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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 10 LT 12 Municipality of Anchorage DEPARTME"NT 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 Permit Number: _~ {¢~ '~_L~¢;~---- PID Number: No. of Bedrooms: LEGAL DESCRIP'flON Township: Section: tELl.: Driller: Yield: [] New [] Upgrade Private, A,B,C): Total Depth: Cased To: Date Drilled: tatic Water Level: Ft. Set at: Casing Height Above Ground: GPM J Ft. Ft. SEPARATION DISTANCES To Septic Lift From Well Surface Water Lot Line Foundation Curtain Drain Remarks: Wastewater System: [] New Jpgrade ABSORPTION FIELD )eep Trench [] Shallow Trench E] Bed [] Mound [] Other . . I Total Depth from original grade: Soil Rating. ~ I J ~. 0'~[.~/ GPD/Sq. Ft:.I -- ~ )e~l ~ Io p,pe bottom from original grade' J Gravel depth beneath p p / ~ Ft. ' 41~ nber of lines: between lines: ~:~ f_ ~/ ----'-' Ft. Total absorption area: Date TANK ~tic anufacturer: [] Holding []S.T.E.P. in gallon: Material: Mai Number of Compartments: LIFT STATION ;turer: "Pump on" level at: water alarm at: Pump Make & Model -:lectrical Inspections performed BENCH MARK Location and Description: ;sumed Elevation: ENGI =.AL S & $ ENGINEERING 17034 Eagle River Loop Road, No. 204 Inspections performed by: -E~¢.k~ .. .0 ~7~,_-- Dates: Department of HealJ~ an.d Human Services approval No.~: 72-013 (1/91) MOA 25 Permit No. ~) Iq~'/~''~ Page_ ~ o! ~ rvlunicipality o~ ~nc~ora~e 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 LegalDescription: ~~ [~ ~ ~ t~ PIDNo.: ~{~~ /\ 72-013 A (2/91)MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920162 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:STEEN RICHARD B & OWNER ADDRESS:9300 ARLENE #221 ANCHORAGE, AK 99515 DATE ISSUED: 6/30/92 EXPIRATION DATE: 6/30/93 PARCEL ID:01744129 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK LT 12 10 LOT SIZE: 27200 (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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS DRAINFIELD MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN DATED 6/22/92. RECEIVED BY: 0' (_2")' DATE: DATF. ~/~ ,/~__ June 23, 1992 ROBERTSHAFER, PE ROGER SNAFER. P.E CIVIL ENGINEERS (907) 694 2979 FAX 694 1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAiN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage, DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 12; Bloc~ 10; Mouv~ain Parr Estates Reques£ you issue a permit to upgrade the septic system serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be less than adequate,. A test hole was excavated and a percolation test performed in the, area of the proposed upgrade,. Attached is the proposed upgrade design. The, lots in this area are relatively large. Therefore, we do not anticipate any adverse, effects on n~ighboring properties by the installation of the proposed septic upgrade. If you have any questions or require addition~ information for yo~ revi~, please contact us. ROGER J. S~AFER~ P.E. JPW/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMFNT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 2O COMMENTS-- SITE PLAN IF YES, AT WHAT ~ DEPTH? [~onilorino? - §~t~: -- Gross Net Depth to Net Reading Date Time Time Water Drop ~f 5;~£ pc- -' 6 Y~" PERCOLATION RATE ~,'~ tm,nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN - _ FTAND - 0 _F7 '~%~')~ CERTWY THAT THIS TEST WAS PERFORMED IN RMED BY $ 8. $ ~;NGINEE[tlNG ~ _ ' -- 17034 mag[e River Loop Road Ne, ~ DANCE WITH A ~ ~ GUIDELINES IN AOCOR ~1¢T8~, ~r~,~ ¢~8¢~ ~c~ ON ~H~S bA~S. oGR ANCHORAGE AREA Bor"'IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J~'/¢¢'/ /~'/~'¢?~:/P/ MAILING ADDRESS /~'/:¢" ~/ LOCATION ~//~¢-~ /~// LEGAL DESCRIPTION SEPTIC TANK: DISTANCE :/ / //~:~.-~..-/f~-~ NUMBER OF _ FROM WELL MANUFACTURER~-~"'.~'¢/'4/~''':-''¢''J MATERIAL ~'d*"~/~2~'~- COMPARTMENTS .... __.LIQUID CAPACITY /-/¢'/¢~'¢ GALLONS. INSIDE LENGTH INSIDE; WIDTH LIQUID DEPTH -- SEEPAGE PIT: NUMBER OF PITS /* DIAMETER LINING MATERIAL/~:/¢~-/¢~Z/Z¢% CRIB SIZE: BUILDING FOUNDATION ~ ," NEAREST LOT LINE ADDITIONAL ABSORPTION OR WIDTH ., LENGTH ., DEPTH ./ / DIAMETER ~ DEPTH ~ DISTANCE FROM: WELL /?-~,;?.:~-'~A % TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~"~'~"~ SQ. FT. WELL: "</~'> ~ /~:~- /~';"??"~2-: ~/~-~-"~" . [¢ ~ "~ DISTANCE FROM: TYPE ~/~/~//~: CONSTRUCTION ~ ~~//~:GEPTH ~ / BUILDING FOUNDATION ~ LOT LINE /~ ,/~SEwERNEARESTLINE /¢-/~ ~'¢~ / TANKSEPTIC/~/.,~:~, SEEPAGEsYsTEM /~'~/'~ APPROVED NEAREST OTHER SOURCES //~¢¢/~/~:-' DISAPPROVED REMARKS PIPE MATERIAL: /:Z:~?'~..: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM G.A.A.B. Form No. EQ-031 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 perMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGAL DESCRIPTION OTHER INSTALLATION OF: SEPTIC TANK ~'~/ . SEEPAGE PIT-- DRAIN PIEL. D TYPE AND SIZE OF FACILITY TO BE SERVED---' Y~' /~'~ SOIL TEST RESULTS NOTE= THIS PERMIT 15 lqOT VALI[} WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED - FINAL INSPECTION: ;~4 HOUR NOTICE REQUIRED. BACKFILLING Of ANY SYSTEM WITHOIJT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANC:BS, REQUIREMENTS SEPTIC TANK TO SEEPAGE PIT WALL ' ~_ ,1~ DRAIN FIELD SEEPAGE Pit --~//'~ ~) ALSO CONSIDER AREA WELLS, SEEPAGE PIT SEPTIC TANK, --//~ SEEPAGE Pit /~)O DRAIN FIELD /~:~ ~ TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIl-, 4 INCH DIAME'rER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT PITTED WITH AIRTIGHT REMOVABLE CAPS, I:)IAGRAM Of 9YSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. [ CERTIFY THAT I AM FAMILIAR V¢ITFI THE REQUIREMENTS OE~ AN ORAGE AREA BOR H ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ~} 4c ~- ¥ '- '7~/- E (~ DATE ~/ ~ ~ APPLICANTS SIGNATUR ~/~/ GREATER ANCHORAGI~ AP, I:iA BOROUGH DEPARTMENT OF EN\~T~aN''iE~val QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For ,'" : ':~,o'-.u: Dated Performe Legal Description: Lot Block This Form Reports Soils Log_:~_ ......................... Percolation Test - Soil Test Must Be Logged To ~' Below Proposed Seepage System Depth Feet Soil Ch arac%er~s~?.~ 1 2-- ~. ~. ~u .:/ Reading Percolation Rate ! t Depth to H20 I Net Date ! Gross 'F'i!lle i Ne Time . Min~I",:e t/ Drain Field Proposed Insi'.l_~'l~t~'~'~,i: Seep ~aclq Pit ~ . · ..... ~--~. . l-~.x Depth oF In.e~ . ........... ~ ....... .. - , .~ ~ Rick Mystrom, Mayor Mu -icipaHW of Anchovag e Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 4, 1997 Steve E & Mary D Waltz 5901 Beverly Drive Anchorage, Alaska 99516 3103 Subject: Lot 12 Block 10 Mountain Park Estates Subdivision Permit #SW960075, PID #017-441-29 The subject permit, issued May 16, 1996 by this office for a single family well and/or on-site wastewater system, has expired as of May 16, 1997. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, /~ J~es Cross, P.E. P~ogram Manager On-site Services enc: Copy of Permit MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 1.96650, 825 "L" STREET, RoOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (uPGRADE) pERMIT PAGE 1 OF pERMIT NUMBER:SW960075 DESIGN ENGINEER: oWNER NAME:WALTZ STEVE B & MARY D o~ER ADDRESS:3901 BEVERLY DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/16/96 EXPIRATION DATE: 5/16/97 PARCEL iD:01744129 LEGAL DESCRIPTION: MOUNTAIN pARK ESTATES BLK 10 LT 12 LOT SIZE: 27200 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS pERMIT IS FOR THE CONSTRUCTION OF: WELL 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) · THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HouRS 3. pROVIDE NOTIFICATION BY pRIOR TO EACH iNSPECTION. CALLING 343-47~4 ( 24 HOURS ) - {NOT REQUIRED FOR wELL ONLY pERMIT) 4. FROM oCTOBER 15 TO APRIL 15 A SUBSURFACE sOIL ABSORPTION SYSTEM UNDER cONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED To.PREVENT FREEZING 5. THE FOLLOWING sPECIAL PROVISIONS SPECIAL pROVISIONS: pRIOR TO iNSTALLATION, ENSURE 100 FOOT sETBACK FROM suRROUNDING SEPTIC SySTEM(S) · ISSUED BY:~ DATE ,0, {~'~ ,, I ~/ ~ · ....- .--_,__ ~ ~, ~1 I~-.., ...... ~ ~f ;,F- -'~ - ~ ' ~ ,' / ~ ~,, ' I ~-~ ~,~r ... / -- ~,~,~ ~ . ~ .. .. . ., . ~ ' ~ ~ ~0T P~ .... AS-BUILT , , , ~OT ~ ~. . T~A~Y .... IT IS ~E RE~ON~ILI~ ~ ~ BUlmER ~ O~, PRI~ TO ~LY ~O~ IMPRO~EN~J ~O~ ~OUND AND ~B~ ~ BE ~E E~S~CE ~ ANY E~, CO~N~ ~ ~¢S~1~S ~,, ~[ ~O~ ~ ~R APPRO~MA~ ~A~, ~Y. ~NOW ~ - .,~ ~ ~'t*.. Robe~ E. Johns, Jr. ~ Assoc. ~~ ~ Prof~l~ol ~nd ~~ ~*o~.y~'~ ~ ~t,~ 8-4-92 ~ 2838 92-095 ~ ~ ~ ~ ¢~ , -.. ~~,,, LOT 12, BI,OCK 10, HOUNTAIH PARK ESTATES o~e ~e~ J ~ .... IO /0 Permit No. (~ [.~,~._[-~.4:~ Page. Municipality of Anchorage 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 Legal Description: ~L.~'~---¢--~ [d.~ ~ ~ ~.-"'~j PID No.: _~)f-"~"~""~{'~.,.~;:~ 72-013 A (2/91) MOA 25 GRE""ER ANCHORAGE AREA Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM NAME.__..~//,?~, i.~/~'~ --_ MAILING ADDRESS LOCATION ~/~ ~//~ __ LEGAL NUMBER OF SEPTIC TANK: "J"'~ ~"'~; f'~-- COMPARTMENTS DISTANCE ¢/ / FROM WELL M AN U F AC T U R E R _~,,,,~/'¢,¢--¢',.~'¢' MATERIAL ~.~ LIQUID DEPTH_ ~ _LIQUID CAPACITY /~:2'.//~' .GALLONS. INSIDE LENGTH m INSIDE WIDTH. SEEPAGE PiT: / ~'" .~'/b · -""' DEPTH NUMBER OF PiTS / DIAMETER OR WIDTH LENGTH LINING MATERIAL~:~'~/g~ CRIB SIZE: DIAMETER ~,DEPTH~ DISTANCE FROM: WELL_/~ · /~.~/. TOTAL EFFECTIVE BUILDING FOUNDATION~,' NEAREST LOT LINE~ ' . ABSORPTION AREA (WALL AREA) ~ SQ, FT. ADDITIONAL ABSORPTION WELL-: / ///~.///L/.~./~..~c/Z__/_.d~'~PTH ..~/....2 / -'/G/.~/~'"~/.,'P~- "' O N ST R U CT I O N ~ ~//~ / ' ' ~/r/ ...... ~ / TYPE _//~/ .... // / . , NEAREST ,-/__ NEAREST ~~ SEPTIC~ BUILDING / ......... /~ ~ SEWER LINE-- ~., TANK, ., FOUNDATION- ~ ~, LU/ u~r. ¢ CESSPOO SOU"C S APPROVED ~ DISAPPROVED-- REMARKS~ ~/~ ~~ __ DISTANCE FROM: SEEPAGE SYSTEM --/ - - DIAGRAM OF SYSTEM G.A.A.B. Form No, EQ.,O31 Rick Mystrom, Mayor 1Vlu ficipality of Anchor ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 3, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for T15N R2W Section 25 Lot 142 Waiver Request #WR970010, PID #051-312-22, HA970101 Dear Mr. Cowan: Your request for waiver(s) of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are the private well on lot to the septic tank on lot of 75 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. lincerelyf/ , I/ lames P. Williams :ivil Engineer On-site Services Program ljm:#6 Newbury 08/11/97 ~ION 09:30 FAX 9075611flS4 Static Water Level ~. feet Draw Down. }.Ilia_ feet RECEIVED AUG 1 1 1997 Municipality of'Anchorage Dept, Health & Human Servioe8 Gallons Per Minute ' -~ _ Total Feet of Casi,ng_ ,~ Material Drilled: to l% 99516 MUNICiPALiTY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES 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 1, GENERAL iNFORIVIATION ~,' '.,' .........: Complete legal description Location (site address or directions) 5901 B~verly Property owner Richard & Patricia Siren Day phone 248-362_ 9 ~ '~. 261-6700 Mailing address --~ // Day phone Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well NOTE: 3 ~ XX Day phone Public water -------- If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. X× TYPE OF WASTEWATER DISPOSAL.: individual on-site 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} ¢ront MOA 1~21 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 verify that based on the information obtained from the Municipality of Anchorage flies 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 17034 Eagle River Lo~ Road Eagle River, AJaska 99~77 Engineer's signature DHHS SIGNATURE .A" Approved for 3 Disapproved. Conditional approval for Phone 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 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 Ps issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 IRe¥, 1/91) Back MOA ~21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: d;~.~o¢~ ~ ~ ["~-- Parcel I.D. A. WELL DATA Well type''~ Log present Total depth Sanitary seal ~_y~N) IfA, B, orC, attach ADEC letter. ADEC water system number Date co m p leted ~::::FO ¢Lt~ Driller Cased to ~ ~ Casing height /~' Wires properly protected ~)'N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION g.p.m.~ ; On adjacent Jots J ¢~ ; On adjacent lots J OO ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main -- I,,..~/-~ Sewer service line ~ ~ Public sewer manhole/cleanout Petroleum tank. WATER SAMPLE RESULTS: Coliform (~ Date of sample: Nitrate ¢k,~£')" ~)PT[~(f~O Other bacteria -/'~ ~ ~- Collected rr B. SEPTIC/HOLDING TANK DATA Date installed ~'Jl(¢l~"~ Cleanouts(~N) ~ High water alarm (Y/N) Date of pumping ~ ~/,-~ Tank size J 4~:~4:~O ~__~-/~ ~ Compartments _ Foundation cleanou~N).,.~ '~ Depression (Y~ Alarm tested (Y/N) ~ "° ,,_[ [~_ Pumper To property line ~:~J' (¢ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [~ (¢~ On adjacent lots I 4;~4:~ iR- Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE 72~026 (Rev. 7/91) F roni C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level -M~ole/Access (Y/N) "Pump on" lev t~'''~ "Pump off" level at j ~ Cycles tested Meets MOA electrical co~s (Y/N) SEPAR~CE FROM LIFT STATION TO: Well on'lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed. '~1' I I ('¢/~'''~- So,I rating Length_.~ / Width ~1 Gravel thickness System t y p e"~~ Total depth Total absorption area _ ~)¢ Depression over field (Y/~ ~ . Results (pass/fail) ~,DJ~,LD ~-----~'-/~-F-J~ Peroxide treatment (past 12 months) (Y(~ I~ Cleanoutspresen (~N)% Date of adequacy test_ ~--~/-¢~ , for ~ ' bedrooms If yes, give date ___ ,/~///'~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ~)~l' / To building foundation On adjacent lots _ '¢'~© ' Surface water ~ O~::P Curtain drain To existing or abandoned system on lot Cutbank t'~ ¢ ¢__., Water main/service line Driveway, parking/vehicle storage area On adjacent lots_ ~ (~O~-I- Propertyline JO/ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signature . 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's Name HAA Fee $ // Date of Payment Receipt Number. 72-026 (Rev, 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number  1 7034 Eagle River Loop Road Ea"--g~e River, Aleska 995?? ~ ** WELL FLOW TEST DATA SHEE1 ** PROJECT: 'C"h \C-V~CLO ~-C~-~ LOCATION OF WELL (Legal Description): ROBERT A. SHAFER CIVIL ENGINEER ~,94-2979 DATE OF TEST:_ '")7-"f ~- c/~ WELL DEPTH: S~'~A' FT. DATE DRILLING COMPLETED: -L'~---~I~I~- STATIC WATER LEVEL (Top of Casing): CASING: ~01't* FT. SOflEEN:_ -- 8 /~ZL~ DRILLER: ELAPSED TIME SINCE CLOCK / PUMPING STARTED/___ ~P~B~e VV~TE~ ~LLONS' ~ PUMPING TIME /. STOPPED, MIN. ~R~) (~&~U~b ~O~)~M~ ~W~ RATE, GPM.. REMARKS ~'.OOp~ 0 ~0~ , 113~swl) 0 Start, ~oKPP- ~fl AT ~_. 45 50 55 60 (1 hour) 90 120 (2 hours) p~ 180(3hours)~_ -- 240(4 hours) ~'.0o 19~ '~"/~-~[ _ Comments: W~_~(.~ P~ZO~(ACF_.~ IN ~N-r-~S' Flow is not Guaranteed 6~ H~o G-~ONS ~ g~y S'ubsequentVariations C~n Occur. CItEM!CAL & --,EOLOGICAL LAB ORATORY A DIVISION OF C.?'/',2RCIAL TESTING & ENGINEERING CO. TEbEPHONE (90*. -~ ~ ~ B 8Itel Ar',~or*ge. Al~s~ g~18 Drinking Water Analysis :.¢;ort for Total CoLiform Bacteda TO BE COMPLETED ~3Y WATER SUPP_E-- RIVATE WATER 9YS'fE~ M~/n¢ ACdr~ gAUPLE D^TF.-: ~ Dey your SAMPLE TYPE: E~ Routine [] Check Gample (for routlrle 9ample with lab ret. no._ E~ Special Purpoae SAMPLE No. LOCATION , t ,.Lo7 TO BE COMPt. ETED BY LABORATORY Analy,ds ehowa this Water SAMPLE to be: ',~ Sati'qaclory E'J Unsatisfactory [] Sample too tong in transit; ~amplo ~hould not I~ over 3o hour3 cid 8'[ examination tO indicate rdlable results. Please send now sample via s~oial delivaW mail O~t. Re,,vod ~/~' -- Time Received Anal~lcsI Method: Membrane ' No. of colonlo~100 mt. READ INSTRUCTIONS Membrl)n~, ;'? ;!feet Count BEFORE COLLECTING SAMPLE TNTC = Too'Numerous !:..;TERIOLO~ICAL WATER ANALY$1.~. FIEOORD ._ O_. Collfer~lOO mi ~lltorm./lOD mi · _.7/t ,? -~ APPLIC, ., iT FILLS OUT UPPER HAL, Mailing AddreSS Buyer ,b"'- ~ i.~.~ tA~- ~ Zip Code ~,ddress Lending Institution Zip Code dress Realty Co. & Agent Zip Code Address V Description I ,¢ 7-/~ ,~)i~ tg /~'~ ~L "4f Street LocatiOn idence ~ Family ,~¢'- [] Multiple Family No. of Bedrooms~ ~ Other ~I Phone vidual E~ Community [] Public Utility Disposal ~.,-i~divid ual ATTACH WELL LOG. A weg tog is required 'ior all wells drilled since June 1975. For wefts drilled prior to that date, give well depth (attach tog if available). Year Individual Installed: When Connected to Public Utility: Public Utility Holding Tank Time Date Inspector Field Notes: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date lespector Time Date Date MUNICIPALITY OF ANCRORAGF- ~ APPROVED BEDROOMS DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE ~ *CONDITIONS OF APPROVAL ALASKA ei1UIROnlTI I'ITAL gOFITROL $ I4UIC S, IBC. JANUARY 3 1983 JEFF. ~CHA~FER PO BOX 1413 ANCHORAGE AK 99511 SELLER - BUYER- SUBDIVISION-MTN PARK EST ~2 BLOCK-10 LOT-12 ~)tDQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTk~4 IS A PIT WI'SH AN AREA OF 426 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 300 GALLONS OF WATER PER DAY. 'SHE SURGE C3LPACI'rY OF THE SYSTEM IS 300 GALLONS. BASED UPON T[-IE TEST IDATA THE SYSTEM IS ACCEF~ABLE FOR A 2 BEDROC~ THE SEPTIC 'SANK WAS PUMPED ON 11-24-82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 2 BEDROCI'4 HOUSE. 1000 IS ADEQUATE 1200 ~J¢sl 33rd Auenu¢, Suilt ~ * Anchora(F, Alosk, 99503 · [907) 276 1361 Jeff Schaefer ¢.O0 Box 10-1413 Anchoraqe, I'XK 995].1 Subject: Lot ].2 )~loc)c 10 ~,'fountain Park J,]:~tates Approw~l for the individual sewer and water facilities cannot be %~ranted until the following items haw~ l"~oen completed: °~ The water analysis report noe(']g~ to bo submitted to this ~ office from the (]he~]l Lab, 5633 ~ Street, for Our reviet~/. The septic tank punt}[~ed with a rece:Lpt submitted to this department. An adequacy best needs to be perforx~ed on the existing leaching area° 'Phi.~ test will determine if the svstem is adequatte ac:cording to National Standard~;. A listing of pr:[vate firms pe]:forming the test is enclosed. This report needs to be sub]~lit;:e(t to this office for our review. Please notify this Depart'n'~ent for a reinspection when the noted discrepancies have been cor~?ected. If there are any further questions, pl(}nse call this office at 264-4720. Sincerely, llobo, rt C, Pratt Associate Environmental Specialist GREATER ANCHORAGE AREA BOROUGH ~ Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Date Received _1(~')-~- Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: ~~q.~p~ ~ ~ ~~; Mailing Address: ~V~,oo ~ ~ ~q~ll~ 2. Property Owner: ~~~S Mailing Address:~ ~m~ ~ 3. Legal Description: 4. Location: . 5. Type of facility to 6. Well Data: No. of bedrooms B. Depth C. Construction Sewage Disposal System: A. Installed~&~. D. Bacterial Analysis Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area 2. Manufacturer 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - ReqL Legal Description ~ m) for Approval of Individual S¢ ~ & Water Facilities Comments al,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED D~te EQ-034 (1/7q) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA Mailing Address: ~)~'~,. ~ - ~'~p ,~ ?'~-~-~ ~ 3. Name of Buyer: FHA CONV Mailing Address: 4. Name of Lending Institution: _.~1 Mailing Address: ~<:~' *~ , \ 5. Name of Realtor or Agent:. Mailing Address: Day Phone Phone Phone Legal Description: Location:_ 7. Type of Facility to be inspected: __ 8. Water Supply If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation No. Bdrms. Type of Supply: Public Utility If Individual, number of dwellings presently served Individual Public Utility -- . Individual (on-site) EQ-037 (1/74) A'~' GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Date of Inspection e 1. Approval requested Mailing Address: Property Owner: Phone: Phone: Mailing Address: Legal Description: 4. Location: 5. Type of facility to be inspected 6. Well Data No. of bedrooms A. Type B. Depth D. Seepage Pit: E. Disposal Field: Distances: C. Construction ~,~¢/~/~,~Z~,m?~ D. Bacterial Analysi Sewage Disposal Sy.stem: (x'~-2~Z~/m.~~ A. Installed /~;y~ B. Installer ~~.~f~ ~,~-)(~,~,~.,~... C. Septic Tank: 1. Size/~~, 2. Manufacturer 1. Absorption Area ,~,~' ~ 2. Material Total length of lines A. Well to: Septic tank ~/, Absorption area /'-~,m'''/, Sewer Lines~.~, Nearest lot line /~' ~,Other contamination ~'~7~'~'-'/~,~. B. Foundation to septic tank ~"',¢~ , Absorption area ~ / C. Absorption area to nearest lot line EQ-O34 (1/74) Page I of two pages Page 2 of two pages - R~ 't for ApprOval of Individual Jr & Water Facilities Comments Approved ~, :~... '::'~'. ...... ~.~'~"'.. .i Disapproved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) [~f~/'i:;~)~),,, ,,,,,.., GREATER ANCHORAGE AR~: BOROJGH \~i:i, ii ii :! i'.:f / Department of Environm~r, tal QualityF ~~/ 3330 "C" St., Anchorage, Alaska 9950S - REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1 Type of Inspection: CMRO 2. Propergy O~ner: dames ~. Brown · ~'M~lJng Address: O,~X ~'~07 Day Phon 3. N~me of Buyer: DennJs H. & Jeri L. Bump Mailing Address: 1626 W. llth Ave., 99501 Day Phone 274-7522 4. Name of Lending Institution: Alaska National Bank Mailing Address: POLICh 7-O1Q, 9951~ Phone 277-5511 5. Name of Realtor or Agent: Star Realty Mailing Address: 640 W. 36th, 995n3 Phone 279-2491 6. Legal Description: Lot l?, Block lO, Mountain Park Estates Location: NII[,I Beverly Drive, Anc§oraqe, Alaska 99'.i02 7. Type of Facility to be inspected: Home No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility Individual x If Individual, number of dwellings presently served If Individual, depth of well ,~<~ ~-"~ ~ ~.~.r~,.~, Sewage Disposal- System ~ -~'~,/)~r .... Type .of S>stem: Public Utili~'~--Individual (on-site) x If Individual, date of installation ~d/~ '¢fl 0 .,~ - ....~ ~~ ~Y/~°~ MOUNTAL~? ~' NBLOCKpARK IOTEs SU BD I~SON