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Home My WebLink AboutMOUNTAIN PARK ESTATES #2 BLK 5 LT 5Mountain Park Estate #2 Block 5 Lot 5 #017-023-29 MUNICIPALITY OF ANCHORAGE DE, ITMENT OF HEALTH AND HUMAN SER\ 7S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES C TO SEPTIC ABSORPTION WELL Address _ AZO Lu N C C/ FROM TANK FIELD Phone(s) Permit No. No. of Be rooms - WELL /DO ' /DD 26L%— v ZZ 4/ LOT LINE r 10 / /p f. LEGAL DESCRIPTION Lot Block 5 Subdivision E5 -# 2 FOUNDATION 3 8 Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, property Imes, foundation, J Z 6 7—/Z X) 7 3 A 5U J driveway, water bodies, etc.) TANKS 77 SEPTIC ❑ HOLDING Manufacturer Capacity in gallons �cA/ 1.250 Material No. of Compartments I TYPE OF SYSTEM - , []TRENCH BED ❑ W. DRAIN ❑ OTHER 3 Depth to pipe bottom from Total depth from original grade 6 6 original grade sV FT FT b r Fill added above original grade Gravel depth beneath pipe 611 //e S / FT N I Graveilengthl /_ / / Gravel width / � 88 See skekA T 2 FT L r 1 C 39r° Total absorpho area Distance between lines SO FT /� X - G FT 4 Number of line Sol[ rating 12,67 Pipe material SO FT D VC - 303 r installer Date Installed/ t r ,p (—fes /v /` i WELLS PRIVATE ❑ OTHER (Identity) A✓ F o 7 -Classification (A, B,C) Total Depth Cased to //G FT FT Installer Date Installed: REMARKS: e. .[,• lit/ [�! (� S ✓ �e W Scale: ` - -w--'E IFEE Inspections Perform d by: Ir // jA I, r flGr. i�'1u r Date: '� b �i/ 50( �`- s, R,06 ,1 A.5%*fm U irk 's�B isle c I c nify that I is >r py. ONG, ' d �� inspection was perlormed according to all r, +,. r 2 tds. i��y•� , Municipal and State gu dl;lM I Y f date: E / /� ( r Date: Health Department Approval-U''/ : v 72-013 (3/85) ' + : . �It, ..... ��:1 IF", 1. -T, U" ![.-,p P, VA U�-_, 0-0 c:3 FR! r.:), IF-3� � DEPARTMENT OF HEALTH AND ENVIRONMENTAL P1--ZOTE-:(,-r1ON 825L STREET, ANCHORAGE, AK 99501 264�4�20 � M M --- E3 Ic Q- M E3 W E FZ EE: FR W-1 :1 -T PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: 850594 09/16/85 WSIDY TAYLOR 12920 LUPINE, RD. ANCHORAGE: AK 99516 264-8422 SUBDIVISION: SECTION: 26 20130 (90. FT 4 MT PARK ESTATES #2 LOT: 5 BLOCK: 5 TOWNSHIP: 12N RANGE: 3W . OR ACRES) Listed below arethe options available to you in designing your septic system" Choose the option that best fits your, site^ T^��EE 91.10 LE:11 01 �� ~ ��8=e ][11-110 DEPTH TO PIPE BOTTOM (FT^} 4,0 4^0 4"0 GRAVEL DEPTH (FT.) 4"5 0"5 3"5 TOTAL DEPTH (FT~) 8"5 4"5 7.5 GRAVEL WIDTH (FT.) 2"5 24.0 5"0 GRAVEL LENGTH (FT. ) 82"0 ** 46"U 79.0 ** GRAVEL VOLUME (CU.YDS") 38.0 40°9 ' 58.6 TANK SIZE (GALS) 1,250"0 ** 1,250"0 ** 1 50"0 ** SOIL RATING (S(,!"FT,/BR) 183 183 183 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT, EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... .... ... ... ._��~~� I certify that: 1" I am T,amiliar with the requirements for on-site sewers and we1ls as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I will install the system in accordance with all MOA codes and,regulations, and in compliance with the design criteria of' this permit" 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is Valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. ' IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODEq, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT BE APPROVED WITH8UT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICII AN^ SIGNED APPLICIA P ISSUED } DATE: d ` Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST (b GifIER�R' ' AL) T ti�N Jt.i �� 9` 4, ombee`A. Shafse �. No. 1457-E ,•'� s PERFORMED FOR: Jm /`0 /^7GC. b'n 1 /-- 7-0 /lJ DATE PERFOR LEGAL DESCRIPTION: Zg—--� N -4d / K2f-r Township, Range, Section: 2 6 DqEPTH %S7p -7C-(- # Z SLOPE 1�EErl Ci9cc ✓IGG 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS L 2. 57P /� 41- z -7 —�, R I— cLn-y /S a MA T/z&-), fE .Y 4,1 WAS GROUND WATER 1/ ENCOUNTERED? !!!! S IF YES, AT WHAT L DEPTH? O 1Q41 E Depth to taterAfter/P Monilaring7 r-tL ate: Reading Date Gross Time Net Time Depth to Water Net Drop —73a -' o A lrj �r� PERCOLATION RATE 30 (minutes/inch) PERC HOLE DIAMETER r � TEST RUN BETWEEN FT AND FT /� r—. � z- ,� -7- 2 r97 / /.CQ2. PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) rte, a. e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: 91..1L.ER&JE SYSTEMS DATE PERFORMED: LEGAL DESCRIPTION: Mo(ihlMZU PAllt< jnSTfiT ,,Township, Range, Section: SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 /Ill-- I -r' t3i2.0wAi 50A/b`/ WI POCKE i S 01z se WAS GROUND WATER )(E75ENCOUNTERED? S IF YES, AT WHAT l L 0 DEPTH? D P E Depth to Water After Monitoring? Date: Reading Date Gross Time pq Net Depth to Time ,4) Water Net Drop 5.7 10,143 D C! -:5 4 01 Z - u p 01,53 0 14Z 0 u n 0, 53 O 0 1 SS 01/0 /11,03 014-5 0 \. rf ; 03 , 55 0, 10 1113 0 a 557 , �\ ; Z3, 6) , 4G v l r 2J4 o 1 0 55 a bk %/ ', 34 1 f9 1 4'S 20°e��oaa''..\4"� lr ft2C? �\ rr /� f 5g[ /�✓ `a 1,V /Cd �`fFOFES5'0�:;r� y PERCOLATION RATE,I� t I ' (minettes/inch) PERC HOLE DIAMETER /� TEST RUN BETWEEN 15 FT AND FTS COMMENTS 6'046 1209 eAD �i / &$ � ,Bo&m Be TwE/,t/ 3 PERFORMED BY: 100 SHUIZ M 61 Y I 61171 LC_e— CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) a�- GREA I ER ANCHORAGE AREA RORu jGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME K �� It Int /V (V f4=� MAILING ADDRESS �� SOX PHONE,34/q �� LOCATION9n.e. �. i LEGAL DESCRIPTION —L-.?- s F 13K S SEPTIC TANK: DISTANCE its-, NUMBER OF FROM WELL 1=1 MANUFACTURER � MATERIAL 'tf"1..�. I COMPARTMENTS L INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH__ LIQUID CAPACITY /000 GALLONS. SEEPAGES nc.k NUMBER OF PITS DIAMETER OR WIDTH—, LENGTH_, DEPTH LINING MATERIAL CRIB SIZE: DIAMETER —DEPTH-- DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA ('�� SQ. FT. ADDITIONAL ABSORPTION f►`�r�h 3L, W/id�� 3 �QPrh eF lur�l(�1 WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION -,LOT LINE CESSPOOL OTHERSOURCES APPROVED_ DISAPPROVED INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: DEPTH NEAREST SEPTIC SEWER LINE TANK_ REMARKS DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM _ i er S' obi' DATE !tO469/ A2 APPROVED %� G.A.A.B. ` ' . ��1 1 F7- F� L_ 1 -11- o -e F77 ��F--R CA kH': DEPHRTMENT OF HEALTH AND ENVIRONMENTHL PROTECTION 2510 ETUDOR RD./ HNCH8RHGE' HK. 99507 276~2221 p_ IL._ �� (Dr -4--_ 1 F"E-E- EE P. -Il FE: R4 '1 7' PERMIT NO. ( 76400 ) APPLICANT KIRK II-ENNIER SRH BOX 1]95 ]44-844] LOCATION LEGHL L5 B5 MT PK EST #2 LOT SIZE 20000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMLV NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 182 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS� �-IF 1-A= -j� �� 1- E-- � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) 8F THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCAYHTION (IN FEET) THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IN FEET). �R=u ic II. I" EE Fz't-.- Fil P -4'T" ��I Pe F 0,:-- EITHER H CLASS I OR II NSF APPROVED PLANT MHY BE INSTALLED. H CONTINUOUS MAINTENANCE AGREEMENT' IS REQUIRED. IF H MAINTENANCE HGREEMENT ISNOT KEPT CURRENT YOU MHY BE REQUIRED TO ENLARGE THE SOIL HBSORPTIL-IN SYSTEM HND/8R YOU MAY BE SUBJECT TO PROSECUTION. IF H CLASS I SYSTEM IS USED THE LENGTH IS 25,0 FEET. IF H CLASS II SYSTEM IS USED THE LENGTH IS ]2.0 FEET. BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPRO\JAL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 200 FEET FOR H PUBLIC WELL. � WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHrt OF THE WELL COMPLETION. SPECIFICHTIONS HND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTION. I J- IF.:# I_I #---u F- C -D F-'-' P-4 EZ ��F-'! �cg 1'ell I IE" I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET FORTH BY THE 11Uy-4ICIPHLITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ]� I UNDERSTHND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED __ � HPPLICHNT KIRK FENNIER DEP/ ]ENT OF ENVIRONMFNTAL QUA—.Y Case # t 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For Leo Sawyer for Kirk Fennier Dated Performed lune 12, 1974 Legal Description: Lot 5 Block 5 Subdivision _Mountain Park _Estates #2 This Form Reports Soils Log XX _Percolation Test -.Soil Test Must Be Logged To 4' Below Pr000sed Seepage System _ Depth Feet Soil Ch;arartPri(�tirc 1 — Light brown sandy silt SM 2— _ 3- 4— Medium to coarse gravels and 5— aggregates with sand GW -SW - 6- 7— 7— .8- .8- 9— 9- 10- I'D- 11- 1 1- 1 2- 12- 13- 1 3- 1 1 4— Grey clay CH 16 Was If Yes, At What Depth? s� O,o F — — Reading Date Gross Time Net Time Depth to H2O Net Drop vv, a b, vi, 1% CL l.0I'I InU L. (2 Proposed ins tal_lation: Seepage Pit XX Drain Field Depth of Inlet Depth to Bottom of Pit or TrencR 161 COMMENTS: We recommend 182 sq. ft. per bedroom. — Test Performed BY John Jameson Date Certified BY: Date. Kirk Fenner Well Log 0-------------16 ft. Sand & Gravel 16------------39 ft. Clay & Gravel 39------------ 63 ft. Gravel 6,3------------g1 ft. Clay & Grave]. 81------------83 ft. ':'later &. Sand g3 ------------ 84 ft. Gravel & � r \ MUNICIPALITY OF ANCHORAGE b 10 3� 9 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES t I CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY a 17- 023--29 264-4744 Application Date �f ey 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, sub/division, section, township, range) /,:� ti .,:;7—J1/%Tf1 I�6:7 Z�S e Location (address or directions) J,%c2 a /izr re r1AWL Tele (b) Property Owner /s, phone: Home26-St%`� s Business Mailing Address `/?- 6r' -3' [J ,/ lqx)G L- ` (c) Lending Institution Mailing Address_ Telephone (d) Real Estate Company and Agent 7 U N� c Ll �� r:� / /cam -- ov r µ / i Address jFio O /� S % Sal /!tet / `a l Aja- 4 1? �`y Telephone k-7—z� 2 ` % zl, S- 57 (e) Mail the HAA to the followino address: or: Check here, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Engle Rover, Alaska 99577 C''v N 711 c 2. TYPE OF RESIDENCE `i) 11 lee / / Single -Family` `Lr /(M % L3� Number of Bedrooms 2 6,5- 3. ,5- 3. WATER SUPPLY Individual Wel`Community 11 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 S&SENGINEERING Telephone ��Z y % l Address Date I Eagle River Loop Road No. 204 River, Alaska 99577 2 � ✓� .� Pia, 1•SCi# ,2 9CAD 4Foptos r15s1a1A' Note: The well for this property meets existin� and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 4.8 mg/l. EPA maximum concentration is 10.0 mg/l. 6. DHHS APPROVAL p Approved for bedrooms by Date t e 8 Approved x Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 (Rev 81861 Back GHoRAGE MUN,C,QA�tSY �flI�Jl61�OF ANCHORAGE (MOA) wME ' �& H AUTHORITY APPROVAL (HAA) FARC CH CKLIST - FEBRUARY 1984 13 lga� 284-4744 �® Legal Description: R��EIv M 0>JI_� r� a A. WELL DATA Well Classification I YJ 91 \J\ If A, B, C, D.E.C. Approved (Y/N) I -312A, Well Log Presentcl) _ Date Completed \c-i_1C,` Yield GPrt Total Depth Cased tot eA"' Depth of Grouting a tr Static Water Level L2 8 Pump Set At t S Casing Height Above Ground t�%N Sanitary Seal on Casing �! I) Electrical Wiring in Conduita)N) y Depression Around Wellhead (Y/&R Separation Distances from Well ( � To SeptictFte+Eting Tank on Lot � �� ; On Adjoining Lots -j- (�� r To Nearest Edge of Absorption Field on not On Adjoining Lots C>C-) I`� To Nearest Public Sewer Line — To Nearest Public Sewer l-li- Cleanout/Manhole To Nearest Sewer Service Line on Lot 2� Water Sample Collected by �/ ��1� �-Its ; Date 4C Water Sample Test Results Comments B. SEPTICA+GLDMG TANK DATA Date Installed 10- 8"5 Size No. of Compartments Standpipes (9N)Air-tight Caps (/N) — Foundation Cleaa(n'outo7N) Depression over Tank (Y/W Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) (J Temporary Holding Tank Permit (Y/N) Separation Distances from SepticlHoldiag Tank: r To Water -Supply Well To Building Foundation r To Property Line t� To Disposal Field i To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Cours Comments Page 1 of 2 72-026 (Rev. 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata � Type of System Design Date Installed (4v ` Length of Field Width of Field '2A t��, �� Depth of Field u Gravel Bed Thickness Square Feet of Absorption Area I, ce'L>1-A Standpipes Present<LY?N) Depression over Field (Y/6V V---) �� Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1 0� ( To Building Foundation 4 Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Date of Last Adequacy Test ^ Lo ( To Property Line � O 4 - To Existing or Abandoned System on On Adjoining Lots 'moo To Cutbank (if present) A To Driveway, Parking Area, or Vehicle Storage Area __ b Comments D. LIFT STATION / Da� stalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) "Pump Off" Level at _—Vent JY/N) "' Check Permitted Bedroom Rating Against HAA Request "' Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MONS, and jHAA guidelines in effect on the date of this inspection Slgne% & S ENGINEERING DateZ/z.Z, W 17034 Eagle River Loop Road No. 204 ;} ' J Come River, Alaska 99s97 MOA No. � Receipt No. 02- '2 r-41-1 Date of Payment / �� a Amount: $ Page 2 of 2 72-026 (Rev 8/86) Back / MUNICIPALITY OF ANCHORAGE I :: I ,:,I. nu i Or- t' c" RAGE K. or )i,rAUH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIdI rs... DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ` '' NOD OF ON-SITE SEWER AND WATER FACILITY 264-4720 i �, _ r S-€ 1. `., 0 Application Date S 1. GENERAL INFORMATION (a) Legal Des ription (include lot, bbllock,'subdivision, section, township, range) Location (address or di (b) Applicant Name Telephone: Home3ys�� y� Business-�y/��/�'y"�`a' Applicant Address fV�—n (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent — Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Z Multi -Family ❑ Other Number of Bedrooms Telephone 3. WATER SUPPLY Individual Well PK Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State. Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteA Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 rn imalG!Wrt SAD 196)" Address ry €9 V, R ALM Date Telephone ", •�o t'ii8 ^i. *ff% �. Ji+6:E34 n q �''.; y' e Bs em C. a^ .r i 6. DHEP APPROVAL Approved for -,bedrooms by Date Approved ! ,'Disapproved Conditional Terms of Conditional ,Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/64) 11 \. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 n Legal Description: G 5 Q -5– E s- 7' 40:�4_ 2? - A. A. WELL DATA Well Classification if �e If A, B, C, D.E.C. Approved (Y/N) �1 Well Log Present(N) ! Date Completed OG T l9 a 6 Yield "EXCee s Total Depth �— Cased toV Depth of Grouting Static Water Level 7 (6 h� Pump Set At 4,C Casing Height Above Ground ��7 !� Sanitary Seal on Casin (Y N) Electrical Wiring in Condui ON) Depression Around Wellhead (Yo Separation Distances from Well: To Septic/MeH+rg Tank on Lot ��o ( ; On Adjoining Lots /00 To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line A -)1A To Nearest Public Sewer Cleanout/Manhole N 1A To Near e t Sewer Service Line on Lot zs Water Sample Collected by ',f S r~14ee'l , ; Date 66 f 2 -/— Water Sampl Comments B. SEPTIC/MOMMM TANK DATA Date Installed !� 16'SSize /aso No. of Compartments 2' Standpipe N) Air -tight Cap (Y N) - Foundation Cleano t (Y N) Depression over Tank (Y N) / Date Last Pumped Pumping/Maintenance Contract on File (Y/N) �! /1 ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/wank: To Water -Supply Well la0 To Property Line C0 -A To Water /Service Line Course Comments Page 1 of 2 72-026(1 1/84) 6 0 ' -+-� To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage t;4UNICIPAUT, OF ANCHOR/,,G1- -DEPT. OF HEAUH 8, J,i;`Ji�ONrAcAT; .L P,-,CFECT'ON C. ABSORPTION FIELD DATA 110 J Soils Rating in Absorption Strata 2 Type of System Design `S�'�'/��1 e G Date Installed /(J �� 5L A8 S Length of Field r / Width of Field Z Depth of Field <. Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y,9— Results of Last Adequacy Test M — Standpipes Presento/N) Date of Last Adequacy Test X0141 Separation Distance from Absorption Field: To Water -Supply Well l U r To Property Line /0 / To Building Foundation Tom Abandoned System on Lot U r On Adjoining Lots <3C_-�- rf r To Water Main/Service Line L0 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Al r(� D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request'" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed J% ''r[x9El'F [apt t� Date /8 Zo — 85 GRU > Aaffi4Ja12' Company, 1t�� MOA No. v UtReceipt t NO. xr Date of Payment Amount: $ ys 00 Page 2 of 2 72-026 (11/84) Pio. i hr7 [ i� MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: G S Q -S' 1,e��f`r12T Es 7 ec:�_4 Z A. WELL DATA Well Classification (/ �e If A, B, C, D.E.C. Approved (Y/N) Well Log Present ( /N) r Date Completed OG 7- Yield 2�5xCee- f O, S9Dlyi Total Depth Cased to Depth of Grouting --- Static Water Level / /�� 7 Pump Set At u Casing Height Above Ground `7 4hSanitary Seal on Casin(Y N) Electrical Wiring in Condui (Y N) Depression Around Wellhead (Y( Separation Distances from Well: To Septic/Me+d9frg Tank on Lot - �� / On Adjoining Lots lr"?D To Nearest Edge of Absorption Field on Lot 1190 On Adjoining Lots 74 - To Nearest Public Sewer Line 1M To Nearest Public Sewer Cleanout/Manhole A) /To Neare t Sewer Service Line on Lot z5 - Water Sample Collected by 'f S �li�ee�� ; Date /CJ ~ 2-�� Water Sampl Comments B. SEPTIC/k0t=0T= TANK DATA Date Installed `� v�Size 4Z'5C No. of Compartments Z Standpipe N) Air -tight Cap(Y N) Foundation Cleano t (Y N) Depression over Tank (YN) / Date Last Pumped Pumping/Maintenance Contract on File (Y/N) �l ; for Holding Tank High -Water Alarm (Y/N) hJ �— Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/wank: To Water -Supply Well `tea r To Property Line LO -- To Water /Service Line Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage r'iUMCIPAU t C /;�CHO,ZAGc DEPT. C; HEALTH C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 97 Type of System Design Date Installed /4 b �Z_, B3g �Q Len th of Field Width of Field Square Feet of Absorption Area Depression over Field (Ye_ Results of Last Adequacy Test /01? Depth of Field Gravel Bed Thickness 45 o/ Standpipes Present9/N) Date of Last Adequacy Test No441 Separation Distance from Absorption Field: r To Water -Supply Well l d U / To Property Line To Building Foundation __ / 7 O Tom Abandoned System on Lot 1�U` On Adjoining Lots -3O -,X- To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course lub N F To Driveway, Parking Area, or Vehicle Storage Area J` -D Comments D. LIFT STATION Date Installed MAN L 6. j LC, Dimensions A."D 0�-JF Size in Gallons Manhole/Access (Y/N) "Pump On" Level at A "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request " I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. try9 -s i.tt Signed �� s �° ��u:a,[+1� r: iG.. _ Date /1J � Zo — 8 r � i,7tiiL S ��1Vi6 O �i d Oa Compar�y,y,'.:c 1� #ALAV_ MOA No. c�c�Yq 2 Receipt No. Date of Payment Amount: $ 4IS- 00 Page 2 of 2 72-026 (11/84) IWO, °C'y��.a 9 4% 30>5) I ID PUIP & WELL 8537 HARTZELL STREET ANCHORAGE, ALASKA 99507 907 — $44-0732 Date: soZ%�'� I I,ump Type: Contractor: Alz �1 01-y/b� -0/6'F 3nping Level: Job Site: ,+/G /z�1�% Static Level. Legal Description: �� /�aS� Start Time: End Time: TIKE DRAIN UY.1 G.I.M. Ii'. DR4'4 LICMI� i /� ��girONOtRGf R 4 P b ` r u Y t GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 r Date Received October 5, 1976 N 5 3i 3 pP2 d ✓ � � Time of Inspection /,nO nm j 4 Date of Inspection /t)-/,12 -7(„ 0/1, 3 TF tz1 /- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR /YlC/a p — Conv. - 1. Approval requested by: Alaska Mutual., Savings Bank Mailing Address: Post Office Box 1120 Phone: 274-3561 x 217 9 3. 4. 5. 6. Property Owner: Franklin K. & Wendy V. Fenner Phone: 344-8443 Mailing Address: 12240 Ellen Street Legal Description: Lot 5 Block 5 Mountain Park Estates #2 Location: Lupine Drive Type of facility to be inspected Single Family No. of bedrooms 2 Well Data: Individual A. Type C. Construction B. Depth D. Bacterial Analysis 7. Sewage Disposal System: on—site system A. Installed 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 Jam, 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 �MUNICIPAUTY OF ANS DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE LNVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION OCT – 5 1976 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF RECEIVED' INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV xXx 2. Property Owner: FENNER, Franklin K. & Wendy V. Mailing Address: 12240 E.1 len street Day Phone: 344-8441 3. Name of Buyer: none Mailing Ad Day 4. Name of Lending Institution: Al ^ak^ Mill -mal Sat7ing-_ Rank Mailing Address: P- n- Rox 1120 Annh , Au Phone: 974-3561 Px[ 917 5. Name of Realtor or Agent: Mailing Address: Phone: 6. Legal Description: Lot 5, Blk 5, Mountain Park Estates #2 — Location: T nni nP Dri crP 7. Type of Facility to be Inspected: Well 85' & aeriation septic No. Bdrms. 2 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 Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) Page 2 of two pages - Re�� t for Approval of Individual ��r & Water Facilities ' Legal Description Lot 5 Block 5 Mountain Park Estates #2 Comments+w Approved isapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 �Ul61I'y I.IIQ{. I.IIC If11V11IJUUIV11 1V111.0 111GU III 1.111) 1G4uc.]1. IVI uVv'V'UI accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) 444 84. • Municipality of Anchorage t, On -Site Water and Wastewater Program n (907)343-7904 saresv Certificate of On -Site Systems Approval Parcel I.D. 017-023-29 Expiration Date: S 1. GENERAL INFORMATION Complete legal description Mountain Park Est #2, Block 5, Lot 5 Location (site address) 12920 Lupine Rd. Current Property owner(s) Dexter & Jody Moses Day phone Mailing address 12920 Lupine Rd. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Fx I Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNadance request for. Received by: TYPE OF WASTEWATER DISPOSAL: Individual El Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '52 -Po Date of Payment kj il,-H Receipt Number b8Sf? 5 u\ COSA# 0`)dq 145 -Jo Date: �D Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may Fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 9/17/2014 Conditional approval for bedrooms, with the following stipulations: By:Z26�=�Original Certificate Date:/ CJS The M cipa ity r f ®rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheet 5 If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Park Est #2, Block 5, Lot 5 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/9/1976 Sanitary seal (Y/N) Y Total depth 84 ft. Cased to 84 ft. FROM WELL LOG Date of test 10/9/1976 Static water level Well production 10 ft. Parcel ID: 017-023-29 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 8/29/2014 6019 g.p.m. 4.0+ 9 - P.M - WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 9.0mg/L Arsenic' �L ug/L Date of sample:� J.� o tl Collected by: PSS :11.19. t�lliL�]R-971 e]WA l211111175rl Tank Type/Material Septic/Steel Date installed 10/14/1985 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N f Date of pumping Z�- O -A�� Pumper //0-.--t= SP/V)- c if S C. ABSORPTION FIELD DATA Date installed 10/14/1985 Soil rating (g.p.d./ftz or ft2/bdrm) 287 SF/BR System type Bed Length 88 ft. Width 24 ft. Gravel below pipe 0.5 ft. Total depth 4-5 ft. Eff. absorption area 1,817 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/29/2014 Results (Pass/Fail) PASS For 4— bedrooms Fluid depth in absorption field before test 3 in. Water added 456 gal. New depth 6 in. Elapsed Time: 180 min. Final fluid depth 3 in. Absorption rate >=450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / 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 Name Steven R. Pannone Date 9/17/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ CE-8149AV in. Municipality of Anchorage Community Development Department Development Services 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 4 141530 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 5 of Mountain Park Estates 42 subdivision. This inspection revealed a nitrate concentration of 9.09 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.