HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 7 LT 4Riverview Estates Block 7 Lot 4 #050- 791- 04 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221202 PID Number: 050-791-04 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Josh Hagberg A ORPTION FIELD [0] De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20933 River Park Dr. Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original g e F Gravel depth beneath pipe . Ft. Subdivision Block Lot River View Estates 7 4 Fill added above original grade Ft. Gr I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between 6 ches From Tank Field Tank Line Ft2 Well 100+ 98* TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100+ 100+ I I Anchors a Tank 1500 Gal. Material Steel Number of compartments 2 Lot Line 5+ 10+ NA Foundation 10+ 10+ LIFT STATION Manufacturer Capacity Remarks *North West corner of bed located during Gal. installation and MT installed. CO installed at connection Alarm location Laundry room Electrical installed by Aaron Chambers of the existing pipe and the pressurized line. Installer PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Northern Excavation Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft InspectionV 6/23/22 2n,,6/23/22 d Location and description 3'" 6/24/22 4h Porch foundation post ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Conditional Approval: Date •"""""'•••.., '•i;i'�1 r ';*•�i — 1, 49TH �NJ�/:N JJJJJJNINJNI tl 1 IANJN! ' (iIW u �� Septic System Approved &JC�Z4Date 7496a2 .'ENN CE ' 16 r r+` '+� ••. ,�' ♦t 1�P ♦� ESS Note: this approval does not include well permit requirements. (Rev 05/02/18) AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221202 RIVER VIEW ESTATES BLOCK 7 LOT 4 PID# 050-791-04 WELL FCO j)EG1k_ • F CCIG C r D NT • 10' UTILITY ESMT A -C=7.7' 101.50 101. B -C=723' A -D=14.4' B -D=75.5' W W W g A -E=15.7' a a B -E=75.7' f B -F=51.1' A -G=24,5' A B -G-44'2 ti 1500 GAL TEP I TANK SCALE, NTS M 97.1 VIC' GRAVEL D/W U 1 NOTES a ��� CO 'G' INSTALLED PRI❑R TO BED. ul Q5 � aFP r ••- . PREPARED FOR: JOSH HAGBERG 20933 RIVER PARK D p AO -49 TH * EAGLE RIVER, AK V) o , ]KENNETH M FIELD BOOKS COMPUTED: E + CEEn —72 B -' �� . BOUNDARY: N A DRAWN: K5❑ 7 �► LL- ti • srAwNcN A giEC110D: KMD ASBUILT- SLS DATES 7/6/22 DWc. FILE: GMD: SW0357 ■ ��� ACAD FILE` FILE roe No' 22134 SCALEi 1' = 40' SCALE: NTS Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section p�cnt C n �t1I1 �v Ucparnnent * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221043 COSA#:OSC221307 Permit#:OSP221202 PID#: 050-791-04 Legal Description: River View Estates Block 7 Lot 4 Engineer: ArcTerra Applicant: Josh Haqberq Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 98.0 feet. See engineer's waiver request for justifications. 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. Waiver is Granted: X Waiver is not Granted: Date: 7 o2O �-C Approved by: �/ ��%I ( (� Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** ov JE R,�, r t A1zCT F:11ItA CONSULTING, INC Y 20441 Ptarmigan Bid, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Ri gs �rI vV.� 1�' A4�'11' July 6, 2022 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Separation Waivers — River View Est. Block 7 Lot 4 - OSP221202 On June 21, 2022, a tank replacement permit was issued and during the installation of the new tank, we were directed to locate the northwest corner of the leachfield and install a monitoring tube to aid in locating the field. We did field verify that the new tank is 5' from the leachfield but the edge of the field is approximately 98.8 feet from the well. We installed a field cleanout in the transmission line prior to the field distribution line. We are requesting a waiver between the existing well and leachfield to 98 feet. After the installation of the new septic tank, an updated survey has been performed which shows the new tank is outside of the well radius but the septic leachfield that was installed in 1993 is 98.8'+/- from the well. The well has a total cased depth of 58 feet and the historic water sampling shows the following nitrate results: 9/10/93 - ND, 4/5/02 - 1.55 mg/L, 4/29/04 - 0.532 mg/L, 5/3/16 — 3.76 mg/L, and currently 5/26/22 — 3.54 mg/L. While there has been a slow increase in the nitrate levels since installation the current levels are approximately steady since 2016 and within current approved standards. We replaced the steel septic tank with a new MOA approved 1500 -gallon steel STEP tank that will reduce further possible nitrate increases from this system. We do not expect there to be any adverse effects to the existing well or this septic system operations in the existing location. If you have any questions, please contact me at 696-6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth . D s, P.E. Attachment Current Water Sample Report 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 From:plc.chambers@gmail.com Subject:20933 Electrical hook up of lift station Date:June 24, 2022 at 9:07 AM To :dea@arcterra.net,Desiree Chambers plc.chambers@gmail.com In Reference to the lift station at 20933 River Park dr. The electrical installation follows the most current adopted NEC rules. There are 2 separate circuits between the panel and the exterior ,feeding the controller. Between the controller and lift station xhhw insulated conductors we’re installed with waterproof splices in vault junction box. The remote alarm is located in the laundry room on a separate circuit. Power is turned on and the floats were tested for auto and alarm functionality. If you have any questions please call or text. Sincerely Aaron Chambers Electrical Administrator EADE1831 Power Lighting and Control LLC AK Business license #1036446 12/31/22 Sent from my iPhone I N89"57'02"W 159.73' Nb9_,')b_,"DU _L IbU.Ub- �IbU.UU_ H) BASIS OF BEARING RIVER PARK DRIVE 6� ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: RIVER VIEW ESTATES SUBDIVISION LOT 4 BLOCK 7 'PLAT 79-5 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoull any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the o-vvners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER, DATE: SCALE; E --MAI(,: JUNE 25, 2022 1 40' schuller0ok.net 22-064-2 DRAM BY. ICHECKED BY, GRID NUMBER: BOOK AGE JAS SW0357 220242 * = FND 5/8" REBAR 01116�1k\, V�� sukv AW AW0 11P ;rol, 4 91H- ...... .......... .... r�/�� x ?A ..................... JOfIN L. SCHULLER.-* 0 LS -10408 1831 Talkeetna Street Anchorage, Alaska 99508 �, ° f Ono\ ARW (907) 227-1455 office essi AMW (907) 274-4992 fax 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: OSP221202 Work Type: SepticTank Upgrade Tax Code Number: 05079104000 Site Legal Address: RIVER VIEW ESTATES BLK 7 LT 4 G:0357 Site Mailing Address: 20933 RIVER PARK DR, Eagle River Owner: HAGBERG JOSH P Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: ,1Ienr Department 6/21/2022 6/21/2023 40000 ❑ Disposal Field Z 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 Special Provisions: • Locate the NorthWest corner of the bed prior to installation to confirm that the 5' separation between the tank and field will be met. Install a monitor tube so the field can be located in the future. Received By: Issued By: Date: Date: I ZZ 3 MUNICIPALITY OF ANCHORAGE )R()5H - - Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-791-04 Property owner(s) Josh Hagberg Day phone Mailing address 20933 River Park Dr. Eagle River, AK Site address 20933 River Park Dr. Eagle River, AK Legal description (Sub'd., Block & Lot) River View Estates Block 7 Lot 4 Legal description (Township, Range & Section) Lot Size 40000 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank Upgrade Duplex (D) El Tank El Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees:.,0225 + 413 5 Waiver Fees: _ Date of Payment: �- (q- 2 Z Date of Payment: Receipt Number: 00 R! oJ79aG Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221202, Deb Wockenfuss, 06/21/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221202, Deb Wockenfuss, 06/21/22 0 rn N89*57 ) 02 1) W 159.73' Nb'J_�b �U L IbU.Ub (IbU.UU N) BASIS OF BEARING RIVER PARK DRIVE I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: RIVER VIEW ESTATES SUBDIVISION LOT 4 BLOCK 7 PLAT 79-5 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER:-- --DATE: SCALE, E—MAJL, JUNE 17, 2022 1 "=40' schuller0ok.net 22-064 DRAWN BY. CHECKED BY, MD NUMBER: Banc AGE I JLS SWO357 220236 * = FND 5/8" REBAR SUR AMW 0 F L A ,.� AI S, 10�� •Ay ct, C� All 49TH .7 ;! * .1 * . . . . . . . . . . . * . . . . .. lz ............ ' JIN L. SCHULLER.,* 0 '00 LS -10408 *4".% Joe 831 Talkeetna Street 11> 17-1-2,-6 AW Anchorage, Alaska 99508 Of \ \,O\I\ AdW (907) 227-1455 office essiono AMW Zit (907) 274-4992 fax Municipality of Anchorage Page of 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: 40-516& PID Number: Name: 4Z44105 de -p— Wastewater System: :New ❑ Upgrade Address: &ifSO rawZ04"-� ABSORPTION FIELD Phone: No. of rooms: ❑ Deep Trench ❑ Shallow Trench XBed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: e55,1F Total Depth from original grad 11 Lot: � Block: /t �t v� d�vis� n� %ino Depth to pipe bottom from original grad: Ft. Gravel depth beneath pipe v� Ft. Township: Range: Section: Fill added above original grade Gravel length: Ft. Ft. WELL:El New ❑Upgrade Gravel width: ��� Number of lines: Distancebetween)ines: Ft. • Ft. C,lasSpcatign (Private, A,B,C): Ke— J Total Depth: Cased To: Ft. Total absorption area: SQ. Ft. Pipe material: {� IQ Driller: Ft. Date Drilled: Static Water Level: Installer: Date installed: Ft. Yield: Pump Set at: I Casing Height Above Ground. TANK GPM Ft. Ft. SEPARATION DISTANCES eptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer:, / Capacity in gallons: From Tank Field Station Tank Sewer Lines Vloco Well [/ Iv l' I �l l _ �l 1 Material:i% 1 � L Number of Compartm nts: e LIFT STATION Water 1�t4' ��f-� r-- -- Lot rr���/ Size in gallons: Manufacturer: Line Foundation ��/ "Pump on" level at: "Pu eat: High water alarm at: Curtain d . t f / _ I Pump Ma odel I Electrical Inspections performed by: Drain BENCH MARK Remarks: J C -7-- Location a Descrip�n: If D6 - Assumed Elevation: �F ENGINEER'S SEAL .n`!Q •• ..•, �� •° �,°� °° '• �"r' S & S ENGINEERING 17034 Eagle River Loop Road, Inspections performed by: %Jq4 St � >` • E&qIe River, Alaska 99577 2nd ✓ {TJ .; . ..,..a..aAl.. . A... Department of Heal d Hu rvices aggro aliTGh2?t �-- 4.1.4;x v � e � �� ., -moo. 1�37•l: �, Dated 27 �j?�•'•rb•- Reviewed and approved b �•',(r�if *.�. 72-013 (Rev. 9/91) MOA 25 n& u_ag_r\ 1D _ D r _ . Ci % ,1��`�`�' "�• Permit No. 031065 Page 2 of 2 Municipality of Anchorage 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 RIVERVIEW ESTATES SUBDIVISION, Legal Description: 131 OCK 7, 1 nT 4 PID No_: CO1 CO2 102.0 FINAL GRADE MT1 MT2' ........ .. .... _...._ ... .... ..__ _.. 102.5 .._�. , . , . .. . Dlsvuno T,E14 INft' ' EAL MTM rADRIC i"� tri, 1 y EXISTING 98.5 1000 GAL SEPTIC r98.3 TANK N.T.S. 72-013 A (2/91) MOA 25 er "1.�+ �°• , . � .vim erj'� 98.5' 99 �f.`; DIST. PIPES LAID VITIDN SEVER ROCK 6 UNDER...,. 1 • - .. I Ac 2' OVER DIST. PIPES . _e..•.. reaa..•lkL.i •• .•ay�t woo P70FESS d 983 993 HEFTY DRILLING WeU Water — it's naturally bettert f 0 3540 AKULA DRIVE TELEPHONE: ANCHORAGE, ALASKA 99516 (907) 345.0593 WELL LOG • Louie K. Brunner Date Drilled 6-1-93 6950 Crav*4*d Anchorage, Ak. 99502 Static Water -'Level 20. Feet Gallons Per Minute• 7 Draw Down N A Feet Total Feet of Casing 58 Type Material Drilled: .. 0 ft. to 15 ft. Rock & Clay 15 ft. to 30 ft. Rocky Gravel • 30 ft.55 ft. Cemented Gravel 55 ft. to 58 ft. Rockv Gravel W H2O I to to to to to to HEFTY DRUM 3540 AKULA DRIVE ANCHORAGE, AK 995% (907) 345-0593 RECEIVED OCT 19 1993 AnunoraDept. Health & Human Services ' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH,!AND HUMAN SERVICES P.O. BOX 196650, 825'01L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930454, DATE ISSUED:10/27/93 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE:10/27/94 OWNER NAME:BRUNNER'LOUIE K,& CATHERINE R OWNER ADDRESS:695011CRAWFORD ANCHORAGE, AK 99502, PARCEL ID:05079104 LEGAL DESCRIPTION: RIVERVIEW ESTATES BLK 7 LT 4 LOT SIZE: 40000 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 . THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ISSUED BY: DATE: DATE • n December 21, 1983 tir. Jack Lyons Lyons Construction P. U. Box 1913 Eagle River, . AIC 99577 Subjects Errors on Handwritten Permits Dear Mr. Lyons: t,,Ie have discovered calculation errors on five permits issued to you. Tile legal descriptions are: Lot 14, Block 5, Riverview. Estates Lot 5, Block 7, Riverview Estates ,Lot 4, Block 7, Riverview Estates { Lot 3, Block 7, Riverview Estates Lot 2, Block 7, Riverview Estates Please contact the Department as soon as possible to make necessary corrections on these permits. Sincerely, Susan Oswalt Engineering Technician SU1/ej/D1U . �U f,-4 1 s:Z: I F--- L 3: -T- C7_1 r--� �r ��K������� � DEPARTMENT OF H�LTH AND ENVIRONMENTAL PROTECTI.ON 825 'L~ STREET, DNCHORRGE, HK 99501 264-4720 : ANCHORAGE 694-2131 EHGLE.RIYER PERMIT NO. 0]1065 APPLICANT: LYONS CONSTR PHONE: '� ADDRESS: PO BO.'-'. 1913 EAGLE RIVER, Al, .'995G7 LEGAL DESCRIPTION — SUBDIVISION: RIYERYIEW EST ' 8LOCK� 7 ' LOT: 4 LOT SIZE Q SQ. FT. TOWNSHIP: '- RANGE: - SECTION: - MHXIMUM NUMBER OF BEDROOMS ] SOIL RATING = 85 85 85 (SQ. ' /BR) ' LISTED OELOW ARE THE OPTIONS AVAILABLE TO -YOU IN DESIGNING YOUR SEPTIC ' SYSTEM. CHOOSE THE OPTION THAT BEST FITS .YOUR SITE. . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -`- ][K2ilr-4 ' WIDTH = 2. 5 FT. ' LENGTH = 32. 0 Fl~ TOTRL DEPTH = O 0 FT' ~ ' GRAVEL DEPTH 4.0 FT. GRAVEL Y0_0lE 13. I CU YDS. TANK SIZE = 1, 000. 0 GALLONS (TWO COMPARTMENT TANK) X=_:r__r_" C -" J[ :3 V4 101 WIDTH0 FT. LENGTH= . TOTAL DEPTH = 5�0 T. FT. GRAVEL DEPTH = 0.5 FT. GRAVEL VOLUME i4. 5 CU' YDS. TR�J{( SIZE = 1, M0. 0 GRLLONS (TWO COMPARTMENT TANK) ' U4 C.x C_x F,-: 1":� 111-4 F-- T. 1= c): �1 2:3 r-4 WIDTH = 5 �� FT. LENGTH = _3 0. 0 FT. ' ' / TOTAL DEPTH = 7.0 FT. GRRVEL DEPTH= I0 FT ' GRAVEL VOLUME = ' 19.4 CU. YDS: TANK SIZE = L000.0 0 GHLLONS (TWO COMPARTMENT TANK) --- ____________ I CERTIFY THAT - i. I HM FAM.ILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 8S SET . FORTH BY, THE MUNICIPALITY OF RNCHORHGE AND THE STHTE OF HLHS|(R. 2. I WILL INSTALL THE SYSTEM -IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED H COPY OF THE CODE SUMMARY RND DIAGRAM HTTRCHMENTS WHICH IS PART OF THIS PERMIT. I I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ' PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY -AND ' THE NUMDER OF RESIDENCES THAT THE WELL WILL SERVE. IF O LIFT STATION IS INSTALLED, ON ELECTRICAL PERMIT AND INSPECTION MUST.- BE UST -BE OBTAINED. RS-8UILTS CANNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT. THE ELECTRICAL WORK MUST BE DONE BY R LICENSED ELECTRICIAN. ' SIGNED: � __________________' ' RPPLICBNTLYONS CONSTR � . ISSUED By: DATE: 12/12/83 p _______________________________ - � MUNICIPALITY OF ANCHORAGE Department (""� Health and Environmentalr"',rotection It z825- L Street, Anchorage, AK. `_ 501 y 0105 264-4720 Permit # �� �� HANDWRITTEN PERMIT WELL AND/04�; ON-SITE SEWER PERMIT Applicant: I Y-6- ffs �&C7 Mailing Address: Location: Phone Number: Legal Description: ',LaT ,��J,�. 7 1P/I�CU1 Fly /3 Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Y Holding Tank: Maximum Number of Bedrooms: 3 Soil Rating (sq.ft/br) The Required Size of the Soil Absorption System Is:' J C, "%o J DEPTH ' LENGTH GRAVEL DEPTH.P`IaT-m-A�e/Ir, WIDTH lVeT Na lAw tlfA�v 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). 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). # # REQUIRED SEPTIC(HOMM-NG) TANK SIZE _ /000 GALLONS # # 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. ' * # * TWO M INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection.and approval by this departmE will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fE for a private well or 150 to 200 feet from a public well depending upon the typE of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper,installation. ## PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that bedrooms. Signed: Issued by : �GGC plicant Date: SWP/024 (1/81) A4— co/&J 1 �1 �( SOILS LOG MUNICIPALITY OF ANCHORAGE • �..�� ❑ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST ~ i 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: L oT ��� / 1 /✓F��EK�T'r�� CS �Lj/��Q DEPTH I O / • !; SLOPE SITE PLAN (FEET) c. 'I/Y �r,PA✓��,/ 1`w .7 3 4 5 ��py �i2.4-✓E� � h/ �S 8- 9- 10- 6 s10 S 11 ` WAS GROUND WATER ENCOUNTERED? 12 IF YES, AT WHAT 13 DEPTH? 16 9m 17 NO S • o•ee.• .'Z 18 .211..-E �6�¢ Opti • ,� 19- fr `;1 .�.`..lr Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE AIA (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS So�G 1'A ��� 8�� .SC7. ;cT• > 7�I2�� ice( PERFORMED B CERTIFIED B ATE: e-11- 63 72.008 (6/79) �• Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-791-04 1. GENERAL INFORMATION Expiration Date: l k 1-4 aoa Complete legal description RIVER VIEW ESTATES BLK 7 LOT 4 Location (site address) 20933 River Park Dr. Eagle River Current Property owner(s) Josh Hagberg Day phone Mailing address Real Estate Agent 20933 River Park Dr Eagle River AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well 1Z Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ Waiver/Variance request for: Well to septic field _Distance: 98 Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment 1,21 1 1,2 0 -9 �2 Receipt Number 0 3 33 6 Co COSA# 6SC-2)-1 3 0i Date: Waiver Fee $ 11 M Date of Payment — Receipt Number Waiver # 0 SV o' ),1 0 `1 � 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a ♦��V system will function satisfactory for current or future t { OF #1 occupants or can ArcTerra guarantee that no unseen...... ••••..,�♦♦ encroachments, deficiencies or discrepancies exist. fes, A r Pr49 L ` 6. DSD SIGNATURE �A Y,ENNFTH I'. V rf uS; System #1 Approved for —3 bedrooms.f♦�• cE 11 #f��F �i System #2 Approved for bedrooms. t cj',�,4.w.,....: Disapproved. t� %�wS+���♦ Conditional approval for bedrooms, with the following stipulations: ,tt�llllttttr•fr�,. T vvHST`: vvArl=o — — f✓KOGRAM o By: Original Certificate Date: 7 b Igo The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet -,10-10-12 doc STEP E. SEPARATION DISTANGE5 From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F iJS�� Community Sewer Manhole/Cleanout > 100' ® Yes if No ft 5Z Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 98* ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Field nearest corner located during new tank install, MT installed to mark for future reference. Waiver reauested. G. ENGINEER'S CERTIFICATION l 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 COSA Checklist yellow sheet LO .•..4 T ,"�� KENPaE7H F iJS�� ;;i F0 64iFE^S►# nGe g4 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-791-04 1. GENERAL INFORMATION Expiration Date:.. II- 23 — L Jo Complete legal description RIVER VIEW ESTATES BLOCK 7, LOT 4 Location (site address) 20933 RIVER PARK DRIVE, EAGLE RIVER AK 99577 Current Property owner(s) MARVIN BALLARD & ULFATOVNA NURIA Day phone Mailing address Real Estate Agent 20933 RIVER PARK DRIVE, EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ . Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community,C.las§ , Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: _ COSA to be released unless otherwise requested by the engineer. COSA Fee $ J �Y Date of Payment 1,6, Receipt Number OS -2- 3 q E) COSA# 0sC ( � 6l � ( Date: $-zZ Waiver Fee $ Date of Payment Receipt Number, Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS _ Date . 8/22/2016 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerre guarantee that no unseen r OF "L � T� encroachments, deficiencies or discrepancies exist. v 6. DSD SIGNATURE ►—< 9 0H S � System #1 Approved for bedrooms. � �; KENr\"�1'H M. F.u1y� System #2 Approved for bedrooms. Disapproved. \\� Conditional approval for bedrooms, with the following stipulations: tnn- d 23-I�o 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 isnot 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 blas sheet_10-UM2.dw 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: RIVER VIEW ESTATES BLOCK 7, LOT 4 Parcel ID: 050.791.04 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 611/1993 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 58 ft. Cased to 58 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 61111993 Static water level 20 ft. Well production 7 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.90 mg/L Arsenic: ND ug/L Date of sample: 818/2016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 4122/16 Pumper JRs C. ABSORPTION FIELD DATA 5.3.2016 a .0 Collected by: ARCTERRA Date installed 811993 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 8/2011993 Soil rating (g.p.d.M2 o ft2/bd 85 System type BED Length 20 ft. Width 14 ft. Gravel below pipe 0.5 ft. Total depth 2.92 ft. (Measured 5/3116) Eff. absorption area 280 ft2 Monftoring tube Y Depression over field N Date of adequacy test 5.3.2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 2_5 in. Elapsed Time: 20 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 _ in. Datum Size in gallons "Pump off" level at —in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? _ On adjacent lots On adjacent lots Public sewer manhole/cleanout 1004 Holding tank 100'+ Manure/animal excrete storage areas 1001+ Building foundation 54 Property line 51+ Absorption field 54 Water main 10'+ Water service line 10'+ Surface water 1004 Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main 104 Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWNI Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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 KENNETH M. DUFFUS Date 8/2212016 COSA canary sheet_2-6-45.doc in. -. `\`_�► GE 8 • '� Municipality of Anchorage ° >� On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 050-791-04 1. GENERAL INFORMATION ExpirationDate: Complete legal description RIVER VIEW ESTATES BLOCK 7 LOT 4 Location (site address) 20933 RIVER PARK DRIVE, EAGLE RIVER AK 99577 Current Property owner(s) MARVIN BALLARD & ULFATOVNA NURIA Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 20933 RIVER PARK DRIVE, EAGLE RIVER, AK 99577 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class —Well ❑ Public Water System ❑ WaiverNariance request for:, Day phone TYPE OF WASTEWATER DISPOSAL: Received by: COSA to be released tl g gi eer, unless otherwise requested by the engineer. COSA Fee $ -j�)$) Date of Payment '511 f l � o Receipt Number 0, a COSA#_ 0564 4 i � (p Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Date: S Z6 -/(m Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 5/10/2016 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future moo\ occupants or can ArcTerra guarantee that no unseen etOFA \ encroachments, deficiencies or discrepancies exist. Air �v Lis , [� TH 6. DSD SIGNATURE System #1 Approved for bedrooms. ? KENNETH L D F ` % T1s j / System #2 Approved for bedrooms. , d�o �/o / .r Fe,stoNp Disapproved. Conditional approval for bedrooms, with the following stipulations: BYi Original Certificate Date: — V The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 COSA blue sheet 10.10.12AM 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: RIVER VIEW ESTATES BLOCK 7, LOT 4 Parcel ID: 050.791.04 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 61111993 Sanitary seal (YIN) Y Total depth 58 ft. Cased to 58 ft. FROM WELL LOG Date of test 611/1993 Static water level 20 ft. Well production 7 g.p.m. WATER SAMPLE RESULTS: - Coliform NEG colonies/100 mL Nitrate 3.76 mg/L Arsenic: ND ug/L Date of sample: 53.2016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 4122116 Pumper JRs C. ABSORPTION FIELD DATA Well Log (YIN) Wires properly protected (YIN) Y Casing height (above ground) 24+ in, AT INSPECTION 5.3.2016 ft. Collected by: ARCTERRA Date installed 811993 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 812011993 Soil rating (g.p.d./fe or felbdrm) 85 System type BED Length 20 ft. Width 14 ft. Gravel below pipe 0.5 ft. Total depth 2.92 ft. (Measured w/16) Eff. absorption area 280 fe Monitoring tube Y Depression over field N Date of adequacy test 5.3.2016 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorptipn.fisid before test 0 in. Water added 450 gal. New depth 2_5 in. Elapsed Time: 20 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_ in. Datum _ Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 751+ Sewer /septic service line 251+ Animal containment areas 504 SEPTICIHOLDING TANK ON LOT TO: Manhole/Access (YIN) High water alarm level at _ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout 1001+ Holding tank 1001+ Manure/animal excrete storage areas 1001+ Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water Service line 101+ Surfacewater 1001+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOVM Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 5/10/2016 COSA canary sheep-5-15.doc ' Ne9 s�So'E /moo, xJ 0 0 0 D P.1 ASBUILT SENARD b ASSOCIATES LAND SURVEYING 6 4-082 t HEREBY CERTIFY -THAT i HAVE SURVEYED THE SCALE! FOLLOWING DESCRIBED PROPERTY• r P., X/�Ti7vvE f�G19CoTf of'� y� DATE,...........9�� OF A(� � AND THAT NO F.NCROACHMENti EXIST EXCEPT AS INDICATED. o �d IT IS THE RESPONSIBILITY OF THE Amp ' OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDS • • • • •� — EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APBEAR ON THE RECORDED SUBDI-OU+ x'ry �7_r7 � �- VISION PLAT. UNDER NO CIRCUMSTANCES SHLD FB+ '. Ouw• M,rk S..cd S / ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTA13LISHING BOUND i ARY LINES. DRAWN Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _,05 O 79 L 0 H 1.; -GENERAL INFORMATION HAA # r )qy r _'lq Expiration Date: 9 ! / % — D Complete legal description 2 r V E2 x11t til E $7A i 6'5 t3 L y Location (site address or directions) 2093 3 R ry6:?_ too rr b kxoc _. Current Property owner(s) LAJ.Vt� +Grf6Ry . Ar.�VALb Day phone 67-2- 77SS :Mailing address' 20933 RX70tLL PARK b22J6; el -(SLA RrrJE- Ar— 995-77 Lending agency Mailing address Real Estate Agent Mailing Address Unless. otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ 'Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public -Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water. supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm bV4, S06-5. Phone 69q-571 I r Address loy2 i w=iA h1. S�r�Z^Zc9! Engineer's Printed Name C rfRr5Tt1,Pffe2 R_1n � Date 5��, Ma y S. DSD IGNATURE Approved for bedrooms. Disapproved. -- Conditional approval for bedrooms, with the following stipulations: Additional Comments • "PROGRAM Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other LL By: Original Certificate Date: Jr 7 " (Rev. 01102) Municipality ;of Anchorage p,,1 �GCtt MBP ! Development Services Department Building Safety Division On-Site Water & Wastewater Program s s 4700 South Bragaw St. E P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904, HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description 121J��• • lil�%� �"'S1 >� L Parcel ID:QSd '701 L Dy. A'. WELL DATA; J Well type �JAMf_* d If A,!B, or C provide PWSID # Well Log�N) Date completed G/ Sanitary seal 6/N) y Wires properly protected N) y Total depth S�Ei ft. Cased to 5�7 ft. ;,Casing height (above ground) + �2 in. FROM WELL LOG AT INSPECTION Date! test ��/ 19 3 13016 y Static water level 1' Well production g.p.m. I g.p.m. ,. i WATER SAMPLE RESULTS Coliform 6a colonies/100•ml. Nitrate 0. S 3 Z mg./l: Other bacteria' 3 colonies/100 ml. s Arsenic: OX, mg /I. Date of sample: 91oI Collected by: vJyy D B SEPTIC/HGL•=etNG TANK DATA,. i I 'T I i j Tank Typ /Material ~ S I t L Date installed � g 3 �., �? Tank size.'J�dcxJ gal ';R Number of Compartments ) 2 Cleanouts N Y Foundation cleanout �Nj G' Depression over tank (Yo High water alarm �('( Date ofl.pumping ''� %3alDY Pumper C: ABSORPTION FIELD DATA n I.. I, I I Date installed 4%Z 9 Soil rating ;(g-p-.d teo #t2/bdrm $5 System type ge"b Length i %c� . ft Width 1 ft. Gravel below pipe D. S ft. Total depth ft. Eff absorption areaft2 Monitoring tube Depression over field SCID { }Date of adequacy test Results (Pass/Fail) P/� S 5 ? For , bedrooms ! i Fluid depth in absorption field before test _ in Water added�gaL New depth Q in. 4b o, Elapsed Time min. h ' Final fluid depth D in. Absorption rate !r>= �i SD g.p.d. !;,Any rejuvenation treatment (past 12 mo.j (Y/N r&type) Al If lyes, give date {! 1. • D. LIFT STATION "OIJL- Date installed Size in gallons-.Mant-bTeRAccess (Y/N) "Pump on" level at in. "Pump qfcjeverat, in. ' High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r f i Septic tank/lift station on lot On adjacent lots Absorption field on lot O y On adjacent lots +/c* / Public sewer main 'x'600 Public sewer manhole/cleanout *100 Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $' :Property line ..Absorption field 5 Water main t Z5' 11 Water service line ZS / Surface water 4- /DO / Wells on adjacent lots + /06 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. _ Property line Building foundation 22 Water main ZS i Water Service line 4- ZS Surface water +lot) Driveway, parking/vehicle storage +/D �. Curtain drain to, VCWu xka- JNWelIS on adjacent lots t/00 / F. COMMENTS G. ENGINEER'S CERTIFICATION certify that I have 'determined through field inspections and *: review of Municipal records that the above systems are in .... ....... conformance with MOA HAA guidelines in effect on this date. _ Engineer's Printed Name 6-HRT57nPitE1Z- IZ, WcrdS CI{RISTOPHEltRW0011) ., Date f 5 /o c. //// MnN HAA Fee $ —4 Date of Payment Receipt Number. (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 05-11-04 02:36PM FROM-CTBE ESI, SGS ENV SERVICES S�$ SGS ReEH 1042176001 Client Name Eagle River Engineering Project Nameld River View Est. B7, L4 Client Sample ID River View Est. B7, L4 Matrix Drinking Water 9015615301 T-283 P.02/04 F-895 All Dates/Times are Alaska Standard Time Printed Date/Time 05/06/2004 14:44 Collected Date/Time 04/29/2004 11:00 Received Date/Time 04/30/2004 9:15 Technical Director Stephe . Ede Released Sample Remarks: EP300 - Nitrite for CCV recovers outside control limits. Sample concentration is less than PQL. EP300 - Floride for CCV recovers outside control limits. Sample concentration is less than PQL. Metals Department Hardness as CaCO3 10.0 U 10.0 mg/L SM17 2340C E 05/04/04 05/05/04 WA Private Individual Analysis Aluminum 40.0 U 40.0 ug/L EP200.8 nlloLimilsle p Any Parameter Results PQL Units Method Container ID Date Dates Init Selenium 10.0 U 10.0 ug/L EP200.8 E 05/04/04 05/05/04 WA' Nickel 4.OD U 4.00 ug/L EP200.8 E 05/04/04 05/05/04 WA' Thallium 2.OD U 2.00 ug/L EP200.8 E 05/04/04 05/05/04 WA Antimony 2.00 U 2.00 ug/L EP200.8 E 05/04/04 05/05/04 WA Metals Department Hardness as CaCO3 10.0 U 10.0 mg/L SM17 2340C E 05/04/04 05/05/04 WA Private Individual Analysis Aluminum 40.0 U 40.0 ug/L EP200.8 E 05/04/04 05/05/04 WA Arsenic 10.0 U 10.0 uglL EP200.8 E (<=50) 05/04/04 05/05/04 WA Barium 6.00 U 6.00 ug/L EP200.8 E (<=2000) 05/04/04 05/05/04 WA Cadmium 1.00 U 1.00 ug/L EP200.8 E (r--5) 05/04/04 05/05/04 WA Calcium 1000 U 1000 ug/L EP200.8 E 05/04/04 05105/04 WA Chromium 3.11 2.00 ug/L EP200.8 E (<=100) 05/04/04 05/05/04 WA Copper 15.0 2.00 ug/L EP200.8 E (<=1300) 05/04/04 05/05/04 WA ]ton 500 U 500 ug/L EP200.8 E (<=300) 05/04/04 05/05/04 WA Lead 0.462 0.400 ug/L EP200.8 E (<=15) 05/04/04 05/05/04 WA Magnesium 100 U 100 ug/L EP200.8 E 05/04/04 05/05/04 WA Manganese 2.00 U 2.00 ug/L EP200.8 E (<=50) 05/04/04 05/05/04 WA Phosphorus 400 U 400 ug/L EP200.8 E 05/04/04 05/05/04 WA Potassium 1000 U 1000 ug/L EP200.8 E 05/04/04 05/05/04 WA Sodium 132000 20000 ug/L EP200.8 E (<-250000 05/04/04 05/05/04 WA Silicon 10300 400 ug/L EP200.8 E 05/04/04 05/05/04 WP Silver 2.00U 2.00 ug/L. EP200.8 E (<=)00) 05/04/04 05/05/04 WA Zinc 12.1 10.0 ug/L EP200.8 E (<=5000) 05/04/04 05/05/04 W/' Chloride 23.3 0.100 mg/L EPA 300.0 (<-250) 04/30/04 JI fluoride 0.100 U 0.100 mg/L EPA 300.0 (<=2) 04/30/D4 JI (Titrate -N . 0.532 .. _w �0.100.r. _ _ ,mEPA 300A��"�13 _ `:3 (r-10) 04/30/04 Jl _ NitriteN �. 0.100 U v 0.100 mg/L EPA 300.0 B (r-1) 04/30/04 ]1 Sulfate 31.4 0.100 mg/L EPA 300.0 B (<=250) 04/30/04 Y 05-11-04 02:36PM FROM -CUE ESI, SGS ENV SERVICES SCS Reftl 1042176001 Client Name Eagle River Engineering Project NamelO River View Est. B7, L4 Client Snmple ID River View Est. 137.. L4 Matrix Drinking Water 9075615301 T-283 P.03/04 F-895 All Pates/Times are Alaska Standard Time Printed Date/Time 05/06/2004 14:44 Collected Date/Time 04/29/2004 11:00 Received Date/Time 04/30/2004 9:15 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQt. Units Method Container ID Limits Date Date lntt Private Individual Analysis Total Dissolved Solids 319 10.0 mg/L SM20 2540C D (<=500) HCO3 Alkalinity 208 20.0 mg/L SM20 2320B D CO3 Alkalinity . 20.0 U 20.0 mg/L SM20 2320B D OH Alkalinity 20.0 U 20.0 mg/L SM20 2320B D Conductivity 600 1.00 tmthos/cm SM 2510B D PH 7.60 0.100 pH units EPA 150.1 D (6.5-8.5) Alkalinity 208 20.0 mg/L SM20 2320B D CTO -1-41 Coliform"' """" "3 OB; IVo Coli "" — COl1l00mL""SM18 9222B" '--A'-7 (<=1) 04/30!04 K 05/04/04 K 05/04/04 K 05/04/04 K 04/30/04 K 04/30/04 K 05/04/04 K 04/30/04 DIS fib Pan ping PO Box 773415 ENOL Rim, AK 99577 - Service Agreement (907) 694-G454, �.... �. , ,...� � Number Otaaep Order Data; 26 -Apr -2004 �IIani IMorm.tlen ^'— _ `- a0Mae orate: 11:20 am Ea9>M River E p nMrtnp '-"" .'- DavIpr.200t Technician; Dave i Tonyr IN421 VFW Rd Ste 201 'lop Dewripbon: 1000p P.O. Number: Eagle River, Ax 99571 T4mw: Net 30 (0071694-6105 Salea+ep: Nkde Job Type RaMl _ ole lldr lnf0neetlon� Map dock: y''-" '-1 Cr*"stra w: HhtttrlaN Drive Map OAd: iw 209,13 Rlwr Parc D6*v Job Commants: , 'l.aataervi0s OWIW2 io0pp —'.'-,. -Meet *1 Chris for pump i metre, news to be be O 4pm, wit Wf Eapb Rlwr, AK 99377 Itlme - (007) 242.2717 CMtt, Gana Tax Peroent ° L UMU Tope �� Cr Am ON Price Each t! Yen Ter Erbrulon� . Actual1 contnaor,lob 95.00 No No WOO �j 4 , ioa.00 No sec $06.00 v% Addltlww Location Comments pJap rtro: 3rd house on the WR to Galbnv Planned: 1000 Ayes M font Of the houea—'-V dwon Us hill D;s Ar A;rA.sr y r� a• rXUr,) ,41, on,vv-J TAW % I Oalbw ACW. Hoes Lanpth: G 00ubla Taft: _ r pump BMW. \ • Bettlaa inlet 0 Gdw ,7/Do 70- ,Li /1� G /�s�cJ�C� Tv' F�gmeted N"Umble TOFF Tauable Total Taut Total Orww Total III90.00 10.00 Sam 0190.00 Cuakormt agrg" to tsrma eP and oondlfws rutted on to beck, TMS A wmNa A(iTtdp,M�NT. gtgnaturs"11110 of Cuakmter ftepraefftow Date =Died ler JRA Pumping For Your awwoanwntena we taa Otab AOpeptrd Pt Vka and Meftr Gard pa m w* over ft phone. Agar N b" 1.5% 1MLL DE CHARGEDI Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 SAi ETT CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D..025c -7Q 1--b (4 HAA # 6> 9 0,-) 0 Z ,-�;7 Expiration Date: -7 — / 7 - 002 1. GENERAL INFORMATION Complete legal description LO1 4 Y, -7 Location (site address or directions) 0Q33 Qiy-e-Y Current Property owner(s) GLty-t�1i S�i-�( �a►�t Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone ��/� 1--e` i�ci► _ k��-u�tt it Day phone %64- &&176 .S Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 7 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well, Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water .system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. it 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 1 olob -eK Address D 3 tai 1 5� go Engineer's Printed Name lolob-e_ ca �" ,v,(Vcu ti wte 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone'- Date hone'- Conditional approval for bedrooms, with the following stipulations: Additional Comments WATER AND WAblEVVAiER PROGRAM J • R � �i9� NT SEN Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other ByOriginal Certificate Date:_a— (Rev. 01102) a Municipality of Anchorage • ''` I'I,` : Development Services Department j ! Building Safety Division t On -Site Water & Wastewater Program'' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 II r www.ci.anchorage.ak.us j (907) 343-7904 i l , i , HEALTH AUTHORITY APPROVAL CHECKLIST , Legal Description Ll % —1 o-e-ly �/��-c�cJ �s�riY� Parcel ID: Osv7`I1- b A. WELL DATA Well typei2 If A,' B, or C provide PWSID # Well, Log (Y/N) r J �' Date'completed �/ 3 Sanitary seal (YIN)' Wires properly protected (Y/N)_ I .r j � � I � I i ,�. Total depthft. Cased to'iJ ft. `-Casing height (aboveground) �2 in. FROM/ WELL LOG 'AT INSPECTION' Date of test 114 3 , q 5 / C i Staticwaterlevel o ft,'=•�I �pft. •I• II� Well production 7 g.p.m. g. P.M. i t II, 4' , ,r WATER SAMPLE RESULTS: � I . a I Coliform =colonies/100 ml. Nitrate's mg./I I Other bacteria colonies/100 mL Arsenic: mg./I. Date of sampled -i ;l Collected by: yr _la�X B. SEP,TICIHOLDING TANK DATA Tank Type/Material P r' e Date installed Tank size �l b y gal. Number of Compartments Cleanouts {Y/N) y I: Foundation cleanout (Y/N) Depression over tank (Y/N) j High water alar lm (Y/N), _ � c �l lt� o um 'er t Date'of pumping l' ZP p ` C ABSORPTION FIELD DATA I " I `.Date installed l4 I Soil rating (g=p-d7ff'oe,ft2/bdrrn) System type�� Length din ft. Width i l 1 ft Gravel below pipe D, 5 ft. I',F ; Total depth 91 ft Eff. absorption area f Monitoring tube I Depression over field Ill, /1i'�i ! i Date,ofadequacy;test �jS c�-= i Results(Pass/Fail) f For bedrooms ;I it i;,1a i ..Fluid depth In absorption field before test = in."! I,� ;Water added�%rwgal.' New depth-0—in. girl Elapsed Time '--� min. Final fluid depth' o in Absorption Irate >_� g.p.d. Ii r ?: I i r ;Any ,rejuvenlation treatment (past'12 mo.) (Y/N &type) i If yes, give date is t x h� I �lillLi ,II i'. 1 is D. LIFT STATION Date installed Siz in gallons anhole/Access (Y/N) "Pump on"; level at in. "Pump of level at i .. High water alarm level at in. {% Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift station on lot On adjacent lots > !-fes Absorption "field on lot On adjacent lots i ts-O• - -- - R 1I;Public sewer main NIA Public sewer manhole/cleanout M%$ Sewer /septic service line 7 Holding tank -I SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line 1 t Absorption field 1 Water mainVA Water service line 7,2 Surface water ,Wells on adjacent lots 'SEPARATION DISTANCE FROM -ABSORPTION FIELD ON LOT TO: �IProperty line I C7 Building foundation �L Water main 4 (Water Service line_ i Surface water I n Driveway, parking/vehicle storage ! O ,tInd _� Curtain drain -• Wells on adjacent lots- !u -o -- - i VIII i , F. iI COMMENTS r G.II II ENGINEER'S CERTIFICATION �, c �. • �, ,, . I 'i � (.^'ate,' , •r t..,-� JEp 1 �, �`A l 1 certify that I have determined through field inspections and F,i, • f�, _ }; f ` c� all review of Municipal records that the above systems are in �.et.- ` ` c...•a49'.•�•nl conformance with MOA HAA guidelines in effect on this date. 5o„ouey •• Engineer's Printed Name iy 66-e ti v Y lock leQ f, % °" C� 2x25 .� { � :Date �'� � 9-� � � `�, '•. �% . c 0FESS)�� IIS III,• ..�. � � - _. HAA Fee Waiver Fee $ Date of Payment i'9 D Z Date of Payment �N' < ReReceipt Number t I, P_ Receipt Number I (Rev.1,12/01) l iI 4 -+2 -CZ: 6:26PM; . 1 - Z Lt ME Environmental Services Inc. roi�r�re000ssoarowreses� CTSE Ref.# 1021761001 Client Name Tobben Spurkland P.E. ProjectName/# 4/7 Riverview Est Client Sample ID 4/7 Riverview Est Matrix Drinhng Water Ordered By PNYS1D 0 :607 561 E30+ •4 </ e All DatesMmes are Alaska Standard Time Printed Date/Time 04/12/2002 16:20 Collected Date/Time 04/05/2002 14:45 Received DateMme 04/05/2 16:15 Technical Dire Ste b C Ede Released By Sample Rtrtarks: Allowable Prep Analysis Pararneter Results PQL Units Method Limits Date Date ]nit watern Departateat Total Nizate/Nitrite 1.55 1.00 mg/L EPA 300.0 04/10:02 3DT Y.:.crobiology Laboratory Total Coliform 0 I coV100mL SM1992228 (<1) 04/05/02 KAP Q Q rd ?l /Q/fJ�X ta9/r'� LJ��vC ASSUIL _ SEWARD & j ► HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE , FOLLOWING DESCRIBED PROPERTY: -It. y� DATE, AND THAT EXCEPT SPONSIBILI-TYOFF INDICATED. IT IT IS THE RETHE ' CWNER TO DETERMINE THE EXISTENCE OF ANY GRID - EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI— ,fiv VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FS, ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- I ARY LINES. DRAWN IM1 \0 C F.1 4 Of At 91 LH7 �•• Dvsn• M -irk 56-8-d � t�,•. LS 5913 • - MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P0"Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING �. Parcel 1. D. # f ) 1�0 -1C� 1 - C)i1- Qt- n HAA It 1. GENERAL INFORMATION Complete legal description Loi 4; Btock 7; R.iye'Av iew E.6ta te6 Location (site address or directions) Ri.veA Pa,%k Drive Property owner Louie Bnunen Day phone 243-2284 Mailing address 6950 Cnaw6ond Anchorage, AK 99502 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 XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of,system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of, Firm Phone Address S & S ENGINEERING 17034E.agieKiverr Loop, o p, Engineer's signature, Eagle River, Alaska 9957 Date 101,(2 t, . tic ... .. I•• 6. DHHS SIGNATURE . Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments, WTir 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 (Rev. 1/91) Back MOA 021 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description, �6e,/I CQ ��-l��s Parcel I.D. A. Well Data Well type �/ If A, B, or C, attach ADEC letter. ADEC water system number L6 Log presen (Y ) Date completed �D- �'�� Driller .tT��� 7' �2r u- I / 1 -}- Septic/holding tank on lot On adjacent lots Absorption field on lot I 10+ ; On adjacent lots Public sewer main IJ0 Public sewer manhole/cleanout O� Sewer service line Petroleum tank �L WATER SAMPLE RESULTS: Coliform 0 Nitrate to •0• Other bacteria d Date of sample: q f G1 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed �� Tank size 4Compartments 7i Cleanouts®/N) Foundation cleanou ) Depression (Yto High water alarm (Y/� Alarm tested (0 Date of pumping /1J45[) 7�?k tJ IL-- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation i S To property line —Absorption field 15 Water main/service line /b Surface water/drainage 72-026 (3(93)• Front 1 S� ���G� %� ����CONTINUED ON BACK PAGE Total depth Cased to -91 Casing height 12 4 - Sanitary sea&) � Wires properly protected fiN) FROM WELL LOG AT INSPEC ION o n Date of test0 Static water level ca m Well flow g.p.m. g.p.m. Pump levell R O Z SEPARATION DISTANCES FROM WELL TO: / 1 -}- Septic/holding tank on lot On adjacent lots Absorption field on lot I 10+ ; On adjacent lots Public sewer main IJ0 Public sewer manhole/cleanout O� Sewer service line Petroleum tank �L WATER SAMPLE RESULTS: Coliform 0 Nitrate to •0• Other bacteria d Date of sample: q f G1 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed �� Tank size 4Compartments 7i Cleanouts®/N) Foundation cleanou ) Depression (Yto High water alarm (Y/� Alarm tested (0 Date of pumping /1J45[) 7�?k tJ IL-- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation i S To property line —Absorption field 15 Water main/service line /b Surface water/drainage 72-026 (3(93)• Front 1 S� ���G� %� ����CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE,FJ Well on lot D. ABSORPTION FIELD DATA Manufacturer Manhole/Acc( �-"Pump off" Level at Cycles tested LIFT STATION TO: On adjacent lots Surface water Date installed 1 r'18�J 4- Soil ratin .SF 9�8fFtP) System type Length Z01 Width �' / Gravel thickness �• / Total depth Total absorption area Cleanout presen (Y ) Depression over field (Y N) Date of adequacy test `"1 Result (pa fail) for Bedrooms Ji Water level in absorption field before test - _ After test D �� Peroxide treatment (past 12 months) (Yf /�� If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots Property line /O il To building foundation 22 / To existing or abandoned system on lot IJZA On adjacent lots 30 r-� Cutbank Water main/service line %C% IV— Surface V -Surface water /00 4— Driveway, parking/vehicle storage area Curtain drain i i1'4L, E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the clate.of this inspection. Co ``� ! •Qt'J 4y Signature �...s n �!p•fyAal{1.Qn...pi/ Engineer's Name S Date E: HAA Fee $ -- `'�m eDz) Date of Payment Receipt Number c c2 ZX 2• Ll�;175O 72-026 (3/93)• Back 3. Waiver Fee $ _ Date of Payment Receipt Number_ ' �. o. �~ VFrry •.o:.'ti�t1'��e: COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES 1908SINCE REPORT of ANALYSIS 5633 B STREET Chemlab Ref .# :93.4726-1 ANCHORAGE, AK 99518 Client Sample ID :L4 B7 RIVERVIEW EST. TEL: (907) 562-2343 Matrix :WATER FAX: (907) 561.5301 Client Name :S & S ENGINEERING WORK Order :70807 Ordered By :R. SHAFER Report Completed :09/14/93 Project Name Collected :09/09/93 @ 11:50 hrs. Project# Received :09/10/93 @ 16:00 hrs. PWSID :UA Technical Director:STEPH�EN/ C. EDE Released By : �' Y _ ��- Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init ------------------------------------------------------------ Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 09/11 LLH ------------------------------------------------------------------------------------------ ---------------------------------------------------------- * See Special Instructions Above UA = Unavailable See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than (Wi SGS Member of the SGS Group (Social Gdn6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA