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MOUNTAIN PARK ESTATES #2 BLK 5 LT 2
(i,ra�a� Ha Ir' t)\Wom) U0, bala, !v a (wo Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES CM07- t ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5"qT-03Oct PID Number: U A 7 — 0 J4 3 - ;L, (a Name: S;4tM � 3rvmY 0004Pd✓ u s Wastewater System: R New ❑ Upgrade Address: 12 $pp Lo PIn1E- 4C) ABSORPTION FIELD Phone: Z 4 3-$9 $ 4 No. of Bedrooms: -+❑Deep Trench ❑Shallow Trench Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: I (SAA Total Depth from original grade: VAAIF-S 2f TV i' 0 FIITE(Z� GPD/Sq. . FL Lot:Block: S Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe r rnr. 9A4eA_tsroTrs Az. vbg4es I.5' o (P.5' Ft. O.5 Ft. Township: Range: Section: Ep�l0 2g3`t Fill added above original grade: VAXI FS Or 1 FL Gravel length: 45•S Ft. WELL: El New ❑Upgrade Gravel width: 1 Numberoflines: ¢ Distance between lines: +3 14 . Ft. FL Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. 0 (04 SG. Ft. PVC_ Driller: Dale Drilled: Static Water Level: Installer: S'CSTIEIMS Date installed: "1-3U-�►2 Ft. ^C,94EA000- Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES X Septic ❑Holding 0S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines AW_-6-6AA<vr_ IZ50 Well f IDs _ I 140 WA, N/A N/^ Material: s Number of Compartments: 2 Surface Water /d/A ►-s/l�1 N lA N(A NSA LIFT STATION LotSize I in gallons: Manufacturer: Line (p01 10 N/A I N/A N/A N/A Foundation 4 f 94 NJp 1`1/A NIA "Pump on" level at: "Pump off" level at: High water alarm at: Curtain N/A gyp' WA Pump Make 8 Model Electrical Inspections performed by: Drain N/A N(A BENCH MARK Remarks: S€SDI0 TO 8E- CorA?LrE_T.'SD Location and Description: IN TiiG SP/11 Y Ac2GA SYST'G,MS• 8l.M M'OtJ OIS wEs PROPERLY l,tNfr. 241 ' FR orA N W P20P C -09A .4- Assumed Elevation: 10Z Ft 'aaeloaf Inspections performed by: )fit, Vk`i60A Dates: 2nd q',S�'9l a __ cera , Department of H alth and Human Services appro all �;�. ' asaeoaaaoaAe Reviewed and PP Y road 6�'`�'('� Date: b: 72-013 (Rev. 9191) MOA 25 Permit -No. Sv.11211203o`1 Page ;?—of I W.O. `02621 Municipality of Anchorage Date 10-6--92 Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 1966.50 Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. soor.10S upwnH ". 141100H e AOLiOUV JO 1�1' �� "!t 0 I � EXISTING HOUSE I SCALE 1" = 20' / ECK // LOT 3 (VACANT) O � p i (TY 'TEST PIT Tu46E \ Q1 ` TP 1 TY -)Z- - 0� % 10o �LKISt. TANV c.2vseFCOs�' gA ;r:1 �t ErJ CLEANOUT (TYP) 1250 GAL SEPTIC TANK SEE NOTE 3 PVC (TYP) PVC (TYfP) *1L%%%%4 AV •� Op Ar'_ 1 AV T_H 'k: 9 •.4..• • r NN.• •• •�• 0♦ o _�_DENNIS`DIr GHj k / �9 % CE 5807 l:��cr ! a profess1on. DATE' %\�tt��" G ile: 493-54 Permit No. S092_03o9 Page 3 of 3 W.O. 92,o2_1 Municipality of Anchorage Department of Health and Human Services bate l0->�-9 Z ENVIRONMENTAL SERVICES DIVISION 13.0. Box 196650 • Anchorage, AK 99519-6650 • 1'el: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. EXIST. GRADE ,-4" MONITOR TUBE ELF -V 43.0r BOTTOM of A00(t�oNAt• 76S'(' t'iT w1 vNoia . Tu 14E . NO WF rC44 4CfJL4ojNTxA" 72-013 A (2/91) VOA 25 ELEV. 92.6' TP=1 A TCAL 51;CTION " 1O' VERT: 1" = 5' 2" DOW HI -30 INSULATION OR ENGINEER APPROVED EQUAL. SEE NOTE 14 GEOTEXTILE FABRIC. SEE NOTE 15 2'-6" MIN. COVER (2'-0" MIN. AFTER SETTLING) I SEE NOTE 18 4" CLEANOUT LA—} SEWER ROCK PER MUNICIPAL SPECS. SPECS. SEE NOTE 12 -- ® 4'-4" O.C.(TYP) INVERT = 97. ' SAND FILTER PER MUNICIPAL' SPECS SEE NOTE 7 .•�, OF q' :.•.•..: 4 ot* Ate'TH /7 ! >•�4 9 /•.•'�iiiiivFHI •.�•..� �♦ � ;DENNIHs '• CE_' ' ci AP �� °�ofess�o� •• DATE ,�\v►���� T11 CONSULTING ENGINEEPS - FIELD REPORT WORK ORDER NO.:22021 PROJECT:Lot 2 Block 5 ML Park Estates DATE: 9/29/92 owNER:Sam Humphrey CONTRACTOR: tNSPFcToP:DeO Hi¢h FOREMAN: WEATHER- 40'F +/- Sunny EQUIPMENT: IN USE: Backhoe2-5 12vd "end dump" trucks laser lever - NOT IN SURVEY CREW: WORK REQUESTED: NONE FIELD TESTING: REQUESTED: NONE WORK IN PROGRESS: SANITARY SEWER (ST. STORM SEWER (STATI, WATER (STATION)_ STREETS (STATION)_ MEXIO ISSUED: YES ( ) NO (X) WORK VERIFICATION FORM ISSUED: YES O NO( X) COMMENTS: 12:05 Arrived on site Acreage systems had complete excavation for bed system. Material at bottom or excavation was the same as we had identified for our design. Shot bottom of bed system using survey level and rod. Area was at 95.0 +I- 0.1'. Dan Boles of DHHS arrived on site at 12:15. Dug test hole north of field to e;elation. 93+I-. No water -similar material as previously logged. Very clean NFS gravel at bottom 1' of hole. Installed 1 1/4" monitoring tube. Gave ed OK to proceed. Ed marked depth of sand material on trench walls using laser level. Began placing sand at about 12:50. He will call when pipe is placed. Expects to be tomorrow. 1:00 P.M. Off site 4:54 On site Reviewed placement of sand, gravel, pipe. Drain pipe set at elevation 97.67. Contractor was using a laser level to ensure accurate placement of pipe, gravel, and sand. Two clean outs were in place at opposite corners of drain pipe. The two monitoring tubes were also in place. Geotextile fabric (non -woven) had been place over gravel prior to placement of remaining Bach fill. Project was neat, clean and appeared to he constructed properly. 5:15 Left site. SIGNATURE DATE: 10- 1-1 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920309 DESIGN ENGINEER:HIGH, PHUKAN & SORENSON OWNER NAME:HUMPHREYS SAMUEL P & OWNER ADDRESS:12800 LUPINE RD ANCHORAGE AK 99516 PARCEL ID:01702326 DATE ISSUED: 9/25/92 CONSULTING EXPIRATION DATE: 9/25/93 I � 2- ,17 2, -�-� LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 5 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: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST TWO HOURS PRIOR TO EACH INSPECTION. DHHS MUST BE PRESENT TO INSPECT PRIOR TO PLACEMENT OF SAND FILTER AND PRIOR TO PLACEMENT OF GEOFABRIC INVERT ELEVATION OF BED PIPING SHALL NOT BE LOWER THAN 97.6 AS REFERNECED TO BLM MONUMENT WITH ASSUMED ELEVATION OF 102.5. ALL GRAVITY LINES FROM THE HOUSE TO THE BED MUST HAVE A MINIMUM SLOPE OF 2%. A GROUND ER MONITORING TUBE M UST BE INSTALLED APPROXIMATELY 30 FT WOF THE EXISTING SOIL TEST HOLE. VERTICAL SEPARATION BETWEEN THE BOTTOM OF THE BED AND GROUNDWATER AS MEASURED AT THE NEW MONITORING TUBE MUST BE AT LEAST 4.0 FT. / /% RECEIVED BY: ISSUED BY. 0 tfit\t &it (7-7.4 DATE:�- DATE: Ct2S q Z T Permit No. Page 1 of 9 Municipality of Anchorage W.O. H92493.1 Department of Health and Human Services Date 8-17-92 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK5 MOUNTAIN PARK ESTATES #2 PID No. SITE NARRATIVE Lot 2, Block 5, Mountain _Park Estates # 2 is bordered by three other lots.. The lot to the . south (lot 3) is currently undeveloped, but should have ample room for a well in the front yard and two septic systems in the back yard, similar to the client's lot. The lot to the north (lot 1) has a well in the front yard and a septic system in the back yard. The replacement system on lot 2 won't affect the lot to the north in any way. The lot bordering . on the west edge of the property is on a community well system, so has no well on-site. The on-site septic system is far enough away that it won't affect placement of the proposed septic system on lot 2. Due to the groundwater level, a shallow trench or bed system is necessary. The relatively small site necessitated using a bed system since there was not enough room to install shallow trenches. The slope is greater than 10% in the area in which the bed will be installed, but the bed will.be placed near the toe of the slop e,.so there should not be any problems with wastewater effluent leaching to the surface. Wells ---No impact on adjacent lots is anticipated from the replacement system. Wastewater Systems ---No impact on adjacent wastewater systems is anticipated from the replacement system. Drainage ---All fills will be sloped to drain in the direction of natural drainage. System will receive topsoil and seeding to prevent erosion. . . RECEIVEDW OFAcgkk ( AUG 1 81992 *t� ry •a�®+o h u i• aue d /4016p*400 * • o6 d ••• • • • Dept. Health Human Sa: v ce 0+ ,DENNIS DEE/ G Fa' ®9 `p CE 5807 : • SAW of • • Fes DATE �� tir®a-as,�®�'� 72-013 n (2/W) N(M 25 —. Permit No. Page L. of Municipality of Anchorage W.O. H9249�.1 Department of Health and Human Services Date iI-ly3- t ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK5 MOUNTAIN PARK ESTATES #2 PID No. SYSTEM pESt6tn1 GA LCU LATtOnI S I. NP. Re-Dazioms = + Z. usE. SED SrsTet,^ 3.. Ae sor_gs-nQtJ. AREA = Calt3Eorzoonns)(tso r-1 Pp/BFt) RZp RATE C4X tSo� 8513 SF • -1 -1E' USe I `x�+�.5'= 9(,4cF RECEIVED AUG 18 1992 . Municipality of Anchorage Dept. Health & Human Services Mound System or Bed Application Rate percolation Rate qpd/sq. ft. min./in. Not suitable 0.8 ` 0 - 1 0.5 1 - 5 0.4 6 - 15 0.3 16 - 30 Not.suitable 31 - 6- _, greater than 60 o. filter layer 1-013 A (2/41) MOA 25 C. FlIw SP Permit No Page_3 of J W.O. H92493.1 Municipality of Anchorage 8-17-92 Department of Health and Human Services Date _ ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. T I I LOT 1 J J - - ,WT 2 BLOCK 5 $ TAIN PARK ESTATES BANG EXIST. EPTIC TANK IN SEE `f 7E 2 ,o --- -- 30' PERCOLATION TEST RADIUS�- 1 --------------- I I o I�R I PROPOSED BED % - SYSTEM (864 SF) I SEE SHEET 4 FOR DETAILS & DIMENSIONS 1 � - _________________________----------- -TEST __-_______ '0? a TEST PIT. 10' DEPTH. SEE SOILS LOG -EXPLORATORY HOLE Sit DEPTH. SEE NOTE 22 72-013 A (2/91) W)A 25 EXIST NG HOUSE i iI OPOSED 50 CAL PTIC TANK I I I T-1 I I i I 1 o i I I 1 - -91 IpO� 9g 10' PROPERTY LINE OFFSET I LOT 3 (VACANT) RECEIVED AUG 18 1992 Municipality of Anchorage Dept. Health & Human Services APPROXIMATE LOCATION OF EXISTING SYSTEM (SOLID LINE LOCATED BY HPCE B-14-92 DASHED LINE APPRQXIMATE FROM AS-BUILTS) SEE NQ_rL9 1L12.._- LOT 7 BLOCK i GREENBROOK SUBD. (COMMUNITY WELL) SCALE; 1' == 30' �.r�'WiY\�� q wL O" AtgSo�, r rr • Lrr�T40 r" .'6_Y RTS `Atm %DENNIS DEE HU � eY 9' ® CE 5807 s •, . o +� a proress(o� 4, DATE VA .0 C. RT 49 -)J Permif No. Page 4 of 9 Municipality of Anchorage W.O. H92493.1 Department of Health and Human Services Date $-17-92 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. 1 I b I EXISTING HOUSE 1 SCALE 1" = 20' I ECK ( // o I / o L LOT 3 (VACANT) G R.: a9l- J I 100' ECEIVED ,. ., ,�... ... AUG 18 1992 CLEANOUT (TYP) of Anchorage / — — — — Dept. pt. Health & Human Service \ 1250 GAL SEPTIC TANK ` SEE NOTE 3 SEE NOTE 21 Td `� �1 /I �` 9�OF ♦ q ro U?? 9TH g (TY ) 4" SOLI PVC jyP) ••••• ••••••• •• ••• 10 SEE NO 13 0•• • • • • •• ••• • 0000® I 1 MONITOR TUBE-- . .....::......:...... _.. I I l8 9 DENNIS DEE HI H 4 �a — _ o \ 6LM MOiv G I 46�` 4" P PVC (TYF) I ®�'S;�o.•• CE 5807 •• c��®r o=re0 ••••••••�O\®A? r- LFy 1 n? B _—�`In. o 9R4� 90 i ��rofessko 4.•R�M�.�.�9� - _ DATE G R.: a9l- Municipality o1 Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 4 - 580y PERFORMED FOR: SAM � BEVErZLY I`4LlMPN2E`r$ DATE PER -05o L4T 2 FSLbGK S �yy°�"Fa^�`� r' '�t'y�4iiTil LEGAL DESCRIPTION: PAil.{G E.STA•TE S ii Z Township, Range, Section: Ir12 M9- tjay14n' ' i G2A SSS 2ooTS SLOPE , —' SITE PLAN IFFET 10 11 12 13 14 51617 15- 16- 17 s19De18- 19- De 20 COMMENTS REPI'W W-OVU l To CxKE'r CLEC SAN1D`7 GtKAVE - W, OCCASIOAiAL COBBLES -E'i12E�i SATU2ATE0 ,. SEAL) v 7-4Z SILT Wl SArJO WAS GROUND WATER (�E S E1J0 G'' IDI ENCOUNTERED? S IF YES, AT WHAT I L C7 . s O DEPTH? P E Depth to Water Alter hionitoring? 9.45 Dale: b- 3-9 z RECEIVED AUG 18 1992 weipallty of Anchorage Health & Human SQrvic C Reading Date - Gross Time Net Depth to Time Water Net Drop t o It '• Z: 15 10 It It z: Is ' (pn - (o it SECCrAo S II PERCOLATION RATE ZZ.s (rmnatesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 2 —FT PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUN CIP L GUIDELINES IN EFFECT� ON THIS D TE. DATE: 72-008 (Rev. 4,05) Permit No Page 5 of 9 Vy 0 H92493.1 Municipality of Anchorage Department of Health and Human Services Date 8-17-92 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. EXIST. GRADE Vii® on 2" DOW HI -30 INSULATION OR ENGINEER APPROVED EQUAL. SEE NOTE 14 GEOTEXTILE FABRIC. SEE NOTE 15 4" MONITOR TUBE MIN. COVER (2'-0" MIN. AFTER SETTLING) SEE NOTE 18 4" CLEANOUT TYPICAL SECTION HOR: 1 10' VERT: 1 = 5' . RECEIVED AUG 18 1.992 Municipality of Anchorage Dept. Health & Human Services '2-013 A (2/9Q MOA 25 C. M: 953-5' Permit No. On—Site Page 6 of 9 VJ,O, H92493.1 Municipality of Anchorage Department pf Health and Human Services Dote 8-17-92 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 Wastewater Disposal System/Well Inspection Legal Description: LOT 2 BLOCK5 MOUNTAIN PARK ESTATES #2 PID No. Report v ru J� 14a I of 3 u - w r L Q N q a ai d Q di U J la N W Q <L N N . CEIVE� 3 AUG l g 1992 ' dept. yaalth�& Yuma gege v;ces N z �: > ►- _ '9 °I w 7 c1 -T J� c a_�__I o! 0 4 ,r- I- 0 > =O N N z z 0 zala: SNN kA z a 4 OF ALgs�o J W 0 rr •.• •. 'r J rw��TH :F 0 xz s �• o••• •••••• •• •• ••0 W Q I, 4 M ; I 0...• a.�... ••. m �•e W m tn cl I 0+ ;DENNIS D a s '. 000 CE 580 : 'S AF d d r �e '•• �•°Doer W N o ® 4 Profess \04& Z og 7 3,( DATE avftw'0* J O w 3 z I G f,.:.9�-� Permit 'No. Page 7 of 9 Municipality of Anchorage 4J,0, H92493.1 Department of Health and Human Services Date 8-17-92 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. NOTES: 1 ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS OF THE MUNICIPAL CODE AS CURRENTLY AMENDED. 2 CONTRACTOR SHALL ABANDON EXISTING SEPTIC TANK AND SYSTEM IN A MANNER APPROVED BY STATE AND MUNICIPAL REGULATIONS, LAWS, AND GUIDELINES. 3 INSTALL NEW 1250 GAL SEPTIC TANK AS SHOWN ON THE DRAWINGS. RECORD INLET AND OUTLET ELEVATIONS OF THE TANK. TANK SHALL BE PLACED ON UNDISTURBED NATIVE SOIL. PLACE OUTSIDE PROTECTIVE WELL RADIUS, 4 SITE TOPOGRAPHIC SURVEY CONDUCTED BY HPCE ON 7-27-92. EXISTING STRUCTURES, WELLS, SEPTIC SYSTEMS OBSERVED WITHIN 200 FT. OF PROPOSED SYSTEM SITE ARE SHOWN ON DESIGN DRAWINGS. 5 ANY DEVIATION FROM THE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO ITS INCORPORATION INTO THE SYSTEM. 6 CONTRACTOR TO LOCATE ALL UNDERGROUND UTILITIES, PROPERTY LINES, EXISTING WELLS, WATER WAYS, SURFACE AND SUBSURFACE DRAINAGE FACILITIES, LAKES, PONDS, AND OTHER FACILITIES REQUIRING SEPARATION DISTANCES FROM THE PROPOSED SEPTIC SYSTEM. NOTIFY THE ENGINEER OF ANY OBSERVED CONFLICTS PRIOR TO CONSTRUCTION. 7 NOTIFY THE ENGINEER 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION. A MINIMUM OF THREE INSPECTIONS ARE REQUIRED. THE FIRST INSPECTION SHALL BE OF THE SUBGRADE, PRIOR TO PLACING SAND ALETER. THE SECOND INSPECTION SHALL BE AFTER THE PLACEMENT OF GRAVEL, DISTRIBUTION PIPING, STANDPIPES, TANK, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD INSPECTION SHALL BE AFTER THE WORK IS COMPLETED. 8 CONTRACTOR SHALL DELIVER TO THE ENGINEER A SET OF RED -LINED, AS -BUILT DRAWINGS SHOWING ALL DATA AS SPECIFIED IN SEC. 15.65.F.2, 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN TEN DAYS OF THE FINAL INSPECTION. INVERTS AND SWING TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT. THESE AS-BUILTS SHALL BE USED TO DOUBLE-CHECK THE ENGINEER'S INFORMATION PRIOR TO SUBMITTAL TO DHHS. 9 STAKE ALIGNMENT OF SYSTEM WITH MARKERS SHOWING THE PROTECTIVE DISTANCES FROM WELLS AND OTHER BODIES OF WATER PRIOR TO BEGINNING INSTALLATION. 10 ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER. RECEIVED AUG 18 1992 Mur(ic(pal(ty or Anchorage Dept. Health & Human Services 72-01! A (2/91) NOA :' G H. 49.1-5/ Farr it' No. Page 8 of 9 Municipality of Anchorage W.O. H92493.1 Department of Health and Human Services Date 8-17-92 ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650' Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: LOT 2 BLOCK 5 MOUNTAIN PARK ESTATES #2 PID No. NOTES: 11 EXCAVATE THE ABSORPTION FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE, AND END OF BED BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. 12 PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS, DO NOT CONTAMINATE ROCK WITH NATIVE MATERIALS OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO t 1" PRIOR TO INSTALLING THE PERFORATED PIPE. 13 ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER -APPROVED EQUAL. 14 ALL INSULATION BOARD SHALL BE 2" THICK DOW 1-1I-35 INSULBOARD OR ENGINEER -APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER PIPES, FIELD, AND SEPTIC TANK. 15 GEOTEXTILE SHALL BE MIRAFI 1405 OR ENGINEER -APPROVED EQUAL. LAP ALL JOINTS 2' MIN. 16 COVER THE DISTRIBUTION WITH ROCK, AND COVER THE EXCAVATION WITH GEOTEXTILE- BEFORE PLACING INSULATION AND BACKFILLING. 17 MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS 18 SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MIN. SLOPE, AND 3:1 MAX SLOPE, AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR, THE FILL SHALL BE LEFT AT B" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MUNICIPAL SPECS. 19 RECORD THE FINISH GROUND ELEVATION OVER TOP OF BED. 20 LOCATION OF EXISTING SYSTEM VERIFIED BY HPCE ON B-14-92. SOLID LINES INDICATE TRENCH ACTUALLY UNCOVERED. DASHED LINES REPRESENT APPROXIMATE TRENCH AREAS FROM AS -BUILT INFORMATION. 21 EXISTING SYSTEM UNCOVERED IN THIS AREA DIDN'T APPEAR TO HAVE EVER BEEN USED. THERE WAS NO EVIDENCE OF ORGANIC MAT OR MOISTURE IN THE GRAVEL LAYER. THE PERFORATED PIPE UNCOVERED WAS BROKEN AND APPEARED TO HAVE BEEN CRUSHED DURING BACKFILL AT THE TIME OF CONSTRUCTION. THE PROPOSED SYSTEM WILL BE KEPT 10 FEET AWAY FROM THE PORTION OF THE EXISTING SYSTEM THAT WAS ACTUALLY USED. 22 EXPLORATORY HOLES SHOWN ON THE SITE PLAN WERE ONLY USED FOR LOCATION OF THE EXISTING SYSTEM. THE HOLES WERE DUG TO 5't DEPTH AND THE SOILS WERE CLASSIFIED VISUALLY AS THE SAME AS SHOWN ON THE SOILS LOG FOR TEST PIT 1. NO WATER WAS FOUND IN THE EXPLORITQRY HOLES. 23 CONTRACTOR TO VERIFY EXIST. INVERT AT HOUSE PRIOR TO CONSTRUCTION. NOTIFY ENGINEER IF INVERT ELEVATION TOO LOW TO GRAVITY DRAIN. RECEIVED AUG 1 8 1992 IVIu:: Dent. 140alt .. , h & rlunlaa.l se Se . ., � ""O �••� " c inc 49Y8 DHI CONSULTING ENGINEERS Civil • Surveying • Planning FAX MEMORANDUM 0 TO:- FIRM ba S FAX NO. 34-3-4740 ATTENTION: 1oiw SM I T14 SUBJECT:_ PPrT£2 Mw� 1 ro 2(N Q W. 0. NO. NO. OF PAGES TRANSMITTED: (including this cover sheet) MESSAGE: _ �� o ,� 3_ TI: J=p L.L pt) IN 6f, I S ATA O A / 9.0 v-% V'nDNltotej NGt 74E, WATaiL TA4LC, r L. (n r . epfte L lnl TEST P�r� 0-3- 92- 9-4-9Z $.46i ' Tri Cu P9ENT 0 ESt Ont Ir- Fbo- 4'-lo lt ►3ov F— Tl-i & Aavt ©uES toN S SENT BY: CAtiQ %pmvo v mrm A-64 W s r.u. nox itiJwywAncnorage, yy�11-1s4Y�(yU/)34�-LS2iJlrAX(yU/)'i4�-1Sif6 w GREt -R ANCHORAGE AREA BOR �IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 Y INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 1W Ckl("b V1 A �uw-0 MAILING ADDRESS A0% � 1i r_-� PHONE ���`�` b-3- LOCATION LEGAL DESCRIPTION lqj R4y_k, Sh{5 it 2 l 1 I 5 «fes SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER 5CtW5="f_' MATERIAL _61Yi9@� i COMPARTMENTS INSIDE LENGTH INSIDE WIDTH - LIQUID DEPTH LIQUID CAPACITY d00 GALLONS. TILE DRAIN FIELD: (pSTOTAL LENGTH , DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE 3 OF LINES �1 F1 , ,�,�"'' NUMBER OF LINES Cry DISTANCE BETWEEN LINES .301 TRENCH WIDTH. IN. TOTAL EFFECTIVE ABSORPTION AREA �% SQ. FT. LENGTH OF EACH LINE - 3rit l qq i- q 3, 1 DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE �1 MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: TYPE- T JY0Rv'-,(e CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE , SEWER LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: D INSTALLED BY: t sal ART - SEWER. SEWER LINE DEPTH: n , PIPE MATERIAL: CQs'� 4%ng c)rat-i e b i nct �— LOT SLOPE: Jcuj n - dLa S LO' J-' REMARKS: Form EQ -032 EPTH DISTANCE FROM: SEPTIC SEEPAGE TANK . SYSTEM_ 04 DIAGRAM OF SYSTEM (V W DATE 2--`t 1 --APPROVED G.A.A.B. APPROVED G.A.A.B. r) M -W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner ''' `=" Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole i ' � ° ` feet Cased to i'' feet Static water level I ft. (above) ; (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at gallons per (l6Ut) (minute) for--L—hours with ft. of drawdown from static level. Date of completion , ,n WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness - TO TO mn M17WA Certified Contractor Certificate No's. 814 & 973 2 — STATE GRE; :R ANCHORAGE AREA BOI JG.H DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. — 3330 "C" STREET ANCHORAGE, ALASKA 99503 �> `• / TELEPHONE 274-4561 k� zt/',v h,� SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT �J�/ %Qf� /1/� /.I%�/ � �°- X PHONE 2-/Y- NAME - NAME -OF APPLICANT MAILING ADDRESS INSTALLATION LOCATION LEGAL DESCRIPTION �f INSTALLATION OF: SEPTIC TANK j' SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED DRAIN FIELD .?. OTHER FINANCED THROUGH TO BE INSTALLED BY �'- �C.�_,S� ! ct- S� „ C / /a/ri e / /NOTE SOIL TEST RESULTS : THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST J COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. j {"gyp O SEPTIC TANK SIZE �� /7( TYPE e"'' SEEPAGE AREA SIZE J 4v .L ! 't/ kV ,vIC. 41 ej �{Ci //is�GLd Qi�L!✓i i 2'"�� MINIMUM DISTANCES, REQUIREMENTS CA 61 i1C*�4/0" DIAGRAM OF SYSTEM; �;i1s� � FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL -n SEPTIC TANK -5 ✓ . SEEPAGE PIT TO NEAREST LOT LINE. DRAIN FIELD DRAIN FIELD //F WELL TO SEPTIC TANK e -el . SEEPAGE PIT 1'" DRAIN FIELD / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK � � SEEPAGE PIT � 11 DRAIN FIELDLLI Jw,) SEPTIC TANK, ��'"�� SEEPAGE PITS DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.S. OR LICENSED DESIGNER 3 I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ov r DATE APPLICANT'S SIGNATURE - FORM NO. EQ -016 i I n,Le � 7- 4A 4A k4le, — I - i I ! 3 I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ov r DATE APPLICANT'S SIGNATURE - FORM NO. EQ -016 r. GREATER ANCHORAGE ARLA I;ORIIUGH l Department of Environmental Quality c 3330 "C" Street Anchorage, Alaska 991J03 SOILS L0(; PIiROLA`I'ION TE'S'L' Performed for Date Perforri•rd 7 _l �_-7S Legal Uescriptioo:._5-x2 ---- This form reports: Soils log Percolation Lest----,-- Depth est_-_Depth Feet C> _'Z_ �vP 2 •-- 3. 2-3 5d fi SL.,.Jr era.e( GM-Gu-�' 4- 5 -Ffilles b- 7 - 8 — S/0 Was ground water encountered? t If ves, at what depth? Reading Date Gross Time Net Time Depth to Water Net Uro4) Percolation rate minute. Proposed installation: Seepage Pit Drain Field Depth of Inlet Depth to bottom of pit or trend COMMENTS: Performed By: j ?� _- Certified cvA_nnn .0/VA\ a • Municipality of Anchorage JOn -Site Water and Wastewater Program _ (907)343-7904 Parcel I.D. 017-023-26 Certificate of On -Site Systems Approval gku5, 3.. Expiration Date: 1 L — 6 — I 1. GENERAL INFORMATION Complete legal description MOUNTIAN PARK ESTATES #2; BLOCK 5, LOT 2 Location (site address) 12800 LUPINE ROAD *ANCHORAGE 99516 Current Property owner(s) EMILY ZANTO Day phone Mailing address SAME Real Estate Agent DETTE OWENS Day phone 865-6586 rcz,b�, 2. TYPE OF DWELLING:Single Family (w/woADU)❑ Duplex❑ Multiple Dwellings (Single Family and/or Duplex)3.'NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF TE A Individual Well Q Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer E WaiverNariance request for: N/A Received by: 1_ COSA to be released to the COSA Fee $ cJ 2-PoII Date of Payment '� 1.3) 15 Receipt Number (511`42, COSA# 0SC15N05 Date: requested by the engineer. Waiver Fee $ Date of Payment Receipt Number Waiver # W4 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road Suite 101 Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date bltS to conducting this evaluation, system in accordance with th Anchorage and industry praci datels of the evaluation. Sep Hidden defects or encroachm operational life of all wells ani limited to, soil conditions, pool construction (materials and w These conditions can vary, at guarantee future pertormanc6 implied) regarding the future { person/party, who person or party, it short, GEG disavi engineering evaluation of the well and/or septic egulations established by the Municipality of (results describe the condition of the systemis on the were measured to readily identifiable features it were not identified during the evaluation. The ieleend on a variety of variables including, but not iat may fluctuate during the year), quality of the water usage of the family utilizing the systemis, control of GEG_ Satisfactory test results do not 'herefore, GEG makes no warranty (express or well or septic system GEG makes no ptic system can be installed on the property in the tent of this report is for the safe benefit of the the information provided in this report by any other ;equent property purchasers, is not authorized In Aher than the presonlparty who paid for this report. 6. DSD SIGNATURE // System 91 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following s' 'SRI ON-SITE WATER AND WASTEWATER PROGRAM By: Original Certificate Date: 6P ' l; Th inial alit g- brag, Development Services .Division (DSD) issues -Certificates of On Site Systems Approval (COSA), based only upon the representations given in paragraph 5 b. an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: / COSA Checklist ✓ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheat. el-1Zdix If more than 1 septic system Is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTIAN PARK ESTATES #2; LOT 2, BLOCK 5 Parcel ID: 017-023-26 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 10/15/75 Sanitary seal (Y/N) YES Total depth 175 ft. Cased to 84 ft. FROM WELL LOG Date of test 10/15/75 Static water level 20 ft. Well production 4 g.p:m. WATER SAMPLE RESULTS: Coliform 0 colonies1100 mi. Arsenic: ND ug./L. Nitrate 8.95 mg./L. Date of sample: X16/15 Well Log (Y/N) YES Wines properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 7/17/15 79.2 ft, 3.5+ g.p.m. Collected by: GEG. Ltd. B. SEPTIC/HOLDINGTANK DATA *FCO & DOUBLE C/0'S PRIOR TO TANK TankType/Matedal SEPTIC/STEEL Date installed 9/30/92 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping Pumper T D'S PUMP" (r C. UMP"(r- C. ABSORPTION FIELD DATA Date installed 9/30/92 Soil rating (g.p.d.ffPo /bdr 0.7 System type BED Length 45.5 ft. Width 19 ft. Gravel below pipe 0.5 ft. Total depth *3.33+ ft. Eff. absorption area 864 ft2 Monitoring tube**YES Depression overfield NO Date of adequacy test 7/17/15 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 629 gal. New depth 2 in. Elapsed Time: 30 min. Final fluid depth E in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date **MT ONLY EXTENDS 4.5" BELOW INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump ofr' level at High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100,+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *10' Building foundation 10'+ Water main N Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ASSUMED BASED UPON DEE HIGH, P.E COMMENT ON 10/5/92 HAA. G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Nm�� JEFFREY A. GARNESS Date 873 -,r (Rev. 11105) Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AIC 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151405 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 5, Lot 2 of Mountain Park Est. #2 subdivision. This inspection revealed a nitrate concentration of 8.95 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division ='"` t �• i On -Site Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 017 -0 Z? — Z.G COSA # d Q O ;2:Z1 Expiration Date: / / — ! !2 - 0q 1. GENERAL INFORMATION Complete legal description Lol- 2. (31oe(c C PfOcrn kin PQr,k BlrAeftl. ",";A 040Z Location (site address) 11-66o J_,40 to e- Tt d Current Property owner(s) Jcff !!/rllr4rn.f Day phone 2ZZ — 990s— Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 12600 Lkn•ne Ro(, 4ne4c nye 99s, 16 Day phone flo Ar Fr cro Day phone Unless otherwise requested, COSA will be held by DSD for pickup. Pl-ewt Calf Gccine��d222-99vr 2. NUMBER OF BEDROOMS: �i _ �✓f+tn ColA �t re�ea), fay �rcl�_..P 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 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 On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Fla Ilan T«tin«a/ Phone 3•ls-- 13s"c— Address _I MSS 0 Cc -,6 # can's^ f? 06 Engineer's Printed Name Ttieoda#-e f. ncvt Date i4un�3lriop 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, ,a•F:�a • w^:J. •:�— ate, �Yee•••su Hee Neee i' ee�se�ly •'YOJOtfi F. "00" N with the following stipulations:: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: o Original Certificate Date: ' 0 (Rev 11105) Municipality of Anchorage • Development Services Department \� Building Safety Division 3 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 Legal Description: Ls1-2,GJoekS`, hM %ark A.r%w #Z Parcel ID: 0t7 -oz3 -26 A. WELL DATA Well type _jLvj If A. B, or C provide PWSID # = Date completed to/ f6- / T.f Sanitary seal (YIN) Y Total depth 1'7S'I. Cased to -e-yLft. FROM WELL LOG Date of test Jo 116' / T.5' Static water level 20 ft. Well production Al 9.p -m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 8.8& mg/L Arsenic: 45' ug/L date of sample: 71 f6/D9 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Srog h'c / / Tank size f ZSa gal. Number of Compartments 2 Well Log (Y/N) Y, Wires properly protected (Y/N) Y Casing height (above ground) _,!( in. AT INSPECTION 7 /i6 /09 ft. 6.3 -1 g.p.m. Other bacteria 0_ colonies/100 mL Collected by: r-1Ah" i 7-1 c4 X. c Date installed 9/30 /9 2 Cleanouts(Y/N) Y Foundation cleanout (Y/N) `r Depression over tank (Y/N) _t High water alarm (Y/N) N- /l, Date of pumping to / r6 / &6 Pumper h-eo an of T fie L/a e1. Pa C. ABSORPTION FIELD DATA -�4„/ Iril}t' Date installed /So / 2 Soil rating (g.p.d./ft2 or ft2/bdrm) O.7 System type eol( Length HS• S ft. Width 19 ft. Gravel below pipe O. t ft. Total depth 4,�- ft. Eff. absorption area 4940f ft2 Monitoring lube Y Depression over field N Date of adequacy test 7/14"109 Results (Pass/Fail) Pew For—bedrooms 0 2 Fluid depth in absorption field before test c) in. Water added{YL gal. New depth o in. Elapsed Time: 30 min. Final fluid depth __a_ in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Non[ (mown If yes, give date N. A,. D. LIFT STATION Date installed 'Pump on* level at _ in. Datum Size in gallons "Pump off" level at _ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on tot log" Absorption field on lot 1 YO' Public sewer main N -A Sewer /septic service line > •ZS' Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots > ryli r On adjacent lots > toys Public sewer manhole/cleanout N. A Holding tank N - A. Animal containment areas Manure/animal excrete storage areas µ A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 64' Property line S7' Absorption field :Z- 7-5" Water main N• A. Water service line > repSurface water > repo Wells on adjacent lots > my, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101 Building foundation 9 Y' Water main N•/4 Water Service line > rep' Surface water > foo' Driveway, parking/vehicle storage > repo Curtain drain None Saes) Wells on adjacent lots > rvo I F. COMMENTS •P.!. it �. ✓ e"`i. G. ENGINEER'S CERTIFICATION °'!' "r•• •••••"•••' `pjt. t certify that I have determined through held inspections and review of Municipal records that the above systems are in ,�'....�., conformance with MOA COSA guidelines in effect on this date.ii3CRE Ll •.•�+,•+*••••••••••••••;•••i- Engineer's Printed Name Th �a o�a� F, t 10 0 "" ; •; ` C{ ='Cse? rte` wt t2. 200 h•.,�/rel?;. Date /4•H COSA Fee $ G% Waiver Fee $ Date of Payment — .1 a — 4 Receipt Number " JYS O 0 C (Rev. 11/05) Date of Payment Receipt Number in. Municipality of Anchorage esA. ,;, '!( Development Services Department :` Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 090271 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 5, Lot 2 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 8.88 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Pact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. | 3^> 2�■ aNTECH 50 g 2!E§ ` ® o��.e .• So »S�''' ®'v| E2(D�m § p/ jam: ^� ,\ �j : �Da • `�§ e/ . aw <� \��\�� � \� o f/ }] {\} } r: �$ �� ( ���(m `& ;SK ®Ik [ e§ -OLL k 3+,CO 30N | ! E p lgw e kinin a §§ } {�------------- -- ------ ƒ �/�j ƒ }/ co� $[®c c @ 'r / 0 kJ ? � \ �\ - ° . , e� / { ) � } { § }e\Ct / s« - m 7±72 {|/{ cn rqz §§ {�LT 1 m§> L \\� /2-4 Q/m&r .p.9� c o s ! !e \ § #y -,w 0 &.222|eee m ]� Q� 0 3tCaoo s ;`2®�• _ �F §f F » m $ o ;� ,� GE § m �CL| % § «!700 zzz ®- fai: } z OV08 ]qdn] ' K! Q 2g i 0 z !:M $ ! ! 0 IA IA �0 V| E� !,$I �|. § iR7 �I ? Municipality of Anchorage Development Services Department Building Safety blvision • On -Site Water & Wastewater Program • • `' 7 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorege.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: v+2 ; ELK (rl avn+; a0, track ESt4fL Parcel ID: o17- Z3 " L A. WELL DATA Well type _L__ Date completed Ia161-,75 Total depth h _51:1. Date of test Static water level If A, B, or C provide PWSID # Sanitary seal'(Y/N)� Cased toy 4 R FROM WELL LOG 161151-75- 101 ft Well production —1 g.p.m. WATER SAMPLE RESULTS: Coliform IL cotonies/100 mi. Nitrate (P-7 S mg.n. Arsenic: 0 mg.A. Date of sample: 03IOS103 B. SEPTICIHOLDING TANK DATA TankType/Material AS(Anse E4.'I Well Log (Y/N) Wires property protected (YIN)_ Casing height (above ground) 12 _ in. AT INSPECTION o3/d3/v3 X31 d,I > y' -S G.P.M. Other bacteria 0. colonies/100 ml. Collected by: -FAJ 7L Date installed Tank size 1250► gal. Number of Compartments L Cleanouts (Y/N) ql-30/gz. Foundation cleanout (YIN) Depression over tank (Y/N) N High water alarm (YM) N/A Date of pumping 7,01 — U Pumper Ry I,- Co — Q peter C. ' ABSORPTION FIELD DATA Date installed y/7o/9Z Soil rating(g.p.d./fts rfe/bdrm) 4"? System type �e Length S "� ft Width ) q R Gravel below pipe t;` ft Total depth 3 ft Eff. absorption area jUjiMonitoring tube JM Depression over field NO Date of adequacy test 03103/03 Results (Pass/Fall) 4S5 For _�__ bedrooms Fluid depth in absorption field before test in. Water added VU gal. New depth 0 in. Elapsed Time: )VA -min. Final fluid depth O in. Absorption rate >= I coo g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) It Or If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. Cycles tested E. SEPARATION DISTANCES at _ in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot r Absorption field on lot �Go Public sewer main /IIA Sewer /septic service line 2S +- High water alarm level at Meets alarm & circuit requirements? On adjacent lots I" I K On adjacent lots I CW -r-� Public sewer manhole/cleanout All* Holding tank /A//)+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation i 1 Property line jo' f Absorption field S Water main 10 Water service line # Surface water Wells on adjacent lots 1601 *1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Build�jgg�foundation jd� Water main 10 Water Service line 41!) m Surface water ` "r Driveway, parkingNehide storage Curtain drain IIA Wells on adjacent lots j 00 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and TF1 review of Municipal records that the above systems are in t' 49— conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name rr ��' e6o �,; µ A.HELOU c 3/.2 �Pr''•. NICE • 9698 Date T� Po��rr�;nN►•. HAA Fee $ 9 7 5 Date of Payment 3 Receipt Number A �% (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number in. 1 �I I ROTO- ;010:00 OOTER 4 SEWER -DRAIN SERVICE AWA, 00 TROUBLES OO�N THE ONAjM® �L� �► j- K01l54e&x Bol If ah rZ6oa LvPT� 497 act 11236A P.O. Box 112688 ANCHORAGE, AK 99511 (907)345-2513 Phone 345-8284 Fax Pte; Job Address DATE 7 3 •02 SALESMAN I t� TERMS -10 DAYS GUSTOMEH OH ERN d ROTO -ROOTER SERVICE CALL HRS. STEAM THAWING HRS. 0 TRIP CHARGE HRS. @ OVERTIME CHARGES HAS. @ ADDITIONAL LABOR CHARGES HRS, 0 PLUMBING NRS. @ PUMBING SERVICE 1 (GAL.) HRS. @ /09,60 W.06 HYDRO -JET SERVICE HRS. @ TV CAMERA INSPECTION HRS. @ MATERIALS C�,� PLEASE PAY FROM THIS INVOICE TOTAL TOTAL FOOTAGE CLEANED OR THAWED BLADES USED E IA01L Nab &wr 55 CtFA 7" j LINE CLEANED 0 JOB NOT GUARANTEED FOR FOLLOWING REASON I4 WORK ACCEPTED BY O See additional job Information form attached. TO PEORCER CALL A.T. PUBLISHING 6 PRINTING INC. • 90740 7506 On TOLL WEE 1 8 4789 52. 1720 APOOTT PO ANCHORAGE, AK 90607 ' .o i o 1 S 89'56'06" E 183.00' a 6LM15, / r r J r N O r� O oC ; Mcn jo rt I! o C3 r TNbe 9'y ® w N 26.3 Ln r + TT1 > r m L i 21.0 6 zN m®® .4 E$'a you O Z 1 G O 60 O O O; J �....... �..... .:�:.. co 1 V 26.3 .5'LJin to 1,10%k6ei 30' C.0 sr1 C r5 r tJt •• A9 (pN.3 3 S 89'56'06" E 1 B3.00' i Viz. W Z 68,0 67.q Swt�.� � rr En'll 3 75.(0 %.8 1 e meas u t^erner� s b y d LL y so -0 80.7 m 6 145-11U.3 s/a•RB w/CAP p 5/s' Ra O 5.250 ALMON. OMONUMENi HU8 It TAgt p FENCE- )VERHA )VERHANO- GOM DECKS- .ONCRETE- 0 ASPHALT- O GRAVEL- O SEPUC STANORPES- WATER PILL- !_W1 ;& • 491U x...0.......1..,...... ° nneth L Dreyer; +� '•, LS -8202 [yap •.......•• 06 0 r°.a anot_`bo AS—BUILT OF: LECAL DESCRIPTION: oeocesn eh KATHI JOHNSON with PRUDENTIAL JACK WHITE LOT 2 BLOCK 5 SURVEY TIFiCADON: LANI CH hos Conducted o physical survey o1 thus o e e properly as shown on this drawing and that the Mnpro.emmta sltuoled thereon Wt0®CTION SURVEYORS -PLANNERS -ENGINEERS ore within the o ert tinea and no enaoachmenls e.ist other Ikon noted. 0 440 %VEST BENSON BLVD. 0 103 MOUNTAIN PARK ESTATES NO 2 EXCCUS10Y NOTE: It Ia the owner; responsibilil to delermine The ee$ience sANCHORAGE. ALASKA 99503 552-5291 (rox)561-6626 , r MV I Vn MI• .. r. .....r.. . -Y:..._ ... _._._... for for lines .� - l .ruK as- -xUn1 r -JU I ALLY 1 149V 1 DMDI 2tl39 I KEN 1 /13/223 1 lhereon be used construction or esloodahing property ■ MUNICIPALITY OF ANCHORAGE Ak,^ • DEPARTMENT OF HEALTH & HUMAN SERVICES fA Division of Environmental Services CIM On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING jj Parcel I.D. # 017-023-26 HAA # t°d�cl 1. GENERAL INFORMATION Complete legal description Lot 21 Block 5, Mountain Park Estates #2 Location (site address or directions) 12800 Lupine Road, Anchorage, Ak Property owner Herb Smelcer 348-2510 Day phone Mailing address 12800 Lupine Road, Anchorage, AK 99516 Lending agency City Mortgage/Shirley Nelson Day phone 263-0700 Mailing address 121 W. Fireweed Lane, Suite 120, Anchorage, AK 99503 Agent Fortune/Max Peterson Day phone 265-9189 Address 2525 C Street, Suite 100, Anchorage/ AK 99503 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 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#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 S & S ENGINEERING Phone K 7 17034 Eagle River Loop Road o. Address Facile River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE _JZ�_ Approved for Eo 26, bedrooms. Disapproved. Date 7 // Sl q y I' fir; .��� •• . . y, .,........ -o •� ROBERT C. COWAN ••f•Q CE - 8801 r a Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. Tharp are nitrates present. It ;s suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate eanee trs :en is 6.98 mg/l. -9:12A maxi am EBnegnGrat=en is 10.0 mg/3 More information on nitrates is available from the On—site Services Program, Additional Comments By: UIT1C1 Date 7-16o- 9q 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. 72-025 (Rev. 1/91) Back MOA 821 XECEIVEL Municipality of Anchorage JUL 15 1999 DEPARTMENT OF HEALTH &HUMAN SERVX9&ALITYOFANCHURAG Environmental Services Division ENVIRONMENTAL SERVICESDIVISI 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Z-07— 13LK6-; /`'0L11V7*11Vps-k rL Parcel I.D.: A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 7i Date completed Total depth 1.751 .75 Cased to Casing height (above ground) / fi Sanitary seal (Y/N) Date of test FROM WELL LOG Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Wires properly protected (Y/N) �5 aM Nitrate (0,4143 O'41S AT INSPECTION 7 /99 Other bacteria 9— p.m- Date of sample: �/ 7 Collected by: MS7&-5U61k4IfNG 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed Tank size 125-0 Number of Compartments Z. Cleanouts (Y/N)-4---5 Foundation cleanout (Y/N) A3L C-4 Depression (Y/N) NO High water alarm (Y/N) Date of Pumping / Pumper �Eo7aPZ-2r C. ABSORPTION FIELD DATA Date installed Soil rating p.d./ft or ft2/bdrm) Q- System type F&D / � / Length 4 ��v Width /7" Gravel thickness below pipe Total depth -3v- Effective y - Effective absorption area O f Monitoring Tube present (Y/N)YtL- Depression lover field (Y/N) A/ U Date of adequacy test 4 Results (Pass/Fail) %� s S For bedrooms Fluid depth in absorption field before test (in.); Immediately after�010 gal. water added (in.): $ Fluid depth (ins) Minutes later: Z® Absorption rate = l QJ .t g.p.d. Peroxide treatment (past 12 months) (Y/N) A-/ If yes, give date /"�/4 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on'mel-at" High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I00 Absorption field on lot /00 /_74 Public sewer main N /A Sewer /septic service line On adjacent lots "Pump off" level at* 00 // On adjacent lots /00 //— Public sewer manhole/cleanout N Lift station OV / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r Foundation j �� Property line Absorption field S Water main/service line /0 '- Surface water/drainage /00 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10 /'L Building foundation /�% /� Water main/service line Surface water zle�?r �� Driveway, parking/vehicle storage area Curtain drain /l PIVef- r1• 0 AI' Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record in conformance with O H gu�del' PIK Signature. G?/G✓es in effect on this date. Ar , '.--- Engineer's Name Date "% / /s/ 61 HAA Fee $_ /A� 1 / q Date of Payment Receipt Number 4A�; Z) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number l RO -ERT C. COWAN P �� CE -8801 are F N,i..v0a £9 07:57 FROM -CTE ENVIRONMENTAL 5615301 7-614 P.03103 F-137 CT&E Environmental Services lnr-. r RIM . Laboratory PibisiGn . ung Water Analysis Report for Total Coliforr: READ INSTRUCTIONS ON REVERSE SIAL jf,CFORE GO1L.I:CTTNG MUST BE COMPLETED BY WATER SUPPLIER €kURLIC WATER SYSTEM B.A. N ?RIVATE WATER SYSTEM a�_ Srrad RraRlts p Strad InvalcF � wnc s ns nasutta C1 Send Invoice fate 7 � C,y ;At"IFLE DATES � ml�� ontn i�ay �g$Y ,P,S%API.E TYPE: 'J RQittinG Repeat Sample (for routine sample witli lab ref. au. Y Special Purpose A:tLF LOCATION d—a'i Jr f3t.aCK S' T'1 TN_ PARK E$7• CornmeAts: q Trearcd water F Untreated Water Time Collected Collected BY lZ3 s M Pieces G'�iuc 200 W. Potter Drive 1 BaCtBrla Anchorage, AK 99518-1605 7m (9071562-2343 SAMPLE Fax: (907) 561.6301 TO sE COMPLFTED BY LAIiOR�TURY A clysis shows this Water SAMPLE to bc. Sansfactory q Unsatisfactory p Sample over 30 hour old, fesults may be unreliable ❑ Sample too long in transit. sample should not be over 4$ hours old at examin"on to indicate reliable results- Please send new sample via ciai drlivery mall Date Received Time Rcceired Analysis began Analytical Method: V—Membranc Filter p MMO-MUG ti Analyst Stat to A.R.F.C_ Apch FbKs Jun Feed Date � Time Client notified of unsatisfactory results: ph®eq spoice with F® 4 Pale T,me — HACTF-MOLOGICAL Y A TF -R ANALYSIS R+ CORJD 11MQ-DNUG Rut,11, Total Coliform Coli �_ membrane Filter: Direct Count Colosiv-000 ml verification: LTB ,�— $G$ COLIFIW4 Fecal Coliform Conilrtnation CAlifor(N100 rot Final Membrane Fetter Results / _fin Fteporred BY Rate Time �� hrs rv'rc - 7" Namu.vu, roc ua,.. Oil -0hur RaffKr.a Main"[ of the >S Group (Societe Generale Qe Sum — �— MISSOURI, NEW JERSEY, OHIOWEST VIRGINI `:;vitOP:MCNTA6 FACILITIgS IN ALASKA. CALIFORNIA. FLOA]I)A. ILLINOIS- MARYLAND. MICHIGAN. _ i `.IAG-99 07:56 FROM -CTE ENVIRONMENTAL a� CT&E Environmental Services Inc. n�ralnle � ._ G'<.fLiform 993188001 S $c S Engiueenng N/A Lara Bcvc.K N,r.v (04,gk 4917. 12SGO Lupiue, Arch, AK Drialug Water I 5615301 T-614 P. 02103 F-137 Client" Printed pate/Time 07/07/99 16:15 Collected Mte/Time 07/02/99 12:35 Received pate/Tlme 07/02/99 16:35 Technical pirector: Stephen C. Ede ALLOwahLe Prep Analw s Resulto PUL units Method Limits Date Date �v ]nit 7 08/100 PL, NO COLI Sm18 9Z221i 07/02/99 KAF 6.98 0.500 mg/L EPA 300.0 10 max 07/02/99 07/02/99 SCL A MUNICIPALITY OF ANCHORAGE MUN071997 OFANCHOgq • DEPARTMENT OF HEALTH & HUMAN SERVIC�IROOFANcS G. Division of Environmental Services SERVIcE0(v(s)ON On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 RECEIVED E C E' V E D CERTIFICATE OF HEALTH AUTHORITY i APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01 - U 3 ` D -G -, HAA # r1.3 LQ 1. GENERAL INFORMATION Complete legal description Lot 2; Biock 5; Mountain Park Est. #2 Location (site address or directions) 12800 Lupine Rd. Anchorage, AK Property owner T, "> George swallows Day phone Mailing address 12800 Lupine St. Anchorage, AK 99515 Lending agency, Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 v 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 345-0325 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 #21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING _ �cI �� Name of Firm 17034 Eagle River r nop Road No. 994 Phone Iq Address Eagle River, Alaska 99577 _ Engineer's signature 6. DHHS SIGNATURE CG Approved for ( bedrooms. 0 Disapproved. Date ���-7/--17 OF FC', 4(1 71 ROBERT C. COWAN 0�l1•� CE - 8801 .P�J �•.^n.. •• 0.1 Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. T Ugggested that-periedie testing -be performed to insure the wells continued suitability. Current nitrate concentration is mg maximum More information on nitrates is available from the On-site Services Program, DHHS, 343-4744. Additional Comments Date4/21/92 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 asa 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 421 MUNICIPALITY OF AN Municipality of Anchorage E IRONMENTALSERVIC DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JUN 27194 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist RECEIVED Legal Description: Z(;' 7 7 13,Le- 5— m0um a,J Pfthe EJj' 0 Parcel 1. D.: I 6 A 3 a A. WELL DATA Well type JO/Z I V4 7-e Log present lffWN) Total depth Sanitary seal (IV) Date of test Static water level Well production `/ go If A, B, or C, attach ADEC letter. ADEC water system number Date completed 17 S ' Cased to yes FROM WELL LOG /o -7s - r a WATER SAMPLE RESULTS: Coliform Q Nitrate � Ll r Casing height (above ground) Wires properly protected 9N) y1i S AT INSPECTION /97 g.p.m. G • q S Other bacteria d r � f g.p.m. Date of sample: Cn / l S /C17 Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99377 Date installed 410/92 Tank size l' Number of Compartments Cleanouts &N) Yk S OS,/dLrL CO'S Foundation cleanout�(,Ya1 P-- 14-,K Depression (YS � O High water alarm (Y/®) ^' ° s.. 1 Date of Pumping /``f Pumper Is /1-4 c-5 c1 C. ABS iJI PTION FIELD DATA. Dafe installed 1 30 .Z Soil rating (g.p.d./ft2 or ftz/bdrm) a'+Bystem type a » Length Sly Width I 9 Gravel thickness below pipe L9 r Total depth S /;Lr Effective absorption area 1 4 r l Monitoring Tube present O/N) Depression over field (YO )V u Date of adequacy test (o % a 7 Results (Pass/Fail) P S s For L-1 bedrooms u r. Fluid depth in absorption field before test (in.); 0 Immediately after 7196 gal. water added (in.): O Fluid depth 0 It (ins) Minutes later: tj Absorption rate = Cgo O g.p.d. Peroxide treatment (past 12 months) (Y/N) No"` ` x"'aww If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles test E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Seii''holding tank on lot lav i Absorption field on lot Public sewer main N / 4 Size in at* On adjacent lots On adjacent lots "Pump off" level at* Public sewer manhole/cleanout /✓ 14 r Sewer /septic service line -1 "r Lift station SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOT TO: NlA Foundation a o } Property line a 0 + Absorption field 'D 0 Water main/service line Surface water/drainage / 00 Wells on adjacent lots Uo 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to Building foundation / 0 0 Water main/service line /uo Surface water 10 U Curtain drain PO ri& k N u w ,✓ F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area a Wells on adjacent lots l certify that / have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature X71 `a� Z � w�-- Engineer's Name /tea C. Co,,,F.-. Date G a y/ oi 7 HAA Fee $ : Gvo. Waiver Fee $ Date of Payment -z- Date of Payment Receipt Number, Receipt Number 72-026 (Rev. 3/96)* 1 c o 4- i4 F Bare too h Public sewer manhole/cleanout /✓ 14 r Sewer /septic service line -1 "r Lift station SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOT TO: NlA Foundation a o } Property line a 0 + Absorption field 'D 0 Water main/service line Surface water/drainage / 00 Wells on adjacent lots Uo 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to Building foundation / 0 0 Water main/service line /uo Surface water 10 U Curtain drain PO ri& k N u w ,✓ F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area a Wells on adjacent lots l certify that / have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature X71 `a� Z � w�-- Engineer's Name /tea C. Co,,,F.-. Date G a y/ oi 7 HAA Fee $ : Gvo. Waiver Fee $ Date of Payment -z- Date of Payment Receipt Number, Receipt Number 72-026 (Rev. 3/96)* 1 c o 4- i4 F Bare MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M}� Division of Environmental Services - On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C111 -C22)- LAIC 1. GENERAL INFORMATION HAA# FAQ')2(` I,t Complete legal description L2 65 MT. PA�.Q-V- ESTAT'FS #L 2 - Location Location (site address or directions) 1 epo Property; owner t Wit^" Day phone Mailing address °y i'�' �Or,-- I A ct4p(4�r.E r Al�99stlI -- Lending age'nv-%: Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ,+ \I, 3. TYPE OF WATER SUPPLY: Individual well —�— Community well Public water 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 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. 7M25 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm P4 ( GoNSuL'rrN_\a Phone 34'S It30S Address Po -&x Irl Engineer's signature 6. DHHS SIGNATURE r� Approved for Disapproved. )�2�L bedrooms. C' Date 4j ",(.,. -5— 7 Z Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is sugggstpd that a periodic tRstj,nq be performed to insure the wells continued suitability. Nitrate concentration is 5.8 mg/1. EPA max Additional Comments 111TIC AA Date /0-/ 2 -f2- 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. 72-025 (Rev. 1/91) Back MOA H21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L Z G 5 m7. PAQ.I< J sSLATES 4t2parcel, I.D. Q/ 7 d—> 3 26 A. WELL DATA Well type INatvtouAL If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y (P Datecompleted 10-I5-2 Driller.Vh-W DJ21LL?"( Total depth 1-15t O Sanitary seal (Y/N) Y v Cased to E34 - Casing height Z Wires properly protected (Y/N) U B. SEPTIC/HOLDING TANK -•DATA Date installed '':.,Tank size 1250 Compartments 2 Cleanouts (Y/N) Y' ( Foundat)an cleanout (Y/N) I*Ous 4- U Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Pt/A Date of pumping NEwy, 7`a Pumper N/A SEPARATION DISTAN(CES�EROM�slrPTIC/HOLDING TANK TO: Well(s) on lot I O`7 t .•. a On adjacent lots 140 rt O Foundation � I To property line (a0 Absorption field Z9to RM .Water main/service line N Surface water/drainage NlAc U mEASu2E0 /oBSIEdGV� QY iii 10-92 72-026 (Rev. 7/91)Front U FR"M Ot4k'S FILES _ U SEE ATTAar1£%J AC5'OLI-S CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION t0 -15-7S© "1-Ih-92CD m c Date of test Static water level i d 312 o Z m Well flow 4 7 ? P r g.p.m. g. p.ro IIS p 0 Pump level m < z l� IV a O SEPARATION DISTANCES FROM WELL TO: '� 3,> Septic/holding tank on t V lot 10`� tV ; On adjacent lots i l0 N m 0 Absorption field on lot 14O t ; On adjacent lots 13p r� Public sewer main til/A` Public sewer manhole/cleanout N/A Sewer service line Petroleum tank owNf:4- INO1[sa NON tr_ WATER SAMPLE RESULTS: PASS U PASS U sass© Coliform Nitrate Other bacteria Date of sample: `1-°)o-92 Collected by: c,�KL Ada ZAMS d B. SEPTIC/HOLDING TANK -•DATA Date installed '':.,Tank size 1250 Compartments 2 Cleanouts (Y/N) Y' ( Foundat)an cleanout (Y/N) I*Ous 4- U Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Pt/A Date of pumping NEwy, 7`a Pumper N/A SEPARATION DISTAN(CES�EROM�slrPTIC/HOLDING TANK TO: Well(s) on lot I O`7 t .•. a On adjacent lots 140 rt O Foundation � I To property line (a0 Absorption field Z9to RM .Water main/service line N Surface water/drainage NlAc U mEASu2E0 /oBSIEdGV� QY iii 10-92 72-026 (Rev. 7/91)Front U FR"M Ot4k'S FILES _ U SEE ATTAar1£%J AC5'OLI-S CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) — High water alarm level N/A, "Pump on" level at Meets MOA electrical codes (Y/N) — Manufacturer Manhole/Access (Y/N) — SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot "/141 On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at — Cycles tested Surface water 30Z2.s s£c/IAx Ft Date installed - `I2 Soil rating cvscv sA.-O Ftorg:) System type 6F -P Length 45. S r Width 1-1.0 Gravel thickness O Total absorption area b &4 SF Depression over field (Y/N) IJ OD Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) N 4� Cleanouts present (Y/N) Total depth vaiz(F-s 2- In" Y G' Date of adequacy test ►sKcy SYSZEW�- for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: r (D t * r) Well on lot Ho On adjacent lots 1 � �(4( d If yes, give date Property line To building foundation To existing or abandoned system on lot On adjacent lots a^r+ Cutbank Nom F d Water main/service line - Surface water NONP © Driveway, parking/vehicle storage area (Za 4 - Curtain drain E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAI Signature .QF Engineer's Name Date /o - 5-- t� v0FASUKE-0 fo6sc Vk-0 6 - 0)41 ru R 2 C� FK-00� ON H S FrWrS HAA Fee $ 17 0 '.- cn-D Waiver Fee: $ Date of Payment Date,of Payment Receipt Number Receipt Receipt Number 72-026 (Rev. 3/91) Back MOA 21 bedrooms 9f this inspection. OCT— 2-92 FRI 16:52 P-02 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING 3 ENGINEERING CO. wowewr 8833 B STREET ANCHORAGE, ALASKA 80518 TELEPHONE (807) 602-2313 FAX: (9D7) 561-5301 INALTSI3 NEWS for INVOICE # 58992 Chonlab Ref.# 92.5365 Semple i 1 Metrix: NITEE Client Sample ID r L2 35 Mr PARE EST #2 SIN IWNPERETS Client Mane :D N I COMSUL710 ENGINE#RS PNSID : Uk Client lect :DNICO13 Collected s SEP 30 92 # 12:20 bra. BPO# : POE :NOME RECEIVED Received : SEP 30 92 # 15:00 bra. Regi : Preserved with : AS REQUIRED Ordered By :C1EL ABRINS 1nslysis Covfleted : OCT 2 92 Send Reports to: LebaxatorySupervisor N� 1111, 1)D E I CONSULTING ENGINEERS �_fEeIsaled Ey : C -- 2) .....................................................................'..--------'---...--........................................... Parameter Resulti Unita method Allowable Limits ---------------------------------------------------- NITRATE-N Sample ROUTINE SAMPLE COLLECTED BT: CARL ABRINS. Reurka . n9/1 EPA 953.2/300.0 10 ......1 ••Teats Performed ............... ...M............................................... .l I.0A-Una ................ . + ....•....... .......................... Speci rai able ND- Mone Datectad " See Sample lemarks Above M1- Mot Analysed LT -Less Than, GT -Creates Than me C :IFr i7L7— Member Of ft SGS Group (Socidt8 G6ndrale de Surva0lance) a,. pp'r— 2-92 FR I 16:5Y. `f CHEMICAL A GEOLOGICAL LABORATORIES ALASKA, INC. TELEPHONE 107? 562-234368;13 a St Anchorage, Al 119618 Drinking Water Analysis Report for Total Colif Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM wi ❑ PRIVATE WATER SYSTEM fft 34S- 136(o (71-41 3�5-1385 _ Name Phone No. W- Box I Mailing Address , . I , , _ —L � e A state Up Code SAMPLE DATE: ®1 � Iv I Faun Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time CoOecled NO. ff LOCATION Collected By T 1 L2 AS --'r /+ E 1T tl z fIH _(zZO f►"" SAW, of 2 3 {� i 4 L 6 Ill A.D.E.C. 10- �.z . 1C READ INSTRUCTIONS BEFORE COLLECTING SAMPLE final Me Reported TNTC = Too Numberous To Count OB = Other Bacteria P.03 TO STE7f;OMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Safactory Un Usfactory El Sa le too tong In transit; sample should not over 30 hours old at examination to II}dicate reliable results. Please send nexlle via special delivery mall. C)IDate 11 celved i Time fieceived i 50 Analytical Method: Membrane Filter ` No. of colonies1100 ml. Lab ReO No. Result` Analyst 1 ® 92.5365 1 m BACTERIOLOGICAL WATER ANALYSIS RECORD Fgter. Direct Count Filter Resells l rh U Colltonwipoml C 11199 tfIODMI Dare__/J.//. Z Time. I GC>—Va.m. 6jam-..v- fLvc,a p.m. GR TpCH09A0f Apt � d e6� N GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality g`�L=LO JATUAM1y �''`3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of - .�". Date . • REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: AJJ &m it Phone: a ?4,(.3c6[0/ 2. Property Owner: M n.rrn ..ter, Phone: 222- g411/ Mailing Address: ,-fin L" 99.66? 3. Legal Description: a AIM k 16 /nu 4AIe L41 -&S 4. Location: APD.Fmb i„ t-V.4h 4„/i Monn Z I IIA AI,�m J, W 00c"A117 5. Type of facility to be inspected ,r( Q,�) No. of bedrooms -(11AA1-0 6. Well Data: A. Type B. Depth C. Construction D. Bacterial Analysis Z()'%S�! 7. Sewage Disposal System: w-�r A. Installed 4J,,,,.I&J /9i�. B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Approved ��-Lay Disapproved Date 11 /i 7 T Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM accurate representation or the suDject sewer ana water Tdciiicles CUM uiebc IOL-iIItlaa are operating satisfactorily. SIGNED Date EQ -034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 — 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection:- CMRO VA FHA CONV X 2. Property Owner: ��//i I.i s/ 9g� % Ldii�C� Mailing Address: �� l Esc Day Phone 27,2 —el Cf 11 3. Name of Buyer:. 11' WW19A) /& 0 Mailing Address: �icX ��' % 38,41-1-4 Day Phone 4. Name of Lending Institution: 151GA1,1d!i9 /"6/ 7-01,t �i4Yielri•S" /3AitJK Mailing Address: Phone7C,L-`�� 5. Name of Realtor or Agent: Mailing Address: Phone 6. Legal Description: GoZ Location: /_c/ / [/F ✓�it//Z c�,� j �! /G1 /L/C*e .Do AlnlYaVA 115�uD i{rGL _/� 7. Type of Facility to be inspected: No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System x Type of System: Public Utility Individual (on-site) / \ _ ;�, _- If Individual, date of installation EQ -037 (1/74)