HomeMy WebLinkAboutMOUNTAIN PARK ESTATES #2 BLK 4 LT 8MOU(,Aa,Xf\
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Municipality of Anchorage
4
Development Services Department '
Building Safety Division `• • "'
-- On -Site Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519-6650 Page 1 of '2
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: S w 03 0 7- 7 8 PID Number. 017 -07-3- 0&
N D Enver � Pauff.Me L.cwal 4 a ¢
Wastewater System: [:]New ®Upgrade
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LEGAL DESCRIPTION
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Development Services Department Approval
.41
Date: IZ IZ D
THEODORE F. MOORE jJF
r;�•.�• CE
Reviewed and approved by:
-3589
PERMIT NO: SW030278
LOT 8, BLOCK 4
PID NO: 017-023-08 MTN. PARK EST. #2
SWING TIES:
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.........
ONIIINIIII
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rIIIIIIIIII -
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*..THEODORE F. MOORE
Cc - 3589 ,: ! rG
�P
"BIOCYCLE"
TREATMENT UNIT
PAGE 2OF2
1500 -GALLON
BIOCYCLE TANK
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1' RESIDUAL DISPOSAL BED
PLAN VIEW
SCALE: 1" = 30'
ORIGINAL
GROUNOLIN
3
F -
1 1/4" SCHED. 40 PVC \
UISGFI. LINL I U SUIL
ABSORPTION BED
,
INV.
95.6'
BOTTOM T.H. #1
ELEV. 75.0'
M.T. DRY. 7/18/03
CROSS-SECTION
NOT TO SCALE
M.T.
0
O
m
fr
t;
0
GRADE
T SOIL COVER DISTRIBUTION
(PIT RUN SAND & TOPSOIL) LAT. INV. 101.6
SEWER GVL.
MOA ISF:FILTER SAND ...
TOP SAND ELEVATION 101.1'
BOTTOM EXCAVATION ELEV. 99.8'
RESIDUAL DISPOSAL BED
LOT 8, BLK. 4, MOUNTAIN PARK EST. #2
SEPTIC SYSTEM UPGRADE
AS -BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES SCALE: AS NOTED
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, AK 99516 NOVEMBER, 2003
FROM ERICK'S ELECTRIC Y FAX NO. 770-2933 Aug. 31 2003 07:07AM P1
&%27/2003 6:40 PAGE -11.1 RightFax '
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Permit Number: SW030278
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MUNICIPALITY OF ANCHORAGE 7_7_7
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 30, 2003
Expiration Date: Jul 29, 2004
Parcel ID: 017-023-08
Legal Description'. MOUNTAIN PARK ESTATES #2 BLK "4 LT -8+
Design Engineer: 0019 Flattop Technical Services Site Address: 013020 FOSTER RD
Owner Name: Dennis Lee & Paulette Lewis Lot Size: 20130 SO. FT.
Owner Address: 13020 FOSTER ROAD Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-3233
This permit is for the construction of:
❑Q Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By.
Date: Z
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.ci.anchorage.ok.us
(907)343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O t Z - 0 23 - oe; Permit Number SW 030278
Property owner(s Denmr � Pa u f e NY Lee Day phone 3 YS -660 i
Mailing address (1) 13 o Lo Forke,- R d
Mailing address (2) Ane4cb,-j 4r,. A -K Zip Code 99r/,<'
Legal description (Lot, Block & Sub'd.) Lo f gk13 lie k Y M M Ec f At 7
Legal description (Section, Township & Range)
Lot Size2,P''Z�(_Acres/Sq.Ft.
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only ❑
Sewer and Well
❑
Water Storage ❑
Sewer Upgrade
($
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi ❑
Swimming Pool
❑
Water Softening Unit ❑
Therapy Pool
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: yGo �� Waiver Fees: _
Date of Payment: 7�c V Date of Payment:
Receipt Number:�_ (� O 5�--� Receipt Number:
(Rev. 12100)
,E�LA'OP.TECiNIGAL SEIty,IGES
MM & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION h ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
P11: (907) 345-1355 July 17, 2003 ANCHORAGE, ALASKA 99516
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for
a permit to construct wastewater disposal facilities on Lot 8, Block 4, Mountain Park Estates, Unit #2,
located at 13020 Foster Road. Soils logs, perc test results, a site plan, design drawings and
specifications are enclosed for your review.
The soils on this lot contain of a stratum of gravelly silty loam extending from 0.5 to 2.75 feet below
ground level. The measured perc rate of this stratum was 16 minutes per inch. Beneath this stratum is a
dense gravelly silt extending to 12 feet and then silty gravel below that. No water table was encountered
to a depth of 25 feet, indicating that these soils are not impermeable — in fact the existing soil absorption
system that was constructed in the deeper strata has lasted for 25 years. however, because three
different perc tests conducted in the deeper strata all gave measured perc rates of slower than 60 minutes
per inch, we understand that Municipal guidelines will require the installation of an advanced treatment
system. The owner has decided to install a "Biocycle" system to serve his residence with the effluent
being discharged into a shallow bed constructed in the upper silty loam stratum.
The proposed residual disposal bed will be constructed in the vicinity of test hole # 1. Using a soil
application rate of 2.0 gpd/sq. ft. as called for in the Advanced Treatment System Ordinance for a
Category II System discharging into soils with a perc rate between 16 and 30 minutes per inch, this 4 -
bedroom residence requires an effective absorption area of (4 x 150)/2.0 = 300 square feet. The
proposed 15 -foot by 20 -foot soil absorption bed does have an absorption area of 600 square feet. In an
effort to enhance the longevity of the system, the bed will be underlain by 12 inches of MOA ISF filter
sand, and also 3 feet of sandy cover will be placed over the sewer gravel without any rigid insulation.
The natural topography of the lot in the area of proposed construction slopes down towards the west
at approximately 5%. The proposed project will have no known significant impact on present or future
water supply and wastewater disposal systems serving adjacent properties, nor will it have any
significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at
345-1355 if you have any questions on this submittal.
Sincerely,
�..-'O%
Ted Moore, P.E.
1
`
ISF: , LOT 7
I
SEPTIC
I
HOUS"("S
EPTIC
AREA
'I
R 100
;
tWELL
--------------
--------
--------------
INSTALL
INSTALL 1500 -GALLON
\ "BIOCYCLE"ADVANCED I
-^
1
LOT 8, BLOCK 4 TREATMENT TANK
MTN. PARK EST. #2
AR.
i
-`-----
-_
BIOCYCLE
1
1
I
'';;jn>SEPTIC
t '
OUS
Lu
LL:
O
::::::::':::� 1
I LL
WELL `•
'?
LOT 17
R 100'
' T.H. "''
CONSTRUCT
BLOCK S
ABANDON EXISTING SEPTIC TANKo#1
15' x 20' SOIL
—
ABSORPTION BED
w.1.0' FILTER SAND
EXISTING LEACH FIELD 51' I
S 0.8' SEWER GVL.
I
1 '
"
,
I
I
SEPTIC
WELL
R109
I
AREA
,
';nom,.ate
LOT 9 HODS
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aoC'
1
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LOT 8, BLOCK 4, MTN. PARK
EST. UNIT # 2
"" ••""••
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WELL AND SEPTIC
SYSTEM
•.�-
49M-
SITE PLAN
r//
FLATTOP TECHNICAL SERVICES
1 INCH = 40 FEET
,(!•.... ... •.•••.•...
14530 ECHO STREET
DRAWN BYTFM
••HE CE•EF. 35E GORE tl
.
ANCIIORAGE.ALASKA "516
JULY.2003
PLAT.
h �dt
4qv'••.••,,..• �rq� �6 NOTE: THIS IS NOT A SURVEYED
ALL LOCATIONS SHOWN ARE APPROXIMATE.
4" DIA. D-3034 'A'
INLET FROM OM
DWELLING ......
Lip
lilli'm
N
lk3tommill
1.25" DIA. SCHED. 40
"BIOCYCLE"
TREATMENT UNIT
4" DIA D-3034
INFLUENT LINE
FROM HOUSE
71
PLAN VIEW
.25" DIA PVC DIST. PIPE
J. 3116" HOLES SPACED
RESIDUAL DISPOSAL BED
3
BIOCYCLE COVER
FILTER
AIR COMPRESSOR FABRIC
ORIGINAL
1 1/4"SCHED. 40 PVC
DISCH. LINE TO SOIL
ABSORPTION BED
r 11NML —
GRADE
V SOIL COVER
DISTRIBUTION
WIT RUN SAND & TOPSOILI
TERALS
SEWER F.� : �-� . : I .
ISF. FILTER .5
L 5 L 2.5 L
15
1
ORIGINAL GROUND—
RESIDUAL DISPOSAL BED
SECTION **A -A"
CROSS-SECTION
-:%:` LOT 8, BLOCK 4, MTN. PARK EST. #2
WASTEWATER DISP. SYSTEM
PLAN AND CROSS-SECTION
A70FILATTOP TECHNICAL SERVICES SCALE: V — 5'.0.
ft 14530 ECHO STREET DRAWN BY: TFM
ANCIIORAGE,AK, 99516 JULY, 2003
L...
SAND BACKFILL
FOAM INS. ON
EXT. OF BIOCYCLE
fii
"BLUE BOARD INS.
DiISCRG!
PUMP
SAND LEVELIt4, G
"BIOCYCLE"
. %'t
A;e,.r, OF A4 �i
LEGEND: TREATMENT UNIT 04'lvr� ........ 4G,
PRIMARY SETTLING CHAMBEFi�"�t) -'*I 9TL� ?o Mol
AERATION CHAMBER
x X4.
'Wr44-.Z.�
........... *00000
THCODORE F. A&00FE
CLARIFICATION CHAMBER
CE .3509
too ...a
*ilo
DISCHARGE CHAMBER
'
r 11NML —
GRADE
V SOIL COVER
DISTRIBUTION
WIT RUN SAND & TOPSOILI
TERALS
SEWER F.� : �-� . : I .
ISF. FILTER .5
L 5 L 2.5 L
15
1
ORIGINAL GROUND—
RESIDUAL DISPOSAL BED
SECTION **A -A"
CROSS-SECTION
-:%:` LOT 8, BLOCK 4, MTN. PARK EST. #2
WASTEWATER DISP. SYSTEM
PLAN AND CROSS-SECTION
A70FILATTOP TECHNICAL SERVICES SCALE: V — 5'.0.
ft 14530 ECHO STREET DRAWN BY: TFM
ANCIIORAGE,AK, 99516 JULY, 2003
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
TEST HOLE # I SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: _LotB 61oclk_4,_Mountain Park Estates, Unit_#2
DATE PERFORMED:—JulyJ_2003
PERFORMED FOR: Dennis Lee
DEPTH SLOPE
(feet) Pt
1 -
SM gravelly silty loam
2-
2.75
3-
4-
5
6 ML GraveltY silt
1
1
1
1
1
1
1
1
18.251
1
2
damp, sidewalls of hole smear
variable sand & gravel content
some boulders
GM/ML Silty gravel
Many rounded cobbles
B.H. (7/1/03)
GM Silty sandy gravel
Depth to Groundwater
to 25
Date
f ••Law
J1 TH
r.............•••••.••••1...�
... r,.OJUd7 f. cpGRE; pp !d•
r
^•LYS q
SITE PLAN
Clods
Time
Net Time
(minutes)
0%
T
12' Presoak
dd water 8—it—art——
#1
3d,water
02
—Add water
p3.
Depth to Groundwater
to 25
Date
f ••Law
J1 TH
r.............•••••.••••1...�
... r,.OJUd7 f. cpGRE; pp !d•
r
^•LYS q
SITE PLAN
5%
Date Reading
Clods
Time
Net Time
(minutes)
ii3Ti3Tl.�
•
12' Presoak
dd water 8—it—art——
#1
3d,water
02
—Add water
p3.
.1:
illi0100
_27314
233/8
217/16.
2312
21518
215/6
I
villi
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•'
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III.
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v/i11i/11
vnlliili.
_ �11y11
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5%
Date Reading
Clods
Time
Net Time
(minutes)
Percometer
Reading
Net Drop
(inches)
12' Presoak
dd water 8—it—art——
#1
3d,water
02
—Add water
p3.
3:37
4:07_
4:07:30—`—
4:37;30
4:382312
:08
30
30
30
_27314
233/8
217/16.
2312
21518
215/6
I
115116
--1-7/8—
17/8
Lenses of SP
PERCOLATION RATE 16._ (minutesAnch) PERC HOLE DIAMETER
25' B.H. (7/10/03) TEST RUN BETWEEN 1.0_FT AND_J,5 _ FT
COMMENTS: Test hole monitor tube extended down to 25 feet on 7/10/03 using truck -mounted auger.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I-�fcw.L_ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 / yE 1Ci�
(Flattop 7echnicaCSemices
14530 Echo Street, Anchorage, AX 99516
Now (907) 345-1355
Lot 8, Block 4, Mountain Park Estates, Unit 42
13020 Foster Road
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of installation of a "Biocycle" aerobic treatment unit that
discharges effluent into a 15 -foot by 20 -foot soil absorption bed underlain by 12 inches of filter sand.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 "Biocycle" Aerobic Treatment Unit
2.1 The new 1500 gallon "Biocycle" aerobic treatment unit shall be manufactured, furnished and
equipped by Biocycle Alaska in accordance with the Municipal and State approved design. Biocycle
Alaska's telephone # is (907)-283-9003.
2.2 The contractor shall prepare a suitable site for the "Biocycle" unit and install it as follows: The
depth of the excavation for the `Biocycle" treatment unit shall be sufficient to allow connection to the 4"
waste line leaving the house at a minimum slope of/." per foot, but no deeper than 10' - 2" below finish
grade in the vicinity of the unit. A cleanout shall be installed within 5 feet of the building foundation.
All pipe connections to the `Biocycle" shall be equipped with waterproof mechanical couplings. The
bottom of the excavation for the `Biocycle" treatment unit shall be carefully leveled and smoothed by
the placement of a layer of clean pit run sand. Two inches of rigid, burial type, insulation with a
minimum compressive strength of 30 psi shall be placed on the sand prior to installation of the
"Biocycle" treatment unit. The space between the sidewalls of the excavation and the `Biocycle" unit
shall be carefully backfilled with sand. The top of the manhole riser shall extend 4" above finish grade,
and the final ground surface graded as necessary to provide surface drainage away from the `Biocycle
unit.
2.3 The contractor shall be responsible to obtain the necessary electrical permit and inspections and
shall provide a copy of the electrical inspection report to the engineer.
2.4 The control and alarm floats shall be set and their proper operation verified by the `Biocycle"
supplier. The high level alarm shall be installed inside the residence at a location selected by the owner.
2.5 The discharge line from the `Biocycle" treatment unit to the soil absorption system shall be
1.25" dia. Sched 40 PVC. All pipe connections in the distribution system shall be glued, and the ends of
all pipes capped.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by creating a 15 -foot by 20 -foot excavation to a
depth of 1.5 feet below ground elevation in the vicinity of test hole # 1. The long axis of the trench shall
parallel a natural contour of the ground and the bottom of the excavation shall be level. Any compacted
or smeared surfaces shall be raked to allow proper infiltration.
3.2 A total of 12 inches of compacted MOA approved ISF filter sand shall be placed in the bottom
of the excavation. This sand is available from North Star Sand and Gravel in Palmer. Ph. 745-1111.
3.3 A total of 0.8 feet of washed sewer gravel shall be placed in the bottom of the excavation with
the 1.25' diameter schedule 40 PVC perforated distribution pipes laid level such that the pipe inverts is
no less than 0.5 feet above the bottom of the sewer gravel. 3/16" diameter holes shall be drilled in the
bottom of the distribution pipe at 18 -inch intervals. All PVC pipe joints shall be glued and the end of
the distribution laterals shall be capped. Sewer gravel shall be 0.5" - 2.5 washed and screened gravel,
with less than 0.5% passing the #200 sieve. Washed sewer gravel is also available from North Star Pit.
3.4 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design
drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel and 3 feet
of sandy backfill without insulation. With the exception of the top 6 inches of topsoil, the imported
backfill shall be pit run sand as supplied by North Star Sand and Gravel.
3.6 The top surface of the cover material shall be graded to smooth contours. Fill slopes shall be no
steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and
seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Existing Septic Tank:
4.1 The existing septic tank shall be properly abandoned by pumping, removing top and backfilling
with soil. The ground surface in the vicinity of the abandoned septic tank and the Biocycle tank shall be
graded to slope away from the house for a distance of 10 feet into a shallow swale that is then carred
south and west around the side of the house until it daylights out.
5.0 Inspections:
5.1 A minimum of 5 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the ISF filter sand is placed and compacted, (4) after the sewer gravel is in place
and the distribution pipes have been laid and connected up to the Biocycle tank, but prior to placement
of insulation or filter fabric, and (5) after rough backfill and grading is complete. The `Biocycle" unit
requires one inspection after it is set level and the piping connected, but prior to backfill. This
inspection may be incorporated with any of the above inspections.
5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
f
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 26441720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
Q NEW
Steve Leinber er
337-6223
UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
Lot 8 Block 4 Mountain Park Estates Addition 02
LOCATION
NO. OF BEDROOMS
Foster Drive
4
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO. l!
O
1031
t
t
780346
—Y
Manufacturer
Material
No. of compartments
Wr
Greer
Steel
2
'�'
Liq.cp citY to gallons
nFj O U
IF HOMEMADE:
Inside length
Width
Liquid depth
d V
DISTANCE TO:
Wetl
Dwelling
PERMIT NO.
—10Z
2? F
Manufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well
120
Foundation
88
Nearest lot line
PERMIT NO.
750346
Lu =
10
� LL Z
No. of lines
Len h of each line
Total legV, of lines
Trench width
Distance between lines
rzw
2
2be'+26'
Sgt'
36inches
Ri ht an les
I..
Top of tile to finish grade
Material beneath tile
Tutal a fxit. absorption area
o
8.51
72 inches
Length
Width
Depth
PERMIT NO.
W
U
<I..
Type of Crib
Crib diameter
Crib depth
Total effective absorption area
Wd
rn
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
'u
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
Cast Iron Lotank- rest P.V.C.
SOIL TEST RATING
s
150 S.F.,li
INSTALLER
Larry Smart
REMARKS
I
/
]T-44-
A OV LEGAL
�D•�(%ATE
V
72 13 IRev. 3l7B1
mus
D rn T liZNT l I'nTI1 nisD ENVIRONMENTAL"W' TCCTIIO
'L' STREET, ANCHORnGE, nl<.
v 2G4-4720
K7tV—SITE 'SEWE1� PERM I T
rCRMIT NO. C 700346 .)
M, F --c
/�:�. 'd
APPLICANT
LOCATION FOSTER
LECnL LG B 4 MT PARK ESTATES LOT SIZE 2ocoo SQUARE FEET
T'�'PC OF SOIL AGSORBTION SYSTEM IS: TRCNCII
-,"TMUM NUMOER OF BEDROO u - 4 SOIL RATING <SO FT/B,'%)= 150
THC REQUIRED SIZE OF THE SOIL nOSORrTION SYSTEM IS:
�E^ T: i= 2� LCi iGTI 1=�,2 GfSf i'v'CL 0Cf'T1-1= G
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRnINFIELD.
THE DEPTH OF n TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIH FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRnVEL DEPTH IS THC MINIMUM DEPT11 OF GRAVEL BETWEEN THE OUTFALL PIPE
nilD THC BOTTOM 07' THE CXCnVnTION <In FEET).
MEG!U I F:ZCC7 f::[=f T I C Tf3Ci1< S I ZC= 1X6:43 GC-SLL_�CiS
PERMIT wPLICnNT HlS THE RESPONSIBILITY TO INFORM THIS DEPnRTMCNT DURING THE
INSTnLLnTION INSrECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMB
ER OF RESIDENCES THnT T11C WELL WILL SERVE.
-- "TWJ <� 7 nml-- mmlmu I I<co ---
BnCICFILL.ING OF ANY SYSTEM WITHOUT FINnL INSrCCTION AND ArrROVnL BY THIS
DCrnRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTnNCC OCTWEE14 n WELL AND nNY ON-SITC SCWnGC DISPOSnL SYSTEM IS
100 FELT FOR n rRIVnTC WELLS OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OT11CR REQUIREMENTS MnY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
r--AMMM I T EXF> I i-�ES E>ECEMGEF2 31, 1 so
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 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON -SITES SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE EMOL} LED TO INCLUDE 0 E 7nN ` BEDROOMS.
S I GP4CD
nPPLI
ISSUED
nnTr CSS /
V3. 2
�onibrucRon EZcsE 1'd�
cJ Mons u+t Ir V'Mh s tkoww"d CTW0111'
2204 Cleveland Anchorage, Alaska 99503
Performed For Schachle Excavating Date Performed
Lecal Oescrintion: Lot_O_Block a Subdivision �t�nt i* Fark Estates_s�
This Form Renorts Soils Lon Yes Percolation Test__ Add. C2
Depth
Feet
2-
4
—4 — Brown Silty Gravel
6-
8-
10 — Brown Slightly Silty Sandy.
Gravel
12 —
14-
16
4-
16
I18—.; Bottom of test hole
20—
Was Ground Nater Encountered? No
If ves, At what Depth?
Readinq I Date I Gross Time
H
��_t��rsw
wm�. � \
�m
Net Time I Depth to H2O I Net Dro
Percolation Rate tiinute
Proposed Installation: Seenaae Pit Drain field
Deoth of Inlet Dept o Bottom Of Pit Or rent
CnmIJENTS: 150 Sq. Ft. drainage area required oPr hedrnnm from
minus 8.51 to 16'.
Test Performed By _ Data Certified By: GTL
Date: --11-22-77
r1�
/� ' KUM
0F W/LLUIMA. EGAN, GOVERNORDEPT. O Ls\`'d1>ONME TAL("ONS131t`•ATIIOSOUTHC£NTRAL REGIONAL OFFICE
MACKAY BLDG.
338 DENALI STREET
March 151 1973. ANCHORAGE 99501
Herman fT Stuefloten
4003 East 9th -Apt. 03
Anchorage, Alaska
SUBJECT: Lot 8, Block 4 -Mo mtain Park Estates
Dear Sirs.'_
We have reviewed your situation in light of the interpretation of
the 40,000 Sq. Ft. -20,000 Sq. Ft. requirement contained in Section
18 AAC 72.030 of the Department of Environmental Conservation Paste
Water Regulations. It is our finding that since you had ownership
of the lot on or before February 5, 1973 and that you intend to
construct a private residence for your personal use, that this particu-
lar Section of the 1'.aste Water Regulations is not applicable in your
case.
We would however advise you that of course all existing Borough
Regulations are in effect and are applicable in all cases except
where State requirements are more stringent.
cc: GRAB -DEQ ✓
Yours truly,
K e J. Jel
Regional Environmental Engineer
RECEIVED
11AR 16 1973 AM
GRIATRR ANCHO"11 ARCA NOROWn
DEPT. Of ENYIIIOWMINTAL QUALITY
r'Iur,J I I-- I PHI_ I Tom' 11F H r -j (-- 1-4 IDI; H+3E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
625 'L' STREET, ANCHORAGE, AK. 55501
264-4720
WELL_ PEFt:rel I -t-
PERMIT
PERMIT NO. ( 771043 )
H PLICANT CHARLES RUBY 333 E. 11TH ANCH 274 2484
LOCATION FOSTER ROAD
CF66L. L$ R4 PIT PARK FST #2 LOT SIZE 20130 SQUARE FEET
PIINIMUM DISTANCE RETWFEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
10o FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOG= ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
TITHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
HVHILHBLE TO INSURE PROPER INSTALLATION.
IJ I=I I-1I'T F=XF 1.1-<E-7-. 1,-1=13Er•1CFEE Ft: =�1_s
J GEP FJFY THAT
1: I AH FRHILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
"FORTH BY THF MUNICIPALITY OF ANCHORAGE.
r: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES.
S1GNED:-
/r+PPL_ICANT CHAPkLES RUBY
ISSUED B4'-- . = ----DATE-L------------
V3. 0
�.``\ WELL CONSTRUCTION LOG
Drilling 'Co. D'_ Z/ e USGS no.
Drlllot rTO,(sACNA4v —Type of rill j ,141X- Date well Completed_.L -T� % % 1
Well ownefWAYle' ✓6e V Nearest community %%uA/z,y �ArA, ifs747P—s
/�
Well location: (address t legal description) 1 a 7A IA? A 'r tip Location sketch of remarks�z aG
EtT rpt 5�6,/:✓itr�N '�2 LoT fs LY/ec/f' 5f Sv6 ? �.T
Depth of well ft. Casing: depth it. dlam. In.
Static water levelft. (above, below) land surface. Dale AI -/7-72
Finish of well: open -en screen, perforated, open -hole, other)
Describe intervals and size:
Well yield tested by(pumping bailing, air) at �� gal/min.
for 7 hours withl5— ft. of drawdown from'statlb level.
DRILLER'S MATERIAL LOG
Depth be low land
surface In feet
Give
(size or material,
description of strata penetrated
color, hardness of drilling, and water
content)
.6_to
,ry e+( 4
-.1'��'._ to
I/
CIA
IF ' 2
..7.2— t o
to
�'A s sf, rFT
—to
to
to
to
to
to
to
to
to
to
to
to
_•;
to
Flt/rn
to
September 23, 1977
176727
Charles Rubey
333 East 11th Avenue
Anchorage, Alaska 99501
Subject: Permit Expiration
Dear Mrs.Rubeys
A permit issued by this department for well and/or on-site
sewer installation on Lot 8 Block 4 Mountain Park Estates
12 Subdivision has expired since the issue date exceeds one
(1) year.
In the event you still plan to install the well and/or on-site
sewer systeamp a new permit is required. The original soil
test may be used to obtain a current permit.
If the well has been drilled, a well log should be sent to
this department to document the installation date.
If you have any questions regarding the above matter, please
do not hesitate to contact thic office immediately at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Sanitarian
RCP/ljh
r• � 1_1 r 1 i �_5�:.: 1-1 L 3 -1-4r' ID 1P 11 rA I— thou I f F -7 1_j �
DEPARTMEtJT HEALTH AND ENVIRONMENTA! Rl,TECTION
251J E. TUDOR RD. • ANCHORAGE, Ar. 0007 004,
276-2221
1•1EL1L F'r=F_r•l I T
PERMIT NO. i 76727 ?
APPLICANT rHRPI_ES, RURFY 333 EAST 11TH AVE 274-24=4
LO'_HTION FOSTER KO
LEGAL L8 E4 MT PK EST 02 L iT 5 EE 20130 SQUARE FEET
MINIPUJM DISTANCE BETWEEN A WELL AND ANY ON-SITE " AGE D SPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUB? C WELL
HELL LOG= ARE REQUIRED AND MUST BE RETURNED 0 THE DEPART 'ENT WITHIN 30 DAY:
OF THE. WELL COMPLETION.
PECIFICATIONS AND CON'=TRUCTION DIAG�'AMS ARE 1 JAILA -E TO ENSURE PROPER
INSTALLATION.
1 F= 1 r-1 S i '•:' r1 L I C• F • �_' -� r F C ' E F FT r '-.. Cl r'1 I •_. •= 1_11.
I CERTIFY THAT
1: I AM FAMILIAR WITH TF= REOUIREIFNTS FOR 01 -SITE- SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALI1 T OF ANCHO 'AGE.
I 41I1 -L INSTALL THE Sr STEM IN ACC IRDA ''_E FJ' FH THE CODE-.
S I GNED : ---Job Y1GG(.ti1__�CdJ?/1/_� _F� __--
APPLICAtJT CHARLE. RUBEY
IS=IIECi E'r'- ---- - - --- = - -- '----C'ATE---
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.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017 - 023 -06F HAA # 045-0 6-0 Z
Expiration Date: '�S / r 1 a2ac> o
1. GENERAL INFORMATION
Complete legal description "it 13/Ccic y ITOCAn%ln Per --4 ES/s►fir #Z
Location (site address or directions) 1302.0 FcJ/en Ro(
Current Property owner(s) DeAA1 4e / P4441114e LeLtAr Day phone'' 3,yr- 660 1
Mailing address 3308 170171IC /l0 Cf.. hnchone�* P 99S01
Lending agency Swn+n+' f rro/i 4e Day phone 6 Y 6 - fs 76y
Mailing address ZoS E (3cnron !j/vim, S«.k 101 /frT i Ax 99S'3
Real Estate Agent RonoL Flor;!e h6"zr Gln hM,Aor eDay phone 7V8 -'IS0n
Mailing Address .517 w. 12_'t" A&w to A-mctio 9% /16c 919-5-01
Unless otherwise requested, HAA will be held by DSD for pickup. P/ewo cc,(/ 17rcr/{0'ljV -7Y8 -q,5Yb
w1+en h�/1.9 i,J rrvory
2. NUMBER OF BEDROOMS: I
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Individual On-site 19
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, I 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 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. We.H 9ra•ch7 tua-k ^&6w cen+p fele —tsr erHvo4 „(
Name of Firm Flah�0P %chrr(«/ ff#-I; cow Phone 3YS-�3SS
Address ly a EcA10 Sh, A"chaecrge, A -►t 99s/6 -
Engineer's Printed Name T%'+Po-�Pmve F. /`icvo z! Date _S- 2WS
5. DSD SIGNATURE. THEODORE F. AA00RE
~`•• CE -3599
z, u
J� Approved for 4 bedrooms. "'Y; •'•.. ,� .••'•
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
ON_en•,- •'•
AND
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other AJ . Aa j;5�
By: _0 _n,_0 d Original Certificate Date:
(R•v. 0IM2)
Municipality of Anchorage
•• N•y
' Development Services Department `^
Building Safety Division
On -Site Water and Wastewater Program ' • "'
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 050502
During a recent Certificate of On -Site Systems Approval inspection and test
of the potable water supply well on Block 4, Lot 8 of Mountain Park Estates
#2 subdivision, a nitrate concentration of 12.9 milligrams per liter (mg/L)
was reported for the property's water well sample. The Environmental
Protection Agency (EPA) has established a maximum contaminant level
(MCL) of 10.0 mg/L for public drinking water systems. While private well
are not subject to this regulation, EPA standards are based on existing health
information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical'
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test', and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
CBM 6 ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E.
PH: (907) 345-1355
i�
i'
Dan Roth, Program Manager
M.O.A. DSD On -Site Services
4700 S. Bragaw St.
Anchorage, AK 99503
Dear Mr. Roth:
November 15, 2005
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
By means of this letter we are requesting reissuance of HAA 11050502 for Lot 8, Block 4,
Mountain Park Estates 42, located at 13020 Foster Road. The terms of the condition pertaining to
adoption of the new well ordinance, camera survey of the well, and pressure grouting of the annular
space around the casing have now been met. I was personally present during the down -hole camera
survey conducted by Brian Wille on 9/17/05 at which time there was no indication of water entering the
casing around the pitless adapter or anywhere down to the static water level. The details of the pressure
grouting are provided on the enclosed 'invoice/report by Brian Wille. Please call him if you have any
questions on that report.
Thank you for your assistance in removing the conditions and allowing the escrow account to be
closed out.
j
Sincerely,
Ted Moore, P.E.
Cc: Rona Florio, Homes Unlimited
By FAX 279-8879
NOV-15-2005 10:50F1 FROM:
70:3451355 PA
AAROW. PUMP & WEU SEROCE, LLC WOO OCC
P.O. Box 110496
Anchorage, AK 99511
Office: (907) 346.8355 • Fax (907) 333.8976 7141
Palmer: (907) 745.9077 • Eagle River: (907) 622.9335
CUSTOMER JOB SITE
1—anvlcs L{el��o Pei)A ��otin r 3 C7 ;L a -374-r r
'330 $ h90 N G,e//o e �
c vra � SO
F�
IemS-Go
a� -
a
-
INV O -OV
WELL DEPTH
fft
CKORWATED
PUMP DEPTM
ERC�OM
QUANTITY
DESCRIPTION
PRICE
AMOUNT
('aw
eorc-
4m
r
o u H ol
-F
' A-elow
POK a-1
arr 3-�Irr AAIAI
irktit'l
_I'
w
Q
CQ
Ilu e l' -5
"-
1
f
,T
Ot wr5f
#/3G
LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
TOTAL LABOR
WORK ORDERED BY
DATE COMP.
TOTAL
LABOR
PAY THIS AMOUNT
Thank You
SIGNATURE
(I HereDy ACknowleoQe the SBIIslactory Completon of the Above DescnDeD Work.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
rcn.n�e nu�nnr AT LYA I'Gnrn uw�.-u um 1 er nu�nn rn nu romnnne Jnr nnux
YLn�WG VnnnYL nl nnM VY n UIVn IfI IPGG 4G Ynnn VGV Vn N�Ln YYG nV VV VHIY.
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND S I U S11
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
O "I day of A[OWMb6V of 20Q5 by and between ft{r ti UlS ,
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
M
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as located at
at '7W4 cu Ct c i i6/ 101f-( , Anchorage, Alaska.
A. Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces
not included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of
(Sf.00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AWWTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWN'VTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's ANVWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner acknowledges Mat the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's ANVWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner:
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severahility. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
) ss.
The foregoing' strument was acknowledged before me this a day of �QLfLPW
20D fby t, Sh ,the Crno�i of
M , on behalf of the Municipality of Anchorage.
O AR Y PUBLIC FO ALA A 'TAR
My Commission expires: d2 0..- Y'-..
u1 '
I /, .1•
4'Pora F1 a t -r c
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box !96650 Anchorage, AK 99519.6650
www.ci.anchorage.ek.us
J (907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. oil- 023 —oe
HAA# 65D50A
Expiration Date: Z — �O ✓r
1. GENERAL INFORMATION
Complete legal description t,.F �� J3/aek Ptuun 1.+rn Park t-thefu 7t Z
Location (site address or directions) 13o w Fothr Ro!
Current Property owner(s) Dennrf 1-e I PAVUHe Itwtf Day phone ? NS- d'e0/
Mailing address
Lending agency
Mailing address
3308 1.104;'xefto Cf,. Co
, A-k9oty�
�unr�.f "Oo tg hyo �
Da"yyp"hone
Real Estate Agent uh Ismo «/ Day phone 7 YB - ys'oo -Ce It
Mailing Address X17 W. Jz '*4 her.. A^ P, Ak 90s4,/
Unless otherwise requested. HAA "behold by DSD ibr pickup. P lea/e my/ i?.%- yi A ce 7VB - ytlr;t:�
wl,a)
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
12
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
12
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (FIM) 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 HMS 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 weds 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 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. l 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. Sip cao" ,* en b on r-Aec(.c /irf
Name of Firm FlAf&t Me"',re/ goraAey Phone 3YS'-r3s-
Address 9NS'30 G—cl.o Sf �tiG^�c. /f~ 9%srd
Engineer's Printed Name Tyco 0-e /=. Moor Date 9/7-0/0s'
• . f
S. DSD SIGNATURE ;} ri000ea """•'
Approved for bedrooms.
Disapproved.
X Conditional approval for 4 bedrooms, with the following SUpuiations:
Honey shall be put in escrow in the amount of $8600.00 to grout the annular space on the
exterior of the water well easing to a depth of 40 feet below ground surface or as close as
possible to this depth Honey in escrow shall also be sufficient to construct a water storage
system in the event the propsed water well code (AMC 15,55) ie not adopted as written bx t e
Anchorage Assembly. Honey In ascraw shall r w e1 dAUIUL
approval. At the time of title transfer the new property owner shall mien the attached
maintenance agreement which shall be returned to this office before an unconditional approval
is issued.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: n,,Z„Original Certificate Date: 0
777 or
pl.. Glen
i
t
i
I
L
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water S Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST'
Legal Description:L-0I# c' � HovnAm#,? Pa. -Ir lg11� i►2 ParceltD: Or7 -a23 -!or
A. WELL DATA
Well type P� t If A, B, or C provide PWSID # M•Q.
Date completed 1?/17/77 Sanitary seal (YIN)_`
Total depth -22—fL Cased to _22_fL
FROM WELL LOG
Date of test 17-/1-7/77
Static water levet 67 R.
Well production 10 g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 ml.
Arsenic, — mg.11.
B. SEPTICIHOLDING TANK DATA
Nitrate 12_9 mg A.
Well Log (YIN) Y
Wires property protected (YIN) Y
Casing height (above ground) 2:r in.
AT INSPECTION
8 S ft.
S. Y6 t g.p.m.
Other bacteria _colonies/100 ml.
Date of sample: _&_7+31Ar Collected by, t=/•/I... Ticf. 5..�
Tank Type/Material 6 re eXcif / Fr Se a /amu Date Installed _ E / Z7 /0 7
Tank size ISW gal. Number of Compartments V Cleanouts (Y/N) _ Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) Y
Dateofpumping 9/'Z1/4Pr Pumper A*
C. ABSORPTION FIELD DATA ,
Date Installed b / 26/O3 Soil rating (g p d.tfe or ftt/bdrm) 2_0yy System type ea
''T��r i
Length 20 It. Width 1s' IL Gravel below pipe O. b" fL
Total depth ,(?.2_ft. Elf. absorption area 20_0 ft= Monitoring tube_Y Depression over field I_
Date of adequacy test 8 / u/os' Results (Pass/Faii). _ ��eu For_Y bedrooms
Fluid depth in absorption field before test O In. Water addec!726 gat. New depth_ in.
Elapsed Time: I min. Fuial fluid depth O in. Absorption rate >= d'Ge g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 6 type) N If yes, give date V-A-,
D. UFT STATION Xi ktr+ l
Date Installed & 1241 e3 Size in gallons ZSy Manhole/Access (YIN) Y
'Pump on' level at 231tin. 'Pump off level at tr4 In. High water alarm level at Z` rit In.
Datum 13 • H o'^ Cycles tested 7 I C Meek alarm d circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/ ift station on lot
1 O'1'
Absorption field on lot
1 34
Public sewer main
A/• A.
Sewer /septic service tine
7 7-,r
On adjacent Tots
On adjacent lots > 14101
Public sewer manlolekleanout >✓
Hokding tank ". A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation I V Property fine T b' Absorption field • �zx ?G'
Water main ti. A. Water service fine ? 10' Surface water > I &O'
Wells on adjacent lots 2460'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property fine too Building foundation _ V Water main N• A
Water Service line 2:1&P Surface water > 100' Ddveway, parkinghehicle storage �y
Curtain drain No•.a tar'• Watts on adjacent lots ;?!tcVp '
F. COMMENTS oec✓n Awle veatte Cfirrrl�l•r ittrvtr e��e+�•� t/ 48✓ren e. Ile✓��.
Pump i wtll 0.7 nv vndre� e
if ww hvN feii Ar -iw i Me evr! w f 06f2& f My t/6 c 7d"/2- `:
Stllai- it �fKA/yi•.
COO 010`10,11.f � p� MrN��q �••%weawrn. 41 * 70 -r
G. ENGINEER'S CERTIFICATION 404ee Owe r'.✓t as+tfN �I•.+�• C ` �✓%� •"r' F'
SaNar• L arc~04"A ,{ynvl� 7b rN/4N Jfuw11.[ wally /it : atsTy � :Tic It
Icar* that Ihave del'Ainedthrough WInspections and E A.W trill .............•••••••••:•••e
review of Municipal records that the above systems are In o �sGna...a
e•l dameaw ...�........ .........
conformance with MOA HAA guidelines In effect on this date. ,1. l ono;. i, uooR: D
Engineer's Printed Name 1 IresolprG T. / rGv-C ••.,y(o�:••e•� c
Date 2J 10r ^•„•/1:.., '^E Qs'
HAA Fee S H 30 '� I I Waiver Fee $
Date of Payment 9 /Zi / os'
Receipt Number 14`-5qq1�__
(Rev. 17/01)
Date of Payment
Receipt Number
09/28/2005 03:36 FAX 8076440788 SUMMIT MORTGAGE ®002/002
405 E. Beroon Blvd.
Sults 101
a+caoroge. AKTo: Dan Roth
99503 Reference: 13020 Foster Road
T 9o�.s,s.e�oo
F 907 eu.070e Summit Mortgage is going to escrow 2 x's the bid amount for Pressure Orouting the well
though 1" pipe and Installation of 1.000 gallon storage tank. The money in escrow will
not be released until MOA approval.
Thank you,
ephens
Summit Mortgage
6464704
�.wrrmlmort�ycstacom
09/28/2005 12:26 9072798879 ROMA FLORIO PAGE 01/01
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•• • • PLAT -ARE -NOT -SHOWN •HEREON. •"t*f rn
SGS
SCS Rett 1055433001
Cunt Name Flattop TechnicalSty.
Project Namt/d L8 114 Mtn Park Est No 2
Client Sample ID L8 [)4 Mm Park Est No 2
hlatrlt Drinking Water
PUISID 0
Sample Remarks:
All Dotes/rimes are Alaska Standard Time
Printed DatcMme
0829/2005 11:06
Collated Date2lme
08232005 11:30
Received Date/time
08232005 13:50
Technical Director
Stephen C.Ede
Adorable Prep Analysis
Panmcrer Results POL Unita Wood ContainerlD Limits Date Date ink
Nitrate•N 12.9 • 0.100 mg/L EPA 3532 A (c-10) 0823/03 AZS
Hierobiology Laboratory
ToutColitorm 0 coVlOOmL SI61209222D A (o-1) 0823105 TLF
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MUNICIPALITY OF ANCHORAGE7.
'
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
,... fin_ /.. .'. r...`.. .. r. -..• ._.Ir. .. -.. y.....n. .i.:y J R 1-; �,. 1 1:.. _ _
P.O. Box 196650: Anchorage, Alaska 99519-6650
r-
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # (N-) tea IS- (A HAA #
1. GENERAL INFORMATION
Complete legal description mou)4;N RA IEskV,,i SArt:d`SIln 42 lat8 15i
'Glot k'q
Location (site address or directions) 130 26 rrJn- D,-.
Anchors Ak:45lG
Proper4 _6wner"3%'ure •&'56tier Dayphone ZX -C-5(-2
Mailing'address '13 Lo *res�e, A- A„cbara4 r- kk 445/C
Lending agency. l� Day phone
.....-Mailing address
Age' .:_Day phone _.. .
"Address -_ -
Unless otherwise requested, HAA will be held for pickup
2. NUMBER OF BEDROOMS:_
-3..---TYPE OF WATER SUPPLY:.
Individual well
Community well -.
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest- T
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site_
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.
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Municipality of Anchorage AL
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: nv,k rIt.S 1'Z 1, 16 1*MParcel I.D.
A. WELL DATA
Well type 12,4 1 0rtt If A. B, or C, attach ADEC letter. ADEC water system number =
Log present a) Yea Date completed 12 117 177 —Driller -A ID4
Total depth - 11 � Cased to '75' Casing height 2.51
Sanitary seal (ION) —Yes Wires properly protected (9N) —Yts
FROM WELL LOG
Date of test t Z- it - 7 7
Static water level 67 �
Well flow 1 0 g.p.m.
Pump level •� Icti• .
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
S%3o l4L
9/
7,o g.p.m.
wet L4 OWA
Septic/holding tank on lot I oa , ; On adjacent lots 100
Absorption field on lot --t On adjacent lots ---1004
Public sewer main —100 Public sewer manhole/cleanout IOe
Sewer service line loo+ Petroleum tank
rn
n
m_
C
rn
Q
WATER SAMPLE RESULTS:
Coliform S,l.ycac lK T_ Nitrate &--q a k 0therbacteria. Av
Date of sample: -- 3/1&/47_ Collected by:
B. SEPTIC/HOLDING TANK DATA
Date Installed 6/31/76 Tank size 15 a b as Compartments 2
Cteanouts (014) yes ' Foundation cleanout ®N) Y« Depression (y& Ne
High watpralarm (Y;� AIc Alarm tested (Y/N)
Date of dumping I23 14-1 Pumper
SEPARAON DISTANCES FROM SEPTIC/HOLDING TANK TO:
',� �
Well(s)onlot-'•103'••••"���+ Onadjacentlots 100Foundation 13
I .. !
To property line -3 q,//>•*• Absorptionfield 8 Watermain/service line 00.4
Surface water/drainage ►°ar
72.026 (Rev. 7151) From - - ' ' �' - - CONTINUED ON BACK PAGE
C. LIFT STATION u A
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
_ Manhole/Access (Y/N)
"Pump off" level at
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed 5 A //_7 r-"
Soil rating 150 So . ri /"111 System type-T'r+t(+
Length 52r Width
37 Gravel thickness—G Totaldepth 19.0
Total absorption area L 2'/
5.1•• Cleanouts present (SAN) y`s
Depression over field (Y/& /Vo
Date of adequacy test - s1361g7
Results(fpaia fail) P• ss
for Y bedrooms
Peroxide treatment (pest 12 months) (Y16P o()# if yes, give date ^
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 120
On adjacent lots 100 + Property line 10
To building foundation 321
To existing or abandoned system on lot -
Onadjacent lots 1001
Cutbank 10°t Water main/service line t./001
Surface water 1O0 f
Driveway, parking/vehicle storage area
Curtain`drain 1004-
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in eflect on the date of this inspection.
q�
�E of Al. >tI
Signature iGj~P'� •�•9�1�
Engineer's Name f ..'49L �_1 *�♦
Date •• /
R` Ca • •. MOr • t�
HAA Fee $ 170.0
Date of Payment 4-to-ciz
Receipt Number
72-028 (Rw. 3/91) B. k MOA 21
Waiver Fee: $ —
Date of Payment
Receipt Number
., ...: rYMh►.�JWY`'iYl•yy}���ritiU}Y�.�w1.rH.'�:W JItaMit%�'.w+_'�w..r. �-.�.. ... .__...
A
H
2%
,r1 1 11 ng Co.WELL CONSTRUCTION L00
�/
Driller •T L �USOS no.
Well ownerDell well Completed
��w>�Pc /p/ � T�"�`�
Wall location: (address t legal deterlpllen ^A T
Nis ect community/in tr ^v/�L�s7
)J•/O Ii A/ • �a /�
.E�t Tw ir•t r,6��: a/t/nN '�y� Location vetch or re■arle
C k u .SSG •�.? Z -7P
OeD1A of wall '0 Calle
t: deDth__.l��It. dla..��ln,
Static water lovel_ It. (above, bole,) land aurlaee. Dale 7 ,
ilnllh of ■ell:encn.ln screen, Perforated. open -hole, other)
Describe Inlarrala and tile:
Wan Yield lasted br (Dumpino boiling. err) at /O
for —„'——pVnln.
Reuss .Iln_[J7--ft, of drawdown boor'
a toile len 1,
Iso Ih below lend
surface In last
a
DRILLER'S MATERIAL L00
Oln du orlpllon of ltrAli penetrated
(1121 of material• color• hardness el drilling. and water content)
1
r
r .
Faa
INVOII
OOFOCS200 SEWER ANDDRAI 04
ok ay Cfe
?1"$&d CLEANING SERVICE
P.O. BOX 112888 PHONeE345-2513 ANCHORAGE.ALASKA 99511.2688
fir/ 4 &c) ;ev—
L/j62D ;Cos 11-e.k- J
Job Address
qo�- 10.Iz
I'
Up
DATE
u/ivnQL
TERMS -30 DAYS
600
CUSTOMERORDERN
Zoe
ROTO -ROOTER SERVICE CALL HRS.
STEAMTHAWING t HRS.
TRIPCHARGE HRS.
OVERTIMECHARGE HRS.
ADDITIONAL LABOR CHARGE HRS.
PUMPINGSERVICEGAL.
HRS. 0
O
o
HYDROJETSERVICE
HRS.
MATERIALS
PLEASE PAY FROM THIS INVOICE
TOTAL
ISS
TOTAL FOOTAGE CLEANED OR THAWED BLADES USED _,—
PROBABLE CAUSE OF STOPPAGE 0
\' LINECLEANED
O JOBNOTGUARANTEEPTJ'�r{-R'F/OJrL/LOWIN E^AS�O
WORKACCEPTED BYE/_ •��:�+�4
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907)456-3116•FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645
Arctic Slope Consulting Group
301 Danner Avenue, Suite 200
Anchorage AR 99518
Attn: Ken Ackerman
our Lab f: A116766
Location/Project: -
Your Sample ID: Well Head
Sample Matrix: Water
Comments:
Method Parameter
EPA 353.3 ' Nitrate -N
Reported By: Susan C. Tifental
Microbiology Supervisor
Report Date: 04/07/92
Date Arrived: 04/03/92
Date Sampled: 04/02/92
Time Sampleds 1625
Collected By: KA
MDL - Method Detection
Limit
Flag Definitions
B - Below Regulatory Min.
H - Above Regulatory Max.
E - Below Detection Limit
Estimated Value
Unite Result Flag
mg/l 8.5
Date
MDL Analyzed
0.1 04/06/92
ARCTIC SLOPE CONSULTING GROUP. INC.
—1
Engineers a Architects a Scientists a Surveyors
b1 �yI ewM McMe9., wr.e 99s19-bs!
IY.pneh: (907) N!-119! rem: (!07) U9-4}1]
LOCATION:
Sub
Client's Name:
Address:
DATE: a 13dI ft
WELL LOG
Ak
TESTER: �khA
Initial Reading on Meter:3af4
DRAW
DOWN
TIME
GPM
GALLONS
VOLUME
GALLONS
TOTAL
FIELD MONITOR
LEVEL
METER
READING
3:ZA
n
40
q/'
OFO
1'3"
3.,qh
3.1
47
41
f2'3"
3107
.' 5 +
l03
1.7
Z -G
" 7.1
QZ'E t
8133
217'
&1:1$•
3.y
IZ
73'7"
916y
3'6*
H733
Z.c
3y
163
•
37- Z3
5'ZY
'i:41)
6.6
►oc
263
9610
3323
s'/o•
5:6z
7.73
1tG
379
1 t.' 16
31431
("(91
5: /9
7.(.z
107
bG
7'1"
35Y.4
$'S~
5:33
6•G
-7
SSS
98'5'
3C49
11'5v
.6-:+/6 ASI -3
v
15
G ud
9 ' 5
,(IF
S:3
9 Se 3
'KI
5:39
�4 K
Z'b°
:y
93' grr
7-4,9, 4,_
93' yrr
Zr
:46
Ci3'
NOTES:
Production Rate: 3.5 GPM 24 -Hour Capacity 5650 Gallons
r�
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date �Q c--
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
30" )15001292-
(b) Property Owner &&e ,&oAer Telephone: Home i 3 Business �7G- G362
Mailing Address /'' FLS TES 7 Af/L�� /%k, 995/G
(c) Lending Institution Ak (%s/g Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the followIina address: or. Check here If hold for pick up.
List contact person and day phone number below.
rA LL.
Mrs V44 -44V)
2. TYPE OF RESID NCE
Single -Family
Number of Bedrooms !!1K
3. WATER SUPPLY
Individual Well Community ❑ Public ❑
Note: If community well system, must have written confirmation from the Slate Department of Environmental Conservation
attesting to the legality and status.
4. SEWAG DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-M (Rsv 8'861 Front
n r,
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. �pn
Name of Firm _Vj&& ���"' ;" _ Telephone
Address yt-iv sr,^7r C' 'D --
Date 40 C;" "'8[7
�i,! S�F� kw /Jd4 PA!Coe "WS O� ',SL G Sy400ee,a{ _
Dole R. M:1
'a'•. No. 2055•E
e
yc'n ........
6. DHHS APPROVAL//! ►'//�
Approved for !��`� bedrooms by Dated ' Z4
Approved— Disapproved Conditional
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2 . 72m5 (R" a 66i ank
n
G3 1 %11� ICIPALITY OF ANCHORAGE (MOA)
143 HEALTH AUTHORITY APPROVAL (HAA)
1, CHECKLIST- FEBRUARY 1984
2644744
1?11Vd'-)�tAvW �3 LegalT; i�q n:
Fl41St�t4 S"; d d5 a
A. WELL DATA
Well Classification �� rNWi/y If A. B, C, D.EC. Approved (YIN) 60K e
Well Log Present (YIN/) � Date Completed • nX 4= 7% Yield IS pw'� 9t
Total Depth111 Cased to Depth of Grouting ^me_
Static Water Level L7F Pump Set At & Ai &Z2? //
Casing Height Above Ground Zrs Sanitary Seal on Casing (YIN) %'C's•'
Electrical Wiring in Conduit (YIN) Y� S Depression Around Wellhead (YIN) NA
Separation Distances from Well:
To Septic/Holding Tank on Lot : On Adjoining Lots
To Nearest Edge of Absorption Field on Lot; ; On Adjoining Lots
To Nearest Public Sewer LinTo Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by LAR AY' ; Date /pAq, IS 7
Water Sample Test Results crs�Atn�+
CommentsX6 "W A,
B. SEPTIC/HOLDING TANK DATA
Date InstalletAgM47— Size No. of Compartments
Standpipes (YIN) x Air -tight Caps (YIN) Foundation Cleanout (YIN) %r
Depression over Tank (YIN) /%o Date Last Pumped -113%
Pumping/Maintenance Contract on File (YIN) — ; for
Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (YIN)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well
To Property Line
To Water Main/Service Line
Course
Comments
Page 1 of 2
1Jpc/ To Building Foundation /0 /
To Disposal Field /Z/
To Stream, Pond, Lake, or Major Drainage
77-026 IFr,r 8'MI From
E
C. ABSORPTION FIELD DATA
1)ECEIVE1D
Soils Rating in Absorption Strata % Type of System Design 71- eA
Date Installed Length of Field ZRF
Width of Field -Ci /is L1 Depth of Field &7,� -e 7
Gravel Bed Thickness
Square Feet of Absorption Area '���✓�1 Standpipes Present (Y/N) y
Depression over Field (Y/N) /✓ Date of Last Adequacy Test,- 1�%AaBi If 07
Results of Last Adequacy Test 44774-.S i
Separation Distance from Absorption Field: �.
To Water -Supply Well Arv/
To Building Foundation Zai
To Property Line >�
To Existing or Abandoned System on
Lot - >V' A ; On Adjoining Lots A00"f
To Water Main/Service Line
To Cutbank (if present) '07o,0 -1,c -
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
— Dimensions
Manhole/Access (Y/N)
_ "Pump Off"Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
'" Check Permitted Bedroom Rating Against HAA Request "
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company
Receipt No. QCC3 I — LAC)O5
Date of Payment (n' ILk-81
Amount: E 100 1 00
Page 2 of 2
72-076 (Rev B'861 AMM
MOA No. C Lp,-) - co� 1_Lob
BESSE, E: M & POTTS r�
October 19, 1987
Mr. Dan Bowles
Municipality of Anchorage
Department of Health and Hunan Services
825 "L• Street
Anchorage, AK. 99501
Re: Lot 8, Block 4 – Mountian Park Estates t2
Dear Mr. Bowles:
MUNIOPALRY OF ANCHORAGE
DEPT. OF HEALTH d
ENVIRONMENTAL PROTECTION
OCT ] 9 1987
RECEIVED
Pursuant your request, we have done further investigation in an
effort to provide further information on the onsite system for the
referenced lot.
We probed the observation tube to determine the trench depth. The
depth to the top of the septic rock is 71. We were not able to
define the make up of the trench below that depth. From very
sketchy informtion, we believe the system was installed in 1977
possibly early 1978. The system more than adequately takes the
water.
The septic tank diameter measures 5.251. The length between stand
pipes is 131. Using the 5.25' diameter and 13' length, the volume
of the tank is 2100 gallons. This number is conservative as the
tank probably is 14' long making the volume approximately 165
gallons larger.
This is the extent of the information we were able to determine
without digging the system.
Sincerely,
Da e H41,PE �—
Partner
]mm
cc: Mr. Bruce Booher
ENGINEERING, PLANNING, SURVEYING
2220 E. 88th Ave. /Anchorage, Alaska 995071 Telephone 907,349-64511344-1352
"Providing a quality personalized service to those building Alaska's future"
BESSE* EPPS & POTPS
^ 2220 EAST 88 AVENUE n
ANa.ORAGEc AK 99507
�G •�F�C�� 3.� (907) 349-6451
to 'a, WATER WELL TEST
%. .4.. Date:
< <�,
-Date R. M,rrell •;^��/ /y/
••......•• .,;,•.,. Subdivision: ,..
4L Saar ssti ." Lot: S
Block- Y
Cl'ient's Name:' e -t
Address:— Fon
r -;tial Raiding on Ma
y��=—%so
DRA:•i
DQ.?L TIME GPM
/U
i
boo . �
GALLONS GALLONS
0 VOLUME rirAA.
tnrz.r -f T
ril
y0g�P2
F.el d METER
Mir: /e��(e rel READING
Rate: /0.03 GP21 21 ._ac- Oallcns
r�%,
INVOICE
Norocsocove'asEWER AOND DRAIN
r>lway �e 7%d4c&e4
CLEANING SERVICE
VO&®ae 24444"
P.O. BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688
11)
- JOb Address ` 1 i� �"1� {� • 1 /' —J
I U I ALF DOTAGE CLEANED OR THAWED
------------ t_BLADES USED
PROBABLE CAUSE OF STOPPAGE
LINE CLEANED
E3 JOB NOT GUARAN`TE'Ep FOR FOLLOWING
WORK ACCEPTED
L � V
n
w
NORTHERN
TESTING
LABORATORIES,
INC.
800 UNIVERSITY PLAZA WEST.
SUITE A
FAIRBANKS. ALASKA 997C9
907479-3115
2505 FAIRBANKS STREET
Time
ANCHORAGE. ALASKA 99503
9072778778
Besse, Epps, & Potts
2220 E. 88th Avenue
Anchorage, Alaska 99507
Attn: Landvean
Source: Mountain Park L8B4
Sample ID#: A100887-1
Parameter Unit
Nitrate -N �,mg/L
Result
2.0
Date
Arrived:
10/08/87
Time
Arrived:
1229
Date
Sampled:
10/08/87
Time
Sampled:
1101
Date
Completed:
10/12/87
ADEC MCC*
10
leported By: CL Date: 10/12/87
Carol J. Garrison, Vice -President
* MCC = Maximum Contaminant Concentration
� � n
NORTHERN TESTING LABORATORIES, INC.
800 UNIVERSITY PLAZA WEST. SUITE A FAIRBANKS. ALASKA 99709 907-4793115
2505 FAIRBANKS STPEET ANCHORAGE, ALASKA 99503 907317-8378
Quality Control Report
Client: Besse, Epps, & Potts
ID#: A100887-1
Listed below are quality control assurance reference samples with a known
concentration prior to analysis. The acceptable limits represent
a 95% confidence interval established by the Environmental Protection
Agency or by our laboratory through repetitive analyses of the
reference sample. The reference samples indicated below were analyzed
at the same time as your sample, ensuring the accuracy of your results.
Sample# Parameter Unit Result Acceptable Limit
EPA WS378-6 Nitrate -N " mg/L
0.93 0.84 - 1.02
Reported By: Date: 10/12/87
_________ - --------------- ------------------------------
Car Garrison, Vic
C
e -President
OCtt51D'E
- -C r-ve
^ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF H:ALTH &
ENVIRONMENTAL FP.OTECTION
926 LStreet- Anchorage, Alaska 99601
•
ENVIRONMENTAL ENGINEERING DIVISION JUL 2 51979
Telephone 264.4720
pp CC /r�CiU ' 1�C
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW& D
DIRECTIONS: Complete all parts on page 1. Incornpleas requests will not be prooasesd. Plains allow ten (10) days for praewing.
1. PROPERTY OWNER
v1"�
PHONE
2ZCo ?130 -
MAILING ADDRESS
r4hQ
MDENT
Li � vd,
PROP R Ilf different from above)
PHONE -
H E2.
2.BUYER
❑ Three ❑ Six
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
D Muep am
PHONE
27ro-2-8o
MAILING ADDRESS
^�
Mole
depth (attach log if available.)
a8n(l Q. t 111
eelfindividual/on•site,giveinstallationdate��a�
S. LEGAL pESCRIPTQIOIJ
L
�+SS2-
CJ
�Y (� l
STREET LOCATION
9. TYPE OF RESIDENCE
NUMB R OF BEDROOMS
El One Mf Four ❑ Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
0 INDIVIDUAL'
' ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
& SEWAGE DISPOSAL SYSTEM
eelfindividual/on•site,giveinstallationdate��a�
0 INDIVIDUAL/ON-SITE"
test is requ.
If system is over two (2) years old an adequacyired
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78) - /
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME -
TIME
TIME
DATE
DATE
DATE
INSPECTOR -
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
r--)
INSTALLER n
(j7 Syr y�
SOILS RATING
❑Sep'ti -Taor ❑Holding Tank
Size: SS If Tank is homemade
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
'I
4. DISTANCES
WELLTO:
Septic/Holding Tank
107
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
dl --.-APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE ^
BY (Title
LEGAL DESCRIPTION
72i110 1Rev. 3118)
r`� n
Anchorage
July 27, 1979
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 2644111
GEORGE M1!, SULLIVAN.
MAYOR
DEPARTMENT OF HEALTH AAD ENVIRONMENTAL PROTECTION
Joseph Valley, Jr.
2804 West Northern Lights Boulevard
Anchorage, Alaska 99503
Subject: Lot 8 Block 4 Mountain Park Estates Subdivision #2
Approval for your individual sewer and water facilities can
not be granted until the following items have been completed:
(1) The water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
(2) A well log submitted to this office.
(3) Seal the well heads of the abandoned wells.
Notify this department for a re -inspection when the noted
descrepancies have been completed. If there are any further
questions, please contact this office at 264-4720
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Cindy Murphy/Graham Young
2804 West Northern Lights Boulevard
99503