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Home My WebLink AboutMOUNTAIN VALLEY ESTATES BLK 2 LT 3Mountain Volley Estate Block 2 Lot 3 #050-063-11 Municipality of Anchorage Page 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Swgyo331 PID Number: C)50(,3111 N8Te ATHAtJ 0LAQS> Wastewater System: 13�New ❑ Upgrade Address: Q01ANAONA ST. HD4�5 ABSORPTION FIELD Phone: No. of Bedrooms: )ZDeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION SOII Rating: Total Depth from iriginal prods: GPD1S Ft Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ^^ S K 1`4000,4TA10 \/AU-fy e$T. So Ft. S' Ft Township: Range: Section: `� Fill added above original grade: ' Gravel length: i --� --- 0..r- I Ft 99 Ft WELL•ExISTI.x.❑ New ❑ Upgrade :).85, Gravel wilt": _ Number of lines: DisnncexweenlnFt. I Ft Ft Classification (Private, A,B.CI: Total Depth: Cased To: Total absorption area: Pipe material: ASTYA -P9LiVATE .7t-10 Ft. nS' Ft. (05 8 -7gq SO Ft. -VaD3H IFSID Driller:r� RAVAPA4T 'D Date Drilled: 810 1-11-15 Static Water L"I' Ft. Installer. nn SO✓rNROQK L,OAJ51, Date Installed: eIS1_95 Yield: I Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES RSeptic ❑Holding 0S.T.E.P. To Satiric Absormldh Litt HWdbip ubliw?rhate Manufacturer: Capacity In gallons: 1000 From Tank Ftald Station Tank Lines Server Lin NCM0RAbf /ANK Welt INS 1551 — 15'+ Material: STEL Number of Compartments: ^ d- Surface Iuo'+. 100'+ �. — — LIFT STATIONWater Loti 1 Size in gallons: Manufacturer. Line 55 1'1 — — r..� "Pump on" level at: "Pump off" level High water alarm at: Foundation (� y Bo ti' — Curtain N 0" ICN0F-1 Pump Make 6 M ecirical Inspections performed by: Drain Remarks: X F00"DAT"Okt sJOT IN Q '{ivAIC BENCH MARK Location and Description: eG ria -JAI.- trJfFECTIOPI -DISTAw+GCS ARE APPzoxtwAz.. Assumed Elevation: / , E S & S ENGINEERING gDates: 1'3D'`ts Inspections performs Eagle River Looe Road, No.204 St $ s r I� vea ' 'j 2nd 9' 3t ' 9S f aOSENT G COWAN ,! 0,, CE - 8801 Department of Health and Human Services approval er'iq�orLF"`.i;��-=r �""�"` Date: Reviewed and approved by: 72-03 (Re". 9191) MOA 25 Permit No. SW940331 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 3, BLOCK 2, MOUNTAIN VALLEY EST. 05063111 PID No.: 7213 A(Row. W91�� 251 'U I \ \ \ I STI ST2 FI AL GRADE µT C04 95.6• 97. ' SR NEW 9 .1' 1000 G SEPTIC L 92.9• TANK 84.1' 1.79.0' NO WATER F011NL, ' 7-3-94 'NOTE—LOC TION "A' " IS THE. WELLHEAD A ST1 146 ST2 152 CO2 155 NEW TRENC CO3 156 ALI% C04 182 sort 7MTi 182 EW 1000 G L:Isr EPTIC TANK 2 \\\ r2KrN\\\ AT 4. I XE/ _ (r.. •.' 01 r�\ RGERT C. COWAN �? c� cJ CE -8801' op to 0 t �a ' •.......•� N m 7213 A(Row. W91�� 251 'U I \ \ \ I 1201 Ramona St. 99515 ANCHORAGE, ALASKA 344-7714 SIX INCH WATER WELL DRILLED---------- OUT TO THE DEPTH OF -- 240 Ft. DRILLED AT THE RATE OF ----------- PER FOOT. Steel casing seated out to 63' . PROPERTY OWNER Bernie D. Claus 344-7714 LOCATION OF WELL SITE Lt. 3 Rlk._2 Mountain Valley Estates DRILLER Bernie Claus of Rampart Drilling Works 344-7714 WELL LOG: 3 18' Silty sandy gravel. 45% coarse gravel & small boulders. 18 - 41' Coarse gravel. 15% silty material. 41 63' Hardpan. A cemented gravel. 63 241' Bedrock. A sedimentary rock material. 'No water production showing until about 116 - 119 ft. 3/4 gpm showing. By 183 to 187 ft. . new water yield uD to one Rom out of a granular rock. From 232 to 235 ft. . a little over two gpm of water was.encountered coming out of a porous rock material. The total water production comes in at 3 gpm. 183 gallons of water per hour coming back up to 45 ft. of surface. 3/4 horse- power submersible pump should be installed down to about 220 ft. This Water Well paid for in full. Materials, casing, ect. This water well produces four gpm after full drawdown, for about 45 minutes, (short duration) then levels off to 3 gPm, (long duration). COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF -------------- THANK YOU VERY MUCH. B NIEE CLAUS OF R RT DR RlL DATE Feb. 12, 1075 SERVICE CHARGE 0 F IY.% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT r�06Y\ PERMIT NUMBER:SW940331 DATE ISSUED: 9/02j9� DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 9/02/95 OWNER NAME:CLAUS BERNARD D OWNER ADDRESS:1201 KAMONA ST ANCHORAGE, AK 99515 PARCEL ID:05063111 Npori gltl°1S X LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES BLK S.F.C. 3:m1w-L-9�- 2 IT 3 LOT SIZE: 45012 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE • 0/7 6-/ DATE: SITE PLAN ' WASTEWATER ABSORPTION SYSTEM "� LOT 3 BLOCK 2 MOUNTAIN VALLEY ESTr�l� 7S� r I HILAND DRIVE y WELL /ELL WELL \� \ o\ SEPTIC o \ SEPTIC �\ d VACANT EXIST WELL SEPTIC i d\ so•R• 1 00 GAL SEP IC TANK v -i TEST HOLE \Z l 'W X 6 D X 47'L TRENCH VACANT 3� \ REPLACEMENT TR NCH AREA BI$DSE[UG DRIF / WELL'T I VACANT VACANT WELL I I V\ THERE ARE NO PRIVATE WELLS WITHIN 100' AND NO PUBLIC WELLS WITHIN 200' OF PROPOSED ABSORPTION SYSTEM. THE LOT IS SERVED BY AN EXISTING PRIVATE WELL � F AZ4 *q THEDRAINAGE EASEMENT CARRIES SEASONAL RUNOFF P *� 9 �?' • �9 @�� LOT SIZE: 45,862 SF �`+ LESS: WELL RADIUS, PERIMETER DRIVEWAY SETBACKS 27,132 SF xe Rr x. x11soN ® AREA AVAILABLE FOR SEPTIC, 18,730 SF t cE-17sa r`/ PREPARED FOR: HENRY H. WILS❑N, P.E. f PbressioN"o NATHAN CLAUS 9601 BUDDY WERNER DR ®we ANCHORAGE, AK, 99516 346-2000 DATE, 7-12-94 DRAVING # SCALE: V = 100' DESIGN WASTEWATER LOT 3 BLOCK DETAILS ABSORPTION SYSTEM MOUNTAIN VALLEY EST 47'TRENCH AVRY x. WILE N CE -1772 A� `o "�+i SS10NP4_ U1 15' MIN. I DESIGN CRITERIA: PROPOSED FRAME HOUSE 3 BEDROOMS X 150 GPD/BEDROOM = 450 GPD SOIL RATING: 20 MIN/IN = USE 0.6 GPD/SF 450 GPD / 0.6 GPD/SF= 750 SF ABS. AREA DEEP TRENCH DESIGN WITH 750 SF 750SF / (2)(8) = 47' TRENCH DESIGN MINIMUM SIZE 2'W X 8'D X 47' LONG 8' MAXIMUM DEPTH OF GRAVEL 2' HD INSULATION REQUIRED OVER FIELD & PIPES IF < 4'COVER INSTALL 1000 GALLON SEPTIC TANK. INSULATION REQUIRED IF BURIAL DEPTH < 4'. rRLr'tiKLu r um: HENRY H. WILS❑N, P.E. NATHAN CLAUS 9601 BUDDY WERNER DR ANCHORAGE, AK, 99516 N W J Q Q U W WJ WJ W J Q u U W j W Fi] U Ll RADE 0 GAL. T. con DN or PIKE SEVER ROCK W BOTTOM Of TRENCH 11.0' M2' HD INSULATION OVER ENTIRE FIELD t ALL PIPES V/ LESS THAN I' COVER M• FILTER FABRIC OVER ENTIRE FIELD 47'TRENCH AVRY x. WILE N CE -1772 A� `o "�+i SS10NP4_ U1 15' MIN. I DESIGN CRITERIA: PROPOSED FRAME HOUSE 3 BEDROOMS X 150 GPD/BEDROOM = 450 GPD SOIL RATING: 20 MIN/IN = USE 0.6 GPD/SF 450 GPD / 0.6 GPD/SF= 750 SF ABS. AREA DEEP TRENCH DESIGN WITH 750 SF 750SF / (2)(8) = 47' TRENCH DESIGN MINIMUM SIZE 2'W X 8'D X 47' LONG 8' MAXIMUM DEPTH OF GRAVEL 2' HD INSULATION REQUIRED OVER FIELD & PIPES IF < 4'COVER INSTALL 1000 GALLON SEPTIC TANK. INSULATION REQUIRED IF BURIAL DEPTH < 4'. rRLr'tiKLu r um: HENRY H. WILS❑N, P.E. NATHAN CLAUS 9601 BUDDY WERNER DR ANCHORAGE, AK, 99516 N Municipality of Anchorage DEPARTMENT OF HEALTH 6 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Ni ArlM N C LADS DATE PER LEGAL DESCRIPTION: L 3 g Z MT. dAc.(_Ey E5/.Township, Range, Section: 71 SLOPE 1 2- 3- 4- 5- 6- 7- 8- 9- to - 11 345s7891011 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 21314151617181920 COMMENTS a -1-S ov94r7fcs� 5;1i Ec- 5CZI-4V'j San la yt y -S {a 3'/ Rilc/< 15-11 51111 gez✓C( ;J Fa /?_1w -533 TU SITE PLAN WAS GROUND WATER ENCOUNTERED? No• S IF YES, AT WHAT �. p 1 0 DEPTH? P E 0*0 Is Witar Altair 11110 in07 -Y'-'I Dalc 1. Reading Date Gross Time Net Time Depth to Water Net Drop G•ZL �• yN L" 0«1 .? ..,t PERCOLATION RATE T-2 (minutesnnch) PERC HOLE DIAMETER o so TEST RUN BETWEEN J— FT AND FT of tit% ti,.dvocK. Use, eittD 4-ve, b,. 6090wr wrtvc-1 I 11 t bi. �osJ Y v e10 3'6e.iow USc Ts<vlff lMS �✓ �� Hitlh Let/t� PERFORMED BY: �' 1+� fNr 1 S e n I _14. wt 13 e✓� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 3 4 72-M (Rev. 4185) ' MUNICIPALITY OF ANCHORAGE 67 !+ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-631-11 1. GENERAL INFORMATION Expiration Date Complete legal description MOUNTAIN VALLEY ESTATES Location (site address) 4916 Birdsong Drive Eagle River Current property owner(s) Mailing address Real estate agent 2-g-2- 0 z-1 BLK 2 LT 3 AK 99577 WENDY WHITEMAN Day phone 4916 Birdsong Drive Eagle River AK 99577 Pete Carpenter 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 907-854-8404 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 412, -90 Coop Date of Payment 20 Receipt Number COSA # 0_"pC�2.0 (.GS 0 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for Phone 907.406.1058 Date 49 .....:. nd �� .• eta .� bedrooms � `cC Ko. CE 11-904 , • �,��d bedrooms �Te�fOpROFESS��NP� bedrooms, with the following stipulations: �C g AND o � ATE K �NASTLto -CO^ i��n�T SER�hG` , Original Certificate Date: �O") o2v The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. IjjWrAj__�_[ =1- COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory� J Well Flow Advisory Other S ce rNa x/iso D v' COSA Checklist blue sheet —T— � Legal Description: MOUNTAIN VALLEY ESTATES BLK 2 LT 3 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1975 Total depth 240 ft Cased to 63 ft 0 Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) ' 12 in. Date of flow test for COSA 10/1212020 Static water level at beginning of test 76 ft. Comments B. TANK DATA Age of tank(s) 25 years Tank type/material septic steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 12 Oct 2020 D. ABSORPTION FIELD DATA Parcel ID: 050-631-11 of Structure served by this system Well production at time of test 0.91 gpm Water storage tank volume 1140 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.16 mg/L ❑ Nitrate less than MRL (ND) Arsenic 9.95 ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 10112/202D C. LIFT STATION ❑ Required maintenance com Age of lift station y Lift station material Comment Which system tested (date installed) 1995 Adequacy test date 10/1212020 ❑ ALL standpipes present per record drawing Results F, -/]Pass For 3 bedrooms Total measured depth from grade 12.6 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.6 ft (min) Water added 583 gal ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state New depth 0 in depth into effective Elapsed time 0 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 1450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' M Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft � Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25'7 Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' r-71 Yes if No ft Water Main > 10' Animal Containment > 50' FV -1 Yes if No ft 0 Yes if No ft P/1 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' MYes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: [j Absorption Field > 5' F-11 Yes if No ft Private Wells > 100' r-71 Yes if No ft Water Main > 10' F71 Yes if No ft Community Wells > 200' P/1 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' [j Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 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. L9GIIE'S COSA Checklist yellow sheet DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201588 Subdivision: Mountain Valley Estates Blk 2 Lot 3 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 25 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. X ,ggg{ � �#� � � � Mailing Address P `O� Box 196650 * anchorage,"Alaska 9919 6650 * wuvw muni org xs � Municipality of Anchorage A. e r::iiiSf ss:a-'r Development Services Department' Building Safety Division .:R ;F e r On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. c i. anchorage. ak. us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) 9 OSC201588 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 3 of Mountain Valley Estates subdivision, the well's productivity was determined to be .91 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD._��-f�31�11 COSA# Expiration Date: - 1. GENERAL INFORMATION Complete legal description Lot 3 Block 2 Mountain Valley Estates, Eagle River Location (site address) 4916 Birdsong, Eagle River AK 99577 Current Property owner(s) _Stacey Childers Day phone Mailing address 4916 Birdsong, Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent _Bill Emoie/Dvnamic Day phone 346-1916 Mailing Address 3111 C Street, Anchorage AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-sfte ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 8 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 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. 1 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone. P.E. Date 5/18/06 Engineers Comments: In conducting an adequacy test, i attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. „aaa The operational lire of all welts and septic systems depend on the local soil condition, ground water •�P� ♦♦♦♦ levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and : `7♦♦ satisfactory test results do not guarantee future performance of the system, nor do they guarantee that o . .r a ♦•, there are no hidden defects or encroachments. PCS can therefore not provide any warranty for future • • performance nor give any estimate of how long the system will continue to meet the operational • _ _ ,,,, requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed Vi f� Steven R. Ponno e �: above. Any reliance upon or use of this report by any other person or party is not authorized nor will it •i c% E t a confer any legal right whatsoever. ♦♦ 5. DSD SIGNATURE ♦♦h..RazrRiS.•�� l/Approved for _3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: rtnacrtments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 06 tR«. „Ast Municipality of Anchorage e • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.,:Vonsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 3 Block 2 Mountaln Valley Estates Parcel ID: A. WELL DATA Wen type E If A, B, or C provide PWSID $ _ Well Log (YM) Y Date completed 212N975 Sanitary seal (YIN) Y Wim property protected (YIN) — Total depth _M _R Cased to eft. Casing height (above ground) 30 in. FROM WELL LOG AT INSPECTION Date of test 2fl2N975 1113012804 Static water level 45 fL 55 ft. Wen production 3 g.p.m. 2 9— p.m-WATER SAMPLE RESULTS: Coliform : g ookaries/10D mL Nitrate aZ& mg1L Other be&w� coloniesl100 ml Arsenic: UV mgn Date of sample: &]BM Collected by: Laura Pannone B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Date installed 11=995 Tank sae ,900 gal. Number of Compartments I Cleanouts (YIN) Y Foundation cleanout (Y44) Y Depression over tank (YM) Ij High water alarm (YM) WA Date of pumping Pumper,ITs Pumping C. ABSORPTION FIELD DATA Date Installed 8="5 Soil rating (g.p.d.lfts or ftalbdrm) U System type Trench Length 49 R Width 2.5 ft. Gravel below pipe 8 ft. Total depth MI fL Ef►. absorption area Zp t? Monitoring tube Y Dep ion over field S Date of adequacy test 11I30R504 Results (Pass/Fall) Pass For I bedrooms Fluid depth in absorption field before test ¢ In. Water addedo gal. New depth? in. Elapsed Time: ¢I min. Final fluid depth g in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date D. LIFT STATION Data installed 'Pump on' level at _ in. Datum Manhole/Access (YIN) _ High water alarm level at Meets alarm 6 circuit requirements? v E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 150' On adjacent kris 100+ Absorption field on lot 180' On adjacent kris 100+ Public sewer main WA Public sewer manhole/cleanout WA Sewer /septic service line 50+ Holding tank WA Animal containment areas 100+ Manurelanimal excrete storage areas 100► SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 25+ Property line 1(L+ Absorption field S Water main WA Water service line 100+ Surface water 100+ Wells on adjacent kris 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 50+ Water main WA Water Service line 100+ Surface water 100+ Driveway, parkingM hide storage 10+ Curtain drain WA Wells on adjacent kris 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION •�•�P\ �, .ee•• 1 cer* that I have determined through field inspections and J �} review of Municipal records that the above systems are in conformance wr'tfr MOA COSA guidefines in effect on Mis date. • •?+ LSleve� R. Per,oce}L Engineer's Printed Name Steven ItPannone, RE••�%; N c E 8141, f 4• Data Co (SIaG •:,;�'w COSA Fee S--tj Date of Payment Receipt Number (Rev. 11iros) &/Z Waiver Fee $ _ Date of Payment Receipt Number w ASBUILT SEI4ARD & ASSOCIATES LAND SURVEYING 694=0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: b' •t� pF At % /JO.�llEl'61�Sl4T�„c�''Z• DATE i �c,....., L,Q \\ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 0�46• Ar �Q S \ rH �q1 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: • •• •••• EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI-�� Mark s, ,,,a j VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' Y l =, LS -691 Ar ANY DATA HEREON BE USED FOR CONSTRUCTION ��' �� tt Al OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN, ARY LINES. \kk 1U a • a 1N B o c � �� ,4'/ � 'o• •w _iT ASBUILT SEI4ARD & ASSOCIATES LAND SURVEYING 694=0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: FOLLOWING DESCRIBED PROPERTY: b' •t� pF At % /JO.�llEl'61�Sl4T�„c�''Z• DATE i �c,....., L,Q \\ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 0�46• Ar �Q S \ rH �q1 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: • •• •••• EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI-�� Mark s, ,,,a j VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' Y l =, LS -691 Ar ANY DATA HEREON BE USED FOR CONSTRUCTION ��' �� tt Al OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN, ARY LINES. \kk Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program TV 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. G 3 1–// HAA # 0 406 6' 0 y Expiration Date: • 3 — O — 1. GENERAL INFORMATION,.'.�� Completelegp(des�iptionQyiyTA/A( VAL445V Z5ct%i%E.s LaT.� QLae[cZ Location (site address or directions) 4/94�0 el e0 sco^fe Current Property owners) L /L Day phone Mailing address`• Lending agency Day phone .. Mailing address Real Estate Agent Mailing Address �yA /-a KtJ Day phone 6'P7Te,'&%e_ Unless otherwise requested. HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 0 Individual Water Storage ❑ Individual Holding tank •❑ Community Class Well ❑ Community On-site' ❑ Public Water System ❑ 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. Name of Firm /'6r�fezgt . /- .c Phone 691,x-70,?6o Address 17023;? Pat,) if(tdle- Engineer's Printed Name Date 6 O 5. DSD SIGNATURE tf"' Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory . Well Flow Advisory Maintenance Agreements - Supplemental Engineer's Report Other By;/( Original Certificate Date: (R". 01)02) Municipality of Anchorage !� +: Development Services Department Building Safety Division ' 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 CHECKLIST Legal Description: M7-Af V Z. /%J 7,_4TEf. 407-3, CaR Parcel ID:_O S10 ' G 3I -I A. WELL DATA Well type F, .If A, B. or C provide PWSID # _ Well Log (YIN) Date completed ZLz/7s Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ?=Y—O—ft. Cased to o3ft. Casing height (above ground) 3C1 in. FROM WELL LOG AT INSPECTION Date of test Static water levet LIS ft. Well production 3 g.p.m. Z- g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./l. Other bacteria Q colonies/100 ml. Arsenic: _ mg./I. Date of sample:/44/Cyr Collected by: o -s F B. SEPTIC/HOLDING TANK DATA Tank Type/Material "V'((C�- ma"I sTf l_ Date installed Tank size Q00 gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) __y Depression over tank (Y/N) y High water alarm (YIN) A(14 Date of pumping 12 O Pumper SbrrrAeie C. ABSORPTION FIELD DATA Date installed 4V36/1-7 Soil rating (g.p.d./ft2 or ft2/bdrm) Q G System type Zrlr36LC� Length ft. Width ft. Gravel below pipe _e ft. Total depth /Z ft. Eff. absorption area 7&'-9 ft Monitoring tube Depression over field Date of adequacy test /4 30 o Results (Pass/Fail) 1P# For X bedrooms Fluid depth in absorption field before test.S in. Water addedOgLO(al.r New depth 7 in. Elapsed Time: 66 min. Final fluid depth :� in. Absorption rate >= d a g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) d/ If yes, give date D. LIFT STATION Date installed Size in gallons anhole/Access (Y/N) "Pump on" level at in "Pump off" level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm ti circuit r uirements? E. SEPARATION DI TANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot _/SO Absorption field on lot /&e 6r Public sewer main v Sewer /septic service line —cS0 �t On adjacent lots /4 G r On adjacent lots f0 O 'r' Public sewer manholelcleanout Holding lank ^X14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation _ S �f Property line /U 'IL Absorption field .5 - Water Water main Water service line /00"' Surface water /00't Wells on adjacent lots /00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /o �'f Building foundation SD �t Water main A(14 Water Service line _/00,r Surface water /D a I- Driveway, parkinglvehicle storage Curtain drain Wells on adjacent lots1Q0 *'i F. COMMENTS G. ENGINEER'S CERTIFICATION .�c,��(•...'•.;'�9�� I certify that i have determined through field inspections and % * ;49TH f�. • ., '?; i..... .... review of Municipal records that the above systems are ini= conformance with MOA HAA guidelines in effect on this date. /.. Engineer's Printed Name STS./E G 16 ,#�4 PE 6 s Yep w "o +�•' 256 Date /Z f6/0'i 1s�; orE5: HAA Fee $ H 3o Waiver Fee S _ Date of Payment�wi Date of Payment Receipt Number to frlSy��, Receipt Number (Rev. 12101) ASSUILT L/ . SEYARD i AS= I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, /��'i��loT�,6t°'r• AND THAT No ENCROACHMENTS EXIST EXCEPT AS S"-E,' ,�i DATE, B/�S INDICATED. IT IS THE RESPONSIBILITY OF THE BRIDt .TMJ-fzr OWNER TO DETERMINE THE EXISTENCE OF ANY EASE>MENTS,COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUM - VISION PLAT. UNDER NO CIRCUMSTANCES SHIM" ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES. OR FOR ESTABLISHING BOUND- --..._. n Municipality of Anchorage J • Development Services Department Building Safety Division On -Site Water and Wastewater Program 9 ° 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.'660 - d63 - I I • HAA # d b/o317 Expiration Date:_ 9 01 1. GENERAL INFORMATION Complete legal description 1 OT 3 81L ;L HQUP! TAW VALLe-f ES -r^ -rt Location (site address or directions) OH " 3t(LDS0N , r Current Propertyowner(s) PAUL.. 1)<'/RIS14E:(L Day phone 341— loib Mailing address !a -1.30X -7-1 9--15 a - -E 12 QtG 57T Lending agency Day phone Mailing address Real Estate Agent SVA L Uk NTS( Day phone Mailing Address V&trAll =tZ Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well[?�( Individual On-site [Kj Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the cn-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 l " "rn Phone Address a03 Engineer's Printed Name t,9Wet S,,ur6C�KC� Date 5. DSD SIGNATURE Approved for bedrooms. Disapproved. :;�' ,ENGIryEER'S ..ST MP ' TC.. dV Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 6 - oZ 9�0 (Ree 12te) Municipality of Anchorage •., • Development Services Department Budding Safety Division ` On -Site Water 6 Wastewater Program : 4700 South Bragew St. P.O. Box 196650 Anchorage, AK 995196650 www,ciAnchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: l.O't 3 Bk .2 NO✓vri'aci rt lid U+ Parcel ID: 050 A. WELL DATA ESTATG Well type &L If A, B, or C provide PWSID # Woo Log (Y/N) T Date completed YIR17r Sanitary seal (YIN) Wires property protea (Y/N) y Total depth 9-4-5—ft. Cased to G�3—ft. Casing height (above ground) 160 in. FROM WELL LOG Date of test Static water level ��' ft• Well production != g.p.m. WATER SAMPLE RESULTS: AT INSPECTION V7/o/ S 8 ft. g.p.m.x t sa r tl+dL 43-r• r& -t lax Coliform coionies/lo0 ml. Nitrate -1L- mg.A. Other bacteria N 1 colonies/loo ml. Date of sample: ` O Collected by: •-S B. SEPTIC/HOLDING TANK DATA Tank Type/Material 1570m- Date installed 8A 0i�j5 Tank size 00 0 gal. Number of Compartments :L Cleanouts (YIN) 1—'Poundation cleanout (Y/N) _%/ Depression over tank (Y/N) _JSJ_/I High water alarm (Y/N) Date of pumping SeP4 PumperSQ u c t0. s eCtm D < e C. ABSORPTION FIELD DATA , Date installed NA Soil rating (g.p.dJW or f 2/bdrm) _lj System type 7#44-H a 4 Length 4 q _ ft. Width CL 5 ft. Gravel below pipe _) ft. Total depth i 2 ft. Eff. absorption area ]BSLfl' Monitoring tube .y-- Depression over field 1`1 Date of adequacy test 7 D Results (Pass/Fail) For .3— bedrooms Fluid depth in absorption field before test In. Water added 1. New depth in. Elapsed Time: =min. Final fluid depth in. , l Absorption rate >= 11 -CO g.p.d. Any rejuvenation treatment (past 12 mo.) (YM b type) t' Y if yes, give date ul", D. LIFT STATION Date installed Size In gallons _ `Pump on" level at _ in. "Pump off" level at Datum Cycles tested 1 E. SEPARATION DISTANCES / Mantwla/Access (Y/N) _ in. High water alarm level at In. Meets alarm d ci=tt requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanMt t station on lot i so Absorption field on lot b0 Public sewer main N/A Sewer /septic service line 85 On adjacent lots > 10 0 On adjacent lots 7 / O 0 Public sewer manhole/dea9put NIA Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation VSb Property line >—/—O Absorption field 5 Water main NIA Water service line �-S 0 Surface water 1,410 Wells on adjacent lots. W PLO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line % /d Building foundation 60 Water main M/A Water Service line X50 Surface water NIG Driveway, parkingNehicle storage f7 Curtain drain N% Wells on adjacent lots x/00 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspectlats and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date HAA Fee $ X600 Date of Payment �0/ Receipt Number C 2 % 0 (Rev. 12/00) Waiver Fee $ r. Date of Payment Receipt Number .: ,0611 To ill!rjIlf.md'� i e+Z <•f •�•• J Date of Payment Receipt Number