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HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 2 LT 11Mountain Valley Esta Block 2 Lot #050-641-08 Municipality of Anchorage Page / o! ,,~' _ 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: ~.~'4v/ (~70,~ ~ PIDNumber: Name: ~O/~ %~ ¢~ ~0/¢ ' Wastewater System: ~ New ~ Upgrade - J No. of Bedrooms: Phone: ~ ~'~I ~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other Lot: Slock: Subdivhlon: Deplh lo pipe botlom from original grade: Gravel depth beneath pipe Township: ~ ~ Range; ~ ] Section:~ Fill added above original~//~ ~rade: Ft, Gravel length: ~ ~ Ft. I I ,, Number of lines: Oislance between lines: WELL: ~ New D Upgrade er.ve~wid~h: ~ Et, / ~ Ft. .C~asslflcatl°n~ t ~(Prlvate' A,B,C): Total~/Depth: Ft . Cased~To: FI. Total absorption~.area: SQ. Ft. Pipe~materla]:~O~/O/ Driller: Date Drilled: Static Water Level: Installer: Date Installed: SEPARATION DISTANCES ~ septic ~ Holding ~ S.T.E.P. To Seplic Absor~llon Lift Holding Public/PrivateManufacturer: Capacity in gallons: From Tank Field Slation Tank Sawer Lines ~C ~¢) ~ ~ Malarial: Number of Compadmenls: Sudace Water /00r~ /co? / LIFT STATION. .... -~-- Lot/ SIzein gallons: Manufaclurer: CurtalnDrain ~ ~/o/t~ /~ ~ ~ ~1 Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: I Assumed Elevation: 17034 Eagle River Loop Roa~, Ne, ~ Department of Heallh.and Human Services apCfa~f 72-013 (Rev. 9/gl) MOA 25 PERMIT NO SW970292 PAGE 2 oP 3 Municip. o, Lit~ oF' Anchoro~ae DEPARTMENT 0¢ HEA~THAND HUMAN SERVICES ENVlRONHENTAL SERVICES DIVISION P.B, 3ox ~96650 eAnchor~ge, ~sk~ 995t9-6650eTelephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL 5YSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 11, BLOCK 2, MOUNTAIN VALLEY EST. P.].]Z NO. 050-641--08 LOT 1 g / ' LOT 11 \\ \ ~ EW TRENCH \ SITE NEW [1000 GAL. SEPTIC TANK ST1 TH#3 \ TH#1 \ \ TH#4 TH~2 qEW WEL \ WELL 40' CE -880i LOT 10 PERMIT NO SW970292 PAC-E 3 OF 3 MunicipaLity oF Anchoraoe DEPARTMENT OF HEALTH AND HUi~AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.B, Box 196650 ®Anchorage, Alaska 99519-6650®Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 11, BLOCK 2, MOUNTAIN VALLEY EST. P,I.D. NO. 050--641--08 ST1 ST8 ~/102' I ~../'FINAL GRADE NEW ~ 1000 GAL , A B FCO 8.0' 54.5' ST1 12.0' $7.0' ST2 18.5' ,35.0' DBL1 20.5' ,35.5' DBL2 21.5' ,35.5' CO1 29.5' 21.0' MT1 29.0' 21.0' C02 78.0' 96.0' MT2 77.5' 96.0' CO1 MT1 C02 MT2 CO1 = 99.5' n III ~"-H-LJCOl = 9a.7' MT1 = [t4.9' MTg ~ 95.1' · NO WATER FOUND 88.1' B.O.H. OWNI-:R OF LAND 'T/'/ LEGAL DESCRIPTION/~'~l PERMIT NUMBER. ~ ~ ;~.~ Da~e T~ INDENTIFICATION NUMBER Is wetl located at approved permit Iocatio?? Method of Drilling: Depth of well: ~ Casing Type Diameter ._ ~/_t Liner Type: ~:~,.)~ ,~J Wall Thickness inche~, deptt~_._.._~ ~!_ ~ORF. HOLE DATA DEPTHT~ Casing Stickup Above Ground: ¢~ . __~*¢ Static Water Level (from ground level): ....... PLlmping level: feet after hr~ Recover Rate: '~ gpm Method of Testing: ~ ~ Well Intake Opening Type: ~en End [ /. ~ Soreened; Stad feet ~ Pedorations Start ~fiee~S~c,~?,:~d Grout Type: ~,'r j~ 'VD u~o_ _,;:.~ ' . Oepth: from 0 feet, to Well Disinfected Upon Completion? ~'~ Metaod of Disinfection: ~N~o~, ~ Comments: I Oriilers Name. RE'C. JVED ~¢t;~¢./-I~altn & Human ATTENTION: It is the respon~ibiiity of the proper;" . :' ,.~ subrnit ~ copy of the well log to the proper authority. Mdnicipalib/ of Anchorage: Department of Health & Human f;r.~-: ~i~d/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Censerwtk}l'L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUPL~N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970292 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:THOMSON, JOHN OWNER ADDRESS:iT343 SANTA MARIA DRIVE EAGLE RIVER, ALASKA 99577 DATE ISSUED: 9/04/97 EXPIRATION DATE: 9/04/98 PARCEL ID:05064108 LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES BLK 2 LT 11 LOT SIZE: 48911 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN kNCHOR_~GE 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 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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 SA=ME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~/ ISSUED BY: ~/'A /~-'~ ~64/~4~ ~ '~4~ ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUOIES AND REPORTS WELL INSPECT[ON & FLOW TEST SITE pLANS ROAO DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN August 22, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 11, Block 2, Mountain Valley Estates Subdivision Request you issue a pernfit to drill a well aud iustali a septic system to se~-ee the proposed three bedroom house ou the refereuced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered in any of the test holes, and after seven day ground water monitoring, no water was found in test hole #1, and water was found at 6.2 feet in test hole #2, dry in test hole #3, and 7 feet in test hole fi4. Tiffs property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional infmxnation, please contact us. Sincerely, 7~o~ert C. Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1"--'60' ~GALE JOHNNY DRIVE SITE-PLAN DESIGN o z~ ~ om z~ o~m~<mm ~o~Zo o DESIGN DETAIL N.'r, S, ~C:ALE ~8 0 PERFORMED FOR: LEGAL DESCRIPTION: 3 4 7 9 10 11 12 13 14 15 16 17 18 t9 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT L DEPTH? pO E o,,t~ to Wat~ Ap~., ,",,"d~'1 Monitoring? ,.~'"' t~ Date: ~'/' SITE PLAN ! Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) I~ERC HOLE DIAMETER TEST RUN BETWEEN I FT AND *~ FT COMMENTS "7 / PERFORMED BY: ,,,..,v~.~ ~.-I. o.'.~. ~C~ o...,I ~d~ - · CERTIFY THA'f THIS TEST WAS PERFORMED IN ....... , ...................... ^CCO~D^NCE W~T~i~l_~&~X~i~llt~,L GU~DEUNES ~. EF.ECT ON T.~S DATE. D^TE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: ~// 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST '~'-~ ~ ~,'}~---N,~ownship, Range, Section: '' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Monitoring? t.¢ .~'"- Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ immures/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~/~"" FTAND /¢5~ FT COMMENTS / //! ,'? //' S & S ENGINEERING ~¢4~/,/~/~/~_ ~ _t~/¢,,,t_...,~7 CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ,.~.a ...,~., .... , ........... = .... · . ACCORDANCE WIT~[~~ GUIDELINES IN EFFEC~ ON THIS DATE. DATE: 72-008 (Rev. 4/85) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~'2~,~ ~ f~ DATE PER FORMED}'_ ~),,,~ ~¢~--1_~. ¥~Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTR? SLOPE SITE PLAN Depth to Waler/~. , ~onit0rino? ~Oate: ~'~'"'~'J~"~"'~l ,, ~, ~ea'~=n~ Date Gross Net Depth to Net Time Time Water Drop t'~¢'- ~.~ O~L ~"r~--~ O~ fi'I*." PERCOLATION RATE [ (minutes/tach) PERC HOLE DIAMETER 'I EST RUN BETWEEN . / FTAND ~ _FT COMMENTS PERFORMEDBY' _~&$ENGINEEEING i .~'.,q~---~/~/'~----- CERTIFY 'rHAT TH,S TEST WAS PERFORMED IN ACC ORDANC E ~IT~I~J[~'~"~P~aG~uIN[~I~ L21N0~ES; N E F F ECl' ON THIS DATE. DATE: ~'/~",~" /¢'~ 72-008 (Rev. 4/85) PERFORMED FOR: ,-EGA,. DESOR,PT,ONLA 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WAS GROUND WATER ~.~ ~ ENCOUNTERED? DEPTH?IFYES'ATWRAT ~ ~_ pO E nepth t0 Water Alter ¢/) ~r "~ ,t1 '1 Monitoring? Date: ~ ..... ~ ................. ~,~,~ DATE PERFORMED: . Township, Range, Section: SITE PLAN I Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE "~ (m,nutes/inch) PERC HOLE DIAMETER 'rEST RUN BETWEEN ./, ~ FT AND ~-"~""~'FT COMMENTS S & S ENGINEERING PERFORMED BY; ]7~4. ~"!fl~ ~;v~r [.g~p ~oa~ ~O, ~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W~~~AL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2 /'~ S~/~ 7 72-008 (Rev. 4/85) HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN E3(TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 11, Block 2, Mouintain Valley Estates Subdivision August 22, 1997 GENERAL: The scope of this project includes the installation of a 1000 gallon septic tank and a five foot wide drainfiel~ to serve the proposed three bedroom residence for the referenced property. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible fbr final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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 Mmficipal Health Department. SEPIIC 'lANK 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. 17034 NORTH EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 11, Block 2, Mouintah~ Valley Estates Subdivision August 22, 1997 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet fi'om 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. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 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. 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. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt ban'ier covers the entire gravel surfhce befbre placing backfill. 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 alcove final grade. The portion of the monitoring tube extending through the gravel shall be peal'orated 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. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the bacldill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation ora depression after sealing. MINIM'U1VI IVIATERIAL SPECIlqCA~IIONS: 1. Any septic tank proposed for installation must be constructed by a lVhnicipally approved septic ta~k manufhcturer. Page Three Lot 11, Block 2, Mouintain Valley Estates Subdivision August 22, 1997 The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use ora type of pipe other than listed above must be approved by the inspecting engineer, Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 34.01, Mirafi 140N, or equal) must be installed between the final leachfield gavel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~e2,00 sieve. When sand is being used as a filter material, its gradation specifications must conform to cmTent MO.A. or D.E.C. requirements, which ever 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: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tm~k may be set in place, but may not be backfllled bet'om this inspection. 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. Page Four Lot 11, Block 2, Mouintain Valley Estates Subdivision August 22, 1997 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/OWNER MUNICIPALITY OF ANCHORAGE Development Services Department 4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-641-08-000 Expiration Date: 9/23/2024 Legal description MOUNTAIN VALLEY ESTATES BLK 2 LT 11 Site address 4533 HILAND RD Eagle River AK 99577 Current property owner(s) OBISPO ANDY PAUL X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: Az bedrooms, with the following stipulations: Original Certificate Date: 1/25/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF ANCHORAGE tI.•- Development Services Department �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 05064108000 Complete legal description MOUNTAIN VALLEY ESTATESBLK 2 LT 11 Location (site address) 4533 H I LAN D RD Current property owners) OBISPO ANDY PAUL Day phone 376-7653 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Plastic ❑ Concrete ❑ Fiberglass Age 11 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑N Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _550 Waiver Fee $ Date of Payment ! 5 % 1-01 `-1 Date of Payment COSA # Q j CZ 4 ) 0OZ2 Waiver # COSA Application—June 2022 COSA Checklist Legal Description: MOUNTAIN VALLEY ESTATESBLK 2 LT 11 Parcel ID: 05064108000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 6/17/98 Total depth 44 ft Cased to 43 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 1/3/24 Static water level at beginning of test 16 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping 9/23/23 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/22/12 ❑■ ALL standpipes present per record drawing Total measured depth from grade 3.5-8.5ft (max) Measured depth to pipe invert from grade 3-8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 1/2/24 date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci COSA Checklist June 2022 Well production at time of test 4 gpm Water storage tank volume0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No 0 Coliform bacteria is Negative Nitrate 2.86 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by NRim Eng. Date 12/11/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 1/3/24 Results g Pass Fluid depth prior to test 3 Water added 600 gal New fluid depth 6 in Elapsed time 60 min Final fluid depth 3 in in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 3 in Effective depth remaining 3 in in E. SEPARATION DISTANCES From Private Well on Lot t4D- (Please enter distances if less than required or if community well an lot) Septic Tank/Lift Station on, Lot > 100' —■ ❑■ Yes if No Community Sewer Man holelCleanout > 100' Surface Water > 100' Yes if No ft ❑■ Yes if No ft Neighboring Tank > 100' ❑■ Yes if No ft Private SewerlSeptic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank �- 100' ❑■ Yes if No fit Neighboring Absorption Fields > 100' Nater Service Line > 10' ■1 Yes Animal Containment > 50' [NYes if No ft Q■ Yes if NO f# IwfanurelAnimal Excreta Storage > 100' Community Sewer Main 5 75' ❑■ Yes if No ft ■❑ Yes if No ft ❑ N/A— Served by Community Well (not on lot) or Public Water From SepticlHolding Tank and Absorption Field(s) on Lot to: (Please enter distances if leas than required) Building Foundations > 10' ❑■ Yes if No ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' ❑■ Yes if No ft Walls on Adjacent Lots: Field to Property Line � 10' ❑■ Yes if No ft Private Wells > 100' ©■ Yes if No ft Water Main? 10' ❑■ Yes if No ft Community Wells 5 200' [■ Yes if No ft Nater Service Line > 10' ■1 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I +rarity that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply andlor wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Namo of Firm NorthRim Engineering phone 694-7028 Engineer's Printed Name Steve Eng l_]aic 14124 CASA Checklist—June 2022 ''vt\\\\\% OF 49 TH , .. ,� nm Ste" Eng VN GE -6256 %'_ Ar � 1/4/24 ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: /llo�it�r%//✓ .!!.GLG�i� EJr✓�T�`oT//di�� ' AND THAT NO ENCROACHMENTS _EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. •JL'ri.cuiU o< J'002 rlliln2 JitTv SUxvhxl.NU 694-( SCALE' 4:1 ya' o�wwa�4y4 ()IF DATE ' • . S�� s •/� y•a 4 �j�'7 Hv GRIDS s.... ....... F & f+ Duane Mark Seward / -5-- .fir LS -,6918 ya, ,y 7 DRAWN. '� ��'rhxlat :,•� Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Pa II.D. o5o-64 -o8 . 1. GENERAL INFORMATION Expiration Date: ~/" ~,- 7 ' ~) J' Complete legal description Location (site address or directions) MOUNTAIN VALLEY ESTATES SUBDIVISION; LOT 11, BLOCK MILE 5.2 HIGHLAND 0RIVE Day phone 552-5499 Current Property owner(s) RANDY HERON HC85 BOX 9448 * EAGLE RIVER, AK 99577 'Mailing address Lending agency Day phone Mailing address Real Estate Agent Dayphone Mailing address Unless o~herwtse requested, HAA w~71 be hem by DSD for plckup. 2. NUMBER OF BEDROOMS: 3 3. 'TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL'. Individual On-site Individual Holding tank Community On-site 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 5 by an Independent professional civil engineer registered In the State of AJaska. 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 less than 30 days old. (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 vedfy that my investigation, based on procedures outlined In the Health Authorfly Approval Guidelines for this applicab'on, show~ that the on-site water supp~ and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrcom$ and ~ of structure indicated herein. I furlher verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspecCon, the on-site water supp~' and/or wastawatar disposal system Is(are) in compliance ~th all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORACE, AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provfde a thorough, conscientious eegtneedng analysis of the system In accon~ance with/{DEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the tos~ and separation dis~nces measured to resdiiy identifiable features. The operational life of all wells and septic systems depend on the Iocal so#s condYJon, groundwater levels that may fluctuate during the year, and the t~'ater usage of the famliy being served by the system. These conditions are outs/de the conb'ol of tho evaluata' of the system. Satisfactory test results do not guarantee future pedorrnance of the system, nor do they guarantee that there are no hidden defects or encreachreente. AWWC, Inc. can therefore not provide any wanan~y or fulure estimate of how long the system will continue to meet the oparational requiremente of the ADEC or MOA DSD. The content of this report Is for the sole benefit of tho owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor v411 It confer any legal right whaz~,,er. 5. DSD SIGNATURE Phone 337-6179 Date ; ON-SIT~/':: WATER AND : ~ Appreved for ~ bedrooms. __ Disapproved. ~'"<<'z,?.. ~.' ,.C' ~ "' ..- 4-,.,~, __ Conditionalapprovalfor .__ bedreoms, wlththefllowlngstipulation,: Attachments: HAA Checldist Septic System Advisory Well Flow Advlsory Manitanance Agreements c,.-"" Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Olvtslon On-Site Water & Wastewater Program 4700 Sou~ Bmgaw St. P.O. B~x 196650 Anch~age, AK gg51g-6650 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MOUNTAIN VA!kFY ESTAI~ S/D; LOT 111 BLOCK 2, Parcel ID: A. WELL DATA Well type Date completed Total depth 44 Date of test Stetlc water level Well predu~on 4 WATER SAMPLE RESULTS: Coliform. 0 colonies/100 mi. Date of sample: 6/6/01 B. SEPTIC/HOLDING TANK DATA IfA, B, orCprovklePWSlD~ 6/17/gs San~yes~(Y/N)YES FROM WELL LOG 6/~7/ga .g.p.m. NIIzate 1.61 mgJL Coaested bT. Tank T~pe/Mateflal STEEL Tankelze 1000 gal. Number of Compartments 2 Foundalion dsanout (Y/N) YES Dapmeslon over lank (Y/N) NO Date of pumping *9/2000 Pumper C. ABSORPTION FIELD DATA 050-641-08 Well Log (Y/N) Wires pmpe~ protected (y/N) Casing height (above ground) AT INSPECTION 6/5/o~ 12 It. 4 +/- g.p.m. 12+ .In. Other becterla 0 .colonies/lO0 AWWC~ INC. Date Installed 7/2/1998 Clsanoute (Y/N) YES High water alamt (Y/N) N/A *JR*s PUMPING Date Instefled ~ ~oll rating (~ .~.~[~or ~/bdrm) 1.2 TRENCH Length 77 lt. Width 5 lt. Gravel below pipe *0.5 It. Toteldepth 4.5 ft. Eff. absoq~onarea 385 It= Monlfodngtube YES Dapresslonoverfleld NO Date of adequacy test '6/5/01 Results (Pess/Fell), *PASS. '8/ Ruld depth In absoq~fon field before test 8.5 In. Water added 481 gal. *7.5 Elapsed Time: 1155 min. FInal fluid depth /9 In. For 3 bedrooms '14.5 Now dapth/16 In. Any reJuvenatfon treatment (past 12 mo,) (Y/N & type) Absorption rate >- 450+ g.p.d. NONE KNOWN If yes, give date - D. UFT 6TATION Date Instated ~lze In ga~ons ~ ·Pump on" ~l at I~ High water aterm level at ._ in. ~ Cycles tested Meete alarm & drcult requlmmente? SepUo tenk/I]ft stet]on on lot N3eerpUon field on lot Publlo ~wer main Sewer/septlo ~ewlce line SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'4- 100'4' 25'+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundallon 5'+ Property line 5'+ Water main N/A Water eervlce line 10% Wells on adjacent lote 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property I~ne 10'+ Water sewlce line 10'+ Curteln drain NONE KNOWN F. COMMENT~ On adjacent lots 100'+ On adjacent lots. 100'+ Publlc sewer manhole/deaneut N/A Building foundation 10'+ Surface water 100'+ Wells on adjacent lote 100'+ N/A Abeeq)tten field. 5'+ Surface water 100'+ Water main N/A Driveway, perldngNeldcte storage, lO'+ G. ENGINEER'S CERTIFICATION I cerUfy ~hat I have determined ~rough f~eld Inspec~ns end review of Municipal records {hat ff~e above R~tems are In conformance with MOA HAA guidelines In effect on fids date. EnglneefsPrtntedName a~H-~rEY A. GARNESS HN~ Fee $ ~) .,~o Receipt Number Waker Fee $ Date of Payment Receipt Number. MUNICIPALITY OF ANCHORAGE MEMORANDUM SEPTIC SYSTEM ADVISORY Prior to a recent adequacy test on the septic system for this lot, ~o~'inches of standing water was observed in %he a~orption field. This indicates that approximately /O0 % of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. -lC: o/ ALASKA WATER WASTEWATER CONSULTANTS, INC. June 15, 2001 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Explanation of septic adequacy test for Lot 11, Block 2; Mountain Valley Estates Subdivision The existing 3 bedroom house is served by a private well and septic system. Both the well and septic system were installed in the summer of 1998. Per the request of the homeowner, we performed a well flow test and septic adequacy test. The letter is an explanation of the septic adequacy test for the purpose ofobtaining a Health Authority Approval. On the date of our inspection (6/5/2001), the liquid levels were checked in both MTI and MT2. We found 8 inches of liquid in MTI and 8.5 inches of liquid in MT2. Both monitoring tubes appear to be installed deeper than the bottom of the drainfield. The cleanouts were also checked prior to the start of the test. In COl, the cleanout was found to be dry and in CO2, we found 2 inches of liquid level in the cleanout. Elevation shots were taken and found that CO 1 is almost 3 inches higher than CO2; and that MT2 is almost 2 inches higher than MTI. After all elevation were taken, water was added to MT2. A total of 119 gallons was added to MT2 and than switched to MT 1. An additional 362 gallons was added to MT1 with a total of 481 gallons being added to the drainfield. The 481 gallons caused the liquid level to rise to 14.5 inches in MTI (a rise of 6.5 inches) and to 16 inches in MT2 (a rise of 7.5 inches). The liquid level was brought to the top of the distribution line on CO 1. After 1155 minutes, the monitoring tubes were checked and found the liquid level to be at 7.5 inches in MTI (a drop of 7 inches) and found the liquid level to be at 9 inches in MT2 (a drop of 7 inches). Based upon this data, it is our opinion that the septic system is adequately absorbing the required 450 gallons per day and we request that a Health Authority Approval be issued. Ifyou have a,nytl[tuestions, please contact us at 337-6179. Thank you for your assistance. Jellr~t iarl~L~s, P.E., M.S. President I 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: {907) 338-3246 * Website: akwwc.com ~Y-31-0! THU 01:40 P~ X3WG/XP FAX:9075§29282 PAGE 2 ASBUILT .. $~TARD & ASSOC!AT~ LAND ~I~ ~9&-O829 I HEREBY CERTIFY .THAT I HAVE SURVEYED TH~ ~ ~'~ ~ ~ I INDICA~. IT IS THE R~NSIBILI~ OF ~E I . ~ '' I ~n~ ';~ I ....;.~.z ..... .~'~ 1 ~ ~ D~E~E VISION P~T. UND~ NO ClRCUUST~CES , ~ DATA H~N ~ US~ ~ CO~S~ION. I ~ ' ~* ~x'''.. ..'"~%~ ~ vzNcz LIN~, OR FOR E~LISHING ~ND In.~, / ~~~'- I ARY LINES. / ....... / · - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVIOES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-641-08 1. GENERAL INFORMATION Complete legal description Lot 11~ Block 2¢ Mountain Valley Estates S/D Location (site address or directions) Hiland Road Property owner · Mailing address Lending agency Mailing address Agent Address .John Thomson Day phone 240-2020 17343 Santa Maria Drive, Eaqle River, AK 99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72'025 {Rev. 1191) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I ver!fy 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 fines 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 s & $ ENGINEERING ~7o~,4 z.~;,, ,~;¥~r L,,,m Ro.d t.;~. 28.4 Phone 6' o/y _ ;L 9 ? '7 Address .~,~e River, Alaska 99577 Date ]o/ DHHS SIGNATURE Y Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 enginee¢s work. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage ..... Jr,,~,~. r ~,~ ~.~^~ DEPARTMENT OF HEALTH & HUMAN SE'R~(~BS-S~RVlC~S ~rVl~r~ Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: )--o 7- I ~ ~3 L ~ P- ~..,~4,,~ v~.y ~sr. Parcel I.D.: O A, WELL DATA Well type /~ Log present ~/N) ¥/U..~ Date completed Total depth Sanitary seal ~fN) "/ FROM WELL LOG Date of test Static water level Well production ~ g.p.m. If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (~/N) AT INSPECTION g.p,m, WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: I 0//'~ 7 / cf ? SEPTIC/HOLDING TANK DATA Date installed -/ ¢";)- / ¢/~ Tank size Foundation cleanout ~/N) ¥¢ ~ Collected by:. I, G ~ Other bacteria S & S ENGINEERING Eagle River, Alaska 99577 Number of Compartments ~2_ Cleanouts (~/N) ¥ /,/o High water alarm (Y/L'~ ~v o /0oQ Depression (Y/~) Date of Pumping ~/4 -~¢ ~' Pumper ABSORPTION FIELD DATA Date installed '7 / ~ / ~ ~ / Length W '? Width Effective absorption area 3 '~ Date of adequacy test ~'~ { 4 Soil rating~.~ff~-~or fF/bdrm) ]' '~ System type 'k ~ t Gravel thickness below pipe O~ ~- ' Total depth Monitoring Tube present ~/N) Y~ ~ Depression over field (Y~ Results (Pa./Fail) FOr ~ bedrooms Fluid depth in absorption field before test (in.); Immedi_at~tcwate~a'a~d (in.): Fluid depth __ (ins) Minu~°rption rate = _ g,p.d. Peroxide t~i 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycle~ Size in gallons "Pump on" level at* .. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ) o 0 -/- Absorption field on lot / 0 On adjacent lots On adjacent lots )oo ¥- I o0 Public sewer main Sewer/septic service line Public sewer manhole/cleanout '3- ~" '-/- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / / Foundation ) 0 ' Property line S- 4'- Absorption field ~ '~' Water main/service line /o + Surface wateddrainage ) o ~) J~- Wells on adjacent lots /O 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I o -¢ Surface water ) 0 ,.) Curtain drain /,~ 0 ,~ ,~.. Building foundation 1 '~ Water main/service line /o -/- J,- Driveway, parking/vehicle storage area ~ 0 ~ o ~ ,,~ Wells on adjacent lots ) HAA Fee $ J~¢' ''~ Date of Payment/~/~. ~/~~;;/~'' ReceiptNumber/_~/----~' / /~/-~'~¢~' ) ENGINEER'S CERTIFICATION I certi that I have determined thru field inspections and review of Municipal recorcl~,l~ tl~['at~ ;~_~a~sterns are in confo~ance with M~A ~guideline~ zn effect on th~s date. Engineer's Name ~4,~ ~ C. C~ ,~ Date. _ ~0~ ~/~ ~ ~.,, Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*