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HomeMy WebLinkAboutVALLEY VIEW TERRACE BLK 2 LT 3Onsite File Valley View Terrace Block 2 Lot 3 #050-352-11 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211367 PID Number: 050-352-11 Dwelling: OR Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Erik L & Natasha S. Gabrielson ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 23401 Upper Terrace St, Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 854-8449 3 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Valley View Terrace 2 3 Fill added above original grade Ft. 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 Ftz Ft. Well *85r N/A N/A N/A >25 TANK © Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1000 Gal. Surface water > 100 ' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >1 0' N/A N/A N/A LIFT STATION Manufacturer Capacity I Remarks *Waiver # OSV211064 Gal. 4" of insulation over tank Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Precision General Contracting Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection �s, 9/2/21 Location and description dates: 2n Bottom of siding on shed 3rd 4111 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp -� �� Conditional Approval: Date • • �.. • .c�,� Septic System • BenjarnJ Schiller FFG' •, 12592 Approved0a-)uLXDate 1/10/2021 CE �'srF 9i8/21 . •'�� low, pROFESSIONP Note: this approval does not include well permit requirements. tmev 0oivu i 8) September 7, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 9/7/21 Subject: Valley View Terrace B2 L3- 23401 Upper Terrace St. Well Waiver Request Dear On-Site Services Engineer: We were originally granted a waiver by the MOA for the subject properties tank replacement permit that allowed for installation of a new septic tank up to 89’ from the existing well in the exact location of the existing tank. Our post-installation measurements indicate that the tank was actually placed 85’ from the well despite placing it in its exact permitted location. Site conditions did not allow for installation of the tank in any other location other than what was proposed. We therefor request a change from 89’ to 85’ for the tank. We expect no adverse impacts on surrounding wells or septic systems on this lot or any other surrounding lot. Sincerely, Benjamin Schiller, PE Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP211367 PID # 050-352-11 VALLEY VIEW TERRACE SUB, BLOCK 2 LOT 3 A B 2CO1 23.4 MH 21.8 SV 17.6 A B 2CO2 15.9 25.5 24.5 23.2 22.6FEET 0 50 100 UP P E R T E R R A C E S T 3-BDRM HOME September 2, 2021 795 780 765 755 750 745 740 735 730 720 770 775 785 790 EXISTING WELL EXISTING WELL EXISTING WELL EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 15' ELECTRICAL EASEMENT SHE D 100' WELL RADIUS NEW 1000 GAL SEPTIC TANK w/ 20" MANWAY PLAN AS-BUILT 2CO1 2CO2 MH SV PROFILE AS-BUILT (NO SCALE) 96.4 91.8 96.9 99.52COMH SV1000 GAL SEPTIC TANK 2CO96.25 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEERSeptember 2, 2021 PERMIT # OSP211367 PID # 050-352-11 VALLEY VIEW TERRACE SUB, BLOCK 2 LOT 3 4" OF INSULATION 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: OSP211367 Work Type: SepticTank Upgrade Tax Code Number: 05035211000 Site Legal Address: VALLEY VIEW TERRACE BLK 2 LT 3 G:0159 Site Mailing Address: 23401 UPPER TERRACE ST, Eagle River Owner: GABRIELSON ERIK L & NATASHA S Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: Front �° : S r Department 8/26/2021 8/26/2022 37026 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Veronica Pope GE 2021.08.26 Received By: 17:44:16 -08'00' Issued By: Date: �y Date: 0 �2 3 Municipality of AnIj P.O. Box 196650 (D 4700 Elmore Road Anchorage Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section z e n t Department xxXXXT /WAI 17 1 T7�C?�CxX Waiver#: OSV211064 COSA#: Permit#:OSP211367 PID#: 050-352-11 Legal Description: Valley View Terrace Block 2 Lot 3 Engineer: Forge Engineering Applicant: Erik & Natasha Gabrielson Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance is 89.0 feet and 85.0 feet, respectively. See engineer's waiver request and well water testing results for justifications. This waiver approval applies to the existing absorption field and proposed septic tank only. Any fixture upgrade to the on-site wastewater disposal system will require all separation distances be met or another: approval from this department. 0asaaasa220aaaRBa9aaaaaaaav0a0aaaaaaaaaaaaaaaaa9aa0avaaaaaaaaa0aaaa9vaaav0aaaaI Waiver is Granted: X Waiver is not Granted: Date: ` g .ZO 2 1 _ Approved by: lay-r—k ctnnx Name of Reviewer •vvavmevvmammmmaavvmmvmmvaavvaeaaeaaaaasaeavvaaamaaaaavavmvaaeaaasaaaavaamam0KI A ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-352-11 Property owner(s) Gabrielsort Erik L & Natasha S Day phone (907) 854-8449 Mailing address 23401 Upper Terrace St, Eagle River, AK 99577 Site address 23401 Upper Terrace St, Eagle River, AK 99577 Legal description (Sub'd., Block & Lot) Valley View Terrace B2 L3 Legal description (Township, Range & Section) Lot Size 37,026 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF)x❑ (w/wo ADU) Septic Tank Fx Upgrade Fil (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: S5' WO 4 4urxk + 0.�Sbfro r -/ P f �'1 �d� Distance:g_�°� I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 9 � 9 5 Waiver Fees: Date of Payment: 7 �do7 Date of Payment: 57+149 Receipt Number: ®�'l 9 iv 7b Receipt Number: Permit No. ©S Pa 1 1 3 6 7 Waiver No. ns V x1106 y Permit App__- ::'-.,:c August 26, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 8/26/21 Subject: Valley View Terrace B2 L3- 23401 Upper Terrace St. Tank replacement design Dear On-Site Services Engineer: The owner of the above lot is planning on selling their home and has a septic tank that has reached its end of useful life. We are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed tank location and any wells or septic system on adjacent lots. However, the tank and majority of the existing absorption trench are actually within the 100’ radius of this property’s well. This is despite the record drawings and multiple previous COSA’s all indicating 100’ separation. Unfortunately, site topography limits us to replacing the septic tank in the same spot. We are requesting that a waiver be issued allowing the new tank and the existing absorption trench both to be 89’ away from the existing well at their closest points. A water sample taken on 8/02/21 indicates that there is no bacterial contamination to the well or nitrates detected, and previous COSA water samples indicate nitrates under 1 mg/L. Therefore, the historical encroachment did not adversely affect the existing well. If the design is followed there will be no adverse impacts on surrounding wells or septic systems. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211367, Rebecca Carroll, 08/26/21 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND VALLEY VIEW TERRACE SUB, BLOCK 2 LOT 3 FEET 0 50 100 NOTE: ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. UP P E R TE R R A C E S T 3-BDRM HOME 8/25/2021 795 780 765 755 750 745 740 735 730 720 770 775 785 790 EXISTING WELL EXISTING WELL EXISTING WELL EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 15' ELECTRICAL EASEMENT 100' WELL RADIUS REMOVE AND DISPOSE OF EXISTING TANK INSTALL NEW 1000 GAL SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211367, Rebecca Carroll, 08/26/21 Received Date/Time 08/02/2021 13:43 08/02/2021 12:35Collected Date/Time 1214773001 Matrix SGS Ref.# Client Sample ID Valley View Terrace B2 L3 Client Name Project Name/# Printed Date/Time 08/12/2021 9:10Forge Engineering Inc. Technical Director Stephen C. Ede Valley View Terrace B2 L3 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS AKA08/10/21EP200.8ug/LArsenic 08/06/21ND5.00 (<10)B Waters Department EBH08/09/21SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)C Microbiology Laboratory M.A08/02/21SM21 9223B100mLE. Coli Negative 1 A M.A08/02/21SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 IN - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ® ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPH9V _A j)'7Ci ❑UP RADE MAILING ADD ES GYO LEGAL DESCRIPTION L e lea c e� Ll � �J LOCATION�'+ n /K NO. OF BEDROOMS DISTANCE TO: Well �p0 Absorption area Dwelling (nQ PERMIT NO. 9 Y W2 Manufacturer ,(A Mat eri No. of compartments Liq. ca acU�t6IF HOMEMADE: neyllons UU Inside len t� h Width Liquiddepth JDZ DISTANCE TO' Dwelling PERMIT NO. O Z Q — 2 H Man rer Materia Liquid capa O m= DISTANCE TO: Well / r [ Foundation r Nearest lot line r PERMIT NO. ! J 7 LL z No. of lines Length f ea line Total length o Trench widt inches Distance betwe lines ( QJ ,<P: p Top of tile refinish grade3 _ , Material beneath tile r itzshes Total effecti a abspr�ti on area at Length Width Depth PERMIT NO. 41- w—y Type of crib i diameter Cri ¢f♦"i Total effecti hTorption area w m STANCE TO: Well Building foundation Barest lot line J J s Depth Driller Distance to lot line PERMIT NO. � DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS 6AV_ ,,- SO] LTEST RATING �� lJ 1 INSTALLER REMARKS v � 9 C� A PROVED DATE LEGAL 72-01 WRev. 3/78) .Z_ �� ���117 ���_� � T- '-0 ��� F�ri ��x- /���c, Eiz ' DEPARTMENT u. 'HEALTH AND ENVIRONMENTAL F'OTECTION 825 /L/ STREET/ ANCHORAGE. HK. 99501 ^ 264-4720 FT VLA --- �70 I -T' iZ7 "0 Fol I'l EZ7 lot F" E=1 1"! 01 1 -1 PERMIT NO. ( 910548 ) APPLICANT THOMAS I LORD P.O. BOX 8882 LOCATION MILE 5 EAGLE RIVER RD. LEGAL LOT 3 BLK 2 VALLEY VIEW TERRHC LOT SIZE TYPE OF SOI( ABSORPTION SYSTEM IS: TRENCH 694-927.3u� 43560 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)=: 226 THE REQUIRED SIZE OF THE SOIL,HBSDRPTION SYSTEM IS: 00 L_ETzhAfw!-T_hl=== 10C3 CiFTFlN?E=L_ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FQEwC1LJlFKE=E> InEE00"T-IF; �folblK ALEACACD ��_L_arAl_w- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -1- 01 C3 1: so 2" ���EE BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO -INSURE PROPER INSTALLATION. I CERTIFY THAT 1: IHM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: T WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 7 BEDROOMS. SIGNEYhk_����________~___-_____ | THOMAS J� LORD K "R too 0L AND WELLS AS SET ENLARGEMENT IF THE --DATE- ___ V4.0 1 - ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE • `+.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: � � C/// �/'�' DATE PERFORMED: 6 �-'t � I LEGAL DESCRIPTION: �� SLOPE SITE PLAN i �l L1'�ZqlV 01v WAS GROUND WATER f ENCOUNTERED? IF YES, AT WHAT DEPTH?- 99Y..h,,,6 ■R■■.■■E■■ Date Gross Time Net Time Depth to Water Net Drop MWENNEEMON (J�N�/ " MEMEEMENEE ENEEMEMENE NOM■N!EMEN if MENMEENNEE ■■lMEMEM■■ /o NEUMENEENN s isor �U r� % `71 WHEMNEENEE EMMUMNEENN NaffiffifflEffiews NERNMERMAN Reading Date Gross Time Net Time Depth to Water Net Drop (J�N�/ " Z if /o s isor �U r� % `71 PERCOLATION RATE ` (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: S S Engineerini CERTIFIED i 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPT. Gi I'" UH R ENVIRONMENTAL i•.=:;CTION tt w'prtt trb 3rt tug on by RECEIVED A & L, DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTIOAL_�'j r DATE -Started ���'°='�'F Ended PERMIT NUMBER KIND OF FORMATION: DEPTH OF WELL ..S ,: `' STATIC LEVELOF WATER F"C DRAW DOWN FT. GALS. PER HR KIND OF CASING FromFt. to'� Ft ��'��'•/��'Ti�J',.._-.J From Ft. to Ft. _ r From Ft. to J - Ft.����%= ��� E `aid_ ` �''`'"From Ft. to Ft. r From Ft. to Ft. 6','t 4v%Z '' i0' -" V -%'From Ft. to Ft. From ' Ft. to -f� t =' Ft. '�� = y l' From Ft. From i Ft. to , '' Ft. i5 S:iJ 'a+-r=� '-Ye4•. %.�1,:; -J From Ft. From Ft. to Ft. From -Ft. to Ft. From Ft. to L) L -' Ft. i -' u ? From Ft. to Ft. From Ft. to `� Ft ".. -Li-' - - 'moi- =-' /•�`�-rii From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to "L ' LFt. `''J��'4'4--�� From Ft. to Ft. From '.+ Ft. to -,:7 Ft / '�: dlt.'a<_/(, r�Z From Ft. to Ft. FromIFt. 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. MISCL. INFORMATION: DRILLER'S NAME - 'I - _ - - -- - - LE DEPARTMENT WvHEALTH AND ENVIRONMENTAL PR TECTION x:25 'I_ =.TREET: ANCHORAGE, AK. 991 264-4720 NA E_ L 1-_ 1=" 1_ F=-. 41 I -1- 'ERMIT NO. C 780511 -L ICANT &QUAD 0 FOX 157 EAGLE RIVER. 694 2588 =1TION VALLEY VIEW TERRACE i% L3 B2 VALLEY VIEW TERRACE LOT SIZE 0 SQUARE FEET 11MUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL.SYSTEM I_- -A FEET FOR A PRIVATE WELL; OR A TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL... I_ LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY= THE WELL COMPLETION. AER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CON:=TR:UCTION DIAGRAM'= ARE iILABLE TO INSURE PROPER INSTALLATION. I E f:;-: 1'•l I 1- 1 E> E= e_ EE 9.1 EA EE FQ = _1._ . aL.. _a : :_: ERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS _•EL -2TH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. APPLICANT THOMAS LORD IE:D B4 L � - ---- -----------_DATE_ 1_2 ------- V3. Mt S N d S AA. I i va. O FF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-352-11 s { f 11 RUSH Certificate of On -Site Systems Approval Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: -be-C 10 • %) 21 1. GENERAL INFORMATION Complete legal description Valley View Terrace Block 2 Lot 3 Location (Site address) 23401 Upper Terrace St, Eagle River, AK 99577 Current property owner(s) Erik & Natasha GabrlelSOn Day phone (907)854-8449 Mailing address 23401 Upper Terrace St, Eagle River, AK 99577 Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: _ Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -b, (9 33o Waiver Fee $ Date of Payment 9' Fzo � I Date of Payment Receipt Number. ! � 3 5 D Receipt Number COSA # O S C 2 I I.5LIZ 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 9/2/21 QF AC TH4 DSD SIGNATURE' �"}� ® €�v ? System #1 Approved for 3 bedrooms Ben'a I ) r�r��chiller ! System #2 Approved for bedrooms �����s�F . 9/2%2192 Disapproved®�P,ROF �SS0 0� Conditional approval for bedrooms, with the following stipulations: OF ATF G'-^ g A1ER ANDpo z J F� S;Wl)�ll\\, By: Original Certificate Date: 1 16 .zo 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 blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: 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 Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade 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 Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Valley View Terrace Sub, B2 L3 050-352-11 ■1.3 7/27/1978 300 70 ■ ■ 16 Forge Engineering 8/2/21 238 8/2/21 <1 Septic/Plastic New ■ Tank installed on 9/2/21 Deep Trench 7/20/81 8/2/21 ■3 7.6 2 3.3 580 2 ■ 1440 4.3 2 >450 ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes 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 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 ft F. ENGINEER’S 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. 9/8/21 85*✔ ✔ ✔ ✔ 90*✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 0.5** ✔ ✔ *Waiver OSV211064 **Waiver OSV161090 ✔ WEST Fd 1/2' Rbr w/ Original wood stake 43' 193,47' 15' Electric Esmt. (Page 68, Book 1001, A.R.D.) 1 32.6. 55 14, Deck d l0 Deck 2s.s 'ti a Z Frame House 12 40- Fd IP w/Original _ wood stake S 64 048 3 °g e LOT 3 BLOCK 2 Septic MH ---@ 7 10'x12' Septic Shed Pipes O LEGEND 0 2' Capped Iron Pipe 1 0 Septic Vent %S ® Well Pipe °°� Q Sewer C/0 Power Pole 9/7/2021 Updated location of new septic system 14'x20' ' Deck o2 Paved Driveway ST I hereby certify that I have surveyed the following described property: Lot 3, Block 2, Valley View Terrace, Plat No. P-574, Anchorage Recording District, and that no encroachments exist except as indicated hereon. This As -built will only show the easements that appear on the recorded subdivision Plat No. P-574, Anchorage Recording District; under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines 0 20 40 SCALE IN FEET 1"=40' September 7, 2021 Valley View Terrace Lot 3 Block 2 As Depicted on: Plat No. P-574 Anchorage Recording District GRID: SWO160 OF A� _ A".Xn TH ony P. Bonet 0 a LS -10393 ASBUILT SURVEY Erik L & Natasha S Gabrielson 23401 Upper Terrace St. Eagle River, Alaska 99577 dVfl@RNR I C ECKMI. APB Land Surveying 12204 East Prince of Peace Drive Eagle River, Alaska 99577 (907)227-1361 • Municipality of Anc On -Site Water and Wastewater (907)343-7904 Certificate of On -Site Systems Parcel I.D. 050-352-11 1. GENERAL INFORMATION JUL _ s„E„ Expiration Date: 11- 3— L i0 Complete legal description Valley View Terrace, Block 2, Lot 3 Location (Site address) 23401 Upper Terrace Street Eagle River, AK Current Property owner(s) Calvin & Haley Ragsdale Day phone 632-2684 Mailing address Real Estate Agent P.O. Box 770952 Eagle River, AK 99577 2. TYPE OF DWELLING: Fx] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx� Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by:/Q���� /'dim, Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 51 y% 9 TI Date of Payment 0—Ig ke Receipt Number ONY9? COSA#— 05GI 6l 3P119, Waiver Fee $ 15.00 Date of Payment 3131901(o Receipt Number 631 a� Waiver# 05\11101090 5. STATEMENT OF INSPECTION SY 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 verifythat 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for a— bedrooms Phone 522-7773 Date 7/26/201 st System #2 Approved for bedrooms#.re .�7 Disapproved Conditional approval for bedrooms, with the following stipulations: By: _ t vViv�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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheet r '-. 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 Valley View Terrace, Block 2, Lot 3 A. WELL DATA Well type ?V-14AIM Date completed 7/27/78 Total depth 300 ft If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to.ft. 70 FROM WELL LOG Date of test 7/27/78 Static water level 90 ft. Well production WATER SAMPLE RESULTS .5 g.p.m. Parcel ID: 050-352-11 Well Log (Y/N) N Wires properly protected (YM) Y Casing height (above ground) >18 in. AT INSPECTION 7/7/2016 236 ft. .61 g.p.m. Coliform 0 colonies/100mL Nitrate •156 mg/L Arsenic ND ug/L Dateofsample: 7/6/16 collected by: And. Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 7/8/2016 C. ABSORPTION FIELD DATA Date installed 7/81 Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N _ Pumper JRs Pumping,, Date installed 5/20/01 Soil rating (g.p.d./ft2 or ft2/bdrm) 226 SF/BDRM System type Deep Trench Length 68 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 9 ft. Eff. absorption area 680 ft2 Monitoring tube Y Depression over field N Date of adequacVtest 7/7/16 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 461 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested E. SEPARATION DISTANCES 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' SEPTIC/HOLDING TANK ON LOT TO: >5' >5' Manhole/Access (Y/N) in. High water alarm level Meets alarm & circuit requirements? On adjacent lots >100' `. ' "• On adjacent lots >100, Pubjjq sewer manhole/cleanout >100' Holding tank >75' Manure/animal excrete storage areas >100, Building foundation Property line Water main >10' Water service line > 1 0' Wells on adjacent lots >100, ABSORPTION FIELD ON LOT TO: Property line 5 Building foundation >10 Water Service line >10' Surface water >100, Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS ***See Lot Line Waiver. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 7/28/2016 COSA brown sheet 10-10-12.doc Absorption field >5' Surface water >100, Water main >10, Driveway, parking/vehiclestorage >10' in. Municipality of Anchoragey a APR 5' � `. Development Services Department` Building Safety Division E,°y On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC161325 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 3 of Valley View Terrace subdivision, the well's productivity was determined to be .61 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX July 28, 2016 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 3, Block 2, Valley View Terrace Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The absorption trench on the subject property has been in place since 1981. Records in the Municipal files indicate the trench was constructed more than 10' from the east property line. Two Certificates of On Site System Approval (COSA) in the file indicate the trench is more than 10' from the property line. Unfortunately the trench is .5' from the property line and a lot line waiver is required. The trench does not impact the property to the east, Lot 5, Block 2, Valley View Terrace Subdivision. The septic system on this lot is located in the southeast corner of the lot more than 100' from the end of the absorption trench. The trench is also more than 100' from all wells in the area and more than 10' from all septic systems in the area. We request a waiver be issued allowing the trench to remain .5' from the east property line. Sincerely, W� C:r a"I� Michael E. Anderson, P.E. To: Thomas J. Lord Subject: Lot 3, Block 2, Valley View Terrace Subdivision Waiver Notification To Whom It May Concern: The Municipality of Anchorage On-site Water & Wastewater Program (On-site) regulates private drinking water wells and septic systems for single family residences in accordance with Anchorage Municipal Code (AMC) Chapters 15.55 and 15.65. The Chapters include minimum separation distance requirements for private drinking water wells and septic systems. The requirements represent a conservative approach to protecting public health. Occasionally, the construction or upgrade of a property's well or septic system cannot be accomplished without reducing the code required separation distances. In these situations, a waiver to the required separation distance may be approved if an Alaska licensed civil engineer can successfully show that the public health will be maintained. The code requires an absorption trench be located a minimum of 10 feet from any lot line. The subject property owner's engineer has formally requested a waiver be granted to allow the absorption trench to be .5 feet from the common lot line with Lot 5, Block 2, Valley View Terrace Subdivision. On-site has reviewed the engineer's request and supporting documents, and is satisfied that the public health will be maintained with the reduced separation distance. A waiver approving the requested separation distance will be issued in accordance with the code. AMC 15.65.140 requires all adjacent properly owners be notified seven (7) days prior to issuing a separation distance waiver. This letter and a copy of the have been sent to you in accordance with this requirement. On-site Water & Wastewater Program Please indicate below if you have no objection to the granting of the waiver. Thomas J. Lord STATE OF ALASKA) THIRD JUDICIAL DISTRICT) r� The foregoing instrument was acknowledged before me this day of, 20 kL0 , by T -1i, OIV16tJ 1,0yw� NOTARY PUBLIC FOR ALASKA My Commission Expires: ) (o IAQkC(_ "official seal" Notary Public .: GWi Langley - State of A10" cammf"1000196969M 93PIM MAbRP19 Fd IP w/original wood stake p Boz TER��e�R � ® Sr © 10'x12' Shed LEGEND o 2' Capped Iron Pipe _ (S Septic Vent 1jS1 0 0, Q Well Pipe 49 Sewer C/O -a Power Pole 7/07/16 Added 2' Capped Iron Pipe and one additional Septic Pipe 1 hereby certify that I have surveyed the following described property: Lot 3, Block 2, Valley View Terrace, Plat No, P-574, Anchorage Recording District, and that no encroachments exist except as indicated hereon. This As -built will only show the easements that appear on the recorded subdivision Plat No. P-574, Anchorage Recording District.under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines. o ?0 s0 v® SCALE IN FEET 1"=40' Surveyed: July 7, 2016 Valley View Terrace Lot 3 Block 2 As Depicted on: Plat No. P-574 Anchorage Recording District GRID: SW0160 OF ALgsIF'+t 5*" 1H. .I..... ...:k �'. Robert W. Rams LS 9865 = fit 1-711 ASBUILT SURVEY Haley A. & Calvin T. Ragsdale 23401 Upper Terrace St. Eagle River, Alaska 99577 APB Land Surveying 12204 East Pdnce of Peace Drive Eagle River, Alaska 99577 (907) 227-1361 WEST 193.47' Fd 1/2' Rbr w/ 15' Electric Esmt. original wood stake— (Page 68, Book 1001, A.R.D.) ' 43' 14, Cb toDeck 30' Deck b- 25.5• i^b P nn�� 'V y Frame House M / / 1 I. le. 5• is, I E'x5'1��13• 21. r Gravel it Stairs I ieck a O LOT 3 Parking i� BLOCK 2 �, -.; Pave d Driveway Fd IP w/original wood stake p Boz TER��e�R � ® Sr © 10'x12' Shed LEGEND o 2' Capped Iron Pipe _ (S Septic Vent 1jS1 0 0, Q Well Pipe 49 Sewer C/O -a Power Pole 7/07/16 Added 2' Capped Iron Pipe and one additional Septic Pipe 1 hereby certify that I have surveyed the following described property: Lot 3, Block 2, Valley View Terrace, Plat No, P-574, Anchorage Recording District, and that no encroachments exist except as indicated hereon. This As -built will only show the easements that appear on the recorded subdivision Plat No. P-574, Anchorage Recording District.under no circumstances should this data hereon be used for the construction or establishing of boundary or fence lines. o ?0 s0 v® SCALE IN FEET 1"=40' Surveyed: July 7, 2016 Valley View Terrace Lot 3 Block 2 As Depicted on: Plat No. P-574 Anchorage Recording District GRID: SW0160 OF ALgsIF'+t 5*" 1H. .I..... ...:k �'. Robert W. Rams LS 9865 = fit 1-711 ASBUILT SURVEY Haley A. & Calvin T. Ragsdale 23401 Upper Terrace St. Eagle River, Alaska 99577 APB Land Surveying 12204 East Pdnce of Peace Drive Eagle River, Alaska 99577 (907) 227-1361 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:]/www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program yrenr � n Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161090 COSA#:OSC161312 Permit#: PID#: 050-352-11 Legal Description: Valley View Terrace Block 20 Lot3 Engineer: Mike Anderson Applicant: Calvin Ragsdale Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is .5 feet. This waiver approval applies to the existing 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. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 3Coo Approved bv: kA N e of Reviewer ............................................................................... MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services WARW On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING q Parcel I.D. # D6r - HAA.# 1. GENERAL INFORMATION Complete legal description Z Location (site address or directions) aA/i :LYn=� aPropertyowner y` N, �°�� Day phone���Y Mailing address.. Lending agency Day phone ?Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 � 3. TYPE OF WATER SUPPLY: Individual well —�-- 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 — 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(FW.1/91) Front MOAU21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE �` Approved for E: bedrooms. Disapproved. Conditional approval for Additional Comments 0 4l1TIC 61141—�L-`t7% Date q i 2-z g 8' ROMT G COWAN ,? CE .6801 ;►�w`�a bedrooms, with the following stipulations: Date 9"Z r' 98 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-M (RW. 1R1) 8aok MOA N21 Municipality of Anchorage !� DEPARTMENT OF HEALTH & HUMAN SERVICES } Environmental Services Division to C (" )' i§ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-A7AA SEF 2 Health Authority Approval Checklist MQNitiwK ItY OF AW -ti JtAGE 3 5 2- d ` I jNVIRQ WENTALSERVICESDIVISION Legal Description: of D'�-�-4 �l�,k.r-� �fr�Parcel LD.: A. WELL DATA Well type ?�'A \I AT -r-- If A, B, or C, attach ADEC letter. ADEC water system number `�— Log present &N) S( Date completed � yf Total depth 1, 00 Cased to �e Casing height (above ground) /L Sanitary seal (�11\1) 1E Wires properly protected C&) FROM WELL LOG AT INSPECTION Date of test Static water level Well production 2 S. p WATER SAMPLE RESULTS: Coliform Nitrate D• 1 8Z Other bacteria / Date of sample: S' �7 % �� �� Collected by: s9 f�z- B. SEPTIC/HOLDING TANK DATA Date installed jcw I Tank size Number of Compartments -7'— Cleanouts�N)—Y— Foundation cleanout &N) Depression (YA,) e3 High water alarm (Y/N) Date of Pumping "'%�' _ Pumper n�� iJMQ+�S C. ABSORPTION FIELD DATA Date installed l bl Soil rating (g.p.d./ft2 or ft�/bdrm) �a System type —�"f�� Length Width. 3 Gravel thickness below pipe Total depth Effective absorption area 6 e Monitoring Tube present O/N)—y — Depression over field (YID J A) Date of adequacy test Results kaas/Fail) ?If�5S For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately afteril4'rgal. water added (in.): `{ N �f ii -- Fluid depth 12 (ins) Minutes later: AIP0 Absorption rate y = Z w g.p.d. Peroxide treatment (past 12 months) (Yg .je JA If yes, give date 72-026 (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: E Septic/holding tank on lot wo 1 Absorption field on lot II ll2 o t Public sewer main "Pump off" level at* _ On adjacent lots On adjacent lots Public sewer manhole/cleanout Oot 1- tk Sewer /septic service line ZS Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5 f Property line 1' Absorption field Water main/service line (o Surface water/drainage foo Wells on adjacent lots (9a SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I o I Building foundation /V I Water main/service line (a I f� �a Surface water l oa Driveway, parking/vehicle storage area .70 Curtain drain A)� Wells on adjacent lots /00 {- � F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA H g id�line n effect on this date. bAIV cj e Signature %��G •_ Engineer's Name 2a 6 c2y _ CQ, AA, T(^ \..'.. RO Date °'r +L w HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.]Jk9BC) During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot 3 Block of \�n��Q�yjpVJ�ef(CiG�i Subdivision, the well's productivity was determined to be O•_�O gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a �j bedroom residence is 0,312 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and -watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. HEALTHAUTHORITY APPROVAL$ SEWER&WATER MAINEXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES ANDREPORT4 WELLINSPECTION & FLOW TEST SITE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS WELL RECOVERY TEST DATA (907) 694-2979 CLIENT: --1 c WELL LOCATION (legal): L 3 3 2- / 6 TEST DATE: a-lZ-Cid TESTS BY: EAMHna.�il WELL DEPTH: (obe' WELL DRILLER: T U k.3 CASING DEPTH: o ' DATE DRILLED: 77Y J 198i /✓)E/P �u, TEST PROCEDURE: MISC DATA: 1) Draw water down to pump. 114- Casing Height: lZ 2) Shut pump off 15-60 min. Sanitary Seal? F 5 -record time Wires In Conduit?��__S���— -record meter reading Grading O.K.? —fS8011 3) Turn pump on. Drawdown. Pump Depth: 4) Shut pump off. Samples Taken? L %S 111133c {ZGTPI� -record time Date: l7 S -e _ -record meter reading (I.2J 5) Calculate gal./min. recovery. OFF TEST DATA: START TIME: STATIC WATER LEVEL: TRIAL PUMP TIME METER GAL./Uhf- 1 OFF C> MI5 �P)� ON OFF 9 ' t� 7 z 4 • 2 OFF 0`�� 7;_ 111133c {ZGTPI� ON _ OFF (I.2J 731..`I 3 OFF �;� pito q2W ON OFF i u 3S 7`I 3 ,� 4 OFF - ON OFF 7 2.1 5 OFF /"M , ON CrJ% � f✓l v -2-A OFF RESULTS: WELL CURRENTLY PRODUCES: ^' `12 6r," Ajs p4A 146/J FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR. oec.74PY 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 SEP -17-1998 09:38 CT&E ESI ANCHORAGE 9075615301 P.01i01 ME Environmental Services Inc. Laboratory Division ����r 200 W, Potter Drive rinking Water Analysis Report for Total Coliform Bacteria Anchorage. - 0 2 299518-1606 43 18 1605 READ INSTRUCTIONS ON RE VERSESIDEREFORECOLLECTINGSAMP�c nnnvrFTEbBYLABORATORY SU PUBLIC WATER SYSTEM LD. R1—i--�— PRI V ATE WATER SYSTEM O Se�dR utts C Sandlnvalce jm�� mmo an fYnem wnd amp'+m urn< u um er o e um r ESendige;uIts ❑ Send Invorce uu 'P Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable le ❑ not Sambe over 48 le too hourin s old tat examination ld to indicate l new sample via sipecciial delivery please erymail' Date ReceivedTime Received t tri Analysis Began _ AnalyticalMethvd: /(3 MMO-MG 'Ite * Number of colonies/100 ml. Result* Analyst SAMPLE DATE: MOM MI onth Day`Year 5 0 913 I t Nit — SAMPLE TYPE: I Fbks Jun 13 Aa Routine ❑ Treated Water ❑ Repeat Sample (for routine sample ❑ Untreated Water Date: Time: with lab ref. no. ) Client notltled of unsatisfactory results: C) Special Purpose Time Collected SAMPLE LOCATION Collected BY O Faxed n f�,��f Phoned Spokewith 1_ 3 Q � g U J Y �� y��=— Date: _ Time Aiwa e.ui BACTERIOLOGICAL WATER ANALYSIS ACCORD MMO-MUG Result: Total Coliform//�� E' Ceil MembraneFilter: Direct Count , � � �1D Q) I,' Colonles/100 m1 TNTC •Too Numsroae Ta Counr Verification: LTB BGB COLIFIRM % Oe-Olhr.aaclen= Fecal Callform Confirmation Final Membrane Filter Results 5 r✓'c�v�i _,,'Coliform/100 ml Reported By Date hrs tt� Time l Comments: ' _ Member of rho SOS Group fSocibtbGdn6rBIB ds Surve1118nce) 1 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAW) MIPtRT_Al1 TOTAL P.01 AUG -21-88 08:56 FROM -CTE ENVIRONMENTAL I AL CT&E Environmental Services Inc- CT&E Ref.N Client Name Project Name/N Client Sample ID Matrix Ordered By PWSW 984544002 S & S lragitteeritlg N/A Lt 3 Bk 2 Valley View Est. Drinking Water 0 Parameter Results POL units Torat Coliform Y6e8i-}e0nrt—no'to}t R&$4M,°L413 Nitrate -N 0.182 0.100 W/L 5615301 7-584 P.03105 F-611 Client PON Printed Datr/Time 08/20/98 17:18 Collected Irate/Time 08/17/98 14:05 Received DatePllme 08/18/98 15:35 Technical Director: Stephen C. Ede Released By 114 a _ / t _ A Method SM18 92228 EPA 300.0 AltoNaele Prep Anatysis limits Date Date /nit 08/18/98 KAP 10 max 08/18/98 RNV MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lop, block, su division, section, township, range) L_,,, 5 f3L_N ' VAL-4-6- r-, t/ Location (address or directions) 12 /Zb (b) Applicants Name/��sc9j1 5 o2la Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder rz7<1; Buyer = ; Other (explain); (d) Lending Institution Telephone 2,rJ`-l'-( Ads s (e) Real Estate Co. 6 Agent Address Telephone (f) Ma- - the HAA to the following address: ri 3t �•. !`-:q%.i 1':'y" � i±iia b l'i Sd e3:>ti 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Individual Well; Multi-Family Community = Other (describe Public M 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 E- ::l Community E:::l Holding Tank El 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 Z] r-1 5. Engineering Firm Providing Inspections Tests File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms By Approved Disapproved Terms of Conditional Approval CAUTION Telephone Raboa A. $ha5sr THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 A. WELL DATA -) AAINICIPALIT'' OP AP!Cf iORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. O,' f.E:•LT,' r. HEALTH AUTHORITY APPROVAL (HAA) ENVIP.ONMEPi;A" 1'N0;ECTI0N CHECKLIST - FEBRUARY 1984 APR 2 9 1985 Legal, Description: 7 - Well Classification S F If A, B, or C, D.E.C. Approved(Y/N) J//a Well Log Present &IN) Date Completed 7-27-7t? Yie1d7�C9PN�. Total Depth ? cam' Cased to 10 / 9 �✓ Depth of Grouting Static Water Level 10 Pump Set At (AA{ Casing Height Above Ground Sanitary Seal on Casing W) Electrical Wiring in Conduit q'_VN) Depression Around Wellhead (Y Separation Distances from Well: To Septic/He1dipq-Tank on Lot /®p On Adjoining Lots /00 To Nearest Edge of Absorption Field on Lot /pp ' on Adjoining Lots To Nearest Public Sewer Lire '--"IA To Nearest Public Sewer Cleanout/Manhole -u 1A To Nearest Sewer Service Line on Lot SZ) . Water Sample Collected By 59.5 6&0,,e, Date - Z_� --66- Water Sample Test Results a�/I T7SA•fl�m /z�/ Comments A k/��i, /M" kJ -7-4 5S9 5/fo1� O T I.•/i��c Tta P go IDUCcz inJ �xC�ss 2ta c,FN. B. SEPTIC/RMSENG TANK DATA Date Installed - Z - 1 Size 1 No, of Ccmpartrrents - Standpipes 6/N) Air -tight Caps (VN) Foundation Cleanout JMN) Depression over Tank Map_Date Last Pumped 2 q -,96- Purriping/Maintenanee Contract on File (Y/N) .A ; for Holding Tank High -Water Alarm (Y/N) fLA Temporary Holding Tank Permit (Y/N)'"I Separation Distances from Septic/1 Tank: To Water -Supply Well /po To Building Foundation /o© i To Property Line ^j0✓4 To Disposal Field To Water Main/Service Line- ✓fi To Stream, Pond, Lake, or Major Drainage Course '�Jg Comments Receipt # 33Caco�� _ Date Paid:y-_;LC) " Amount: uS'Co [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 2 31A16zz_ Type of System Design( Date Installed 7 -Z -0 -el Length of Field lnCR' Width of Field .�(� ` Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 6,80 r1b Standpipes Present �Y%/N)� Depression over Field (Y&Y Date of Last Adequacy Test -z5--Sr Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply We11 /yO / To Property Line /p To Building Foundation /630 ' To Existing or Abandoned System cn Lot fZA 1 Cn Adjoining Lots 30 /(- To (To Water Main/Service Line /40To Cutbank(if present) '"1a To Stream/Pond/Lake/or Major Drainage Course L/6 To Driveway, Parking Area, or Vehicle Storage Area go Convents D. LIFT STATION Date Installed Dimensions Size in GallonsManhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for in C cles during Adequacy Test. Meets MOA Electrical Codes(YM) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. —r [Page 2 of 21 2 -15 -?S Signed Company ��IIaB RIVER ALAS{C�V X301? MOA NO. 6_3 JOY �Y RBl/a5/S arw,s V Nal�nr9 A. 3hattirp No. 1074: [Page 2 of 21 2 -15 -?S