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MOUNTAIN SHADOWS BLK 2 LT 3
Mountain 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: * to 0 L'' ata ! 4;_{C1 r i; *. c Is OF e°oeoy d4 0e• e°ee°en•e eee eons e y°° A m\ John E. Swanson J R B s S °° CE -1834 � ((,,• C.'O61 QFO 0e••0oee boe••4y --- iji?0 Os 147 r_E.st,€ re—,}'0/`r�� OP //letlt=KJsii�-1 Le.efe .�.Ya ewe �S Com.>vr✓-�.-u.c.fP' / t/ to5 „i4jCl.9W.�Et Jl i;)7(i ;71 E7 7. o o /v74,...s-464.a04.05 r ` "7"io .Z OFAlp ����`11 1jO°..01°^� • ,4 -� ae OA ° Sa 4e John E.ISwanson cof ° CE -1834 �n•Q� fi ' ye) ^e• ,'��t\m �k5 PROFESS\ONP 0 47445-4 la= al 5. ,' -77 s- 1 / �— i -!a - f J�w y CA • L 1 J 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 v x "-13 /3 Z. ,3 Lz C' b-//:;',, 4-c _5 5/t? 0 (ht::;14„) 1<t) 6,,// 0 441qE . p0). Bogie.4 •e 13 oeeoeN TH au Ey -! i, °0 2248.. ° 447 °+°eaeee° E4 \ °9 00A 0000 00000000 o° ` �. Vu.44)® r.��)G✓G f •A to/ 5 (-) iss " ,4? ( ;.);,-/3 )' /- / e, (1) ( .(:-.)) /'-e."--,(.)(• • (c_:fc: ?(-4q 6) )77.( ( _)( ,)/( S -Q •• S .41:1T72,%44 .0. ArAl?^•• 0° •• .0'i ° e49: 0.. ir * P OMAR R. S ITH 0 00 0 0 0 0 0 0 0 0 0 0: • 03 e e 0* 2248-E 4 0000 4114Zerja":10e.4.41' uj 0,4) • 05 Si? a ft I' • 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 uv:s�ceJ- - .�a:uiis�iw-3u:n»3u[.w.c-i=e��.T-sl9v-cw-lfxaa.tt��:r�a:l-�`aat t S�t��+��ev�s+-.i�t:s—u �+.v9s-rrs vvtil+a _kms—syH..v�va vGSf .ety�vau•�fH[. a -.nice 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 L (xjF, LO- 2,0 Sonci.nl SIH wdh ;one -_, TAN);.Ar-' .`JOLT sANO Nr'tI .som C.t{�-AV4L� T2.AcC- -' 60Me, :+It_7) TAN, r P kc' rrpl5'f - C.LLP„ 6" ) GQwet_ 6rt11t>Eb, 0,6-/NC[.j) wlrrt t<nn 'GI) COh8'-E5 N 122; Der15C -S1 Yw 2.64e5 6nrr 6.0 ILS' Stl--4 0QA'/EL Wr 5514 SA?Jb, I Pki,1 (O13e1x5 To 12 -(j.)..131T101 ST/ S(cr e..160rL.ki FL45RL, 9TIFG; SA4)6 AUGOL/11-, wdL- 64141:0/ NeAVC _ A'UG I'i Q- (Ter, OE,). REF VSA- O,.J p6D0.P' 1L COMMENTS _ - `� <e• 4)4 SLOPE 6\ 1' z. to U C t 2 WAS GROUND WATER S ENCOUNTERED? /400 L o IF YES, AT WHAT E DEPTH? ■■. =Mal 21573ill ®11111111111 �� 7 , Reading Date Gross Time Net Time Depth to Wate I C ((I . _/---a 5,0 ,,' ,. ,c_, 10 2114/e3 O .5- I:Oto k y,,,,,, 4-, 5 a S'l - (0'7 1:07.5 I -mom_ 0,,, ,,,A ."\ 4 .2.5 U_Zst. __ 4.0 L.O 1:08 1',0Q 0•5 M11_.-__. 1 on 1'n „ / Sg _ I-_aQ,6 1:10 ---- — ...0.,. -M.^ _. <9.5,-n _ 3 Y4 f 3/4" 5,0/ Z,0 �_-__V,.i�..__-._ 1 114- .- - _. _-2 0..n___.-_....._-... 2 ..__-_2."_..__ s_ 2-, 5- .'__,,._3M// _. Z.."5- 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 G_UL:]::IST!i [LAC 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 0 0 `0 0 0 0 N C E 0 O 0 0 C O 0 O -p 0 W008038 83d 03b10038 V38V NOI1d8OS8V 30 1333 3NVflOS 0 .6f. ^.lv Oi-..-. V �"" - V V C bf `V v O a . _r Y fet • • = a Cr:O G '6 V ••-.,'—• v O .I•• - -O v^) r U v u u4 x Ge uJ m u v u CL q _ V .CYO: - yv V .V . s. _V be obf ,J 1— CJ — ;:z.3, "' r • V 'rz • 0• C y- u C Z o« Vn`C OV 0"Ln ▪ ` V v-. riO r. ,..1 c VV M — O uC 2T • • VaVxC LW X O hV aQu 0• i .••... V Z C • r• � y c' 0 O •r 0 0 c; V o 0 V' rN V • V. n N o N EV CC ,. -VO 7 _ o c o o o,ow,L " O ^. -3v Cci r .. `-; V -O C O N • • O O b . 0 C .orbf = V.,n,,-, V e i~ 0 a°C vaC c- ?, o-0 v . _u✓c d O n V a bv 4Y J n bD F., v j= u pV o v o° wo 7 772 , 0) v v 0 In, O '^ i ^ m C V UI)SI .'v, V 0) C 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 \I I V, , \ \ I \� 1 \ 1 \ ,\ I SEt W_LL.:\ \ \ \ v N 1 0 ��O I'''cy inn pi ISmD m] \ \ 1 � m � � ItLp IBCA O�WILI i n ` I RECUT _Fr,„ iT vimn A� 1 1 16' -1 \ : rs q se 55,9T r rm /- ' 1711001-429- , I IGVf1GD e a <,4cA/N 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. • •0•0•ety, •'i ib t. p..- • 4., tI • w l n. !' f 149•01% Nna1� ''CE -47 :•,.✓• pp 4). .• r. J-: •• F�,—,.er ... ..•s3 r}4rK. t at..F 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