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MOUNTAIN PARK ESTATES #2 BLK 7 LT 2
Mountain Park Estates #2 Block 7 Lot 2 #017-432-14 inspection npe ort-1-1z.aoc Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT 'JAN312014 Permit Number: OSP131388 PID Number: 017-432-14 Dwelling: © Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade Name: STEVE TUTTLE ABSORPTION FIELD El Deep Trench El Shallow Trench ❑Bed ❑Mound Address 12620 FOSTER RD ANCHORAGE AK 99516 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MOUNTAIN PARK ESTATES #2 7 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ 25'+ TANK ■ Septic ❑ S.T.E.P. ❑ Holding ■ Other Manufacturer - ANCH/ADVANTEX Capacity 1500 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'+ STEEL 2 NA Foundation 5'+ _ LIFT STATION Manufacturer Capacity - Curtain Drain 50'+' Gal. Remarks EXISTING SEPTIC TANK Pump on level at in. Pump off level at in. High water alarm at in. ABANDONED PER MOA REQUIREMENTS NOT OBSERVED. Pump make and model Electrical in MV/1 ctions performed by Installer PIPE MATERIAL Housetotank Tankto drainfield 3034 Drainfield CO/MT Inspector LARS SPURKLAND BENCH MARK (Assumed elevation) 100 ft Ins daction 1'r2" Location and description tes: 2 3b 4'h BACK DOOR JAM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL a"���+€ to p OF A�q0 11j Conditional Approval: Date Ca. f♦/ i Approve LAAAA /ZC 11 pRStONP� Date jjg inspection npe ort-1-1z.aoc r. C M 0 U N T A/ N 25 0 25 50 75 100 125 150 SCALE: 1' = 50 FT. I S7'UW 15TH. VENE Mlrv(i I I MOUNTAIN PARK ESTATES 2 BLK 7 LT 2 I ( SEPTIC SYSTEM ASSUILT 203 W 15TH. AVENUE ANCM AK. 99501 STEVE TUTTLE BATE., BEC, 5, 2013 !9077 279-3916 12620 FOSTER RD., ANCHURAGE, AK 99516 SHEET, 2/3 GRID, 2839 PERMIT # aSP131388 PID # 017-432-14 HPE#2B6L5SC50 ASB.DWG 6" 1 1- •i SUOE SE( OF 6" OVER THIS CONNE( TO PRC SHEER PROTECT EXIENI BRIDGE EXCAVA....I 1500 GALLON ADVANT£X TANK BENCH MARK DOOR JAM ASSUMED ELEVATION 100' 0 ISPURKEAND ENGINEERING I I MOUNTAIN PARK ESTATES 12 BW 7 IT 2 I I SEPTIC SYSTEM SCHEMATIC I 203 W15th Ave STEVE Tum DATE, DEC, 5, 2013 Anchorage O0.e Ak 99501 12620 FOSTER RD ANCHORAGE AK 99516 SHEET: 2/2 GRIDS 2839 I PERMIT / OSP13IJ88 PARCEL ID / 017-432-14 MPE1287L702-AS&M I On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131388 Tax Code Number: 01743214000 Work Type: Septic Permit Effective Dates: November 01, 2013 to November 01, 2014 Design Engineer: SPURKLAND ENGINEERING Subdivision: MOUNTAIN PARK ESTATES #2 Site Legal Address: MOUNTAIN PARK ESTATES #2 BLK 7 LT 2 G:2839 Owner/Address: TUTTLE STEPHEN A & VICTORIA A 12620 FOSTER RD ANCHORAGE AK 995163229 Site Mailing Address: 12620 FOSTER RD, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 19032 Total Bedrooms: 4 N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B) Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERANELL PERMIT APPLICATION Parcell.D. 017-432-14 Property owner(s) STEVE TUTTLE Day phone Mailing address 12620 FOSTER DR., ANCHORAGE, AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES #2 BLK 7 LOT 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field El Initial El Single Family (SF) (w/wo ADU) Septic Tank 0 Upgrade Q Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APP AT I7LUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with ap icab M nicipal Codes. ( Ignatu of property owner or authorized agent) Permit/Rush Fees: 40166 Date of Payment: /0 fl-hia Receipt Number: Q 831161 Permit No. 0SPISI39 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. SPLIT almd Eim olmeenong Environmental Consulting and Design SEPTIC SYSTEM DESIGN Mountain Park Estates #2 B7 L2 Municipality of Anchorage October 10, 2013 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic Tank Installation Permit 12620 Foster Rd, Anchorage AK 99516 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The owner of the above referenced lot would like replace the septic tank with an Advantex AW WTS. The submittal consists of two (2) drawings showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, LSA Lars Spurkland, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net LOT I W I'I Septic o Area INSTALL 1500 GAL AOVANTEX AWKS CONNECT TO EXISTING DRAINFI£LD M D U N T A/ N P U 4 BDRM SFR K o r I a I LOT 3 � I ESTATIES #2 NOTESLOPES EXCE£ORIG 25% WERE NOT OBSERVED WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED ABSORPTION FIELD LOCATNIAC NOTE. THIS IS NOT A SURVEYED PLAT. WELL k SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 25 0 25 50 75 100 125 150 SCALE 1' = 50 FT SPURKLAND ENGINEERINGSEPTIC SYSTEM DESIGN 203 w 15TH AVENUE AfOUNTAIN PARK ESTATES f2 BLK 7 LT 2 ANCH. AK. 99501 STEVE TUTTLE DATE OCT 15, 2013 (907) 279-3916 11 12620 0STER RB., ANCHORAGE, AK 99516 SNEfh Z13 OKIP 2839 PERMIT B OSP121OXX PID If 017-432-14 NPEB2B6L5SC50.DVG 6" JIM CAP 6" PUMP-OUI OPTIONAL SLIDE SECTION OF 6" PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION - EXTEND TO BRIDGE EXCAVATION ADVANTEX 24" AX20 POD INSULATED RISER 1500 GALLON ADVANT£X TANK J L SHUKKLAND ENV1NLLKINU HOUNTAIN PARK ESTATES 12 BW 7 LT 2 SEPTIC SYSTEM SCHEMATIC 203 W15th Ave STEVE TUTTLE DATE- OCT 10 2013 Anchorage Ak 99501 12620 FOSRW BO ANCNORAOE AK 995f9 SHEET. 2/2 GRID 2839 I PERMIT 10SP131XXX PARCEL ID / 017-432-14 MP£1287L7D2.DWG I ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND 57_f17/fN ANO VICrOA/4 Tr7,tf THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 3'/ Day of Q LT ST&Ae,v AV, c7_t ,4 of 20 � 33, by and between i u r7 4k herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement 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 V 4,\f T located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). 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 Anchorage Municipal Code (hereinafter, "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. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. 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. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations. Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the AW WTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any 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. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the AW WTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: STEOy iA 4,Np V, e so,e, a ' r7 L e b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement 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 Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: By: J (signature) Date: -4'7--fAmeu T rT � E (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrum� gnt w was acknowledged before me this 3 i-4day of © c- ober 20A_? Mai nq NOTARY PUB�R 4ASKA My Commission expires: S • i � 2-0 IT MUNICIPALITY: By: (signature) STATE OF ALASKA010 NOTARY PUBLIC Mai Xiong My Commission Expires. 26I --,L Date: name) Title: 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 5KEWL O UPGRADE MAILING ADDRESS 4 LEGAL DESCRIPTION LOCATION NO. OF B DROOMS Uy DISTANCE TO: Well 90 / Absorption area Dwe11' / 3 PERMIT NO. F- Z LU- Manufacturer Mat eri�al- � Q No. of compartments Liq; cap�ci,�,y 6gallons IF HOMEMADE: Inside length Width Liquid depth JAZ DISTANCE TO: Well Dwelling PERMIT NO. = z F Manufacturer Material Liquid capacity in gallons aWell®� w y DISTANCE TO: / { Foundations / Nearest biV (j PER[jJT NOO 6 3 J LL Z Z w No. of lines 1 Length of h e/ Total len th of lines Trench id h/� inches Distance between lines cc- cc IZ o Top of tile to finish grade/ Material beneath tile / inches Total effectiv absorption area w Length Width Depth PERMIT NO. a a H LU Type of crib Crib diameter Crib depth Total effective absorption area Lu y DISTANCE TO: Well Building foundation Nearest lot line J J Clas - Depth Driller Distance to lot Iine PEF;,MIT�NO. Q .� 1 ''jj CCJJ w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER E PIPE MATERIALS r -L SOIL TEST RATING INSTALLER REMARKS P� L APPROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. � P1 IQ � DEPHRTMENT OF HEALTH AND ENVIRONMENTHL PROTECTION 825 'L/ STREET, ANCHORAGE, Al.,— 99501 �� ^/�W(A� �u 264-4720 E:- ��� ~�~� 1� �� �� �o �_ �~ HPPLICHNT SRH BOX 1585B ]49 4207 LOCATION MT PHRK EST LEGAL L2 B7 MT PHRK E�T LOT SIZE 20000 SQUHRE FEET TypE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS - 4 SOIL RATING (SQ FT/3R)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION S-YSTEM IS: 9,3o ����� � ������� �� ����� ������ THE LENGTH DIMEHSION S �THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE nEpI� n� A Tpcmr� nA PTT T� THE DT�TANCE 8ETWEEN THE SURFACE OF THE ''= '`~''~'`'^' ^- ���~ ~--��'---� �� GROUND AND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH QRHVEL BETWEEN THE HND THE BOTTOM OF THE EXCAVATION (IN FEET.) �I C: �F-B rA K OUTFALL PIPE _~___~� �V=D C, #-=_, 0"A Ci r -z 0=:, 0-~R:::� r -J 1- CH F> -9-' -1 CH P-4 H PACKAGE PLANT MHY BE INSTALLED HT THE PERMITTEE/S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER H CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM HND/OR YOU MH; BE SUBJECT TO PROSECUTION. ~'~� ���� ���� ������������������ ����� ���LJ I�L� ~_~_ BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MIHIMUM DISTHNCE BETWEEN H WELL AND ANY ON~SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN �0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS FIRE HVHILHBLE TO INSURE PROPER INSTHLLHTION. 1 7' I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE. 2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTHND THAT THE ON~SITE SEWER SYSTEM MAY REQUIF?E ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNE ~~�---~ January 5, 1978 22ose Pendergrass Star Route A Box 1385B Anchorage, Alaska 99507 Subject: Lot 3 Block 7 Mountain Park Estates Subdivision /S#77560 Idot 2 lock 7 Mountain Park Estates Subdivision ermit #77559 Lot 7 Block 8 Mountain park Estabes Subdivision Permit #77561 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section !—! wir"; in , N in , � r i 000 1 Aviv 1-11 b 10,10- 10 i 1 in i P"FA w rw "In" 1 �I " 1 rw.�n , ; A 1 1 ip. n P! ink 1 . X i Hi- ; ;.:!i Id 1 se L) 11 'i,..,' F:1 i A A , Rk'"M 10 1- 1 1 1: Aw vNijiKys DIP 41 MY pit v 1 In: 1 Q., ky 0- to - rw "Orwyn 1 fjqf: Mi 1 yAq! A P 1 by "m i i r t; r : n KP i A . " + i v � " . V& 4 1 Aw i K it i 1 r- i o F; ('sysivy:1 j 4 i: 1XI—vi ion.;n lot: RX r> W "1011"Wip wn lKi ! FuM invy w -V in l va q vo- Put P .J: 1VP Mmi ill v. Wn wom 1 1 i 1 pis 1 "PAWN sy a) k" 1 H 16! 710Lrr 'i i ; A kov I i Q- Av lot- A ;0 wci" 1 PKA ri n Y -ww 1 :lj- n :pql'l FQA?, pal) 0 Quy"PIN MA: ;-- V- P:y .� v F v 4 w�'= -4 0 ", & 0 �� '- 1-m in, 10 . 0-h-0 1 V At ,4'r j w p ` ; n Q - .I '- }:1 \I ®a ,4'r j 11 �; 3 ; Z Q ®a � 6c• � � C4 U Y J F F p l `n a @ < Z E1 v: p p U jC ,4'r j 3 ; Z Q ®a � 6c• � � C4 U Y J F F p l `n a @ < Z E1 -1 p p U jC old LU > i 1. c� tr a li !um Lu N x 0 W m rti t'j E 1 LL O \ ` R J: r: f , C�lti '• � , Z ? 1 : w „ VQ a w ttl k OC4z n UO LZJ ,4'r j MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALI� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date fes✓ �d�� 9 7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) 1-07 A./3K77 -P" PsJaj, I'-2- ��22 'T1.4 M IeS Location (address or directions) I ;IL (PAC) (b) Property Owner Mailing Address r Wacra YL -ST 0 12 Ir F Telephone: Home (c) Lending Institution 1*14e z. -wGw &t" -Telephone Mailing Address �'L4 (d) Real Estate Company and Agent Business 51- 3 —s S ao Address / ^— --` Telephone 5'n3 — 5 -S -0-e-) (e) Mail the HAA to the following address: or: Check here if hold for pick up. _ List contact person and day phone number below. n bb -e" �DorkLm-r 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Not If comm nity 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: f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 91 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ��� Telephone Address _ �d L� 4 Date o�� &-7 V.. ..., ,,,.,...... • '', Engineer's Seal E .: •t •22:'.5-L. DHHS APPROVAL Approved for f"' C`9 bedrooms by �' �%"` "� Date Approvedy Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/86) Back n A. WELL DATA ,-1 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: —r Well Classification R If A, B, C, D.E.C. Approved (Y/N) tq/r-< Well Log Present (Y/N) —,Y Date Completed `7@ 7' 7'S Yield 5 7prid Total Depth 1!�.__Z 2 Cased to Depth of Grouting lyej o e_ Static Water Level �-L-`_ Pump Set At Bo -Me vul Casing Height Above Ground Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot m ; On Adjoining Lots L`{ To Nearest Edge of Absorption Field on Lot ISO ; On Adjoining Lots To Nearest Public Sewer Line N 0 N L=F To Nearest Public Sewer Cleanout/Manhole MCj Gvl To Nearest Sewer Service Line on Loot ` / U Water Sample Collected by X ; Date -Z-110 C < 7 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 742' 7 rl Size 125e2 No. of Compartments 7—t)4- 0 .O Standpipes (Y/N) eai%,�—_Air-tight Caps (Y/N) Foundation Cleanout (Y/N) r Depression over Tank (Y/N) �4 // Date Last Pumped �1?/b: 1 Pumping/Maintenance Contract on File (Y/N) Mfg ; for "fes Holding Tank High -Water Alarm (Y/N) NTemporary Holding Tank Permit (Y/N) IV%r Separation Distances from Septic/Holding Tank To Water -Supply Well q'X� t To Building Foundation To Property Line /a * To Disposal Field To Water Main/Service Line I To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a.J�; Type of System Design Date Installed %_ /F9 _7e�t Length of Field 5- 7 Width of Field 3o ii Depth of Field Pa Gravel Bed Thickness Square Feet of Absorption Area, Standpipes Present (Y/N) l 6J -fit: i Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Z � ul r l 3 t jr-(-3co avr" Separation Distance from Absorption Field: To Water -Supply Well / 3a To Property Line To Building Foundation 0 Lot N 0 v) To Water Main/Service Line �) ( u To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) !q« 1"f [. f Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ) Signed - �t�� Date Z` «fl l Company MOA No. Receipt No. Srl)c-�>) - Date of Payment Amount: $ 3)-�a Page 2 of 2 . 72-026 (11/84) f3 a Engineer's Seal )U,J� `1S, 197t 40 inn 2UV jl +I�j� �p�p Z A CHORAGEEALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 2, BLOCK 7, MOUNTAIN PARK LOCATION: 12620 FOSTER DRIVE OWNER: SIGMA CO. /WALTERSTORFF r.'. • s• •• ,u TYPE OF WELL: SINGLE FAMILY...:. No. 2225-F )ij )t 2b 1971 WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: NO. DISTANCE BETWEEN'WELL-'' AND SEPTIC TANK ON LOT IS APPROXIMATELY 951. REQUIRED DISTANCE IS 100'. WAIVER APPLIED FOR. WELL YIELD FROM WELL LOG: 12 GALLONS PER MINUTE PUMP YIELD: 8 GALLONS PER MINUTE DATE OF INSPECTION: FEBRUARY 18, 1987 TEST PROCEDURE: WELL WAS PUMPED WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. STATIC WATER LEVEL WAS FOUND AT 43 FEET BELOW TOP OF CASING. AT THE BEGINNING OF THE TEST WELL DELIVERED 8 GALLONS PER MINUTE. AFTER 100 MINUTES OF PUMPING THE DELIVERY WAS 5 GALLONS PER MINUTE. THE DRAW DOWN AT THAT TIME WAS 70 FEET. TOTAL WATER COLUMN AT STATIC LEVEL IS 100 FEET. A TOTAL OF 620 GALLONS WERE PUMPED. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON FEBRUARY 19, 1987. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. 1�1 ` TO D n 'CONSULTING ENGINEER 03 W 150) W� ._J��UU�C mq U ago I Z ANCHORAGE, kALASKAl995ui TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y T E S T LEGAL: LOT 2, BLOCK 7, MOUNTAIN PARK ESTATE #k2 LOCATION: 12620 FOSTER DRIVE OWNER:- SIGMA C./WALTERSTORFF ..<.. RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS`' �..... ....... WELL: PRIVATE, ON SITE ;> ;`'�: o.F222971 1U N_ 2�. 19 l SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1250�4,GAT;._":"-' ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 342 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: JULY 1978 DATE OF PUMPING: FEBRUARY 18, 1987. ROTO -ROOTER DATE OF TEST: FEBRUARY 18, 1987. TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH THREE FEET OF COVER AND A LIQUID DEPTH OF 48 INCHES. TRENCH WAS FOUND 8 FEET DEEP AND WITH 2 INCHES OF LIQUID. 620 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH WHILE THE WATER LEVELS IN TANK AND TRENCH WERE MONITORED. TANK LEVEL REMAINED UNCHANGED WHILE THE WATER LEVEL IN THE TRENCH ROSE 14 INCHES. NEXT DAY THE TRENCH WAS BACK TO TWO INCHES OF LIQUID. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. MunicipaiLty of Anchorage February 26, 1987 P.O. L X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Tobben Spurkland, P.E. 203 W 15th Avenue, C Suite 203 Anchorage, Alaska 99501 Subject: Lot 2 Block 7 Mountain Park Estates Subdivision #2 Waiver Request WR87-020 Dear Mr. Spurkland: Your request for a waiver of the 100 foot separation required between the septic tank and well on the subject property has been granted. This distance has been waived to 95 feet. This waiver is valid for the existing septic tank only. Upgrades or enlargements of the septic system are not covered by this waiver. Sincerely, Stephen S. Morris Civil Engineer On-site Services i CONSULTING ENGINEER tip jQadgmDg pow 03 W. 15th AVE "C" SUITE 203 2 A CHORAGE,ALASKA99501 TELEPHONE: 1907) 279-3916 MUNICIPALITY OF ANCHORAGE FEBRUARY 19, 1987 DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 6-6650 ANCHORAGE, ALASKA 99501 SUBJECT: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL. LOT 2, BLOCK 7, MOUNTAIN PARK ESTATE #2 Gentlemen; We are submitting a request for waivers from the separation distances stated in Title 18, Alaska Administrative Code Chapter 80.020 On a Health Authority Inspection conducted on February 18, 1987, it was found that the septic tank on Lot 2 was 95 feet distant from the well. Said well is 146 feet deep. The installation of the septic system was inspected by a Municipal Inspector who noted that the distance to the well was 90 feet. The installation was accepted by the Municipality in spite of the noted non-compliance with the code. There is absolutely no possibility that the separation distance of 95 feet constitute a potential for contamination of this well. I request that a waiver be issued for this property. Yours Tobbe Spurkland P.E. ni � NSE 4$� Ds, .5 AIA 2 -Z6 -OIL. XXXXXXX 264--4724 August 30, 1977 Mose Pendergrass Star Route A Box 1535-6 Anchorage, Alaska 99507 Subjects Lot 2 Block 7 mountain Park Estates Subdivision #2 Dear ?r. Pendergrass Public sewer and eater is not available to the subject property. Can -site is a feasible alternative. if there ars: any further cpcestions, please contact this office at 264-4720* sincerely, Les N. Buchhol'L, I.S. unitarian L14Bfljh 5. LEGAL DESCRIPTION i MUNICIPALITY OF ANCHORAGE 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION .,. • 825 L Street- Anchorage, Alaska 99501 /� •- ,. ., NUMBER OF BEDROOMS ENVIRONMENTAL ENGINEERING DIVISION r Telephone 264-4720 ❑ MULTIPLE FAMILY REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER CK INDIVIDUAL* PHONE ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well 7 MAILING ADDRES$� 8. SEWAGE DISPOSAL SYSTEM C�iINDIVIDUAL/ON-SITE** ®� "t S71 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. PHONE / O / MAILING A D S - 3. LENDING INSTITUTION PHONE 6 s� 7L7 6 MAILING ADDRESS 4. REALTOR/AGENT PHONE fii) '� f MAI LI NG ADDR ESS 5. LEGAL DESCRIPTION STREET LOCATION / 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS rg SINGLE FAMILY ❑ One A Four ED Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY CK INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM C�iINDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY - INSPECTION APPOINTMENTS DATE RECEIVED - TIME TIME TIME DATE DATE - DATE INSPECTOR - INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY - ❑ PUBLIC UTILITY Connection Verified - PERMIT NUMBER - - DEPTH OF WELL DATE DRILLED - - LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1Q.50 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTUREFj , y'�- '`•^"', TOTAL ABSORPTION AREA MATERIAL r' 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE / l �— "7 Y (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) �''