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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES #1 BLK 3 LT 14Mountain Volley Estates # 1 BIO k 3 Lot 14 #050-651-07 Municipality of Anchorage Community Development Department QUB �� On -Site Water and Wastewater' Program '�"" ° ■ 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://Www.muni.org/ ite • 07 343-7904 ON-SITE WASTEWATER INSP€CTION REPORT DC b a 2015 Permit Number: OSP141502 PID Number: 050-651-07 ❑ New ❑✓ Upgrade Name: Gregory Rhodes & Charmine Mallipudi ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed EI Mound Address 4120 Johnny Dr. Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. I Gravel depth beneath pipe - Ft. Subdivision Block Lot , Mountain Valley #1 3 14 Fill added above original grade Ft. I Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches - From Tank Field Tank Line Ft2 Ft. Well 327.2 N/A N/A N/A TANK ❑ Septic I] S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,25oGal. O'F Surface water DNS( N/A NIA N/A Material Number of compartments 20 Lot Line 18.9 NIA N/A N/A Steel 2 NA Foundation 7.1 N/A N/A NIA LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A I NIA Anchorage Tank 250 Gal. RemarksInstalled S.T.E.P. tank and connected into house Pump on level at 43 in, Pump off level at 421n. High water alarm at 45 in. septic system. Pump make and model P20o5 Electrical Inspections performed by ;zy E1ec4r;c Lt: C. Installer PIPE MATERIAL Housetotank 3034 drainfeld TanBto 3034 Wilco Contractors Drainfleld 3034 Co/MT 3034 Inspector Pannone Engineering Services, LLC. BENCH MARK (Assumed elevation) 10011 Inspection u - dates: 1 161)(,t (S2 - Location and description 3d 4m Garage finished floor COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp � _0 Conditional Approval: Date seven '}. }Sonnorle/ �'—_� _I Approved �,,,,� Dateirk {i��•C Inspection Report _1-1-12.doc . l v lC1 MH -- INSTALLED 1250g S. T. E. P. TANK NEW \ \' FC WITH 1 .25" PIPE TO INLET END OF �� LOT UNDEVELOPED •� A HOUSE SEPTIC TANK NO WELLS OR SEPTICS— HOUSE A GARAGE INSTALLED RIGID INSULATION UNDER DRIVEWAY (E) 1� -W/ 1BR ADU 4$� PRESSURE LINE S'104+ JOINTS WITHIN 10 FEET OF THE WATER CROSSING 224 W/ o M —M �A4 GARAGE (E) HOUSE LOT 14 YU N E) W /' a a N S Q O TH 1 ._. (GARNESS) TH2 c HOUSE (E) - 4'F�P4. 4" SERVICE 'p, FROM HOUSE P 96G 0 WYE NEW TANK (F) 0 SERVICE TIE IN DETAIL NOTES: TANK RECORD DRAWING NJC PLAN NO WELLS OR SEPTICS M In n In o, 99.8 11—IL 95.7 PROFILE TANKSEPTIC 509 NEW PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MOUNTAIN VALLEY ESTATES #1, ELK 3, LOT 14 GREGORY RHODES & CHARMINE MALLIPUDI 4120 JOHNNY DRIVE EAGLE RIVER. AK 99577 A B FC C1 T1 Al2.O21.8 MH '1. Date 'OF . ACgsli� 0/20/2015 Scale 49 1 -50' ..; <57.. .... .. ... �j P.I.D. NO • Steven R .Pannon PF,,. CE 8149 (PERMIT NO. OSP141502 2 O 2 Permit Number: Tax Code Number: On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 OSP141502 05065107000 Work Type: SepticTank Upgrade Permit Effective Dates: November 18, 2014 to November 18, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: MOUNTAIN VALLEY ESTATES #1 Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BILK 3 LT 14 G:0758 Owner/Address: RHODES GREGORY L & MALLIPUDI CHARMINE A 4120 JOHNNY DR EAGLE RIVER AK 995770000 Site Mailing Address: 4130 JOHNNY DR, Eagle River This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 94350 Total Bedrooms: 4 N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: HIM RUBS MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION RUSH Parcel I.D. 050-651-07 Property owner(s) Gregory Rhodes & Charmine Mallipudi Day phone Mailing address 4120 Johnny Drive, Eagle River, AK 99577 Site address 4120 Johnny Drive Legal description (Sub'd., Block & Lot) Mountain Valley Estates #1, Block 3, Lot 14 Legal description (Township, Range & Section) Lot Size 94,350 Sq. Ft. Number of Bedrooms 3+1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank Upgrade ❑X Duplex (D) F-1Holding Tank ❑ Renewal F-1 Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ %� Water Storage El§" it THIS APPLICATION INCLUDES A VARIANCE / Myvio I�J*UES FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: 2157- @n -V- t'2-rl Date of Payment: li 11zlly C Receipt Number: DVi-Ag (n Permit No. OSf tLi 1502 - Permit App__ ::L:c, Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com November 11, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Mountain Valley Estates #1, Block 3, Lot 14 Septic Tank Upgrade Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1250 gallon S.T.E.P. tank be issued for this lot. The proposed system will serve an ADU above the garage. Currently the lot is developed. The existing septic system was designed and installed for four bedrooms. The house has 3 bedroom and the ADU above the garage will make a total of 4. This lot is served by a private well that is over 100' from the septic system. The surrounding lots are also served by private wells that are over 100' from this system.. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 14 slopes from west to east at approximately 15% in the area of the tank replacement. The proposed installation will be located in the northern portion of the lot, next to the garage. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 LOT UNDEVELOPED NO WELLS OR SEPTICS .GARAGE (E) W/ 1BR ADU INSTALL 1250g S.T.E.P. TANK P WITH 1 25" PIPE TO INLET END OF HOUSE SEPTIC TANK INSTALL RIGID INSULATION UNDER DRIVEWAY I PRESSURE LINE SHALL HAVE NO JOINTS g WITHIN 10 FEET OF THE WATER CROSSING I � 1224 r1� 1 GARAGE (E) HOUSE LOT14 'DIP E) w J ss IV TH 1 - r(GARNESS) TH2 oR�LF HOUSE (E) 4" SERVICE A FROM HOUSE - � w_ W O 15C, WYE (P) _ 0 -LOT UNDEVELOPED TANK NO WELLS (E) O OR SEPTICS - SERVICE TIE IN DETAIL - NOTES PANNONE ENG SVC, LLC � k'k� Date TANK INSTALL PERMIT P.O. BOX 100217 ANCHORAGE, AK 99510 �� •' 451�� 11/17/2014 PHONE (907) 272-8218 FAX (907) 272-8211 .. �y++/ sc' Ie sa �...... ... .. ....../ PID NO MOUNTAIN VALLEY ESTATES #1, ELK 3, LOT 14 .--TS I - m GREGORY RHODES & CHARMINE MALLIPUDI /Steve"n 'R"Ponnonej PERMIT N0. 4120 JOHNNY DRIVE /+P ' CE 8149 _ �// OSP141502 PLAN EAGLE RIVER; AK 99577 �,`l`�\ JFESSSOA' Sh1 O Municipality of Anchorage Community Development Department Page 1 of 4 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131207 PID Number: 050-651-07 ❑ New ❑� Upgrade Name: ROBERT WOLVINGTON ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench EI Bed El Mound Address 4120 JOHNNY DR ❑ Other Phone Number of Bedrooms y' Soil Rating Total depth from original grade c3' 0.6 GPDlSF 2 Ft. LEGAL DESCRIPTION Depth to pipe invert from odginal grade 0.5 Ft. Gravel depth beneath pipe 1.5 Ft. Subdivision Block Lot MOUNTAIN VALLY ESTATES #1 3 14 Fill added above original grade 2 Ft Gravel length 160 Ft Township Range Section Gravel width SFt. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank i Line 1025.6 Ft 2 1 O Ft. Well 200.3 176.8 193.4 N/A TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1250Ga1. Surface water 100+ 100+ 100+ N/A Material Number of compartments Lot Line 44.1 0.14 40.7 N/A Steel 2 NA Foundation 44 34.6 58.6 N/A LIFT STATION Manufacturer ORENCO Capacity 500Gal. Curtain Drain N/A N/A N/A N/A Pump on level at Pump off level at High water alarm at RemarksSEE ATTACHED FOR LOT LINE WAIVER AND 40 in. 36 in. 45 in. STEEP SLOPE WAIVER Pump make and model P2005-1 Electrical Inspections performed by J's Electric PIPE MATERIAL Housetotank 3034 Tankto 3034 drainfield Installer ' JR'S SEPTIC PUMPING Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.Oft Inspection 1"Location 7/10/2014 7/11/14 and description dates: 2a Back door Threshold P - 7/10/14 a'" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date rr,PC`�5�li� 4,w co • • ��even � f�aniiotae �i . CE 8149 Approved Date Inspection Report_ -1- 2. c LOT UNDEVELOPED tl f ❑ M �'M �- 0����. A B OCT 47.60 45.20 DC2 48.50 46.10 T 1 49.20 46.70 T2 57.50 54.60 DC3 61.90 57.90 DC4 62.70 5 8.70 T3 63.60 59.30 MH 66.00 62.00 mi 36.10 -4-3-9 0 M2 31.CO 56.10 M3 1100.90 105.00 M4 1113.60 112.60 GARAGE i. (E, 4BR LOT 14 �� HOUSE B _ . (E) A ♦ / a a125Cg SEPTIC TA K w ♦ '"•^ �C^ INSTALLED �OOg (F BO LiF STATION Q� 340 M1 z 0 54.8 \/rM 2 Z� Y,IELL (E, -MH RESERVE FIELD 3-0 - --� BASED ON CAT III - \ `\kms TH1 5 177.3� TO✓ (GARNESS) TH2 j .,c. \ .o•CceAR i ti N DRAIN FIELD (E) DRAIN FIELD 'Nl i ABANDONED !'F` 86LF x 5.0'W x 1.5ED x 2.0 TD ^\ VIA PER CODE, REMOVED 74LF x 5.0'W x 1 SED x 2.0'TD BIOMATTED MATERIAL - \ j WITHIN 10' OF THE , EXISTING SWALE, PREVIOUSLY NEW SYSTEM AND FILLED `♦ INSTALLED BY OWNER \ WITH CLEAN GRA'•iEL _ \ FILLED AT TIME OF CONSTRUCTION - 15 W LOT UNDEVELOPED NO 'WELLS -- _.MAYBE PART OF A SEPTIC NOTES: _���� \\ Date RECORD DRAWING PAMONE7 ENG SVC, 99 0 ��OF�A�gslt� 9/25/2013 PHONE BOX 100217 272-8218 FAX (907) 272-8211.Scale 1„_50' MOUNTAIN VALLEY ESTATES #1, BLK 3, LOT 14 / % osa--est o7 Steven R. Pannone / ROBERT WOLVINGTON 7 /PERMIT N0. 4120 JOHNNY DRIVE+Ps: CE 8149�� OSP131207 PLAN EAGLE RIVER, AK 99577 ,1�klk� ..... P`, sheet �\ `��� 2 OF 4 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALLED NEW 5009 LIFT STATION AND SOIL ABSORPTION SYSTEM. 3, GROUNDWATER WAS NOT OBSERVED BELOW EXISTING GRADE A ANY OF THE EXCAVATIONS LESS THAN 7.0' FEET BELOW EXISTING GRADE. - RIGID INSULATION FILTER FABRIC IX" a DRNN PIPE W/ 1/8" HOLES 18" O.C. DRAIN ROCK 5" ABOVE PIPE INV FINISHED GRADE FG 1040 (PRIMARY FIELD) .% IN - FG 102.4 4:1 INFILTRATION 2 5 LINE (PRIMARY FIELD) 1003 DRAIN ROCK 10.0-{�6.0—y 3.0 12_)� OLD SYSTEM ABANDONED SECTION GROUNDWATER 93.3 ELEV 96.2 12x9 SEPTIC TANK ;IS DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g (E) INSTALL 500g LIFT STATION PERC RATE = 16-3C MPI SOIL RATING: 0.6 GPDSF- AREA ROD: 1000 SF SYS. TYPE: WIDE TRENCH 1.5' E.D. RF: 0.78 MIN LENGTH: 156.0 LF USED (2EA) 80 LF X 5' WIDE, 1.5' E.D., 2.0' TD TOTAL AREA 1025.6 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC 98.3 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST. HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# =RIGID INSULATION M# MONITOR TUBE N0. R, 1. RIGID INSULATION DCO —FILTER FOBRIC o DV DIVERTER VALVE k V' Y /—DRAIN ROCK 5 ABOVE PIPE INV OG ORIGINAL GRADE - - FG FINISH GRADE IX 9 DRAIN PIPE Nj /d" HOLE S 0 C, FG l02 a HOUSE IE? D D D ELEV_ 100-3 D ELEV 96.2 12x9 SEPTIC TANK ;IS DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g (E) INSTALL 500g LIFT STATION PERC RATE = 16-3C MPI SOIL RATING: 0.6 GPDSF- AREA ROD: 1000 SF SYS. TYPE: WIDE TRENCH 1.5' E.D. RF: 0.78 MIN LENGTH: 156.0 LF USED (2EA) 80 LF X 5' WIDE, 1.5' E.D., 2.0' TD TOTAL AREA 1025.6 SF PROFILE LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC 98.3 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST. HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT N0. M# MONITOR TUBE N0. R, 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE - - FG FINISH GRADE NOTES: Dote PAMONE ENG SVC, LLC — QF /i� \�t 9/25/201: RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510'•qS PHONE (907) 272-8218 FAX (907) 272-8211 %g�p �9�+ Scale *: 49R .*♦✓/ NTS ...... .. .. . .... P.I.D. NO MOUNTAIN VALLEY ESTATES #1, BILK 3, LOT 14 50-651-07 ROBERT WOLVINGTON / Steven R. Pannome j PERMIT NO. PF. •. CE 8149 ,.-Q� 4120 JOHNNY DRIVE c OSP 131207 DESIGN DETAILS EAGLE RIVER, AK 99577 +111 D"ao",sso�P :G Sheet 3 OF 4 J ELECTRIC LLC 6732 E. 99th AVE. ANCHORAGE, AK. 99 507 July 11, 2014 Flintstone Enterprises 1300 Oren St. Anchorage,Ak. 99515 RE: Robert Wolvington 4120 Johnny Drive Eagle River, Ak. This letter is to certify that J Electric LLC wired a septic at the above address in accordance to the NEC and MOA Codes . I a4S]- J ELECTRIC LLC Contr . Lie # 34469 8 TEST HOLE 2 1 9 OR ORGANICS 10 2 W 11 5.30 -- 3 00 M2 e BOH 4 13 12:00 14 5 --- 15 -- _ TH1 16 GM SILTY GRAVEL 6 12:30 18 7 --- 6 �7 7/10/14 8 SI &A CLOCK TIME 9 WATER LEVEL READING (E) / 10 A W 11 5.30 -- 12 00 M2 e BOH b 13 12:00 14 U Z --- 15 -- _ TH1 16 6.55 (GARNESS)� TH2 17 12:30 18 5.30 --- DATE PERFORMED: 7/26/13 SOILS LOG - PERCOLATION TEST SLOPE WAS GROUNDWATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -7.0'- DEPTH TO WATER AFTER MONITORING? -7.0'- DATE: 711812014 Y[99: TH X READING SI &A CLOCK TIME HOUSES WATER LEVEL READING (E) / KU as A W --- 5.30 -- 2 00 M2 e i J Q J b 3 12:00 --- U Z --- 4 -- _ TH1 30 MIN 6.55 (GARNESS)� TH2 WAS GROUNDWATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -7.0'- DEPTH TO WATER AFTER MONITORING? -7.0'- DATE: 711812014 Y[99: TH X READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP 1 7/10/14 11:20 --- 5.30 -- 2 1200 30 MIN 6.55 1.25 3 12:00 --- 5.30 --- 4 12:30 30 MIN 6.55 1.25 5 12:30 --- 5.30 --- 6 1:00 30 MIN 6.55 1.25 PEROLATION RATE 24 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS: Test hole excavated by ISABELLE CONSTRUCTION 8u EXCAVATING LLC . Perc hole was presoaked. Test run for one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ENG SVC, LLC —��� ��� Date F RECORD DRAWING SO...1 9/23/20 P.O. BOX 100217 ANCHORAGE, AK 99510 O PHONE (907) 272-8218 FAX (907) 272-8211 //ig�p �y ��' Scale *: 49NTS �.... .... .. .... P_I. D. NO MOUNTAIN VALLEY ESTATES #1, BLK 3, LOT 14 .. 050-651-( ROBERT WOLVINGTON Steven R. Pannone PERMIT N 4120 JOHNNY DRIVE �+ �.. CE 8149 . a, OSP1312C SOILS LOG EAGLE RIVER, AK 99577 '��l gFOpRpSS10NP �� sheet 4 of 4 On -Site Water & Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131207 Tax Code Number: 05065107000 Work Type: WellSeptic Permit Effective Dates: August 02, 2013 to August 02, 2014 Design Engineer: - Pik tnLet 0-k.Sr lie :5 Subdivision: MOUNTAIN VALLEY ESTATES #1 Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BLK 3 LT 14 G:0758 Owner/Address: WOLVINGTON ROBERT K PO BOX 771333 EAGLE RIVER AK 995771333 Site Mailing Address: 4130 JOHNNY DR, Eagle River This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 94350 Total Bedrooms: 4 N Privy Y Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receive Issued C61 ckoty� ew�`„,eers ow.d y*vNief 4R 6wgo'l Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.org/Onsit Development Services Division On -Site Water and Wastewater Program went ftel **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131208 COSA#: Permit#:OSP131207 PID#: 050-551-07 Legal Description: Mountain Valley Estates #1. Block 3. Lot 14 Engineer: Garness Enuineering Group Applicant: Robert Wolvington Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the 25% or greater slope has been approved. The approved separation distance is 27.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Date: Waiver is not Granted: Approved by: Name of Reviewer ............................................................................... Rec#: 02787G Amount: $200.00 Date Paid: 7/15/2013 **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcell.D. QSD-(o�l Ori Property owner(s) ROBERT WOLVINGTON Mailing address 4120 JOHNNY DRIVE * EAGLE RIVER, AK 99577 Site address 4120 JOHNNY DRIVE * EAGLE RIVER, AK 99577 Day phone 854-9640 Legal description (Sub'd, Block & Lot ) MOUNTAIN VALLEY ESTATES N 1 ; BLOCK 3, LOT 14 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: (M all that apply) Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Sq.Ft. Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DEWELLING: Initial ❑ Single Family (SF) Upgrade ® (w/wo ADU) F-1Renewal F-1Duplex(D) Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: DRAINFIELD TO CUTBANK/STEEP SLOPE WAIVER Distance: 27 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: �53Co° Waiver Fees: Date of Payment:Date of Payment: Receipt Number: Receipt Number: i7�8i (r Permit No. Waiver No. CLSpl3 k209 (Rev. 09/12) 1261 Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(a)naneneak.com September 3, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Mountain Valley Estates #1, Block 3, Lot 14 Permit #: OSP131207 Septic System Upgrade Permit Change Order Ladies and Gentlemen: I am writing to request a change order for OSP131207. The proposed systems will serve an existing three (3) bedroom house (designed for 4 bedrooms). Currently the lot is developed. An existing 1250g septic tank will remain and a 500g 'Fat Boy' lift station will be installed. The design will be changed to utilize Zea 5'W trenches instead of a bed type drain field. This lot is served by a private well that is located over 100' from the proposed drain field. The surrounding lots within 200' of the system are undeveloped . There are no wells on surrounding lots within 200 feet of this system. 1. Soils. One test hole was excavated in the area of this drain filed by Garness Engineering Group in June of 2013, and groundwater was encountered in the test hole 7.0 feet below the ground surface. Itis my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.6 gallons/day/square feet should be used for a conventional wastewater system. Due to the distance from the test hole to the northwest end of the field I request that a provision be added to the permit allowing the excavation of an additional test hole at the time of construction. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from the east to west at approximately 8% in the area of the proposed drain field. There is a slope approximately 30' downhill of the proposed system with a waiver already granted for this system. See waiver request for modification of this waiver. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Co i Page 2 of 2 5. Waiver Request: I request that the waiver (OSP131208) granted for this permit me modified to 30 feet from a slope for a conventional drain field. The proposed drain field is further from the slope than the existing surcharged drainfield, which is not daylighting anywhere on the slope. Assuming a 4:1 daylight line 2' above the drain field to the existing slope any effluent would travel 38.8 feet before daylighting. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 200 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 LOT UNDEVELOPED NO WELLS OR SEPTICS ' 41 .401 GARAGE . . . ........ (E) t % Ir GARAGE (E) 3BR HOUSE LOTI 14 (E A '22.3 1250g SEPTIC TANK (E) cavil77 INSTALL 500g (FAT BOY) LIFT STATION \N WELL (E) CD 202.7 j. 175.3.. /0 TH1 L/O --- RNESS Co M DRAIN FIELD (E) IN FAILURE REb5E 151rF *9 RE BA91FE) DRAIN FIELDOil e*f III C (2EA) 8OLF x 5.0'W x 15ED x 2 TO A EXISTING SA E PREVIOUSLY INSTALLED OWNER TO BE FILLED W LOT UNDEVELOPED NO WELLS ...MAYBE PART OF A SEPTIC NOTES:Date CHANGE ORDER PAMONE017 ENGANCHSVC, 11C 10 OF kit 9/3/2013 P.O. BOX SVC, 995 PHONE (907) 272-8218 FAX (907) 272-8211 Scale 1"=50' ...... . . . . ..... P.I.D. NO MOUNTAIN VALLEY ESTATES #1, BLK 3, LOT 14 050-651-07 ROBERT WOLVINGTON I Steven me R. anno , *. CE 8149 PERMIT NO. 4120 JOHNNY DRIVE 0SP1 31207 PLAN EAGLE RIVER, AK 99577Sheet I 10-S 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALL NEW 500g LIFT STATION AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS OBSERVED AT A DEPTH OF 7.0' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 7.0' FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. ) INSULATION ER FABRIC P DRAIN PIPE W/ 1/8" HOLES 1B" O.C. N ROCK 6" ABOVE PIPE INV GRADE FIELD) ROCK 1-10.0—I-5.0 4:1 INFILTRATION LINE (PRIMARY FIELD) DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g (E) INSTALL 500g LIFT STATION PERC RATE = 16-30 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 1000 SF SYS. TYPE: WIDE TRENCH 1.5' E.D. RF: 0.78 MIN LENGTH: 156.0 LF LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC USE: (2EA) 80 LF X 5' WIDE, 1.5' E.D., 2.0' TO TOTAL AREA: 1025.6 SF NOTES: CHANGE ORDER DESIGN DETAILS PANNONE ENG P.O. BOX 100217 ANCHOR, PHONE (907) 272-8218 FAX ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE GM TEST HOLE FC FOUNDATION CLEAN OUT T# SECTION C# 6/27/,3 M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG 38.8 OG ORIGINAL GRADE FG FINISH GRADE (AT NEAREST POINT) 125 w m F? z z RIGID INSULATION z 0 r � FILTER FABRIC C 0 0 o N g DRAIN ROCK 6" ABOVE PIPE INV s z z .1 6?PROFILE 1$" P GRAIN PIPE W/ HOLES 18" D.C. o IHHL TRENCH SEE DESIGN n12509 SEPTIC TANK (E) DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g (E) INSTALL 500g LIFT STATION PERC RATE = 16-30 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 1000 SF SYS. TYPE: WIDE TRENCH 1.5' E.D. RF: 0.78 MIN LENGTH: 156.0 LF LEGEND W WATER LINE/ WELL RADIUS — SS — NEW SEPTIC USE: (2EA) 80 LF X 5' WIDE, 1.5' E.D., 2.0' TO TOTAL AREA: 1025.6 SF NOTES: CHANGE ORDER DESIGN DETAILS PANNONE ENG P.O. BOX 100217 ANCHOR, PHONE (907) 272-8218 FAX ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE LLC"X OF A4. kk � 272118211TH MOUNTAIN VALLEY ESTATES #1, BLK 3, LOT 14 ROBERT WOLVINGTON 4120 JOHNNY DRIVE EAGLE RIVER, AK 99577 CE 8149 Date 9/3/2013 Scale NTS D.I.D. NO 050-651-07 HERMIT NO DSP131207 Sheet 2 OF GARNESS ENGINEERING GROUP, Ltd. .... _= CONSULTANTS & GENERAL CONTRACTORS-� -__ - — 3701 E. TUDOR ROAD, SURE 101 ' ANCHORAGE. AN. 99507 • PHONE: (907)337-61]9 • FA%: (907)336-3246 • WEnffE: gornenonglneerin SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES S/D #1; BLOCK 3, LOT 14 PERFORMED FOR: ROBERT WOLVINGTON DATE: 6/17/2013 DEPTH =---ORGANICS (feet) -- TEST HOLE #1 1 7 8 9 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 6/17/2013 7' SOIL CLASSIFICATIONS 2 6" — 2 4:00 30 4.75" 1.25" 3 4:00 — a �o" GW ORG 3 30 4.75" 1.25" 5 4:30 GP 6" ML 6 5:00 30 4.75" 1.25" GM CL 4 GC OL 00 0�0 o 0 SW MH 5 9? SP CH SM ' ON 6 sc G M 7 8 9 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 6/17/2013 7' 6/27/2013 7' 7/2/2013 6" — 0 o�obo�o�44 4 o QF 0 CE-7Tq 53 ,pro fes siolc SEE ATTACHED SITE PLAN DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/21/2013 1 3:30 — 6" — 2 4:00 30 4.75" 1.25" 3 4:00 — 6" — 4 4:30 30 4.75" 1.25" 5 4:30 — 6" — 6 5:00 30 4.75" 1.25" 19� PERCOLATION RATE 24 (MIN./INCH) PERC. HOLE DIA. TEST RUN BETWEEN 3.5 FT. AND 4.5 FT. 6 (INCHES) 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERCOLATION READINGS WERE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WA� PFRFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: //lay/r 3 GARNESS ENGINEERING GROUP, Ltd. -„.--.- �= CONSULTANTS & GENERAL CONTRACTORS - 3701 E, TUDOR ROAD. SUITE 101 • ANCHORAGE. AN. 99507 - PHONE: (907)337-6179 • FM: (907)38-3246 , NE85rtE: g4rneaeengineerin SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES S/D #1; BLOCK 3, LOT 14 PERFORMED FOR: ROBERT WOLVINGTON _ DATE: 6/17/2013 DEPTH _ ORGANICS (feet) — 1V LOAM(SM)/ORGANIC 2- 3- 4- 5- 346 GM 7 8 9 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 6/17/2013 7.5' 6/27/2013 8.0' 7/2/2013 6” - SEE ATTACHED SITE PLAN DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 6/21/2013 1 3:34 - 6” - 2 4:04 30 2.5" 3.5" 3 4:04 — 6" — 4 4:34 30 2.5" 3.5" 5 4:34 — 6" — 6 5:04 30 2.5" 3.5" 79 PERCOLATION RATE 8.6 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.0 FT. AND 4.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERCOLATION READINGS WERE WITHIN 1/16 OF INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS VERVORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: "7 ro e3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111072 Tax Code Number: 05065107000 Work Type: Septic Upgrade Permit Effective Dates: May 20, 2011 to May 19, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: MOUNTAIN VALLEY ESTATES #1 Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BLK 3 LT 14 G:0758 Owner/Address: WOLVINGTON ROBERT K PO BOX 771333 EAGLE RIVER AK 995771333 Site Mailing Address: 4120 JOHNNY DR, Eagle River Lot Size in Sq Ft: 94350 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: Date: f' _ s` MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development r .. • Program MayorDan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.C,- CSS 1— Property owners) e- T LjotV 4&-TyA,,; Day phone Mailing address P-0- 90A -77133_.3. 6ce� Atyk5A, Afid 92S77 Site address QIZO -;Z50&,vY DPI a , t c -cc 9i ijFg Legal description (Sub'd., Block & Lot) MwN,,9jy Mcj-E,! C-- ,r,z,9r4p,, 6r I k t T /y Legal description (Township, Range & Section) Lot Size, 3SX, Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (N all that apply) Field ❑ Initial ElAbsorption Septic Tank Upgrade [ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signa ure of prop r er or authorized agent) t/ ush Fees: Waiver Fees: of Payment: Date of Payment: Receipt Number: Permit No. Receipt Number: Waiver No. GABuilding\On Site\Forms\Client Forms\Permit App_010411.doc (Rev. 1 /11 ) Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panensak.com May 20, 2011 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Mountain Valley Estates #1, Block 3, Lot 14 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1250 gallon Septic tank be issued for this lot. The proposed systems will serve an existing four-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a four-bedroom house and is operating adequately for four bedrooms. The existing steel 1250 gallon tank is collapsed. The damaged tank is exposing the raw sewage to the environment. The existing tank will be filled with clean gravel or concrete and abandoned per code. The existing drain field location is in question and the sump will be located during tank replacement. Any issues discovered will be addressed prior to final inspection report submittal. The surrounding lots are served by private water systems and there are no wells within 200 feet of the proposed septic tank. This lot is served by class C well that is 192' from the proposed septic tank. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 14 slopes from east to west at approximately 20%. The proposed installation will be located in the south-central portion of the lot next to the existing septic tank and absorption system. Ave, t ¢` ,dry y j$ . Telephone: ne: (907) 272-8218 2`P21FAX (9E; f) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, 49 TH E ♦♦ Steven R. Pannone.••�'[f/! ♦ CE 8149 222AIV i 44 It Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: "Tyskad: 62.1� East 62 Ave, Ckjite B6, AJICI'10�'age, AK 9950-15 Tele' hone: (907) 272-8-418 FAX: (9071272-8211 SUE NORM RK SCP�E . �•s6o NUOPG SSOR 5� X100 s=. I/V •D b .• 1250g SEPTIC TANK (P) AND DOUBLE CLEAN OUT N POSSIBLE LOCATION OF DRAIN FIELD (E) UNABLE TO LOCATE SUMP DURING SITE VISIT. WILL BE LOCATED DURING TANK REPLACE ALL ISSUES, IF ANY, WILL BE ADDRESSED PRIOR TO SUBMITTAL OF FINAL INSPECTION REPORT. i K ' EXISTING 1SED 2508 COLLAPSEPTIC TANK ABANDON PER CODE /M ._---M ------J4' M i CLASS 'C' WELL (E) 4 j * sept ie CaFpvnents added to s:x ver, "Loc. reconstructed frau t' t} ( records. NOTES: PANNONE ENG SVC LLC _-�9f A , Date EMERGENCY REPLACEMENT P.O. BOX 100217 ANCHORAGE, AK 99510 r '�� `� 5/20/11 PHONE (907) 272-8218 FAX (907) 272-8211 �y�� Scale *: 49 TH 1"=60' 0.1 .... ... ..... r P.I.D. NO MOUNTAIN VALLEY ESTATES #1, BLK 3, LOT 14 50-651-07 ROBERT WOLVINGTON Ste've'n R:'Pannore� PERMIT NO. CE 8149 P.O. BOX 771333 +,Fs• xxxxxxxxx A PLAN EAGLE RIVER, AK 99577�Ip�= Sheet li FD pROFESSI __ ��\\\��� 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264--4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Tn SEPTIC ABSORPTION Address FROM sle G //v w 6---tz, Phone(s) Permit No. No. of Bedrooms WELL _ _-5-6 3 — 3.33 3 /✓/sr _ LEGAL DESCRIPTION _ LOT LINE Lot Bloc Subdivision mrN r/u /f h FOUNDATION Township, Range, Section T AS -BUILT DI. / C- .3.f� driveway, water _ TANKS i] SEPTIC Aba��. ❑ HOLDING Manufacturer Capacity in gallons Material TYPE OF SYSTEM Ike / NCH ❑ QED El W. DRAIN El OTHER ND�FO .+ �fcw Depth to pipe bottom from Total depth from original grade original grade FT FT Fill added above original grade Gravel depth beneath pipe FT FT Gravel length Gravel width FT FT Total absorption area Distance between lines SQ FT FT Number of lines Soil rating Pipe material SQ FT Installer Dale Installed WELLS XPRIVATE �x�rr ❑ OTHER (identity) Classification (A,B,C) Total Depth Cased to FT FT P WEI�_d A (Show location of well, septic system, property lines, etc.) ivZ'f, REMARKS: — :��� /`Z o � I✓/T C� cu-�.%d it so u.,, Scale: fY:lee/ tom. T� L' q r i� . %1+ •i �rnsp cti n performed b ago liwer Englncer�ng Sorvic.. �Cyv ✓� ""f' O..r L}.4 a a G(ov� r t C.f i' ON /� . /'ft C—P- El. Box %7829't yerDale: Eagle River, AK 99577 Wafter' /ANG G» ! 51 2Evv-4 f' 6:4 eft >A_ Sr�r /a_ 694+-5195 I ��< !r t' cerlily [hat this inspection was performed according to all Municipal and State guidelines in ellect on this dale: _ V_4_/Y� — Health Department Approval: 72-013 (3/05) Date: h A EJi�fitr1EER 5 sBP4 r 7:, y ,o +" iA Ir, t Ir �v� i�•I J V'�� nc mea=oo oa - e.acronue� F, � '� 1,' ..t1 yl{cl � 1 % i i-. i•HV{ll%.(rE .� j AIME NT OF H[ AITH ANO HUMAN Um( Y Enwonrrxnlel Heath Dmismov irFrt' - bi5'1. J�rW! AIF tfI4NAQr- A.,I,►e 4>W1 Tr!rphw* 2G4-4,20 ' ,z +O&SITE SEWAGE DISPOSAL SYSTEM AND (OR WELL INSPECTION REP ORT 41 DISTANCES TO I SEPTIC AUWTI N E TANK i 3 ��� t _. 7770 TO WILL tC�i��,} �45a4kt Y 1 n, +moi 07.E t 101 LINE, T r FOUNDATION •'� F ,�� sa'"`� ' "� Z eFW[;tt�. '�� �♦/ �`'/� AS®U-ll DIAGRAM <. ,... .•�...•rpr , ,,,W. Nt*""mm %ro Yw, 1�• CAI Al Lr.lO ,tz. TANKS r • F HOLDING JE{ - :J iR.a.na �'^•"V�� I )r r Tf TAPE OF SYSTEM ri XTRf NGFI BED W. DRAIN OTHER irT , r, ' `T ?] '.. a-�'at tir3cs::LA•a,.f,., �._.. _. 6. yY.. _ i, _ I , -;"I 10.0_1, 0;17 F7. _ 5%O FT —� i !a•Ir�e C. -13 fL.Ct+• yr v.Y SL�'Y^y ; y� I ' �. •�.• WELLS 4, PRIVATE OTHER {Idenbtvt E HARKS: �— -- _.-.__. • - p\� .{p� � � � t` y°�' UIL - II11� 0 !)eWME[l1II i#ALy, rvy �'.` by n a. e Cq 4; v r •4 1.�-���T�-'r►1�V/Y'...���—�— cM.•� ••. ,Af ,r�Cr t•«n r. tt p+n,r lt�f0 JGR "�Y� M � .... q...•e•..I��X� ;�: Iry ; w{.a sem,s K 44577 - — —* a • I o , .. _� °'•1 yr, A it �• a n iAOtERIVmt A IPAL1TY OF T"'CilOWC • p ! i h� it r1 s C I + +,,(' Hew_ and Environmental Proter� ,ten Fourth Floor West tf 925 L Street r ? ` Anchorage, Alaska 99501 i aea�lrs Ire 279-2511, x 224. 225 T. J ,.` �r� �, .• INSPECTION REPORT OPS -SIZE SEWAGE DISPOSAL SYSTEM i I+I• . 0' U .i PF#O7`NE4 � ^��. SEPT:,GTANK: r I NUMBERrOF -.MUo�w�:_ AT1 01, } f`;1NSTJF LENGTH, �_-_'NSICL'.til: 7,1 :If I i l - r--_LIquIDCAPACI`T)V �? GAL. LO►4$ ` F TILE'DRAM FIELD Q r 1 I 1 TOTAL LENGl t R� c . V GIi ANCQiRO�.� WELL t�'�-_ + •.I AHESI rC,t LINO-..�.-t__-OF LINE SPO May F0.•4DAIIc '..�•®r < ' • i.5..' :41E of�1 Lines U: S1 ANC E 4,! T ..., ', L I?.1 :, N .� T fir l4Cl+ W IDT11� � IN ;TOTAL CFFE�� E ',435014glo'4 AREA it" TII r : ACf I. INF e- -- - r, ,IEPII OF IILIL i ��:.� rY,:• 5,t �F^��, '{ AIE 4IAI, 11FAlTILE 1 L .;,.oEpTI`/, TOP or TILL To 1 1 .ISI1 G4 AD( � -- - : � C,E _ N. ABOVE TILE SEEPAGE PIT: r UTAYETLP DEPTH —wa Ad ` WELL - Log Crib` Rings Crab Size: :•in"LTL 4 _--_uf vllf! DISTANCE FROM: ' WELL £ k iD7AI. EFI-ECTIVE BUILDING FOUNDATION_._-, NEARCiT Ll,)T L:NC AP'.('41f'TION AREA (WALL AREA),__ ^.R�:_7�'+'. _-'�S'-��-_ .__.. �_ ..—. _-_ __---•—.--_.._._� _I— Imo.---�-.._.-.�.. ass t Depth: Well Distance To: lot Line Sbll . Feld_. 'Sot Sewer Line: 1 t Pipe k'ater�als: I.1ai.a.ta p+ ^ # of Lr'-drooms: — - --g, , eo ! Renarks: l �t1 / . f IIp Aip L=�. ti A MwAco ity al And we DEPARTMENT Of HEALTH 8 HUMAN SERVICES 825 _L Street. Anchorage. AWAS 99`.,02 0650 SOILS LOG -- PERCOLATION TEST � 4 ,�h'4 . ��j i a • e II .� ` 1 50 • f o2 IL C D IV `r• DATE ' i 4 �lE1tfORMEp i0A' --- k Isv! M l t aP 3 3 , rsow-ishlp. Range, Section: Nlrw✓.« t t i ECsIbL b£SCAi/ TLOM.� SLOPE 1 ,; � cEr�r aQ pPra.a.Q,.a Px� X -; • i 7 m'` T /' • .• yt ; ZZ'� -8 Q WAS GROUND WATER ENCOUNTERED? r {. S L If VES, AT WHAT O DEPTHS _ a P i2 q E Iko is Mani ll � ''/ � Sjj"$ L t 13, arla�� Ao � Hc. A SITE � F ' ,a rr� i �J `, j 's *&jV4 Reding DateGross Tin* Nit rme rotm %, .f/ V�'�v •� QC F-io►-& t S /'l�Sf. S : � c� ""'! 7'', 15 t r Ib. 14Na +�♦ �" A SITE � F ' ,a rr� i �J `, j tT 7(I .. Reding DateGross Tin* Nit rme rotm r a .f/ V�'�v •� QC F-io►-& t S /'l�Sf. S : � c� ""'! 7'', 15 j � i 1 • � 3 � ,: 40 4rL.A 1 pAMEi EA —- •�� ' 17 TEST RUN HETWEENFIAND _es f1 4 47 P �/�%A►f y rr t �iFL r D _ _ �� _ ' ;F4 , COMMENTS _ e r S & S ENGINEERING 96)C CERTirr THAT THIS TEST WAS rMOHMEDIi k PERFORMEDDY. t ��� PK 9951 23 E0 ' 14 `, j Reding DateGross Tin* Nit rme rotm r a .f/ V�'�v •� QC F-io►-& t S /'l�Sf. S : � c� ""'! 7'', 15 j � i 1 • � 3 � ,: 16 et K PERC(.,LAI,ON RATE 1mrvut,ch) Pt pAMEi EA —- •�� 17 TEST RUN HETWEENFIAND _es f1 ., •.� a 18 �/�%A►f y rr t �iFL r D _ _ �� _ ' ;F4 , COMMENTS _ e r Dep ;, r T a •f;. j � i 1 • � S" G 1 ' ST.' et K PERC(.,LAI,ON RATE 1mrvut,ch) Pt pAMEi EA f. ...-.i. TEST RUN HETWEENFIAND _es f1 -,HOLE G 1 ' et K PERC(.,LAI,ON RATE 1mrvut,ch) Pt pAMEi EA f. ...-.i. TEST RUN HETWEENFIAND _es f1 ., •.� �/�%A►f y rr t �iFL r D _ _ �� COMMENTS r S & S ENGINEERING 96)C CERTirr THAT THIS TEST WAS rMOHMEDIi k PERFORMEDDY. t ��� PK 9951 23 E0 �Iy�RC ACCORDANCE WITH ALL SiA E AN MV i I AL GUIDEUN EGT ON THIS DATE DATL __ n f1 12 -IM IRai bl\- E GEO t .CFINI CAL Ef DEVEL (_ MENT. YWa• Butt 90,Davis St, Engle �pRi�vn.�pA ��bak� 9957 ly ht U -2774 d VW-LION _ Y• 1 , �•�' r1 lNstsr SOIL LOG ' �s!gou~�no� .. I j: t.«+e D�oprr+aasc Kormed'toro._ Kam: Tel b +G, Mailing Address: ��� fit,. .�Sy Vis ,: T TLegai;OescMptlon:,, �T `� ����• �.��w� s�w�ec. if F� k fit' '1`k 0e th4 teen SoiiaraEteristics 'f 149 V. -f ["�. \1 T ��t'!7 alA ��../ W .TVs �' tD'7�'�! s V�ii.9 a•� �: �' i� �%�`�(i, 'i �* '~� s r, r'� 1 tii., - p n L� ��.-ti 7+a;'l �� L^ `ice. AYt�/ W .t•v. �Q3�4�v'�/� 1 . 1 X ., �', �{� x i r l T l � s4 ♦'Tr - �" C J[J�-n1�t1 vi 94 �.. �.-1 ,,, i '1 � rNy,� , 'QPM. -±{ ?c.r+s ay' *I Jt— 61;br% s -1 60 aYt.tt.,� vlN,:.' hit iii=�. Ari x, , %3h ''. _: �T4 � r. ♦Nf��i'". 1- L1♦ ef•. �Y �..A Oast 3 i;� `.�wl Nf i 3 w.r `['. t-M'r v. .tea ' y> JL pC.n )• �! 9 , i1N' r. �1,� .., � � ' 'r'•�� u s: ice'' a 1. 3 �v ,j . rr 1 t •li t IL 1 16 ".4'r j 3 :Ground water Encountered: Yes No If yes, what depth, G i +.� I • 4 t y ._ Proposed Installation: Seepage Pit Drain Field �, Corvnents: ��'.� c�tA•,.�ay ��c.• 4��.. 3 _� i Performed by: �`�, k,� Date: IF ry STATE OF ALASKA �.+I �n DEPARTMENT OF ENVIRONMENTAL. CONSER ATION CONSTRUCTION AND OPERATION CERTIFICATE A1. A5 for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or modification of ! -- % h , i°� �I ' //r (-I. ,rj G �-)public water system located In A , Alaska, submitted in accordance with 18 AAC 80.100 by J� f I ^ h have been reviewed and are J approved. ❑ conditionally approved (see attached conditions). By TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) C. APPROVAL TO OPERATE Approved by Date The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the //° ip" public 4N water system was completed on ! ' / 7 7 --(date). The system Is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY 180407 (Rev. 11/83) TITLE DATE DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section Q 2 YELLOW - WATER SYSTEM FILE (Complete Section C 3. PINK • ENGINEERtMUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) MUNICIPALITY OF ANCHORAGE — DL- .RTMENT OF HEALTH AND HUMAN SER4ruES Environmental Health Division 825 "L'• Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION DISTANCES" -- TO SEPTIC ABSORPTION WELL FROM TANK FIELD e Phone(s) Permit No. No. of Bedrdoms WELL LOT LINE( ---- LEGAL DESCRIPTION lot Block Subdivis1io�i --� — NI il- y, lslrLta !^ 0z I FOUNDATION Township, Range, Section I _r> _ s Irl 11 `, -t F, • , _ �`• O N �`� C_ Ole AS-BUILT DIAGRAM (Show location of well. septic system. property lines. foundation, 7`iA V`„J��12 3 � �_ dnvewa water bodies, etc pF IF, TANKS - — l SEEP•GfC ❑ HOLDING Man faCl Urer Capacity in gallons Y I - aQPo Material No. of compartments TYPE OF SYSTEM -- TRENCH ❑ RED ❑ W DRAIN ❑ OTHER — Depth to pipe bollom from Total depth horn original grade original grade / - __ __ __ n � FT _ _ _ � D. DFT III RII added above ongmal grade Gravel depth beneath pipe D, 0 FT _ SID FT — Gr Gravcl length-�-- ------ Gravel width - — Z�Jrli FT �r5 FT 1 p r F Tole( absorption area �^ Distance between hoes ?i120 SQ FT p FT- Nurnber o-11-1 ines Soil rating Pipe material -� �Z��sQ— Installer ,! Date Installed —��Yr�c,-•WSJ P3 WELLS_ t_ — ❑ PRIVATE -- OTHER (Identify) ---- Class6caUon (A, ©,C)----- ---- Total Depth - cased to - _ 6it.i�j—-- FT FT Installer Date Installed. - - rV _ l REMARKS: -- -- ° Scale: IT, - p ENGINEER'S SEAL Inspections P r rrned by — p .,.Date.`yI 0 jt °r ��� JGt .761tlV1�\1 S.G��\�i —�-- '�` r {+5'J,7S �'� �.ea�•r�or - uuirc•.ue - rr SR -B--} X---- certify that this inspeclion was performed according to all Municipal and SlaleEl,� GLEnl�(WFf%sAK 92 — �'t �r t1�°1' -� •`:art, a•"°'I .. ' a l'>' � ' Health Department Approval:� ��•r „ l � -- 5--.��-•e � - � �1 � ��, Date. q T10 P a ^ < G\: . '�r%�N/.._.-P , ,i -. .�. c-:.iir.-. �saYf'�'t..rcas5nsa.�•..iy�ei-.�3.-.rov;.�..-sas.E:��a¢3c--a,. � ..-..:-.-C^-.n--..awvL-:._:4r5'$1�-t'ZfeeJ€.Y3'°}�'��� `[ Y c, F' jk t q T10 P a ^ < G\: . '�r%�N/.._.-P , ,i -. .�. c-:.iir.-. �saYf'�'t..rcas5nsa.�•..iy�ei-.�3.-.rov;.�..-sas.E:��a¢3c--a,. � ..-..:-.-C^-.n--..awvL-:._:4r5'$1�-t'ZfeeJ€.Y3'°}�'��� `[ Y 0 W 1. 0 H A I X 4: 1 1: Roo So 0 !A: - 0 C P F7 �����IF::--,V 1r,71 IS I H: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 Ups"--AHT X.T-M Q TH R.All RMTO FlEn FT WR ALA PERMIT NO: 860217//xg���� _�l DATE�� IE�SUED: 07/03/86 �/`' ^° v APPLICANT: SOUTH FORK CONSTR C/O S in S ENGINEERIN � not /y ADDRESS: SRB 196X (� ^ C� EAGLE RIVER, AK CONTACT I GAL DESCIA IP: SUBDIVISION: MOUNTAIN VALLEY EST1 LOT: 14 BLOCK: 3 SECTION: 33 TOWNSHIP: 14N RANGE: 1W LOT SIZE: 94350 0311.1M OR ACRES) LOT LOCATION: JOHNNY DRIVE MAX BEDROOMS: 1 Listed below are the options avai1able to you in designing your septic system` Choose the option 1 a t. best Fits your site" U�11 -11 JET PEE 1D. Twj 113 INV A X POP DEPTH TO PIPE BOTTOM (FT" ) GRAVEL DEPTH (FT.) 5"0 TOTAL DEPTH (FT") � GRAVEL WlDTH (FT"} 2.5 GRAVEL LENGTH (FT,} 23.012, , 2 GRAVEL VOLUME (CU.YDS") 11"8 . 18 T�ANKSIZE (GALS) 1!00),0 ** 1� .0 ,O00" * SOIL RATING (SQ.FT^/BR) 225 213 \ / 225\ / / � ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ..... .... ... ~._~__~~~�... ��_..�_~_�... ~,._�^~^_ I certi�y that: 1. I am familiar with the requirements {or on~site sewers and wells as �et Forth by the Municipality o[ Anchorage (MOA) and the State of Alaska, 2, I will install the system in accordance with all MOA codem 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. 4. I understand that this permit is valid ff,or a maximum of' 1 bedrooms and any enlargement will require an additional permit^ IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND lNSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE 8Y A LICENSED ELECTRJCIAN" / SIGNED — DATE: �-v~--w~�-,~--^°~~r-�~��~��~-~-�^^-��� APPLICANT: SOUTH FORK CONSTR C/O S & S ENGINEERIN ISSUED BYDATE: v�~�~'�' /~� ` ` Municipality of Anchorage 0* DEPARTMENT OF HEALTH & HUMAN SERVICES 82.5 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 5o�C7L2 / &ov �/ LEGAL DESCRIPTION: L.. It/ 13 3 Mro''). VA -41-,/ Osr, oWnshlp, Range, Section: I L] O�T SLOPE p 2 �U 3 Z_ Z' Jr� 5 0 • o- �/��vST��' 6 / e 7 �a 8 x/ O 1 _10 % 12 F' 13- 14 Ile 15- . 3dt To r� 8 G of 16- 17 18- 19- 20 PERCOLATION RATE 00 _ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _ �r FT AND S7-_ FT K -I S <A 4 l �1 1 A 1) W 1 -_?_1 PLAN WAS GROUND WATER ,�lv ENCOUNTERED? S IF YES, AT WHAT L DEPTH? �'a 0 P E Depth to Water Alta 4 Menilarin07 __: ' hate: KA Reading Date Gross Time Net Time Depth to Water Net Drop COMMENTS AA L k1w-s S&SEN L PERFORMED BY: RffiAIJ, 96X I S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNI II�I�ALL G�UIDELIN I ECT ON THIS DATE. DATE: .-MAY �i 3 1986 72-008 (Rev. 4/85) =+ BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 'E' STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 July 2, 1986 S & S Engineering ATTN: Robert A. Schafer, PE SRB 196X Eagle River, Alaska 99577 SUBJECT: Lot 14, Block 3, MOUNTAIN VALLEY ESTATES #1 Chugiak, Alaska 8721—FA-001 Dear Mr. Schafer: We have reviewed the plans and specifications for the subject project and are hereby issuing this letter and a "Certificate to Construct" which constitutes written approval required by A.S. 46.03.720(a) for construction of the sewerage and water, systems. Final approval will require the submission of Engineered as—built plans. Inspection and sign off of as—built plans shall be performed by a Professional Engineer registered in the State of Alaska. Arrangements for this inspection work is the responsibility of the developer. In addition, the owners signature, address and telephone number is required. The "Certificate to Operate" the water system will be issued when the Department has approved the applicant's as—built plans. Any future expansion of the subject project will require additional approval from this office. All future correspondence should include the above assigned project number. Sincerely, Michael P. Lewis Environmental Engineer MPL:pkk ENCLOSURE F ANCHORAGE/WESTERN DISTRIC'r OFFICE 437 'E' STREET, SUITE 80:3 ANCHORAGE, ALASKA 99501 ,July 2.0 , 1986 S & S Engineerinq ATTNs Robert A. Shafer, PE SRB 196X Eagle River, Alaska 99577 BILL SUM -1110, GOVERNOR SUUJECT: Lnt 14, Block 3, MOUNTAIN VALLEY ESTATES t#1 Chugiak, Alaska 8721 -FA -001 Dear Mr. Shafer: 274 -?533 The Department has reviewed the Fngineer As—built plans for the subject project. Final approval is hereby given for the water system and the "Certificate to Operate" 1S attached. Any future expansion of the subject project will require additional approval from this office. Sincerely, Michael P. Lewis Environmental Engineer MPLspkk ENCLOSURE STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION iq CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or modifiration of_ t_ _- _public water system located in flb �'� �� Alaska, submitted in accordance with 18 AAC 80.100 r „r by--_.__._--_._J.-__.L' ?� r'n_� �l iri- -----_-_------._.------ --.-_-have been reviewed and are ,,LSC approved. EJ conditionally approved (see attached conditions). --GJ /� _.y- _._---------------. .—/gin/'µ-r•��/ /__-�, /__ fi'/ BY TI rLE DATE If construction has not started within two years of the approval date, this certificate is void and new pians and specifications must be submitted for review and approval before construction. R. APPROVED CHANGE: ORDERS Change (contract order no. or descriptive reference) C. APPROVAL TO OPERATE Approved by Date The "APPROVAL TO OPERATE" Section must be completasd and signed by the Department before any water Is mado available to the public. The construction of the -___._1_!- -- - — - ------------ public t water system was completed on______ -�j�E 1 /� %______._—__.____..__ (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITL.F DAT F. Wal. 11183) UISTRIBUTION: 1. WHITE . ENGINEEn (Complete Seellon C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEERIMUNI-BOFIOUGIT (Coniploto Section C) d. GOLDENROD - MUNI-80ROUGH (complete Section A) M -W DRILLING, Iric. P.O. boy 110378 0 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Mike Mantsch Well Owner- Location (address of: 'township, Mange, Section, if known; or distance 14, Block 3, �Valley Est Ir"1 ¢� 86- i_96 DomesI-iC of Well_.__—_ Size of casinr__-._j_.__Depth of Bole 1B3 .__�.-feet Cased to__- 80 ' � £eet Static water level--.80--Yft. (aWW� (below) land surface. Finish of well (check one) open end ( ) Screen ( ) ; Perforated Describe screen orperforation-.s71d._��-�1:. Perfo� at_i_on/ft: 55'to58' Well pumping test at-�_-gallons pet (hour) (minute) for-.- 2 _-hours with -__101_% __ft of drawdown from static level. Date of completion .Ju-l-y-,-4L--19.�-6,-_. Depth in feet from ground surface — 9— —_21..---TG--A 5_-__ WELL LOG Give details of formations penetrated, size of material, color and hardness CSG Stickup G).-avel )will organics Silty Gravel Gravelly Hardpan. Water Gravel; 2. GPM,- Hardpan PM Har.d an Silty water _Gravel; ---1 GPM —^ _Salt�Iiardpan ----- - ------ Sof_ Bedrock; Black Bedrock; Gray tare, water ;soaps in fractures 140'-160' INWW!?; Certified Contractor -------------------4'ert3fi�td; 1 -CUSTOMER MUNICIPAIIITY OY ANCIIORAGE Ilea' and Environmental. h.r.otec on Fourth Floor west 825 L Street Anchorage, Alaska 99501. 279•-2511., x 224, 2.2.5 INSPECTION tiE:VORT C>N-Slid SF -WAGE DISPWAL S`e'S>iIVA NAM U. SC_ .- MAR IN( ADORL s .�e '��.- 1 QP, hEloNr ? 1,� LOCATION �.otilnv-� .2_--- -. -_ LICv L ULSCRII'11ON �1�-_� 3 wlt_ UTa``��,, sh_.__. "tel . SEPTIC TANK: DI 5-i ANCI-: t NUMBE-ft Of .2 FROM WLLL_tw-__._.. MANUI ACIURL_f+ - _ � fit \IFRIA.L _ - _ __C0FAPART1,/'G:H1 >.. _-.---.--- . INSIDE. N,IUIIi_ _ -._ LIQU f_I )E.P1N -I_I<t1/1D CAPACI -fY GALLONS TIE_ts DRAIN FTI_D:�_V_p C.uH�L A_-._DIiIANCEGE.T4^JfCNLINES ___7fWflcIIWIUill3�;?IN. 101 AL LF-It-C'1IV: 1 DI Tn(JCE FROM WLhI_ . �bv ' 7 _FOL)NOAT ION_ t _ o-- ( -_hi(- lRl`"ST (CiT L.IhJC - i� F .__ To"Tnl_ LrNC;ThI t _OF UNE it of L:A.Yl/3.i A_-._DIiIANCEGE.T4^JfCNLINES ___7fWflcIIWIUill3�;?IN. 101 AL LF-It-C'1IV: 1 J AHSORPTIory ARI'.n ___. _� S(1. 1 T. 1 ENGTII OF FACH LINE[ -- 1 DLPTH OF F ILTCR > "FILE -> OLI"111: TOP O1-'IILI_ 1'O 1INI`01 GRADE: _ 19n'If-TRIAL (it :.NL:nT11 l ILC _ .IN. n(lOVF _—...�___.._I!'I. SEEPAGE PIT: DIAMETER _— _ OR WIDTH.---_-, LVNGTH ____, DLPTI-I ...... __--_--_---__._................. Log Crib Rings _ Crib Size: DIAME'fF.It___._DLf)m.OISIANCLf-'ROM: WF.(_L__._- .._.___._.. - — TO"TA(. EFFECTIVE. BUILDING POUNDA"f ION..__,_.., NEARES`f LOT LINE__._.._._.__ . ADSORPTION AREA (WALL. AREA) -__---- ____.___$O. El'. Well 1 Class: �y, Depth: I t r L _ , I Well Distance To: Lot Line Bldg: ->o_F_ Sewer Line: _� _ + ( J - ipe Materials. It of Bedrooms: _ _ -I. Inst.all_er: Remarks :FC' i L)AI1- Co 2,j-1.7APPROVI.D _ - r 1 CHIS' I PURE 11FRASCH If? I 4:4 I'1' � I A -d F.::�i: 1"If FS'l AND IOU IN(THIRIAT 20 SOIL WIM )A'.11:1,G. I I ': k! -i-50 ME REMUS& SWIT OF THEI SCIII n-'111 04, 1 . kv. I K! Il.._ A –F 1-1 — off 1, C. if 9"s V V 0 . 171 K 0' 1– U-1 �nn Zy. XQ Q! c:' W: A 3: 1 TARMY Fs hot F: F;'�]:: f( �� :!! R, , .9 II : !I C., F4:'I'I:-:KF 1f L.1 . 1i'-'I(!j 1:,41 SYM Ell NJ I 141OLYF F 1 ML 1 FAIMM 1 YJ AND 103FIR1_AMR. By ITI 19-.. WITAHAMAR WALL W AT"'...' F:C: I TO I -Y K wit 110 1 -1 - v w" A H ... -.ij::IF:::' V-.1; S: r� 7"' h'.. il-::It 11 V�:-i Rii � '. p :1 :!i ",; 4 1! ji 0 Et E GEO) _CHNI CAL & DEVEU ."MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name:�i,_x `&\"4,w- ��.�rh� �\ Tel . No. _ 7`�- `7 7�7 {- Mai1ing Address: V�2)\.k� \`S Legal Description:,•,,N�r:\1 2ektLifeetl Soil Characteristics 0 (� \^�c� 'i `/�`a .J r��� I�ZAV`r,✓ W\c \a �p�'S v1 r: c.� ..1 Sew. �_-�-.Jg4.5 \ / , 4 t C fa 2-�C•z: s5 c7�Y C_._`t)a ta'�.�-'- `�?, �t-�� 5 �e ��YJ\Y,L_..� Its/�n- 5 7 ..�...s l� C �-� L:�<--e `alalloY 9 .,�� _ �� 4•..-<' - � � f-: \\ : Fi`' 2. VJ �-C'\'�'�� � tri \1 10 1L -- 12, 13 1>a 15 16 Ground Water Encountered: Yes -rV, No� A If yes, what depth Proposed Installation: Seepage Pit Drain Field® Comments; Performed by: � ,, u_��_ ,_, Date: \ is _ j 11 1.1-11 c:- X low 1=1 R... :1 "T Owl M 107 F! IS Q 1-1 (3 IF�", V-1 PI3i� DEPHRTMENT ^ HEHLTH OTECTION STREET/ HNCHORHGE/ HK 279-2511 PERMIT NO. ( 77172 ) HPPLICHNT 6]6 WEST 18TH HVE 279��]76 LOCFI, ION JOHNN: 0 DRIVE LIo: GHL 1 14 MT ',,-'Al LEY EST LOT SIZE 4]560 SQUHRE FEET MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON~SITE SEWHGE �ISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE HELL COMPLETION. SPECIFICHTIONS HND CON�TRUCTION DIAGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTIOti. Rol ET FG: Py !11,.11 v op R 11:3 V-4 PEE: Owl UE Q FG! V, lot CIA M X STS3 0_11�� I CERTIFY THHT 1 I HM FHMlLIHR WITH THE REQUIREMENTS FOR WELLS HS SET FORTH BY THE MUNICIPF')LITY OF HNCHORHGE 2� I WILL TP SIT THE SYS M I HC CE WITH THE CODES SIGNED�� - Ft}, A & I, DRILLING COMPANY_' BOX 97, EAGLE RIVER, ALASKA 99577 o TELEPHONE 694-2588 OWNER of LAND A / `,r j_� DEPTH OF WELL Y _ r ADDRESS STATIC LEVEL OF WATER FT. J r LEGAL DESCRIPTIONc ) �'4L r t" DRAW DOWN FT. DATE - Started �% ` �_ Ended -�/�� GALS. PER HR _ 7 , KIND OF CASING PERMIT NUMBER 9 KIND OF FORMATION: From �� FL to Ft. 0 0 %` �'' ` 4 Frmn Pt. to Pt. From .7 Ft. to ..�_Ft.�,• L : %, lit �G --� Frmn_._Ft. to -----Ft. From - Ft. to—Q— Ft. From Ft. to Ft. From a Ft. to_,, �� Ft.—IOL i;< t;r,< rf V%� %�«<_`? From __ Ft. to_ _Ft.. From , .y Ft. to Ft.F''L%'c '<_,_ �i �i /.' From. Ft. to Ft. From f-) 2, Ft. to7 Ft.'<•'� Froin—Ft. to - Ft. From Ft. to _Ft From_ Ft. to ------Ft. From >-.' Ft. to Ft. f<'t,e.<s: From Ft. to Ft. FromFt. to Ft. From Ft. to Ft. From Ft. to Ft.. Froin—Ft. to Ft. FromFt. to Ft. From Ft. to— _Ft. FrmnFt. to Ft.. From Ft. to Ft. FromFt. 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 Pt. Froin—Ft. to Ft. Fran —Ft. to— _Ft_ MISCL. INFORMATION: 0 DRILLER'S NAME{-t'j' MUNICIPALITY OF ANCHORAGE Development Services Department P P �` -- Phone: 907-343-7904 On -Site Water & Wastewater Section ' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-651-07 1. GENERAL INFORMATION Expiration Date: )U0 ,a Complete legal description MOUNTAIN VALLEY ESTATES #1 BLOCK 3 LOT 14 Location (site address) 4120 JOHNNY DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) JASMINE KHAN Day phone Mailing address Real estate agent 4120 JOHNNY 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: 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: 4 Day phone TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Distance: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ 15-5-7) Date of Payment qlj /A) 2o Receipt Number �/R(}L%j� COSA # (�' S C aO //415 Date: Waiver Fee $ Date of Payment Receipt Number 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 4/8/2020 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 a�i system and maintenance. The operational life of all well and septic systems are subject to A V, • ' • • ' • :'� 4 these various and dynamic characteristics and are outside the control of the evaluator of the r,4",••' • • �.��¢ well and septic system. Therefore, any estimate of how long a system will function satisfactory ; •TM 4 • •• for current or future occupants or guarantee that no unseen encroachments, deficiencies or /d discrepancies exist can be given by First Water Consulting & FWi S . ' • • • ' • • ' ' • ' • • • • • • • • (� 6. DSD SIGNATURE �jj Curtis Huffman f$ �'�'`�• CE 128991 •`4.� System #1 Approved for bedrooms W, -.4/8/2020 • •. off, System #2 Approved for bedrooms �� ESS0Y�"' Disapproved Conditional approval for bedrooms, with the following stipulations: itc«ctcc�trrr Oji �r ON-SITE _= \NATER AND PEOGRA �lJ j�1SER :1 By: i(�'� �� Original Certificate Date: 1 2`0 L.J 9 f� 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 COSA Checklist Legal Description: MOUNTAIN VALLEY ESTATES #1 BLOCK 3, LOT 14 Parcel ID: 050-651-07 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/4/1986 Total depth 183 ft Cased to 81 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 36+ in. Date of flow test for COSA 4/7/2020 Static water level at beginning of test 80 ft. Well production at time of test 1.18 gpm Water storage tank volume 220 gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.24 mg/L Nitrate less than MRL (ND) Arsenic 17.5 ug/L Arsenic less than MRL (ND) Collected by Date of Sample 4/7/2020 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) 6 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49” Standpipes/foundation cleanout per record drawing Date of pumping 4/7/2020 C. LIFT STATION Required maintenance completed Age of lift station 4 & 6 years Lift station material STEEL Comments: 1250 STEP & 500 LS – Fluid levels normal at float levels. D. ABSORPTION FIELD DATA Which system tested (date installed) 7/10/2014 ALL standpipes present per record drawing Total measured depth from grade 4.3 / 3.7 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 Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 4/7/2020 Results Pass For 4 bedrooms Fluid depth prior to test (West Field / East Field) 0 / 0 in Water added 840 / 210 gal New depth 6 / 7 in Elapsed time 40 min Final fluid depth 0 / 3 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: Southern MTs were not found / buried under snow. 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 ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No *0.14 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *MOA Waiver. 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. 4/13/2020 MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Arsenic Advisory   Certificate of On‐Site Systems Approval # OSC201145  Subdivision: Mountain Valley Estates #1, Block: 3, Lot: 14  A water sample revealed an arsenic concentration of 17.5 micrograms per liter  (ug/L).  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.    MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section `4: - J Fax: 907-343-7997 Owner_ L.,1,_de_ Septic Tank: -Sludge levelinches Lift station: Lift Station/Pump Vault Maintenance Log Street Address 41;2_0 -Pumping: required -Pump basket cleave no -Control floats cleaned a no *Operation satisfactory es no Alarm System: es o -Pumping completed es' no Z-/7/20 *Effluent filter cleane esu no *Proper float settings confirmedes no -Dedicated electrical alarm circuit esl no -Audible nd visual alarm inside dwellin . es no -Alarm system operation satisfacto not satis actor Manhole Riser -Ground water intrusion at riser to tank connection -Ground water intrusion around pipe penetrations yet no -Weep hole functional kye§Zno -Manhole lid: Functionales no Insulate es \' o Properly Secure es ' no Other -All manufacturer required inspections and maintenance complete es o Comments: Qualified Maintenance Provider: Technician Company ,°I Signature Date of maintenance ` DateZI MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water &Wastewater Section `'�� -->�'f Phone: 907-343-7904 Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner a, cJe-c,�) e__ Septic Tank- -Sludge level inches Lift station: Street Address (A -I 2,0 31 Vr, -Pumping: required *Pump basket cleaned a no •Control floats cleaned a no -Operation satisfactory es no es no -Pumping complete ���sno *Effluent filter cleaved es no L.), �� ��� *Proper float settings confirmed es no Alarm System: -Dedicated electrical alarm circuit es no •Audible nd visual alarm inside dwellin es no -Alarm system operation satisfacto not satisfacto Manhole Riser *Ground water intrusion at riser to tank connection a no -Ground water intrusion around pipe penetrations e no -Weep hole functionales no -Manhole lid: Function es > no Insulate esno Properly Secured� es , no Other `— *All manufacturer required inspections and maintenance completed ygs no Comments: 5 co 60 Qualified Maintenance Provider: Technician !,,'A �,f 1.l % Company -Sg � Signature Date of maintenance `-✓ Date ��?;kO Parcel I.D. 050-651-07 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval �rt Expiration Date: �� i a 0 ( 7 1. GENERAL INFORMATION 3 Complete legal description Mountain Valley Estates #1 BlockXLOt 14 Location (site address) 4120 Johnny Drive Current Property owner(s) Rhodes, Gregory, Mailing address 12811 Oomiak Circle Ancho Real Estate Agent 2. TYPE OF DWELLING: Fx7l Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage. ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by Day phone le, AK 99515 Day phone TYPE OF WASTEWATER DISPOSAL: Individual El Holding Tank ❑ Community ❑ Public Sewer ❑ Date: 3 COSA Fee $ Waiver Fee $ Date of Payment �S �� Date of Payment Receipt Number Receipt Number COSA # 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 effecLat the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm P,,nnone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone Date 1/5/2017 OFA 6. DSD SIGNATURE tj j System #1 Approved for bedrooms : Steven R.• lint / CE -8149 System #2 Approved for bedrooms did Disapproved t��l �ftO SSIUt �k\\6& Conditional approval for bedrooms, with the following stipulations: By: _%Uto` CA l A.ucW A2 Tr71 LC12,Lj/ Original Certificate Date: IL/2C I f 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 Stale of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist x Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet S ., - If more than 1 septic system ison the lot: COSA Checklist # 1 of X'12- Structure '2Structure served by this system I"2 Certificate of. On -Site Systems Approval Checklist Legal Description: Mountain Valley Estates #1 133 L14 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 7/4/86 Sanitary seal. (YIN) Y Total depth 183 ft. Cased to 80.7 ft. FROM WELL LOG Date of test 7/4/1986 Static water level 80 Well production 7.0 WATER SAMPLE RESULTS: ft. Coliform NEG colonies/100 mL Nitrate ..0.194 mg/L Arsenic ND ug/L Date of sample: 12/16/16 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Parcel. I D: 050-651-07 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 48 in. AT INSPECTION 12/16/16 80 ft. 5+ g. p. M. Collected by: PES Date installed 6/3/11 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 12/15/16 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 7/10/2014 Soil rating (g.p.d.Ift2 or ft2/bdrm) 0.6 GP9 PS I System type SHALLOW TRENCH Length 86/74 ft. Width 5 ft. Gravel below pipe 1'5 ft. Total depth 4.1 ft. Eff. absorption area 1025.6 ft2 Monitoring tube Y Depression over field N Date of adequacy -test 12/16/16 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 600 gal. New depth 1 in. - Elapsed Time: 120 min. Final fluid depth DRY in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date f D. LIFT STATION Date installed 7/9/2014 Size in gallons 500. . `Pump on. level "at 5 in. "Pump off' level at 36 Datum BOTTOM OF TANK Cycles tested 3 Manhole/Access (Y/N) YES in. High water alarm level at 45 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES, WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 1,00+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING'TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water.service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 4-&+— U•' Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+.Wells on adjacent lots 100+ F. COMMENTS Survey on file Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTIFICATION �+�Nk, A�9sl� 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. l Engineer's Printed Name- Steven Pannone r • • : Steven )2.��annone4 Date 1/5/2017 ��14 CE -8149►' COSA canary sheet_2-6-15.doc in. If more than 1 septic system is on the lot: COSA Checklist #X � of Structure served by this system y'L Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Valley Estates #1 B3 L14 A. WELL DATA Well type If A, B, or C provide PWSID # Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m: WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA mg/L Parcel ID: 050-651-07 Well Log (Y/N) Wires properly protected (Y/N). Casing height (above ground) in. AT INSPECTION Collected by: Tank Type/Material STEP/STEEL Date installed 7/10/2014 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N— High water alarm (Y/N) Y Date of pumping 12/15/16 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ftZ Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field.before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 7/9/2014. "Pump on" level at 43 in. Datum' BOTTOM OF TANK E. SEPARATION DISTANCES Size in gallons 250 "Pump off" level at 42 Cycles tested 3 WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ in Manhole/Access (Y/N) YES High water alarm level at'45 in. Meets alarm & circuit requirements? YES On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line .10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 4$+- DA Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. uAAr Do flu G. ENGINEER'S CERTIFICATION I certify that -1 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. Engineer's Printed Name Steven Pannone Date : 1/5/2017 COSA canary sheet_2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ W, Y O Q to d N W Q U N = i0 U 0 0 U Z SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 16-13, pg 56, LK MW 30 1 O LU O > LO IUD N �F OF •A4 00 • Sir 11 % ,�F-. s C7. 9 49tH 0 CV z = i*:. *000 �7;;w % p 01 / •l /'.Fred Walatkci.'o i �� 0 0 si' • 3255 - S 5 m ,1�R�o• •d�h0 z 1�1oE. aSION��� REVISED 1-17-17 AS -BUILT NO CORNERS SET THIS DATE 30 I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 14 BLOCK 3 MOUNTAIN VALLEY ESTATES ADDITION No. 1 Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property ging adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 12th day of January , 2017. FRED WALATKA & ASSOCIATES Engineers and Surveyors BE 1 (907-248-1666) n Parcel I.D. 050-651-07 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 -u Certificate of On -Site Systems Approval t? Expiration Date: 1. GENERAL INFORMATION Complete legal description Mountain Valley Est. #1, Block 3, Lot 14 Location (site address) 4120 Johnny Dr. Current Property owner(s) Robert Wolvington Day phone Mailing address PO BOX 771333 EAGLE RIVER 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 3 = pm ❑ Single Family (w/wo ADU) ❑ Duplex S__ El Multiple Dwellings (Single Family and/or Duplex) `') 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ LO T LIIVE AIVD S T EEP SLOPE U. ID % 19r Waiver/Variance request for: Distance: Received by: Date: _L) COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ��� t �b�.10 '—�0� `Waiver Fee $ r�``J f!! 1�J� 1 Date of Payment q b4 h '' Date of Payment Receipt Number fX'tkA-1 � Receipt Number COSA# CiDL61 �,�� Waiver#__ C�jq!'-rd� 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. In conducting an adequacy lest, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with'MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the fest, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineers Printed Name Steven R Pannone Date 91W2014 6. DSD SIGNATURE �.... System #1 Approved for L4bedrooms � � 5 even onnone �- CE -8149 e� System #2 Approved for bedrooms d� `�'•,,� Disapproved P P Conditional approval for bedrooms, with the following stipulations: ON-SITE By: Original Certificate Date: The &', alit/oYAnchorage 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 COSA blue sheets c If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Valley Est. #1 Block 3, Lot 14 A. WELL DATA Parcel ID: 050-651-07 Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/4/86 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 183 ft. Cased to 80.7 ft. Casing height (above ground) 48 in. FROM WELL LOG AT INSPECTION Date of test 7/4/1986 9/2/2014 Static water level 80 ft. Well production 7.0 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.109 mg/L Arsenic ND ug/L Date of sample: 9/02/2014 B. SEPTICIHOLDING TANK DATA 78 ft 5+ g.p.m. Collected by: PES Tank Type/Material Septic/Steel Date installed 7/10/2014 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N)/ / Date of pumping NEW Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 7/10/2014 Soil rating (g.p.d./ftz or ft2/bdrm) 1.2 GPD/SF System type Wide Trench Length 80 ft. Width 5 ft. Gravel below pipe 1.5 ft. Total depth 2 ft. Eff. absorption area 1025 fe Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 7/9/2014 "Pump on" level at 4;3�40in. Datum Bottom of Tank E. SEPARATION DISTANCES Size in gallons 500 Manhole/Access (Y/N) Yes "Pump off' level at lt*V71441 in. High water alarm level at 45 Cycles tested 3 - Meets alarm & circuit requirements? YeS WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO Property line 0.14 Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ 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. Engineer's Printed Name Steven R. Pannone Date 9/24/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ even R. aririane . • F . CE -8149 .•Lt: 111121 Stn R. . h h C�h Found 1 1/2" Aluminum Cap to w 2—Level'Wood Frame Garage & Cy N N: Storage on Conc. ^� N` Block Foundation �►� 2' 2, ;'�5.5x 6.6' mR , Cantilever Walk Brick Walk 0 O N CDz Conc. Landing Pad\;�Woocl & Steps LOT 13 LOT 14 BLOCK 3 Wood Shed SCALE: 1 "=40' 0' 20' 40' 80' 3.1 44.1 u 4.0' x 16.3' \ Cantilever N N 7 42.9 2—Level Wood i, Frame Residence on Conc. Block \�. \ 1—Level Wood Frame Garage — 7,0' >,r Foundation on Cana. Slab W Wood Deck &Steps w Wood \ oA No Retaining Clean Out (Z' �" Wall (Typical)^`e o o N Tank Lid Well p Anchor & Power Pole Over�ad Utilit \ 382.8 - Coble �- LOT 15 I hereby certify that an accurate survey of the following described property: MOUNTAIN VALLEY ESTATES (74-17) LOT 14, BLOCK 3 was made on September 15, 2014 and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing - Anchorage Alaska, this 22nd day of September 2014. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve2oanengak.com September 24, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Mountain Valley Estates #1 Block 3 lot 14 Record Drawing Waiver Requests Ladies and Gentlemen: Waivers. We request a waiver to 0.14' to the lot line. The adjacent property is owned by the current owner of the system and has no objections to the lot line waiver. The second waiver is for the separation distance to a steep slope from the approved original waiver of 27 feet to 19 feet. The old system was about 12.75' from the steep slope at its closest point and has been in failure for years and has never had sewage seeping from the slope. So a new system at a greater distance should have no problems. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 �t Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131208 COSA#: Permit#:OSP131207 PID#: 050-651-07 Legal Description: Mountain Valley Estates #1, Block 3, Lot 14 Engineer: Garness Engineering Group Applicant: Robert Wolvington Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the 25% or greater slope has been approved. The approved separation distance is 27.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this iss department. / f p PZ. eYO _]7,0Z /,�! �/.nZ �-" �Ev sey'®(r'b�n '7a� QAo riP�ovo v�p"_ ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: (Z' Approved byr'%-1 Name of Reviewer ............................................................................... Rec#: 02787G Amount: $200.00 Date Paid: 7/15/2013 **** VARIANCE/WAIVER REVIEW **** 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 1� Mountain !.Valley Estates, Lot 14, Block 3 (T.14N. R.1W. Sec 33) Location (address or directions) NHN Johnny Drive (b) Property owner —_ 222 W. 8th Ave Mailing Address H.U.D. Telephone: (home) Box N-64), Anchora (c) Lending Institution N/A Telephone Mailing Address — (d) Real Estate Company and Agent _ Address Telephone N/A (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: -Business271-4342 Ak. 99513 Pickup by Engineer i 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms 3ti 3. WATER SUPPLY Individual Well KI Community ❑ Public ❑ Note: If community, well system, must have written confirmation from the State: Department of Environmental Conservation attesting to th legality and status.``` 4. SEWAGE DISPOSAL ` On-site El 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. 72-025 (Rev. 7/88) Page 1 of 2 r. Pickup by Engineer i 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms 3ti 3. WATER SUPPLY Individual Well KI Community ❑ Public ❑ Note: If community, well system, must have written confirmation from the State: Department of Environmental Conservation attesting to th legality and status.``` 4. SEWAGE DISPOSAL ` On-site El 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. 72-025 (Rev. 7/88) 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 dates hown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection: Name of Firm Eagle River Engineering Services Telephone ( 907) 694-5195 Address P.O. Box 773294, Eagle River, Ak. 99577 Date4. ° - - Q3Gooi'aC��se : .. .. . _ .A o°os yloso0a°y �uoeu°�°e �ae�! • q Cc -673 � ¢• 00 F05."'.600 FOFESSI0�� zv� i 6. DHHS APPROVAL Approved for 3 bedrooms by Date Approved_ Disapproved Conditional Terms of Conditional Approval a The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a`certificate is issued. The Municipality of Anchorage isnot responsible for errors or."omissions in the professional engineer's work, 72-025-(Rev.i/88)Back Page,2 of 2, ". �. e 0, MUNICIPALITY OF ANCHORAGE MOA Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /-4)r /e/ =$ LA //envi- s lz. fc` J` ?,f' A. WELL bATA Well Classification -� / If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y ', Date Completed �Z&'6 Yield Total Depth lk3 Cased to �'7 Depth of Grouting /Y/� Static Water Level Pump Set At -f/1-?/ i Casing Height Above Ground y Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /`/� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /70 r ; On Adjoining Lots To Nearest Public Sewer Line _ A'/4 To Nearest Public Sewer Cleanout/Manhole ^//a To Nearest Sewer Service Line on Lot Water Sample Collected by ;Date Water Sample Test Results Comments ;Jr:: Gf 7L B. SEPTIC/HOLDING TANK DATA Date Installed /y; 2I:;-)� Size /dog No. of Compartments Standpipes (Y/N) /1Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) NDate Last Pumped �Iy° ✓�f Pumping/Maintenance Contact on File (Y/N) �J'# Holding Tank High -Water Alarm (Y/N) ;for Temporary Holding Tank Permit (Y/N) W/o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well I90 To Building Foundation 6d v To Property Line 3v To Disposal Field -.5- To To Water Main/Service Line .-1,2 / To Stream, Pond, Lake or Major Drainage Course /V /I Comments /J Ne -9e4 ar'. f -we /dr+ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /Sd Type of System Design Date Installed /9» Length of Field Gy Width of Field 3 Depth of Field 6 i Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test 310 Results of Last Adequacy Test ��� taw 41�6j—'.6 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well �/ 70 To Property Line y / To Building Foundation 70 ' To Existing or Abandoned System on Lot h'/4 ; On Adjoining Lots To Water Main/Service Line /o To Cutback (if present) �✓ To Stream, Pond, Lake, or Major Drainage Course ^-1114 To Driveway, Parking Area, or Vehicle Storage Area Comments 16 .reoo1TG" zkro4-' ,6?a 6u . D. LIFT STATION �//4 Date Installed Size in Gallons 'Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Eagle River Engineering Services Company P. 9.Box ,7329 �. ... Eagle River, AK 99577 ��� Engineers Seal Date �.� ---< U aaesc -- ,c s. rct MOA No. Receipt No 3_2 / Receipt No Date of Payment ` Q D Amount: $ % 0 Waiver Fee: $ — Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Municipality of Anchorage Department of Health and Human Services dl'lh5 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 June 12, 1990 Lou Butera, P.E. Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 Re: Waiver Request For Lot 14 Block 3 Mountain Valley Estates #1, Waiver Number WR900014, P.I.N. 050-651.-07 Dear Mr. Butera: Your request for waiver of the required 100 feet separation between a septic system absorption trench and a spring has been denied. The requested separation distance was 60 feet. Based on our site investigation, it is apparent that since the septic system was constructed and approved by this office, several feet of fill was added over the septic system to create more driving and parking area next to the dwelling. In the process of adding this fill several of the cleanout/monitor tubes were eliminated. It also appears that a trench has been constructed on the up slope side of this fill to carry surface water around the fill area. This added fill and trenching may be causing the spring to breakout on the down slope side of the fill. The vegetation on the down slope side of the fill does not readily indicate that this spring has always flowed there. It is possible that the spring in question could be tied directly into the absorption trench. This could be determined by replacing the monitor tube in the absorption trench and also a ground water monitor tube somewhere adjacent to the absorption trench to a minimum depth of four (4) feet beneath the bottom of the system. If you have any questions, please contact our office at 343-4744. S'n erely, Daniel J. Roth Civil Engineer On -Site Services Co currence, J hn Smith', P.E. rogram Manager On -Site Services s-29-90 sIi E VISIT 7-0 0T /4 %Lk Gtr &VER /S >?F-Qu,EtTEO POR A SEP.9/RA7}Iay OF AA1 i9psP�QpT�oiv rl Rti cIy 7-o l9 s PRI &6 of i Fl NDINGS: �paK 1. No To vE FOG(,vp NE I T)YEI? O.v rIve SEPT/CA oIp ON THE VRNINF/ELp 4CC0/{PING 7-0 771tE P�+TEi1 0 7-Y — 86 %ye,?,r SHOK L p BE R EOUA0,0#PIO.v aB,*OO,,tT, 7"I,vO StSPTIC TigNK C'LA',9Nok,7-.,lr ON,E' CLERI,aur 4F'rEN THR SEPTIC j-}YN/Z/ O&C CLE-4,0va447- PA'/o/? TO 71HE 7-Rk vc11 V.vD ONE Cl -f! kaml A}T 77fE RNV OF rIPENCI-I WITH 0941 #PP17'10,tigl MOV) Tae 7-1(#E I& 7'1-11F TfFA--C/a 4P)WaxIAi,4 l -4Z y 47- m, jo - Pol * r. 7-IaID-PaINT, T1l1s To7-44f 7 STfhvP,apPEs rH/TT sw&i.yo ,DE` n/?ESEN F. 2, dA' TME RausE 7'0 ri-eE Sakry or rl-ec sta?XEcT h'Pure, t eWCeA-49 I N 7`a rHF sr1fPO P1PF F ,r AS -88th /wou& FiL-4 IS w ' u.47 -ER Iry /7e riYflFk- / s o9 L S O 4 N E N.4 Y iWS7#t Z EP Mild 1 TPR 7-u nc 7-;Y•9r It oRY, rHIr SEPTIC tYsrEli IS 19AMIRFevN 1r 6Olwer 7-0 9.f uPGRROCI% T FOVkP TI -1E SPRI,v6 70 QF AfECTLY 94A'497IYl TIVE AIUCOMP fib? ?Rr/®N 7'1?C-A/CA1 rHe 4 " DR/g1,vl°II',E Is /945"0 IN L iaR soMr-wicor wires 77YrE PRA1A,,c1uv AaP T/-tE .SPIvIA,G. Ivl7Mo447 4,VV ST/tNDp/PEs resouGt/� TIIE�eE If 410 wRr of TEIIIA,G G-IyCf4 7'RE rl4EacN Is Exp c TL Y, (ONCL:"S/a,vS I T A PP64 t? S 7-1-o T r -H /S S,E P7 -1c S Yf TC/i w 1tf ca e,,E/pEp w177 -t It Suljsr,4p7119-t Aeou i of F14 L F /?DA`s r/ -LE 7-/ At F / r- x,45 IN STALLC-P /N /? N fa POI,vG 41L ft;9.vp/°/PFS We/Pf CovFCT60 A-f-lvFL./_. T 1 -(If F/LL Coulp #five C4(,(fFV i'/ris 5Pl?rti6 TO AppF, Ir AT TI -(L= 7-0C of T/'/L e,#*Ie OP %HB' PILL. 19 E C AU SE T -1-Y 9� A o u T FAA I A,�f/CH Z G,-/ y G P/PFsdnE J.5, /4 FaoT/,,,G 19)?f,IN OF faAKFF/r/N,o /f dvET POAAJ' A*P T'IY6 ori 4 t?w IL/SA-Pr/C 5;s7 /4 /Yfjs wq�'El� /APO Ir (Nv of K,v aCCUPIEP) fvWcH /3 LESSr 7-,q A, wl FEET pEFP A.ut7 7`YE LFA0fF/F4 9 /N 4?u,Ff77av /l i9 7-07I9L t%PTM /A, 7A/e A-IA714 °AL So/L of /0 FFE i l T l S f�FE %/d *XfkrtLF W /rHouT IYom/re; R r(AeEs r//Ar r/-eC :rrfTE�7 /.f /.v G/PautitP 14,47'Fif, IN MY OPIN/Ga THE SPRI,vG C ouLd vE r?Y lA F'LL 133 rle'V P/RFCTLY rO THE PI #ldl,r/E-LD /t/acv ,9-f * 1?E5uc4" ar /kl$ FOL1- �L19cEV 0voFR nfc- : EEPPC sYs!'E�. 7-gElre' /s iv/a7-ER e�7- WF uPH 11-L. (BE6 /av/"6) of 7x/E F11 -L lvfl/C'H ogjilrgw&�vJ AZ auG TiVE BRIG,NAL GI?ou,vtl rgRPfcz- c.*vsNT/N TKE FILL Atip 7-/-rk',v to 7- or- QF ritr= x/L,L„ /P 7'I2F FoRIsr aF /P /i/O LA, 4/11FR SHOULD 9E C©Aif/nl'-1?7A7. Heal 325 h�cl-ioracc 29Z02 '-- C) t -, I , 31 a CA 3 J a, i +'r; 'aoun'.M.In, Va�lc�., Addri r,01', .1111tera, `x .(7, --13nx VV3794 lRagle River, Alaglu, 99577 TLICIflione (DP'/) 694-5795 i Y OF ANCHORAGE f,'N)'p,.4 'r)f(tv,,ENTAL SERVICES DIVISION' 2 1990 I V ED A t t h a ,ter (:, -u e s t f I, -v c .1 a n t . °717';1 7 --.: -j c, or .J. :s . L -"s-, - 1) n-,:!. :".�Z's'Zola tn q,�ts'st:10:1 was Anstallod in, 1306 �n Sevin; a jatnajtpd Oci alloaq a cpmIator clr-*,.--,.-:!-n,:T/-oc.:.--'-�c.. Our of 3-20 CiPM Lc--cw --ate with to de.21nMe drainacre channe: belo,.%, Am fKAUTTUE, Thc r1prAwc in; locrAnd on v ac, L:,. -'. C a -. -, C t 1, e re f C) r 0 co ("I n o �- b o c a E, i 2 v on o r: t at ine J !) ;, :�c,, --,, d'a i c, dL �7 h o b s e v n, c thn s jr: f 11 a -7 e it 1. round C) A 13 Lin. 'uh c C, i c Gn c m a- 11 d r a i n a cr a 0 e a 1 in ..'E..'.-. . Tim n0lvucheC. soA2. low nhows 21301. rl `vie soil. A, 15 , depith wztce.--�, mio,:�fto-CJ. c: . 77' J;. vsAver/t-o a sma-' 1 A.�- -E.C. 19-3-1 s a --I Ce C, �- t5,& , I a',. t P. C h 0 C� ) , The e-,,,a-1.Uatjo7j of QjjEj ;qajvC]j- QIcalcl fpciticle C. E3 j: 0 `!_132, 1, pq cc have a 1 Es o -n 0 t C (� :7. r.. c- C C -s o j. -1 Cl 1:, c C, 0 ti -le flowana water. This pipc will haVe to lie Is leach arc -,.a Thu sL2-ptac has Twssed oun ademaw MIA based on a con', -om:Lrt�te-vra.; Dted ylater flaw f-:-�to tank. 71. e, v 1 c if you have 07 fU,--'--ho:v y. -le oft) pleb 6 ,-- M)MORAGE/WESTUN DISTRICT OFFICE 437 "L" STBFFT, SUITE 303 APTMORAGE, ALASKA 99501 July 12, IVU Mr. Lou Dutera, P. E. bagle River Engineering Services P. 0. Boa 773294 Eagle River, Alaska (99;77 274-2533 SUBJECT: Horizontal Separation Waiver Between Spring and Septic, Lot B, Block 5, Fountain Valley Estates, Cl.ugiuk, Alacka 8521 -WA -010 Dear Lir. butera: The Department has reviewed the subject waiver request and hereby con- ditionally waivee the horizontal separation between the sFring and septic systems to 77 feet on the subject property for a 3 bedroom single family residence only. Waiver is conditionally approved upon the receipt of a written statement by the engineer giving assurance that the subject sluing rims not bavc year around flow. If the subject spring does have year around flow, a second waiver request grey be sutmAtteu with the following change for approval. All flows of the springs channel will be culverted within 100 feet of the septic systcu. If you have any questions, please contact me at 274-2.533. Sincerely, Michael P. Lewis EnvirotmwmUl Engineer ba)L/dd ,5' .?/ Uv I _ N i"3 ��/f�`cd 7AN� ��dap 4 11 D / I i 7AN/( n y 'I .0 / e . • i � y6 O.a`A.N \\ rQl% _ _ • lllV y _ so a pert A u .xNvESTi6W9 ,F -p S -29 So 7k14 tis /pHY> 4 �� pR�v�ti plPt° � rr�itipPl r'r�tltK[IN� 1 �� ' J I�MHT ! S A � 0/T/1/vP/�I� ? , %F!7 -Al" N Q SP l p" V 151 D11C NUDE/IC��CI� n Z�yEN O n'UUUUUU\ O v � ♦" G J o F A4 t ® • I � ����- •i •,ii1 i•p tal,i Y• •e ii ®� Y' I L ` i eo •° coot oieaoeoe Louis A. Butora o 4� ��,i�� •�® C[-6736 e•" `<� 4 *septic components added to survey, loc.F280F otS10N�� p�`m reconstructed from MOA ����' records. ov ASBUILT-NO CORNERS SET THIS DATE. SEHARD 6 ASSOCIATES LAND SURVEYING 688-4566 I HEREBY CERTIFY THAT I HAVE SURVEYED THE �'�-E'_ ►o•��>t FOLLOWING DESCRIBED PROPERTY 1 -40 0F Mountain Valley )states Addn. No.1,Lot14,D.3 DATE: s �,. ••. AP S0 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 3-26-90 r ,'• •� �j INDICATED. IT IS, THE RESPONSIBILITY OF THE r * ; ,4c;TH` %�1 ••�,9* OWNER TO DETERMINE THE EXISTENCE OF ANYGRIDS 09 ............00 . EASEMENTS, COVENANTS, OR RESTRICTIONS SW 758 0,.(.Z WHICH DO NOT APPEAR ON THE RECORDED SUBDI- a'., Dvan° Mark Seward A VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FBr 0 °'qf •.•. LS • 6918 A ANY DATA HEREON BE USED FOR CONSTRUCTION 7--60 �� ai•�f •,• i' ,o OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN / � y +..� a ARY I-INES. DMS e n/CA v " Ja 14 JAZ, NY((M M -W DRILLING, Inc. o0 E 1+CYP 0 101C Ua S *ata N,p►•aar ANC14:41AGE ALASKA 93511 � DRILLING LOG �'s y Mike Mantsch Aotee9C x fid'4?[,geatioA (address of: Township, Range, Section, it known; or distance 14, Block 3, ?'.a,=tain- Valley Est f1ot F?S v 807 6 , ;�Sizexlf casing--6—Depth of Hole 183 feet Cased to . feet .P �: Static water 1eveL--a0—it. (&UW19 (below) land surface. Finish of well (check one) open end Perforated (v, )• ; Describe scorn or perfontien Fzz11r sl�c _Perforation/ft: 55'to58' = ', alfpuinping test at 2 gallons per (hour) (minute) for 2 tiolin with 100% '' ,i $ of 'drawdown from static Level. yes' { f a' ';Date of completion 1u 1 Y r �+ - ua F{ i f ` ' WELL lDQ 3 '.]Depth in feet from j 1�round surface Give details of formations penetrated, size of material, color and hardness' C; G Stickup E TO Gravel t -11 ! .._ Z...:—TO �_ Organics e- ---�- P Silty Gravel Gravelly Hardpan _. �►,'a--TO��_ Water Gravel; 2 GPM - -. .To—.U— V., To—. _ Hardpan Silty Water Gravel; 2 GPM': Silty Hardpan I _$.fit Bedrock; Black u„ Bedrock; Gray tan, water ;seaps in fractures N%'WA Certifled Contractor 1— CUSTOMER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -7– S'- Ole 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township,, ange) Location (address or directions) (b) Applicant Name _MIY u Telephone: Home `) Z`�"� — Business Applicant Address 5?, Z X eq'* ' _PAL fle-A$%7 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderj- Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent— Address --- Telephone — (f) Mail the HAA to tlV60J' `9ftf1t@K1NG EA QI.E-RVV . A. K 99577 2. TYPE OF RESIDENCE Single -Family Kr Multi -Family ❑ Other 4, Number of Bedrooms _ 3. WATER SUPPLY Individual Well ❑ Communityg Public ❑ UrS 1 G Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) 4 5. ENGINEERING FIRM PROVIDING 1,1SPECTIONS, TESTS, FILE SEARCH, DATw ,,ND INFORMATION " As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGIIN Name of Firm Telephone -- Address SR B 196X Date EAGLE RV 6. DHEP APPROVAL nC�� Approved for bedrooms by Approved [ Terms of Conditional Approval Condition Meg CAUTION f Of F 1'AO�� The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. 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. Page 2 of 2 72-025 (11184) A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY o% -&H AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH®,HMIST - FEBRUARY 1984 ENVIRONNIFNTAL PROTECTION 264-4720 "OL 2 41986 RECEIVED Legal Description: _L"n SLt� .3 If A, B, C, D.E.C. Approved &N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to epth of Grouting Static Water Level _ Pump Set At _Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y/N) t On Adjoining Lots To Nearest Edge of Absorption Field on Lot %So tk ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by S `�= ����--�� ; Date Water Sample Test Results —1 Comments B. SEPTICA+OtDTNG TANK DATA Date Installed Size VZ'50 No. of Compartments — 2__ StandpipesON) — Air -tight CapsdYM) Foundation CleanoutON) Depression over Tank (YQ _ Pate Last Pumped - 5– 7-—eto Pumping/Maintenance Contract on File (Y/N) P n1 ; for Holding Tank High -Water Alarm (Y/N) 16, Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/Hat trtg Tank: To Water -Supply Well St> 'Sr To Property Line — C kA_ To Water Main/Service Line t Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata s5 44 � Type of System Design Gam- o Date Installed 8'23-1 Length of Field Ivor er Width of Field �� Depth of Field Gravel Bed Thickness Square Feet of Absorption Area L�(2)0 1P Standpipes PresentON) Depression over Field (Y40 Date of Last Adequacy Test S -24—e)(, Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well `Sp r� To Property Line To Building Foundation Lot §70 To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION On Adjoining Lots l 0 To Existing or Abandoned System on -J o I�- To Cutbagk (if present) 50 Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that 0h&6M4CWbJff&JNGr conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed SU B 196X Date jt ii I rs ir;r Company �-.AGLE RIVER, AK 9957�OA No. �? S` � o� Receipt No. 'q 1 coc S Date of Payment - 1— Amount: $ ('s •op Page 2 of 2 ova J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264••4720 Application Date - -/- o- o(o _ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 1`� tt> K (b) Applicant Name �� �:�-_N � �YI�13__— Telephone: Home ��`'t'' � � - '' Business SV2 ` U Applicant Flddress ---a-(,>I 5 r� iJ i j _ rte j (c) Applicant is (check one): Lending Institution 0; Owner/builder(; BLIyer L1 ; Other El (explain); (d) Lending Institution __._ _--___— Telephone Address --- —------------- -- -- -- -- CU (e) Real Estate Company and Agent Address -------- ----------------- - Telephone .------------------ ------ (f) Mail the HAA to thelcrl�avy�1i �9��0 _Lmt9957 - ----- ------- 2.. TYPE O: RESIDENCE Single -Family Mcdti-Famlily E] Other`/ ----__—_-_ __-- Number of Bedrooms 3. WATER SUPPLY Individual Well D Community E Public C7 � Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, S-EWAGE DISPOSAL Onsite [�'- Public EJ Community D Holding Tank D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(111811) 5. ENGINEERING FIRM PROVIDING .NSPECTIONS, TESTS, FILE SEARCH, DA7,. 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 waters upply 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. Marne of Firm _ ti �2NG1NEE s:°- ------ Telephone --------- Address __ SR Pe 1966 --- -- AK 9 Date —- --- JUI_—I-------- - (gy '.-' 4 q �) �HaL.o 2.no•.00neoo B Li' C' o1457 h aerr@'�C:�1 t1 ¢F,4QFr;` G. ®HEP APPROVAC.6��/b/ce-r Approved for --L--- bedrooms byC�F ��` Date Approved --- Disapproved Terms of Conditional Approval _ Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in Paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DFIEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. Page 2 of 2 72-025 (11 V84) �HaL.o 2.no•.00neoo B Li' C' o1457 h aerr@'�C:�1 t1 ¢F,4QFr;` G. ®HEP APPROVAC.6��/b/ce-r Approved for --L--- bedrooms byC�F ��` Date Approved --- Disapproved Terms of Conditional Approval _ Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in Paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DFIEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. Page 2 of 2 72-025 (11 V84) A. WELL DATA Well Classification MUNICIPALITY OF ANCHO AG, bEP7. OF HE/Ull 2, MUNICIPALITY OF ANCHORAGE (MOA) TNVIPONMENTAL PROTCCTION HEALTH AUTHORITY APPROVAL (HAA) 19� CHECKLIST - FEBRUARY 1984 264 4720 Legal Description: I V r DtA If A, B, C, D.E.C. ApprovedON) Well Log Present (Y/N) _ Date Completed Yield Total Depth _ Cased to epth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Je&-D a ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 1 Sb On Adjoining Lots — To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by 1� �itJ�t�,^�G ; Date Water Sample Test ResultsL�rif�ID — Comments B. SEPTICA4Qt9ffi& TANK DATA Date Installed I — 6- `ie Size I c2c90 No. of Compartments Standpipes (6'a'N) — Air -tight Caps &N) Foundation Cleanout(ON) .Z_ Depression over Tank (Y/40 Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) e, 1A Separation Distances from Septic/HvtdtrTg Tank: To Water -Supply Well . t To Property Line t5 1 To Water Main/Service Line 10 Course )k - Comments Page 1 of 2 72-026(11/84) V. Date Last Pumped _ P ;for Temporary Holding Tank Permit (Y/N) A -- To Building Foundation To Disposal Field 5 1 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 Type of System Design Date Installed 1' (3 " lab Length of Field Z3 r Width of Field Square Feet of Absorption Area Depression over Field (Y/9— Results of Last Adequacy Test Separation Distance from Absorption Field Depth of Field Gravel Bed Thickness — Standpipes Present4p/N) )at� of Last Adequacy Test 1' + To Water -Supply Well �Sb t "(' To Property Line 1 r To Building Foundation 1S To Existing or Abandoned System on Lot _ .2201 On Adjoining Lots 3a h To Water Main/Service Line lb I f' To Cutbank (if present) a To Stream/Pond/Lake/or Major Drainage Course � 1�+ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions 5• Size in Gallons 1 Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that WA§Uiq&fi4b2r conformed to all MOA and HAA guidelines in effect on the date of this inspection. SR B 196X Signed Date hfF Company EAGLE RIVER Company No. ����a 3 _ �m��'► `ty._ 'it i [ r�•a• . ar . � 5ti.4nr w �.• Ba ��• t457-� t 430 MUNICIPALITY OF ANCHORAGE V DEPARTMENT OF HEALTH -& ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL ENGINEERING DIVISION Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS; Complete allpartson page 1. Incompleterequests will not be processed. Pleaseallow tenI10) days for processing. 1. PROPERTY OWN R PHONE 6. TYPE OF RESID NCE MAILING ADDRESS_ SINGLE FAMILY PROPERTY ESIDE T (If different -from above) - PHONE 2. BUYER - - - -- - - - - - — - - -- PHONE - MAI LING ADDRESS 3. LENDING INSTITUTIONPHONE • �n T- MAILING ADDRESS ALM 4. REALTOR/AGENT —� HO E MAI LINGADDRESS since June 1975. For wells drilled prior to that date, give well B. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESID NCE NUMBER OF BEDROOMS SINGLE FAMILY ED One ED Four ED Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7: WATER SUPPLY -- A INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM **If individual/on-site, installation date 7 INDIVIDUAL/ON-SITE** give - If system is overtwo (2) years old an-adequac test is required PUBLIC UTILITY by this Department,- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN 13E INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYP F RESIDENCE SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS / ❑ ONE IBJ THREE ❑ FIVE ❑ OTHER ❑ TWO /❑ FOUR ❑ SIX 2. WATER SUPPLY CP INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED / "7 / LOG RECEIVED [� 3. S WAGE DISPOSAL SYSTEM INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED /� l/ INSTALLER Septic Tank or ❑ Holding Tank Sizer If Tank is homemade give dimensions: SOILS RATING VV s TYPE QFTANK MANUFACTURE TOTAL ABSORPTION AREA q �ro MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line ' 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Titl) LEGA ESCRIPTION 72-010 (Rev. 3/78)