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MOUNTAIN PARK ESTATES #2 BLK 4 LT 2
Mountain Park Estates #2 Block 4 Lot 2 #017-023-02 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Permit Number: OSP241004 Work Type: Well Initial On -Site dater System Permit Effective Date: Expiration Date Tax Code Number: 01702302000 Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 4 LT 2 G:2839 Site Mailing Address: 12820 FOSTER RD, Anchorage Owner: ESPING ANTHONY C Design Engineer: This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy n f t)epartinent 1 /5/2024 1 /4/2025 Lot Size in Sq Ft: 20130 Total Bedrooms: 4 ❑ Private Well Q Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 5 �� 1% �'�' Date: Issued By: Date: =5-Zb Z `% MUNICIPALITY OF ANCHORAGE Development Services Department _� Phone: 907-343-7904 On -Site Water & Wastewater Section ��--' Fax: 907-343-7997 ON -SITE SEPTICMlELL PERMIT APPLICATION Parcel I.D. 01702302000 Property owner(s) ESPING ANTHONY C Day phone 907-306-6782 Mailing address 12820 FOSTER RD, ANCHORAGE, AK 99516 3231 Site address 12820 FOSTER RD, ANCHORAGE, AK 99516 3231 Legal description (Sub'd., Block & Lot) MOUNTAIN PAR ESTATES #2, BLK 4 LT2 Legal description (Township, Range & Section) Lot Size 20,130 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial EJ Single Family (SF) [] (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage n 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. (Signature o p owner or authorized agent) Permit/Rush Fees: 2 �� Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. i� S Z G1 / d y Waiver No. GADevelopment Services\Building Safetyl0n Site Water and WastewaterTormsUient FormsTermit Application.doc Q> C-) 7V Uq sa M, 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: 5(U °�,3�_3�� PID Number: Name: Wastewater System: ❑ New 9�-Upgrade Atltlress:Z���6�T� ABSORPTION FIELD Phone :/Y No. of Be rooms: ❑ Deep Trench ❑Shallow Trenc ed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Q,3 l�l�r�3 /�IDepth from original grader 2 PD G/S . Ft. Lot: Block: � A Subdivision: 2 "Ou1, >7-'/7v /4CE5 Depth to pipe bottom from original grade: Z /• 5 Ft. Gravel depth beneath pipe a6 Ft. Township: Range: Section: Fill added above original grade/: Gravel length: %!off "54E / / Ft. Eau 50 Ft. WELL: ❑ New ❑ Upgrade Gravel width: 1 2J1�J Number of lines: Distance between lines: !w Ft. / Ft. Classif antion (Private, A,B,C)) / /� ( I`' rz- `Gl��s� Total Depth: Ft. Cased To: Ft. Total absorption area: f l �� SQ. Ft. Pipe material: j a Td Sl Ji / / �� Driller: Date Drilled: Static Water Level: Install erY,�� �-p � �'K--• Date installed �� /� G Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding �S.T.E.P. To Septic Absorption Lift Holding Public/Private anufac�t/ure�r. Capacity in gallCons.:7, l �V From Tank Field Station Tank Sewer Lines /�CTr �J Well lr�, �t� !�� rL �7 Material: Ir�EL pL Number ofCo�mpartments: �i Surface �2� �� / � � LIFT STATION Water 6 Lot 1 /� Q ,l ,--, f Size in /SD�lons: Line J J j /� Y4Cu���` Foundation /Li 1 /.l �� r -.— "Pump on" level at: le�3 "Pump off' level at 3341/ High water alarm at: Curtain ^ l lLC/l> ` l Pump Mo el Electrical Inspections p rformed by: !+! r" l7IL Remarks: 12 v �� `�e livGL6/��/ BENCH MARK Location and Description: Assumed Elevation: (�D✓ Ft ENGINEER'S SEAL G r"' _r P_ s PmGiNEERING °r 17034 Eagle River Loop Rear Ne.> Eagle River, Alaska 94577 Inspections performed by: Dates: 1st 2nd ` Department of Heal't and Hum Services approlyall `�' f Reviewed by Date: Mill and approved 72-013 (Rev. 9/91) MOA 25 :�Vl*40 Permit No. sSyyg:jg� 1 g Page 2 of 2 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 MOUNTAIN PARK ESTATES SUBDIVISION #2 Legal Description: BLOCK 4, LOT 2 PID No.: 01702302 SOUTH BED MT2 MT3 - FINAL GRADE COS CO _ _ /98.2' pp��q FINAL GRADE WSULATID 9,! -1'1 `- SIH _. _. FILTER FABRIC INSULATION 0 0 0 q1 NEW bl 1500 GAL 5? 95.&/95.3' _ S.T.E.P. SYSTEM 88.3' IMPERMEABLE LAYER(NOWATER FOUND) N.T.S. A B FCO 18.0 22.0 INORTH BED C01 34.0 25.5 MT6 MT7 MH 41.0 34.0 FINAL GRADE DV 46.0 39.5 00.9' 100.9' MT1 50.5 79.5 _ INSULATIo MT2 39.5 72.5 MT3 305 405 FILTER FABRIC- MT4 44.0 51.0 MT6 54.0 35.0 I MT6 42.5 20.5 A MTe MT7 66.5 27.0 MT8 71.5 35.5 I 0 SCALE f' = 40' 72-013 A (2/91) MOA 25 MT5 97.2J 11.1 -- ♦ 91.2` IMPERMIEABLE LAYER(NO WATER FOUND) --- - r NEW B(705+ SQ. FT.) IY J7 � EXIST. 4_ BDRM FCO HOUSE NEW 1 00 GAL .T.E.P. 1 J4DONED SUCH THAT r 1fAY BE USED IN THE I 'URE V. L 10' UTIL. ESMT-� A MTe I 0 SCALE f' = 40' 72-013 A (2/91) MOA 25 MT5 97.2J 11.1 -- ♦ 91.2` IMPERMIEABLE LAYER(NO WATER FOUND) --- - r NEW B(705+ SQ. FT.) IY J7 � EXIST. 4_ BDRM FCO HOUSE NEW 1 00 GAL .T.E.P. 2. W BED (1100 SQ. FT.) N ENGINEER'S SEAL e fa i yr i. I4j74: A 4 2. W BED (1100 SQ. FT.) N ENGINEER'S SEAL e fa i yr i. I4j74: A NI 0 f.' N c f 1 N C C fo I, S 1; p Id 1; D I C 11 it If U T 1 A Jj S 43 "12 KJ T 1 A A 1.11 '. "',01 � A i� � I " " 0 "-'1 T-' L 0W U TU RUMAN UM AT NEXT 1 W A PU C T 1 D N 11 A KI NOT UNT F'j. If n'cE C Il i: f! CIL I % 1t.C WIN c, INT IONS APF MADA , PUARK '.UL Vill! MWITT Fill! L. U14 T 1; All A ". 114, P v oil, C H 1-3 NO 11 10 O'D I NiG 1 1" �f I � Oil P 11 .0' A ff .!9 Q- f-; :14 K - TINCIPhAT TOM NO WAV SM 1 1 111 u AN sl Mon, PTIRM is T, 1 9 0 to �f/! 0 W7 K v I susim, rarl VARK 140 419 O.N .. UK' WSPECTION: UUTT"MAL .. r" 7. .... .... .... .... . () 0 NI 0 f.' N c f 1 N C C fo I, S 1; p Id 1; D I C 11 it If U T 1 A Jj S 43 "12 KJ T 1 A A 1.11 '. "',01 � A i� � I " " 0 "-'1 T-' L 0W U TU RUMAN UM AT NEXT 1 W A PU C T 1 D N 11 A KI NOT UNT F'j. If n'cE C Il i: f! CIL I % 1t.C WIN c, INT IONS APF MADA , PUARK '.UL Vill! MWITT Fill! 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:SW930318 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SHORT DANIEL E & OWNER ADDRESS:12820 FOSTER RD ANCHORAGE, AK 99516 PARCEL ID:01702302 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 4 LT 2 LOT SIZE: 19800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: _� 3a q -air -9_S DATE ISSUED: 8/23/93 EXPIRATION DATE: 8/23/94 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 OR 343-4681 AFTER BUSINESS HOURS 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: THE NEW ABSORPTION BED MUST BE NOT LESS THAT 10.0 FEET FROM THE EXISTING TRENCH. DUE TO THE FACT THAT THE DESIGN OF THIS DUAL BED SYSTEM IS BASED ON THE ASSUMPTION THAT EACH BED WILL HANDLE 50% OF THE SEPTIC TANK EFFLUENT, A PRESSURE Afelc tI39 � CSG tm?� _ /Nsr*i bm__tdl 14_4 710 �� ) J PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOR ALASKA 99519-6650 DISTRIBUTION SYSTEM MUST USE . RECEIVED BY: DATE: ��TIII 2 3 ISSUED BY: DATE: August 12, 1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage HEALTH AUTHORITY APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street Anchorage, Alaska 99501 SEWER&WATERREFERENCE: Mountain Park Estates Subdivision, Block 4, MAIN EXTENSIONS Lot 2 equest you issue a permit to upgrade the septic system SEWER &WATER INSPECTION erving the four bedroom house on the referenced property. adequacy test performed on the existing system on April 3, 1993, for Health Authority Approval purposes found the ENGINEERING STUDIES absorption capacity of the existing system to be inadequate. AND REPORTS o test holes were excavated and percolation tests performed 'n the area of the proposed upgrade. The monitoring tubes ithin the test holes have been checked and found to be dry. WELLINSPECTION kttached is the proposed upgrade design. & FLOW TEST e do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. SITE PLANS If you hay-equestions or require additional information or yo rev w, please contact us. ROAD DESIGN A. Shafer, P.E. SOIL TEST v S/LSU/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 30' SCALE aA. ��1 4 y y�>Cp in z 2 o rn ry pn0� o � o' zy cram Op d v v ncm o m �d� �o<cznviDm 9 b t"rgC] mmZO-�< dxy OS Nim m i y �� zy� O m `D � D�r,�O ��=n m D 0 A moo OD L7 D SEPTIC < y D vO_ PO z ()Ir � r ED � z m m m o N N (AU) G� pll m -° o -q 2 „ II m -io �o C� O ° o A W 61 N cI X X N O \ 0-0 0-0 tij r ,a 00 0 2 Ilp Il U)O D m nro ► ° N' W rnm Wm 0 oz0 r moo o a4 ro fn d DECK a � d b CNn > o x�m oma yy W a z ti -0 m O z.. x OVI CrJ N ..�t.j yci � ao �mczi�y<v' _ nOc cn ro `d y d m zOA� C) ito N y rtl -q =0 nN�mQJ Zcz l� a z " UI C x o � N � U) U)? Joa S13M 'Opj m>< p� O a r ,00 d z C = m omo � O ro-°mom Ocwn ��Nrrn Z z _ Z G>{MM ti 5p a 0-1W U)F z DD r yo O -A Z�r- c \ n > m o➢➢ �J00 Z::EZO W (n O m U) ➢ co �O O �7 o- .-[�7M Z O C ZJ 2 b m00�➢ zm 0A070 OOn ZZ �t O Oyu � Z znz Dm .O O FOSTER ROAD O c n '='-=` :.• s. !!� u 94 �A tmy a z T b zm 02:5 m mol O L7 O7 FrI rn O Z ,Z' ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Mountain Park Estates Subdivision, Block 4, Lot 2 GENERAL: 1. The scope of this project includes the installation of an absorption bed to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed and abandoned in place. The existing leachfield is to be abandoned such that it may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Mountain Park Estates Subdivision, Block 4, Lot 2 August 12, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement. 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. 4. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Mountain Park Estates Subdivision, Block 4, Lot 2 August 12, 1993 5. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 6. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. 7. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Mountain Park Estates Subdivision, Block 4, Lot 2 August 12, 1993 5. 0 7. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. (ENGINEER. ,§SEAL) q • Municipality of Anchorage rt" DEPARTMENT OF HEALTH & HUMAN SERVICESr 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST /^� �C\ �\� / l.� (,SAA +Vo. i 'Y•r �,°��;i�:�. �Y 1� v C �.J`�. \ PERFORMED FOR: DATE PERFO �13DfQ.'Ers / 1 ,�Rj LEGAL DESCRIPTION: LO_- i" Li, /07N, }?RRj, &'�F ownship, Range, Section: DEPTH SLOPE SITE PLAN 1 ( CI?GANICS fr '1 Wf3 N 5- 6- 7- 8 9 10- 11 12 13 14- 15 16 17 18 19 20 ML — LEN; L/— S" TliK{Ss Gnn Cuvy - �M Ln6RQl F[ V, (� WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT _ L 0 DEPTH? p E Depth to Water After Monitoring? DLA Date: z�I R3 PERCOLATION RATE 16 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEENFT NO 1� FT PERFORM99W Egli River LOOP PI®aCI No, 204 Inagle �iv�t', �s a Aa ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI 72-008 (Rev. 4/85) rZ W Fr( -C=a �iOIRT[ — j2t Sr as IS7. �y� _CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: 1-4;� 711- �: I v ° h h. • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES j- 825 "L" Street, Anchorage, Alaska 99502-0650 bs'l SOILS LOG — PERCOLATION TEST s No. 1457-I PERFORMED FOR: DATE PE ED LEGAL DESCRIPTION_ -4 R9. MIN, � EF}m �n Township, Range, Section: DEPTH SLOPE SITE PLAN 1 i 1 2 t\ Sfi /S - t"y n. 4-jII I I] I A 6 7 8 cynic, S7tLZ $ Lc Ay 9 10 11 12 13 14 & a 15 �\ \ 16- 17- 18- 19 6171$19 20 COMMENTS S & 5 ENGINEERING WAS GROUND WATER ENCOUNTERED? _ J S IF YES, AT WHAT L 0 DEPTH? P E Depth to Water After Monitoring? DR� Date: 4-0 In PERCOLATION RATE /(minutes/inch) PERC HOLE DIAMETER u TEST RUN BETWEEN FT"AND FT PERFORMED BY: ha to River Alaska 9957 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI ES IN 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: Mr. John Smith August 16, 1993 On -Site Services, Municipality of Anchorage Mr. John Smith, I am submitting this letter per your request to document my A,prqrmtl5 rk on my new septic system myself. ��;��,�6' �® o I am a 40 yr. -old Captain with the Anchorage Fire Dept., and am curre gokng at the need to replace the septic system on our family home property, °� Lot 2, Blk.4, Mtn. Park Estates #2. e0 Po 0s This is currently our family residence, and we have no intention of moving. The new septic system is needed due to our desire to re -finance our home. In April we tested our current system to document adequacy for re -finance paperwork, and it failed. I have been working with Jim Williams at S & S Engineering, and he has designed a new system with awareness that I intend to install it myself. I intend to call on him for direction on an as -needed basis in order to assure only the highest level of quality in the installation of our new system, and he is aware of my need in this regard. I have experience in operating several different types of heavy equipment, and am competent in the operation of the Case 580 Extendahoe, which I would expect to use that or the equivalent on this project. I expect to rent from Stephan's Tool Rental, which I have rented this same piece of equipment from for use very recently. (7-16-93, Receipt Copy Attached). I do not plan to use any subcontractor(s) on this project except for materials delivery (eg, sewer rock likely delivered by trucking company). I intend to do all the excavation and installation work myself with advice, direction, and inspection as needed from S & S Engineering. My lack of experience will make me slower than the experienced contractor, but I could produce many references to attest to my care and thoroughness as a matter of personal character. I am determined to install a system that will last a long time with no problems for our family, and expect that it will at least meet, and probably exceed, the quality and care that would be accomplished by an experienced contractor. I hope this letter meets your needs for documentation of this matter, and again, I urge you to do anything you can to expedite the issuance of my permit because my work will no doubt take me longer than most to complete. Thank you very much for your consideration in this matter. Sincerely, Daniel E. Short 12820 Foster Rd.; Lot 2, Blk.4, Mtn. Park Estates #2. 345-1784; 345-2234 . Martret of Health and Human ' Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 1, 1993 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 2 Block 4 Mountain Park Estates #2 Waiver Request #WR930056, PID #017-023-021 SW930318 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 feet from the north property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, i -Robert W. Robinson Civil Engineer On-site Services MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID# 017-023-02 HA# Permit #SW930318 Date Received: August 30, 1993 Legal Description: Lot 2 Block 4 Mountain Park Estates #2 Engineer: Robert Shafer, P.E. S & S Engineeri 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: Daniel Short Waiver Requested: Lot line waiver - 5 feet north property line Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: % s, /e-1/ Zile Rec #: 25096.9810 Amount: $ 115.00 Date Paid: Aug 30, 1993 ngrn. HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Augws� 30, 1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE Munci.pa? icy o6 Anchorage ENVIRONMENTAL SERVICES DIVISION DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. Box 196650 AUG 3 0 1993 Anchorage, AK 99516 Attn: Robbie Rob.in6on RECEIVED REFERENCE: Lot 2; Btock 4; Mountain Pak E.6tate6 #2 Dean Mn. Robiuon, Request you i6sue a 5' pnopenty tine waiver .to attow the 6eptic sy,6tem permitted under permit PSW930318 to be i"ta22ed within exi,6ti,ng avai&b.2e .6pace. The area ava%eabte bon the upgrade og this .6epti.c .6ydtem requ,i,nes 6uP2 curage up to the 5' tine o4 the propecti,ea on both .bides. Thebe waivers wiU not advenaety a64eet the devetopment o6 the pnopmtie/s on eitheA side. I4 you /gk additi.ona2 injonmati.on ptea.6e contact u3. A. SHAFER, P.E. ENCLOSURES �2S6�� a v ,(edll 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1'; = 30' SCALE r,3zE7,lc A V P nz- m- zon > m UZiwg:gym ODm 0C 7 < m Z v'zm wn Q OZ� � z D mTW-C m, Z D Om UA fa19v 0 T z SITE PLAN 4 � 0 0 0t4p o zo 0 d m „ o a7 S co tJ DECK wtz m N Ly U O F WPP L'] LZ H G� n C W ! 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O 0 AZO O zw � • Ua In H a�M O z Yl V O O4 O D D C/)D z z r, �7 O= N � N OxC) 0 O �-3 t�7 o U) ca m y 11.0 p m M m P 'rl Z N 0 � v � tPJ O 0 O— I Z= .� F •' 3 tZnD<Dec in �C)x ONZ'C cn O C13 0 N < m O cm td 0> N�U) Z Z (n(n 2 m C oma cC(AD > U] -Umz i<wr9 ;umO AZco zm:iK: m DD �4 0--Aco mm < m _ -I D -O -I N -� Z�DN M W t -<.00 G7�Z0 O rC-9 Zz>; CA m ZM= mm rT,TJm co cn cn0m tin <ycZi \ _ 7J D 0n= z (nn Oy �A-, o= 0 I> Z m Om O z N Z(� ON - Y:YQ• e < s�~`' Sq• � : � e .•cam 5'rq '�� eq.e • L q ��L� J Oo t9 ' P/L WAIVER O REQUESTED x 'o s ro z oo W O O mco O ca ri �_. t7 rom d 0;U W 00 � 0 >I m - Z � -i O c � D r x Z— Cir m�N M x xr;;o ht -'O >C) �t-j <-qc mm,.., Dmf .O O -1(Am -3�! O 0 AZO O zw � • Ua In H a�M O z Yl V O O4 O D D C/)D z z r, �7 O= N � N OxC) 0 O �-3 t�7 o U) ca m y 11.0 p m M m P 'rl Z N 0 � v � tPJ O 0 O— I Z= .� F •' 3 tZnD<Dec in �C)x ONZ'C cn O C13 0 N < m O cm td 0> N�U) Z Z (n(n 2 m C oma cC(AD > U] -Umz i<wr9 ;umO AZco zm:iK: m DD �4 0--Aco mm < m _ -I D -O -I N -� Z�DN M W t -<.00 G7�Z0 O rC-9 Zz>; CA m ZM= mm rT,TJm co cn cn0m tin <ycZi \ _ 7J D 0n= z (nn Oy �A-, o= 0 I> Z m Om O z N Z(� ON - Y:YQ• e < s�~`' Sq• � : � e .•cam 5'rq '�� eq.e • L q ��L� J Yl V O O4 O D D C/)D z z r, �7 O= N � N OxC) 0 O �-3 t�7 o U) ca m y 11.0 p m M m P 'rl Z N 0 � v � tPJ O 0 O— I Z= .� F •' 3 tZnD<Dec in �C)x ONZ'C cn O C13 0 N < m O cm td 0> N�U) Z Z (n(n 2 m C oma cC(AD > U] -Umz i<wr9 ;umO AZco zm:iK: m DD �4 0--Aco mm < m _ -I D -O -I N -� Z�DN M W t -<.00 G7�Z0 O rC-9 Zz>; CA m ZM= mm rT,TJm co cn cn0m tin <ycZi \ _ 7J D 0n= z (nn Oy �A-, o= 0 I> Z m Om O z N Z(� ON - Y:YQ• e < s�~`' Sq• � : � e .•cam 5'rq '�� eq.e • L q ��L� J - Y:YQ• e < s�~`' Sq• � : � e .•cam 5'rq '�� eq.e • L q ��L� J J N.T.S. SCALE `Z, s o �f T N � v N � D m z Z y m OK 5 y w 3' (TYP o 0 v d C7 W mN UTA c pV�1 ��J1 N _ rrl Cn � 0 U1 � rrri —( IN F -0 D M I Z wO O V r- r— xrN D M 2 MOriG W z omZ-uO TI -9 r -n m N �� = O Dco \x = b�-d ® mG)D -DiD \ZDrr �O m^ Nm �m D (n m t ---i-- 0 ITT m a 0 D D " F u s o �f T N � v N � D m z Z y m OK 5 y w 3' (TYP o 0 v � � IN V m l W 1-9 II l O z � v n y o.c. O N p U N O O ri z m w � O x O o z O o S � � m - B S' w "' N m/ ti o v 10 O ! V \ O y -I o N rn m D N m m 0 Lad 0 00 N Co w AO z7.e• Ti 0 m tzi IN IN V �- i�. RETURN i0: on of Geological and G/�wsicSurveys (DGGS) STATE Uf ALASKA 3001 2 DEPARTMENT OF NATURAL RESOURCES - � 3001 Porcupine Drive (Tele .. 277-6615) Anchorage, Alaska 99501 r WATER W E L RECORDO R D I Or III ing Company Na mQ�] .� �TO qtr—��C'j—Vf'1^Yl f nJ✓Ling 77777777-= e;sher la_ Ib. or Ic. U.S.G.S. Local No. Drilling Permit No. A.D.L. No. 1a.'^Borough An ch Subdivision Lot 2 Block Ib. Fraction / / / Section No. Township H/S Range E/N Meridian I,. Distance and Direction from Road Intersections : Mt, Park Estates #2 Street Address and Area of Well Location J� - I ()C) L:,( 3. OWNER OF WELL: Dan Short Address: --- 2. WELL LOG Material Type Fee[ Below Surface Top Bottom 4. WELL DEPTH: (completed) 360 ft. Surface El evatlon Date of Completion 25 gravely with cobbles 0 12 g 5. []Cable tool [: rcotary 11Driven E] Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: sandy 12 14 rnravel till w boulde gp s1 0 6. USE: �Domes[ic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commercial []Test Well ❑ Other: ar an O 2 hard till moisE @ 52160 2 gra black bedrock18 gray rock streaks of whit 7, CASING: ❑ Threaded elded 6 in. to �ft. Depth Weight Ibs/f t. —4—i n. to 360 ft. Depth r'ac ures 18 200 cmng o m era e rock 200 20 gray r�qck 205 1360 8. FINISH OF WELL: Type. Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: seepage 185 190 gpm 270 280 heavy seepage 25 2 0 eavy seepage 40 250 9, STATIC WATER LEVEL: ft. ❑ Above Ergelow land surface Type of Measurement: O a 1 z O 2 gpm 10. PUMPING LEVEL below land surface ft. after hrs. pumping g.P.m. ft. after hrs. pumping g.p.m. 11. WELL HEAD COMPLETION: ❑ In Approved Pit ❑ Pitless Adapter inches above grade MLINICIP., IJP At D NVIRONM efio� 12. GROUTING: Well Grouted: ❑ Yes ❑ No Material: ❑ Nea[ Lenient ❑ Other: 757— ` 13. PUMP: (if available) HP Length of Drop Pipe � ft. capacity _ 5 g•p• Type: n4ubmers lble ❑ Reciprocating ❑ Jet ❑Other: 14. REMARKS: Water Temperature: 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Alaska Now-Well-Vernos Drilling & Ent AA 3327 Registered Business Name Contract License Number Address: 12241 Avion, SRA Box 1560 Anchoragei, AnchorageAlaska 99516 Signed: Date: Authorized Representative Form 02-WWR Copy Distribution: WHITE - State DGGS, PINK - Driller, CANARY - Customer re1H_HP.-A T c:: _ ' ��._.:E _E.=�" �:_�f �ff-4C:=h J�Fm_H=!®=-iLr DEF'FlRT.IlEPdT _a- E-!EIALTH AND E=.Y• VI!r:OY• ME NTAL r-r--.,OTECTION 22-65- L 'STREET: ANCHORAGE., iAE-:_ 99501 2614-4720 H_a 1-41- n _. 9' _F E=. 0-_-9 E_ I— L- F=- EE lam° r- m 11 -V PF F:C'1I I NO: i;,:a.0 cli cls, t_: F iE='P!_.I CANT: : DA d I+L•;i_. E. :.-t-{ORT C1. -j dTACT PI-li=+YdE : 7-45-1. j.. r 84 I EGFIL.. DESJ:r,.IP E,I_81:'I'v'IWION: t�limst_NTFIIY•d PARE1 EST 2 LETT': BLOCK: 4 _. SECT I O.kl : 6 TOWNSHIP: : :12N RANGE: -:I•a LOT _,I : Si, F:, OR r-.ICRES) I CEF:TIF''v' THAT: 1.. i Arl FAMILIAR !._(i -n-i THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH E,',' 1 HIE t UN1I C. I PAL I T',' OF' ANCF-{+_+h:AGE C'1E+F) FIND THE STATE OF' ALASKA. 2. T. WILL INSTALL .'}1E SYS,TEM IN ACCORDANCE WITH ALLC'1+=A CODES AND REGULATIONS: AND IN COMPLIt=tY•FE WITH THE DESIGN CRITERIA OF THIS PERMIT. S. T. idTL.t_ F=IC:'t{ERE rl-+ ALL tR=iF FlPdE: '.'T"FI'TE CIF" ALASKA f:E+.!i_ITF:EC'iEYdTE, FC+F: THE _ET BACK W DISTANCES CE' FROM H!''dY E ; I S 1- I NG f.'.{EL.L: WASTEWATER DISPOSAL SY STEM OR PUBLIC El'.IEE=:Ft iE: =TEM ++Yd l"IdT �f; FIYd4' ADJACENT OR YdEr`iF:E',' LOT. T GNED DATE: FiPPLICANT: DANIEL. E. _,EIOF::T Q` MUNICIPALITY OF ANCHORAGE 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 t PHONE ;�1 d(,�_(��' i `7 r 6 UPGRADE � - MAILING ADDRESS � � A- 04A LEGAL DESCRIPTION LOCATIONOFBEDRO MS Uy DISTANCE TO: Well �® Absorption area Dwelling PERMIT NO. 1—Z Manufacturer Mater' I No. of co artments rn Liq. capacity gallons IF HOMEMADE: Inside leth V)�A, Width ,,.—_ Liquid depth _ DISTANCE TO: Dwelling PERMIT NO. = z F Manufacturer Material Liquid capacity in gallons D w = DISTANCE TO:�2-0 Well © Foundation Nearest lot line - PERMIT N{�j p I O d Ltq a— J LL Z F Z w No. of li s ,� �@�ng^th of ach line .7�x LOO Yi Total length f lines lei ' Trench width inches Distances etven lines R� Top of the to finish grade Material beneath the inches Total effective absorptio area w 0 Length Width Depth PERMIT NO. a F• wa Type of crib Crib diameter Crib depth Total effective absorption area W rn DISTANCE TO: Well Building foundation Nearest lot line J J Class_„ Depth Driller Distance to lot line PERMIT �t DISTANCE TO: Building foundation - Sewer line Septic tank Absorption area( s) r OTHER .%v ' `� , ` n p PIPE MATERIALS - v?,a iw C SOIL TEST RATING I le INSTALLER REMARKS �r r 1 APPROVED DATE LEGAL 0 -(-1— 7,e 72-013 (Rev. 3110 t✓ u r-4 i c- x =o L_ r ce F= Fi P -j ::-. H F;:- F=l C -i E --- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' 825 �L` STREET: ANCHORAGE., AK. 9'95011. 264-4720 Wl—=L-L- IL)l U PERMIT NO. 780492 APPLICANT DICK WRIGHT SRA PX.1585�A ANCH "'.44-42h LOCATION DEARMOUN LEGAL LT. 2 BLK. 4 MTN. PK. EST. 'S"eD LOT SIZE 20000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FTr,,BR: 1.50 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF' THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE 15 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). I D-_ U I FRI r= -E=" F= F:" -T' I IZ- F n " K 4 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"Ilj C') <_."m 11 F=:, EE r:- -r I C!"I r -A nH. f=1 F? EE F-7 F=_ 11 -1 U 'r F= I=- P --,n BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL. BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 1'--; 100 FEET FOR A PRIVATE WELL.; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC 14ELL.. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN _30 DAYS OF THE WELL. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=0 E-: F;-'.* M 1 7 E=._-_° F;!" I F -C F-="=-- C.- E. f--- EE M E3 U_ Fo =---::L , -L --° 7';E`4 I CERTIFY THAT 1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS, SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:.z, AZ /j 4� ------------ PLICANT DICK WRI T C I $SUED _L_ ---------------- V:3. 2 SOILS LOG MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6.650, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: -T? IC—K w -A I (-, `+ c DATE PERFORMED: " / 40 LEGAL DESCRIPTION: i� 14 �" msDEPTHs+ SLOPE SITE PLAN (FEET) i 1 2 / 4 5 6 7 _- >8 9 10 11 12 13 14 15 16 17 18 19 20 �-- I -L' eAn ly Sd COMMENTS L)S G i WAS GROUND WATER S ENCOUNTERED? r L 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN OQ LA-VOa, /)1 (minutes/inch) FT AND FT �2 t=AUIkC" L i) r pL)A4r PERFORMED BY:C 6 A)e> r �j �ak!� CERTIFIED B : ` k DATE:A r 72-008 (7/76)- M -W DRILLING, 'INC. LSGS SITE ID LOCAL NO, DRILLING LOG %( 0 G 12 1 Ll-ci 444770 S B la- 3 = 9,G Ab'BAa-sS Well Owner Dick B. Bright Use of Well Dom. Location (address of: Township, Range, Section, if known; or distance main M111 7 Size of casing—AL—Depth of Hole340----feet Cased to 69 •3 ___feet Static water level 6"D ft. (dwue) (below) land surface. Finish of well (check one) open end (xx Screen Perforated N/At Describe screen or perfo a7t* I r 100% Well pumping test a allons pe (K&Tr) (minute) for hours with of drawdown fr st tic level. in t 9 -- Date of completion_]�2 27 79 WELL LOG Depth in feet from ground surface Give -details of formations penetrated, size of material, color and hardness 0 To ------------- Casing -stickup 2 TO15Sandy-gravel 15 Tp27Sand 27 TO ----L9- 3 9 TO 55 55 To 59 59 To 340 TO TO RAA�rfl*n-L-- -�WAt-Alr qpam-z in Qnnrqrlic-- fractures throiahhout NTVVWA Certified Contractor — STATE -W DRILLING, INC. MUNICIPALITY C1 ,A< nRcGE DEPT C, d Fi�✓120 -..--. "TION DRILLING LOG Well Owner Dick Wright 1 Location (address of: Township, Range, Section, if knowit or distance main Lot 2 Block 4 Mountain Park Estas' Anchorage �f ee : om. Size of casing_ -� Depth of Hole 200 _feet Cased to 65.9 feet Static water level 35 ft. (AKI?�) (below) land surface. Finish of well (check one) open end ( xx). Screen ( ); Perforated ( ), Describe screen or perforation_ N/A Well pumping test atm at2 per (hW (minute) for --1 100% of drawdown fro,r ,"n hours with x Date of WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO 2 Casing stickup 2 TO 3 Organics 3 _TO 16 Silty ravel 16 TO 40 Sandy gravel 40 TO 44 Wet gavel ---4A—TO 61 Hard pan —661 TO 200 Bedrock: water sea_ps in sporadic fractures throughout TO TO TO TO t _!V I'll.- Municipality of Anchorage • -� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 1%650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 Parcell.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 017-023-02 1. GENERAL INFORMATION COSA # )000* Expiration Date: — d Complete legal description Mountain Park Estates 112, Block 4 Lot 2 Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12820 Foster Road David Walters 336-3106 Day phone 12820 Foster Road Day phone Mark Soquet 727-1616 Day phone Soquet Realty, Inc. Unless otherwise requested, COSA will be held by DSD for pickup. 41-- 2. NUMBER OF BEDROOMS: - - - 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: - - Individual Well - --- - -�- �� � � �- --- -Individual On-site R X Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 seal affixed hereto and as of the validation date shown below, I verify that my.investigation, based on procedures outlined in the Certificate of Onsite 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. 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 694-7028 NorthRim Engineering Name of Firm P.D. Box 7707F4 Phone Address Engineer's Printed Name 6. DSD SIGNATURE _JZ Approved for _ bedrooms. Disapproved. 4/15/10 Date -� OF At, �br R `firj'c ••tea lot 1 �s�• PE 0 v � � ��'�• a,� nOfE.. �..,w• Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory 2( Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: - �2 -/0 (no, 11N5) Municipality of Anchorage ' Development Services Department Building Safety Division —� On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST :Wz Legal Description: Mountain Park Estates, B4 L2 ParcellD: 017-023-02 A. WELL DATA Well type _ P If A. B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 3L25/84 Sanitary seal (Y/N) 4 Wires properly protected (Y/N) Y Total depth 1 l], ft. Cased to _3j6DLfL FROM WELL LOG Date of test 2/25/80 Static water level 105 ft. Well production 1.5 g.p,m, WATER SAMPLE RESULTS: Coliform _(Zcolonies/100 mL Nitrate?.(14ng/L Arsenic: <MRLug/l. <1 dateofsample: 3/9/10 B. SEPTIC/HOLDING TANK DATA Casing height (above ground) 18• in. AT INSPECTION 4/8/10 152 tt. 0 S g.p.m. Other bacteria ng_colonies/100 mL Collected by: NRE Tank Type/Material _ AnrhnrneP Tnnk (steel) Date installed 9/?4/93 Tank size __LaAXgal. Number of Compartments _D Cleanouts (Y/N) y Foundation cleanout (YIN) _Y Depression over tank (YIN) N High water alarm (Y/N) _Y Date of pumping 4/13/lOPumper IssaCS C. ABSORPTION FIELD DATA Date installed 9/24/93 Soil rating (g.p.d./ft' or felbdrm) 0.3/0.4 System type Length 20 ft. Width 22 ft. Gravel below pipe 0,5 ft. Total depth 3 ft. Eff. absorption area JaQO: Monitoring tube Y Depression over field N Date of adequacy test 4/14/10 Results(Pass/Fail) Pass's For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depthl in. Elapsed Time: 120min. Final fluid depth 4 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) unk If yes, give date D. LIFT STATION Date installed 9/24/93 Size in gallons 1500 Manhole/Access (YIN) Y 'Pump on' level at 43 in. 'Pump off' level at 33 in. High water alarm level at 45 in. Datum Tank Bottom Cycles tested 3 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100' On adjacent lots 100' Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main no. Public sewer manhole/cleanout NA Sewer /septic service line 25'+ Holding tank NA' Animal containment areas 100'+ Manurelanimal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' + Property line 10' + Absorption field 5' + Water main — Water service line 10• + Surface water 100• . Wells on adjacent lots inn, + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 51+ Building foundation 101+ Water main nn Water Service line 10' + Surface water 100' + Driveway, parking/vehicte storage 25' + Curtain drain NA Wells on adjacent lots 100' + F. COMMENTS 4'a".A fC O /NGa P), AAer Va 1v e. SLu/ fcL d 7 _U _dC _. r I OF ACM1 G. ENGINEER'S CERTIFICATIONu it M ��:' •• cr :t9 1 certify that 1 have determined through field inspections and v* ;• review of Municipal records that the above systems are in s ' : 49. ........... •r conformance with MOA COSA guidelines in effect on this date. +. V •"' Engineer's Printed Name Steve Eng �,r��:.• "s; Pena ne 56 Date 4/15/10 4eTF'••. f��/n .Ey' l�Fo •••... •.,. COSA Fee $ H O Date of Payment !:I ' /S– O Receipt Number () "7' s - (Rev. 11105) Waiver Fee b _ Date of Payment Receipt Number W 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.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # 100096 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 2 of Mountain Park Estates #2 subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 3 ti cn 0 Z ,$iJor*'Got/2.f tir r rnF� d✓���. r, Aja'95&a& 79t M rrN flGLjC 76 lws FRAL Mss reyofm) 4.10i/G FENcE q0= G11��✓�� D2iv� •" /N i7' 5-6 0a u.1 ti Ir -3 r 010 00 -t -P /t PVCD Subdlaislon was made on _J.S�G' GZZii._ and that the Improvements situated thereon are within the property lines and do not overlap or encroaCn on the property lying adjacent thereto, that no improvements on Drooerty lying adjacent thereto encroach on the premises In Question sod that there are no roadways, transmission lines at other vis'ble •asemants on said properly except as Indicated hereon. It Is the responsibility of the Owner to determine the existence of any easements, covenants. or restrictions which do not appear on the recorded suCdlvislon plat. Under no circumstances should any data hereon be used for censtructlon orforestaplishing bo+u+qnndaboundaryorfence lines. Dated at Anchorage. Alaska. IhIS 1.. Z— day Of CONSTRUCTING ENGINEERS, INC. 96C1 Buddy Werner Dr. Anchorage, Alaska 110•23M MOOM Sac., it.. 3 0' O ujcLL 0 0 Z O cv co N 4'Rona Fla ri o Municipality of Anchorage !� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. r y P.O. Box 196650 Anchorage, AK 99519-6650 tj www.ci.anchorage.ak.us .✓ (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. or 7 - 0 Z3 - G8 1. GENERAL INFORMATION HAA# 65D50a Expiration Date: I DL Complete legal description & 13/41ck � lKoun Ace 107 Park ►=�/,x/,� zt 2 Location (site address or directions) I3O ZO Fol'/ -e,- Ra( Current Property owner(s) DRnnu Lc¢ j Pauldir Day phone 3 VS-- d?01 Mailing address 330,6 "o4>ieello Cf. Ai Clp,- 2 A-k99SvL? Lending agency _.19"M.77;f lKc.1-y V c Day phone Mailing address Real Estate Agent 1?Gn s. 1= lu1�,oy an is,", /.a/ Day phone .7 YB - ys-ao ce f1 Mailing Address X17 W. )Z"" Avrr,4�,t4o r! gn 4-k ggye l Unless otherwise requested, HAA will be held by DSD for pickup. P /ea/c col/ l %r @ 716 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site [� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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. Sap com in an,& on ctircic lirf Name of Firm FlafhW T.cbl.e�/ Sac✓ey Phone Sys --SIAM Address �'/S 30 �cAo Sf /}^cticro pe, fit" Printed Name ��R co dome !_ • 700 -c Date 9/2-9/.42S— Engineer's 5. DSD SIGNATURE Approved for bedrooms Disapproved. X Conditional approval for 4 a�• ,• V•N�ya ••' rP• �' nKODOR: F. 11,1001te rJ C-c.35E:9 •. •••.4 ion. bedrooms, with the following stipulations: Money shall be put in escrow in the amount of$8600.00 to grout the annular space on the exterior of the water well casing to a depth of 40 feet below ground surface or as close as possible to this de th. Money in escrow shall also be sufficient to construct a water storage system in the event the propsed water well code (AMC 15.55) is not adopted as written 4y the Anchorage Assembly. Money L3 a 1, s x.1T r t cif chi nffira +�� ni..nn Find approval. At the time of title transfer, the new property owner shall sign the attached maintenance agreement which shall be returned to this office before an unconditional approval is issue Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: N.c Original Certificate Date: g 0� )Rec 01A7) Municipality of Anchorage Development Services Department �f Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description: Lo 013IJ Hoven 4M m) Pa.Ic 1 .4k it2 Parcel ID: 017 -023 -Og A. WELL DATA Well type Pv t If A, B, or C provide PWSID # N• A. Date completed12 /17177 Sanitary seal (Y/N) __r Total depth -22—ft. Cased to _eft. FROM WELL LOG Date of test 1 Z / 1-r / 77 Static water level 6 7 Well production 80 g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Arsenic: - mg./I. B. SEPTIC/HOLDING TANK DATA Nitrate 14.9 mg./I. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 2 7 in. AT INSPECTION Fs 3 ft. 6. Y6 -f- g.p,m, Other bacteria 0 colonies/100 ml. Date of sample: _6/23/01' Collected by: _ FP (eA/.,+ 7:;rcA Cs Tank Type/Material 6rocy4c(,e / F�� lsry Date installed B / 2.7 /O 7 Tank size )V'40 gal. Number of Compartments Y Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping _9/ 21 / of Pumper C. ABSORPTION FIELD DATA Date installed b ( 2B/413 Soil rating (g.p.d./ft2 or ft2/bdrm) 20 System type G3ea Length 20 ft. Width is- ft. Gravel below pipe 0.6- ft. Total depth Q,Q ft. Eff. absorption area 22�Lft2 Monitoring tube Depression over field _A// Date of adequacy test B / 2,)1 ot" Results (Pass/Fail) Pari For _Y bedrooms Fluid depth in absorption field before test O in. Water added gal. New depth__ in. Elapsed Time: I min. Final fluid depth O in. Absorption rate >= 6 6 o g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date ?J.A-. D. LIFT STATION Sn I{#r+•1 Date installed 1 18Ao�7 Size in gallons 24V Manhole/Access (Y/N) Y "Pump on' level at 1,3 ' in. 'Pump off" level at 41� iA 4 in. High water alarm level at 26 i in. Datum 13• H•o— Cycles tested 7 IV Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I &V' On adjacent lots 1 �' Absorption field on lot 13 9 On adjacent lots > 16'0' Public sewer main N• A• Public sewer manhole/cleanout Al. Sewer /septic service line 7 24,' Holding tank N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation f Property line 3 b ' Absorption field 3G ' Water main N • A. Water service line 10 Surface water Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Iy' Building foundation S 2' Water main 1'•1• Water Service line >101 Surface water > 1010 • Driveway, parking/vehicle storage Curtain drain No•14 542412 Wells on adjacent lots > lGti ' F. COMMENTS Down Awla vra/co C4&1erwcte<rvty Pc..fo.., Mcl ,yy BrAan 69 Aetrrow Pwrnr a Wt it eo 9/17/ArS40tu404 #1V1,nof#Leho?._i.^: Stller` iI pnt/1Pyi�� cen/►oe! >� p�:Clu•7r-,q�w•l,KnaNAos';y.•,�•,... �••,,:�r`�.. G. ENGINEER'S CERTIFICATION S.paK• o../r-a/e N �'�' c ; : se q Or• V tf cra win ni(f ylo InfAr•411 1larlt.l wah" rjf&4- 1r ":• ci�T- tt 'N% I certify that l have dateined through field inspections and it slow "W1 r' •• .............. review of Municipal records that the above systems are in o drawn K dame -conformance with MOA HAA guidelines in effect on this date. ; 1NLDDGRL F. rwooRe.= f3 Engineer's Printed Name % tieea�ore T• �"r�'2 •.,•y/o :•' ,. T. Date 9 / 2f / or �" �: ^'•' HAA Fee S `/ :30 1�" J J'K 606kj Waiver Fee $ Date of Payment Sri/, fes//SOS- Receipt Number '1 `'f`•• q J104 _ (Rev. 12/01) Date of Payment Receipt Number 09/28/2005 03:56 FAX 9076440788 SUMMIT MORTGAGE e 002/002 205 E. Beryon Blvd. Suite 101 Anchoroge. AK To: Dan Roth 99503 Reference: 13020 Foster Road 7 907.646.8700 F 907.644.0788 Summit Mort gage is going to escrow 2 x's the bid amount for Pressure (}routing the well though 1" pipe and Installation of 1,000 gallon storage tank. The money in escrow will not be released until MOA approval. Thank you, aephens Summit Mortgage 646-8704 wW w -W ryftortgcgeolasko.com 09/28/2005 12:26 9072798879 RONA FLORIO PAGE 01/01 �^" cro14 01120A FROM: 70:2798879 Aa:ow Pomp & Well S"to Ssha'Wi1ls (9" 34&9= Prbposai �3oao �a7� F o D, o 0 APssur� %''�i�Ir• ,�r�'�ti loin e -/—d) .rr°7Puc 1, Al Ira (f sY sfi�tA,. il:-, X to 7FIllo P:1o'1 1,�OU Ga ll 57o -F40 'Fo. po7cla 6l,C &jc 7rr QQfrvPq. a-7?_ 7c -lo rl h d MUNICIPALITY OF ANCHORAGE • T DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services - On -Site Services Section P.O. Box 196f50 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY a APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. It Cx—) - C)') 'I)- aa HAA # �") N ntA 1. GENERAL INFORMATION Complete legal description Lot 2• Btock 4• Mountain Pack Estates #2 Location (site address or directions) 12820 Fo6tu Road Anchottage, AK 99516 ' Property owner Dan Shont Day phone 345-1784 (h) 345-2234 (hT- Mailing address 12820 Forten Road , Anchorage, AK 99516 345-3748 (w) Lending agency Mailing address Gran# G l'i!i YaCC Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone 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 XXX 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 N21 5. STATEMENT OF INSPi_�rION 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. :; Li S Lidtiii•IG�' :ING �'�/ Name of Firm r � - Phone T Address Eagle laver, Ala Engineer's signature 6. DHHS SIGNATURE Joo�_ Approved for — bedrooms. Disapproved. Conditional approval for Additional Comments Date d z G oborl A. `shaky ;" 4','11 bedrooms, with the following stipulations: 11 ]TIC The Municipality of Anphorage 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 statq 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. 1/91) Back MOA N21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 2 BZ/ Bch• 4PZ4Le, (' FTf 1r2 Parcel I.D. IV A. Well Data � I 4 '!J Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y N) Date completed Z ZS— 8 Driller (/M_l S Total depth ,3 60 Cased to 36 D Casing height /Z /,-/— Sanitary sea (Y N) Wires properly protecte i ( /N) ROM WELL LOG AT INSPECTION < 3 Date of test 2- 2-- g v z / Static water level /0 �5 M —t 3 v h Well flow �� S g.p.m. 3 G g.p.1W r.> m r m T / Pump levell 3nD 3r' 9 < s r -n C.0 < D N -t S I 6N ® Cr. c SEPARATION DISTANCES FROM WELL TO: U) or Septic/} tank on lot /D U ; On adjacent lots l 00 Z Absorption field on lot `; On adjacent lots /0 o Public sewer main A Public sewer manhole/cleanout Sewer service line Z Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate �< g c/� Other bacteria Date of sample: �T S Collected by: s a FNGtNrr RING 17034 Eagle River Loop Road No. 204 B. SEPTIC/ TANK DATA Eagle River, Alaska 99,577 q 3 l s� Date installed 2 Tank size Compartments Cleanouts (Y/) Foundation cleanout (Y N) Depression (Y N) High water alarm (Y Nl Alarm tested (Y/N) Pumper a VU pumping SEPARATION DISTANCES FROM SEPTIC/hkG, TANK TO: c Well(s) on lot 169 d On adjacent lots /00 Foundation Z r � To property line S ? Absorption field Water main/service line _ r Surface water/drainage lOD 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /,2 Manufacturer 41,j e Size in allons /�6 CD Manhole/Acces6N) Vent Y ) ..Pump on" level at � 3 "Pump off" Level 3 3 High water alar level//�� 41r r Cycles tested Meets MOA electrical codes9N) PlAO) ���cg Z 7LS— SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 6� D / On adjacent lots 14— Surface water D. ABSORPTION FIELD DATA / Date installed 9'12- 3 Soil rating (GPD/Ftz) Or `7< System type �P r Length lfWidth 1'I�e Gravel thickness Total depth Total absorption area /900 SFf Cleanout presen (Y N) Depression over field ()/N) Date of adequacy test Ne Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Results (pass/fail) /,t).Zi for Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: After test If yes, give date r Well on lot lD U On adjacent lots /D O Property line To building foundation To existing or abandoned system on lot c r On adjacent lots 2O 4-- Cutbank N! / /q Water main/service line_ /D Surface water /Ott r 7L Driveway, parking/vehicle storage area ,SZ) — Curtain drain IV() n! r, 115- 1�f o w AJ 4 zv/9/C�J%e / s.S6csF w 2 9 3a0,S� E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the; date p0his inspection. s z t Q� 1. Signature•::; f! Engineer's Name VENGINEERING 1 34 Eagle River Loop Road No. 204 Date /0 / �y HAA Fee $ �� C)Z) Waiver Fee $ Date of Payment lU Date of Payment / Receipt Number J? 7 r �2 ) Receipt Number_ 72-026 (3/93)` Back I WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. RA I D � O F During a recent Health Authority Approval on-site inspect io and test of the potable wat r supply well on Lot _, Block of w PA 2 k S� -TES 0- Z Subdivision, the well's productivity was determined to be 0.6 gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a bedroom residence is O, ' gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as'washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. HEALTH AUTHORITY APPROVALS SEWER WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN WELL FLOW TEST DATA ROBERT SHAFER, RE ROGER SHAFER, P.E. CIVIL ENGINEERS (907)6942979 FAX 694 121 1 CLIENT: PAIU SH6/t7 DATE OF TESTI 4 LOCATION OF WELL (Legal Description): _6 7 WELL DEPTH: 36a' CASING DEPTH: 360' TESTED BY: SS %ZS S�v DATE DRILLING COMPLETED: 7-10519 DRILLER: VE/Ws 1>I2/(C6U6 � &QT MISC. DATA: CASING HEIGHT: z- SANITARY SEAL?: ES WIRES,IN CONDUIT?:I(_ ES GRADING O.K.?:Cj BACTERIA & NITRATE SAMPLES COLLECTEDi I. 3 RESULTS: WELL CURRENTLY PRODUCES GPM WITH A DRAWDOWN FLOW RATS NOT GUARANTEED—SUBSEQUENT VARIATIONS CAN OCCURI 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 CLOCK TINE DEPTH To WATER DRAWDOWN PUMPING RATE(GPN) REMARKS :30 (�O'sWl 5.4 S 11 ' 11 /3e7 S. Z /2:00 X0:43 30R� Z4� _- l� Prn1„o MISC. DATA: CASING HEIGHT: z- SANITARY SEAL?: ES WIRES,IN CONDUIT?:I(_ ES GRADING O.K.?:Cj BACTERIA & NITRATE SAMPLES COLLECTEDi I. 3 RESULTS: WELL CURRENTLY PRODUCES GPM WITH A DRAWDOWN FLOW RATS NOT GUARANTEED—SUBSEQUENT VARIATIONS CAN OCCURI 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ROBERT SHAFER. P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS A WELL RECOVERY TEST DATA (907)694-2979 FAX 694-12 11 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION d FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN CLIENT: WELL LOCATION (legal):. TEST DATE:_4 hz. 93 TESTED BY: SS `s S WELL DEPTH: WELL DRILLER: CASING DEPTH: DATE DRILLED: TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min. recovery. TEST DATA: START TIME: MISC. DATA: Casing Height: Sanitary Seal?: Wires in Conduit?: Grading O.K.?: Pump Depth: Samples Taken?: Date: STATIC WATER LEVEL: TRIAL PUMP TIME METER GAL./MIN. 1 OFF 43 �?S ON OFF Z: rZ 442a 2 OFF Z :re- q 4Z0 Z-? ON OFF 3 OFF Z:S`� 44CZ ON _,- OFF S:q? 4 OFF S:4) 4 S 2� ON OFF +:Z6 4-W 5 OFF 7 ON OFF S: l3 4541 RESULTS: WELL CURRENTLY PRODUCES: 3 & Gltl'l FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR! (��L�vEt�C`� l�S % %�Er2/=�2N►�'1� %Lc.._or,.�/�v� JA ( /q6o t �G� 3 17034 EAGLE RIVER LOOP, SUITE 204,E/-GLIER, ALASKA 99577 A AL HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN WELL RECOVERY TEST DATA CLIENT: WELL LOCATION (legal):. TEST DATE: 4 (/31 y'3 TESTED BY: S WELL DEPTH: WELL DRILLER: CASING DEPTH: DATE DRILLED: TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min. recovery. TEST DATA: START TIME: MISC. DATA: Casing Height: Sanitary Seal?: Wires in Conduit?: Grading O.K.7: Pump Depth: Samples Taken?: Date: ROBERT SHAFER, P.E ROGER SHAFER. P.E. CIVILENGINEERS (907) 6942979 FAX 694 121 1 STATIC WATER LEVEL: 3U�� TRIAL PUMP TIME METER GAL./MIN. 1 OFF �'is ST S e� z 2 ON _ OFF 2 OFF ON OFF 1:44 s� 3 OFF I;1144S S � 0• S (, ON OFF Z:40 O /Z 4 OFF 2:4,obiz 3� C� /> f ON OFF 3 3i �Oy 3 S OFF 3.31 (oC��{3 ... � � = U, Ir /Cvj = c:>' � OFF 5! Or 6 � �� RESULTS: WELL CURRENTLY PRODUCES: FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR! 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 JNICIPALITY OE ,NCHO DEPT- G I i':..I ( " r 5. LEGAL DESCRIPTION Ft^IYIRONi�teNTAL I'' fLCTION � MUNICIPALITY OF ANCHORAGE - - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION . , ��.�� i, � � 825 L Street -Anchorage, Alaska 99501 • _ ^�N� ENVIRONMENTAL ENGINEERING DIVISION RE_ � I.VE Telephone 264-4720 — — y REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P OPERTYOW ER - 7. WATER SUPPLY PHONE ING ADDRESS- *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well PROPERTY REST ENT (If different from above) - depth (attach log if available.) PHONE - , INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date 2. BUYER If system is over two (2) years old an adequac test is required PHONE by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDRESS 3. LENDING INSTITUTI PHONE A G AI ING ADDRESS - ' 57, 4. REALTOR/AGENT PHONE 22 L Olt rx.QG MAILING ADDRESS r 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE MBER OF BEDROOMS yy--A SINGLE FAMILY ❑ One A Four ❑ Other eN ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY �l INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - , INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequac test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED YO 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER _1 LII Ol, DATE INSTALLED a D INSTALLER ❑Septic Tank or ❑ Holding Tank Size: jg�ST— If Tank is homemade give dimensions: S01 LS RATING I TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL _ 1 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)