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HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 2 LT 13Majestic Va'lley Estates Block 2 Lot 13 #050-731-37 Municipality of Anchorage Page I of Z 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: 17,r.70` PID Number: D5 21 Name: J c.Octt12-1 Wastewater Wastewater System: New ❑ Upgrade Address:-;- ABSORPTION FIELD Phone: No. of Badrooma. [3 Deep Trench AS Trench ❑ Bed O Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 40•4GGPD/S Total Depth from original grade: Jl Ft Lot: j... Block: Subdivision: 2 Depth 10 pipe bottom frompratle original Gravel depth beneath pipe } M k I AEFt Q• FI Township: Bangs: is Fill dded above original grade z Gravel length: r I •5;•—Z.4*' Ft Z Ft WELL: ❑New ❑Upgrade Gravel Eapib.hy,�t} Number of linea: Distance belween,rros: Ft CI mhcauon (Private. A.B.C): Total Depth: Cased To: Total absorption arae: Pipe material: �1 fj Ft Ft. SO Ft Driller. Date Drilled: Static Water Linel" Installer. Date Installed' Ft. GCG Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft Ft SEPARATION DISTANCES Xseptic ❑Holding 0S.T.E.P. To Septic Absorption Da Holdup bliNPdvate M nufacturer: Capacity in gallons: From Tank Field abtion Tank Sewer Lin» a well�4 Material: Number of Com anments: Surf eye I do'r 100' -- LIFT STATION Lot , , Size in hone: Manufacturer: Line�- Foundation I�-f I D 1 _ "Pump on" level at: "Pu el at: High water alarm at: Curtain I�OIA.� Pump Make a Model Electrical Inspections perfortned by: Drain —(�l0 Remarks: BENCH MARK Location and Description: GP GetJG. PLOOiL. 1fasln� -�-+�t•� Assumed Elevation: Ft I ov= ENGIr1kip�LL J�CP�•",,.......ea�Vs, iii ;'+�+49u► tie oil 5&S ENGINEERING 17034E le River LNig-»•»' Inspections performed by: '� coP R°aa, I�tes:ls '» '•• 2nd'=�t ... .. ». .. O K: R SHAFER ROG 1.11 No. Department of Health and Services approval „S,.••''.��e'� �Human (ai'e���:N�+ Reviewed and approved by: �� Date: 2�- _ � M-01711/91) MOA 25 Permit No.9:!�7 V�l Page 2 of ?� 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 1-tt�trff�'1G vo�t.t�j� �st�r� Col GoZ Iota I i S.T I w Air G,52AcQE PID No.: 74'}.02 yNE1 1 tuoo c,nrt.y q• 56?tip TANS . •'ff11 Ga.r•a£ A t Ky sy �i .•• PL Cot Coy col Gaf- !�(o Gb8 r tf r y . A ••% p � ih9IL+�'v �_...__......_._ 9.1.....«... ' a ow zjS coo 03' 1 o4% +fie?^�: Rpp SHAPER 1W "1 I �l�" C^ �� No. 215 :' �• d ', r• �vf G 0�' 2� 2�° ediaF�PROFE5S1�NPs�'� 72-00 A (Re. 911) 40A 25 1 2E a V Municipallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:�DATE P LEGAL 1 2 4- 5- 6- 71 5 6 7 IY . 8 13- 14- 15- 16- 17- is- 19 - 20 314151617181920 COMMENTS 9 M —0 cr T Section: WASGROUND WATER ENCOUNTERED? O IF VES, AT WHAT 1Ot.,;;rr LL DEPTH? k± E Depth to Water �Nl�1e � /� 1-•L�13 Monitoring? "`-""T — Dale: / ®mmm �ff�—v mmmm0` w«� E&M NN 0`Y/L-7ri�7�3� v��or:�s_�■�rn� c� PERCOLATION RATE (minutevinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 3 FT S & S ENGINEERING PERFORMED BY: -VM4 Eaule e'RTlJNR'•' 4� CERTIFY THAT THIS TESTI WAS PERFORMED IN ACCORDANCE WI1rP,1g1t 'A fE RND3 AL GUIDELINES IN EFFECT ON HIS DATE. DATE: 72-008 (Rev. U85) . E a o-; !._';OWNER OFaLAN .ADDRESS ,§LEGAL DESCRI •. ;DATE Started PERMIT NUMBER , II .vr lnyr(, w• r m.-.. a 11{w,aY'• y-3ar•yV�N•{Y-4µ+ y•'.� r^ SI � t V ''ry b!:`H 0.i YII • t rdJ! , e �` r ,. I a , +. !,T'1t,"�iJ `C!„'i"'f.0��� �':: < - ,♦C- v/ f f( 0.4,1 li /l'r "x" ", i11 >` jlr Iar R7 ;riG t,.,, rk'Ii.f y i' Z ! 't •) ..a.:,. ,' 'ooc,co aw.&w t.I•{'6 .. SUGG`IVAN W ATER;:WELLS l MT P.O. BOX 670272 CHU0IAK, ALAS KA99587.••�TELEPHONE6882759 .t 1 , r.: •i v t I\{}Y,,j. , L{� D{QJ t 10, ST/L tS . ;'^ DEJ TII OF WCLL �O t� ` 9�6 pJNOTdP'.C"/tCCtr'/�n1G�I ST, LEVEL OF WATER FT PTIOtL1d�4de-17•G (%gtcrl!� , nW F19? I- t Ended GALS PER NR �9 K}INT) OF CAST\C " l��0 � [;{,r �y • J ..++rM1. �w�)a!'iir 1 1 1: s. 1 tik:iY.rsvJ'>: �->, 4�t' 1G fit' }11 � 1-l'. � �• '`t, la •r..T�'' �•. . +.wxct .x9 •;^.-..irHi..�: 1 ,i r. L �.. -'n. A.ZXsr ��`s�'-•.. , a=�'^•Y.-'!l° �i': 'i.r .'. > KIND OF FORM TION: �.., ... 4 f; : 1 , ; . , � "aYrr .. ,„ r.;' t Fromd � Ft�to LFt fC�SiG SrIGK' From Ft to FL 4�.From�='-it O�LQ��At+) to?'IFt1 From ' Ft: to FL` From i SA.JO L 64,4J 14, From Ft. to-]_''' FI. From Ft tc;-2- - r T From Ft. to FI '�Ft.'Io From Ft.�i1R[/�=_C Ca R[?(6S From ^F1.to— Ft --- -0 j(TbfjeL From �7` FLto.�Ft..SAFy 15W" From Ft. to FI. Dd1cS,..... From Ft. to Ft. From Ft. to Ft. '' From Ft. to From��•„Ft.t �T Ft. r Q G'K ',// Ft. //,,,, Ft. to_Ft.a' Qt OQoGL Jli1�g [�'LYoJvrom '•�h. to Fiom�� Ft. 1' AJ ,q RTZ - From p�:ZQF4 to�Ft. 6r'A Qa' (,Rf'c From Ft. to Ft. . is��r ���� Ffom�'! r Ft to7�-Ft J? ARIGtL i'A41t'TJ'Qc4 Frorq Ft to - Ft. Fiom Ft to �� 6 n�w1 r j From ' t Fl to FI. 1 _Ft .;'pc—QdDCt_ �S[i[r/i`UfQCCep%m ;;1 tf:Fi FromlvTT F.loa�� Ft.Ft. to F ReOQJGC FQAG7JRe"Q \ Fto Ft�to3p0 Ft From-,! Ft. to, Ft. FromtoFt` ,� G;arn Fromttt/r CI.L.t A ,. :>a'.iit'1. - ,., From Ft to Ft From �• Ft. to Ft:+ .r, t .,.t li 'n�'.>•a'aY .a ,l„aaV 1 ,'. f _ .T {9,". a L - From`11 . ' FL'to Ft. l ., 1: > . Iq r a a "' Fiom FOR 2—a `�9 -�. �Y/r 1Ja,1 a ,+. {, 1, : nTa r �1;• i -+ -t4 tlici ili1Y0 MISCL.INFORMATION- . hf 1 ,,�, t, �., a r }�1a�u P h�Hutq rvRCes t A t• C{'i tst l i '� V6 RHea - t,s a t.. a (,I : > {• :,,�h.�•sv Lr, 1 i !'f 1vi��Y .L ��a-/� s''•y�nh •• �h! f fl l'it�l. ,l .:.f if t• •l ul i. f •�7�t. `('14jj� i r1(rJr k� 1, 11t rL f C-, am, ,y l.; y a (_ ry tat a {t. ,,• ; f.t v i / t t t• t.j ' 31 lY �f l tJ)<N .C.a�tl i t ?1 kliO n fH;•,� 1+: F +,r.�'t i•..4i ! +h•6 , •„ rt i� t t} R, l ! Z+ 1•� C 'a. a"""��� aF`t) �lal i1 N K Tf '1 r" 4<�rt Ltt 1�l�. ♦2 �l a+1f. , <f laY'"9+♦t'� 7 W, l r 7 f }`fit r V .f I 1 I c 3�.t' 17 X11 `fit r 's f 7:44_, +tt!�•+'. • �-A1 a. j f v �'t ,i �41i �'l�w P-Znft -J ys}..+•7�fi-1 1l� f R, •.IS'at+2 �,ft IJr +-rl�.t f'1 •ter a r[�..:. y+'I,+l t� f' 1 ,. :. •s•1.♦ " y t'x � y1:�� at1.N f :.;>;`i n♦ 1 )r1., 1. 11r 1,. eM.•..>e Y t{. .1 ,. ,x.1�r,FL .$.}w �l f. !, t . . Kr +. ..1. '�'•L,!%�1, .'. f,r'•{LaSy„..� •4.J, sl:� IYN.•A .''1 y,l... , w' all-r�,t1 a - +',. .� tat •r <rNt+• Nt�> •� ,r ->: w ar 1... i t1 X\�'� , Y i'+{) :. ''"t lrt {...\�.. ..� �a k ,I � � t' yl �✓1 Irf.l " -t,,St lt• ?I �a DRI„LLERSWAME�+' a:a s •. 1t 1;'. 1 `. , i. • \. ,.S>!•i tdl . 1 i • a,rl PR. LLa?7 ,,t1 >.,I f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920049 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:STILES DAVID T & LAURIE LEE OWNER ADDRESS:3936 ROUND TOP CIRCLE ANCHORAGE, ALASKA 99504 PARCEL ID:05073137 LEGAL DESCRIPTION: MAJESTIC VALLEY ESTATES BLK 2 LT 13 LOT SIZE: 54508 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 PAGE 1 OF 1 DATE ISSUED: 4/02/92 EXPIRATION DATE: 4/02/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ISSUED BY: A'-� DATE: -_ x ^ 9 �� March 26, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS 190 71 694-2979 FAX 694 1211 HEALTH AUTHORITY Municipality of Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 SEWER& WATER MAIN EXTENSIONS REFERENCE: Majestic Valley Estates, Block 2, Lot 13 SEWER & WATER INSPECTION We request you issue a permit to drill a well and install a septic system to serve the proposed 3 bedroom house on the referenced property. ENGINEERING STUDIES Test holes were performed on the property on June 18, 1991. AND REPORTS The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes were checked on June 25, 1991 and again on March 22, 1992. WELL INSPECTION This property has enough area for a septic upgrade which can & FLOW TEST p p y g p pg be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. S17EPLANS If you have any questions, or require additional information for your review, please contact us. Sincerely, ROAD DESIGN u r Roger J. hafer, P.E. SOIL TEST RJS/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 N' 1 C n N V J h � W H Z w 2 M W 2 Q j Z3a�b-. 0 U Uvoce U g W oho a� %C A Qk 9r 0 of `.,a �g M 12, � N V J .05 wd C PERFC LEGA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 n TEST RUN BETWEEN 3FTAND 41 FT COMMENTS- `�'I y ��I 22-�1Z, -,,-1 PERFORMEDg1y7034 Eagle River Loop Road No. 204 ttgG-River, Alaska99577 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINEECT ON THIS DATE. DATE: 72-0081Rev. 4;851 IN Municipality of Anchorage DEPARTMENT OF HEALTH 8 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:_ 1%��V 151 ����L DATE PERFORME LEGAL DESCRIPTION:y��Z t4A, IG Township, Range, Section: DEPTH A_ 1 !G '' SLOPE SITE PLAN ,QF ft) /^ "7 . 2- 3 �.0. 4 5 r" eo 6 l Q. 8- 10- 11 10 11 12- 13- 14- 2 13 14 d R rCQ�1 15 ROG �.. ... ``.S. 16- L% No f� �9 '0.. 17- AQOF ,6 1s 20 COMMENTS t1.- I - A * f4 ... 1I SHAFER . y,A A. Show TSo. ,air -E - WAS GROUND WATER ENCOUNTERED] IF VES, AT WHAT /f I DEPTH? Depth to Water Attu 1 4 I Monitoring? Cate: ®®MMM IVA n ^ N PERCOLATION RATE (/y (minutes/inch) PERC MOLE DIAMETER t TEST RUN BETWEEN FT AND FT 3.22-171 1NG PERFORMED 917034 Eagla River Loop Road No. 204 Eag • River, AJoSka V93/1 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEI 72-008 (Rev. 4185) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: 59 MUNICIPALITY OF Development Services Department` On -Site Water & Wastewater Section Parcel I.D. 050-731-37 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Complete legal description MAJESTIC VALLEY ESTATES BLK 2 LT 13 Location (site address) 26301 White Spruce Dr Current property owner(s) SEYMOUR Day phone 865-6472 Mailing address Real estate agent Sabra Day phone 865-6472 V 567 9,0- 3 2. TYPE OF DWELLING: ti Fx� Single Family (w/wo ADU) Q ❑ Duplex SEP 2 20;� ❑ Multiple Dwellings (Single Family and/or Duplex) ti h 3. NUMBER OF BEDROOMS: 3 `�� 6 8 L 9 `' 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well F -I Private Septic R Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 9/26/19 rI DROG1RAM �? '61" SVT SEI>>\1�,�, 7 Original Certificate Date: 16 —) qrj 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. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory 'n Other- a,4Z }q pdyi- LAy 6. DSD SIGNATURE System #1 Approved for bedrooms a � `• System #2 Approved for o bedrooms `_ ��® �1 .,t❑ %N1. Eng ° L6 Zn I7 Conditional approval for bedrooms, with the following stipuIbfions?OFESSO' -.`�� rI DROG1RAM �? '61" SVT SEI>>\1�,�, 7 Original Certificate Date: 16 —) qrj 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. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory 'n Other- a,4Z }q pdyi- LAy Legal Description: MAJESTIC VALLEY ESTATES BLK 2 LT 13 Parcel ID: 050-731-37 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/92 Total depth 300 ft Cased to 62 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12* in. Date of flow test for COSA 9/23/19 Static water level at beginning of test 77 ft. Comments * Inside Manhole w/Daylight Drain B. TANK DATA Age of tanks) 724192 years Tank type/material Steel Measured operating fluid level in septic tank 47 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/17/19 D. ABSORPTION FIELD DATA 7/24/92 Which system tested (date installed) 7/24/92 ❑ ALL standpipes present per record drawing Total measured depth from grade 5. ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ON Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test g+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No t(trColiform bacteria is Negative ate I,. 4�hg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) i Collected byk'i'1'` Date of Sample l+ 1 C. LIFT STATION ❑ Required maintenance completed Age of lift station new years Lift station material Steel Comments: Adequacy test date 9/23/19 Results ❑✓ Pass For 3 Fluid depth prior to test 0 Water added 450 gal New depth 5 in Elapsed time 60 min M I fl "d d th 1 bedrooms in ❑ Code -required soil cover over field Ina uI Up In OR System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced 2000 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' ✓/ Yes Community Sewer Manhole/Cleanout > 100' F/ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' F71 Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Q Yes if No ft Q Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes 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' Q✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5'✓Q ✓/ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' Q Yes if No. Water Main > 10' Q✓ Yes if No ft Community Wells > 200' Q✓ Yes if No. Water Service Line > 10' p 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' ✓0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' p Yes if No ft Community Wells > 200' Yes if No Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and reviewk of Municipal records that the above systems are in conformance with t>, MOA COSA guidelines in effect on this date. ' CSF COSA Checklist yellow sheet ft ft ft III DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191458 Subdivision: Majestic Valley Estates Blk 2 Lot 13 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 27 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. ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT i HAVE SURVEYED THE SCALES It, S©# FOLLOWING DESCRIBED PROPERTY: + OF Rt14R DATE= AND THAT NO ENCROACHMENTS EXIST EXCEPT AS y/J�JP•.•' �' S 4 INDICATED. IT IS THE RESPONSIBILITY OF THE t H` • • ! OWNER TO DETERMINE THE EXISTENCE OF ANY GRID= y•••.• •• ••••• •• ' ••••g EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- , Dv.n. Mark s.W.,a / VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' t �'•.•• LS -6918 *�► ANY DATA HEREON BE USED FOR CONSTRUCTION -OF ARY LINELINES, OR FOR ESTABLISHING BOUND- DRAWN:tifi�...'' 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 of FOR A SINGLE FAMILY DWELLING Parcel I.D. �.`7t) r31� 3 HAA# n5�1�i3 Expiration Date: 1. GENERAL INFORMATION Complete legal description ., BZ Location (site address or directions) .26301 V tl117"E .9iolz Icrs hof'rile, Current Property owner(s) 04""4 Day phone SSo7 2634(232 Mailing address'"W#f7, SPZ Jc a /31?ttfC Lending agency Mailing address Real Estate Agent Mailing Address Day phone &4rri3A-tA CRr77—aVA15;tJ Day phone 4-c'%/d'6e_ PZJ4ZV7-/4L V/ -f'7' -f vTic E.W�-.2,!4a Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: 0 Individual On-site R ❑ 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. Name of Firm Zt r IV loin Phone %!f" 70e74p Address L7, 237 PCI Pe_ Engineers Printed Name _STr_5✓E 9(/W Date SVS -As 5. DSD SIGNATURE Approved for > bedrooms. Disapproved. c OF A/_ 191Q ........... sloven WE K 6156 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: ! �.{ c n 1 �d\ 1 f .r (in Original Certificate Date: � .i (Rev OIA1) r Legal A. WELL DATA 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 Well type tp If A. B. or C provide PWSID # Date completed 4&j.Z Sanitary seal (YIN) Total depth 3!q.0 --ft. Cased to 62 n. FROM WELL LOG Date of testq� Static water level OW S n. Well production S g.p.m. WATER SAMPLE RESULTS: Parcel Ib: t eso - l31 37 Well Log (YIN) Wires properly @protected (YIN) _ C%NngW� (P/Tvw yd) `N L in. � rJ AT INSPECTION /2/OS 7-5' n. 9 g.p.m.I- Col form _(:j_colonies/100 ml. Nitrate DL mg.A. V Other bacteria _Z_ colonies/100 ml. Arsenic: mg./I. Date of sample:441—ISAOS Collected by: B. SEPTICIHOLDING TANK DATA / Tank Type/Material eft loaOi5 ErAZ Date installed 7/2 i(1 i2 Tank size Ica 0 gal. Number of Compartments _jj_ Cleanouts (YIN) V Foundation cleanout(//YIN))��T� Depression over tank (YIN) V High water alarm (YIN) Date of pumping Pumper S'&/Zn19t/ fcAmAly'ye C. ABSORPTION FIELD DATA Date installed ZZ Soil rating (g.p.d./ftp or6�) g -L System type�/f!rL.r TRdf Length /SZ n. Width S n. Gravel below pipe Total depth _,� n. Eff. absorption area 7_,I�Q ft2 Monitoring tube Depression over field Nd Date of adequacy test l OS Results (Pass/Fail)TWX For 3 bedrooms Fluid depth in absorption field before test A_ in. Water addeddsu gala' New depth in. Elapsed Time min. Final fluid depth Q in. Absorption rate >= 44SOO g.p.d. 4 - Any Any rejuvenation treatment (past 12 mo.) (YIN & type) I" - If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at n. 'Pump otr level at High water alarm level at in. Datum Cycles tested Meets alarm & circuit re menls9 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot t Absorption field on lot Public sewer main A r Sewer /septic service line L s t On adjacent lots /040 /11 On adjacent lots / a B ~ Public sewer manhole/cleanout AV Holding tank Nlq SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S t Property line /a r* Absorption field Water main A//. Water service line /O r+ Surface water /00 r* Wells on adjacent lots ©orf SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 11 11 Building foundation 0 Water main NIA r Water Service line /0'00 Surface water /00 �*' Driveway, parking/vehicie storage Q Curtain drain am Wells on adjacent lots !00 r F. COMMENTS tr`iyrr DC.f/n/ /NA'T,4ueA /N w&4 Pit __:;•.. t��•�. t::...; r�: G. ENGINEER'S CERTIFICATION r,�r •.•• ;, , ���:Z• 0-Z;/ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineers Printed Name STE_/E EAJC I ye"^" w. E "a I4 Jf'.PE 6255 Date S S OS f� 9F� 1!: AC�FS�iC"' •v HAA Fee Eqw •Co Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number SCS ReL# 1051931001 Client Name NorthRint Engineering Project Name/# Various/3 B Client Sample ID Majestic Valley Estates Matrix Drinking Watcr PR'SID 0 Sample Remarks: All Dates/rimes are Alaska Standard Time Printed Date/time 04/20/2005 16:02 Collected Date/rime 04/15/2005 8:30 Received DateMme 04/15/2005 11:13 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate -N 0.100 U 0.100 Microbiolovy Laboratory Total Coliform 1 OB, No Coli mg/L EPA 300.0 B (<-10) 04/15/05 XM coUl00mL SM209222B A (<-I) 04/15/05 TLF - 1 SGSlCT3E ENVIRONMENTAL SERVICES -SG$- Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER 0 PUBLIC WATER SYSTEM Me PRIVATE WATER SYSTEM ❑ Send R"Uhs Send bwoke w... iywm 11.nr 1 Ti.... UY GOO. SAMPLE COLLECTION: Dau: O.r Y. TM1e: d�3Q' AM PM peewwm Tmnspo.ud to Lab By: am@ as collector Other: TO BE COMPLETED BY LABORATORY t3 Send Result 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax: 907-Wl-5301 Lab Ret No. 1051931'-W 0 Send In"Im SAMPLE TYPE: 0 Routine Sz L13 0 Repeat Sample Sample Receiving: , J Date: Sample ever So hors Old: Results may be une0able Tune: Temp: Q'19L.Cr oir Waiver or Remote LOc W a Delivery Method: Received By: 0 Treated Water 0 Untreated Water to lab no. t 0 Special Purpose ❑ RUSH SAMPLE Phone 4: Fax 1f: ................................................................ ............ ........ ......................................................... Bacteriological Water Analysts Record: Analyda Bpan• Analyst ?/F Analytical Method: �—Membrane Filter MMO-MUG (P/A) Reported By: &I/ At• In„ 6,w". SM1o.MUO (PIA) RESULTS: TOW Cdwwm: E. Coll: MEMBRANE FILTER RESULTS: Dkea Cootl o./sQ CobnAaH00mL VedOcation: Teva Gr.iw LTH: -:�t LOGO' EC'. - 200 C: DateMme: il,%161; 1,100 Sent b ADEC: ANC FSK NN DauRkne: r b Client ned FaxedRime: ke wxh: -Satisfactory ❑ Unsatisfactory Trm:.Tae M..isae.cw a -Goer- Form Goera Form S FW- 0053 12/17103 �G �,vrvss ,,,rl. t✓ .per N` Yr� , 1I9 �'Q • /iia w ASBUILT I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION . OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. AAI&.'s1 lwl SCALE: �._ So• DATE: GRID: FB: /off 6e DRA Nt o", L c .0;0:wqkvk%• %� pF'At:9S�♦ .te - . -�- f • �; \ � Ate; .".' ,� ,S�i.r Majestic Valley Estates, Block 2, Lot 13 Steve Eng, PE, P1 On 5/19/05 improvements were made to seal the manhole lid which contains the water well on Majestic Valley Estates, Block 2, Lot 13. A daylight drain had previously been installed in the manhole, at the direction of the MOA On -Site Program. A 11/. inch thick Butyl Tight Sealer was obtained from Hughes Supply in Anchorage. This sealer is designed to seal a manhole lid. Photographs below: Open Manhole w/ Butyl Tight Sealer Installing Butyl Tight Sealer Butyl Tight Sealer In Place Manhole Cover Sealed Into Opening i even r. Eng j ; FE 6256 a .......... .......•`� .� GiF55lC' •r' 1 if 1.' "1� ! 4 sal=+ ->••x �f I L i� ' � •� 1 - r � 1 r .�...�� - � �•' ✓=.'� moi; yr Yr i � s r .�...�� - � �•' ✓=.'� moi; yr Yr i Municipality of Anchorage Development Services Department • +.r Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: NorthRim Engineering Legal description: Majestic Valley Estates. Block 2. Lot 13 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ❑ Incomplete; missing _ ❑ Incomplete; missing _ ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. 1.) Pit well needs water tight seal; 2.) Cleanout cap missinc Name of reviewer: Julie Makela, P.E. Date: 9/11/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OFANCHORAGE • DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Q 6 - 13N - 3_1 1. GENERAL INFORMATION HAA # WZ0 1T)O L1?1 Complete legal description Lot 13; Btock 2; Majutic. Valley SubdEvi6ion Location (site address or directions)—bltiU Property owner _Rglntt P0nnPha Day phone 694-9681 Mailing address PEPPERS CONSTRUCTION/P.O.. Box 771064, Eagte Riveh, Atadka 99577 Lending agency Mailing address Agent 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 3 y Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site (XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-075(Aw.1/91) front MOA121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 17014 Eagle River Loop Road No. 204 Address Eagl_ Riyer Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for .3 bedrooms. Disapproved. Conditional approval for Additional Comments A Date 1'21-9'R �. YI•�I I 4'! Z e_r1,�0} t•:. Jtf'�, .nom :.• bedrooms, with the following stipulations: Date 2 - 9-9Z 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. nan (n... iA,) 8�k MOA121 a Municipality of Anchorage ARL Department of Health & Human ServicesMW HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description-.\=!�!rt3 Parcel I.D. .tA_F_y A. WELL DATA I Well type If A, B, or C, attach ADEC letter. ADEC water system number � `a Log present Date completed Z Driller Zol'uy&-( Total depth '��� Casedto `Z 4 Casing height ��- Sanitary seal &N) 4 Wires properly protectedd N) Date of test Static water level Well flow Pump level FROM WELL LOG -1,-9Z _ 15.C> g.p.m. %3 Y__ SEPARATION DISTANCES FROM WELL TO: AT INSPECTION rn n Lp.rti.'n to �o � T L O Septic/holding tank on lot co ; On adjacent lots Absorption field on lot 1 , ; On adjacent lots Public sewer main —Public sewer manhole/cleanout— Sewer anhole/cleanout Sewer service line 2'S t�- Petroleum tank WATER SAMPLE RESULTS: Coliform b )O'" Q Nitrate tC> Other bacteria Date of sample: 1 7,1 - 93 Collected by: S & S ENGINEERING 17074 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska "S77 Date Installed -7 ' 7- "t �'X-L— Tank size \bo0 Compartments Z Cleanoutsl, i'/N) Foundation cleanou (Y N) 4_ Depression II(Ya IJ High water alarm (Y& �-1 Alarm tested (Y/N) �lA Date of pumpingPumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Weil(s)onlot —on adjacent lots X055 Foundation 1A To property line to Absorptionfield Watermain/service line Surface water/drainage � o o \� 72026 (Rev. 7M) Frons CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent(Y/N) High water alarm level "Pump on" levet at Meets MOA electrical codes —Manufacturer Manhole/Access (Y/N) p ofP'levelat `Cycles SEPARAT19N-MTANCE FROM LIFT STATION TO: on lot On adjacent lotsSurface water D. ABSORPTION FIELD DATA Date installed 1 ,24-9Z- Soil rating 0•L0 U -(�'" System typel�Y-A�.SFtE�.*a Length Z� Width S Gravel thickness Total depth S -Total absorption area i Loci `¢ Cleanouts present ON) Depression over field (Yb)Date of adequacy test •"� NE� Results (pass/fail) Jlti for rJ1D- bedrooms Peroxide treatment (past 12 months) (Y& If yes, give date AA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ca On adjacent lots o tom% Property line o r To building foundation �� ►�`p To existing or abandoned system on lot Onadjacentlots 2� Cutbank Water main/service line o�� Surface water o o 04- Driveway, parking/vehicle storage area S D0c- Curtain drain '%Ab E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecty lVR,"tjof this Inspection. = L OF-AGgmtt 5 S 5 ENGINEERING c '•>.�j ~•. 9 0 s o: Signature 17034 Eagle River Loop Road No. 204 P`t ?;� .i , y ti R mA �Iv River, Alaska 99577Z f �•• q Iu.� e. N.I N�1 •1•M• Engineer's Name e' Date ,27-� 3 t' 'HAFErt • W p v fir'^: 'Ip• •• i, v iROFESSl4yr,A+."' HAA Fee $ /ly Waiver.Fee: $ Date of Payment - Z-7- n Date of Payment Receipt Number 4- Receipt Number 72-M (R.. "I) 6"k MOA 21 COMAIER!CIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY I EIFPHGNC (907) 562•:3x3 $633 B Street Anchorno. Alaska 09616. Drinking prate, Analycis Report for Totai Coliform Bacteria TO BE COMPLET'et) L'Y WATCR SUPPLIEn O PUBLIC WATkA 3'137EFA LD. '14Z PRIVATE WATER SYSTEM s a s rUCINCERING T7—*?A-Ea4hAtrscLoaphoedlte.44+ --- •- """owe.:• Eve RlverrAlasks"Jrj -- ...-_ . -cone_ ---- ._.._ Ioouo: _.. SAMPLE DATE: Lu!J CZ << J Mo. Day Year SAMPLE TYPE: ff Routine ❑ Check Sample (la ruvtlna smrpla With tab ret. no. ___--� El Treated Water ❑ Special Putposs 7 Untrratcd Water SAMPLE !)o. LOCATI0t1 t 3---------- ._.._.__.J • 5 _---------� nEXD INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,'l�Satialactory ❑ Ursatsfactory ❑ Sample too long In tron3't; sample should not bo over 30 hours old at examination to Irdicate reliable results. Please send now sample via spocial delivery mail. Date Received --2_ Time Received Analytical Method: Membrana Filter R) of co!cnies/100 rrd. Time Cott•ct•d Cnn•cteG By Les Ral. No. Result, Ana et . 93.C316 U-1 F-T C3--. BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane fitter: bir•ct Count _ 0 Colllornt1100 ml Verlflce!lon: L9B local Colllorm Conllrmatlon ,—,—_ Bos rin•t Membrane riper Results Colllormno0 ml PsPorted Dy- Date TNTC a Toa Numerous To Count Trm.; 600 OB = Other Bncterla e'm' PART ONE OF TWO r�� � Mtr.7erotthsSG56rc REMAINDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORY A DIVISION CF COMMERCIAL TESTING E ENGINURING CO. 5533 u STRUT ANCHORAOE. ALASKA 90516 TELEPHONE (907) 552.2343 FAIT: (907) 561.5304. Chenlob 1e1 1 client Searle ID :111 /2 NA3ISYIC 91:611 Matrix I NAICA Client Nene :S C S tl'cl11LA1Ac Ordered ly :1. SFATRB Project Nene 1 Project) MID 101 Semple lounw.A SwLP CuLSICTID IT: EAI. Isnarke: IIPOIT of ANALYSIS Collected :01/22/91 4 10:00 he. loceized :01/22/91 A 15:05 las. MON[ 0rd4t 162S64 16101t Cogleted :01/26/91 Tachnical Directot 4ML�-a— a 10146[64 ly: Allowable pezaeetor pnulti ¢.:sl. Urite Nsthed tietts .........................................._.......-•--••.................---- ..................... NIT1171•N c.': L• n . IPA S3.2/300.0 10 Ixtract Analysis Dote Date Init ---------------------------- 01/26/9) 01/26/93 LLS ....................................................................................................................................... Su Itp -tal Insttucticna ALa/e 0A • Ulnretlable See Semple twtks Above NA • pct Analyzed U • Undeteetsd. loportsd Talus Is the practical quantification limit. LI • Lice Than D • Sec9ndat7 dllntion. ��•+•e��.r��r. OI • Ouatar Than ry`i71.��`!. Member ei ins SOS Oenup (SoeiM6 Uridrele do Survell(enee)