HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 7 LT 7Mountain Park
Estates #2
Block 7
Lot 7
#017-432-09
Alpine Drilling & Enterprises
Well Log
Permit Number: 4SWOSPIO1275 Date of Issue: 11-22-10 Parcel Identification Number: 01743209000
Date Started: 11-25-10 Date Completed: 11-26-10 Is well located at approved permit location? x Yes ❑ No
Legal Description: Mtn Park Estates #2 Blk 7 Lt 7
Property Owner Name & Address: Kitt E. Van Dyke & Melissa L.
13140 Saunders Road
Anrhnrana Alaska 99516
Borehole Data:
Depth (ft)
Method of Drilling x air rotary ❑ cable tool
Soil Type, Thickness
& Water Strata From - To
Casing type: steel
Stick-up
silt
0 2
2 3
Wall Thickness:.250 inches
Diameter: 6 inches Depth: 66 feet
Liner Type:
gravelly sandy silt
3 16
Diameter: inches Depth: feet
silt
16 21
Casing stickup above ground: 2 feet
Static water level (from ground level): 76 feet
gravelly silt 21 34
silty gravel
gravelly silt
34 43
93 64
Pumping level: 388 feet after
16 hours pumping 1_5 gpm
Recovery Rate: 1_5 gpm
bedrock
64 388
Method of Testing: air li t
Well Intake Opening Type:
❑ Open End x Open Hole
H2O
320 360
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite granules Volume:2bg
Doth: Start 0 feet Stopped ? feet
Pump: Intake Depth feet
Pump size hp Brand Name Well Disinfected
Upon Completion? x Yes LJ No
This well collapsed starting at 110'. PVC liner could not
WXI'ER QUALITY TESTING
be installed It was found to have a conduit between this
well construction and the original well which had ceased
Collform
Nitrates __
Arseni- _
_._oer Col/100ml-
/O. / mg/L
NO �` ug/L
production. Original well was pumped over a period of
time at +- I gpm. Well 42 was capped and water was
pumped from both wells to supply the house. If needed in
the future, well # number 2 can be lined with steel with
stoppage at 250 feet but is not cost effective now.
Well Driller: Alpine Drilling & Enterprises
PO Box 110496
Anchorage AK 99511
MUNICIPALITY OF ANCHORAGE
Community Development Department s Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
May 18, 2011
Kirt and Melissa Van Dyke
13140 Saunders Rd
Anchorage, AK 99516
Re: Nitrate Advisory for Mountain Park Estates #2 Block 7 Lot 7
Attn: Kirt and Melissa Van Dyke,
Water sample results from Mountain Park Estates #2, Block 7, Lot 7 have been submitted to this department to
finalize well permit OSP101275. The results revealed a nitrate concentration of 10.1 milligrams per liter
(mg/L). 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.
If you have any questions, feel free to contact the On-site Water & Wastewater Program at 343-7904.
Sincerely,
Deb Wockenf iss
On-site Water & Wastewater Program
On -Site Water 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: OSP101275
Tax Code Number: 01743209000
Work Type: Well Upgrade
Permit Effective Dates: November 22, 2010 to November 22, 2011
Design Engineer: ANDERSON ENGINEERING
Subdivision: MOUNTAIN PARK ESTATES #2
Site Legal Address: MOUNTAIN PARK ESTATES #2 BILK 7 LT 7 G:2839
Owner/Address: VAN DYKE KIRT E & MELISSA L
13140 SAUNDERS ROAD ANCHORAGE AK 995163283
Lot Size in Sq Ft: 19032
Site Mailing Address: 12701 LUPINE RD, Anchorage Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field N Septic Tank N Holding Tank N Privy Y 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.
Special Provisions: Existing well to be hooked up with the new well or it is to be decommissioned
prior to final approval.
Received
Issued By:
Date:
Date: Z Z
Municipality of Anchorage
NpP� Sp
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
�. P.O. Box 196650
{ Anchorage, Alaska 99519-6650
F s www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
o5p 10)215
Parcell.D. 017-432-09
Property owner(s) Kirt and Melissa Van Dyke Day phone
Mailing address 13140 Saunders Road Anchorage, AK Zip Code 99516
Site address 12701 Lupine Road Anchorage, AK Zip Code 99516
Legal description (Sub'd., Block & Lot) Mountain Park Estates No. 2, Block 7, Lot 7
Legal description (Township, Range & Section)
Lot Size 19,032 Sq. Ft. Number of Bedrooms Three (3)
THIS APPLICATION IS FOR (® all that apply):
Absorption Field ❑
Septic Tank ❑
Holding Tank
❑
Privy
❑
Private Well
0
Water Storage
❑
THIS APPLICATION IS AN:
Initial
❑
Upgrade
0
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: Z C0 / 12-0 Waiver Fees:
Date of Payment: ���Z Date of Payment:
Receipt Number: L)O `> TL Receipt Number:
(Rev. 11/05)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
November 20, 2010
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 7, Block 7, Mountain Park Estates No. 2
Well Location and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The existing well on Lot 7, Block 7, Mountain Park Estates Subdivision No. 2 is
currently producing little or no water. The current owner intends to construct a new well
on the lot in hopes of increasing production. We are therefore requesting a permit be
issued for the construction of a new well. The existing well will be abandoned in
accordance with Municipal Code. The attached Site Plan and backup documentation
identify the location of the existing and the proposed well. Also identified on the plans
is the existing septic system and those on the lot to the south. The new well will be
placed more than 100' from all septic systems in the area.
The ground surface on the lot is basically flat. The new well will be constructed near
the southwest corner of the lot to shadow the well on the lot to the south. This well is
known to produce between 4 and 5 gallons of water per minute.
If the well is constructed in accordance with our design the following statements apply:
1. The well, if constructed as designed, will have no adverse impact on the wells in
the area or those to be constructed in the future.
2. The well, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The well, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
Lot 7, Block 7, Mountain Park Est. No. 2
November 20, 2010
Page 2 of 2
4. The well, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
-A4J, J, ,
Michael E. Anderson, P.E.
Attachments
Tom;.••` Sys
P'• 49th GV ••••°:
MICHAEL E. ANDERSON
No. CE -4381 J
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Municipality of Anchorage
Development Services Department 4
Building Safety Division s,
Onsite Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page ( of
www.ci.anchorage.ak. us (907)343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW050011 PID Number: 017-432-09
Name:
Greg & Lu Sonnabend
Wastewater System: []New E] Upgrade
Address: 12701 Lupine Rd
ABSORPTION FIELD
Phone. 345-0030 Number of Bedrooms: ,3
Treh Shallow Trench Bed Mountl Ogle[
[3 Deep Trench ❑ O ❑
LEGAL DESCRIPTION
Sail Rating:
6.0 (Category 3) CpC,,2
Total Depth from original grade:
+1.04 ABOVE OG Ft
Block: Lot Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
7 7 Mtn. Park Est #2
+1.54 ABOVE OG Ft,
0.50 Ft
Township: Range: Section:
Fill added above original grade:
Gravel Length:
4.6 Ft.
15.0 Ft.
Well: ❑ New ❑ Upgrade
Gravelwidth:
0.5
Numberofllnes:
1
Dista c between lines:
Ft.
NA FL
Classification (Private, A, B, C):
Total Depth:Cased
to:
Total absorption area:
Pipe Material:
Ft.
FI
75.0 Ft:
ASTM D3034 / F610
Driller:
Data Drilled:
Static Water Level:
Installer:
Date Installed
Denali Excavating
1/26/05
FL
Yield :
Pump Set at:
Casing Heght Above Ground:
TANK
GPM
FL
F[.
SEPARATION DISTANCES
❑septic [I Holding ❑S.T.E.P. E] Other:
To
Septic
Absorption
Lift
Holding
ublio/Private
Manufacturer
Capacity:
From
Tank
Field
Station
Tank
sewer Line
Anchorage Tank
1500 Gal.
Material:
Number of Compartments:
Wall
107
141
119
NA
89
3/16" steel
2
Surace Water
100+
100+
100+
NA
LIFT STATION
ae'
Mammacturer
Let Line
45
26
50
NA
100 Gal,
Anchorage Tank
'Pump on" level at:
"Pump off' oval at:
High water alarm at
Foundation
16
50
1 27
NA
32 in.
22 in.
36 in.
I NA
NA
NA
NA
Pump Make & Model
Electrical Inspections performed by:
Curtain Drain
OSI 20
Curt Rappe / MOA
Remarks:
AdvanTex AX20 system. Old tank and lift
BENCH MARK
Location and Description:
station were abandoned in place. 1989 bed
Top of Pump Basin Cover
Assumed Elevation:
retained. Pump basin has 2 outlets. New trench
Ft
100.02
insulated with 2" rigid foam.
En ' tamp
�E... � F.......4
Inspections performed by: Cindy W. Ellis, P.E. Dates: at 1/26/05
*4�9�TH
1/26/05
GL''L�G1
2nd
Approval
................ ..... `... G(!. ........:.....
Developme t Services Department
�`... Ci1. W, Ellis
Reviewed and approved by: Date: `��
12/00)
CE-10577 �.�
�(. ..
`Op"'
(Rev.
........
....... •
ROFES510NP1-d��
N 89059'40"E 183.00'
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I ADVANTEX AX -20
ti FILTER POD'
WELL
DECK �+(
O B ( MP BASIN
V A ST1 (DUAL OUTLET)
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Uloo. 1500 GAL STEEL MANHOLE
` ADVANTEX
00
SEPTIC TANK
P (V MT1
� \ S O
O \ / 1989 Bed
U Retained
O MT2
/ N 89059'40"E 183.00'
i
A
AS -BUILT
91
C
B
O
STI
ASPHALT DRIVEWAY
19.0
58.4
MH
61.7
25.8
2� F
PB
65.7
29.6
62.5
MTI
O.M. y 4�
1 TH#3 O
I ADVANTEX AX -20
ti FILTER POD'
WELL
DECK �+(
O B ( MP BASIN
V A ST1 (DUAL OUTLET)
O \ FCO
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` ADVANTEX
00
SEPTIC TANK
P (V MT1
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O \ / 1989 Bed
U Retained
O MT2
/ N 89059'40"E 183.00'
i
A
AS -BUILT
91
T
Mountain Park Estates #2, Blk 7, Lot 7o
oOoo�OCC-\_
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54.1
19.0
58.4
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61.7
25.8
60.7
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65.7
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62.5
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86.6
55.9
--
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81.3
56.2
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--
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Mountain Park Estates #2, Blk 7, Lot 7o
oOoo�OCC-\_
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Record Drawing of Septic Upgrade
....
Greg& Lu Sonnabend
Watkins Engineering, Inc.
o� �P.
o �� a9rH�<<<>
Parcel ID: 017-432-09
Permit No: SW050011
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m CIND W. ELLIS
4Q�„@'._ c 10577
Cindy W Ellis, P.E. P.O. Box 110443
February 14, 2005
Anchorage, Alaska 99511-0443
Scale 1 inch = 30 ft
Phone: (907) 349-1851, Fax: (907) 349-1934
FCO
FINAL GRADE
ST1 99.29'
100.16'
ADVANTEX MAN -
93.85 AX -20 POD HOLE
STEEL ADVANTEX TANK
93.21' 1500 GALLON
102.08'
102.08'
AS -BUILT
SEPTIC SECTION
N.T.S.
MT3 MOUND
n FINAL GRADE = 105.80'
MT4
100.02'
PUMP
BASIN To Old
Drainfield
FILTER FABRIC & INSULATION / 102.93'11 I
LEVELING SAND
LENGTH
15.0'
Base of Organics
99.96 -101.04
Relative Depth of Water
in Test Hole = 95.94'
Bottom of TH = 92.54'
Mountain Park Estates #2, Blk 7, Lot 7
0 OF,q� 4i
Record Drawing of Septic Upgrade
Watkins Engineering, Inc.
oaAQ�
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Greg & Lu Sonnabend*
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Parcel ID: 017-432-09
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Permit No. SW050011
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CI Y W. ELLIS
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Cindy W. Ellis, P.E. P.O. Box 110443
February 2, 2005
Anchorage, Alaska 99511-0443
Phone: (907) 349-1851, Fax: (907) 349-1934
Op.
07/20/05 WED 16:57 FAX 9073491934 Watkins Engr
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MUNICIPALITYOFANCHOR4GE ` O
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jan 25, 2005
Expiration Date: Jan 25, 2006
Permit Number: SWO60011 Parcel ID: 017-432-09
Legal Description: MOUNTAIN PARK ESTATES #2 BILK 7 LT 7
Design Engineer: 0844 Watkins Engineering, Inc Site Address: 012701 LUPINE RD
Owner Name: GREG & LU SONNABEND Lot Size: 19032 SQ. FT.
Owner Address: 12701 LUPINE ROAD Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE, AK 99516-3224
This permit is for the construction of:
g 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 ( I BAAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
-WITH THE ORGANICS REMOVED THERE NEEDS TO BE ENOUGH SAND ADDED TO ELEVATE THE BOTTOM
OF THE PROPOSED SYSTEM .9 FEET ABOVE GRADE.
-THE UPPER SIX INCHES OF A MOUND SYSTEM MUST CONSIST OF TOP SOIL; AND THE MOUND MUST BE
VEGETATED SUFFICIENTLY TO PREVENT ERROSION.
-A MAINTENANCE AGREEMENT NEEDS TO BE SIGNED AND SUBMITTED WITH THE AS -BUILT.
Received By:
Issued
Date: l' 05__1155
Date: 7 S >,S
Municipality of Anchorage
Development Services Department w
Building Safety Division
On -Site Water and Wastewater Program sa pry'
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-432-09 Permit Number SW
Property owner(s) Greg & Lu Sonnabend
Mailing address (1) 12701 Lupine Rd
Day phone 345-0030
Mailing address (2) Anchorage, AK
Zip Code 99516
Legal description (Lot, Block & Sub'd.) Mountain Park Estates, Addition #2, Elk 7, Lot 7
Legal description (Section, Township & Range)
Lot Size 19,032 Acres/Sq.Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only
®
Well Only
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
0
THIS PROPERTY CONTAINS:
Hot Tub
®
Jacuzzi
❑
Swimming Pool
®
Water Softening Unit
❑
Therapy Pool
❑
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.
1016
(Signature of property owner or authq ized agent)
Permit Fees: q60 Waiver Fees:
Date of Payment: !11s��i Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12100)
Watkins Engineering, Inc.
RO Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis®gci.net
January 25, 2005
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Mountain Park Estates, Addition #2, Blk 7, Lot 7
Septic System Upgrade
To Whom It May Concern:
Attached please find the application and supporting documentation for upgrading the
septic system for the referenced 3 bedroom house. The existing steel septic tank was
installed in 1978 and has failed, allowing groundwater to enter the tank. It is proposed
to abandon the tank in place, as well as a lift station installed in 1989. A mounded bed
drainfield installed in 1989 is now surcharged. It is proposed to retain the existing bed,
and install a new AdvanTex AX -20 with a pump basin and 5 -wide drainfield.
The proposed design is based upon a test hole dug on January 17, 2005. There was
groundwater influx at 6 ft when the hole was dug, and it was determined to be 5.1 ft
below grade after 7 days of monitoring. Therefore, the drainfield will be mounded, with
the bottom of the sewer rock 0.9 ft above grade. The organics had been removed in the
area of the test hole, so measurements will be made from the bottom of any existing
organics. The test hole was dug to a total depth of 8.5 ft and encountered silt and sand.
A percolation test conducted immediately below the frost between 1.8 ft and 2.3 ft
resulted in a rate of 4.2 minutes per inch. An application rate of 6.0 gpd/ft2 is used in the
design. The soil log is attached.
Proposed Soil Absorption System:
3 Bedrooms x 150 GPD/BR =
System Type:
Application rate:
450 GPD / 6.0 gpd/ft2 =
Maximum Depth:
Effective Depth:
Dimensions:
450 GPD
AdvanTex w/5 -wide
6.0 gpd/ ft2
75 ft2 required
0.9 ft above base of organics
0.5 ft
5ftx15ft=75 ft2
Sewer Upgrade Permit Application for Mountain Park Est #2, Blk 7, Lot 7
Watkins Engineering, Inc.; January 25, 2005; page 2
There are no surface waters or private wells within 100 ft of the proposed septic system.
I am not aware of any adverse effect that this upgrade would have on any adjacent
properties' water and wastewater treatment needs.
Thank you for consideration of this permit application. If you have any questions or
need further information, please call me at 349-1851.
Yours truly,
G 4- �����
Cindy . Ellis, P.E.
President
z
j
4
BLOCK 6
5
o Septic I
Septic Area3 , o
\ Q / Area I yl \
/ V I I Proposed S@c
S stem
TNPARK ["P-
6/
Ri nr.K s L=C
/Septic I Septic
Area I Area
BLOCK 7Ld
— — — — —
MOUNTAIN PARK ESTATES, ADDITION �2 �'II
Private Wells and 100 ft radii shown. �/
O
L�
7D
Mountain Park Estates #2, Blk 7, Lot 7
Proposed Septic Upgrade - Site Plan
0000 00��
�� OF.A4q`���
s'r u0
Watkins Engineering, Inc.
o�x?'
TTH
Greg & Lu Sonnabend'?'
/
Parcel ID: 017-432-09
THo
Septic
Cindy W. Ellis, P.E. PA. Box 110443Q
Anchorage, AK 99511-0443
W c DY W. ELLIS v
- 10577 e
Pd�s
January 25, 2005
Scale 1" = 100' Phone: (907) 349-1851 Fax: (907) 349-1934
*
�p�90
Area
I/
WELL
I Existing Septic
/
�
❑
System
71
TNPARK ["P-
6/
Ri nr.K s L=C
/Septic I Septic
Area I Area
BLOCK 7Ld
— — — — —
MOUNTAIN PARK ESTATES, ADDITION �2 �'II
Private Wells and 100 ft radii shown. �/
O
L�
7D
Mountain Park Estates #2, Blk 7, Lot 7
Proposed Septic Upgrade - Site Plan
0000 00��
�� OF.A4q`���
s'r u0
Watkins Engineering, Inc.
o�x?'
TTH
Greg & Lu Sonnabend'?'
49 9<��
Parcel ID: 017-432-09
�../.��......../.:/.7. p.�....:....�
Cindy W. Ellis, P.E. PA. Box 110443Q
Anchorage, AK 99511-0443
W c DY W. ELLIS v
- 10577 e
Pd�s
January 25, 2005
Scale 1" = 100' Phone: (907) 349-1851 Fax: (907) 349-1934
*
�p�90
Mountain Park Estates #2, Blk 7, Lot 7
Proposed Tren h:
/
Proposed Septic Upgrade -Site Plan
Watkins Engineering, Inc.
5 wide x 15 ft Igng,
Greg & Lu Sonnabend
LOT 8 0.5 ft effective I
J
_
Btm of sewer rgck
CindyW. Ellis, P.E. P.O. Box 110443
January 25, 2005
/\\ Extent of Mound 0.9 ft above ON
Scale 1 inch = 30 ft
with 3:1 Slope INSULATED
C�Q000000���
N 89°59'40"E 183.00'
\
\1 30
SFR = TH#3I +CO
MT 1
Purnp Basin CO
o
L
°WELL m
w
F
n
roposed LS I m
w
AdvanTex AX -20 w/ 1978 I m
n
0
1500 gal steel tank -4
o
ADrpapinfield
x.
Existing Location
1989 Bed
Septic Tank & LS
To be Abandoned To be
1
/ ai
in Place Retained
/ l
N 89°59'40"E 183.00'
° WELL /
LOT 6
/
DESIGN DETAILS
3 BR, 450 GPD
100 ii Well
AdvanTex
Radii Shown
gpd/ft2;
AUse6.0
Requires 75 ft2 drainfield
5 -wide trench x 15 ft long
/
0.5 ft effective
Remove organics &
level w/sand
/
Max Depth: 0.9 ft above OG
10RU Esmt
Mountain Park Estates #2, Blk 7, Lot 7
0 0000���
o OF .A
�s1Ui1
Proposed Septic Upgrade -Site Plan
Watkins Engineering, Inc.
w���
Greg & Lu Sonnabend
49 TH 7'
Parcel ID: 017-432-09
W.
0 a CIN LL S'
��g - 10577 .�
CindyW. Ellis, P.E. P.O. Box 110443
January 25, 2005
Anchorage, Alaska 99511 0443
Scale 1 inch = 30 ft
Phone: (907) 349-1851, Fax: (907) 349-1934
C�Q000000���
Municipality of Anchorage
Development Services Department
Building Safety Division
„�. Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Soils Log - Percolation Test
Performed For: Greg & Lu Sonnabend Date Performed: 1/17/2005
Legal Description: Mountain Park Estates #2, Elk 7, Lot 7 Township, Range, Section:
1
1
1
1
1
1
1
1
1
1
COMMENTS
WAS GROUND WATER
ENCOUNTERED? YES
s
IF YES, AT WHAT DEPTH? 6.0 t
0
Depth to Water After 15,11
I P
Monitoring? 511 E
Date: —� '•(%�
Site Plan
Reading
Trf-43
Depth
,Feet)
0 fc�an ICs %aJ
Depth to Water
6j'A rwrnr ved- .
ML
1/17/05
1:21-1:31
3,0
6-3.75
SPS
5a11d w tk
ML
S�rLCf✓�5 0�
10
stlt.
1
1
1
1
1
1
1
1
1
1
COMMENTS
WAS GROUND WATER
ENCOUNTERED? YES
s
IF YES, AT WHAT DEPTH? 6.0 t
0
Depth to Water After 15,11
I P
Monitoring? 511 E
Date: —� '•(%�
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1-2
1/17/05
1:21-1:31
10
6-3.75
2.25
3-4
1:41
10
6-3.625
2.375
5-6
1:52
10
6-3.625
2.375
7.8
2:02
10
6-3.6875
2.3125
9-10
2:12
10
6-3.625
2.375
11 - 12
2:22
10
6-3.625
2.375
PERCOLATION RATE 4.2 (minuteMnch) PLHU HUIt UTAML I LH e
TEST RUN BETWEEN 7.8 Fr AND 2.3 FT
PERFORMED BY: Cindy W. Ellis, P.E. I N 2f/` CERTIFY THATTHIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELI S IN EFFECT ON THIS DATE. DATE: / —x-05
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name -
Q1l( RoCFt`n
DISTANCES
TO
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Address
P•o• (3oX 1i 13&S, /4nckora�! 995/l
WELL
j0,5't
I ZS �
Phdnen)
3'fs Y9S0
Perm, No.
169' 2 1
NoofBedrooms
3
LOT LINE
it I
V
S '
I
LEGAL DESCRIPTION
Lot
%
Block
7
Subdivision
Mtn, Park, Est #k2
FOUNDATION
!8�
3S'
S`/
Township, Range, Section
T 12H R 3W, Si 2i /
AS -BUILT DIAGRAM IShow location of weu, septic system, property lines, foundation,
driveway, water bodies, etc.)
TANKS
❑ SEPTIC STAr'll ❑ HOLDING
Manutactmer
f}nC40 P Tank
Capacny in gallons
,5'00
Material
No. of Compartments
It oaf,
TYPE OF SYSTEM
cr dry �n
❑ TRENCH 91 BED ❑ W. DRAIN K OTHER
Depth to pipe bottom from -
original grade
O FT
Total depth from original grade
O.S FT
71'
rt
Fill added above original grade
50"1 /o level + FT
Gravel depth beneath pipe
B" FT
Gfavel length
29 FT
Gravel width
2 - FT
No 4
Total absorption area
- 37 2 SQ FT
Distance between lines
- - S.S FT
E rrN
- kN T k
°G n " r
TN
CN t
Number of lines
y
Soil rating
I IT SQ FT
Pipe material
Sabcd '(O PVC
Installer! -
Ch(,C JCS t3crckhoe
Date Installed
7MI99
C. A D T ,
I
WELLS C—A&1ii
W So L
A So P op/
Pita
t R
❑ PRIVATE ❑ OTHER (Identify)
Classification IA, B,CJ
Total Depth -
FT
Cased to
FT
lnstallei
Date Installed-
REMARKS: OFo21P %en r+.o.+arC anp(Zia/wrap(
w, all TowAco" pacac�e 1iFi Sitrimn in ,00�o/
An[fmr e_ Tank Awr a/,. Ji ,
S'
jwbmEr7rbleum�� fenfrs-I f'laa/i ftF per SypPAtrs
re[Osnroe4 oleo [Onn-!' PrGvu.rrteoC o[� f.,yu/teo r %+
Scale: In = 2ryrq�
Inspections Performed hy:
ll Tee// �' e_r
EN
4G®til�
p vll .. e
A t;. '
p� �°�``
•'••• •' Fk
/. :....
%?).
40 [0 • • • •; • °
THEODORE F MOORE
ti
t' CE-3589at
�a �®
Int, tfe.t ukfisln� 2"SeAepl Pill /h¢w, w un.K
!'!y rSCliaoC W PVC fai4 YraW. ?/!6" oleo MoI
(✓�� _
Date: �5�
/�
11A0149
/v gvcr/ 30". r}[t Jets& !x 2" rntul n
S @leo-
i 2' Cor f/ prrCr Mound. Eyer/zn �t.f /nrPee[rd 4n�
('Jeeu C•O, Inr eerL�on
certify that this inspection was performed according to all
Municipal and State guidelines in effect on this dale: %//r /�,
Health Department Approval: Date. to •
72-013 (3/85)
Municipality of Anchorage
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
October 17, 1990
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Lot 7 Block 7 Mountain Park Estates Subdivision #2
On-site Sewer Permit #890112, PID #017=432-09
Dear Mr. Moore:
The as -built inspection report of the new (replacement)
wastewater disposal system that was installed on the subject lot
is incomplete. The inspection report must be accompanied by a
copy of the Municipality of Anchorage electrical inspection on
the lift station portion of the system. Approval of the
as -built cannot be made until this information is provided.
If there are any further questions, please call our office at
343-4744. ,
Sincerely,
' A"/
Joh Smith,
Program Manager,
ljm:267
On-site Services
cc: William Rochin
PO Box 10-1385
Anchorage, Alaska 99510-1385
Robert W. Robinson
Civil Engineer, On-site Services
Kids Are Our Future
ICIF`ALITy
Department of Health
825 L Stremt, Anchorage,
//./`0
9
/
O F A N C H U R A G E
uu^ �*0,L (7
�
& Human Services
Alaska
SEWER PERwTT
Permit Numbers 890112 Upgrade (l/^\(7/lx'\/)q
Date issued: 06/30/99 Engineer Designed
Owner Name: BILL ROCHIN Day Phone:
Owner Address: P.O. BOX 10-1385 345-4950
ANCHORAGE, AK 99510-1335
Parcel Id: 017-432-09
Lot Legal: Subdivision: MTN" PARK ESTATES 02 Lot: 7 Block: 7
Section: 26 Township: /2N Range: 314
Lot Size 18720 (sq.ft. or acres)
Max Dedrooms: This Permit: 3 Total Capacity: 3
SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic
tank must have at least 2 compartments` Depth to top of septic tank(s) < 4^0
feet requires insulation over tank(s).
INSTAL! IN ACCORDANCE WITH ENGINEER'S PLANS AND SPECIFICATIONS
NOTIFY DMHS PRIOR TO ALL CONSTRUCTION INSPECTIONS
REMOVE PEAT AROVND UPSLOPE PERIMETER OF wVUND
VERIFY OPERATIONAL ADEQUACY OF EXISTING LIFT STATION PUMP
DIVERSION OF EFFLUENT TO THE OLD EXISTING DRAIN FlELD WILL ONLY
BE ALLOWED %F GROUNDWATER LEVELS ARE 4 FT. BELOW DRAIN FIELD
1 CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2. 1 will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. J will adhere to all MOM and State of Alaska requirements for the set hack
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. T understand that this permit is valid for a maximum of 3 bedrooms. }
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will require an additional permit.
Signed; 10
DATE:
�^°- - - J - - - - -'~ - - - - - - - - - - - - -^- - - - - -�
(Owner) 8TLL ROC
Issued By: DATE:
�y / �
Muni �pality of Anchorage
K
Department of Health and Human Services
Tom Fink, 825 " L' Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
June 30, 1989
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 7 Block 7 Mountain Park Estates #2
Waiver Request #WR890031, Permit #890112
PID #017-432-09
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 2 feet from the south property line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sinc r+el,
Jo Smith, P.E4
.
Program Manager
On-site Services
DJR/1jw #7
G�
0 \S\pC\
Lot 7, Block 7. Mountain Park Estates #2
12701 Lupine Drive
Septic System Upgrade
Design Notes and Specifications
1. The design of the soil absorption bed is based on a measured perc rate of
4 minutes per inch, which translates into an area requirement of 125 square feet
per bedroom. For a three bedroom residence the required area is (125) x (3) x
(1.5) = 562.5 square feet, which is accomplished by a 22'x 26' soil absorption bed.
2. A lot line waiver is requested allowing construction up to within 2 feet of
the south property line. This waiver is needed to achieve separation from the
existing lift station and drainfield, and to take advantage of the relatively lev@l
terrain away from the swale in the center of the lot. As shown on the site plan,
granting this waiver will not impact the existing system on Lot 6, nor will it limit
the ability to upgrade that system in the future.
3. The configuration of the system shall be as shown on the plans, except
that minor modifications may be allowed or required by the engineer conducting
the inspections.
4. All material specifications and construction practices shall conform with
M.O.A. regulations.
5. The property owner shall assume responsibility for the location of
property boundaries and any underground utilities.
6. The existing lift station (Zoeller M53 pump specifications enclosed) shall
be modified by the addition of an insulated manhole riser extending above ground
surface, and the installation of a float activated alarm to warn the residents when
the lift station is filled above the normal operating level.
7. A 1.5" diameter schedule 40 PVC discharge line shall be installed leading
from the lift station to the 4" diameter manifold in the soil absorption bed. All
joints in this discharge line shall be glued. If requested, the contractor may install
a diversion valve in the discharge line, allowing future periodic diversion of
effluent to the old drainfield to give the new seepage bed a rest.
8. The old drainfield shall be disconnected and abandoned in place, except
that a perforated monitor tube shall be installed into the gravel of the field near
it's end.
9. The soil absorption bed shall be constructed by stripping only the 6" thick
layer of peat and roots off the 22'x 26' site to expose the underlying sandy loam.
Care shall be taken not to compact this material by driving equipment on it. On the
downhill side of the bed the stripping shall extend an additional 8 feet outside of
the bed to allow placement of impervious fill material to prevent seepage of
effluent out the side of the built up mound.
10. Medium sand fill shall be then placed on the bed area as needed to
create a level surface before placement of the sewer gravel. A total of one foot
thickness of sewer gravel is required, with the bottom of the 4" diameter
perforated distribution pipes being carefully leveled 6" above the top of the sand.
The manifold shall not be perforated. Cleanouts and monitor tubes shall be
installed as shown. Filter fabric shall be placed on top of the sewer gravel before
placement of a minimum 3' of soil cover, 3:1 side slopes.
11. Four inspections will be required during construction: (1) Initial ,
stakeout, (2) after the peat is stripped, but before placement of sand, (3) after the
sand is placed, but before placement of gravel, and (4) after the gravel is placed
and the pipes are laid and connected, but prior to backfill.
olt'
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p F/I-r_ li✓{RRIER�
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81 --•^j
STKIPPING 1- 117
SECT toN "A -AI'
OF A4 %4
THEODORE F. MOORE
f
CE -3589
f8 4d�r�o
L.71 a7, 11 TN. P�4Rk ,EST # 2
SEPTIC SYSTEM UplrRADE
PIAN e PRopli-E
SCA( -R=: f"c,5-1, DAiE: 6Y69� Plu#St':7xr1
SS'
H��PfFl. ASTI'7 o3v3y
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77
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STKIPPING 1- 117
SECT toN "A -AI'
OF A4 %4
THEODORE F. MOORE
f
CE -3589
f8 4d�r�o
L.71 a7, 11 TN. P�4Rk ,EST # 2
SEPTIC SYSTEM UplrRADE
PIAN e PRopli-E
SCA( -R=: f"c,5-1, DAiE: 6Y69� Plu#St':7xr1
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
,,•� Municipality of Anchorage
t DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 13111 RoCh in DATE PERFORM
49TH yep ;r*•
..........
•THEODORE F. MOORE;
CE - 3589 nQa
GOA
s
LEGAL DESCRIPTION: 1-7, B7 hTfn Parfc Esi #ZTownship, Range, Section: 'T 12N, A3W Sec. 26
DEPTH Pf. SLOPE SITE PLAN ,
F F FTI
1
2 .$1`i (feoQo{rrG Sand G.owy
?•7,S
s i l k
5 GrYcat /
6
W Cace rte S'QA of
7
8
1-
9--
10-
11
.910
11
12
13-
14-
15-
16-
17-
18-
1 9
3141516171819
20
T. H. #2
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
t1
s
L
7r O
P
E
Depth to Water Alter
Monitoring? CLB° Dale: 27/8
D
Reading
Date Gross
Time
Net
Time (M*'n)
Depth to
Water
Net
Drop r�
fVP
6'/2U
* f4%o
2: SY o0
23 �✓B
!
3:oM:oO
To
20 p/i
2 Is1/ir
3:o4:�j
23 ��B
4t eiN•so
3:/Y:JO
(0
20 7/y
2 r/s
+ o
7"/'r:60
2-T Y&
3: of :00
/o
20 rs/16
2 We
t3:
ZS'3o
23 7,7
3 : 3S' 3o
d
20 •s/i6
Z/i�
t Hzo
3:36: 00
PERCOLATION RATE _ (minutes/inch) PERC HOLE DIAMETERS -1
TESTRUNBETWEEN I.7S FTAND A ?J- FT
PERFORMED BY: -E atk" 7-e-c.Agee4( I !T:a r; c tom CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4185)
Flattop Technical ServicesAV
0- Ur H •!
14530 Echo StreetGuuE�R SE S 0
Anchorage, Alaska 99516 0 Co.: 49TH •:����
y, Municipality of Anchorage of.......................... ��r�.
t DEPARTMENT OF HEALTH & HUMAN SERVICES % T`�'.
....�...
825 "L" Street, Anchorage, Alaska 99502-0650 �A THEODORE F. MOORE ;
SOILS LOG — PERCOLATION TEST 0+ CE -3589 .*.kw
7 it. 1$ I- .ae-Re
PERFORMED FOR: Bill Roth in DATE PERFORMED:_ _z/ "!�t %
LEGAL DESCRIPTION:_.7, 1777 1`4 fn &rlt' Es74 02TOWnship, Range, Section: 'T 12N R 3 to Sec 26
DEPTH p,, SLOPE SITE PLAN
1
2 I SK Re-""Sh sandy loam
1 PoOtt b 0 Z etron sand
4I M4 Sgnay (rrcc.+ttty V$//.
5 --
6--
7-
a--
9-
10-
11
—7891011
12-
13-
14-
15-
16-
17-
20
2131415161720
T
COMMENTS
Stu C&Ctrw S4noL
�Sa '44 ret
ML 7r�Ak srlf'
Q.
WAS GROUND WATER
Date
ENCOUNTERED?
Net
Time
Depth to
Water
S
IF YES, AT WHAT
L
I_lov
DEPTH?
,; P
E
Depth to Water After
Monitoring? EI -0 "
IMMlri
NO
UN
on
ONE
No
`' ` •
.!MEN
No
«�
�
=.-..�=�.!
WAS GROUND WATER
Date
ENCOUNTERED?
Net
Time
Depth to
Water
S
IF YES, AT WHAT
L
I_lov
DEPTH?
,; P
E
Depth to Water After
Monitoring? EI -0 "
Date: 2
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
/ TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER
FT AND FT
PERFORMED BY:-Efai'I.4 %[.Amrent Siarr(G 1 _ ��4 Zpe _
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 61.2.7 /6r}
72-008 (Rev, 4/85)
GOP MUNICIPALITY OF ANCHORAGE to
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
*0 ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
PHONE
[5jNEW
Frank Tadda
344-8261
DUPGRADE
MAILING ADDRESS
SRA 440X Anchorage, AK 99507
LEGAL DESCRIPTION
Lot 7 Block 7 Mountain Park Estates #2
LOCATION
NO. OF BEDROOMS
Fronts on Lupine Street
3
Well $ 1 Absorption area
Dwelling
PERMIT NO.
V Y
DISTANCE TO: aperox 11O1 2r
24r
78015.7
i Z
Manufacturer
Material
No. of compartments
w
Greer
Steel
2
Liq. capacity in gallons
1,000
IF HOMEMADE:
Inside length
Width
Liquid depth
6 M
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JD2
=ZFa-
Manufacturer
Material
Liquid capacity in gallons
DWell
Foundation
DISTANCE ro: approx_120 38t
Nearest lot line
10,
PERMIT NO.
780157
Lu T
Trench wigthh
Distance between lines
u.Z
No. of linesLength of,eacl� line Total length of liges
1
FZw
4J 4S
6-
inches
F
Top of tile to finish grade
Material beneath tile
Total effective absorption area
0
32"
8
inches
See Permit
Length
Width
Depth
PERMIT NO.
w
7
iF
Type of crib
Crib diameter
Crib depth
Total effective absorption area
wa
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
"' �
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
£
OTHER
`
PIPE MATERIALS
Cast iron to tank-P.V.0 in drainfielc
SOIL TEST RATING
140 S.F./B.R.
INSTALLER
/
Frank Tadda
SL
2'
REMARKS
r
Y
KA
Lift station installed on ou
of tank. Insulation 2" st rofo
installed over drainfield.Bottom cf
iA
ma
D
trench 4' ab0�7Wr'Px*fling ground-
3'a,
water,
q.�
T .,
APPRO ED "' -"' TE LEGAL
72-013 ev. 3/78)
R._a F F4 r-.0 l-.. F...A F:f A:a E_ (I Las
DEPARTMENTpii
_=1HRPCdIP91 Cid
:25 FEET1Y_HF?1=E, HF. +-
.511
264-4720
@-•-E E_" 9._.. L. F11 P E ° A A •9 — '__ ...E.. �::: _--- EE= F ...I E_= A=' F ' E= Fes° t I E -
PERMIT NO. ( 780157
APPLICANT FRANK 'TADDA S. R. A. BOX 440--};
N44-8261
LOC>='tl"I:OPd LLtF']:PdE DR:I'v'F_
LEGAL. LOT 7 EAK 7 MT. PARK EST. #2 LOT T _-; IEE 20 :=;i:-UAR:E: FEET
TYPE OF SOIL ABSORE:TION SYSTEM IS: TRENCH � Yl �. �� � a r
�}ajzv_� S
I'1ft;i:f1LfP1 NUMBER: OF BEDROOMS ? :_OIL.. RATING (:=0
THE REQUIRED SHE OF .THE SOIL_ ABSORPTION SYSTEM IS:
@_;-° E:_: E_." .. x..1--9 —= :$. _�_ L.._. F_ 9"-„1 a., -n ...�... �...g _ _:::,„'_:. A:_a �” R -q °_.^° E._" �..._ E ° �_ �" .T.. d ---R --_ -� •,
THE LENGTH DIMENSION 15 THE LENGTH (IN FEET) OF THE TRENCH OR: DRAINF.T.EL_D.
THE DEPTH OF A TRENCH OR: PI -F IS THE DI-TANC'E. BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR: TRENCHES,
THE GRAVEL DEPTH L: THE PlIP 1PIUPI DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F;--' E_-_ C- R_R _E 1-=' E._ E> <3 E= F ~ . 1-1(0. -9- R --R r j l °- g _. E-..._ _: E.. CA C5 A:=�A C3FAL.L.C3PA03
PERMIT APPLICANT- HAS THE RE:':F'Ilp'SIBIL...ITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT ..O THIS PROPERTY AND THE
NUMBER'. OF RESIDENCES THAT THE WEL...L.. WILL -ERNE..
-- -- Y A 1 (_A °_: ° 19'A n : F "E= C"_ _$_ I A_A R" -AQ F4 Ems' EE FR E= N__® R_R 'I: F,' E - -
BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION AND APPROVAL. BY THI_:
DEPARTMENT WILL BE SUBJECT TO PROSECUTION-
IINIMUPI DISTANCE BETWEEN A WELL AND ANY ON --SITE =:E:.WA+:E DI.=_F'ii_AL SYSTEM IS
LOO FEET FOR H PRIVATE WELL; OR.
L50 TO 200 FEEL- FROM A PUBLIC: WELL DEPENDING UPON THE I-YPFE. OF PUBLIC WELL.
4ELL. LOG_; ARE: REQUIRED AND MUST BE RETURNED TO THE: DEPARTMENT WITHIN ZA_i DAY_:
OF THE WELL COMPLETION.
OTHER R:E:QUIR:F.MENT_=, MAY APPLY. SPE_CIFICA(IONS AND CONSTRUCTION DIAGRAMS ARE
AVAIL.ABL.E TO INSURE PROPER: INSTALLATION.
F= E --'F? r-1 1 T E= 14F" • T FTE_ n5 L_° E _= s_::: E ':: F I ER E= F-::° Ill., _: N_ = _.9... _=:fl 71
E CE.R:T-IFY THAT
L: I AM FAMILIAR: WITH THE:: REQUIREMENTS FOR ON-SITL-. SEWERS AND WELLS 1=ls SET
=ORT'H BY THE MUNICIPALITY OF ANCHORAGE,
_. I WILL INSTALL_ THE: SYSTEM IN ACCORDANCE WITH THE CODES.
I UNDER"= 1jD THAT THE rlN-_ITE EWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE.
: SIDEP-4 Is ":EI1''ODE l �l:NrL.IIDE MORE THAN 3 BEDROOMS.
I
IGNED:���
APPLICAN FR:ANk: TADDA
_,_.
--
UL.C? BY
Fw!O-C" CLASce
�ts NQS _ tv'st D� .Q e A � %c c �cGi Vt fc:5Y )L -q k4l 5
. l
ko-u-e-- a -Ill &U -k
0onsforudtion CTrit 20
V" test is worth a thaosend npiedont'
2204 Cleveland Anchorage, Alaska 99503
Performed For Frank J. Tadda Date Performed 4-11-75
Lenal geserintlon: Lot 7 Block 7 Subdivision Mountain Park Estates #2_
This Form Renorts Soils Loq Yes Percolation Test_ Yes
neoth
Feet Soil Characteristics
Peat
4---% Light Brown Silty Sand
6Brown Sandy Silt, Gravel
B — Per,
2oNt.
10 —
12
14 — Brown Sandy Silt
16—
is — Bottom of Test Hole
20—
Was Ground Water Encountered? No
If Ves, At what Depth?
tmww
G�.S!�y�-Mali•►
Readinq Date
Gross Time Net Time Depth to H2O Net Dron
4-12
-1
24 Hr. Sat 39 12"
No water
4-11
"
10 min.10
n u
min-
n
u10
u 13 n
min- 72 1
n n
u "
r—
n "
Percolation Rate 1"/6 Minute
Prnrosed Installation: Seenaos Pit Drain Field
Deoth of Inlet Dept o ottom Of Pit Or Trench
CI)MMENTS: 140 Sq. Ft. drainage area required per bedroom.
Test Performed By
Data Certified By: CTL
Date:
u®m 113609 t�i-r�n azourlu 4\ 2�n-ullllmAf-AgUA $D"501
x414 —7 a Sl4
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 150 Teel .
DRILLED AT THE RATE OF 118.00 PER FOOT.
344-8261
PROPERTY OWNER 1/l;t, Ttaak Tcddd '
440 X Rn.ch. P„L"ka 99.5o7
LOCATION OF WELL SITE Lt. B.Lk. sub.
DRILLER BeAuu.e Cia1l,6 of Panpah Oot/
WELL LOG:
0-----28' St,bj 4and1 9AaveC wtith 30i, c1 b.inde�c.
28----59' D=,a c la4. 15$ 9& uc . Small Gou tde t4.
59----68' St tly cgwuet. Bedhack 4ta4t� at 68 feet. Ro wcvtet on top of- Bedrock.
68---350' Bed -tock. A 4edsmentaA* Zack. Ra MateA any wh.e to a.tong untU 235 ,to 240
deet. SCme 4dgr4 to a cy� tock nhouring a 4naU amount o� V etd.
&t,jo 4ome 4tgiL4 of watet of 315 to 318 reet. P paw" tack at, tIL6 deuet.
To-ta-1 pAoduct Lan o�- G7e Lt 4houd d show ;Aoa 600 .to 800 gall, of wa tett pee dat, .
Th.iz welt 4hou-Ld alio dncAea4e .in, y ie.Ld w.i t . u4c.
To -tat stand of watet in, ca4.ng .i4 ouet 280 .-ect o,� wate�t. Thti m.ak ing the tedewe
at 1.6 gai j pe ,e foot .to 448 gala.
Tota t co4-t of D&ZUt g: f 18.00 pelt foot .to .300 feet an.4: 35400.00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 15400.00
THANK YOU VERY MUCH.
BER CLAUS OF RAMPART DRILLING WORKS
DATE_ & 14-t. 1978
SERVICE CHARGE OF IVz% PER MONTH WILL BE ASSESSED ON PAST DUE TS.
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
017-432-09
1. GENERAL INFORMATION
SpPET
COSA # 05 P 10 1205
Expiration Date: _ — / % - / C1
Complete legal description Lot 7, Block 7, Mountain Park Estates No. 2
Location (site address)
12701 Lupine Ddve Anchorage, AK 99516
Current Property owner(s) Lu A. Leslie
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address.;;,
12701 Lupine Drive Anchorage, AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
Day phone
Day phone
2. NUMBER OF BEDROOMS:
Three (3)
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 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 Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Date 9/91110
A
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: - Original Certificate Date:
(Rev 11M)
Municipality of Anchorage ez
P at
• Development Services Department,
Building Safety Division
On -Site Water & Wastewater Program s " "`
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: Lot 7, Block 7, Mountain Park Estates Subdivision No. 2 Parcel ID: 017-432-09
A. WELL DATA
Well type Private
Date completed 6/1/76
Total depth 350 ft.
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to 66 ft.
FROM WELL LOG
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
Date of test 611/78 5/27/10
Static water level 70 ft. 63.2 ft.
Well production .4-.5 g.p.m. .4-.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate N/D mg/L
Arsenic: N/DD mg/I Date of sample: 9/6/10
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Advantex/Steel
Tank size 1.500 gal. Number of Compartments Three
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Other bacteria 0 colonies/100 mL
Collected by: M. Anderson
Date installed 1/26/05
Cleanouts(Y/N) Y
High water alarm (Y/N) Y
Date of pumping 9/2/2010 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Date installed 7/89 Soil rating (g.p.d./ft or ff /bdrm)125 SF/BDRM System type Raised Bed
Length 26 ft. Width 22 ft. Gravel below pipe .5 ft.
Total depth 2.5 ft. Eff. absorption area 572 ft Monitoring tube Y Depression over field N
Date of adequacy test 5/27/2010 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 1 in.
Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >= 450 g,p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 1/26105 Size in gallons 100
"Pump on" level at 32 in. Pump off" level at 22 in.
Datum Bottom of Tank Cycles tested Three
Manhole/Access (Y/N) Y
High water alarm level at 36
Meets alarm & circuit requirements? Y
in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
On adjacent lots >100,
Absorption field on lot >100'
On adjacent lots >100'
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line >25'
Holding tank N/A
Animal containment areas >50,
Manure/animal excrete storage areas >low
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 >t0' Building foundation >10' Water main >10'
Water Service line >19 Surface water >100'
Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots
>100'
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
t certify that t 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 5/22/2009
COSA Fee $ - ( Waiver Fee $
Date of Payment �� 3 Date of Payment
Receipt Number Receipt Number
(Rev. 11105)
W,
` 4918
40FESSIZO-
Municipality of Anchorage a
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci. anchorage. ak.us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 101205
During a recent COSA on-site inspection and test of the potable water
supply well on Block 7, Lot 7 of Mountain Park Estates #2 subdivision, the
well's productivity was determined to be 0.4 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
3 -bedroom residence is 0.31 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-47U
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # (oil HAA # VA (,�" ) K '4 2-Fti
1. GENERAL INFORMATION
Complete legal description LoT- -7 4 U'LDC.K 7 MOUNTAtA) PARK
�STATLS Z 1 IZt\7 ,93v\f SEC, zrn
Location (site address or directions) 1270 1 l-1-4P/N E COAD t NCXAOQQGIE
`9SYS (6
Property owner MS. KkmH it ELL Day phone
Mailing address I2-70 1 WPINE RID. brx4�o�2QC�� I �K 9gSl� 3 Z �
Lending agency WOKNOtA1tJ Day phone
Mailing address \\
Agent U>JkUIOvJN Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: _�3 `j
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.
72-0a(Rw.1/91) Front MOAp l
5.
6.
By:
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 f=irm C0MPRr.Iy Phone 34S-2737
Address 13610 VEMU�, QA
Engineer's signature
DHH SIGNATURE
ry ; Ri;an 1Y. t.1unNt �
i1n. A 7j4:
Approved for bedrooms.
Disapproved.
Conditional approval for
Date r: w '
bedrooms, with the following stipulations:
,1—
Date /C S - 19 H_
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 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.
72-0=(S- 1/91) Beck MOAW
ENVIRONMENTAL SERVICES DIVISION
SEP 171997
Municipality of Anchorage CC
DEPARTMENT OF HEALTH & HUMAN SERVIracr VC �
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: i_ 7113 7, MOU&/ AIA) P4k0C 6_MTF5*Z Parcel I.D.: 01 `7, 43Z-oV
A. WELL DATA
Well type?i1U1 ATf:. If A, B, or C, attach ADEC letter. ADEC water system number IJ/A
Log present (Y/N) 4 Date completed b 17 111 LL4ly
Total depth 3 5 O �t. Cased to 10 fE . Casing height (above ground) _
Sanitary seal (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
70
^- 0.4. 0 0 •S g.p.m.
WATER SAMPLE RESULTS:
Z00
Wires properly protected (Y/N) Y
AT INSPECTION
--- 4_S F
O.S
Coliform Nitrate 0./ mg/L. Other bacteria AANE
Date of sample: gLoSh- 7� $�� �9� Collected by: A.W. MoAF 1 �Tp.E
I�CLCCS 1
B. SEPTIC/HOLDING TANK DATA J
g.p.m.
Date installed 51-9 Tank size IOQp COAL Number of Compartments z Cleanouts (Y/N)Y
Foundation cleanout(Y/N) Deppl1ression(Y/N) High water alarm (Y/N) y(ON Li
Date of Pumping S 9 Pumper 1C 'OkW-D) 9riw1oN)
C. ABSORPTION FIELD DATA
Date installed -7I 9�') Soil rating (g.p.d./ft2 or ft2/bdrm) 12547j rSystem type M6 q j\jn
Length Width 22 r -L . Gravel thickness below pipe B Total depth Z S
Effective absorption area S7Z r z. Monitoring Tube present (Y/N)-3— Depression over field (Y/N)
Date of adequacy test 06LOST197 Results (Pass/Jail) FA &S For e- 3 bedrooms
Fluid depth in absorption field before test (in.); Immediately afters gal. water added (in Oe�
L
Fluid depth (ins) Minutes later: 1 3 7 Absorption rate = �S7 g.p.d.
CO TiSk A1- 55—�i�CE o F G"Uc-i,
Peroxide treatment (past 12 months) (Y/N) If yes, give date �a
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed 7 / S 9 Size in gallons 5 0 0 O bft Ad 1AAK
Manhole/Access (Y/N)
"Pump on" level at* Z5; rr "Pump off" level at*
High water alarm level at* .2 � r/ *Datum 7-0/® d(, �/ E
Cycles tested l 6Juf2/ 6 WU4 T�S�[�
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot tDS { L. On adjacent lots 't"' i an rl",
Absorption field on lot
On adjacent lots IL 100 Ft -
Public sewer main A) /A Public sewer manhole/cleanout N%1
Sewer /septic service line 8S [Z • Lift station It S
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 1; ft Property line 40 rt 3Absorption field 1-7 R: -
Water main/service line S0 F'` Surface water/drainage N/j N Wells on adjacent lots --I-/ o 0 (� .
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
/A -3Z&1
Proper line Tom• Building foundation 3� Water main/service line 70 rt.
CitiMOU RG ON FILO
Surface water IVA Driveway, parking/vehicle storage area %s
Curtain drain A)0A)E 11KQ eJ 0EZ(D Wells on adjacent lots -t' /0O r,f
F. ENGINEER'S CERTIFICATION
OF A
1 certify that I have determined thru field inspections and review of Municipal recothtih�°bov'g��Prms are
in conformance with MOA HAA guidelines in effect
ct on this date. o C9or
•, % d�
jo
8®
Signature
Engineer's Name C/�li✓ �i•l/i (1 7 P ' aI �a w m r* f'f
Date
1 sF s
l�h USS' 20 � 1`l %%
HAA Fee $ J rD •
Date of Payment !2,// 7 b% 7
Receipt Number 3 Z? !7 l e3 -2-Y b
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. " %,q 3
During a -recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot
Block of NIT.�AP Esj.2 Subdivision, the well's
productivity was determined to be �D gallons per minute.
The minimum well productivity required by this Department
(AMC 15,55) for a ``,�Ee bed -room residence is Q, DMZ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
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. # 0f7 — 4a -Oct
1. GENERAL INFORMATION
HAA#l�oi�f)LIR�
Complete legal description Lor 7 BOK 't KTa. PARK EsTATes #2
Location (site address or directions) 12'701 LuPiNe
ANcFio RAGE Alc 4951 L,
Property owner BILL RoCRIN Day phone 3k5-g4So
Mailing address BOX 111385'., ANCN. Ar- 995-11
Lending agency
Day phone
Mailing address
Agent VIsTt1 KATHY FERN40c7� Day phone -562-4146+
Address 30oo C 5T ANCN AK 91SO3
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well ✓
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site ✓
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) FroN 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 furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm FLATTOP TECH, Svcs Phone
345- 135,5'
Address I453o ECH/o ST, AMCN. AK ggsr6
Engineer's signature ��^ - Date Ru /993
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
1IITIr
.... Y.i............
;a T 0. HEODORE F. %loopE
•. CG - 3589 r
ve
bedrooms, with the following stipulations:
Date 8-21-93
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 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(R.v.1/91) Back MOAH21
Municipality of Anchorage
AEM
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: COT 7� ELK 7 MT.PARK FIT, Parcel I.D.
A. Well Data
Well type PR WATE If A, B, or C, attach ADEC letter. ADEC water system number N,A .
Log present (Y/N) v Date completed 611 178 Driller RAMPART DRiCC11qr;
Total depth 35-0, Cased to 6S Casing height 21
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump levell
Wires properly protected (Y/N)
FROM WELL LOG
61117%
0.4 — 0.5 g.p.m.
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
SIIi193 /Z7 D
Septic/holding tank on lot I D5 ; On adjacent lots
Absorption field on lot 125 ; On adjacent lots > too
>r00
M
3
A C
Z3O z
M D
r
A O
< Z
0 000
0
0
N G)
5 m
Z
Public sewer main
� loo
sewer manhole/cleanout -� t 0
Sewer service line 85, Petroleum tank NONE 055ERVE-D
WATER SAMPLE RESULTS:
Coliform D CoC. 1000 � 1 Nitrate O IL Other bacteria O
Date of sample: 9151 93 Collected by: FLATTOP TE CH 5 YC5
B. SEPTIC/HOLDING TANK DATA
Date installed 5172 Tank size 1000 GAC Compartments 2-
Cleanouts (Y/N) Y Foundation cleanout (Y/N) i Depression (Y/N)
High water alarm (Y/N) H,A • Alarm tested (Y/N) N.A .
Date of pumping 5/1,193 Pumper 15AAC's
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 105' On adjacent lots > 1Oo Foundation 18
To property line 140 Absorption field > 10 Water main/service line
Surface water/drainage > /oo
N
so '
72-026(W93)•Fmnt CONTINUED ON BACK PAGE
r11
C=
`f0�nx
o«narer'n
n
M
-�
0.5
g.p.m.
cx
C
U n is
M
w
Septic/holding tank on lot I D5 ; On adjacent lots
Absorption field on lot 125 ; On adjacent lots > too
>r00
M
3
A C
Z3O z
M D
r
A O
< Z
0 000
0
0
N G)
5 m
Z
Public sewer main
� loo
sewer manhole/cleanout -� t 0
Sewer service line 85, Petroleum tank NONE 055ERVE-D
WATER SAMPLE RESULTS:
Coliform D CoC. 1000 � 1 Nitrate O IL Other bacteria O
Date of sample: 9151 93 Collected by: FLATTOP TE CH 5 YC5
B. SEPTIC/HOLDING TANK DATA
Date installed 5172 Tank size 1000 GAC Compartments 2-
Cleanouts (Y/N) Y Foundation cleanout (Y/N) i Depression (Y/N)
High water alarm (Y/N) H,A • Alarm tested (Y/N) N.A .
Date of pumping 5/1,193 Pumper 15AAC's
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 105' On adjacent lots > 1Oo Foundation 18
To property line 140 Absorption field > 10 Water main/service line
Surface water/drainage > /oo
N
so '
72-026(W93)•Fmnt CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed -789 Manufacturer OREN Co
Size in gallons Soo Manhole/Access (Y/N) Y
Vent (Y/N) Y "Pump on" level at 29" FLUM D&PTIf "Pump off" Level at 31 FCvI o oePT H
High water alarm level Y Cycles tested R
Meets MOA electrical codes (Y/N) No VIOLATIONS OBSERVED
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot I �. o On adjacent lots > loo, Surface water
D. ABSORPTION FIELD DATA
125 Ft</BDRn
Date installed 7' 89 Soil rating (GPD/Ft2) 1.2 GPD/F(I System type MD"ND
Length
Width :22 Gravel thickness 8 Total depth
2.5
Total absorption area 572 Ft' Cleanout present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test 5 111 193 Results (pass/fail) PA 55 for 3 Bedrooms
Water level in absorption field before test 2 After test 2'1
Peroxide treatment (past 12 months) (Y/N) No N E KNIowN If yes, give date N • A
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 125 On adjacent lots >/DO Property line
To building foundation 35 To existing or abandoned system on lot = to
On adjacent lots > 4o Cutbank N.A. Water main/service line
Surface water > tool Driveway, parking/vehicle storage area 6S
Curtain drain NoNE oBsER ve b
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and NAA guidelines in effect
Signature _-Ir A,0-1 -
Engineer's Name 1A e,-, �&V)e ? -Mood
DateAu� / i 3, 6?9�
HAA Fee $ 170
Date of Payment
Receipt Number
72-026 (3/93)` Back
Waiver Fee $
Date of Payment
Receipt Number
V49TH
70
of this inspection.
..............
DDOP.E F. n4OORE
CF -3589
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MUNICIPALITY OF ANCHORAGE
DEPT.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOW-17 - ';TION
�-
825 L Street - Anchorage, Alaska 99501
•
t!; Ay 3 _
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
RECEIVED
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 00) days for processing.
1. PROPERTYOWNER
PHONE
❑ MULTIPLE FAMILY]
Three ❑ Six
f�
MAILING ADDRESS
[ INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
PROPERTY RESIDENT (If different from above)
❑ PUBLIC UTILITY
PHONE
8. SEWAGE DISPOSAL SYSTEM
,
b INDIVIDUAL/ON-SITE**
**If individual/on-site, give installation date a _
If system is over two (2) years old an adequacy test is required
2. BUYER
by this Department.
PHONE
I
MAILING ADDRESS
3. LENDING INSTITUTION
4'TT{Ir !(1A
41L,
PHONE
MAILING ADDRESS --
4. REALTOR/AGENT'
PHONE
�
a-
MAILING ADDRESS
5. LEGAL DESCRIPTION
"�.
L
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
C7' SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ 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.)
8. SEWAGE DISPOSAL SYSTEM
,
b INDIVIDUAL/ON-SITE**
**If individual/on-site, give installation date a _
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.
2-010(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: /LM If Tank s homemade
give dimensions:
SOILS RATING
�d
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL _
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
C?�_APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY (Title)
S/
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
