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Home My WebLink AboutROLLING HILLS VIEW ESTATES BLK 2 LT 4Rolling Hills View Estates Lot 4 Block 2 #050-322-04 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP21157 PID Number: 050-322-04 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name CHRISTOPHER WALDEN ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 19011 UPPER SKYLINE DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. ROLLING HILLS VW. EST. 2 4 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption St Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA FoundationF10, + LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. New MT installed. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer � RS drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection15' 6/11/21 nd 6/11/21 Location and description dates: 2 3`d 4'" TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL - :WQ AMW Conditional Approval: Date I -W '•:tp,�l� i* •• TH .. - .....�. l • Curtis Huffman Septic System Approve r-- �� 'F�• CE 128991 6 Q �-� Date 'lG�'- 2 �slF�• - Adw Note: this approval does not include . 8/17/2021. PROFESSIQAP well permit requirements. trcev ua/UZ/ 10) PID: 050-322-04 PERMIT. OSP211157 JLS Q FWCS o - O 1 " = 30' PAGE: LLJ m w `o W = x 0 o Li O o Z Q m 25.0' A 22.0' B FCO Lil GRAVEL D/W O p WELL O O NEW MT INSTALLED ® 6. 60' i O W/ FIELD TO STD C 4, O z VERIFICATION MH DECOMMISSIONED EXISTING CO S.T. & INSTALLED NEW E DCO 1250—GAL HDPE SEPTIC TANK WITH DCO & NEW MT. MT ®F in LOT 4 BLK 2 A—C=28,6' B—C=30,1' A—D=33,3' B—D=35,6' A—E=35.8' B—E=38,9' A—F=48.3' B—F=56.3' EXISTING FIELD 196.53, 9 6 R) AVSD S7 57' A "w 196 ER SKYU'NE DRIVE D/W L6 (S78 ST� ALE, 1- = 50 SEPTIC SECTION ROLLING HILLS VIEW ESTATES B2, L4 PREPARED FOR: CHRIS WALDEN 19011 UPPER SKYLINE DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK®gmail. com ;UPPORT SERVICE Fwc.5 41K� DATE: 8/17/2021 SURVEY: JLS DRAWN: FWCS SCALE: 1 " = 30' PAGE: 1 OF 1 SCALEi NTS OF A.L,� * 9 TIi rtis Huffman CE 128991 8/17/21 Alf ��ssioNa�' ,8Z'6ZZ M„OO,OO,OON ,AG LC �'0 U x m [1y _.....�C Z 00 '� in 0 CQ QtG a n lU P a � •0•01 Li.w II 11 � 40 � �40 H CJ o � morn CO q J •D O(D Z "0 '' � I aG 0, co l d N E- x o ,� Cn o � 0VA O• � 1 "j �/A O -i �, W E-il } �4 —gym a „{;x� CD ��' tn xJX '-0 O f -CQ 1 °M aco v ti00 uj LO 75 Z O Ul7v TO30 ONOO U v O d' cs ce ai 'v C o to n Z o v o A'Z£ ® ` H t N �.� o o o o N 11 mo rP p o °J <r N iismH cn ONIISIX3 N O >. m cq ,0'09 w+ � �? NO30 Q O a7 C N v 181 C14 45 C-4 y .9'Z L l 0 (� Q> N m 7 0 0 3„OO,OO,OON gS -et E~ U y” z z N ONNV30 30 SISVO e+ w C .o U aa�4 >.�oa�� o o I <� 0 zmoo ce MUNICIPALITY OF ANCHORAGE On -Site Water & Wast water Program PC Box 10fi9::r1 4700 Elmore Ruud Andhorage, AM&M 90519.0650 Pho dr � 343-79D4 FW: �9 ) 34U-7XY h*J wrrwlnuni.vrgorwikB On -Site Wastewater Disposal System Permit Permit Number- CSP291157 Work Type, Septli;Tank Upgrade Tax Cuda Number= 05032204000 Effective Date; Ex&atlon Me, S i to Legal Add res s; ROLLING HILLS VIEW ESTATES CLIA 2 LT 4 G;0254 Slta Malting Addrass. 19411 UPPER SKYLINE OR, Eagle Rimer t". c n , a r u U pa I— t ntt n l EV412021 U412022 Ownar_ VdALOEN CHRISTOPHER J Lot Size to Sq Ft- 50094 Design Engineer, FIRST WATER CONSULTING Total Bodro-oms: 3 This permit is for the coostructic r1 of: 0 Dj5pusal Field Q Septic Ta nk ❑ Holdl n 9 Teak El Priory ❑ PMV011e VYe11 ❑ Water Storage All consttuciian shall be In accordance with, 1. The attar~hed appravad design. 2. All requirements speci$ed in Anchorage Municipal code Chapters 15-55 and 15-55 grid the State of Ala:ska VVastewater Disposal Reg ulaUuns (18AAC72) and Drinking 'mater Regulations (18AAC80) 3. The wastewater code requires mspeatioris during the installation. The engineer she II notify the Development arvlcas aapartm-eni par AM 15.65- Prnvlda not'llfwtIon by callIng (907) 343-7904 (2417). 4- From October 15 1,o April 15, a subsu rfaca soil absorption system under ow s�tru ctlon durIng "ezing Weather shall he either_ a. Opened and Closed on the same day. or b. Covered, sealed. and heated to preveT)t freezing r provleln= Leat 1<h bgir�ninf the fill to ca mtat theparticr� f�tv�en C end fief vrill be rnek. Received B� Issued Sy: 6!412021 Dake; Date: MUNICPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-322-04 Property owner(s) CHRISTOPHER WALDEN Day phone Mailing address 19011 UPPER SKYLINE DRIVE, EAGLE RIVER, AK 99577 Site address 19011 UPPER SKYLINE DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) ROLLING HILLS VIEW ESTATES, B2, L4 Legal description (Township, Range & Section) Lot Size 50,094 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (N all that apply) Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) 0 Upgrade (w/wo ADU) Q Duplex (D) E-1Renewal ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit/Rush Fees:22� Date of Payment: Receipt Number: So � S Permit No. 05P Z I 11 ,57 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com May 20, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ROLLING HILLS VIEW ESTATES, BLOCK 2, LOT 4 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211157, Deb Wockenfuss, 06/04/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211157, Deb Wockenfuss, 06/04/21 l MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264.4720 \ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ,&P4SttEti PHONE NEW6? UPGRADE MAILING A� RESS S LEGAL DESCRIPTION LOCATION S.6 7-/W NO. OF BEDROOMS 13 OY DISTANCE TO: Well / O Absorption a� 138=9 / JJ T� PEIT JII71s L/ 73 �rJJ �tiFF'"' — i Q Manufacturer � Mat • a'1r No. of colfipartments Liq. c a nons IF HOMEMADE: Inside length Width Liquid depth 6 Y JUZ I —4 DISTANCE TO: Well w ling Manufacturer Material PERMIT NO. Liquid capacity in gallons 0 W DISTANCE TO: Well HO V Founda7b { Nearest 1 t hne f4 PE IT V -7-3 ZNo. I. Q of lines Length e h L / / Tatal le qth i Ifes Trench wi th // inches -Material beneath tile /f 12 inches Distance b.}lyeen Ves (J Total effective absorpti area f Top of(1de to finish grade /L l)Ff7 / W U Le gth Width Depth PERMIT NO. d H W 1 Type of crib Crib diameter Cr i pth Total effective absorption area y Well DISTANCE T0: Building filfundlitidn Nearest lot line J J Class epi '--guildinglound5floil Driller Distance to lot line PERMIT NO. W 3 DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATER] LS ' ✓G SOIL TEST RAT] NG'17 L INSTALLER REMARKS nif CIQ 3 8 VtT 'W,tj _ zt40i t•p .� •f, r 4 Y APPROVED - - - ---- DATE GAL iI S � �' E'IAti�EEFiIY(3 � 1iZ �� !l 17 p SRR 75CY. 72-013 (Rev. 3178) 1: ; ( OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE Started / ' iFa Ended. PERMIT NUMBER DEPTH OF WELL ___$TATJC.LEVELOF WATER FT. ; ` DRAW DOWN FT. GALS PER HR J O KIND OF CASING " KIND OF FORMATION: From -'Ft.*fo 'U .Ft. n.� �. r! /./.-' From • Ft: to Ft. From �L'• Ft to' Ft. 145%d . From J Ft. to Ft. r— From Ft. to Ft. From Ft. to Ft. From efr Ft.to�Ft. 9'cn r-�r.,rc_ /,:cc -1 .From Ft. to Ft From Ft. to . `Ft. ` From Ft. to Ft From r Ft to 1 iu Ft r r /1P„� ._ ra'>"c i-�+Fiom Ft. to F From Ft to Ft :. = ' ir_' /'From ; 1.'�\IGIF,1Utt rpt E117anGE 'Ft. r<P7. 4`tHE��e;oA From t %'f Ft. to 'T 'rFt. cAi/:.� = h4�= From' Ft.�fo IFOiitiFt N�t. From •> rFtto ��41� Ft. l; •'� k c ti �/ r r .� From Ft. to From--- Ft. to ' Ft. tl r-.1 f lr r': L C 4%A.�G From Ft. to !C!, y From tit Ft to ��t'FL r ��''�' "'J w"From Ft. to Ft. From Ft to Ft '' '^'" er.'m5'. From Ft. to Ft. From Ft to ' ` ' Ft. w r From Ft. to ..Ft. Ft. ' From 4 Ft. to • n FL t.rr'. k,...._ j f r= ;.� From to—Ft.' From FLAG Ft:—' From Ft. to Ft.' , From Ft. to Ft. From Ft. to Ft. From Ft. to ' Ft. i From Ft. to—Ft' ' IUISCL INFORMATION: .. . r J t L ✓.r i•7 r",(S�M I' r DRILLER'S NAME�- i�IlJN I G I F _-n- I TY OF �itJCH� .URGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK. 99501 264-4720 iDN—SITE SELJER eE WELL— PERM I T •-PERMIT NO: 840473 HAND WRITTEN DATE ISSUED: 06/18184 APPLICAFJT: % S&S ENGINEERING SCOTT EXCAVATING ADDRESS: EAGLE RIVER EAGLE RIVER, At" 99557 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: ROLLING HILL VIEW ES LOT: 4 BLOCK: 2 SECTION: 6 TOWNSHIP: 14N RANGE: 1W LOT SIZE: 50097 (SQ.FT. OR ACRES) CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IFJ ACCORDANCE WITH ALL MOR CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK. DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT'STATION IS INSTALLED IFJ SN AREA COVERED BY MOA BUILDING CODES, THEN C1> AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2> AS-BUILTS WILL NOT BE APPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT; AND C3) THE ELECTRICAL WORK, MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED _1 - C` DATE: APPLICANT: % S ENGI EERING OTT EYC JG� ISSUED BYDATE: ------------- P, eA �Z.00khs: II /AC. -oep7v z, o' «$-' CUA�P-� _ s Gknuel ` l�p�- IMO d OUGDkIS PERFORMED LEGAL DESCRIPTION: A� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST L Lf L Z 1, L./ N SLOPE 'frEEIT e-? /%l C 1 / "Y y. 2- 3- 4- 5 4 6 •/ //� 6- 7 7 8- // /V C- `1 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 IF YES, AT WHAT DEPTH? 13 •►1\� 14 ..., n 17- is- 19- Reading 7 18 19 DATE PERFORMED: ` Io Reading Date Gross Time Net Time Depth to Water Net Drop • 20Ai PERCOLATION RATE /-I-- (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: 14s 72-008 (6/79) CERTIFIED DA o SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONP4-1 TESTOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Cgaet-rS L• MIL -Lr -e- DATE PERFORMED: 5--2-3-63 LEGAL DESCR I 9- 10- 11- 12- 13- 14- is- 16- 17- 1011121314151617 - s192018- 19- 20-1 SLOPE oe.Ca P•* -t ( L 2En S/�+�10� Stc.T S A<N O(� C—1 z-At/'t- c��«�S � 0 &V %I b� C I �J'GROUND WATER _ ([' S ENC I OG J ENCOUNTERED? 'y O P c A IF VES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop 1 - t0 Z 0;00 An g z 1 4 165 4 ! � 10:2 .O AM D F3 t) 13d /D 112 Atl PERCOLATION RATE / (minutes/inch) �{ TEST RUN BETWEEN 122- FT AND 3 FT 72-008 (6/79) lL fid! L'] U MM IJ A U T Y (OF 1-1- Development Services Department On -Site Water & Wastewater Section Parcel I. D. 050-322-04 R Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Complete legal description ROLLING HILLS VIEW ESTATES BLOCK 2, LOT 4 Location (site address) 19011 UPPER SKYLINE DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) CHRISTOPHER WALDEN Day phone Mailing address Real estate agent 19011 UPPER SKYLINE DRIVE, EAGLE RIVER. AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic 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. COSA Fee $ 55 0 / Waiver Fee $ Date of Payment / 1 I /o_o g 1 Date of Payment Receipt Number 1�10 1 1 9 a Receipt Number COSA # a S c a 1 13 .'� a Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/912021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to +� . k k � A these various and dynamic characteristics and are outside the control of the evaluator of the •� well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q:•' • .: 1.9 ��} for current or future occupants or guarantee that no unseen encroachments, deficiencies or I 49 TH discrepancies exist can be given by First Water Consulting & FWCS j *' .�....•.* DSD SIGNATURE �% • Curtis Huffman System #1 Approved for bedrooms�F�60••• CE 128991 �Aw .Q/9/21. P�ca� System #2 Approved for bedrooms �� PR9FEWO \\\\1�' Disapproved Conditional approval for bedrooms, with the following stipulations: Y OF'�� w/ATRE �- V�Sq�_-SA N� rn 11 _ R PROD o JJ� ' i \ . �V <- ! C� SERVIG, on By vim- Original Certificate Date: �r 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: ROLLING HILLS VIEW COSA Checklist Fsk-. I.IlLocL-2 Cri If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 10/4/1984 Total depth 600 ft Cased to 18 ft (INTO BEDROCK) ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/18/2021 Static water level at beginning of test 56 ft. Well production at time of test 0.9 gpm Comments B. TANK DATA Age of tank(s) NA — NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 6/22/1984 ® ALL standpipes present per record drawing Total measured depth from grade 4 ft (max) Measured depth to pipe invert from grade * ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective * CJS Q Parcel ID: XXXX of _ Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.08 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FwC5 Collected by �> Date of Sample 5/21/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/18/2021 Results N Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time <1 min ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date ES Comments/Deficiencies: *No field CO to measure invert. No known issues with freezing. F 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 if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® 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 Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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. low AW . .... ....�:. • Curtis Huffman B ��'c�`�•, CE 128991 ��`r>�c,9' • 619/20;1 •'ti�i�� F� PROFEWO ft ft ft ft ft ft ft ft Municipality of Anchorage R Development Services Department :: _ Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC211322 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 4 of Rolling Hills View Estates subdivision, the well's productivity was determined to be .9 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 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 050322-04 1. GENERAL INFORMATION COSA# 088Ugq Expiration Date: 9-.2—c-03 Complete legal description Lot 4, Bock 2, Rolling Flills View Estates Subdivision , Location (site address) 4 19011 upper skyline Drive Eagle River, AK 99567 Current Property owner(s) Siom Dudek Day phone: Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1810 Jordan Drive Corpus Christi, TX 78412 Unless otherwise requested, COSA w�7l be held by DSD for pickup. L HUMS -R U^ tStJFiVVhi:.. _�� Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well R1 Individual On-site (] 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 Onsite 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 Onsite 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 onaRe 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 Finn Anderson Engineering Phone 522.7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. Date 4/162008 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms: bedrooms, with the following stipulations: �s�• ON-SITF •' :YPATERAND WASTEWATER : PROGRAM a Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory .Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: r % . Original Certificate Date: (R«. nae) T - Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsde (90 7) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 4, Block 2, Rolling Hills View Estates Parcel ID: 050-322-04 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y Date completed 104/84 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 600 ft... Cased to 1$.. ft- Casing heiL,ht (above ground) - >18 in::. FROM WELL LOG AT INSPECTION Date of test 10/4/84 4fd/2008 Static water level 100 Well production 0.5 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic 17_8 ugA B. SEPTICIHOLDING TANK DATA fL 9 -p -m. Nitrate 9.19 mg/L Date of sample: 4rero8 150 ft 1.0 g.p.m. Other bacteria 0 colonies1100 mL Collected by: S. Gilbert Tank TynefA-terial septic/Steel _ _ Die install a 6MIM Tank size 7.000 gal. Number of Compartments TWO Cleanouts (YM) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alar (Y/N) N �I Date of pumping 41=006 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 6122t94 Soil rating (g.p.dAe or ff /bdr)150 SF/BDRM System type s• wds shallowTrm,d, i Length 98/40 R Width 51 ft Gravel below pipe 1 ft �I Total depth 5 ft ;Eff. absorption area 446 tt Monitoring tube Y Depression over field N Date of adequacy test 41=2008 Results (Pass/Fail) Pass For 9 I 'bedrooms Fluid depth In absorption field before test 0/0 in. Water added l=0 gal.! New depth 10 -SM in. Elapsed Time: 960 min. Final fluid depth 0/0 in. Absorption rate >= 450 g.p.d. I, Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION :•�P\`"`" Date installed Size in gallons Manhole/Access (YIN) 'Pump on' level at —in. 'Pump off" level at _ in. High water alar level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES review of Municipal records that the above systems are in SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100• Absorption field on lot >1W On adjacent lots >100• Public sewer main N/A Public sewer manhole/cleanout NIA Sewer/septic service line >2' Holding tank N/A Animal containment areas None Manurelanimal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property line >5' Absorption field >s Water main N/A Water service line 110' Surface water >100• Wells on adjacent lots >100• SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >t0' Building foundation >10' Water main >10 Water Service line >19 Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: Note: Lower Absorption Trench is Less Than 10' From the Road Cut Bank. No Cleanouts In Drainfields as . no.... ai Approved design and As Buitt. G. ENGINEER'S CERTIFICATION :•�P\`"`" * ;$`rye • I certify that I have determined through Geld inspections and : aij' review of Municipal records that the above systems are in 491h ; conformance with MOA COSA guidelines in effect on this date. r',_ Engineers Printed Name Michael E. Anderson, P.E. MI.^,NAIL E. MJ[MSCN l 4 �%.� N c[ -+Jai Date 4n612ooe � COSA Fee $ 1/1;d Date of Payment 9 �/ UJ Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division —� On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 080099 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of Rolling Hills View Estates Subdivision. This inspection revealed an arsenic concentration of 17.8 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 1�5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Onsite Services Section A P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel l.D.# 050-322-04 HAA# ��3aT`ndf'h 1. GENERAL INFORMATION Complete legal description ROLLING HILLS VIEW FSTATFS S/D: LOT 4_ BLOCK 2 Location (site address or directions) 19011 UPPER SKYLINE DRIVE EAGLE RIVER. ALASKA Property owner JEFFREY & DENA WHEELER Day phone TA Puff . -r=NT= 1:11MR11=51MME4111 a = i - Lending agency Day phone Mailing address Agent- CAROLINE GREINER W/ REMAX OF EAGLE RIVER Dayphone (907) 242-4282 Address 16600 CENTERFIELD DRtVF EAGLF RIVER. AK 99577 Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA 921 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,400.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system Is in compliance with all Municipa� and State codes, ordinances, and regulations in effect on the date of this inspection. , 1 Name of Firm Phone (907) 337-6179 Engineer's Signature DateT77/GO In conducting this evaluation, AWWC, f �� d pled t de a thorough, conscientious engineering analysis of the system In accordance with AL and t D S Guidelines & Regulations. The reported results described the performance of the system under the condition encountered at the time of the test and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water 6000000p� usage of the family being served by the system. These conditions are outside the control of o the evaluator of the system. Satisfactory test results do not guarantee future performance c�� +QF • 9 of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the Op Cij ' y system will continue to meet the operational requirements of the ADEC or MOA DHHS. 0 ...... .. .. .........:. The content of this report is for the sole benefit of the owner listed above. Any 0 reliance upon or use of this report by any other person or parry Is not authorized, nor will it confer any legal right whatsoever. of ey n. Gar ss: 6. DHHS SIGNATURE QQ nI CE -7953 ; _`G r. _L -,f Approved forbedrooms Disapproved Conditional approval for Additional Comments 0 professio bedrooms, with the following stipulations: Date—S-Z 3-00 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 engineers work. 72-025 (Rev. 1/91) Back MOA B21 Computer Version -RECEIVED Municipality of Anchorage AUG 1 g DEPARTMENT OF HEALTH r3< HUMAN SERVICAIGPAun 0FnN Environmental Services Division a �t�t1A1 S i, ! 825 "L' Street, Rm 502 Anchorage, Alaska 99501 (907) 343�J4a Health Authority Approval Checklist Legal Description: ROLLING HILLS VIEW S/D; LOT 4, BLOCK 2 Parcel I.D.: 050-322-04 A. WELL DATA Well Type PRIVATE If A, B. or C, attach ADEC letter. ADEC water system number N/A Log present (YM) YES Date completed 10/4/84 Total depth 600' Cased to 18' (TO BEDROCK) Casing height (above ground) 18"+ Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test 10/4/84 Static water level 100' Well production 0.5 g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 8/9/2000 '1.3 g.p.m. •RECOVERY AT MAXIMUM DRAWDOWN OVER A 27 MINUTE PERIOD. Coliform 0 Nitrate 0.5 Other bacteria O Date of sample: 8/16/2000 Collected by: A.W.W.C., INC. B. SEPTICIHOLDING TANK DATA Date installed 6/22/84 Tank size 1000 Number of Compartments 2 Cteanouts (YM) YES Foundation cleanout (YM) YES Depression (Y/N) NO High water alarm (YM) N/A Date of Pumping 8/7/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA •SOUTH/NORTH Date Installed 6/22/84 Soil rating (g.p.dJft2 of bd ) 150 System type DUAL TRENCHES Length 38'/40' Width 5' Gravel thickness below pipe 12" Total depth 5' Effective absorption area 446 SO FT Monitoring Tube present (YIN) YES Depression over field (YM) NO Date of adequacy test 8/9/2000 Results (Pass/Fall) PASS For 3 Bedrooms Fluid depth 16 absorption field before test (in.); *020" Immediately after 684 /179 gal. water added (in.): 0713.5 Fluid depth 0"/6" (ins) Minutes later. 1006 Absorption rate = 450+ GPD Peroxide treatment (past 12 months) (YM) NONE KNOWN If yes, give date ----- 72-026 (Rev. 3wr Computer Venlon D. LIFT STATION Dale installed Size Manhole/Access High water alarm level at' "Pump off level at' 'Datum E. SEPARATION DISTANCES *MEASURED WITH A TOTAL STATION. (EDGE TO EDGE) SEPARATION DISTANCES FROM WELL ON LOT TO: Septic(holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot • 102'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water maintservice line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain F. ENGINEER'S I certify that I of Municipal n with MOA HI Signature_ Engineers HAA Fee S a 0Z1 ' O -Z) KNOWN field Inspections and review systems are In conformance 2n this date. JEFFREY A. GARNESS Date of Payment g / % d -D Receipt Number 4S/S_ (a q7 72-026 (Rev. 3198)• Computer Version Wells on a Waiver Fee Date of Payment Receipt Number Aug -02-00 07:08P .Carolyn Greiner 907 694-4151 P.02 Jul -14-00 08:00p Carolyn Greiner 907 694-4151 P.12 r WA— 1 i» 60 Ar �� (• •,.NN, • � r J`Z A. �S. fit w:+Vw�.ti �.+.w...i:...•� ' �{JR+1.• Ruoe•i C. Jahr:.n AS•Ru1LT 1 heteby unify that 1 ha.r survevrd the fot'ruins duale Mchora80RecvIt` rrednit, Alaska, an,1 th:t t:•r imrtase inerts iftvarea thoean are within dre lrroretn Mtn and d.• nn overlap nr encroach or. the pn.remv Irn6 aJiourm cherub, d:a no InMvern•nts an property MnR adjiccni thenen f*cmad on Ibe pmmius in ques.noq and that !here ale no Toadwa�•s eranamiawn I'nff nr ether vhible fatf- lkm% nn said rwpen) except as indicated hereun. Dated at�PSTs River. Alaska this l day of po, 7Y r�I ,.. n: ReFtslrred Lana Survivor Nc. i1 MI.S 1'• `;p • tlna 7.744.4. HaFA6 Rivet. Alaska •KA77 O MUNICIPALITY ANCHORAGE • DEPARTMENT OF HEALTH 8 HUMAN SERVICES Mj Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # LOLL --1Q21 4114 1. GENERAL INFORMATION HAA# IJ41�1 ](�iySti Complete legal description Lot 4; Block 2; Rolling Hills View Estates Subdivision Location (site address or directions) 1an11 flipper 4;k=1' ayagIp Ri>xer. rdaskn Property owner M .rgaret And nn Al rl nj nn Day phone 69a-GC83 Mailing address P.O. Box 771093, Eagle River, Alaska 99577 Lending agency CITY MORTGAGE Day phone Mailing address Eagle River, Alaska/ATTENTION: Jeanne Mee 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 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 XXX'' Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72425(Re 1791) Font MOA.21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S tr. S ENGINEERING Phone i ; n1l Eagle River Loop Roaa NO. Address - 1 alcsl:a 99577 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments 0 bedrooms. • Date bedrooms, with the following stipulations: Date 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 cou rtesy to purchasers of homes and their lending institutions in orderto satisfycertain 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. 72.M(Rw 1,911 Back MOA -2t Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:, / Parcel I.D. l.lti A. WELL DATA Well type If A. B, or C, attach ADEC letter. ADEC water system number Log presentV?N) �:J Date completed tc' Driller �� -�✓�+ 1 Total depth Casedto-trd - Casing height Sanitary seale'N) Wires properly protectedl-P7N) y FROM WELL LOG AT INSPECTION,�-, 1 Date of test t�-�' e'�4" l o -'i - 12 L' t rM G' Static water level {-L O r Well flow o S g.p.m. t o 9 P m T Pump level �o y�V, rT1 ro O 4 SEPARATION DISTANCES FROM WELL TO: 1 � Septic/holding tank on lot t oto ; On adjacent lots C=Dt=> I1 Absorption field on lot A- ; On adjacent lots 1; Public sewer main 4 Public sewer manhole/cleanout G Sewer service line WATER SAMPLE RESULTS: Coliform M 14- // Petroleum tank NONE /C/�o 1,✓N Nitrate c7• 1 G Other bacteria Date of sample: '1' ',> -ew, Collected by: S `Y -: E> . B. SEPTIC/HOLDING TANK DATA Date installed 22' t3 4 Tank size 1 � Compartments Z Cleanouts &?N) Foundation cleanoutTWN) y Depression (YAlp tJ High water alarm (Y/N) Alarm tested (Y/N) .__ Date of pumping °�y Pumper R-15 �Jrt Qli l�j SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot t 0o On adjacent lots (�DI� Foundation S-4 � 1 1 To property line Absorption field S Water main/service line low Surface water/drainage loo 1:1 72-026 (Rev. 751) FmI CONTINUED ON BACK PAGE C. LIFT STATION - Date Installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at — Cycles tested Surface water _ Date installed 15 Soil rating �Snrv� System type ' • �t��-�5 Length . Width Sk Gravel thickness (r Total depth 4,75- 14- � Total absor ticnarea P Cleanouts presenliMPN) Depression over field (Y(;F Date of adequacy test l0-'1-92 Results Jg1_ssItail) for bedrooms Peroxide treatment (past tz months) (Y/W-ADAR' 174 WN If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ov On adjacent lots �� t '� Property line r t � To building foundation To existing or abandoned system on lot a rV le—A-p ' On adjacent lots "��r Cutbank �% 01' Water main/service line f— nor-I�FPti/E�r,PAYf-14W-r1N4. Surface water Driveway, parking/vehicle storage area Curtain drain - OL74 Y-4 9 � E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this inspection. 5 & 5 ENGINEERING Of A( X10 17034 Eagle River Loop Road No. V"�•''��•��•"•••QS �+ Signature � ov ; •• IaCIZ , % ti A p Engineer's Name rQ.CjL ........... .. Date . �^•.;.y ..... .�:•�,.•Ft. nocc J. SHAFER VN•• N15 .• � � :o HAA Fee $ I_)0 .017 Date of Payment 11- 3-`i a - Receipt Number. 72-028 JAw. 1/91) Back N0A 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal D�esgript Lo (b) Applicants Applicants Add Application Date isio section oa C� r�a . Telephone - Hompe77- 3 Z/ ZZY rY ns ip, range) 7 Business (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer ; Other [_:] (explain); i_ (d) Lending Institution. ! �1]'F�17/J7/cTelephone Address (e) Real Estate Co. 3 Agent /U10 13J)—= Address Telephone (f) A Che HAA to the following address: S f. i* CAGIFIEEMNIG u n r.I.;LG ffIVE(i. A' pro, 0i PK 2. Type of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms L_ 3. Water Supply Individual Well CE� Community Q Public Q Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage ,Diisspoosal Onsite) XI Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Address c ALB Date 6. DHEP Approval j Approved for%44z (9J bedrooms t.' i (ENGINEER SEAL) Telephone By �,1. a 1. �l�¢.(.( L(l Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 i By �,1. a 1. �l�¢.(.( L(l Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 A. WELL DATA WellClassificati /tJeT If A, B, or C, D.E.C. Approved(Y/N)- -- I+;ell Log Presen (Y i Date Ccnpleted /O1�' _ Yield Total Depth C d Cased to /9-/f 13jCDepth of Grouting Static Water Level /O V Pump Set At 1.4- Lr Casing Height Above Ground Sanitary Seal on Casing (Y ) Electrical Wiring in Conduit (Ya) Depression Around Wellhead ( ) Separation Distances from Well: To Septic/Holding Tank on Lot /00 On Adjoining Lots /M To Nearest Edge of Absorption Field of Lot e,�O On Adjoining Lots /610 i-/ i To Nearest Public Seder Lire To Nearest Public Sewer Cleancut/Manhole To Nearest Serer Service Lire on Lot Water Sample Collected By11rt/ $,IMte Z19IC! Water Sanple Test Results CaM nts i B. 3EPTIC/HOLDING TANK DATA 2 Date Install d Z . �� Sire �D!?� No. of Canpartments Standpipes ( ) Air -tight Cap (g/i0� Foundation Clearcu ( /tQ) Depression over Tank( Date Last Pumped Pumping/Maintenance Contract on File (Y /3- ;for .. Holding Tank High -Water Alarm (Y )v Temporary Holding Tank Permit (Y Separation Distances from Septic/AA4ivq-Tank: To water -Supply Well /i/U /� To Building Foundation S To Property Lire /O �� To Disposal Field To Water4MairVEervice Line To Stream, Porti, Lake, or Major Drainage Course SCJ o NF Car,, nts A.1 o NF C,' ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) c«T. ct HEA!.TH a HEALTH AUTHORITY APPROVAL (HAA) ITAL F:: C. ABSORPTION FIELD DATA Soils Rating in Abscrpticn,Strata /, / [7iL Type of System Designi�/'uFi�`�� Date Installed G 22,. B Length of Field 76 Width of Field C O Depth of Field c - Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present()/N) Depression over Field (Y Late of Last Adequacy Test Results of Last Adequacy Mtrst Separation Distance from A8sospticn Field: To Water -Supply Wall /00 /� To Property Line To Building Foundation /0 To Existing or Abandoned System on Lot A.) a /-J 6- ; On Adjoining Lots k O ^f ,=- To To Water%&WService Line 30 I� To Cutbark(if present) `O /f To Stream/Pond/Lake/or Major Drainage Course AJ o iv el To Driveway, Parking Area, or Vehicle Storage Area �-p Cements iV o Al E D. LIFT STATION Date Installed Diutansicns Size in Gallons Manhole/Access (YIN) "Pump On" Level at "Puna Off" Level at High Water Alarm Level at J Vent (YM) Tested for Pumping Cy ing Adequacy Test. Meets MOP, Electrical Codes(Y/N) Ckmrents *' Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAF�Go�ie3Ytpgls in effect on the date of this inspection. lG1NE2Bl,f0 L�ta�! •� Signed v?.. Js: ti Ccapany `u�JIE PH 694-2970 �• MOA Ki r;r'�' '•. 4k- %�iC•.i JVW„wi.I [Page 2 of 21 P•��-moi!