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MOUNTAIN PARK ESTATES #2 BLK 3 LT 4
Mountain Park' Estates Block 3 Lot 4 #017-.022-16 Municipality of Anchorage Poge 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: .345-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000150 PID Number: 017--022--16 N°me:KATHRINE ANDERSON Wastewater System: [] New · Upgrade Address: 12900 SAUNDERS ROAD ANCHORAGE, AK ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907~ 545-9111 · Deep Trench [] Shallow Trench [] Bed •Mound []Other LEGAL DESCRIPTION 0.8 oPD/S,. ~ 9' MAX 4 5 MOUNTAIN PARK EST. #2 1.55-1.95 r~ 7 - - - 0.4 - 0.8 ~ 41 Grovel wTOth: Number of Irnea: WELL: [] New [] Upgrade 2.5 F~ 1 Clu~lflceflon (Pdvote, A.B,C)=.(-' \ \\~'\~'~'\( ~ Cus.d To: Total absorption oma: 574 Pipe mutedal: ASTMD-3054/F810 Driller:. Dote O~,,ed: st,u= Wot.r g,,.b 'n'*°"°"OWNER INSTALL 6/12/00-6/19/00 ~ ~ TANK SEPARATION DISTANCES ·Sept~o..r~,H~°~?~'~.,.~a'~'T'E'"' Woter Lot Droin NONE KNOWN I I Remarks: BENCH MARK TOP OF FOUNDATION CLEANOUT 100.00 Inspections performed by:. AWWC, INC. Dates: 1st 6/12/oo ! ....... V~ .... " ..... Department of Health and Human Services approval -~/~ PERMIT NUMBER: AS BUILT DRAWING PARCEL ID NUMBER:, SW000150 ' 017-022-1 6 I / , / · ~ MOUNTAIN PARK EST pO~/I yELL RADII WERE FLAG BY I e~'/ I A REGISTERED LAND SURVEYOR -~// I (SHANE HOLT, LS.). ~ I /~/ GENERAL LOCATION ~ ~ I / [ ~ /~lmNO 1000 OALLON ' ' ~ ] ~ ~ LBBL1 SEP~C T~K ST2 56 0 38 0 USeD ~ A RESERVE SI~. C03 67.048.5 ~ / ~°~ ~=.o=~.~ I I ~o~,~o~ / ~ ~o.~~.o MOUNT~N PARK E~ ~2 MT2 51.473.2 ,,~,~ ,o,: ,,o.~ .,..~,: ,~ ,~,.e,: ~,~,~.... ,~... ~,~¥, .~..~;....,..., KATHRINE ANDERSON (907) 271-8209 2 OF ~L DESORIP~ON: ~PE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE'~ess PERMIT NUMBER: AS BUILT D~WINC PAROEL ID NUMBER: SWO00150 ' 017-022-16 / - - / / O~l~lN.~. ~F.A~ 90,7~:)1,1 // ~' IN~ ~ PIF~ ~OM ~ PREP~ED~gOI ~=~R RO~, SUit= Za ' ~CHO~g~. ~ ~0~ ' PHON= (~07)~=Z'~I7~ ' f~ (~eT~-=z~fOr: PHONE NUMBER: ~a~e NUMBER:N'T'S' KATHRINE ANDERSON (907) 271-5209 5 OF 5 MOUNTAIN PARK ESTATES ~2; LOT 4, BLOCK 3, PROFILE AS-BUILT OF SEPTIO SYSTE~ UPORAD~ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 Upgrade Date Issued: Jun 06, 2000 Expiration Date: Jun 06, 2001 Permit Number: SW000'IS0 Legal Description: MOUNTAIN PARK ESTATES #2 BLK Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Kathrine Anderson Owner Address: 12900 Saunders Rd. Anchorage, AK 99516-3237 Parcel ID: 017-022-16 3LT 4 Site Address: 012900 SAUNDERS RD Lot Size: 20130 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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. Received By: ~/'~--~' ~'~"/'~F, ~c~7"L_,~ / tO, Date: Date: ALASIO WATER & WASTEWATER May 26, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On~Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Design Upgrade for Mountain Park Est. S/D #2; Lot 4, Block 3 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing drainfield is surcharged and in need of an upgrade. The exisitng tank was installed on 1/24/95 and will not be replaced. The tank will need to be raised as needed along with the plumbing within the house to obtain gravity flow to the drainfield. One test hole was excavated on the property. The proposed septic system will be designed within the 30 foot radius of this test hole We are proposing that a deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: I. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a SM/GM material to a depth of 10 feet and then transistions to a ML/GM material to a depth of 15 feet (bottom of test hole). No groundwater was encountered during the excavation of this test hole but small weeps at 7.5 feet and 9 feet were noted. A percolation test was performed between the depths of 5.0 feet to 5.5 feet which had a percolation rate of 12 minute/inch. It is our opinion that due to the overall a 2 ppearance of the soils, a application rate of 0.8 gallons/day/ft should be used. 2. TRENCH DESIGN: a. Percolation Rate: 12 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Nmnber of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 ft2 f. Total Depth: 9 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor: N/A ~ Minimum Length: 41 feet long · Effective absorption area = 574 ft2 69ol Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 - Fax: (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography of this property is a 12 to 14 percent running from approximately east to west; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. PreL eht NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, 1 soil log, and a 7 page construction specification letter which are allpart of the design package for this septic system. 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 - Fax: (907)338-3246 J ~ ~ I LOT 24, BLOCK 3 I { LOT 1, BLOCK 3 LOT 1, BLOCK 2 i MTN PARK EST. #2 ' I LOT 2, BLOCK 3 LOT 23, BLOCK 3 I I MTN PARK EST. #2 ~ LOT 22, ~OCK 3 ]/7% / /- LOT ~, BLOCK 3 ] I / ~ ~ ~ //] ~/ LOT 4 BLOCK 2 i~ [ LOT 20, BLOOK ~ ] I ~ / ~ P~K EST. ~2 ~IUS_~I LOT 6 BLOOK ~ I I ~ ~/ MTN P~k EST. ~2 .... ~ LOT 6, BLOCK 2 i L ~ & W TEWATER 6g0] DEBAR RO~, SUITE ZB ' ~CHO~GE, ~ ggS0~ ' PHONE (gO7)337~lTg ' F~ (g07~38-3Z~6 = 100' PREPPED FOR PHONE NUMBER: PAge NUMBER: KATHERINE ANDERSON 271-3209/345-9111 1 OF 2 ~OUNTAIN PARK ESTATES SUBDIVISION ~2; LOT 4, BLOCK 3 SITE P~N FOR DESIGN OF SEPTIC SYSTEM UPGRADE I ~ ~ /'~ MOUNTAIN PARK esr ~2 " ~ ~ ~ -, .... X / A~ ;VATER & ;VASTEWATER K.D.W. ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~SOIL LOG - PERCOLATION TEST] PERFORMED FOR: ~THRINE ANDERSON,~ ~', DATE PERFORMED: 5/4/00 ¢~"., DEPTH (foeO ..... :~- TEST HOLE ~l u 1 ~ ~ ORGANICS 2-- [¢~¢~ SOIL C~SSIFICATIONS ~ i / ;¢g~'.~¢:}~ GW z:~: ORG -- I~ J ~ MTN PARK G~ CL ~ 4 GC OL DEPTH TO DATE ~ Xl. ,[ / ¢ SROUNDWATER -- ~ t-, WEEPS ~ 7.5' 5/2/00 ~ I- '~ / WEEPS ~ g.O' 5/2/00 J LOT 5, BLOCK DRY 5/10/00 JJ II ~ / j 10 DRY 5/2~/00 ~ ~ 11 DATE ~EADING CLOCK NET TINE WATER LEVEL NET DROP TINE (HINUTES) READING (INCHES) 12 5/3/00 PERC, HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING ~ 1 1:19 2 1:49 ~0 ~ 7/16" 2 9/16" 1~ - ~' ---- ~ 1:~9 6" 4 2:19 30 3 7/16" 2 9/16" 15 5 2:19 6" 16~ 6 2:~9 30 3 7/16" 2 9/16" 17 18 19 PERCOLATION RATE 12 (NIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. COHHENTS: PERFORMED BY A~SKA WATER · WAST~ATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFO~ME~ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: ~ DEPTH TO DATE SROUNDWATER WEEPS © 7.5' 5/2/00 WEEPS © 9.0' 5/2/00 DRY 5/10/00 DRY 5/2¢/00 Sent By: Alaska Water & Wastewater Consu; 907 338 3246; Jun-6-O0 10:00; Page 1/1 A_~LASKA WATER & WASTEWATER ............ CONSULTANTS, INC. Facsimile Transmittal Date: Number of Pages: / (including cover) - Alaska water and Wastewater Consultants, Inc. Comments: t 6901 Debarr Road, Suite 2B - Anchoraee AK 99504 - Ph' (907)337-6179 -. Fax' (907)13g-3946 ~ akuavc corn 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: '~ljOk~)O0~ PID Number: ~) Name: CUpgrade 11o~,%, ~f~"-I L. ~ T-HocffA-.s ,A- Wastewater System: [] New Address: / Phone: No. of Bedrooms: ,-~__ [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION .~: ~_ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: I Range: Section: Fill added above original grade: Gravel length: I Ft. Ft. WELL: [] New [] Upgrade Gravel width: Number of lines: Distancebetween lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SQ. Ft. Driger: Date Drilled: Stadc Water Level: Instager./:"~) /'~ Date install,ed: Yield: GPM J Pump Set at: Ft. Casing Heighl Above Ground:Ft. TAN K SEPARATION DISTANCES ~Septic [] Holding [] S.T.E.P. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank S ..... Lines-- ./~ ~N,l~ ~". ~L Material: Number of Compartments: Surface Water t'~ >.~, LIFT STATION Lot Size in gallons: Manufacturer: Line I ~ Foundation ~ ~ "Pump on" level at: "Pump off" level at: High water alarm at: Curtain 1.,j? Pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Assumed Elevation: ENGINEER~SSEAL Inspections performed by: ':~' ¢ Dates: 1st ~>/?: Department of Health-and Hu Services approval, '.. '.- Reviewed and approved by: ' Date: 72-013 (Rev. 9/91) MOA 25 I NOTE: I EXISrING T~NK FILLED WrH SA~D AND LEFT IN GRflUND 15 O 15 30 45 60 75 SCALE: ! INCH = 30 FT, + Wel_l 90 TOBBEN SPURKLAND P.E. I ILoT Ii 20,5 W 15TH. AVENUE ANCH. AK. 99501 (9o7'~ 279-3916 4, BLOCK $ MOUNTAIN PARK ESTATE 12900 SAUNDERS TOAD THOMAS AND TERRY MORRIS I I SEPTIC SYSTEM AS BUIULT DATE: JANUARY 24, 1995 SHEET: 2/$ GRID: 2559 ]000 GAL. SEPTIC TANK ANCHDRAGE TANK AND ~/ELDING BENCH MARK: FINISH FLDLTR FIRST FLOUR ASSUMED ELEV. 100.00 FT TBBBEN SPURKLAND P,E, 203 W15th Ave Anchorcge Ak 99501 1~90~ SAUN~£RS II 1-HZTMAS AN~ T£R£Y MDRRIS SEPTIC SYSTEM AS BUILT DATE: JAN, 24, 1995 SHEET, 3/3 ~RI~, £839 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Septic System Upgrade Permit Permit No. 950004 Lot 4, Block 3 Mountain Park Estate Gentlemen: J~uary25,1~5 Transmitted herewith are the inspection reports for this septic system upgrade. The tank was replaced by Carl's Excavating on Jan. 24, 1995. An HAA was applied for on Jan. 17, 1995. Please include this As-Built with the HAA. Yours Tobbefi Spurkland P.E. RECEIVED JAN 2 5 t995 D Mumc~pai~[y oi Anchorage ept. Health & Human Services ON PERMIT NUMBER:SW95 DESIGN ENGINEER:TO] OWNER NAME:MORRIS ' OWNER ADDRESS:55?7 NAPE[ PARCEL ID:01702216 LEGAL DESCRIPTION: LOT SIZE: 19800 (I NUMBER OF BEDROOMS THIS PERMIT IS FOR SEPTIC TANK SYSTE] ALL CONSTRUCTION 1. THE ATTACHED Al 2. ALL REQUIREMEN' 15.55 AND 15.6! REGULATIONS 3. THE ENGINEER PRIOR TO EACH CALLING 343-47~ 4. FROM OCTOBER 1! ABSORPTION SYS' WEATHER MUST A. OPENED AND B. COVERED, SE] 5. THE FOLLOWING MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ?.0. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 -SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) )004 ~BEN SPURKLAND, P.E. FERRY L & THOMAS A [ TIMBERLANE DRIVE [VILLE, ILL 6053-1069 MOUNTAIN PARK ESTATES #2 BLK 3 LT 4 PAGE 1 OF 1 PERMIT DATE ISSUED: 1/19/95 EXPIRATION DATE: 1/19/96 ~Q. FT. ) 3 THIS PERMIT: 3 THE CONTRUCTION OF: IST BE IN ACCORDANCE WITH: ?PROVED DESIGN. IS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS ~ AND THE STATE OF ALASKA WASTEWATER DISPOSAL ~AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . IST NOTIFY DHHS AT LEAST 2 HOURS iNSPECTION. PROVIDE NOTIFICATION BY L4 (24 HOURS) [ TO APRIL 15 A SUBSURFACE SOIL .EM UNDER CONSTRUCTION DURING FREEZING ~ EITHER: ~LOSED ON THE SAME DAY ~LED AND HEATED TO PREVENT FREEZING ~PECIAL PROVISIONS. SPECIAL PROVISIONSJ RECEIVED BY: / DATE: DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Septic System Upgrade Permit Lot 4, Block 3 Mountain Park Estate PIN 017-022-16 January 17, 1995 Gentlemen: During an HAA inspection for this lot is was observed that the septic tank was severely corroded, and partially collapsed. We are requesting a permit to replace the tank. The existing tank was backfilled after exposure, but the added load on the tank caused by this excavation activity may aggravate the situation. Please issue a permit as soon as possible. Your~ ~obb~)~and e.~. ' T LOT £ LLTT II ii LOT =PO I I I LDT 3 LITT 3~ LDT 4 LOT 5 ,~ $0 0 ~0 180 150 BO0 ££ALE: .1" = l_OO FT, 203 W 15TH. AVENUE ANCH. AK. 99501 (907) 279-$916 4, BLOCK 3 MOUNTAIN PARK ESTATE //2 12900 SAUNDERS TOAD THOMAS AND ?ER£Y MO£RIS SEPTIC SYSTEM DESIGN DATE: JANUARY 16, 1995 SHEET: I/$ GRID: 2839 i £EPLA£E , 15 0 N SCALE: ! INCH = 30 FT. NOTE: gEPLACE EMS'~/N~.'. ?gNK , olsPos£,.Ok rx/srmo r~Nx 'O~r S/rE ~ '." ~,, ~ '~ ,' '.' 5 "~Ec'.-~ ~<'~"'. ,' : ',"~'.' 75 90 203 W 15TH. AVENUE ANCH. AK. 99501 (907/ 279-9916 4, BLOCK 3 MOUNTAIN PARK ESTATE//2 12900 SAUNDERS TOAD THOMAS AND TERRY MORRIS j j SEPTIC SYSTEM DESIGN DATE: JANUARY 16, 1995 SHEET: 2/3 GRID: 2859 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 NO. OF BEDROOMS LOCATION % ~t~,l~0 ~C~)~ (~ O ~---~- ~ ~ ~ Well Absorpt on area Dwelling PERMIT NO .... . ~ DISTANCE TO: ] ~ O O G ~ ~ ~ ~ ~ ~ ~ ~ ~ Material ~ Z ~ Manufacturer ~ ~ ~ I ~ ~ ~ ~ No. of compartments ~' Lq capacty nga OhS ............ ~ Width '~:[~ Liquid depth "/~ ~O~ Ir n~v,c,v~: Inside length ~..~ ~ DJSTANCETO' iWelI ~ ~ ~ Dwellin9 PERMITNO. ~ ~ ~ Manufacturer . Material Liquid capacity in gallons ~ I DISTANCE TO: I XOO Nearestlotline PERMITNO. ~~~ ~g~~~ h~gr d~idth ~ ~~We~ ~ inches T°tal effective abs°rpti°n area ,,,. to ~,n~; ~ M.t.~.~.~.a~h~i~ ~ O'~ i.~h~ GO~ Depth PERMIT NO. T~.. o~..i~ ~ C~ ~.~ C.~ ~,t~ Tot.] ~.~iv..~or,~ion ~.~ ~ DISTANCE TO: Building foundation Nearest lot line IClass ~ Depth Driller Distance to lot line ~ PERMIT NO. ~ ~ ~ lAbsorptionarea(s) ~ DISTANCE TO Building foundation Sewer line Septic tank OTHER PIPE MATERIALS / o SOIL TEST RATING INSTAELER REMARKS 72-013 (Rev. 3/78) )DATE LEGAL 't '" -. ' ."' ",M-W DRILLING, INC. '"'.. DRILLING LOG we20;v~er_ A.b£~cn l~eoL~D .u~e o£ we~ LocaLion (address of: Township, Range, Seetion,~f lmown; or distance main road {;ize of easing ~// Depth of Hole_~fi)L) ~eet Cased to .... feet :{latie water level___~~2 ft. (above) (below) land surface. Finish of well (cheek one) f3ereen ( ); Perforated ( ). Describe screen or perforation J0ZJJ_ Well pumping test al I~,~gallons per (J'~) (minute) for__ I .hours with .of drawdown from stat$e level. Date of completion . 7/ open end Xrt' ); WELL LOG Depth in ~eet £,'om !J l-ollrt ct sur~tace 0 .TO Give details of formations penetrated, size of ~naterial, color and hardness 2_2_._o__,ro~_ goo .TO .TO ....... TO .... TO__ ...... TO. / / 3- CONTRACTOR January 5, 1978 Norm Bristow Star Route A Box 449-A Anchorage, Alaska 99507 Subject: Lot 4 Block 3 Mountain Park Estates Subdivision Permit ~77892 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 questionsv please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section L CT' 27;].Z'[E ;.:?:E~-'_'.:~:~:.J ~f.-t!i, JFtl::i?IE{ FEET 1:.1T )_ CIN. [)[EF'RF?."I HEZf.,I'T i. HEff!i..TH t::ti'4[::, F~ii'.4V ]Z Fi:ONHE:N"f Fl[ .... )"['E:t;::"I' :I: (i~;;.i:L5 '" L. '" 'J:.';"f'F?.Ei:~T., ffiNCHEff;;:FIGE:., F:ff::.'. ~.:Z, ~"-J.4 .... ~'E; :fl: "!"- ~EE: dFZ;; ~E: L,,~ ECE [-4: ii:':" E~ ~:'~: ii"""il % ""ii" HF:I;:-:;]:i',li..tH iql...tHii~:E::i:;i: '-d::: EflEDFR(Jff)Hff; = 2: THE: '::';O ]: L I::IE:L::i;OFi:F:'T L[ ::'iN .:, ~ .:, 1 D.i' t ]: '-:;: "i'lqtE I..i::iZNG!'H E:,:JiHEN:E;iC~N t% THE: IjEi'.,iGTH ,::Zi:t"4 FEEl'F) -;if; THE 'I'F.:E:NCH r'Bl:;i: t:)RI:::IiNF:']iFJLJ::'. 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F:f COt"4TINI. jOUS HF:~:[N"f'IEI",IFINC':['-:: REii:RIEEI'tlEi",I'f' ];S I:;;:E:6:!LJ].'I:;.~E[.':'. ];F R I"IRIhi'T[~:NFINE:E F:IGF.'.IEii:HEZN'[ iF.; NOT I<ZIEF"I" CLIffd::::EN"i' FIE[~!;OI:;;'.t:;>T Z[ ON LE;"r'ST[.:.:I"I fflNE:',-'"OI:;-". "r'OU t"iFt'¢ ErE S;LI[3.J'E:CT TO I::'RE~SECLt'F]ZON. H ]: I"4 :f. HIJi'"l [::' :i: '::;"f'FII",ICL{ E:ETTHE:EN 1:4 HELL. t::ff',iE:' :'it~:.il;:j i::'EE'i F:'EIF?. ffl F'F.::i:',,,'FI"HE HEL.L Oi4'. 2EIEt F'E:ET F'OF.: FI t::'I..IE:LZE: HELl .... I.,.itiEt...i... L.(:)(:~i'.:J; t::I[(:E l:;.:Et';!t...l :[ B:E[::' Fli",l[::' i'"Ii_i~B'T i3E F::ETUD. i",tE:E:' "f'O 'f'HE E:,EF'F:tF.:THEN-t" H :J: TH ~' N '~ E:J E:,F:l'9'.~i; Oi::: THE I.,.IE!;L..t.. :::FthlF't....ET i CI"f HiEF;: [(:lEi;¢...t :[ F~:Et'"IE:NTE:; l"lFl"r' h h f- _. ¥. :E~,PIi:'C: PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 7 8 0 ~4 17 20- COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch ~.650, Anchorage, Alaska 9960:2 276-2221' SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST SLOPE DATE PERFORMED: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop f C~_.M ?.,.~r.~ £ £ PERCOLATION RATE ~ 1//>,.~ /'~ //~1 (minutes/inch) TEST RUN BETWEEN ~ , FTAND ~ FT 72-008 (7/76) g ALS MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 017-022-16 O Expiration Date: - 3 I �l q 1. GENERAL INFORMATION Complete legal description Mountain Park Estates #2, Block 3, Lot 4 Location (site address) 12900 Saunders Rd, Anchorage, AK 99516 Current property owner(s) Scott & Rebecca Hauser Day phone 230-8386 Mailing address 12900 Saunders Road, Anchorage, AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: H Single Family (w/wo ADU) F---1 Duplex (l Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic (� Water Storage ❑ Holding Tank n Community Well ❑ Community C Public Water System ❑ Public Sewer n Waiver request for: Distance Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 556 © GS k Waiver Fee $ Date of Payment 571 `19 Date of Payment Receipt Number Oqc2/4,L) Receipt Number COSA# 105(Mit 90Q Waiver# 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, 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 Forge Engineering Phone 907-522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 5/24/19 444. • 69."� y, 49th 6. DSD SIGNATURE • % System #1 Approved for 3 bedrooms MICHAEL E. ANDERSON j� ��r,: �•-j•\ No. CE-4381 ' a System #2 Approved for bedrooms • �F�, 05/24/19.�''`' �•• ♦ �O . _....• V „tipDisapproved f�ia •• 1. Conditional approval for bedrooms, with the following stipulations: ON-SITE WATER AND �c" WASTEWATER a PROGRAM X65— 'PA/ SER\g C'c-- tt r_ By: l— Original Certificate Date: 5=31-17 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval(COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other `—rct„a COSA Checklist blue sheet COSA Checklist Legal Description: Mountain Park Estates #2 Block 3 Lot 4 Parcel ID: 017-022-16 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 5.95 gpm Date drilled 7/17/78 Water storage tank volume NA gallons Total depth 300 ft Well disinfected for coliform test? ❑ Yes 0 No Cased to 300 ft ❑■ Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate 9.84 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic _ ug/L ❑■ Arsenic less than MRL (ND) Casing height (above ground) 32 in. Collected by Forge Engineering Date of flow test for COSA 1/7/19 Date of Sample 5/16/19 Static water level at beginning of test 58.5 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 24 years ❑ Required maintenance completed Tank type/material Septic/Steel Age of lift station years Measured operating fluid level in septic tank 50" Lift station material El Standpipes/foundation cleanout per record drawing Comments: NA Date of pumping 10/29/18 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 6/2000 Adequacy test date 1/7/19 ❑� ALL standpipes present per record( drawing Results ❑✓ Pass For 3 bedrooms -I Total measured depth from grade 9.c ft(max) Fluid depth prior to test 25 in Measured depth to pipe invert from grade 2:S ft(min) Water added 606 gal ❑ N/A— pressurized field New depth 35 in [' Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ElCode-requiredsoil cover over field Final fluid depth 18 in ❑■ Absorption rate 450+ gpd System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ✓❑Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line> 25' E Yes if No ft Absorption Field on Lot> 100' Q✓ Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' p Yes if No ft 0✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft El Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' ['Yes if No ft Property Line> 5' ✓0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' p Yes if No ft Private Wells > 100' p Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' p Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' p Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells> 200' ❑✓ Yes if No ft Surface Water> 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION _ P-nF iissuasi I certify that I have determined through field inspections and review arc:., ;.••'•�� ''•..2 C. of Municipal records that the above systems are in conformance with L.- •%..9 vj MOA COSAguidelines in effect on this date. a �`1.I AN '' 49th .. • • To�' MICHAEL E. ANDERSON 1�• ♦ -J, .% No. CE-4381 .. _= ••A e,,9'.� 05/29/19 ...•(.CSU. COSA Checklist yellow sheet ,,FO ................P.. "4 •�'11%lisissy 1•• MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT . r. 907-343-7904 tl 1. On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisors' Certificate of On-Site Systems Approval #0SC191192 Subdivision: Mountain Park Estates #2 B3 Lot 4 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. .q .. „. Nir , � � s '� A wy tii vit I ,.._ ...:' -: '. ,,, ,, .. 4 4,2 . 4„ ..4 , - . . 4- s .–v 0, 404,,,. ,,,r. _ :, '1 `Y • f S fi. -tau .� � .. ..dl �t{� ` t ': _.. Y ses ,14, "t; e Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • t1 ,'�I 907-343-7904 On-Site Water and Wastewater Section ` ` /' Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC191192 Subdivision: Mountain Park Estates #2, Block: 3, Lot: 4 A water sample revealed a nitrate concentration of 9.84 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. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org N .r o ,\ / z N / Lot 22 I / Lot 3 30.0' -I \ CHAIN—LINK/FENCE \ /S 89'56'06"E 183.00' • n I [WELL Lot 4 100' PROTECTIVE RADIUS M U) z I 20,130 s.f. l Cl, C 0o x WOODEN-- rCANT8 3 Q Z FENCE 0 o W = r 5.0'x6.2' (4. ITI 110.9' 14.1' 42.0' PORCH - / Lot 21 , x I \ N a l '+ X / I \ - x ,. 2 STORY 1 28.7': ' p SEPTIC _ w RESIDENCE N'": o / x Q, . ASPHALT. O bo I PIPES . DRIVEWAY. 8 40.3 �' ' > / x \ :— v 2.1'x8.2' CANT I / ^ 8.2'x12.2' SHED 1!!!!&• 'C'71 / -f- ' N 89'66.06"W^183.0 1 / II I CHAIN—LINK FENCE Lot 20 I I Lot 5 10' UTILITY EASEMENTS I PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 2839 Project No. 19-010/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone 0000O�.i (907) 522-4625 Fax o �Q Professional Land Surve ors kenOlangsurvey.com OFA 'N Y jonathanOlangsurvey.com 404=77 ..... ''•gs41, I hereby certify that I have surveyed the following described property: ��a�P ��� '7 LOT 4, BLOCK 3, MOUNTAIN PARK ESTATES SUBDIVISION No. 2 (PLAT No. P-561) * 49� �� :�*vi Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that D no improvements on the property lying adjacent thereto encroach on the surveyed .. KENNETH .�0 premises and that there are no roadways, transmission lines or other visible O c� : off easements on said property except as indicated hereon. 'OA 11.t G(VI p Dated this the ��44' Dayof Jpti�- L 'LJ1a ��'��'••• S-5202.•'' c,JO� w at Anchorage, Alaska 4OokOFf3SIONAl deo It is the responsibility of the owner to determine the existence of any easements, 0401z==..o covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality o.f Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program -,,,...1_.,/ 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (~07) Parcel I.D. 017-022-16 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Expiration Date: Completelegaldescription cblOUNTAIN PARK ESTATES ~2; LOT 4, BLOCK 3 Locatlon(slteaddressordiracflons) 12900 SAUNDERS ROAD Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KATHRiNE ANDERSON Day phone 345-9111 12900 SAUNDERS ROAD ANCHORAGE, AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for plcl<up. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well E~ Individual Water Storage Community Class Well ~.~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority Approval are raquirad for the transfer of flue (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date cf issue for preperties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod 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 cf Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I varify that my investigation, based on procedures outlined in the Health Authodb/ Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate forths number of bedrcoms and b/pe of structure Indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation end 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. a~empted to provide a thorough, consdenEous engineering analysis of the system In eccon~ance wi~ ADEC and MOA DSD Guidelines & Regulations. The reported results descflbed the performance of the system under the conditions encountered at the time of the tesf, and sepeta#on d/stances measured to readily Identifiable features. The operattonal lEe of all wells end septic systems depend on the Iocal solls ¢~dition, gmondwater levels that may flucfuete dudng the year, and the wafer usage of the family being sen/ed by the system. These conditk~s are outside the contn31 of the evaluetor of the system. Satisfactory test results do not guarantee fufure performance of the system, nor do they guerenfee that there are no hIdden defects or encroachments. AFt4/VC, Inc. mn therefore not provide any wen-tnb/orfufure estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DmD. The content of this report is for ~e sole bener~ of the owner listed above. Any reliance upon or use of this ~pott by any other per-'~on or perfy ls not aufhorized, nor wl111t confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for __ bedrooms, with l~e fllowing stipulations: - ~: WATERAND : m Attachments: HAP, Checldist Septic System Advisory Well Flow Advisory Odginal Certificate Date: /o- ,P. 2.- Ol Municipality of Anchorage Development Services Department On.~te Water & W~tewatar Program 4700 ~x,llh Bragaw St. P.O. Box 196650 Anc~rage. AK ~95'19-6650 HEALTH AUTHORITY APPROVAL CHECKLIST MOUNTAIN PARK P. blATES ~2j LOT 4~ BLOCK 3 ParcellD: 017-022;-16 A. WELL DATA Welt type mrVA~ Date completed 7/'17,/78 Total depift 300 fi If A, B, or C provide PWSID~ N,/A Casedto 300 fit. FROM WELL LOG 7/'17/78 8O fit. 1.5 g.p.m. Date of test Stet]c water level Well production WATER &N~IPLE RESULTS: Nllrate 3.93 mgJL. Well Log Wires properly protected (Y/N) Cas~g he;ght (above ground) AT INSPECTION 4//21//2000 5.5+ .g.p.m. 24. In, Date of sample: 10//2/2001 B. SEPTIC/NOLDING TANK DATA Tank T~1~e/Mateded ~ Tank size 1000 gal. Number of Comperlmante 2 Foundatloncleanout(Y/N) YES Oepressinnovertank(Y/N) NO O~er becteda o colonies/IiX) mi. AWWCt INC. Date Installed 1/'23/9,5 - 1/'24/95 Cteanoute (Y/N) YES High water ~ (Y/N) N/A Date of pumping - 12/12/2000 Pumper ANCHORAGE CESSPOOL PUMPiNO C. AB$ORFnON FIELD DATA Date Instefled e/~2/oo-e/~g/oo Soil raUng (~[~or ~llxlrm) 0.8 System type TRENCH Length 41 fit. Wldlh 2.5 .fit. Gravel below pipe 7 fit. Totaldepth e fi. Eif. nbsorpfionerea 574. It* Monltedngtube YES Depre~slonoverfield NO Date of adequany test NEW ReSUlte (P~all) __ For ~ nuld depth In abso~tion field before ~ In__ow depth In. . n tmalmant (past 12 mo.) (Y/N & type) If yes, give date D. UFT ~rATION Date Installed Size In gallons ~ 'Pump on' level at in. 'Pump n. High water alarm level at ~ In. Oa~.a_a_a_a_a_a_aJ_~ Cycles tested Meets alarm & cln:ult requirements? F... SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 8epllo tenYJllff station on lot, 100'+ Absorption field on lot 100'+ Public sewer main N/A 8ewer/septic service line 25'+ On adjacent lots, 100'+ On adjacent lots, 100'+ Publlo sewer manhole/deaneut Holdlng tank N/A SEPARATION DISTANCE8 FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service Ilne 10'+ Wells on adjacent lots 10o'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmpmty line. 10'+ Water senflce line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation 10'+ Surface water. 100'+ Wells on adjacent lots. 100'+ Absorption field 5'+ Sur[ace water lO0'+ G. ENGINEER'S CERTIFICATION I cerUfy that I have determined through field Inspec#o~ end review of Murdclpal records that the above ~/afema ere In conformance ~ MOA HAA guidelines In effect on this date. Enginse~'s Pdnt~ Na}:ne Date J~-rI-~EY A. GARNESS Water matn .Driveway, paddng/vehlcle storage 10'+ Oate of Payment Receipt Number (Rev. Waiver Fee $ Date of Payment, Receipt Number ParcelI.D.# MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of EnvJranmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 017-022-16 1. GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES ~2: LOT 4. BLOCK 3. Location (site address or directions) 12900 SAUNDERS ROAD Property owner Mailing address Lending agency Mailing address Agent Address KATHRINE ANDERSON Day phone 12900 SAUNDERS ROAD ANCHORAGE. AK 99516-3257 Day phone 271-3209 Day phone Un/ess otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legafity and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide wdtten confirmation from State ADEC lng to the legafity and status of system. 72-025 (Rev. 1/91) Front MOA 421 Computer Version 5. STATEMENT OF INSPECTION BY ENGINEER As cedified 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 vedfy that based on the information obtainad from the Municipality of Anchorage files and from my investigation and inspecfien, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal a'~/d/State codes, ordinances, and regulations in effect on the date of this inspection. ..~.//// / Name of Firm ALASKAWA'~W ~/TE(~.~/I'ER~OONSULTANTS, INC, Phone (907/337-6179 Engineer's Signature ("'"..~' ~'-~) Date C/~.q./CO In conducting this evaluation, AWWC, Inc./~tt~mt =.d tot provide a thorough, conscientious engineering ~,alysis of the system in accordance with ADEC and MOA DHh Guidelines & Regulations. The reported results described the performance of the system under the conditions bhcountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions ars outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AW1/VC, Inc. can therefore not provide any warranty for future estimate of how long the system v~ll continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor ~11 it confer any legal right whatsoever. 6. DHHS SIGNATURE / Approved for '~ bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 tn 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. ~'2-025 (Rev. 1/91) Sack MOA #21 Computer Version KtLtlV D · · ' hora e JUN 2.8 Mun~mpahty of Anc g ~K.4~ALt~ OF AN DEPARTMENT OF HEALTH & HUMAN Environmental Sewi~s Division ' .............. 825 "L" Street, Rm 502 ~chomge, Alaska 99501 (907) ~3~7~ Health Authority Approval Checklist Legal Description: MOUNTAIN PARK EST. S/D #2; LOT 4-, BK 3, Parcel I.D.: A. WELL DATA Well Type PRIVATE f A, B,~or C attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production 300' YES Date completed Cased to 300' YES FROM WELL LOG 7/17/78 80' 1.5 g,p.m. 017-022-16 7/17/78 Casing height (above ground) .Wires properly protected (Y/N) AT INSPECTION 4/2!/00 44' 5.5+ 2.0' YES g.p.m. WATER SAMPLE RESULTS: 0 Coliform Date of sample: 6/15/2000 Nitrate. O 4,61 mg/L Other bacteria Collected by: A;W.W.C., INC. B, SEPTIC/HOLDING TANK DATA Date installed1/23/- 1/24/95Tank size Foundation cleanout (Y/N) YES Date of Pumping 6//8/00 1000 Number of Compartments 2 Cleanouts (Y/N) . Depression (Y/N) NO High water alarm (Y/N) N/A PumperISAAC'S PUMPING YES C, ABSORPTION FIELD DATA Date installed 6/12-6/19/00 .Soil rating (~or fl2/bdrm) 0.8 System type TRENCH Length 41 Width 2.5 Gravel thickness below pipe 7.0' Total depth 9' Effective absorption area 574 SQ. FT.. Monitoring Tube present (Y/N) YES Depression overfield (Y/N). Date of adequacy test NEW Results IPass/Fail) For 3 NO Bedrooms Fluid depth in absorption field before test (in.); - Immediately after - Fluid depth - (ins) Minutes later: - Absorption rate = Peroxide treatment (past 12 montbsl (Y/N) - If yes, give date 72-026 (Rev. 3/96)* Computer Version gal. water added (in.): - D. LIFT STATION ~ Date installed . Size in~ ~eJat* "Pump off" level at* Manhole/Access (Y/N) High war_ ~ *Datum .~sted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100% On adjacent lots 100'+ 100'+ .On adjacent lots 100% N/A Public sewer manhole/cleanout_ N/A 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Surface water 100'+ Curtain drain NONE KNOWN F. ENGINEER'S CERTIFIC~,$1ON / / / car#fy that/~ gata,~rt(ine, d"~ ~e/d inspections and review of Municipal/ecord ~ tiT/~gth~' a/5/)ve ~ystems are in confon'nance with MOA ~AA gui~ 'ept/~/~ect ~n this date. Signature "------~/~/,4/~/,-/~ L _ f Engineer'sNaJ ~ JEF~A. GARNESS Date ~,/"2, 7 IO Absorption field 5'+ Wells on adjacent lots 100'+ Water main/service line. 10'+ Driveway, parking/vehicle storage area 10'+ Wells on adjacent lots 100'+ HAA Fee ~ ~ DT-)/ ~ Date of Payment ~ ,/~'/{~ Receipt Number ~ ~-~'- 72-028 (Rev, 3/98)* Computer Version Waiver Fee $ Date of Payment Receipt Number Parcel I.D. # I~r~--OA~-[G 1, GENERAL INFORMATION Complete legal description · MUNICIPALITY 0F ANCHORAGE DEPARTMENT OF R~ALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 .Anchorage,iAlaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # Location (site address or directions) y I-7o / Property owner Mailing address Lending agency Mailing address ,5'~' 7'7~' ~ ~,~ b~r'lo~ .On X Na/~.rt/,lt¢ .~L. ~od-~Z-Io~ -- Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: -~ TYPE OF WATER SUPPLY: Individual well Community Well NOTE: Day phone Public water If community well sYStem, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank :; community on-site NOTE: · Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. · 72-025 (Rev. 1/91) Front MOA #21 Name of Firm Address.. Engineer's 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, ordine, nces, and regulations in effect on the date of this inspection. DHHS SIGNATURE .Approved .fqrd~ Disapproved. Conditional approval for Date I//..~ /96- 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 courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work '. 72-025 (Re~. 1/91) Back MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.o f ~/'/ ~/~ J~f-/-n P/~ ~.~}- Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number. Date completed 7//17 / 78 Driller Cased to Casing height 1' A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) FROM WELL LOG Date of test '7/' / 7 / '7 <~ Static water level ~' O Well flow I, ~' Pump level1 -- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Wires properly protected (Y/N) AT INSPECTION g.p.m. ~". 2 g.p.m. ; On adjacent lots .'~ (.oo ' ; On adjacent lots ~ ! on J Public sewer manhole/cleanout N. ~,, Petroleum tank WATER SAMPLE RESULTS: Coliform O CC,( //(00,'~,~ Date of sample: I / ! ~./0,.5- B. SEPTIC/HOLDING TANK DATA Date installed ~ / '7 ~ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Nitrate _~.~ ~ Other bacteria Collected by: F'l~/-J-o/~ 7"¢~:,A Tank size ! 000 ~'~/ Compartments Q Foundation cleanout (Y/N) tr" Depression (Y/N) /N, AL. Alarm tested (Y/N) /'J. /J~- Pumper ~)~,o ocli' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J 0~' On adjacent lots To property line ~ lO ' Absorption field Surface water/drainage ;> (oc2, Foundation Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION N, ~. Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed ~'/ I ~ / 7 Length '~ 0 ' Width Total absorption area ~'~ Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Sudace Water Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) ¥' Results (pass/fail) ~',t/'_/ ~,:rr' If yes, give date ~/E~r~ System type Total depth I Depression over field (Y/N) for After test N Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ! ( To building foundation On adjacent lots '~ Surface water ';> On adjacent lots I 0 ~ ~ Property line To existing or abandoned system on lot Cutbank I\1, A-. Water main/service line Curtain drain Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I cert/'fy that I have checked, verified, or conformed to all MOA and HAA gu/delines/n effect:~r~ ~h~d. ate of this inspect/on. ~'/" '~ L.~;V ,~'~ ..:,'q:,~. Signature Engineer's Name Date d-'-~n c(c~-,~/ /~ t95)3- "; :..'o HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3,'93)* Back T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA Lot 4, Block 3 Mountain Park Estate PIN 017-022-16 Gentlemen; January 17, 1995 We are applying for a HAA for this lot. During the field inspection it was observed that the septic tank was severely corroded, and partially collapsed. We are requesting a permit to replace the tank concurrently with the processing of this HAA. 825 L Street- Anchorage, Alaska 99501 t ENVIRONMENTAL ENGINEERING DIVISION SEP 2 6 1978 Telephone 264-4720 RECEIVED REOUEST 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. MAILING ADD~ ESS P~ 0 P EHTY ~ ES [ D E NT {If different from above) PH ON ~ 2, BUYER PHONE MAILING ADDRESS "..% 3, LENDING INSTITUTION ~ PHONE MAILING ADD~ES$ I .~HON E MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATI ON 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other~ ~ SINGLE [] Two [] Five FAMILY [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY . ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ iNDiViDUAL/ON.SiTE.~ [] PUBLIC UTILITY **If individual/on-site, give installation date .__Z,/~/.~/ , If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72q)10(3/78) ~, THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR : INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED EZ]PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: ]~;)~2(:~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTUR~iI~ . ~. , TOTAL ABSORPTION AREA MATERIAL ,..,%~, ~ , 4. DISTANCESwELL TO: Septic/Holding Tank IAbsorption Area ISewer Line [ Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS d~"'-APPROVED FOR ~_--~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)