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HomeMy WebLinkAboutMOUNTAIN SHADOWS BLK 2 LT 3Mountain
Shctwdos
Block 2
Lot 3
#017-401-18
MUNICIPALITY OF ANCHORAGE
DE ,dYMENT OF HEALTH AND HUMAN SER. ES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name_
DISTANCES
" 1_ / , '4.-D T ;i
TO
SEPTIC
ABSORPTION
WELLAddress
FROM
TANK
FIELD
' �.� yj� c_
Vic?
✓
�,`T'-
Phonetsl /7
Permit No
No. Bedrooms
WELL
/ b i
1
. we-�l'�'i�
l
• <� 3
- Y
LOT LINE
U ' •"`?r
����
_
LEGALGESGNIPTION
/c,
c„-,u�,'s'
Lot 4_.
4'
Block
m-
Subdivision /
1", ti�"4 C✓,D c._S
FOUNDATION
rr
='.
ter'_ ✓
j % ✓
Township, Range. Section
7 ' ! • %
/ //r/V . C,
AS BUILT DIAGRAM (Show location of well. septic system. property lines, IOulldaaOO,
dnvt,way, water bodies, etc.)
—::-/-' '/ -JA-'j:-&)
—J- TANKS
I■■Irma
•■
J HOLDING■r
Ji
-SEPTIC
Manutactu, et
Capacdy In yallons����� /�_:,()
..
■
Maleneu
Sc�E /
No- of Gompadmenls
■■
■
■■•TYPE
OF SYSTEM■
■■
❑ TRENCH ❑ BED X W. DRAIN ❑ OTHERT
►
1
iv:11
Depth to pipe bottom Iron)
original grade !
1 oral depth tro rloriginal grade
7 {_ FT
■
I
■
■■
�
■Gravel
1
depth beneath pipe �c�j✓✓iIIIbNIiL'
FT
Gravel width
FT
l oral absorption area
Distance between Imes111
.
a
1-C/SQ FTFT
1
t
'
,
■
Soil
Pipe matenal /r-GCes
Number of nneS
>
rating
SQ FT'
,c'eecT�.-
fare /red -4Z,/,!-7(' 303 `/
I
Installer
iLe
Dale Installed��7
PFil
� p-..-t✓6t /CT r�: G••7-t�4L -.
(�1//�C./ ,
'LLS
'l�
PRIVATE ■ OTHER (Identity)
:
,
�
��
���
ClassJlcatron (A.B.C;
Total Depth Cased t0/at
_ --e L3 l �t.ro P
FTI FT
.
l,
I
_�
i
a
Inslal'er
.
Date Installed1
111
A
ME
6111■
III_Eli—
REMARKS: (-�C l 6 ,/e-/(�...- caf- C_..xlsT"„,t; C��
c, zit � ``�C l
■
■,
�,'
■
�
1
••%
.7-!J([3
j-/�__.() c7 ic>67 ,J.4't Ar.'-o''-7%Ly t-, .-E'-, c-e-e f/cel -” •1‘,, I
70/4._ P C-l-,J.5 J2 ' c•-•(' -17, ` 4` (5....,' Cr'�, -.7c,S<- ;
Scale:
Inspections Perlormed by:
,.ENGINEER'S SEAL
.4b7krkt®gv�
JL'e 0jc-� >•(s., e-s-r✓nc /� _ Or-
_,[J-4-=5�%�/ /c.C:
„. �� OF
/;:-:,.: s."• ; -N
} - l``� i r
II /�/i ,'�C��,4y`-K KZ SY 2)`�r
Dale. 6/�tGf/S�k,
4A4�%1
air /� e
�/.e�e�ee a��!�
`S
�_Leui� ce:7'- /:��.; ,. ,� -1r :;/yc J/i.�e.S-/l:Jo={c'-
-�'j,+
C.il/G/C%1ro� C�-LC-�:I)'-
'I
_ -
� 9�•ape
: d t e
{�Y ieo •+a � 000.. Ba �oaa10 % a44 ®4
i /
1 `„ lr 1- ._T1114 10 -. c fifty that This inspection was performed according to all
.�A o L�1L11
WI.
dale
John E%. Swanson t
®� Crt °a CE-1834 ,.�
Municipal and Stale guidelines in eltecl on this
cj� l _. /-. 77/�r Date: �' -1-6
.•
oa
Qe 9Fonae,00ear.,o°�b���
®�®AOR.-.: OC1a.
Health Department Approval:
,��-� �H+�
79_1115 t% -ft
71- MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I11 ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
Mohamad Ghaffari
PHONE
344-8042
IR)NEW
El UPGRADE
MAILING ADDRESS
c/o GEOLAB 1131 E. 76th Ave. #101 Anchorage, Alaska
LEGAL DESCRIPTION
Lot 3 Block 2 Mt. Shadows Subd. Sec 25 T12N R3W S.M.
LOCATION
Jeanne Dr. off Upper Huffman
NO. OF BEDROOMS
3
SEPTIC I
TANK
DISTANCE TO:
Well
109'
Absorption area
7'
DwellingnOt in
is ••O ed 40'
PERMIT NO.
Material
Steel
No. of compartments
2
Manufacturer
Greer
Lig. capacity in gallons
1250
IF HOMEMADE:
Inside length
NA
Width
Liquid depth
OJ t7 z
oz FQ-
DISTANCE TO:
Well NA
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TELE
DRAENFIELDf
TRENCH CI,
DISTANCE TO:
Well
99.5'
Foundation not In
propose• AI'
Nearest lot line
10'
PERMIT NO.
Total length of lines
50'
Trench width
5 feet inches
Distance between lines
6'
No. of lines
3
Length of each line
12' 18' 20'
Top of tile to finish grade at least 4'
final grading not done
Material beneath tile
drain rock 18 inches
Total effective absorption area
SEEPAGE
PIT ip{
Length
NA
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
d
n
Class
Individl
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS Cast iron hse to tank,D30:4
tank to field & dro• linAg12729 in
\
i
:-A-k%1
=
�(
SOIL TEST RATING I _ 1
field.
/0 '1z ''-� _ , �° _/,d,
\,'
v
y
` 7,-,z,
r6:(r--
q
INSTALLE' t t.... .. ✓1.. f v
Cadil.lac Const. ction j�
1E1
C
"�r,c,
wee',>
re"`x'tr'e"(-^
rrL
�C----
u.
REMARKS
Paper used as a silt barrier in
)Y')
).t)30
1 l
drain field. 2" Dow Styrofoam-1;e
used over septic tank and over
,
��"7�
}"
,0
JZ
lc
ler
/.,,`7f
/,
<f
line from house to septic tank
14Ju1 fN6,1., 4.3,7.04/-60_rrlr7, >/ F. -/--#1,v GL? 7O
y
7
t
��,�
((//
�""
k4 ^
6-
•
,
t
I 1
:�.
VE-11.6 61,1 b 6/c!(i" WE'LL 'ie�,
/ y)J I '', / / "7 ,v," I l,-,- y.� !,( �, �i -.
a 1
�;
r
1I7/:--
ME
I,
S
p�,,,y
fir t, Crl ..
( v '? ✓ "
c,_, > . („
-`
'
c/./4.4
, 2.0.i
.-�c. ��<�<h '� f
t,-,:;.) u„ /C<h_c,, fQr��cor
.
1101E
1
Ilk
,5-e-6
fiTl`15LsiEi)
-u-?-?<,e<(. Al'
/
relS
6,11.1g
d ,'-
a�('
{-r L�Ga ACta"--116261't1n^02. l
'7cWA9 fie ro 9 r 1': ,. e�n\".'h
�,
APPROVED '1(c:/ g DATE LEGAL <'
ri
72-013 (Rev. 3/78)
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF J-IE.ALTH & ENVIRONMENTAL PROI PION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE NEW
344-8042 l ❑UPGRADE
Mohamad Ghaffari
MAILING ADDRESS
c/o GEOLAB 11:31 E. 76th Ave. #1_01 Anchorage, Alaska
LEGAL DESCRIPTION
Lot 3 Block 2 Mt. Shadows Subd. Sec 25 T12N R3W S.M.
NO. OF BEDROOMS
LOCATION
Jeanne Dr. off Upper Huffman
` Well Absorption area
109'
DISTANCE TO:
U Y
F-
2 Manufacturer
n<
UJH
Liq. capacity in gallons
1250
Z I DISTANCE TO:
Z d I Manufacturer
pr. r
Greer
IF HOMEMADE:
Well
NA
�x I DISTANCE To: 99.5'
w u r No. of Ines �I r�gth� of eachli ZO
Gw 3
Inside length
Dwelling
3
NA
Dwelling not in
proposed 40'
Material
PERMIT NO.
No. of compartments 2
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Foundation not in Nearest lot line PERMIT NO.
101 - r '
Qnaae
focal length of lines
50''
Trench width
5 feet inches
k- -- f----- ,- 1 Material beneath tile
'II_ Top of the to finish grade at least 4
®__ final arad1na not done drain rock
w ILength Width -..-._. Depth
\A
O
Q f- �-i ype cf crib
a I
W
La
Well
DISTANCE TO:
1 8 inches
Distance between lines
Total effective absorption area
PERMIT NO.
Crib diameter
LI
Crib depth
Total effective absorption area
Building foundation
Class Depth ------- Drill er
inciiv>du:1
in Building foundation Sewer line
DISTANCE TO: ------
Nearest lot line
OTHER
PIPEMATERIALS Cast iron hse to tank,D30
tank to field & drop lines,D2729 in
SOIL TEST RATING f 1.P 1d •
NSTAL LE
Cadillac Construction
REMARKS
Paper used as a silt barrier in
drain field. 2" Dow Styrofoam
used over septic tank and over
line from house to septic to
Ovot
Distance to lot line
PERMIT NO.
Septic tank I Absorption areals)
/
_
4-94 4 1N
E'
����
•,'/ -6 U U040U�
J it
-,fir,
r(s_
X -
,.t
4,4
-APPR OV ED
72-013 (Res. 3:781
,1
'*I
) Tse - S gin., r—
n , rl
LEGAL
vi7
i oa'
1
J `o u ()Liz*
Lfill'q C2:. AT I 1'te eANDLHI-DE mhnPor,0�
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264~4720
PERMIT NO: 860136 HAND WRITTEN
DATE ISSUED: 05/21/86
APPLICANT: FRED FARJAMI
ADDRESS: 12845 JEANNE RD,
ANCHORAGE, AK 99516
CONTACT PHONE: 243^4631
LEGAL DESCRIP: SUBDIVISION: MT" SHADOWS
SECTION: 25 TOWNSHIP: 12N
LOT SIZE: 20800 (S(1.Fl. OR ACRES)
LOT:
RANGE: 3W
BLOCK: 2
I certify that:
L. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State or Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot,
IF A | TET STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY 0 LICENSED ELECTRICIAN.
SIGNED
APPLICANT : FRED FARJAMI
ISSUED BY
y
/*zt"''c�CL-A.,` / e C.) C.
DATE7--
o'�
~���^�� ��4 . s �� �� /+���
* /��
.
...-ckepet f��4_ 4" �'*�� �� 144� �u�14.,_
. �c" m^��62 /*e-
°
�UV�������� ��� �� O����T����U�
....~~.-, -- ��
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
.~.^ � ��-_�- .^~~-.._ .�' .._.^ � `
L �!���\� H��MUV0u�, *n �,00�
264~4720
PERMIT NO: 850158
DATE ISSUED: 05706/
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIIT'
:
LOT SIZE:
MAX DEDROOMS:
ME. LA.:LIAJIL Mr
MOHAMAD GHAFFARI
7811 KIANA CIRCLE
ANCHORAGE, AK 99507
I:HROIVISION: MOUNTAIN SHADOW
SECTIIJN: 25 TOWNSHIP: I2N
T,4RO« (SQ.FT. OR ACRES)
LOT:E BLOCK: 7
Listed below are the options available to you in designing your
DEPTH TO PIPE BOTTDM
GRAVEL DEPTH (FT)
TOTAL DEPTH (FT,)
GRAVEL WIDTH (FT.)
GRAVEL. LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.)
lANK SIZE <GALS>
SOIL RATING (S(':,.F.TBR)
(FT.)
TANK MUST HAVE AT LEAST !WO COMPARTMENTS
r„":1
1,0
5,0
5.0
58.0
I certi�y that:
1. I am {amliar with the requirements [or on~si�e sowers and
forth by the Municipality or Anchorage (MOA) and the State
2. I will install the system in accordance with all MOA c�des
. I will adhto all MOA and State oi Ala�ka roquireo�ents
or publi
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN F|FG:TIR7-!(N PERMIT nND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED W1|HUUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE .DONE 8Y A LICENSED ELECTRICIAN,
`t��'~^~~
SIGNED
APPLI�ANT: MOHAMAQ GH/
ISSUED BY
DATE:
~-----c=r�
|s,
MUNICIPALITY OF ANCHORAGE
Department - Health and Environmenta" rotection
825 L Street, Anchorage, AK. 173501
264-4720
* HANDWRITTEN PERMIT
_KIE 7 OR- ON-SITE SEWER PERMIT /
,0 Mailing Address: V?&/ i4,2cric 641 91S©2-37J�
Permit
Applicant:
Location: !may Qi 92x 1 7 auf4wtfal Phone Number: 21D//
Legal Description: Lot Size: X25000
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: i Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) I/O
The Required Size of the Soil Absorption System Is:
!/
DEPTH i LENGTH 3rtZ GRAVEL DEPTH
WIDTH
The length dimension is the length(in feet) of the trench or. drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE o /0" GALLONS *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlar•ement if
the residence is remodeled to include more th a �3 bedroom
Signed:
Applicant
SWP/024(1/81)
Issued by:
Date:
Ca/el/4)44f wve,o-le. X,Q-4
<Permit #: 820211
January 31, 1983
TO: Permit Applicant
Subject: .lot 3 Block 2 Mountain Shadows Subdivision
A permit issued by this department for an individual well
and/or on --site sewer system has expired as of December 31,
1982.
Permits arc issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on --site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264--4720.
Sincerely,
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/1jw.
enc: Copy of Permit
SWP/057
L' STREETHI' Cl13RHGE
PERMlT �U ( �2@21l )
H.:14.:%•! JHMES CO
L���L L � B 2 MTSHHDONS
[REHCH
FT/G�)= 230
THE REQUIRED S[ZE OF THE SOlL H8SORPTI0M SYSTEM I5
THE LENT -1-4 DIMEMSION IS THE LENGTH (lH FEET) OF THE TRENCH OR DRHINF[ELDT
THE DEPTH OF H /RENCH OR Pi lS THE 0ISTHNCE BFTWEEN THE SURFACE OF THE
GROUND AND THE BOTTUM OF THE EXC9YHTMH ({N FEM.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHYEL DEPTH lS THE MlNIMUM OEPTH OF GRHVE| BETNEEH THE OUTFALL PIPE
AND THE COTTON OF THE EXCHT[ON (lH FEET!
HERMIT APPLICANT HAS THE RESPONSTBlLITY TO INFORM TAPS DAPARTMENT DURING THE
TN�THLLHT�ON IHSPECT[UNS OF ANY WELLS HDJHCFmT T0 THlS PROPERTY AND THE
NUMBER OF RESIDENCES 1:HH-1 THE WELL WILL SFRYE
H �"!rEyH.:" 'HT!:E
8HCKFILLI�G UF
ROI SYrFTEM HITHOUT FINAL INSPECTION HNC APPROVAL 8Y THlS
DEPPRTMENT SUBJECT TO PROSECJT[ON
MTNl�UM DlyTHMCE BETNEEN H NELL AND ANY GN~SIE SEHHSF DISFDSHL SYSTEM l�
UPON THE TYPE 0F PSLIC NELL
I CERTIFY THAT
1: I AN r::HMELIHR NITH THE REOMIREMEN[S FOR ON ..... SITE SENERS HND HELLS HS
FORTH RY THE MUNICIPALITY OF HNCHORHGE
2: I WILL INSTHLL THE SYSTEM [N HCC0R0HHCF WITH THE CODES
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] B�DRO0MS
[
ISSUE�~_
BY-
���
�.
�� �0`
T
!.E
James Company
8301 Arctic Blvd.
Anchorage, AK 99502
Permit 810081
January 4, 1982
Subject: L 3 B 2 Mt. Shadows S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as--bui_its for our
files.
If there are any further questions, please call this office
-at 264-4720.
Sincerely,
Les N. Buchho.lz2.'.
Program Manager
Sewer and Water Program
Enclosure: Copy of Permit
PERMIT NO.
(
�1.3 ID:E: I ' FAL. I -1F ole c) Fl [CA- Fn- 'Li EL
DEPARTMENT . HEALTH AND ENVIRONMENTAL ROTECTION
825 'L/ STREET/ ANCHORAGE / HE 99501
264~4720
rl ra-~!E; I~FIE EE EE F" P1�~�
810081 )
S.12,(1
APPLICANT JAMES COMPANY ��64.*tHRCTIC BLVD. 99502 344~0501
LOCATION JEHNNE ROAD
LEGAL L ] B 2 MT. SHADOWS S/D LOT SIZE 24114 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS - ] SOIL RATING (SO FT/BR)= 250
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I5:
C.:74EA=''1- VA == ES. EE Ica 1- E A -- iG) �EF. I._ EDI EE�����
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
mnraK AJocicii ciFia_o_k_uras3
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
�II-41 :::" VA F" EEC: ""1- I CH VA ��EL. If 11;;i;.". r")
BACK FILLING OF HNY SY''ti;TEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTIOR
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
FR! "T IE: ICE: EN DE 1::!EI: �::-.L !FR �L11..
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED:~_~___�~���~���~�����^�_^_.����~�~������_
APPLICANT JHmES COMPANY
ISSUED BY_
{}�
_____~-~~~~~~^~_DHTE��-����
'91 ' /l�'�y //�`
.~ ... .~ ..^~ �^��~ -
oJ 3 U�� i«]>�� /1l� \//L/�� /~],
L
yK� �N�CyNd
�� ,/ /�� � /~ /\/� Ll�` � 0 ��J /y|/ \' ^.,�)
V4.0
MUNICIPALITY OF ANCHORAGE
Department ' Health and Environmenta )rotection
825 L Street, Anchorage, AK. 59501
264-4720
* * * HANDWRITTEN PERMIT * * *
-ANDA R ON-SITE SEWER PERMIT
Applicant : / `► e ,YY - e2- Ce) , Mailing Address: l3 cj /
Location: ..r2/9gill✓4-' Phone Number: ,5}'' / ._(a (i/
Legal Description: (.)7.- 3 16 - , ,4. 5//a CE' Size: :j1
Type of Soil Absorption System Is:
Trench: L., Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) i.i
%/`7/ 5�F
The Required Size of the Soil Absorption System Is:
DEPTH � LENGTH /6)6 ( GRAVEL DEPTH /vcS v WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE _ /rely GALLONS * *
* *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number_
of residences that the well will serve.
•
* * * TWO(2) INSPECTIONS ARE REQUIRED * **
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * PERMIT EXPIRES DECEMBER 31, 1 9 3 1
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may r quire enlargement if
the residence iss r modeled to include mor that bedrooms.
Signed: c�?2 Issued by
SWP/024(1/81)
Date:
*
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Municipaliityr
of
Anchorage
June 30, 1986
Mr. Dave Stanley
6258 East 41 Court
Anchorage, Alaska 99504
P.O. BL.A 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Subject: Lot 3 Block 2 Mountain Shadows Subdivision
Waiver Request, WR86-077
Dear. Mr. Stanley:
This department has approved the modifications to the septic system on
the subject lot Please consider this an approval of the modified system.
Modifications of the septic system were required because part of the old
system encroached on the well located on the lot below (Lot 3 Block 1).
Your request for a waiver of the 100 foot separation required between the
modified portion of the septic system and well on the subject lot has been
approved. The department concurs with your assessment that sloping bedrock
conditions would prevent contamination of the upslope well from the septic
system. This waiver is valid for the existing three bedroom single family
dwelling. The 100 foot: separation has been waived to 93 feet.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
cc:
Fred Farjami
12845 Jeanne Road
Anchorage, Alaska 99516
June 13, 1986
Department of Health and Human Services
825 "L" Street 4th Floor
Anchorage, Alaska 99502
Attention: Mr. Steve Morris
Reference: Mountain Shadows Sub. Lot 3 Block 2
Dear Mr. Morris;
C2
1
Pursuant to our telephone conversation of June 1 1 , 1 am submitting this request for a waiver of
the 100' required distance from the on-site well to the on-site septic system for the subject
property.
As you know, a modification of the existing system is about to be constructed due to the
encroachment of the septic system into the 100' radius of the well for Lot 1 Block 2. The
modification was first designed with the replacmont lines south of the existing system and
extending to the south property line. However, if the new lines are constructed by extending the
original lines to the north, the possibility of future interference with the lot adjoining the subject
property will be reduced. Construction of the new lines will also be considerably easier if they
extend north. The extended lines will be located near the edge of the driveway, but will be buried
by greater than ten feet of fill and will thus be protected from freezing.
The well log which appears in your files shows that the well penetrates a relatively thin soil layer
before penetrating into bedrock. Casing was driven or drilled into bedrock to a depth of 14'.
As the attached sketch shows, the ground surface at the highest point of the drainfield is located
12.7' lower in elevation than the ground surface at the well casing. The bottom of the perforated
pipe is 1 1.3' below the surface at this point. Thus, there is 24.0' of vertical separation between
the effluent and the ground surface at the well casing. It would be virtually impossible for effluent
to reach the well casing without moving upslope through bedrock. Also, please note that the septic
tank is 109' from the well. There is essentially no risk of contamination of the well from the on-
site septic system.
We request e distance waiver to 90' from the well to the septic system. Should you have any
questions regarding this matter, please do not hesitate to contact me at 333-9883.
David A. Stanley
6258 E. 41st Court
Anchorage, Alaska 99504
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daylighting of effluent on the cut slope along Jeanne Dr. Sealed concrete
drop boxes were installed at the intersection of the manifold line and the
upper two trenches to assure equal distribution of effluent to each of the
laterals.
In response to a call to the DI -IEP offices, GHOLAf3 received a call from DHEP
to notify us that a complaint had been made. Upon review of the site
conditions, we noted that the lowermost trench had been excavated to
within 98' of a well across Jeanne Dr. The trench was partially backfilled
with native material tamped into place to restore the soil to as near
original condition as possible. The trench was then moved upslope, out of
the protective 100' radius for the well. This trench, as mentioned above,
also has a Visqueen barrier installed to help prevent daylighting of effluent
on the slope.
Review of the sketches will show that the middle trench was inadvertently
installed 99.5' from the well casing. We feel that there is no added risk of
contamination of the well, since it is several feet higher in elevation and
the well casing is driven into bedrock.
Should you have any questions regarding this matter, please do not hesitate
to contact us at 344-8042.
Sint;erely,
6,7
David A. Stanley, P.G.
President
•..3- }fR9�:! l�F� A
1 1 31 EAST '76111 AVENUE
111TE 41 1 0 1
ANCHORAGE, ALASKA 991502
July 1, 1985
907- 344 8042
Municipality of Anchorage
Department of Health and Environmental Protection
825 "L" Street
Anchorage, Alaska
Reference: Mt. Shadows Subdivision Lot 3 Block 2
Gentlemen:
Attached are the as --built inspection report and detail sketches for the
installation of the on-site septic system for the subject. lot. Some
modifications were made to the system design to accomodate conditions
differing from those which were indicated by the design which was prepared
by 5 & 5 Engineers in January 1983. Permit No. 850158 was issued on May
6, 1985, based on the 5 & 5 Engineers design. GEOLAB Inc. has based its
work on a copy of the design which was obtained from Mr. Mohamad Ghaffari,
the owner of the lot.
The permit which was issued utilized a wide drain design with a gravel bed
depth of 1.0'. The redesign changed the gravel depth to 2.0', thus shortening
the drainfield. The 5 & 5 Engineers design incorporated the use of a 90'
protective well radius. The waiver for the reduced distance was never
obtained, so a decision was made to redesign the system, without the use of
the waiver, to avoid possible delay. The system was installed with three
lateral trenchs instead of the two called for in the original design. The
system was installed downslope from the site originally indicated by the
3 & 5 Engineers design due to slope requirements, and due to lack of
availahle space.
The three trenches were installed progressively downslope with a drop from
trench to trench of about 18". Since the lowermost. trench was installed
closer to the cutbank than was originally intended, a Visqueen barrier was
installed along the downslope edge of the trench to aid in preventing
{seol�a i :�l Ca�nsail4inr 'iestin t.aborattr� livaBit�J ?fitr-o9 a ;nr is . stern p s2i3n A lif c�:tien
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S & S ENGINEERS, E+.RS, INC 1r?/
1
7125 Old Seward Hwy. Anchpr ge, Alaska 99502 �� 0
349=6561 2j
SOILS LOG - PERCOLATION TEST 11J
DATE PERFORMED: W/2 -1/ 9n
PERFORMED FOR: \)(1/12,H. )',)I F-L<'f7Kj
SOILS LOG
,1• PERCOLATION
TEST
3 13e-beoom
LEGAL DESCRIPTION: L.O/ 3 RLC--(( 2. 140()/vr'f/A' SNAWows Su8f>ivisipN
SITE PLAN
12-
13 -
14
15-
16-
17
18-
19-
20 -
0 —1 ,0 / 61 - Y -£J; /rl) /710'r.:1
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SA4)6 AUGOL/11-, wdL- 64141:0/ NeAVC _ A'UG
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REF VSA- O,.J
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COMMENTS
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SLOPE
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WAS GROUND WATER S
ENCOUNTERED? /400
L
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IF YES, AT WHAT E
DEPTH?
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Reading
Date
Gross
Time
Net
Time
Depth to
Wate
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10
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PERCOLATION RATE
TEST RUN BETWEEN
r'll✓� Vt: S (minutes/inch)
4,6" FT AND S1O FT
PERFORMED BY:
CERTIFIED BY: DATE:
R £:NI CONSULTANTS, INC. 5oz4 CON(]JVA • IICIX GOP,) • ANCHOIlACC. ALA::KA 90562 M PHA 90) 2)i,04O] 5 TL%. 91°rz,s,,
P.N SIN If [IS
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u [IV C Y O :17.
February 10, 1977
Mr. Gary Larimore
c/o Wirecom
4134 Ingra Street
Anchorage, Alaska 99503
R & M No. 751108
y`-
Re:
\
Re: Test Hole and Soil Log Report for Sanitary System, Lot 3, Block 2,
Mountain Shadows Subdivision, Anchorage, Alaska
Dear Mr. Larimore:
Weare submitting herewith the test boring results and our comments
regarding soi:L conditions encountered at the subject site. This investi-
gation was performed in accordance with the request of Mr. Denny O'Day
of Polar Realty on February 4, 1977, and those procedures outlined in a
letter dated July 15, 1975, by Mr. Rolf Strickland of the Municipality
of Anchorage Department of Environmenta]. Quality.
A_s:ingle_test hole was put down within the subject site area for the
purpose of defining -general -subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type drilling
rig and the test hole was extended to a total depth of 10.5 feet below
ground surface. The final log prepared for the test hole has been
included in Drawing A-01.
Groundwater was not encountered in the test hole while drilling.
CA percolation test was performed from a depth -ind, teal and reflects
.average infiltration from that depth to the bottom of the hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Rooney
Vice President
JWR:mh
xc: Municipality of Anchorage
ANCMOnAG[
FAIOD nlnt!: )uNcnu
ye. -'1--(..t--(4--6--4.-‘.'''.--,- fi.
7
TH-1
2-7-77 All Samples A
0.0'
ORGANIC MATERIAL, Black
0,5'
SILTY SAND
Brown, Very 'foist J f ‘%v'
------ ---2.0°
3, Block 2
'_ ?iountai(fi Shadows Subd
SILTY SAND W/SOME GRAVEL
Brown, Occasional. Cobbles
SANDY GRAV_:L
1.7/SOME SILT,
TRACE CLAY
Brown, Mani/ Cobbles
Refusal on,'Bedrock
Test Hole locations are approximate
and have not been located by survey ,
methods.
(1/of)
OWN! M A M
CKD! EY '
DATE! 2-7_17
n&CV! CONSUiTANTSYINC.
1
• !10.5 ° TD
This log represents subsurface soil.:--
conditions within Lot 3, Block 2,
?fountain Shadows Subdivision
LOG OF TEST HOLE
AND LOCATION DIAGRAM
Lot 3, Block 2, Mountain
1
r. p.
GRID
PROJ.N .
2841
TIME
2:41
2:42
2:43
2:44
2:45
2:46
2:47
2:48
2:49
2:50
2:51
2:56
3:01
3:06
3:11
3:21
3:31
3:41
PERCOLATION TEST
Lot. 3, Block 2, fountain Shadows Subdivision
R F M NO. 751108
ELAPSED DROP IN
TIME INCHES INCHES
0 3.00 -
0.00
1 4.00 1.00
2 4.75 1.75
3 5.25 2.25
4 5.75 2.75
5 6.13 3.13
6 6.50 3.50
7 6.63 3.63
8 6.75 3.75
9 7.06 4.06
10 7.50 4.50
15 8.50 5.50
20 9.38 6.38
25 10.38 7.38
30 11.00
8.00
40 13.00 10.00
50 14.00
11.00
60 15.13 - 12.13
4.95 minutes per inch
0
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SOIL ABSORPTION SYSTEM
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
ii
ROBERT A. SHAFER
Apn.LJ 20, 1988
Mn. Robbie Rob -Leon
MunLc panty o4 Anchonage
Vepaktment ob HeaP_.th and Human Senu,Leee
825 L S.tneet
Anchonage, Ataefza 99501
CIVIL ENGINEER
694-2979
REFERENCE: Lot 3; Btocfz 2; Mountain Shadowe Subd.iv.ie ion
Dean Robbie,
Requee-t you keeue a penmit to attow the pntiva-te weft toca-ted on ,the
ne4eneneed pnopen-ty .to be nedevetoped.
The ne3.idence Located on the ne4eneneed pnopen.ty Le cunnentty unoccupied,
haweven, wa:ten ana,eye.Le neponte indicate that the n i.-tna to Levet in
tk-Le were exeeede alto vzbte t.im,LUe.
In nedevetop.ing .th.ie wet we pnapoee to .Lneent a 4i inch PVC kinen
to the bottem o4 the wett with a ehate .tnap k.netaeked at appnox.ima-tety
95 beef. Oney the area between 105 and 125 beet w.itt be pen4anated.
A combination o4 dny bentonite pettete and a bentonite etunny w.i,tt
be injected anound the outside o4 the PVC t.<,nen. We hope that ,th.te
w.Ltt eea,e obb aPt wa-ten councee above .the 95 400,t teveP and con3equentty
neduce the injection 4nom high ni.tnate waters eauncee. We w tt neeampee
upon eamptet.Lon ob .the won(z and pkouide a nev.Leed week. tog.
Skncenet y,
7
/ _.
:--
kOB kfA. SHAFER, P.E.
-RAS/ee
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
LOUNSBURY & ASC I A T E S, INC.
ENGINEERS PLANNERS
SURVEYORS 723 W. 6th Avenue, Anchorage, Ak. 99501 Tel. (907) 272-5451
February 13, 1986
TO WIIOM IT MAY CONCERN:
This letter is to certify that on the 10th of
February, 1986 Lounsbury & Associates, Inc. measured
the horizontal distance between a well belonging to
Mr. John Klingbeil. on Lot 3, Block 1, Mountain Shadows
Subdivision, and a septic system located across Jeanne
Road on Lot 3, Block 2 of Mountain Shadows
Subdivision.
No As -built survey work was done to confirm the
location of the improvements in question; only the
horizontal separation was measured. The horizontal
distance between the well and the nearest of five
standpipes connected with the septic system was 92.3
feet.
Sincerely,
LOUNSBURY & ASSOCIATES, INC.
Craig L. Savage, R.L.S.
Executive Vice -President
CLs/sw
1
Municipality
of
Anchorage
April 4, 1986
Fred Farjami
12845 Jeanne Road
Anchorage, Alaska 99516
oP
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Subject: Notice of Violation, Anchorage Ordinance 15.65.060C
Dear Mr. Farjami:
It has come to the attention of this department that the septic system on your
property (Lot 3, Block 2, Mountain Shadows Subdivision) was installed within
100 feet of the well on Lot 3, Block 1, Mountain Shadows Subdivision. The
horizontal separation between the cleanout on the septic system and the well
has been measured at 92.3 feet.
This is a violation of AO 15.65.060C which states: "Except as provided in
Section 15.65.070, no person shall cause or permit to be constructed or
installed any subsurface disposal field located less than 100 feet from any
river, lake, stream, or any source of domestic water supply."
All components of the septic system which encroach on the 100 foot protective
radius surrounding the well must be properly abandoned. Some provision must
be made for "making—up" the lost disposal area resulting from the abandonment.
Engineering plans outlining procedures for abandoning portions of the ].each
field in violation of AO 15.65.060 must he submitted to this office prior to
May 15, 1986. These plans should include provisions to enlarge the system to
make up for disposal area lost due to abandonment. The disposal system must
be enlarged in manner that will meet state and municipal separation distance
requirements. An approved waste disposal system must be installed prior to
July 1, 1986 or legal action will be initiated.
If you have any questions regarding this natter, please call me at 264-4720.
Thank you for your cooperation.
Sincerely,
Stephen S. Morris
Civil Engineer
On—Site Services
SM1/dEH9
cc: Thomas R. Smith, P.E.
emiwpwaromparmorimmem.,mom
RLrunH TO:
Division of Geological and C
3C01 Porcupine Drive (Tele
Anchorage, Alaska 99501
yslcal Surveys (DGGS)
e: 277.6615)
WATER WELL RECORD
Drilling Company Name _
LOCATION OF WELL 1
__Please complete complete either la, lb, or lc.
la. Borough Subdivision I Lo[ Block 16. Fraction Section No.
Ic. Distance and Direction from Road Intersections
Street Address and Area of Well Location
2. WELL LOG
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
U.S.G.S. Local Ho. _
Drilling Permit No. _
A.D.L. No. _
Township
N/S
Range
E/W
Meridian
3. OWNER OF WELL
Address:
Feet Below
Surface
Top I Bottom
Material Type
Al lvvi�yn
herd
Qec4roc .
12y
4
ELL DEPTH: (completed) Surface Elevation Date of
Completion
7/2%61
125ft. n
5. 11 Cable tool 0Rota ry ❑Driven L.21 Dug
❑ Auger ❑Jetted fl Bored ❑ Other._
6. USE: ODomestic U��J I
Public Supply [Industry
0 Irrigation LlRecharge ❑ ConKrerciel
Test Well ClOther:
7.
CASING: ❑ Threaded L1 Welded
iin. to _ft. Depth Weight lbs/ft.
in. to ft. Depth
MUNICIPALITY OF AN
DEPT. OF HEALT'rl &
ENVIRONMENTAL P":UTLCTION
I III 2? 1
R-ECEivE-I1
8. FINISH OF WELL: 01:1-eVY
Type: Diameter:
Slot/flesh Size: —_ Length:
Set between ft. and ft. —
Fittings:
9, STATIC WATER LEVEL: j.J ft.
ElAbove ❑Below land surface
Type of Measurement: _
10. PUMPING LEVEL below land surface 5
ft. after hrs. pumping g•p•m•
ft. after hrs. pumping g.p•m•
11. WELL HEAD COMPLETION: In Approved Pit
El Pitless Adapter
inches above grade
12. GROUTING: Well Grouted: Yes ONo
Material: ❑Neat Cement 0 Other:
13. PUMP: (If available) HP
Length of Drop Pipe ft. capacity ,g•p•
Type: []Submersible ❑Reciprocating
❑ Jet ❑Other:
14. REMARKS: o_
15. WATER WELL CONTRACTOR'S CERTIFICATION:
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief:
Contract License Number
Address:
Registered Business Name
Signed: - -
Date:
Authorized Representative
UN1TF - State DGGS, PINK - Driller, CANARY - Customer
AICO FORM NO. 50.176
rf KAMA
fS its. �L f3, 4i- 4iii l'd L4']S4Y 144 illi WIC All, CiV 1Wins t3'R
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
July 19, 1985
[1111. SNLFFIEID, GOVERNOR
2742533
L. Ste-+ OS w 4.C-¢;
Geolab
1131 E. 76th Avenue
Suite 101
Anchorage, Alaska 99502
SUBJECT: Waiver Horizontal Separation between Well and Septic
Trench, Lot 3, Block 2, Mt. Shadows Subdivision,
Anchorage, Alaska (8621 -WA -02.2)
Dear Sir:
The Department has reviewed the subject waiver request and hereby naives
the horizontal separation between the well and septic tank to 99 feet
on the subject property for a single family residence only.
Sincerely,
Steven W. Eng, P.E.
District Engineer
SWE/msrfl
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY Y'f
264-4744 Yf 75
Application Date May
I r
CF7�
9,1988 �"'
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 3; Back 2; Mountain Shadow Sabd•i.v.isi,on
Location (address or directions)
12845 Jeanne., Anehonage, A.ta4(za
(b) Property Owner Fned Fna*ani. Telephone: Home Business
Anehonage., A2a6lza
Mailing Address 12845 Jeanne,
(c) Lending Institution Telephone
Mailing Address
(d)
Real Estate
Address
Telephone
(e) Mail the HAA to the following address: or: Check here, if hold for pick up.
List contact person and day phone number below.
S & S ENGINEERING/694-2979
Company and Agent
2600 Cokdova, Anehonage, A.2a6fza
276-2761
RE/MAX PROPERTIES/Chanu.o.te
99503
17034 Eag.2e Riven Loop Road, Smite. 204
EagCe Riven, A2a6fza 99577
2. TYPE OF RESIDENCE
Single -Family Q
Number of Bedrooms
3
3. WATER SUPPLY
Individual WeIA Community 0 Public 0
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 [2 Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (Rev 8/861 Front
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm S &S ENGINEERING Telephone [�J i % 9
17034 Eagle River Loop Road No. 204
Address Eagle River, Alaska 99577
Date
Nit2ate, Zevetb in the wa-ten Suppe y tinom pkivate
we.P,P_3 in .h.i4 akea have been known to exceed .the
ae.eowabfe ti.m.i.t6 utabtLi head by the State Axa-IZa,
.thexeliane, it ti3 necommended that aceupant4 6amp.ee,
the. waters .supp.ey 4on, n,i..tnate3 quaatex.y.
6. DHHS APPROVAL
Approved for / I bedrooms by
Approved Disapproved
(5-A?/.2r.s/
A. Noris
a 6 . N. 14574 4`'
�1tOPE551.s
Date
Conditional
Terms of approval .Sigv, i- 1171 r97:5/S _bia_l".- /,- , / fG/���f /qe,�
72). .1` i2 7 7 •I'1 - S �yU(G-PS , Z 1 X/s5 /! 7-,--.4'rz- / e Imo' 444_2
4'I? iLeee,'l�vl , QS// /I/1/�4 ,e.J /5 pe) ,''" /1 Crl d as 10:11 ds'/gi,� rn �„1'
Slidul1 h/'Ti-)Iv_ lP lS eVegee 4�.,'�,� A ivy-/� �c all -?.i- nd, aid �,�
Svuv.4-e ,1-2105 4e n--1-7:2_4/, lli
dhhs
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a 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.
Page 2 of 2
72-025 /Rev 8/861 Rack
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
fldVI ONMENiAL SERVICES CRAGS 264-4744
MUNICIPALITY CFA
NC
DIVISION
r 1 6 1988
A. WELL DATA
Well Classification
RE-
WED
Well Log Present (Y )
Total Depth IZS Cased to
Static Water Level
rr 3 --
Legal Description
01 Q
Z3
z Pe/n. Shad )
If A, B, C, D.E.C. Approved (Y/N)
Date Completed 7/5/e/ / Yield s 7L- y/t, vr)
F� 2ocGr
/� B Depth of Grouting
Pump Set At / 2 3 /
Casing Height Above Ground
Electrical Wiring in Conduit t'JN)
go Sanitary Seal on Casing
Separation Distances from Well:
To Septic/Hutting Tank on Lot
/0 9
N)
Depression Around Wellhead (Y
To Nearest Edge of Absorption Field on Lot 9J
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Line G'1 /6- To Nearest Public Sewer
Cleanout/Manhole P ` To Nearest Sewer Service Line on Lot CS -F
Water Sample Collected by Oki. dd` C i% 9 r' S ;LS E'Ix Date
Water Sample Test Results M 7/ STAG zn/z
Comments S'e e CJ -JC c ✓ E >2 G 93 9 . LM <72,
c, itJ / re va- L t" 0 OE Pfr2 y
7-172F-- /44A4 yEXC • a A) c a w, F Lewij i f
,/,C.2. --14‘,1.4-)e.--/ 67 c n 1 J,
B. SEPTIC/HOLDING TANK DATA
t;//516'1).
Date Installed /9g-5 - Size /2 SC-) No. of Compartments 7
T///,/oeyfe , oJecs-• 4.- L-1
CTL0,74 IC/ C GY, /d
Standpipes (Y N) Air -tight Caps
Depression over Tank (Ye Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) / /
; for
hi/6-
Foundation Cleanout (Y N)
-241-88-r"'5aacS
Holding Tank High -Water Alarm (Y/N)
Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well l©19_Z To Building Foundation
3
/
To Property Line To Disposal Field
To Water Main/Service Line ld r-74
7 To Stream, Pond, Lake, or Major Drainage
Course N 0 Nj 6
Comments /N F° • DA-) S T( Tfl -t-( pur2tp//t/ 7/9?/( "—I r= -/e
Tv BgCN 5 -re 1 PE, ,Pe, oR r - c // /9fig
Page 1 of 2
72-026 1 Rev 8'861 Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata //0 Type of System Design G✓, ✓%2 `1/6 ///C'L.d
i
Date Installed /ff 93 - (9 B 6 Length of Field 9
Width of Field ✓ Depth of Field 3
/. $ .
Gravel Bed Thickness
Square Feet of Absorption Area Y9 99 ' Standpipes Present YiN)
Depression over Field (Y� Date of Last Adequacy Test
Results of Last Adequacy Test .5-4 - 'f1 c 7-0Ke7 ,0
Separation Distance from Absorption Field:
To Water -Supply Well 43 r
To Property Line ( )
/
To Building Foundation Z Z To Existing or Abandoned System on
/ r
Lot ; On Adjoining Lots /0"'
To Water Main/Service Line
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course /t> o ti E
To Driveway, Parking Area, or Vehicle Storage Area
Comments (-e--)a F'e? '.:; "9- G 30 /g 6
*-* f9cVe. e /N s�arRt-tic w,� 10 4'EefOoee-7- rvt Pc-a_cra z3, I988
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 /v1 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 I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S & S ENGINEERING Date 5//3/8S
17034 Eagle River Loop Road No. 204
Compar'aglo River, Alaska 99.57'7 MOA No. C� — rg, — OD
Receipt No _# 4- (7
Date of Payment
Amount $
7
Page 2 of 2
72-076 (Rev 8 861 Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT TMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CFR -lit -AGATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
_c.,lyat Banc ,t co (include lot, block, subdivision, section, township, range)
{ ; 1aac ;s Subc7. Lob 3 Block 2 Sec. 25 T121\I R3W
Application Date August 26, 1985
t,O_sat.r tat €:r.as cr directions)
7. Dr". ve
at as Ghafrari
A?r,yi.;a^t Telephone: Horne
c/ -o GEO.LA.B
Business 344-8042-
A r.-:/0 GEOLAB 11.37. E. 76th Ave. #101 Anchorage, AK 99518
(c) ApF f`c:ar;t is (deck one). Lending Institution [xl ; Owner/builder 0 ; Buyer U ; Other D (explain)•
Id) Lonarng re-=fttl'"e^.Alaska National Bank of t'i'eril1orrCth
Ad'dr--'
(e) Rea' Estate Company and Agent None
Arterr=s
(f) Mail the Hi-fi to the foilowmg address:
1 -:6th Ave. a +x101.
Jse Alaska
2. TYPE OF RESIDENCE
Bingle Fam:lyt
Multi-Farmiy 0 Other
Number of B4-drfr oras 3
3. WATER SUPPLY
Individual ;' el LI Community Li Public 0
Note: If comm 3r:'y v,e:i system roust have written confirmation from the State Department of Environmental Conservation
attesting to tho sga ty and status.
4. SEWAGE DISPOSAL
Onsite [= Fc 0 Community 0 Holding Tank 0
Note: If comcur.., v, o.: s,stom. must have written confirmation from the State Department of Environmental Conservation
attesting to tt e essSty and status
Page 1 of 2
72-025 511;II 1)
EA -SNEERING FIRM PROVIDING ...£PECTI©NSS, TESTS, FILE SEARCH, DA1,..:ND INFORMATION
r=;,seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
h r9,App.rc..al snowsthattheon-site water supply and/or wastewater disposal system is safe, functional and adequate
u= r - rur t.er f mos oorns and type of structure indicated herein. I further verify that based on the information obtained
tt&Sur :, it of Anchorage files and frorn my investigation and inspection, the on-site water supply and/or
eF.;:,(:Ei.al system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
ira11-�.7; Fry;..
a;0LA3, Inc. Telephone
344-8042
=1 �. 76th Ave. #k101 Anchorage, Alaska 99518
26, 1985
CHE' APPROV
a,
Engineer's Seal
a,::::7\:'
M1/H
°TJU�O`O Uo3
°
Oma r"
.^
v o °O°
0,Y000°°
040002/�' Og000Q
0„ �°As'. as u a �c7f0
V© q+ o°%%LV-E 4'47
41
3; °°t 0000000° �©NJ
'VLA �3Gv aSa"tt1G ?
DisapprovVd Condition
Approval
0110
CAUTION
Mu"' chorage Department of Health and Environmental Protection (DHEP) issues Health Authority
>ed solely upon the representations given in paragraph 5 above by an independent professional
•r. ne State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
s n satisfy certain federal and state requirements. Ernployees of DHEP do not conduct inspections or
Laf a ert;f,cate issued, The Municipality of Anchorage is not responsible for errors or omissions in the
_---.F27,12
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description. Mt. Shadows SubdL3 B2
Sec 25 T7.2N R3W
A. WELL DATA
Well Classification Indiva If A, B, C, D.E.C. Approved (Y/N)
7/3/81. Yield 5,2gpm
Well Log Present (Y/N) Yes Date Completed
Total Depth 1.25 ' Cased to 4
85'
Static Water Level
Depth of Grouting
none
Pump Set At 123'
Casing Height Above Ground 1.2" Sanitary Seal on Casing (Y/N) yes
Electrical Wiring in Conduit (Y/N) Yes Depression Around Wellhead (Y/N) No
Separation Distances from Well:
To Septic/Holding Tank on Lot 1.09 ' c'plOn Adjoining Lots 100' +
To Nearest Edge of Absorption Field on Lot 99' ; On Adjoining Lots 100 +
To Nearest Public Sewer Line
Cleanout/Manhole —
Water Sample Collected by _
Water Sample Test Results
NA
NA
To Nearest Public Sewer
To Nearest Sewer Service
DA Stanley–GEOLAB
74,151'a y
; Date
Line on Lot
8/26/85
NA
Comments * See attached waiver from DEC
<qe, / "-f!'" i{L yti.. C�. �a - �1. g?., � v d ,Wi x--.
B. SEPTIC/HOLDING TANK DATA
Date Installed 6/15/85 Size 1250 No. of Compartments
2
Standpipes (Y/N) Yes Air -tight Caps (Y/N) Yes Foundation Cleanout (Y/N) Yes
Depression over Tank (Y/N) No Date Last Pumped NA new system
Pumping/Maintenance Contract on File (Y/N) NA ; for NA
Holding Tank High -Water Alarm (Y/N) NA Temporary Holding Tank Permit (Y/N) NA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 1.09 To Building Foundation 35'
To Property Line 10 To Disposal Field
7'
To Water Main/Service Line NA To Stream, Pond, Lake, or Major Drainage
Course NA
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 110 sgft/BR Type of System Design wide drain
Date Installed 6/15/85 50'
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N) Yes
Width of Field 5
Square Feet of Absorption Area
Depression over Field (Y/N) no Date of Last Adequacy Test None
Results of Last Adequacy Test NA
Separation Distance from Absorption Field:
To Water -Supply Well 99.5' * To Property Line 10'
To Building Foundation 28 To Existing or Abandoned System on
Lot NA ; On Adjoining Lots 100' +
To Water Main/Service Line NA To Cutbank (if present) ±18 '
To Stream/Pond/Lake/or Major Drainage Course NA
To Driveway, Parking Area, or Vehicle Storage Area 10' +
357 sqft.
7'-15' after final
grading
2'
- new system
Comments * See attached waiver
from DEC
D. LIFT STATION
Date Installed NA 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 I have clhecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed `1, . /16 .i. G:; Date August 26 , 1985
Company GEOLAB, Inc, MOA No ST85-007
Receipt No
Date of Payment
Amount. $
Page 2 of 2
72-026 (11/84)
eeeaesooe,, e
110.1
Engineer's Seal
TM M
Itk17.lib3{'. OF EN V4I{ G:vi` tvillil]TRH.C�I'J�
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
July 19, 1985
BILL SHEFFIELD, GOVERNOR
Geol ab
1131 E. 76th Avenue
Suite 101
Anchorage, Alaska 99502
SUBJECT: Waiver Horizontal Separation between Well and Septic
Trench, Lot 3, Block 2, [It. Shadows Subdivision,
Anchorage, Alaska (8621 -WA -022)
274-2533
Dear Sir:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separati on between the well and septic tank to 99 feet
on the subject property for a single family residence only.
Si ncerely,
i
Steven W. Eng, F'.E
District Engineer
SWE/msnr
FLATTOP TTOP TECHNICAL SERVICES
CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 August 27, 1985 ANCHORAGE, ALASKA 99516
Geolab
1131 E. 76th Ave. #101
Anchorage, Ak. 99507
Attn: Dave Stanley
Dear Sirs:
Per your request I conducted a flow test today on the well
serving Lot 3, Block 2, Mountain Shadow Subdivision, located at
12845 Jeanne St. in the Anchorage Hillside area.
At the start of the test the static water level was 96 feet
below the top of the casing of this 125 foot deep well. When
pumped continuously at 5.2 gpm for a total of 460 gallons, the
water level was drawn down to 110 feet below the top of the
casing, which then recovered shortly after the water was turned
off.
Based on this test I am pleased to be able to inform you
that the well flow is more than adequate to serve the three
bedroom residence on this lot.
Please feel free to call me if you have any questions.
appreciate the opportunity to have performed this test for you.
47 OF AZ, A
0 44 6'. . OCIK
49TH
ILII .••� 0©
M 0
4 THEODORE F. MOORE j
1.)0 ••. CE - 3589 L g
s
® ..0 41
�'ro/CnioWa\
®®��°• .....
***6117
Sincerely,
Theodore F. Moore
4$ 5o
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1711001-429-
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Parcel I.D.
1.
Municipality of Anchora
Development Services Department
Building Safety Division
On -Site 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
017- L101-10,
COSA# Oa 0390
Expiration Date: 1— . - /0
GENERAL INFORMATION
Complete legal description Lot 1, Rk 2, Mnuntain Shndnwn
Snhdivininn
Location (site address) 12845 Jeanne Road; Anchorage, Alaska 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent Vivian
Phil Shapland Day phone(907)345-1196
12845 Jeanne Road; Anchorage, Alaska 99516
Day phone
Mailing Address
Coleman/Prudential Day phone(9n7)440-6392
3801 Centerpoint Drive, Suite 200; Anchorage, Alaska
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑ Individual Holding Tank
❑ Community On-site
❑ Public Sewer
0
0
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my 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 Plnard Engjrnering Phone (907) 232-1347
Address PO Box 871347 Wasilla. Alaska 99687
Engineer's Printed Name Paul E. Pinard, PE
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By:
Date
• r
JINL •
•
w 1
S,•• •.1.
% •
ttJ
•
�n
•
• Ptut E. Plosid /Fr!
�•. ' CC -4722
0 4/ycr.
j`: ON-SITE
WATERAND ; �t—
WASTEWATER
PROGRAM
` !.•
JntiVTSRIV-
)4rlliftl1lrt
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(R•v.1 tIOS)
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
11. iqfrcyl--
r
Original Certificate Date: 10 `c2 moi- 07
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 3, Bk 2, Mountain Shadows Subd
A. WELL DATA
Well type ha
Date completed 7/3/81
Total depth 125 ft.
Parcel ID: DO— 4f 01-49
If A, 8, or C provide PWSID # NA Well Log (Y/N) Y
Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Cased to 14 ft( bedrock) Casing height (above ground) 18+
FROM WELL LOG
Date of test 7/3/81
Static water level 85 ft.
Well production 5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100mL Nitrate7.42 mg/L
Arsenic: NT) ug/L date of sample: 9/17/09
B. SEPTIC/HOLDING TANK DATA
TankType/Material Septic/Steel
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N)
AT INSPECTION
9/9/09
97.1 ft.
3.2 g.p.m.
In.
Other bacteria 0 colonies/100 mL
Collected by:Pinard Engineering
Date installed 6/16/86
Cleanouts (Y/N) Y
N High water alarm (Y/N) N
Date of pumping 9/19/0R Pumper Al- Home Services
C. ABSORPTION FIELD DATA
Date installed 6/16/09 Soil rating WITetirft2/bdrm) 110 System type "5" Wide
Length 50 ( total)ft. Width 5 ft. Gravel below pipe 1.5 ft.
Total depth 5+ ft. Eff. absorption area250 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9/9/09 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 640 gal. New depth 0 in.
Elapsed Time:205 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date
D. LIFT STATION NA
Date installed
'Pump on' level at _ in. 'Pump off level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 99' +
Public sewer main NA
Size in gallons
Sewer /septic service line 251+
Animal containment areas NA
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots 1001+
On adjacent lots 1001+
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10 I + Property line 1 n +
Water main 101+ Water service line 101+
Wells on adjacent Tots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1 5' Building foundation 10' +
Water Service line 101+ Surface water 100' +
Curtain drain NA Wells on adjacent lots 100' +
F. COMMENTS
Waiver granted by the MOA & ADEG for the
G. ENGINEER'S CERTIFICATION
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 Paul E. Pinard, PE
Date 9 fbela!eq
Absorption field 10'
Surface water 1001+
Water main 1 n' +
Driveway. parking/vehicle storage 51+
99' eeparat(�icanibitwat'n`\we11 &SAS.
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COSA Fee $
Date of Payment
Receipt Number
(Rev. 11105)
1110
(0
l a.SStic
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 090388
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 3 of
Mountain Shadows subdivision. This inspection revealed a nitrate
concentration of 7.42 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
PINARD ENGINEERING
P.O. Box 871347
Wasilta, AK 99687
(907) 357-ENGR (3647)
WELL FLOW TEST
LOCATION: Lot 3, Block 2, Mountain Shadows Subdivision
DRILLER:
DATE WELL COMPLETED: 7/3/81
WELL DEPTH: 125'
STATIC WATER LEVEL (top of casing): 97.1'
JOB NUMBER: 09-205
DATE OF TEST: 9/9/09
FIELD STAFF: PJ Pinard
Time
Elapsed
Time
(Minutes)
Static
Water
Flow
Rate
(gpm)
Cumulative
Gallons
Pumped
Remarks
Level
4:15 PM
-
97.1'
3.3
-
Meter- 91860
4:30
15
106.1'
3.3
50
91910
4:45
30
111.4'
3.3
100
91960
5:00
45
118.0'
3.3
150
92010
5:15
60
119.2'
2.7
200
92060
5:30
75
114.3'
3.3
240
92100
5:45
90
119.7'
3.3
290
92150
6:00
105
118.6'
3.3
340
92200
6:15
120
119.5'
2.7
390
92250
6:30
135
110.8'
3.3
430
92290
6:45
150
118.3'
3.3
480
92340
7:00
165
119.6'
2.7
530
92390
7:15
180
118.7'
3.3
570
92430
7:30
195
113.6'
3.3
620
92480
7:45
210
119.8'
2.7
670
92530
8:00
225
116.5'
3.3
710
92570
8:15
240
118.9'
-
760
Stop Test 92620
RECOVERY
8:30 PM
15
101.9'
All well protection features are adequate.
Water stopped flowing several times during testing.
Average Flow Rate: 3.2 ppm
Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 3.3 GPM. THIS TEST DOES NOT CONSTITUTE A
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE.
Reviewed by. Paul Pinard
Date: 9/12109
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 3, Block 2, Mountain Shadows Subdivision
APPLICANT: Phil Shapland
12845 Jeanne Road
Anchorage, Alaska 99516
SEPTIC TANK TYPE/SIZE: Stee01250 Gallons, per MOA Records
ABSORPTION SYSTEM: '5' Wide Shallow Trenches, per MOA Records
DAILY FLOW:
3 BEDROOMS x150 GAL/BR - 450 Gallons
TEST DATA
JOB NUMBER: 09-205
DATE OF TEST: 919t09
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.0' SLUDGE: Minimal
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes XX No
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soll Absorption System
Comments
PM
(GPM)
(GALS)
(GALS)
Liquid Level
•
A Level
Monitor
Tube 1•
A SAS
Level
Monitor
Tube 2'
A SAS
Level
4:50
3.3-
-
4.0'
-
0.0'
-
0.0'
-
Start Flow - Meter 91980
5:05
3.1
50
50
4.1'
0.1'
0.0'
0.0'
0.0'
0.0'
92030
5:20
3.1
47
97
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
92077
5:50
3.3
92
189
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
92169
6:20
3.1
100
289
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
92269
6:50
3.0
92
381
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
92361
7:20
3.1
90
471
4.1'
0.0'
0.0'
0.0'
0.0
0.0'
92451
7:50
3.1
92
563
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
92543
8:15
-
77
640
4.1'
0.0'
0.0'
0.0'
0.0'
0.0'
Stop Test - 92620
RECOVERY
Date
Time
SAS MTI
SAS MT2
'ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: System appears to be operating satisfactorily. Two SAS MTs were located. It appeared that another may
have been under a large brush pile. The monitor tubes for the ST bad proper caps, however the pipes themselves were loose
at the ground level. As such, measurements on the ST were taken from the ground leveL
Reviewed by: Paul Pinard fi.
Date: 9/12109
B SVE$
00027785KEM
ka
Guaranty Agency
serving tfie at land
'ALYESKA TITLE GUARANTY AGENCY
3801 Centerpoint Dr, Suite 102
Anchorage, AK 99503
Phone: (907) 569-2842
Fax: (907) 569-2843
AS -BUILT SURVEY
LETTER OF AWARENESS & HOLD HARMLESS
PROPERTY ADDRESS: 12845 JEANNE ROAD, ANCHORAGE., AK 99516
LEGAL DESCRIPTION: LOT 3, BLACK 2, OF MOUNTAIN SHADOWS
Now comes the undersigned borrower(s) and do hereby acknowledge that they are aware that the following matters,
recited herein, exist on the property as depicted on the As -Built Survey dated
by Surveyor Fred Walatka.
Description of encroachment or survey issue:
All Encroachments. ifAny, 2��4>pr kn. .n.r,,t:y �'SQ1L
Action plan (if any)
t_
And whereas, the undersigned borrower(s) do hereby assure Alyeska Title Guaranty Agency, Stewart Title
Guaranty Company and Lender, IIOMESTATE MORTGAGE COMPANY, LLC, its successors and/or
assigns, that they accept the title to the property with the existing matters recited above.
Therefore, the undersigned borrower(s) understand that in order for Alyeska Title Guaranty Agency to insure this
property from any question of the above recited survey issues, the undersigned does hereby agree to expressly
release, relieve, indemnify and hold harmless both, its successors and/or assigns and Lender, Ilomestate Mortgage
Company, LLC from any costs or damages which may arise from the above recited matters and hold them harmless
from any and all liability or claim of any nature sustained under these matters.
Dated: Dated:
BUYERS:
Quincy M. Buck Jennifer J. Buck
CERTIFICATION OF ASBUILT SURVEY
We the undersigned owners of the subject property, hereby certify there have been no additions to the improvements
located on the property and no additional buildings constructed thereon since the as -built x a copy of said survey
dated 4 )0/28 jog is attached hereto or O No copy available at closing. The undersigned shall indemnify,
defend and hold harmless from Alyeska Title Guaranty Agency, Stewart Title Guaranty Company and Lender,
HOMESTATE MORTGAGE COMPANY, LLC, its successors and/or assigns, against any and all claims,
demands suits actions and damages of every kind and nature arising from or out of, or in any way connected with As -
Built Survey.
Dated:
Dated: /C/2`) /09
BUYERS: SELLERS:
Quincy M. Buck
Jennifer J. Buck
Philip T. Shaplptid