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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 5 LT 6Mountain Park Estates #2 Block 5 Lot 6 #017-023-30 Municipality of Anchorage 8` Development Services Department Building Safety Division On Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page ( Of www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S VO ocb 0 O"( PID Number: 0 ( ?- — 0 2--7> — 3 � Name: t Wastewater System: El New Upgrade Address: to , ABSORPTION FIELD Phone: Number of Bedrooms: - ❑ Deep Trench ❑ Shallow Trench 0 Bed ❑ Mound j$Other. LEGAL DESCRIPTION Soil Rating: 2.4fr Total Depth from original grader GPD/F(= F t. Block: Lot: Subdivision: G �n L, 00i 4 4 Depth to pipe bottom from opinal grad, 5t' Gravel depth beneath pipe: ' Mpn A �— l + 2 � Ft. z Ft. Towiuhip: Range: Section: Fill added aboveongin Igratl�: t "y Gravel Length: ^ _3V Z ' �� Ft. Ft. Well: [_1 New El Upgrade. Gravel width: (Z Numberoflines: Distance between lines: n Ft. !r FL Classification (Private, A, B, C): Total Depth: sed to Total absorption area: q Pipe Material: 17 Ft. FL J &o Fla Q 3 Dnller. ate Drilled Static Water Level: Installer r^� I Date installer V FL 3 O b YId Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DIST NCES ❑ Septic ❑ Holding IB S.T.E.P. ❑ Other: To Septic Absorption Holding ublia'Private Manutactunef capacity: From Tank Field tation Tank Sewer Line ,,t, 2,, p Gel. well r�: /GV t /GD'� C^ JOff Material: // II r7Y.'Ci` Number M Compartments Z� Surface Water o � fc) LIFT STATION LM Line t tot! ^^ 2Vv'F Sim: Z$D Gal. an urer. %v Foundation 2.P o 'Pump on' level at: _170j6 'Pump ofr level at: High water alarm at: It in. Ztl in. in Curtain Drain / G Pump Make & Model d1� Electrical Inspections performed by: {¢• �� 5— r �+ g�jj Rema` ( l l BENCH MARK Ir ✓`I-�dn - .s r yr rs c Rt A, Location and Description: / rrrr / W Oile4 k Wol(rYV re t1{C 0(k4 r4 tUr H'T✓ •� 'r / 3 I ® t 4- (/old #Z Assumedlevation: too Ft. Dates: let 71 -Nprq ED �k Inspections Inspections performed by: v ,rte Off ..- �� .... a -1j, .2nd 7/�I �,. � I" � G'4•` `0•• ,q� Development Services Department Approval o a ; •: o • - 49*H : t Conditional Approval _Date: 0 #V��. MlCHABL N. ANDERSON e �� �'. CE -9469 ` l Reviewed and approved by: ate:7,2112— 1, P"?£t3"i (Rev. 04M6) Permit No. SWO80091 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 6, BLOCK 5 MOUNTAIN PARK ESTATES#2 SUBD. PID No.: 017-023-30 I ti � 1! \ ��TH#2 # �i� -I �\\�TH i / / I / / / / / / CO LIDS Il y — 11—�I--------- 1\ / 1\ INE 0 BENCH, TOP OF DECK I \\ \�` J,r� AIR PUf P IN GARAGE WAIVER FdR�SEPARATION� 'A-/ _ \ FC k I, AREA FILLED DUE TO SURFACE \�AgE_R_<®\\ i 11 APPROX. CURTAIN DRAIN - - - - - - - II A K q g GRND. PIPE FCO 5 20 99.2 i .5 C01 31 42 96.8 94.1 TC01 33, 45 W.9 TCO2 35 49— 97.8 MT 66 79 99.8 CO LIDS 70 84 99.8 1,250 C IEWN STEP TPNH VAULT -]-.[AENN..E i.N Nq SEPTIC SECTION N.T.S. 561 BUILT ALE: 1"=30' PIPE i r\ OF .. _o.o M 49 TFi RIR LINE..�/ Ngo ® 88 1.25 PVC PIPING iSLRE LRE SM/CM / ••• ;MICHAEL N. ANDEF 3 �1��•nr4vKL-L.L0(.0 ♦IGS• No E9469 wTti/` end. ��i�'••.J��/%/..• 0 r\ i OF .. _o.o M 49 TFi RIR LINE..�/ Ngo ® 88 1.25 PVC PIPING iSLRE LRE SM/CM / ••• ;MICHAEL N. ANDEF 3 �1��•nr4vKL-L.L0(.0 ♦IGS• No E9469 wTti/` end. ��i�'••.J��/%/..• 0 i � / I OF .. _o.o M 49 TFi RIR LINE..�/ Ngo ® 88 1.25 PVC PIPING iSLRE LRE SM/CM / ••• ;MICHAEL N. ANDEF 3 �1��•nr4vKL-L.L0(.0 ♦IGS• No E9469 wTti/` end. ��i�'••.J��/%/..• 0 Munici Anchorage Alaska 9 pality of Ancho Development Services Division On -Site Water and Wastewater Program Ment Q... �Mtm,�n Y�'Depart **** VARIANCE/WAIVER REVIEW **** Waiver#: 0SP121041 COSA#: Permit#: SW080091 PID#:01702330 Legal Description: Mountain Park Estates #2 Block 5 Lot 6 Engineer: Mike N. Anderson Applicant: Barbara Maier Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the absorption field has been approved. The approved separation distance is 4 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ...................................................man......................... Waiver is Granted: X Waiver is not Granted: Date: Approved by: Ll Name of Reviewer .................. ooman................... Room ................ .............. Rec#: 142078 Amount: $200.00 Date Paid: 5116/11 **** VARIANCEIWAIVER REVIEW **** Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 May 16, 2011 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Mountain Park Estates Blk 5, Lot 6 To Whom it may concern: This is a request for a waiver between the new and old beds. Due to the existing well radius, the small lot size and the not being able to used the easement along the north property line the separation distance between the existing and new beds cannot be meet the minimum separation of 10 feet or twice the gravel depth. Justification for the waivers is we have no option except a holding tank or the Sand Filter system. A conventional system will not fit into the remaining area outside the well radius. None of the neighboring lots will be impacted by this new installation. If you have any question please call me at 727-8864. Sincerely Miche N. Anderson, P.E. Zoo 14 Z07 L f="F�4i�rnf wv(( r"�taS, (AJcI� nVi ir�P0..r�' n� Sg61n-,� Zoo 14 Z07 0' 25P PR0[1:Er'S ELECTRIC INC 27^c 95900" 70%345IJ9r inspection Report Municipality of Anchorage, wilding Safety Division 4700 Elmore Road INFO R HELP (907) 333-3211 INSPI?CTION VOICE (907) 343.8300 - FAX (907)249.7777 - wNw,muni,org Name eds Mac Permit # 08.8191 company tnspeAtion Date 18 -Jun -2008 Address 12940 LUPINE RD phone 272.4591 Grid SW2A39 Subdivision MOUNTAIN PARK ESTATCS LOT S SKS TR n!q #2 Work Description septic lift stabcn Permit Technician DAY, J4NNY R. Comments or Dlrectlone late am early pm call to meet Inspection Type EleetrlcaI:0Ihet Electrical Comments (for'Aspector use only) tzot Baa w=t �Ai. 4 C V RCY-J Ste. P.] inspECRor 1�iRF ��1 Date 4P MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO80091 Legal Description: MOUNTAIN PARK ESTATES #2 BLK 5 LT 6 Design Engineer: 0088 ANDERSON CONSTRUCTION & E Owner Name: BARD MAIER Owner Address: 12940 LUPINE RD ANCHORAGE. AK 99516-3225 Date Issued: Jun 23, 2008 Expiration Date: Jun 23, 2009 Parcel ID: 017-023-30 Site Address: 012940 LUPINE RD Lot Size: 20130 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 0 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. dWr and closed on the same day. B. Covered, sealed, and heated to prevent freezing...__ 5.'The following special provisions. SEPTIC FIELDS BUILT ABOVE GRADE MUST HAVE SIDEWALL REINFORCEMENT AS NEEDED. SAND USED SHALL HAVE LESS THAN 2% PASSING THE #100 SIEVE AND LESS THAN 1 % PASSING THE #200 �1 SIEVE. A GAUGE AND AN AUDIBLE ALARM MUST BE ADDED AFTER THE AIR COMPRESSOR TO HELP ENSURE THAT WHEN THE PUMP GOES OUT, REPAIRS WILL BE MADE. THE ALARM WILL BE ON A SEPARATE CIRCUIT. f' j a` Received By: Date: • = ': LG w,�ii Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519.6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. aT- ^ 023 —r3 0 Propertrt Mailing Site address Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size d 100 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage u phone :ode 99%6 Code %? # Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade 7- Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: J4LT Waiver Fees: Date of Payment: Iq S + O Date of Payment: Receipt Number. 10762_q Receipt Number. (Rev. 11/05) Michael N. Anderson, P.E. CivillStructural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 3,2008 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Blk 5, Lot 6, Mountain Park Estates 92 Subd. REVISIONS II Tax Id. 017-023-30 To Whom it may concern: A second test hole was excavated in March 08, the soil log and perc were the same as the first test hole. Water level was at 7 feet, however during the spring thaw the water increased to 2 feet. The entire sand filter has been increased to 36 inches of sand after the organics have been removed. Checking the MOA records show water at 6 to 9 feet on the surrounding lots, however during excavation of the tank it was discovered that the water table is very high, why I don't know. To protect the ground water and keep the system dry we will raise the system. The top of the system will be mounted up to blend with the raised ground to the north for positive drainage. All of these changes have been revised into a new drawing for your review. If you have any question please call me at 345-3377 Sinrely Michael N. Anderson, P.E. Michael N. Anderson, P.E. CiviVStructural Engineering R Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 April 29, 2008 Municipalities of Anchorage Departments of Health and human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Dlk 5, Lot 6, Mountain Park Estates N2 Subd. Tax Id. 0 17-023 -30 To Whom it may concern: This is a request for a new septic permit on the above referenced lot. An intermittent dosing sand filter has been selected by the owner, due to cost/maintenance issues. Two test holes were excavated along the north property line, which showed silty sandy gravel for the full test hole depth of 10 feet, with water observed after the 7 day monitoring period at 6 feet in the first test hole (October 2007) and 7 feet in the second hole . The perc rate from both test holes was 8 minutes per inch. We tried to get a waiver from the utility companies to move the sand filter parallel to the north property line, to keep the bed as high as possible, but this was denied. Now the sand filter is located in the only spot possible due to a high water table and surface water to the southwest, possible out fall of the curtain drain. Previous to my investigation another engineer had excavated a test hole near the southwest comer, this was all rejected due to high water table and the existing curtain drain, see the plan. The lot has a gentle slope of about 3 to 5 percent from the east to the west, as shown on the plan. There are no cut banks within 50 feet of the existing or proposed systems. The neighboring lots to the west are served by community water and will not be impacted by the new addition. The other neighboring lots have not be impacted or affected by this upgrade. If you have any question please call me at 345-3377 Sincerely, Michael N. Anderson, P.E. Z , MOUND OVER DESIGN CRITERIA: GRADE 3 BDRM X 150 = 450 GPD (TH82) (THpt) +0.0 SOILS = 450/1.5 = 360 SF 3'g0114. \q�, 360 SF/12 = 30' V15ORG -1 U ORG o -0.5 ' "i�ILTER FABRIC W/ INSULATION (1) 12' WIDE SAND BED -2.0 (H020) -2.0 (H2O) 12.0' 1.250 PIPE 2.0' DEEP 36' OF WASHED 0.5' EFFECTIVE SM/GM SM/GM FILTER SAND 12.0' WIDE 30' LONG -10 -10 i LOT SERVED BY WATER ICOMMUNITY CO MUNITY WATER WLL -LOT 4- LOCATED OVER 400 I FEET NORTH WEST -LOT 5- PROPOSED DRAINFIELD EXISTING SEPTIC DRAINFIELDA` EXISTING WELL, _I TO BE ABANDONED -_` �% I ' tOEI' RADIUS PROPOSED SEPTIC TANK 'LOT 6 - WELL' I i EX E R6OM HOUSE, m ING(3 B LOT SERVED BY COMMUNITY WATER LINE NO SLOPES > THAN _, 25% WITHIN 200' I I• o i I 1 o' NO 200' -LOT 7- LOT SERVED BY�`.� z i COMMUNITY WATER / - �tf___ �' -LOT 8- M / J� I Septic Design Prepared For •,,,,♦♦ ��..........•�Qp1♦♦ BARBARA r[AIER �.��OF �P LOT 6, BLOCK 5, D[OUNTAIN PARK ESTATES #2 Lj.. T9 = Anchorage, Alaska 4L:' 49 n, ! % 0 Prepared By .....�.......y^ ..jf ......... •:.....� /....'•,l•l lhr7.:S.10 MICHAEL N. ANDERSON, P.E. I ';MICHAEL N. ANDERSON:% 4661 NATRONA AVENUE ♦♦�� ° (907) 345-3377 /FAX (907) 345-1391 No. CE 9469 ♦♦J� .. ... ♦ "y� • ♦♦1♦♦\����� SCALE: 1"=100' JUNE 3, 2008 l �I �\ EXISTING WELL 1 -'� 100' RADIUS / 1 SEPTIC BED AREA` W , i a P50'OSED 12.0' X 30.0' a SAND FILTER W/ AIR LINE i -LOT 5- v � LOCATED BELOW SAND �n LINE r Ij ; MT 3-57. SLgF EXISTING\ I DTANK rg^N rct ev EXISTING i \ GRAINFIELD TO I BE ABANDONED ---- ax I \ I f— 3-57. SLOPE NEW 1250 GALLON STEPS TANK DOUBLE CO ------ I 1 I 3-57. SLOPE �� 1 �X{STING DECK II, �P\N oa�te i ,, TEST HOLE BY OTHERS AePg Y ; 3-57, SLOPE SLOT 6- -LOhj - EXISTING WELL�� ' 100' RADIUS �\ Septic Design Prepared For BARBARA MAIER LOT 6, BLOCK 5, MOUNTAIN PARK ESTATES #2 Anchorage, Alaska Prepared By MICHAEL N. ANDERSON, P.E. 4661 NATRONA AVENUE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=20' JUNE 3, 2008 FCO 10' UTILITY EASEMENT AIR PUMP LOCATED IN CRAWL SPACE 3-57 SLOPE EXISTING 3 BEDROOM HOUSE 'aE 49TM AEL N. ANDER No. CE 9469 FA Performed For: Legal Description: Municipality of Anchorage Development Services Department Bulling Safety DivWon On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196050 Anchorage. AK 99519-6650 www.cj.anchomeak.us (907) 343-7E04 Soils Log - Percolation Test �tiaa� �A i h: '• jif i'/t� 49TH r ( ��• MICHAEL N. ANDERSON .•� CE - 9469 Date Perfonnod: opt fn.r,l M.Ls- -- L1, t G 61k,5' FIe t e� na. k_� Zownship. Range. Section: Slope T h t f -T -FT -1 fI I I- 17- 18- 19- 20 - WAS GROUND WATER ENCOUNTERED? 5 f L Pj0 tient IF YES. ATWHAT DEPTH? �_ D #A, Depth to Water After r p / I `` Monitoring? _,Cl_ E !i DaW / /D n COMMENTS . /A 4-C- Readng Date Gross Time Net Tune Depth 16 Water Net Drop r PERCCLT�—� Lr- ;lesuwol PERC HME DIAMETER fD 'r ;EST RUN BE,"-NEEN 2 FT AND FT PERFORMED BY: Mrz Le, ( &( AJ C440" t CERTIFY THAT THIS TEST rrWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: v"i opt c s 1 2- 3 - 4 - 5 M� 5- 6- 7- 17- 18- 19- 20 - WAS GROUND WATER ENCOUNTERED? 5 f L Pj0 tient IF YES. ATWHAT DEPTH? �_ D #A, Depth to Water After r p / I `` Monitoring? _,Cl_ E !i DaW / /D n COMMENTS . /A 4-C- Readng Date Gross Time Net Tune Depth 16 Water Net Drop r PERCCLT�—� Lr- ;lesuwol PERC HME DIAMETER fD 'r ;EST RUN BE,"-NEEN 2 FT AND FT PERFORMED BY: Mrz Le, ( &( AJ C440" t CERTIFY THAT THIS TEST rrWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: —oF nr eS 1 4_ Si"ff ,,A 5- Clpq 6- 6 WAS GROUND WATER ' ` ENCOENCOUNTERED?NfERED7 9_ 1 (2j �0 y� �ep., ' L 10- •� IFYES.ATWHATOEPTH? 0 �jt v Depth M Water Alter P 11- Monitoring? E 12- Dale: 3 110—' 13- COMMENTS Reading Date Gross Time Net Time Depth ip Water I Municipality of Anchorage 467 "'" "" •v - Development Services Departmentk;� Building Safety Division Wastewater Program 49T �� ' • • ' 0 . "' Mat..'. on -Site Water and /:... 3r73' it (y 3.-7 S 47110 SWUI Bragaw $L P.O. Box 196650 Anchorage. AK 99519-6650 70 • MICHAEL N. ANDERSON r �'. CE -9469 •``�% • i t www d anchoraoe.ak.us (907)343.7903 ,/f.. y\ f�"•. •``'`epi Soils Log - Percolation Test .h 2 __Date Per;oM: As ell Zy0� 60r �)AP I``(m Ur'er Performed For. Legal Description: �• �+ n ITL Nip•^ E� C"r�' tE 1— Township. Range. Section: Slope Site Plan Depth t�2 o4ytaa•L r s nr eS 1 4_ Si"ff ,,A 5- Clpq 6- 6 WAS GROUND WATER ' ` ENCOENCOUNTERED?NfERED7 9_ 1 (2j �0 y� �ep., ' L 10- •� IFYES.ATWHATOEPTH? 0 �jt v Depth M Water Alter P 11- Monitoring? E 12- Dale: 3 110—' 13- COMMENTS Reading Date Gross Time Net Time Depth ip Water I Net Drop T, n Per ec,. 3/9f 6„ 3r73' it (y 3.-7 S PERCOLATION RATE TEST RUN BF—I KEEN (rm:bsSnct) PERC HOLE DIAMETER L/ FT AND L FT PERFORMED BY: 141,/ T 1f C—• ( CERTIFY THAT THIS TEST AS // PERFORMED IN ACCORDANCE WITH ALL STATElNND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6 i� O ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND TRIS MEMORANDUM OF UNDERSTANDING made and entered into as of this 2-4 Day of M of 20 0,S, by and between $n r h e+w Mjj, �, • > herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as %Alr•,,., 4..--4- kv located at 12.9x40 �tiP h G , Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AW WTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AW WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of (S_.00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWNVTS Operating Permit is: C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AW WTS is the governing professional guidelines for the construction, maintenance and repair of the OwTer's AW WTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: By: Z k/ J,44-- Date: V -P yfOg STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: By: Title: Date: ) ss. The foregoing instrument was acknowledged before me this V4 day of AAori. 20��, by'&7,6o,i w,— _ , the ikYO V2C lab 0�,sr� ✓ auwl �.���►►7EW��'�i� fARY PUBLIC FOR AL S ��.�� + ""... My Commission expires: % 2`1 I/ �OTMq . J Q OF 1111111110" MUNICIPALITY OF ANCHORAGE - MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL F"OTECTION DEPARTMENTENVI 119 81 I. ONMENTAL ENG NENVIEEERINGNTAL IVISIONPROTECTIUN J �� 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTI*KFW E NAME PHONEE ('y'07) 1 IF4NEW ❑UPGRADE MAILING ADDRESS P®, 19ox AK LEGAL DESCRIPTION L of- /%E LOCATION LtAir►e� 7t4 Lot NO. OF BEDROOMS r fvge. Well Absorption area Dwelling PERMIT NO. Uy DISTANCE T0: , (-)OL Z az Manufacturer Materi I No. of compartments W � Liq. capacity in gallons ��j IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling PERMIT NO. JUZ 2 z F_ Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well . Foundation Nearest lot line PERMIT NO. W = �Ll J W Z No. of I es_ Length f each line Total IFngthlf li es Trench width Distance between lines BZW � inches Top f the to finish Material bene h cct- grade = 1 4- 2 tile Total effecti a absorption area Z o inches 7 Lengt6 Width Depth PERMIT NO. Lu C7 CL F w� Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well BuilclOv foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. W R63k. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER r PIPE MATERIALS SOI L TEST RATING INSTALLER REMARKS Z44 4tx 17 � o _±FT1 APPROVED DATE LEGAL �j IY /2-U 13 I Hev. 3118) NICIPALITY OF ANCHORAGE Department c,� Health and Environmental _..otection s 825 L Street, Anchorage, AK. 99501 264-4720 1�(? r�Cr # # # HANDWRITTEN PERMIT # # # WELL AND ON-SITE SEWER PERMIT Applicant: Mailing Address: Pd tai to - 13yj Location: Ll La .'Int//'J Phone Number: Legal Description: Vim$' %tli� %�,s,�� �[� Lot Size: �ppa o Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: XHolding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) 4S0 The Required Size of the Soil Absorption System Is: d DEPTH LENGTH GRAVEL DEPTH+��+� A WIDTH % O'd5 The length dimension is the length(in feet) of the frencYttoor drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS # # 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. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a 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 this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedroo Signed:�— Issued by: Date: (/ SWP/024(1/81) / ALASKA R ROWnTAL COnTROL SRICCS, InC. l3n9ineering & l3nuironmental Studies SPECIFICATIONS FOR SEEPAGE BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM— LOT 6, BLK 5, MT. PARK ESTATES #2 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 2.0 LIFT STATION (NOT USED). 3.0 SEEPAGE BED 3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 1.5 INCH AND RELATIVELY FREE FROM SILT OR SAND. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2". 3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF REGULAR PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN— CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE PIPE. 3.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC SUCH AS MIRAFAR FIBRETEX 200 GRADE, OR POLY—FILTER X OR EQUAL. 3.6 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE THICKNESS SHOWN ON THE DRAWINGS. 3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 1220 West 25th Auenue • Anchorage, Alaska 99503 9 (907) 276-1361 ~� 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: !/ 4 3 67 en e!>. / _/ / DATE PERFORMED: LEGAL DESCRIPTION:�� �P/OcLJ %1%f ��/ �\ST2J z• DEPTH SLOPE SITE PLAN ET 1 2 sv/ Sa a wr - 3 r 4 e . d 6 5 c 6 t 7 S 17-' C�L� 8- 9- 10- 11 91011 12 13- 14- 15- 16 3141516 17- 18- 19- 20- COMMENTS 71S1920 COMMENTS (I 1--P ke PERFORMED BY: 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S (f S L O P E eft Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) FT AND FT DATE: 60 �O r ALASKA ENVIRONMENTAL CONTROL SERVlr� , INC. 1220 West 25th , ,Ue ANCHORAGE, ALASKA 99503 Phone 276-1361 Ko T2w_1 yes W.W.' Wu oi<so SHEET NO. CALCULATED BY—&e .. DATE____//_ CHECKED DY DATE�S2� "C'f , SCALE Ko T2w_1 yes W.W.' Wu oi<so r-. PENINSULA ENGINEERING w s' 7' v CL CL LU o FZ/ 20 TEST HOLE LOG PROJECT: PI—e-7 LOCATION: I—e- LOCATION: 6J/oC�S )*17 v PARK �ff,5r rf�5 ! SOIL DESCRIPTION TEST HOLE #: 6 P4RK ?32awN aQ, F}A covcr2 l..l Ci4-r 6REC 5'/IA/Dr -51L.7- C ,ti 4-) 12 " 1.4YcR 4�v'J L -I GfIT a {BEY S/46v -oY c,L/iYh Y 5/L1 (v),����� ,E /Y n 1-16 /-,e REMARKS: `%�� e f �o �e c r�m� A c_cc �C, d o iv 76 ��eLs ' C:. r- Al e -1- -// 2 /� t 6 , ,/ -776 c� �t /. JJ //� / klerNa`, C �u..lti'^� �JJCJ /5 6-n 14 1� .1 0. v e- lT-� e �' T tf//'//�' W ca -S 2 YiC U c<,+�'f 2 e- cl I� 1-2- LOGGED 2LOGGED BY: W e-mC\ D I-- ( Ye v o -yl . �i XHIS /T /� PENINSULA ENGINEERING TEST HOLE LOG LL u 2 F- a w a PROJECT: E ` 7 LOCATION: '� f G / (�Alc'If jvfl v. Park- gf5 / i/-e�5 SOIL DESCRIPTION TEST HOLE #: 0 -PdRK BRow v eiQGAiUlc Covc2 1-1614r w?owIv/g}f :c-Rjffr 5ArvPK 7` civ A Ho 4.6 20 REMARrK�S: %1 uT 4/ //A t' J2 � s 7/ ✓ter nV / � y /give . I 1�Y ud � c �? CL S cc 6 a ,. c4a-pxee. � wI iW�t yr Vt-0m-5 c/ 1CovCif 4p c`Y- fee- !. LOGGED BY: ti f A*-� 14-. d ee sn N, PENINSULA ENGINEERING TEST HOLE LOG PROJECT: Fl -e-7 LOCATION: j"r'-t- Z' /f3/o c {r .S tpl-41V ki �STT�ti a SOIL DESCRIPTION TEST HOLE #: Af- 0 p9KK �?2ow/v GI+AJIL CDV)S-A2 L./GNT" BROWN-A/Vni' (M/-) Z w R rc r2 Tri 6/-.0 .3 ,E'n! 1a Ho t.c 20 REMARKS: V%z 5 f /k Xe— a✓a,0 si c�e 0--14 6 W 2E,�/ v�fr-y �;�� . V � unci;,..,' /r Lort'Tlr' wn.5' '�oct+� A e � r �_ /i o /� w a u rt b o- Clem .I d. I n. Ivo 15 awNr�L"�/�/—. ex Fifa s(�i rr0,cL. d6L4j �oryGtMd 'tel Oar ��� 4:2 a-4 ia�Q LOGGED BY: of cxw e- t Lz y` l p--kSD r-- "t/' 1B / /-'-X/-//3/T "/; MUNICIPALITY OF ANCHORAGE • MEMORANDUM �/J R Date ✓ / 19 r+ 1 To: From: ./% £ ✓' Z Re: LO T v j/ -11 Signed 91 -015 -(Rev, 1/81) r ALASKA RU11�011�1 NAL COnTROL JtrI�U100, II t��LITOYFOh Ai Ti RAGE �ngineerinq & 6ironmental Studies ENVIRON✓,ENF ;;,i ,TCTION 'J t Mr. Rolf Strickland RECEIVED Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Dear Rolf: As requested by Jim Roberts I went to Lot #__Block 5 Mt. Park Estates #2 to invest in the problem of water in the seepage bed. Inclosed is a copy of the on-site inspection report. This system was put in approximately June 30th to July 2nd 1981. The location of the test holes are marked on the inspection report. Also an additional copy of the elevations of the various water level is included. We checked the distance from the well to the sewer system. And the system is well beyond 100 feet from the well. As you can see the diagram the water level to the south of the bed is some what higher than the water in the bed, to the east of the bed there's no water to minus 12 feet. To the west of the bed the water level is approximately.1.2 feet lower than the bed. Also to the north the liquid level is approximately half a foot lower then the liquid in the bed. It is my belief that the water which has flooded out this bed has come from the area to the south of the house. On September the 20th 1981 a curtain drain was cut from the corner of the house toward the south lot line and then parallel to the south lot line to the power easement. The curtain drain intercepts the gravel seams that were substantially higher than the bed. The elevation of the water confirmed the drill test conclusion that water was going into the bed from the south. The curtain was completed and taken to the power line which terminated approximately 2 foot below the ground surface. At this point gravel was piled over the end of the pipe and a drainage ditch dug through the power easement. The ditch was producing approximately 10 to 15 gallons per minute of water by Sunday afternoon at 2:00 o'clock. On Monday noon September 21st the flow decreased to approximately 5 gallop per minute but flowing very clear and cold. The level of the water in the stand pipe had dropped 11 inches since Sunday at 2:00 o'clock. We also investigated the damage done by the electrical contractor in placing the power lines across the sewer system. We come to a conclusion that this was insignificant as they had only done a very minor amount of damage to the insulation. In my opinion this curtain drain has solved the problem 1220 Test 25th Auenue 9 Anchorage, Alaska 99503 • (907) 276-1361 of the water going into the system and I see no reason not to hold up approval for the house. Sincerely Yours, Ler<C.d Jr., PhD. PE President FROM: ARCO ALASKA FAX NO.: 9072656224 -> rvavu I Qn Wlw 1 �1 • 1 I&/ t, 7 Ipdpe4 v To J prom SECTION TOWNSHIP, Co./Dept. Co. �4Ug Pho-e a Pho"e a C 714 Fax a Fax Ft 12-23-97 01:54P P.01 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD BOROUGH 1 ON LOT BLOCK SECTION CTRS SECTION TOWNSHIP, RANGE MERIDIAN �4Ug [IN ❑ E ❑s Ow LOCATIONISKETCH: WELL OWNER: 111 � DEPTHS MEASURED FROMAasing top ❑ground surface WELL DEP H: DATE OF COMPLETION Depth of hole -ft BOREHOLE DATA: Depth Depth of casing;_ ft Material Type and Color From To )� � // DEPTH TO STATIC WATER LEVEL: (r(J[1JFi ft below Ll'top Of Casing ❑ ground Surface ZDate: METHOD OF DRILLING: IN -air rotary ❑ cable tool `�f ❑ other USE OF WELL: J;R'domestlo ❑ irrigation ❑ monitor 6 f � ❑ public SUDDIy ❑ other ,�(� ,ey % g CASING STICK-UP: ft- Diam! in- to -Z&14( 7,—.n -4 p Casing type: to jr WELL INTAKE OPENING TYPE: ❑ open end Cl screened �Q '&perforated ❑ open o e � !p y//�}tJ&B.a Depths of openings: ,4ce to "�.? ft i�ypL( SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft /1 GRAVEL PACK TYPIS; 11 J0 I c Volume used: Depth to too: GROUT TYPE: Volume: Depth: from ft to ft DEVELOPMENT METHOD: Duration: JAN Z PUMPING LEVEL AND YIELD: a ft after hr5 pumpinq_];_6.jr gprn Dept. Healt& Human Se h C@s PUMP INTAKE DEPTH: . p L ft Horsepower: WELL DISINFECTED UPON COMPLETION? Q YES 0 NO CONTRACTOR INFORMATION: , REMARKS: Regis ed By�s� s,NiLrtie � , 7 ignature of Aut Onzed Res Date esentat+ve PLEASE MAIL WHITE COPY OF LOG TO: ONRIDIVISJON OF MINING & WATER MGMT 3601 C St, Suite SOD ANCHORAGE AK 99503.5935 Phone (907)269 -9639,r -ex (9071562-1304 ..-- n I . ✓ Wei I Log For.. C•C`.....................`..........`.................:..................................... ................................ C� Le rdLt, f6.�2 +GTS C Location..... L`�'?...... '...�....�' L ..:..... ...:.......................................�................. Date completed........ .1..` r?...1 .�............................................I...... Depthof well.......... .' . i........................................................................................ ....................................................................... Size of casing................................ ..... Distance to water.. (j. •••. .�.. �_r� I ......... Distance to water while pumping ........................................................at rate of..............�.......................gallons per hour. Formation ( from I to I r, v -% to J oc6zz '`� .........................................riIIer DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 MUNICIPALITY OF ANCHORAGE ® Department of Health & Human Services y1e j DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 017- 0=00--zo HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) or 6 Al K�6_ M 92ARMA I W IBA R rE STA 1 J12, Location (address or directions) M940 Lupi IIF A n"AL 995149 (b) Property owner 13E'7"'f'&ALAS Telephone: (home) 3 � usiness Mailing Address 12140 U'j oliva A M l-4- r13.45%4o (c) Lending Institution IV Telephone N' 1A Mailing Address (d) Real Estate Company and Agent Address -1 Telephone (e) Mail the HAA to the following address: (or check here7jf hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Number of bedrooms 3N.- Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site} Public ElCommunity ElHolding Tank ElNote: If ccYmmunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 G }o 3 abed DOUG (80/L A08) SZO-ZL •�aoM s,aaauibue leuolssaloid agl ul suoisslwo ao saoaaa aol alglsuodsaa lou si a6eaogouy }o Al!ledioiunW ayl'panssi si aleollpao a aaolaq elep azAleue ao suolloodsui lonpuoo lou op SHHQ to sooAoldu(3 •sluawaalnbaa alels pue leaapa; uleliao Alsiles of aapao ui suoilnl!lsui 6ulpual aiegl pue sawoq to saasegoand of /solinoo a se slgl saop SHHQ 9g1 Te sely to alelS agl ul p8aa1sl6aa Jeouibuo leuolssa}oid luapuadapui ue (q anoge g gdea6eied ul uaA16 suoileluasaidw agl uodn Aluo paseq paleoilpoo lenoaddy Aluoglny g11eaH sanssi (SHHQ) saoiAaaS uewnH pue glleaH to luawliedap a6eaogouy;o A!pdioiunw ag1 • leuoll!Puo0 lenoaddy leuol}lpuoC to swaal panoaddesia - panoaddy Aq su�ooapaq ao; panoaddy 6� �' pw-oq 'I'dAOaddb SHHQ '9 leas s,aaaul6u3 v c CiAF � �• L 4t11r [ � c7 °. L. P1 !C ssaaPPy euogdalal S I Wald do aweN •uolloadsul slgl to alep agl uo loa;la ui suollelnbaa pue 'saoueulpao 'sapoo alels pue ledlolunW Ile t4j!m eouelldwoo ui sl walsAs lesodslp aalemalseM ao/pue Alddns calm ails-uo aql 'uolloadsul pue u011e61180nul Aw woal pue salll 96eaogouy ;o (llledlolunyq agl woa} paulelgo uo!lewiolul ag} uo paseq legl A}uaA aaglan} ! •ulajag paleolpul eAnlonals }o odll pue swooapeq;o aagwnu agl aol alenbape pue Ieuolloun} 'a;es sl welsAs lesodslp aalemalsem ao/pue Alddns aalem alls-uo eql legl smogs lenoaddy Allaoglny glleaH slgl to uolle5llsanuI /w legl A j!JE)A ! Wolaq uMogs alep uo!leP!IeA aql}o se pue olaaag paxige leas Aw Aq pailpao sy NOIldWFiOdNI ON`d V 'd0 `HOkid3S 3-1Id `S1S31 `SN01103dSNl JNIaIAOdd Wdid ONId33NION3 '9 J.�0:Q\,\S\ �;i\C�' MUNICIPALITY OF ANCHORAGE (MOA) 1 t 1 • T Health Authority Approval (HAA) � t CHECKLIST - FEBRUARY 1984 343-4744 dI1f15 Legal Description: �-- 0-r (> RL K_ l P A. WELL DATA -� Well Classification /- C) Ize 4e If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) N Date Completed I 1 N L LICu' i�( Yield -5- Total Total Depth .2 �� Cased to JADepth of Grouting OM K.Nc)ccli'l Static Water Level Pump Set At rix ((r-AX9cJW Casing Height Above Ground j /i Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) K1 SEPARATION DISTANCES FROM WELL To Septic/Holding Tank on Lot 9s- ) �(; On Adjoining Lots -�7' 1 G'n To Nearest Edge of Absorption Field on Lot loo, ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot x/-70 r Water Sample Collected by J E �' f� ✓ P_t' S 5' ; Date Water Sample Test Results I Comments � lniu l ve! B. SEPTIC/HOLDING TANK DATA Date Installed / `» ( Size ), « No. of Compartments Standpipes (Y/N) YAir-tight Caps (Y/N) y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) W Date Last Pumped -2/a 1% J .Sf} cs' Pumping/Maintenance Contact on File (Y/N) A ; for %f //q Holding Tank High -Water Alarm (Y/N) NJA -Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: _i To. Water -Supply Well ��S To Building Foundation To Property Line 3 - ' : To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course U //-t Comments' /L41 bl&_ 4C) Ie! 9 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata <i s-• Y,i�n� Type of System Design Date Installed &/Length of Field / / / � 4) -K Width of Field f 7 X 44- Depth of Field 4 Gravel Bed Thickness % X Square Feet of Absortion Area sP `� k Statndpipes Present (Y/N) r Depression over Fi( Date of Last Adequacy Test 2 , &I0 Results of Last Adequacy Test SP- r/S 1�',NCLLOCY �sf G'c.C_ Li Pi e c. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well jC� /+ To Property Line r'O To Building Foundation �O ` To Existing or Abandoned System on Lot �)T1� ; On Adjoining Lots Z« t To Water Main/Service Line To Cutback (if present) ] q To Stream, Pond, Lake, or Major Drainage Course M %A To Driveway, Parking Area, orVehicle Storage Area // Comments l- ('/- 141,ic-r 04 / A-,' - Su, /+ D. LIF STATION Date In alled Size in Gal ns "Pump On" Le el at High Water Alarm evel at Tested for Meets MOA Electrical Co Comments *'Check Permitt d Bedroo I certify that f b eec eck d, inspection. Signed Company Date MOA No. KI // ,- (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Against HAA Request*" d, or conformed to all MOA and H Receipt No.�/lo������ / Receipt No. — Date of Payment _ Waiver Fee: $00 _ Amount: $ 7 -�� _ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 gtAc��lO"911 in effect on the date of this a r..,_ Engineer's Seal J„., . is -, .-- 1%;"; PROJECT: 1 % > > T Ai`K L� S1fd S DATE OF TEST: LOCATION OF WELL (Legal Description): 4IELL DEPTH: (Zv t FT. CASING: F T SCREEN: DATE ORILLIIIG C0:-iPLETEO: DRILLER: STATIC �IAT`cR LEVEL (Top of Casing): 6z I FT Clock Tine apse( lime Since( Pumping Started/ J Stopped, Nin- j Depth to Water, ft. Ora.idown/ Punping Recovery Rate, GP:4 Renarks i 0 ZI Swl 0 0 Start s s 10 PROD VM I I� 1rc. cmm Va. 01471 LEGAL `CORWIN & ASSOCIATES, INC. 1000 E. Dimond Blvd. ANCHORAGE, ALASKA Suite 205 99518 CALCULATED BY (907) 522-1311 DATE. CHECKED BY DATE -ADEQUACY TEST -tta GALLONS SEPTIC LEACH . . . ..... .... . ......... . ....METE..R.... ...M41S..... ............ ....... J.T......O.....TAL ............. TANk FIELD. TIME READING PERIOD GALLONS GPM DEPTH DEPTH . . DEPTH .. . ..... . .... . 0 .......... ......... . -4 . ...... F .......... . . .................. ............ . .. . ......... .......b .. ............ J5 . as 1.06 ............ . ..... ......... .. .... A .. - ...... . .. . ------- ...... .......... 44 3 IZJ� . ...... .. . . . ....... . ...... ........... . . . .... 170 60 .. . ...... 3. .. ... .. ..... z . ....... 1432-1 ..... . ....... . ... . ......... . ..... . ......... .. .... .......... .......... a:._-6 . . . . ...... 3--s s34_ 3z- ......... .... . .. ........ _7._i_4 . . .. ........ ...... .... . .. ............ . ........... .......... ...... ....... ..... .. . . .......... . .... .. ........ . ... .. ...... .. . . ..... .. ........ .......... . ... . . ..... . .... . ..... ... ....... . . . . ......... . ...... . . . . ....... . .......... . ... ........ . . . ....... .......... ..... . . . ............ . ........... . . ........ ............. . .. ..... . ..... ..... . ... . ........ . . . . ....... ..... . . ...... ..... .. . . . . ... ...... . . .. . ...... - .. . ....... . ....... ... - - ........ . .. ........ .. . - .. . ...... .... ............ - .... ..... .. . .... .... -4 . . ......... ....... . . ..... . ... ...... ..... ... . . ... ... . .. .... .. . ...... ........ .. ...... . ...... .......... . ...... ...... .. ... . ... .. ...... .. . .. . ............ .......... .... . .... .. .. .. ...... - ........... . ........ .. ............. .......... . .......... ... . . .. ............ ... . . ...... .. . .. . .... . ...... ............. . . ........ . ........... . . .. .... ..... ....... - . ....... . . .... . ....... ... ...... . .......... ............ . . ........ . ...... . ............ ........... .......... . .... ...... . ............ .. . ......... . ....... .... ........ . . . ........ . - .. ........ ..... . ... . .... ... ............. ....... . .. . ............ .............. .. ....... ... . .... ....... . ... ....... ... . ............ .. ........ ... . ... .......... ......... ............. . ........ .......... . .......... ........ .... . .. . V ........ ..... ... . ......... . . ..... .. ... .. ............. .......... ............ . . ....... ...... . ... ........ . ...... .......... ... . . ........ . . . ....... .... . . ... . ........... . . . ...... .... ...... . . - ........ .. ......... - . ........... ...... .... .......... . ...... 2 .. ........ ...... . ...... .. . ... .......... ... . ...... '7 .. . ...... ..... - ............. . ........ . ;r ......... .1111 PROD VM I I� 1rc. cmm Va. 01471 HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX 10 # 92.0040440 APIPUT BY fox 4Iovk Oye,-i t Dat', ","502A PYlDled; jr.lf 30 90 C 15:03 �linnt 36.fools TI),:J,6 35 MT PAU IMT. �'2 Chant Name (,TRWIll ck MS001 Ment fleet ""o"MIll? C!,'Lloaiod; .1701 25 90 C 14:30 I)xs. D,0A MM RECEIVE) JIU "A 90 16:C3 i1S5. Ilaq c' I d witil :'ll RVollIRYiD ordarel By J. NRESS hn«i.ysie Co;n>>.loted 7A11 29 9!1 30110 Reports to: ?)CoRvllu & il.lio"ric 2) \� C, 96.16 til5tialf, S;: Clullib ilai #: 9113a U'b sh,pl ID: I WMBR par"wivt, cr_. I'es tea' Ros ul, Units Motll-'d Liwl t s NI�l;1171i d1 4. --1 lw-tj'l Epl353.2 10 Sc' mlpl -, IllouleUt MI LE R-ure;- Iu., ; 6l,!VLL "'C-UECU'P f,Y J. YMUS. c ", ts ?ezfor:nec. Sue Special 1 ns t .tions A bo vo UA.4jlsvailablu lWu Iilmo ljoref"tod 3ao '.Ftmple, Poimks ..novo Than, "T-Gyeatev Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. & TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 "'� • "�° Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY PUBLIC WATER SYSTEM I.D.# Analysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM satisfactory Askxj ❑ Unsatisfactory Name 7� Phone No. �C�JJ /�/�hN f�ZCJ f� ❑ Sample too long in transit; sample should not be over 30 hours old at examination Mailing Address to indicate reliable results. Please send new sample via speciai delivery mail. City State Zip Code Date Received SAMPLE DATE: m Mo. Day Year Time Received SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected I B 2 IJUr�?�� Et z J 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst 9338 ® - z m I m ED f� W BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: L BGB Collform/100mi Final Membrane Filter Reessulfts Coliform/worm Reported By- ` !� Date A� 7�`%7� Time: l a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART ONE OF TWO REMAINDER TO FOLLOW Municipality of Anchorage } i Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 2, 1990 Bruce Corwin, P.E. Corwin & Associates PO Box 230608 Anchorage, Alaska 99503 Subject: Waiver Request for Lot 6 Block 5 Mountain Park Estates #2 Waiver Request #WR900006, PID #017-023-30 Dear Mr. Corwin: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 94 feet from well to septic tank. This waiver approval applies to the existing septic system well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, 9&I -.A Daniel J. Roth Civil Engineer On-site Services ljm:#6 Concur: Fc hn Smith, P.E. rogram Manager On-site Services to WAIVER RE47t4c si ltV-Rpood6 T SEFrIc sYf7"E�r r0i? L07' 6 Oto° r &fri, Pk, EsT. *Z G� S F_ PT/[ S YS 7-E,-1 ! S R 6 t p % rPc S /,S TE L 0 Cwt Tt V Two FEET #EWb4T# olPOG/tiHL 6t?,VDE, rllE fLopE OF THE 6nOu,vD twRFRCt Stp PEs AP/'Roa /0% fRom rti� wccc oow,v ro rkF ved a roq-tit, rkF_ riga* is RPP►?OY. 7 ' p►F-2!P, W ELL G- A-5 PRIL L EP /N TuLr F /f t/ foVJ9 IvNo,vuC65- 796 6ALl ONS PxR 14ou * r 6 2 v 72 Ffrj' j*p 7G - 7r/A7 %G J-fiL 1%Er'%lY If % fl F1; tN I iy SE E!? Al CoNF/ a�►,v/ L 4- YFR f 8Twa PRODUCING Afk lF,047 AA -V fu1 FACE. SEPd9/?f}Tf0ti %',#Oe 7-0 6.ELL /S 91 u)wRrER r* C9 -b� SaiL so�pT�o,v C) PEINIEAQa i TY (FIP f -Ks i l �> E.ATfR TRlPGE G�I9lC/SMT APPS O.Y. LEv�L 2 9 e) kaR�z oN7'AL SEf'AIP9 t/®.tr —y 74*2.76 2.76 Com- fie- - zERo�ho C qhs *Ftp °69k0,� -ANCHORAGE / „Ph 4b DAT e T\ a � e as folla�� 1. The en�� separation Ac tank and well byNn in September 23, 1 airements, this waiver approva must be recalculated by the A.D. luideline Point Method. 2. The second requirement is the rest letter in the lot file written by Dr. Reid in Septe r of 1981 explaining that the septic system was apparently constructed into the ground water table. Then on September 20, 1981, a 'foundation/curtain drain' was installed somewhere in the vicinity of the newly constructed bed. The ground water that the bed was constructed in then drained away in less than 24 hours. In order to consider the septic system properly functioning, this 'foundation/curtain drain' needs to be as -built and water monitored possibly through spring break-up at least 4 feet below the bottom of the absorption bed. Information needed on the curtain drain is, 1) How deep is it constructed; 2) Where is it constructed; 3) Is it up structure of the absorption bed or down structure; 4) Is it tied in directly to the absorption bed; 5) The specific location of the foundation drain daylight. The engineer was made aware of these requirements on February 13, 1990. G� \gyp`„ \5\p\J p� G U-0 & associates,inc. \'! Consulting Engineers x000 E. Dimond Blvd. • Suite 205 • Anchorage, Alaska 99515 • (907) 522-1311 February 19, 1990 Mr. John Smith, P.E. Municipality of Anchorage Department of Health & Human Services 825 L Street, Fifth Floor Anchorage, Alaska 99501 SUBJECT: WAIVER REQUEST LOT 6, BLOCK 5, MOUNTAIN PARK ESTATES #2 - 12940 LUPINE - ANCHORAGE, ALASKA. Dear John: It has been brought to our attention that the Municipal Department of Health and Human Services (DHHS) requires a new waiver application for the well to septic tank distance on the above referenced lot. As you well know, this lot was built upon in 1981 and, at that time, the septic tank was installed 94 feet from the well and this distance was officially waived by granting the original Health Authority Approval (HAA) in 1981. Subsequently, the system has passed Municipal HAA process in 1986 and 1987. The current owners have done nothing to the system to alter it in any way since they purchased this property under a HAA in 1987. There has also been no change in this system since 1981. Our reasons for requesting this waiver are merely to assist the DHHS in updating their files so that a valid waiver exists for this property. We have done nothing to make the separation distance different than it was in 1981 when it was installed and approved by the Municipality. First of all, it is physically impossible for the flow to come out of the septic tank and go toward the well. The natural ground surface and, therefore the underground flow characteristics are toward the sewer system and not the well. Regardless of other considerations, this should be paramount in your decision to grant the requested waiver. Next, the soils in the area are generally silty clay or sandy gravels. The static water level is 69 feet below the surface and this means that any of the contamination that would defy gravity and flow toward the well would need to travel some 60 feet through various levels of treatment to get to the water level. Other neighboring wells are also in the 60 foot range indicating that this is not necessarily a confined aquifer. We r see no reason to believe that sewage contamination could take I place form the septic tank. Mr. John Smith February 19, 1990 Page Two The well log for this lot indicates that there is 8 feet of gravel just below the surface, next 18 feet of silt and clay, next 16 feet of clay and gravel, next 20 feet of sand and gravel, etc. Again, we see little if any way contamination can get to this well even if it could flow there from the septic tank. The septic tank is also constructed of steel and has been treated which means it should provide adequate protection against leakage. Finally, the system has been installed now for over 8 years with no previous problems of any kind. We respectfully request approval of this waiver for the septic tank to well distance of 94 feet vs. the 100 feet required as soon as possible since the current owners have done nothing to create the situation and they are merely being forced to correct a problem which should have been addressed in 1981 and has already been approved by your department on several different occasions. As a related issue, we request that your department meet with us on this lot as soon as possible to satisfy the concerns with a curtain drain. We believe that there is no logical reason to believe that the sewer system is tied to the drain system unless you have evidence of flowing water year round out of the sewer system into the drain. We do not believe that Mr. Reid meant that when he wrote his letter previously and you may even want to have him on site to verify that the sewer system is not tied to the drain. We have enclosed well logs and soils tests to aid in your review of this matter. Should you have any questions or need any other information, please let us know immediately. Very truly encl �& ASS CIA Sr INC. J. orwin, P.E. E'ent tures — 12601I /O / 12600 0 7200 /6 1 / 6 2 12620 12621 9 }72 17100 7130 7200 7230 7330 LL 6940 5 12720 7051 ww / 6941 /4 I / 2 3 _ I ICI 2(/ (7/( DR FFa.E�'CPG 6740 /l0 vc JI I0 SOUTH PARK 12731 p 3 8 9 7 6 5 4 12530 12531 /2 I a U) ! X Q YV 7101 71311 7201 7231 12550 NORTH / PARK DR. 12601 12800 12820 = — 12600 5 r,J 4 / \/ 12621 / VJ 6821 3 2�- 5 4Q. 6820 ! 2 12620 Q. 1 3 / 6801 ?!vy 2 4 1 '3 12640 6800 // 4 12700 12601I /O / 12600 0 7200 /6 1 / 6 / 12600 12620 2 3 12640 4 12.700 0 12620 12621 9 }72 12621 9 1 2 12620 12641 12640 8� 3 12701 �T70� 7 4 883 12641 1 3 12640 12701 7 4 12700 12700 C / 5 6 5 512720 5 26 12720 7051 7101 7209 7301 V.J 2(/ (7/( DR SOUTH PARK 12731 p �/9{ _ 7000 12800 12600 7300 U) 212730 X Q YV / 1280124 / 24 / / J 12800 12801 12800 12820 = y 12820 12821 8 7 2 2 23 Z 12820 2 a 12801 1282123 – 12800 \ 12840 12840 1- — 29 12840 3 1284122 3 12840pp 12841 3 12840 to 3 Ir 7Z W LI 12900 Z 12901 12900 6 4 12900 a 2/ 1290111 4 12900 H 2/ 4 4 7 v 12900 920 J 0 5 Co 12920 5 2 V j 5 20 5 22 / 14 6 12901 12920 12921 12920 12916 12901 L _ Ls iNGSiON L 1 ~A 6",6 2 1294 W / 12941jjj91 1294 12341 /9 6 r 1294 12940 2/ U 5 5 N 12935 6; W 13 1 13000 �T 12936 12935 15 �Y4 �iQ S" / � 7 13 /6 7 7 13000 Z 13021 13021 13020 13000 13001 9 4 4 6 /7 8 /7 8 6 13020 20 o_ 13001/6 13020 13CQ0 13040 13040 13006 Q 3 9 13040 13041/6 9 1304116 9 9 13040 6901 3 CA«4Wq 13100 /O /0 13101 13100 /5 /O 13101 /5 /0 13100 13036 13100 /9 /7 13035 2/ 13101 13100 6900 // // 13120 2 _ o � 13121 13120 /4 // 13121 /4 // 13120 n / 2 13120 � w a / / I I 1 13141 /3 /2 /3 /2 13140 /2 7301 o 13130 13101 /6 DE ARMOUN RD. UNNISON CARITA 14BUENA VISTA I GR. 2839 233 2w244 -4®>- 246 DeArmoun Area Reference Map—P14 Y © COPYRIGHT 1985 JMR 255 DRILLING IN DRILLING LOG vner _Les Pace s 4. 7 nse W. Comm i tt fk �'•a=s' i "!' — Vii' ""�`�^+.:, L,ocatIon (address of: Township, lunge, Section, if known; or distance main roa ( Well Site — Greenbrook Subtlivision uuao of casing_.'_„ epth of Hole SQ reet Cased to—J5- 0.5 feet (Ttl iCegaS2,'9 r n `W, ievet 2 ft. (above) O&D j land surface. Finish of well (check one) open end (=3 ' Screen (1,X ); , Perforated ' ( ) ' liescribe screen or perforation Johnson 304 SS, 00040 slot. 56.35 tov50.5' def�th" F r wiel1 pumping- tesi, .at 50�allons per (MMM)cx (minute) for `' ours 4b with ft of"drawdown from static level Ft �i Of COmple�on9 JLl v 7 gds N= i WELL LOG 1 9 lie .th feet from f ' =sgrouhd surfaPe Give details of formations penetrated, size of material, color and hardness Es 47Existing Well s 177 ,�.1"p Silty Sand: small' amount of or vel clfivev Sandy aSLel ¢ eav;nfl A/As htj � � iii •,1 t:,. aMtie Crzlilicutc Ru's. Yld Jr ti1:1 �i ; r i , ' 1 —CUSTOMER E I L 4 { t� I1 F f tat } LV ll to t;U i Viol(i: i2 � l tiati <<r ' cr levcl: 641 b le Jri? ari! :rr _a � l t '.: 011 Cori - i F S f S o ' s 1 ' � S - ! 3 i j { r , A k ALASKA RUIROWnTAL COnTROL SCRUIRS, Inc. o 6ngineerinq & Enuironmental Studies P. 0. Box 240668 Anchorage, AK 99524-0668 (907) 279-5553 *** FAX (907) 276-8706 February 28, 1990 Municipality of Anchorage Department of Health & Human Services 825 L Street, 5th Floor Anchorage, AK 99501 RE: Lot 6, Block 5, Mt. Park Estates #2 Dear Dan: I have found my old field notes which were written at the time the levels on the test holes were taken. Those measurements which I gave you yesterday are water levels we found when the system flooded in 1982. The letter to Rolf Strickland would explain the sketch. It shows the water to come from the south and east. I can't find any field notes for the July 1981 inspection. The letter to Rolf Strickland, however, shows the curtain drain to have been built on September 20, 1981. The design of the system shows the bed to be 2 feet below ground level and 4 feet above the water level. The top of the tile would be 1.2 feet below the original ground level. Our report shows the top of the tile to the finished grade of "3 feet plus 2 inches of insulation". That would put the top of the system exactly as designed. The old forms did not reference the original ground level. Our design shows rail-'dd sand (SP) at 150 sq ft/bdrm. See design sheet. However, the system was built to 166 sq ft/bdrm. I can't find anything in my notes that shows a sand fill. You might check with Doug Bloom at D & B General, Inc., (349-6965), to see if there was sand used. They may still have records. At any rate, the system would have been installed at 4 feet above the water level. The curtain drain intercepted water in sand and gravel seams and diverted it away from the system. With water no longer running toward the system, the water level would return to normal. I don't remember exactly how deep the curtain drain was, but I believe it would have been at least 4 feet below the system. That was my normal practice. That would put the curtain drain at an approximate elevation of about 92 feet at the outfall, which itself was 2 feet below ground. The ground elevation at the pole was 94.4 feet. It was fairly flat across the back of the lot. If there is a cleanout at the house corner you can measure the bottom of the curtain drain. The bottom of TH 5 was 4 feet below the ground. From surface to 3 feet was wet silty sand, and from 3-4 feet was wet sand. In wet sand the drill hole would collapse so we wouldn't have been able to determine what was below 4 feet (95.1 feet). At the standpipe, the old field notes show 4 feet to the bottom of the gravel or 96 feet relative elevation. The water level was 96.9 feet at TH 2 in the bed. This would be enough water to nearly fill the rock. In my letter to Rolf, I noted that 11 inches of water had drained from the system in one day. I hope this helps fill out your records. I'm sorry there isn't more. But after 9 years, 4 moves and a record reorganization, I'm surprised that there was this much available. Sincerely yours, Leroy C. Reid, Jr. PhD, PE, DEE President LCR/sr Wn Mm 01450 If, M0m MUNICIPALITY OF ANCHORAGE MEMORANDUM DATE: February 21, 1990 TO: John Smith, P.E., Program Manager, On -Site Services FROM: Daniel J. Roth, Civil Engineer, On -Site Service129) SUBJECT: Requirements Prior to Approval of Health Authority Approval Number HA900052 Lot 6 Block 5 Mountain Park Estates #2 The referenced Health Authority Approval will require two additional items to be submitted prior to approval. They are as follows: 1. The engineer references a prior approval of the separation distance of 94 feet between the septic tank and well by Mr. Rolf Strickland of the M.O.A. in September 23, 1981. Pursuant to A.D.E.C. requirements, this waiver approval is no longer valid and must be recalculated by the A.D.E.C. Waiver Review Guideline Point Method. 2. The second requirement is the result of a letter in the lot file written by Dr. Reid in September of 1981 explaining that the septic system was apparently constructed into the ground water table. Then on September 20, 1981, a 'foundation/curtain drain' was installed somewhere in the vicinity of the newly constructed bed. The ground water that the bed was constructed in then drained away in less than 24 hours. In order to consider the septic system properly functioning, this 'foundation/curtain drain' needs to be as -built and water monitored possibly through spring break-up at least 4 feet below the bottom of the absorption bed. Information needed on the curtain drain is, 1) How deep is it constructed; 2) Where is it constructed; 3) Is it up structure of the absorption bed or down structure; 4) Is it tied in directly to the absorption bed; 5) The specific location of the foundation drain daylight. The engineer was made aware of these requirements on February 13, 1990. 111 11 111111 11111 jm-!11�1111 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 • FAX 274-9645 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115 > FAX 479-0547 Municipality Of Anchorage DHHS/Water Quality Section P.O. Box 196650 Anchorage, AIf. 99519-6650 Attn: Dan Bolles Source: Mountain Park Estates '2 Z,-fL G lk r Sample ID: A022390-19 ----------------------- Parameter --------------------------- Parameter Unit Date Arrived: 02/23/90 Time Arrived: 1500 Date Sampled: 02/23/90 Time Sampled: 1435 Date Completed: 02/27/90 A022390-19 Fecal Coliform #/100ml <2 Nitrate -N mg/1 9.9 Reported By: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION [!AR" �9Q RECEIVED Date: 02/28/90 Francois Rodigari, Anchorage Operations Manager 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 6 y >-9 7 17034 Eagle River Loop Road No. 204 . Address Eagle River" Engineer's signature Date /a r .......... C�QS. 4 pj. YEN .N � N I�11 MM NJ r ROBERT C. COWAN e ti 4d ops ., CE - 8801 6. DHHS SIGNATURE X- Approved for - , bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There-a>=e nitrntes-present It _th .1 :� b suggestede s performed to insure the wells continued suitability. Current nitrate cone More information on nitrates is available from the On-site Services Program, DHHS,343-4144. Additional Comments By' „�-: Q Date./ -12 •F 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 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. 1/81) Back- MOA 821: i' IN f Cit ANU'Il -,U, VIRONMENTAL SERVICES DIVISIO. Municipality of Anchorage JAN 02 1991 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division F I E — 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3 4q Health Authority Approval Checklist Legal Description: 1-6 % G P, [.D C S— Parcel I.D.: 0 17 _Q Jt " 3 Msij, -r.4//v P,42K t--sr4M-S 412 A. WELL DATA Well type P41'44 -r#- If A, B, or C, attach ADEC letter. ADEC water system number Log present (y/N) it Date completed 994,.10 i^' i -d U31-1 7 Total depth S" , Cased to Casing height (above ground) Sanitary seal Ifl'/N) y#� s Wires properly protected&N) Y FROM WELL LOG AT INSPECTION Date of test r3 / 9 7 r Static water level 17 q Well production 1, S g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: I�,�3o%97 S ` W Other bacteria C7 S & S ENGINEERING Collected by: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 .m. B. SEPTIC/HOLDING TANK DATA Date installed -7 1 � i I?'[ Tank size /000 Number of Compartments Cleanouts 0/1\1) %� 3 Foundation cleanoutjq/N) J Y* --S Depression (YA9 °' d High water alarm (Y/(SP^' a Date of Pumping ! I 3 / g 7 /a Pumper 4- t'ag�Ij C. ABSORPTION FIELD DATA Date installed -7 r Soil rating (g.p.d./ft2 or ft2/bdrm IS -0 System type Length `f 14 / Width 1 7 Gravel thickness below pipe 1 a /f Total depth �N Q Effective absorption area /'i r6 �% Monitoring Tube present 01N) Y45 Depression over field (Yo Date of adequacy test I a-/ 30 / `t 7 Results (Pass/Fail) 842'5 For -3 bedrooms a Fluid depth in absorption field before test (in.); 0 Immediately after! 7gal. water added (in.): Fluid depth O if (ins) Minutes later: 33 Absorption rate = IYS d - g.p.d. Peroxide treatment (past 12 months) (Y/N) No,4&- k vow 72-026 (Rev. 3/96)" If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level ate "Pump on" "Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROMWELL ON LOT TO: / Septic/holding tank on lot CH l ",& A 100 r Absorption field on lot ) 0 o t Size in gallons On adjacent lots On adjacent lots "Pump off" level at' Public sewer main Public sewer manhole/cleanout i Sewer /septic service line` S Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r r Foundation 5 t Property line S Absorption field s Water main/service line / 0 + Surface water/drainage 10 D T Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 --j- Building foundation /0 f Water main/service line /O r � r Surface water ) 0 0 f � Curtain drain L Q 4 F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area _ _ Wells on adjacent lots 10 a l certify that I have determined thru field inspections and review of Municipal rec in conformance vyitLi MO7HAA idelines in effect on this date. Signature Engineer's Name p d `�^' d o-"Fq.✓ Date HAA Fee $ 30010-0 Waiver Fee $ Date of Payment j / Z I ? - / h Date of Payment Receipt Number 0 3 3 V o ` 602 3/l Receipt Number 72-026 (Rev. 3/96)' ,C 1� S. `R08ERT C' COI CE - 8801 y ms are . ;SrQI tM aN (f) the HAA to the following address ,Mail Ir/J� e lli7'r'E... ; y a a < T f, 2 TYPE OF RESIDENCE /� r Single Fa milyX Multi-Family ❑ Other Number of"Bedrooms .3 ,•. 3. . WATER SUPPLY Individual Well 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 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 (17/84) 5. ENGINEERING FIRM PROVIDING.. 4SPECTIONS, 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. / A i Name of Firm Address Date 13 4-5 - ¢4_D J. co- :vio : , i eer's Seal b',`': '• •'app, �>'':.P� 6. DHEP APPROV.AALL r Approved for ,U�Lbedrooms by Date - t `v ApprovedDisapproved 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 (11/84) A. WELL DATA �1 o r -7 023 -3a MUNICIPALITY O MUNICIPALITY OF ANCHORAGE (MOA) DEPT. �THORITY APPROVAL (HAA) ENVIRONMENEPR�ION64-4744 KLIS2UARY 1984 TALOT APR 2 ? 1988 Leg I Description: RECEIVED M242 6r A r tit t�� I� (`° �� r "�.'4••��� 41- z.-- Well Classification If A, B, C, D.E.C. Approved (Y/N) Yield 7, Z gem, Well Log Present (Y/N) Date Completed Total Depth CJI Cased to Static Water Level (-;� i Casing Height Above Ground j Electrical Wiring in Conduit (Y/N) Separation Distances from Well: �' To Septic/Holding Tank on Lot /5 Depth of Grouting — Pump Set At Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) ; On Adjoining Lots `- / To Nearest Edge of Absorption Field on Lot 00' ; On Adjoining Lots >- 00 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot -70 Water Sample Collected by Date �1 � � ��5& V_zlp 8d Water Sample Test Results Commentsr AA�� ' t� ylz�/�e B. SEPTIC/HOLDING TANK DATA Date Installed "" ! ize /. DOO No. of Compartments 7 Standpipes (Y/N) y Air -tight Caps (Y/N) _--- Foundati Depression over Tank (Y/N) i� Date Last Pu ped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) ) - I" / e-, - Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /5 To Building Foundation To Property Line 1 c; To Disposal Field —Jr To Water Main/Service Line � Course Comments Page 1 of 2 72-026 (Rev_ 8/861 Front To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA J1 d( ,k Soils Rating in Absorption Strata Type of System Design Date Installed ��—� Length of Field �( Width of Field ( Depth of Field _ !l Gravel Bed Thickness Square Feet of Absorption Area f }iy q P � _ Standpipes Present (Y/N) �r Depression over Field (Y/N) /_�l- _— Date of Last Adequacy Test r3 1 Results of Last Adequacy Test = +'-" /5!-> o.-•,;' Separation Distance from Absorption Field: To Water -Supply Well > 100 To Property Line i rl To Building Foundation 3 -= To Existing or Abandoned System on Lots! / ; On Adjoining Lots To Water Main/Service Line > I _ To Cutbank (if present) &A ZA To Stream/Pond/Lake/or Major Drainage Course 1 .//.A To Driveway, Parking Area, or Vehicle Storage Area d' D. LIFT STATION \ J3 Date Install d Size in Gallons "Pump On" Level a High Water Alarm Lew Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** ChecAPer d Bedro m Rating Against HAA\iequestI certify eck , v ified, orconformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed DateCompa MOA No. Receipt No. Date of Payment T r c2 Amount: $ Z20 Page 2 of 2 72-026 (Rev 8/86) Back Engineer's Seal V N 1l S 89 5425E /d3,ov/i1Fsf3• sa9s6o6� /83,00 2Ec'. I I I I V V� Ta ,eE9,e 1 /S 3 S7o2✓�� _. G✓/Tf/F,2o.�/T� .B�if/�� 2 srae�s i� � � �89`56Ob��✓ 4�7 OF AL LEGEND Primary monument recovered • Iron pipe and/or rebor recovered p V8 "x 50" rebar eel th/s survey (pee a 000a•e$eo Abba oe ooeae ••o w a � Wli6lmn S. Sm11h ° � Pto. to S aha oa ��D�a°�JQ` � plea •eooaoa �1� •WFMeeuAL � Qb PREPARED FOR: &ZE111 � 36./01 � I• Q\ DRWN BY•'Ad55 DATES 1/ Zo 87 SCALE /= 30 SHEETNO. of CHCKD BY -,&JG W.O. NO. F.B. NO. 23 GRID AS BUIL T Lo? G / BLDG/L 5 MDI/1t/TA/.�/ Pf12.� ESTATES - ADS `N � Z / hereby certify that on accurate survey of the following described property- M,9aA1?A1W ES7-47E S SC/BD — �6Di✓ #.ZO LO 7- /o BLL 5 was mode on NZZ-0 467 and that the improvements situated thereon are Wifh/n the property tines and do not overtop or encroach on the property tying djaca?t thereto, that no improvements on pro erfy /ying adjacent thereto encroach on the premises In pvestlon and that there are no roadways, franSm/SS/an tines or other visible easements on sold property except os indicated hereon. Dated at Anchorage, Alaska, thfS�4' �Ag?�qday, of rl/oj1�i� to L.S. No. 4107-5 PREPARED BY CORMW & ASSOCIATES 12001 INDUSTRY WAY BLDG. B, SU/rE // ANCHORAGE, ALASKA 99515 1907)345-4440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water -) Special Purpose O Untreated Wate? SAMPLE Time Collected NO. LOCATION Collected LBy 1�' r 2 3 4 9 Analytical Method: Membrane Filter ` No. of colonies/100 ml. Lab }R{eff7 No. Result' Analyst V Yom/ i Im I m I m I m BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count BEFORE COLLECTING SAMPLE O Coilform/100ml Verification: LTB BGS Final Membrane Fi r sul s O Coilform/100ml rt Repoed By Date I/Lg 11 1?7 Time: U a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART t OF 2 REMAINDER TO FOLLOW TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# Analysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM ley Satisfactory (�? env, i 1 A Woc ❑ Unsatisfactory Name �zCJD' " ty' -K ' o : �I / Phone No. 5 9/0/16 "' El Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send Mailing Address Tq riC_ A K new sample via special delivery mail. Received City State Zip Code SAMPLE DATE: m i ) FT Date Time Received Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water -) Special Purpose O Untreated Wate? SAMPLE Time Collected NO. LOCATION Collected LBy 1�' r 2 3 4 9 Analytical Method: Membrane Filter ` No. of colonies/100 ml. Lab }R{eff7 No. Result' Analyst V Yom/ i Im I m I m I m BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count BEFORE COLLECTING SAMPLE O Coilform/100ml Verification: LTB BGS Final Membrane Fi r sul s O Coilform/100ml rt Repoed By Date I/Lg 11 1?7 Time: U a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART t OF 2 REMAINDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 A!iALYSIS REPORT BY SAMPLE Client PO# : VERBAL Req 4: Client ST! ID: LT b BLIT 5 NTH PL ESTATES Sample Rec d : NOV 20 87 Ordered By : JERRY DRESS Send Reports To: COPWIN & ASSOC 1200 INDUSTRY `RAY. kLDC B, 411 A11CHORAGE, AL, 94515 Special Instruct: Cnemiab Res #: 847 Lab STI ID: 1 hatrix: Water Parameter Tested Resuit/Units --------------------------------------------------------------- IIITPATE-N 2.8 mw`i $ample ROUTINE SANPLE Remarks: ANALYSIS COKPLETED:11-20-87. LABORATORY SUPERVISOR- STEPHEN C. EDE 1 Tests Periormea See Special Instructions Above l&- None Detected +r+ See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than Rork Order No. : 4037 Client Account : CORWI111' Date Report Printed: NOV 23 87 'a 16:5i: Released By : c z✓ Reports Address #2 Cie tnod Ailotiable Ltoilts N r� y HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE; ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT 8; SAMPLE for Mork Order. 4 6149 Date Report Printed: APR 18 98 @ 11:46 Client 3amplo ID:L 6, 8 5 'IT PY EST PWSID :UA Colie^ted APR 15 BS A 08:30 ;us. Receivod APR 15 88 2 10:00 us. Preeerved with :4 deg C Analyais Completed APR 15 88 Laboratory 'supervisor :STEPHEN C. EDE Released By ✓,;, ;� _ i ...................................... Special inst(uct: C1 lab Rei ;<: 970? Lab Smpi ID: 1 Hatrix: Water Client Name CORWIN & ASSOC Client Acct CORWINP P.0.4 NONE RECD Raq f Ordered By : W. SMITH 3CIA Reports to: I)CORWIN & ASSOC 2) Allowable Paraueter Tested Result/Units Method Limits tiLTRATE-N 2.9 mg/1 EPA 353.2 10 Sampla ROUTINE SAMPLE hiyatks: SAMPLE COLLECTED K':' W. SMITH ............................................................................................................. 1 Tests Performed Seo Special Instructions Above UA•Unavailable ND- None Detected See Sample Remarks Above HA-- Not Analyz=d LT -Less Than, GT -Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. J ox TELEPHONE (907) 562-2343 5633 B Street i _ Anchorage, Alaska 99518 v Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER(� TO BE COMPLETED BY LABORATORY 11 PUBLIC WATER SYSTEM I.D.# th' W t SAMPLE to be• L1PRIVATE WATER SYSTEM LP 2tyi.t/ F _745--4-A- A Name Phone No. /7� c / /�✓/�JS%/� G��7 1 L41%7 -j J-.2//TC Mailing Address . � �4/✓Gl� - L 9iSJ5 City State Zip Code F] FTI-rl SAMPLE DATE: o Q % Mo. Day Year SAMPLE TYPE 1-1Routine ElCheck Sample (for routine sample with lab ref. no. ) ❑ Treated Water E)Special Purpose ® Untreated Water SAMPLE Time Collected NO. �1LvOCATION Collected By 1 Imo- AieSt` 6/6 �Pi 3pAM GUS 2 3 4 5 � 1-9-111C At" %,e. READ INSTRUCTIONS RCCPIDG COLLECTING SAMPLE Analyses shows Is a er Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received K. /5-- a Time Received f/or-a Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Em Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Coilform1100ml Verification: LTB BGS Final Membrane F' ults Coilforml100ml Reported By Date��r Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART 1 OF 2 REMAINDER TO FOLLOW r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date a 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, secti townshi range) ca fa.sM rk Location (address or directions) C% ( Ci (b) Applicant Name Telephone: yHome J "� Business Applicant Address ` �x t 7 9"1 yr_k. qq 5a (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderAl ; Buyer ❑ ; Other ❑ (explain); - �e (d) Lending Institution Address (e)i Real Estate Con)pany and Agent Address Telephone (f) 'Mail the NAA to the following ad( s6 c� 2. TYPE OF RESIDENCE Single-Familx Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well 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 Onsite'OI 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 dispos,al-sgs"pm is in comliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this ir?sp/ctio / Name of Firm &0�_ Telephone Address /`f(L- � 'C - I& -6> Date 6. DHEP APPROVAL C� Approved forbedrooms by Approved Disapprove Terms of Conditional Approval Engineer's Seal my • see O•C .•i� .�.• s4F Y.T . 1fA PATRICK CORSER ?� CE • 6418 I> Date Disapproved Conditional rJhep 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 (11/84( MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & MUNICIPALITY OF ANCHORAGE (MO.j ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) APR 18 19W CHECKLIST - FEBRUARY 1984 264-4720 Le al Description: _ /0t6 D&-A�atn arL A. WELL DATA 1;(14-o 4AtftnPs brrae Well Classification ILeSr"o"+fi0. f!Tk If A, B,QD.E.C. Approved (Y/N) Well Log Present (Y N) Date Completed 2d $� Yield - al%ns , r' Total Depth % Cased to �� Depth of Grouting NTq Static Water Level 5/ Pump Set At N r Casing Height Above Ground 3'S Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit �/ 1) VGS Depression Around Wellhead (Y/O h Separation Distances from Well: To Septic/Holding Tank on Lot 100 . ; On Adjoining Lots 1 b0 , To Nearest Edge of Absorption Field on Lot !ad ; On Adjoining Lots To Nearest Public Sewer Line n/ To Nearest Public Sewer Cleanout/Manhole AM To Nearest Sewer Service Line on of �4M�' ry Water Sample Collected by p' ; Date Water Sample Test Results Ste. R 71_RCdM6A1r Comments B. SEPTIC/HOLDING TANK DATA Vr Date Installed &.V_V�_uL Size _]4+ No. of ompartments Z Standpipes (Y/N) GS Air -tight Caps (Y/N) r(L hdY Foundation Cleanout (Y ��/N JJ)) Depression over Tank (Y/N) N d ate ast Pumped 4-l��-i Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) �0 Temporary Holding Tank Permit (Y/N) IVA Separation Distances from Septic/Holding Tank: 0 1 To Water -Supply Well loo To Building Foundation q /`• 1 5^ Q • To Property Line W To Disposal Field AA 72-026(11/84) - To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /150 Type of System Design _cool am how-' leacki'/C 4 Date Installed �. �Length of Field /7 x 4` Width of Field Depth of Field 4' Gravel Bed Thickness 1 ' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test �}Q L 7TU f Standpipes Present (Y/N) y e'S i Date of Last Adequacy Test _ `l0- Separation Distance from Absorption Field: To Water -Supply Well 00 1 To Building Foundation Lot N) 1> To Property Line >' 0 ; On Adjoining Lots To Existing or Abandoned System on ttj To Water Main/Service Line f" I ` To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course �0 A To Driveway, Parking Area, or Vehicle Storage Area M Comments D. LIFT STATION Date Installed i ensions Size in Gallons Ma o /Access (Y/N) "Pump On" Level at Pu p Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify t� ave chec od, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed - Date —4—s: Ag& 142 Company Receipt No. 2:77':K%:7 Date of Payment L) �C�Ca Amount: $ Page 2 of 2 72-026 (11/84) MOA No ,. D. ,: RECEIVED INSPECTION APPOINTMENTS , TIME TIME TIME DATE DATE DATE SINGLE ❑ Two ❑ Five ❑ MULTIPLE FAMILY INSPECTOR INSPECTOR INSPECTOR INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled n since June 1975. For wells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H`A.LTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTL901RONMENTAL F(:C'TECTION 825 L Street - Anchorage, Alaska 99501 54, INDIVIDUAL/ON-SITE** (�iFt' P 1 0 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RE �� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER LI I DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNERn ` �1 &) le� PHONE MAI LING ADDRES1� /JJ /dam /• !/ �� � �n /0/ 16-19 V G PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. -LENDING I TITUTI N ,n_ PHONE MAILING ADDRESS 4. REALTOR/AGENT � � � - N%✓! PHONE MAILING ADDRESS 5. LEGAL D SCRIPTION _ ALoGG � 19P ,7�res STREET LOCATION , A/ j N 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS FAMILY El One ❑ Four E]Other SINGLE ❑ Two ❑ Five ❑ MULTIPLE FAMILY 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.) B. SEWAGE DISPOSAL SYSTEM WAS INSTALLED. 54, INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) /Z ��E L) 79-n1n (Rnv-(3/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE THREE ❑ FIVE ❑ OTHER ❑ SINGLE FAMILY MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. W�R SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E`ADIVIDUAUON -SITE DATE INSTALLED / 7:1 PUBLIC UTILITY / Connection Verified INSTALLER eptic Tank or ❑ Holding Tank Size: / 0 `f 0 If Tank is homemade SOILS RATING -I give dimensions: _ / TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR/EA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL T0: Absorption Area to nearest Lot Line 5. COMMENTS 1 `( rd F•- �--Z�-�i 171APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE L) 79-n1n (Rnv-(3/79)