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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 13 LT 9Mountain Park Estates Block 13 Lot 9 #017-391-57 Parcel I.D. 017-391-57 Certificate of On -Site Systems Approval Expiration Date: 8/1/2025 Legal description MOUNTAIN PARK ESTATES BLK 13 LT 9 Site address 13131 ALPINE DR Current property owner(s) KOHLER CHRISTOPHER E & ANNA C X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: c/ Original Certificate Date: 8/16/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone. 907-343-7904 On -Site XA/n+mr R. XA/ncfnxhi-_i+ Section 907 '�A'� 7007 1�1 I IN -1 1-1 Ili " UA 1-4 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 01739157000 Complete legal description MOUNTAIN PARK ESTATES Location (site address) 13131 ALPINE DR Current property owner(s) KOHLER 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS BLK 13 LT 9 Day phone 3. TYPE OF WATER SUPPLY: RN Private Well R Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units El Community Well or Public n Water Storage 4. TYPE OF WASTEWATER DISPOSAL: � Private Septic E] Private Septic serving 2 dwelling units F Holding Tank F Community Septic or Public Sewer 5. SEPTIC TANK: 9 Steel 0 Plastic n Concrete F] Fiberglass Age J I - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F] AWWTS F-1 Bed nN Deep Trench F-1 Wide Trench n Seepage Pit Waiver request for: Distance: Expedited review requested: 1-1 By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ �50_ X, 3 30 Date of Payment COSA# Waiver Fee $ Date of Payment Waiver # COSA Applicationjune 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 6/14/24 Development Services Department Building Safety Division �e of e F On -Site Water & Wastewater Program o °'<a rt 4700 Elmore Road U ' P.O. Box 196650 a Mark Begich Anchorage, AK 99507 s A E T Y Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 01'1- 3� 1- 51 Legal Description Property Owner Name & Address: 3 / 1 /q (_-Pl XDT=— D iZ Pump Installation Date: ! a/,?, -2 jZ. Pump Intake Depth Below Top of Well Casing: 06 feet Pump Manufacturer's Name:�� Pump Model: Pump Size 1 hp Pitless Adapter Burial Depth: % d feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: ji Well Disinfected Upon Completion?JKYes ❑ No Method of Disinfection: Comments: Pump Installer Name: /�1J/P� .�NO'+e;, ANCHORAGE WELL & PUMP SERV. /-1 330 EAST 76T"AVENUE z„ ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. UBMITT Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 .JUN 644013 of 2 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSP131071 PID Number: 017-391-57 Dwelling: K Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade Name: ROBERT MANCUSO ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 13131 ALPINE DR., ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4' GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot MOUNTAIN PARK ESTATES 13 9 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches I From Tank Field Tank Line Fe Ft. Well >100' TANK M Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1250 Gal. Surface Water >100' Material Number of compartments Lot Line >10' STEEL 2 NA Foundation>10 LIFT STATION Manufacturer Capacity Curtain Drain >20' Gal. Remarks EXISTING SEPTIC TANK Pump on level at in. Pump off level at in. High water alarm at in. ABANDONED PER MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 dreirrfleltl Tank to 3034 Installer GROUND BREAKERS LLC Drainfield CO/MT Inspector ANSON MOXNESS BENCH MARK (Assumed elevation)100 ft Inspection 105/21/13 Location and description 2nd ection BOTTOM SIDING SOUTH OF BACK DOOR 3`tl 0 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL E2p'6'SXe,' —� oF Conditional Approval: Date 4 H 10 0 �! �• E. SPURKL.AND,': JJ 500>� ! �FOPfiI.i,3.NP�,�,� Approved Jli Date � 1� �`z- Inspection Report -9 -1 -12 -doe' 1 \ a r � 1 z m 1 11�YI 1 m SWING TIES 1 A ABANOONEO EXISTING SEPTIC TANK PER MOA IIWI CODE REQUIREMENTS I I 1NSTAILED NEW 1250 GALLON STEEL SEPTIC CONNECTED TO DRAIN FIELD NOTE., THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER min 25 0 25 SO 75 100 125 /50 DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. SCALE., 1' = 50 FT DDUBLE 2 FEET CODER FZIUNBATIBNC aEANDurs—,,t � / I R __. �L INSULATINN CONNECTED TO EXIST DRAINFIELD 1250 CALLUN SEPTIC TANK BENCH MARK BOTTOM OF SIDING SOUTH OF BACK DOOR ASSUMED ELEVATION 100 FEET SPURKLAND ENGINEERING ,FOUNTAIN PARK ESTATES BLK 13 LT 9 i SEPTIC SYSTEM AS -BUILT 203 W 15TH. AVENUE ANCH. AKK, 99501 ROBERT MANCUSO DATE: MAY 21, 2013 (907)279 16 13131 ALPINE DRIVE, ANCHORAGE AK 99516 SHEET: 1/1 GRID: 2838 PERMIT # OSP 131071 PID # 017-391-57 M5UNTAINPARKESTB13L9-ASB.DVG On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131071 Tax Code Number: 01739157000 Work Type: Septic Permit Effective Dates: May 02, 2013 to May 02, 2014 Design Engineer: SPURKLAND ENGINEERING Subdivision: MOUNTAIN PARK ESTATES Site Legal Address: MOUNTAIN PARK ESTATES BLK 13 LT 9 G:2838 OwneNAddress: MANCUSO ROBERT W & KIMBERLY S 13131 ALPINE DRIVE ANCHORAGE AK 995163130 Site Mailing Address: 13131 ALPINE DR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 20000 Total Bedrooms: 4 N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-391-57 Property owner(s) ROBERT MANCUSO Day phone 250-7639 Mailing address 13131 ALPINE DR., ANCHORAGE, AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES BLK 13 LOT 9 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedroo si 3 der LS• APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade F Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or authorized Permit/Rush Fees: 9(.200- Waiver Fees: _ Date of Payment:4/��5 �/� Date of Payment: Receipt Number: Receipt Number: Permit No. Sib/R16?,-1 Waiver No. PermitApp_-1-12.doc SPHT oand EngmMn ong Environmental Consulting and Design April 23, 2013 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Mountain Park Estates Block 13 Lot 9 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced property is 40 years old and the owner would like to replace it. This submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The existing septic system is certified for 3 bedrooms. We are proposing to upgrade the certification to 4 bedrooms, with the installation of a 1250 gallon tank. The existing crib installed in 1973 had an effective absorption area of 750 sq. ft. plus, an additional trench was connected to the crib in 1987 and added and effective absorption area of 708 sq. feet. The soils were rated at 250 sq. ft. per bedroom in 1973 and 231 sq. ft. per bedroom in 1987. There is a total absorption area of 1458 sq. ft. The minimum required for a 4 bedroom system is 1000 sq. ft. An adequacy test was conducted on April 4'h 2013, and the absorption field was capable of disposing of more than 600 gallons per day. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. 203 West 15`a Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net 1 LOT 8 DOUBLE CLEANOUTS CVWCr TV EXIST BRAINFI£LB DARK cs, ATES - --------------- SUN -------------- SUN VALLEY HEIGHTS 1 BLOCK 1 COMMUNIYY WATER LOT 1 25 0 25 50 75 100 125 150 SCALE., I' = 50 FT. 2 FEET COVER (N/N) 2' INSULATION FOUNDATION CLEANOUT 1250 GALLON SEPTIC TANK SPURKLANU ENGINEERING MOUNTAIN PARK ESTATES BLK 13 LT 9 SEPTIC SYSTEM 203 W 15TH. AVENUE ANCH. AK. 99501 ROBERT MANCUSO DATE. APRIL 23, 2013 07 279-3916 1 1 151JI ALPINE DRIVE, ANCHORAGE AK 99316 SHEEP• 7/1 GRID. 2855 PERMIT # OSP 111XXXX FIB # 017-391-57 MOUNTAINPARKESTB13L9,BV6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES _ 3ii 57 Environmental Health Division D 17 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES LORI AFRkIS TO SEPTIC I.ABSORPTION Address 13 )3! i� 19� > 9gSi6 FROM WELL Phone(s) Total depth from original grade Permit No. 1 ; zaxor r �p FT No. of Bedrooms 13 LOT LINE LEGAL DESCRIPTION Lot Block S Subdwiswn T. 2. 4'i1 FOUNDATION Township, Range, Section s / � +V ,s�� 0-:r FT ASD(, way, w water driveway. Total absorption area TANKS Distance between lines SEPTIC /SrN ❑ HOLDING Sal rating Manufacturer II I Capacity in gallons Seo 303 WELLS PRIVATE ❑ OTHER (Identifv) q Total Depth Cased to FT FT WELL (Show location of well, septic system, property lines, foundation, Installer Date installed: REMARKS: .IiPlSR 'T1�A4I► a TEDd O/Z):- '�eea�—��iC •- Scale: s C lhll�' Inspections Performed by: 4, RM P1 - i Lk Date: �— nattily that this Inspedion was performed according to all Municipal and State guidelines In sated on this date: /L72—r7 Health Department Approval: r Date: 7 BB 72-013 (3/BS) I ENGINEER'S SEAL TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe twttom from Total depth from original grade original grade r �p FT — /'0 FT Fill ado eo aoove original grade Gravel depth beneath pipe 47—/ FT FT Gravel length Gravel width 3 0-:r FT FT Total absorption area Distance between lines SOFT ! FT Number of lines Sal rating Pipe material II —31 SO FT Seo 303 installer ,.' rt—/�� he N% WNI/I Date Installed 9 // / WELLS PRIVATE ❑ OTHER (Identifv) q Total Depth Cased to FT FT WELL (Show location of well, septic system, property lines, foundation, Installer Date installed: REMARKS: .IiPlSR 'T1�A4I► a TEDd O/Z):- '�eea�—��iC •- Scale: s C lhll�' Inspections Performed by: 4, RM P1 - i Lk Date: �— nattily that this Inspedion was performed according to all Municipal and State guidelines In sated on this date: /L72—r7 Health Department Approval: r Date: 7 BB 72-013 (3/BS) I ENGINEER'S SEAL e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 4401Z1/E/ZRI s DATE PERFORMb�-*' fI s�`�/ LEGAL DESCRIPTION: Ldi9 &A /3 )rr lwe ESf. Township, Range, Section: �_�/ ,g��,/ 3EL Zb 7DE–P—THI SLOPE SITE PLAN (FEET)%/�` I 1 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 WAS GROUND WATER ENCOUNTERED? O S IF YES, AT WHAT L DEPTH? O P E Depth to Water Aller Monitoring? Bate 1 18- 819 19- 20 1 tr PERCOLATION RATE (mmutes/inch) PERC HOLE DIAMETER 1 LTEST RUN BETWEEN FT AND FT COMMENTS LOIy fie�3�)�;�1b e;J71tr &A?Ad r TZdIW. PERFORMED BY. —"' S I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) .. �^ M U N I C I 1=' A L I T Y OF ANCHORAGE Department of Hz�alth & Human Servicer_ S:_'U I_ Streeret, Anchorages Alaska 99501 343-4720 O N- S I T E Permit Number: £3702.6- Upgrade Date Issued: 10/0e'/87 Owner Name: LORI FERRIS Owner Address: 13131 At -PINE ANCHORAGE, Ak, 99 516 ISEWER PERMIT Day Phone: 263-24^1 Parcel Td: 017-391-5.7 Lot. Legal: Subdivision:i1F'"ESTATES"#1""'"'Cott 9 17T'acF '" 1," Section: 26 1township: 12N 'r%ange: ,W ............. Lot Si --e 239=3 (sg. ft. or acres) Max Eleedrooms: This Permit: Total Capacity: 3 SEWER SYSTEIIS: Listed b( -clow are the options available to you in designing your sewer system. Choose the option that best fits your site. --A Gra.vc-1 length ; 50 feet requires multiple soils tests. LIFT STATION: If a lift. station is installed, a. high water alarm must be connrct-ed to the residence. SEPTIC TANK.: Hinimum total. septic tank capacity: 1,000 gallons. Each septic ta.nI, erUSt hav0 at least2 compartments. Depth to top of septic tank (s) <: 4.0 relent requires insulation over tank(s). PR"0VTI)F SFCOND HOTLS (.00; WITH AS -RLI ):I T. DOCUMENT :.;OIL=, CONDITION THROUGHOUT TRENCH. I CERTIFY THAT: 1. I afn familiar with the requirements for, on-site e;ewers and wells as sL_-�t forth by the Municipality of Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA code-, and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of* Alaska requirements for the set back distances from any e:iistinq well, wastewater disposal system or public !,rvjor'age system on this or any adjacent or nearby lot. 4. I Under :tand that this permit is valid for a maximum of = bedrooms. I als-.c understand that the! capacity of the total system is 3 bedrooms and any en1<,rgfmnnt will rcquire ern additional permit. 13 igrivAl �%- DATE: (Oatner ) LORI FERRIS Ise>e.e-=d I+y: ') t'-_ T R E N C H R E D W. I) R A I N Depth to Pipe Eottom (ft): 4.0 4.e:) 4.0 Gravel Depth (ft) : 6.0 0.5 3.5 Total Depth (ft): 10.0 4.5 7.5 Gravel Width (ft) : 2.5 23.0 5.0 Gravel Length (ft): 58.0 -M 43.0 75.0 4a* Gravel Volume (cubic yds): 35.0 36.7 55.6 Soi l Rating LJspd (sq ft/brm) : >1 217 X31 --A Gra.vc-1 length ; 50 feet requires multiple soils tests. LIFT STATION: If a lift. station is installed, a. high water alarm must be connrct-ed to the residence. SEPTIC TANK.: Hinimum total. septic tank capacity: 1,000 gallons. Each septic ta.nI, erUSt hav0 at least2 compartments. Depth to top of septic tank (s) <: 4.0 relent requires insulation over tank(s). PR"0VTI)F SFCOND HOTLS (.00; WITH AS -RLI ):I T. DOCUMENT :.;OIL=, CONDITION THROUGHOUT TRENCH. I CERTIFY THAT: 1. I afn familiar with the requirements for, on-site e;ewers and wells as sL_-�t forth by the Municipality of Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA code-, and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of* Alaska requirements for the set back distances from any e:iistinq well, wastewater disposal system or public !,rvjor'age system on this or any adjacent or nearby lot. 4. I Under :tand that this permit is valid for a maximum of = bedrooms. I als-.c understand that the! capacity of the total system is 3 bedrooms and any en1<,rgfmnnt will rcquire ern additional permit. 13 igrivAl �%- DATE: (Oatner ) LORI FERRIS Ise>e.e-=d I+y: ') t'-_ Municipality of Anchorage AW DEPARTMENT OF HEALTH & HUMAN SERVICES i * ;• = 825 "L" Street, Anchorage, Alaska 99502-0650 •�•' SOILS LOG — PERCOLATION TEST ,.• FA+.ve PERFORMED FOR: DATEPjF • 41 l LEGAL DESCRIPTION: tory $cA' /3 h% Phi' e77:Township'. Range, Section: TZ,J 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 :/ 6)v✓<c oBl t!3 SLOPE SITE 11L'wM '1t{�ER'S SEAL) R 0666.0 40-01M, rR ........ .. .R Y C. REID, JR. L • J► - Qc97 �'�sEc Zb WAS GROUND WATER ENCOUNTERED? O S IF YES, AT WHAT L DEPTH? P S P o E Depth to Water Aller D� 7 Monitoring? Oete: Reading Date Gross Net Time Time Depth to Water Net Drop ,0 7 -,XJ --:7 1i3: - >sdS /o N/ .&7 - .59 , 64F 3. is4/i- /ZfS .G7— .G= , DS J. /1Sf- /JoS .47 - ,Gst , o S• iilS- i3st j , 47. ij:s- ii3f ,L7- .43 ,o 20-t f .r III PERCOLATION RATE -1-01' (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN 60"5' FT AND 7 FT COMMENTS So/L �D AT Zi7 f16D�+ Fi&M '% /� 1. PERFORMED BY: Ore , A- ii/L/ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: -7 7 72-M (Rev. 4/85) i 1s. 'say''-�}llasral 3 G93 OFMCA zril `% b� Jt- tc 3r TJrr•�' •� • I'D' brt r✓ 16%11 1 K IJE',6,I�pc1 o Zlrs •�••' ss L1 .1 v' 3 �pe_v ' � J it••.•1J •t••. • tE E1D, JR. A:_ .:451 � rA Q t,► Ila irm,*o W ➢c2 ,Arerlcr co �-' SBcj,p.5W L -0•E IcPe-,>ji SyLFrJD� % Y5• 0512011= • 1106 0,l ozr= r�c•�'�T1!471 -If t,P� t •�'`,OF�s ,.• $' s SURVEY CERTIFICATE 1 hereby certify that I have surveyed the following deseribEd property LOT 0) 6L0C1C 13 M^Ut-.2rAjQ PhnL- ESTATES SJ13r�, and that the improv:ments situated thereon ore within the property lines and do not overlap or enc+occh on the property lying odjoccnt thereto, that m i,,provements on the property lying adjoccnt• thereto encroach on the premises in a:cstion and that there are no road- vocyr, trcntmisslon lints, or other visible ac;crr.c•tE on acid property except as hl:rcon 0 AS -BUILT SURVEY LOT c) Bix>c V_. t3 MOUNTAIN F'%Czy_ ESTgT cS O. STAN SEARS It ASSOCIATES REGISTERED LAND SURVEYORS POST OFFICE BOX 283 EAGLE RIVER, ALASKA SER577 Date Scccc G•ior :Tr -C-0.^ t �� v~_ C . • . • r G ` I ...+ ...... ....�.. . r Lff Cif N D // aPEXAhE' ofF Coe CWS'*A• G916 O 1:1Q ° I;ZLyQ PIPE—=8 .A/o trrArt tta�f�1tTi.✓b /r/Et.t..S KECAVt=R� =%� •✓mJ%✓ /so' sf r-Mr✓C AteA. • JeJ.1at 3 �STe.4 Zt5lr✓o AziA _NDTff-S 1. i?EGOQD tNF02MAT10N TAY-Et�i F20M Tr1E PLAT DF "OliNiTA+t..l _... PA21L l=ST�T�S �Vt371Vc�p►�1 R��F-D1+JG1 NO. P—•501. 1 hereby certify that I have surveyed the following deseribEd property LOT 0) 6L0C1C 13 M^Ut-.2rAjQ PhnL- ESTATES SJ13r�, and that the improv:ments situated thereon ore within the property lines and do not overlap or enc+occh on the property lying odjoccnt thereto, that m i,,provements on the property lying adjoccnt• thereto encroach on the premises in a:cstion and that there are no road- vocyr, trcntmisslon lints, or other visible ac;crr.c•tE on acid property except as hl:rcon 0 AS -BUILT SURVEY LOT c) Bix>c V_. t3 MOUNTAIN F'%Czy_ ESTgT cS O. STAN SEARS It ASSOCIATES REGISTERED LAND SURVEYORS POST OFFICE BOX 283 EAGLE RIVER, ALASKA SER577 Date Scccc G•ior :Tr -C-0.^ t �� v~_ C . • . • r G ` I ...+ ...... ....�.. . r GRE" ;ER ANCHORAGE AREA BOIP 'UGH Department of Environmental Quality T 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME JOHN] LOWE MAILING ADDRESS 75 FI S 2A PHONE 344 -1376 LOCATION A L r" N F_ D P. LEGAL DESCRIPTION LOT 9. UK 13, M O l) N TA I N SEPTIC TANK: DISTANCE'^^ i NUMBER OF FROM WELL JILLL_MANUFACTURER GLEE P --MATERIAL STEEL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH L/yV IQUID CAPACITY / 0 GALLONS. SEEPAGE PIT: 'Z 4 XS 0)(2,0 % 3 I , NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_, DEPTH 9,11 LINING MATERIAL LAG CRIB SIZE: DIAMETER-SLDEPTH—IL/DISTANCE FROM: WELL [� TOTAL EFFECTIVE BUILDING FOUNDATION J B , NEAREST LOT LINE 2,C1 ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: r (2 IV AT E TYPE DP -I LIED CONSTRUCTION DEPTH _A PPROX , IS 0 /DISTANCE FROM: BUILDING NEAREST NEAREST SEPTISEEPAGE / i FOUNDATION LOT LINE K SEWER LINE , TANSYSTEM - ! 3 Z CESSPOOL , OTHERSOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: Jc/I%1 I PIPE MATERIAL: L • r Ql�ll -1 PANS ITE LOT SLOPE: REMARKS: Form No. EQ -091 REMA DATE ALPINE DR DIAGRAM OF SYSTEM *S$ i' 3 BDRM / Nouse IG foo' 132 S EPT I c za z4 =�� TANK SEEPACIE 51, o PIT :a 30, �'�•'•"•''•� NI=AREST .LQLOT LINE OVED , '/• ri GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3700 TUDOR ROAD [-OUCH R.07O PERMIT NO. G ANCHORAGC. ALASKA 99702 "" ' Tt1.tPMUNC 279.9506 IrV �� � S� SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMITS /TT L .217,E-padC NAME OF APPLICANT tl o A� " d ala?-, _ __ MAILING ADDRESS�/ e- •' PHONE~—a INSTALLATION LOCATION LEGAL DESCRIPTION /__0 f 3 k - INSTALLATION OF: SEPTIC TANK ✓ SEEPAGE//PIT DRAIN FIELD �� OTHER TYPE AND SIZE OF FACILITY TO BE SERVED 3— %rn7 f1I ase' TO BE INSTALLED BY SP�� SOIL TEST RESULTS ('}Sys Tu?%/�/� NOTEt THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED �r «/L./ 1 �7�� /'"'�'�'`n-• /� !�� _1PFBMTT_VALIQ nNF YFAR__ FINAL INSPECTIONt 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. (/ SEPTIC TANK SIZE /4 y TYPEStPPT Or Ctlt" fl[TPPSEEPAGE AREA SIZE ��A'�2 r,%�TYPE I 1. 7Sob� re�,ut.=a.1 oyuitlal�-Lt MINIMUM DISTANCES. REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK 5 ft* 1 7 FOUNDATION TO SEEPAGE PIT 20 ft. DRAIN FIELD TO ft. SEPTIC TANK TO SEEPAGE PIT WALL X15 fto SEPTIC TANK 5 ft* SEEPAGE PIT 20 ft, , DRAIN FIELD 10 ft. TO NEAREST LOT LINE. CAfI^1R WELL TO SEPTIC TANK �O ,SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 ft• SEEPAGE PIT 10 ft, . DRAIN FIELD 10 fte C^ F` SEPTIC TANK, 25 ft• SEEPAGE PIT 1 50 ft - TO ft* DRAIN FIELD • . TO RIVER• LAKE. STREAM. 4' CAST IRON S11 SEPTIC PIPE WITH AIRT11 ,IA::C/CRP$ Level -3 CAST IRON INTO UNDISTLRSBIO SOIL y;:'•:.: IxINu: mntxuN C 1 tnpulr¢d whenever line crosses (CRIB A RMcr driveway. TABLE) CRIB •.i �i AT[L PA(eFILL . Ono 0011. ' NININUN ABOVE WATER: 4 INCH SEWER t1rr. CCMILCR ARL? WELLS. SE(PACE PIT IICATATIOn BASED ON 'ttLL • SOIL TEST. 0 Brede: 1'."r ICJ' Ir iN• p r Too: except 10' prtcrvdlnD E teak i the. Mould 1 Rot exceed T.. 0 B• per 100 OR Pitt :1 CAST Ir011. terrains. IrTn ED �4 STEN fTUPERt[CAST IRON SIPHON ►VC soft \\ �S[[►ALC PIT • J CRIB tRAVEL BAER/lll S -`—_ to, "TRITIUM 1 t(Ir[4T LOT llllf 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREAT ANCHORA EAR ORO H OR CE NO. 25.58 AND THAT THE ABOVE DESCRIBED SYSTEM IS ACCORDANCE WITH SAID CODE. / OATEx� 11_ APPLICANT'S SIONATUR "��' X11.19011 WTIt, Vi yirE.i�F— CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING OAP OF Io' EXCAVATION FEET INTO UNDISTURBED SOIL. "nu.0 t'; -= VO - "PIT 10 w PIT- TOO - LP SEVEN LIRE- I 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT Fl fr1 LIS •11— i FITTED WITH AIRTIGHT REMOVABLE CAPS. � 10 TA!:N• 00•' ' T, r1i• 170' LO uctR 1 In;. 4 GRAVEL SACKPILL 4n•.R,' OnLT tAf1 IROR star, I ❑:E CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I.nnl IC To TAnt• 200' In PIT - 200' •/. XL • LAVE 1?(," SCl'[R LIVE r'1.. ��L! IGr.•. N1 S,OrCt OF HEALTH AUTHORITY '•O:Ar.!!u.T ION OR LICENSED DESIGNER CRIB •.i �i AT[L PA(eFILL . Ono 0011. ' NININUN ABOVE WATER: 4 INCH SEWER t1rr. CCMILCR ARL? WELLS. SE(PACE PIT IICATATIOn BASED ON 'ttLL • SOIL TEST. 0 Brede: 1'."r ICJ' Ir iN• p r Too: except 10' prtcrvdlnD E teak i the. Mould 1 Rot exceed T.. 0 B• per 100 OR Pitt :1 CAST Ir011. terrains. IrTn ED �4 STEN fTUPERt[CAST IRON SIPHON ►VC soft \\ �S[[►ALC PIT • J CRIB tRAVEL BAER/lll S -`—_ to, "TRITIUM 1 t(Ir[4T LOT llllf 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREAT ANCHORA EAR ORO H OR CE NO. 25.58 AND THAT THE ABOVE DESCRIBED SYSTEM IS ACCORDANCE WITH SAID CODE. / OATEx� 11_ APPLICANT'S SIONATUR "��' 0 t•11 _I h -J T 1-:: 1.. s H 1 _ I T' -r F- H h-1 0 F . '• > z -:o n 9--i E ~-DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION £25 'L' STREET. ANCHORAGE, AK. 995=+1 264-4720 LJF-=I-L- F}ER-:t-1 I T PERMIT NO. i 771.029 ) APPLICANT DONALD MCDFRMnTT SRA SX. 374-4J 344-4026 LOCATION ALPINE DR. LEGAL LT. 9 PK. 13 MTF. PK. EST. LOT SIZE 20000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SE14AGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 210 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MIST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY= OF THE WELL COMPLETION. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER, INSTALLATION. F*[F-_M I T E;> -.;F=• I <:11 j__=+ 7 77 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I -JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. S I GNED : -------------------- APPLICANT DONALD MCDERMOTT ISSUED BY --- ----- ------DATE_ll _ _ �! V3. 0 ./" r!'! iii C. '' d•j: tt (i �:� ri al?� .. :f!:I!I�1..\.._.........�» ..� DEP A.R1Pl'EU OF ENv-f �1f!!': ..'l.'Ql1:1_1!. CASE 3500 TODOR RrAD ANCHORAr3E, ALASKA 99502 Performed For �e�r Lowe Date Performed 9 -2 -S -"'L Leaal Descrir.tion: Lotci_Block 13 Suhdivision c Es1a4es This Form Reports Soils Log >0 Percolation Test r)eoth Feet Soil Characteristics _ 1 — 2- 3 __.' A- C-ra�elly gi Icy $o.r.si (o -za")11 SM • z5o Was Ground Water Encountered? NI If Yes, At what Depth? Reading ( Date I Gross Time i "Jet Time Denth to H2O Net Dron u E Percolation Rate F±i�t,f� �-`""-""`---- --•• Proposed Instafl—at ian: see Pit _ Priiin Fic.ld Deeth of Inlet_ nent;i Tn 3o�-tar.7 ��� !'it 0 Trenc "- n r+!A _ C ENTS:�eat_�s/e�o�_.isJ_2� cif 6a,C� �_.��'frf ➢,'t d��w�j�y �nrki,nr •• - �i �_i e s i / 7-�_�Nt.'SGtw��_.�.lNi�c_tu ��1 _!1�P�e�r _S`� ��.L�y�Z•�O s.• ��ee Test Performed Rv �- TA..._'''"`?�.T�----.. I'a `•a'"f ert i f e,! P�� �.._— --- i r' • n �M♦ f��lF 1• Pn. i;!'1l 11 fl r, I' F.. V'.l�l"' DEP APlME11 OF E1:VIR01111 i)'`.1. QU;"L t : CASE # 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For N N law 071 Date Performed Legal Descrintion: Lot q Block 13 Subdivision Meyh This Form Reports Soils Log h Percolation Test oto l �_ Reading, Date-- -- Gross Time- Denth Feet Soil Characteristics 1 � el r rra n_�_�as'— si �nl (uacr-1�rj 1�twr�1�1 — s�5� �o�G c(�Ein�-r -�„ r-/��er•h � f �'r�., 7 do 2 t G vaoc'I% So—J., S+ It StA- ML 3 n 5 t; 0 F' .7 �=a of 9y� Z, 10 — 0 fA o Was Ground Water Encountered? YES If Yes, At what Dehth?_$ oto l �_ Reading, Date-- -- Gross Time- Net Time Denth to 120 I Net Dron; el r rra n_�_�as'— si �nl (uacr-1�rj 1�twr�1�1 — s�5� �o�G c(�Ein�-r -�„ r-/��er•h � f �'r�., 7 do oto l �_ Reading, Date-- -- Gross Time- Net Time Denth to 120 I Net Dron; el r rra n_�_�as'— si �nl (uacr-1�rj �Lc — s�5� �o�G c(�Ein�-r -�„ r-/��er•h � f �'r�., 7 do rrut'UJCrI III JLctI IC1LIsr, -III lie 1'1L_ !'Y'il111 ".r IQ Deeth of Inlet ;!e�thTr� (3ottc:,^,) Of Pit Or Trench. _ —. CnMVENTS: ZCZ Test Performed Ry ^� ['a `a fern f- er1 Cl !MUNICIPALITY Or ANCHORAGE r^,� DEPARTMEI OF HEALTH AND ENVIRONMENT PROTECTION 825 "L Street, Anchoraap. Alaska 99501 • 264-4720 Date Received: March 30, 1978 #1: Time #2: Time #3: Time Date _ Date e/- 11--7R 011ie Date WA -` A Lot Insp Insp,-i, o ' "" Insp(l a REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Bank of Commerce % ("In,, 1 ), D O,ninS. Mailing Address: Pouch 7-012 99510 Phone: 279-5641 2. Property Owner: Donald F/Toni K. Mc Dermott Phone: 344-4026/h Mailing Address: Star Route A Box 374-W 99507 272-5522/254 hs. 3. Legal Description: Lot 9 Block 13 Mountain Park Estates Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: 5. Well System: Individual Well (x* Community/Public System ( ) Permit # Depth of Well 338' Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1973 Installer Septic Tank Size loco Manufacturer ," Absorption Area Soils Rate ;I:Ta Material 7. Distances: Well to Septic Tank /00 to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line rob Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 9 Block 13 Mountain Park Estates Subdivision Comments: ) 4y,� L� P,'Tn'— 77 v _ , V Affadavit Attached: ( ) Letter Attached: (') Approved: Date: Disapproved: Date: Department Worksheet: . r P ggl0 LSI 0dD a 1Irw 1YNOIlYNN31Ni BO! JON 316f , a S—MOIAOOd 35VV3AO3 33NY80SNI ON 008E cued Sd _.».........».»»...».._._�eAIn ►�/ «�wyxe - � AUA1130 1Y103dS i0S»...»..........._....._.......................... - O - • AIN 0 33SS3NOOV 01 M3A1130 iS2 —' qua MMI)pe 01 AlaAI1aP 411M 2331Atl3S E ISf » "AIpV ew4M Out eRY 'r04r p tMe4S Z' *S9 """""" Aluo aassaiDDe 01 AJa�NaD 471M 1d1393tl it 091 .» " MArAIIIP N1P Jug Iug4wt @I iwa4S_l N9013tl 5333 1YM011100� tlOJ 331 3S 1►N0�110 3000 dlZ CNV 331VIS "0'd06 • - - ON ONV 13381S 3ri0 tl0 AYYYI1SOd i 01 1NIIS (a8elsod snid) ; OC —IIVW 031AI1t133 801 1d1333a MUNICIPALITY OF ANCHORAGE r Department of I3ealth and Environmental Protection 825 L Street, Anchorage, Alaska 99501 264-4720 J request for Approval of Individual Sewer and Water. Facilities 1. Property Owner: Alht--D F9� 1sNY Y. M& ,12i2M Mailing Address: S RA ijo%L 3� -W Phone:.:��l e2 G 2. Name of Buyer: LL £a Mailing Address: 332.Y Lt'£ S�'''.�� Phone: :?33-C39z. Ale. 3. Lending Institution:�p�� Mailing Address: Phone: 4. Realtor/Agent: Mailing Address: Phone: i 5. Legal Description:�v �t_0!CIc �i4iek���''_��7 S Street Location: '4 L PIrv[ 7iz l V E 6. Single Family Residence: (Vj' Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (Vj Public/Community System ( ) r If Individual Well, well depth 33 8 If Community System, name of system 8. Sewage Disposal System: *°On-site System (LYOO' Public System ( ) If On-site System, date of installation: SUmmelk i3 *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 I . . 0- � % eC�ue.st for Approv� � rtdlviftai Sewer & .water Full! �'es Page two • s comments= i"" ' c�y .t" Zn�.e ?! yc.�a► g6s:iE�t., Date 221 Approval va.Ud,for One Year prom Date Signed Greater AnOborago Area 00roudh, Department of Environmental Quality DIAGRAM cF a YSTEµ I certify that the inforcOU010 contained in thi,$ request for approval to be a true and accurate representation of the:sutliect sever and Nater facilities located at: Date a 1. Anproval Address: 2. Prooertl+ 3. Legal De 4, Lo.Gat.ob S. Typo of Nwbe.lr a 6. well Dat r ,r GREATER ANQHORAG& ARRA 13M=GH neparU40"t of EnviT*n%ental Q„ality 3500 Tudor Road, Anchoragelp A oska 99507 2798686// Date Received .7 ! Time of Inspection// ; Date of Inspection (,2 Zi Oli M FOR APPROVAL OF INDIvM= SBVER & WATER FACILITIES FOR A. 8, Depth ,ee,� !„CvX. /1 d C. D. BaGteriai Analysis, 7. Savage 016nosal S�cstep►e r�--•�`��' A. Installed -,S"° ,• 71' ?i"t#---- g.. Instal ler r 7also• GOG✓er" G. $#Iptia [llrikt I. $1tel.0/ _.._ ` 2. Manufacturer fa�"i D. Seepage Pitt: 1 S% 2. Material,l_d46: :Ide? B, Diwpasai Fields Tiotml• �� of Lines, ��,� a, Distiances s A. Wel:! Tar Septto Tjnk ,01' Abdorpt QA Area.3�:? ' . Saxer ines { Nearest Lot LiOther Contamination "CAA r4✓N. R. Foundst "on to Septan 'C'.ank lWpeAb$MMtlon Area f c. Aftorption Area to. Nearest Lot tine _ ► . Parcel I.D. 017-391-57 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: !] - a fc 3 Complete legal description MOUNTAIN PARK ESTATES BILK 13 LT 9 Location (site address) 13131 ALPINE DR ANCHORAGE AK 99516 Current Property owner(s) ROBERT MANCUSO Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 'x q Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well F Individual R Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 1-1 WaiverNariance request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ y90 Date of Payment (o I 1 l 3 Receipt Number C)G\ COSA# D�Qt)k,;)�-3 Waiver Fee $ Date of Payment Receipt Number 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 SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE j I✓ System #1 Approved for 7 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the follow Phone 279-3916 Date 6118/13 Xk p it l 4C Tj By: t /._i/��1! �/ `r Original Certificate Date: (0 -2 60' C 3 The Municipitflity 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f i .. If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTAIN PARK ESTATES BLK 13 LT 9 A. WELL DATA Well type PRIVATE Date completed 1977 Total depth 338 ft If A, B, or C provide PWSID # _ Sanitary seal (Y/N) Y Cased to 40+ ft. FROM WELL LOG Date of test Static water level ft. Well production 9 - p.m - WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate 1.96 mg/L Arsenic ND ug/L Date of sample: 614/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 1 Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping NEW C. ABSORPTION FIELD DATA Date installed 11/9187 Length 78.5 ft. Pumper Parcel ID: 017-391-57 Well Log (Y/N) N Wires properly protected (YIN) Y Casing height (above ground) >12 in. AT INSPECTION 4/18/13 205 ft 4.4 g.p.m. Collected by: ANSON MOXNESS Date installed 5/23/13 Cleanouts (Y/N) Y High water alarm (Y/N) N/A Soil rating (g.p.d./ftz or ftz/bdrm) 231 System type TRENCH Width 3 ft. Gravel below pipe 416 ft. Total depth 10 ft. Eff. absorption area 708 fe Monitoring tube Y Depression over field N Date of adequacy test 4/18/12 Results (Pass/Fail) PASS For 'a Y bedrooms Fluid depth in absorption field before test 0 in. Elapsed Time: 0 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added 620 gal. New depth 0 in. in. Absorption rate >= 620 g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off" level at in. E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot >100, Absorption field on lot >100' Public sewer main NA Sewer /septic service line 25 Animal containment areas >50' Manhole/Access(Y/N) --- High High water alarm level at - Meets alarm & circuit requirements? On adjacent lots '100' On adjacent lots >100' Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas >100, SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5 Water main NA Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10' Water Service line >10 Surface water >100' (N.O.) >50' (N.O.) >100, Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKAND Date COSA brown sheet -1 0-10-1 2.doc Absorption field >5 Surface water >100' (N.O.) Water main NA Driveway, parkingivehicle storage >10, in. i �P,�E.gF A<q�111d i TH , 10 / ..... .......... LA, E. SFUFiKLAN,o • I 1A0 o „ o PE. OF 1 O O 'SHANE A. HOLT c�G �NFp LB -5914 ADO S 89°59'00"W 200.22' WELL_ b`b2 E If ♦r�n U+Lk �._23.I O C p I 'k/o'PZ' w �f ❑ Q w I w �^ W Cc I J ] ❑ 1 10, O L� X321 o ❑ -__._..._...._ ° Z GRA VEY PARkiNG ARI, w o I c 5 I1.5 �_-- N 89°S320'W 168.97' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINE5. EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINE5 THAT MAY APPEAR ON THI5 DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE, AS -BUILT SURVEY V =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 9, BLOCK 13, MOUNTAIN PARK ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _4th_ DAY OF _]UNE , 2013. 10057. F3 122-22, 158-ZO HOLT IAND SURVEYTN6 600 F66HVLEW DRIVE AW"ORAGE RK 99515 345-523 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O.'Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-391-57 1. GENERAL INFORMATION HAA# 030;iy S' eQQ k SSUQ, Expiration Date: Complete legal description Lot 9; Block 13; Mountain Park Estates Location (site address or directions) 13131 Alpine Dr. Anchorage, AK 99516 Current Property owner(s) Joyce Swiney Day phone 345-3783 Mailing address Lending agency Mailing address Real Estate Agent same Day phone Day phone Mailing Address�/ % Unless otherwise requested, HAA will be held by DSD for pickup. �����/ • �{�2,,.. 2 i/;. 3 A y 2. NUMBER OF BEDROOMS: 3 iii (1 �•13'��l��t���>11;Z�'l Individual Well Q Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 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 private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 02-18-04 04:35PM FROM-CT&E ESI, SGS ENV SERVICES 9075615301 SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE a= BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER (� PUBLIC WATER SYSTEM IW ] PFWATE WATER SYSTEM Rf send Results wa—" r7daa P Send In mca SAMPLE COLLECTION: Fe MI rn.r■ woo tow "W MI I m M MIIM •rlwk■ Data: 1 O a I I Menet Orr Yraf Tian: O H S- AM PM "Note-) Location:1-a,, cl 81uc,vC 13I"f��Nrrrl�✓ �i''��l'�K h' -s Collector. An 3 • o- C- C a „✓ a n. "1G� Transported to Lab By: IM Same as collector other T-406 P.03/03 F-540 200 W. POTTER DRIVE ANCHORAGE, ALASKA 69515 Tel: 907-562-2343 Fax: 907-561-5301 141.9•/"- 10:40740 -4.AL .. ioao7ao-l0. �IV 1�f�li9u�lll�l� ❑ Send 11"U" [] Send Irmo MR ft"M Ns- cellae Nlenr �� Fes NulOrr MON ""a ..u••... u..• u■ell.u•r•u•■.■■Bur.■•■.••u■■r■••■••u•■■■.■un•u■■•u.•.■•■..•■■■.••a■■.r■■■•■urenuuuu■u■n•rer■r•■.■e■•r•u■ur■ SSM cede SAMPLE TYPE: I 'Routine Q Treated Water . Q Repeat Sample Untreated Water q r gg 5 (rater to tab no, t Q Special Purpose TO BE COMPLETED BY LABORATORY Sample Receivin[U Date: 2 i2-� ❑ Sample over 30 hoots old: ❑ RUSH SAMPLE Results may be unn"Ma Time: 11 o Temp:! EI 40 How WOW Phone V. Delivery Method: c �N� Remote Fax tf Received By: �- L— Prned Name Comments: Reported By: Datef i ime: -- C- I 1 m SWna:ure �. ; Form 0 FV1- 0053 12/17103 ..u••... u..• u■ell.u•r•u•■.■■Bur.■•■.••u■■r■••■••u•■■■.■un•u■■•u.•.■•■..•■■■.••a■■.r■■■•■urenuuuu■u■n•rer■r•■.■e■•r•u■ur■ Sentto ADM BactetiologIcat Water Ana a Record; MM041UG (PIA) RESULTS: ANC FBK JUN li ToUd Coliform Qatemme. Analysis Bagen: Analyst: E Calc Sent to CAetlk MEMBRANE FILTER RESULTS: Phoned ❑ Faxed [] Analytical Msttwd: Direct Cow* i �{� Caloniesl10Qg11 Datrima: Membrane Filter varfricatlon: Spam wm- MMO-MUG (P/A) TOW Gap" LT$• JL-5GIl. Satisfactory ❑ Unsatisfactory ,w„,,, { EC, ■ Ue 1jaworeee to COW4 %?NTC 17- GO - 09w s4cftft Reported By: Datef i ime: -- C- I 1 m SWna:ure �. ; Form 0 FV1- 0053 12/17103 02-18-04 04:34PM FROM-CT&E ESI, SGS ENV SERVICES SGS Ref.N 1040740001 Client Name S & S Engineering Project Name/# Mountain Park Estates Client Sample 1D Lot 9 Block 13 Matrix Drinking Water PWSID 0 Sample Remarks: 9075615301 T-406 P.02/03 F-540 All Dates/Times are Alaska Standard Time Printed Date/Time 02/18/2004 8:27 Collected Date/Time 02/12/2004 10:45 Received Date/Time 02/12/2004 11:20 Technical Director Stephen . Ede Released Allowable Prep Analysis Parameter Results PQ1. Units Method Container ID Limits Date Date Init Waters Department Nitrate -N 0.962 0.100 Microbiology Laboratory Total Coliform 1 OB, No Coli mg/L EPA 300.0 B (<=10) 02/12/04 coV100mL SM18 9222E A (<=1) 02/12/04 Municipality of Anchorage o • u Development Services Department °•�„°;7: �':'� a Sn. _^ Building Safety Division, Onsite Water and Wastewater Program . t 4700 South Bragaw St. ° � s " "' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorag6.ak.us (907) 343-7904 CERTIFICATE OF HEALTuI AUTHORITY APPROVAL f ORA 51NGLE rAMIL"r DWELLING Parcel l.D. 017-391-57 ' ' HAA # 0' (>O � • Expiration Date: 1. GENERAL INFORMATION ��' Lot 9• Block 13; Nountain Park Estates Complete legal description Location (site address or directions) ...13131 Alpine Dr, Current Property owner(s) JoyrP Swiney Day phone 145-3783 Mailing address Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address ` Unless otherwise requested, HAA wi/16e held by DSD for pickup.. %� ?�a 3 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well n Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site n 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 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 private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify 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 structure indicated herein. I further verify that based on the information obtained from the . Municipality of Anchorage files and from my investigaU66:and ,inspection,- the on-site water supply and/or wastewater disposal system is(are) in compliance with all appl-icable Municipal and State codes, ordinances. and regulations in effect at the time of installation. Name of -Firm _ S . & S . Engineering._ . _ • _ •_. _ _ Piy,•i),r�694-�-2979 — Address 17034 N Eagle River V60'11 4rP_ �01�' Fac]p.'}Z'iver.,. AK 9957.7 Engineer's Printed Name Robert C: "`Cowan - Date R �a-7 A 3 ,..• �.: �,,:'•�': it >�;. .�� .. <` ,'' :'• •'� ROBERT C. COWAN ilk ' 5. DSD SIGNATURE Ve Approved for,; bedrooms. 4�'��v •...«.:_,t�. Disapproved. Conditional approval for bedrooms; with the follow ng'stipulations Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory • .. WATER AND ....• • .. X Maintenance Agreements Supplemental Engineer's Report Other PROGRAM By: 01 Original Certificate Date: 9-3—o3 (R•+. 01102) ON -ITE S -_ • rn • .. WATER AND ....• • .. X Maintenance Agreements Supplemental Engineer's Report Other PROGRAM By: 01 Original Certificate Date: 9-3—o3 (R•+. 01102) Municipality of Anchorage • Development Services Department Building Safety Division 54 " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CI IECKLIST Legal Description: LoT 0) 8L0Gk 'I3 hoyiw7-* fAQk E.Si. Parcel ID: O/ T —3A/—S7 A. WELL DATA Well type A� V *rf If A, B, or C provide PWSID # = Date completed/q 7 7 Sanitary seal (WN) yE f Total depth 3 3 $ ft. Cased to y0 f ft. FROM WELL LOG Date of test Static water level ft. Well production Z9.p-m. d WATER SAMPLE RESULTS: Well Log (y& Al 0 Wires properly protected (9N) yz5 Coliform a colonies/100 mi. Nitrate ©• gs'`ingdl. Arsenic: mg./I. Date of sample: Casing height (above ground) )X-1 in. AT INSPECTION S/r)1/O3 a- o 3 ft. 3 5� , g.p.m. B. SEPTIC/HOLDING TANK DATA Tank Type/MatejQ -SEP -I C_f, L Tank size / gal. Number of Compartments ! Foundation cleanout pN) 19 Depression over tank (y6h N Date of pumping S �a a 0 3 Pumper A f gam C C. ABSORPTION FIELD DATA '.•� Date installed Soil rating (g.p.djf12 or t2/bd o� 3 Length 7 `B • r ' ft. Width � 3 ft. Other bacteria 0 colonies/100 ml. Collected by: S >4 S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed S /a/ / 7 3 Cleanouts (YJN) Vf-S High water alarm (Y/(D �' J -V*-AvSC-41 System type TA C -H Gravel below pipe / 6 ft. Total depth 10 ft. Eff. absorption area 7 0 q fe Monitoring tube Y#5 Depression over field H ° Date of adequacy test I a 1 O 3 Results Pa Fail) For 3 bedrooms Fluid depth in absorption field before test _0 in. Water addedi 17q gal. New depth / 8 in. Elapsed Time:a ISS min. Final fluid depth 0 in. Absorption rate >= _ �1 i�0 g.p.d. i Any rejuvenation treatment (past 12 mo.) (Y/N & type) NoN+E GCNi:rn/ If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at Datum Manhole/Access in. "Pump off" level at _ in.water alarm level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot JO 0 Absorption field on lot / 0 o rt Public sewer main t4 A Sewer /septic service line Meets alarm & circuit requirements? On adjacent lots /00 + On adjacent lots / a r '/ Public sewer manhole/cleanout V XV Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation S, f Property line Sd r} Absorption field s ol Water main PJ %A Water service line /0 -7� Surface water J o o -yo- Wells on adjacent lots J 0 f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r Property line J O f Building foundation S 0 t Water main JV 14 Water Service line JO Surface water / 0 0 y Driveway, parking/vehicle storage / 0 0 7' - Curtain Curtain drain Na^r'- Krcwo Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through (eld inspections and • " »•»••»'•••••••t't review of Municipal records that the above systems are in �, , ,r ,•,T ... . ......... conformance with MOA HA}A� guidelines in effect on this date. TOP, � ROKU C COWAN 174 �7+ Engineer's Printed Name /� 6�£,iLT C • Ca A14,% �'��"88Ut v�vF We t J Date 9/a7103 ,t1�2JJ::'= = i�'�`•►'? HAA Fee $ 3 7 s' ++ J Waiver Fee $ Date of Payment g/ 'a A Date of Payment Receipt Number d HO `y 49 G Receipt Number (Rev. 12/01) I f V i 14 L t. �O I,V ' '• , • ,1 � 1'•' f�• I 'r I. , I :i 1 44YY .z n 0 VEto � f't^ •i'' � 8,0i(+I , 1 f - I � � I. Js�n�ji r. .r � i . ) ,.•M rte. t 7�"• •.O i J� t r r t )•s � Y „! -vQ i wl .f�s�gtvl ( 11, s.(.*Jlf��,. f ' 46"♦ ..k •t. 5 �� �{�1 � (�I�� ' .:{. 4al (':.� J.`: ru \ .t �` •�t�.�:11 Gf�J Nll ♦ Y;E'-'1A1, ,,�tf ,'• �; tt' /• } !tit°A�1ST M t �}vrt+r i t {•RM41 • 1 s A 17 � / • v 1,t' t i L' t • I�.i t 1f(�'I J J r.. 1 : ! V • + r' - i ..'1f 5 F r. 1�1 ``� :�• hs ! }. � 1 iJaw..r y�-d l I...i�jjr/�r L' 1.+:, r \.,',1''t •+ ( ii+1: r.! irrt( n�$•� r4OFP •% ,;�3 U100q'rr'e+NG� " ,-` r y ` :' f ' i +t 5 r(.tl `k `� r , c. ��; ^� �� � P'��•�•M. �•q�,�, t 1: rev '.J • /'\ ,i , / .•I tN+y. ✓- 7 EIIVG.2,a�9G1CS •1 { ';'' .T... [ ., �.. s.c ..�.� • .,,1,, ��" 4971. t �, r.. .......... «...00S. •, H `I } trt l+C'! {(` '''t '• { s. iy rl♦ �BU� / .�.{•1.•!!ti 1•... r!' i{' til!M(r'. � _ .r y� 1 1 � Y ,L • j y wfK j^�',',•h � 91 {latnet KOYI Dowd r ..., ,•, ,' r'.. '.::,fir ,.• 1.C�:•+..'F i.Yf `It is the responsibility of: the owner to determine I.J. •� •� , il rs1561S `the''existencefof any•easements,;covenants;'or.re" 'a t'_ t{i!�^`' r ,�,��7""If fFq••• 7;1 .••Q ' strictions'irrhich i8o not annnear'on'•the recorded sub' `J ',� i[' Firi j� `4i'.;�t `�o •..::.••*ao,� h-..1. Yf J , 6 1'I).r..• d a.... 'ss•:!= e L -�i : C�r�'�OTE{ r �T"�--­v; ` ision;plat , fnder.no,circumstances should an a"•�; '. 1 ,.,.,�. i ,�>������ :. ddtai�ereon be used'.for.fconstruction'or,fo'r;esta �`' ': TSOFRECORD•OTHER;THANTHOSE +' ` • !;SHOWN ON 7�1E;RECORDED PLAT"r•ARE NOT I;c : t lash n"w"'boundary or fence 116es..The.surveyor taPpe*j#,ti;, .gHOWN't+� ori: �' ��a� �� e.i tesponsb0ity'for tlie' ini al.;ti-ansaction on1Y }' 1• �"�` `'� `�'' f" f +i . d Ml J L t aar' /� ti't✓ Iwl { A•/ �� r :•,It - f t v et :T /t�l��(r 3 ,�+rt [ - • »•. rw r H LOZr."=A. 4 i ri,l'.B�OI�t\� N�ta�tfJ • i A t,4.... ,1` X9.,1; f:J �, ., . r y. i t„ 1•T r, (�+ .tµ ([; �. kASS, NO �g Y'D�if /TiQI T S .' fyLAT �f N0. • R[fAR%ROr.COR:/NO :ANCHORAGERECORDINGDISTFtfCT;: ,_o *w• - �. REPAIbEVI BY. DOWUNG,; a,'ASSOCIATES R y`ut ° "°'"' ' rw I;VA6 l�YD� �S T�?E� Ti I �' wc. tin AaYll wrm t y.x . ne ; �` RM /;ailfNIMbP/..rga.tK�".v�•tY.trrr�trnwnry awpMNnrmL,e• P..eaar.w I {, ac ,7.-,ANCHORAGE 3ALASKA,tr x99501 ar, mwu./; . s..,,kr,Kv,,,-i„H,w,.�, MDATE1M i U1TE' Y'jt ►+/rQy�F BY: SCAGE's 'N_"a - WORkbROER::•<ti.t•''PIEtD Kato wr GRfD:Yr • 9 a l '7.i1/"-:..��4'�+•i i,� �^ -'r,'. jj' �' qS. r��y. dQ• .1<.1 i, t� �� y' r .w T1!",!••. p.�.... .n. a , ,.., .. ye��I p �n- C,•f ... s.,-._ :Y4 , �. . moi.. :�1 •p„n.l .�-r� i,. iq:,^ f r. - ..r'ikPf';1:1''i. i.ti 1T:..: J • 1. ., .: r, , MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH 8t HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 017-391-57 1. GENERAL INFORMATION HAA # HA 950048 Complete legal description Lot 9; Stock 13; Mountain Pa,%k Ea.tatea Location.(site address or directions) 13131 A.t'pine Dhi.ve. Anehanag2._ AK 99516 Property owner G,%ant Yuznzenka Day phone Mailing address C/0' 'UNISEA Pouch 500 Dutch Hatbox, AK 99692 Lending agency Day phone Mailing address Agent ' Day phone Address Unless 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 legality and status of system. " 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M(Rw.1/91) Front MOA021 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 5 & 5 ENGINEERING Phone Ccl y —;"Q 7 Ci 17034 Eagle River Loop Road N*. Address Eagle RiveEZA19aka 99571 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. I bedrooms. Conditional approval for - .Additional Comments M Date ? h Y%gr bedrooms, with the following stipulations: 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. rims (P.. »» euk MOA m HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN :d IS Juty I 18, 1995 CIVILENGINEERS 694-29 79 FAX ( FAX (907) 694-4- 1211 RECEIVED MUNICIPALITY OF ANCHORAGE JUL 1 81995 Deparbnent o6 Hea?tth and Human Se vice.6 P.O. Box 196650 Municipality of Anchorage Anchorage, AK 99519 Dept. Health & Human Services REFERENCE: Lot 9; Stock 13; Mountain Pank E6tate6 13131 Atpine Dec i.ve ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. A Conditi.onat Health Authority Approval: (HAA) wa.6 .c66ued on 3/13/95 6o,% the ujwnced property. AtZ work requited 6or the Condctionat HAA ha6 been comp.Leted. Pte"e .i.66ue a 6u t Heatth Authority Approval at th,i-6 time. Ib you require additionat .in6ormation, ptea6e contact u6. S.incene.Ly, Robert C. Cowan, P.E. RCC/gk 1 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 S • MUNICIPAUTYOFANCHORAGE , TZ • DEPARTMENT OF. HEALTH 3 HUMAN SERVICES J Division of Environmental Services r ; - On-Site Services Section'- P.O. Box 196650 'Anchorage; 'Alaska 99519-6650 • _ ^34.9-4744 ,. y„iL f.... :lj 1N �... n w :`. ,. 5.� .. ... :�. /•_-.- ••1„SI-''^'_ ! a - ].., � 't v .. _ CERTIFICATE OF HEALTH AUTHORITY, r 1 . %, APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.� # -0177— 3�1( -S' 7 HAA# - `HR 9sg " GENERAL INFORMATION .. ++. -r. .. .,.,. »�..a-•,..r......... ... _... _ :"•ZC..�•r,- 1� 1'1 ts• `!.• ' fy may..,. 1 'r Complete legal description Lo '9; 136ck -13 -Mountai.n Pank'Ed aces ( -v_ ._ .- ',Location (site addressor directions) 13131 Af tt pc.rte VJu.ve -: Lt ).h•. i.":F \ `Z� it -y _ !.. 9_:.+� ly Archonage';, .AK 1-99516 Property owner Gnaiit . Yu tAzenka : Day phone , 7 C/0 UNISEAPouch`.500. Dutch Han6on, ":AK ,Mailing address '. .. I. ....,.. ,.:... .•aro..%..'•i y�i o'�s. :w.• �.. -. ,.r . 'w ...c .: �.. "3 x.e ar. Lending agency Day phone ling address '` t A�gent Day phone . - , Y s i rn`� ..R 3 ('.' (' l i y ,' „ --�•w+ n: !f :r+. � ,µ V a.•2 tP'-t -[ Fr _ ! y 3'- 1� Ir:\ £ST _:' 4T2""" ... _.r '. - 3 wi• . a. ...ro,> 1,.34) a4,.ti �1�.ry 'e r t Unless otherwise requested, HAAwill be held for pickup • - 1 !. Ja � JI ialV 4 1 .. 4 .awn .,< 3 • w,-•r•-..I .-.:rw. b,d. t ...1* 1 i J:.. 1.�� 2� NUMBER OF BEDROOMS 3 TYPE OF WATER SUPPLY. ^' A Individual well Community well ! .. .r...a.�.•i..r ,. .[... ..._._ - _i:i:ry-' .a.. C}'"„rCe:i.bt�.l. ijtl}.,•,3,- i j13-„S,r.,.. r.Publlc water - : - .r.• •.311 L �.:.�.... wn _ .. _ _ - _ 1' Y ~ _ NOTE If community well system, provide written confirmation from State ADEC a� 't Strei 's' t 'in torthe legality and status of system 4. TYPE OF WASTEWATER DISPOSAL*: �> �l p Individual on-site 6 5-„ gi1+d,, ti r f h F.1T+^' ai it ' N ., ♦- .n ,}. b It,ati„^-� • •S �j • z r r Holding tank. h, 1 1 ! , .+r > • 3, t .. ten( , , !- ,q - .:'• •I •Y G• !,rr ,..•.. 1.. 111 3 JJt � i� „�t���,1t1'Sr..j 41 '��.ti, r 4r vCom munfty on-site; M,,1 •: t � .3 -lar � , �i�= lo- 3^1• ,. .: r - -Y}. y . t, `Public sewer`,� _ >' ..-.'_” }-...:•Lf 'rl !•'3.:4'• L _., '.«�:! a. ::;• _:.t'. S-11�.41t+1ai��'l\- - NOTE 11 comm.unity wastewater system, provide written confirmation from State AbEC attesting to the legality and status of system. .. rZ-=(Rw. 1191) Fmllt MOA #21 r 5.., :STATEMENT OF INSPECTION . BY ENGINEER---.;;, As certified by my seal affixed hereto and as of the validation date shown below, l verify that my' Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functionaland adequate for the number of bedrooms and of structure indicated herein I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or waste watecdisposal system Is in compliance with all Municipal and State codes, ... fir.•. Y• .:.•... w.-. ..• _ ordinances, and regulations in effect on the date of this inspection. :-Name of Firm g a S ENGINEERING -. Phone _,, 17034 Eagle . - Riwr,Loop Road N wia3 - Address _ R ` J Egineer's s ,. tier ignL iatur . ♦ ,C• ♦•1.�. 1 .. r Vit. DOIe ' ♦ �. ne �; REQUEST�YOU .ISSUE A _CONDITIONAL HEALTH AUTHORITY APPROVAL '_; DEPRESSIONS 'OVER .THE SEPTIC :SYSTEM ARE TO ,.BE:;FILLEDjAND ;FINE GRADED..POSITIVE,DRAINAGE TS.TO BE st PROVIDED AROUND THE (DELL HEAD ALL G10RK`IS TO .BE COMPLETED1995 ..44L•'A77 � t! , S- it �\ i '! �.. rrY } 1 , F a'1 I i �•r l• _i 1 Na f tY• .r M r' /NNU r../H.r J 5.' _ .l�/� Yuwr.•...• •n •. •r.. . Y/�.wwe�lli ,r il. I� %] ROEERT C COWAN« 6." DHHS SIGNATURE -. �1�`"n�, , CE 8801 Z•,r� l: , , ♦ ;�a i ,» , tiedrOOm3,t F� 1 N •• (�� • . T Approved for,. --- ,�;.o- .,.v. Y .fir .�-, :.. r_a.�.1� F�itSS1�♦�y�^i'.,,F,:' „1, f... +-r' ♦-1 r.,_ii Dlsapproved rev. r.. 2.1 :3brooms with the foliownng sitpulations ' Conditional approval for r J.. IJ v,.(�� Y I , t, r5 ,. .r., ly w. •.,. ; ,1 �f. t .♦ - �, -�.w 9fl f.r '.pl a _ s.' :FSCRaKi- e�tU•yEY tU Rrr�Ai T9E'`�98DllEr'aCO/yD/T7bN�i3f! ,y. •' ei0. LATER "; T C_l9u TGili•F. ��-.�q�%S-" s t .c,., <a , r-. +- I :^.. J , .r r T1 r- .. \ -YI %'r _ .. [ .+-j r_Z.. , .,L` ... r'w_' •1 c.:. -Additional'Comments "N'--" �r :`• rw•y•pq �y .11 ..Y. .l..r IJ:• .I ?, Gl'C a, it trt ,.. �t: 111 �} \ ti ICt a . f,j1j e 1. •.Y �Y, 1r/3 -3Tt ` 6W J.y war i� t . •^v •. ?I r i C Lz CAUTION t The .M�niclipality ot�pchorage Department of Health and Human Sennces'(OHHS) (ssuesr Health Authority x, %Approval f:ertificatis based 'only upon the representations given: in paragraph 5,above by an independent Rr • , ,,. a• d\ • r °;! pni`ressional a eerrz. egistered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes P Y ,and ttie�� lending institutions in oiderto satisfy certain federal and state requirements. Em to of DHHS do not 4/r,...n•• f itconduct Inspections or analyze data before a certificate,is issued The Murnapahty of Anchorage is not •. responsible for errors or omissions in the professio13 nal engineer's work res _ ._ .w \4 M14 '.i 72-M (Rw. M BackMonet .:_ - _� L.':--...:M..•....n....q.Ar.,....-.r .. .._r 4....s.... � -w-_-. .,e_a.. •_�► -- J:._.�i....��.ifr H........._.. .. ._r Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description 16L,,e.. 1 _� IAD u Tr4n � PM�f<+c Parcel I.D. 15,71 A. Well Data Well type ?R-NrrC_ It A, B, or C, attach ADEC letter. ADEC water system number 1� Log present (Ya) Date completed Pc,o¢ Lo-1'5—Driller- Total o-'Y5DrillerTotal depth 3'P�� Cased to lio%ir Casing height lol' Sanitary seal OI) .1 Wires properly protected ON) J FROM WELL LOG AT INSPECTION Date of test Static water level Well flow g.p.m. Pump levell SF.Y- rre roe �a� (p.�o rn..l cti SEPARATION DISTANCES FROM WELL TO: Z-2.Ct5- 'i o7, 3.a g.p.m. Septic/holding tank on lot loot ; On adjacent lots 90' & AV- %AS1ktA1Ca I9_12� Absorption field on lot loo's ; On adjacent lots 100' Public sewer main A ', Public sewer manhole/cleanout Sewer service line 2S ti Petroleum tank t�6k_y_lo tS d WATER SAMPLE RESULTS: Coliform O Nitrate D• L 2- 1 141e. Other bacteria O Date of sample: !-13 _5S Collected by: -5y S E,441JE6gxl^f 4 B. SEPTIC/HOLDING TANK DATA Date installed Tank size Ifl oa Compartments Cleanouts ON) J Foundation cleanout (YQ r, Depression (Y)o rL High water alarm (YQ Alarm tested (YM) �� A Date of pumping _ 9 -\'5 - CI • ,. Pumper �o�E �a-arc Es SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \oo� On adjacent lots Wo Foundation l C> To property line ►o �} Absorption field 10 k Water main/service line \b %� Surface water/drainage 72.026(3W)•Fmm CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on" level at High water alarm level Meets MOA electrical cod��es��(Y/N) SEPARATION DI STA C�FROM - t - D. ABSORPTION FIELD DATA LIFT STATION TO: at adjacent lots - Surface water Date installed 8-1 Soil rating (GPD/Ft2) 2-!> � fx System type Length -7,8,5 Width 3 Gravel thickness `� I- Total depth 9-i0 Total absorption area 1000 Cleanout present (53N) _Depression over field4M Date of adequacy test Z -z A s Results ail) Po.ss for 3 Bedrooms Water level in absorption field before test ON After test 1 " `IPeroxide treatment (past 12 months) (Y/Q Aon IL-aaa� If yes, give date ~ I ► SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 t�- On adjacent lots do` Property line to ` 4 - To building foundation 10 } To existing or abandoned system on lot 1 C> On adjacent lots ?� t + Cutbank 'IA- Water main/service line 10 Surface water ` Driveway, parking/vehicle storage area to Curtain drain 'SID E. ENGINEER'S CERTIFICATION I ceftify that t have checked, verified, or conformed to Signature �5 ENGINEERING ~1— Engineer's Name Eagle (aver; Alas= r Date - I /; - HAA Fee $ Date of Payment Receipt Number 72-026 r=)• Beat HAA guidelines in effect on the"e of this inspection. Waiver Fee $ _ Date of Payment Receipt Number. •rt J� f{. Y.1 fir. Y� 31 Waiver Fee $ _ Date of Payment Receipt Number. MUNICIPALITY OF ANCHORAGE / s� DEPARTMENT OF HEALTH & HUMAN SERVICES 0 �f 3 DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 1 Application Date �'JO 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) !rT ee 13 h7 % z57 —140'1 -kA/ ,:344J Location (address or directions) l tLz�e�s3 (b) Property.Owner Telephone: Home / Business Mailing Address 313/ u. (c) Lind ing.Institution TelephorLe r Mailing Address (d) Real Estate Company and Agent Address Telephone y74, —2-774- (e) Mail the HAA to the followino address: or. Check here , if hold for pick up. List contact person and daY➢hone nurryber below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. r. 4. SEWAGE DISPOSAL Onsite Public 0 Community 0 Holding Tank 0 Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Pagel of 2 72-0251Rev 8/861 Front L9 ani e37' 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 /��Gf Telephone Address L� 33 Alef'aiTc� $ *IeW. Date • o♦ y' 'p f s Ar 1k,44 10:01 6. DHHS APPROVAL dd Approved for n•-- -� bedrooms by Date r Approved Disapproved Conditional / Terms of Conditional Approval I CAUTION r, 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 theirlending 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. Page 2 of 2 72-025 Wev 81861 Back r. _.. _.._., ... ... ........... __... ............ MUNICIPALITY OF ANCHORAGE (MON) 60 HEALTH AUTHORITY APPROVAL (HAA) MUNI(:IFAIITY Of AMC- IST - FEBRUARY 1984 ZWMONMENTM. SERVICE 2644720 APR 2 11988 Legal Description: A°7_ 9 AteeeO )17' Rl*de E37- � 77AINI .e3hr s4a, XG A. WELL DATA RECEIVER/ Well Classification yAtl k If A, B, C. D.E.C. Approved (Y/N) -41 Well Log Present (YQ� D� CH ole�ted 977 Yield Total Depth 331, Cased )o BEaR°eK Depth of Grouting Static Water Level Za Pump Set At tit A i Casing Height Above Ground f" Sanitary Seal on Casing A Electrical Wiring in Conduit) Depression Around Wellhead (Y& Separation Distances from Well:/ 1 / To Septic/Holding Tank on Lot f� f ; On Adjoining Lots r To Nearest Edge of Absorption Field on Lot /�07 ; On Adjoining Lots 1d�D t To Nearest Public Sewer Line A) /,4 , To Nearest Public Sewer Cleanout/Manhole � ,A1 To Nearest Sewer Service Line on Lot Water Sample Collected by �G3 /7� �J/ 4 ; Date r/ -e -S7 Water Sample Test Results r%Y' T $ 1J17Z0"r$ &.0/7 Comments Ab u - f�J T6sr /3-85r. Ai�cltu.47E, B. SEPTIC/HOLDING TANK DATA Date Installedd�� S -��-73 Size /612 No. of Compartments StandpipesrtYQtV) Air -tight Caps�N) Foundation Cleanout (Y� DepressionoverTank (Y© Date Last Pumped 4, 7 ReN'",G�J Pumping/Maintenance Contract on File (Y/N)A%J� ; for / A Holding Tank High -Water Alarm (Y/N) A) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well To Building Foundation fro r r � To Property Line To Disposal Field Z To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 23 Type of System Design � 7X0" /`A' Date Installed 69 ���✓ /%1_ 7 Length of Field �PiS B � , �' Width of Field alh Zj Depth of Field e,*-31*44 j Gravel Bed Thickness Square Feet of Absorption Area ,GPin fi TiA� 701, Standpipes Present©N) Depression over Field (Y® Date of Last Adequacy Test — Results of Last Adequacy Test Separation Distance from Absorption Field: 04 To Water -Supply Well ALA AT '/ i17r;yew /67 To Property Line I_< r To Building Foundation 16 f To Existing or Abandoned System on Lot e2tf W 7WW61 7,i%b T,-6&- erg ; On Adjoining Lots m r't i To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /Cry Y To Driveway, Parking Area, or Vehicle Storage Area p'�-fi� Comments &C18 fifte� /14e� '%T S- —97•/ / c D. LIFT STATION Installed � I Dimensions Size in Ga11oA� "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Manhole/Access (Y/N) "Pump Off" Level at •• Check Permitted Bedroom Rating Against HAA Request " Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I h ch - ed, vlrified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed A,4111-- Date -34 Company MOA No. X7"G �� OFA AV PSE,...... �gsio Receipt No. o 10 Date of Payment % j,;1 9T a Amount: $ 4 �) En i s�eai•• *10... .......... ....X oS �a oa 7Y ,� • OY C. REIt), JR 0 � CE -2251 ,: A F eAF Page 2 of 2 ��� \Ave v�s�\ -,0 72.026 (11,84)