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MOUNTAIN PARK ESTATES #2 BLK 3 LT 10
Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221161 PID Number: 017-022-22 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JACI & BERNARD VANN EE ABSORPTION FIELD - EXISTING El Deep Trench El Wide Trench El Bed El Mound Site Address 13100 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MOUNTAIN PARK ESTATES #2 3 10 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well *97+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other S.T. INSULATED Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 101+ __ NA Foundation 5'+ ILIFT STATION Manufacturer Capacity Gal. Remarks NEW TANK INSTALLED IN SAME LOCATION AS EXISTING DECOMMISSIONED S.T. W/ CONT. WAIVER. Alarm location Electrical installed by Installer A+ PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 15` 7/26/22 2nd 7/27/22 Location and description 3'd 41h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL \ or-\t� it Conditional Approval: Date ....•:* • • • • • • • • • •V• Septic System Approve �j Curtis Huffman /� - (� �Fc�s •. CE 128991 ���� Date C •. I . 8/05/22 c, pROFESS10Ha (this Nothis approval does not include well permit requirements. kmtw V.7/VL/ 10) PID: 017-022-22 PERMIT: I 16 10' UTILITY EASEMENTS 1 =ENCE 8.2 10.2' SHED w/ RAMP OSP221161 Lot 9 '00- A ATF cl WOODEN FENCE S °56'06"E 183.00' s I - fI , I O GRAVEL WE B 26.3 Z 8.4'x12.3' SHED—j' O ON DECK < O C4 L®t 10 C U moo= >- `'' � 20,130 S.F. �30K o L 0 15 D 0 m �- a —► NEW 1000—GAL HDPE SEPTIC TANK D D MH CC 2.0 --' O DCO F C O cl i 00 FCO ^ 12.0'- r I nn 40.3' cv A -C=20'9' B -C=49'3' A -D=25'9' B -D=46'7' A -E=27'6' B -E=46'0' A -F=25.4' B -F=53'9' FILED 11.7'x12.2' SHED w/ RAMP ON SKIDS N 89°56'06"W 183.00 O Ii N ASPHALT DRIVEWAY 45.0' BMS DOOR JAM SEPTIC SECTION SCALE, NTS ,up, O 0 O W -P cn m O O O MOUNTAIN PARK ESTATES #2, BLK 3 LT 10 SUPPORT SERVICES: ®®®- PREPARED FOR: OF �A JACI & BERNARD VAN EE 13100 SAUNDERS RD *TH ANCHORAGE, AK 99516 4tu� 0 FIRST WATER CONSULTING 0 J111" DATE: 8/12/22 ` tis Huffman / 13030 SUES WAY SURVEY: LANG r� CE 128991 DRAWN: FWCS 8/12/2022® ,0 ANCHORAGE, AK 99516 SCALE: 1r' = 30' 907-350-9566 FirstWaterAK@gmail.com L m ci l `t o Ancuori e P Department Of Health and Human Services 825 "L" Street Rick Nlystrom, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 28, 1997 Jeff Garness, P.E. Alaska Water & Wastewater Services 8471 Brookridge Dtive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 10 Block 3 Mountain Park Estates #2 Waiver Request #WR970048, PID #017-022-22 Dear Mr. Garness: Your request for waiver(s) of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are an on-site well to the on-site septic tank of 97 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions please call our office at 343-4744. , Sincerely, Daniel J. Roth Civil Engineer On-site Services Program ljm: #6 Lang s waiver, AmeJ iaq7 wt 1've,' dor /1,- &t) - u.A k osv2.210-67 R 7 ' alPDroVe 'Q /;,/ W 0A5/2Z 0 Firsl Wder ' C O N S U L T I N G i 4 3 T i E Vi t is 4NH 7 13021 Montego Circle, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 5, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: MOUNTAIN PARK ESTATES #3 BLOCK 3, LOT 10 — WELL TO TANK WAIVER The previously existing aged, steel septic tank was removed and decommissioned and the recently installed HDPE septic tank was installed in the same location. At this septic tank upgrade, the 100' well radius was staked prior to construction and it appeared the new septic tank was approximately 99' to the well. The septic tank upgrade design was also based on the digitized as -built survey and available MOA documents. However the attached as -built survey by Kenneth G. Lang, shows the septic tank approximately just over 98' to the existing well. We are therefore requesting a continuance of the existing MOA waiver to 97' between the referenced well and septic tank be granted and continued at this time. Granting and continuation of this waiver is justified in the fact that the well is upgradient from the new septic tank, any potential effluent surface runs would be in excess of 100', the slopes continue away from the well and septic tank with no chance of surface effluent reaching the well, the actual septic tank material is of higher HDPE quality than the previous exiting tank in the same location, the HDPE tank was properly bedded with material and should have a long properly operating life with no real influence on the well or aquifer, the well is on the opposite side of the house and there have been no known issues or influence over the past few decades from the previous existing decommissioned steel tank. Granting and continuance of this waiver will not impact any of the neighboring properties. Please contact us if you have any questions. Respectfully, 0 �� Curtis Huffman, P.E. Attachments: As -Built Survey Inspection Report MUNIGIPALITY OF ANC HO RAGE Ort -Site Wal.er & WaMewater I'rDgram PO Box 195550 4 F00 Elrnor& Rand. ArtchorW, Alas%a 99579- Pl1wne- (947) 343 -MM FaoS, (90?) 343-7W h11p1fb%ww muni,argkms4te Ori -Site Wastewater Disposal System Permit Fennit Number- OSI 1161 Work Typa.' Sep&'Fan k Upg(ade; Effective date; Fkpiration Date: Tax Dade NunilbeT: 017022220OG Site Legal Address: MOUNTAIN PARK ESTATES42 13l -K 3 LT 10 G-2839 Site Mail i ng Address' 13100SAUNDERSRD,An&orap Owner; VAN EE BERNARC) J & JAOI L Design Engineer' F1RST WATER CO NSULTING This permit is for the construciJan of: ❑ Disposal Field 19 Septic Tank ❑ H151ding Tank ❑ Privy 8('2022 EV8(2023 Lot Size in Sq Ft: 2013 Total Bedrooms= 3 ❑ Private Well ❑ Watkvstorage All constructlon shall be in accordance wEf , 1. The $tWAX4 approved design_ 2, All requiremerMts speclfied ir, Anchorage M -u nicipal code Chapters 15.55 and 15.65 and the State of Alas ka Wastewater Disposal Regulations ( 1 8AAC 72) and MnRkiQ Water RegulaWns (1 BAACBt)j 3. The wiastawalln r emde FF.girirF-R incpl%r_tumsz 4Juring th- installsti4n. Tho Incur shall notify tho Dev0Dpmnt Services Department per AMC 15,65. Provide notification by ealllno J907} 343.7904 (24f7 4, From Wober 15 to April 15, a subsurface soil abscrp#Ion sWiam under con,structlon during freezing weather shall be either' a. Opened and lvee•d on the same day, or b. Cared, sealed, and h -eased to prevent freeing Raoalued Sy- Data' 2 Issued By- + � Date: a � , MV UHU ALfj_\T0F HCHORANG f � Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section---' Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. 017-022-22 Property owner(s) BERNARD JACI VAN TRUST... Day phone _ Mailing address 13100 SAUNDERS ROAD, ANCHORAGE, AK 99516 Site address 13100 SAUNDERS ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) MOUNTAIN PARK EST #2 B3, L10 Legal description (Township, Range & Section) Lot Size 20,130 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade F-1 Duplex (D) El Holding Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (St-rra-ture of property owner or authorized agent) Permit/Rush Fees: 2 Date of Payment: JtIg G a 0�2 a Receipt Number: 1 b a l '� Permit No. 06i') 2116 / Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 1, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: MOUNTAIN PARK ESTATES #2 B3, L10 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The required separations will be staked by a RLS and a final asb survey will be submitted with the MOA IR. The design is based on an old Ken Lang, RLS survey. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221161, Rebecca Carroll, 06/08/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221161, Rebecca Carroll, 06/08/22 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: ~(~t -~O~ ~)\L.\~2jL PID Number: 0/7- 0~2- ~ ~ Name: /~ Wastewater System: ~ New ~'Upgrade Address: ABSORPTION FIELD Phone: ~ ~S~ ~1~ IN°'°fBedr°°ms:~ ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Subdiv~ion: ~F~ ¢~ Depth to pipe bottom from original grade: Gravel depth beneath p~pe Township: Range: Section: Fill added above~ f original grade: Ft. Gravel.~length~, Ft. WELL: ~ ~ New Q Upgrade G~ave~ width: Number of lines: Dist~nce between lines: Pipe material: Ciassification~lV A 7 E(Private' ~C): Total Depth: Ft. Cased To: Ft. Total absorptions. J'~area: SQ. Ft. ~V ~ f'8/~ Driller: ~ Date Drilled: Static Water Level:Ft. InstalIer:~ ~ ~0~ Date~ ~ ~installed: Yield: GPM PumpnpS~Set: Ft. Casing Height Above Ground:Ft. N__ TAN K SEPARATION DISTANCES ~Septic~ding S,T.E.P. To Septic Absorption Lilt Holding Public/Privale Manufacturer: ~ Capacity in gallons: From Tank Field Station Tank Sewer Lines Material: ~ber of Compa~ments: Sudace ~ w~t~r ~/A - - LIFT STATIO~ Lot ¢ ~O f Size in gallon~facturer: Foundation ,~, j,~.~, .... "Pump on" level at: ~~el at: HJgh water alarm at: Cu~ain ~ ~ Pump Make & Model J Electrical Inspecfion~rmed by: Drain BENCH MARK Location and Description: Assumed Elevation: Inspections performed by: Dates: 1st_ 7- ~- ~[~ .~. Department of Health and Human Services approval ~.~ "~-~,~]]?: Reviewed and approved by: ¢ · Date: 7- 2~-¢6- 72-013 (Rev. 9/91 ) MOA 25 Permif No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 198650 · Anchorage, AK 99519-6650 e TeI: 343-4744 $ Page ~of ~ W.O. 95191 Date 7-14-95 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 10 BLOCK g MOUNTAIN PARK ESTATES NO. 2 PID No. 017-022-22 Nsg'56'O6"W 18,5.00' x ' x ^ x x x WOOZ[ / SHEO:~' ......... ,.. .~ ~ __~,... "~ o. .':':, :~'. G RA~E'~":: D i~%~! :'.'.'.' ABANDON .~' EXISTING ~' _~ / J LEACH FIELD ~/' ~ .~- ~ ~,EXtST. S[PTIg TANK ~b~" z ~ ~ ~ T~ = ~oo.o u'.~l~u~~ ~,' '"~ = /~' ~ ~woog ~3 ~ ~ ~ ~' ~ /~ ~ WALKWAY ,m ssg" 56'06" E 18,5.00' 78 LINEAL FEET OF DEEP TRENCH-SEE DETAIL~) LEGEND PROPOSED EXISTING DISCRIPTION [] ~ CLEANOUT & DRAIN LINE ® 4" MONITOOR TUBE O TEST HOLE --E O.H; ELECTRIC --X !FENCE ~, SPRUCE TREE SCALE: 1"= 50' WELL $0' 50' ..~ Permit No Page ~ of W.O. 95191 Municipality of Anchorage Department of Health and Human Services Date 7-14-95 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650' Tel: 343-4744 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 10 BLOCK 3 MOUNTAIN PARK ESTATES NO, 2 PID No. 017-022-22 GRADE NOTE: CUENT ADDED SEVERAL FEET OF FILL OVER S, W. CORNER OF PROPERTY, TOPSOIL AND SEEDED. ORIGINAL MONITORING AIRTIGHT CAP .2% FILTER FABI~ 4" PERFORATEI PVC PIPE SEWER ROCK PER MOA SPEC'S ~TEST PIT NO. 5 SL SANDY GRAVELLY SILT W/ ROOTS AND ORGANICS SRO'~ SL. SANDY GRAVELLY SILT BRO~lq SANDY GRAVELLY SILT MEDIUM DENSE, DRY DEEP TRENCH, SCALE: NTS 13 14 t5 16 MEDIUM TO COARSE SAND 1 7 -- DRY 18-- 19 20 3. O.H. DATE Permlf No..~ On-Site Legal Description: Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650 * Tel: 343-4744 Wastewater Disposal System/Well Inspection LOT 10 BLOCK 3 MOUNTAIN PARK ESTATES NO. 2 Page, ~of ~ W.O. 95191 Dale 7/14/95 Report PID No. 017-022-22 SYSTEM DESIGN CALCULATIONS RECORD DRAWING 1. NO, BEDROOMS = 3 2. USE DEEP TRENCH SYSTEM 5, ABSORBTION AREA = (5 BEDROOMS)(150 GPD/BR) 0.45 = (3)(150) : 1000 SF O.45 4. USE DEPTFt OF GRAVEL= T 5. LENGTH OF TRENCH= ABSORBTION AREA 2 * DEPTH OF GRAVEL THEN LENGTH OF TRENCH = 72' PERCOLATION RATE MIN/INCH 0-1 1-5 6-15 16-50 31-60 PIT & TRENCH APPLICATION RATE MOUND & BED APPLICATION RATE GREATER THAN 60 FILTER LAYER OPD/SF GPD/SF NOT SUITABLE NOT SUITABLE 1,2 0.8 0.8 0.5 0.6 0.4 0.45 ] 0.3 NOT SUITABLE NOT SUITABLE 1.0 .7 Permi~ No On-Site Legol Description: LOT 10 BLOCK 3 MOUNTAIN PARK ESTATES NO. 2 Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ° Anchorage, AK 99519-6650 ° Tel: 343-4744 Wastewater Disposal System/Well Inspection Page ~ of '~' W.O. 95191 Dale 7-14-95 Report PID No. 017-022-22 NOTES: THE EXISTING 1000 GALLON STEEL SEPTIC TANK WAS EXPOSED AND INSPEACTED DURING CONSTRUCTION OF THE LEACH FIELD AND FOUND TO BE FREE OF LEAKS. A NEW TOP WITH A 4" CL£AN OUT WAS INSTALLED ON THE OUTLET CHAMBER. THE EXISTING TOP NEVER HAD A CLEAN OUT. SWING TIES DESCRIPTION A B C D INV CLEAN OUT (S. W. CORNER Of PROPERTY 26.5' 13.5' 89.5 MONITURING TUBE ( 4" ) 25.0 14.$' 81.6 90 DEGREE ELBOW 25.6' 45.9' 89.5 CLEAN OUT (START OF LEACH FIELD) 21.6' 54.1 15.5' CLEAN OUT AFTER TANK'(~I)- 25,8' 18.9' 93.25 CLEAN OUT AFTER TANK (#2) 24.8' 19,6' 93.35J CLEAN OUT (OUT LET END OF TANK) 26,8' 12,1 CLEAN OUT (INLET END OF TANK) 19,5' 14.7' FOUNDATION CLEAN OUT 7.9' 23.8 INLET &: OUTLET OF TANK 93.75 90 & 45 OUT OF TANK 93.6 45 DOWN' (8' NORTH OF LEACH FIELD) 95.01 A = SPRUCE TREE B = SOUTH WEST FENCE CORNER C = SOUTH WEST CORNER OF HOUSE D= SOUTH WEST CORNER OF 10 X 10 PORCH RECORD DRAWING LEGAL DESCRIPTION: LIO B3 MOUNTAIN PARK EST. NO. 2 TOWNSHIP RANGE,SECTION: %~ " . SLIGHTY SANDY GRAVELY SILT WITH ROOTS & QRGANICS BROWN SLIGHTY SANDY GRAVELLY SILT BROWN SANDY GRAVELLY SILT MEDIUM DENSE MEDIUM TO COARSE SAND, DRY B.O.H. SLOPE WAS GROUND WATER S ENCOUNTERED ? NO L 0 IF YES, AT WHAT p DEPTH ? N/A E DEPTH OF WATER AFTER MONITORING ? SITE PLAN DATE: 7-8-95 8:30/9:00 30 MiN, 6'-5 6/16' 10/'16" ~8 MIN./IN, 7--8--95 9:05/9:55 ~ U~t4. 6'--S 5/1S'! 11/~S" ;43 ~IIN./IN, PERCOLATION RATE: 48" (MINUTES/INCH.) PERCHOLE DIAMETER: 6" TEST RUN BETWEEN: . 5'--0" FT. AND FT. COMMENTS:.SOILS PER--SOAKED PRIOR TO TEST. PERFORMED BY: DEE HIGH , I DEE HIGH CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7-8-95 191CSSCD ............. /ii;~ SEAL) DEPARTMENT OF HEALTH &: HUMAN SERVICES PERFORMED FOR: CHRIS LAMPE DA~ PERFORMED: 7-8-95 LEGAL DESCRIP~ON: LIO B3 MOUNTAIN PARK EST. NO.2 m~SHIP,RANGE, SEC~ON:, ' / / /~ OEGANIC SiLT WITH EOOT MAT /C4.PiSLOPE Sl~ PLAN ~/'~:'/., BROWN SLIGHTLY SANDY SILT '7 ~F ? ·, 5 .~/.~ 9 ~.¢.:~i BROWN SANDY GRAVELY SILT t , MEDIUM DENSE DRY WAS GROUND WATER S ~ ~. ~; ENCOUN~RED ? NO L 1 o 11 ~' ~.~' iF ~S, AT ~AT 0 ~ p / /'/] DEP~ ? N/A , E ~'¢ /. DEPTH OF WA~R 12 ~.~/.~ AFaR MONITORING ? NONE DATE: 16 Z'~'~ BROWN SANDY SIL~ GRAVEL , 17 Z /~d. i, I! 18 : ..'., ,, 1 9 ' ,'~'; SAND WITH GRAVEL 6" ' PERCOLATION RATE: ~3" (MINU~S/INCH,) PERCHOLE DIAMETER: 20 ' '> "' B.O.H. TEST RUN BET~EN:. .5' FT. AND 5 1/2 FT. COMMENTS:SOILS PRE-SOAKED PRIOR TO TEST. PERFORMED BY: DEE HIGH , I DEE,HIGH CERTIFY THAT ~IS ~ST WAS PERFORMED IN ACCORDANCE WI~ ALL STA~ AND MUNICIPAL GUIDELINES IN EFFECT ON ~IS DA~. DA~: 7-8-95 191CSSDD 7-8-95 8:15/8:4.5 30 MIN. 6'-5 5/16" 11/16" 43 MIN./IN. 7-8-95 E,:.50/9:20 30 MIN. 6'-5 4/16' 12/16' 40 MIN./IN. PAGE 1 OF 2 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:SW950142 DESIGN ENGINEER:DHI ENGINEERING OWNER NAME:LAMPE CHRIS J OWNER ADDRESS:13100 SAUNDERS RD ANCHORAGE, ALASKA 99516 PARCEL ID:01702222 DATE ISSUED: 7/07/95 EXPIRATION DATE: 7/07/96 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 ELK 3 LT 10 LOT SIZE: 19000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER SHALL EXCAVATE A.~$OILS TEST,HOLE TO A MINIMUM DEPTH VERFY THE INTEGRITY OF THE EXISTING SEPTIC TANK AT THE TIME OF_ AT THE TIME OF CONSTRUCTION ENGINEER SHALL RUN ADDITIONAL %i~Y THE PROPOSED TRENCH DRAINFYELD.~ ISSUED BY: DATE: 7-- 7-- Permif No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ° Anchorage, AK 99519-6650' Tel: 343-4744 Page 1 of 5 W.O. 95191 Dale 7-7-95 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 10 BLOCK 2 MOUNTAIN PARK ESTATES NO. 2 PID No. 017-022-22 N89'56'O6'IW 183.00' :--~-.. )/,/ : r,,, WOOD> /--REMOVE FENCE >'/ "~'--- ~,~---~ ~ ! ~--~',,~DECK /FOR ACCESS ......... /)~ ~ I ~ / ~x --TO SITE STORAGEf~ ~ , ~ ~ ~ ~ '-~...~ / ~[~ ~ "-.:.,. ....... .~........... .... ~ ...... ""f -..........-..,...- ..::... ~-:.-.~' :. ~......:.~: .. z .. .... , --- ); ~ // ALDER '-,~'", ,/ k ,"~ HOUSE ~ , -- ,, , ,. ~ I ~TH~I~ ?' ~ f ~, / /' ::, EXlSTING~/ ./-' ~ - I ~ 6 c h, LEA~~/ / ~,,~ '~ . ~ ~.. / /~MON. ~ - /mSE/~ 't~:': ~~' WOOD r ~ t [ , ~ ...... I~:.:..',:¢-. WALKWAY ~ ~ o~ w , TH~3 I~,::-' ', S89'56'06'E ,/ 183.00' GARDEN INSTALL 72 LINEAL FEET OF DEEP TRENCH-SEE DETAIL~ LEGEND PROPOSED EXISTING DISCRIPTION " ~ CLEANOUT & DRAIN LINE · 4" MONITOOR TUBE [:~ TEST HOLE --E O.H. ELECTRIC --X FENCE ~ SPRUCE TREE SCALE: f'= 30' WELL 30' 30' 4 ~ 0 Permif No.. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650' Tel: 343-4744 Page 1 of 5 W.O. 95191 Dale 6-21-95 Legol Description: On-Site Wastewater Disposal System/Well Inspection Report LOT 10 BLOCK 2 MOUNTAIN PARK ESTATES NO. 2 PID No. 017-022-22 N89°56'06'! W 183.00' .-?L )/' [ r.. WOOD. /~-REMOVE FENCE ' /-"~- )'T----] ~ ~ F-?-~x ~DECK ~FOR ACCESS ..... ~ ~ ~, ~ / ~, TO STE ' SHED~ ..... ~ / ~ ~' '~. ~-..~ , , . ...,....... .............. ' ~ TH~2 ~-/~_ / ";".' .~GRA~E[ :. DRiVEWAy:.:'... ~ .... r .... ~ ~/ '~"- / -'" :"-' .. '~ "," ~.:.: '.'".'=.' '.. "". Z~ /-'-~ 5 ----.. ) 4 "~C.. ~ '-', ..... ::.~ : '..- '.....:..:: ~[~ /.' '... '.. ,/ ~ .' , /' ALDER '.. ~ .,,~ HOUSE ~ t m ~ //Z ~/~2~''SEPTIC TANK = k, ~ /'~ ~ .... ~, ,-SEE NOTE 11 'xl~ x k ~ x /x x x ~ --, G WELL 30' S89'56'06"E 183.00' GARDEN INSTALL 72 LINEAL FEET OF DEEP TRENCH-SEE DETAIL~) 50' LEGEND PROPOSED EXISTING DISCRIPTION = [] I CLEANOUT & DRAIN LINE · 4" MONITOOR TUBE 0 TEST HOLE E O,H, ELECTRIC X FENCE O SPRUCE TREE SCALE: 1"= :50' Permif'No. Municipality of Anchorage DeparLment of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650' Tel: 343-4744 Page 2 of 5 W.O. 95191 Date 6-21-95 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 10 BLOCK .~ MOUNTAIN PARK ESTATES NO. 2 PID No. 017-022-22 FINISH GRADE SEE NOTE 15 ORIGINAL ~IONITORING FUBE ~ ZZ ZZ ~ z: BACKFILL-SEE NOTE 14 FILTER FABRIC MARIFI 140S OR EQUAL~ 4" PERFORATED PVC PIPE SEE NOTE 8 SEWER ROCK PER MOA SPEC'S SEE NOTE 9 AIRTIGHT CAP 2%~ 1 2 4 7 10-- 11 12 OROANICS, 4' BOULDER PIT SILT WITH GRAVEL LENSES OF SANDY SILT AND SAND 'PRACE SILT BALLS & TRACE GRAVEL SILT WITH SOME ANGULAR GRAVEL B.O.H. DEEP TRENCH $ ECTI 0 N~2 SCALE: NTS P'e r..rn it 'N~, Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION On-Site Legal Descripfion: LOT 10 BLOCK~MOUNTAIN PARK ESTATES NO. g Page 3 of 5 W.O. 95191 Date 2-21-95 P.O. Box 196650 · Anchorage, AK 99519-6650 · Tel: 343-4744 Wastewater Disposal System/Well Inspection Report PID No. O17-022-22 NOTES: ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS OF THE MUNICIPAL CODE AS CURRENTLY AMENDED. ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION INTO THE SYSTEM. CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS, WATER WAYS, SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. CONTRACTOR TO STAKE PROPOSED SYSTEM PRIOR TO CONSTRUCTION. NOTIFY THE ENGINEER OF ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION. NOTIFY THE ENGINEER AND DHHS 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF THREE INSPECTIONS ARE REQUIRED. THE FIRST INSPECTION SHALL BE OF THE SUBGRADE, PRIOR TO PLACING SEPTIC ROCK. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF GRAVEL, DISTRIBUTION PIPING, STANDPIPES, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD INSPECTION SHALL BE AFTER THE WORK IS COMPLETED. CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED-LINED, AS-BUILT DRAWINGS SHOWING ALL DATA AS SPECIFIED IN SEC. 15.65.F.2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF THE FINAL INSPECTION. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE AS-BUILTS SHALL BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWING TO DHHS. CONTRACTOR SHALL STAKE ALIGNMENT OF SYSTEM WITH MARKERS SHOWING THE PROTECTIVE DISTANCES FROM WELL AND OTHER BODIES OF WATER PRIOR TO BEGINNING INSTALLATION, ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER iF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN. Per~if No, Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION Page 4 of 5 W.O. 95191 DaTe 2-21-95 P.O. Box 196650 * Anchorage, AK 99519-6650' Tel: 343-4744 On-Site Wastewa[er Disposal Sys[em/Well Inspection ReporL Legal Description: LOT 10 BLOCK 2 MOUNTAIN PARK ESTATES NO.2 PID No.017-022-22 NOTES: 8. EXCAVATE THE ABSORPTION FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL. RECORD ELEVATIONS AT BEGINNING, MIDDLE, AND END OF TRENCH BOTTOM. FACE OF TRENCH WALL SHALL BE SCARIFIED BEFORE PLACING SEWER ROCK. 9. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO ± 1" PRIOR TO INSTALLING THE PERFORATED PIPE. 10. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D5054- OR ENGINEER-APPROVED EQUAL. MIN SOIL COVER SHALL BE 4 FT (OR 2' SOIL AND 2" INSULATION BOARD - SEE NOTE 15) 11. INSTALL MISSING C.O. PIPE & AIRTIHGT CAP ON EXISTING SEPTIC TANK. 12. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER-APPROVED EQUAL. LAP ALL JOINTS 2' MIN. 13. COVER THE DISTRIBUTION PIPE WITH MIN 2" SEWER ROCK, AND COVER WITH CEOTEXTILE BEFORE PLACING BACKFILLING. 14. MATERIAL USED AS BACK FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 15. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MIN. SLOPE, AND 3:1 MAX SLOPE, AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. PLACE 4" OF TOPSOIL & SEED (SCHEDULE D) PER MOA 1994 STANDARD SPECIFICATION FOR STREETS, DRAINAGE, UTILITIES, PARKS AFTER COMPLETING INSULATION. 16. RECORD THE FINISH GROUND ELEVATION OVER TOP OF TRENCH. Permit No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650' Teh 343-4744 Page 5 of 5 W.O. 95191 Date 6-21-95 On-Site Wastewater Disposal System/Well Inspection Report Legol Description: LOT 10 BLOCK 2 MOUNTAIN PARK ESTATES NO. g PID No. 017-022-22 g SYSTEM DESIGN CALCULATIONS 1. NO. BEDROOMS 3 2. USE DEEP TRENCH SYSTEM 3. ABSORBTION AREA = (3 BEDROOMS)(150 CPD/BR) 0.%5 0.45 1000 SF 4. USE DEPTH OF GRAVEL= 7' 5. LENGTH OF TRENCH- ABSORBTION AREA 2 * DEPTH OF GRAVEL THEN LENGTH OF TRENCH = 72' PERCOLATION RATE PIT & TRENCH APPLICATION RATE MIN/INCH GPD/SF 0-1 NOT SUITABLE 1-5 1.2 6-15 0.8 16-30 0.6 31-60 0.45 GREATER THAN 60 NOT SUITABLE FILTER LAYER 1.0 MOUND & BED APPLICATION RATE GPD/SF NOT SUITABLE 0.8 0.5 0.4 0.3 NOT SUITABLE ,7 DEPARTMENT OF HEALTH & HUMAN SERVICES 82H "L' $1R££T, ANCHORAGE, ALASKA gg§02-0650 801L8 LOG-PERCOLATION TE8T TEST HOLE 1 PERFORMED FOR: CHRIS LAMPE LEGAL DESCRIPTION: LIO B2 MOUNTAIN PARK EST. NO. 2 DATE PERFORMED: 6-16-95 TOWNSHIP,RANGE, BROWN, LOOSE TOPSOIL, -3' BOULDER GREY DRY SANDY SILT WITH ANGULAR ROCK TO 4", FINE GRAVEL TO 1/8", OCCASIONAL BOULDER DENSE, GREY, BROWN LIGHTLE SANDY SILT SOME ANGULAR SAND & GRAVEL TO 1/8" PERC. SILTY GRAVEL TO 1/16", WITH SAND SAND SAND WITH SILT BALLS & FINE GRAVEL SLOPE WAS GROUND WATER S ENCOUNTERED ? NO L IF YES, AT WHAT DEPTH ? DEPTH OF WATER AFTER MONITORING ? 0 N/A P E NONE DENSE SILT WITH TRACE SANDY GRAVEL TO 1/8", TRACE COBBLES TO 4" SANDY GRAVELLY SILT AND LENSES OF SILT MOIST SILTY GRAVEL B.O.H. SITE PLAN DATE: 6-26-95 1 6-16-95 2:23/2:53 30 MIN. 5 9/16" 9/16" 53 MIN./IN. 2 6-16-95 2:53/3:23 30 MIN. 16 3~16" 10/16' 48 MIN./IN. PERCOLATION RATE: 55 (MINUTES/INCH.) PERCHOLE DIAMETER: 6" TEST RUN BETWEEN: 7 1/2 FT. AND 8 FT. COMMENTs-SOILS PER-SOAKED PRIOR TO TEST. PERFORMED BY: DUSTI~N HI~GH_ , I O~F /g~JCERTiFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC~pN THIS DATE. DATE: 6-16-95 191CSSAD ldI~IIOIPAL~Y OF ANOHORAQE DEPARTMENT OF HEALTH &: HUMAN SERVICES 825 "L" STREET, ANCHORAGE, ALASKA 99502-0650 SOILS LOGI-PERCOLATION TEST TEST HOLE 2 PERFORMED FOR: CHRIS LAMPE DATE PERFORMED: 6-16-95 LEGAL DESCRIPTION: LIO B2 MOUNTAIN PARK EST. NO.2 TOWNSHIP,RANGE, 17 18 19 2O ORGANICS, 4' BOULDER SILT WITH GRAVEL LENSES OF SANDY SILT AND SAND WITH TRACE SILT BALLS &: TRACE GRAVEL SLOPE SITE PLAN SILT WITH SOME ANGULAR GRAVEL B.O.H. WAS GROUND WATER ! L L ENCOUNTERED ? NO DEPTH ? N/A DEPTH OF WATER AFTER MONITORING '~ NONE DATE: 6-26-95 2 6-16-95 1:18/1:48 30 MIN, 7 13/16' 1 5/16" 23 MIN./IN 5 6-16-95 1:4-9/2:19 30 MIN. 7 5/8" 1 3/16" 25 MIN./IN 4 6-16-95 2:20/2:50 30 MIN. 7 7/8" 1 3/8" 22 MIN./IN, 5 6-16-g5 2:51/3:21 30 MIN. 7 5/16" 1 5/16" 23 M~N./IN. PERCOLATION RATE: 25 (MINUTES/INCH.) PERCHOLE DIAMETER: 6" TEST RUN BETWEEN: 7 FT. AND 7 1/2 FT. COMMENTS: SOILS PRE-SOKED PRIOR TO TEST. PERFORMED BY: BUSTI~N HI__GU , I '~-C~:'f ~//~CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF~-C<F/ON THIS DATE. BATE: 6-16-95 191CSSBD Municipality of Anchorage Page 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: .~'V~ ~/4~/5._~' PID Number: ~://'~4:~, Name: Wastewater System: u New ~Upgrade 0~ Wtcz Address: Po ~x II0~$~ A~, ~ ~'t/ ABSORPTION FIELD-~D~r~*~ Phone: No. of~drooms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other 3q~~- 2/IZ Soil Rating: Total Depth from~r~ginal grade: LEGAL DESCRIPTION .4 ~.D/sq. / Lot: /~ B~ock: ~ Subdivision: /1~, Depth to pipe bottom from originar grade: Gravel depth beneath pipe Township:/Z/~ Range:~ ~--~ Section: 2~ Fil~ added above original grade: Gravel length: ~' O -- , ~ Ft. ~ Ft. ~ST/~u ~ New ~ upg u ' '--ra~e Grave~ depth: Number of lines: Distance between lines: WELL: / ~ Ft. / -- Ft. Classification (Private, A,B,C): Tota~ Depth: Cased To: Total absorption~ Pipe material: Ft. Ft. ~ ~ ~ 77~SO. Ft. DriJler: Date Drilled: StaticWater Level: Installer: Date installed: Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. ~/z/~ TAN K ' ~[ ~ ~/~ SEPARATION DISTANCES ~eptic ~ Holding D S.T.E.P. To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines / ~ ~ ~ Material: Number of Compadments: Surface Water ~r)'~ Nr ~g , LIFT STATION- Lot 4~/'; Size in gallons: Manufacturer: Line ~/ ~{ '~E tt v Foundation¥/~ ~/~/~ /,-[~ t I~ ~ [/ "Pump on" level at: "Pump off" level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections pedormed by: Drain ~ Y~ / ~< >~ // Remarks: ~~ ~ ~ ~ ~ BENCH MARK ~ Location and Description: Assumed Elevation: ~~ SEAL Inspections performed b,: ~~~ Dates: lst~~~ ~~ Department of Hea~and, Human Se~vmes approval ~-~'~;'- ~: :~%, ~..¢~.,~ ~' Reviewed and approved by: . . Date: ~-~ -~/ 72-013 (1/91) MOA25 Permit No. SV~/ ~'/~/_~' Page ~- of -~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report 72-013A(2/91)MOA25 3EAL Michael E. Anderson 4381 - E S~'IEET ___,~,'~____ OF-'~-- JO~ NO. _ ............. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SWg10155 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:OBOLEWICZ DAVID B & OWNER ADDRESS:P.O. BOX 110684 ANCHORAGE, ALASKA 99511 DATE ISSUED: 6/14/91 EXPIRATION DATE: 6/14/92 PARCEL ID:01702222 LEGAL DESCRIPTION: MT PARK ESTATES #2 BLK 10 3 LT LOT SIZE: 19800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: TEST HOLE SHALL BE EXCAVATED TO A M~IMUM DEPTH OF 15 FEET AT THE TIME OF CONS~q3~;~ION & VERI~ NO PRESENCE OF BEDROCK. June 5, 1991 Municipality of Anchorage DHHS 825 L Street Anchorage, Alaska 99501 To Whom It May Concern: This permit request is to add onto an existing system installed in 1980 which was not designed large enough for the 3 bedroom dwelling on the lot. An absorption test was performed on the existing drainfield which indicated the system could hold the 450 gallons required but was too slow to absorb the volume as the level was 9" above the starting level in the system after 24 hours. Based upon the attached soils log the percolation rate is 20 minutes per inch. This indicates that 750 square feet are required however only 464 square feet were provided. Please call me if you have any questions. ~~Y°urs Truly, L. Wayne McFadden BY CHKD. BY DATE DESCRIPTION CLIENT SHEET OF .... JO~ NO. _ ............. i:N lS (10/78) Fid 1.~ Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ENGINEER'S SEAL) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17- 18- 19- 2O DA'I Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SiTE PLAN S L IF YES, AT WHAT O DEPTH? p E Deplh to Water Aller Monitoring? /'J&, MJAT'E-F.,Dale: Gross Net Depth to Net Reading Date Time Time Water Drop '~{.{,~ ~ - o - - ~.... ~ '1 $ · ll, V,- PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FTAND ~ FT COMMENTS PERFORMED BY: {./( '"' , {/' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ 72-008 (Rev. 4/85) ON SITE SYSTEM IMPACT L10 BL 3 Mountain Park #2 Subd. Construction of an additional 25 LF of drainfield to the wastewater system for this lot should have little if any impact on the surrounding properties due to: 1. Absence of water in the test hole monitoring tube during breakup indicated no water which means that wastewater should be treated in the soil before leaving the lot. 2. This construction will still allow room on the lot for another system in the future. 3. Due to the topography of the lot and surrounding area there should be no impact of drainage caused by constructing this addition to the existing system. If you have any questions please contact me at 561-5829. Yours _Truly, L. Wayne McFadden , ,~ ~.~ ~ MUNICIPALITY OF ANCHORAGE ff~,~.~.m~! 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 Well Absorption area Dwel,ing ~ ~ DISTANCE [~ f ~-- / ~ ~ Manufact~rerl ~~ Material~~ No, of compa.~ ~ ~ Liq. c~llons IF HOME.DE: Inside leng,h Width ~ Liquid depth ~ ~ DISTANCE TO: Well Dwelling ' PERMIT NO. t~ Manufacturer Material Liquid capacity in gallons D Well Foundation~ Nearest lot line ~ ~ PERMIT NO. ~ ~ D ISTANCETO: ~00 ~ lend, in es Trench Distance ~.= No. oflines / Length°f~h?e Total ~ inches ~ ~ Top of tile ,o finish grade ~. Material beneath tile ?~ inches Total effec,~ a~on area Length Width Depth PERMIT N~. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area a Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. a Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER SOIL TEST RATIN'/Z~ INSTALLER , . ~ ~ / 72-01 lev. 3/78) PERMIT NO. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ~[_~ STREET, ANCHORAGE, AK. 99501 264-4?20 ~4ELL RI4[:. IDN ......... SITE SEbJER PEr, MIT ( 800~77 ) 24~-4220 LOT SIZE 201~0 SQUARE FEET APPLICANT Q.C. TUCKER 2~70A CANARY CT. LOCATION C8NARY CT. LEGAL LOT t0 BLK ~ MT PARK EST. TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= :1.2 LFI".IGTH-- 2-~ C~RR~/EL DEPTH= 8 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. 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). SEPT I C TR[4K: S I ZE= ~L25E, 6RLL. C~[4S 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. T~lO (2) I ~4SPE£:TI~]~4S liRE REI~LIIRE[~ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR i50 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 R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, PEF-:~-~ I T E~'~P I RES DECFf48ER '~:l.. iL~88 I CERTIFY THAT i: 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 THE CODES. Z.:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THA~ 4 BEDROOM;~. V4. 0 Test Hole' #9-3 Table A WO #A19102 Date: 10/10/79 Logged by: O. Hatch D~epth in Feet From To 0.0 1 .0 1.0 2.0 · 2o0 7.0 7.0 16.0 Soil Description Brow~ Peat, damp, soft, Pt F-4, brown Sandy Silt, damp, stiff, non- plastic, ML F-4, brown Sandy Gravelly Silt, damp, stiff, non-plastic, rounded particles to 4", ~ F-4, brown slightly Gravelly Sandy Silt, to Sandy Silt with trace gravel, grades very sandy at 10', damp, stiff, non-plastic, subrounded particles to 2", ~4L Bottom of Test Hole: Frost Line: Free Water Level: 16.0 Feet <_~_ None Observed None Observed Percolation Rate = 4 min./inch with water level in standpipe = 7 Feet Sample Depth Numbe~ (feet) Unified Classification 1 5 ML 2 10 ML 3 15 NiL Remarks: 1. Ail samples obtained from cuttings brought t~ surface by auger. General Information, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see Sheet 3. PERMIT NO. DEPARTMENT ~ XlEALTH AND ENVIRONMENTAL ~ECTION 825 'L' STREET, ANCHORAGE, AK. 264-4720 P~EL~ ..... ~]~ C~4--SITE SE~ER PE~ IT ( 800i?~ ) RPF'LICANT LOCATION LEGAL Q.C. TUCKER CANARY CT. LOT ±0 BLK ~ MT PARK EST. 2~708 CANARY CT LOT SIZE 24~-42~0 20t~0 SQUARE FEET TYPE. OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING <SQ FT?BR)= 275 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EF'T~:::= ? L~I'-IGTH: -132 GAF! '-..' E L 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE 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 BETWEEI AND THE BOTTOM OF THE E~CAVRTION (IN FEET). !NFIELD. THE OUTFALL PIPE RED SEPT I C: TI~hiK: S E= it PERMIT APPLICANT HAS THE RESPONSIBILITY INSTALLATION INSPECTIONS OF ANY WELLS NUMBER OF RESIDENCES THAT THE WELL WILL 'MENT DURING THE RTY AND THE T~dC~ <2> I ~SF'ECT BACKFILLING OF ANY SYSTEM WITHOUT FINAL DEPARTMENT WILL BE SUBJECT TO PROSECUTI MINIMUM DISTANCE BETWEEkA WELL% AND AN' t00 FEET FOR 8 PRIVATE WE~L OR t50 TO 100 FEE UPON THE TYPE OF PUBLIC MINIMUM DISTANCE FROM A TO A COMMUNITY SEWER LINE WELL LOGS 8RE REQUIRED AND OF THE WELL COMPLETION. .L. 'RTE NELL 75 FEET. ;T BE OTHER REQUIREMENTS MAY APPLY. AVAILABLE TO INSURE PROPER REQL~IRF[:' ND APPROVAL BY THIS EWAGE DISPOSAL SYSTEM IS 8 PUBLIC WELL DEPENDING ) A PRIVATE SEWER LINE IS 25 FEET AND URNED TO THE DEPARTMENT WITHIN _~0 DAYS ICRTIONS AND CONSTRUCTION DIAGRAMS ARE F'ER~-'I I T E>(P I RES D~ ~-:Et'IB~R ]<~l.. it98~3 I CERTIFY THAT i: t AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: ........ APPLICANT Q.C. TUCKER ISSUED BY ...... DATE V4.0 825"L"Si REET /'C'..CHO,r{?,.G E, ALASKA 99.601 ,'~r ~, 2644'i1'i '.;~;t :;GE f.', December 31, 1979 Q.C. Tucker 2370A Canary Court Anchorage, Alaska 99502 Permit ~ 790628 Subject: Lot.10 Block 3 Mountain Park Estates Subdivision A permit issued by this department for well and/or sewer system has expired. 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 has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, LNB/ljw enc: Copy of Permit ..... i:j: (il [:I.,t. .i',i T P F:! l','q: i< F~'~.; T F:i]'E E; ~:::::,, F....i~ !~"!~:: l~'r'c, CIF Pf..iEILT~: !.,~Ei....! THE i.,.!ELL. C:CiMF:'L, ETiON. t::iF:'F'I Ti'":I::tFJT 0 "" TI -'.:'~'[~' PERMJ T NO. DEF'FIRTMENT F:~ 'RLTH FtHD F_N'v'IRCIi,~MEHT£4L Fr'-~CTII}H ,:',~: , "L' _, ~F:EE ¥., F~NCHORFtCiE., FIK. I-.J E L_ L_ ~ f'-.I l]:, C) r-4 --- ':G I T E] '~--: E I...I E}.: I::: F:' E R f- I I T' ( ) LEGRL TYPE OF ~OIL_ RE:~ORE',T~Cffi S'¢STEH ~¢ - MFtXIP1UM HI_IME~EF: OF E:EC, ROCff'IS = (. LO'F SIZE SL~I_IRRE FEE]' SO~L RFITIHG (SO. FT,--"E:R)= ~,.~"- THE REQI_IIFtEC, SIZE OF THE SOIl_ FIE:SORF'IION S"r'STEP1 IS: TliE LEHGTH DII'IEHSIOH IS TtiE LEHCJlIH (iH FEET) OF TtqE TREHCH OR D~'RI,'~FIEL[:'. THE [:,EF'?M OF R TREHCH IqF'. PIT iS THE DI_,FRN_.E E',ETP~EEH THE SI~RFRCE OF TtiE GROUH[:, RH[:, THE BOTTOM OF THE EXCR'v'RTIOH (IH FEET;). THERE IS NO SET WIDTH FZIR TRENC:IiES. THE GRff,,,'EL DEPTH IS THE HIHIHUM DEPTH OF GRFP,,'EL E',ETHEEN THE OLITFFILL PIPE RND THE BnTTDM 0F THE EXCRVRTIOH (IH FEET). F'ERM[T FtF'F'L[C:FINT HFIS TFIE I?ESF'ONSIE:iLiT'¢ TO INFOIq:r'I THIS DEPFtF.:TMEHI [:,IJF~':ING THE INSTF~LLh]I-ION INSF'ECTi-ff.~c; CIF Rt'l'¢ c . _ 4EL L_, Fff':,JRCEh~T TO THIS PF:OF'ERTY Elf.iii) THE · lUMBER OF RESIDENCES THFtT THE I4ELL 14ILL SEF.:',,,'E. T I-.J C~ ,:: :=~: ]:, I I'-4 ~ F' F< Fi: -f- I ~]~ 1'- l '--:- Ft R E] F: E': C-3 LI I F.: E::] E, HCKFILLIHG F~F FIH¥ S"r'STEM H]Tt401iT FIHRL INSPECTION FIHD RFFR_,,~L EAr' THIc C'EF'RF.:TMENT HiLL BE SUBJECT TO F'ROSEC:LIT]ON. MINIMUM DISTRIWCE DETHEEH R HELL BH[:, RN'¢ OH-SITE SEHRGE DISPOSRL SYSTEM IS ±E~O FEET FOF.: R F'RIVFtTE HELL.; ±5~:] TO 26~g FEET FROM F~ PUE',LIL-: 14ELL [:'EF'EHD!HG UPOH THE T'¢PE OF PUBLIC:. HELL HEI_L LOGS RRE REGIJ!RED FIH[) r,IUST 8E E:ETURHED TO THE DEPRRTMENT HITHIH OF THE HELL_ COMPLETIOH. OTHER REgUIREMEHTS f'lR',r' RF'PL.'¢. SF'ECIFIE:FITIONS FtHD COHS';TRL~C:TION DIRGRRMS FIRE FiVFtlLFIBLE TO IHSLIRE PROF'ER INSTRLLRTION P E R r'l I 'T' E >-:; F' I R E ':5 C:, ,r{:z ~Z: E r"l ES: E F=: _--c-: :_'L .. -_1._ ~ 7 ~ I C:ERTIFY THRT ~b: I RM FFff'IlLIRR 14ITH THE RE(:~IJIF:E_'MENTS, FOR OH-SITE SEHERS ~H[:' NELLS RS SET =ORTH DY THE ML. IHIE:IPRLITY OF F4HC:HCffi:RGE. ~: I HILL It'tSTRLL THE SYSTEM IN RC'E:E~RDRHCE IdITH THE CODES. ]<: I I_INDERSTRND THRT THE OH-SI'rE SEHER SYSTEH f'lR'~-' RE~IJIRE ENLRRGEMENT IF THE ~ESIDENCE IS REMODELED TO iHCLUDE MORE THRN ~ BEDROOMS. RPPL ~ CRNT ¢? ............. ¢:,~ ~ =,..' ~ :. : - : . : : : : : - · : · :. ..... ..: ~' .,: : : : .,- ~: .'~. ~ nC ro _ ' ' · ,-, · 0 0 __ o-o o o o o o o o - ....'::.: -,. ;,,. . .-:~, z i 5'.;'.: :' :' .: :' .: i i i .:- "'/"i * ' ~ ;: ~;i ,..: .: : : : ": : : i .: "'.' ' · ' .: j: ,~: F4: ,.~: ~:.~: <,-'- 2.4' ,,:,': ,~: c: ~,_: ' . ,' L: .';'~i ;.ti ' :...: ';;~i ', ~';i- ~'..: 0-'i.'.i ;'~'4.:. ¢:¢:.: · '¢:Oil ~--~' '1' I .: -¢,-:¢ ~ ~:.i' r.:,~ .C: ~:; ' C? x,O.: L".:. '...~ ~:'-.::. ' ,.;-" I ' - : .:! ! i i ·i. i,?' ;,'~,'i-"i i -1 0 0 0 O 0 0,-'0 0 -O 0 0 O - · : : -.,~,: ¢",: (" :.. ¢.': ":¢ ,~-4: .-4: ~-~ ¥-: o:.. ~0 .... ;. / /.' ·- .0 0 0 0 0 0 O' '0 0 ' 0 O. 0 ,._," ,""--~"/ ' · '. · i '. ~,~, "¢. : ' .' ' ~-'~,-'-.-': ~'¢::.i: -' ;;~ ',,~; :: ~ -¢,,;,,. .... -. ,-,.. . . ..... - . . ... .. ..~'.;.~ ;.':.'~-. MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 907-343-7904 © On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-022-22 1. GENERAL INFORMATION Expiration Date: i / - A ` 2 Z Complete legal description MOUNTAIN PARK ESTATES #2 63. L10 Location (site address) 13100 SAUNDERS ROAD, ANCHCORAGE, AK 99516 Current property owner(s) BERNARD & JACI VAN REV. TRUST... Day phone Mailing address Real estate agent 13100 SAUNDERS ROAD, ANCHCORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment '81 ?, a 02�2 Receipt Number _ W3 0 9 3 COSA# OSCaQ139 ? Waiver Fee $ Date of Payment Receipt Number Waiver # 5. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/29/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the `tt\\\�\ system and maintenance. The operational life of all well and septic systems are subject to ��46 �1�,� these various and dynamic characteristics and are outside the control of the evaluator of the r �i well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q;•' . • !� for current or future occupants or guarantee that no unseen encroachments, deficiencies or g.' discrepancies exist can be given by First Water Consulting & / *: -49'1<1-I -.* 6. DSD SIGNATURE ' "" •"" / • ' • Curtis Huffman �'c<`�• CE 128991 System #1 Approved for bedrooms �f 7/29/22.-����r System #2 Approved for bedrooms l�� �PROFESS0 Disapproved Conditional approval for bedrooms, with the following stipulations: t.�-- Original Certificate Date: '22 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: MOUNTAIN PARK ESTATES #2 BLOCK 3 LOT 10 Parcel ID: 017-022-22 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 11/29/79 Total depth 240 ft Cased to 40 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 36+ in. Date of flow test for COSA 5/25/22 Static water level at beginning of test 196 ft. Well production at time of test 4+ gpm Comments B. TANK DATA Age of tank(s) NA — NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by NIB Date of Sample 8/4/22 — SGS LAB C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Which system tested (date installed) 7/8/95 Adequacy test date 5/25/22 ® ALL standpipes present per record drawing Results E Pass For 3 bedrooms Total measured depth from grade 8.7 ft (max) Fluid depth prior to test 2 in Measured depth to pipe invert from grade 4.9 ft (min) Water added 590 gal ❑ N/A — pressurized field New depth 5 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective MOA IR 7'ED MEASURED 3.71ED Elapsed time 1440 min ® Code -required soil cover over field Final fluid depth 1/2 in ❑ System presoaked Absorption rate 590 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date F'', Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' IN Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *97' ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' IN Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *97' MOA WAIVER #970048 — CONTINUED WITH THIS SEPTIC TANK UPGRADE — SEE LETTER 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. � � AW •.tir [ 1�SJ.' • TH 777000 . . .. .. .... .......... Curtis Huffman I��Fc,�j. • . 8%6%2291 ��0� PROFESSow Lot 16 WOODEN FENCE I I I I 10' UTILITY EASEMENTS T 8.2'x10.2 SHED)P I w/ RAMP Lot 9 WOODEN / FENCE S 89'56'06"E 1 ZI I 8.4'x12.3' SHED—Jt ON DECK Lot 15 v, Ip O STORAGE --t -- Lot 14 Lot 10 20,130 S.F. \ N� MANHOLE% SEPTIC 11.7'x12.2' SHED w/ RAMP t N 89'56'OE FENCE 7 .00• GRAVEL• ' 26.3' ASPHALT •• ' DRIVEWAY U Cv x T" ' :KM 0W 8' m a V) `�L � 45.0' 12.0'; \ O ` N W 183.00' Lot 11 I 31--- °-0,I I PLOT PLAN AS BUILT _x SCALE _ 1" __ 40' _ GRID SW 2839 __ Project No. __ 22-490/R2 __ 9, Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & S S o c (a t G S inc. c s (907) 522-6476 Phone 9 (907) 522-4625 Fax �4,�c000�D Professional Land Surveyors kenOlangsurvey.com v F A jonathan0langsurvey.com I hereby certify that I have surveyed the following described property: LOT 10, BLOCK 3, MOUNTAIN PARK ESTATES SUBDIVISION No. 2 (PLAT No. P-561) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Nl Day of '�� , = �r'& _, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ' 49TH y*( KENNETH G. LA o G Op �F '••.LS -5202.• •5,©© 4p©i�R�FfSSIONAI � a� AECC963 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 1. GENERAL INFORMATION Complete legal description ~"'T /Or ~-l~- ~/ ~O~c'~rp~ ¢~q~r& E~'7'~ ~,~' Location (site address or directions) Property owner Mailing address Day phone Lending agency ,./ Day phone Mailing address / Agent ~.~-A~t~ ~'~-'~-,/,~,,~,,>- C~.&S~-q,-~ Day phone Address ~-' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/§1) Front MOA #21 MUNICIPALITY OF ANCHOP, AGE ENVIRONMENTAL SI~RVICE$ DIVISION Municipality of Anchorage AU( 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3 .- Health Authority Approval Checklist A. WELL DATA Well type /¢~/"I~V'~ 7'"~'. If A, B, or C, attach ADEC letter. ADEC water, system number Log presel~N) Total depth Sanitary seal~'~N) FROM WELL LOG Date of test //~'~/7 ~' Static water level Casing height (above ground) z~/,~z' l/ Wires properly protecte Ul AT INSPECTION Well production ~.5' ~ ~,~" g.p.m, t,,~, ~ g.p.m. WATER SAMPLE RESULTS: , Coliform Nitrate ~, O[ ~ Other bacteria Date of sample: ~/~7 Collected by: ~F B, SEPTIC/HOLDING TANK DATA Date installed ~~ Tank size ~ Number of Compadments ~ Cleanout~N) FoUndation cleanou~N) N~¢~ Depression (~. ~ High water alarm ~ ~ Date of Pumping ~~ Pumper ~'~ C. ABSORPTION FIELD DATA Date installed ~~ Soilrating~rff~/bdrm) ~,~ Systemtype~~ Length 7~ Width ~, ~ Gravel thickness below pipe ~ ~ ~ Total depth/~ Effective absorption are~~~o~itoring Tube present ~) ~ Depression over field (Y~ Date of adequacy test ~~ Results~ail) ~ For ~~ bedrooms Fluid dePth in absorption field before test (in.); ~ Immediately affer~ gal. water added (in.): ~ Fluid depth ~ (ins) Minutes later: ~ Absorption rate = ~ / ' g.p.d. Peroxide treatment (past 12 months) (Y~ ~ If yes, give date 72-026 (Rev. 3/96)* : S~er'~ptic~se~i'C~ line Water & Watt.war.ir August 14, 1997 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On-Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 8471 Brookridge Drive - Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers Subject: Waiver of separation distance from existing septic tank to existing private well. Lot 10, Bk3, Mountain Park Estates #2. To whom it may concern: The subject property has a 3 bedroom house, served by a private well and septic system. The septic tank was installed in 1980. The distance from the tank to the well is approximately 97.7 feet. At this time, we are requesting a waiver of the required separation distance to 97 feet. The topography is such that the wastewater would not flow towards the well. Attached is a diagram showing several elevation shots. The other potential path of contamination would be leakage through the tank sidewalls (rusted tank). The drairrfield was upgraded in July of 1995, and is greater than 100 feet from the well; however, the previous drainfield encroached several feet into the 100 foot well radius (per the inspection report submitted by Dee High, P.E. on 7/14/97). Based upon my review of the DHHS records, this encroachment, which existed for 15 years, did not cause any bacterial contamination, and nitrate levels (2.9 - 3.6 mg/1.) were only slightly elevated. Recent water analysis indicated nitrate levels of 3.0t mg/l and no bacteria present, which is virtually the same as when the encroachment of the drainfield existed. If your department deems an ADEC point evaluation to be necessary, I would be more than willing to perform one, however, I believe this real data is a more reliable indicator of the contamination potential than the ADECpoint evaluation system. Based upon the aforementioned data, it is my recommendation that the required separation distance from the septic tank to the well be waive~ from 100 feet, to 97 feet. If you have any questions, please contact me at 1-800-481-1162. Tha .nk you for your assistance. Since~ly, Prin~ilbhl ' 337-6179, or on my digital pager at DISTANCE FROM CENTER DF FIRST SEPTIC TANK C/D TO CENTER OF WELL WAS SHOT WITH M,D.A TDPCDN UNIT DN 8/12/97 (DAN RDTH). DISTANCE = 100,46 XISTING SEPTIC TANK ~ELL ASSUMING HEIGHT I]F INSTRUMENT = 100,00 GRnUND ELEV, AT THE WELL = 96,8 GROUND ELEV, AT THE SEPTIC C/O = 95,4 GROUND DROP 1.4 FEET FROM WELL TO SEPTIC TANK WAIVER: LOT 10, BK 3, MOUNTAIN PARK ESTATES PREPARED FOR: ANDREA LANG PREPARED BY: ALASKA WATER & WASTEWATER CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 974395002 AK Water & Wastewater Services N/A 13100 Saunders Rd. Drinking Water Client PO# Printed Date/Time 08/08/97 07:58 Collected Date/Time 08/04/97 14:10 Received Date/Time 08/05/97 15:10 Technical Director: Stephen C. Ede Total Coliform Results PQL Units Method col/lOOmL SM18 9222B Allowable Prep Analysis Limits Date Date Init 08/05/97 TMU Rick Mystrom, Mayor Department of Heaith and Human Services 825 "L" Street P.O. Box ~96650 Anchorage, Alaska 99519-6650 343-4744 August 28, 1997 Jeff Garness, P.E. Alaska Water & Wastewater Services 8471Brookridge D=ive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 10 Block 3 Mountain Park Estates #2 Waiver Request #WR970048, PID #017-022-22 Dear Mr. Garness: Your request for waiver(s) of th~ required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are an on-site well to the on-site septic tank of 97 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Dan±el J. Roth Civil Engineer On-site Services Program ljm:#6 Lang ~MUNICIPALITY OF ANCHORAG~-/ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~~ PID# #017-022~22 HA# HA970368 Date Received: August 14, 1997 Permit Legal Description: Lot 10 Block 3 Mountain Park Estates #2 Engineer: Alaska Water & Wastewater, Jeff Garness, P.E. 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: Andrea Lang Waiver Requested: Private on-site w~ll the on-site septic tank off9/7 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: List Conditions or Reasons' for ab( Date: ~-27- f7 Rec #: 03061/2155 Amount: $ ,? j9 o1~, 7'X 2/.2 /~ 7 15021 LL.] 15020 /7 15041 i~040 /5 tt RD. 12940 7 15O0O 15020 /0 13100 // 1~i20 /2 MUNICIPALITYOFANCHORAGE . ' :. DEPARTMENT OF HEALTH & HUMAN SERVICES 'Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) p r 0'~'~, 'o~-n~ r -' ~j~ ~./.~ r'Mailing ~ddress '~ ~ Lending___ agency Mailing address .... Day phone ~(S- ~'~/y Day phone '- Day phone Add ress ~ .... "~ Unless otherwise requested, HAA will be held for pickup. ' 2. NUMBER OF BEDROOMS: .-~ '~ __. .......... ~,~ ................. 3. TYPE OF WATER SUPPLy: . ' . ~ ~ . . .-.'?'.~,":---?~.:_-:- . .--...~..?....-._-,...- · .: .. ............................... . ~ ~ ~ '~ 9" _ ....... ~ndi~idual well ~ ~ ~ ~ o :- .- Community well ............ . ..... : .... ..- .._.. ' Public water NOTE: If community well system, provide written confirmation from State ADEC attest- . ,~ lng to the legality and status of system. ,~, 4. TYPE OF WASTEWATER DISPOSAL: .' ~%¥,,' .t '-- " ~,..- ..~ Individual on-site _ ..... "'~" Holdingtank .... ~. ~- ~, '::'~ ~,- ~;.'~ ,-~"~ ~ - ~,, ,;~ ~.~ 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my inves.tLgation 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. Address ~C~ ~:.__.~'t~-cc.~ (f~'Z.U~_____./. ~ ' ~ -- ~ Date EngineeCs signature~'''''/%-- ~'~" ' ' - · ,,_.2-- ~ ' DHHS SIGNATURE /v~ Approved for 3 bedrooms. Disapproved, .. ,%. :. Conditional approval for '~)edrooms, With the follOwing stipulations: Additional Comments conduc~ ins'pections 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. 72-025{Rev. 1/91) B~ck MOA~I Legal Description: A. Well Data /._/dj Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Log present (Y/N) Total depth ~/.-/'4)" Sanitary seal (Y/N) y Date completed ~Y/~ ?/? ~' Driller .~"^~' Cased to ,,-/4P ~ Casing height Wires properly prelected (Y/N) .1[/ Well type ~'~"~E.5~,.~'~ If A, B, or C, attach ADEC letter. ADEC water system number - ,./,./,, FROM WELL LOG AT INSPECTION Date of test //~ ~.?- '7 ~' ~,'" /'~- ~'-~ Static water level ~o" ~ Well flow ~ g.p.m. ~' ~ Pump level1 '~ ~5~ t SEPARATION DISTANCES FROM WELL TO: ~ Septi~holding tank on lot /~/ ; On adlacent, lots //~ ~bsorption fi~ld on lot //& ; On adlacent lots ~ Public sewer main ~ Public sewer manhole/cleanout Sewer semice line ~ Petroleum tank ~t~ WATER SAMPLE RESULTS: Coliform Date of sample: '~-/~'" ~,~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) '}'/ · High waler alarm (Y/N) /v'/~ Date of pumping ~,/5//C/~..~' Nitrate Collected by: Tank size /~..~'~_-~ ~,,,4/_~.- Compartments FoundatiOn cleanout (Y/N) ~' Depression (Y/N) Alarm tested (Y/N) Pumper ~ '/-',P SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~ / On adjacent lots /'/~' To properly line ~ f Absorption field '~ ~' Surface water/drainage J(.J)~/a~ Foundation Water main/service line ~L)~j~-- CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pu~on" level at High water alarm level Meets MOA electdcal ~/~Y/N) SEPARATION DIS/~NCE FROM LIFT STATION TO: / Well on lot // On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access _._.__~"Pu/m~ off" Level at z/ Surface water Date installed Length 7L~ ' Total absorption area Date of adequacy test Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) C), fY' ~ System type ~)~ 7"/~ / Gravelthickness '7,~ ' Totaldepth /~ Cleanout present (Y/N) ¥' Depression over field (WN) Results (pass/fail) /,.~..,.2 ~¥¢ ~ for ~ Bed'rooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / Well on lot //~.., On adjacent lots Properly line To building foundation ~ ~.(.,, r To existing or abandoned system on lot On adjacent lots ~ Cutbank /'W'~,,.~ Water main/service line Surface water N'~,',/'~'~ Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA, of this inspection. HAA Fee $ ~,~'[~O Date of Payment Receipt Number // ?;, n% ~e,1)' Back Waiver Fee $ Dale of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anch, orage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot I0; BlOck 3; Mountain Park ~stat~s #2 Location (site address or directions) 13100 Saund~..~s Road Property OWner Mailing address Lending agency Mailing address Gladys Byington 13100 Saunders Road Anchorage, Day phone 345-.5442 AK 99516 Day phone Agent -Susan Mi~er/CRAWFORD REAL ESTATE Address 3380 "C" Street Suit~ 110 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 11 3 ~ TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: Day phone 562-5592 Anchorage, AK 99 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 Public sewer NOTE: XXX 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 o 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 inves_tLgation 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 Phone ¢/~'~'~ ~_/¢/'7/~ S & .5 '6NGINF..IZRING / / Address ................ , ...... ~ ,,,,,- ~,~-~ ~- Engineer's sign~iJ~'~'~t"~'~e~;~";a~'~'--~...---~'%' ~ ~ Date ,c~//o//~ -¢ o Approved for Disapproved. Conditional approval for bedrooms. Ho, 1457-~ bedrooms, with the following stipulations: By: 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 cer[ain 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. 72-025 (Rev. 1/~1) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT' /O ~(_o¢_.,~ .'~ /~o(.,/tM74/xJ Parcel I.D. A. Well Data Well type pI~IM~7'-~- If A, B, or C, attach ADEC letter. ADEC water system number Log present Y~) ~/z(6',$ Date completed Total depth ,~--Or Cased to Sanitary seal~,~N) c//.__________________~- ~ FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic,%X,~G tank on lot _ Absorption field on lot Public sewer main ~O~g Sewer sewice line ~ Casing height Wires properly protecte (c~N) AT INSPECTION ~.m. /, r,/ g.p..nC.r1~ ; On adjacent lots /Oo ~+ ; On adjacent lots /OO ~"f- Public sewer manhole/cleanout ,"L-"-~'~- ~'~'-------------------~-~ Petroleum tank /~'/-J -~'- WATER SAMPLE RESULTS: Coliform (~//~ ~ ~ I Date of sample: ~/~-~/ Nitrate Collected by: Other bacteria B. SEPTIC/I,I~BtI~I TANK DATA Date installed ~ Cleanouts Y~I) High water alarm (Y/~%~ Date of pumping Tank size Foundation cleanout(~N) / ~_,-~C~ Compartments '7"~"~' Depression (Y/~_)~ Alarm tested (Y/N) Pumper ~ ~ ~ ~ SEPARATION DISTANCES FROM SEPTICP~I~L=~"~TANK TO: Well(s) on lot /~,.~ ~ ~ On adjacent lots /~) ~1~ To properly line / ~! ~ Absorption field ~'/'¢" Surface water/drainage /~-)/¢'-- 72-026 (3/93) Front Foundation ~ / ,,~ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ,...----"'""'~Cycles tested Meets MOA electrical codes (Y/N) ~ SEPARA~FI' STATION TO: Well.¢mldt On adjacent lots Manufacturer Manhole/Access (Y/N) ~ ~ Level at Surface water D. ABSORPTION FIELD DATA 7-,~£,OCH/T~E4Jc~I uPG,cJ~Z3~ Date installed ~/~/~//~/~/ Soil rating (GPD/Ft~) //~/~'~ Systemtype / t ( / [ / I / Length ~ /~ ~ Width ~ /~ Gravel thickness ~ /"," Total depth Total absorption area ¢~ ¢ 30¢~Cleanout present) ~ Depression over field (V~ Date of adequacy test ~/~//¢~ *esults~ail) ~ ;~ for ~ Bedrooms Water level in absorption field before test ~O ~O ~ After test Peroxide treatment (past12 months) (Y/N) ~ ~~ .Ifyes, givedat6 SEPARATION DISTANOE FROM ABSORPTION FIELD TO: Well on lot / ~_.2..~ To building foundation On adjacent lots ~O/~ On adjacent tots /COO fo'- Property line To existing or abandoned system on lot Cutbank .,OBOE /'¢'(.~;::r~"'/,~7~Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified,_or conformed to all MOA and HAA gu/defines in effect on the date of this inspection. Signature · HAA Fee $ / 70 - ¢/) Date of Payment Waiver Fee $ Date of Payment Receipt Number 72-028 (3/93)* Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & H~UMAN 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 GENERAL INFORMATION Complete legal description LoT-/~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address DaY phone $,-/5'-ZllZ- Day phone Agent Address Day pho.ne Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ '~ TYPE OF WATER SUPPLY: Individual well ~ Community well NOTE: 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: 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 5. 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 ,4/,4 D ~-f~ $0 ,'.) ~-'/'J 6 ,,J ~ ,"J 6 Phone Address Engineer's signature '~~' (~ ~__.,u~,~, 'Date DHHS SIGNATURE 1:~/.~ Approve8 for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: 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. 72K)25 (Rev. 1191) Back MOA ~21 Municipality of Anchorage ~, Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L/4) /~.~ /~lr/,/ PAN/(' ~S'fi', ~2. Parcel I.D. A. WELL DATA Welltype P,,~/u',~'~ IfA, B, orC, attach ADEC letter. ADEC water system number Log present (Y/N) / Total depth 7_ 5/¢ / Sanitary seal (Y/N) ~/ Date of test Static water level Well flow Pump level Date completed /?-Z?- 7~ Driller Cased to ~0' ~ Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION I,~1 2 ~' 4," ~- g.p.m. '~ N~T o~ Le6 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /0~' Absorption field on lot /~ 5' ' ; On adjacent lots /oo' ~- ; On adjacent lots /0°~ ~" ~/?' F Public sewer main Public sewer manhole/cleanout ~ ¢ L E5 RuJal~sewer service line Petroleum tank No~ ~Jor~J~ e~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~,//~'//~ o Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping Tank size / 2. ~'O Compartments 2- Foundation cleanout (Y/N) ¥ Depression (Y/N) /v//¢ Alarm tested (Y/N) A//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /03 / On adjacent lots //~ / To property line 3 ~ ~ Absorption field //' Surfacewater/drainage /,JoNF- /NAR. EA Foundation Water main/service line 72-026 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA ~-%d~..I FT STATION '~_ [:)~ Man ufactu rer Size in gallons ~ Manhole/Access (Y/N) Vent (Y/N) "Pum~ "Pump off" level at High water alarm level~ Cycles tested Meets MOA electrical codes (Y/N) ~ [;)ate installment/ /¢~& Length ~ ..4'7~t Total absorption area Depression over field (Y/N) ~ Results (pass/fail) F,~5.5 Peroxide treatment (past 12 months) (Y/N) ¢ /q~l Soil rating · G System type Widt~_~ .~J/ Gravel thickness .5-, ,~'~ Total depth '~-'¢~,~' '~'Z r Cleanouts present (Y/N) Date of adequa,cy test for $ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~~3~ On adjacent lots To building foundation On adjacent lots Surface water Curtain drain LoT' Property line To existing or abandoned system on lot Cutbank ~J¢~.e. P'~E~E~r Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineer's Name Date HAA Fee $ '-----~ Date of Payment '~ '?'~-~ '~ / Receipt Number ~'7'c~ ~" ,~¢ ('/ 72-026 (Rev. 3/91) Back MOA 21 e. ffect.~the date of this inspection *~&~)~}ael E. Anderson , ~ Waiver Fee: $ Date of Payment Receipt Number )CHi(D. BY DESCRIPTION ~- /~ ,~ .~ SHEET OF .... ~0~ NO. SHEET &O~ NO. HKD. BY SHEET OF .... JOB NO. - ............. : - j EN 1S (10/7~J DATE RECEIVED INSPECTION APPOI NTI~ENTS DATE DATE~ ~ ~. )~ ~ DATE MUkff~lpAIt~ ~F ANCHORAGE DEPT. OF HEAgH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTE~ION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION L S E P 5 0 1980 ENVI RON~ENTAL SANITATION DIVISION RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~e~. Please allow ten (10) days for processing. 1. PROPERTYOWNER ~ ~ ~' g// · H PRO~ERT~ RESIDe{If diff~rom above) PH~E 2. BUYER MAILING ADD~ESS 3. LENDING INSTITUTION~ ' PNONE 'AILING ADD'E~}T '~~ X' O0 ~ /~ ~Z ~/ 4..EALTO.JAG ~' - , ~ PHONE MAILING ADDBESS STREET LOCATION ~ [] One I_~ ~ur [] SINGLE FAMILY ,~,t~, Two [] Five ~ MULTIPLE FAMILY ~Three ~ Six [] Other 7. WATER SUP,,~PLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) i'~v*. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified iNSTALLER []SepticTank or []Holding Tank ~'~-c.. Size: /,,,~,;~q~) If Tank is homemade SOILS RATING give dimensions: ~ -.~ TYPE OF TANK MANUFACTURER 4. DIST~E8~ TO: Septic/~oldin~ Tank ]Absorption Area line I ~earest Cot kine Absorption Area to nearest ~ot ~ine ~. a a oous ~ CO~DITIONAk A~BOVAk {letter mu~ompang certificate) 72-010 (Rev. 6/79)