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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 5 LT 1 Municipality of Anchorage Page ! of 2 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: SW980154 PIDNumber: 01702325 Name: O.T. Myers Wastewater System: [] New J~ Upgrade Address: 7000 S. Park Drive ABSORPTION FIELD Phone: 345-4957 JN°'°fBeOr°°ms: 3 [] Deep Trench [] Shallow Trench E]Bed []Moan/d/Other LEGAL DESCRIPTION so, Rating: Total Depth from/~9~inal grade: GPD/Sq. Ft. Lot: Block: 5 t.; :::Pa~J~ .TEs t~ates# 2 Ft. 7t Ft. M Subdivision: Depth to pipe bottom from original grade: G h beneath pipe 1 Township: I Range: I Section: Fill added above original grade: / '~ravel length: ,.-'" Ft. Ft. WELL: I~ New [] Upgrade,..~..~ Gravel width: ' / Number of lines: Distance be~een lines: Ft. I Ft. Classification (Private, A,B,C): ,_.- ~ Ft. Cased To: Ft. Total absorp~ SQ. Ft, Pipe material: Driller: /...........--"- Date Drilled: Static Water Level:Ft. Inst.;,/' Date installed: Y~GPM Pump Set at: I Casing Height Above Ground: ~t, Ft. I TAN K SEPARATION DISTANCES ~ Septic[] Holding [] S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Anchoraqe Taflk 1 , 0 0 0 Well-' 8 8 ~ Material: Number of Compadments: steel 2 Surface Water n/a LIFT STATION Lot Size in gallons: Manufacturer: Line 1 5 t Foundation 3 5 i "Pump on" level at:~evel at: High water alarm at: CurtainDrain n/a Pum~ Electrical Inspections performed by: . Remarks: Tank replacement only. BENCH MARK Tank to well waiver per DHHS letter Location and Description: Finish floor exiSting house dated June~-}8,'i1998 elevation= 100.00 I Assumed Elevation: A~"o CE - 58[,)7/ Department of Health and Human Services approval ,~ ~,~,o Reviewed and approved by: ~/-/--///./~,~-- ~ ¢¢--~ Date: ~ - '~ o -' ¢ $ .,~,~.~.~.~.-~/ 72-013 {Rev. 9/91) MOA 25 Permlf No, Municipsl!ty of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION Page ~ of ~ Date 6/16/98 P.O. Box 196650. Anchorage, AK 99519-6650. Tel: 343-4744 On-Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 1 BLOCK 5 MT. PARK EST. #2 / \ I':i: i '.:.i i---is,E,, I,- f...,,...:.o:..:':.,,.,,X... ""':"';' :' ;":";:' '}i!' i:XTB~ ~ > ~-I\ ~.;i'".'"'{":'~i:':'"':;~; £XlST~NG : LOT 1 ~ \ \.i., .:. :'.., .'.".",:'~ HOUSE o ~,., ~ I ' ~:";' ;~' '''''/ .,/ b . z z ~ ~ \~-oPPOS,NG c~ o =, ~lc~ I (\ INSTALLED \ ~ · ~ : \ x \ DECK / I o I . \ ~ ~ _~,r' CLEAN OUT z ~ X % ~' INSTALLED , I'¥',m''~ I I --~ 4" PVC LINE · ,r LIED 1000 GALLON 2N8956 06 W 185.00' 1~1 EXISTING , COMPARTMENT STEEL TANK LOG CRIB ~ SWING TIES ELEVATIONS A B INVERT 1. T.B.M. TOP OF' SLAB AT SOUTH !1 65.3 40.1 96.~7 GARAGE DOOR ELEV.= 100.0. 259.2 52.0 96.15 2. TANK TO WELL WAIVER APPROVED PER DHHS LETTER DATED 6/8/98. 9 · · %...-'...~.**.*:¢.:'4. DATE W.O, 98;558 I F.B. NO. I SCALE: 1" = ;50' C, FILE ;558CTRAD SWING TIES ELEVATIONS A B INVERT !1 65.3 40.1 96.57 2=59.2 32.0 96.13 PAGE 1 OF 1 MUNICIPiS_LITY OF 3LNCHORAGE DEPARTMENT OF HEALTH i~ND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ~_LASKA 99519-6650 ON-SITE WASTEWATER DISPOSi~L SYSTEM (UPGRADE) PERMIT PERMIT EIIMBER:SW980154 DESIGN ENGINEER:DHI ENGINEERING OWNER NAME:MYERS O T OWNER ADDRESS:7000 SOUTH Pi~qK DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/05/98 EXPIRATION DATE: 6/05/99 Pi~qCEL ID:01702325 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES ~2 BLK 5 LT 1 LOT SIZE: 20130 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MI/NICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18~AC72) i5~ND DRINKING WATER REGULATIONS (18D2~C80). 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: RECEIVED BY: ~~ ISSUED BY: ~~ Rick Mystrom, Mayor Mum c paHW of Anchorage Department of Hea~th and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us 343-4744 June 8, 1998 Dee High, P.E. DHI Consulting Engineers 800 E Dimond Boulevard Suite 3-545 Afichorage, Alaska 99515 Subject: Waiver Request for Lot 1 Block 5 Mountain Park Estates #2 Waiver Request #WR980022, PID #017-023-25, SW~80154 Dear Mr. High: Your request for waiver(s) of the required 100 foot horizontal separation of an o¢-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank on property of 87 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. Civil Engineer On-site Services Program ljm:#6 ~ MUNICIPALITY OF ANCHORAG~-J Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# ~A~q~y~3~.O PID# 017-023-25 Ha# Date Received: May 27, 1998 Permit Legal Description: Lot i Block 5 Mountain Pakk Estat-es ~/2 Engineer: DHI Consulting Engineers 800 E Dimond Boulevard, 'Suite 3-545, Anchorage, Alaska Applicant: O.T. Myers Waiver Requested: Septic tank to a priva~e~well of 87 feet 99515 Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E.' Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: 2_ List Conditions or Reasons for abo Date: Rec #: 03720/0833 Amount: CON, S sUuLrTING ,ENGINEgERS DSlcivil veying Plannin May 27, 1998 W.O.: 98358 Mr. Jim Cross Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519-6650 RE: Lot 1, Block 5, Mt. Park Estates # 2/Tank to Well Waiver Dear Mr. Cross I am requesting a Tank to Well waiver of 87 feet to the well located on this property. I have enclosed a drawing showing the relationship between the well and tank, as well as other well information on surrounding lots. After careful consideration of all the alternatives, I believe the best location for the tank is the one proposed. My justification is as follows: 1) 2) 3) 4) The existing tank was installed in 1972 with a 70' +\- separation from the existing well. In 26 years, there has been no reported nitrate or coliform problems with this well or any of the surrounding wells. By placing the tank at the requested location, it is making an existing condition better by increasing the distance the tank will be from the well (87' verses 70'). The proposed location reduces the risk of damaging the existing log crib. It is my recommendation, that any excavation be at least 20 feet away from any portion of the log crib system. Due the age of the system, there is substantial risk that the existing crib could collapse or be damaged by the excavation or vibration of heavy equipment working too close to the field. The proposed location places the tank over the existing drain lines. This allows !h.e d. r.ain line to run in a straight line from the house through the tank to the crib, there by m~n~m~z~ng the length and number of bends in the line. The surface elevation for this area generally slopes from east to west. Though there may be some local variations, the water table gradient also runs in this direction. The static water level in the area is between 30 to 60 feet. The lots to the east are serviced by a community well. In my opinion, the risk of contamination to the subject well as a result of Dimond Center Tower, 5th Floor · 800 E. Dimond Blvd., Suite 3-545 · Anchorage, Alaska 99515 (907) 344-1385 ° Fax 344-1383 5) May 27, 1998 W.O.: 98358 page 2 this waiver is very Iow. This is substantiated by the fact that the existing tank has been within 70 feet of the well for 26 years with out any reported problems. There is one very small area on the lot that is outside the 100' protective well radius on which a tank could be placed. Placing the tank in this area would require a lot line waiver. In my opinion, this location is unreasonable. It will require the tank excavation to be right next to the crib and for reasons stated above, there is just too much chance that the log crib system could be damaged. If the crib is damaged and needed to be replaced, it would create a major problem since there is no other place to construct a new field outside the 100' well radius except in the same location. Reconstruction of the leach field would require getting a lot line waiver, obtaining temporary construction easements from two adjacent property owners, as well as incurring very large and unnecessary costs. For the reasons state above, I am recommending that DHHS approve our well waiver request. Enclosure(s) cc: O,T. Myers 358dc27m Very truly yours, ng Engineers Dee High, P.E. Principal I I / x 4~ 4~ P£,/?M~'/~-~'I/.. I T Y' 2-.~3 ~ O l? ! Z o 'V TPr L ¢ t; P19-I~ n r t o ,,u GAAB-HDd G[~ ~.ER ANCHORAGE AREA BORO!? ~1 DerARTMEBIT OF ElYVIFIOBIMEIYTAL 0.UALI~. 31300 TUDOR I~OAD ANOHOFIAGE, ALASKA ggB07 27g-8688 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME tiP'/ LOCATION MAILING ADDRESS PHONE LEGAL DESCRIPTION /~eT'- J SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /d(k'~ NUMBER OF · MATERIAL k~"(q~' ~ ~'~:t'~j, COMPARTMENTS. "/~' '//' /"/'~ i~:~'~ LIQUID GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER LINING MATERIAL / ..... OR WIDTH /(~ ' , LENGTH -,~/ ' , DEPTH DISTANCE FROM WELL J/cz x BUILDING FOUNDATION ~/~ NEAREST LOT LINE TILE DRAIN FIELD: TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE .SQ. FT. · FOUNDATION , NEAREST LOT LINE DISTANCE BETWEEN LIN~ES - TRENCH WIDTH ....... S(~'~:FT. LENGTH OF EACH LINE TOTAL LENGTH ~--T-OF' LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE,__ WELL: TypEit, ifliti bL'lli~ 1) DEPTH ~?,r')(~ i DISTANCE FROM , ., BUILDING FOUNDATION '~(~ NEAREST SEPTIC ,' SEEPAGE LOT LINE /O ( ~" , SEWER LINE~;LL (<~.~ / , TANK "7(-; , SYSTEM WATER SAMPLE '" CESSPOOl A)C ?d).L , NEAREST OTHER , SOURCES DISTANCES: EFI3 i iP,£,g~ '1:~.:~'- g/~'!'~ '~t~/ DIAGRAM OF SYSTEM DATE . /~/',~' 6/,, /(2]2. APPROVED '" / G .A.A.B. SEWAGE GREAi~R ANCHORAGE: AREA BOF ,iCH DEPARTMENT OF ENVIRONMENTAL OUALI'I'¥ 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-S6S6 DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO.. NAME Of APPLICANT MAILING ADDRESS PHONE INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED SEEPAGE Pit DRAIN FIELD OTHEr TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: '~4 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY TH= HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REOUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT, SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE Pit TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN field SEPTIC TANK, ~ SEEPAGE PIT TO RIVER, LAKE. STREAM. SEEPAGE AREA SIZE ., DRAIN FIELD DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE P~T DRAIN FIELD. CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S feet INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BA{:KFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. TYPE DIAGRAM OF SYSTEM HEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-66 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, DATE APPLICANT'S SIGNATURE R&M Civil Engineers ENGi -, EERING & GEOLOGIC Z CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087-- ANCHORAGE, ALASKA 99503 TELEPHONE 907--279-0483 TELEX 090-35419 Geologists Land Surveyors JAMES W. ROONEY, P. E. MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. RALPH R. MIGLIACClO Engineering Geologist June 29, 1972 R & M No. 26540-1 Mr. Marion Arturo 1409 West 27th Anchorage, Alaska RE: Test Hole and Soil Log Report for Sanitary System Lot 1, Block 5, Mountain Park Estates No. 2 Dear Mr. Arturo: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed {n accordance with your request o~ June 28, 1972, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rol~ Strickland o~ 'the Greater Anchorage Area Borough Department o~ Envlronmental Quality. A s{ngle test hole was put .down within the Lot 1 area ~or the purpose o~ defin- ing general subsurface so{1 conditions for the proposed sanitary system. Exca- vation was accomplished with a tractor-mounted backhoe and the test hole was ex- tended to a total depth oJ~ 13 {eet below ground surface. The ~inal log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact US. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS ./.Ja ~rfles W .~oon e~ JWR:wb E nclo sure cc: Greater Anchorage Area Borough ANCHORAGE FAIRBANKS JUNEAU T.H.- I 6 -28-72 ORGANICS 0.0' I .0' ORGANIC SILT SILTY SANDY GRAVEL (GM) W /COBBLES Dense SANDY GRAVEL (GW) SILTY SANDY GRAVEL (GM) W/COBBLES Medium Dense SANDY GRAVEL (GW-GM) W/COBBLES SOME S,,T No Water Table Note: Hole excavated with tractor mounted backhoe. Engineering ~ Ge°logical Consultants ANCMOI~AeE FAIRBANt~e ALASKA JUNEAU Morion Arturo Property LOG OF TEST BORING Anchorage Alaska Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING C51~) .- 0~).._.~_ ~,~.~ NAA# ,~r~ GENERAL INFORMATION Complete'legal description LOT' t '~"'~i/-- "~' Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address. Day phone Day phone Agent 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 Public sewer NOTE: If community WasteWater system, proVide written confirmation from State ADEC attesting to the legalitY and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 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 Ds 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 s~pply and/or wastewater disposal system is in compliance with all Municipal and State codes, o~'dinances, and regulations in effect on the date of this inspection. NameofFirm i o/~/~-~-( uc~.~L~b~,~' '1~ ~ Phone Address ~O'_*~ ~G' 1~-,~ ~t ~o ~ E~gineedssignature ~ ) .. . 2 / DHHS SIGNATURE )1/ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with th"e following stipulations: Additional Comments Date 'The M~nicipality of AnChorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MAR 1 6 Environmental Services Division N P, ITYC 825 L Street, Room 502. Anchorage, Alaska 99501-(907)~.3N'~-~,i~;At' SERVICES DIVISION Health Authority Approval Checklist Legal Description: ~-/~/~ ~:~k:. E> 1,4~ IE. ~t 'z.- Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) y Date completed Cased to "7 ~ ~ If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) Y Date of test Static water level Well production WATER sAMpLE RESULTS: Coliform C-) Date of sample: ~////~ FROM WELL LOG AT INSPECTION g.p.m. ~ g.p.m. Nitrate ~ [~ Other bacteria Collected by: 'i ". ~ B. SEPTIC/HOL'DING'?ANK DATA Date installed 6. d~. ~[ ~ Tank size Foundation cteanout (Y/N) y Date of Pumping t,,~.~ ~_ '~.~.~?~Pumper tlJ-O~,-) Number of Compartments ~ Cleanouts (Y/N) ~ Depression (Y/N) [~ High water alarm (Y/N) ~1 C. ABSORPTION FIELD DATA Date installed [-~ '7~ Soil rating (g.p.d./ff Length ~,~ ~ width [ d~ Gravel thickness below pipe Effective absorption area w ~/z. ~4 ¥ Monitoring Tube present (Y/N) Date of adequacy test ~///~ Results (Pass/Fail) '"~ Fluid depth in absorption field before test (in.); Fluid depth q/z~ (ins) Minutes later: L/ Peroxide treatment (past 12 months) (Y/N) System type O( ~' [~t'~o~aI depth . Depression over field For ~ Immediately affer~D gal. water added (in.):. Abso~tion rate = ~ ~ g.p.d. If Yes, give date 72-026 (Rev. 3/96)* F. LIFT STATION ~",~///~ Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum "Pump off" level at* Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots On adjacent lots '~ Public sewer main Sewer/septic service line Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation -:-;-;-;~ Property line I ~ Absorption field Water main/service line .'> ~" Surface water/drainage bi' I [~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -~ ~ Building foundation '~ .~.~ ~' Water main/service line Surface water I'q I ~ Curtain drain I,~[ I ~ Driveway, parking/vehicle storage area Wells on adjacent lots ,.~'. . ,:' ,.: : .,, ENGINEER'S CERTIFICATION ~-~,.. . I certify that I have determined thru field inspections and review of Municipal record$:~i~at th'e above ~ystern$ are in conformance with MOA HAA guidelines in effect on this date. Signature '~'--- Engineer's Name Date HAA Fee $. (--~:>~' ~ Date of Payment 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 GENERAL INFORMATION Complete legal description Location (site address or directions) -tooo ~. O,~-.J~_ Property owner Mailing address Lending agency Mailing address Day phone Day phone- Agent Address Day phone 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 v" ,~ Holding tank community On-site · Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 Address ~O. Engineer's signature ~~ Date DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. 72~25(Rev. 1/91) Back MOA#21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type t~r~,J~DU^g If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth ~ Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of.test Static water level - -- * -- Well flow g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ''14'~ Absorption field on lot |O Public sewer main N/,Z~ ; On adjacent lots ; On adjacent lots ~s°"~ 'to ~T Public sewer manhole/cleanout N//~, Sewer service line N.//~ " ~' 0 Petroleum tank o ~ ~--¢-. Ir'~ o''c--/~ 'r P-O WATER SAMPLE RESULTS: Coliform 0 (~) Nitrate 5- 0¢-.- "l"~ (E> Date of sample: Other bacteria Collected by: ~'~'¢'~- /~'~¢"~ 5 B. SEPTIC/HOLDING TANK DATA Date installed '7--~?- (~ Cleanouts (Y/N) ~0 High water alarm (Y/N) Date of pumping h-- . Tank size t 00o (~ Compartments ¢ FoUndation cleanout (Y/N) ~-"~ Depression (Y/N) . ' ~/~ Alarm tested (Y/N) ~/~ '- ~ o~ ~ ~-0~- q ~ Pumper ~OooAUD5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ,~ '~ (~ It4-'~ TO sou'rl4 ~ -77--) ~ . ' Well(s) on lot r7 4 (' ~,ST~LE~-O '7 On adjacent lots >'w too To ~ ow~'SFoundabon To property line ~'~' ~' (~ '- Absorption field GZ ~ (~ Surface water/drainage N/,4,, 72-026 (Rev. 7/91) Front ~ ,c:~-D~'t D/~ ~ .~ ,1~ (~. E- $ Water main/service line CONTINUED ON BACK PAGE C. LIFT ST~'T~ Date installed Size in gallons "~'-"-"- level at _,..~leT~ccess (Y/N) "Pdmp..9~n"_ "PUmp off" level at Vent (Y/N) D. ABSORPTION FIELID DATA Date installed ~-"-I~ (9 Length ~2-' (~) Width High water alarm level Cycles tested Meets MOA electrical codes (Y/ "~-....~ SEPARATIO FROM LIFT STATION TO: Well on Io~../"' On adjacent lots '"'"~Su fr~.ce water Soil rating [°10 ¢ ® System type Lo~ Gravel thickness cf i ~ Total depth Total absorption area -T%~ %~ (~ Cleanouts present (Y/N) Depression over field (Y/N) j'4 (3~) Date of adequacy test Results (pass/fail) ~)A$ '"' © for ~ (P Peroxide'treatment (past 12 months) (Y/N) If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I O%~ +-- ® On adjacent lots I'~± TO S~ %ropertyline_ ~' d)~ To building foundation ~,~F ~+~0~1) To existing or abandoned system on lot Al ~',~, Onadjacentlots~O'~l'o s~u-~4 (D Cutbank ~//~' Water main/service line tq/A Surface water Curtain drain N/~- Driveway, parking/vehicle storage area rJ/A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature '~ En g i nee r,s N,.aom e ,,j~_~_ ,z~//~...~., Date 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number APPLK':~NT FILLS OUT UPPER HA[~-~ONLY ~Pr, c.,~per ty Owr~r d'"--~.,~,.~...~ '-'~ ..¢>- '7Z-~-"-'~.-.1 Phone ,- Buyer Address Zip Code Lending Institution j~ ', .... /~ .-- ~ ~/~ ~ Phone_ ~ Addre,s : Zip Code ~ / (-.- I I - ' T(~f Resi~nce ~Single Family W~cSupply ndividual A~ACH WELL LOG, A w~l Icg is required for all wells drilled since June 1975. ommunity For wells drilled prior to that date, give well depth (attach Icg if available), ~ Public Utility ~e~ Disposal '~lndividual Year Indiv~ual Installed: ~ Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Ti~.~ Date Date Date Date fnsp~tor Insp~tor Inspirer Insp~tor -- ' '-- ~' ENVI~., ~t, :f RECEIV[D ( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APRROVAL* Soils R~ting Date ~wer Installed Well To Absorption Area ~ Well Log Received ~ ~'¢ '~., Well toTank ¢~ SepticT~kSizo ~ 72-023 (3/82) ~4r. James ~,~orton SRA T~ .~ox 137 M Anchorage, Alaska October 7, 1982 99507 Subject.~ Lot 1, Blk5 ~4ountain Park Estates 92 Dear Mr. Norton: Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: o The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. The septic tank pumped with a receipt submitted to this department. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review° Please notify this Department for a reinspection %;hen the noted discrepancies have been corrected. If there are any further questions, please call. his office at 264-47200 Sincerely, Robert C~ Pratt Associat~ Environmental Specialist Enclosure RP. 1 ALASKA ~rlul~onm~nTAL CO[1T[~OL S~I~UIC~$, IFIC. ~n§in~r. inc1 ~ ~ngironmcntaJ 51u~Jics MUNICIPALiTy OF ANCHo ' ' "; .,g..E~TiON K A.~.~ ,.~..l:.~', M C)J:('FE~Af3E: (.'tA~., ~..,,,-~t..,I. (~J-( 99','.'~U',:~ (~[)EEC}UACY "FiiEE~"i' FOR !i;ENE'.F,' ET?S'¥'Ii[H L. 0 '¥' .... 1 "fklE: 'i"¥J::'!i~: ('.)J::' .:, ,,~:., ... 'rr ,,~ '":', :L O 0 0 1220 UJcst 25th Aoenue · Anchornqe, Alask~ 995o3 · (907) 276-1361 DATE~_v~v_RECEIVED INSPECTION APPOINTMENTS 3 TIME. -~' TIME TIME DATE DATE DATE , s%L MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHO~GE  DEPARTMENT OF HEALTH ~ ENVIRONMENTAL PROTECTION DEPT. OF 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL F;:OT~CTION ENVIRONMENTAL SANITATION DIVISION MAR 2 ? I980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~ ~&[l~i D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAI LING ADDRESS 4. REALTOR/AGENT MAI LING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATI OI~Y/ 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other ~' SINGLE FAMILY [~' Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY 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** ~C[~_~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) 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 [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: /(~.~(~ If Tank is homemade SOILSRATINO give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~'~APP ROV ED FOR "~'~-- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY ~¢./~ .~ 72-010 (Rev. 6/79) ~; MUNICIPALITY OF ANCHORAGE ......... ,~v ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEd~'~I DEPT. OF HEAL/m 825 L Street - Anchorage. Alaska 99501 ENVIRONMENTAL pROTECTION ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 ~'!0V 1_ 1978 .EouEsT Fo. A...OVA' ~DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY OWNER PHONE MAILING ADD~ ESS PR'~PERTY RESIDENt(If different from above) PHONE 2. ~R . PHON~ MAILING~R~S ~ . ~ ~ /. ~ 3. LE~DING INSTITUTION ~ ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION . STR E ET LOCATI ON 6. TYI~E OF RESIDENCE 1~ SINGLE FAMILY [] · MULTIPLE FAMILY 7. WATER SUPPLY  I NDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other [] Two [] Five /~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to/that date, give w~ell depth (attach log if available.) ~/~ ~75 ~( °/' ~ **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required 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 DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIR-ECTIONSi 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] puBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED ~]PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: "/¢¢~E.~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~//APPROV ED FOR ~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) //~ LL:GAL DESCRIPTION 72-010 (Rev, 3/78) JML John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 · ~'r'"~,, PHONE Nb~BER 276-41 SOIL ABSORPTION SYST~'4 TEST PERFOPJ~ED FOR: LEGAL DESCRIPTION: li_~,T- ~ ~_~,..~r_.~. ~ ~W-~,~ ~r~ ~~ ~ M · N0, O~ ~EDROOMS: ~ RECORDS ON FILE: m~ I~~o~ ,~,~a~' CRIB ~ ORAINFIELO ~ OT~ER ' TEST PERFORMED IN ACCORDANCE WITH JML STANDARD PROCEDURE ACCEPTED BY MUNICIPALITY OF ANCHORAGE, DEPT. OF ENVIROI.~4ENTAL QUALITY ON ~/~/~ WITH THE ~LLOWING MODIFICATIONS: SURGE CAPACITY:' SOIL ABSORPTION SYST~ (SAS)~~,'~AH SEPTIC TANK PLUS SAS ABSORPTION RATE 0,~0 AVERAGE 24 hrs ~5-70 OBSERVATIONS: TEL~PHONm: ~,~4 '~,~ DATE OF TESTS: ~l/l~/~ STEADY STATE JML I John M. Lambe, P.E. 4303 No,~;, Star Street Anchorage, Alaska, 99503 902-279-8056 DATE ///J~F/7~PERFORMED BY: /~-~-~L? /~,-~ ~- / - LEGAL DESCRIPTION: DEPTH BRT4DW METER READING GALLONS PUMPED TIME R. EFERENOE ( GALLONS ) ( ArET ) , '7 '.-~'" ~'//~.:'o /o0 / ~ :I{ t ~ "'~4~ 4'/:'4~ /~"-~' / . - .-. 7: 31~ d~ ~9~ ?<:o j '2 ;'/~ 7 '.-?" ff?:')4o 7>~-0 ] o-~'~ ~2 /~ x~0 ~ ,,, o. 4o ,~ l / ZO JML '-4-_OF John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 DEPTH BELOW METER READING GALLONS PUMPED TIME REFERENCE ( GALLONS ) ,~.~>~" _7 -'--7 ,, ~.,~./ , 7 c./.~. ~'/-,-;o .... 2 :o 7: 48' , , ? ~ ~' '--~ .!.~" 3'-t 73o x 'd cL.,,:7 7rf:'7 ,., ,6 '&'-f "' ,':;': ~c? ,, /~', ~'/--7~," .. /(., .' ~'i .30~- LOT~ ~ '//- ZO'7(~ · LOT SURVEY CERTIFICATION j Pro?erty of