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Home My WebLink AboutMOUNTAIN PARK ESTATES #2 BLK 7 LT 5Mountain Park Estates Block 7 Lot 5 #017-432-11 Municipality of Anchorage Page I of 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: ~'N?.~O q~¢-¢- PID Number: O/7~Zl/ N~e: Wastewater System: D New ~Upgrade P~V D, You~ Address: ABSORPTION FIELD Phone: No. of Bedrooms: ~ ~ Deep Trench B Shallow Trench B Bed ~Mound B Other L E G A L D E S C R I PT I O N so~, .~,i.,: To,a, ~,~h ~ro~ odcna, ,.a~¢, ¢.¢ G~/S,. ~t. Lot: Block: Subdivision: Depth to pipe bottom om or g nil grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: 2 -2~Ft. ~O ~t. WELL: ~ New ~ Upgrade Gravelwidth: Number of lines: Distance between lines: /~ ~t. ~ G Ct. Classification (Private, A,B,C): ~ Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: I Yield: Pomp Set at: Casing Heighl Above Ground: q ~.~ z/¢ ~'-I /z"w~,. TANK SEPARATION DISTANCES TO Seplic Absorplion Lift Holdin9 Public/Privete Manufacturer: Capacity iR gallons: From Tank Field Station Tank S .... Lines Material: Number of Compartments: Surface ~, -- LIFT STATION Water /¢ I~O ~ t~¢ t~ , , Lot /¢ ~ l~ Size in gallons: Manufacturer: Line /O /~ /O ~ "Pump on' level at: "Pump off" level at: High wster alarm at: Pump Make & Model Electrical Inspections performed by: Curtain ~¢~ ~ 2~ Drain ~/ ~ ~ ~ ~/~ Remarks: B~NCH Location and Description: Assumed Elevation: E NGI~E~?S'.SEAL 17034 E~gle Rlvar ~ Inspections performed by: E~gie Kiver, Ata~ka ~77 2nd // Department of Heal.and Hpman Services approval Reviewed and approved by: ~~ 72-013 (Rev. 9/91) MOA 25 Permit No. $w930445 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disl~osal System and/or Well Inspection Report MOUNTAIN PARt[ ESTATE'S #2 BLOCK 7, LOT 5 01743211 Legal Description: PID No.: MT 1 i MT2 89.3' WATER ::FOUND 10-2-9~ i A B C01 23.5 13 ¢02 26 17.5 M.H. 26.5 19 MT1 56.5 55.5 Mr¢2 48.5 45.5 MT3 66 73 ~T4 59 67.5 SCAL~ 1' = 40' 'l'i ..... DRAINFEILD 125D GAL. S.T.E.P. ,_~ ~3 BDRM ~IOUSE 100' WELL RADIUS -- SEAL 72-013 A (1/93) 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 WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930445 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:YOUNG DEWEY D OWNER ADDRESS:7101 SOUTH PARK DR ANCHORAGE, AK 99516-3251 DATE ISSUED:10/21/93 EXPIRATION DATE:10/21/94 PARCEL ID:01743211 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES #2 BLK 7 LT 5 LOT SIZE: 18720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 343-4744 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 RECEIVED BY: ...~~~, ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 15, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEAL TH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99519-6650 REFERENCE: Mountain Park Estates Subdivision No. 2, Block 7, Lot 5 We request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property. An adequacy test performed on the existing system for Health Authority Approval purposes found the absorption capacity of the existing system to be inadequate. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation water was encountered at 9 feet and after seven day water monitoring no water was found. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. /t~brt A. Sharer, P.E. RAS/LSU/Isu 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1'~'= 30' I UPGRADE · SCALE FOSTER ROAD iii/ rrI m ~moo 0 o 0 z~ z~<~ o~ N.T.S. · SCALE DETAIL/PROFILE J(TYV) L3' (~P) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 -5 7 8 10 ~2 ~3 14 15 18 2O Township, Range, Section: SLOPE ti WAS GROUND WATER ENCOUNTERED? / ~--.~ DEPTH? ~ SITE PLAN D e Pth '0 Wale r A~e r,'2,.~ ,4~'_..~ Monitoring? ~ Date: _ Gross Net Depth to Net Reading Date Time Time Water Drop s'p~-'( 16 :~/~.~ -- ~ %" : ,-j~ ~ ,~ ~ '/~" I ~" :~ ~. ~, ~I~R'' I vv" ~ ~l ~ " ~'/~ " ~" PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~ "' ' TEST RUN BETWEEN ~'~"~ F.,T,'A"ND ~ FT , agl iv;r Alaska 99577 '~FEC/O ACCORDANCE WITH ~E ~E AND MUNICIPAL GUIDELINES iN N THIS DATE. DATE: / 72-008 (Rev. 4/85) ON-SITE WASTEWA TER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MA TERIAL SPEClFICATIONS REFERENCE: Mountain Park Estates Subdivision #2, Block 7, Lot 5 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon effluent pumping (S.T.E.P) system and an absorption bed to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped crushed and abandoned. The existing leachfield is to be abandoned in place. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Page Two Mountain Park Estates Subdivision #2, Block 7, Lot 5 October 14, 1993 Aft standpipes on the septic tank shaft extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shaft be insulated. A foundation cleanout shaft be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shaft be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shaft be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shaft be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked er scratched (ruffed-up) before gravel or sand placement. Ifa sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shaft be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shaft be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Mountain Park Estates Subdivision #2, Block 7, Lot 5 October 14, 1993 Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shaft be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gra vel depth shaft be perforated six (6) inches below the bottom of the horizontal distribution lines. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MA TERIAL SPEClFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe .Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shaft be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shaft be fitted with watertight couplings (Caulder, Femco, or equal). Page Four Mountain Park Estates Subdivision #2, Block 7, Lot 5 October 14, 1993 A permeable nontoxic silt barrier (Typar 3401, M/raft 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. 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 DISTANCE TO: Well //0f I Absorpti~ / Dwelling/o ¢ P ~ I~(Z Liq. ~allons IF HOMEMADE: ,ns~oth Width Liquid depth ~ ~rial Liquid capacity ~anu[acturer BISTANCE TO: OD ~ Total len~,~' Trench wid~ Distance betw~s No. of lines ~ Length of each line inches :~ --- Total ef~Z~tion area Top of tile to finish gra [ Material beneath tile ~ ~ inches Length ~ ~ Depth P~ ~ype o~ Crib diameter Total effecti / Well · DISTANCE TO: B~I~ ~~ ~ OTHER PIPE MATERIAL~~ p~ KS ~ ~ ~ L ~ ~.~ 72-013 (Rev, 3/78) ~IX INCH WATER WELL DRILLED AND CASED oUT TO'THE DEPTH OF AT THE RATE OF PER FOOT. )PERTY OWNER_ ICATION ;OF WELL SITF, 304 ~o Sea./., :)~COST INcLUDEs ALL LAB'OR A~'D MATERIAl-' F~)R COMPL~,'I ION OF SAID' DRILLING, cHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~NK YOU VERY MUCH.''~ ERNIE CLAUS OF RAMPA~ DRILLING larGE O F ~ PER WILL BE ;ESSED DN PAST DU F E.F.flI F. NO. I DEPFIR'Tf'IEI'.,IT C F ,iERLTH FIND EN',,,'I F' ] NMENTFIL F, .._FFECT I ON ,_~, .-:, ~ ....... '"L'" S'FREET, FiNC:HF~RFIGE., FiK. 9950± -FFL. 1 ..HN]' L. 0 C FI T 10 N LEGFIL DEf-,.IE'T' D. '¢OLING SOUTH F'FtRK & FORSTER ,:: 79042~9 ', SRR BOX 2-'::'.'L E. DEFIF.:MOUN'' "; 279 :,., :t -':" i$2 ' .t.902:2 :F.:6!URF.:E FEF.~T-..- L.5 B7 HOUNTRIN PFIRK E_,F UST SIZE 'I"'¢F'E OF SOIL RESOF.'E:'FION S'T'S'FEM IS: TRENC:H MR;:.:,'ZMI_IM N_IMBEF.' OF BEE:,ROL-iM':.7 = _. f- T ,." E,P. ..... ::LDO ';OIL. RATING ,iSL.':! ..... '"'~'- _,I,..E OF THE: =,L IL RE:SOF.:F'TION E;'T'$TE.M THE REQU I RE[) '= ' "'-' -' '-' q ' THE LENGTH DIMENS;ION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRRINFIEL. D. THE DEP'FH OF' R TRENCH OR PIT IS THE DIS;TRNCE BETWEEN THE SURFRE:E OF THE GROUND RND THE BOTTOM OF THE E::.:,'CR'v'RTION <IN FEET>. 'THERE IS NO '_.:;ET W:[DTH FOR TRENCHES. THE GRR'¢EL DEPTH IS THE HIN[MIJM DEPTH OF GRR',/EL BETWEEN THE OUTFFILL. P~PE RND THE BOTTOM OF THE EXC:R'v'RTION ,::IN FEET). ~:;..:-: [£ (::.,. tJ I fi: tTE [> _. E F T ! C: 'f' R 1'-.1 ~-=:: .... X Z E = -.1 ~.3 ~.Za Cl n3i R L_ b. C~ P-.] F'ERMiT RF'F'LIL-:RNT FiRS THE F..E=,FLNz, IE, ILIT'r TO INFORH THIS [.,EFHRFflEN'f [:,URING THE: INSTFILLF~TION IN';PEF:TIF~N': LSF RN"? HEL_:, RD..TFICENT 'f'l:~ THIS F'RISIF'ERT"r' laND THE N.ME, EF. OF RES I£,Ef',I:::E'---; THFIT THE [4EL. L 1.4ILL SERVE. MINIMUM DISTFtNCE BETWEEN R [4ELL RND aNY ON-SITE SE[,.IRGE [:,ISF'OSRI.. SYSTEM IS :[.OR FEET FOR R PRI'v'FtTE WEL. L.~ OR Z5~3 TO 200 FEE]' FROM a PLIE,'LIC ~4ELL DEPENDING UPON THE T'¢F'E OF PUBLIC ~,.IELL WELL LOGS RRE REQUIRED RND P1UST BE RETURNED TO THE DEPFIRTMENT WITHIN F-tO DFf'T'S OF THE NELL COMPL.ETION. OTHEF.: REG:!UIREMENTS MR'T' RPPL."r'. SPECIFIE:RTIONS FIN[:' CI:)NSTRUCTION [."IFIGRRMS RRE R',,"RILRBLE TO INSURE PROPER INSTRI_LFtTtON. I CERTIF:"¢ THRT ~.: I RM FRMILIFIR b. IITH THE REQUIREMENTS FOR ON-'"SITE SEWERS fiN[> WELLS FI:5 '_SET FORTH B'T' THE HUNICIPRLIT'T' OF' RNCHORRGE. 2: I FIILI_ INSTRLL THE SYSTEM IN RCCORDRNCE 1.4ITH THE C:O[:,E:.:.;. ~:: I UNDERSTRND THFIT THE ON--SITE SEt.,.IER S;:'STEM HR'¢ REg!UIRE ENLRF.'.GEMENT IF THE RE2 REID ENVIRONMENTAL ENGINEERING SRA BOX 1584R ANCHORAGE, ALASKA 99507 (907) 344-1205 May 29, 1979 Mr. Dewey Young SRA, 231 E. DeArmoun Anchorage, Alaska 99507 Dear Mr. Young: On May 25-26, 1979 I performed a soils investigation and perculation test on Lot ~.~.Block 7, Mountain Park Estates to determine the suitability of that lot~.o accept on-site sewage disposal. The lot slopes from the east to the southwest at a relatively gentle slope. The topography is amenable to on-site systems. Vegetation consists of large white spruce 1-1.5 ft. in diameter, with some small birch and larger alders. The vegetation is indicative of a well drained area. The first part of the investigation involved digging a test pit with a tractor mounted backhoe to a depth of 13'6" and visually inspecting the soils. This test hole was selected after field checking the location of surrounding lots for wells and seepage systems. The pit location is at the intersection of two 80 ft. lines pulled from the northwest and southwest lot corners. -- After completion, a small hole approximately 4'x4' was dug adjacent to the deep pit but far enough not to affect the test. At the bottom of this pit a small test hole was dug and wetted. The following morning a perculation test was performed in the hole. The soils encountered in the deep test is presented in the table below: Table 1: Visual Soil Test L~, B7 Mountain Park Estates - May 25, 1979 Depth (ft.) Soil Description Type O-I 1-4.5 4.5-8.5 8.5-13.5 Decomposed Organics Silt (Dry) ME Sandy Gravel* Very Compacted Silt ML *Note: At the interface with the silt layer there was a small inflow of perched water 'Mr. Dewey Young Page two A visual inspection of the sandy gravel indicated that it was rela- tively clear but the sand was very fine. The water found in the test pit was definitely perched and not a part of the water table. The hard pan layer apparently is too tight to allow vertical percolation as the underlying silts were very dry. An inspection of prior soil tests on the block showed soils with ab- sorptive capacities of 150 to 185 sq ft/bedroom. The percolation test on the smaller test pit was performed on May 26, 1979 at 9 a.m. Table 2 presents these results. The hole, previously wetted the night before, was filled with water and measurements of the rate of fall of the water surface were taken every 10 minutes for 1 hour, 10 minutes. Table 2: Percolation test measurements taken at L~'"B 7, Mountain Park Estates - May 26, 1979 Elapsed Time Measured Distance (in) Rate (min/in) l0 3.1 3.2 20 3.9 2.6 30 2.8 3.6 40 2.6 3.8 50 2.5 4.0 60 3.4 2.9 70 2.0 ~ 5.0 The average rate of fall was 3.4 minutes per inch, and the last l0 minutes of test indicated an absorption rate of 5 minutes per inch. Using Figure 3, Manual of Septic-Tank Practice, U.S. Pulic Health Sense, 1967 the absorption area requirements for this lot would be 125 sq ft per/bedroom. The perched water should not create any major problems with this sy- stem. However, during the spring snow melt, or during a wet summer, the quan- tity of water in the lens would be expected to increase. It is therefore recommended that to obtain reserve field capacity for such a period, the soils should be derated to 150 sq ft/bedroom. This would increase the trench length from 47 ft to 56 ft for a three bedroom house. The cost of the addi- tional 9 ft of trench would be small compared to the overall cost of the home. It is therefore concluded that this lot is acceptable for an on-site sewer system. The soil rating should be 150 sq ft/bedroom. The system should be a trench with the bottom at the tqp of the silt layer, 8.5 ft below the surface, and the top should be on the top of the sand/gravel lens at 4.5 ft below the surface. If, during the construction, it is found that there is a change in the quality or dimensions of the sand/gravel layer, then the trench depth and length should be adjusted accordingly. Mr. Dewey Young Page three If you have any questions, please feel free to call me or leave a message at AECS, phone 276-1361. }~~; Or.,-~,~m., P.E. LCR:ak ~.. ~, .~;J-J ~' . , '~,~ • • • GE 8V •t1 � Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 017-432-11 Expiration Date: I r L ' 17 1. GENERAL INFORMATION: Complete legal description MOUNTAIN PARK ESTATES#2; BLOCK 7, LOT 5 Location (site address) 7101 South Park Dr. *Anchorage,AK 99516 Current Property owner(s) Stuart Parks Day phone 952-4793 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: r/ .�✓ Date: /16 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5210 Waiver Fee $ Date of Payment 16/51,6 Date of Payment Receipt Number 6326C4 Receipt Number COSA# OOc l$t5a5 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: /o 0/U' In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o in accordance with the guidelines and regulations established by the Municipality of Anchorage and o� .O `� 4�4 industry practices. The reported results describe the condition of the system/s on the date/s of the O • _'•. ,�O evaluation. Separation distances were measured to readily identifiable features. Hidden defects or j • A T / .h encroachments may exist that were not identified during the evaluation. The operational life of all wells 0 * O and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and • -' VA workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and /.... 0 are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Ph J f • y . Gar ess. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of PA • the well or septic system. GEG makes no representation whether an alternative well or septic system VQ • CE— , e ' c�O can be installed on the property in the event either of the current systems fail to perform adequately in 4 fP iil.f,s ('(� F,o°o the future. The content of this report is for the sole benefit of the person/party that retained GEG to v�eaprofessioro�o perform the evaluation. Reliance upon the information provided in this report by any other person or ��OPp0" o party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved \N Ut" NO ,21 Conditional approval for bedrooms, with the following u I tigr�s1-cE � N y�{P�EWP t.R o= a W PROGRAM a'= { 1311E7NT SOS\ i:y: CA,:‘ • Original Certificate Date: (6 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. y s� $ 7. ATTACHMENTS: COSA Checklist Nitrate Advisory- Septic dvisory ,• Septic System Advisory Arsenic Adviiissory, Well Flow Advisory COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of_ Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES#2; BLOCK 7, LOT 5 Parcel ID: 017-432-11 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/10/1979 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 330 ft. Cased to 330 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 7/10/1979 9/6/2018 Static water level 60 ft. 181.1 ft. Well production 4 g.p.m. 4.5+ g.p.m. 'i vl WATER SAMPLE RESULTS: tl. C1 Coliform NEG colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: `5 ug./L. Date of sample: 9/6/2018 25 YEAR OLD STEEL SEPTIC TANK IS APPROACHING THE END OF ITS USEFUL LIFE B. SEPTIC/HOLDING TANK DATA *SEE ATTACHED MAINTENANCE AGREEMENT Tank Type/Material STEP/STEEL Date installed 11/17-18/1993 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout(Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping 9/10/2018 Pumper AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA `BELOW EXISITNG GRADE AT MONITORING TUBE Date installed 11/17-18/1993 Soil rating kp.d./Vor ft2/bdrm) 0.5 System type MOUND Length 50 ft. Width 18 ft. Gravel below pipe 0.5 ft. Total depth *1.9+ ft. Eff. absorption area 900 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/6/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 759 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - • BOTTOM OF ALL MT'S WERE WITHIN 1"OF EACH OTHER IN REGARDS TO ELEVATIONS • DRAINFIELD IS SHY ON COVER;SEE ATTACHED EMAIL FROM OWNER *2ND COMPARTMENT OF 1250 STEP TANK **SEE ATTACHED MAINTENANCE AGREEMENT D. LIFT STATION NO MOA ELECTRICAL INSPECTION REPORT ON FILE Date installed 11/17-18/1993 Size in gallons *412 Manhole/Access (Y/N) ** "Pump on" level at ** in. "Pump off' level at ** in. High water alarm level at ** in. Datum ** Cycles tested ** Meets alarm & circuit requirements? ** 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 75'+ Public sewer manhole/cleanout 1004 Sewer/septic service line 25'+ Holding tank 1004 Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *MET CODE AT TIME OF INSTALLATION DRAINFIELD IS SHY ON SOIL COVER. SEE ATTACHED EMAIL FROM OWNER STATING NO PAST FREEZING ISSUES *lovas ■I .•4 ._ �F ' l 44# G. ENGINEER'S CERTIFICATION I: .... ��P;,• •••.9S ••1• ,,),••* l certify that 1 have determined through field inspections and • . •• review of Municipal records that the above systems are in • i conformance with MOA COSA guidelines in effect on this :••• • ; tr i date. • c^ • r- •A. Garne.s:: cu JEFFREY A. GARNESS •• •..; CE-791i. .•C>=• Engineer's Printed Name .♦1 FO, S (.v k.. • Date 1401/$ �� PROFJESS\�P•••• LICENSE •II%%wove:. #AECC884 (Rev. 10/12/12) 44 MUNICIPALITY OF ANCHORAGE .\ DEVELOPMENT SERVICES DEPARTMENT . f ,�'� 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181535 Subdivision: Mountain Park Estates Block: 7 , Lot: 5 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 25 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. 1. 5; 1 - } �i: .lC V ... V f r� .E�l. 11 jM1' M1 i 044 �, � 4 .., 20'';-R, 0 122 Mailing Address: P. O. Box 196650 * Anchorage,Alaska 99519-6650 * www.muni.org MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner 51'-eG/ct rf P-1 I"(, Street Address 7/o/ s so S./`Z Pczr/ clt Septic Tank: -Sludge level G inches -Pumping: required ves -Pumping completed es no Lift station: -Pump basket cleaned eLio -Effluent filter cleaned a no -Control floats cleaned no -Proper float settings confirmed a no 'Operation satisfactory et no Alarm System: -Dedicated electrical alarm circuit el no •Audible and visual alarm inside dwelling el no -Alarm system operation satisfacto not satisfactory Manhole Riser 'Ground water intrusion at riser to tank connection vesno -Ground water intrusion around pipe penetrations yes G) -Weep hole functional no •Manhole lid: Functional s no Insulated no Properly Secured a no Other •All manufacturer required inspections and maintenance completed CD no Comments: tt 1 b(2I.01 �a� - ��P �p s bp as&ec) +6 C.4 Qualified Maintenance Provider: Technician C/1/ Ziyet.5 Date of maintenance 01-a2)451' Company / 'C Signature / Datc / a.e Mailing Address: P. 0. Box 196650 ' Anchorage, Alaska 99519-6650 *www.muni.org I LOT 4 LOT 7 1 N89° 56' 06"W 183.00' --- sV X x 30' IA K -LIFT N STATION SHED•:::::::` : 63.4' -- o r/1111111/ 30.2' o o z co o W : : : ::.:: :: : : : -,,,Ti EXISTING o ��III! �o :',2 ; :•:.....:::::: o r, �/ LOT6 ® ® `" HOUSE LOT 5 �o W co fo = 30.2' to I re (h - ............ . _ ch o 0 ::: 0::::::: ::::'::' A o O s9tl RETAINING WALL—`—' :"•'::•::::: a000000p�� o O r L �� 10' UTILITY EASEMENT a,,,,\7-`. o,`� 9s��0 i 30' �P �) S89° 56'06"E 183.00' rip: 49TH 1� *--57 0p 0 + 4Jr• ' - ,/,, / 0 m m O •. STEVEN CALLAGH • .• ci Q0 0, 9L –1 �' o`�� SOUTH PARK DRIVE 4 Ofessi0n0\ �. o 4�\\000o•4o NOTE: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN LEGAL DESCRIPTION: WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. 250 H Street Anchorage,Alaska 99501 LOT 5, BLOCK 7, ADDRESS: 7101 SOUTH PARK DR. PARCEL#: 017-432-11-000 MOUNTAIN PARK ESTATES AS-BUILT SURVEY CERTIFICATION:LCG LANTECH,INC HAS CONDUCTED A PHYSICAL SURVEY OF THE SufVe Department PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS y Phone 562-5291 SUBDIVISION N0.2 LEGEND: SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED. Y��.. Inc Mainline DRAWN DATE: 9/20/2018 WORK ORDER: 18131 Phone 243-8985 SEPTIC STANDPIPE O$ • - EXCLUSIONARY NOTE:RIS THE OWNERS'RESPONSIBILITY TO DETERMINE THE EXISTENCE AECC 668 DRAWN BY: AP PLAT: P-561 WATER WELL 09 '.concrete •-. OF ANY EASEMENTS,COVENANTS,RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO CHECKED BY: SC GRID: SW2839 ee5e Overhang .,.,, NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES FENCE —X—X— SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION,FOR ESTABLISHING PROPERTY ORDERED BY: STUART PARKS SCALE: 1"=30' FB/PG:811/35 REF:01 L431 Wood Deck- LINES,OR FOR PLOT-PLAN PURPOSES. Municipality of Anchorage Development Services Department Building Safety Divisfon On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.a k.us (907) 343-7904 Parcel I.D. '1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ., Expiration Date: Completelegaldescription ~ MOUNTAIN PARK ESTATES S/D #2; LOT 5. BLOCK 7 Location (site address or directions) 7,0~ SOUTH PARK DRIVE Current Preper~ owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOE FEDERICI 7101 SOUTH PaRk DR. Day phone 729-4906 Day phone DAVE wEIR w/ PRUDENTIAL JACK WHITE Day phone 4241 "B" STREET, ANCHORAGE AK 99503 257-~109 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OFWATER SUPPLY: Individual Well [] 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 Developmer~t 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 Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. (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 va#fy that my Invesb'gation, based on procedures outlined In the Health Authorily Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, funclional and adequate for the number of bedrooms and ~e of structure indicated herein. I further vedfy that based on the information obtained from the Munidpalily of A~chorage files and from my investigation and Inspoc~'on, the on-site water supp~' and/or wastewater disposal system is(are) in compliance wfth all applicable Municipal and State codes, ordinances, and regulations in effect at the time of lnstalla~on. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date 337-6179 Engineer's Comments: In conducting ~hls evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engine~fng analysis of the system in accordance with ADEC and MOA DSD Guidolines & Regule~ns. The reported results described the pedom~ance of the system under the conditicns encountered at the Ume of the tes[ and separation dislances measured to readily Identifiable features. The operatlonal lile of all wells and septic systems depend on the Iocal selis condition, groundvmter levels that may fluctuate during the year, and the water usage of the fam#y being served by the system. These conditions are outside the c~3tr~ of itte evaluat~ of the system. Sat/sfac'too/test results do not guarantee future pedormance of the system, n~ do they guarantee that there are no hidden defects or encroachments. AWWC, Inc.. can therefore not provfde any v, arranty or futore estimate of how long the system will continue to meet the operaEonal requlren~nts of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the ownor listed ab(we. Any reliance upon or use of this report by any other pe~on or party Is not autherlzed, nor will it confer any legal rlght whatseever. 5. DSD SIGNATURE ~'~ Approved [or /"lL bedrooms. Dtsappmved. Conditional approval for .~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Cer[ificate Date: Municipality of Anchorage Development Services Department Building ~afety DMslon Ol~Slte Water & Wastmvater Program 4700 Soulh 8mgaw St. P.O. Box 196650 Aflchomge, A,K 99519-6650 wvM.d.anchomge.ak, ua HEALTH AUTHORITY ~,PPROVAL CHECKLIST Legal DeacdpUon: MOUNTAIN PARK ESTATES S/D #2: LOT 5. BLOCK 7 Parcel ID: A. WELL DATA Well t~pe ~ Data completed ~/10/79 Total depth 550 ft, IfA, B. or C provide PWSlD~ N/^ Sanitary aeal (Y/N) YES Caaedto 350 it. FROM WELL LOG Date of test ~/10/79 Static water level 60 ~ Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Nitrate ' mgJl.. Data of uample: .~ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Typa/Materlal S.T.E.P./STEEL Tank aize 1250 gal. Number of Compartments ...Z_ Foundationcleanout(Y/N) Y_[~ Oepresslonovertank(Y/N) NO Oata of pumping ~ Pumper C. ABSORPTION FIELD DATA Oata installed ~ ~/]e/9= Soil rating (~'~or it'redrm) 0.5 Length 50 lt. Width 1 ~ It. Well Log (YAd) Wlres pmpady pmtacted (WN) CosIno heloht (above oround) AT INSPECTION 6/26/01 ~4 ft. 4,g g.p.m. YES YES in. Other bacteria ~._.colonles/lO0 mi. ~WWC, Data installed 11/18/95 Cleanoute(Y/N) Y[~ Hlghwatara~n(Y/N) YES ROTO-ROOTER Water added 904 gal Now depth _ . in. Absorption rata >= 450+ NONE KNOWN If yes. give data Total depth 3.6 it. Eft. absorption area 9O0 it= Monitoring tube YES Date of adequacy test ~ Results (Pass/Fall) PASS Fluid depth in absorption field before test 0 in. Elapsed Time: g min. Final fluid depth O Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type BED Gravel below pipe 0.5 it. Depression over field NO For ~ bedrooma C) in. g.p.d. D. UFT STATION Date installed 11/18/93 'Pump on' level et 41 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES Size in gallons 1250 'Pump off' level et 41 in. Cycles tested 3 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic ten~lfl sta0on on lot 1 oo'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic ee~ce line 25'+ Manhole/A__ccess (Y/N) YES High water alarm level at 45 in. Meets alarm & drcuit requirements'/ YES On adjacent lots 100' + On adjacent lots 10o' 4- Public sewer manhole/c~eanout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water sen'ice line. 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10' + Water sen/ice line 10'+ Curtain drain NONE KNOWN F. COMMENTS Building foundation. 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Absorption field 5'+ Surface Water ~ 00'+ Water main N/A Driveway, parldng/vehlcle storage 15+ G. ENGINEER'S CERTIfiCATION I certify that I have determined through field inspactfons end review of Municipal records that the above systems em in conformance with MOA HAA guidelines in effect on this date. Engineers Prlnted am? JEFFREY A. GARNESS HAA Fee $ ~x Date of Payment '7'/! Receipt Number Waiver Fee $ Date of Payment Receipt Number LOT 7 LOT 4 i~'::~.~:~....:.~ __~ .I '" ..... "' 1 U~ , j SSg~6'O~'E ~ ' SOUTH PARK LOT 5, BLOCK 7 ~*~.~*~* ~3 ss~-s~(~*=)~-ss~MOUNTA1N PARK ESTATES 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 (-"~\"~ - L\.'~,"~- ~ \ HAA# GENERAL INFORMATION Complete legal description Lot 5; Block 7; Mountain Park Estates #2 Location (site address or directions) Property owner Mailing address Lending agency Mailing address Dewey D. Youn¢ 7101 South Park D~vc Day phone 229-0855 Anchoraq~ AK 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XXX Public water If community well system, Provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site NOTE: xxx 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ Phone Address 11o~4 ~:~: R~v~r L~ R~ ~,~ -- Engineeds signatur~aCe "l~er' Al~'ka ;~ Date DHHS SIGNATURE · ~, Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 'l"he 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 omiosions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA ¢21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/'~E7~/,,,/~,,~7,,",// ~/'~/~ ~-,~'~' ¢¢~ Parcel I.D. A. Well Data Well type ~!/-/d ~ Log presen (TN) Total depth ~zb Sanitary se~(Y'N) '~/ / If A, B, or C, attach ADEC letter. ADEC water system number /--)./ Date completed '~//~'/:-~ Driller /~/~7'YT/'~,~F, Cased to ,_~"~O/ Casing height Wires properly protected/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/b,e~ tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION · g.p.m.i,.~i o ,.- -' ; On adjacent lots /~'~ ~ n ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /._/o,._/E WATER SAMPLE RESULTS: Coliform ~) Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/H~L=DIN~ TANK DATA Date installed High water alarrr~NI0 Date of pumping ,/L~/-~ Tank size / ~--~-"~ ~'~--Compartments ~ Foundation cleanout~/N)y Depression (Y~ /x,~/ SEPARATION DISTANCES FROM SEPTIC/N(~L--~-~;~ TANK TO: Well(s) on lot /~-~ r--'/'-- To property line /~ /°~- Surface water/drainage On adjacent lots Absorption field Foundation ¢ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed // Size in gallons /¢-~'~--~ Ver~;N) ~/ "Pump on" level at High water alarm level Meets MOA electrical code~N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot //ET~ /-/ On adjacent lots Manufacturer Manhole/Acoess(~/N) "Pump Level at Cycles tested // Surface water ABSORPTION FIELD DATA Date installed ///- / ?'~ Length ::~-~ / Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (~ Soil rating (GPD/FF) E'), '~ System type ,~E~LX_/~' ~-~ Width ,7~ ! Gravel thickness ET, ~' / Total depth '~ / ¢4~) ¢ C~. p~res~n~/N) Depression over field (Y~ /k.)/"~. Results(pass/fail) r'"/~'7/,/'C)~r-'~'~'~r']-~ for .~ Bedrooms ,/~ After test ,~,/ If yes, give date /"-)/7~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,,/¢-r~ /-7~ On adjacent lots To building foundation '~/ / On adjacent lots ...~ ~ Surface water //~ /'~ Curtain drain /"J//~ Property line To existing or abandoned system on lot Cutbank ~v'--//O/'-,/~' Water main/service line Driveway, parking/vehicle storage area /o '-/-- E. ENGINEER'S CERTIFICATION I certify that I have checked, Signature ~, Engineer's Nar~& j~/? 170::[~Eagle Date Eau_la RiverS, HAA Fee $ ~ ¢~::::~ Date of Payment Receipt Number verified, or ormed to all MOA and HAA guidelines in effect on the da f this inspection. / /., ///// .'.', ,, Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* B~ck · ? , ·" ' .- ,,,:l.,h ...... -,-~, ~ ~ OF /-',K~i:~u;";A'.:,~: MUNICIPALITY OF ANCHORAGE 825 [. Street - Anch~)¢~ge, A~aska 99501 ENVIRONMENTAL PROTECTION OCT; 0 1979 . FOR APPROVAL OF i~,3~,/IDUA~ WATER A['JD SE I ! DH~C'_';Ot~S: Cccr ple~¢ ali parts on page 1, Incomplete [oquests will ~ot ~e p~oce~ed, P!esse allow ten (10} clays for processh~g, ~,. P ...... ~, u~,,.En Work 279-9471 (D~e~YONE ~ Dew~ ~. and Jerri L~ne You~ ' ~ 3~9~ ,,,*~,IL,:~ AOuR~ --' Work 276~726 '(Jerr~ ~ne) ........... ~ ~_..~!_ E~mu~, Anchorages_ Alaska 99507 N/A Inter~m-Long Term Financing __1 M;\[ LiNG ADC, RESS $. /.E?,.JOiI~¢ [,2,_'-S'J'~ FLJ'FiON I PFtONE Alaska Mutual SavSngs Bank Debbie Johnson I 274-3561 ~-.)49 99510 PHONE k'iAl L! F~G ADDRESS P. O. Box l120~L Anchora__~ej_ Alaska 4. i~ALIOF;/AGH[~T I MAIL[NGADDRESS 5. LEGAL DESCRIP'i-ION LS, BT, ~ountain Park Estates S'I'R E ET LOCAT~ ON ~ corner of South Park DrS~e amd Fo~ter Road O. 'fYPE OF [~ESIDEi~ICE NLIM, FJER OF BEDROOM, S [~ One [~1 Four '~:~-~ SINGLE FAMILY ~ Two E] Five [_q MULTIPLE FAMILY [i~D( Three [~] Six Eli Other 7. WA'[%R SUPPLY ~ IND!VIDUAL* ! ill CO.MMtJNITY ~ PUBLIC UTILITY · 8. SEWAGE DISPOSAL SYSTEM [~ INDIVI DUAL/ON-SITE*~' [~-J PUBLIC U'FILITY * ATTACH WELL LOG. A well Icg is required for all we!l:; drilled since June 1975. For wells driiied prior to tllat date, l~iv~ well dep[h (al tach log if available.) t ~ ~ *~lf indh[idu~]i/on-she, 9ire instaHa¢on date._~_~_ ........ If system is over two (2) years old an adequ(~cy test is by this Department, I-JOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST ~EFORE PR()CEgSiNG CAN [~E tiq!7'IATED. 72-0! 0(3/78} Octobe~ 29, 1979 TYPEO~ F, ES,DENCE / ~'J oING_E FAMILY ' ' I ~-] ONE L..J fwUL~ ir la I-AIVIIL¥ I.J TWO WATER SUPPLY --~] INDIVIDUAL E]] COMMUNITY E] PUBLIC UTILITY Com'~ection Verified 3. SEWAGE DISPOSAL SYS'F~M ~C~L-] I N B ! V I I') UA L/O N -SITE !_--JPUBLIC UTILITY Conn~clion V~rifJed ......... "'ra_]Septic ]';.lilk or El Holding Tank Size: .\j[~:)~(~.(~) ....If 'Fanl( is homemade give d;mensions: Nt)MBER OF BEDROOMS ' ~'"'F~] THREE IZ] FIVE L J] FOUR LI SIX OTHER IIERiv!IT NUM[~ EFi DEPTH OF WELL DATE DRILLED' LOG RECEIVED _~) , P EI~ I',AIT NUMBER ........ _~_q o~_g,% ....................................................... DATE INSTALLED INSTALLEB q~--Y-P '~-'6 F'~}', N 'f~ .................... I MANUEACTUHER ' TOTAL, ABSORI~~ION AREA I MATERIAL ~ ('T~ ~I('F(' /-['~ ic/HoldmgTank Absor)t on AFe: S'wer ., D ............. ' ] I - l.ine W['t, ', O' j ] ' ..... ~ .................. Z "'~__'' . ......................... ~ ............... [Nearest Lot Line [~_~'"" APPIROVED I:Ol~ _ ~ ....... BEDROOMS F2] CONI~ITIONAL. APPROVAL (le{ter m~st accoml)arW ce~tifie~lo) I~J DISAPPROVEI) i-'~m"" ..................................... I"'~'*~"~' ......... '-"/-7 .......................................................... 724 I )