HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 7 LT 4Mountain Park
Estates
Block 7
Lot 4
#017-391-15
Municipality of Anchorage
Development Services Department
Building Safety Division 5
On -Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW09077 PID Number: 017-391-15
Name:
Robert Swangler
Wastewater System: ❑ New ® Upgrade
Address:
13000 Rid eview Dr, 99516
ABSORPTION FIELD
Phone: Number of Bedrooms:
344-4567 3
® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other:
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
0.8 GPD/Ft'
8-10 Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
7 4 Mountain Park Est
2-3 Ft.
7.0 Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
1.3 Ft.
17131 Ft.
Well: [_1 New El Upgrade
Gravel width:
Number of lines:
Distance between lines:
2 Ft.
1
14 Ft.
Classification (Private, A, B. C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Exist' Private
Ft.
Ft.
672 Ft'
3034 PVC
Driller:
Date Drilled:
Static Water Level:
Installer:
Date Installed:
Ft.
XslFlintstone
6/4/2009
Yield:Pump
Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
ublic/Private
Manufacturer:
Capacity:
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1000 Gal.
Well
107,5
100,5
---
---
80
Material:
Steel
Number of Compartments:
2
Surface Water
100+
100+
--
--
LIFT STATION
Lot Line
16
4
---
---
Size:
Manufacturer:
Gal.
36
p
28
--
--
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Foundation
in.
in.
in.
Curtain Drain
100+
1 oQ+
----
---
Pump Make & Model
Electrical Inspections performed by:
Remarks:
Exist'g Septic Tank abandoned per code. fill placed over both
BENCH MARK
Location and Description:
trenches. Installed Diverter Valve.
Back Door Jam
Assumed Elevation:
100.0 Ft.
Engineer's Stamp
Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1" 6/3/2009
OF ■��,
�.
2nd 6/4/2009
Development Services Department Approval
�•�p� •• • 9sb4#
••;
�•.-• ��
Conditional Approval Date:
49TH
�..••...
.... ........... .••••�
:Steven R. Pannone!Tt:
C
••............................
No. C 8149
AW
�1 `� \
Reviewed and approved by: Date: l c�— C�t�
•''••��
(Rev. 04/06)
X11,■ E;
'.�
41
2
0
BLK -7 RIDGEVIE� DRIVE,.,,"'
LOT 2 A 41
BLK 7 , = w
N'E UPGRADE LOT 3
1 @31" F 1 @ 1I71-1`
'ED, 10 TD 1%k
st
Z,
W 105.0 BL 7/ 3
EXISTING,, L 4 -0
S PTIC AREA
100,
J C
01.1
B
w- NN \0 BLK 7
107.5
4A -1 S FC LOT.,,
EXISTING C5 A
SEPTIC M C3 El Co� �
AREA
�E 2
... .. ... ...
BLKh 7 EXISTING SEPTIC TANK
LOT
ABANDONED PER CODE
*-__INSTALLED NEW 1000g
SWING TIES
:!-bO A B EXISTING LEACH
FC 19.0 43.1 FIELD IN FAILURE
w"-..-..W
CO 39.4 46.4 TO BE REUSED
T1 46 � 1 55.6 3�
T2 51:.7 58.7 I DV & DC`
DC 54.8 57.2
IDV 56'0 52.4 BLK `7
`%T1 58.2 '39.4-' LOT,-fo
F-2 101.465.4
I U-N,Q.EVELOPED
FS, 74.1 29.0 it
M3 79.0 40-5-, HOLDEN DRIVE...
C381.0 42.0
C4 89.1 31.4 . ....
.....
M4 88.8 32.1
C5 99.11 54,
M5 97.5 5 SEE NOTE 5
NOTES:
PAMONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
NoAk�
4
4, f 00
Date
6/7/09
RECORD DRAWINGS
Scale
PHONE (907) 272-8218 FAX (907) 272-8211
49 RMI
.. ..
st " r� :
Stevenannone
ro# -V, -. CE 8149
A '�w
1.0 0,
Aw
6/7/091"=50'
MOUNTAIN PARK EST, BLK 7 LT 4
Robert Swangler
13000 Ridgeview Drive
P.I.D. NO
--017-391-15
-
PERMIT 10.
SW090077
Sheet
PLAN
Anchorage, AK 99516
OPRO��S'smk�
2 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY
OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN
CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
3. SCOPE OF WORK: 3 BEDROOM HOUSE, NEW 1,000 g SEPTIC TANK, NEW DRAIN FIELD. INSTALL DIVERTER VALVE.
REUSE EXISTING FIELD
4. CONTOUR INTERVALS 4 FOOT
5. SITE PLAN BASED ON SURVEY DATED 13 JAN 1998. PES ASSUMES NO RESPONSIBILITY FOR ITS ACCURACY
RESERVE FIELD
1' FILL, TOPSOIL &
96.0 TH2
—1
—3.5
Su/
NL
94.0 93.5
Drain rock 6" above pipe
inv
4" diam. drain pipe
L 87.0 6ss Drain rock below pipe inv.
—12 --�
S./ 3.0' 3.D I—
YLmQn
80.0 —16 eon No groundwater
monitored SECTION
oz o o a mo_ �w 5
5
gg¢w ¢ o
o . U u oo z 20 o� ,
TWO EACH TRENCHES
PROFILE
DESIGN PARAMETERS
ABBREVIATIONS
LEGEND
SEPTIC SYSTEM
CU
COPPER—w—w—
WATER LINE/
NO. BEDROOM: 3 (450 gpd)
DIP
DUCTILE IRON PIPE
WELL RADIUS
TANK SIZE: 1000 gALLON
TH
TEST HOLE
PERC. RATE: 5-15 MPI
FC
FOUNDATION CLEAN OUT
— ss ss — EXIST'G SEPTIC
S OIL RATING: 0.8 gpd/SF
T#
TANK CLEAN OUT NO.
AREA ROD: 562 SF
SYS. TYPE: TRENCH 7'ED,
C#
CLEAN OUT N0.
_ss ss — NEW SEPTIC
MIN LENGTH: 40 LF
M#
MONITOR TUBE NO.
USE:
R.I.
RIGID INSULATION
CHAINLINK FENCE
48LFx7'ED,10' TD
DCO
DOUBLE CLEAN OUT
TOTAL AREA: 672 SF
DV
DIVERTER VALVE
FS
FLOW SPLITTER
NOTES:PANNONE ENG SVC, LLC OF A1_'kDate
P.O. BOX 102954 ANCHORAGE, AK 99510 r �� grill 6/7/09
RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 /rc,DP
'�'Fyl� Scale
6/7/09 *: 49111 :*�r�
P.I.D.TSO
MOUNTAIN PARK EST, BLK 7 LT 4 017-391-15
Robert SWangler Steven R. Pannone PERMIT No.
�� . CE 8149 c�j
13000 Ridgeview Drive +� �sT. SW090077
NOTES/SECTION Anchorage, AK 99516 illiF�PROFESSioNP`— Sheet
30F3
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 995196650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jun 02, 2009
Expiration Date: Jun 02, 2010
Permit Number: SW090077 Parcel ID: 017-391-15
Legal Description: MOUNTAIN PARK ESTATES BLK 7 LT 4
Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 013000 RIDGEVIEW DR
Owner Name: ROBERT SWANGLER Lot Size: 18900 SQ. FT.
Owner Address: 13000 RIDGEVIEW DR Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE, AK 99516 -
This permit is for the construction of:
Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
A. Permit includes waiver # W RO90026 allowing the proposed drainfield to be 4 feet from the west property line.
Received
Issued
By Date:
By l Date: P 0
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907)343-7904 • Fax (907)343-7997
httn://www.muni.org/O nslte
Development Services Department
On -Site Water and Wastewater Program
Ment
Q n
w
Department
**** VARIANCE/WAIVER REVIEW ****
WR#:090026 HA#:_ Permit#:SW090077
PID#: 017-391-15
Legal Description: Mountain Park Estates: Block 7: Lot 4
Engineer. PES
Applicant: Robert Swangler
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 4.0 feet.
This waiver approval applies to the existing absorption field to property line separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
...............................................................................
Waiver is Granted: x Waiver Is not Gran
ted:
Date: 6/2/09 Approved by:
V Name of Reviewer
................................................•..............................
Rec#: 042994 Amount: $200.00 Date Paid: 11109
**** VARIANCEMAIVER REVIEW ****
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
U S www.muni.org/onsite
A`a n l (907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017.391.15
a e
i
t e
RUSH!
Property owner(s) Robert Swangler Day phone 632.5300
Mailing address13000 Ridgeview Drive Zip Code 99516
Site address 13000 Ridgeview Drive Zip Code 99516
Legal description (Sub'd., Block & Lot) Mountain Park Est, Bik 7 Lt 4
Legal description (Township, Range & Section)
Lot Size 18.900 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply)
Absorption Field
Septic Tank
Holding Tank ❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 3
THIS APPLICATION IS AN:
Initial
❑
Upgrade
El
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
Pannone
(Signature of property owner or authorized agent)
Permit/Rush Fees: ;s'3 o + 318' Waiver Fees:
Date of Payment: i0 / Date of Payment: 6
Receipt Number: Receipt Number:���%�
(Rev. 11/05)
Pannone Engineering Services uc
Steven R. Pannone, P.E., Principal
Licensed & Registered in Alaska and Florida
E-mail: steveraoaneneak.com
May 30, 2009
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
P. O. Box 196650
Anchorage, Alaska 99519
Re: Mountain Park Est, Block 7, Lot 2
RUSH Septic System Upgrade Permit Request
Ladies and Gentlemen:
I am writing to request an upgrade septic permit be issued for the above referenced lot. The
proposed system will serve an existing three-bedroom house; the lot is currently developed.
The lot is served by a private water supply system located on the north portion of the lot. The
surrounding developed lots are served by private water systems; the private wells are located
over 100 feet from the proposed soil absorption system.
1. Soils. A single test hole was excavated in May of 2009. Ground water was not
encountered to a depth of 16 feet and during the excavation and after the monitoring period.
Bedrock was not encountered in the test holes. Based on the percolation test results and the
overall soils appearance, the soils are suited for the use of a conventional wastewater septic
system with an application rate of 0.8 gpdpsf.
2. Proposed System
a.
Percolation Rate:
8.7 Min Per Inch
b.
Application Rate:
0.8 gpd/sf
c.
Design Flow:
450 gallons per day
d.
Min. Absorption Area:
562 sf
e.
Total Depth:
30 feet
f.
Effective Depth:
7 feet
g.
Width:
2.5 feet
h.
Minimum Length:
40 feet
I.
Design Length:
48 feet
J.
Effective Absorption Area:
672 sf
k.
Septic Tank Size:
1000 gallon
Mailing: P.O. Box 102954, Anchorage, AK 99510-2954
Physical: 11301 Olive Lane, Anchorage, AK 99515
Telephone: (907) 272-8218 FAX:(907)272-8211
Page 2 of 2
3. Surface Water: There is no surface water within 100 feet of the proposed tank or the
drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface
water and drainage courses.
4. Topography: The average topography in the area of the proposed septic system is
approximately seven to eight percent based on contour information.
S. Waiver Request: I request a lot line waiver be granted to place the proposed upgrade
drain field within four feet of the west property line. This is necessary due to the effective
depth of the existing field, and the proximity of well radiuses. The proposed drain field will
maintain 14 feet from the adjacent drain field. Granting this waiver will not affect the
development of the neighboring lots.
6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written
notification that the review is complete, and that there are no further comments, is received
from MoA On -Site Department, the note will be removed and "Issued for Construction"
drawings will be issued.
The proposed Installation will not affect the future development of the surrounding or existing
lots. There are no wells or septic systems within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Attachments:
Sincerely,
Steven R. P�
CE 8148 i
5/30/09
Steven R. Pannone, P. E.
Principal
Mailing: P.O. Box 102954, Anchorage, AK 99510-2954
Physical: 11301 Olive Lane, Anchorage, AK 99515
1 .
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t ! EXIST•G jNELL l f+�. ♦�\
1
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1
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1
NOTES: P O E ENG SVC, LLC Date
09
''
P.O. BOX 102954 ANCHORAGE, AK 99510�s�9 �I1 Scale/
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 i6j,• •.
6/1/09 i*: .*l� 1"=100'
�••• •••••� P.I.D. NO
MOUNTAIN PARK EST, BLK 7 LT 4 .. .. ... 1 - 1-15
Robert Swan ler �, S'te'ven annor+e'j PERMIT NO.
g � . CE 8149r Swxxxxxx
PLAN
13000 cAnchorage, eAKw99516 f +��tt ....`.. Sheet 4
'M '•N ........
1 M
0
BLK -7
RIDGEVIE�'J DRIVE
F'
LOT 2 / I M/M M \M 1
IBLK 7 1 ��
PROPOSE UPGRADE LOT 3 °
\ 1®31'" F 10 �7LF
\ 'ED, 10* TD //
w /
w�w.�v?\ i 100.0 BLK•
.;`
EXISTING, 4 j' L 4
S PTIC AREA \
V
00.
CONNECT TO'
4 a
MIDPOINT"'OF 14 w 100.0
w w 3/
_ BLK 7
\ \\/ 4 I ° .LOT 5
EXISTING s
SEPTIC \ \ 1
AREA
IN TALL FLOW\ w� w�
SPLITER w
\M •'� . EXISTING SEPTIC TANK
d TO BE ABANDONED
1 I \w INSTALL NEW 10009 ��
\ EXISTING LEACH
FIELD IN. FAILURE
;BLK 7 TO BE REUSED 1 I �w --w—W/
LOT 7 INSTALL DIVERTER VALVE
BLK "7 j-'' I & DOUBLE C.O.'S
LOT.. -6
UNDEVELOPED f.
a 1 1
a HOLDEN DRIVE--.--'
r
NOTES: P oNNOoNEaENG ANCHORAGE, CK 99IsL1oC (OFA/- Xk Date
6/1/09
�' ;f' Scale
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 wco .9
6/1/09 Aw TH 1'-50'
•• •• ••••• P.I.D. NO
MOUNTAIN PARK EST, BLK 7 LT 41s
Robert Swangler " te'ven' annone'j PERMIT NO.
13000 Ridgeview Drive �� 0�• CE etas i swxx..x.
PLAN Anchorage, AK 99516 ,I��b....s.... Sheet 4
\\\ ��
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY
OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN
CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
3. SCOPE OF WORK: 3 BEDROOM HOUSE, NEW 1,000 g SEPTIC TANK, NEW DRAIN FIELD. INSTALL DIVERTER VALVE.
REUSE EXISTING FIELD
4. CONTOUR INTERVALS 4 FOOT
xrxwe t a
,- FILL. roesolL a
SEED
a Fitter Fab
_I Slo, o.a Drain rock W above pipe
3.5 im
a � vw +. � V diam. drainpipe
Ti 4v
�v :.
Drain rock below pipe Inv.
_Iau Ho p.ouM.ob.
SECTION
NEW 10DO9
COPPER
DIP
Y
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
Ty
SEPTIC
TANK
CLEAN OUT NO.
MN
MONITOR TUBE NO.
R.I.
RIGID INSULATION
a
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
NEW 10DO9
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
Ty
SEPTIC
TANK
CLEAN OUT NO.
MN
MONITOR TUBE NO.
R.I.
RIGID INSULATION
a
DOUBLE CLEAN OUT
DESIGN PARAMETERS
SEPTIC SYSTEM
NO. BEDROOM: 3 (450 gpd)
TANK SIZE: 1000 gALLON
PERC. RATE: 5-15 MPI
SOIL RATING: 0.8 gpd/SF
AREA ROD: 562 SF
SYS. TYPE: TRENCH 7'ED.
MIN LENGTH: 40 LF
I ICF•
48LFx7'ED,10' TO
TOTAL AREA: 672 SF
PROFILE TWO EACH TRENCHES
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
Ty
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
MN
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
LEGEND
w—w WATER LINE/
WELL RADIUS
— as — as — EXIST'G SEPTIC
NEW SEPTIC
—0 CHAINLINK FENCE I
NOTES: PANNONE ENG SVC, t _ ��oF ALS k% 0ate
6/1/09
P.O. BOX 102954 ANCHORAGE, AK 99510 �S'(1�� Score
�OD9 FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 * *ll, NTS
.... .. ... ...P.I.D. NO
MOUNTAIN PARK EST, BLK 7 LT 4 �001-15
Robert Swongler tleven . •Panr oAe j PERMIT NO.
�.•CE 8149 r Swxxxxxx
13000 Ridgeview Drive l� 4f•.,i
DESIGN NOTES Anchorage, AK 99516 lift \ q1�� SheetOF 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TEST HOLE PES 1
OR ORGANICS
Silly SAND
SM
Silty Sand to Sift
Sw
ML
SLOPE
TEST
Silty Sand to Sift WAS GROUND WATER
ML tighter ENCOUNTERED? N
ML
IF YES, AT WHAT
DEPTH?
BOH DEPTH TO WATER AFTER
MONITORING? -DRY -
DATE: 5/29/09
TEST HOLE EXCAVATED ON S/2l=
F9Sy1�
TH 1
PERCOLATION RATE 8.7 (min/nch) PERC HOLE DIAMETER 6 inches
TEST RUN between 6 and 7 FT.
COMMENTS: Test hole excavated by OKmer. Test }sole was presoaked before pert test& ran for 1 hour.
PAM
T�T� �T LLC
T � �� �UOte
NOTES: PAMONE ENG SVC, LLC — OFA( �k% 6/1/09
P.O. BOX 102954 ANCHORAGE, AK 99510 „tp��'' ••..9, 1III scale
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 r7.• '9 �� NTS
6/1/09 *.. ... *. P.I.D. NO
MOUNTAIN PARK EST, BLK 7 LT017-391-15
Robert Swongler•$•teven 0nnone / pENMI 0.
CE 8149
Rideview Drive
PLAN AnOcOho age, AK 99516 /�1 9�gE � PERMIT/ Sheet
3 4
CLOCK
WATER
READING DATE
NET TIME
LEVEL
NETOROP
TIME
READING
1 5128.09
S:M
8.19•
0•
2
5'.18
10 MIN
9•
381
3
5.16
5.19'
0'
4
528
10 MIN
863'
3"
8
528
8.t9•
0'
6
508
IOMIN
863-
3.N
PERCOLATION RATE 8.7 (min/nch) PERC HOLE DIAMETER 6 inches
TEST RUN between 6 and 7 FT.
COMMENTS: Test hole excavated by OKmer. Test }sole was presoaked before pert test& ran for 1 hour.
PAM
T�T� �T LLC
T � �� �UOte
NOTES: PAMONE ENG SVC, LLC — OFA( �k% 6/1/09
P.O. BOX 102954 ANCHORAGE, AK 99510 „tp��'' ••..9, 1III scale
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 r7.• '9 �� NTS
6/1/09 *.. ... *. P.I.D. NO
MOUNTAIN PARK EST, BLK 7 LT017-391-15
Robert Swongler•$•teven 0nnone / pENMI 0.
CE 8149
Rideview Drive
PLAN AnOcOho age, AK 99516 /�1 9�gE � PERMIT/ Sheet
3 4
MUNICIPALITY OF ANCHORAGE J
J DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL
ENGINEERING DIVISION
825 L Street
- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
PHONE
�EW
A"^HpM1
❑UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
M- z_K
LOCATION
NO. OF BEDROOMS
QF_ 1262�:SpAE>I)tJ
�, 1 �
41vPjb
WeII
Absorption areai
Dwelling
PE I
G3
Uy
DISTANCE TO:
Z
15
e
ZZ
wMa
nufacturer
Material
No. of compartments
~
co
Liq. capacity in gallons
IF HOMEMADE:
Inside le
Width
_
Liquid depth
�-
G yDISTANCE
TO:
Well
Dwelling
PERMIT NO.
JAZ
_ <
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well /
Foundation
`4O -
Nearest lot line,
PERMI NO.
=
lri
Tl
Z
No. of lines
Lengt
f bac ine
1 Total len th ot% lines
Trench wi
Distance bet een lines f
P w
Z
inches
Lam.
Top of the to finish gradef
Material beneath tile�C ,\
Total effe ' e �b p ' area
4q
U f inches
Length
Width
Depth
PERMIT NO.
LU
Qa F
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
wa
W
Well
Building foundation
Nearest lot line
DISTANCE T0:
J
Class
Depth 5
A D[illef { ��•
//
Distance to lot line
PERMIT NO.
J
12
L ,v
Lu
DISTANCE TO:
Building founds' n
.:$ewer line
-
Septic tank
Absorption area(s)
-HER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
M �o,J�•i �
�
REMARKS
Per- 45
`
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APPROVED
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linA�ee �p�$\IY^•.
DATE LEGAL
`IE�R6e�A
IV,'371
�_
1,21-X5
/\1
72-013 (Rev. 3/78) 4-e4 v:?Y',Gu!✓
`
US MH :1 C', 1. 11'." A L. X W Ar 10 F", IT E=:
'^ DEPARTMENT / HEALTH AND ENVIRONMENTAL�,�)TECTION 1J
, ^ ^ �~ `
825 1 501
264-4720
11. ""If" EE �1L,-fd1 EE: IF:'? 1"E": L- ��N-11 .1r '_ Ps"'
PERMu NO:
�
DATE ISSUED:
APPLICANT:
�ADDRESS:
CONTACT PHONE:
840980
12/31/84
DANMAR CONST"
2830 EAST. 88 Th AVE
ANCHORAGE� Al-.-.': 99503
3492386
�LEGAL DESCRIP: SUBDIVISION: MT, PARK EST"
� SECTION: 26 TOWNSHIP: 121A
�
LOT SIZE: 15600 (SQ.FT. OR ACRES)
�
MAX BEDROOMS: 3
LOT: 4 BLOCK: 7
RANGE: 3W '
Listed below are the options available to you in designing your sep�ic
system. Choose the opti �site,
_ � ~ _ ' � � � �� ~ - � � � � � _ _ ~
���� ��= ������][�
��11
�
DEPTH TO PIPE BOTTOM (FT.4. 4.0 4.0
�GRAVEL DEPTH (FT.) 0,5 3"5
�TOTAL DEPTH(FT.) 4.5 7.5
GRAVEL. WIDTH (FT.) 24"O 5,0
�GRAVEL LENGTH (FT.) 47,O 93.0 **
GRAVEL VOLUME (CU"vDS.) 41"8 68`9
�TANK SIZE (GALS) On 1 00 **
� SMIL RATING (SK FIT. /BR) 207 250 287
�
** GRAVEL LENGTH > 75 FT" R IPLE RUNS (NOT EXCEEDING 75 FT. EACH>
� ** TANK MUST HAVE AT LEAST TWODY��/RTMENTS
� � _ � ~ ~ � � � � � _ _ _ � � ... ~ ~
`
�
I certzfy that:
1, I am hamiliar with the requirements for cur -site sewers and wells as set
forth by the Municipality ofAnchorage (MOA) and the State of 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.
3" I will adhere to all MOA and State of Alaska requirements for th�� set back
� distances from any, existing well, wastewater disposal system or public
� . sewerage system on this or any adjacent or nearby lot" `
4, I understand that this permit isvalid for a maximum o� 3 bedrooms and
any enlhrg|sment will require an additional permit.
[F A LIFT STATION IR INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES
�THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) ASPBUILTS
�
f WILL 11401"BE APPROVED WITHOUT AN ELEC/RICAL INSPECTION REPORT; AND (3> THE
ELECTRICAL WQRK MUST BE DONE BY A LICENSED ELECTRICIAN"
�SIGNED DATE:
APPL. I CANTI DAN
ISSUED BYDATE:
� y _-............ ___�^^
- JNICIPALITY OF ANCHORAGE j
"i DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
C,
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG = PERCOLATION TEST
PERFORMED FOR: 11'r rn�-�. NPY1-1`(YDATE PERFORMED:_
LEGAL DESCRIPTION: 11\00n-tn�n I i✓Sia e� �ock �6l
SLOPE SITE PLAN
x`F
Date
Gross
Time
bL.
Depth to
Water
r
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Leroy C. Reid, Jr.
N 2231 •- •• .,
WAS GROUND WATER S
E" COUNTERED? L
O
P
E
IF YES, AT WHAT
DEPTH?
0ci Il 1q c
1`10A S� r3r,y
V Reading-
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
tNZO
cr+ „
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i
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V Reading-
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Drop
tNZO
cr+ „
rryl
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ZU AMO Qin °••,, ••• 4k.� PERCOLATION RATE -30
(minutes/inch)
®®®ESSI� TEST RUN BETWEEN 2 /Z F AND FT
COMMENTS 16' N6ry Gar- ! l,er� rnS'Fail;nh
StnS�(rh �' n.�<1•,itr• IU r\CI 'k ea,_ kc"JQ <IIS Neo- !c" I�rlrs.
PERFORMED BY: r%o- CERTIFIED BY: DATE: _
72-008 (6/79)
WELL LOG
Date Drilledt 111.-P5
Static Wateb Level 165 feet
Draw Down NIA feet
Type Material Drilledt
T,ot 4
� Rlko 7
Mt o _park r tater
Gallons Per Minute '-N
Total Feet of using 205
0 feet to 20 Silty ;ands ?ravel
90 feet to 60 Silty sand
60 feet to
160 feet to
170 feet to
70 Cravelq rocks
cla
177 feet. to !75 ��ravel. t,. 15 R!rm.
441A17C/P41;
7
Ro�MF7VT44 `�ql hcy°Rq
-+ j 019
ke ,
m
1.7.5
feet
to
1.99
t, oht,
gravel._...__..__--..___�._
190
feet
to
200
200
feet
to
205
„Sa_1d$
nrwel- Xa/abater _ .... _. _.._...._
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
Municipality of Anchorage
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
Parcel I.D. 017-391-15
1. GENERAL INFORMATION
Complete legal description Mountain Park Est Block 7 Lot 4
Location (site address) 13000 Ridaeview Drive
COSA a ORD l G 2
Expiration Date: 9—/0-0-9—
Day
/a—Oq
Current Property owner(s) RobertSwangler Day phone 344-4567
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
13000 Ridaeview Drive Anchorage AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well 19
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
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 seat 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/ wastewater disposal system is(are) in compliance with all applicable Municipal ang state codes,
ordin regulations in effect at the time of installation.
W,rite of Firm Pannone Engineering Services, LLC Phone 272-8218 r
Address _P.O. Box 102954, Anchorage, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 617/09
Engineers Comments: In conducting an adequacy lest, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. 71c reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
71c operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system,
These conditions are outside the control of the evaluator of this system. All systems eventually fail an
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PFS can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the hIOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SI NATURE
Approved for -3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory_
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: — / 0 _ 0
(Rer. r
Municipality of Anchorage
• Development Services Department d °:
Building Safety Division "' ..
On -Site Water & 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 CHECKLIST
Legal Description: Mountain Park Est Block 7 Lot 4 Parcel ID: 017.391.15
A. WELL DATA
Well type Private If A. B, or C provide PWSID q _ Well Log (Y/N) Yes
Date completed111 111985 Sanitary seal (Y/N) Yn Wires properly protected (Y/N) Yes
Total depth 205 ft. Cased to 205_ft. Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 111111985 511312009
Static water level 165 ft. 163 ft.
Well production 5 g.p.m. 3.2 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 5.3 mg/L Other bacteria 0 colonies/100 mL
Arsenic: mg/I Date of sample: 5-13-09 Collected by: Michael Wehr
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 61412009
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) y" Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 61412009 Pumper Now
C. ABSORPTION FIELD DATA
Date installed 6512009 Soil rating (g.p.d./fe or ftp bdrm) ¢8 System type Deep Trench
Length 17131 ft. Width 2 ft. Gravel below pipe 7.0 ft.
Total depth 10 ft. Eff. absorption area ¢72 ftz Monitoring tube y Depression over field D
Date of adequacy test 61512009 Results (Pass/Fail) New For 3 bedrooms
Fluid depth in absorption field before test — in. Water added_ gal. New depth_ in.
Elapsed Time: =min. Final fluid depth _ In. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ In.
Datum
Size in gallons Manhole/Access (Y/N)
"Pump off"level at _ in. High water alarm level at — in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 107
Absorption field on lot 100.5
Public sewer main 50+
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 50+ '
Sewer /septic service line 80 Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 36 Property line 16 Absorption field 5+
Water main 100+ Water service line 50+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 4• Building foundation 28 Water main 100+
Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 50+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / 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 Steven R. Pannone, P.E.
Date 617109
COSA Fee $ ?– .5,Z) `% 17 p 'Sus 4 -
Date of Payment rO 9
Receipt Number�-
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Steven Ponnone/
� i4 No. CE 81411
r, S> .
���"••.. .... r-ES�i
SCS RefN
1092014001
Client Name
Pannone Eng. Srv.
Project Name/M
Mountain Park Estates R7,IA
Client Sample ID
Mountain Park Estates f17,1A
Matrix
Drinking Water
Sample Remarks:
Parameter
Results
PQL
Metals by ZCP/MS
Received Date/time
05/13/2009 14:34
Arsenic
ND
5.00
Waters Department
05/20/09
1D%
Total Nitratc/Nitrite-N
5.30
0.100
Microbiology Laboratory
Colony Count
0
Total Coliform
0
Fecal Coliform
0
Printed Dole/Time
05/22/2009 17:00
Collected Date/time
05/13/2009 13:21
Received Date/time
05/13/2009 14:34
Technical Director
Stephen C. Fade
Allowable Prep Analysis
Units Method Container ID Limits Date Date
ug/L
EP200.8
C
(<10)
05/19/09 05/20109
NRB
mg/L
S%1204500NO3-F
11
(<10)
05/20/09
1D%
col/IOOmL
SN1209222B
A
(<200)
co1,t100mL
SN1209222B
A
(<1)
col/IOOmL
SN1209222B
A
(<I)
05/13/09 DLC
05/11/09 DIX
05/13109 DLC
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.orglonsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 090162
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 7, Lot 4 of
Mountain Park Estates subdivision. This inspection revealed a nitrate
concentration of 5.3 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.
Page I of 1
Poet, Jeff W.
From: Steve Pannone [sieve@panengak.com]
Sent: Wednesday, June 10, 2009 9:47 AM
To: Poet, Jeff W.
Subject: 13000 Ridgeview Drive
Jeff,
Per our conversation this morning, and based on my notes from the installation, the northern clean-out
on the eastern trench is the flow splitter (FS) between the two new fields.
Please call if you have any further questions or comments.
Steven R. Pannone, P.E.
Pannone Engineering Services, LLC
(907) 272-8218 Office
(907) 272-8211 Fax
(907) 227-3522 Cell
6/10/2009
\ r��
SCALE: 1"= 30'
P�e FAl- \X �
49 _e i
.LY.� .
/ Fred Vla a:ka
No.
3255S ..�
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED FH 6 — c%'O y
PLAT ARE NOT SHOWN HEREON. FB 09-3, pg M70
BE
8340X
NO CORNERS SET THIS DATE
I hereby certify that I have perforated a Mortgagee's Inspection
of the following described property, LOT 4, BLOCK 7.
MOUNTAIN PARK ESTATES SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property fines
and do not overlap or encroach on the property tying
adjacent thereto, that no improvements on the property tying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission fines or other
visible easements on said property except as Indicated
hereon.
Dated at Anchorage. Alaska
this 8th day of JUNE .2009
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
(907-248-1888)
MUNICIPALITY OF ANCHORAGE /
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # OI`1 391 l_rHAA # IUMLIA 22
1. GENERAL INFORMATION
Complete legal description
0 iAa414
Location (site address or directions) 17 �� i'ear
Property owner h) LC u Day phone
Mailing address
Lending agency Day phone
Mailing address
Agent JA1 AL% La_"'Al Day phone '3q4- AVIS
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
,Y
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: 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
5.
.3
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage 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 E_ Phone
Address oto 3 Lv /5 GG7 o2t9 6
Engineers signature d - --- Date Q_/ (,3
l, z
i
r
`t
DHHS SI NATURE
_lam Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-0?" 'RAV. 1/91) Back MOA #21
Municipality of Anchorage
O Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I - IS-, zz' Parcel I.D. C)1`7 3l' 1 15
A. Well Data
Well type i� if A, B, or C, attach ADEC letter. ADEC water system number NSA
Log present (Y/N) Y Date completed 1 111 1 8S Driller
0
Total depth a Oar Cased to 42-Oys Casing height is
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
1/11'$'5
SEPARATION DISTANCES FROM WELL TO:
Wires properly protected (Y/N)
AT INSPECTION
8/5 13 MUNICIPALITY OF ANCHORAGE
/ ENNIRONMENTAL SERVICES DIVISION
` AUG 12 1993
P.M.
3m RECEIVED
Septic/holding tank on lot 105 4- ; On adjacent lots
Absorption field on lot I t On � ad'acent Into
Public sewer main
Sewer service line
/3a
/ 30 f
N/A Public sewer manhole/cleanout / 1'11A
'750 Petroleum tank �` 0
WATER SAMPLE RESULTS:
Coliform / Nitrate r Other bacteria
Date of sample: �!S! �l3 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size I rs-o D Compartments
2
Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) 14
High water alarm (Y/N) ?11A Alarm tested (Y/N) 11,4
Date of pumping ylY 3 Pumper .-L- A *-ates
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
/05±
On adjacent lots 115 Foundation C 3 6
To property line > l O Absorption field 1 Water main/service line
Surface water/ drainage 1 �l o 4 2
.SD
72-026(3/93)'Front CONTINUED ON BACK PAGE
C. LIFT STATION N%%^
Date installed /t -T
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
Date installed 11x1 185 Soil rating (GPD/Ft2) c� % s �0 hSysterntype Z"CA
Length t> Width 13 t Gravel thickness B ! Total depth
Total absorption area q Vy Cleanout present (Y/N) Depression over field (Y/N)
Date of adequacy test 51 R3 Results (pass/fail) for 5 Bedrooms
Water level in absorption field before test /7 After test 026
Peroxide treatment (past 12 months) (Y/N) / Y If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I )b :
To building foundation -2� t
On adjacent lots 1 110 -1 Property line '7 I b C 13 ± J
To existing or abandoned system on lot N1
On adjacent lots ,>,, � b Cutbank�-L rpt -e Water main/service line >50
Surface water lyc 0 Driveway, parking/vehicle storage area �� O
Curtain drain N/'o
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines iri effect ori the date of this inspection.
G U
HAA Fee $ 1-76 Waiver Fee $
Date of Payment 0— 0 - Date of Payment
Receipt Number _`� �� �� f L7ta) Receipt Number,
72-026 (3/93)' Back
COMMERCIAL TESTING & ENGINEERING CO.
► ENVIRONMENTAL LABORATORY SERVICES
SiNOE 19CS
REPORT
of ANALYSIS
5633 B STREET
Chemlab Ref.#
:93.3898-1
ANCHORAGE, AK 99518
Client Sample
ID :L4 B7 MOUNT. PARK EST
TEL: (907) 562-2343
Matrix
:WATER
FAX: (907) 561-5301
Client Name
:TOBBEN SPURKLAND, P.E.
WORK Order
:69182
Ordered By
Report Completed
:08/10/93
Project Name
Collected
:08/05/93
@ 11:30 hrs.
Project#
Received
:08/05/93
@ 14:00 hrs.
PWSID
:UA
C EDE
Technical :S1'"'21
Released
1
-
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.S.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
------------------------------------------------------------------------------------------------
Nitrate-N 2.02 mg/L EPA 353.2/300.0 10 08/09 LLH
See Special Instructions Above UA = Unavailable
*'* See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. GT = Greater Than
1IBM?SGS Member of the SGS Group (Societe Generale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
1. GENERAL INFORMATION
(a) Legal DeVription (include I
Application Date��G
block, subdivision, section, township,
Location (address or directions)
(b) Applicant Name Telephone: Home s3 ��S^ ��BLBusinesso':?W' -? 51`S�5_
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ; Buyer ❑ ;Other ❑ (explain);
(d) Lending Institutionfc l/��1� Telephonnee 79-( 73 �9
Address
(e) Real Estate Company and Agent .2f.�'��—�
Address
Telephone —
(f) Mail the SIaddress:
& S ENGINEER
GU -RaVERy A
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3, WATER SUPPLY
Individual WelIX Community ❑ Public ❑
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 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 (11164)
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. l 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 5 & 5 ENGINEERING Telephone 69-K'4-4?7 c1
Address 5R B 196X
Date
EAGLE RIMER AK 99577
6. DHEP APPROVAL
Approved for bedrooms by t-2 t L ` Date
Approved — Disapproved Conditional
Terms of Conditional Approval
dhep
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to" satisfy certain federal and state requirements. Employees of DHEP 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 (1 1184)
To Nearest Edge of Absorption Field on L
jUZ / ; On Adjoining Lots O D / '�-
To Nearest Public Sewer Line �' To Nearest Public Sewer o/
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by 5 S � 6 (niFL/z /e tnIC ; Date 'V—
Water Sample Test Results � `�� 1T0 YZ
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size 1p0zp No. of Compartments Z
Standpipes *-N) Air -tight Caps %NJ_ Foundation Cleanoute6k
Depression over Tank,�Y Date Last Pumped�/�
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well �UZ
To Property Line
To Water +Asha/Service Line
Course
Comments.;
Page 1 of 2
72-026(11/84)
Temporary Holding Tank Permit (Y/N)
To Building Foundation
t
To Disposal Field
U
/L5-01
SO /—'
To Stream, Pond, Lake, or Major Drainage
"'IN1�1VALITY OF ANCHORADg
DEPT. OF WEALTH 8,
OF ANCHORAGE (M6^71
ENVIRONMENTAL PRO,EETION
MUNICIPALITY
HEALTH AUTHORITY APPROVAL (HAA)
NiAY U 2 9986
CHECKLIST - FEBRUARY 1984
264-4720
RECEIVED
�j
G
Legal Description:
25:�717i
A. WELL DATA
Well Classification -" ' '
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present��l)"
Date Com I &_ aJ_ Yield
Completed P
Total Depth Z_6S Cased to
is
ya Depth of Grouting v
Static Water Level
Pump Set At zdx�
Casing Height Above Ground
c.
Z Sanitary Seal on Casing4G"
Electrical Wiring in Conduit*wy
Depression Around Wellhead (N
Separation Distances from Well:
To Septic/Holding Tank on Lot
;On Adjoining Lots
�U
To Nearest Edge of Absorption Field on L
jUZ / ; On Adjoining Lots O D / '�-
To Nearest Public Sewer Line �' To Nearest Public Sewer o/
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by 5 S � 6 (niFL/z /e tnIC ; Date 'V—
Water Sample Test Results � `�� 1T0 YZ
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size 1p0zp No. of Compartments Z
Standpipes *-N) Air -tight Caps %NJ_ Foundation Cleanoute6k
Depression over Tank,�Y Date Last Pumped�/�
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well �UZ
To Property Line
To Water +Asha/Service Line
Course
Comments.;
Page 1 of 2
72-026(11/84)
Temporary Holding Tank Permit (Y/N)
To Building Foundation
t
To Disposal Field
U
/L5-01
SO /—'
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Z g ���' Type of System Design
Date Installed _Z / "8`7- Length of Field �y
Width of Field 3c' Depth of Field / Z
9� y
Square Feet of Absorption Area ravel Bed Thickness Standpipes Presento/Ar
Depression over Field �*a Date of Last Adequacy Test
ate/
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well % Z ' To Property Line a
To Building Foundation Sb r To Existing or Abandoned System on
Lot
To Water Main/Service Line
S�
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
On Adjoining Lots
To Cutbank (ifrsent)
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 checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed
8, S 2NGINEERIRIG Date S= Z-"8C�
SR a 196X SO O 3
Company MOA No.
LE RIVER K 9n qi0
Receipt No. T
Date of Payment Z _
Amount: $
Page 2 of 2
72-029 (11/94)
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MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
'D
DEPARTKENT OF MUTH AN EN WIRONMENTAL PROTECTION
APPLICATION FOR TEMAT, H AUTHORITY APPROVAL CERTIFICATE
Bneral Information Application Date
a) Legal Description
/_ � 43 7
(include lot, block, subdivision, section, township, rdati!
M
Telephone
(f) Mati the HAA to the following address:
'M
0Sia Y.
2. Type of Residence
Single -Family Multi -Family Other (describe)
Number of Bedrooms �5
3. Water Supply
Individual Well 5kT Community Public
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 Public Community Holding Tank
Note: If community well system, must have written confirmation from the State
Department ef Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
Inspections, Tests, File Search, Data and Information
t:Lfi,*d by MY seal affixed hereto and as of the validation date shown below, I
certify
this Health Authority Approval shows that the o
th#g pry investigation of
erify Ws 1� n -site
e 'r, . 001 and/or wastewater disposal system is safe, functional and ad
. equate for
d
of bedrooms antype of structure indicated herein..
numW I further verify that
based information obtained from the Municipality of Anchorage files and from my
and inspection, the oz -site water supply and/or wastewater disposal
tem
us 1,4 compliance with all Municipal and State codes, ordinances, and regula-
offect on the date of this inspection.
Mame of Telephone
Ad
GA dress ------ � -
Date If
z 5r)
7
(ENGINEER SEAL) A4 rere c
?Wbofl A. 5'..,
6. DEEP Appk
bedrooms By
Approved N'c j26L) Date�
'Approved Disapproved Conditional
Terms of Q00ditional Approval
CAUTION
THE MUNI,T,�IALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL
(DHEP)
. ES W-kLTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE
ATIONS 0143� IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL: ENGINEER
THF -7
swTs OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF
; IN
,THEIR Lgw,%'STITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE
,.,LOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA
CERTIFICg
,�g IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE
OR OMISS�L-N
j � Iti TEE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
PROTECTION
REPRESENT -
REGISTERED
HOI MES AND
REQUIRE_
BEFORE A
FOR ERRORS
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONDEPT. EA4�NN HEALTH &
TAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 ( 1 G ����
A. WELL DATA Legal Description:�;�)
Well Classification If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present /N) Date Cmpleted Yield
Total Depth Cased to 11-r_, '•+- Depth of Grouting
Static Water Level Pump Set At U {�
Casing Height Above Ground Sanitary Seal on Casing_}'N )
Electrical Wiring in Conduit /N) Depression Around T%Jellhead (Y)&,)
Separation Distances from Well:
To Septic/Hol-ding-Tank on Lot ( L7 -.z- ' ; On Adjoining Lots j — � -%-
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots l
To Nearest Public Sewer Line ``� �/1 To Nearest Public Sewer
Cleanout/Manhole AJA/ To Nearest Sewer Service Line on Lot t3 t_3
Water Sample
Collected By
Water Sample
Test Results
P'rt
Conane r_ts
B. SEPTIC/HGT=9!? ;--TANK DATA
Date (r.- Cr- --�_'
Date Installed 2-1 -45'�__> Size No. of Ccapartments r
Standpipes ("/N) Air -tight Caps d�(/N) Foundation Cleanout tTM)
Depression over Tank (YR Date Last Pumped
Pumping/Maintenance Contract on rile (Y/N)'-) ; for
Holding Tank High -Water Alarm (Y//N) YI.-IIA Temporary Holding Tank Permit (Y/N)/fa
Separation Distances from Septics ng Tank:
Tc Water -Supply till L To Building Foundation (-L-
To Property Lire l��,� fi To Disposal Field ( N
To Water Aa-i-r./Service Line t5 C_ 'L To Stream, Por_d, Lake, or Major Drainage
Course /fq
Comments
Receipt #��I 3� L
Date Paid:
Amount: L�t7^'_�
(Page 1of2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata d_�/�,ntw-Type of System Design
Date Installed k &;_`a Length of Field 5;el '
Width of Field '� Depth of Field 1,- j
Gravel Bed Thi ckness
Square Feet of Absorption Area r/ Standpipes PresentN, )
Depression over Field (YAO Date of Last Adequacy Test �k1
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Fb11 c`% -Z_ ` To Property Lire
i_
To Building Foundation 5� To Existing or Abandoned System cn
Lot On Adjoining Lots
r
To Water MaitT/Service Line = To Cutbank (if present)Lja
n�
To Stream/Pond/Lake/or Major, Drainage Course �a
i�
To Driveway, Parking Area, or Vehicle Storage Area
Con ents
D. LIFT STATION
Date Installed Dinensions
Size in Gallons Mgnhole/Access (Y/N)
"Pump On" Level at - /'Pump Off " Level at
High Water Alarm Level at Vent (Y/II)
Tested for PunVineCycles during Adequacy Test. !Meets MOA
Electrical Codes (YM)
Comments
** Check Permitted Bedroom ratir-g Against HAA Request **
I certify that I have checked, verified, or confor*red to all MOA HAA Guidelines in effect
on the date of this inspection_.
Signed .9 i ", Date j 'i-
t 1 P r
Ccmpany MOA No.
KB1/d5/s
[Page 2 of 21
2-15-8a