HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 5 LT 4Mountain Park
Estates #2
Block 5
Lot 4
#017-023-28
Municipality of Anchorage
Development Services Department
1 �;
Building Safety Division y
On -Site Water and Wastewater Program. 4700 Bragaw St.
P.O. Boz 196650 Anchorage. AK 99519-6650 Page I 0
www ci.anchorage ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: _(��Q �Q� PID Number: 0 if %— 03a
Near AI
Gvj Wastewater System: ❑ New JKUpgrade
T
I
a ABSORPTION FIELD
P"dr r}.�. NumEe d B6&o
�J L
O IHep Tnr hV15W. TwA h 0 Bel 0 Mand D 01W
LEGAL DESCRIPTION
Sol Rmng If I/�
O�GPD,e
Tote DeM can dgmel pda
/ Fl.
BidckM Ld. Sp/pswn A
Depth r PW dnlan edn wig dGrevedepth
+��
Cereh prye
^/
Toenemp Range sea.on
vC FI.
Fd dlded dune dpinY ads
•� Fl.
CX FI
Gr" Lerglh
FI.
Well: ❑ New ❑ Upgradel
Numper dines Daddrweee.ren lees
Casvnulrn IPnvau. A B 1 T Td& Depm Cased Id
FI.
Tad wadrPlrn dea ����
FI
M •ane
/ � � FI
Ff
Dauer Dea Duni sulKwee Levo
FI
Insular
✓Q
Dee Y�ndrd
_lT// '
Yror +mp see Aoove Grand
.P /
//)
GPM FI. FI
TANK
SEPARATION DISTANCES
021 Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
utNiUPnvate
Sewer Lina
"ade'
ref" P S
w.olr
06Gd
Wei
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OPE
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LotLne
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(
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'Perow .ed
Pun ry / HO . Yarmd
/
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n
n n
Cunrn Drrn
no 1
Pump Mi a . be
Eladn,al ns mw by
Ramerxs
BENCH MARK
urn 4_4 e
Lwum and Dewrem A
6 LI ,wined ^^Vr^vemn
1/ *FL
S i S 11NOINNERINt3/
Inspections performed by: 170id Eapl� Rlv�r Leep Reid, Ne.2%S: 1n /7-0%
fes` tam p
Eagle Rlwr, Alaska 99577 2
nd
OF
At Ott
Development Services Department Approval
Conditional Approval Date:CC
9 i;. ROBERT C. J,Q fi
-8 gCoO1
Reviewed and approved by: ate: 12- O%
tett �F�_'st'�
`t -ILZa�`�•
rn� aoal
PERMIT NO. SW070103
PACE 2 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEATH 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
LEGAL LOT 4, BLOCK 5, MOUNTAIN PARK EST #2 P.I.D. NO. 017-023-28
I
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LOT 3
1'
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WELL RADIUS
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100' WELL
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RADIUS LOT
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I I EXISTING BED
MT:�Mm�—T
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1000 CALLON
SEPTIC TANK
00W
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a
EXISTING 500
CALLON S.T.E.P.
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ROBERT C. COWAN !C
I `clC :� CE 88 1
�� �.
PERMIT No. SW070103
PACE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Bax 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 4, BLOCK 5, MOUNTAIN PARK EST #2 P.I.D. No. 017-023-28
FINAL GRADE
NEW
2" INSULATION
92.9'-/ 11000 GALLON
POLYETHYLENE 92.6'
SEPTIC TANK
MT2 MTI
MT2 = 97.4'-qMTI = 98.0
(FINAL GRADE
2" INSULATION
SR DISTRIBUTION PIPE = 9H•9'(,
MT2 = 92.9 MT1 = 92.9'
WATER FOUND ® 88.9'
84.9' B.O.H.
N. T. S.
10ROBERT C. COWAN
'"c c: 88 I
rf,:.............. '%r. e7.:
MUNICIPALITY OF ANCHORAGE Ii3IC4
I 3DU
Development Services Department J I
On -Site Water 8 Wastewater Program & D U
4700 South Bragaw Street
P.O. Boz 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Renewal
Date Issued: Jun 13, 2007
Expiration Date: Jun 12, 2008
Permit Number. SW070103 Parcel ID: 017-023-28
Legal Description: MOUNTAIN PARK ESTATES #2 BLK 5 LT 4
Design Engineer: 0003 S & S ENGINEERING Site Address: 012900 LUPINE RD
Owner Name: MIKE ATCHLEY Lot Size: 20130 SO. FT.
Owner Address: 12900 LUPINE ROAD Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99516-3225
This permit is for the construction of:
❑✓ Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
G/fT/07 - fIDPz TA JIL wj ll �e •tee. j 4o r?ep(h e e Kv, ,,ud .Cl«/7" iNs��.,�
Received By.
Date: 6 4/'/'> 7 t
Issued By r 1 \\ Date: b I ( 01
Municipality of Anchorage
Development Services Department
c L% Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. (DV1–b:? Zai
Property
phone 351-g3%0
Mailing address SAA—'Af, Zip Code
Site address )-.)go()-Lu I Dave Zip Code
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size O� 1 %:!U Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
1.
Septic Tank
14
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
certify that the above info tion is
Single Family Dwelling A is in acct
(Signature of property�ovvXer o�o�#d agent)
Number of Bedrooms ,)
THIS APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
I further certify that this application is being made for a
with applicable Municipal Codes.
Permit/Rush Fees: — Waiver Fees: _
Date of Payment:6� Date of Payment:
Receipt Number: O aS -74 F3 04—i"o Receipt Number:
(Rev. 11/05)
MNTIIAntT tY
APPRMAU
SEWER S WATER
WWE%TEN51"
BEWER 6 WATER
mrECTE7N
E1KIA+EEINHOSILMS
WEILPAiPEC?"
SREPIN4
RWOESWN
SaUES1
PE1r,E"TION
IEST
SfucnRVLa
WECK-MM
MPECD"
O1M511E
WASIEWMER
DISPOSALSYSTEN
OESM
ROBERT C. COWAN .
CIVIL ENGINEERING
PH: 907-694-2979
FAX: 907.694.1211
June 1, 2007
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 4; Block 5; Mountain Park Estates Subdivision #2
It is requested that you issue a permit to install a septic system upgrade to serve the
existing three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test performed. The approximate location of
the test hole is located on the attached site plan. At the time of excavation 5/20/07, ground
water was found at 9 feet. After monitoring, ground water was found at 8 feet.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you
Enclosure
information, please contact us.
P.E.
15861 S. Birchwood Loop Itond - Chuglak, Alaska 99567
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ROBRT C. COWAN
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CIVILEENGINEERING
ErtGltt��KtttG
PN: 907.694-2979
FAX: 907.694.1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
AT'FnOYN!
REFERENCE: Lot 4; Block 5; Mountain Park Estates Subdivision #2
Junel,2007
SFWEnA WATER
W EXTENSXM
GENERAL:
1.
The scope of this project includes the verification of the existing 500 gallon
SEWEnAWATER
S.T.E.P. tank and the existing 1250 gallon septic tank, and replacement if
mricIICN
necessary. Also included in the scope is the installation of 2 valves inside
or after the S.T.E.P. tank, and installation of a new pressurized trench to
serve the existing three bedroom residence located on the referenced
[TRC"FEt SIL MES
A"p TTETgRS
property.
2.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and
WFE[T"SPECTM
all applicable State and Municipal Wastewater Disposal Regulations.
SROWTE91
3.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
SITEPIA/q
4.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
TTOADDESM
settling.
S.
Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department or ADEC if required, for
smUST
system installations. Owners installing their own systems must also receive
prior approval from the respective agency.
Ft"CMDON
TEST SEPTIC TANK INSTALLATION:
1.
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access. All HDPE
sinmwwA
WCFWNM
septic tanks are required to have a 4" monitoring pipe installed next to the
MPFC11"
tank extending to the bottom of the tank.
ORSITE
WASIEWAIEn
MPOSKSMIEM
DES all
15861 S. Birchwood Loop Bond - CiTuglnk, Alaska 99567
Pepe 2
Lot 4; Block S; Wwtaln Park ESWN SWxWWM n
.hare 1.2007
2. The septic tank shall be sufficiently bedded to prevent settling of shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All HDPE septic
tanks are required to have a minimum of 2" direct burial insulation.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalis of the excavation
become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer
rock) placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the holes
faced downward. The distribution piping is to be of PVC (ASTM D3034 or equal).
All joints are to be solvent cemented. Gravel is then to be placed over the distribution
pipe to provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent
to the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
Pege 9
Lot 4; Block S; khrUln Park ESWN SIANSbn $2
Jule 1. 2W7
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipally
approved septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type ofPiae Perforated Solid
Cast Iron Yes
Yes
ASTM D3034 (PVC)
Yes Yes
ASTM F810 (HDPE)
Yes No
ASTM D2662 (ABS)
Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever specifications applies.
Paye 4
Lot I: Sbck 5'. Mwntah PA Ubles SuW*,bn /2
June 1. 2007
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre -construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to cant' out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
Municipality of Anchorage
Development Services Department
Building Safety Division
yr On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 796650 Anchorage. AK 99519-6650
www cianchorage ak us
(907) 347-7904
Soils Log - Percolation Test
Performed For.
Legal Description:
OR
fr � ov
I" L
Gph4o
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d.o.H -
Date Performed:
Township, Range, Section:
Gert Al OF"
11► "W4
WAS GROUND WATER jr
ENCOUNTERED? S
�e
IFYES.ATWHATDE OL
Depth to Water After / P
Monitoring?- E
Date a 07
Reading Date Gross Time
Net rime
Depth to Water Net Drop
o
L /o u
2 o
/ a
- 41
rt1
/0
F L `// ` ,33 !I
c
PERFORMED BY: �� L
PERFORMED IN ACCORDAVCE WITH
PERCOLATION RATE Im+wlesnecN PERC HOLE DIAMETER
TEST RUN BETWEEN LT FT AND � Fr
( r CERTIFY THAT THIS TEST WAS
AND MUNICIPAL 10 INES IN EFFECT ON THIS DATE. DATE:
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Municipality of Anchorage Page / of z -
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 e Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW 944609 PID Number: 01702.34P
Name: ,
Wastewater System: ❑ New O -Upgrade
VAP -i> T�12/5T/ilif} NOItlO LLI
Address:
ABSORPTION FIELD
1z,F00 G v ,vE /Za�ry
-pheae-
,dcHo/2RGE % 9�s/G
No. of Bedrooms:
y
❑Deep Trench ❑Shallow Trench Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
y
Total Depth from original grade:
3
10 GPD/S .Ft.
Lot:: Block: Subdivision: #'L
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
`
'7 S V A CST TliS
2.6 Ft_
,9 Ft.
Township:
Range:
Section: .fill
added above original grade: ,
Gravel length:
/-1 Ft.
32- Ft.
WELL: ❑ New ❑ Upgrade
Gravel width:
Numberoflines:
/9
Distance between lines:
24 Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
19AIVATB
Ft.
Ft.
76i SC. Ft.
4gr&4 QeOi41 ?'}-
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
2 0/411/
Ft.
WEED Cx c..a• v,4 T/
ur
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
-7teptic erK1ST1.Ub0 Holding ❑ S.T.E.P.
To
Septic
Absorption
Lin
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
p fj a- % N
1260
Well,
/O $
//0 /
//Z
Material:
S
Number of Compartments:
EES
Surface
LIFT STATION
Water
/oo't-
/ou't
loo'-,.
LotISize
in gallons:
Manufacturer:
Line
L/s
600
c.1 D A GC
"Pump on" level at:
"Pump off" level at:
High water alarm at:
Foundation
1�� r
5-7
L4
v8
IV(
a
CurtainN6iLJE
KN0
N
Pump Make &Model
Electrical Inspections performed by:
0.
Drain
OS/ OSH/f
/Z' • ,4.
BENCH MARK
Remarks:
Location and Description:
— e? OG Ou U0/9 r/O.fla14U.
. JIV, C014"14- OF L.ACr.
Assumed Elevation:
00.60
ENGINEER'S_ SEAL
o
17034 Eagle River Loop Road, No. 204
,91
Inspections performed by: Eagle River, Alaska 94577 Dates: ist s ao 44
e '
2nd
Department of Health" nd Hu Services appr al
f;' _
Reviewed and approved by: Date:""`
72-013 (Rev. 9/91) MOA 25
Permit No. SW940009 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
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
Legal DescriptionMOUNTAIN PARK ESTATES #2, BLOCK 5, LOT 4 PID No.:O 172328
NEW 500 GAL.
S.T.E.P.
rco
PQ 0
B
4
I,j I
Z
DRIVE
EXISTING 1250 GAL.\
SEPTIC TANK
(INSTALLED 1992)
(INTEGRITY VERIFIED)
SCALE 1" = 40'
72-013 A (2/91) MOA 25
MT1
MT4
Col 98 8 CO2
<( I Y
99.3'
99,
INSULATION
-----------
-- ----- ...............
. .
EXIST.
90.7' 1250 GAL 93.5'
S.T.
-94.81
�94.8'
A 84.8'
NO WATER FOUND
991.01
MH
N.T.S.
A B
FCO
23.5 21.5
NEW
'COI
60.0 50.0
500 G
9141 S.T.E.P. 93.2'
CO2
68.0 57.0
SYSTE
CO3
68.0 63.0
MH
67.5 64.0
MT1
64.5 71.0
NEW PRESSURE
MT2
85.0 91.5
DIST. BED
MT3
87.0 100.01
I
MT4
63.0 80.5
O/H
POW ER
LINE
NEW 500 GAL.
S.T.E.P.
rco
PQ 0
B
4
I,j I
Z
DRIVE
EXISTING 1250 GAL.\
SEPTIC TANK
(INSTALLED 1992)
(INTEGRITY VERIFIED)
SCALE 1" = 40'
72-013 A (2/91) MOA 25
<( I Y
- 14,
PAGE 1 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940009
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HOMOLA WARD & KRISTINA
OWNER ADDRESS:12900 LUPINE RD
ANCHORAGE AK 99516
PARCEL ID:01702328
LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK
5 LT 4
LOT SIZE: 19800 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
i�"�v
DATE ISSUED: 1/13/94
EXPIRATION DATE: 1/13/95
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
REFERENCE CONDITIONAL HEALTH AUTHORITY APPROVAL HA930791.
THE ENGINEER MUST PERFORM A PERCOLATION TEST ON THE ML LAYER
THAT OCCURS AT A DEPTH OF 7 FT. IF THE PERCOLATION RATE IS
SLOWER THAN 120 MIN/INCH THE BED MUST BE RAISED 2 FT.
II PAGE 2 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
VERTICALLY. GROUNDWATER MUST BE MONITORED THROUGH MAY 15,
1994
RECEIVED BY: W DATE: r �L
ISSUED BY: J���c� `' t� DATE: 13 %cl
. o
A
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERINGSTUDIES
AND REPORTS
WELLINSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
December 22, 1993
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99519-6650
REFERENCE. • Mountain Park Estates #2, Block 5, Lot 4
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
We request you issue a permit to upgrade the septic system serving the
four bedroom house on the referenced property and issue a conditional
Health Authority Approval,
An adequacy test performed on the existing system for Health Authority Approval
purposes found the absorption capacity of the existing system to be inadequate.
A conditional Health Authority Approval is requested until Spring 1994 when the
existing system can be upgraded.
A test hole was excavated and a percolation test performed in the area of the
proposed upgrade. The approximate location of the test hole is located on the
attached site plan. The monitoring tube within the test hole has been checked
and found to be dry. Attached it the proposed upgrade design.
We do not anticipate any adverse effects on neighboring properties by the
installation of the proposed septic system.
If you have any questions, or require additional information for your review,
please contact us.
A. Shafer, P.E.
17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577
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'STN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Mountain Park Estates #2, Block 5, Lot 4
GENERAL:
The scope of this project includes the installation of a 500 gallon septic tank
and pressurized distribution bed to serve the four bedroom residence
located on the referenced property. The existing septic tank is to be
excavated to verify its integrity. If of poor integrity, the tank is to be
abandoned and a new 1500 gallon septic tank effluent pumping (S. T. E. P.)
system installed. The existing leachfield is to be abandoned in place.
2. Construction shall be in accordance with the approved site plan and design
drawings; Municipal permit with any special provisions or conditions; and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the mounded
area.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
V
Page Two
Mountain Park Estates #2, Block 5, Lot 4
December 22, 1993
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shall be
two adjacent cleanouts (unless an effluent pumping system exists within the
septic tank). These cleanouts shall be located on undisturbed soil not more
than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward
the leachfield. The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a positive slope exists
away from the septic tank.
LEACHRELD BED INSTALLATION:
1. Excavate the proposed Bed Area to the depth shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the bottom of
the excavation becomes smeared, it must be raked or scratched (ruffed -up)
before gravel or sand placement.
2. If a sand layer is required, place sand over entire excavation to the required
depth shown on the design. The top of the sand layer must be within 2
inches of level.
3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated
distribution pipe must be installed level with perforations down. Gravel
depth below the perforated pipe shall be a minimum of six (6) inches.
Gravel depth above the perforated pipe shall be a minimum of two (2)
inches. The total gravel depth throughout the entire bed shall be a
minimum of twelve (12) inches.
4. The perforated distribution pipes must be no more than six feet apart. The
distance between the outermost perforated distribution pipes and the
sidewall of the absorption bed must be no more than three feet.
5. Silt barrier material must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel surface
before placing backfill.
Page Three
Mountain Park Estates #2, Block 5, Lot 4
December 22, 1993
6. Monitor tubes shall be of four (4) inch diameter and installed at the
locations shown on the design. The portion of the monitor tube extending
through the gravel depth shall be perforated six (6) inches below the bottom
of the horizontal distribution lines.
7. Backfill over the final gravel layer must not be less than twenty-four (24)
inches. Insulation must be installed when the backfill depth is less than
thirty-six (36) inches. The finished grade over the bed must be mounded
to prevent the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam Hl or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must
be installed between the final leachfield gravel layer and the native soil
backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with
less than 3% passing the #200 sieve.
Page Four
Mountain Park Estates #2, Block 5, Lot 4
December 22, 1993
7. When sand is being used as a filter material, it's gradation specifications
must conform to current M.O.A. or D.E.C. requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
1. The first inspection must be conducted after the excavation of
ditches, pits, trenches, or beds and before the installation of any
gravel. A septic tank may be set in place, but may not be backfilled
before this inspection.
2. The second inspection must be conducted after the placement of the
silt barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the
installation of multiple trenches, sand filters, pressurized distribution systems, etc.
Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start
of construction. If necessary, a pre -construction meeting will take place on-site.
(ENI ER $Ai)
ayr §
Municipality of Anchorage c
t DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST r
/� /� n n l I p� _
PERFORMED FOR: '' `�7TIt-1) L( I�f(�MA4,A DATE PE OR
LIOT 1 / &Ir_CS q 4
LEGAL DESCRIPTION: M7N PRIVL �S� V—� Township, Range, Section:
rjEPTH SLOPE 'S11ITE PLAN
(�EEr) OI�NlG5 T
ML, -- S tc'--L
COMMENTS
WAS GROUND WATER
U
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depthtri Water
p
Monitoring?
Monitoring?
Oate:
Reading Date Gross Net
Time Time
Depth to
Water
Net
Drop
- 1 D M 0N
sIZ AKtr+
6u3
I`/ rr
!�
3/yrr
I ti it
1
PERCOLATION RATE LhLf (minutes inch) PERC HOLE DIAMETER
TEST RUN BETWEEN �' -'� FT P, NO FT
S & S ENGINEERING
17034 Eagle River Loop Road No. 20.4
PERFORMED BYEa
gle River, Alaska 99577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI i
72-008 (Rev. 4/85)
ON THIS DATE. DATE:
IFY THAT THIS TEST WAS PERFORMED IN
Municipality of Anchorage " r
DEPARTMENT OF HEALTH & HUMAN SERVICES
n
825 "L" Street, Anchorage, Alaska 99502-0650 j
SOILS LOG — PERCOLATION TEST
rr I�nn;;�� �\qq n/���
PERFORMED FOR: �nJTp 1 1�/IYlAL4 DATE PERFOLo-r 4 , 8tx S Y"
LEGAL DESCRIPTION: nA7N 1 99L CST #Z Township, Range, Section: _
SLOPE SITE PLAN
1
2
3
4
5
6-M
7
8
9
DEPTH
(FEET)
�„
NIC arw S1-7.
Sw — WEU- 61�r�0 Seo
S�
(sem - Sexy 5a�y C�
DFMnQ.
SIl�Z
b `�
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b ' �
0.
•N
Reading Date
Gross
Time
Net
Time
Depth to
Water
10 WAS GROUND WATER V
11
12 17•U. N .
13-
14-
15-
16-
17-
18-
19-
ENCOUNTERED?
3141516171819
ENCOUNTERED?
IF YES, AT WHAT O
DEPTH? P
Depth to Water After
Monitoring? It Date:
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
ffr- r�
1
A-0D—
;�1H
S ,.
yl(y
I"
4
„
S ` `f
,
S 6 1
MIN
Vq
u
I I V3,
t
20 a: 0 1 N 519
Ll PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN S�JFT AND FT
/!r 7J.^_ice ci.r z7' /
COMMENTS
5 ENGINEERING
'"4 kag)e River Loop Road No. 2
� j
PERFORMED Bier -(le ciesAr 44-1-995" / 1
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELi / IN
72-008 (Rev. 4/85) .✓
V CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
Municipality of Anchorage
t DEPARTMENT OF HEALTH 8, HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
Y
PERFORMED FOR: 4'I g -D I WALL DATE PER
G071(7 5645
LEGAL DESCRIPTION:
�A7 *� tTownship, Range, Section:
/l /N P/Tl�( '7
SLOPE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
OI2G W%%�
Sw
/AAL—Slam,7
sw
ML,- S
SITE PLAN
WAS GROUND WATER �—
ENCOUNTERED?
S
IF YES, AT WHAT L
O
DEPTH? P
E
Depthto Water
Montt ,
Monitoring? gate:
Reading Date Gross Ne Depth to Net
Time ,me Water Drop
PERCOLATION RATE
TEST RUN BETWEEN _>
ACCORDANMEgW}rllLN*k9/WIMNICIPAL GU
72-008 (Rev. 4/85)
(minutesiinch) PERC HOLE DIAMETER
71' AND FT
V I c�lCr S'' G L L
r
CERTIFY THAT THIS TEST WAS PERFORMED IN
I EFFECT ON THIS DATE. DATE:
Municipality of Anchorage Page —lot 2—
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 9 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 920319 PID Number: 01-702328
Name
Wastewater System: [INew Kupgrade
WAyNE z ECK
Address:
ABSORPTION FIELD
12 00 'LUPINE RD NCN 995f6
Phone:
606-1911
No. of Bedrooms:
3
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
GPD/S Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
y 5 MT. PARK EST 2
FL
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
12 I�
3 W
Z �
F,_
Ft.
WELL: New L1 Upgrade
Gravel width:
Numberoflines:
Distance between lines:
E I T
J^ Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
FL
FL
SQ. F[.
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft.
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
- Ft. I
Fl.
SEPARATION DISTANCES
Xseptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
NCdOR GE TANk
1250
r
Material:
Number of Compartments:
2
Well
I Cis
STEEL
-
Surface Surface
?�OOf
LIFT STATION
Water
Lot
t
Size in gallons:
Manufacturer:
Line
50
!
"Pump on" level at:
"Pump off' level at:
High water alarm at
Foundationt{S
Curtain
Pump Make & Model
Electrical Inspections performed by:
Drain
BENCH MARK
Remarks: Tan be fnfful(eC,� er !-
12.erini
Location and Description:
-ft, re,elo-ce ectril rufi`ee_X ouf fank
TOP OF LOWEST STEP -ro DEC
Tctn� hw �� Cover• ower ',f
EN1 ovSE
Assumed Elevation:
ENGINEER'S SEAL
A4
i
Inspections performed by: FLATTOP TECH Svcs Dates: 1st Io l/2••49TH
•• a
�...................... ,k
2nd
P1 .....
,.....,T"
THEODORE F. MOORE
Department of Health ns approval
� � •. cs -35-. K
Reviewed by:Date:
,
�`f 3
and approved 're
12-013 (Hev. 9/91) MOA 25
I
Permit No. SW 9203191
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Loi LF $Lk S MT PARK EST 2 PID No.: 01702323
iC EX15r(N6 SOIASS. TRENCHlWNEW SEPTlq0AND
.o I
123'
M
q5�
VERTICAL SCALE 1" ,T'
No HoRT. ScALE
72-013 A (Rev. 9/91) MOA 25
WELL
l
HOUSE
T.B.M.
Cz
w
fL l
T.B.M.
TOP o F
LowES T
STEP = I00.0
1250 GAL
SEP TIC -rANk ENGINEER'S SEAL
14V6RT ELEVATIONS:
IN LIFT = 92.3, -
OUTLET -92.o
jiklq� '10
.• • ' V
—
04.l9TN
0*00
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Oil% CE - 3589 •,• YT Al
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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:SW920319
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:ZECK WAYNE A &
OWNER ADDRESS:12900 LUPINE RD
ANCHORAGE, ALASKA 99516
PARCEL ID:01702328
LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK
5 LT 4
LOT SIZE: 19800 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
DATE ISSUED: 9/30/92
EXPIRATION DATE: 9/30/93
THIS PERMIT IS FOR THE CONTRUCTION OF:
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:
RECEIVED BY:
ISSUED BY
DATE: Y/90 f 9 L
�j G
:zs�� �' DATE: /-30 _/ Z
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Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 995IP
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MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAG[
® DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION DEPT (;' C:
ENVIRONMENTAL ENGINEERING DIVISION ENVIF0N; ., i..:CTION
82.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REP91R'Tr_) O
NAME
PHONE
NEW
4P 2�,
RADE
MAILING ADDRESS - J
LEGAL DESCRIPTION
A67 4
LOCATION
NO.OFBEDROOMS
U pi/u F_ Z10AC)
Ar
Well
Absorption area
Dwelling
PERMIT NO.
U
DISTANCE TO:
5-0
A Cts' 6 1 !
Y
F Z
Manufacturer
Material
No. of compartments
tzL
N
Liq. rapacity in gallons
Inside length
Width
Liquid depth
IF HOMEMADE:
6 =DISTANCE
TO:
Well
Dwelling
PERMIT NO.
Jag
O Z Q
-F
Manufacturer
Material
Liquid capacity in gallons
S
O
Well
Foundation
Nearest lot line
PERMIT NO.
w y
DISTANCE TO:
.2-uj
LL z
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
h Z w
t
inches
'
R
Top finish
Material beneath tile
Total effective absorption area
of tile to grade
p
57
16 C3 inches
_
Length
Width
Depth
PERMIT NO.
w
0
QI-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
as
Lu
Lu V)
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
Lu
�
Building foundation
Sewer line
Septic tank
Absorption areas)
DISTANCE TO:
OTHER
PIPE MATERIALS
p
P4 6 Sr
SOL TEST RA'il NG
96 s �� al
qJ-
INSTALLER
-
1-4
r
REMARKS
QF At At.
o.
.................
24,1970...*,
,.00T.
APPROVED DATE LEGAL
F-O&ENL i'- b/iilF-o
72-013 (Rev. 3178)
.^ DEPARTMENT HEALTH AND ENVIRONMENTAL JTECTI@N
825 /L' STREET/ ANCHORAGE, HK. 99501
^ - ^ 264-4720
^
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 ' SOIL RATING (SQ FT/BR)= 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
A ;R L_�r-41:7i-rFl� =<:=_�* ����"== 0-:3.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET} OF THE TRENCH OR DRAIMFIEL[\
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
13R8UND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
���U I F;-12E=C-v =�.EF-`r I CD ���F-C !�F- l���
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
c� -F 1 0 F= , F= 0 U I F.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAyS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. -SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
���M I -F �X F=" I P-! F= 0-H. ����M F� F= F.:' ��- A S? E�_ C -i
I CERTIFY THAT
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE,
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
S I G t -4ED ----~~
A P P D&B GENERAL CONST.
ISSUED BY DATE -Z
Y4. 0
L4F=l I�
PERMIT
NO. ( 800611 >
APPLICANT
D&B GENERAL CONST. P.O. BOX
:10-1349
349~6965
LOCATION
LUPINE R8OHD
LEGAL
LKOT 4 BLK 5 MT. PARK. EST..
LOT SIZE
20130 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 ' SOIL RATING (SQ FT/BR)= 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
A ;R L_�r-41:7i-rFl� =<:=_�* ����"== 0-:3.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET} OF THE TRENCH OR DRAIMFIEL[\
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
13R8UND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
���U I F;-12E=C-v =�.EF-`r I CD ���F-C !�F- l���
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
c� -F 1 0 F= , F= 0 U I F.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAyS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. -SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
���M I -F �X F=" I P-! F= 0-H. ����M F� F= F.:' ��- A S? E�_ C -i
I CERTIFY THAT
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE,
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
S I G t -4ED ----~~
A P P D&B GENERAL CONST.
ISSUED BY DATE -Z
Y4. 0
o,
SOILS LOG
MUNICIPALITY OF ANCHORAGE
• +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: .�-� I�, ('-r%f�=%-19Az-- I_r✓t�y DATE PERFORMED: I 7 c? c'` 6
LEGAL DESCRIPTION: AOT- /':�1l0/f
DEPTH SLOPE SITE PLAN
(FEET) %t11 OPTOP��
vSGS~ G��1
2
3
1--74
5
(=P.J I_Y g'bjN a
6
uSCS` C)P
7
8
9
10
11
,--12
13
14-
15- U'5 CS - ''p
16 S A 1,J 0 (1d i 7-11
cc�mr CL'-1�JFYl
17
18
19
20
COMMENTS
r, = Zoo
WAS GROUND WATER S
ENCOUNTERED? Nb L
O Q
P N
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
N.EN■■■■■
„■■MMM■■M■
11■EEMMM■N■
FIENMEN
„■■EME■■■■SEE'
so
0
■■■■■■■.
W■
MEMEMENNEE
■■NIM■■■E■■
MERMENNENE
'.■■■■■■■■■■
WAS GROUND WATER S
ENCOUNTERED? Nb L
O Q
P N
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
0
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: 02Izz, CERTIFIED BY:
72-008 (6/79)
FT AND
49TH Ile
f No. 2.100 - E�
N r
� � AL
I
61 90-6
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
WATER WELL RECORD
Liddel tun �,
sed: Depth to top:
YPE: Volume:
BOROUGH
au
LOTatoex
s[CTId1 oTRa SECTION
to B CIE
d
NFnAN
:
S
0 ❑W
EVEL ANDYIELD:
it after hrs pumping00TAKE
DEPTH: It Horsepower.ISINFECTED UPON COMPLETION? ES ❑ N
LOCATIONISKETCH: I WELL OWNER: I IT- IAM
DEPTHS MEASURED FROM Casing top ❑ground surface WELL DEPTH: V DATE OF COMPLETION
Depth of hole: it
BOREHOLE DATA: Depth Depth of casin7 � ft I q I
Material Type and Color From To
DEPTH 19 STATIC WATER LEVEL:
S�ftbelow
Ztop of casing ❑ ground surface
A / Date: 6%.—/ / l�
p METHOD OF DRILLING: air rotary ❑ Cable toot
G[Iu� ❑ other
USE OF WELL:domestic ❑ Irrigation ❑ monitor
❑ public supply ❑ Other
CASNG STICK -LIP' jt. Diam:In. toE
WELL INTAKE OPENING TYPE: ❑ open end ❑ screened
❑ perforated $Kopen hole
Depths of openings: to tt
F_ I I I SCREEN TYPE: Diem: in.
I
11 simmt..n Slze: Length: It
TYPE:
sed: Depth to top:
YPE: Volume:
rom ft to h
PMENT METHOD,
EM�APACK
:
EVEL ANDYIELD:
it after hrs pumping00TAKE
DEPTH: It Horsepower.ISINFECTED UPON COMPLETION? ES ❑ N
CONTRACTOR INFORMATION: c _ REMARKS:
egis uBxess ame tt Y?`— PLEASE MAIL WHITE COPY OF LOG TO:
DNRIDNISION OF MINING & WATER MGMT
ignature o ut nze esprese uve c dfe _ ANCHORAGE C t. Sts 800 935
Phone 19071269.8639,Fox19071562.1384
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DRILLING
(907) 243-2282
KEN JOHNSON
Wayne A. Zeok
12900 Lupine Ade
Anchorage, Alaska 99510
( 344-7586
Ret Lot 4 B11s 5 MTN* PARK ESTATES No. 2
3163 LINDEN DRIVE'
ANCHORAGE, ALASKA 99502
JUW-,1, 1984
WATER WELL LOG
TOTAL DEPTH AT START 75 fts 6j ins t top of `casing )
3 ft* of water in well
Sand pumped out very clean course sand and gravel
Water table has dropped approx9 15 ft, since. Nov. 1980
75 ft
to 79 ft
Course gravel and light brown silt
79 ft
to 83 ft
Course gravel and gray siltesWeeps H2o
83 ft
to 88 ft
Course grav & cobbles with Light Brn silt
88 ft
Gleam Med sand and gravel water bearing
15 ft head
Test bailed 2 hrs. at 10 gpm
3 fte.drawdown
p i
Bottom stable..Total rasing 88 ft. .o
Total depth 88 ft ( top Of casing )
TEST PUMP DATA
Matic
68 ft. 6 ins
`1
t 19 fte 6 ins ) `�
TIM
G Pid DRAWDOWN REMARKS
1103
7.5
7Oe6 XXI Dirty
1110
890
70.7 clearing
1115
1500
7395 Clean & clear
1123
15
73910 Clean & clear.-( sparkles )
1124
Pump sgaeling but performing well
1130
15
73.10 Clean & clearoosPump noisy
1135
15
74 N N » N
11.55
15
74 N N « N
1200
15
74 » N
1203
Shut down
Returned
to Static
in one minute ( 68 ft. 6 pti}nvP4ITY OF ANCHORAGE
OF HEALTH &
Very Strong
15 GPM
Wells DEPT.
PROTECTION
ENVIRONMENTAL
EEB2'���,
RECEIVED
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
(907) 243-7893
KEN JOHNSON
D. & B GENERAL
P.0. aox 10343
Anchorage, Alaska 99511 349-6965
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
November 3, 1980
REs Lot 4 Blk, 5 MTN Park Estates No. 2
WATER WELL LOG
0 ft. to 8 ft. Course gravel and brown silt
8 ft. to 20 ft, Brown silt with some gravell
20 ft. to 25 ft, course gravel and brown silt
25 ft. to 4.7 ft. Brown silt with trace of gravel
4.7 ft. to 53 ft. Course cravel and cobbles ( tight )
53 ft. to 66 ft. Course gravel and brown silt ( tight )
66 ft. to 75 ft. Heaves while drilling ( 5 ft. ) weeps water -
Casing follows.. Med. gravel and sand
75 ft. Clean course sand course gravel..water bearing.
Static WL 60 ft.
Test bailed two hours at 7 GPM
Drawdown to 63 ft.
good recovery
Bottom stable
Set permenant pump 1 ft. off bottom
Municipality of Anchorage
-. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
r. tit P.O. Box 196650
4' 5677 Anchorage, AK 99519.6650
www.muni.orglonsite
(907) 343-7904
Parcel I.D.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
017-02328
1. GENERAL INFORMATION
Complete legal description
COSA # 0-702 D 9
Expiration Date: 9 O 7
Lot 4; Block 5; Mountain Park Estates K2
Location (site address) 12900 Lupine Rd. Anchorage, AK 99518
Current Property owner(s) Michael Atchley
Mailing address a=rne
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone 351-8370
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑�
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my 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 S d S Engineering Phone 694.2979
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name JAkA7- C, Cp c,,�,,. Date(/A,/.O
C
I,-
ROBERT
,
ROBERT C COWAN
5. DSD SIGNATURE a-eaot
Approved for �_ bedrooms. QfSFp *- r
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X_
Septic System Advisory
Well Flow Advisory
Nitrate Advisory ,X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: v Original Certificate Date: (0 d %
(R". 11M)
Municipality of Anchorage
• Development Services Department
Building Safety Division `#SAtTy
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: � ' / T t�� lit RFK & Pa cel ID: D( -023-a$
A. WELL DATA
Well type�vMT-
Date completed -on 11
Total depth , _ft.
If A, B, or C provide PW SID #
Sanitary seakl 1)
I
Cased to 12_ft.
FROM WELL LOG
Date of test
r
Static water level a ft
Well production S'Q g.p.m.
WATER SAMPLE RESULTS:
Coliform 2--colonies/100 mL Nitrate cl r*5 3 mg/L
Arsenic: b x439 ug/L date of sample: V If
B. SEPTICIHOLDING TANK DATA
Tank Type/Material 1C
Tank size I DOC) gal. Number of Compartments
Well L (/) �—
Wires properly protectec(nN) _
Casing height (above ground) W %+in.
AT INSPECTION
Ie� g.p.m.
Other bacteria )or colonies/100 mL
Collected by:
Date installed 6 1 q O
Cleanouts l&) -F
Foundation cleanot(0)N) -XS Depression over tank (w) &2V High water alarm veD M
Date of pumping QEW TrCQK- Pumper til! 9
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft' or ft=/bdrm) (• a System type S�}
r
r
Length ft. Width 5 ft. Gravel below pipe
Total depth � ft. Eff. absorption area 3�: Monitoring tube Depression over field -)O
Date of adequacy test Results (Pass/Fail) --44/A For _a, bedrooms
Fluid depth in absorption field before test = in. Water added= gal. New depth ---in.
Elapsed Time: =min. Final fluid depth — in. Absorption rate >= — g p•d•
Any rejuvenation treatment (past 12 mo.) ( D type) �.) b If yes, give dale
D. LIFT STATION
Date installed a0
"Pump on' level at A?�rr in.
Datum _BOTTOYy'\
E. SEPARATION DISTANCES
Size in gallons Manhole/Accest 1) Yt�
A
'Pump off" level at in. High water alarm level at ?1r in.
Cycles tested Meets alarm a circuit requirements? lus
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot JOS r 1 I Zr
r
Absorption field on lot /is
Public sewer main n.9
Sewer /septic service line_ a6r +
Animal containment areas
50 rfi
On adjacent lots /00 f4
On adjacent lots tLb 1+
Public sewer manhole/cleanout
Holding tank
I
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line 1 Absorption field 5 1+
Water main1
Water service line 10 '/' Surface water /C '� -I-
Wells on adjacent lots 100 14 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r t
Property line /a Building foundation 41,2 Water main A) A
Water Service line 10 t 1 Surface water 00 r Driveway, parking/vehicle storage 10 +
Curtain drain AJCW& Me tyt) Wells on adjacent lots 1Gt0 +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and a• �/� -»
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. A; rt0eerrt C,, cowgN J/ e
Engineer's Printed Name 6,84f4.T �dwl.✓ tcf�\ C`:.
Date 6 /}r /07 ttth; « StC,t*
COSA Fee $ Waiver Fee $
Date of Payment �Iti2h�`-r Date of Payment
Receipt Number 005405 Receipt Number
(Rev. 11/05)
Municipality of Anchorage •.
Development Services Department
Building Safety Division
- On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 070208
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 4 of
Mountain Park'Estates #2 subdivision. This inspection revealed a nitrate
concentration of 9.53 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.
ANALYTICA
GROUP
S&S Engineering
Attn: Tami / Yoshi
17034 Eagle River Loop Rd.
Eagle River, AK 99577
907-694-2979
Fax: 907-694-1211
Client Sample ID:
Sampling Location: LT4 85 Mtn Park Estate 2
Client Project: none
Sample Matrix: Aqueous
COC N:
PWS#:
Residual Chlorine:
Comments:
Analytica International, Inc.
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date: 6/22/2007
Receipt Date: 6/152007
Sample Date: 6/152007
Sample Time: 4:20:OOPM
Collected By; YN
Elia Definitions:
MRL - Method Reporting Limit
MCL - Maximum Contaminant Limit
B e Present also in Method Blank
11 - Exceeds Regulatory Limit
M Matrix Interference
J - Estimated Value
D Lost to Dilution
•• - RL higher than MCL; target not detected
TNC - Too Numerous to Count - result rejected
CF - Confluent Growth - result rejected
TCNG -Turbid Culture No Growth - rejected
Lab#: A0706189 -01A
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
200.8200.8 (Aqueous) - Family Well Water l Test was conducted by: Analylka - Thornton
Arsenic 0.439 ug/L 0.15 10 200.8 6212007 6212007 KS
LabN: A0706189-0IB
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
92228 (Aqueous) - Membrane Filtration MF Test was conducted by: Analytica - Anchorage
Bacteria, Other <MRL CFU/IOOmL 1.0 6/152007 6/152007 PL
Total Coliform <MRL CFU/IOOmL 1.0 1 6/152007 6/152007 PL
LabN: A0706189 -OIC
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
Nitrate as N
Reported by: Krissy Plett,
Laboratory Project Manager
9.53 mg/L 2.5 10
Page 1 of 1
was conducted by: Analytica - Anchorage
6/162007 6/162007 AJ
06/20/2007 :a 9072432081 FRED WALATKA&a o PAGE u
2/§
§§k
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76 -D
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH 8t HUMAN SERVICES
Division of Environmental Services IN
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. # CV-) - ��'a
1. GENERAL INFORMATION
Complete legal description
HAA# 1aQQfI)%D 1\
Mountain Park Estates #2; Lot 4; Block 5
Location (site address or directions) 12900 Lupine Road
Anchorage
Property owner ward & Kristina Homola Day phone
Mailing address 20516 N.E. 167th, Battle Ground, WA 98604
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: I%L)4 l/
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 MOAN21
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 thi�sjnk�pection.
Name of Firm _ _ _ _ _ _ Z Phone 6 % `f- 2-9 7 f
Address 17034 Eagle
Eagle River,
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
a
Disapproved.
Conditional approval for
Additional Comments
Date Z
bedrooms, with the following stipulations:
WTIC
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.
.... " r . M., une 411
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: lRooy7-41 / /BAR,-- CsrAn&-' 4� Parcel I.D. O170232 -F
Gy, !3S
A. Well Data
Well type /91vs07'6If A, B, or C, attach ADEC letter. ADEC water system number ,)' 4
Log present (Y/N) Y Date completed 61 =/ tyy Driller KEN (fo.
Total depth
Sanitary seal &N)
Date of test
Static water level
Cased to
FROM WELL LOG
9.. S'
Casing height /P „
Wires properly protectedON)
N)
Well flow !S g.p.m.
Pump levell UN le,
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
AT INSPECTION
v
/O-zr-9?
iv11,A
D
�
(o•� g.p.g'
�
ro
Petroleum tank ,uo,vc
�
()NK 3
T
�r X.
t:v
CP
cU
On adjacent lots /00 f o 0
N
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
iv11,A
Sewer service line
1/0,-1-
Petroleum tank ,uo,vc
orP�6KyE�
WATER SAMPLE RESULTS:
Coliform 0 Nitrate /UD Other bacteria
Date of sample: /Z-/7-93 Collected by: _5_F S
B. SEPTIC/HOLDING TANK DATA
Date installed /0192 Tank size 126'0 Compartments z
Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression (Y/N) N
High water alarm (Y/N) N1/A Alarm tested (Y/N) N f Fl•
Date of pumping t1,11A - /JE6tJ _ 12 --Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /OT ' On adjacent lots /00 ' r Foundation 117
To property line rc) Absorption field z Water main/service line /O'+
Surface water/drainage /00'-t
72-026(3/93)'Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed 6-Lz019el Manufacturer ti,-oRf+G&-� -7;4,u,&_
Size in gallons Svo Manhole/Acce ( N) Y
Ve t (Y/) "Pump on" level at� Z8 " "Pump off" Level at
High water alarm level 8" Cycles tested
Meets MOA electrical cods (Y N) Y
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot ///' On adjacent lots /00 ' t Surface water /00/-/-
D.
00'-f
D. ABSORPTION FIELD DATA
Date installed -12-0J9 y Soil rating (GPD/Ftz) O.? System type /3190
i
Length 32' Width zy' Gravel thickness O S Total depth
Total absorption area 76e z Cleanout-present6)/NV Depression over field (Y/N)/ N
Date of adequacy test ��P Results (pass/fail) OAU � �S7`��for L�� Bedrooms
Water level in absorption field before test After test kj
Peroxide treatment (past 12 months) (Y) If yes, give date /
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot //0, On adjacent lots /00 ' a Property line
To building foundation S7' To existing or abandoned system on lot ZL
On adjacent lots 30 '+ Cutbank Al /A Water main/service line_( o' 4 -
Surface
Surface water /oo ' a- Driveway, parking/vehicle storage area So ' +
Curtain drain NONE kNawnl
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conf ed all MOA and HAA guidelines in effect on the date of this inspection.
72-026 (3793)' Back
May 24, 1994
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS Municipality of Anchorage RECEIVED
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650 JUN 3 1994
SEWER &WATER Anchorage, Alaska 99519-6650
MAIN EXTENSIONS Municipaijiv Ut AilchOrage
Dept. Health & Hurnan Services
REFERENCE: Mountain Park Estates #2; Block 5; Lot 4
SEWER & WATER
INSPECTION
A Conditional Health Authority Approval (HAA) was issued on January 13,
ENGINEERING STUDIES 1994, for the referenced property. All work required for the
ANDREPORTS Conditional HAA has been completed.
Attached is the On -Site Wastewater Disposal System and/or Well
Inspection Report for your approval. We request you issue a Final
WELLINSPECTION Health Authority Approval for the referenced property.
& ROW TEST
If you have any questions or require any additional information, please
contact us.
SITE PLANS -
S' cerely
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
. Shafer, P.E.
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:,
�1 0 N �4fi� r �
LEGAL DESCRIPTION:
—
DEPTH
T)
1
2
• id ' e'
4
0,n.�
U -
5
q d
6
t'u
�Vj
7
8-
9-
910
10-
Y 1 1
11
11
12-
213141516171819
13-
14-
15-
16-
17-
18-
191
20
DATE P
Township, Range, Section:
WAS GROUND WAT
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After .�
Monitoring? W;
y (ENGINES '3•SEAL)
r>
SLOPE SITE PLAN
=®®m
�1 0 N �4fi� r �
—
—
zI i_r
PERCOLATION RATE
4 61 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN �._'L_—F'j AND 3-t5 FT
COMMENTS
PERFORMED BY:S & S ENGINEERING
17034 Eagle River LOOP Koad No._ /
ACCORDANCE VvEA"K& AIQQ49) a MMAL GUIDE LIfVE-
72-008 (Rev. 4/85)
i
CERTIFY THAT THIS TEST WAS PERFORMED IN
f ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D.# !`�11-OQ*23-QFs HAA# 012�9-0,d1g1
1. GENERAL INFORMATION
Complete legal description Lot 4; B.2och 5; Wountai.n Pd)tk Ebtatu #2
Location (site address or directions) 12900 Lune Road
Anchorage. AK
Property owner wand Homa2a Day phone
Mailing address 20516 N.E. 167th Battle Ground, WA 98604
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
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
L& Aoe9 (16A'AGU) 9Z0-ZL
•>laonn sdaeui6ue leuoissaload agl ui suoissiwo ao siona aol elglsuodsaa
lou si a6eaogouy to /l!ledloiunn eql •panssi si aleoipliao a ajolaq elep aztleue jo suoiloadsui lonpuoo
IOU op SHH(3lo so9Aoldwq •sluawaambaa alels pue leaapal uieljao llsiles oliepio ui suoilnIpsui buipual alaglpue
sawoq to sjasegoind of AsalJnoo a se sigl saop SHHa agl TNsely to alelS aql u paaals'bGJ aaaul6u8 leuoisselad
luapuadepui uv Aq anoge 9 gdw5vied ui u9ni6 suoileluasaidaa eql uodn Aluo paseq saleollilaaC) lenoiddy
(li.loginy g11eaH sanssi (SHH(1) saoiAieS uewnH pue glleaH to luawpeda4 abeaogouy to AliledioiunN agl
1 VIAS q :Aq.
sluawwo0 leuoillppy
:suollelndlls Bulnnollol aql q;inn 'swooapaq � aol lenoidde leuolllpuo:D "
•panoaddesia_
'swooapeq aol panoiddy
3unlHNDIS SHHa '9
•� n �x F��C.tNV btl D!.i HOCUYI^t". iM1'i• ry E/r
r
AY /
IP
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--�—, ssaappb'
voz .0690a o7 .aenla Gj0e3 4EOLL
aUOgd ONIa33NIJN3 S'8 S walk to aweN
•uolloadsul slgl to alep eql uo loage ul suoilelnBaa pue 'saoueulpio
'sepoo alelS pue lediolunW lle gllnn eouelldwoo ui sl welsh 1esodslp aalemelsenn ao/pue Alddns
aalenn ells-uo aql 'uolloadsul pue u0lle6lls9nul r(w woal pue salll 96eaogouy to AllledlolunW agl
woal paulelgo uolle(wolul aql uo paseq le4l Ajlaanaaglanl l •ulaaaq paleolpul ainlonilslo adfl pue
swooapaq to aagwnu aql aol alenbape pue leuollounl'ales sl welsAs lesodslp aalennalsenn io/pue
Alddns aalenn ells-uo aql legl smogs uolleolldde lenoaddy Ajpoglny glleaH slgl to uolleBllsanul
Rw 4ugl All.ian l 'nnolaq unnogs alep uoilepllen aql lose pue olaaaq paxille leas Aw Aq paippeo sy
H33NIJN3 AS N01103dSN1 d0 LN3W31tf1S 'S
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: MX P6/2r_CS7'�, G'%, SS Parcel I.D.
A. Well Data
Well type 1 12(V,47If A, B, or C, attach ADEC letter. ADEC water system number %y/�
Log present (Y/N) Y Date completed c��6 / 8`t/ Driller
CXKENS �Un"/'Y
Total depth �U r Cased to R Casing height
Sanitary sear/N) Wires properly protected (YIN) /Y
rn
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
d /S y
DOvv,Sr
U N� .
SEPARATION DISTANCES FROM WELL TO:
M.
AT INSPECTION
�6 r
UN
i
Septic/holding tank on lot IOS ; On adjacent lots
Absorption field on lot 112' ; On adjacent lots /0(
Public sewer main NSA Public sewer manhole/cleanout IJIA-
Sewer service line 70 ( NO
t Petroleum tank / NE_ 6LEAVr?P
WATER SAMPLE RESULTS:
Coliform Q Nitrate Other bacteria 62
Date of sample: �ZI lql�Collected by: �k S.2 1=NGrnf�cfttNG
B. SEPTIC/HOLDING TANK DATA
Date installed l0 ka Tank size %S6 Compartments e2
Cleanouts O/N) y Foundation cleanout (Y/N) Y Depression (YA
High water alarm (Y/N)' / O/A Alarm tested (Y/N)
Date of pumping r!v/%�— — (!��W Pumper
SEPARATION DISTANCES DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
105
On adjacent lots
106 + Foundation bis r
To property line 9 ' Absorption field ^ S ` Water main/service line .0 V
Surface water/drainage 100'4
72-026(3/93)•Front CONTINUED ON BACK PAGE
c
� Z
N
y <
r 0
N
g.p.m.
z
m
W
�0
oR
Z
Public sewer main NSA Public sewer manhole/cleanout IJIA-
Sewer service line 70 ( NO
t Petroleum tank / NE_ 6LEAVr?P
WATER SAMPLE RESULTS:
Coliform Q Nitrate Other bacteria 62
Date of sample: �ZI lql�Collected by: �k S.2 1=NGrnf�cfttNG
B. SEPTIC/HOLDING TANK DATA
Date installed l0 ka Tank size %S6 Compartments e2
Cleanouts O/N) y Foundation cleanout (Y/N) Y Depression (YA
High water alarm (Y/N)' / O/A Alarm tested (Y/N)
Date of pumping r!v/%�— — (!��W Pumper
SEPARATION DISTANCES DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
105
On adjacent lots
106 + Foundation bis r
To property line 9 ' Absorption field ^ S ` Water main/service line .0 V
Surface water/drainage 100'4
72-026(3/93)•Front CONTINUED ON BACK PAGE
C. L?F�ATION
Date installed _Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes
SEPARATION
Woloni� lot
"Pump on" level at
FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
On adjacent lots
Cycles
(Y/N)
mp off" Level at
Surface water
Date installed 0, I S1 90 Soil rating (GPD/Ft2) System typeqK
Length 0� Width y Gravel thickness Total Total depth
Total absorption area 1333 Si Cleanout present &N) / Depression over field (Y/6I NJ
Date of adequacy test iO�a l (f3 Results (pass/fail) F� /� for 4 Bedrooms
Water level in absorption field before test\ t�� After test �y
Peroxide treatment (past 12 months) (Y/() r vO7 K"OwN If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: � �1
Well on I
On adjacent lots 100yd
Property line
To building foundation r�,° To existing or abandoned system on lot A)//4
On adjacent lots Cutbank /J/ Water main/service line aU ��
Surface water �l� - l� �� Driveway, parking/vehicle storage area 5a
Curtain drain V VdkrR-- �Nowf"
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or con/b,
Signatyr@ �,,.o. 4gR4tF
EnginelJPftRdfiAe River
Eagle PNer, ATasf
Date
HAA Fee $ =�60
204
C?
Date of Payment 1 Z 2 6l / 9
Receipt Number Sy3 Q C
72-026 (3193)' Back
all MOA and HAA guidelines in effect on the date of this inspection.
Waiver Fee $
Date of Payment
Receipt Number
W
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I. D. #
1. GENERAL INFORMATION
HAA # k-1 Q�C1'DLLLl n
Complete legal description L.o f -W E loc k- .�_ r7oun lar" Park Es/,�fer t�2
Location (site address or directions) 12900 6.up/ne IiaooC
Property owner WcAy nc � Marr IXn Zec-t Day phone (2 141) 608-78!/
Mailing address 3213 V. Bry "S . P /ano TX 75093
Lending agency
Mailing ad
Day phone
Agent
Pe ire S frau% fie t`fe x
Proper f tef
Day phone 257 —0165
Address
2600 Ccraroucc
A-nchoruye,
/41-c 9-95--C3
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. 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.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site ✓
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev- 1/91) Front MOA 021
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 Ff xF1-ce f Tervecy Phone 3YS- i3 -0 -
Address !'Y6730 Cc -4 514. 14nc-Aoray2 A k 99,, I>S
Engineer's signature ��r0'� Date fO &192
At
W � k 4 ei � to ✓ • y
• C
0••\.7:.•.\.1..
1. THcODORc r. ;;100Re '•
�,� Std •'u CC - 358'i •`, t,�i '1Q
V
yRl •• .• 1lN
6. DHHS SIGNATURE
_4� Approved for
Disapproved.
Conditional approval for
Additional Comments
bedrooms.
bedrooms, with the following stipulations:
DateL
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 courtesyto purchasers of homes
and their lending institutions in orderto 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: LoT 4, BLk S MT- PARK EST #Z Parcel I.D. 01702328
A. WELL DATA
Well type PRII/ATE If A, B, or C, attach ADEC letter. ADEC water system number N•A
Log present (Y/N) y Date completed 6 �� /84 Driller KENS COMPANY
Total depth g8 r Cased to 98 Casing height 18
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
J
FROM WELL LOG
6 �I ls�r
6s' 6
Wires properly protected (Y/N) y
Is g.p.m
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
7' 31/ 12 MUNICIPALITY OF ANCHORAGE
,ENVIRONMENTAL SERVICES DIVISION
7
-, ,'-I
`, „I ,� 1 J J L
> 7 g.p.m.
>70RECEIVED
Septic/holding tank on lot I os, ; On adjacent lots -;;./0o'
Absorption field on lot 112- ; On adjacent lots 100
Public sewer main > oo Public sewer manhole/cleanout /00 /
r
Sewer service line ti So Petroleum tank NONE OBSERVED
WATER SAMPLE RESULTS:
Coliform U cot //00 ,h 2 Nitrate OA 45 my/ -e Other bacteria oco! /100Ar
Date of sample: 1016/9.2 Collected by: FLATTOP TECH S!/CS
B. SEPTIC/HOLDING TANK DATA
Date installed 10/92 Tank size 1250 GAL Compartments
Cleanouts(Y/N)
High water alarm (Y/N)
2
Foundation cleanout (Y/N) i -- Depression (Y/N) 1`(
�. A • Alarm tested (Y/N) N.A.
Date of pumping'' N.f}. NES✓)` Pumper N.A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wel I(s) on lot IDS r - On adjacent lots > foo Foundation
E W�
qS
To property line So- Absorption field S Water main/service line 20
Surface water/drainage >/oo'
72-026 (Rev. 7/91) Front - - CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
"Pump off' level at
Cycles tested
Surface water _
D. ABSORPTION FIELD DATA
t'(YICi �
Date installed 10%80 Soil rating 9D aa18DRM System type—TREN04
r 1 /
Length * 1+D Width `(-Gravel thickness * 8.33Total depth ;K
Total absorption area K 1333 C3 Cleanouts present (Y/N) Y _
Depression over field (Y/N) —
Results (pass/fail) * * P455
Date of adequacy test `7 �3Oq 2
for
Peroxide treatment (past 12 months) (Y/N) NONE KNowN oP If yes, give date
1�
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ) 12 r On adjacent lots / 00 Property line 40 FRoM C.O.
r
To building foundation SS FROM C•R- To existing or abandoned system on lot N.
On adjacent lots >SO Cutbank 7/Oa' Water main/service line } 20
Surface water ----100' Driveway, parking/vehicle storage area 75
Curtain drain NOn1E p13SERVED * INFORMATION FROM 14SPECTION REPORT'
* * K6ASvRED ABSORPTION RATE = $00 GAL/p$`/
E. ENGINEER'S CERTIFICATION 1''464 TRENCH FILLE=D To JvST BELOW LNVEL
OF HOR120NT4L DISTRIBUTION PTFE
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature �� Y.- 2�
Engineer's Name Th eat�o re l=. me cy re
Date C>elv�e� S /992
HAA Fee $ V 7e '
Date of Payment �tl�� -9-)�
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Wyk o '° A� °•,P ��
.`�* 0
0
°° THEc�DQRE r'.:d'JORE o° I;i"
I ` CE
3589 • 1k 0
ff
-
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME -
TIME
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
DATE
DATE
DATE
❑ Two ❑ Five
❑ MULTIPLE FAMILY
-L0-qj-i
INSPECTOR -
INSPECTOR
INSPE OR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
• J h
I1�)"�
i
ENVIRONMENTAL SANITATION DIVISION �jy� G�
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER -
PHONE
VMMS E & Victoria A
345-0179
MAILING ADDRESS
29 L ' e ra e AK
PROPERTY RE IDENT (If different from above)
PHONE
same as above
2. BUYER
PHONE
ZECK Wayne & -McarilVn
MAILING ADDRESS
SRB Box 7236 Palmer Alaska 99654
3. LENDING INSTITUTION
PHONE
Hcxne Savincrs& Loan
272-1451
MAILING ADDRESS
"STIS D"
4. REALTOR/AGENT
PHONE
Clair Ramse - Coldwell Banker Jack Mite Ccmpany
563-5500
MAILING ADDRESS
3201 "C" Street Anchorage AK 99503
5. LEGAL DESCRIPTION
Lot 4, Block 51 Mt. Park Esta #2
STREET LOCATION
12900 Lupine
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
® SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Rk Three ❑ Six
7. WATER SUPPLY
® INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
EX INDIVIDUAL/ON-SITE**
1p %Y YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
-------�
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE Q''THREE ❑ FIVE CI OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
P- INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
26NDIVIDUAUON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
f
Septic Tapy or ❑ Holding Tank
Size: Z '2-5 v If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELLTO:
Septic/Holding Tank
d
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
e�
APPROVED FOR /� BEDROOMS
LJ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE f
Y /\
72-010 (Rev. 6/79)
ALASKA Ci 01ROURTAL COnTROL SCRUIUS, InC.
Cngineerinq & 6nuironmentol Studies
FEB 7 1984
THOMAS EDWARDS
12900 LUPINE
ANCHORAGE AK 99516
SELLER — CLAIR RAMSEY BUYER — SAME
SUBDIVISION — MOUNTAIN PARK ESTATES 2 BLOCK — 5 LOT — 4
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 650 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON FEB 7 1984 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
OFA•s3'q �Cyf p0°soepO��'yt Si�9@
'�;p e• sm
O
O evO O 9m• ea tae loan "t+ �" /D
Ler C. P.eid, Jr.
�d�P]% No. 2251•E °. r
1200 West 33rd Ruenue, Suite B • Anchorage, Alaska 99503 • (907) 561-5040
m
A.
t
♦; „
DAit RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
_
7Q�CP�- 1 L 81(Ic�as�Ll�1
TAME
°z51
v r ,�
NUMBER OF,BEDROOMS -
DATE
DATE • p / 1
In d n (U
DATE
CS
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Lo
INSPECTOR
INSPECTORCf
INSPECTORp,�
* ATTACH WELL LOG. A well log is required for all wells drilled
t �5L
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAOF
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIp� DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 IVIRONMENTAL PP,OTECTION
•
ENVIRONMENTAL SANITATION DIVISION jUIV 1 2
Telephone 264-4720
F
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWR' QI'/E&.J
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
3
PHONE
3y`l-696's
MAILING A/D,DRES/
P Cj � � <y /` 4 �S �I
PROPERTY RESIDENT (if diffefrom above) - PHONE
rent
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION -
PHONE
MAILING ADDRESS
4. REALTOR/AGENT -
PHONE
t�7s� 013 � ,�GGi%
Z- • rJ �"
AILINGADDSS
MAIL ADD S,
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS -
E:1 One � Four ❑ Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
L2 INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
M INDIVIDUAL/ON-SITE**
116C) 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
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
yy.
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: l Z5'0 If Tank is homemade
give dimensions:
SOILS RATING
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
"APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE JB
Y `
I/
72-010 (Rev. 6/79)