per bedroom per day. This well exceed this requirement. The assessment o~ the condition o~ the well applies only to the conditions as o~ the day tested. The ~low rate may change due to subsurface conditions that may not be observed ~rom the sur~ace~ and changes in the land use and other ~actors that may impact the aclui~er ~eeding the' well. NORTHERN TESTING LABORATORIIES, 3330 INOUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 2778378 · FAX 274-9645 PRELIMINARY RESULTS REPORT June 28, 1991 Customer Name LabN Customer [D Method Parameter Units Result Constructing Engineers Al11479 LIO BIO Mtn NO3 Nitrate-N mg/l 1.1 Park Estates NORTHERN TESTING LABORATORIES, INC, Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. # ~PRIVATE WATER SYSTEM Mailing~ddress ~ SAMPLE DATE: 7 / / ~/ Mo. Oay Year State Purchase Order No. SAMPLF TYPE: ,~outine [] Special Purpose [] Treated Water [] Untreated Water E] Check Sample (for original contaminated ~ sample with lab reference no. ) Sample Time No. Location Collected 0 C olle~,~b~ Zip Code 4boratory/Re~f, NO,~'~ 9 Signature of Representative FOR LABORATORY USE ONLY CASH CIIARGE PREPAIO TRANSMIHAL SPECIAL INSTDUC¥1ONS MAIL HOLD FOR PICKUP TO BE COMPLETED BY LABORATORY Received at: /Anch. [] Fbks. / Date Received Time Received Next Sampte Due COMMENTS: SATISFACTORY UNSATISFACTORY RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT U R OB TNTC Dlte~t Verification Final Count LSB BGB Result* ~N .~'f~Total Coliform.,,~olo~ies per 100 mis. Date ~ ~ NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-456-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIEN'r PUBLIC WATER SYSTEM I.D. # ~ PRIVATE WATER SYSTEM Mailin9 Address City State Zip Code SAMPLE DATE: ~o 2_,~- ~x Phone ~©z)~'g Mo, Day Year Purchase Order No. SAMPLE TYPE: 'J~ Rout[ne [] Treated Water [] Special Purpose [] Untreated Water [] Check Sample (for original contaminated q//~sample with lab reference no.. Sample Time No. Location Collected 2 3 4 5 6 7 8 9 10 ) Laboratory Ref. No. Signature of Representative MAIL HOLO FOr~ PICKUP FOR LABORATORY USE ONLY TO BE COMPLETED BY LABORATORY Received at: ~Anch. [] Fbks. Time Received / 3/~ Next Sample Due COMMENTS: SATISFACTORY ~ UNSATISFACTORY U RI--SAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final Count LSR RGB Result* 041o.8. ---~ D4- l o.b. Comments a~ ~..~f o r~~ Time APPLI(' ~T FILLS OUT UPPER HAl ONLY Lending Institution ~/ t~ "~" Street Locati~ , ~ Type of Residence /~' Single Family Multiple Family No. of Bedroom_ ~ Other Water Supply  Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. Community t"' For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal Year Individual Installed: .~ Individual ~uBlic ~tiHty Whon Gonnocted to ~ubHe ~tility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. 7 Time I Time Time i Time , Da Date Date ~, / '~~ ~~ /~--_ ./ . ( ) CONDITIONAL APPROVAL* DATE '~ '~' ~ / Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received 6 '--~ ~ Well to Tank Septic T~k Size 72.023 (3/821