HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 6 LT 2Mountain Park
Estates
Block 6
Lot 2
#017-432-04
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE 1
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATIQN NO. OF BEDROOMS
Well ~ Absorption area Dwelling [ PERMIT NO,~
~Z Manufacturer Material ~,~. / No, ofcompartments~
~ ~ Liq. capacity in gallons Inside length Width Liquid depth
/~ ~ O IF HOMEMADE: _
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line / PERMIT NO.
~ ~ ~ No. of lines ~ngth bf each line / Total length of lines Trench width Distance between lines
~~ / ~ ~'' ~ 8~ inches
~ ~ Top of tile to finish grade / Material beneath tile Total effective absorptign area
Length ~idth Depth PEBMIT ~O.
~ ~ T~Oe of crib Crib diameter Crib deoth Total effective absorption area
m ~ell Buildin~ foundation ~earest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER ~, ~1~
PIPE MATERIALS
REMARKS , I ~ ~
I
APPROVED DATE LEGAL
72-013 /. 3/78)
;2(i!H::B(:~u:2.~ '.S :;! ...:iRI:E FEET
THE; L[Si",KiiTH ';.:.';; ! MENS ].' ON ]; S THE LENGTH ( i N FEET 1:, OF THE 'T'RENC:H OF: DRFI I NFi El...[>.
THE DEF'TPi (;;iF' R 'T'F:ENE:bi Of~ F'!T IS '.THE; DiSTFIi'.;iE;E BE'T't4EEN THE SURFFIC':E OF' TH.FiT
G!:~iOU?,!D !:fi,iL':, THE E:O'T'TOi"! OF THE ENC:ff,/FITIEff-4 -'.';IN FEET).
'T'HER&" ;f.:.-"i; NO SET i,.!l!.qvTH FOR TREhiC:,LiES.
T,HE EiF.!Fi',/EL. rS:dEPTH IS THE ?1iNl!'IU!'1 DEPTH Eft: G~'.FA,?,':'~X.. E',~;.:;"F!.,.iEEI'-4 THIS; OUTFRLL. I';:'iF'E(
FiND 'THE .r::i~CFT'TC,'i'! OF:' THE E:4C;ff,/F:IT I ON ( ~ N FEET .':,.
..... · ..... "j" F?F'!._T -:I:::iMT_ . i.,.IFi."_'~; TIJnT F~:',:~: '"i :'T": 'rI ','T- "rr',, .~. .t~ -..,~.l'l 'T'klTC;. ........ !.')Ei::'FIF::'T',~'!EI",IT £:,U~:'".t, q-'.., THE
i ?,!';;;."[' :IL L FFF T "_' ?4 ]; HSF'E(::T i ONS E!F FiJ"~P¢ k. FL !_S RD..:rRE:ENT 'T'r.] '1"I-..I_.!; S :'? '" F:'E~'T'¢ FiND THE
?,IUi"IEL, Ei;F;: F'!r::' ................................. .~;'i~::'::;" ', :::'i'.J '" ,~::',--., THFi"F THE kiel _ !4 1 LL ::,"-'"*"'!:::.r~. ,,, ..... ~:..
~"::'" ~" TIdE
.... , .... 4 "r'¢F'E F:' IF! 'i'r] l'~:i i
.'I]'~.,T,*!....PI [:,i~;T!~NCE F~i:r'3H ~;~ ?~'.!',/F!TE !.,I~:LL TO Fi F:'¢;i;["/Fi'T'E; ':~:I~'~::' LINE !S ':"= FEET r'J, ....
P.!EI...L.. LO(:~iS ~,,.~-',,- r" .................... ~'E r:)! !T F?EF:, iq!',lD P!UST ,:'F' ....... .................. ~?FT Pi'¢::'D Tq THE- DEF'IaF~:TF!ENT ,,,,~ 'r.."L.,.,,***~ };R' ,r"c','"~ .,._.,"-
........... ~E:L .....
F¢:' 'i"F!F:' . ...... t FCh'.F'L[ST'[
EF!"H[CR REE¢..i I f~:E?IEENTS hiF:I%' F!F:'PL."¢. SF'EC :!: F :[ C:F~T Z ONS ~Btt) '~ r' ?.?:q'T'[;;:UE:T): ON [:, ! F!GF;:FIHS FIF:E
;[ CERT! F'..,'" THFiT
:!..: ! F~i','.t FRH!L. IFi.r.;;; !.,.IiTH THE RE(;:!Li:£P:.'EME;',Ff'S FCIF..: OI',!.-.SITE SEH!:ZF..:S; R!',iD I.,.iI_'iiZ_LS; RE; SET
F:'EI.~;i:-!"i.-! Es? THE .i'4U.,"-~
:7:: ! P-!!L.L. iN'/:i;TRLL THE .S'.¢S"FEH iN F!CCORDF:!i'.,IE:E t.,.!Z"f'l...i THE E:ODES.
;.'~:: Z iJI'..i[:,ERSTRND "!'P!.FiT 'T'H~._ E$,i-'.:~;!TE SE,,',.IER S'T'S"FEM H_,'-;::I'¢ f.;i:Ei.;:!L!!RE EN!._RI:;?.C~iI:':tI"iEN"f' ;,,'.'F THE
"i',::, _. _..._ ----¢-% --/Z....'_
PERFORMED FOR:
LEGAL DESCRIPTION:
~' ~ICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTJ:CTION
Pouch 6-I~50, Anchor,.ge, Al~ka 90-.502 276-222'[
SOILS LOG-- PERCOLATION TEST
SLOPE
SOILS LOG
PERCOLATION
TEST
SITE PLAN
IF YES, AT WHAT
· DEPTH?
Gross Net Deplh to Net
Reeding Dote Time Time Woter Drop
~'"'~- ' PERCOLA3'IoN RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
TEST RUN
~_ ),~ CERT~FIEDBY:
FT AN~ FT
MUNICIPALITY OF ANCHORAGE
[~T 0c '[:l_T'q ~-
ENVIR., iL_l. A. ', ~.0 E_TL ,q
1982
- WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of 6eoIogicDI & Geophysical Surveys
RECEIVED Drilling Permit No.
lb lc.) A.D.L. No.
Io.lJaorough ,Sgbdijviliion lot mock IL.Ii '/4qtr$. Section NC. TownshiPN[~ Range Ei~
Ic. JJDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL: ~.~(~.] (~
2, WELL LOG Feet Belo~ 4. WELL DEPTH: (¢1~1) 5. DATE O¢ 60~PLETION
Material Type Top Bottom
-:/~[;~?~ ~ )~:~Je diem. in. to ~)~ ft. Depth Weight
-['~ ed~,oc:b: 'b:Lu e-grey a:d,3 ~ard
,. :),,~ ~01~ Slot/Mesh Size: __ Length:
Set between ft. ~nd
Bock filling Gr~vel pock
I0. STATIC WATER LEVEL: Z['fi ,ft.
Equipment used: ;c?_[[(~
]1. PUMEIN6 LEVEL below Io~d surface ond YIELD
' ft. after hrs. pumping g.p.m.
12.GROUTING Well Grouted: ~ Yes ~ No
Material: ~ Neat Cement ~ Other:
~ Subs, ~ Pet ~ Cen~rific~l ~ Other
I~. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION: - 15. Wofer Temperdfure o ~ F ~ C
~' .... ~uthorl'zed-Repr~}~ntolive
Form Og-WWR (11/81) Copy Distribution; WHITE-Stole DGGS~ PINK-Driller~ CANARY-Customer
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
1: GENERAL INFORMATION
CERTIFICATE OF HEALTH ,b, UTHORITY ,&,PPROVAL
FOR ,b, SINGLE FAHILY DWELLING
o17-4 2-o4
Expiration Date: ~ ° '//~ - O ~
Completelegaldescription ~LOT 2, BLOCK 6; MOUNTAIN PARK ESTATES SUBDIVISION ~2
Location (site address or directions) 12620 LUPINE DRIVE * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DICK &: MARY DAVIDSON Dayphone 345-7625
c/'o CLNR DALTON w// DYNAMIC PROPERTIES
Day phone
CLAIR DALTON w/ DYNAMIC PROPERTIES Day phone
3111 'C" STREET * ANCHORAGE, AK 99503
261-7600
Unlessotherw~erequeste~ HAAw~beheldbyDSD ~rpi~.
2. NUMBER OFBEDROOMS: 4
3. TYPE OF WATER SUPPL~:
Individual Well ~
Individual Water Storage
Community Class Well [~]
Public Water System
II
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 4 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 propedies 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 private or Class C well and may
be reissued with new water samples. (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 er B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pdor I
to closing for the engineering services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authority 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 strocture indicated herein. I further vedfy 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBAER ROAD, SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Nome JEFFREY A. CARNESS. P.E.
Date
357-6179
Engineer's Comments:
In conducting this evaluation. AWWC, Inc. attempted to provide e thorough.
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results desc#bed the performance of the
system under the conditions encountered 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, groundwater levels that may
fluctuate durtng the year. and the water usage of the family being served by the system.
These conditions are 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. AWWC. Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. 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 will it confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations: .d.[tt[?,f~(-%r~rr~--,
..
· ON-SI ·
~ WATERAND : m~
~ ~ WASTEWATER : ~
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
< ,...PROGRAM '- ..... ·
Manitenance Agreements
Supplemental Engineer's Reort
Other
(Rev.
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Legal Description:
A. WELL DATA
Well type pt~VAl[
Date completed
Total depth 104.
'C.
Building Safety DNIslco
On-Site Water & Wastewater Program
4?00 South Bragaw St.
P.O. Box 196650 Anclx3rage, AK 99519-6650
www.cLancfmrage.ak, us
(~07) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
MOUNTAIN PARK ~ S/D ~2; LOT 2~ BLOCK 6 Pan=el ID:
5/7/82
It.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: N/A mgJl..
SEPTIC/HOLDING TANK DATA
If A, S, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 62 lt.
FROM WELL LOG
5/7/82
49 .lt.
7.5 .g.p.m.
017-432-04
6.8
Well Log (Y/N)
Wires pmpan'y protected (Y/N)
Casing height (above ground)
AT INSPECTION
1/22/2002
49 .lt.
g,p.m.
Nitrate 2.04 mg./L. Other bacteria
Date of sample: ,3/5/2002 Collected by:
Tank Type/Material STEEL
Tanksize 1250 gal. NumbarofCompartmenla 2
Foundationclaanout (Y/N) YES Depression over lank (Y/N) NO
Date of pumping 1/24/2002 Pumper.
ABSORPTION FIELD DATA
Date installed 4/27/82
Length 35 .fi.
12+ in.
0 colonies/100 mi.
AWWCt INC.
Date installed
Claanoute (Y/N)
High water alarm (Y/N)
A+ HOME SERVlCES
4/27/82
System type DEEP TRENCH
Grovel below pipe 5 fl,
Depression over field NO
For 4 bedrooms
New depth 26 in.
6OO+ g.p.d.
If yes, give date -
Absorption rote >~
Soil rating (g.p.dJlt~oa:~ 85
Width 3 lt.
Total depth 7.5 fi. Eft. absorption area 350 ifa Monitoring tube YES
Date of adequacy test 1/22/2002 Results (Pass/Fall) PASS
Fluid depth In absorption field before test 0 in. Water added g56 gal.
Elapsed Time: 430 min. Final fluid depth 11 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
D. UFT STATION
Date installed Size in g~llone ~
"Pump on* level at. in. "Pump o n. High water alarm level at .in.
~ Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Pmparty line 5'-I-
Water main N/A Water service line. 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:.
Proper'o/line 10'+ Building foundation 10'+
Water sew/ce line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
F. COMMENTS
Absoq~tlon field 5'+
Surface water. 100'+
Water main
Driveway, parking/vehicle storage 25'+
G. ENGINEER'S CERTIFICATION
I certify that I have detenTe/ned through field inspections and
review of Municipal mcerda that the above systems am in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Print? N/~me
Date '~/~/0 ?-
aI:J'tI<EY A. GAYNESS
HAA Fee $ 3 '7'c,~,
Date of Payment
Receipt Number
(Rev. 12/01)
L
7955 .." ·
..... ~. ~,~
Waiver Fee $.
Date of Payment
Receipt Number
~R-OT-0Z 01:20~ FI~:)~-CT&£ ENVIR0~EKTAL
,~tK. CT&E Environmental Services Inc.
9075615301
T-8Z9 P.O2/O~ F-506
CT&E Ref.#
Client Name
Project Name/~
Client Sample ID
IHatrix
Ordered By
PWSID
1021139001
AK Water & Was~Wat~r Consuttan~ h~c.
Mm Park Est. #2 Il; B6
Mtn Park Est #2 L2; B6
Drinking Water
Sample Remarks:
R~selu PQL Units Mcthod
NitTate-N
0.200
mg/L EPA 300.0
Client PO~
printed Dategl'lme 03/07/2002 12:38
Collected Dategrime 03/05/2002 10:42
Received Dategrlme 03/05/2002 11:30
Technical Dlrettor, Stephen C. Ede
Allowable Prep Analysis
Limits [hte Date Init
(<10}
03/05/02 ll:Yr
Microbiolo~y LaboratorY
Tolat Coliform
col/100mL SMI8 9222B
03/05/02 KAP
i~R-0?-02 01:20~ FRO~I-CT,IE ENVIROfl~NTAL SRV 9075615:301 T-BZ9 P.03/0~ F-506
,finldn8 Water AnalySTS
0.9
b
55. Z~'
oo
FO,dNDA-I--ION ONLY ' '
16'5.00'
S¢S
INC.
7~25 OLD SEWARD HWY.
ANCHORAGE. ALASKA.D950'
3167-5
'-" APPLI( 'fiT FILLS OUT UPPER HAL "'ONLY'
Property Owner ~ {,.~___. ,~ W~- ~,.~ C C~ ~.~ .~.~, ~_ 'O C ~ ~ Phone
MailingAdd~e~ Zip Code ~ ~ ~ ~
Buyer ~ ~ ~.~ ~ ~ ~C') ~
Address . rio C&, ~ ' ~ C~ Zip Code
Phone
Lending Institution ~ ~ ~
Address ~' ~ ~ ~- Zip Code ~ ~ ~
Realty Co. & A~nt Phone
Address ~ ~ ~ Zip Code ~ ~(~ ~
~ Multiple Family No. of Bedroo~
~ Other
~dual ~, ~. ~ t ~ ~ t ~A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal ~
~idual Yoar Indiv~ual Installed:
~ Public Ulitity When Connected to Public Utility:
~ Holding Tank -
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date
Inspector Inspector Inspector Inspector
Soils Rating Date ~wer Instelled Well To ~sorption Area ~ ~ 0 ~ ~ Well Log Received
;'2-023 (3182)
