HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 6 LT 4 P-561Mountain Park Estates #2 Block 6 Lot 4 #017-432-02 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW ❑UPGRADE MAILING ADDRESS S(�q Is -4(o r'7 LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption rea Dwelling / PERMIT NO. vy DISTANCE TO: ->7/ �� �Q91�z0 o~. Q Manufacturer Material -�L No. of compartments wF , o2 c Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ----- � i' DISTANCE TO: Well Dwelling PERMIT NO. jaz 2 z < Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well r y ' U Foundation / �5' Nearest lot line 30a(0 PERMIT NO. , j �— 11 z P z w No. of lines ' Length of each line ' 1 Total length of lines ( Trench width 36 inches Distance between lines -- Top of tile to finishrade Material beneath the / Total effecti ? absor tipp area Q / . /t ir�eHes �J !�( Length Width Depth PERMIT NO. w f7 Q F Type of crib Crib diameter Crib depth Total effective absorption area as Lu w rn Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line / Septic tank f I Absorption area(s) UU � /�) OTHER PIPE MATERIALS � `� V C� J p i V SOIL TEST RATING xA UC l INSTALLER -ycsf-. (CrRN REMARKS I I P AS 3 APPROVED DATE LEGAL 72-013 (Rq6�/78) �/J 6/ i nreTtnM nc Wr1 I MUNICIPALITY OF ANCHORAGE WATER WELL RECORD P rPT Cr I'7,13' ­1 R.. ENVIE —ii: -1,:A O E'- 1: N STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES AV q o =0 Division of Geological 81 Geophysical Surveys ;FLri Q R E C E I V E prillin9 Permit No. I P ea se ea In o l e l e. el the la. Ib or Ic:) A.D.L. No. Ea. Borough Subdivision Lot Block _)/4 qt rs. Section No. Township N ❑ Range E ❑ Meridian 70 F Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS - 3. OWNER OF WELL: , - Address: r Street Address and Area of Well Location. - - 2. WELL LOG - - - Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION _ Surface rJ it. Vii; Material Type - - Top Bottom _ d,� i ;✓, r -- i e'Cable fool RotaryDriven Du ❑Auger E] Jetted ❑Bored C3 Other: _-, 1 i. 1 L�;.0 f- J 11 �' ] ;.,j*; �� DEPHRTMENT OF HERLTH HND ENVIRONME�THL PROTECTI /1 | | 825 'L' STREET/ HNCHORHGE/ HK99501/ '^^~ . . � �264�4720 'd�� ��� �NN / ` ' PERMIT NO ( 55 8201 HPPLICHNT BEETER CONST SRH 154� E ]45~]878 LOCHTION LUPINE DR LEGHL L4B6 MT "F9 IF EST LOT SIZE 20000 SQUHRE FEET ' TYPE OF SOIL HBS�RPTION SYSTEM IS� TRENCH MHXIMUM �U�BER OF BEDROOMS � 4 5OIL RHTING T/BR)� 85 -HE REQUIRED C-, OF THE SOIL HBSORPTI8N SYSTE� IS� ��� ��������� �� � � THE LENGTH DIMENSION IS THE LE�GTH (IN FEET) OF THE TRENCH QR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETHEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTIQN (IN FEET) THERE IS NO 5ET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GR�VEL BETWEEN THE O�TFHLL PIPE ClND THE BOTTOM OF THE EXCHVHTION (IN FEET) it���� ����� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO IMFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS 8F HI-I'll.NELLS HDJHCENT TO THIS PRQPERTY HMD THE NUMBER OF RESIDENCES THHT THE WELL WILL SERYE - ­} ... �...... �_� ­,'. __��� BHCKFILLING OF HNY SYSTEM WITHOUT F�NHL INSP�CT�ON HND HPPRQVHL BY THIS DEPHRTMENT WILL BE SUBJECT T- -i' T i O IIM DISTHHCE BETWEEN H WELL �ND HNY ON�SITE SEWHGE DISPOSHL SYSTEM IS FHMILIHR �00 FEET FOR H PRIYiTE WELL OR 150 TQ 200 FEET FROM H PUGLIC NELL DEPENDING OF HNCHORHGE UPON THE TYPE OF PUBLIC WELL 2� I WILL INSTHLL THE SYSTEM I� HCCORDHNCE NITH THE CODES ]� I ND THHT THE MINIMUM DIST�NCE FRGM H PRIVHTE WELL TO H PRIVHTE SEWER LI�E IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET WELL LOSS HRE REQUIRED HN� MUST BE RETURNED TO THE DEP�RTMENT NITHIN ]0 DHYS OF THE WELL COMPLETION OTHER REQUIREME�TS MHY HPPLY� SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS H�E HYF�ILHBLE TO INSURE PROPER INSTHLLHTION I CERTIFY THHT FHMILIHR WITH THE REQUIREMENTS FOR ON~5ITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM I� HCCORDHNCE NITH THE CODES ]� I ND THHT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMQDELED TO INCLUDE MORE THHN 4 BEDROOMS zco'cn ;u -�� ���� /�S�� ���' '�.^ � -� 9 P �\IICIPALITY OF ANCHORAGE p 'ry.c DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorcge, Alaska SE502 276.2221 SOILS LOG — PERCOLATION TEST t SOILS LOG So D PERCOLATION TEST PERFORMED FOR: fit— l•e—� 4—%e— f DATE PERFORMED: -77 LEGAL DESCRIPTION: !A !A�_ DESLOPE SITE PLAN PTH �] (FEE -n - - 1 co 2. C. A FA t t_ sus s: I a -s k, .sa.`.tc�.1/ A -t . e ; �••aa•a•m "@ T110MASR.. SM iYIi , i 8,1 •��fy COMM WAS GROUND WATER S ENCOUNTERED? L Depth to Water O P E IF YES, AT WHAT DEPTH? E ReadingDete Gross Time Net Time Depth to Water Net Drop Is PERCOLATION RATE TEST RUN 13ETWEEN (minutes/inch) FT AND FT US� Parcel I.D. 017-432-02 a 9 Municipality of Anchor#AeAUG 11 2015 On -Site Water and Wastewater Progr (907) 343-7904 W Certificate of On -Site Systems Approva��l 6 a 1. GENERAL INFORMATION Expiration Date: l i — / a • /5' Complete legal description Mountain Park Estates #2, Block 6, Lot 4 F—S W Location (site address) 12700 Lupine Road Anchorage, AK 99516 Current Property owner(s) Scott E. Gardner Day phone Mailing address 12700 Lupine Road Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fx_j Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well i] Individual i] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:. Received by: 74jL z 6,-e, Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Ski — Waiver Fee $ Date of Payment 012-116 Caw_ Date of Payment Receipt Number B�`iv-t 5 Receipt Number COSA#- a5C15 1� 28 Waiver # 5. STATEMEN - LTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE LL Phone 522-7773 Date $/11//2015 OF A4®0®w®a0e to 11- ®,�: 49TH . C3 _System #1 Approved for bedrooms / A : MICHWffAkailDERSON System #2 Approved for bedrooms ®®®®sf�•, 381,z���z®,� Disapproved 4iVitin....... ®®per®,•4' Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: The nici ity�orage 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. 7. ATTACHMENTS: COSA Checklist X . Septic System Advisory Well Flow Advisory COSA blue sheet f U c Nitrate Advisory v Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Park St. No. 2, Block 6, Lot 4 -0' Pa cel ID: 017-432-02 A. WELL DATA Well type Private Date completed 4/28182 Total depth 90 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 69 ft. FROM WELL LOG 4/28/82 WATER SAMPLE RESULTS 58 ft. 10 9 - p.m - Coliform 0 colonies/100 mL Nitrate 11.8 mg/L Arsenic ND ug/L Date of sample: 7/29/15 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 6126/15 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 8/7/15 64.8 ft. 8.5 g.p.m. Collected by: And. Engineering Date installed 4/27/82 Cleanouts (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) "f Pumper Northland Pumping Service C. ABSORPTION FIELD DATA Date installed 4/27/82 Soil rating (g.p.d./flz or ft /bdrm) 85 SF/BDRM System type Deep Trench Length 43 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth 7 .. ft. - Eff. absorption area 344 a Monitoring tube Y Depression over field N Date of adequacy test 8/7/15Results (Pass/Fail)'aSS For 4 bedrooms Fluid depth in absorption field before test 7 in. Water added 645 gal. New depth 21 in. Elapsed Time: 1,440 min. Final fluid depth 7 in. Absorption rate , 600 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) N 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: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main >75' Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: >5' Building foundation Property line >5l Water main >10, Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: in. Manhole/Access (Y/N) High water alarm level Meets alarm & circuit requirements? On adjacent lots >100, On adjacent lots >100, Public sewer manhole/cleanout >100, Holding tank >75' Manure/animal excrete storage areas >100' Property line >/0 Building foundation > 10 Water Service line >10' Surface water >100, Curtain drain None Noted Wells on adjacent lots >100, F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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 Michael E. Anderson, P.E. Date 8/11/2015 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage > 10' A, MICHAEL E. ANDERSON F CE -4381 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 # 151428 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 4 of Mountain Park Estates #2 subdivision. This inspection revealed a nitrate concentration of 11.8 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department r Building Safety Division _ x On -Site Water and Wastewater Program $ q T Y 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-432-02 COSA # 0 5C_ 1 1 i'AI-)--1_), Expiration Date: 1 ` 3 1 - % 2 1. GENERAL INFORMATION Complete legal description Mountain Park Estates Subdivision No. 2, Block 6, Lot 4 P_ '5' (P j Location (site address) 12700 Lupine Road Anchorage, AK 99516 Current Property owner(s) Timothy and Diane Matthews Day phone 529-9129 Mailing address 12700 Lupine Road Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ✓❑ Individual On-site ❑✓ individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bed rooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Phone 522-7773 Engineer's Printed Name Michael E. Anderson, P.E. Dat—�'�i ' -7 AV �r; 4.9Stt �o M1CI�AEL Fr. /1[tD8tSOPI; 44s C+ •• 4r p 5. DSD SIGNATURE #0/0 r4381 �a& Approved for _ bedrooms. ,�1 j p�DFfS510�p�.► Disapproved. i�����'�♦ Conditional approval for bedrooms, with the following stipulations: .1t,t � f% ,,, Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other BY Original Certificate Date: (Rev. 11/05) Municipality of Anchorage • '-� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Mountain Park Estates No. 2, Block 6, Lot 4 Parcel ID: 017-432-02 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 4/28/82 Sanitary seal (Y/N) Y Total depth 90 ft. Cased to 69 ft. FROM WELL LOG Date of test 4/28/82 Static water level 58 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate mg/L Arsenic: N/D mg/I Date of sample: 10/09/11 B. SEPTIC/HOLDING TANK DATA Tank Type/Material septictsteel Tank size 1,250 gal. Number of Compartments Two Foundation cleanout (Y/N) Y Depression over tank (Y/N) Date of pumping 5/2011 Pumper Roto Rooter C. ABSORPTION FIELD DATA Z Well Log (Y/N) . ~ Y Wires properly protected (Y/N) Y Casing height (above ground) >24 in. AT INSPECTION 10/13/2011 63.9 ft. 8.5 g.p.m. Collected by: MEA Date installed 4/27/82 Cleanouts (Y/N) High water alarm (Y/N) Y Date installed 4/27/82 Soil rating (g.p.d./ft2 or ftz/bdrm) 385 sF/BDRM System type Deep Trench Length 43 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth 7 ft. Eff. absorption area 344 f:2 Monitoring tube Y Depression over field N Date of adequacy test 10/13/11 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 3 in. Water added 612 gal. New depth 29 in. Elapsed Time: 1,380 min. Final fluid depth 3 in. Absorption rate >= 600 g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A in. Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Sewer /septic service line >26 Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: G. ENGINEER'S CERTIFICATION = �t,`Pi' ;v. ' ••.;S',��� I certify that /have determined through field inspections and ,� # 4921 review of Municipal records that the above systems are in �••• �� •••• conformance with MOA COSA guidelines in effect on this date. e.... „...„. OP Engineer's Printed Name Michael E. Anderson, P.E. '►tea+ r XAeOWN 38 $tri Date 10/25/2011 'tJ�'�®•••..j.`..•� `�'�� t��lIOF1ESS10��w�► COSA Fee $ 14OL10 — Date of Payment Receipt Number O(O (Ocl (Rev. 11/05) Waiver Fee $ _ Date of Payment _ Receipt Number _ Municipality of Anchorage }6 g 4P �! Community Development Department z �_ 4 c 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 # 111422 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 6 p- 561 of Mountain Park Estates subdivision. This inspection revealed a nitrate concentration of 10.7 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. SGS SGS Ref.# 1114959001 Client Name Anderson Engineering Project Name/# Lot 4 Block 6 Mountain Prk Est Client Sample ID Lot 4 Block 6 Mountain Prk Est Matrix Drinking Water Printed Date/Time 10/14/2011 9:05 Collected Date/Time 10/09/2011 10:45 Received Date/Time 10/10/2011 9:00 Technical Director Stephen C. Ede Sample Remarks: 450ONO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/11/11 10/12/11 NRB Waters Department "Total Nitrate/Nitrite-N 10.7 * 0.100 mg/L SM20 450ONO3-F B (<10) 10/10/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/10/11 DLC Total Coliform Negative 1 100ml- SM20 9223B A 10/10/11 DLC 0 J a co -X- ,£'•9Z a ;n rn 00 z Lupine Road N00°03'45"W 1 104.00' 1 0 06 N m C x N O'00 3 G . 0�]no O J °7 -N QE 2LOC ZD ii e[ o Eo �¢ac°� C � U) 6 O (n 0 avv _O.O°3o cn v 0 a U W u wo v.6 c � U) ° m °�c a 1D v m G a i 48.2 � u �� O ..'b" � 4�ID o N O — p W LIJF U) -F-.. r p DO N X W 48.2 b x 0 00 - 6Z ®=ILO 0 ;n x a, 00 U) d- 4-0 0 x __.1 I x F— X— x x Q) W X10 U) cn © x X 10' Utility Eosement S00°03'45"E 104.00' 0 C x N O'00 3 m 0�]no L v�x0 J °7 v 00U) QE 2LOC ZD ii e[ o Eo �¢ac°� C � U) (n 0 avv _O.O°3o cn v 0 a U W u wo v.6 c � U) ° m °�c a 1D v m G a i 05: 0 00 � u �� O ..'b" � 4�ID o N O — p W LIJF s v, o o y ow Ooo�O ^� 1 G �m= '�-'".. mm �a'vo..+ W� m V) O o U U W O O DLLJ - U 0� F= UDcm C �C°OUa '`'x r= o° opo JW m W c, m Qo2�s J Q W v= c z c m U A L V; p �- UJ = S ,- m ♦r C m �arnim J++ C U m o::3 y 0 Q '0 N_ ZQ �r o®� X- m x v o - x � ena U y � U - 6Z ®=ILO 0 ;n x a, 00 U) d- 4-0 0 x __.1 I x F— X— x x Q) W X10 U) cn © x X 10' Utility Eosement S00°03'45"E 104.00' 0 vl�;N W Nc0 W LO c 1 C� (D <D Z Ln Ln W 1 a� x QN o Li w z° Z N Q J D_ 1 m V)0 m OC C, m W a 0 v D o wO Uprno J Dm N Cif ) o Q) d c� Om o v m 0 o` J dam• <1 0 3 O N LO L v�x0 J °7 v 00U) d � CFn � U) <o cn v 0 a M M N 00 d a a rn v •o vl�;N W Nc0 W LO c 1 C� (D <D Z Ln Ln W 1 a� x QN o Li w z° Z N Q J D_ 1 m V)0 m OC C, m W a 0 v D o wO Uprno J Dm N Cif ) o Q) d c� Om o v m 0 o` J dam• <1 0 3 ct 30 11 11:29a 10/27/2011 Dad ARROW Pump & Well Service 907-727-3541 Concerning Findings at 12700 Lupine Rd, Anchorage, Alaska 99516 3388078 We at Arrow received a request for service concerning findings of lab results that concluded a high concentration of nitrate readings at this site. During the service call we scoped the waterwell with a camera to try and find any evident causes to why this water well would have such findings. During the scope of the well. I found that the pitless was located @ 11 ft below grade, and saw that there were no signs of anything permeating through the seal of the pitless. It was properly sealed and in good condition. I found no signs of cracked or broken casing which extended 65 ft +. I found no perforations during the inspection. I found the water wells static water level was at 65 ft. The well casing extended above grade within the limits set by code. The water well Casing cap was the only thing l found in need of repair/replacement, as the seal was in poor loose condition and missing manyof the necessary rubber seals that a split seal of this kind would need to prevent pollutants from penetrating the cap_ This did result in some residual moisture/light corrosion directly beneath the cap. I replaced the cap with a new bolt down rain cap including all proper seals required for safe operation. I also replaced the prior metal conduit with 1" pvc electrical grade conduit. I saw nothing on the property thatwould indicate the possibility of pollutants to leach into the water well. The closest septic pipe was at least 90 ft and well down grade from the position of the well. At this time I can find no possible cause for the contamination found at this location. if there are any other questions or concerns please call us at the number listed at the head of this page. John Netherton / AAROW Pump & Well Service 115-C Vl*' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 0t7-`f3Z-4091 HAA# 1. GENERAL INFORMATION Complete legal description G of H 3 to cl,- G. M aun,ec,n Park Cs luf-er #2 Location (site address or directions) JA Rot Property owner Do vf Mc Nccu h fvn Day phone 3'y -E-72-78 Mailing address 17-700 1-upine R c AtiCA0ra¢p. /4-k 9951 Lending agency Pru Olenha l - n1ua��Day phone -Z9 32- x 273, Mailing address 2500 CelZ weft 131"(, Su'fe �tOO N• uj41,, TX 7704 2 Agent CarOl DO" l -Ai f- Ae Ntax Pro e, --r H -e( Day phone 276 - 2-761 Address 2600 Cc�rc�a�x Sl - Ai) cho i-cr4?. A-(< 91,7,T-0-7 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: �— 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 r(akbre T-,echn'rca/ S<rv'tcDi Phone 3 YS -13s5 - Address 11S30 /='ctio Sf/-i-nchorcce, /3-`c 99,10! Engineer's signatureT'4"L :E )-)-I' Date Mau /r; 199 y �6 T-Av 'iS ct [o�y of - pr¢vcow (-bA6 `warca/ion ttvALCA &tid%( SwLM 1-Feo< -jo 1)4o_f on 9/13/9Yi bul 41y D4H-f. P/ra/e mai/ 5*Ae r,erhArale C-6rec�y to hlancy l-untian, of Prrcde4Aell' 1*3e/accrA6A 2900 C(�y Wesk r31veC, Surl-G 'toot l%u(A" TJX %� 6'Y'? MP 6. DHHS SIGNATURE Approved for Disapproved. 14— bedrooms. Conditional approval for bedrooms, with the Cf R;�- �. 491 -ti PA THEODORE F. MOORE • 1' •.� CE - 3589 �4V � r�'�' • ...... •' 44"0 Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that a periodic testing be performed to insure the wells cq)�tinued sui,ta�ility." Nitrate concentration is 5.6 mg/1. EPA Date NUTIC 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 orderto satisfy certain federal and state requirements. Employees of DHHSdo 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.=(Rev.1r91)Back MOAN21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST #Z Legal Description: `.oF'Y�3 / G Mfn Pari Esf Parcel I.D. A. Well Data Well type PL/IL. If A, B, or C, attach ADEC letter. ADEC water system number /15—_C_ Log present (Y/N) Yet Date completed W 30 / 8 2 Driller �sJ 9 /15, / 9 y Collected by: Total depth 9a, Cased to 0 Casing height 18 " Sanitary seal (Y/N) Y Wires properly protected (Y/N) Date of test Static water level Well flow Pump levels FROM WELL LOG AT INSPECTION 0 Other bacteria n(o,,e r4�or k&( Date of sample: 9 /15, / 9 y Collected by: v K B. SEPTIC/HOLDING TANK DATA /9y T=; Tank size I Zso q / Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N, A. Alarm tested S6 " 60 ' 9/1,( l 9 Y 5 ►-ri s= < to -g-P.M. g.p.m. o �S c � cin _ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I = n co i "r•I to = -P, 0 N (D On adjacent lots > tao ' 0 Absorption field on lot 1 z 7 " ; On adjacent lots > 10a " Public sewer main N. 4. Public sewer manhole/cleanout Sewer service line > 2S , Petroleum tank Alone See") WATER SAMPLE RESULTS: Coliform © col / MO of Nitrate S. G vhg /-( Other bacteria n(o,,e r4�or k&( Date of sample: 9 /15, / 9 y Collected by: FlatfoP Tech Svc. B. SEPTIC/HOLDING TANK DATA Date installed `/ / 2,7 / (6 2 Tank size I Zso q / Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N, A. Alarm tested (Y/N) N. A. Date of pumping 9/1,( l 9 Y Pumper Tsai c - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 113- , On adjacent lots > 1G0 " Foundation Io' To property line 27t Absorption field 5 ' Water main/service line > 2S' Surface water/drainage > 100, 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION N.A. Date installed Manufacturer Size in gallons —Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off" Level at Cycles tested Surface water Date installed Al / 2 7 / & 2 Soil rating (GPD/Ftz) &S- C" 10*<rm System type i r cn C_h Length `i 3 Width Gravel thickness 4.1 Total depth 7' Total absorption area 3 'Ly 0 Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 9 / / 4 y Res Its (pass/fail) P &-rs for `f Bedrooms Water level in absorption field before test �s After test y� Peroxide treatment (past 12 months) (Y/N) None 1-1--/7o^ vf If yes, give date N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 12 7 To building foundation 2s On adjacent lots. > 1O0' Property line iM To existing or abandoned system on lot N. A. On adjacent lots > 30 ' Cutbank N. A. Water main/service line > Z,5- ' Surface water > too' Driveway, parking/vehicle storage area So' Curtain drain /lone seems E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the HAA Fee $ 300 ' Waiver Fee $ _ Date of Payment 9 / 13 /9 y _ Date of Payment Receipt Number OS — 00 ? --7S- Receipt Number. 99.[1981.'AW Rack rs. iN o+P u � pp P Signature ��,.S.6tyr Engineer's Name TG cocF'o�L l=• Mia e . A'e ne souv" a.e p. �y ffr, M ODU;:L e F. A0 OPE • �H; Date Nou 10/ &,9 y CE ct YeV[GLtr l�/4N n�,vhce, icn �41,131,9 Y l., CGI 17 i" 1.,-qnn GT / l3 / 9 [l ht,�`nf y� HAA Fee $ 300 ' Waiver Fee $ _ Date of Payment 9 / 13 /9 y _ Date of Payment Receipt Number OS — 00 ? --7S- Receipt Number. 99.[1981.'AW Rack CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 11/10--19y ,� , rn Cv� Sf D /10J J �M 1�2r2 a r� n-c� Cor/ o F m /y 9 / 13 / 9 Y IJ -Alf cc ck7t fl �or 1-0 Y� Q/ Gc Mfn Parti CSf Jt#Z , wtitcA wou (ne pr cp rW7FIyrn'sr /et ceof 4J. yok'" /G ejt���r�P iAG /lrocest C- oul� l/bK r II�SC ►ascii/ �e Or,.�rnc�l� Srgn�r� (f/FN C.erILZfrccx-Ae f3 Ate Pru alen 1-i«.1 ire loco iron 2S Oo Cray Gclrsf (31 volS ur�P yoo� yk'n ouS s %X 77OY2 Gtnc? acro Stns u / 1-/,e s, neGQ C�er hFr ccr/2� �a mt of �c cc.ha�x 2Go o C0-'-0e0`e Sfi pe he,( a ra l D a i n i f @ Re lloLA Pro p -9 AnGhcrexie,,, A -k q9S"c73 �unkt� of -1 ivxAA 5 co 0e s 5c,4 111 1-7jgq 1-6 j�'Q �uVYYvt �x MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # 1. GENERAL INFORMATION Complete legal description Lo 1- y1 S/oc k cC 11 -n PaarJc Cs f #2 Location (site address or directions) ►2700 4!?4eme Not Property owner QcAw Mc /Vau�fh fa, Day phone 3 yS- 7 27f Address 2600 6ae-aeoveL Mailing address 12700 l ueln� 3 A-;,? C6. /etc 99S/6 Lending agency un k Mailing add Day phone Agent Carol pa« k-7; l Re Nexx Pl-operr he Day phone -2 V- 27d/ Address 2600 6ae-aeoveL p Rk 919s-03 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F1 d ffrsec6,1 e cul Ser1i1 C Phone 3 y.S- 1355 Address995'/6 Engineer's signature �� Date Se4t 13o 199' alt; Joe ................l....is ° Y..... Y�I... •.•I.��..Y• i 1. THEODORE F. MOORE' t ��- �': •,, CE - 35&9 yr 60. 6. DHHS SIGNATUREG�ux.040 Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 MITIr, Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev.1/91) Beck MOA M Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-4 C36.,- , Min fartr Csf #2 Parcel I.D. A. Well Data Well type Pv f- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Yes Date completed y/ 30 / 8 z Driller Fos✓ Total depth 90' Cased to 69 Casing height 18" Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test Y130 /92 9/ 6 l 9 y ;� CnrrA 3a r - n Static water level 5-8 1 GO -° a Well flow 10 g.p.m. 'S t g•p•m• if�r7 w o Pump levell > 1Cn < Z o SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 )!� On adjacent lots Absorption field on lot I2-71 ; On adjacent lots > too, Public sewer main N. A Public sewer manhole/cleanout N. A. Sewer service line > ZS' Petroleum tank NoAe scut WATER SAMPLE RESULTS: Coliform O cot Itoorn•e Nitrate Otherbacteria hole rWor/rar Date of sample: 9 / 6 / 9 y Collected by: Fla F�� TtcG, Svc B. SEPTIC/HOLDING TANK DATA Date installed 'i / 27 / 6 2 Tank size C ?_15y ea ( Compartments -a Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) N.A. Alarm tested (Y/N) N. A. Date of pumping 211Y 1 9 Y Pumper �.suaZcs SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IIS , On adjacent lots > t oto r Foundation 10 To property line .271 Absorption field Surface water/drainage > laa r S' Al Water main/service line .> 25'' 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION N. A. Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed q / Z 7 / 8 2 Soil rating (GPD/Ft2) 8, a ViTo(rm System type 7-re/1oi Length 413' Width Gravel thickness Total depth 7' Total absorption area Cleanout present (Y/N) Y Depression over field (Y/N) IV Date of adequacy test 9 / 6 / 9 Y Results (pass/fail) Pec SJ for `y Bedrooms Water level in absorption field before test :3 & " After test '/6 " Peroxide treatment (past 12 months) (Y/N) Ivo e knoc­n o F If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot f Z 7 1 On adjacent lots > too ` Property line To building foundation To existing or abandoned system on lot N. On adjacent lots > 3o' Cutbank_ N1 A. Water main/service line --> zs'' Surface water > r oa ' Driveway, parking/vehicle storage area Curtain drain iya-)e s e el) E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in .qjg ton the date of this inspection. 1 ,r,�P t} •s ///y r•�is �, {w '•FR 0 �'i3hC' � •�9�' la" • a6•es0 •! lxPeeA 1.x•11. Signature 0-r Engineer's Name TAcoeeo e E. MooYc f�'' '•'�Xi: r. O °```>�"' e THGODO„�: F. HSOORt e C 1: E 3589 ! , Date Serf t3 /99`/ . 44 �4 Al k ,q HAA Fee $ 300 00 _ Waiver Fee $ _ Date of Payment Date of Payment Receipt Number 9Z 2 S Receipt Number. 72-026 0931' Back Time APPLI'J• `,NT FILLS OUT UPPER HAf'--` ONLY Property Owner � I ' ��,-�yfl.� % �- !i r"L%j �rJ Phone _.t..V��-✓ Date Date M•ilin Address 3 9 p T-;�. .,✓-_3 /F-. "1,7: _ [ �i %J.i� ') . Zi Code Buyer 7 Address �r' � ��/ � .c � � r In j ,;, ,, � Zip Code Lending Institution - i! /��`/:,,/" ��,-.� Phone Address r f _ •� �1 Zip Code Field Notes: ( Realty Co. & Agent I Phone 1/% C / Address r;a�l Zip Code - ECEiVEp Legal Description �, �� , riG;�, f�%{ �.�Y%��'• `•� ( ) DISAPPROVED - ��;:tY- Street Location - Type of Residence 04Single Family r �/ ❑ Multiple Family No. of Bedrooms ❑ Other Date Sewer Installed Water Supply Individual 1 c"r lr -i`-- - !` ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community ---/��^•,: For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal r� Individual Year Individual Installed: O Public Utility When Connected to Public Utility: ❑ Holding Tank _ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Q 4. Date Date Date Date 7 Inspector Inspector - Inspector Inspector _I IWil, Field Notes: ( MUNICIPALITY OF ANCHORAGE aDEP;, C), rr r. HrAITH 1': ENVIRCi`;:rC_,N,-AL PROTECTION C / 10 ECEiVEp APPROVED BEDROOMS _ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED - ( ) CONDITIONAL APPROVAL /).J - DATE `� BY: �A- LAA Soils Rating Date Sewer Installed Well To Absorption Area d Well L�TankSizve Septic % 00o ---/��^•,: Well to Tank 72023 (3182) C-) Time APPLI( NT FILLS OUT UPPER HA; QNLY - ,Property Owner Phone , D to U C- C—_ �- ��' Mailing Address Zip Code`! 1 6 Buyer Inspector Inspector C)� Address - Zip Code ( ) DISAPPROVED Lending Institution - - Phone TE ` C B Address 1-- -l'.,_� Zip Code Daae/ Sewer Installed Realty Co. R.Agent - r --"e- Phone -7 71 2 ! r- 7/(> Address Zip Code Septic Tank Size ( � Legal Description t Street Location Type of Res' oce - gle Family Multiple Family No. of Bedrooms ❑ Other Water Supply - ny� '^�'Vmdual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. LJ Community - - - For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility k..- 1 C -ND Sewer Disposal - r ❑ Individual Year Individual Installed: 25 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time D to Date Date Date Inspector Inspector Inspector Inspector Field Notes: - ( ) APPROVED BEDROOMS 2 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL- - TE B Soils Rating Daae/ Sewer Installed Well To Absorption Area Well Log Received Y-- 61r Well to Tank Septic Tank Size ( � 72023(3/82)