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VALLEY VIEW ESTATES #1 BLK 2 LT 1
Valley View Estates #1 Block 2 Lot 1 #050-521-47 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Pert -nit Number, OSP211225 PID Number: 050-521-47 Dwelling: W Single Family (SF) E_J with ADU F-1 Duplex (D) Fj Two Single Family Project: R New ❑ Upgrade Name KUNNEN BRYAN ABSORPTION FIELD ❑ Deep Trench R Wide Trench El Bed EJ Mound Site Address 25642 Berryhill Rd E] Other Phone Number of Elcdroorns Sod Rating Total depth frons original grade 947-1908 14 GPUSFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft lGravel depth beneath pipe Ft. Subdivision Block Lot VALLEY VIEW ESTATES #1 BLK 2 LT 1 F1II added above original grwJe Ft.1 lGravel length Ft. Township Rang ge Section Gravel with Ft.1 Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Holding Suver To Septic Abscrption Lift Station Total absorption area lNumber of trenches Dist. between trenches From Tank Field Tank Line Ft. Well 100'+ na na na TANK M Septic 0 S.T.E.P. ®Molding (3 Other 1 Manufacturer Greer Capacity 1250 Surface Water 1001+ na na Material Plastic Number off compartments Lot Line 10'+ s na na NA Foundation 10'+ na na LIFT STATION Manufacturer Capacity Remarks Septic Tank Replacement Gal. Alarm location Electrical installed by PIPE MATERIAL HousetotankTank to D3034 drainfieldD3034 Installer Dean Drainfield CO/NiTD3034 1nS;,QCtoT NorthRim Eng. BENCH MARK (Assumed elevation) 100 ft Inspection 1-16129121 6130/21 2"� Location and description dates: Deck 3,1 4t'� ON-SITE WATER AND WASTEWATER SECTION APPROVAL e:ZtA4 044 #_* Conditional Approval: Date -491H �4 -A Steve Eng W 0, S, � , - " 0 #,A CE -63256 ; 7/ T/ 21 Septics stem Approved Date '7/8'/202 Note: this approval does not include well permit requirements. Jr. �I ,•' • cD ' 9t��tt s R' C� < o D n FTI d frl 7� -< m < (� -I F- M M -MM 0 � f'1 D z 7K F m C a C 70 ti ru �' m a m C) I I Ul W o co ox �l c V e o 3 U 14 V Jr. �I ,•' • cD ' 9t��tt s R' C� < o D n FTI d frl 7� -< m < (� -I F- M M -MM 0 � f'1 D z 7K F m C a C 70 ti ru �' m a m C) I I Ul W o co rrl m < Q rT,z �zqo(Dzo C+ FD c0 CD Z� p ax e N r 3 rrl� 0 0 ro O �10 n.)U1- ro kO 00 N 'o�o W n U1 1 C�V r0 Q V FO V) D f9 z H /; n F9 F— D D Z 3 F9 ;;u z o --1 -9 H F9 �;UF),) m tj ME D F9 m < Q M < C+ FD Q `<° C+ O Q O 0 c+ ro 0 0 ro O �10 n.)U1- ro kO 00 (D (D ,O W n U1 Q r0 Q Q C+ C+ LA bd (o 0 C+ 5 n V) (o 0 -0 Lt N V) rD n MK -u �Q rD _0 Q Q co Oro L rD D -3 ro 90 O r m :5 n ro :3 s r n s C+ () 3 ro < O � ro o -b 1>--- Q r �� 0 m0 -0Cl �Q fl D c c0+ Q Q �� n Q 0 0 �D O< Q N 7� W rp Q Q ro �:5 0 c c+ 0 m < Q M < C+ FD Q `<° C+ :5 Q O 0 c+ ro 0 0 ro O �10 n.)U1- ro kO 00 (D (D ,O W n U1 r0 Q 0 C+ LA bd (o C+ (o (o V) (o 0 -0 Lt V) rD n rD _0 --i Q Q co � rD 90 r :5 n ro :3 s r n s w NOTE: THE LOT DOES NOT MATHEMATICALLY CLOSE. (C) = COMPUTED (R) = RECORD PLOT PLAN ___ AS BUILT _X_ SCALE _1" =60__ GRID _ SW 0263Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000p�pp0 (907) 522-4625 Fax oo F A ppp Professional Land Surveyors kenOlangsurvey.com c .. 9 0 ionothanOlonasurvev.com o . s Q 1 hereby certify that I have surveyed the following described property: LOT 1, BLOCK 2, VALLEY VIEW ESTATES — ADDITION No. 1 (PLAT No.74-191) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. 11 Dated this the __ t�--- Day of l _, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. OSP..• /�p� ' 49TH �tr . —KENN H LAN •off � sfi'•. � Cco (21 ,���� 04 �Fa'-..LS-5202.••' y�oG 4�� �FESSIONA� �o 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: OSP211225 Work Type: SepticTank Upgrade Tax Code Number: 05052147000 Site Legal Address: VALLEY VIEW ESTATES #1 BLK 2 LT 1 G:0263 Site Mailing Address: 25642 BERRYHILL RD, Eagle River Owner: KUNNEN BRYAN L & KATIE E Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: trent Depa rCnleiit 6/22/2021 6/22/2022 65109 ❑ Private Well ❑ Water Storage Id 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 LS�ecial`. Provisions: Locate the beginning of the field to confirm that the 5' separation between the tank and field et. Received B� Issued By: Date: �/ )a / a / Date: 6 2Z Z MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-521-47 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) KUNNEN Day phone 947-1908 Mailing address 25642 Berryhill Rd Site address same Legal description (Sub's., Block & Lot) VALLEY VIEW ESTATES #1 BLK 2 LT 1 Legal description (Township, Range & Section) Lot Size 65,109 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo AD U) Septic Tank El Upgrade 0 Duplex (D) ❑ Holding Tank F-1Renewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 Waiver Fees: Date of Payment: 1 �Do21 Date of Payment: Receipt Number: Receipt Number: Permit No. 051021122.1 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Form s\Client Forms\Permit Application.doc SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 6/15/21 Number of Pages: To: MOA On-Site Services Subject: Valley View Estates #1Block 2 Lot 1 500-Gallon Septic Tank Failure The subject septic tank has failed- a new tank will replace the old one. The existing seepage trenches appears to be working OK. Please issue a permit so the 500-gallon tank can be replaced. Please review as soon as possible. This is a large lot with no nearby neighbor conflicts. Slopes are depicted on drawing. If there is need for additional information or clarification please give me a call. Thanks-Steve Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211225, Deb Wockenfuss, 06/22/21 TH IM FE,ZINEERING SteveEng.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE CONPUANCE OSP211225, Deb Kbckenfuss, 06/22221 Valley View Estates #1 B2 L1 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current 500 gallon septic tank has failed- the seepage trenches still function. This lot is large with nearby wells drawn on plan sheet. No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. 2' of rigid insulation over the 500 gallon tank to reduce soil load. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 500 gallon septic tank. Watertight couplings on inlet & outlet. • 5' minimum between the tank and trench. 5' to property lines & 10' to house. • 4' of cover or insulation is required for tank; an equivalent of 1 " insulation for 1 ' foot soil cover. Tank & solid pipe must be set on well compacted, stable soil. • No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel. • 4" diameter cleanouts with airtight caps are required 1 ' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in 2nd tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. Manhole Riser required in 1" tank compartment. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) * :49TH Stew Eng °� awl Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211225, Deb Wockenfuss, 06/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211225, Deb Wockenfuss, 06/22/21 ®evelopmenT Services ®cpur°tment Building Safety Division �tr of On -Site Mater A Wastewater Pro gram o AGE e.0 t l ',) 4700 Elmore Rood r ° P.O. Box 196650 Mark Begich Anchorage, AK 99507 s A e r v Mayor www.muni.ora/onsite (907)343-7904 PUMP hata Mon Log Well Drilling Permit Number: SW Date of issue: Parcel Identification Number. o50- Legal Description Pro ertz Owner Name & Address: Pump Installation Date: '�,1 Pump Intake Depth Below Top of Well Casing: jv Feet Pump Manufacturer's Flame: Pump Model: Pump Size C hp Pitless Adapter Burial Depth: �' feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Comments: N � ANCHORAGE WELL & PUMP SERV. Pump Installer Mame: TH 330 EAST 76 AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. inspection Repon_i-r-iz.aoe Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSPI31200 PID Number: 050-521-47 ❑ New ❑✓ Upgrade Name: Lorelei Hass ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 25642 Berryhill Road ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft.Gravel depth beneath pipe Ft. Subdivision Block Lot Valley View Estates #1 _ 2 1 Fill added above original gradeGmvel Ft. length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. well 116.0 (E) N/A N/A 109 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1000Gal. Surface water 100+ (E) NIA N/A Material Number of compartments Lot Line 44.5 (E) N/A N/A Steel 1 NA Foundation 6.5 (E) N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Tank Installation Only. Pump on level at in. Pump off level at in. High alarm h water alaat in. E Existing ( ) = 9 Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 dralnfield Tank to 3034 JRs Septic Pumping Draingeld C01MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) loon Inspdates: 1� 9/9/2013 n Location and description 2 3'" a Invert @ FCO COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date��� .4 5 Pan nbrae CE 8149 Approved PP / a_ O. 3 !N Date 40'4L Z inspection Repon_i-r-iz.aoe I \� fRRYNICC &DID '77 \\ DRAIN FIELD (E) 3 I COLLAPSED 1000g SEPTIC TANK ABANDONED PER CODE NSTALLED SINGLE COMPARTMENT 1000g SEPTIC TANK (P) W/ DCO 500g SEPTIC TANK (E) REMAINED 3� Sq �G n� O� F NEW 1000g J SEPTIC SEPTIC TANK �. S5009 EPTIC I I A I B I rz T1 I 11.9 I 29.3 1 s -e 1 rF w\ W� W� W WELL (E) 4BR HOUSE 14, AMM h (E) /C1` A. /116.0 10' UTILITY EASEMENT �1 WELL (E) \� 12 SEPTIC AREA (E) \ W—� NOTES:PAMONE ENG SVC, LLC.����p Q(\\` Date RECORD DRAW NG P.O. BOX 100217 ANCHORAGE, AK 99510 J C� • '"' • 9S`l 279713 PHONE (907) 272-8218 FAX (907) 272-8211 y'yy++� Scale j*r4 1"=50' %..... .. ..... P.I.D. NO VALLEY VIEW ESTATES #1, BLOCK 2, LOT 1 050-521-47 LORELEI HASSteven R annoae PERMIT NO. 25642 BERRYHILL ROAD(CE'�1i OSP131200 PLAN EAGLE RIVER, AK 99577([11` "`D�p� � SheettOF 1 o� 40o _ o z wo m= s 0 = 5 0 m= OLLU U w U oti U �w ou NEW 1000g J SEPTIC SEPTIC TANK �. S5009 EPTIC I I A I B I rz T1 I 11.9 I 29.3 1 s -e 1 rF w\ W� W� W WELL (E) 4BR HOUSE 14, AMM h (E) /C1` A. /116.0 10' UTILITY EASEMENT �1 WELL (E) \� 12 SEPTIC AREA (E) \ W—� NOTES:PAMONE ENG SVC, LLC.����p Q(\\` Date RECORD DRAW NG P.O. BOX 100217 ANCHORAGE, AK 99510 J C� • '"' • 9S`l 279713 PHONE (907) 272-8218 FAX (907) 272-8211 y'yy++� Scale j*r4 1"=50' %..... .. ..... P.I.D. NO VALLEY VIEW ESTATES #1, BLOCK 2, LOT 1 050-521-47 LORELEI HASSteven R annoae PERMIT NO. 25642 BERRYHILL ROAD(CE'�1i OSP131200 PLAN EAGLE RIVER, AK 99577([11` "`D�p� � SheettOF 1 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131200 Tax Code Number: 05052147000 Work Type: Septic Permit Effective Dates: July 24, 2013 to July 24, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: VALLEY VIEW ESTATES #1 Site Legal Address: VALLEY VIEW ESTATES #1 BLK 2 LT 1 G:0263 Owner/Address: HASS LORELEI 25642 BERRYHILL RD EAGLE RIVER AK 995770000 Site Mailing Address: 25642 BERRYHILL RD, Eagle River Lot Size in Sq Ft: 65109 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receive( Issued B 3 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcell.D. 050-521-47 Property owner(s) Don & Lorelei Cuthbert Day phone Mailing address 25642 Berryhill Road, Eagle River, AK 99577 Site address 25642 Berryhill Road Legal description (Sub'd., Block & Lot) Valley View Estates #1, Block 2, Lot 1 Legal description (Township, Range & Section) Lot Size 65,109 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank NUpgrade ❑X Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: (`b— Date of Payment: 1 .lam Receipt Number: Permit No. r6\0 L�i;\ Permit App_:' :L,:cl Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCaoaneneak.com July 8, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Valley View Estates #1, Block 2, Lot 1 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon septic tank be issued for this lot. The proposed systems will serve an existing four-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a four-bedroom house and is operating adequately for four bedrooms. The existing 1000 gallon septic tank has collapsed and is exposing raw sewage to the environment. The existing 500 gallon septic tank downstream of the 1000 gallon tank is still intact. The existing 1000 gallon tank will be abandoned per code. This lot is served by a private well that is over 100' from the septic system. The surrounding lots are served by private wells that are over 100' from this septic system, with the exception of Block 1, Lot 2, which is served by a class `C' well that is over 150' from this septic system. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 1 slopes from northeast to southwest at approximately 15% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Mailing: P.O. Box 10€3217, Anchorage, AK 99510-021.7 Physical: 332 1J2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 1.00217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907)272-8211. �J\ 3 DRAIN FIELD (E) COLLAPSED 1 ODOg SEPTIC TANK (E) ABANDON PER CODE INSTALL SINGLE COMPARTMENT 1 OOOg SEPTIC TANK (P) W/ DCO 500g SEPTIC TANK (E) TO REMAIN -a \ 6E�\ CC ROAD r< W � Wim_ W W � \ \ WELL (E) M 4BR HOUSE -z (E) /V 123.4 �t v / 1 .3Q R 10' UTILITY EASEMENT \\\ WELL (E) �G n� O� \ 12 SEPTIC AREA (E) W� W NOTES:PANNONE ENG SVC, LLC ���_OF A \\` Date _ EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 i 't�'•'••' `:gstl� 7/8/13 PHONE (907) 272-8218 FAX (907) 272-8211 j g�pgf�j s 11=50 *: �.. ... .. .... /� P.I.D. NO VALLEY VIEW ESTATES #1, BLOCK 2, LOT ... f521—a7 DON & LORELEI CUTHBERT Steven R. Rannone PERMIT N0. .•. E 8149 j ospxxxxxx 25642 BERRYHILL ROADl+ qs �.t�,e.�yz_.r PLAN EAGLE RIVER, AK 99577 <<l`EppR0Sheet 1 OF 1 MUNICIPALITY OF ANCHORAGE . DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name L~,C'~ DISTANCES ~: J,~~ ~____~1_.,, ABSORPTION ~ddress ~ TANK FIELD Phone(s) Permg NO. No. of Be ms W~LL ~, ~' LOT LINE~ I-,~ ~ I Township, Range, S~tion AS-BUILT DIAGRAM (Show location of well, septic system, prope~y lines, foundstion, driveway, water bodies, etc.) TANKS N ~ SEPTIC ~ HOLDING TYPE OF SYSTEM ~%'~x~ ~TRENCH ~ BED ~ W. DRAIN ~OTHER ~,~~, Depth to pipe bottom from Total depth from odgina, grade 3~ ~[~ '~ Fill added above original grade Gravel depih beneath pipe ~i ~ '~ ~ ~ ~ Gravel ~e~gth Grave width Total absorption area Distance between lines 12 X ~ ~ ~ W ,~ [~SQ FI ~ FI N.mber of lines Soil talin% ~/ Pipe mateba, ~[0 ~, ~ ~ ~ Instsner D~le InslsI]ed WELLS ~RIVATE ~ OTHER {Identifvl REMARKS: '; Scare: ;:~ : ,2721., [~Jv~, L~ B~2 ~]c, 20~ cedify that this inspe~ion was pedormed according t0 all I 702~ 72-013 (3/85) .OCnTJON OF WELl,. '.'IR1, fl.~lth~r ' ' ~*f~Of~ef-- ,,,,,, 'W~"': .... ' "" · :F'. ~'. ~D ,, , ...... ..:': '".., '; .,','" . A~,,,.~ Ea~le '~e~;'.~k.' 99577 "' '" ':"" ';':':?:,,,', 8fr*~f idgrl(~ ~fld ' ~' . ,.- ,. . · ,.~., · ', ., Fill i11o~ 4, W~ DEPTH; (final) ~, w~k~ kO~ .,,..' . ',, ',.. i., · I*rlOI'/T Top ~otfom :'' ' ' ~ ' '~ 7.'_. ' '' ....... '~ D .... ' ...... ,~'..' ~1 ~ Al ? ., · ..... ,,, ,. -* ..... ". ' ~17, AA5 T,u.~ ~0~...~' ~naie ', '. ~, ~B ~55 ~ ~,t w*, ~ ~ ~i',~ .... ' "' '.'.' '." ...... .. c~sm~, D ~"~'~ ~:'Wi~*~" .,'~- ' ~ec~u~e...~'h~.~t~ ~85 495 .,. . ,. ,, o~,,~":.~W,,,i: '"7". ' ~o~' ~ ~'~''; '~' ' .,. ..... . . ,. . ,,. .. ,........... ~,~ . ,. ,' ~.';, & ", " . "'" ...... ~ · ."~.~llm~Y*t~'.. · _ "'" "'"'" ' L '~' "'"~'~" / / ' -","" "," . "~%~h,~ ~ . ' ....... lO, ITA~I~ WA~R LEV~gl, ~ '~'""vq ,~,, ,' ' '" " ' ' ' '- .... -"A'~,~:~ ..... ... ,... ... ,-... j' .~' ',' .'" '":'"'~"' ' '- fi. aflme '" ' ". ':?' ~-,.:, -u., , efl*~. .~ .., ~ I.P.m. : ,, , ...... ~> ~ ., .,., .... .......... ~ ,.. ~:~¢,. ......... ~ DY D'~i~ : . ..... -., , . . t~.2ROUTI~ Will"~rgvfe ' *i'~ ..... -':" . -,, ~i "~:~"~' · . · '" t '" ',:~- .' * ' ,, , Molltlel; OHiat Clml~f., t~1 ?', ~, , .... · ' "'": .... ' 0 Of~tr ~.,' ~ , , . : ..... ~ .... ./....-.;. . - ..L. ,,: ';,' · , ,, .. 14.NIMARKI~ ,- .;: r~.~,/~.~,.:.-~, , ' ,.,.' : .... ~OdUC~ ':: , .... ,.', . ....... .: .~' ~,~ ,~,r:~'.-,:~ ~);,. ..: ,.. : ,,.,',,:.. . ,. ," . ~,~., · , , ~9. WATER W(~L CON~NAOTOR'i'O[RtlP/CATION~ . . , ,,~,~., ,, ,?,' ,,.' ....,, , - -- Rlllllt~14.'l~lhlli N~ml,'. '. '' ~.lrQ~t LIOI~Ii Number *.., r"~ ....'., ,,,.,,, P,O."BO~. ."77050,~, BaSle, _ ~t~e~ ~, Ak. 99577 ~ . ,,,.. 5' .. March 7, 1991 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stre~ P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot I'; Block 2; Valley View Estates #I; PER~IT REQUEST NARRATIVE: Request you issue a p~rmit to upgrade the septic system on the referenced property to Serve the existing four (4) bedroom house. The cx~ting l~achfiald, i~talled in 1982, is currently in a state of f~ure with sewage s~rfacing occasionally. The proposed upgrade drainfields are s~ to the existing drainfields only larger in size due to a higher so~ r~ting and l~tge bedroom capacity. The proposed drainfields use a spill-over from the upper trench to the lower trench. The bottom of the drainfield is to be 5 ft. deep since groundwater was encountered at 9 ft. during the i~tallation of the original field. We have also d~ign~ed an a~ternate site for any necessary future upgrades. Use of this ~rnate site will require a lift stat~o n. We ask that you ~ive the requirements of AMC 15.65.060 A-lC. As we have shown on our site plan the proposed drainfields are only 30 ft. uphill from a cu~bank. However, this cutbank is relatively smo~ being only 2 ft. to 5 ft. high. Therefore, we feel the 30 ft. separation should be sufficient to prevent daylighting of efflue~ through the cutbank. The lot is v~ry ~rge and generally slopes from north to sou~h. The proposed upgrade should not effe~ drainage on the ~rop~y, nor shoed it effect any neighboring prope~c~ies. If you require additional information for your revrew, please co~t STRUCTURAL & MECHANICAL INSPECTIONS ONSITE ~R0~ERT A. SHAFER, P.E. WASTE WATER ~S/gm DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE 7__ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST / ~---p-'~, '"'~ ~ SLOPE SITE PLAN 4- 5- 6- 7- 8- 9- 10- 11 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter "'~/"~/'~ I MonltoriflD? ~ Oate: , 13- 14- 15- 16- 17- 18- 19- 20- Gross Net Depth to Net Reading Date Time Time Water Drop 7-- 4: ~ ~ ~, ~ ~ [~ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' ~A N~,~.D(-¢~ FT PERFORMED BY:1'1¢~2,4 ~a~Je River Loop Eoa~ No. 204 I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN DA E: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 19- 20- DATE PERFOF Township, Range, Section: ~'~¢~ I ~-t~/~J ~-c-~-~, ~-z~ SLOPE SITE PLAN I IF YES, AT WHAT DEPTH? Oeplh to Woter After Monitoring? ~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~- ,A',~ ~ ~, ~/~ t~/~" PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BET EEN FTAND FT PERFORMED BY: _ . . ~ ~~ CE,~ HAT THiS TES' WAS ACCORDANCE ~ a~ 1'9 i~ ~ V~ t '/1'[ a' ~ ["la ~ 9~'?~~~ ~ ~: WITH A%L STATE AND MUNICIPAL GUIDE[ CERTIFY THAT THIS TEST WAS PERFORMED IN MUNIClPAt-ITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Teiephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 995'77 LOCATION ~-AIL NG ADDRESS EGAL DESCRIPTION bO-C '1, :',loci( 2, valley View 1,.;8~&~es NO. OF BEDROOMS Well ~Absorption area ~ ~ ~ ., O ...... % ¢ e L~q cap~c~2n gallons IF HOME.DE' Well Dwelhng DISTANCE TO: STANCE TO; '~ 25' of tile ~o finish grade 4' Width ' Tvpe of cr~ Crib diameter -- Well DISTA Foundation Total len tn f lines Material De n ea~h~dle Crib depth Bugdin9 foundation ISTANCE TO: OTHER LPIPE MATERIALS 'SOl L T ESTER A~ G INSTALLER S'teel Nearesttothne 50; ',- '~'{0 r¢.I:'.DO;E Trench~iCth 1~s~stancebet~ine$ ' 1 I ' DATE LEGAL APPROVED ' ~'-' . F. oelzs 10.-11~82 Lot I, Blk 2, z / k k } § m m In :1 § ; 0 0 0 ; :1 ] k / § § § d § k k k k k k\ j k k k / \ j \ \ \ § \ ( � m o m o 0 0 0 0 0 0 o m o m m o | L \ |L % b \b % i4 ) / $ �%a § § $ § \ \ | h 7 \ [ % ƒ B \ \ ! R | / ID ) / \ ) . . \ \ § In :1 § ; 0 0 0 ; :1 ] k / j § \ k § k k g } k / § § § d § k § § § ) ) ) m o m o 0 0 j § \ k § k k g } k / n 0 ~8~ 0 _M~I~IPALITY OF ANCHORAGE ~I~ .~. Department/ iealth and Environmenta]/ ~0tection . ~ 825 ~ Street, ~nchorage, AK. ~3501 ~. ~-~'~ ' ' ~ 264-4720 * * * HANDWRITTEN PERMIT * * * ~ermit ~_~ WELL AND~ ON-SITE SEWER PERMIT Applic~t: I<~T d~r t(~aX Mailing Address: P~ ~V ~~ Location: Phone Nu~er: ~--E/O ~ ,,. Type of Soil ~sorption System IS: ~ ~ Trench: ~ Drainfield: Seepage Bed: __ Holding Tank:_~n The Required Size of the Soil Dsorption System Is: ' DEPTH '~ENGTH -7-~ GRAVEL DEPTH 'f~ WIDTH tAe bottom o~ tbe e~ca~atio~(1~ ~eet). ~be~e i~ ~o set Ni~tb ~o~ ~Se g~a~el depth is the mis~ ~ept5 o~ g~avel betNee~ the o~t~all pipe the bottom o~ the excavatio~(i5 ~eet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = [~0 GALLONS * * of residences that the well will serve. ~ ~ ~ TWO(2) INSPECTIONS ARE REQUIRED ~ ~ ~ B~ckfilling of any system without final inspection and approval by this department ~ill be subject to prosecution. Minim~ distance between a well and any on-site sewage disposal system is 100 feet f:or a private well or 150 to 200 feet from a public well depending upon the type o~f public well. Minim~ distance from a private well to a private sewer line is: 25 feet and to a co--unity sewer line is 75 feet. Well logs are required gnd must be returned to this department within 30 days of the well completion. ~ther requirements may apply. Specifications and construction diagr~s are a~ailable to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 2 * * * Ii certify that: (!) I ~ f~iliar with the requlrements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) I will install the system in accordance with codes. (3) Z understand that the on-site sewer system may require enlargement if the residencies remodeled to include more. that 3.bedrooms. Date: / S~/024 (1/81) ~ - ........ : ................... / PERFORMED FOR: Hal .~T©~m ~ _T;qo: LEGAL DESCRIPTION: Lot 1, Bl~ck 2, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST REVISION 0P TEST PERPORMED SEPTEMBER 4, 1982 DATE PERFORMED: ' S Valley View Estate SOILS LOG PERCOLATION TEST Oat, 4~ 1982 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- Topsoil with some organics GP, Poorly graded Sandy gravel SM, Poorly graded Silty sand New Water Surface SLOPE SITE PLAN ~E] t ~E~'ICUS RI;P0~T WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Old Water Surface S Yes ~ E q f~. Gross Net Depth to Net Reading Date Time Time Water Crop SEE PREVIOU2 REPORT PERCOLATION RATE 1 4 (minutes/inch) TEST RUN BETWEEN ~ - 5 , FT AND ~- ~ FT COMMENTS Ground water surface rose as a result of recent wet weather PERFORMED BY: Vor.~o!l Y~; ...... fc CERTIFIED BY: Verno~l T,. l~f~.] fs 72-008 (6/79) DATE: ~nt. 4: 1982 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: Hal Johansen, Inc · OATEPERFORMED: Sept. 4, 1982 LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 Lot 1r Topsoil with some organics Poorly graded Ssmdy gravel Poorly graded Silty sand Block ? Vglley View ~,s~,ates SLOPE / / / / 11 WAS GROUND WATER S ENCOUNTERED? Yes ~ P E I¢ YES, AT WHAT 13 ft. DEPTH? 13 14 15- 16- 17- 18- 19- 20- surface )an COMMENTS Silty s~ iR constant rate Gross Net Depth to Net Reading Date Time Time Water Drop 1 9/4/82 30 2,5" 2 " 30 2.25" 3 " 30 2.125" IO PERCOLATION RATE 1 4 (minutes/inch) TE~T RUN BETWEEN ~r o ~ PT AND 6.0 FT PERFORMED BY: Verenm T,. Roe!rs CERTIFIEDBY:V~,~qOTI ~'; Roe!rs DATE: 9/4/82 72-008 (6/79) ' r CA Lt v 11L MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC241481 Parcel ID 050 -521-47 Expiration Date: I I h L Legal description VALLEY VIEW ESTATES #1 BLK 2 LT 1 Site address 25642 BERRYHILL RD Current property owner(s) CROCCO SAMUEL X The On-site system(s) is/are approved for 4 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 11/27/2024 s'Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject W'� (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, ielopment Service Department (DSD) issues COSAs based upon representations provided by an ependent professional engineer. The Municipality of Anchorage is not responsible for errors or issions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department ✓� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 4 Certificate of On -Site Systems Approval Application �1 1. GENERAL INFORMATION Parcel I.D. 050-521-47 Complete legal description VALLEY VIEW ESTATES #1 BLOCK 2, LOT 1 Location (site address) 25642 BERRYHILL ROAD, EAGLE RIVER, AK 99577 Current property owner(s) SAMUEL CROCCO Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: E 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: E Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel E Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench E Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: E By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. c;;l;. COSA Fee $ � U \� Waiver Fee $ Date of Payment COSA # Date of Payment Waiver # COSA Applicalion.doc COSA Checklist.docx COSA Checklist Legal Description: VALLEY VIEW ESTATES #1 BLOCK 2 LOT 1 Parcel ID: 050-521-47 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/18/85 Total depth 505 ft Cased to 140 ft (Per 1982 Well Log) Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 11/15/24 Static water level at beginning of test 265 ft. Well production at time of test 4.6 gpm Water storage tank volume 250 gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.24 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 11/15/24 Comments Per MOA record documents there are 2 well logs and it appears the 1982 well may have been extended with a 1985 well deepening. There was only the one storage tank, which only periodically requested well water and remained mainly full during the test. B. TANK DATA Measured operating fluid level in septic tank 58” Date of pumping 11/14/24 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA (Upper / middle / lower trenches) Which system tested (date installed) 3/28/91 ALL standpipes present per record drawing Total measured depth from existing grade 7.2 ft (max) Measured depth to pipe invert from grade 3.2 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 1.6’ / 1.4’ / 1.8’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 11/15/24 Results Pass Fluid depth prior to test 9” / 5” / 3” Water added 1000 gal New fluid depth 14” / 9” / 11” Elapsed time 1400 min Final fluid depth 8” / 3” / 1” Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 30 in (MOA 2.5’ ED) ED used 18” / 16” / 9” (Final Fluid Depth + Missing ED) Effective depth (ED) remaining 12” / 14” / 21” Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate with 0.9’ / 1.1’ / 0.7’ ED missing – not measurable. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or 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. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 11/19/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 11/19/24 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.Dd50-521-47 1. GENERAL INFORMATION Expiration Date: Oct D 11 ao"21 Complete legal description VALLEY VIEW ESTATES #1 BLK 2 LT 1 Location (site address) 25642 Berryhill Rd Current property owner(s) KUNNEN BRYAN Mailing address Real estate agent 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 947-1908 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '� �-o �'u S H Waiver Fee $ Date of Payment 19-021 Date of Payment Receipt Number. AFC) O b Receipt Number COSA # O S C 2 11 S'3 1 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/7/21 ,;!;,!--OF `% - 4/,,1444 (A,, 0.0. 0* 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms a -62W AW W Disapproved 7/ 7 Conditional approval for bedrooms, with the following stipulations: OF ON-bli I r- 1c� D \N PS -t D v, A PK C� S By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates'of Or -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 angineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory COSA Checklist Legal Description: VALLEY VIEW ESTATES #1 BLK 2 LT 1 Parcel ID: 50-521-47 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 81 1$/85 Total depth 505 ft Cased to 140 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/1/21 Static water level at beginning of test 296 ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material 5e° "_" Measured operating fluid level in septic tank new ❑■ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA 3/28/91 Which system tested (date installed) same ❑■ ALL standpipes present per record drawing Total measured depth from grade 7 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 8+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑R Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 6/1/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/1/21 Results Q✓ Pass For 4 Fluid depth prior to test 15 Water added 600 gal New depth 27 in Elapsed time 30 min bedrooms in ❑E Code -required soil cover over field Final fluid depth 17 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tan kJLift Station on Lot > 100' Q Yes Community Sewer Manhole/Cleanout > 100' 2] Yes if No ft 2] Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No. Water Main > 10' Animal Containment > 50' 0 Yes if No ft Yes if No ft Yes if No. Water Service Line > 10' Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Q Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10 Q Yes if No ft Surface Water > 100' Yes if No. Property Line > 5' if No Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' Q Yes if No ft Private Wells > 100' Q Yes if No. Water Main > 10' Q Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' Q 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' 21 Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' El Yes if No Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. OF q�4 12' Ar2 Steve Eng tu 7/7%21'+�' 40 STA. ft ft ft ft fi 01 Parcel I.D. 050-521-47 V N Municipality of Anchor e MAR pj o 2utb On -Site Water and Wastewater Progra (907)343-7904 Certificate of On -Site Systems App 1. GENERAL INFORMATION 3 Expiration Date: Complete legal description Valley View Est #1, Block 2, Lot 1 Location (site address) 25642 Berryhlll Dr. Current Property owner(s) Lorelei Hass Day phone Mailing address 25642 Berryhill Dr. Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual F� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverlVariance request for: Received by:_ Date: k111 0 f & COSA to be released to the engineer, unless otherwise requ ed by the engineer. COSA Fee $ 19 24 — Date of Payment 3131 l I �- Receipt Number b'l�l lC> G) COSA# ©:_ ([ Iib` Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affiOnSI ge'l�And as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of pproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may Fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE _I System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 3/23/2016 S}evert �. � �aririoriey CE -8149 Conditional approval for bedrooms, with the following stipulations: By �v�OX Inn Pic Original Certificate Date: L o 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet' ., - If more than 1 septic system is on the lot: COSA Checklist # of r Structure served by this system Certificate of On -Site Systems Approval Checklist r Legal Description: Valley View Est #1, Block 2, Lot 1 Parcel ID.'050-521-47 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 10/8/1982 Sanitaryseal (YIN)Y— Wires properly protected (YIN) Y Total depth 406 ft. Cased to 140 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/8/1982 3/18/2016 Static water level 200 ft 269 Well production 3 g.p.m. 5.0 9 -P.M. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate _IJ 0 mg/L Arsenic ug/L Date of sample: 3/18/2016 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 99/2013 -3/28/1991 Tank size 1,000-500 gat Number of Compartments 1_1 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y /Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 3;/;t Iao! Pumper C, ABSORPTION FIELD DATA Date installed 3/28/1991 i z 0.6 GPD/SF Shallow Trench Soil rating (g:p.d./ftorft /bdrm) System type Length 128 ft. Width 5 ft. Gravel below pipe 2.5 ft Total depth 6.6 ft. Eif. absorption area 1,000 fe Monitoring tube Y Depression over field N Date of adequacy test 3/18/2016. Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 616 gal New depth 0' in. Elapsed Time: 120 min. Final fluid depth 8 in. Absorption rate >= 800+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFTSTATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT. TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 00+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ` ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage _10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone 3/23/2016 CE 8149 Date COSA canary sheet 2-6-15.doc ®m I I _wo 0{YN6 w c zZ �U -ism. O 2 -to N~ o `oc 4. rn w o m Cp wD n n y w..e 'E .N °vg 0) VO 7S% K OJN w TO E aEa �i `w 6 gg w corn �,F S, o90N z o a a N ��U2W8SB� (jljl-- O a ay wo Q o N E y m LL w if I� _,o� _ a w W NL_G'-LTO V .c .,wo'S a,� v c 2'o m Q —�w m N w N �.c cm m aEi Nw L� I EiOJ ¢ wE r I a mN¢ LOa IwJU��O� n O s w (� w5 Gna mw...nmv c ¢ EmmmLw..>c�s a IE U) F I Ll1 m f � I W 0 I o w' N 3 �^ OLil d / / cli ; J r 0 U o f 0 Z / w I N J 00 Q; 72 1 N W/00 LO OD LL 0. rn r n / / I t a�/ / / a w E E LL co W N� 0 3 � O ../ J �r a i co a 0 O OWE 0_ZT w W Z OHO O�o� '1- z �oz W�< ww¢ Qog wF-a i �—� Municipality of Anchorage o pl B • yf� Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. F.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CCR i iFIGA'i E Or= f'I!~f1L i Fi FiU i ii Jt Cl I Y APPROVAL FOR A SINGLE F=AMILY DWELLING Parcel I.D. 05()_991-47 HAAS_ Expiration Date: / D 3C) O 3 1. GENERAL INFORMATION Complete legal description Lot 1; Block 2! Valley View Estates Subdivision Location (site address or directions) 25642 Rprryhill Rd= Current Property owner(s) Larry Taylor Day phone 696-2575 r Mailing address PO Box 772048 Eagle River, AK 99577 Lending agency _ Day phone Mailing address Real Estate Agent _ _ Day phone _ Mailing Address Unless otherwise .requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: • TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site B Individual Water Storage ❑ Individual Holding tank Ei 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 req&red 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. (Ceilificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties servdN by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors orzmissions 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 fs(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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. Nc:MZ Of firm F S FnIgirinPrines riiJnc b�4-2979 Address 1 7034 N. Eagle River Loop Ste.204 Eaple River, AK! 99577 Engineer's Printed Name Robert C. Cowan Date -7./A A k /o E 5. DSD SIGNATURE Pj�� i�ROBERT C. COWAN•• I� CE -8801 Approved for _bedrooms. �t44 a":4S J Disapproved. •LkZi•.,,.r Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: NAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other PROGRAM 1)))1111 By: !it% Original Certificate Date:?' (Rev. CIM2) Municipality of Anchorage • �' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEAL i H AU T HORI I Y APPROVAL CHcCKLIjT Legal Description: erl i&n-(Ar 4.-f.! &vir 61V A �yo Parcel I0:1%y - 5-2 / :-�YZ A. WELL DATA Well type L� If A, B, or C provide PWSID # — '62i Date completed Sanitary seal (Y/N) `i Total depth �ft. - Cased to FROM WELL LOG Date of test Static water level Z00 L/NKft_ Well production 3f v Z g.p.m. WATER SAMPLE RESULTS: Coliform —Colonies/100 ml. Nitrate t✓ mg./l. Arsenic: mg:/I. Date of sample:T7/0103 B. SEPTIC/HOLDING TANK DATA Well Log (YIN) V Wires properly protected (Y/N) / V- - Casing height (above ground) If> in. AT INSPECTION —q / 410,5 401 ft. r?a Z I g.p.m. 4-50t9 GA L w51 -g r ^f Other bacteria colonies/100 ml. Collected by: /A/ 1 tgli(/L Tank Type/Material �Zt fu Date installed 3 �/ Tank size AXI�O gal, Number of Compartments 3 Cleanouts (Y/N) y Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping t73 " Pumper C. ABSORPTION FIELD DATA /4A -L LLQ Date installed Soil rating .d.l z rfzfbdrm) %.6 System type SW. 7WIH Cff Length /2ii ft. Width 6 ft. Gravel below pipe 2 "5'ft. Total depth ft. Eff. absorption area �ft' Monitoring tube -_ Depression over field Date of adequacy test v Results (Pass/Fail) P.S For -3 bedrooms Fluid depth in absorption field before test /7i in. Water added gal. New depth in. Elapsed Time: in. Final fluid depth /e in. Absorption rate >= 45t g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A% If yes, give date D. LIFT STATION Date installed A "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: t.- Septic tank/liftion on lot �� Absorption field on lot / co �t Public sewer main Af Ali S .3� wer /septic service line 7 Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots l 0 p 't- On adjacent lots /OO r•t- Public sewer manhole/cleanout x/ () Holding tank AJ /f}' SEPARATION DISTANCES FROM SEPTIC/HOLING TANK ON LOT TO: 1 Building foundation FJ -!- f Property line Absorption field i �- Water main N /47 Water service line X Surface water Wells on adjacent lots 1 QQ l�f' in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �0 *- ' Building foundation �0 'I' Water main N ^i ,,nf-� I r_ Water Service line j'V fi Surface water / C5� � Driveway, parking/vehicle storage /(2 t Ig ;v drain/�s�Z'F-f��✓t*71/�J Wells on adjacent lots _ ! 4- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and "� • " review of Municipal records that the above systems are in:..1!Z:.... . conformance with MOA HAA guidelines in effect on this date. >, toeeRr c COWAN d C �Pift CE -8801 �A Engineer's Printed Name �+., Date i Al�Y /0 3 41 )J HAA Fee S 3 7r- u o Waiver Fee $ Date of Payment i a y l p 3 Date of Payment Receipt Number O 3 17 0,7 5i Receipt Number (Rev. 12/01) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Well Advisor Health Authority Approval # 030358 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 2, Lot 1 of Valley View Estates subdivision, the well's productivity was determined to be 0.21 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. IEALMA11IIgItlIY Afrnom 5 SEWEn&WAIEn UVll"Illm1ofR SEwm E wAl E n r1SPECIKMI Eliot E Hill K151 t)[ A 5 A1ElnEronts wu l IrlsrEC11011 EiIONIE51 SIlEI'IA115 110AOrIESK111 SOA IESI 1'EflC01 Will IESI 5I11t1CIUnAI S (.Ea JA1 *CAE rlsrrclKaa C1I511E WASIEWAIEn trSP(A.AI.SVSIElA 11ESK'al 111y IwDER) C. COWAN, P.E. 110nEnr A. SI IArEn, PE. CIVIL ENGINEERS WELL RECOVERY TEST DATA (907) 694-2970 CLIENT: l A- `f L O/Z WELL LOCATION 11e a11: L / c (—!V I Lr—:s '-- TEST DATE: 03 TESTED BY: WELL DEPTII: S WELL DRILLER: "H e-A/us eA) 7�vu jipi-i CASING DEPTII: Lfn7 f- DATE DRILLED: ! o Fr? f3 �� TEST PROCERIIRE: 1) Draw water down to pump. 21 Shut pump o1115-60 mill. OFF 14709- -record little �• 4" �0 24 -record meter reading 1) Urn plllllp oil. Wawdown. A) S11111 pml,p all. 1• U -record Ihne ON �iO� -record meter reading 5) Calcutale galJndn. recovery. MISC DATA: 1 Casillig I1CIgl11: Sanitary Seal? Wires In Condult? Oradhlg O.I(.? rlollp Deplll: Samples Taken? Dale: /6" t Y PUMP TIME METER GAUMIN. �T OFF 14709- • OZSO �• 4" �0 24 ON / [ & _31 OFF / �4 H . A. t3.4 , 3 2 OFF 2, 1• U TES.1 t)A7A: START TIME: 1630 STATIC WATER LEVEL: ! 0� f TRIAL PUMP TIME METER GAUMIN. I OFF 14709- • OZSO �• 4" �0 24 ON / [ & _31 OFF / �4 H . A. t3.4 , 3 2 OFF 2, 1• U 3.3/ I&= ON �iO� OFF %10543 0-3 9 OFF ON OFF 4 OFF ON OFF 5 OFF ON OFF R2ESULLS. WELL CURRENTLY PRODUCES: OA FLOW RATE NOT GUARANTttD--SUBSEQl1ENT VARIATIONS • CAN OCCUR.. 17034 1101111 1 EAGI E RIVER 1 OOP • Sl1IlE 201 • EAGLE ItlVER AI ASKA!1.9577 JUN -29-9? TUE _.._._ 9:T9 DHHS P. D1 ^, Post -it' brand f ^ransmi!tai memo 7671 orpagca --1 - _ •1 Tu � b•.� From t- 1 , t a�L Z ''''yh R, ` 17/p. • �r:ee T7t{ 4 KS t ni Gsi-.2�i-G-C' s�roofe� . 4 ,w AS-EVILr 1 ` 1 l:crcb;• cer/tify that ishava rurvevcd the folluwing dCscribeAjoM � ye ..- '•x. '(rte j ; ": , ; `• Ancher*ge Feco rdine }'reetnct. Alsska. find that the IMP7Ve' hus and dc .::.' , 1 ^ .� • • • .. r..cnts sttusted thereon art: t�'fthin the p:operty net overlap or encroach on the property adjacent there adjacent adjacent ,. ! •'," ,: • '• ' + ' lrg tv, that no lmpprover:cnts un -property and Aft A( fit quosucn and that there ars n< • :0" ' ' en nn the prcrnms roadwayA, transntis^ir,n lions or other visible easemenU Oz ;!A'+ti1 .• • ••••• • ••"� •' • ' " o 1 r « ry!y"1;•', .. said prt)perty C%Cept a9 irdlestcd heron. I:atwl at £.aple filter, .11aikci -'. .. .. .�'1 .say ROBERT C. JOHNSON •%' •• ='•, SCALDRc,istcrM f and Surveyor No 8A0•I•S 'j..'. h. r Box 451, Ea�lo River. Alaska Yhonc iU67► 694-2543 .,_._. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES 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 1. GENERAL INFORMATION Complete legal description Lot 1, Block 2, Valley View Estates Location (site address or directions) Berryhill Ln.-- Eagle River Property owner Mailing address Lending agency Mailing address Agent Address Callahan Day phone 276-8335 1914 Park View Ct., Anchoraqe, Ak. 99501 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Day phone Day phone :' /*-;,' ,' i\'J ':J: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng 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~)25 (Rev. 1/91) Front MOA #21 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 -. 7hA4 ::~gle River LoJ~J:to'ed Eagle River~ Al a 99577. ' ~ ~-" Address Engineer's signature __ Phone 6; ' DHHS,.,SIGNATURE :_ ~--. 'A, pproved for Z/ · i :~ DiSapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~~/~ . Date 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 th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA~f21 Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescnptlon b--\ ~2-2~- Y~n--4~-¢-'~/ ~'~¢¢1~'~. ParcelI.D. Well type ¢~¢~ If A, B, orC, attach ADEC letter. ADEC water system number Dateco~pleted ¢-~ Driller Log present rN) Totaldepth ~ ' 'q ~ Casedto ~ ' Casing height Sanitary seal. N) 7 Date of test Static water level Well flow Pump level FROM WELL.LOG Wires properly protecteddC~N) AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~. ~ ~ Absorption field on lot [ "~ ; On adjacent lots Public sewer main Public sewer service line ; On adjacent lots Petroleum tank WATER SAMPLE RESUL~/~: Coliform (:::;~ ~//.q Nitrate Date of sample: ~-~ - ~¢' ~ I ~,~ ~*'~ (C~, I ~ "~ Other bacteria ~ Collected by: B. SEPTIC/HOLDING TANK DA/TA Date installed ~c>c~ "~-,~1 [ Tank size Cleanouts¢/N) ~ Four~d~tion cleanoutrN) '7 Depression (Y~:~ High water alarm (Y/N) /.4 / ¢, Alarm tested (Y/N) ' ~ Date of pumping "'2~1 ~<:::~ ~ Compartments SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ \'~* ~- Onadjacentlots To property line ~ c::, t 4- ~ Absorption field Surface water/drainage ~ ~ I.~_.. ~ Foundation ~ f"'~- ~ Water main/service line ~-~ ~ ~ CONTINUED ON BACK PAGE 72-0~6 (Rev. 3/91 ) Front MOA 21 C. LIFT STATION Date ~, Size in gallog.~' ~ Vent (Y/N) ~ ,,. "Pump o~ ,?-' ?.%" Hig b~ater,~aib~'m I~y'~/ ____ ,,-' .-~ets~.,. ,[~DA.x el~c.~--~l aI. Dt~ codes (Y/N) __ __. SEPARA~'~ISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Surface water D, ABSORPTION FIELD DATA Length \'~Z...~5 Width Total absorption area Depression over field (Y/~,~, Results (pass/fail) Peroxide treatment (past 12 months) (Y/~ /~( Gravel thickness System type "~;;~--~-~ ¢'~:'~.M'~ ~) Total depth t.~ I ,L)/;// Cleanouts present 42i5~N) Date of adequacy test or If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I '"'] ~"'~~ ~' On adjacent lots / ~'? "~' Propertyline To building foundation ~--'-~ ~ '~ To existing or abandoned system on lot On adjacentlots ,o.~:=.~.~¢ '~'~utbank '°~c:~ ~ Watermain/serviceline Surface water \ ~ IF ~ Driveway, parking/vehicle storage area Curtain drain ~ c~.~ ¢_~. ~-'~ ~2't,~ J E. ENGINEER'S CERTIFICATION Engineers Nome Date ~ HAA Fee $ / Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 and HAA guidelines in effect on the date of this inspection. Waiver Fee: $ Date of Payment Receipt Number . ,PPLId' N -'FILLS OUT UPPER HAl Realty Co. ~ ~ - ~ ~ Phone Legal Description ~ ~ ~ t ~' ~ V~t~5 V' ~ ~~ ~ Individual ~ ~ ~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 19~5. ~ Public Utility ~ ~ ~. Individual ~(~q ~ ~ Year Indiv~ual Installed: Time Time Time [~.C~. ~ (-~ O Field Notes: ~ MUNICIPALI o ENVIROi~Mzh;A-: ,O,:CTION ( ) APPROVED BEDROOM~ ~ 'CONDITION8 OF APPROVAL ( } DISAP~OVED Soils Raling Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size