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MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 8
# C)ff)vo- tdo I-11 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231068 PID Number: 050-661-11 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade Name Brandon Hill & Bronwen Nicholls ABSORPTION FIELD El Deep Trench 0 Wide Trench ❑ Bed El Mound Site Address 3828 Birdsong Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907)529-6737 Three(3) 5 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original 3,55 grade Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Mountain Valley Est #1 5 8 Fill added above original grade 1.7 Ft. Gravel length 25 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number n/a of Lines Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1255 Ft2 1 n/a Ft. Well >100' >100' N/A N/A >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑E Other Manufacturer Advantex Capacity 1,500 Gal. Surface Water > 100' > 100' N/A N/A Material Number of compartments Lot Line >5' >10' N/A N/A NA Plastic 2 Foundation T> 00' >10' N/A N/A LIFT STATION Manufacturer O re n co Capacity N/A Gal. Remarks Alarm location Front of house Electrical installed by Rising Sun PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer Northern Excavation Drainfield D3034 CO/MTD3034 Inspector B. Schiller BENCH MARK (Assumed elevation) 100 ft Inspeection o vt 8/7/23 8/7/23 Location and description 2nd ction Garage Slab 3rd 4"' ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp .� Conditional Approval: Date *: 49 TH 1 r • ` .� Septic System `'� Approved ron— WDGG a�vxv0 Date 9 � Zoo �j Benjarr;6Schiller ���is�•• C$/212232,.••������0 F�OFE �®^� Note: this approval does not include well requirements. PRSSIONA� permit (Kev U=211 6) V V V 50' WELL RADIUS Benjamin Schiller CE 12592R E GISTEREDPROFES S I O N A L E N GINEER 1"=20' 25' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCH w/ 2' SAND FILTER AND ERS TO RECEIVING SOILS 3-4 BDRM ADVANTEX FAP 2.0 w/ AX20 POD CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT DV - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MT2 TH PERMIT # OSP213068 PID # 050-661-11 A B MH 40.9 VAULT 44.0 DV 71.4 AB CO1 73.9 MT1 74.5 CO2 99.1 MT2 98.9 28.6 31.1 59.8 62.8 62.5 85.8 84.7FEET 0 20 40 BI R D S O N G D R 3-BDRM HOME PLAN AS-BUILT 8/21/23 MOUNTAIN VALLEY ESTATES #1, BLOCK 5 LOT 8 MT1 CO2 CO1 10 ' U T I L I T Y E A S E M E N T DV EXISTING TRENCHES BENCHMARK: GARAGE SLAB 2" DISCHARGE LINE TO DV FCO LOCATED UNDER DECKING 50' SEPARATION TO SURFACE DRAINAGE DITCH CLEANOUT FOR FOUNDATION DRAIN APPROX OUTFALL LOCATION Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N GINEER PERMIT # OSP213068 PID # 050-661-11 MOUNTAIN VALLEY ESTATES #1, BLOCK 5 LOT 8 PROFILE AS-BUILT (NO SCALE) 96.5 91.6 FINAL GRADE 100.4 93.8 FINISH GRADE 25' DRAINFIELD ROCK MT 1 TH # 8 81.1 GROUNDWATER 7/22/22 88.1 88.6 CO 1 CO 2 76.1 88.1 88.6 92.1 ORIGINAL GRADE MT 2 1500 GAL ADVANTEX FAP 2.0 TANK AX-20 FILTER POD 8/22/23 MOA-APPROVED SAND ERS 2" DISCHARGE LINE 4" FOAM INSULATION OVER INLET 82.1 MI C H A E L D R I V E BLOC K 4 MOUN T A I N V A L L E Y E S T A T E S # 1 BLOC K 5 Taylor L. Dosch No. 189892 R E GISTEREDPROFESSION A L L A N D S URVEYOR MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231068 Work Type: Septic Upgrade Tax Code Number: 05066111000 Effective Date: Expiration Date Site Legal Address: MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 8 G:0758 Site Mailing Address: 3828 BIRDSONG DR, Eagle River Owner: HILL BRANDON W 50% & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy »cnt S No � c Depal'tment 7/10/2023 7/9/2024 Lot Size in Sq Ft: 58840 Total Bedrooms: 3 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing -Rsceiued_-By_ ZS5U P J to zt�—_o ra e _ Date: Issued By: l/�GY�r Date: ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-661-11 Property owner(s) Brandon Hill & Bronwen Nicholls Day phone 907-529-6737 Mailing address PO BOX 90507, Anchorage, AK 99509 Site address 3828 Birdsong Dr, Eagle River, AK 99577 Legal description (Sub'd., Block & Lot) Mountain Valley Est #1, Block 5 Lot 8 Legal description (Township, Range & Section) Lot Size 58,840 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) Q Septic Tank Q Upgrade 0 (w/wo ADU) Holding Tank El Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. f (Signature of property owner or authorized agent) Permit/Rush Fees: 5- 9 S Waiver Fees: Date of Payment: _01 Z07-3 Date of Payment: Receipt Number: n nZC)K () Receipt Number: Permit No. OSP 2 3 /D G R Waiver No. Permit App_'- : . �..:c April 14, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Mountain Valley Estates #1, Block 5 Lot 8 – 3828 Birdsong Drive Septic system design Dear On-Site Services Engineer: The septic system on the above lot needs to be replaced, so we are submitting this permit application for a new one. The attached site plan identifies the location of the home, well, and existing septic system as well as the proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes steeply down from the west, although there is a flat area for the existing home pad, and the driveway cuts across the slopes. The new trench will be located parallel to the contours just uphill from the driveway. The slope in that area approaches 30%, although it flattens at the driveway before dropping off again. The new trench design meets the code criteria for construction on steep slopes except that there are slopes in excess of 46% less than 100’ downhill. We have submitted a stamped profile of the slopes and the line of influence of the septic effluent to demonstrate that the effluent will not daylight. Due to the depth of the receiving soils in the excavated test hole, a percolation test was unable to be safely performed. A lab analysis of the soil classified it as SW-SM, “Well-Graded Sand w/ Silt and Gravel”, with more than 55% sand and less than 6% fines. Typical soils with that composition would perk at less than 1 min/in. To be conservative, we have assumed a percolation rate of 6-15 min/in, and assigned an application rate of 5 GPD/SF for a Category III Advanced Treatment System. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new system will be a minimum of 50’ from all wells and surface water, and more than 5’ away from the septic tank. We are proposing the placement of a diverter valve with a connection to the existing trench, which is more 6’ away. This will allow for that trench to be used as an alternate site. Please refer to the attached test hole log, lab analysis, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231068, Deb Wockenfuss, 07/10/23 V V V 1 7 8 5 1 7 8 0 17 7 5 17 7 0 1 7 6 5 50' WELL RADIUS Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=20' 24' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCH w/ 2' SAND FILTER AND ERS TO RECEIVING SOILS 3-4 BDRM ADVANTEX FAP 2.0 w/ AX20 POD CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MT TH FEET 0 20 40 FCO BI R D S O N G D R 3-BDRM HOME SEPTIC PLAN 4/14/23 MOUNTAIN VALLEY ESTATES #1, BLOCK 5 LOT 8 2CO MT CO CO EXPOSE AND DECOMMISSION EXISTING SEPTIC TANK PER UPC PROPERTY LINE >50' AWAY FROM SEPTIC SYSTEM 50' SEPARATION FROM SPRING PATH OF SURFACE WATER FROM EXISTING SPRING INSTALL FLOW DIVERTER VALVE TO EXISTING TRENCH 10 ' U T I L I T Y E A S E M E N T Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231068, Deb Wockenfuss, 07/10/23 MOUNTAIN VALLEY ESTATES #1, BLOCK 5 LOT 8 TYPICAL TRENCH SECTION (NO SCALE)NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 4'-6" 6" DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: NONE- SW/SM RECEIVING SOILS APPLICATION RATE: 5 GPD/SF 6" SHALLOW TRENCH SYSTEM 1500-GAL CAT III ADVANCED TREATMENT SEPTIC SYSTEM BOTTOM OF TRENCH: 4' BELOW GRADE FLOW LINE ELEVATION: 3.5' BELOW GRADE BOTTOM OF ERS: 10' BELOW GRADE 450 GPD / 5 GPD/SF / 5' WIDE * 1 RED FACTOR [6" DEEP] = 18.0 LF TRENCH REQUIRED (24 LF SPECIFIED) GEOTEXTILE FABRIC 6" 9/7/22 2' ENGINEERED RECIEVING SOILS - MASS TYPE II OR IIA, OR FILTER SAND COMPACTED IN 12" LIFTS DEPTH EXTENDS TO RECEIVING SOILS 4' MOA-APPROVED FILTER SAND ADDITIONAL 6" COVER ADDED TO PREVENT DEPRESSION AFTER SETTLEMENT 3' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231068, Deb Wockenfuss, 07/10/23 1750.00 1755.00 1760.00 1765.00 1770.00 1775.00 1780.00 1785.00 1750.00 1760.00 1770.00 1780.00 0+00.00 0+50.00 0+82.50 1"=10' SLOPE CROSS SECTION SEPTIC TRENCH Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 46 % AN G L E O F E F F L U E N T INFLUE N C E FEET 0 10 20 9/7/22 MOUNTAIN VALLEY ESTATES #1, BLOCK 5 LOT 8 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231068, Deb Wockenfuss, 07/10/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231068, Deb Wockenfuss, 07/10/23 AGGREGATE/SOILS TEST REPORT PROJECT:DATE TAKEN: PROJECT NO.:DATE TESTED: CLIENT:TESTED BY: SAMPLE NO.:REVIEWED BY: LOCATION:DESCRIPTION: SIEVE ANALYSIS TEST GRAIN SIZE DISTRIBUTION (ASTM D422) Sieve Diameter Total %% Gravel: 38.4 Size (mm) Passing %Sand: 55.5 6"152.4 % Fines: 6.0 4"100.0 D60: 4.51 3"76.2 D30: 1.00 2"50.8 100 D10: 0.15 1"25.4 97 Cu: 29.8 3/4"19.0 93 Cc: 1.5 1/2"12.7 83 % .02 mm: 3/8"9.5 77 % Moisture: 10.1 #4 4.75 62 Fine Modulus: #10 2.00 43 #20 0.85 28 (ASTM D4318) #40 0.425 19 Liquid Limit: #60 0.25 14 Plastic Limit: #100 0.15 10 Plastic Index: #200 0.075 6.0 (ASTM C127) HYDROMETER TEST Bulk SpG:MOISTURE-DENSITY RELATIONSHIP (ASTM D422)SSD SpG: Elapsed Diameter Total %Apparent SpG: Time (min) (mm) Passing % Absorption: 0 0.5 (ASTM C128) 1 Bulk SpG: 2 SSD SpG: 5 Apparent SpG: 8 % Absorption: 15 30 (ASTM D1557) 60 Dry Den (U): 250 Dry Den (C): 1459 M% (U): 2750 M% (C): SpG (assumed): M-D Test Method: CLASSIFICATION:Well-Graded Sand w/ Silt and Gravel USC:SW-SM FROST CLASS: Remarks: 7/26/2022JOHN A. BUZDOR, P.E. 7/18/2022 7/19/2022 DEM JAB BIRDSONG IN SITU 22-417 EKLUTNA ENGINEERING 22P1031 TEST SVCS 2022 110 115 120 125 130 135 140 145 150 0 2 4 6 8 10 12 14 DR Y D E N S I T Y ( P C F ) MOISTURE CONTENT (%) 0 10 20 30 40 50 60 70 80 90 100 0.0010.01 0.11 10 100 % F I N E R B Y W E I G H T GRAIN SIZE (mm) 3335 Arctic Blvd, Suite 100 Anchorage, AK 99503 Phone: (907) 564-2120 Subject to review by our Materials Engineer REV 1-29-20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231068, Deb Wockenfuss, 07/10/23 OWNER: (signature) Date: Z - (Print name) STATE, OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this z- day of 2023, byw�f(cyn I *1c,"Ornmissiolt-exi-ires: RY P FO ALASKA SANDER GOLDTHWAIT & „ 90-2(, Notary Public State of Alaska My Commission Expires Sep 26, 2026 MUNICIPALITY: i By: t �/'1 ri � --' (signature) Date: 7n/2_ (print name) Title: Sep 01 22 11:23p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department°} Phone: 907-343-7904 & On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 050 _ 661 11 Date of Issue: Legal Description MOUNTAIN VALLEY ESTATES #111 Block 5 Lot 8 Property Owner Name & Address: HILL BRANDON W 50%& NICHOLLS BRONWENM PO BOX 90507 ANCHORAGE, AK 99509 Pump Installation Date: 06 - so - 2022 Pump Intake Depth Below Top of Well Casing: 70 feet Pump Manufacturer's Name: STA -RTE Pump Model: S7P4HS05231-02 Pump Size: • 50 hp Pitless Adapter Burial Depth: 8 feet Pitless Adapter Manufacturer's Name: BAKER Pitless Adapter Installer: Well Disinfected Upon Completion? XYes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET Company: ANCHORAGE, AK 99518 907-243-0740 Mailing Address: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE A DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ._ _ Y__.-__ NAME --\--, PHO N E N F. W ❑UPGRADE MAILING ADDRESS epi LEGAL DESCRIPTION -PA LOCATION / ��qq����/�� _ 6 / " NO. OF BEDROOMS Z_ Well Absorption area Dwelling /� U Y DISTANCE TO: 169 0 rv� `� PERMIT NO. /may t 001 a Z Manufacturer Mater No. of compartment N Liq. cep; ty_in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Oz z FQ- Manufacturer Material Liquid capacity in gallons 0 w $ DISTANCE TO: Well f Foundation Nearest lot line t � PERMIT NO. 17 J LL z F Z W No. of lines nn _ f>,. — Length of each line _ 7 Total length of lir)es �'2 Trench width inches Distance between lines �} A111 . cc ¢ o Top of tile to finish grade y l �� Material beneath tile / inches_ Total effective abf_ �l ior;,alea _- 7� 11.or ll o � �1! Length Width Depth PERMIT NO. W C7 Q F- wd Type of crib Crib diameter Crib depth — Total effective absorption area W w DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) OTHER PIPE MATERIALS SOIL TEST RATING - INSTALLER REMARKS / /�' t-17 14 a Iwo F& r — i r — ry� _ I e -LO C I tC&V2P V f , JJ i APPROVED DATE LEGAL �, 72-013 rev. 3/78T V I -e I 1_9 r -.I 1" c'" T. " a=u L_ 1 ._E'" ke ewe r_ A E" -j K-1- F -4,-,q FR. 19 13 E 2 , S DEPARTMENT HEALTH AND ENVIRONMENTAL cOTEC:TIOF-I 825 'L' STREET, ANCHORAGE, AF,. 99501. 264-4720 W FEE L. I_ IF 9 I" IG* eke hti8 - "= I -F" E I4 E-7 F�Z I"=° F= I'='-' r- I T i' PERMIT NO. :: 8001.72 APPLICANT JIM ADAMS GEN. DEL, EAGLE RIVER - LOCATION HIGLAND RD LEGAL LO7 '8 BLK 5 MT VALLEY_- ES•T'' LOT SIZE 60000 SQUARE FEET' TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS . W SOIL RATING (SO FTeBR)= 1.25 THE REQUIRED SIZE: OF THE SOIL ABSORPTION SYSTEM I S : CA t I-0 "7'-"= = C-3 L_.... E r'-4 e.. Y"' F- I = .4 a 0 IFS -w FF1 %.' E-: I_. E., IE F -T H == 4. THE LENGTH DIMENSION I S THE LENGTH (IN FEET'S OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO LET WIDTH FOR TRENCHES. THE GRAVEL_ DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET}. F.."EG:0o_J I FeF_"r;�N QFEE F~ -r I eZ� i"'J:4P-EI'f S 1 2:E= d -171i01:21 (3nL.L... Ler-J:E— PERMIT APPLICANT HAS THE RE-75KINSIBILIT'i TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT 'THE WELL WILL SERVE. -r L-4 me r_ ;-2-> 11""_=5I='''E.C-:-IF T. e'..}P--0"_ F-1FZE SIE=0!R...11 Imo."I-C:+ BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN'•SPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON --SITE SEWAGE DISPOSAL SYSTEM IS 1.00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND 1*0 A COMMUNITY SE14ER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 GAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE IRE PROPER INSTALLATION. F::"1—=F;_oM l `lF EXE" l EF<'lEES. GdEw=EMImo'E:F' 2":JL_. ::L:P-1 i I CERTIFY THAT 1.: I All FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS FIND WELLS AS SET FORTH BY THE MUNIC:IPALiTY OF ANCHORAGE. 2: I WILE,. INSTALL, THE SYSTEM IN ACCORDANCE WITH THE CODES. : I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO 'INCLUDE MORE THAN 3 BEDROOMS. SIGNED: /m_P I I': NT JIM ADAMS ISSUEE> ____ ti?„_' .�s� __ E ATE_._.�E CJ tiro. El O & E ENGIINEERING & DEVELOF-MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Hussell Oyster 694-2774 Performed for: Mailing Add Legal Description: /-- V Depth (feet) SOIL LOG Soil Characteristics 0 -- PLFAr 2 GU�4cc t 2�Adie-'�, -r- 3 Z3 -- 4 5 z� 7 8 .77 Ne445� Earl Ellis 688-2280 _Tel. No.692 �� r � . � "'9z) 9 -- L 'J' /%1 d rt_u ,mo i r- 10 _— �� Map �` �� /u PLOT PLAN Ise - 11 12 r� )" PERC. TEST 13 14 15 16 ni• Ground Water Encountered: Yes No �^If yes, what depth Proposed Installation: Seepage Pit ^ Drain Field ti Comments:PP���� f'116ar� sr arc/ girl wl�v«f% IsfT�4i�� Performed by: 5::�. V �' e�4 ��� � Date:--J-«��= r / Myo 1 9 -- L 'J' /%1 d rt_u ,mo i r- 10 _— �� Map �` �� /u PLOT PLAN Ise - 11 12 r� )" PERC. TEST 13 14 15 16 ni• Ground Water Encountered: Yes No �^If yes, what depth Proposed Installation: Seepage Pit ^ Drain Field ti Comments:PP���� f'116ar� sr arc/ girl wl�v«f% IsfT�4i�� Performed by: 5::�. V �' e�4 ��� � Date:--J-«��= r / Myo tr DOC Co. dOa SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND _ ADDRESS LEGAL DESCRIPTIOP� DATE. - Started Ended PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft. From Ft. to Ft. From Ft. to Ft, From Ft. to Ft. Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft, From —Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From__ _Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. DRILLER'S NAME MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 050-661-11 Certificate of On -Site Systems Approval Expiration Date: 2 V -7zD -z- Legal Legal description MOUNTAIN VALLEY ESTATES #1 BLK 5 LT 8 Site address 3828 BIRDSONG DR Eagle River AK Current property owner(s) HILL & BRONWEN X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: NA bedrooms, with the following stipulations: Original Certificate Date: 9/7/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovWjune 2022 WE'VE 1111JI01 Development Services Department On -Site Water Q. IN Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION I' Parcel I.D. 050-661-11 Complete legal description Mountain Valley Estates #1 Block 5 Lot 8 Location (Site address) 3828 Birdsong Drive, Eagle River, AK 99577 Current property owners) Brandon Hill & Bronwen Nicholls Day phone (907) 529-6737 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑® Plastic ❑ Concrete ❑ Fiberglass Age < 1 yr - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑® Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. r COSA Fee $ �! I b Waiver Fee $ Date of Payment 151-4 3� Date of Payment COSA # 05'C 7- 3 (3Z 2 Waiver # COSA Application June 2022 Mountain Valley Estates #1 Block 5 Lot 8 050-661-11 3.8 7/7/80 88 N/A 88 0.448 18+ 7/25/23 Forge Engineering 7.5 7/25/23 N/A New Installation 8/7/23 N/A N/A N/A New Installation > Benjamin Schiller, P.E.8/21/23 (907) 522-7773 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and pnter'd : ixro as of th'of �'` t=;�- of 20r}�, by and between s "`� herein the "OW.\, TR," and the Municipality of Anchorage, herein the "MUINICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65 365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWV7TS), described as Advantex System located at (legal description) Mountain Valley Estates #1, Block 5 Lot 8 2. Maintenance, Repairs and Alterations. �-(Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement 1 IZKI or the manufacturer's representative will inspect and make any necessary maintenance, /repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential v ' failure of the system, which could include sewage backup and costly repairs or drainfield with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality replacement. (rev, 05/18/2018) Pagel of 3 t• v Owner acknowledges that the Municipality may request records of maintenance and ` repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and 'inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new a Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. r Omer agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. i1 onwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 ( � OWNER: By: (signature) Date: v riot Warne STATE OF ALASKA THIRD JUDICIAL DISTRICT The foreg ig uistr me 20_n, by� i C _ , ! 5 NOTARY PUBLIC FOR My Commission expires: ) ss. d before me this day of AW.S , N i = NOTARY: Y OF uPo \\\� IVCUl\IICIPALIT Y: By: _ l/"`�- (signature) (print name) Date: � ( � o 3 Title: G i V i L C- ^' �l ,• ��/-f� (rev. 05/18/2018) Page 3 of 3 • • i_k.9 10 li ,,c,,c a,, •;V..' Municipality of Anchorage '?o - On-Site Water and Wastewater Prografri-/ _ IA II-a c, (907) A'- (907) 343-7904 1:.1 SA ETY w Certificate of On-Site Systems AO val �, 050-661 -11 Parcel l.D. Exp iration Date:6 $ ��.I ee 19, O tr-1 1. GENERAL INFORMATION Complete legal description Mountain Valley Estates #1 , B I k 5 Lt 8 Location (site address) 3828 Birdsong Dr Current Property owner(s) Alex & Kristina Wright Day phone 744-1981 Mailing address 3828 Birdsong Dr, Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ • Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer El WaiverNariance request for: _ Distance: Received by: Veikitie.4 L04/9q1(.2 Date: iI//C7//7 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Jia(, Waiver Fee $ Date of Payment gi g f/9 Date of Payment Receipt Number (,lQr965C Receipt Number COSA# 05C11/36? 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. Name of Firm Forge Engineering Phone 522-7773 Address 1399 W 34th Ave, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, PE Date $-23-2017 or .C�.f1 f rj .c a,•a `4 S y4 or Ay.* v 6. DSD SIGNATURE s ....... System #1 Approved for bedrooms Ijis i •,� z System #2 Approved for bedrooms tP¢ �Asaa 92 „o• Disapproved -���' Conditional approval for bedrooms, with the following stipulations: yo f. ON-SITE ‘11 WATER AND WASTEGRAMR PRo '_ 111701TSER\/ • By: faMO_A_ eQ717J-Q Original Certificate Date: VI 7201 7 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 blue sheet_f - c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Mountain Valley Estates #1 , Blk 5 Lt 8 Parcel ID. 050-661 -1 1 A. WELL DATA Well type Private If A. B, or C provide PWSID # Well Log (Y/N) Y Date completed 717180 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 88 ft Cased to 88 ft. Casing height (above ground) >18 in FROM WELL LOG AT INSPECTION Date of test 7/7/80 8/22/17 Static water level 6 ft. 6.5 ft. Well production 40 gpm 5.1 g p m WATER SAMPLE RESULTS: Coliform ND colonies/100 mL Nitrate 0.394 mg/L Arsenic ND ug/L Date of sample: 8/14/17 Collected by: Forge Eng. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic / Steel Date installed 7/1 7/80* Tank size 1 000 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) N Date of pumping 8/23/17 Pumper JR's Pumping C. ABSORPTION FIELD DATA 7/17/80125 SF/BDRM Trench Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) System type Length 47 ft. Width 3 ft. Gravel below pipe 3 ft. Total depth 6.5 ft Eff. absorption area 282 ft`' Monitoring tube Y Depression over field N Date of adequacy test 9/11/17 Results (Pass/Fail) Pass For 2 bedrooms Fluid depth in absorption field before test 0 in. Water added 340_____ gal. New depth 0 in. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 320 g p d Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date *Septic Tank is over 30 years old and nearing the end of its service life_ D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main '751 Public sewer manhole/cleanout >100' Sewer/septic service line '251 Holding tank >75' Animal containment areas 'S01 Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: >5' >5' Building foundation Property line '5 Absorption field >10' 1** Water main Water service line >10' Surface water 77 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10' Property line >10' Building foundation >10' Water main Water Service line >1Surface water 77 Driveway, parking/vehicle storage 0 Curtain drain None Noted Wells on adjacent lots '100' F. COMMENTS Septic tank integrity verified by camera. **Waiver in file for surface water, #8521 -WA-010 G. ENGINEER'S CERTIFICATION 1, c.0.'44,Q 14I I certify that I have determined through field inspections and 4....dr .* .�,.; ,.'6 d� review of Municipal records that the above systems are in - ;CI: 49 TII ,t ; •0 conformance with MOA COSA guidelines in effect on this date. Benjamin Schiller, PE • Engineer's Printed Name �. '":" t:g- Ijarili a ~.cri Date 9/12/17 IS Qs Purls�� ‘.s� O%n� �o a COSA brown sheet 10-10-12.doc FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 17,2017 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Mountain Valley Estates #1, Block 5 Lot 8 COSA inspection Dear On-Site Services Engineer: The owner of the above property at 3828 Birdsong Drive asked us to perform a septic and well inspection for a Certificate of On-site Systems Approval. Not much information was available in the records for this property. The original engineer as-built showed two trenches, one crossing under the driveway', and the other running parallel to it. It was unclear if these were one trench or two separate trenches, although a note on the original as-built mentioned `steps between trenches' with no explanation. The layout of cleanouts and monitoring tubes did not help, and the pipes at the far end of the system were missing. The homeowners had not had any problems with freezing in trench running under the driveway. Our initial test seemed to pass. The water in the single monitoring tube stopped rising after a certain point, and all the liquid was gone the next day. However, we were able to find and fix the pipes at the far end of the system. We found that the second part of the system had standing water in it, and during a second test that section of the system flooded. It became necessary to expose the system at the "angle point" next to the driveway. We discovered that there were two separate trenches, the second several feet lower than the first. However, the lateral for the second trench tied into the monitoring tube less than a foot from the bottom. There was not much separation between the trenches, either. The result was that nearly all the liquid put in the first trench ran right through into the second trench. This second trench was not able to absorb enough liquid to pass the test. We directed the contractor to cut the lateral to the second trench, remove the connection to the monitoring tube, and tie into the first lateral with a valve that will allow us to isolate the first trench completely. We also added a layer of plastic to the near end of the second trench, to prevent the first trench from seeping into the second. We tested the system for a third time when we were done. The house had been mostly vacant for about 2 weeks. The water in the first trench absorbed all the liquid as it was being added. The I The homeowners did not have any problems with freezing in that trench. levels in the second trench stayed the same. We are confident that the upper trench is no longer leaking directly into the lower trench. With the valve connecting the second lateral to the first, it is possible to use the first trench exclusively and allow the lower trench to recover. However, it may be that even with the valve wide open, effluent will fill the first trench before it flows through the lateral to the second trench. In that case, this system will be functioning as a `spillover' set of trenches. This is not an ideal setup- it would be better for the second trench to have its own connection back to the tank, with a flow splitter evenly dividing the effluent between the two trenches. We recommend that the homeowner monitor the system on a regular basis to see if effluent is flowing to both trenches, or if it is filling the first trench exclusively. Any company used to pump the septic tank can look at the levels in the trenches and let them know how the system is working. Sincerely, ' •9"*1 4th• .e • Benjamin Schiller, PE 1.0):. 3 j SCtIi� r ''c� • � • $Gmq ]cz 0b MOUNTAIN VALLEY ESTATES #1 B5 L8 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT: 343-7904 4700 ELMORE RD. ANCHORAGE, AK 99519-6655 WASTEWATER DISPOSAL SYSTEM INSPECTION DETAIL 0 z F- X 0 W W U w Q LQ J a_ I— W O Z W H O Z O W Z Z J W O < 2 > U EXISTING GRADE INSULATION /1i/moi//�l/�llil//�/iii/ NEW CONNECTION TO SECOND TRENCH FIRST--TRENCH " PREVIOUS CONNECTION TO SECOND TRENCH (REMOVED) s i r. L� rr• � / I. [• 1 } r,'!a i {v•''�.I_F.l.�+,,i„yef-M,. a f SECOND TRtNICH' :; JL;•'�/ rl..� C.S Y'�1�::4'�.1..•' �5 5'v:.1�'�:�•,`.P:•i 45•���������;f�za':j::�',, ^+ ����.` �. r..•- h / ADDED PLASTIC BARRIER i'.•j;�:l:.;;;i;s.i.t:� i� �'r":;'i'. ,.:�•,i.=•i�.��: ..:.:: ..f�K��.� / Miff .. .rl�'wr. 4. ....-.:._...�:.:Yi''M�.��':. •.' .f " "T:�.;„ •;�:'.•iz.•<•: ti:. ti\\\\ AtAik . Ito r 00, PROFILE AS-BUILT Benjamin Schiller rr�'•• AEL 12592 • (NO SCALE) ��1,,`�ROFESStiON� ` • moa 0 4...5-'S,',7"'''''W 2-op.9B • i n i L1 Yi M1y 7,f fir A • /b) MIun1 / ' za 3 I . •1 'J tib w N /i to 3 .o. —c- / • 0•• .`� ;- um ilie i • ... .0''�- G - , , „ . o, o _ tsroi 'o• •_ / f a I 1 •.R - -- 1 /o v7:4417l," Er fivT A i i7/QQ o O6 -,,LP""-- 0-/Q.Cad Zglee5-e, .gel I ,77-/G9T/ 4.7 9 ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: Oxq►a p FOLLOWING DESCRIBED PROPERTY: *'. OF A4°AN /7dl//',' i-/!/�CLEYE�"TAT�T•41'.,-.4 .t/D,/��T ,,.-4,.,-:"� DATE, '� '� •• •. '9• 4 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS p1z�iy= x'L/2.4. �.•'� . s p INDICATED. IT IS THE RESPONSIBILITY OF THE �. 4 '�' * ,,z,1 OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: f EASEMENTS, COVENANTS, OR RESTRICTIONS .r�/%sc� !� ,_ WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ♦ o,,.,, ;,,� s.. ,� VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB! t '•. is-69 C8 /.� � ANY DATA HEREON BE USD FOR CONSTRUCTION �t rH � � OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN a� a,► Parcel I.D. 050-661-11 c cam/ GC Q4 Municipality of Anchorage ° On -Site Water and Wastewater Program < (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 61' 2 q — 1. GENERAL INFORMATION Complete legal description Mountain Valley Est. #1, Block 5, Lot 8 Location (site address) 3828 Bird Song Dr. Current Property owner(s) Dennis Be[ Isle Day phone Mailing address PO Box 771293 Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx I Individual 7 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:, Received by:,-' Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5�!o Waiver Fee $ Date of PaymentII —q ' S Date of Payment Receipt Number 0 (vY 9 2 0 Receipt Number COSA# ©SC_ 151(j!? Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation dateshown'+be&,-I�ent that m 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 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for __Z System #2 Approved for _ Disapproved Conditional approval for 72 Date 3/&I-/2016 bedrooms /� : Seven R. Pannone bedrooms i$g , CE -8149 ��3cr, bedrooms, with the following stipulations: ✓t� 3- 2u' 16 Original Certificate Date: 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 CCSAbluesheet f :., c If more than 1 septic system is on the lot: COSA Checklist # ' of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Mountain.Valley Est. #1, Block 5, Lot 8 parcel ID:050-661-11 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y *7/7/1980 Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) Y ' * Total depth 88 ft. Cased to *88 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test *7/7/1980 ' 10/16/2015 Static water level. *6 ft. 23 ft. Well production *40 g.p.m. 5.0+ g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ,ND mg/L Arsenic ND ug/L Date of sample: 3/14/2016 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/1,7/1980 Tank size 1,000 gal., Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 7/7/2015 pumper JR'S Pumping C. ABSORPTION FIELD DATA 7/17/1980 2 125 SF/BR Deep Trench Date installed Soil rating (g.p.d./ftor ft /bdrm) System type Length 47 ft. Width 3 ft.. Gravel below pipe 3 ft. Total depth 6.4 ft_ ' Eff. absorption area 282 ft2 Monitoring tube Y Depression over field N Date of adequacy teat 10/161201.5 Pass 2 Results (Pass/Fail) For _bedrooms' Fluid depth in absorption field before test 7 in: Water added 453 gal. New depth 12 in. Elapsed Time:. 140min. Final fluid depth 7 in. Absorption rate >= 450+ y,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) No If yes, give date D. LIFT STATION Date installed Size in gallons "Pump -on" level at ' in. "Pump off" level at in. Datum. Cycles tested Manhole/Access (Y/N) High water alarm level at _ Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankAift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+' On adjacent lots 100+ Public sewer main 75+. Public sewer manholelcleanout 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+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 77** Wells on adjacent lots 100+ ABSORPTION FIELD ON LOTTO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ _ Surface water 77Driveway, parking/vehicle storage 0 Curtain drain. 50+ Wells on adjacent lots 100+ F. COMMENTS *Well log unreadable. Info taken from 1993 COSA. **Waiver on File. House vacant. Septic presoaked with 2,000 gallons. ***2nd trench was tested: G. ENGINEER'S CERTIFICATION I certify that / 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 3/22/2016 COSA canary sheet -2-6-1 6.doc 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-butlined. inthe Certificate of -On -Site -Systems. Approval. Guidelines .for this application, shows that the on-site water supply and/orwastewater 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 ofAnchoragefiles and from; my investigation and inspection, the -on-site water supply and/or wastewater disposal-systemis(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at - 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, andseparationdistances measured to' readily. identifiable features. Theoperationallife: 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 controlofthe. evaluator of this system. All, systems- eventually fail and satisfactory' test results do not guarantee future - performance,of thesystem, nor ado they guarantee that there are no hidden defectsor encroachments. Therefore we.cannotprovide. any warranty_ for future performance, nor can we estimate remaining life of the system. The content of this report is for the sale benefit of the owner listed above. . Name of Firm Pannone Engineering Services LLC Phone (90:7) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 11/4/2015 6. DSD SIGNATURE ... . . ... ........ t� System #1 Approved for Z bedrooms Seven "flonnone CE 8149 System #2 Approved for bedrooms � � ., AWr Disapproved Conditional approval for bedrooms, with the following stipulations: By: _1 Original Certificate Date: The Municipality of Anch ge 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 Tor 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 COSAbluesheetf c If more than 1 septic system is on -Eke lot:. COSA Checklist # + of + Structure served by this system .+ Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Valley Est. #1, Block 5, Lot 8 Parcel ID: 05®=861.=1-1 A. WELL DATA Well type Private ' If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed *7/7/1980 Sanitary seal (Y/N) _ Total depth *88 ft. Cased to *88 ft. FROM WELL LOG Date of test *7/7/1980 Static water level *6 Well production *40 WATER SAMPLE RESULTS: Coliform /lips,— colonies/100 mL Nitrate 0•S'X-.)mg/L Arsenic Ali I ug/L Date of sample: /0/1G 6,0 is B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Wires properly, protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 10/16/2015 23 ft. 5.0+ g.p.m. Collected by: e 6 S Date installed 7/17/1980 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) Date of pumping 7/7/2015 Pumper JR's Pumping C. ABSORPTION FIELD DATA 7/17/1980 z 125 SFfBR Deep Trench Date installed Soil rating (g.p.d./ftz or ft /bdrm) _$ystem type Length 47 ft. Width 3 ft. -Gravel below pipe 3 ft. Total depth 6.4 ft. ; Eff. absorption area 282 a Monitoring tube Y_ Depression over field N Date of adequacy test 10/16/2015 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 7 in, _ Water added 453 gal. New depth 12 in. Elapsed Timer 140 min. Final fluid depth.7 in. Absorption rate >= 450+ _ g.p:d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date w D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot -100+ Absorption field oil lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO On adjacent lots 100+ On adjacent lots. 100+ Public sewer manhole/cleanout 1.00+ Holding tank 100+ Manure/animal excrete storage areas 100.+ Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 77** Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+1 Water Service line 10+ Suffarce water 77 Driveway, parking/vehicle storage 0 Curtain drain 50+ Wells on adjacent lots ,100+- F. COMMENTS *Well log unreadable Info taken from 1993 COSA. **Waiver on File House vacant. Septic presoaked with 2,000 gallons. G. ENGINEER'S CERTIFICATION I certify that f 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 11/4/2015 -Kff COSA canary sheet 2.6-15.doc I SBUILT-NO CORNERS SET THIS DATE. HEREBY CERTIFY THAT I HAVE SURVEYED THE )LLOWING DESCRIBED PROPERTY: �uiiT/iv (/iiYGEYE �r�7TFT/�OGiY/.�0. /, tUr� qD THAT NO ENCROACHMENTS EXIST EXCEPT AS IDICATED. IT IS THE RESPONSIBILITY OF THE VNER TO DETERMINE THE EXISTENCE OF ANY 4SEMENTS, COVENANTS, OR RESTRICTIONS HIGH DO NOT APPEAR ON THE RECORDED SUBDI- ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD VY DATA HEREON BE USED FOR CONSTRUCTION F FENCE LINES, OR FOR ESTABLISHING BOUND- RY LINES. SEWARD & ASSOCIATES LAND SURVEYING 688• SCALE- `- lk DATE X�Q�� OF A4 ,_ r .DTH GRID. . .. FB, 4++ D..n. M.rk 3..,d ct•" _ LS -6918 d C R DRAWN•,. 1� G �.:m MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ' Division of Environmental Services ti On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# G S1Una 1. GENERAL INFORMATION Q -3-- Complete legal description Loa 8: B.Cock 5: Mountain Va.Pet Estatea Su,bdivizion #1 Location (site address or directions) NUN MachaP_� Q)Uve [Q{� Haand Road) Property owner Rachan.d Hiatt Day phone 265-7527 Mailing address C/0 REMAX EAGLE RIVER 16600 Cewten4ae2d Dnave Eagte Raven. AK Lending agency Day phone Mailing address- Agent ddress Agent EVA LOKEN - RL -MAX EAGLE RIVER Day phone 694-4200 Address 16600 Cenaen6ae2d V ive Eagte Raven., AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If.community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system.. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site _XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA p21' ^v� l.N41 4 VtA 10_\V13 - 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _ Phone �l Zc/7 % 5 & S ENGINEERING Address _ 17034 Eagle Kiver toop Ro- Engineer's Eagle River, Alaska 99577 Date 1OZ6 9' signature _ 4. . r ff , ... ., .. .pdo nn 9n nV•.q :x {I'JbWi A. slink,{, a 1 J4 .0 ao°ea Baa�' � 10FI:3S\ON., Y, 6. DHHS SIGNATURE / \ Approved for C) bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: By: "I,", Date auTIe 0 _ 3 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/911 Back MOA #21 Municipality of Anchorage O Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-oT a tit✓K-- Parcel I.D. e�-r. S l A. Well Data Well type q N -i Fi-- If A, B, or C, attach ADEC letter. ADEC water system number_ Log present/N) Date completed 1 -1 = � o Driller S3 Total depth `��` Cased toy`� t Casing height _ Sanitary seal &N) Date of test Static water level Well flow Pump levell Wires properly protected (YIN) FROM WELL LOG 'I -e, o L10 . o 9 -p.m SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ oc_� AT INSPECTION 0 K_ On adjacent lots Absorption field on lot \ o -D ; On adjacent lots Public sewer main 1n� Public sewer manhole/cleanout Sewer service line ZS \ Petroleum tank WATER SAMPLE RESULTS: MUNICIPALI I (A- AN(.Hc t</\Ut ENVIRONMENTAL SERVICES DIVISION (,C 0 G 1993 g.p.m.R C E 11/ D Coliform D Nitrate 0, 312, Other bac d� a. 5 i P3Cil� ,I Date of sample: `I -2Cl-`lq? i`a 5 Collected by: 1703'. :lr F=ivo' LOW,) Road No. 204 X0()1: C;!ivcr, e arca a B. SEPTIC/HOLDING TANK DATA Date installed Tank size -loo o Compartments 2 Cleanouts &N) Foundation cleanout (YQ *� Depression (YQ High water alarm (Y& rl Alarm tested (Y/N) '`l �a Date of pumping C\ - (Dl 3 Pumper C ,"s Pa;t- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: k Well(s) on lot `,D D \ On adjacent lots \ o z \ Foundation 3S _ �k I r�- To property line \ C) Absorption field Water main/service line /, o t Surface water/drainage �_ v i Vt iD 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes SEPARATI on lot "Pump on" level at FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Manhole/Access (Y/N) es tested Level at Surface water Date installed 3 Soil rating (GPD/Ft) l y� �g R- System type Length 1 Width 3, Gravel thickness 3 Total depth S� l Js u `A? -0-o Total absorption area 202 Cleanout present t�j'1 /N) Depression over field (Yo P1 Date of adequacy test Q� — \ `'IZ Results as ail) ��� s for 3 Bedrooms Water level in absorption field before test Lo U — 3 �� After test O I— 3d Peroxide treatment (past 12 months) (Y& J If yes, give date 1a SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ o L-� ` On adjacent lots � LDo � Property line �- e I �- To building foundation �O To existing or abandoned system on lot rd ", On adjacent lots 30Ar � Cutbankk 2v G -7 I Water main/service line t o k �r- Surface water 'I'I ion L Driveway, parking/vehicle storage area Curtain drain '-L I n %fvr-A 'I —35- 11 DIPS E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all Signature Engineer's Name Date S & S ENGINEERING er Alaska 'o G, i HAA Fee $ 4.�66 o Date of Payment 6-J3 Receipt Number s 5 7 72-026 (3/93)' Back HAA guidelines in Waiver Fee $ Date of Payment Receipt Number i`f `bf'this inspection. �O4 _�✓ aifo' c;a' MUNICIPALITY OF ANCHORAGE }� • DEPARTMENT OF HEALTH & HUMAN SERVICES M -j Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# HAA# QL,1. -A,, 1. GENERAL INFORMATION Complete legal description Lot 8; Block 5; Mountain valley Estates Subdivision 1 Location (site address or directions)NHNMjohael Drive off Hi1anr9 Rcnar7 Property owner Richard and Becky Hiatt Day phone 265-7527 Mailing address P.O. Box 201336, Anchorage, Alaska 99520 Lending agency Day phone Mailing address Agent AHr1racc Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well —xXX— Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank -- Community on-site -- Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev_ 1/91) Front MOA 921 5. STATEMENT OF INSPECTION BY ENGINEER ' I verify that my As certified by my seal affixed hereto and as of the iacat onoshowos that he olidatin date shown lnsite water supply investigation of this Health Authority Approval app and/or wastewater disposal system in I furtherve)roify thatanal and sed on the inforequate for mation rmation obtained from and type of structure indicated here the Municipality of Anchorage files and from my investigation and inspection, the on-site wa er supply and/or wastewater disposal systemheis in date of this re e with tionll Municipal and State codes, ordinances, and regulations in effect on t Phone Name of Firm 17331 Eagle River Loc Road No. 204 _2 t Address ,,aaia?iver. Alaska 99577 Date Engineer's signaturemo:+�����®� ,®.t �j.•�p�ese0 5f lee •e'•� o�g A �ee. e��peuev e. e.e a'o.e oe ., O 1, se•• e i A. . poGE J. HAFE 1 4Pa I10.8 5 4ZF,4 ®ROFES�a�+�. 6, pH SIGNATURE Approved for v bedrooms. Disapproved. Conditional approval for --- bedrooms, with the following stipulations: Additional 0 L J �. Date / issues Health Authority Department of Health and Human n paragraph 5 above by an independent The Municipality of Anchorage Dep to urchasers of homes Approval Certificates based only upon the representations given in this p professional engineer registered in the State of Alaska. The DHHS does this as a courtesy p re a certificate is issued. The Municipality of Anchorage is not and their lending in in order to satisfy certain federal and state requirements. Employees c DHHS do no conduct inspections or analyze data be nal engineer's work. responsible for errors or omissions in the professio 72-025 (Rev. 1/91) Back MOA k21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:' Lt`t5- oporlrA A�� Parcel I.D. +r <. r > A. WELL DATA Well type If A, 13, or C, attach ADEC letter. ADEC water system number ,_�lA- Log present (�)'N) Date completed _7�1"6a _ Driller 5,eL-k 11%,A( Total depth `ag1 Cased to k SQ' Casing height 17- J"_ Sanitary seal &/N) �4 Wires properly protected (VN) // -y q A reA �� ` Z r% FROM WELL LOG AT INSPECTION Date of test 1'�I-8V �l-\—`(2 � m Static water level Lft 1T U N Well flow g.p,m, gr. Pump level L) JIL- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 ob t — ; On adjacent lots _ 1 uu Absorption field on lot OC� t ; On adjacent lots t as A - Public sewer main —'� Public sewer manhole/cleanout Sewer service lined t Petroleum tank WATER SAMPLE RESULTS: Go c r Coliform d �jD�w-Q Nitrate O,3 Yu �R, Other bacteria _ /JJ�� Date of sample: 8 " 25'- Z Collected by: S & S ENGINEERING 17034 Ea-�RTver� P B. SEPTIC/HOLDING TANK DATA Eagle Rlver, Alaska 99577 Date installed 7' So Tank size lebo Compartments iL Cleanouts &N) Foundation cleanout (Y& _ N . Depression (YAC High water alarm (YO) d Alarm tested (Y/N) "JIA Date of pumping g - 7_9— 9Z Pumper Z4. �Ea Poe L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 16 0 On adjacent lots 1.06, Foundation 3S r To property line /,11 Absoffrption field 5 Water main/service line % Surface water/drainage �1 WAA4.4 '7 -1�� rn C oC D cno M- < Z C) N O 0 < D N M � rn z 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes SEPARATI ISTANCE FROM LIFT STATION TO: I on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed I Tao Soil rating 125�6�. System type _7:0r4n1[,N. Length 4� Width 3 a Gravel thickness 3 Total depth 5 bA1S 4-A 7"Z Total absorption area 25 2 Cleanouts present O/N) Depression over field (Y. f�j Date of adequacy test -Z- Results /fail) PA"�Sfor -rA¢�- (!R) / bedrooms Peroxide treatment (past 12 months) (YO rj 4 If yes, give date ,�C D,•LI.N ��J&.ST�,�,{r ZR�Cy b�PPR-•�l,ori. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot lay a l � On adjacent lots I oo NF Property line B To building foundation I '� To existing or abandoned system on lot " 1`// A It On adjacent lots 3o Cutban Zo G / 7 Water main/service line_ 10 14- i Surface water 77 V4MJ6c Driveway, parking/vehicle storage area -64 oAf Curtain drain t44, 'rcnL F I t%PPA to kA h lker" -1 - I'1- s s E. ENGINEER'S CERTIFICATION I certify that i have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. y rf. 5 FNGiNFERING Signature 17034 Eache River Loop Fuad No. 204 Ew3is ".iv:.r, Alaska 99577 Engineer's Name Date 9 HAA Fee $ Date of Payment CL2 --,-1 —.7 )- Receipt Number 4LL U/pQ 3 72-026 (Rev. 3/91) Back MOA 21 � Waiver Fee: $ Date of Payment Receipt Number _ s xt PK a 'iia ff MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CEF`f IFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SG:WER AND WATER FACILITY 264-4720 Application Date LF> fi.cF?FiL IiVF()R149A'iION �]J Legal De-cr:Ption (include lot, block, subdivision, section, township, range) - - ------------------- - ation tar cress or directions) n� e C Telephone: I-lomc —1---- --- Business check one): Lending Institution D ; Owner/buildorrf; Buyer 1 ; Other I (explain), ............ Telephone •r. (lr cseQ y-1— c r ... .rrpany and Agent ,a : f.e H/Ll- 'o the following address: - TYPE OF RESIDENCE ;-Far-,Xy�j Mjili- Family 0 Other --- __— -- ,-a WATER SUPPLY Cernmunity Public D "f; ,rrrnuray rt 11 system, must have written confirmation from the State Department of Fnvironmental Conservation c fj`o c ! : t/ and status. SE1YAGE DISPOSAL f Fu : O Community ❑ Holding Tank El i s/stern, roust have written confirmation from the State Department of t=nvironmental Conservation 11 it el f:; ,l/ and status. 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigatio . -J this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functionai -d adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the inform,- _vn obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site Ovate! -,,,;ply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and reglath__ <, in effect on the date of this inspections baa td ✓ coo+ rjr1.r vr- w„� -, ,C7„ e:,_ . < Name of Firm v ---WGTelephone Address EMU nim, AK 335%7 ---------- pa U: QpI( 72329--- ------- --- ---------� Date --Vl Engineer's Seal r'0 oho°�yy � ✓:�� Cnn��nn[ �-, Si V^eti' boa°°Ou'�io yy[�oi4 vov to Op,(--�� Louis A. 13v}oro ° fry 6. DI -IEP APPROVAL Approved for _—_ bedrooms by '-' --_ _ Date Approved _ �'� —___ Disapproved —/—___. —. Conditional Terms of Conditional Approval ew oo /Vt��-- 9° /✓c! CxJ�✓1164—�A'f/Ly.� �`F �'sF�l�ssE' r;lF-G:'7 l.7ffJ/�7 .r�4 i� t.r?P� .:.,,�� rP �� CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues lion filth Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independenl professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and lhoir londing institutions in order to satisfy certain federal and state requirements. Employees of DI IEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or orris ;unu, m the professional engineer's work. Page 2 of 2 rJCOgf r�Jd6��: f.✓ .� Tfe'T /07 ��L'be mit 7� %/��d fr'!”'-� fe#��%f�' �tG�� �1�sr,c`rF�e.�y pl�rVocC°.f �✓��lj //zcs�.+'fit �-e'%�� Yeti' t.✓>'�J'irl�� d�' .'®,� �`.^�-� .�r�.r.'a✓-`�'���'�r:, � 4 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues lion filth Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independenl professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and lhoir londing institutions in order to satisfy certain federal and state requirements. Employees of DI IEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or orris ;unu, m the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCFIORA06 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) IJL HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED264-4720 Legal Description: /-lei % A. WELL DATA Well Classification -A.e c I -c _— If A, 13, C, D.E.C. Approved (Y/N) � Well Log Present (Y/N) r Date Completed -/;7 A 0 _ Yield Total Depth _0 Cased to / Depth of Grouting Static Water Level — Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) _-V Electrical Wiring in Conduit (Y/N) )01 Depression Around Wellhead (Y/N) y Separation Distances from Well: To Septic/Holding 'rank on Lot /00 __ ; On Adjoining Lots / OU r To Nearest Edge of Absorption Field on Lot /�" ; On Adjoining Lots 16r') 7' To Nearest Public Sewer Line �o�. To Nearest Public Sewer Cleanout/Manhole �U"¢ To Nearest Sewer Service Line on Lot Q 5 - Water Water Sample Collected by Eh s e e Date 6� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7'� Size kava �'� No..of Comqa�rtments __CZ Standpipes (Y/N) _ t/ (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/Nj . /V _ Date Last Pumped � 5e s' Pumping/Maintenance Contract on File (Y/N)Z1_4 ; for Holding Tank High --Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) yA Separation Distances from Septic/Holding Tank: To Water -Supply Well / 00 To Property Line - /0 i To Building Foundation To Disposal Field To Water Main/Service Line _ /0 Course�'�` Comments 6 Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage (� 0- fi _ .n_ - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata has #Zrz Type of System Design T�-e c 4 Date Installed l5 O Length of Field Width of Field Depth of Field iA I "" EJ Gravel Bed Thickness 3 Pff Square Feet of Absorption Area Standpipes Present (Y/N) y Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Testi Separation Distance from Absorption Field To Water -Supply Well /06-1- To Property Line eF / To Building Foundation r�/D To Existing or Abandoned System on Lot IVa -.n e ; On Adjoining Lots 30 To Water Main/Service Line �� To Cutbank (if present) a1/ f� If 21 To Stream/Pond/Lake/or Major Drainage Course s� w To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed �� Date 7�/ Company 4;•r.6.S. MOA No. SJ" -265' Receipt No. r'� Date of Payment 3 c Amount: $ �� r Engineer's Seal e co^ eo°°ann. 7 p e°°e Geo oci �p�7 ° d Page 2 of 2 Q �, = Louis A. 6vtera ; (J ( ® O CE 67 72-026 (11/84) Q� Op ROFESS�o� OX 0 C. -W PRo,=lz de—ld ws> EAGLE RIVER ENGINEERING SERVI(C�M'--)' Of -117�1 Loll is„tera P.E. P.O. Box 77329} - _ - Eagle River, Alaska 99571 7bLl)hone (907) 691-3195 July 26,1985 Susan Oswalt Municipality of Anchorage Health Department 825 L Street Anchorage, Alaska 99501 Ref:Lot 8 Block 5, Mountain Valley Estates Dear Susan Oswalt; This letter constitutes a statement as to my knowledge of the nature of a drainage that is located on the above referenced lot. The drainage is located as shown on the attached plot plan. The immediate source is unknown and is believed to be groundwater that exits the ground from a cut made in the hillside. This cut was made to remove ground water from the area of the house. The flow rate out of the hillside cut is estimated at 3-5 GPM and is directed by means of a ditch toward the North lot line where it flows downhill into the road drainage system. The flow rate out of the cut has reduced in the period of time I have been involved with the project. I have no way of knowing if the flow of water stops completely during any part of the year. If there are any questions or concerns please call me at my office 6911-5195. Sincerely, Lou Butera P.E. July 1.8, 1985 Eagle River Engineering Att: Lou Butera P.O. Box 773294 Eagle River, Alaska. 99577 Re: Lot 8 Block 5, Mountain Valley Estates , Eagle River. Concerning spring located on upper portion of lot draining across diagonally and ending at lower right hand property line. This spring is mostly ground water and is most apparent during break-up when the run off is at its greatest. By mid summer it,,,has usually dried up to a small -trickle. This spring has been there since the house was built and has lessened some because of con- struction of houses on the road above -the property. Sincerely, Richard V. Hiatt �Nv FpT of Nc MFNT'1Z pR0 �c�RAGc -Q-7 V N n ANMORAGE/RTS"TLEN DISTRICT OFFICE 437 "Er' STREET, SUITE 303 AMIORAGE, ALASKA 99501 July 12, 1885 Mr. Lou Dut:era, P. E. Eagle River Engineering Services P. 0. Box 773294 Eagle River, Alaska, 9&577 541 274-2533 :UBJECr: Horizontal Separation Waiver Between Spring and Septic, Lot S, Block 5, Mountain Valley Estates, Cbugiak, Alaska CZ21-WA-010 Dear Mr. Butera: The Department has reviewed the subject waiver request and hereby con- ditionally waives the horizontal separation between the spring and septic systens to 77feet on the subject property for a 3 bedrom single family residence only. Waiver is conditionally approved upon the receipt of a written statement by the engineer giving assurance that the subject spring does not have year around floe. If the subject spring does have year around flow, a second waiver request nay be suLmitted with the following change for approval. All flows of the springs channel will be culverted within 100 feet of the septic system. If you have any questions, please contact me at 274°2533. Ag)L/dd Since: -re ly , Michael P. Lewis Enviromental Engineer oNV'RONMFNTq( Pp4 c&oRAGC ecr1oN iVt® 5. LEGAL DESCRIPTION r� - DATE RECEIVED INSPECTION APPOINTMENTS STREET LOCATION TIME yo TIME TIME �] SINGLE FAMILY DATE DATE DATE f INSPECTOR INSPECTOR INSP R ` since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM d lef INDIV] DUAL/ON-SITE** D_YEAR ON-SITE SYSTEM WAS INSTALLED. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HE„LTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOIIINVIRONMENTAL P.':JTECTION 825 L Street - Anchorage, Alaska 99501 • JUL 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ACILITI DI FLECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS . e)• e6o //,0// 'Zer h Ll-”, PRIOPERTY RESIDENT (If different from abov6T PHONE 2, BUYER PHONE ��/• MAILING ADDRESS —� 3. LENDING INSTITUTION PHONE r LL MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION r� - d f d �/� /+ / S%���/ CC ' P.1 �d STREET LOCATION ✓z; yo 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS �] SINGLE FAMILY ❑ One E7 Four ❑ Other _ ❑ Two E7 Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY 0 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.) 8. SEWAGE DISPOSAL SYSTEM lef INDIV] DUAL/ON-SITE** D_YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE LJ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEE AGE DISPOSAL SYSTEM L DIVIDUAUON -SITE ❑PUBLIC UTILITY Co n'ection Verified PERMIT NUMBER DATE INSTALLED INSTALLER EDI�eptic Tank or ❑ Holding Tank Size:,n�_ If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 6. COMMENTS V-- APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79)