The URL can be used to link to this page

Home My WebLink AboutMOUNTAIN PARK ESTATES BLK 6 LT 1Mountain Park states lock 6 Lot I -10 Mark Begich Mayor bevelopment Services bepartment Building Safety bivision On-Site Water & Wastewater Program 4700 Elmore Rood P.O. Box 196650 Anchorage, AK 99507 www.muni.orq/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number:O Date of Issue: Legal Description L4/ 6' Property Owner Name & Address: .... ~' L ~ %~ ~ ~ '~'~ ' ~?~. Pump Installation Date: Pump Intake Depth Below Top of Well Casing: ~,:'~:/' feet Pump Manufacturer's Name: i:,· :/;~¥ m Pump Model:..~'~ ~ ': . ~ ~ '::~ TM Pump S~e " hp Pitless Adapter Burial Depth: /~' feet Pitless Adapter Manufacturer's Name: Pifless Adapter Installer: ~, ~<~<~ Well Disinfected Upon Completion?~ Yes ~ No Method of Disinfection: .~4~'/~ Comments: Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page ! of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,S~¢~ c~lo~ ~ PIDNumber: ~l'7-- Name: ~ ~1~ . TH~O~ WastewaterSystem: D New ~ Upgrade Address: ABSORPTION FIELD No. of B~rooms: Phone:~,r~'~--[~ DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION soil Rating: .~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Ran~: ~ Section: Fill added above original grade: Gravel length: Gravel ~pth: Number of lines: Bistance betwee~ lines: WELL: ~ New ~ Upgrade ~ Ft. J ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date in,tailed: Yield: Pum p Set at: Casing Height Above Ground: ~ GPM Ft. Ft. SEPARATION DISTANCES ~Septic U Holding U S.T.E.P. To Septic Absorption Lift Holding Public/Privat~ Manufacturer: . ~ Capacity in gallons: From Tank Field Station Tank SewerLines ~¢~ ~~ ~ Material: ~ ~ Number of CompaKments: wemm ~ ~~/~ I/ ~ ~% ( Manufacturer: SuRace Water N/~ N/A LIFT STATION Lot ~- Size in gallons: une ~ "~ump on" I~vol at: "~ump off" Iovol at: ~h water alarm at: Cu~ai~ ~1/. N/~ Pump Make & Model Electrical Inspections pedormed by: Drain Remarks: BENCH MARK O[~ C~ [~ [~ ~ . Location and Description~ ~ Inspections performed by: % ~ Dates: lst_ 5/, ~ Department of Hea Hu vices apprqval / Reviewed and approved Dat~)/ % [ 72-013 (1/91) MOA25 Well / / 'VERTA VAL IE ~'CR-I~ £rEEL RINGS U.G PDk/ER AND PHDNE 25 D N $£ALE: 1' = 5~ FE l£5 150 TDBBEN SPURKLAND P,E. 203 W 15TH, AVENUE ANCH, AK, 99501 LIlT 1 SLOCK 6 MDUNT,4IN PARK SEC. 26, TI~N RSh/ SEPTIC SYSTEM ASBUILT DATE, AUG. 80, 1992 SHEET, ~3 GRII), c°938 IL Monitor 62,5 ' C~eon Out S tondord ?rench, 68,5' LONG 10' DEEP 6' OF SElF=Fi? POCK 3' mln. Cover SEEPAGE PIT D[VE,~TA VALVE ~ gal Sep~:ic fzank Mira Pi 140 6 feet o£ Septic Rock /-- Monlgor I=050 GAL SEPTIC TANK 99~_ 94,8 ~ C.O TDBBEN SPURKLAND P,E, 203 ~ISTH. AVENUE ANCH, AK, 99501 £ £LDCK 6 MDUNTAIN PARK TED G£CHIF[ND S800 HOLDEN zgI~IVE SEPTIC SYSTEM ASBUILT ])ATE, AU~, =00~ 199=° SHEET, 3/3 GRII), 2838 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910364 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:GSCHWIND THEODORE R & OWNER ADDRESS:5800 HOLDEN DR ANCHORAGE, AK 99516 DATE ISSUED:il/16/91 EXPIRATION DATE:il/16/92 PARCEL ID:01739110 LEGAL DESCRIPTION:~MOUNTAIN PARK ESTATES BLK ' LT 1 6 LOT SIZE: 21400 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. REPLY ~t~® 4S 472 SIGNED PART 3 WILL BE RETURNED WITH REPLY. POLY PAK (50 SETS) 4P47e2 203 ~ 15th. Avenue, Suite 206 ANCHORAGE, ALASKA 99501 (907) 279-3916 LOT 1 SEPTIC SYSTEM DESIGN BLOCK 6 MOI~NTA ! N PARK TED GSCH~IND ESTATE Ixlc.~ Ground Water or Impervious L. ayer .l:e 16 Use Standard Trench Seil Rating. From test October 3~ 1991 10 min/in = .B gal/rain Required Area per Bedroom: 150/~8 = :[87.5 sq.ft.,, Tank Outlet Elev,, 93.75 Bo'~.t. om Testhele E1 ev 8J.. 0 Bc]ttom of System E].ev. B7~0 Depth Jif Rock 93-87 = 6 ft. Ground Surface at Absorption Field 98/96 Number of Bedroom!~ Length of Trench (:t. 87.5 x 4)/ (2 x 6) .':: 62.5 ft. SYSTEM CONFI6URATION STANDARD TRENCH TOTAL LENGTH TOTAL ~IDTH TOTAL DEPTH ROCK DEPTH COVER b2.5 FT. FT. 11/~ FT.F FT. ~, 4/3 FT. SEPTIC TANK 1250 GAL. EXISTING VERIFY INTEBRITY~ REPLACE IF REQUIRED ABANDON EXISTING STEEL CRIB p.-- PUMP~ CRUSH, AND BACKFILL The :i. nstallatJ, on of this septic .system will not prevent wells frc, m be installed (~n the adjacent lots. There are ne develc~ped or natural sur-f:ace / sub surface drainage ¢::ourse~ on this or the adjacent l~t.s, The proposed septic system t, fill not change the general stc.~pe of the area. Pond:i.r~g and/c)r c:encerr~ra'~.ion c)f surface runoff wJ. 11 resuli: from this :i.n~ta.1.].ation. Septic System Design Lot 1 Block 6 PIc)uni:ain Park Estate I:)q- :[ .% PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ][/"~ /[/O0t-f. lCz4~ ~C~'[2¢~ Township, Range, Section: 8 9 10- 11 12 13~ 14- 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? p E Oepth l0 Water After ~,i O Monitoring? Dalo: 0 z~ (' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~ lO (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND ~'~TL FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- J ~' -"(I~GIN,~, E~S'~SEAL) < ~ '~ /}A T°wnship' Range' Secti°n:'F~j, SLOPE S'ITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water After Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop la, 2., ~ I "/~,/L~ r~o,t PERCOLATION RATE '('/-~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ Y,?~ FT COMMENTS PERFORMED BY: .~'/'g~i,,6"-C~J ' .'~ ~-/c¢¢' '¢¢~¢¢''4~¢/ CERTIFY THAT THIS TEST WAS PERFORMED IN ACOORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFEOT ON THIS DATE. DATE: O ~1~.¢ ,~e~l 72-008 (Rev. 4~85) ! 8 0 I I VACANT 6 / I / // N 'DBBEN SPURKLAND P,E, 203 ~ 15TH, AVENUE ANCH, AK, 99501 LOT 1 BLOCK 6 MOUNTAIN PARK SEC, ~6, TI~N R31V TFfl 100 ]50 200 SCALE; 1' -- ]OOFT, ,950 300 SEPTIC SYSTEM DESIGN D^TE, OCT, 16, 1991 SHEET, ],/3 GRID, 2838 Well ./ell T~M T[IP o lANK S FEEL U, 5 PDVE,9 Afl~? PHI?NE 100,00 ONE COMP N .50 7.5 100 SCALE; 1' -- 50 Fi', 150 SPURKLAND P.E, 203 W 15TH. AVENUE ANCH, AK. 99501 L[1T1BLDCK6MDUNT~INsgc. e~, TZeN ~3v P~RK EST][ TFP fi.W?NIVfNrl SEPTIC SYSTEM DESIGN DATE, ~OZ 16 1991 SHEET, ~/3 ~RID, 2838 _1 I]- 6£.5 Stondord Trench; 52,5' LDMG I0' Y2£EP 6' DF S£[WER /?DCK 3' m/n, Cover 12S0 gal Sep~c tonk 140 Peet o£ Septic Rock 3' Cover Monitor GAL SEPTIC ?AMK Ground 4' Nih Cover ~over Tank I]B]3EN SPURKLAN3 P.E, BO3 ~15TH. AVENUE ANCH. AK, 99501 3LZTCK 5 H/~UNTAIN PAP, t( EST TED GSCHk/IND 5800 HDLY?EN 9RIVE SEPTIC SYSTEM DESIGN DATE, DC~ 1~ I991 SHEET, 3/3 GRI3, 2838 203 ~ISTH. AVE, SUITE 206 ANCHOR~GE, ALASKA 99501 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT 1 BLOCK 6 MOUNTAIN PARK ESTATE SEC 26 T12N RSW GENERAL 1.1 Owner is Ted Gschwind~ 5800 Holden Drive~ Anchorage 995:L6 Ph~ane ;/;45.-]L747 3-19-6572 1.2 Engineer is the person or entity hired by the Owner 'kc) inspect i:m ~] ~. S project. The Engineer FFiL.~S~t be recognized by the Munic:~pality of AncJhorag8~ gepartAlerl'~ o~ Health al'id HL[~aB Services. 1,,3 Contractor is the person or' entit, y Inired by the Owner to install this project. The Contractor must be recognized by the Municipalit. y of Anchorage~ Department of Health and Human Servic:es. 1.4 The Dra~ings~ sheets 1 through 3~ shall be part o-E this speci f ication. 1.5 All materia].s and workmanship shall meet the require .... ments of the Municipality of Anchorage~ Department of Health arid Human Services,~ the c:ondi'L~ions of the permit~ ancl all applicable rules and regulations currentI, y iJ'~ e~ect. 1.6 A:I. Il excavat i (:]iii depths are adv:i, sory ~ and are to be veri.~ied and may be modified in the ~ieI. d by the Engineer,, 1.7 It is the responsibility o.F the Owner or the Contractor to adhere to the approved design,~ to veri.Fy that the speci- ¥ied separ'ation distances are met~ and that the required inspec:tions arle per,or'med. .~.,8 The Contractor or 'lzine Owner shall report 'ko the Engi- neer any observed condition which would put 'L:lqe sept:i.c system in v:Lolation o.~ State or Municipal regulations. 2.0 SEPTIC TANK 2.1 I~ '~l-)er'e is~ an e,,xist:i, nq~ septic tank~ it may be used if 'it meets the capacity reqLc~remerrk for t. he residence. The tank shall be inspected by the Enginmer~ and its water tightness and structural integrity shall be ver'i.fied. 2.2 A new septic t, ank shall be one fabricated by either Anchorage Tank and Welding or by Greet Tank Speci'fications .For septic system installation Lot :J, Blocl< 6 MoL~ntain F:'ark Estate pg.1 Tl:le septic tank shall be a UF'C-appreved two-compartmerrl:'. tank.~ constructed of 12 gauge~ or better,~ steel ,/~ith bitu mastic c:oatir~]~ The tank shall be set level on undisturbed seil,,The tank shall be cow~red with the equivalent c~-~ ~ou.r 2.3 The septic tank shall be installed a minimum o~ -Five feet from the house fclundation acid a mirlimum o¥ five feet frem the absorption area. 2.4 The sept. ic tarik shall, be a minimum of 100 ~:eet from any well ser'ving a single residence; :1.(}0 feet 'From any body of 'water~ creeks or drainage ditches with ~lowing water; 150 ~eet .From Class "C" wells~ and 200 ~eet from Class A or Class B wells,, 2~5 Ail pipe connections to the tank shall be mechanical watertight calder couplings. Cleanouts shall be installed as designated and capped ~i'Eh air-ti~tht rain caps. Clean- outs shall extend a minimum cfi 12 ir~c:hes above final ground elevation. Pr'ovisions shall be made for landscaping and :i. mpc)rtation if topsc)il. 2.6 L:i. ft. station shall, be as manufactured by Anchorage Tank and Welding 3.0 ABSORPTION FIELD 3. 1 Grave], used :i.n the absorptien field shall be 0.5 to 2.5 inch screened rc)ck~ ~ith less tlnan ;.~% passing the No~ 200 3.2 Sand~ used for leveling or -For filtering,~ shall tnave an effective grain size bet~een No. 40 sieve and No. 18 sieve. Uniformity coefficient shall be less than 4. Net mc)re than 5% by weight sha].l pass the No. 200 sieve,, .3,,3 4-inch perforated pipe shall be ASTM F810. For' [)res-., sure distributic..n~ pi'pe shall be Schedule 4(} PVC or" ABS. 3.,4 Sol:i.d 4.-..inch pipe shall be Cast. Iron or ASTM D3034~ 3.5 Monitor standpipes shall be installed as .shown,, That section o-F the pipe penetrating the gravel shall be per'fo- r"ated,~ either by drilling 0.5" holes on 6-inch centers or by joinin~ a section of F810 per-Forated pile t.o a solid sectic~n (:~ pipe. i;~6 Geotextile shall be Mirafi 140,, ~.7 Insulation shall be extruded direct burial polystyrene,, Dc:)~.~ Chemical Styro.foam HI 40,, · 3,,8 -[opsoil shall be a mixture ~ 4,0-60% organic matter~ Specifications for' septic system installation Lot I Block 6 Meuntain Park Estate pc~.2 ~,~0-30% sand and more that 20% silt' measured by volume. Alt quantities are 3.9 Grass seed shall be Kentucky bluegrass. 4.0 INSTALLATION 4. 1 Locate al ]. underground utilities ~ property lines ~ ~uture driveways~ exist~ing or proposed water ~ells~ water ways~ sur.~ace and sub sur'~ace dr'ainage ~acilities~ lakes~ ponds~ and all other ~acilities requiring separation dis tances ~rom the proposed septic system. Noti-~y Owner or' Engineer o.~ any observed possible con¥1ict. 4.2 Stake alignment o~ system with markers showing protective distances -~rom wells and water bodies. the 4.3 Establish an elevation benchmark. This BM shall be easily identi~iable~ stable and permanent. An arbitrary elevation o~ 100 can be assigned to the top o.~ -~oundation o,~ the residence. 4.4 Install the tank as shc)wn on the drawings. Record the inlet and outlet elevations o~ the tank,, Tank shall be pi. ac:ed on undisturbed native soil. 4.5 Excavate the absorption ~ield. Bottom o~ excavation shall be level and scarified. I..F side,s, ails smears~ they shall also be scarified. Record elevation o~ begil-~ning~ mi(::ic:l].e and end .c:)~ trenc:h. Record elevation o~ each corner and center point o~ bed. Construction equipment shall not operate on the ~].oor o~ the excavation. Any material cam- patted by the operation o~ the construction equipment shall removed and replaced ~ith uncompacted materials. 4.6 F'lace the rock to the depth speci .i: i ed ,, Dc] not contami- nate rock [~,i'l:h nat:i.w~ materials or spoi].s -from the excava- tion,, Level the rock surd:ace (~ ..... 1") before insta].].ing the pet'(orated pipe. 4.7 Ins'~:all the distribution pipe. Record the elevation e. ach ,joint. [:or pressure system '-.solver~t weld the joints. 4.,,8 Cover' the distribution pipe with rocl..'.~ ancl cover the e.'.,'cavation with geote.xi:ile before back.Filling and placin(~ insulation,~ i~~ required. 4.9 Record the ~in:i. shed ground elevation at the beginning~ middle and end o'[ trench. Record the ~inish ground eleva tiorl at each tort:er and a'~: the midpoirit o.~ the bed~ 4,,10 Furnish a copy of all survey notes to the Engineer~ Speci~:icat:i. or~s 4:o1'" septic system installation L..ot I Block 6 Mountain F:'ark Es'~ate p g ~ 3 5~0 INSPECTIONS 5,~1 A minimum o~ three inspec'~:ions are r'equire, d. The .~irst inspection will be o~ the open excavation~ At this · ~ime the soil condi'L~ier~s ~ill be observed and compared to the design assumpti~:]ns. Ground water conditions or presence o¥ bedr'ock will. be veri~Cied. The second inspection will be a~ter placement o~ standpipes,~ distributiorl piping~ tank(s) and other nents as speci',~ied. gravel~ The third inspec:'l:ior~ will be a+ter" complet:i, on o+ the work. Any deficiencies w:i. lt be noted and tine Contractor noti¥ied. Such de.Ficiencies sha].l be corrected within ten days. 5.2 All electrical work requires either an MOA electrical inspection or cer'~:i ~i cati on by an licensed electrician. Submit proo.~ ('.).F inspection or certi.~ication '[:o the Engineer. Submit catalog data o~: all mechanical equipment. 5,,4 Noti~:y Engineer at least 24 hours in advance c,~ beg:i.n .... ning any Specif:i. cations for' septic system insta].].ation I...ot :I. Block 6 Mountain Park Estate GRfI .'ER. ANCHORAGE AREA MC, ', J 'UGH ~,~H~//~ Department of Environmental Quality ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~J~/~ ~7'~/~:~m- MAILING ADDRESS .~¢~/c/~. ,./~g'2/~.-~ ~;~/~ PHONE LOCATION ~//~'~/(///~/ LEGAL DESCRIPTION ~ ~ ~ /~/~ SEPTIC TANK: DISTANCE .... ¢, ~~'z~/~' NUMBER OF FROM WELL//~'~ MANUFACTURER /~"~-~/~ MATERIAL ,j.~'-~z-~-~ COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH __.LIQUID CAPACITY /~'-~'~) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH /// LENGTH /~, / · DEPTH LINING MATERIAL -~:--~'~//~Z CRIB SIZE: DIAMETER ~ DEPTH ~ /DISTANCE FROM: WELL/// ? -- / TOTAL EFFECTIVE BUILDING FOUNDATION~, NEAREST LOT LINE///~.~'ABSORPTION AREA (WALL AREA) ~//~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE/~/~/~~ -~ ~//~/~/- CONSTRUCTION BUILDING ~/ FOUNDATION , CESSPOOL //~ APPROV E~/~/' DISAPPROVED NEAREST ~.~2~ / NEAREST LOT LINE SEWER LINE ~'~ ~ OTHER SOURCES DEPTH ~'~' '~'~'-~ / DISTANCE FROM: SEPTIC //~,~ / SEEPAGE TANK // ~ S~STEM DISTANCES: INSTALLED BY: /~/~/~'~' PIPE MATERIAL: _~" LOT SLOPE: R E M A R KS: DIAGRAM OF SYSTEM / ,,~..~--,..-' I - J ' I APPROVED G.A.A.B. GREATER ANCHORAGe Area BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM --- APPLICATION AND PERMIT PERMIT NO. INBTALLATiOM Of: SEPTIC TANK ~ SEEPAGE Pit ~., DRAIN FIELD ~ OTHER TYPE AND SiZE OF FACILITY TO BE SERVED ~ _~--'~'/ _r ~/~_~' ' //~"' ~//~' ~.~._-5j ...... ~ FINANCED THROUGH -- ~ TO BE INSTALLED bY ~//~/~/~ SOIL TEST RESULTS ~~ /~ ~~ NOTE: THI~ PERMIT I~ NOT VALID WITHOUT ~OIL ~T HOUR NOTICE REQUIRED. BACKFILLING ANY SYSTEM WITHOUT FINAl INSPECTION .bY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY Will BESUIIJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS .~'{~ ~; 2 ~;Z: / DI.~AM OF SYSTEM SEEPAGE PiT ~ [ . SEEPAGE PIT /~ / . ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK /~ / . SEEPAGE PIT /~ ~ DRAIN FIELD ./~ J-. SEPTIC TANK, /~ /, SEEPAGE PIT /~ , DRAIN f~ELD/OO TO RIVER, LAKE, STREAM. CAST IrON iNTO AND OUT Of SEPTIC TANK AND INTO CRib CROSSING GAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED With AIRTIGHT REMOVABLE caPs. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE With RAID CODE. --~soi] ~ Gm The sediment~ were compac$, w%th a low mo! stuJf~ 6oA~,ent~,. The '~-G,m/ ~,o,,,G~ body" wa~ but 8~e%1 to thi6~en in a we's,t~erty dire~c~l-on ' "~ ~'~, i~, ~ O, .. (;round ;!aZer Encountered? i'e$, ,',t ','[F. dt :';ei:.~. ~0 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-391-10 HAA# 1. GENERAL INFORMATION Complete legal description Lot 1, Block 6, Mountain Park Estates Location (site address or directions) 5800 Holden Road Property owner Mailing address Lending agency Mailing address Ted'Cschwin~ ~ObO~E ~. 5800 Holden Road, Anchorager Fed Alaska - Kathy Matthews Day phone 345-1747 Alaska 99516 Day phone 257-9123 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 ~TATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythatbased on the information obtained from the Municipality of Anchorage files and from my invesd_gation 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. NameofFirm S~_even R. Pannone, P.E. Phone 274-0308 Address p.O. Box 142025. Anchorage, Alaska 99514 Engineer's signature- ~-- Date ~-~(-¢/~ DHHS SIGNATURE //"/ Approved for ¢ Disapproved. Conditional approval for bedrooms. 'bedrooms, with the following stipulations: Additional Comments By: --~'!' , . -- , _ . , Date 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 engineers work. 72-025 (Rev. 1/'91) Back MOA~¢21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Lt' 1, A. Well Data Private Well type Log present (Y/N) - ¥" '(attached) Total depth 290 ' Sanitary seal (Y/N) Y Blk. 6, Mtn. Park ParcelI.D. 017-391-10 Estates If A, B, or C, attach ADEC letter. ADEC water system number Date completed 5/74 Driller Ault Cased to +200 ' Casing height 2 ' Wires properly protected (Y/N) FROM WELL LOG ATINSPECTION 7/30/94 165' g.p.m. 5.3 g.p.m. Date of test 5/74 Static water level 178 ' Well flow 5 Pump level1 unknown SEPARATION DISTANCES FROM WELL TO: m Septic/holding tank on lot +100 ' Absorption field on lot 10 ? ' Public sewer main Sewer service line +50 ' ; On adjacent lots +100 ' ; On adjacent lots +100 ' Public sewer manhole/cleanout Petroleum tank +100' NA WATER SAMPLE RESULTS: Coliform ~ Date of sample: 7/31/94 Nitrate ~ ~) o( O Other bacteria Collected by: SRP B. SEPTIC/HOLDING TANK DATA Date installed 8/14/92 Cleanouts (Y/N) ¥ High water alarm (Y/N) NA Date of pumping 6/].0/94 Tank size 1250 Compartments 2 Foundation cleanout (Y/N) ¥ Depression (Y/N) Alarm tested (Y/N) Pumper Isaac's N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot +'100 To property line 20 ' Surface water/drainage On adjacent lots Absorption field +100 ' +100' +5' Foundation 20 ' Water main/service line + 50 ' 72-026 (3/93)* Front CONTINUED ON BACK PAGE Size in gallons ~ Manhole/Access (Y/N) "Pump off" Level aton" Vent (Y/N) "Pure. I~ov High water alarm level -'"~~ Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Surface water Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed 8/.'1_4/92 Soil rating (GPD/Ft2) ¢ (ID, ~ Length ~ 2 o 5 ' Width 3 ' Gravel thickness 6 ' Total absorption area ? 50 SF Clea~nout pre.~ient (Y/iN) ¥ .uess ~nan z years old Date of adequacy test Not required. Results (pass/fail) . for 9" standing water in bottom of trench 7/30/9~ Water level in absorption field before tesf After test Peroxide treatment (past 12 months) (Y/N) N If yes. give date SystemtypeDeep trench 9.9 ' Jfrom T0taldepthqround level Depression over field (Y/N) N Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 107 ' To building foundation 32.5 ' On adjacent lots +.'l,f~ 0 ' Surface water +100 ' Curtain drain +100 ' On adjacent lots +.'1_00 ' Propertyline +20 ' To existing or abandoned system on lot + 12 ' Cutbank + 100 ' Water main/service line 4-50 ' Driveway, parking/vehicle storage area + 50 ' E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect/on. Signature Engineer's Name Steven ~.. Pannone, P.E. 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Client Sample ID Matrix ClientName Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.3864-3 L1 B6 MTN. PARKEST. OUTSIDE HOSE BIB** WATER PANNONE ENG SRV. WORK Order 80891 STEVEN PANNONE Printed Date 08/03/94 ~ 11:40 hrs. CollectedDate 07/31/94 ~ 14:30 hrs. Received Date 08/01/94 @08:30 hrs. UA Technical Director STEPHEN C. EDE Sample Remarks: Parameter RO1J'IlNE SAMPLECOLLECTED BY: S.R.P. ** 5800 HOLDEN RD. QC Results Qual Units Method Allowable Ext. Anal Limits Date Date Init Nitrate-lq 0.10 U mg/L EPA 353.2/300.0 10 08/01/94 DJS * See Special Instructions Above ** See Sample Remarks Above U= Undetected, Reported value is the practical quantification limit. D = Secondary dilution. UA = Unavailable NA = Not Analyzed LT= Less 'Ihan Gl'= Greater Taan 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 ~74-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property'Owner: Mailing Address: 3. Legal Description: 4. Location: ~/~--~ 5. Type of facility to be inspected Well Data: A. Type C. Construction B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed ~ B. Installer C. Septic Tank: 1. Size ~~/~.~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area ~-/-/~/~/~.~;2. Material E. Disposal Field: Total length of lines o Distances: A. Well to: Septic tank //~/~/-, Absorption area /~/~, Sewer Lines Nearest lot line _~ / , Other contamination B. Foundation to septic tank /-~/ , Absorption area C. Absorption area to nearest lot line x/~ LQ-034 (1/74) Page 1 of two pages '~ ~ge 2o9f t~6 pages - Rekq,~-~st for Approval of Individual ~ & Water Facilities Legal Description Comments Approved Disapproved Date Approval Valid for one year from date signed Greater Anchorage ArEa Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED /(///~ Date EQ-034 (1/74)