HomeMy WebLinkAboutSUNNY VALLEY LT 16 REMunny Valley
Lot 16
#050�354�17
Se- 2 92C! 121: CZ- r; Anchw&ga fcnli& Punic, Seg 90724-:�0742
Pitless Adapter installer: A114 -
Well Disinfected Upon Crvalpletioa? No
Method of Disinfectiqn:
comnienis:
Pump Installer Name: AL
mp Service,
..,.chorage '#/ell?A Pl,
330 Fast 76th Avenue
Anchorage, r1%1( 99518
Phon: 907-243-0740
i -ca: 907-243.0142
Attention: '111e.0tialp- inst?l ter shall provide a purip ws1,&1a,.ic1)i log to the OSDI -vvithin 30 days of p-orinp :nstallation,
SC' -F'.?
ii .rOn—Site
F E
Mayor
--437904
Pump Installation Log
Well Drilling Perm it N U111ber: SW
t. ---- Date of Isssue:
rarcel Identification Mini ber: 050 - 3 S- Ll - 97
Ee7! JTe, 7cri P 11 C, U Prolvirty Ovvner Name & Address -
v L
N nip Insta, 4:
Pump Intake Depth Betow'Top of �Xell. feet
P" Inp il, anU, 'actu-, rer"Nanw: 4.0
4),J� -
ftniplldodel;
hp
PifleSS Adapter Burial Depth: /0 feet
I Pirlcst Ad-apter )vlanufacturer's -N;me: 1911A?1-,-#1TO1j
Pitless Adapter installer: A114 -
Well Disinfected Upon Crvalpletioa? No
Method of Disinfectiqn:
comnienis:
Pump Installer Name: AL
mp Service,
..,.chorage '#/ell?A Pl,
330 Fast 76th Avenue
Anchorage, r1%1( 99518
Phon: 907-243-0740
i -ca: 907-243.0142
Attention: '111e.0tialp- inst?l ter shall provide a purip ws1,&1a,.ic1)i log to the OSDI -vvithin 30 days of p-orinp :nstallation,
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 as Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: PID Number: C)Tc> 1,5elc 1,1
Name
A �0%o�"v
Wastewater System: 11 New >?:Upgrade
Address I
CA<0L$5 \�
ABSORPTION FIELD
Phone UCA 4 A-5 % L>
No. of 8 �T ooms
0 Deep Trench 0 Shallow Trench VBed 0 Mound 0 Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from origw grade:
I
0.g5_ GPD1Sq F,
Lot. Block: S.bd a on
Depth to pipe bottom from orpoinal grade.
_
Gravel depth beneath pipe
UIlLAF
-3.5 Ft
0,:5- Ft
Township — — —
Fang,
siction:
Fill added above original grade:
Gravel length:
I
0 — /,5Ft
Ft
WELL: 0 New 13 Upgrade
Gravel width:
P 0
Number of lines
�4
Data behvem fires;
.5615
F,
F,
Clit5sification (Privilte. A.B.C)
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft
Ft.
/200 SO Ft
V A -512f &9-3c,>f-
Driller.
Date Drilled:
I
Static water Level:
I
lns�aller: jDaturistalled:
Ft
5011
Yield
MTP
ump Set at.
I
Caring Height Above Ground
TANK
G P
Fi
Fi.
SEPARATION
DISTANCES
VSepfic 0 Holding 0 S.T.E.P.
To
Sepl.c
Abwlpi.on
L.11
Holding
, bliclPrivale
Manufacturer -—7
apacityi gallons:
�
From
Tank
Fnild
Stal.o.
Tank
So.*, Lines
P�� e, 1;d.4T
;2 .3;-0
Well
%
%*
—
—
Material
N umber of Com parlments:
C) r>
\ oc)
Surface
%Jr-
%Ar
LIFT STATION
Water
\00
\C>t.
Lot
Jr
Size in gallons:
Manufacturer:
I
Line
I c�
Foundation
jr
'Pump on" level at��p
off" level at: 719h
water alarm at:
0
Curtain
�ACI
"
Pump
Electrical Inspections performed by:
Drain
o
Remarks: CLy -V�orif 9-rmb\tr_o.
BENCH MARK
Location and De
vo J� gsp
Assumed Elevation:
Ft
ENGINEER'S SEAL
'ek;!,*V%A I ;
0C YA
0.. Ono
.. . , Q
JW
S S ENGINEERING
OF % �4
Inspections performed by: 17034 Eagle River Loop R*&d(%Re?ist
Eagle River, Alaska "577
2nd 10-Sk"I
go
Department Health Hum v I
1 1 itolbort A. She 1�
of aWd appir
r.ervices
A
4 keo ........
Reviewed and approved by: Date.. -
7
72-013(R" 9,11)MOA25
PermitNo. SW930388
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
4ZI IMMY VAI I rY I ()T I r PrkA nRn,7,r Al 7
Legal Description: PID No.:----- ' ' '
col CO CO3 1IT2 MT1 C05
03.81 99.51
NEW INSULA71ON
IC
100.3' 1250 GAL
SEPTIC 100.11 94*
TANK 94'
A 74.0* NO WATER FOUND
A B
COI 25.5 54.5
CO2 60 84
CO3 69.5 95
C04 109 128
C� C05 107 125
MT1 105.5 123
NEW DRAINFEILD hrr2 68.5 93.5
60.
CO2
CO3
LJ 2
NEW 1250 GAL SEPTIC TANK
FIE
W 001
A D ENGIPfflaq� SEAL,
FCO
4 BDR
HOUSE %
W
... .... .. ............ 01.
DRIVE ,4
40 art A. S,%ah� ":;6e
s 1" 40' No. 1457-E
op
72-013 A (2/21) MOA 25
PAGE I OF I
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 (UPGRADE) PERMIT
PERMIT NUMBER:SW930388
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HOLLAND GUY H &
OWNER ADDRESS:9535 W LAKE DR
EAGLE RIVER,AK 99577
PARCEL ID:05035417
LEGAL DESCRIPTION: SUNNY VALLEY LT 16 REM
LOT SIZE: 47045 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 9/22/93
EXPIRATION DATE: 9/22/94
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 OR 343-4681 AFTER BUSINESS 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 BY:
ISSUED BY:
DATE: q (ZZ14-?
ol
DATE :/4/v7 -
f
September 20, 1993
-'�'�unicipality of Anchorage
HCALINAUTHORITY DEPARTMENT OF HEALTH AND HUMAN SERVICES
APPROVALS 825 L Street
lAnchorage, Alaska 99501
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELLINSPECTION
A FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSALSYSTEM
DESIGN
: Sunny valley Subdivision, Lot 16
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVILENGINEERS
(907) 694-2979
FAX 694-1211
you issue a permit to upgrade the septic system
the four bedroom house on the referenced property.
adequacy test performed on the existing system found it to
in a state of failure.
test hole was excavated and percolation test performed in
e area of the proposed upgrade. Attached is the proposed
grade design.
do not anticipate any adverse effects on neighboring
.:)erties by the installation of the proposed septic
If you
for va
A
/LSU/lsu
questions or require additional information
please contact us.
er, P.E.
17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577
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ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
Sunny Valley Subdivision, Lot 16
GENERAL -
1 The scope of this project includes the installation of an
absorption bed to serve the four bedroom residence
located on the referenced property. The existing septic
tank is to be excavated to verify its integrity. If of
poor integrity, the tank is to be abandoned and a new
1250 gallon septic tank installed. The existing
leachfield is to be abandoned in place.
2. Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
4. Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling. On all leachfield mound
systems, the property owner shall be responsible for
ensuring a satisfactory vegetation growth over the
mounded area.
Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 40
cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
Page Two
Sunny Valley Subdivision, Lot 16
September 20, 1993
4. Septic tanks installed with less than 4 ft. of cover
shall be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. in the line between the
tank and the leachfield there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank) . These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
LEACHFIRLD BED INSTALLATION:
1. Excavate the proposed Bed Area to the depth shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the bottom of the excavation becomes
smeared, it must be raked or scratched (ruffed -up) before
gravel or sand placement.
2. If a sand layer is required, place sand over entire
excavation to the required depth shown on the design.
The top of the sand layer must be within 2 inches of
level.
3. Sewer rock shall be placed uniformly throughout the
entire bed. Perforated distribution pipe must be
installed level with perforations down. Gravel depth
below the perforated pipe shall be a minimum of six (6)
inches. Gravel depth above the perforated pipe shall be
a minimum of two (2) inches. The total gravel depth
throughout the entire bed shall be a minimum of twelve
(12) inches.
4. The perforated distribution pipes must be no more than
six feet apart. The distance between the outermost
perforated distribution pipes and the sidewall of the
absorption bed must be no more than three feet.
5. Silt barrier material must be installed between the final
gravel layer and the native soil backfill. Ensure the
silt barrier covers the entire gravel surface before
placing backfill.
Page Three
Sunny Valley Subdivision, Lot 16
September 20, 1993
6. Monitor tubes shall be of four (4) inch diameter and
installed at the locations shown on the design. The
portion of the monitor tube extending through the gravel
depth shall be perforated six (6) inches below the bottom
of the horizontal distribution lines.
7. Backfill over the final gravel layer must not be less
than twenty-four (24) inches. Insulation must be
installed when the backf ill depth is less than thirty-six
(36) inches. The finished grade over the bed must be
mounded to prevent the formation of a depression after
settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in
septic system installations in the Municipality of
Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 20 thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam. HI or
equal) .
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi
140N, or equal) must be installed between the final
leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.50-2.50
screened gravel with less than 3% passing the #200 sieve.
Page Four
Sunny Valley Subdivision, Lot 16
September 20, 1993
7. When sand is being used as a filter material, it's
gradation specifications must conform to current M.O.A.
or D.E.C. requirements.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic
tank may be set in place, but may not be backfilled
before this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -
construction meeting will take place on-site.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 OL" Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
JK-
PERFORMEDFOR: 6A,3� DATE PER
LEGAL DESCRIPTION: ".r It. tTownship, Range, Section:
COMMENTS
-tC GINEM-6;EAL)
? -, 7
77
'tobcl A. Z:'O*'
RME
WASGROUNDWATER \ 0
ENCOUNTERED? t� �
S—m
IF YES, AT WHAT L
DEPTH? IoAk
P —
E
Depth to wavl�4 Batt
molbring? N*J�2
PERCOLATION RATE (minutesionCh) PERC HOLE DIAMETER G-4
TEST RUN BETWEEN TAND A*'9w;'1FT
PERFORMED 8 ;7034 Eagle River Loop Road No. 204
kaglo River, Alaska 97577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN(
72-OD8 (Rev. 4185)
��CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. IDATE-
IXF EtfW
2-
3-
4
5-
6-
7-
8
9
10--
12-
f>. 0
13-
14-
15-
16-
17-
18-
19-
20 -
COMMENTS
-tC GINEM-6;EAL)
? -, 7
77
'tobcl A. Z:'O*'
RME
WASGROUNDWATER \ 0
ENCOUNTERED? t� �
S—m
IF YES, AT WHAT L
DEPTH? IoAk
P —
E
Depth to wavl�4 Batt
molbring? N*J�2
PERCOLATION RATE (minutesionCh) PERC HOLE DIAMETER G-4
TEST RUN BETWEEN TAND A*'9w;'1FT
PERFORMED 8 ;7034 Eagle River Loop Road No. 204
kaglo River, Alaska 97577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN(
72-OD8 (Rev. 4185)
��CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. IDATE-
r- MUNICIPALITY OF ANCHORAGE ;
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
J-h�uu_
PHO NEW
V �Et 7 4 -NUPGRADE
MAILING ADDRES!� ID
6
LEGAL DESCRIPTION
L-1
LOCATION
NO. OF BEDROOMS
DISTANCE TO:
Well
C'
Absorption area
Dwelling
PERMIT NO.
Pz
is<
Manufacturer
No. of c rtments
Liu. ca E�_'X`o
IF HOMEMADE:
Inside length
Width
Liquid cht=_
6 he
DIST.
7 —1
PERMIT NO.
Oz
.3��
I. turer
t ------
Material %Z--
;FF&u`id capacity in gal ions
.J
DISTANCE TO:
I- I I L� C)
Found I
Nearest lot fine
4- /to
PERMIT NO.
3 CF()
W,X
_,u.2
zw
;:;i ,
No. of lines LC>
Length of each I)ne i
ve-)
Total length of ii
TOO
-
Trench width -
ches
6e) "
Distance taetweenT
Top of tile to finish grade .2 /
C4
Material beneath tile
'!�3 =
Total effective a Ion area
-7
US
Length
WOO
Depth
I PERMIT NO.
b diam
depth bsorption area
2�a
DISTANCE TO:
Wefl�
Building foundation Nearest lot line
.a
_0
9�1�
Depth
Driller Distance to I
1
W
DISTANCE TO: I
Building f d
Or- Tb
Sewer line Septic tank
Absorption area(s) 0.6
OTHER
sip
PIPE MATERIALS
SOIL TEST RATING
INSTALLERIl
�4��i
_xAr
REMARKS
tA
I
J
;a
I I
I
ILI
'7_7
C
C' I
__71
APPROVED DATE LEGAL
*`_� /&I I
72 013 fRevil/78)
MU"11=lF='nL_l-rV Of= n"(Z�"CAF?nC3E:
DEPARTMENT Pw,HEALTH AND ENVIRONMENTAL("tOTECTION
825 STREET, ANCHORAGE, AK. 9$ -Ji
264-4720
C) r-4 I -r 1-= C- 14 E: F_ F=* Ea FZ rl I -r
PERMIT NO. ( 810380 )
APPLICANT HAMANN CONST.
LOCATION SUNNY VALLEY
LEGAL LOT -.,,Ii SUNNY VALLEY SUB
TYPE OF SOIL ABSORPTION SYSTEM IS
MAXIMUM NUMBER OF BEDROOMS = 4
PO BOX 617 EAGLE RIVER
LOT SIZE
DRAINFIELD
694-2776 ;6j,
43560 SQUARE FEET
SOIL RATING <SO FT/BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
125 pt
15 L_E:NC3-r"= 15SD C3FZnVFZL_ E>I---F=-rH= :3:
THE LENGTH DIMENSION IS THE LENGTH 0N FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
I-fiEo lFFZEnr4CTV4 w3cwirvi 3" E3 Zo. E300 FiKE"l-.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEETX
FZ E7 CA LJ 3" FQ En E> n5 EE F" -r "r co 17 FA 64 K "3 3121 EE JL 12 t5 ED C3 FA L_ L_ CA t4 E_�_
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
_F_WCA �2 > I "E3 F=* I -r I CA n FZ 1-= Fz.* a CA U I Fz I=- E>
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F> Es FQ 41 :1 77 EZ >4 F" I F1 E" ED E> En CT Es PI ED E7 FZ it K a AL ED ED _AL
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
ISSUED
F is
0al -
I LH
V4. 0
(004)
10"�"
0 SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 13 PERCOLATION
TEST
825 L. Street. Arwhorago, Alaska 99S01 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: /j, 'o �0�&f_r "' DATE PERFORMEDY dl�71
LEGAL DESCRIPTION: --5;o7,wt7!v Mrz.11iev
D E S�OPE SITE PLAN
(/F
r2
,2-
3 -
AL
4- U I -e
12S pyz
6-
.7.
7-
8- v
9. -T-T-
10-
11 WASGROUNDWATER Z/,z7,j S
ENCOUNTERED? L
__7_ 0
7 P
12- IF YES, AT WHAT E
13- DEPTH?
�%A%%
14- � cl %t -
S &' At
15-
tk
16-
ot"
17-
&h6r. 4
'40 tto. Its �'4
181 t
19
20
I
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN. — FT AND FT
I` / —7 41 '—_ "-2 ".v
PERFORMED BY: .4.4 SJ:ngineerinq —CERTIFIED
I
72-008 (6/79)
DATE:
OF=
CEPARTMENT HEALTH AND ENVIRONMENTAL' ATECTION
825 'L' STREETo ANCHORAGEo AK. 99501
264-4720
L4 IE L_ L_ F=* E: FR tl I -r
PERMIT NO. ( S10202 )
APPLICANT DAVID RICHARD 705 MULDOON ROAD 338-3082
LOCATION WESTLAKE DR.
LEGAL LOT 16 SUNNY VALLEY SUB LOT SIZE 43560 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO 8 COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F"E=FZPlD1!— E"XF"31FZEnf5 E>EwCTE7PlE3EwFZ ZEAL, AL n3 ED AL
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
SIGNED
NT DAVID RICHARD
ISSUED D A T E — _%vj— 1/2022 <:V V4.0
1, 2 1 C-70- 'T
-DEMMENI OF HEALTH AND ENVIRCOMNIAL PROIECIJON
S25 JLr--0(7REET. F04MASICto FK
2C4
TRMI 7 MR C Ed 62eQ,
LIMITT 0%%YID 7f* MILMON FORD x -X -w.;2
AIICIM W.5-lLffa M
FIL LOT 16 v-tR*Oe Vrr4LLE%' VC L07 SIZE - 43!5 -Ce, 5AFFS FEEI
JMM DISIFOCE KIWEEN ft W -LL FM FM6 CO -S -ITE 'MWF-lrA Dle.-F-M-m 5VSTEM IS
i FEET FOR R MIME WELL M.' 35b 10 A03 FEET FM4 A PCX-zL)C. HELL DEMNDIW3
R THE 7%VT OF PMAAC: WELL.
�)MM PIS7f#4C:E Ff-.C" A PPIVAIE WELL 10 ft MINTilE !-EWER LINE IS 25 FEET AND
It CMILINITY SEWER LINE JS 75 FEET.
I LCIDS NRE REQUIFID fiND 11M.7 BE PEUMED 10 THE DEPWIMENT NII"M W, K&E.
THE WELL UffLETICIU.
ilk REQUIREMENT& r# -Yb' RPPM -c.KCJFICAIIC*C- F#Ax M61RUC.,730" Plsowwo- fiFzE
ILABLE 70 IWJN�E F'&[*'Ek IW-7FlLLRT)(*t
EPTIFY IHNI
'I Ni FAMILIFOL W21" THE REVUH&MEN15. FOR CO -SITE SENERE. FM WELLS FIS SET
Ili M' 7HE MMICIM-31Y OF FtK$CCAGE.
MILL INSTALL THE S%SIEM IN PX:CC4UX*CE WITH THE CXOES,
fW&'Ib NC$V4;1�j Ir -----------
I IED ----- DRTE
I
V4. 0
Trr'firb Drt t '[Jag
by
DOC Co. dba MUNICIPALITY OF ANCHORAGE
DEPI. OF HEALTH &
SULLIVANWATER WELLS ENVIRONMENTAL F.",CIZCTION
P.O. BOX 272, CHUG IAK, ALASKA 99567 * TELEPHONE 688-2759 APR 2 8 1981
1
OWNER OF LAND fi414-6 ' �e I C /7'�lf -< 0 f
ADDRESS -7,)5- r-7t&o��)_J ee) J jO 1,F6
LEGAL DESCRIPTION 4 /,( jr,*0-44.1-e
DATE - Started 6 � -2 3 ILI Ended < r
PEP -MIT NUMBER 02
KIND OF FORMATION:
E -11V r
DEPTH OF WELL /7R E'C . L
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. C,
GALS. PER HR a
KIND OF CASING
From Ft. to- _-217t. 12 From —Ft. to— Ft.
From Ft.to_Ljj_Ft. _ncTro'r;_Ft.to_Ft.
From—Ft.
L�l T1, 7
From /S_ Ft.to_L4LFt. c- 't l< 4
From—Ft. to—Ft. All,)�, oi�,t r
From —Ft. to— Ft.
From—Ft. to—Ft
From—Ft.
From
Ft. to -L(—./ Ft.
01
H9kc'l'*"from_Ft.
to—Ft.
From
Ft. to -L2 -Ft.
E4 I e7
'IP/rom
—'Ff. to_Ft.
From—Ft.
to—Ft.
4Uer,:<�, —
From—Ft.
to_Ft.
From L- cl it. to / 71 Ft.
el K'--fi -7
From—Ft.
to_Ft.
From—Ft.
to—Ft.—
tu xt r z;:lc
From_Ft.
to_Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From
—Ft. to
Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
Ff om
Ft. to_Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft.
From—Ft.
to—Ft
MISCL INFORMATION:
DRILLER'SNAME
Municipality of Anchorage
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.orglonsite
(907) 343-7904
S A 14. 1 1
CERTIFICATE OF ON-SITE SYSTEms APPROVAL
FOR A SINGLE FAmiLy DWELLING
Parcel I.D. 35Z4 COSA # Notm*
Expiration Date: �? - -3 1 - 0 G
1. GENERAL INFORMATION
Complete legal description
Location (site address) 94; 95 10ts-f- t -A" -Dr--
Current Property owner(s) :Ro6r4 Dayphone 04 -MV
Mailing address
Lending agency
Mailing address
q5�3s WA.�rf L-AI6-4- br., Ei4t A7k 951��-n -1 S'
Day phone
Real Estate Agent R0,.1S-,, L21Dynami? Dayphone
Mailing Address
Unless otherwise requested, COSA will be hold by DSD forpickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
El
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 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 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 Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of installation.
Name of Firm Eagle River Engineering Servlm Phone V7,1/ - 61 '15
1 LJ421 VFW Hd., Sufte 2OT-
Address Eagle RhAag. AK 995=
Engineer's Printed Name _CLicislybe r- ?-. Word Date 50(�10&
5. DSD SIGNATURE
_Izo� Approved for bedrooms.
Disapproved.
DNER P. WOOD
CE:1�387
Conditional approval for _ bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ttl Original Certificate Date:
By. OZ4�lf '
4:�;' lre7
(R�. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onske
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEms APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Wen type Er;vrl�x_ If A, B, or C provide PASID # _
Date completed ��3191 Sanitary seal &N) 1Z,1_
Total depth __L-Zj_ft. Cased to _L2j .. ft.
FROM WELL LOG
Date of test A -3 / 9/
Static water level ITY fl.
Well production so 9 -P.M.
WATER SAMPLE RESULTS:
Conform _g_colonies1100 mL Nitrate _LLD_ mg/L
Arsenic: dD mgA Date of sample: gtvac_
B. SEPTICIHOEDM TANK DATA
ID: 0,T 0 — 3 / 7
Well Log (?IN) L� A -
Wires property protected (Y/N) YA4=
Casing height (above ground) /.;- n.
AT INSPECTION
51 gl o�'
9 P.M.
Other bacteria 14r colonies/100 mL
Collected by: 0 -in -g Wood
Tank Type/Material S -e gil:L / 4."-L Date Installed /61 (1 � 33
Tanksize gal. Number of Compartments Cleanouts ON) �P_ _J_
Foundation cleanout O/N) *-I- Depression over tank (YAM 'J� High water alarm (Y49) --.rt
Date of pumping 51�5 limb Pumper Ole_ j S TXA�� . A0
I 1 11
C. ABSORPTION FIELD DATA
Date installed 101 11 19 � Soil rating fg�.p.dor fe/bdrm) 0.5 System type lecd
Length (00 ft.
Width I C)
ft. Gravel below pipe e?- 6 ft.
Total depth 4 ft. Eff. absorption area L-ALUe Monitoring tube L 64- Depression over field We-,
7—
Date of adequacy test IV / Oif, Resuttsp�all) Pa -a For_'L_bedrooms
Fluid depth in absorption field before test .0 - In. Water addedj&Q gal. New depth 3 in.
Elapsed Time: 2 0 min. Final fluid depth 0 in. Absorption rate >= 600 g-p.d.
Any rejuvenation treatment (past 12 mo.) (Y6& type) "jr�pn_ If yes, give date vi let.
D. LIFT STATION
Date installed
"Pump on' level at
Datum
Size In gallons
in. "Pump ofr
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100
Absorption field on lot -t- / co,
Public sewer main T JC)0 I
Sewer /septic service line -t ,
Animal containment areas t I 0(-�,
water alarm level at
Meets alarm & circuit requirements?
On adjacent lots -t-lc)O
On adjacent lots * ICI),
Public sewer manhoie/cleanout
Holding tank f- -75 '
Manure/animal excrete storage areas -# IPW
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1,5 Property line -"5� Absorption field -t Cz
Water main + to, Water service line -tic, Surface water (cc)
Wells on adjacent lots -f to 0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line + In , Building foundation -# F0 ' Water main +- 1C)
Water Service line +if) Surface water 4 fre), Driveway, parkingivehicle storage
Curtain drain V,5o Wells on adjacent lots 1AW I
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineees Printed Name (-'hr;S-1CQJLCn 22--4L)CL
COW
Date 157
...............
COSA Fee $ C)
Date of Payment -2- 6 - L,) 6
Receipt Number 490 4z 3
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
f in
E.
I HEREBY CERTIFY -THAT I HAVE SuRVEYED THE
FOLLOWING DESCRIBED PROPERTYs
AND THAT NO ENCROACH;MENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF T14E
OWNER TO DETERMINE THE EXISTENCE OF ANY
r-kSEMENTS, COVENANTS, OR RESTRICTIONS
'+I DO NOT APPEAR ON THE RECORDED S(MDI-
)0�10N PLAT. UNDER NO CIRCUMSTANCES SHOULD
kNY DATA HEREON BE USED FOR CONSTRUCTION
DF FENCE LINES, OR FOR ESTABLISHING BOUND-
%RY LINES.
SCALEs
DATE,
;'-�04zv�r
.rwLrl-o
FS,
DRAW
/i f
5D
I*! I
.tUlft % % t I
ae OF At
4V
jo �� ....... A:�S 'o
Mark 3award
LS -6918
lzwsl
SGS kct#
1062203001
All DatesMmts are Alaska Standard Time
Client Name
Eagle River Engineering
Printed
Date/Time
05/19/2DO6 13:16
Project Narne/11
Sunny Valley Lot 16 REM
Collected Daleff Ime
05/03/2006 10:30
Client Sample ID
Sunny Valley Lot 16 REM
Received Daft/Time
05/03/2006 12:44
h1strix
Drinking Water
Technical
Director
Stephen C. Ede
PWSID
0
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
POL
Units
Method
Comaiw ID
Limits
Date Dote
Init
Nitritc-N
ND
0.100
mg/L
EPA 353.2
D
05/03/06
ALR
Nilrate-N
ND
0.100
mg/L
EPA 353.2
B
05/03/06
ALR
Metals Department
Hardness as CaCO3
222
5.00
mg/l,
SN120 2340B
C
051ON6 05/11/06
SCL
Private Individual Analysis
Aluminum
ND
20.0
ug/L
EP200.8
C
05/0&D6 05/11/06
SCL
Antimony
ND
1.00
ug1l,
EP200.8
C
(<-6)
05/ON6 05/11/06
SCL
Arsenic
ND
5.00
ug/L
EP200.8
C
("10)
05/08M6 05/11/06
SCI.
Barium
38.4
3.00
ug/L
EP200.8
C
("2000)
05/08/06 05/11/06
SCL
Cadmium
ND
0.500
ug/L
EP200.8
C
(-5)
05/OM6 05/11/06
SCL
Calcium
54000
500
ug/L
EP200.8
C
051ON6 05/11/06
SCL
Chromium
ND
1.00
ugfL
EP200.8
C
100)
05/0&D6 05/11/06
SCL
Copper
7.92
1.00
ug/L
EP200.8
C
1300)
05108106 05111106
SCI,
Iron
ND
250
ug/L
EP200.9
C
(�300)
05/08/06 05/11106
SCL
Lead
0.429
0.200
ug/L
EP200.8
C
15)
05108/06 05/11/06
SCL
Magnesium
21200
50.0
ug/L
EP200.9
C
05/08/06 05/11/06
SCL
Mmgmese
114
a 1.00
ug/L
EP200.8
C
(�50)
05108/06 05/11/06
SCL
Phosphorus
ND
200
ug/l.
EP200.8
C
05/08/06 05/11/06
SCL
Fluoride
ND
0.100
mg/l,
EPA 300.0
B
(<-2)
05/10/06 05110106
JEM
Chloride
13.5
0.100
mg/l,
EPA 300.0
B
(�250)
05110/06 05110/06
JEM
Potassium
1350
500
ua
EP200.8
C
05/08/06 05/11/06
SCL
Selenium
ND
5.00
ug/L
EP200.8
C
(<-50)
05/08106 05/11/06
SCL
Sodium
4730
500
ugIL
EP200.8
C
("250000)
05/08M6 05/11/06
SCL
Silicon
4940
200
ugIL
EP200.9
C
05/08/06 05/11/06
SCL
Silver
ND
1.00
ugIL
EP200.8
C
("100)
05108106 05/11/06
SCL
Sulfate
26.4
0.100
mg1l,
EPA 300.0
B
(-250)
05/10106 05/10/06
JEM
Thallium
ND
1.00
ug/l.
EP200.8
C
(<-2)
05/09/06 05/11/06
SCL
qq
97md
SGS Rtf.#
1062203001
Client Name
Cagle River Engineering
Project Namc/#
Sunny Valley Lot 16 REM
Client Sample ID
Sunny Valley Lot 16 REM
Matrix
Drinking Water
PWSID 0
All Dalesffimes are Alaska Standard Time
Printed Dateffime
05/19/2006 13:16
Collected Daternme
05/03/2006 10:30
Received Dalefrime
05/03/2006 12:44
Technical Director
Stephen C. Ede
Allomble Prep Analysis
Pas-ameter Results PQ1. Units Method Container ID Limits Date Date Init
Private Individual Analvain
Total Dissolved Solids
Zinc
Nickel
I IC03 Alkalinity
CO3 Alkalinity
011 Alkalinity
Conductivity
PH
Alkalinity
Total Coliform
286
10.0
mg/L
SM20 2540C
D
(�500)
05/04/06
AZS
26.8
5.00
ugtL
EP200.8
C
(�5000)
05/08/06 05111106
SCL
ND
2.00
ug1L
EP200.8
C
(-100)
05/OU6 05111106
SCL
230
20.0
mg/L
SM20 2320B
D
05/04/06
PLW
ND
20.0
mg(L
SM20 2320B
D
05/04106
Pl-W
ND
20.0
mg/L
SM20 2320D
D
05104/06
PLW
490
1.00
umhos/m
SM20 2510D
D
051010%
CRY
7.59
0.100
pi I units
EPA 150.1
D
(6.5-8.5)
05/03/06
ALR
230
20.0
mg(L
SM20 2320D
D
05/04106
PLW
0
col/100ml,
SM20 9222B
A
1)
05/03/06
TLF
05/26/2006 13:46
JRs Pumping
PODOX773415
Basle lUver. AK 99577
(907) 694-6434
9073449821
a Information --_1
Number.
Eagle River Engineering
Job Description:
10421 VFW Rd Ste #2oi
Service Date:
25 -May -2006 12;0
P.O. Nurnber:
Eagle River, AK W577
Tam%x:
(907) 694-5195
sal":
MapSook,
Wb Sit* Informal
Cross Streets:
Stephanie
Job Comments:
9535 West Lake Drive
Eagle River, AK 99577
(907) 604-5195
Additional Location Comments Diag,am;
#'S are an wooden fence - Home Is
Cedar
Septic @ front In yard by DW
Service Type Oty Price Each
Septic Service 15K 1 $135.00
JRS SEPTIC
12009
Net 30
Karfla
Eagle River Road
PAGE 01
Service Agreement
Number.
019965
Order Date:
22-may-2om
Service Date:
25 -May -2006 12;0
Technician:
Dave
-15 Little Low - No Solids
Tac %: 0
Job Type- Repeat
Map Grid: 112- -
Gallons Planned: 1250
Gal. Actual:
Hose Length: 2
Double Tank;
Pump System:
Baffles Infet: 0
Baffles Outlet: ED
Tax? Extension Actual
No $135.00
NonTaxable Total T"mUsTotal Tax Total Granell Total
Effornoiled Charges: $135,00 $0.00 $0.00 $135�1)0
Actual Charges,
Customer agre" toft larms and condiflons shown. THIS 15 A BINDING AGREEMENT.
Vgmature ard Tide of Customer Represtaritative
Daft
Accepted by JR# Pumping Dow Accepted
For your addod ccnvsn(� " accept American Eipress. 10cover. Mae ard Master Card payments � the phone.
After 30 Days accounts will be turned ow to edlections. S25.00 For NSF Checks Returned
e, tj
MunicipaRty 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
FORA8INGCIfFAMIL'YDWELL_1NG '
Parcel I.D. OGO 26q 1.7
1. GENERAL INFORMATION
HAA
Expiration Dale: Ic Lf
0
Complete legal description _'SLi0Qy
VALIZ
L-br / 6, REM
Cocation (site address or directions)
g635
h)F_S—J L�jftr_ vP_
Current Property owner(s) CL1_--A)bok)
*- LAtA&jjLXLKTbay
-CA)
phone ON- 31(,3
Mailing address PO ?,cK
7712_-)Z�
EAfwr i�:ia-Ls AK
-7-9=-JZ
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
..Unless othenvise requested, HAA willbe heldbyDSO forpickup.
2. NUMBER OF BEDROOMS:
q
3. TYPE 0 F WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Individual Well
Individual On-site
ER -11,
z Individual Water Storage
Individual Holding tank
El
Community Class Well
El
Community On-site
El
Public Water System
El
Public Sewer
0
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 inde ' pendent 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-sile waste."Ir 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 we!I and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with va;id 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 seat 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 riles 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.
Namc of r-Irm ]Eagle RiVCr IStrigineering Se^joes
Address P-()- Bu,' .13419W, 50e Yiver, AK W77,3294
Engineer's Printed Name. C14RT_5TpPf(Fk R. Woob
6. DSD SIGNATURE
__LZ Approved for
Disapproved.
bedrooms.
Conditional approval for _ bedrooms, with the following stipulations:
Additional Comments WAI;:R'Zn
WAqT-;:WATF:p
Aftachments:
HAA Checklist X
Septic System Advisory .
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: Ire -03
(R.. 0IM2)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
47DO South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
G
Legal Description: 4;UA)M\/ VAII,---Y L07 It, Rr-M . Parcel ID: oSo - /7
A. WELL DATA
Well type J2?-T�A_ If A, B, or C provide PWSID #
I
Date completed ga3 /,� I Sanitary seal (YIN)
Total depth _12-1—ft. Cased toi-2-1ft.
FROM WELL LOG
Date of test co fZ3 41
Static water level ev ft.
Well production '�p 9 -p -m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mi. Nitrate �.-IJVWAP%.A.
Well Log (Y/N) V
Wires properly protected (Y/N)
Casing height (above ground) aq in.
AT INSPECTION
Iz -5 k 7>
97
51 _r
9.P.M.
Otherbacteria 0 colonies/100m].
Arsenic: _ mg./I. Date of sample: 6Z&Vo-5 Collectedby: CtfP75
S�LDING TANK DATA
Tank Type/Material 04 1 1 cl S 57A�O_L Date Installed if
Tank size .0 c�(-, gal. Number of Compartments Cleanouts (Y/N) X
Foundation cleanout(Y/N)_�J_ Depression over tank (Y/N) High water alarm (YIN) A-)
Date of pumping elbu.k !, . Pumper "T iz I �'
C. ABSORPTION FIELD DATA
Date installed to hlJ9 Soil rating ��r ft2/bdrm) V _'Z— Systerntype
Length �n ft. Width — 20 ft. Gravel below pipe 6.17 ft.
Total depth q ft. Eff. absorption area LLOD ft� Monitoring tube _�_ Depression over field k/
Date of adequacy test 9/7 -;LS Results (Pass/Fail) PA 4; 4; For _�_ bedrooms
Fluid depth in absorption field before test In. Water added 0
poogal. New depth �h in.
4 7�
Elapsed Time: -ZOPS min. Final fluid depthq4L in. Absorption rate >= 4cnt_ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) A I If yes, give date
D. LIFT STATION
Date installed --A1-1+— Size in gallons
"Pump on" level at_ in.
Datum
E. SEPARATION DISTANCES
"Pump off" level at — in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 1(go-t-
Absorption field on lot 17 -5 -
Public sewer main
Sewer /septic service line
Manhole/Access (y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 1C0
On adjacent lots /Ool-
Public sewer manhole/cleanout i0c.) +
Holding tank V14
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I
Building foundation 7-3 Property line to Absorption field 73
Water main /C 4- Water service line ID Swfar� watar /-,
Wells on adjacent lots k -,n 1"'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line C) -t- — Building foundation Water main 1r)
Water Service line it) 4- Surface water
----Ja2j_ Driveway. Parking/vehicle storage
Curtain drain,wovC IeAk�jJ Wells on adjacent lots Jim) I-
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Munkloal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name - Ctf RTS ToPj+ CIZZ- (Jo,,t.)
Date
HAA Fee $ 15- 1 :> Waiver Fee S
Date of Payment ( L) Date of Payment
Receipt Number Receipt Number
(Rev. 12101)
A Mj�-H�
*111IMTOPHR It W0(x
CEIM
- .�. -.- .1 -
Eagle River Engineering Services
Louia Butera, P.r�.
Christopher R. Woml, PX.
P.O. Box 773294
Eagle River, AK 99577-3294
October 10, 2003
Jim Cross, P.E.
Manager, On-Sitc Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Sunny Valley L 16 REM
Septic Adequacy Report
Dear Mr. Cross:
(907) 694-5195 tel
(907) 694-3297 fax
The purpose of this letter is to report our findings of an adequacy test of the septic system and
well at the above referenced property. The well production rate exceeds the quantity required to
be produced for a 4 bedroom home. The septic system accepted all 789 gallons of water added
into the septic system, and the water tables recovered to their original levels within I hr after the
total amount of water was added. However, when the test was begun, there was 1.5 inches of
standing water in the cleanouts at the beginning of the leach bed, and 9 inches of standing water
in the monitor tube. The design depth of gravel is 6".
The cleanouts and monitor tube at the far end of the leach bed were dry. Ile water level rose 4
inches in the far monitor tube during the addition of the test water, but the level had dropped
back down to 0" within an hour after the completion of adding water. We shot elevations to see
if the beginning end of the bed had settled, but that did not appear to be the case. We believe that
the bed is "arched" with the beginning end of the field with a perched water table, and the far end
dry, and still capable of receiving effluent.
We recommend that this system be passed and granted a Health Authority Approval, despite the
perched water table at one end, since it has been demonstrated that the other end of the leachfield
is dry and capable of receiving effluent. Please see our attached elevations showing that the ends
of the bed are level. We have also attached the as -built for your convenience.
If you have any questions please call our office at 694-5195.
SmMcer,
Christopher R. Wood, P.
EAGLE RIVER ENGINFFF ING SERVICES
\2()03%98-010Rn.Doc
-15
-Z -
-3
IMII
- L
-cl
- h)
EAGLE RIVER
ENGINEERING SERVICES
P. 0. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
JOB !)"� 0 10
SHEET N -- F
CALCULATED BY c yj - DATE
CHECKED
SCALE
DATE
�awq� � 81471
-03
T 7_
t
-----
-----
7
. ..... .....
4
Li
-v
1-4
c I
0
.... ...
A-1
... ...
..
o AT 12-
;g I wT-1 --7 t
�awq� � 81471
10- 7-03410:31AM;
SGS Ref.0
aient Name
ProjectName/0
alentsamplell)
Matrix
PIVSIDI
Sample Remarks:
1036338002
Eagle River Engineering
NIA
Sunny Valley L16 REM
Drinking Water
0
;907 15815301 0 3/
Ali Date&Tlmes are Alaska Standard Time
Printed DattMme
10/06/2003 14:24
Collected Date/Tlme
10/01/2003 9:00
Recelyed Date/Time
10/01/200J 13:30
Technical Director
Ede
Itelcas
A=I,le Analysis
Parameter Qualificn; Ranks PQL Units Method container ID t, Itc Init
Kicrobiology Laboratory
Total[Colifotm 0 col/100mL SM199222D A (<-I) 10/01/03 DKC
10- 6-03; 1:51PM; ;907 5615301 a 2/
EE
SGS Ref.#
1036198001
ClIentliame
Eagle River Engineering
P'rojectNamd#
Sunny Valley Lot 16
Client Sample ID
Sunny Valley Lot 16
Matrix
Drinking Water
All DatestTimes are Abska Standard Time
Printed Date/Time 1010312003 15:50
Collected DateMme 09/2312003 15:32
Received Daterlme 09/2412003 13:30
Technical Director Stepbea4Ede
Released
Sample Remarks:
20.0 U
20.0
ug/L
EP200.8
D
EP 300.0 - *Me matrix
spike for fluoride and nitrate failed due to matrix interference.
.5.00 U
5.00
Parameter
Qualifiers Results
PQL
Units
Method
le
Contain" ID "arith
P
PL Analysis
Init
3.00
U91L
EP200.9
D
(<-2000) 09/25/03 09129/03 WAW
Cadmium
D Date
Selenium
5.00 U
5.00
ug/L
EP2DO.8
D
O9a5/03 0912&*03 WAW
Nickel
2.00 U
2.00
ugfL
EP200.9
D
09125/03 09/28/03 WAW
Antimony
1.00 U
1.00
ug/L
EP200.8
D
09/25/03 09128/03 WAW
Thalliurn
1.00 U
1.00
ag1l.
EP200.9
D
09/25/03 09/28/03 WAW
Metals Department
Hardness as CsC)03 234 5.00 mgfL SIM172340C D 09M/03 09/28/03 WAW
Private Individual Analysis
Aluminum
20.0 U
20.0
ug/L
EP200.8
D
09125103 09/28/03 WAW
Arsenic
.5.00 U
5.00
ug/L
EP200.9
D
(<-50)
09125/03 09128M3 WAW
Barium
38.1
3.00
U91L
EP200.9
D
(<-2000) 09/25/03 09129/03 WAW
Cadmium
0.100 U
0.100
ug/L
EP200.9
D
(<-S)
09/25103 09/29/03 WAW
Calcium
57900
500
U91L
EP200.3
D
09t25103 09/211/03 WAW
Chromium
1.00 U
1.00
ug/L
EP200.8
D
(<-100)
09M/03 09/28/03 WAW
Copper
2A3
1.00
ugIL
EP200.9
D
(<-1300) 09/25tO3 09128/03 WAW
Iron
* 459
100
ug/L
EP200.8
D
(<-300)
09/25/03 09/28/03 WAW
Lead
0.364
0200
ugtL
EP200.8
D
(<-15)
09a5/03 09/28/03 WAW
Magnesium
21700
50.0
ug/L
EP200.9
D
09/25103 09/28103 WAW
Manganese
a 194
1.00
ugtL
EP200.9
D
(<-50)
09/25/03 09/28103 WAW
Phosphorus
30.0 U
30.0
ug/L
EP200.8
D
09125/03 09128/03 WAW
Potassium
4000
500
ug/L
EP200.9
D
09125103 09129103 WAW
Sodium
4990
500
ug/L
EP200.8
D
(<-25000 09/25103 09/2=3 WAW
Silicon
6050
200
ug/L
EP200.9
D
09/25/03 09M/03 WAW
Silver
1.00 U
1.00
ug/L
EP200.8
D
(<-100)
09/25/03 09/28M3 WAW
Zinc
60.5
2.00
ug(L
EP200.8
D
N-5000) 09125/03 09/29/03 WAW
Chloride
11.0
0.100
mg/L
EPA 300.0
B
N-250)
09/24/03 IMP
Fluoride
0.10OU
0.100
mg;1L
EPA 3DO.0
D
(<-2)
09/24103 IMP
Nitratc-N
0.1
0.100
mg/L
EPA 3DO.0
D
N-10)
09/24103 IMP
Nitrite -N
OJOOU
0.100
rng/L
EPA300.0
D
(<-I)
09/24103 IMP
Sulfate
29.0
0.100
mg'L
EPA300.0
R
(<-250)
09/24103 IMP
Total Dissolved Solids
291
50.0
mg/L
SM202540C
C
(.0-500)
09/30/03 jyC
Sep 19 03 09:19a Tl-- Ramseu Team 9n7-261-7555 p.2
LCS SAMEY PAGE 02
tL-
tot
RArUroAj lohl,103
cHArxroPitLX jZo4vbP?.C�\\
Al9tnLT-NO CORNEAS SET THIS DATE.
3SQUAWD 4 IATZS LAND SURVIlITIM 684-4365
I HEREBY CERTIFY -THAT I HAVE SLWVXYtD THE
SCAL11
MLOWING DESCRIBED PROPERTyl
'eoxsw
A
AND THAT NO INCROACIINIENTS MST MEF� AS
CAM
INVICATIED. rr 10 THE RESPONSIBILITY Or THE
49
V*M To bmillAtts Tot EXISTME Of ANY
811101
EASIDNENTR C014MANTS OR RESTRICTIONS
*HW 00 1;&i APPEAR Q THIE RECORDED 8UW-
..rwj-lr
VISION IPLAT. UNDER NO CIRCLOOTANat WcouLD
ro,
ANY DATA HEMON ILE USED FOR CONSTRUCTION
1
OF rl!N= LINES, OR FOR --
DRAWN-
44%
ARY LINES.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES ZAa'
Division of Environmental Services
On-Sfte Services Section IN
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcell.D.# 04 -n -14A-1-1
i �el 42 t# 1. " 4 112 Firelitm,2% trenk
Complete legal description Lot 16 Sunny valley
Location (site address or directions)
HAA # �j Q01 12�j n --I
9535 West Lake Drive
Property owner Guy and Teresa Holland — Day phone 694-4510
Lending agency
Mailing address
Agent —
Address —
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxxxxxx
Community well
Public water
Day phone
Day phone
15-3-7
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 xxxxxxx
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.
72-025(R".1/911 F�t MOAN21
5. STATEMENT OF INSPECTION BY ENGINEER
6.
By:
Ascertified bymysealaffixed heretoanclasof the validation date shown below, Iverifythatmy
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
Address 17034 EaqTe
Eagle (`[,or,
Engineer's signature
DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Phone �F
Date
bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof homes
andtheirlending Institutions in order to satisfy certain federal and state requirements. Employeesof DHHSdonot
conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional enginrees work.
72-025 (R�. 119t) Swk POA 021
Municipality of Anchorage AL
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: X,-c�f Ild qtn,&f_=1 —Parcel I.D. 0'5r0'>54 t�l
A. Well Data
Welltype If A, B, or C, attach ADEC letter. ADEC water system number Au
Log present &N) -Date completed -Driller 'Sa L_k� Q b,-4
Total depth 1-10, —Casedto —Casing height x '2�%
Sanitary seal &N)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
Wires properly protected O/N)
AT INSPECTION
';,0- 0 —g -P.M. _g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septictholding tank on lot I IDO On adjacent lots
Absorption field on lot C> : On adjacent lots \ 00 04
Public sewer main —Public sewer manhole/cleanout A,
Sewer service line Petroleum tank -Z-15
WATER SAMPLE RESULTS:
Coliform 0
—Nitrate
0 0
—Other bacteria
Date of sample: 1011871
Z
—Collected by: 12-0
M
C
M
C
Coliform 0
—Nitrate
0 0
—Other bacteria
Date of sample: 1011871
il
—Collected by: 12-0
B. SEPTICIHOLDING TANK DATA
Date Installed \o -\\-,11'S - Tank size —Compartments
Cleanouts ON) 4 —Foundation cleanoutaYN) Depresslo (YA
High water alarm (YO 4 Alarm tested (Y/N).
Date of pumping — A Puml5er
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot C> t> k -On adjacent lots I ID c. k Ar -Foundation
To property line X C> \� —Absorption field — A- Water mairdservice line
Surface water/drainage I ID 0 %.V-
-7-
72-026 (=)- Fmt CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Manufacturer
Size In gallons Manhole/Access (Y/N)
Vent (YIN)
High water alarm level
'Pump on" level at
Meets MCA electrical codes (Y/N)
tested
at
SEPARATION D E FROM LIFT STATION TO:
ell on =lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date Installed —Soil rating (GPD/Ft) O.C;, -System type R��Z`
Length Loc" Width � % -Gravel thickness' 0.5,- Total depth :5-J"
Total absorption area if 2- na Cleanout present (ft) X Depression over field (yo W
Date of adequacy test AN -�� —Results (pass/fail) for Bedrooms
Water level In absorption field before test I —Aftertest
Peroxide treatment (past 12 months) (Y64')_ 'k—If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot k (::) D k —On adjacent lots I Ll;)o I. Property line
To building foundation —To existing or abandoned system on lot
On adjacent lots -Cuthank— Water maintservice line
Surface water ov-, Driveway, parking/vehicle storage area -.Z, 0
Curtain drain rl� _Pk- V_40 Q o
E. ENGINEER'S CERTIFICATION
I cerVfy that I have checked, verified, or
Signature
Engineers Name
Date
HAA Fee $
17034 Eagle River'
Date of Payment ZQ -,�'7-23�
Receipt Number ��3 2 2
72-026 (3193)* Back
warned all OA and HAA guidelines in effect onlilhe his inspection.
% 4,10.
Road No. 204
77 1
Waiver Fee $
Date of Payment
Receipt Number
.a -
5. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
1-4 'A q A t 0
DATE
DATE
DATE
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
C�'
0 One 0 Four 0 Other
SINGLE FAMILY
0 Two 0 Five
INSPECTOR
INSPECTOR
INSPECTOR
OF ANCHOp
,Ar
MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & E
DEPARTMENT HEALTH & ENVIRONMENTAL PROTECTION EtTVIR041AENTAL
OF
[_�CTICTION
825 L Street - Anchorage, Alaska 99501
since June 1975. For wells drilled prior to that date, give well
0 PUBLICUTILITY
JUL 1 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
RECEIY�D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITI
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
X',
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
PHONE
.4, , ,'sr
MAILING ADDRESS
PROPERTY RESIDENT (if different from above)
PHONE
2. BUYER
V A, A"
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
MAILING ADDRESS
5. LEGAL DESCRIPTION
Z� /_'/Z ellle :2
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
C�'
0 One 0 Four 0 Other
SINGLE FAMILY
0 Two 0 Five
13 MULTIPLE FAMILY
0 Three 0 Six
7. WATER SUPPLY
dW3 INDIVIDUAL-
*ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
0 PUBLICUTILITY
depth (attach log if available.)
B. SEWAGE DISPOSAL SYSTEM
J�T INDIVIDUAL/ON-SITE--
—YEAR ON-SITE SYSTEM WAS INSTALLED.
0 PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (R�. 6/79) —NX C, LAj't_0S_"
JA�) 4_1_4D
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
0 SINGLEFAMILY
0 MULTIPLE FAMILY
NUMBER OF BEDROOMS
0 ONE 0 THREE 0 FIVE 0 OTHER
0 TWO 0 FOUR 0 six
2. WATER SUPPLY
INDIVIDUAL
COMMUNITY
0 PUBLICUTILITY
Connection Verified
PERMITNUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
OPUBLIC UTILITY
Connection Verified
PERMIT NUMEER
DATEINSTALLED
INSTALLER
[3septicTank,or OHoldingTank
Size: J;:j S -V If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES WELLTO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
6,---A'PPROVED FOR BEDROOMS
El CONDITIONAL APPROVAL (letter must accompany certificate)
E] DISAPPROVED
DATE
r-7 L( — �—(
BYP
I
N 72 010 (Re.. 6/79)