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Home My WebLink AboutMOUNTAINSIDE VILLAGE #1 BLK 4 LT 17 I Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~"~',,z,J R~<:D=7,,'~ PIDNumber: Name: Wastewater System: ,]~,New [] Upgrade Address: ABSORPTION FIELD Phone: INo of Bedrooms: ~ ~ [] Deep Trench '1~Trench [] Bed []Mound []Other Soil Rating: Total Deplh from original grade: LEGAL DESCRIPTION ~-~,,.,/.~, GPO~Sq. Ft 4,~ Lot: Block: Subdivision: Depth to p~pe bottom from original grade: Gravel depth beneath pipe Township: Range: Fill added above original grade: Gravel length: .... ~ ~ ~ F~;, __ ~.__ Ft. WELL: ~ New ~ Upgrade Gravelwidth: Number of lines: Distance betweenlmes ~ ~t. ~ /~ ~t. Classdication (Private, ~,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Stalic Water Level: Installer: Date installed: Yield: Pump Set at: /Casmg Height Above Ground: ~ ~.~ ~ ~.l ~ ~h TAN K SEPARATION DISTANCES ~Septic ~ .o~di,o ~ S.T.e.~. From Tank Field Staeon Tank S .... L,nes ~ ~ ~ / ~ ~ Well /~l ~ ~/~ % % Material: Number of Compartments: Surface ~/& '~ * LIFT STA! ION Water .... gallons~anufacture,': ~ ~ / Curtain Pump Make & Model Electrical Inspechons performed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: 1 ~ r~, Inspections performed by: ~,~~o~¢~ D~tes:2 Department of Heatt~ and Human Services approval I ~*.%~/E¢ 72-013tRey 9;91) MOA25 \ S II Vi N 714 jSco!(, I" C "'IH .,~t:'~1 ~1 ~ 8RIDOKWAY ~rASHII/OTO~I ~ NO, 12085470800 t,m ~.,.~ ...... P, 02 J PLOTFLAI~ ANBUILT~ 80AL$ ~..~__~ O~IID ~d~L~_ JOSNo, ~-I~. ll~*,..' Il, ~ ,,,' PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" S[reet, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 10 11 12-- 13 14 15 16 17 18 19 20 Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? p E Reading Data Gross Net Der~m to Nat Time Time. Water Drol3 PERCOLATION RATE TEST RUN BETWEEN (m~nutes/mcl~l PERC HOLE DIAMETER FT AND ~:~ FT ~OMMENTS PERFORMED BY: ¢' ~ '---'~'~-~[:~"~"~O"~' '~'~*~/"~ ~ [ &,"~:~,-'~J.,t) O~ ,~' ,~'~, {~ CERTIFY THAT THIS TEST WAS PERFORMI"D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; '~--' ~;,~ ~ ~ ~ 72-008 (Rev. 4/85) JUN-21-94 TUE 14:55 BRIDGEWRY NRSHIN6TONFA× NO, ~2065470800 P, Ot Facsimile Cover Sheet To: Mr. R. Robinson Company: MOA Phone: 3434470 Fax: 343-6f~40 From: company: Phone: Fax: Date: Pages including this cover page: Greg Davis¢ourt (206) 632-0800 (206) 547,..0800 6-21-94 2 Comments: Good afternoonj please find enclosed a copy of the appraisal roport on my home. I does prove that it iea four bedroom home. If you need any additional information, please do not hesitate to contact me. Thank you for your help. Sincerely, Greg Davlscourt JUN-21-.94 TUE 14:55 BRIDGEWAY WASHINGTON FA× NO, 12065470800 P, 02 ~aska ' 99-50~ Hodson KoroPu & Levine 6044L UNIFO~ R~.~ID~ ~~A~ ~H~O~{F ?~ No. 6044L ~ This ie ~ ~t~li~h~ residenti~ neig~rh~ on the u~r ~ll~ide south~t cent~, se~ice~' ~d ~ute ~ive ~ is s,,~, __. __ ?1t655 ~are feet a.~,~. K-10 Rural residential of the centers are witkin a 25 to 30 familz_r, esidence~ on lar. 9~,..~ lots with views of Un~ I Fou~a~n Cone blk ~.~ None Pta~ ~ ~ 8a~ ~O~e ~l~man~ NODe U~r ~n ~oM None I~lealatbn None enoroacb~en~s, Typical for area adequate Panoramic view Averaq~ Gravel None apparent No X Roads are m~{n~ained year rou.,.nd., but: four wheel drive C are no 597 941 2,5 ~,~(.)~ ,538 ~u~,o ~ ol c~o:, u~n~ ,~e~ ~PROVF~'~T ~Y~I8 ~ A~. P~ I i? c>~: "y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division CITIZEN COMPLAINT TYPE: /2 [] Nuisance 3 [] Housing ITIME 6 [] Public Facilities 10 D Child/AdultCare 7 [] Swimming Pools, Spas 13 [] Dust 8 [] Air 14 E~ Water&Wells 9 [] Noise 15 [] Hazardous Waste/Materials Complainant'~ Name Last, First, Initial) Address Telephone Day Other Location of Problem Zip Code Cross Slreel ~ Foll~w-up I CALL YES D NO D Violator/Owner Name, Address, Phone Number 70-006 (Rev. 3188) TVPE I[~ ~' NEW LISTING (AD~ UODEI [] B. CHANGE PI~OPERr~TYPE (ALLIN~' LIST, ~E~I(~&~N1 INPUT SHEET I~ C. C~NGE LISTING ~IST e RE~IRED, ~MP~ & CIRC~ ONLY I~MS TO BE ~ I P~O C~E I ~ C~E~FO~CJ~L~ ~E~NO~iRE~OFEXPI~DLISTI~I~R~ I ~ B.p~RE~ESTED ~ B.N~-TOBE~LT C. S~T~ A~HED ~ C. ~W- ~R ~BTR~TION IM~ L~STING ~ ~O~ ~L~ ~O~E LIB~NG ~ ~ ~ · ~ _~ ~ D. ~ p~RE REQUES~O/ ~ D. NEW- ~NST~CT~N ~MPL~ ~~ ..... CFC TO SUPPLY ,~.~.~j ~ [~:::. .... ,~. ~X~I~ ~.::~-,~ 25 3439 6985 Big ~n~n Dr~ve ~, ~ .~~ .... ~~-~ ~~(~ ~%m~side Village~ ~'i""~-'~L17 ,-~ DAVISCOURT, ~ a~ Pa~icia = O~ER PH~E IoP~ 2 ~B . _,~ '93 ~ ., ~ ~5A8 BUILT w~ * YEA~ ~5~D~ mEN~ · ~ GA~GES(~ * ~CARPORTS ¢~ HEAT(~ · ARCHffE~U~L S~LE ~ ~] I ~ 1 ~ a. CH~ ~ESALE 'N~" ~ERO LOT UNE 'MOBI~ ~ C.A-FR~E RESIDEN~AL(SRS) RESlDEN~AL~ TOWNHOUSE ~L) HOME(MH) ~ ~.OOLON~L 3540 , 1600 , ~940 ., ~ F, ~ME · ~OTAL APX S~ ~ (~n APX SQ FT-~ s~FL (~s~ ~PX SQ FT-2nd FL Q a. uomt~ HO~ In~Lm _ ~RMS ~ ~ ST OEED TRUST [tm~ 1 ST % u~) 1ST P~ ~E FIN ~EPTABLE TO SE~ER) (CH~SE UP TO FQUR) ~APX LQT S~E ~ ~ D. L~P I PURCH 2NO % ~) 2ND P~ ~ ~UN~R.EACRES ~ E. EQSH 2NO~EDTRUST(~m ~ B. OVER.ETO I~RE ~ F. XCH ~ .-~ C. O~R 1 TO 5 ~S ~ ~. NF 2ND LENDER & LOAN ~PE O.O~REACRES ~ H. R6FI P (~ I TAXES ~ 5 ASSESSORS (~ ~S~ ~H~) ~ES/~H (~). ~ ,SELLERASSISTS GLO~ING COST~.(~) ~nus r~ ~d RE~RKSLINE 1 ~) .... Ak ~nge. ~aut~tuiiy desi~ 2 styf].~l~ w/ 4 BD~ on 1 lvl PLUS a O~ R MS mm * # BATHS · ~LOOR PLAN ! STYLE ,~ SPLIT S. TR[- LEVEL [] D. H~LLS~O5 RANCH [] E. 'P¢/O STORY 71655 APX LOT SQ FT {~ *WATE RPRNT ¢¢~N) APX SO FT-3RD FL into 10 ' ceilinq REMARKS LINE 2 (~ - __~ an office over the 940' ger. HUNI mtn rd. ~ GPM well. Can easily exp~mnd REMARKSLINE 3 crawlspace. Dble hydronic hea~ing system. Built w/ atte~tion to detail[ REMARKS LINE 4 (R~) * GAS ~ A. NATURAL BASEMENT O~ ~O FLOO~ (~ [] B. pROPANE IST ~LOOR ~%) 2ND ~LC~9 R I~l [] C. FUEL OIL BA m~ ~ ~ 4 ~ ~A, PUBLIC SEWER LR X * WATER -- [~ A. pUBLIC F R X ._ ~ EL PRIVATE WELL KT X __ [] c. COMMUNn'Y WELL UR X -- Form DR ~ ~. '- TD~IING ROOM D~SCRIPTIOH Rk~x, X Office RM(x~ __ -- 1STEXTRA RC~ DESCRIPTI(~4 (xm) Hansh~ · JUN[OR HIGH SCHOC~ ~ Bear Valley ELEMENTARY SCHOOL _Carpi, J~ ~OUthi~t FEATURES ~2~ A. ViEW [] ~. pAVEO STREET C. FENC~ D. RV pARKiNG [.~ ~. DECK F, ~ H, B~MENT ~ L [] K. FIXER UP [] L. REFRIGERATOR ~ M. OVEN/RANGE N. DISHWASHER ~O. OISpOSAL ,T~ P. CARPET Q. D RAPi'-' S R. D~NJNQ ROOM -' ' 8. FAMILY ROOM T. ELECTR)CITY 2ND EXq/FtA ROOM DESCRIPTION Servzce ~ SENIOR H~GH SCHOO~ 257-011_6 · LIST AGENT PHC~NE 1 AGENT NAME(S) = ~LL~--- ~ ~, ~~:~P_.~F.~a-~, InC. OFFICE PHO,h~ { ~NLY ~ ~T~ ~PE OF LISTING M=~s~R G=GROUP ~ ~ k~S_~L SORT SPEC (~) A- IN SUB ~ ~T IN SU~ LIST AGENT PHONE 2 DISC SHEb-r SELLER INrr .... PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930073 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:DAVISCOURT GREG & PATRICIA L OWNER ADDRESS:6985 BIG MOUNTAIN DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 4/26/93 EXPIRATION DATE: 4/26/94 PARCEL ID:02017260 LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE #1 BLK 4 LT ]_7 LOT SIZE: 71655 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST ]BE IN ACCORDANCE WITH: 3 o 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. THE ATTACHED APPROVED DESIGN. 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 (iSAAC80). THE ENGINEER MUST NOTIFY DHHS AT LF. AST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS . SPECIAL PROVISIONS: 1. ~TOTAL DEPTH OF SYSTEM MAY NOT EXCEED 1.5' BASED ON ELEVATION OF T.H. #1~. I ' DATE' DATE: ISSUED BY: /~_.~__ ~¢<.~-w~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16- 17 18 19- ECEIVED iUN 4 199b pahLy of Anchorage ,alth &14umanServ BeG 20- Township, Range, Section: f-,~',, ( ( a,~__. SLOPE SITE: PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? p E Depth Io Water After Moniterin0? ~)f"~-- Bale: ~/~-/4,.!~ Gross Net Depth to Net Reading Date Time (.].4,r~'~ Time ('~,¢~.~ Water Drop PERCOLATION RATE TEST RUN BETWEEN __ (minutes/tach) PERC HOLE DIAMETER FT AND ~ FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS BATE. DATE: (-~ -- ~"/~.-~ 72-008(Rev 4/85) · / ~ECEIV Municoahty ~9~h CE -8149 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: /v'fo,.,~ ~,~,~ ,~/¢~ ,:( .~]-ownsh~p, Range, Section: k~, It ,,~ SLOPE RECEIVED JUN 4- 1993 3 4 5 6 7 8 9 10 11 12 13 14 15. 16- 17 18 19 20 3OMMENTS Murficipality of Anchorage Dept. Health & Human Services WAS GROUND WATERf~-':JO ENCOUNTERED? SITE PLAN S L IF YES, AT WHAT O DEPTH? p E Oeplh tn Waler After 0 Monitoring? vf ~.) Oate: Gross Net Depth to Net Reading [)ate Ti m e ~./,,4,~ Time (.j~r d/ Water Drop '2.0 tO ~ q ~10 lO 5 ~ PERCOLATION RATE ~-'~' (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN '2~ FT AND ~'~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) WAS PERFORMED IN .'1 / REcFIV.F.!D i ' ~ dON 4 19¢5 Mulhc~'t.~d~y O! ,~nchorage Dept. Health & Human Servi~e~ by 00~ ¢o. oba SULLIVAN WATER WELLS P,O, [lOX 610272, CHUOIAK, ALASKA99551 · ?ELEPHONE 688-21S9 ADDRESS LEGAL DESCRIPTIO,',L DATE, Stalled PERMIT NUMBER DEICfH OF WELL STATIC LEVEL OF WATER DRAW DOWN ~ f. GA~, PER [IR ~ KIND OF CAGING KIND OF FORMATION: From- 0 Fi, to.g..~ From~Ft. to, , From .... Ft. to . From.__Ft, to From__Ft, to__~ Ft, Fl'om__Ft. to~__ Ft, From_ Ft. to______,Ft. ~,__ From ..... Ft. to Pt, Froro Pt, to Ft From_--Ft. to Ft._ From Ft. f(t .... lei'. From .... Ft. to .... Ft.~. Ftom~.__Ft. to Ft. From Ft, to Ft. _, rt, y_~J From ~ Ft. From.~Ft, From__ Ft. From__Ft. r,,,,,, . to .... Ft. lo .... Ft. . Pr. to_ From Ft. to.. From~_Ft. to ,Ft._ Fromm. .Ft, to___Ft From .... From ~Ft, to__. Ft Prom Pt. Ptom~Ft-to- Ft. From Ft, to_~Ft Ftom__Fhto ..... Ft._ From~Ft. to Pt. Fi.om~Ft, to ..... Ft M1SCL, INFORMATION: DRILLER'S NAME STATE OF ALASK/3, DEPARTMENT OF NATURAL RESOURCES LOCA?ION OF WELL DIVISION OF WATE!~ WATER WELL RECORD LOCATION/SKETCH: DEPTHS M~ASURED FRoM:r']casing top r-]ground surface ~', curt DATA: B.,P, .... L~ Material Type and Color ~epth From To / / Depth of _ , Dcpbh of c~sir4:~__~t ,'~'---- )E~H TO STATIC WATER L~E: ~ ft below ~top of casing ~ ground suflace METHOD OF DRILLING: ~'air rotary [] cable tool [] other .: USE OF WELL: ,,[~omestic El irrigation {~ monitor [] public supply [] other. CASING STICK-UP: ~ ft. Diam: _.~_in, to ~AKE OPTING TYPE: ~ open end {~ screened ['3 perforated ,~open hole Depths of openings: to SCREEN TYPE; Diem: Slot/Mesh Size: - Length:__ in. G P-~VEL PACK Volume used:__ Depth to top: GROUT TYPE: Depth: from. DEVELOPMENT METHOD: _~ Duration:.. //~.~/~'~,~- ' .. PUMPING LEVEL AND YIELD: hrs pumping ~ ~-O/-¢¢ ft after _ ._./:f' _..= PUMP E~TAKE DEPTH:__ ft Horsepower:. ,.~ _ftto ft gpm WELL DIS~FECTB3 UPON COi~PLETION? E~Y,,ES [] NO REMARKS; PLEASE MAIL WHITE COPY OF LOG TO: DNPJDIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930073 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DAVISCOURT GREG & PATRICIA L OWNER ADDRESS:8143 HILLSIDE WAY ANCHORAGE, ALASKA 99516 DATE ISSUED: 4/26/93 EXPIRATION DATE: 4/26/94 PARCEL ID:02017260 LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE #1BLK 4 LT i[7 LOT SIZE: 71655 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM 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 (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-.4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. TOTAL DEPTH OF//YSTEM MAY ~OT , ELEVATION 0~ #1.~ RECEIVED ISSUED BY: EXCEED 1.5' BASED ON DATE: DATE: Tom Fink, Mayor Municipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 1, 1992 Mark Do Wilkins 8465 East 20th Avenue Anchorage, Alaska 99504 Subject: Lot 17 Block 4 Mountainside Village Subdivision #1 Permit ~SW910120, PID ~020-172-60 The subject permit, issued May 30, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of May 30, 1992. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions ! Smi ~rogram ~anager On-site Services , please call this office at 343-4744. enc: Copy of Permit PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM ]PERMIT PERMIT NUMBER:SW910120 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:WILKINS MARK D OWNER ADDRESS:8465 E. 20TH AVENUE ANCHORAGE, ALASKA 99504 DATE ISSUED: 5/30/91 EXPIRATION DATE: 5/30/92 PARCEL ID:02017260 LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE #1 BLK 4 LT 17 LOT SIZE: 71655 (SQ,~.> NUMBER OF (3 : BEDROOMS:' 33HIS PERMIT 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. TOTAL DEPTH OF SYSTEM MAY NOT EXCEED 1.5' BASED ON ELEVATION 0~. #1. RE C E I VE D BY: ~_-3c~'~ ?fg[~L~ May 23, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTtON & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 17; Block 4; Mou~ide V~age Subdivision PERMIT REQUEST NARRATIVE This is a large mou~ainside property with all n~ighboring lot~ undev eloped. The bedrock is shallow with good soils above. Due to the slope of the lot we have specified 5 ft. wide drainfields to be stepped down the hillside. We anticipate no adverse effects on neighboring properties by the installation of the proposed we~ and septic system. Sincerely, ROBERT A. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOI.ATION 'rEST DATE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- .~i0~T6ownship, Range, Section: SLOPE SITE PLAN s L IF YES, AT WHAT O DEPTFI? p E Oeplh to Waler IA~)~c~o · / Gross Net Depth to Net Reading Date Time Time Water Drop 'IP PERCOLATION RATE__~ (m~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' ~FTAND ~ FT COMMENTS PERFORMED BY' ~¢, * - I' ~ ' ?,~2P, t,~,,-.~..~ ,~ ..... .I ~/ / J CERTIFY THAT THIS TEST, WAS PERFORMED IN ACCORDANCE WI'~tLC'3-'~,~E/Z~II~L~'i~I{~r~'A' GOIOELIN~OT ON THIS DATE. DATE: ' ~ /Z //¢ / / 72-008 (Rev. 4/85) / SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? p Oeplh to Waler AII,~A~,~..~, ,, Moniloring? 2 V'~'~ E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE____~ (minutes/tach) PERC HOLE DIAMETER .~' t4 'rEST RUN BETWE '-"'"'O~ FT AND "b FT COMMENTS _~ 7 PERFORMED BY: E4A'~o ~!ve", '~ ii ~ ,,~'77 /// ~/ CERTIFY THA%THIS T~S~ WAS PERFORMED IN ACCORDANCE WlTH ALL STATE AND MUNICIPAL GUID FFECT ON THIS DATE. DATE: '¢7¢~//¢~ 72-008 (Rev. 4/85) HAY 20 '~4 0~:04 FROM VISTA RERLTY BHAG TO ?852011 PAGE.001 TO $~VE LOTS I. ~, & ~ LOT ooJ EXISTH'~G ~.tOuSE LOT 1 LAN~CH hoe coAdu~od o LEGAL DES'CRtP~0N: ' LOT 5 MIQA'S MEADOW 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING NAA# ~A 1. GENERAL INFORMATION Complete legal description w"l Location (site address or directions) /¢¢) _~ q~4 /w'~-~~u~..~ ~/~ cl~- / ¢;~1,'.. : o~ o) ~--/ ~. Property owner Mailing address Day phone Lending agency __ Day phone Mailing address Agent Day phone Address r Un/ess.otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATFR SUPPLY: Individual well ~¢, Community well Public water NOTE: If cornmunity well system, provide written confirmation from State~A'D,E.C a~test-.-.,,,, lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer . NOTEi If community wastewater system, provide written confirmation from State ADE'_C attesting to the legality and status of system. 72-025 {Rev. 1/91) Front MOAI¢21 DHHS SIGNATURE 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. EngineeCssignature,~~ - Date /~-~/~ bedrooms. Approved for '~ Disapproved. Conditional approval for bedrooms, with the following stipulations: ,Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent · professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto 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 ~or errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA¢~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: /-/-7-/Bz/ ~¢~-r¢~ ',//~A~,~ ParcelI.D. oCZ, o~'%&o A. Well Data Well type'--~ra ( d ~'-r-~. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) '¢~- s Date completed _~-'-/~-e..3 _Driller /0 ~."-~..~'~-- Total depth ~ o ~ ~ Cased to /8 f Casing height Sanitary seal (Y/N) '7¢,¢--~ Wires properly protected (Y/N). "~ FROM WELL LOG AT INSPECTION Date of test .S-- 1 3 -~'~ ~,/'4.~m ~ Static water level / %- /"+ ~-~ Well flow ¢=, g,p.m. Pump level1 ~ c:, r~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main .g.p.m. Sewer service line ; On adjacent lots _; On adjacent lots / ~c~ Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed lcd/q ~ Tank size /~c-o Compartments Cleanouts (Y/N) ~( Foundation cleanout (Y/N) '-¢1 Depression (Y/N) High water alarm (Y/N) ~/A Alarm tested (Y/N) Date of pumping ,/~¢ u,~ .-~,,,.J F- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / 5-,5-/ On adjacent lots To property line 9 4' Surface water/drainage Foundation "~ Water main/service line 72-026 (3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ,..'v/,,~ Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed c~ c.---c Length /c>o Total absorption area Date of adequacy test Water level in absorption field before test ~'/'~ Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) Width .5- c,c~ ~ ~ Cleanout present (Y/N) ,,w ~- ~ ::c-/.s-v,~. ~:,-wRe~Jults (pass/fail) Gravel thickness .System type Total depth '%~ Depression over field (Y/N) '-~ ~_~ for ,v.¢ After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~c, ' To building foundation ~ ~ J~ On adjacent lots /~ -~' Surface water ~/~ Curtain drain .-,~,~! ,c, On adjacent lots ? ~ ~ -h Property line To existing or abandoned system on lot Cutbank ~'/~ Water main/service line /'t'//A Driveway, parking/vehicfe storage area o'-'o E. ENGINEER'S CERTIFICATION I cerYfy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~tb.e.,~.t,~ of this inSPection. Signature .~-~,~---- Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back AL CT&E Ref.~ Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.5644-1 RICH DAVIS COURT - HILLSIDE WATER Client Name PAN/qONE ENG SRV. WORK Order 10619 Ordered By STEVE Printed Date 11/07/94 @ 16:14 hrs. Project Name Collected Date 11/02/94 ~ 15:40 hrs. Projecu~ Received Date 11/03/94 @ 16:45 hrs. PWSID UA Technical Director STEPHEN C, EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: M.A. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 1.28 mg/L EPA 353.2/300.0 10 11/04/94 CMR See Special Instructions Above UA = Unavailable See Sample Remarks Above NA = Not Analyzed Undetected, Reported value is the practical ql/antification limit. LT = Less Than Secondary dilution. GT = Greater Than 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES iN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA