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HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 5 LT 5River View Estates Lot 5 Block 5 #050-792-28 C'��1 ./19 fe04«.�l �... �.... to MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES On Site Services Transmittal Sheet TO:/3e 6 S h a -Ac✓ LEGAL: L -S /3 -5 - GPI UBR v/� The attached paperwork has been reviewed and is being returned for the following reason(s): Discrepancy in legal description and/or owner name. Discrepancy in number of bedrooms. Signature and/or stamp missing on Show measured distances to sewers/wells, curtain drains and streams within 200 feet of proposed system. Replacement disposal site not shown and/or tested. Calculation error in design. Show locations of all soils, percolation or water table tests. Proposed system too deep for soil test submitted. Topographic information missing or inadequate. Narrative missing or inadequate. V Additional soil/perc test needed. Sand filter requirements not satisfied. Water monitoring results missing or inadequate because Incomplete; missing L ncr .c- A d- 13 t' -In 1� s— r'"' Well log req Water sample / 1� S ired. unacceptable becaus Other /!/ cyC h ow / c5! ho �e /h 30— Please 0Please supply the necessarnformation and re -submit your request. Your cooperation is appreciated. Reviewer // e - Date / — � - ®a LEAVE THIS FORM ATTACHED TO PAPERWORK /203 -rev. 4/93 Municipality of Anchorage Page I of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S I" )7 9 0a 6�? PID Number: 050--79a-D9 Name: D ;507e I/ c__1`ate 770'a�0 Wastewater System: ® New ❑ Upgrade Adders: �ox a!`'ls E le 14r 0/9,577 FIELD Phone: No. of Bedrooms: ❑ Deep Trench P4ShaIIOW Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: � Total Depth from original grade: R GPD/Sq. . Ft. Lot:Block: Subdivision: // S S ki'vel-view 6Sf Depth to pipe bottom from original grade: Gravel depth beneath pipe . IX Ft. Ft. Township: Range: Section: e: Fill added above original gra1e:0 Gravel length: q a � FL Ft. WELL: New ❑Upgrade Gravel width: S Number of lines: I Distance between lines: Ft. Ft. Classification (Private, A,B,C)I:_ P/ Total Depth: Cased Tion Total absorption area: ^-/� 3/ Pi/p�g material: O Q f V L I T© Ft. �(/ Ft. SQ. Ft. /, 5 O3 Driller: S//I, Date (DIrilled: � Static Water Level- Installer: �Q .i Date installed - (� J / b L, a� wg7e✓�G'�1S L Ft. w¢2U CLGLVg1/rn l Yield:/ Pump Set at: Casing Height Above Ground: TANK L6 GPM FL Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E-P. To Septic Absorption Lift Holding Public/Private Mapufacturer` Capacity in gallons: From Tank Field Station Tank Sewer Lines (/e/✓J (e/ / C 5 1000 Well N 4- 00 '004 — _� Material- nO'Ly PiY� /ewe t` Number of Compartments: Surfac X00'4- I(V+ LIFT STATION Water Lot�( /�♦ I k Size in gallons: Man rer: Line 1 V Foundation �� { 3` {{{ "Pump on" level at: "Pu "leve High water alarm at: Curtain Pump Make el Electrical Inspections performed by: Drain G f'! _ y1 (�/ f/l Remarks: BENCH MARK Location and Description: To We / Assumed Elevation: 100 O0 ENGINEER'S SEAL r.. S & 5 ENGINEERING 17034 Eagle River Loop Read, No. 204 99M Dates: 1st 9 6`19 Inspections performed by: E-91, Rivor,Alaska '%` 9 9 2nd 6— Department of Health and Human Services approval Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW990268 PAGE 2 OF 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 5, RIVERVIEW ESTATES P.I.D. NO. 050-792-28 LOT �d II/Cy WW \ TH#Z \ 10� oeu s neA / \ 1000 GALLON 0E 1 \ o PHLYETHYLENE TBM PTIC TANK i T3 \ 1p \ TH 1OSi1T2 co A,�tic EXISTING .It. MT2 CO2 FOUNDATION Sid N LOT 4 SCALE: I" = 40' , I . " PERMIT NO. SW990268 PAGE J OF Municipalit of Anchora e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.0, Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 5, RIVERVIEW ESTATES P.I.D. No. 050-792-28 102.0' Mm FINAL GRADE INSULATION NEW 1000 GAL. POLY. TANK 98.9' C01 MTI CO2 MT2 C01 = 101.8' CO2 = 102.1' FINAL GRADE 2" INSULATION zmzzzznza C01 = 98.7' 14 R CO2 = 98.7' MTI = 95.8' MT2 = 95.8' WATER FOUND @ 91.3' 88.8' B.O.H. N. T. S. \r. osN MT %LT:rf iffirb Prilling by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND D,SoTL!(, domiS I^ ADDRESSA> i3Q)( 7 7 O d i O E 2. LEGAL DESCRIPTION 134K S 4o7 KIVta�yl15Mj PERMIT NUMBER. 7 0 d4 Date of Issue- /Q -_n TAX INDENTIFICATION NUMBER oTa - -M2 dr Is well located at approved permit location? es O No Method of Drilling: air rotary ❑ cable tool Depth of well: Casing TypeTEt� Wall Thickness inches Diameter 611 inches, depth C2 D feet Liner Type: 1%)0OJC - Casing Stickup Above Ground: 01 feet Static Water Level (from ground level): Jr feet Pumping level: feet after hrs. pumping gpm Recover Rate: 6 gpm Method of Testing: 4iA Well Intake Opening Type: Q Open Endpen Hole Q Screened; Start feet Stopped feet Q Perforations Startt Stopped feet Grout Type: 13c.4 4A`'Volume Depth: from 10 feet, to feet Pump Intake Depth: Pump Size p Brand Name Well Disinfected Upon Completion? 43 -Yes nQ No Method of Disinfection: C41 %, �14C V s ?/O Comments: BORE HOLE DATA DEPTH From To D oZ C45110(p J�P ok l oyC it I� SI<i7 C<04i s64.f�:'G 1S' Q�dQ�ca 6e�Y S -S lot %SfdOtoce /¢,a.co 6Rc� r.J 1061 Oct, ,041 c C. 644-e / / 1?6d40Ce- 64041 6?,acs01e60 6-�prr1 /y° gerswoc-c 6RAY Driller's Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW990268 Legal Description: RIVER VIEW ESTATES BLK 5 LT 5 Date Issued: Aug 10, 1999 Expiration Date: Aug 09, 2000 Parcel ID: 050-792-28 Design Engineer: 0003 S & S Engineering Site Address: Owner Name: Disotell Construction Lot Size: 42716 SQ. FT. Owner Address: PO Box 770210 Total Bedrooms: 3 Permit Bedrooms: 3 Eagle River , AK 99577-0000 This permit is for the construction of: ❑✓ Disposal Field ✓❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours priorto each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: A Date: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 nclosure ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 July 30, 1999 HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 MAINEXTENSIONS REFERENCE: Lot 5, Block 5, Riverview Estates S/D SEWER & WATER INSPECTION Request you issue a permit to install a well and septic system to serve the proposed three bedroom dwelling on the referenced property. ENGINEERING NDIR P Two test holes were excavated and percolation tests performed. The approximate TSSTUDIES locations of the test holes are located on the attached site plan. At the time of excavation, 7-7-99, water was found at 9 feet. After seven days of WELCTION &RLOWTESowresr ground water monitoring, water was found at 9 feet. The existing septic system installed in 1982 has never been put into use. The tank has been removed, and the existing trench will not impact the development of this lot as SITE PLANS proposed. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve ROAD DESIGN areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SOILTEST If you require additional information, please contact us. Sin'or l PERCOLATION TEST Rob. Sha e , STRUCTURALB MECHANICAL �+' C �� INSPECTIONS ' nclosure ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 7" = 60' zm CN som 'o z El 0 DESIGN SITE -PLAN o m s� o C C =mA� o�mo � ooAA Z M m m m m v G rWVo m o rn b �c Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: lqc;--CY/,L/ii L -L 1161 . DATE PERF( LEGAL DESCRIPTION: 0�� 7 K\i&_\i((-.aVAeownship, Range, Section: �� D t� 1 49 2 9' U 3 4 �• p'. 'r 6 Es' 7 $ =o 9 S 10 11 J ;� 12 31415 13- 14- 15 16- 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT 31 b`I DEPTH? t� ( Depth to Water After Sr Monitoring? SLOPE SITE PLAN N T S L O P E Dale: Reading Date Gross Time Net Time Depth to Water Net Drop e,x-K� �cA-r[7G7 PERCOLATION RATE�L'� `minutes/inch) PERC HOLE DIAMETER � L s rEBT RUN BETWEEN FT AND /'� FT COMMENTS PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W H LST AN MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) - Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 12IS O'��—Ll� L° It CR DATE LEGAL DESCRIPTION: L S fScrTownship, Range, Section: i yyyyy SLOPE 1 � ) 5 / 3 ` 0, `20 U U>6-" \ 4- 6 6 7- 8- 9- 10- 9 10- 1 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? �- J S IF YES, AT WHAT I L O DEPTH? P E Depth to Water After r %"vY-W Monitoring? Date: 7'"12f'ql SITE Reading Date Gross Time Net Time Depth to Water Net Drop a 3" w S� 3" t IDw�.nl 5" 3" 1l?' 3 20 L_J (� PERCOLATION RATE 1,6 (minutes/inch) PERC HOLE DIAMETER EST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEW AE ND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-00 (Rev. 4/85 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS Lot 5, Block 5, Riverview Estates July 30, 1999 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon polyethylene Premier septic tank and leachfield trench for the proposed three bedroom house located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page 2 Lot 5, Block 5, Riverview Estates July 30, 1999 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 5, Block 5, Riverview Estates July 30, 1999 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tyne of Pine Perforated SWW Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 5, Block 5, Riverview Estates July 30, 1999 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE / ® DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT NAME ) ---- PHONE 2 m EW C IWS' S .._/G-Yf �..CJ,7`I �_L� _ R 1 J U ❑ UPGRADE MAILINGADDRESS Gq}Cq� ` �a%i � Io l E1_0'y�)- L5 T ],_ -- LEGAL DESCRIPTION - G� 1 s -46-11 Lf6 1 � S� �9 77"� LOCATION, I g. NO. OF BEDROOMS Well Absorption area ng /{, DISTANCE TO: /V� ��? _ PERMIT UO. Ef aQ Manufacturer al w G 2 CE; L2STEL_ TMa No. of compartments Z Liq/c@p�it�y in gallons Inside length (' IF HOMEMADE: ®�- Liquid dept,h e` n0Z DISTANCE TO: Wcll Dwel ing -- PERMIT NO. = z h —._-- Manufacturer * Material Liquid capacity in gallons O .-� 2 J u.Z Z Well DISTANCE TO: No. of lines Length of each line Foundation Total le i flues Nearest lot line Trench width PERMIT NO. Distance between lines w inches aF Top of rile to finish grade Material bee rile�qq %7, Total effective �)s�r�.tftyyly�ea inches W Length / 3� _ Width �� l9 Depth % PERMIT N x778 A <F I� Type of_crib -�-__ Crib diameters Crib depth Total effective absorption area 9 W DISTANCE TO: Well N .4 Building f m tyorlr1 g nv (jam y, Nearest lot line 'zv t in J Class DISTANCE TO: Depth �/h/ A,/ I-�"-��'-'-"-� Building founclation Drillerye r�� 5� Sewer line v` Distance to lo[ line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS PYA _ SOIL TEST RATING _ INSTALLER REMARKS ,,,•:'cy 't" Robort A. Shj or �� -- — No. 1e57 -E a'-�_.vY�_/ /.<Z—__ AP OVE '_ / DATE LEGAL—----�� V2 -0,A (Rev. 3%78) MIIJPA I r._- I F- FOL_ I T'V 1-D F= F=l t•a1:-VACAFTF=1C3K DEPARTMENT C- HEALTH AND ENVIRONMENTAL r"OTCCTION 825 'L STREET, ANCHORAGE, AK. 90._j1 264-4720 PA E: L_ L_ F1 VA E> CA 4-4 =• :C -7" E_ :-. E= Lal E= F:' P E= R r l I T PERMIT NO. ( 820778 ) APPLICANT JOHN L GROSS PO BOX 1151 E.R. 49577 694-9138 LOCATION LEGAL L5 85 RIVER VIEW ESTATES LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSEiRPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (50 FT/BR)= 140 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ` 5 9 a, 0E:F•IFHW � L_Ert••L'aTVi= clot C3F='F44RE:L. L>E Fes'TL-E= - THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION {IN FEET). "T•HE TIRIE:t-.L(::H L.4 I LC=DI"H I !E; 5-5_ ►�G�w� FIE E: T. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION ON FEET). E:C-!1•-1 I RU_0' T'FEt-4t< :E; 12TIE'= :L R�Ola C3EIL_L._E't-4'°F PERMIT APPLICANT HAS THE RESPONJSIBILITY 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. -- - - "lr t4 C-1 <;2. > I 19 Fe E F R LE CA r_E I FZ E:I> BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE I5 25 FEET AND TO A COMMUNITY SELLER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MAST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SP'ECIFIC:ATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EEL;,e m i -ir Er ;F? I FZE CaEC Lir*yE E_F :2�:1.r ��Er I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE HEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL 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. L� SIGrd-D:__ APPLICANT JOHN L GROSS ISSUED B',_._\�_ ��=�/_1/_ .____.DATE---_���C L �` V4. 0 ® & E: ENGAEERINC & DEVELO'r MEW CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774SOIL LOG n,�/��j Performed for: Name:_ J A C A) Mailing Address:�� Legal Description: �F✓rLI�'-y_ Depth (feet) Sol] Characteristics 0 3 - 4 5 6 7 8 nldocy C ",mrf �L tt1 �,-wr!nr-r-7si✓1 Wr�-��I ��� �, 9 F _l�� DrrdM 4� 17- 10ND—. 12 13 14 — s 15 4, fifJF(;51G� qv 16 Ground Water Encountered: Yes_ -No_ 11 -/If yes, what depth Proposed Installation: Seepage Pit Drain Field Tel. No n' L k yC' n, ti C �fzr. PLOT PLAN Earl Ellis 688-2280 L/- 3 7:5-3 q9:5 '1.>d A I. L PERC.TEST�� Performed by: � U -6' 1>- Date: A�j) e N Municipality of Anchora ~ Mat -0 7. zy" Q On -Site Water and Wastewater Progra (907) 343-79046r s x E T Y c .� ��0169L95 Certificate of On -Site Systems Approval P&cel I.a. 080-792-28 Expiration Date: 1. GENERAL INFORMATION 'Completelegal description River View Est. Block 8,Lot 8 Location (site address) 21208 Falling Water -Dr. Current Property owner(s) Joseph Nelson & Judy' Rusk Day phone Mailing address 21208 Falling Water Dr. Eagle River; AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Dupl& ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community Public Water System ❑ Public Sewer WaiverNariance request for: Distance: - Received by: - Date: w E 9 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $o"Co ' Waiver Fee $ Date of Payment ah /I(,. / Date of Payment Receipt Number 68 ?� l G Receipt Number COSA # O�Ct �0'I Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal and as. of the validation date shown below, I verify that my investigation, based on procedures outlined - in the Certificate of On - a M'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 with all applicable Municipal and. State codes, ordinances, and regulations in effect at the time of installation.. - -- Inconducting 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 systemunderthe conditions encountered at the time ofthe 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 waterlevels thai-may fluctuate during the year, and the water usage of the family tieing served by the system. These conditions are outside the control of the evaluatorof 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 this report is for the. sole benefit of the owner listed above. ....... _ _..: Name of Firm Pannone Engineering Services LLC Phone 1907) 272'8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone pate 10/12/2015 , 6. DSD SIGNATURE System #1 Approved for bedrooms / Steven k ' tinnone System #2 Approved for bedrooms �'• CE 8149 r� 1� r Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate bate: The Municipality of Anchorage Development' Services Division (DSD):issues Certificates -ofOn-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 engineers work. - - - 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory ' Arsenic Advisory Well Flow Advisory Other CO$Ablueaheet t ..r -c ,f If more than 1 septic system is on the tot: COSA Checklist # 1 of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: River View Est. Block 5, Lot 5 - A. WELL DATA Well type Private If A, B, or C"provide PWSID # Date completed 8/17/1999 Sanitary seal (Y/N) Y Total depth 140_ ft. Cased to 20 .. ft. FROM WELL LOG Date of test 8/17/1999 Static water level 5 ft. Well production 1 9— PIM- WATER SAMPLE RESULTS: Coliform A)colonies/100 mL Nitrate O- _.y?mgiI_ Arsenic ug/L Date of sample: b 60 i (� Parcel ID: 050-792-28 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 18+ - in. AT INSPECTION 8/31/2015 1221- 2.5+ .5+ g.p.m. Collected by: N✓ a .B. SEPTICIHOLDING TANK DATA Tank type/Material Septic/Polyethylene Date installed 9/6/1999 Tank size 1.;000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression overtank(Y/N) N High water alarm (YIN) N Date,of pumping O l Pumper �1 `S P� —sa r •"-S.. C. ABSORPTION FIELD DATA - 9/6/1999 z 1.2 GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ftz or ft /bdrm) System type Length 44 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 6.1 ft. Eff. absorption area 379 if Monitoring tube Y Depression over field N Date of adequacy test 10/5/2015 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 17 in. 'Water added 500 gal New depth TOP in. Elapsed Time; 30 min. Final fluid depth 17 in. Absorption rate >= 450+ g.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 in. 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 75+ - Public sewer manhole/cleanout 100+ Sewer /septic servi6e 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 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Water main. 10+ Driveway, parking/vehicle storage 1 �+ F. COMMENTS Well produced a lot of sediment at time of test. Discussed issue -with SullivanA/Vater Wells. Well needed to be flushed to remove accumulated sediment. Owner performed flushing. G. ENGINEER'S CERTIFICATION i certify that t have determined through field inspeeohs"alitt 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 10/12/2015 COSA canary sheet 2-5-15.doc ti Y rlru_,'ty tix AS -BUILT I hereby certiffy, that I have su/rv/eyed the following descnbed la ,�•' }%r��r�t. �,,–�"..zr 5✓tea j Anchorage Recording Precinct,. Alaska, and that the imp...mve- ments situated thereon are within the property lines. and da not' overlap or encroach on the property lying adjacent thereto, tkzt no improvements on property Iying ad'acent thereto encroach on the premises in question and that, t�ere are no. roadways,, .transmission lines -or other visible easements on said property except as indicated hereon. Dated of ag)e. River, Alaska y, 4 this j__day of /AJOROBERT C. JOHNSON N NAW-,- 19—Ln_y>� SCALE: Registered land Surveyor -,- Box 77-0456, Eagle River, Alaska 945TL: Phone (907) 694-2543. . Municipality of Anchorage • Department of Health and Hurnan Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343.4744 CER-fIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 050=792-23 1. GENERAL INFORMATION HAA# flP\0000TT Expiration Date: Complete legal description Lot 5, Block 5, Riverview Estates Location (site address or directions) NHN Falling Water Circle Current Property owner(s) Mailing' address PC Lending agency Mailing address Real Estate Age Mailing Address Disotell Construction Dayphone 694-5797 Box 770210, Eagle River, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System 3 TYPE OF WASTEWATER DISPOSAL: X❑ Individual On-site ❑ Individual Holding Tank ❑ Well ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 01/00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S& S ENGINEERING 6 q Name of Firm '_n'4 Eaa•'e River Loo Rnael No '904 Phone Address a:Jle River, Alaska 99577 Engineer's Printed Name pa,'AT C, cows '/ Date _ or- OFA1 6. DHHS SIGNATURE 1/ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ROBERT C. COWAN E•@ °G'��•.� CE -8801 \,, bedrooms, with the following stipulations. Maintenance Agreements Supplemental Engineer's Report Other By: ��„�,,�,/ /i(/. ���c- Original Certificate Date:/S-o 0 Expiration Date: r , - /S- O D Reissue Date: 75025 (Rev. 01/00)' I< t. EI V Municipality of Anchorage C L) C* --)D DEPARTMENT OF HEALTH & HUMAN SERVICER 75 goon Environmental Services Division AquNic,pAll 825 L Street, Room 502 • Anchorage, Alaska 99501 "('907: `�4T4WHuk cE SERVICES plVl�- Health Authority Approval Checklist Legal Description: 407 5 8 4 0cK _T Pj vk2 v l i- w E57_ Parcel l.D.:_o S'O -- 7q), — '�L Y _ A. WELL DATA Well type _Pk) V # T 6 _ If A, B, or C, attach ADEC letter. ADEC water system number Log presentON) —y Date completed T / 1 7 / 9 c) i Total depth _ 4 0 _ Cased to a.o r ° 8-k. Casing height (above ground) _ Sanitary seal) _ Pz S Wires properly protected QY)N) . y FROM WELL LOG AT INSPECTION Date of test 17 / -7 % _ Static water level Is - Well Well production _ G g.p.m. _g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate C'q .ori -5 Other bacteria----(-) v 0 p Date of sample: _ —� / Collected by: S& S ENGINEERING17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 9 /6 /') % Tank size J 0 0 D Number of Compartments a Cleanouts (Y N) y6 f Foundation cleanout &)N) Depression (Yo l✓ 0 High water alarm (Y(9_0N 0___ Date of Pumping N�� " Pumper C. ABSORPTION FIELD DATA Date installed 1/6 /9 I Length _Width S f//iboo w Soil rating J&.�d./f2 or ft2/bdrm) a System type r/e Gravel thickness below pipe S Total depth _ G Effective absorption area 3 er f Monitoring Tube present (ON)Vr-S Depression over field (Y,O _'V O_ Date of adequacy test Results (Pass/Fail) _ For - _bedrooms Fluid depth in absorption field before test (in.); id aiely aftergal. water added (in.): f� Fluid depth _ (ins) ater: Absorption rate = _g.p.d. Peroxide 72-026 (Rev. 3/96)' 12 months) (Y/N) If yes, give date D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at' 'Datum Cycles to E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /00 rf Absorption field on lot Public sewer main Size in gallons ;I at* "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line a � —1— Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r Foundation a Property line 0 Absorption field Water main/service line / o Surface water/drainage / 0 0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Li /00 f d4A Property line j ci Building foundation 3 Water main/service line" , Surface water 0 0 i Driveway, parking/vehicle storage area Curtain drain NU N� K IJ o w N Wells on adjacent lots 0 0 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance wit HAS g=fiffect on this date. Signature Engineer's Name lC D6 CoW'I Date -:3 1, — HAA Fee $4 `%�' Waiver Fee $ Date of Payment Date of Payment Receipt Number J t V� Receipt Number 72-026 (Rev. 3/96)' 106 f . ROBERT C. COWAN i CE -8801 ;r , ast .......... are 03-14-00 15:19 FROM -CTE ENVIRONMENTAL 5615301 CT&E Environmental Services Inc .d� �s r�ucrirosir�si.,mri..,r�rrnrr�viw CT&1E Ref.# 1000982001 Client Name S & S Engineering Project Name/H 1.5, 135, Riverview Est. Client Sample 1D 1.5, 135, Riverview Est. Matrix Dnnking Water Ordered By PWSID 0 Sample Remarks T-533 P. 02/02 F-362 Client PG# Printed Date/time 03/14/2000 12:01 Collected Date/Time 03/08/2000 12:15 Received Date/time 03/092000 1035 Technical Direct Stephen, C. Cde Released Attoued a Prep Analysis Parameter Results POL units Method Limits Date Date Init WATERS DEPT Nitrate -N 0.555 0.500 m9/1. EPA 300.0 (<to) 03/09/00 SCL